Surveillance of antibiotic resistance in invasive isolates of Neisseria meningitidis in Australia 1994-1999

A total of 1434 strains of Neisseria meningitidis isolated from cases of invasive meningococcal disease (IMD) in Australia between 1994 and 1999 were examined by standard methods for susceptibility to antibiotics used for treatment and prophylaxis. The proportion of isolates fully susceptible to penicillin decreased from 45% in 1994 to 26% in 1999 (P<0.001). All the other isolates were less sensitive to penicillin except for two meningococci with a penicillin MIC of 1 mg/l. The geometric mean penicillin MIC increased from 0.045 to 0.065 mg/l from 1994 to 1999. There was no significant difference in the geometric mean penicillin MICs of serogroup B and serogroup C meningococci. Penicillin susceptibility was significantly associated with a poorer outcome. Isolates from survivors of IMD had a higher geometric mean penicillin MIC (0.06 mg/l) than those from fatal cases (0.048 mg/l) (P< 0.001). This suggests that factors other than the decrease in susceptibility to penicillin observed were more relevant to outcome in IMD. All isolates were fully susceptible to ceftriaxone. Rifampicin resistance was infrequent (eight isolates in 6 years) and sporadic. A single isolate had decreased quinolone susceptibility. Despite the significant shift in susceptibility to penicillin recorded, this group of antibiotics remains a suitable treatment for IMD in Australia.     

药品研发、参考定价与知识产权--中澳自由贸易协定和后续的中国双边贸易协定中的一个议案

文章针对的是在中澳自由贸易协定中提出的一个议案,旨在促进医药产品研究和产业合作.该议案认为,如果能将按"与贸易有关的知识产权"(TRIPS)的标准对药品的平行进口和强制许可给予保护的条款写入中澳贸易协定和后续的双边贸易协定,再加上美国Bolar条款对仿制药(即通用名药)的推动,中国必将取得相当的优势来保证WTO制订的TRIPS协定继续维持对本国药品有利的条款.目前,市场正受到一系列美国为保护"创新性"药品和旨在终止药品参考定价体制而提出的涉及知识产权的双边贸易协定的威胁.因此,上述举措对于保持药品参考定价体制显得尤其重要.     

Patient delay in responding to symptoms of possible heart attack: can we reduce time to care?

In Australia, many deaths and significant cardiac disability result from delayed response to symptoms of heart attack. Although delays due to transport and initiation of reperfusion therapy in hospital may contribute to late treatment, the major component of delay is the time patients take in deciding to seek help. A critical examination of campaigns to shorten patient delay concludes that they were based on a factual, short-term, non-targeted approach that included education and mass media strategies. They achieved equivocal results. One randomised controlled trial has been conducted. Although this showed an improved understanding of heart attack symptoms, it did not shorten pre-hospital delays. The implications of these findings are that future campaigns to shorten patient delay are likely to be more effective if they address the psychosocial and behavioural blocks to action, are ongoing rather than short term, and focus on people at highest risk, including those with known or high risk of coronary heart disease, those in rural locations, and Indigenous Australians. The National Heart Foundation of Australia proposes a comprehensive strategy to incorporate this approach into its future campaigns to reduce patient delay for suspected heart attack.     

不同地理株间日疟原虫环子孢子蛋白基因多态性的特征

目的：探讨间日疟原虫环子孢子蛋白（ＣＳＰ）基因多态性的地理特征及其实用意义。方法：用ＤＮＡ的ＰＣＲ扩增与电泳切带纯化法，获得所研究的基因片段；用引物标记周期反应测序法，测定ＤＮＡ序列；用图解法分析比较各地ＣＳＰ基因的氨基酸序列的变化。结果：所测定的中国、菲律宾和所罗门的１５个间日疟分离株均属ＰＶ－１型，但各株有较明显的地理性变异。６个中国株与ＮＫ株相似，其中Ｃ－２与ＮＫ株完全一致，而与其他Ⅰ型株有明显区别。结论：根据ＣＳＰ基因中央重复区及重复后可变区推导的氨基酸序列的变异情况，在Ｑａｒｉｔ和Ｍａｎｎ的分组基础上，迄今已发表的所有Ⅰ型株可归纳为２族６个组。分组序列特征有可能用于不同地理株的检出和鉴定，从而在疟疾的流行病学与防治上有实用价值，并将有助于疟原虫的生物学、分类学和种系发生的研究。     

不典型纤维黄瘤出现神经周和神经内浸润：2例报道

作者报道2例不典型纤维黄瘤（AFx）患者，均出现以往未报道过的神经浸润特征（1例神经周浸润，1例神经内浸润）。大约有10％的AFXs病例复发，但罕见转移。与复发有关的特点包括切除不完全和侵犯脂肪。与转移有关的特点包括复发、血管和深部组织浸润及肿瘤坏死。这些肿瘤都侵犯深部皮下组织，甚至达到深筋膜。一些作者会因如此深的扩散而将这些病例当作恶性纤维组织细胞瘤（MFH）；但是，将AFX作为MFH的表浅型变异的观念是过时的——AFX是一种独特的临床病理学疾病，具有明确的临床、组织学和免疫组化特征。