Clonal evolution multi-drug resistant Acinetobacter baumannii by pulsed-field gel electrophoresis.

Background: Acinetobacter baumannii is usually multi-drug resistant (MDR), including third generation cephalosporins, amino glycosides and fl uoroquinolone. Resistance to these antibiotics is mediated by multiple factors such as: lactamases, effl ux pumps and other mechanisms of resistance. Pulsed-fi eld gel electrophoresis (PFGE) was then used to investigate the genetic relationships among the MDR isolates. Aim: The aim of this study was to determine MDR isolates and the existence of OXAs genes among MDR isolates of A. baumannii collected from Kermanshah hospitals in west of Iran. Materials and Methods: Forty-two MDR A. baumannii were collected from patients at Kermanshah hospitals. The isolates were identifi ed by biochemical tests and API 20NE kit. The susceptibility to different antibiotics by disk diffusion method was determined. Polymerase chain reaction (PCR) was performed for detection of blaOXA-23-like, blaOXA-24-like, blaOXA-51-like and blaOXA-58-like betalactamase genes in isolates and clonal relatedness was done by PFGE (with the restriction enzyme ApaI) and patterns analyzed by Bionumeric software. Results: This study showed high resistant to ciprofl oxacin, piperacillin, ceftazidime and also resistant to other anti-microbial agents and more spread blaOXA-23-like gene (93%) in MDR isolate. The PFGE method obtained six clones: A (10), B (9), C (5), D (4), E (11) and F (3) that clone E was outbreak and dominant in different wards of hospitals studied. Conclusion: An isolate from the emergency ward of these hospitals had indistinguishable isolates PFGE profi le and similar resistance profi le to isolates from intensive care unit (ICU), suggesting likely transmission from ICU to emergency via patient or hospital staff contact.

The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting.

Aim: To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program for retinopathy of prematurity (ROP) screening in underserved rural areas using an indigenously developed tele-ROP model. Materials and Methods: KIDROP currently provides ROP screening and treatment services in three zones and 81 neonatal units in Karnataka, India. Technicians were trained to use a portable Retcam Shutt le (Clarity, USA) and validated against ROP experts performing indirect ophthalmoscopy. An indigenously developed 20-point score (STAT score) graded their ability (Level I to III) to image and decide follow-up based on a three-way algorithm. Images were also uploaded on a secure tele-ROP platform and accessed and reported by remote experts on their smart phones (iPhone, Apple). Results: 6339 imaging sessions of 1601 infants were analyzed. A level III technician agreed with 94.3% of all expert decisions. The sensitivity, specifi city, positive predictive value and negative predictive value for treatment grade disease were 95.7, 93.2, 81.5 and 98.6 respectively. The kappa for technicians to decide discharge of babies was 0.94 (P < 0.001). Only 0.4% of infants needing treatment were missed.The kappa agreement of experts reporting on the iPhone vs Retcam for treatment requiring and mild ROP were 0.96 and 0.94 (P < 0.001) respectively. Conclusions: This is the fi rst and largest real-world program to employ accredited non-physicians to grade and report ROP. The KIDROP tele-ROP model demonstrates that ROP services can be delivered to the outreach despite lack of specialists and may be useful in other middle-income countries with similar demographics.

Genetic Variation of the VP1 Gene of the Virulent Duck Hepatitis A Virus Type 1 (DHAV-1) Isolates in Shandong Province of China / 中国病毒学·英文版

To investigate the relationship of the variation of virulence and the external capsid proteins of the pandemic duck hepatitis A virus type 1(DHAV-1) isolates,the virulence,cross neutralization assays and the complete sequence of the virion protein 1(VP1) gene of nine virulent DHAV-1 strains,which were isolated from infected ducklings with clinical symptoms in Shandong province of China in 2007-2008,were tested.The fifth generation duck embryo allantoic liquids of the 9 isolates were tested on 12-day-old duck embryos and on 7-day-old ducklings for the median embryonal lethal doses(ELD50s) and the median lethal doses(LD50s),respectively.The results showed that the ELD5s of embryonic duck eggs of the 9 DHAV-1 isolates were between 1.9 × 106/mL to 1.44 × 107/mL,while the LD50s were 2.39 × 105/mL to 6.15 × 106/mL.Cross-neutralization tests revealed that the 9 DHAV-1 isolates were completely neutralized by the standard serum and the hyperimmune sera against the 9 DHAV-1 isolates,respectively.Compared with other virulent,moderate virulent,attenuated vaccine and mild strains,the VP1 genes of the 9 strains shared 89.8％-99.7％ similarity at the nucleotide level and 92.4％-99.6％ at amino acid level with other DHAV-1 strains.There were three hypervariable regions at the C-terminus(as 158-160,180-193 and 205-219) and other variable points in VPI protein,but which didn't cause virulence of DHAV-1 change.

Single-neuron encoding of surprise in auditory processing.

The main role of structures in ascending sensory systems is to extract raw features of sensory input and compartmentalize the information-bearing elements for use by the brain. Information-bearing elements can be apparent, as in the case of stimulus frequency or intensity (Ehret and Merzenich 1988; Tramo et al. 2002; Yu et al. 2010). The features of sound that drive neuronal fi ring at higher auditory centers, however, remain elusive. In their exciting article, Gill and colleagues (2008) show how “surprise” is a dimension of auditory experience that alters fi ring patterns of central auditory neurons. By elaborating the method for calculating and extracting spectro-temporal receptive fi elds (STRFs), the authors demonstrate that auditory neurons, mainly those from hierarchically higher-order areas, modulate their discharge rates in response to sound elements that deviate from expected values. This work is the fi rst to capture and separate encoding due to surprise from the ongoing encoding of spectral and temporal elements of acoustic cues (Theunissen et al. 2004). The coding of auditory information was studied in a highly social songbird species, the zebra fi nch (Taeniopygia guttata), which frequently engages in vocal exchange as part of its normal behaviour (for reviews, see Zeigler and Marler 2004). On the receiving (sensory) end of this exchange, the acoustic elements of the incoming birdsong, including notes and syllables, are encoded by auditory neurons (for reviews, see Mello et al. 2004; Gentner 2004). As with words in human speech, for a song to be recognizable over repeated use, the order of all of its individual sound elements must also be largely preserved across time. Consequently, songbirds naturally generate expectations not only for specifi c songs but also for the general structural rules, internal correlations or probability statistics that apply to song elements. To determine if surprise was predictive of altered neuronal activity, electrophysiological recordings were made in key structures of the ascending auditory pathway, including the songbird analogue of the mammalian inferior colliculus (nucleus MLd), the primary auditory forebrain area (Field L2) or an association auditory forebrain area (CLM) (Vates et al. 1996; Mello et al. 1998). One of the main goals of this work was to isolate the impact of surprise on auditory encoding for different cells (Gill et al. 2008). To this end, different forms of STRF were compared, including a STRF that was specifi cally developed to capture the impact of fi ring due to unmet expectations in stimulus structure (a surprise-STRF). In order to drive neuronal fi ring by surprise, Gill and colleagues generated song stimuli in which certain song elements were louder or softer than expected. Deviations were only introduced as changes in power for a particular element given a brief sample of “stimulus history”. This manipulation allowed for the measured and elegant application of “surprise” embedded on the song elements without having to interpret surprise in the context of the entire song. The authors show that surprise-STRF had far greater predictive strength relative to other STRF metrics and, therefore, was useful to parse out and quantify changes in fi ring given the probability of that change occurring based on prior experience. Surprise-STRFs were shown to have provided improvement in predictive power for select neurons at all three levels of the auditory pathway that were tested. Great gains in prediction were, however, frequently made by surprise-STRFs in the higher-order auditory area CLM, for two dominant cell types named by the authors as off-set and complex auditory neurons. Interestingly, in neurons that are surprise-responsive, Gill and colleagues found that the degree of altered fi ring was relatable, in linear terms, to the magnitude of change introduced. In addition, surprise coding was directionally sensitive; surprises to augmented stimulus power could be encoded at an entirely different sub-set of neurons than cells tuned to the surprise of a lower than expected stimulus power.

RevoLix 2 micron continuous wave laser vaporesection for treatment of elderly and high risk benign prostatic hyperplasia: re-port of 36 cases / 国际外科学杂志

Objective To investigate the curative effect of RevoLix 2 micron continuous wave laser va-poresection for treatment of elderly and high risk benign prostatic hyperplasia patients. Methods Clinical data of 36 benign prostatic hyperplasia patients with medical complications aging 70 -82 years were retro-spectively analyzed. Operations were done after their complications were controlled. The RevoLix 2 μm laser system with output power of 70 W was used, and normal saline was used as rinse solution. Operations were started after positions of seminal colliculns and distances to neck of bladder were confirmed. Results Oper-ation time varied from 65 to 135 rain with a mean time of (83.6±10. 6) rain. Occasional venous hemor-rhage occurred during operation but no arterial hemorrhage was observed. No blood transfusion necessitated and no TURP syndrome was observed. Catheter was removed 2-4 days after operation. All the patients could urinate freely. No urinary incontinence was found during follow-up except 2 patients with temporary urinary incontinence. A 3-6 months follow-up showed that IPSS decreased from 24. 26 ±2. 70 to 8.47±4. 32, QOL dropped from 4. 51±0. 56 to 1.34 ± 0. 53, and Qmax increased from (6. 37 ± 1.31) mL/s to (17.24± 2. 32) mL/s. Conclusions RevoLix 2 micron continuous wave laser vaporesection is a safe and effective method with less trauma and fast recovery for treating elderly and high risk benign prostatic hyperplasia pa-tients.

The cut-off value of N-terminal portion of pro-brain natriuretic peptid in heart failure at different ages / 中华急诊医学杂志

Objective To investigate the cut-off value of N-terminal portion of pro-brain nairiuretic peptid (NT-proBNP)for detecting various degrees of heart failure(HF)at different ages.Method Totally 48 patients with cardiac dysfunction(NYHA Ⅰ-Ⅳ)were from Department of Emergency Nedicine of Zhongshan Hospital Fudan University.The inclusion criteria inclued:organic heart disease,cardiac dysfunction(NYHA Ⅰ-Ⅳ).The exclusion criteria included:acute coronary syndrome,continuous atrial fibrillation,pulmonary emphysema,lung embolism,chronic renal insufficiency,anaemia,abnormal function of glandula thyreoidea,and tumor.The NT- proBNP was studied in order to find out the relevance of NT-proBNP to the classification of HF among patients aged over75 years old(age≥75 years)and patients aged below 75 years old(age＜75 years).Moreover,the NT- proBNP values were used to differentiate acute cardiogenic dyspnea.The data were expressed as(x±s)and ana- lyzed using analysis of variance and Student's t test with SPSS 11.0.A P value less than 0.05 indicated statistical significance.Results The analysis of NT-proBNP levels showed the leveis of it were associated with the grades of cardiac function and left ventricular ejection fraction(LVEF).NT-proBNP levels in patients aged over 75 years were higher than those in patients aged below 75 years.When patients wele of NYI-IA Ⅱ grade and NYHA Ⅳ grade,the levels of NT-proBNP showed signitieant differences between two sorts of patients(407±277 vs.1358± 967 P＜0.05;3727±1342 vs.9031±2363,P＜0.01).The cut-off value of NT-proBNP determined in 48 patients was at 525 pg/ml(AUC=0.958,sensitivity 100%,specificity 76%),at 1911 pg/ml(sensitivity 73%, specificity 96%)in patients with NYHA Ⅱgrade,which were used to identify severe symptomatic heart failure.The cut-off value of NT-proBNP determined in patients aged over 75 yeats was 849pg/ml(AUC=0.922,sensitivity 100%,s pecificity 57%),at 2990 pg/ml(semitivity 81%,specificity 100%)in patients with NYHA Ⅳ grade.Cobckysions NT-proBNP levels are associated with grades of cardiac functions limit of 75 years.It suggests that higher NT-proBNP value in patients aged over 75 years should be considered to evaluate caidiac function and identify acute cardiac dyspnea.

Efficacy and Safety of Different Density of Levobupivacaine for Combined Spinal and Epidural Anesthesia in Elder Patients / 中国药房

OBJECTIVE:To compare the efficacy and safety of different density of Levobupivacaine for combined spinal and epidural anesthesia (CSEA) in elder patients. METHODS: Sixty elder patients undergoing transurethral prostatectomy (TURP) were randomly assigned to 1 of the 3 groups: Group Ⅰ(n=20,hypobaric group) received 0.75% Levobupivacaine 1 mL+ 0.5 mL 0.9% Sodium Chloride Injection,Group Ⅱ(n=20,isobaric group) received 0.75% Levobupivacaine 1 mL+0.5 mL cerebrospinal fluid,and Group Ⅲ(n=20,hyperbaric group) received 1 mL 0.75% Levobupivacaine+0.5 mL 10% Glucose. RESULTS: All the 3 groups achieved satisfactory anesthetic efficacy. The incidences of hypotension,nausea,vomiting and shivering were significantly lower in Group Ⅲ than in other two groups (Group Ⅰ and Group Ⅱ)(P

The safety of application of combined spinal and epidural anesthesia to hip surgery on the elderly / 重庆医科大学学报

Objective: To observe the effect and safety of application of combined spinal and epidural anesthesia to hip surgery on the elderly.Methods: 47 patients aged over 70 years underwent hip surgery;All patients were given combined spinal and epidural anesthesia with 7.5mg~10mg of 0.5% bupivacaine(1~1.4ml of 0.75% bupivacaine was attenuated with 0.5~1ml of cerebrospinal fluid;density: 1.010).The time to anesthesia?sensory block levels and the effect of analgesia and muscle relaxation were recorded;BP?HR and SPO2 were monitored.Results: Foot febrile and lower limb numbness appeared in 40 patients immediately after drug administration;foot febrile appeared in 7 patients 3min after drug administration.There were 3 patients at the highest sensory block levels(T6)?40 patients at T10~12 and 7 patients at T7~9.Combined spinal and epidural anesthesia could provide 100% satisfactory analgesia and muscle relaxation during operation.BP and HR had no obvious variation after anesthesia.Conclusion: The application of combined spinal and epidural anesthesia has the advantage of low-dosage?fast-acting?consummate analgesia?satisfactory muscle relaxation and small interference with recirculating and respiratory system;etc,and so it is safe and effective for hip surgery on the elderly.