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In recent years, the carbapenem-resistant Klebsiella pneumoniae (CRKP) continues to significantly threaten public health. The limited therapeutic options are increasingly challenging for clinicians to reintroduce the polymyxin as last-resort drug, with the results that polymyxin resistance is not scarce in settings. The polymyxin resistance mechanism is diversified, mainly the modification of the lipopolysaccharide (LPS). In addition to phoPQ, pmrAB, crrAB and mgrB on chromosome, plasmid-carried mcr gene have been found to mediate the LPS modification. The mgrB gene variation plays an important role in polymyxin resistance. Above all, the aim of the current review is to discuss the mechanism of polymyxin resistance mechanism in Klebsiella pneumoniae provide insights for preventing this phenomenon.
RESUMO
Objective To investigate the influence of Hui medicine flatiron moxibustion therapy and nursing intervention on pain and serum IL-2,TNF-α in rheumatoid arthritis (RA) patients before and after treatment and care interventions.Methods 89 cases RA hospitalized patients from Traditional Chinese Orthopedics and Traumatology department of General Hospital of Ningxia Medical University were collected and were randomly divided into the control group (43 cases) and the treatment group (46 cases) from May 2011 to September 2013.Two groups used a combination method of overall and portion acupoints.The control group used warm acupuncture,30 min every time,1 time per day,routine care was given.The treatment group was given with Hui medicine flatiron moxibustion instrument by the professional Chinese medicine nurses,direct moxibustion acupoints site to portion skin slight degree redness,30 min every time,1 time per day,and with routine care,focused on the reasons things out the enlighten,emotion,suggested transferring,calm the nerves of the traditional Chinese medicine psychological care guidance.10 times as a course,to rest for 3～5 days on treatment interval,for efficacy evaluation after three courses.Meanwhile,before and after the application,to test the pain degree with NPRS; to assess the psychological and emotional status with SCL-90,serum IL-2 and TNF-α levels were tested with radioimmunoassay.Results The total effective rate was 89.13％ on the treatment group,the control group was 74.42％.After treatment,the NPRS,SCL-90 scores were significantly improved than those before treatment; the NPRS,SCL-90 scores of the treatment group were better than those of the control group.After treatment,serum IL-2 and TNF-α levels were significantly improved compared with those before treatment; after treatment,IL-2 and TNF-α levels of the treatment group were better than those of the control group.All the above comparison had statistical significance.Conclusions Hui medicine flatiron moxibustion therapy and nursing intervention may effectively improve pain in RA patients,ease the psychological anxiety,increase serum IL-2,TNF-α levels,enhance the quality of life for patients,and promote disease recovery.