Effect of Xinfeng Capsule on Lipoprotein Metabolism of Rheumatoid Arthritis Patients / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the effect of Xinfeng Capsule (XC) on lipoprotein metabolism of rheumatoid arthritis (RA) patients.</p><p><b>METHODS</b>Totally 180 RA patients were assigned to the experimental group and the control group by random digit table, 90 in each group. Patients in the experimental group took XC (three pills each time, three times daily), while those in the control group took Methotrexate Tablet (four tablets each time, once per week). One month consisted of one therapeutic course and all patients were treated for two therapeutic courses. A healthy control group consisting of 60 patients was also set up. Changes of lipoprotein indices, clinical efficacy, lipid metabolism, joint symptoms and signs, activity indicators were observed, and correlation analyses were performed.</p><p><b>RESULTS</b>Compared with the healthy control group, expression levels of prealbumin (PA), globulin (GLO), high-density lipoprotein (HDL), apolipoprotein Al (Apo-A1) were lowered in RA patients (P <0. 05, P <0. 01). Correlation analyses showed that PA was negatively correlated with joint tenderness, morning stiffness time, disease activity score (DAS-28), C-reactive protein (CRP), interleukin (IL)-6, respectively. Total protein (TP) was negatively correlated with joint tenderness. GLO was negatively correlated with joint tenderness and DAS-28. HDL was negatively correlated with erythrocyte sedimentation rate (ESR) and endothelin (ET)-1. Apo-Al was negatively correlated with joint pain; Apo-B was negatively correlated with CRP; LDL was negatively correlated with morning stiffness time (P <0. 05, P <0. 01). Compared with before treatment, expression levels of PA, HDL, Apo-A1 , Apo-B, and serum IL-10 contents increased, and expression levels of ESR, CRP, IL-6, ET-1 , joint pain, joint swelling, morning stiffness time, and DAS-28 decreased in the experimental group (P <0. 05, P <0. 01). PA increased more after treatment than before treatment in the control group (P <0. 01). There was statistical difference in joint symptoms (except joint tenderness) and activity indices (except ET-1) in the control group (P <0. 05, P <0. 01). Compared with the control group after treatment, PA and HDL increased, ET-1 and duration of morning stiffness decreased in the experimental group (all P <0. 05).</p><p><b>CONCLUSIONS</b>Lipoprotein metabolic disorder exists in RA patients, and it is associated with disease activity. XC could obviously improve lipoprotein metabolism and joint symptoms.</p>

A randomized controlled single-blind clinical trial on 84 outpatients with psoriasis vulgaris by auricular therapy combined with optimized Yinxieling Formula / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the therapeutic effect of auricular therapy combined with optimized Yinxieling Formula on psoriasis vulgaris.</p><p><b>METHODS</b>A randomized controlled single-blind clinical trial on 84 outpatients with psoriasis vulgaris was conducted. The patients were randomized to a treatment group (43 cases treated by auricular therapy combined with optimized Yinxieling Formula) and a control group (41 cases treated by optimized Yinxieling Formula alone) according to a random number generated by SPSS 17.0 software. The treatment duration for both groups was 8 weeks. The therapeutic effect was comprehensively measured by the primary outcome measure [Psoriasis Area and Severity Index (PASI) reduction rate] and the secondary outcome measure [PASI, Visual Analogue Scale (VAS), Dermatology Life Quality Index (DLQI), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS)]. The outcomes of both groups were obtained and compared before and after the intervention.</p><p><b>RESULTS</b>The PASI reduction rate in the treatment group was 74.4% (32/43), which was higher than that in the control group (36.6%, 15/41, P<0.01). The PASI scores decreased in both groups after treatment and was lower in the treatment group compared with the control group P<0.01). With stratified analysis, there were significant differences between the PASI scores in the following subgroups: age 18-30, baseline PASI>10 and stable stage (P<0.05). DLQI decreased in both groups on some categories after treatment, but there were no significant differences between the two groups in SDS, SAS and VAS (P >0.05). No obvious adverse reactions were found in either group.</p><p><b>CONCLUSION</b>The therapeutic effect of auricular therapy combined with Optimized Yinxieling Formula was superior to Optimized Yinxieling Formula alone with no obvious adverse reaction.</p>

Gene chip array for differentiation of mycobacterial species and detection of drug resistance / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gene chip array can differentiate isolated mycobacterial strains using various mycobacterium specific probes simultaneously. Gene chip array can evaluate drug resistance to isoniazid and rifampin of tuberculosis strains by detecting drug resistance related gene mutation. This technique has great potential for clinical application. We performed a retrospective study to investigate the capability of gene chip array in the rapid differentiation of species and detection of drug resistance in mycobacterium, and to evaluate its clinical efficacy.</p><p><b>METHODS</b>We selected 39 patients (54 clinical mycobacterium isolates), used gene chip array to identify the species of these isolates and detect drug resistance to isoniazid and rifampin in Mycobacterium tuberculosis isolates. Meanwhile, these patients' clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>Among these 39 patients whose mycobacterium culture were positive, 32 patients' isolates were identified as Mycobacterium tuberculosis, all of them were clinical infection. Seven patients' isolates were identified as non-tuberculosis mycobacterium. Analyzed with their clinical data, only two patients were considered as clinical infection, both of them were diagnosed as hematogenous disseminated Mycobacterium introcellulare infection. The other five patients' isolates were of no clinical significance; their clinical samples were all respiratory specimens. Clinical manifestations of tuberculosis and non-tuberculous mycobacterial infections were similar. Isoniazid resistance was detected in two tuberculosis patients, while rifampin resistance was detected in one tuberculosis patient; there was another patient whose Mycobacterium tuberculosis isolate was resistant to both isoniazid and rifampin (belongs to multidrug resistance tuberculosis). The fact that this patient did not respond to routine anti-tuberculosis chemotherapy also confirmed this result.</p><p><b>CONCLUSIONS</b>Gene chip array may be a simple, rapid, and reliable method for the identification of most mycobacterial species and detection of drug resistance in Mycobacterium tuberculosis. It is useful in diagnosis, treatment, and hospital infection control of mycobacterial infections, and it may have a great potential for clinical application.</p>

Molecular characterization of vancomycin-resistant Enterococci / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the homology and resistant mechanism of vancomycin-resistant Enterococci (VRE) isolates.</p><p><b>METHODS</b>A total of 9 VRE isolates were collected from 2006 to 2007 at PUMC hospital. The susceptibility of these isolates to 10 different antibiotics including vancomycin was tested by E-test. These strains were processed by brain heart infusion agar screening in the presence of vancomycin (6 microg/ml), and were analyzed for genotypic characteristics using the multiplex PCR. The homology of the isolates was determined by pulsed-field gel electrophoresis (PFGE).</p><p><b>RESULTS</b>All the 9 VRE isolates were identified as Enterococci faecium. The visual analysis of PFGE patterns revealed 6 different PFGE types. The vanA gene was confirmed by PCR and sequencing in 9 VRE isolates, which were consistent between phenotype and genotype for glycopeptides resistance.</p><p><b>CONCLUSIONS</b>Only vanA genotype was detected in PUMC hospital. Clonal dissemination, horizontal gene transfer, and the selective pressure of antimicrobial agents may contribute to the increase of VRE.</p>

In vitro antimicrobial activity of ampicillin-sulbactam,clindamycin and cefoperazone determined by E test / 中国感染与化疗杂志

Objective To investigate the in vitro antimicrobial activity of ampicillin-sulbactam,clindamycin and cefoperazone a- gainst common clinical isolates.Methods MICs of these three antibiotics were determined by E test.Results Ampicillin-sulbae- tam showed inhibition rate of 100% for methicillin susceptible S.aureus (MSSA),E.faecalis,Group A Streptococcus,H. influenzae,penicillin-susceptible S.pneumoniae (PSSP),M.catarrhalis and anaerobes (including 10 strains of Bacteroid spp.,2 strains of P.aches,1 strain of E.lentum,1 strain of Fusobacterium innocuum,and 2 strains of Peptostreptococcus spp.).Ampicillin-sulbactam was active against 86.7% of extended-spectrum?-lactamase non-producing K.pneumoniae (NES- BL-KPN) and 53.3% of non ESBL-producing E.coli (NESBL-ECO).Ampicillin-sulbactam only inhibited 23.3% of A.bau- mannii isolates and 25.0% of E.faecium isolates.For MSSA,anaerobes,PSSP and group A Streptococcus,about 60.0%, 31.2%,30.0% and 10.0% of the isolates were susceptible to clindamycin,respectively.For MSSA,NESBL-ECO and NES- BL-KPN,96.7% to 100% of the isolates were susceptible to cefoperazone.About 40.0% of P.aeruginosa isolates were sus- ceptible to cefoperazone.No A.baumannii isolate was susceptible to cefoperazone.Conclusions The ampicillin-sulbactam has good antimicrobial activity against MSSA,E.faecalis,Group A Streptococcus,NESBL-KPN,H.influenzae,PSSP,M.ca- tarrhalis and anaerobes.In this study,clindamycin is active against 60% of MSSA isolates.Most of other species are relatively resistant to clindamycin.Cefoperazone shows good activity against MSSA,NESBL-ECO,and NESBL-KPN.These three anti- microbial agents can be used as empirical treatment for community-acquired infections.

Comparison of antimicrobial susceptibility of common gram-negative isolates from blood stream between Hong Kong and Beijing patients / 中国感染与化疗杂志

Objective To compare the antimierobial resistance of the gram-negative isolates from blood stream between Beijing and Hong Kong patients.Methods Non duplicate blood stream isolates were collected between 1998 and 2003 from Peking U- nion Medical College Hospital(n=530)and Hong Kong Prince of Wales Hospital(n=2913).Disk diffusion method and broth microdilution(MB)method were used to determine the antimierobial susceptibility of these strains to 13 antimicrobial a- gents including imipenem,ceftazidime,cefepime,etc.Results The resistance rates of E.coli to amikaein,ceftazidime and cefepime were 0.6%-5.0% and 7.5%-23.5%,and to gentamicin,cefuroxime,ciprofloxacin and cefuroxime were 12.6%- 28.4% and 29.4%-68.4% in Hong Kong isolates(n=1471)and Beijing isolates(n=213),respectively.The resistance rates of Klebsiella spp.to piperacillin-tazobactam and ceftazidime were 3.3%-11.3% and 4.3%-17.7%,and to amikacin, gentamicin,cefotaxime and ceftriaxone were 1.5%-10.1% and 5.8%-27.1% in Hong Kong isolates(n=586)and Beijing i- solates(n=70),respectively.The strains above and the ECS group of bacteria in Hong Kong(consisting of Enterobacter spp.,Citrobacter spp.,and Serratia spp.,n=333)were all susceptible to imipenem and meropenem,but 4.6%(n=65)of the ECS group bacteria in Beijing were resistant.About 8.8% and 14% of ECS group isolates were resistant to cefepime.Such isolates resistant to the other?-lactams ranged from 28.4% to 96%.In Hong Kong,Salmonella typhi remained susceptible to most of the antimierobial agents tested,but in Beijing,the resistance rates to ampicillin and piperacillin were from 9.1% to 18.2%.In Hong Kong,The resistance rates of Acinetobacter spp.and P.aeruginosa to imipenem and meropenem were lower than 10%,but in Beijing their resistance rates to imipenem were 13.6%-15.3% and 8.8%-30.8%,respectively.Conclusions The resistance rates of gram-negative bacteria isolated from blood stream in Beijing to most antimicrobial agents were higher than the corresponding rates in Hong Kong.This result will be useful for empirical therapy of local bacteremia.

Infection of Penicillium marneffei / 中华病理学杂志

<p><b>OBJECTIVES</b>To elucidate the etiology, pathohistology, clinical characteristic and differential diagnosis, reduce missed diagnosis and improve the early detection and treatment of Penicillium Marneffei infection, by means of this case report and literature review.</p><p><b>METHODS</b>A patient hospitalized Penicillium Marneffei infection were presented here, together with 27 cases in the literature, among which 10 patients had complications of AIDS and 5 with other diseases.</p><p><b>RESULTS</b>Penicillium Marneffei is a temperature-sensitive, two-phase fungus, which can infect healthy and immunocompromised subjects. The common symptoms are lymphadenopathy and infection of the lung. The infection may be local or diffuse, involving the intestinal tract, soft tissue, bone, liver, spleen and bone marrow etc. The lesion can be classified into the granuloma type, suppurative type and anergy/necrosis type histologically. The yeast-like fungus were mainly found in the cytoplasm of macrophages, which were demonstrated by PAS and Giemsa staining. The wine red color developed on the culture confirms the diagnosis.</p><p><b>CONCLUSIONS</b>The diagnosis of Penicillium Marneffei infection should be considered when tuberculosis is suspected but not confirmed, and if the patient has a history of having lived or traveled in Southeast Asia, is anemic or resistant to anti-tuberculosis treatment. The major differential diagnosis is histoplasmosis. Early administration of anti-fungus drugs is essential for recovery.</p>

Mechanism of carbapenems resistance in Acinetobacter baumannii / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the mechanism of carbapenems resistance in Acinetobacter baumannii.</p><p><b>METHODS</b>WHONET-5 software was used to analyze the trend of carbapenem resistance in Acinetobacter baumannii collected from 1999 to 2001 at Peking Union Medical College Hospital. Analytical isoelectric focusing was used to measure the pI of the beta-lactamase. Conjugation experiment was used to study the transfer of carbapenem resistance and plasmid DNA was extracted and purified with Qiagen Plasmid Mini Kit. The homology of the isolates was determined by pulsed field gel electrophoresis (PFGE). Integrase genes and blaIMP-, blaVIM-, blaOXA- genes for resistant isolates were amplified and sequenced.</p><p><b>RESULTS</b>Imipenem resistance in A. baumannii was ranged from 1.8%-8.5%, but only 9 resistant isolates were viable. They were co-resistant to other carbapenems, ceftazidime, aztreonam, and gentamicin, and four isolates were resistant to ciprofloxacin. Impipenem resistance could not be transferred to susceptible strains. No plasmid was extracted. Each isolate produced TEM-1, AmpC, and two enzymes (pI 6.7, 6.0), which can not be inhibited by cloxacillin and clavulanic acid. Each isolate had class I intergase gene. Nine isolates were all negative for PCR of blaIMP- and blaVIM- genes, but positive for blaOXA-23 specific PCR. Sequencing found 100% homology with blaOXA-23. PFGE found 3 clones (A type: 5 isolates; B type: 3 isolates; C type: 1 isolate). Control isolates (imipenem-susceptible, but ceftazidime, ciprofloxacin, and gentamicin resistant) were also A clone.</p><p><b>CONCLUSIONS</b>Production of OXA-23 carbapenemase in A. baumannii was one of the main mechanisms of carbapenems resistance at our hospital. It brings concern that imipenem-resistant clone has evoluted from nosocomial multiple-resistant strains.</p>

Evaluation of Vitek 2 Compact for antimicrobial susceptibility testing of clinically relevant bacteria / 中华检验医学杂志

Objective To evaluate a new system,Vitek 2 Compact,for antimicrobial susceptibility testing(AST)of gram-negative and gram-positive bacteria.Methods Eighty-nine clinical isolates of Peking Union Medical College Hospital,including 48 gram-negative strains and 41 gram-positive strains,and 66 reference strains kept in our laboratory,including 41 gram-negative strains and 25 gram-positive strains, were studied.The antimicrobial susceptibility of these strains were tested by Vitek 2 Compact with AST- GN09(for gram-negative bacteria),AST-P536(for Staphylococci),AST-P534(for Enterococci and S.agalactiae),and AST-P533(for S.pneumoniae)susceptibility cards.The Etest was used as the reference method for comparision.Thirty-two ESBL-producing strains assessed with the confirmatory tests for ESBLs of CLSI(16 strains of them had been confirmed by PCR amplified and sequencing)were detected for ESBLs by Vitek 2 Compact.Results According to the breakpoints of Clinical and Laboratory Standards Institute (CLSI),for the 1 626 microorganism-antibiotic combinations,Vitek 2 Compact gave 90.83% strains with category agreement(CA),4.91% strains with very major errors(VME),2.09% strains with major errors (ME),6.40% minor errors(MIE).The AST for more than 90% of Enterobacteriaceae,nonfermenting bacteria,micrococci and streptococci were completed within 11h,13h,11h and 12h,respectively.The ESBLs tests for thirty-two strains by V-itek 2 Compact are all positive.Conclusions Vitek 2 Compact system can give rapid,reliable and reproducible result with high sensitivity and specificity in assessment of antimicrobial susceptibility testing for clinically relevant gram-negative and gram-positive bacteria,and would become a powerful tool in clinical microbiology laboratory.

Let us understand clinical outcome in surveillance of resistance of bacteria / 中华检验医学杂志

It is an important task to lab of clinical microbiology to surveille multi-drag or pan-drug resistant strains,such as penicillin-or macrolide-resistant Streptococcus pneumoniae,methicillin-resistant Staphylococcus aureus(MRSA),3rd generation cephalosporin-or quinolone-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa or Acinetobacter baumannii,and so on.We must understand characteristics of these resistant strains to guide doctors' empirical therapy of infective diseases.

Controlled comparison of two supplemented aerobic and anaerobic blood culture bottles to detect simulated bacteremia specimens / 中华检验医学杂志

Objective To compare BACTEC Plus aerobic and anaerobic bottles with BacT/ALERT FA aerobic bottles and FN anaerobic bottles in the ability of detecting simulated bacteremia specimens.Methods The 202 pairs of specimens were composed of 5ml sterile blood and defined loads of microorganisms.112 pairs of specimens in them also contained defined doses of antibiotics to simulate the patients undertaking antibiotic therapy.Time-to-detect(TTD)and positive percentages were evaluated in four groups,including aerobic bottles detecting aerobic bacteria,anaerobic bottles detecting anaerobic bacteria and facultative anaerobic bacteria,and aerobic bottles contained antibiotics detecting aerobic bacteria.Results The positive percentages of two kinds of aerobic bottles were both 100%.For the specimens with bacterial concentration of 10~2 and 10~3 CFU/ml,average TTDs of BACTEC Plus aerobic bottles[(13.69?3.74)h,(11.54?2.87)h]were faster than those of BacT/ALERT FA bottles [(16.76?5.62)h,(14.47?4.30)h;t=-5.674,-7.294,P

Evaluation of Vitek 2 Compact for identification of clinically relevant bacteria and yeasts / 中华检验医学杂志

Objective To evaluate a new system,Vitek 2 Compact,for identification of bacteria and yeasts.Methods 185 clinical isolates of Peking Union Medical College Hospital,including 69 gram- positive strains,66 gram-negative strains and 50 yeasts,and 50 reference strains in our laboratory,including 25 gram-positive and gram-negative strains respectively,were studied.All the strains were identified by Vitek 2 Compact with GP,GN or YST identification cards.The API method was used as the reference method.Results Among the 93 gram-positive strains,85 strains(91.40%)were correctly identified, including 5 low discrimination identified strains,and 8 strains(8.60%)were correctly identified to the genus level,but misidentified to the species level.About 90% of gram-positive strains were identified within 7 h.Out of 91 gram-negative strains,90 strains(98.90%)were correctly identified,with 5 low discrimination identified strains,only 1 strain(1.1%)was correctly identified to the genus level,but misidentified to the species level.Above 90% of Enterobacteriaceae were identified within 5 h,and over 90% of nonfermenting bacteria were identified within 10 h.In the 50 strains of yeasts,46 strains(92%) were correctly identified,including 8 low discrimination identified strains,and 4 strains(8%)were correctly identified to the genus level,but misidentified to the species level.In all the yeasts,45 strains (90%)were identified in 18.25 h,and another 5 strains(10%)were identified in 18.50 h.Conclusions As Vitek 2 Compact system can give us reliable identification results of clinically relevant bacteria and yeasts,together with its significant reduction of handling time,it will definitely become a powerful tool in clinical microbiology laboratory.