Background: Blood cultures (BCs) are obtained to identify etiologic organisms, demonstrate antibiotic efficacy, determine duration of treatment, and/or suggest further interventions. Published guidelines do not clearl...Background: Blood cultures (BCs) are obtained to identify etiologic organisms, demonstrate antibiotic efficacy, determine duration of treatment, and/or suggest further interventions. Published guidelines do not clearly state indications and timing for obtaining BCs. As a result, clinicians may obtain too many BCs, increasing cost and patient discomfort. Objective: To determine frequency of BCs performed at our hospital as part of a quality improvement project. Design: Retrospective review of all BCs submitted during a randomly selected month. Setting: A New York City 535-bed, university-affiliated community hospital. Measurements: Patient demographics and BC data were obtained from medical and laboratory records. Results: During the selected month, 2280 BCs were performed for 379 patients. Negative BCs were seen in 221 patients (58%) with one-half having multiple BCs performed within 48 hours of admission and prior to obtaining results of initial BCs. Repeat BCs frequently did not reveal further pathogens among patients with either negative or positive initial BCs. Conclusions: Two-thirds of BCs were obtained from less than one-half of patients without added clinical utility. Often, BCs were repeated prior to results of initial BCs or repeated in patients receiving antibiotics in spite of known low yield following antibiotic initiation. Clinical assessment and review of initial BCs prior to obtaining further BCs is necessary. Staff education regarding appropriate clinical setting for BCs and indications for repeat BCs is required to maximize utilization of resources, improve diagnostic yield, and limit patient discomfort.展开更多
目的评价用于血培养报警瓶基质辅助激光解吸电离飞行时间质谱（matrix assisted laser desorptionionization-time of flight mass spectrometry,MALDI-TOF MS）细菌直接鉴定的前处理方法。方法建立优化差速离心法流程。收集首都医科大...目的评价用于血培养报警瓶基质辅助激光解吸电离飞行时间质谱（matrix assisted laser desorptionionization-time of flight mass spectrometry,MALDI-TOF MS）细菌直接鉴定的前处理方法。方法建立优化差速离心法流程。收集首都医科大学附属北京同仁医院2015年10月至12月外周血培养报警标本100例（均为单一菌）,以转种培养后菌落MALDI-TOF MS鉴定为金标准,对比差速离心法优化前后、BRUKER SEPSITYPER试剂盒（简称试剂盒法）鉴定结果,评价优化差速离心法的准确率。收集2016年1月至10月外周血及体液培养报警标本516例（经革兰染色确认为细菌）,对优化差速离心法进行大样本应用研究。结果优化的差速离心法、试剂盒法及优化前的差速离心法鉴定准确率分别为97%、94%及92%,差异无统计学意义;优化的差速离心法鉴定分值〉2.0的例数则多于其他两种方法,与优化前相比差异具有统计学意义（χ~2=3.916,P=0.048）。516例样本单一菌486例,混合菌30例。优化的差速离心法鉴定准确率为92.2%（476/516）。外周血及其他体液样本鉴定准确率分别为96.5%（179/289）、86.8%（197/227）,差异有统计学意义（χ~2=16.92,P〈0.01）。单一菌鉴定准确率为97.1%（472/486）,其中革兰阳性球菌和阴性杆菌分别为96.9%、99.1%,均明显高于阳性杆菌（55.6%）,差异有统计学意义（χ~2=25.329,P〈0.01;χ~2=48.526,P〈0.01）。混合菌鉴定准确率为13.3%（4/30）。体液样本混合菌比例为11%（25/227）,显著高于外周血[1.7%（5/289）,χ~2=20.008,P〈0.01]。结论优化差速离心法鉴定率高、成本低、易操作,优于试剂盒法,对单一细菌MALDI-TOF MS血培养报警直接鉴定更具临床应用价值。展开更多
Gal alpha(1, 3) Gal (gal epitope) is a carbohydrate epitope and synthesized in large amount by alpha(1, 3) galactosyltransferase [alpha(1, 3) GT] enzyme on the cells of lower mammalian animals such as pigs and mice. H...Gal alpha(1, 3) Gal (gal epitope) is a carbohydrate epitope and synthesized in large amount by alpha(1, 3) galactosyltransferase [alpha(1, 3) GT] enzyme on the cells of lower mammalian animals such as pigs and mice. Human has no gal epitope due to the inactivation of alpha(1, 3) GT gene but produces a large amount of antibodies (anti-Gal) which recognize Gal alpha(1, 3) Gal structures specifically. In this study, a replication-deficient recombinant adenoviral vector Ad5sGT containing pig alpha(1, 3) GT cDNA was constructed and characterized. Adenoviral vector-mediated transfer of pig alpha(1, 3) GT gene into human tumor cells such as malignant melanoma A375, stomach cancer SGC-7901, and lung cancer SPC-A-1 was reported for the first time. Results showed that Gal epitope did not increase the sensitivity of human tumor cells to human complement-mediated lysis, although human complement activation and the binding of human IgG and IgM natural antibodies to human tumor cells were enhanced significantly after Ad5sGT transduction. Appearance of gal epitope on the human tumor cells changed the expression of cell surface carbohydrates reacting with Ulex europaeus I (UEA I) lectins, Vicia villosa agglutinin (VVA), Arachis hypogaea agglutinin (PNA), and Glycine max agglutinin (SBA) to different degrees. In addition, no effect of gal epitope on the growth in vitro of human tumor cells was observed in MTT assay.展开更多
AIM： To describe a new classification method of righth epatectomy according to the different special positionsof tumors.METHODS： According to positions, 91 patients with malignant hepatic tumor in the right liver lo...AIM： To describe a new classification method of righth epatectomy according to the different special positionsof tumors.METHODS： According to positions, 91 patients with malignant hepatic tumor in the right liver lobe were divided into six groups： tumors in the right posterior lobe and （or） the right caudate lobe compressing the right portal hilum （n = 14, 15.4%）, tumors in the right liver lobe compressing the inferior vena cava and （or） hepatic veins （n = 11, 12.9%）, tumors infiltrating diaphragmatic muscle （n = 7, 7.7%）, tumors in the hepatorenal recess （infiltrating the right fatty renal capsule, transverse colon and right adrenal gland, n = 8, 8.8%）, tumors deeply located near the vertebral body （n = 3, 3.3%）, tumors at other sites in the right liver lobe （the control group, n = 48,52.75%）. The values of intraoperative blood loss （IBL）, tumor＇s maxim cross-section area （TMCSA）, and time of hepatic hilum damping （THHC） and incidence of postoperative complications were compared between five groups of tumor and control group, respectively.RESULTS： The THHC in groups 1-4 was significantly longer than that in the control group, the IBL in groups 1-4 was significantly higher than that in the control group, the TMCSA in groups 2-4 was significantly larger than that in the control group, and the ratio of IBL/TMCSA in group 1 was significantly higher than that in the control group. There was no significant difference in the indexes between group 5 and the control group.CONCLUSION： The site of tumor is the key factor that determines IBL.展开更多
文摘Background: Blood cultures (BCs) are obtained to identify etiologic organisms, demonstrate antibiotic efficacy, determine duration of treatment, and/or suggest further interventions. Published guidelines do not clearly state indications and timing for obtaining BCs. As a result, clinicians may obtain too many BCs, increasing cost and patient discomfort. Objective: To determine frequency of BCs performed at our hospital as part of a quality improvement project. Design: Retrospective review of all BCs submitted during a randomly selected month. Setting: A New York City 535-bed, university-affiliated community hospital. Measurements: Patient demographics and BC data were obtained from medical and laboratory records. Results: During the selected month, 2280 BCs were performed for 379 patients. Negative BCs were seen in 221 patients (58%) with one-half having multiple BCs performed within 48 hours of admission and prior to obtaining results of initial BCs. Repeat BCs frequently did not reveal further pathogens among patients with either negative or positive initial BCs. Conclusions: Two-thirds of BCs were obtained from less than one-half of patients without added clinical utility. Often, BCs were repeated prior to results of initial BCs or repeated in patients receiving antibiotics in spite of known low yield following antibiotic initiation. Clinical assessment and review of initial BCs prior to obtaining further BCs is necessary. Staff education regarding appropriate clinical setting for BCs and indications for repeat BCs is required to maximize utilization of resources, improve diagnostic yield, and limit patient discomfort.
基金National..973" project, the Special Funds for Major State Bacsic Reseaxch of China (G1999053905) and NationalNatural Science Fou
文摘Gal alpha(1, 3) Gal (gal epitope) is a carbohydrate epitope and synthesized in large amount by alpha(1, 3) galactosyltransferase [alpha(1, 3) GT] enzyme on the cells of lower mammalian animals such as pigs and mice. Human has no gal epitope due to the inactivation of alpha(1, 3) GT gene but produces a large amount of antibodies (anti-Gal) which recognize Gal alpha(1, 3) Gal structures specifically. In this study, a replication-deficient recombinant adenoviral vector Ad5sGT containing pig alpha(1, 3) GT cDNA was constructed and characterized. Adenoviral vector-mediated transfer of pig alpha(1, 3) GT gene into human tumor cells such as malignant melanoma A375, stomach cancer SGC-7901, and lung cancer SPC-A-1 was reported for the first time. Results showed that Gal epitope did not increase the sensitivity of human tumor cells to human complement-mediated lysis, although human complement activation and the binding of human IgG and IgM natural antibodies to human tumor cells were enhanced significantly after Ad5sGT transduction. Appearance of gal epitope on the human tumor cells changed the expression of cell surface carbohydrates reacting with Ulex europaeus I (UEA I) lectins, Vicia villosa agglutinin (VVA), Arachis hypogaea agglutinin (PNA), and Glycine max agglutinin (SBA) to different degrees. In addition, no effect of gal epitope on the growth in vitro of human tumor cells was observed in MTT assay.
文摘AIM： To describe a new classification method of righth epatectomy according to the different special positionsof tumors.METHODS： According to positions, 91 patients with malignant hepatic tumor in the right liver lobe were divided into six groups： tumors in the right posterior lobe and （or） the right caudate lobe compressing the right portal hilum （n = 14, 15.4%）, tumors in the right liver lobe compressing the inferior vena cava and （or） hepatic veins （n = 11, 12.9%）, tumors infiltrating diaphragmatic muscle （n = 7, 7.7%）, tumors in the hepatorenal recess （infiltrating the right fatty renal capsule, transverse colon and right adrenal gland, n = 8, 8.8%）, tumors deeply located near the vertebral body （n = 3, 3.3%）, tumors at other sites in the right liver lobe （the control group, n = 48,52.75%）. The values of intraoperative blood loss （IBL）, tumor＇s maxim cross-section area （TMCSA）, and time of hepatic hilum damping （THHC） and incidence of postoperative complications were compared between five groups of tumor and control group, respectively.RESULTS： The THHC in groups 1-4 was significantly longer than that in the control group, the IBL in groups 1-4 was significantly higher than that in the control group, the TMCSA in groups 2-4 was significantly larger than that in the control group, and the ratio of IBL/TMCSA in group 1 was significantly higher than that in the control group. There was no significant difference in the indexes between group 5 and the control group.CONCLUSION： The site of tumor is the key factor that determines IBL.
