Implementación de un programa para mitigar la resistencia a los antimicrobianos en escenarios de bajos recursos / Implementation of a program to face antimicrobial resistance on a low resources hospital

Estudio cuasi-experimental desarrollado para disminuir el impacto de la resistencia a los antimicrobianos a través de un programa de prevención de infecciones y optimización del uso de antimicrobianos construido "a medida" según las posibilidades de la institución. Se implementó: vigilan-cia de colonización e infección por enterobacterias pro-ductoras de carbapenemasas (EPC); vigilancia y medidas preventivas para infecciones urinarias asociadas a sonda vesical (ITU); vigilancia e intervenciones para mejorar la higiene de manos; guías locales de tratamiento de enfer-medades infecciosas con evaluación de adherencia a las mismas y consumo de antibióticos (ATB). Resultados: Comparando periodo pre y postintervención: tasa de EPC en muestras clínicas: 1,1 a 0/días paciente; razón de tasas de incidencia (IRR: 0.00, p: 0.033); tasa de colonización: 3,3 a 0,61/días paciente (IRR: 0.18, p: 0.5). Tasa de ITU 8,9 a 7,2/1000 días catéter urinario (IRR: 0.81, p 0.5). Adherencia a higiene de manos: 77,5% a 70,38% (p 0.0067). Consumo de ATB: 376,24 a 176,82 DDD, (disminu-ción 53%). Adherencia a guías en elección de ATB: 57,1% a 95,4% (p 0.00031); duración de ATB: 92,8% a 98,4% (p 0.16); adecuación según rescate microbiológico: 57,1% a 100% (p <0.01). Conclusión: Un programa con medidas simples, a medida, con supervisión externa, redujo en un tiempo relativamente corto las infecciones por EPC, el consumo y uso apropiado de ATB en un hospital público de medianos/bajos recursos

This quasi-experimental study was developed in a public hospital with the goal of reducing the impact of antimicrobial resistance through an infection prevention and antimicrobial stewardship program. The following measures were implemented: surveillance of colonization and infection by carbapenemase-producing Enterobacteriaceae (CPE); surveillance and preventive measures for urinary catheter-associated infections (UTIs); surveillance and interventions for hand hygiene; local guidelines for treatment of infectious diseases with compliance and antibiotic (ATB) consumption metrics.Results: comparing the pre-intervention and post-intervention period, CPE rate in clinical samples 1.1 to 0/patient days, incidence rate ratio (IRR): 0.00, p: 0.033 and colonization of 3.3 to 0.61/days patient, IRR: 0.18, p-value: 0.5. UTI rate 8.9 to 7.2/1000 days urinary catheter IRR: 0.81, p 0.5. Hand Hygiene compliance: 77.5% to 70.38%, p 0.0067. ATB consumption: 376.24 to 176.82 DDD, 53% decrease. Compliance to guidelines in ATB selection: 57.1% to 95.4% p 0.00031, duration of ATB from 92.8% to 98.4% p 0.16, and adequacy to microbiological rescue of 57.1% at 100%, p <0.01. Conclusion: it is possible to reduce CPE infections, the consumption of antimicrobials and optimize their use in a public hospital in a country with medium/low resources through a program with basic and tailored measures

Research on the improving function of endothelial progenitor cells in diabetes / 药学实践杂志

Endothelial progenitor cells (EPC) are stem cells derived from bone marrow and peripheral blood, which could proliferate and differentiate into endothelial cells and participate in repair after tube injury. Studies have shown that the improving function of diabetic EPC could prevent and reduce the occurrence of diabetic complications. The research progress in improving the function of EPC in recent years and the improvement of function in the development of diabetes were reviewed in order to provide new ideas for the treatment of diabetes.

Ensayo de reproducción inducida en Ariopsis seemanni / Induced spawning trial with Ariopsis seemanni / Ensajo de reprodução induzida em Ariopsis seemanni

Resumen El bagre marino Ariopsis seemanni es aprovechado como pez de consumo en la alimentación de pescadores y pobladores de la región pacifica colombiana y como pez ornamental (5 a 10 cm -longitud total), a nivel comercial nacional e internacional. En Colombia esta especie ha sido priorizada en la agenda nacional de investigación en acuicultura de 2011-2012, como una de las especies marinas potenciales en actividades acuícolas. El objetivo de esta investigación fue evaluar el efecto de la gonadotropina coriónica humana (HGC) y el extracto pituitario de carpa (EPC) sobre la maduración final y el desove en hembras adultas de la especie. Se utilizaron 24 parejas de peces silvestres capturadas del medio, con un peso promedio de 263.6±42.2 g y 174.4±30.4 g para hembras y machos, respectivamente. Se utilizaron cuatro tratamientos hormonales: T1: 5 mg EPC/kg; T2: 7 mg EPC/kg; T3: 2000 UI HGC/kg y T4: 1000 UI HGC/kg. Se identificaron tres tipos de oocitos en maduración, no se presentaron diferencias estadísticamente significativas (p>0,05) entre los tratamientos utilizados y la cantidad de oocitos en maduración; no se obtuvo desove espontaneo en ninguna de las hembras inducidas con las dosis hormonales empleadas.

Abstract The tete sea catfish Ariopsis seemanni is a fish used for human consumption by fishermen and residents along the coast of Colombia and as ornamental fish (5 to 10 cm -total longitude), at national and international comercial level. In Colombia, this species has been prioritized in the national aquaculture research agenda 2011-2012, as one of the potential marine species for aquaculture activities. This research was aimed at evaluating the effect of human chorionic gonadotropin (HGC) and carp pituitary extract (EPC) on final maturation and spawning adult females of the species. 24 pairs of wild fish were used, with an average weight of 263.6±42.2 g and 174.4±30.4 g for females and males, respectively. Four hormonal treatments was be used: T1: EPC 5 mg/kg; T2: EPC 7 mg/kg; T3: HGC 2000 IU/kg and T4: HGC 1000 IU/kg. Identify three types of maturation oocytes was. There were no statistically significant differences (p>0,05) between treatments used and the number of oocytes achieving maturation. No spontaneous spawning was obtained in any of the females induced with the hormonal doses used.

Resumo O bagre marino Ariopsis seemanni é aproveitado como peixe de consumo na alimentação de pescadores e moradores da região pacifica colombiana e como peixe ornamental (5 a 10 cm de comprimento), a nível comercial nacional e internacional. Na Colômbia A. seemanni tem sido priorizado na agenda nacional de pesquisa na aquicultura de 2011-2012, como uma das espécies marinhas potenciais em atividades aquícolas. Esta pesquisa teve como objetivo avaliar o efeito da gonadotrofina coriónica humana (GCH) e o extrato pituitário de carpa (EPC) sobre a maduração final e o desove em fêmeas adultas desta espécie. Utilizaram-se 24 casais de peixes retirados do meio natural, com um peso médio de 263,6 ± 42,2 g e 174,4 ± 30,4 g para fêmeas e machos, respectivamente. Empregaram-se quatro tratamentos hormonais: T1: 5 mg EPC/kg; T2: 7 mg EPC/kg; T3: 2000 UI HGC/kg e T4: 1000 UI HGC/kg. Identificaram-se três tipos de oócitos em maduração, não houve diferencias estatisticamente significativas (p>0,05) entre os tratamentos utilizados e a quantidade de oócitos em maturação; não foi possível obter desove espontâneo em nenhuma das fêmeas induzidas com as doses hormonais empregadas.

Study on Protective Effect of Atorvastatin-induced Increase of EPC-MVs on Myocardial Cells in STEMI Patients / 中国药房

OBJECTIVE： To observe the protective effect of atorvastatin-induced increase of EPC-MVs on myocardial cells in ST-segment elevation myocardial infarction （STEMI） patients， and to investigate its potential mechanism. METHODS： Totally 168 STEMI patients was collected from our hospital during Feb. 2015-Feb. 2018， and then divided into group A （88 cases） and group B （94 cases） according to the dose of atorvastatin. All patients received percutaneous coronary intervention， and then given Bivaleridine for injection， Clopidogrel bisulfate tablets and Atorvastatin calcium tablets. Group A was given Atorvastatin calcium tablets 20 mg， once a day. Group B was given Atorvastatin calcium tablets 20 mg， twice a day. A treatment course lasted for 30 d， and two groups were treated for 3 courses at least. The levels of blood lipid （TC， LDL-C， HDL-C） （before treatment and 30th， 60th， 90th day after treatment） and the number of EPCs positive cells （30th， 60th day after treatment） were observed in 2 groups. The expression of miRNA of EPC-MVs （60th day after treatment） was detected， and the expression difference of miRNA were validated. Target gene and KEGG pathway enrichment of miRNA with most significant expression difference were analyzed， and the effects of it on the proliferation of cardiac HCM-a cells were evaluated. The occurrence of ADR was recorded in 2 groups. RESULTS： Totally 8 patients withdrew from the study in group A， and 6 patients in group B. There was no statistical significance in the levels of TC， LDL-C and HDL-C or the number of EPCs positive cells in peripheral blood between 2 groups before treatment or 30th day after treatment （P＞0.05）. After treatment， the level of HDL-C in 2 group （60th and 90th day after treatment） and the number of EPCs positive cells in peripheral blood in group B （60th day after treatment） were increased significantly， and group B was significantly higher or more than group A at the same time point （P＜0.05）. Microarray analysis showed that compared with group A， 16 miRNAs expressed more than 1.5 times differentially in EPC-MVs of group B， 7 of which were up-regulated and 9 down-regulated. Top five differentially expressed genes were hsa-miR-126 （up-regulated）， hsa-miR-1275 （up-regulated）， hsa-miR-7704 （down-regulated）， hsa-miR-105-5p （down-regulated）， and hsa-miR-3180 （down-regulated）. Fluorescence quantitative polymerase chain reaction results showed that compared with group A， relative expression of hsa-miR-126 and hsa-miR-1275 in group B were increased significantly； and relative expression of hsa-miR-7704， hsa-miR-105-5p and hsa-miR-3108 were decreased significantly （P＜0.05）. The expression difference of hsa-miR-126 was the most significant， and its target genes included Ang-1， PDGF， p38 MAPK， Smad2/3， HIF-1， TGF-β， etc. The signaling pathways involved in regulation mainly included angiogenesis signaling pathway， chronic myelogenous leukemia related pathway， renal epithelial cell carcinoma related pathway and so on. CCK-8 test showed that the optical density （OD） of cells in hsa-miR-126 specific interfering substance group was decreased significantly， and the OD value of cells in simulated substance group was increased significantly， compared with blank group （P＜0.05）. There was no statistical significance in the incidence of ADR as diarrhea， nausea and vomiting， rash， etc. （P＞0.05）. CONCLUSIONS： Different doses of atorvastatin can regulate the level of HDL-C， and large dose of atorvastatin can increase the number of EPCs significantly， but dose not influence the safety of drug use. This effect may be associated with up-regulating the expression of hsa-miR-126 in EPC-MVs so as to promoting the proliferation of myocardial cells.

Influence of Xuefuzhuyu decoction on EPC repairing injured vascular endothelium / 中国药理学通报

Aim To investigate the role of Xuefuzhuyu decoction ( XFZYD ) combined with EPC in repairing damaged vascular endothelium using traditional Chi-nese medicine way of blood circulation combined with cell therapy. Methods The repaired situation of inju-ried endothelium was observed and the effect of XFZYD on EPC was analysed after the endothelial in-juried rats were gavaged XFZYD and vena caudalis in-jected EPC. Results Compared with EPC group and XFZYD group, the XFZYD joint EPC group ’ s endo-thelial thickness was reduced significantly(P<0. 05). And there appeared more significant role in lowering triglycerides, total cholesterol and increasing HDL lev-els( P<0. 05 ) , the calcium was decreased more sig-nificantly( P <0. 05 ); vascular eNOS protein expres-sion increased significantly(P<0. 05); vascular SDF-1 expression was significantly increased. Conclusion XFZYD can promote EPC repairing damaged endotheli-um, and the mechanism may be relevant to improving the environment and promoting the EPC homing.

Regular Exercise Training Increases the Number of Endothelial Progenitor Cells and Decreases Homocysteine Levels in Healthy Peripheral Blood

Endothelial progenitor cells (EPCs) are known to play an important role in the repair of damaged blood vessels. We used an endothelial progenitor cell colony-forming assay (EPC-CFA) to determine whether EPC numbers could be increased in healthy individuals through regular exercise training. The number of functional EPCs obtained from human peripheral blood-derived AC133 stem cells was measured after a 28-day regular exercise training program. The number of total endothelial progenitor cell colony-forming units (EPC-CFU) was significantly increased compared to that in the control group (p=0.02, n=5). In addition, we observed a significant decrease in homocysteine levels followed by an increase in the number of EPC-CFUs (p=0.04, n=5), indicating that the 28-day regular exercise training could increase the number of EPC colonies and decrease homocysteine levels. Moreover, an inverse correlation was observed between small-endothelial progenitor cell colony-forming units (small-EPC-CFUs) and plasma homocysteine levels in healthy men (r=-0.8125, p=0.047). We found that regular exercise training could increase the number of EPC-CFUs and decrease homocysteine levels, thus decreasing the cardiovascular disease risk in men.

Derivation of Ecological Protective Concentration using the Probabilistic Ecological Risk Assessment applicable for Korean Water Environment: (I) Cadmium

Probabilistic ecological risk assessment (PERA) for deriving ecological protective concentration (EPC) was previously suggested in USA, Australia, New Zealand, Canada, and Netherland. This study suggested the EPC of cadmium (Cd) based on the PERA to be suitable to Korean aquatic ecosystem. First, we collected reliable ecotoxicity data from reliable data without restriction and reliable data with restrictions. Next, we sorted the ecotoxicity data based on the site-specific locations, exposure duration, and water hardness. To correct toxicity by the water hardness, EU's hardness corrected algorithm was used with slope factor 0.89 and a benchmark of water hardness 100. EPC was calculated according to statistical extrapolation method (SEM), statistical extrapolation methodAcute to chronic ratio (SEMACR), and assessment factor method (AFM). As a result, aquatic toxicity data of Cd were collected from 43 acute toxicity data (4 Actinopterygill, 29 Branchiopoda, 1 Polychaeta, 2 Bryozoa, 6 Chlorophyceae, 1 Chanophyceae) and 40 chronic toxicity data (2 Actinopterygill, 23 Branchiopoda, 9 Chlorophyceae, 6 Macrophytes). Because toxicity data of Cd belongs to 4 classes in taxonomical classification, acute and chronic EPC (11.07 microg/l and 0.034 microg/l, respectively) was calculated according to SEM technique. These values were included in the range of international EPCs. This study would be useful to establish the ecological standard for the protection of aquatic ecosystem in Korea.

Angiogenesis and cell therapy / 대한내과학회지

All cells in human body receive oxygen and nutrients and remove metabolic wastes through the vascular network. New vessel formation in a human body is significantly decreased in adults compared with fetus. New vessel formation is a critical process in pathogenesis, thus, it is a therapeutic target in several diseases, such as cancer, diabetic retinopathy, myocardial infarction and cerebral ischemia. Angiogenesis initiates through the interaction of several factors. For the increment of angiogenesis, new vessel promoting factors, such as vascular endothelial growth factor, or their genes have been directly injected to patients in the past. However, in recent studies, direct injection of cells promoting blood flow to patients has been attempted. In this paper, I will focus on cell therapy and its application in promoting blood flow in patients with impaired vessel such as myocardial infarction, cerebral ischemia and limb ischemia.

The Effect of Leptin on the Proliferation of the Endothelial Progenitor Cells from Peripheral Blood / 대한수혈학회지

BACKGROUND: Leptin has been found to be involved in the regulation of hematopoiesis processes and angiogenesis. Therefore, we investigated the effect of leptin in the proliferation and angiogenesis of peripheral blood (PB)-derived endothelial progenitor cells (EPCs). METHODS: Mononuclear cells were isolated from PB of healthy male volunteers and were cultured in endothelial cell growth medium-2 (EGM-2). After 6 days of culture, cells were treated with 50 ng/mL vascular endothelial growth factor (VEGF) and/or with various concentrations of leptin (10 ng/mL, 100 ng/mL, 1microgram/mL, and 10 microgram/mL) and were further cultured for one week. Proliferation of EPCs was examined by an assay measuring the uptake of 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbo cyanine-labeled acetylated LDL (Dil-ac-LDL) and tubule formation on a matrigel. The control group of cells was not treated with VEGF and/or leptin. RESULTS: The number of Dil-ac-LDL labeled-EPCs, tubule formation on matrigel and the number of cells present along tubules were significantly increased in the leptin-treated groups of cells as compared to the control group or VEGF treated group of cells (P<.05). The effect was synergistically increased in the group of cells co-treated with leptin and VEGF. The number of EPCs was increased in a leptin dose-dependent manner that was maximal at a concentration of 1microgram/mL leptin. CONCLUSION: This study shows that leptin increased in vitro proliferation and angiogenesis of EPCs derived from peripheral blood.

A Priority Anti-collision Algorithm Based on RFID in Healthcare Environment / 대한의료정보학회지

OBJECTIVE: Today, Korean medical community faces rapid changes in medical environment due to opening of medical market, more emphasis on making profit and introduction of private medical insurance. Therefore, it is apparent that around, major university hospitals, efforts are being made to adapt to such changes by establishing mid to long range strategic plans. We want to keep pace with changing times and diverse demand of patients by introducing state of the art system, utilizing Radio Frequency Identification and Ubiquitous Sensor Network technologies for improvements. In doing so, we want to distinguish our hospital services from others. However, Hospital Information System that integrates ubiquitous technologies are introduced in limited basis due to problems like standardization and limits on medical use, where responsibilities lie, legal safeguard on transmission, invasion of privacy etc. Particularly, problems like absence of tag design suitable for medical environment, compatibility issue with previous medical information system, and also, problems on sharing information with other organizations and patients need to be addressed on application of Radio Frequency Identification technologies. METHODS: In order to solve such problems, we have designed medical tags for the first time that are consistent with future ubiquitous environment by deciding on medically suitable field with 96bit tag offered by Electronic Product Code as its base. Second, improving on previous multi-tag recognizing crash prevention algorithm, we have designed a priority anti-collision algorithm that reflects priorities on the needs in medical environment, This means, by designing group bit that reflects priorities, this algorithm is able to recognize tags with faster priorities. RESULTS: For performance evaluation of proposed techniques, we have designed medical tags on 96 bit Philips U-code tag to store and to use medical information. A priority anti-collision algorithm showed superior performance than previous algorithm by recognizing tags with at least 4 times faster priorities. CONCLUSION: This study represented a priority anti-collision algorithm based on RFID in healthcare environment. we expected that the designed algorithm could provide high quality services in hospital.

Pathologic and VEGF changes of transplantation of endothelial progenitor cells for hindlimb ischemia in diabetic rabbit model / 中国实用内科杂志

Objective To explore the effects of transplantation of endothelial progenitor cells(EPC)from autologous bone marrow for hindlimb ischemia in diabetic rabbit model,and the difference between diabetes and nondiabetes.Methods Rabbits were randomly allocated into three groups for transplantation therapy,PBS control group(n=8,A group),EPC transplantation with diabetes group(n=14,B group),EPC transplantation without diabetes group(n=8,C group).Diabetic rabbit model was established by injecting alloxan,and hindlimb ischemia was induced by complete excision of femoral artery.Diabetic rabbits with hindlimb ischemia were therapied by transplanted ex vivo expanded EPC,and then effects were assessed by capillary density and capillary to muscle fiber ratio,and VEGF in muscle was also determined.Results Capillary density,capillary to muscle fiber ratio,and VEGF in muscle increased significantly in EPC transplantation group with or without diabetes after transplanting 14 days(P

Treatment of experimental femoral artery obliterans in rat by transplantation with endothelial progenitor cells from bone marrow / 中国康复理论与实践

@#ObjectiveTo observe the treatment possibility and effects on rats models with experimental femoral artery obliterans(EFAO) by transplantation of endothelial progenitor cells(EPC) from bone marrow. MethodsEFAO rat models were successfully made. Bone marrow mesenchymal stem cells(MSCs) were isolated from allogeneic male Wistar rat,cultured in DMEM in vitro. EGF,bFGF and IGF-1 were added into culture medium on the 10th day and the active EPC were labled with BrdU. 5×106 of the above cells were transplanted into the right hindlimbs i.m. as Group A in the 16 rats,and the same volume of normal saline into the opposite as Group B as control. Laser Doppler perfusion imaging was taken on the 0 day、the 14th day and the 28th day after transplantation. On the 14 day and the 28 day 8 rats were sacrificed respectively and muscles of all hindlimbs were extracted for immunohistochemical examinations (by FⅧ and BrdU).Results1. In group A the skin blood perfusion in hindlimb were significantly increased as compared with group B(P<0.05). 2. Some positive stained EPC by BrdU were found in Group A but not in Group B. 3. The numbers of blood vessels with positive staining of FⅧ in hindlimb on the 28 day in Group A were more obviously than that in Group B (P<0.01). ConclusionTransplantation of EPC from bone marrow can significantly increase the skin blood perfusion and capillary density in ischemic hindlimbs in EFAOrats.

Inhibitory Effect of Halothane on the Electrophysiological Parameters of Neurotransmission in Rat Cut Diaphragm / 대한마취과학회지

It has been known that halothane potentiates the effect of muscle relaxants. We electrophysically studied the atterations by halothane in the rat diaphragm. The diaphragm -phrenic nerve preparation was dissected out of the anesthetized rat. In 1% and 2% halothane groups, control determinations were measured on infusion of simple Ringer's solution. Following infusion of halothane-saturated Ringer's solution for 10 minutes, determinations studied were recorded. Transmembrane currents were elucidated using the standard two microelectrode voltage clamp. To determine the mean MEPC amplitude and , 30 MEPC's were first gotten. A series of EPC's were elicited by stimulation of phrenic nerve at 0.4 Hz and 40 Hz. EPC's of both frequencies were used to evaluate the amplitude and quantum content (QC) of EPC. With tetanic stimulation, the degree of rundown was calculated. 1) MEPC amplitudes were reduced under 1% and 2% halothane, to 80.9% and 71.6% respec- tively. of MEPC shortened to 84.1% and 70.7%. 2) Amplitudes of EPC lowered to 65.9% and 49.4% at 0.4 Hz, and 70.7% and 52.2% at 40 HZ. 3) QC of EPC diminished to 81.5% and 70.1% at 0.4 Hz, and 87.2% and 74.1% at 40 Hz. 4) THe degrees of rundown by the tetanic stimulation were augmented to 119.1% and 136.1%. It is concluded that halothane reduced the amplitude and time constant of decay of MEPC, and the amplitude and QC of EPC, and augmented the degree of rundown at tetanic stimulation.

Bioavailability of Single Oral Dose of Galanthamine Hydrobromide Extended-release Pellet Capsule in Dogs / 中国药房

OBJECTIVE:To study the bioavailability of single oral dose of galanthamine hydrobromide(GH) sustained-release pellet capsule (GHSRPC) in healthy dogs. METHODS: By a two-cycle crossover trial, 6 dogs were randomly assigned to receive GHSRPC or GH capsules respectively by ig. Blood samples were taken at different time and the plasma concentrations of GHSRPC and GH capsules were determined by HPLC, meanwhile their pharmacokinetic parameters were computed. RESULTS: After a single dose administration of GHSRPC and GH capsules, the pharmacokinetic parameters were as follows: AUC were (1 867.24?321.05) and (1 604.60?289.17) ng?h?mL-1; tmax were (5.42?2.24) and (0.73?0.62) h; Cmax were (89.62?11.23) and (162.82?15.35) ng?mL-1; t1/2 were (8.93?1.82) and (7.58?1.21) h, respectively. The relative bioavailability of the GHSRPC was 116.36%. CONCLUSION: The results showed significant sustained release characteristics of the GHSRPC, It’s bioequivalent with GH capsule.