To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae(CRE) and their related superbugs during gastrointestinal(GI) endoscopy. Reports of outbreaks linked to GI endoscopes contami-nated with d...To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae(CRE) and their related superbugs during gastrointestinal(GI) endoscopy. Reports of outbreaks linked to GI endoscopes contami-nated with different types of infectious agents, includ-ing CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature(via the United States National Library of Medicine's "MEDLINE" database); the Food and Drug Administration's Manu-facturer and User Facility Device Experience database, or "MAUDE"; and the Internet(via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at "Hospital X" located in the sub-urbs of Chicago(IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Con-trol and Prevention(CDC), which published a report about this outbreak in Morbidity and Mortality WeeklyReport(MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's in-fection control practices following this CRE outbreak, were also reviewed. While this article focuses primar-ily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infec-tious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently as-sociated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, know展开更多
目的探讨肠道病毒71型（enterovirus 71，EV71）感染所致重症病例的临床特征、病理生理变化，评估治疗效果。方法对2008年湖北省9家定点医院收治的EV71感染重症手足口病（hand，foot and mouth disease，HHMD）病例的临床资料进行回顾...目的探讨肠道病毒71型（enterovirus 71，EV71）感染所致重症病例的临床特征、病理生理变化，评估治疗效果。方法对2008年湖北省9家定点医院收治的EV71感染重症手足口病（hand，foot and mouth disease，HHMD）病例的临床资料进行回顾性分析。结果12例重症病例经RT—PCR检查EV71核酸阳性，其中男10例，女2例，中位数年龄1．96岁。发热持续时间6．5d，皮疹持续时间7d，起病至出现重症表现时间为3．7d。神经系统受累10例，合并呼吸循环衰竭5例。5例X线胸片显示两肺或单侧片状阴影，4例为肺部纹理增多。白细胞计数、血糖、血沉和C-反应蛋白无特征性变化。11例选择大剂量静脉注射丙种球蛋白，7例使用甲泼尼龙治疗；4例肺水肿-呼吸衰竭患儿经呼吸机辅助通气，平均支持72（48—96）h。11例治愈，1例死亡。结论EV71重症主要发生在年龄小于3岁患儿，以中枢神经系统感染为主，半数可发展为呼吸循环衰竭。早期使用呼吸机辅助呼吸对纠正呼吸循环衰竭，防止多脏器功能不全和降低死亡率尤为重要。展开更多
Besides their possible effects on the development of inflammatory bowel disease(IBD),some environmental factors can modulate the clinical course of both ulcerative colitis(UC) and Crohn's disease(CD).This review i...Besides their possible effects on the development of inflammatory bowel disease(IBD),some environmental factors can modulate the clinical course of both ulcerative colitis(UC) and Crohn's disease(CD).This review is mainly devoted to describing the current knowledge of the impact of some of these factors on the outcome of IBD,with special emphasis on smoking and diet.Although the impact of smoking on the susceptibility to develop CD and UC is firmly established,its influence on the clinical course of both diseases is still debatable.In CD,active smoking is a risk factor for postoperative recurrence.Beyond this clinical setting,smoking cessation seems to be advantageous in those CD patients who were smokers at disease diagnosis,while smoking resumption may be of benefit in ex-smokers with resistant UC.The role of dietary habits on the development of IBD is far from being well established.Also,food intolerances are very frequent,but usually inconsistent among IBD patients,and therefore no general dietary recommendations can be made in these patients.In general,IBD patients should eat a diet as varied as possible.Regarding the possible therapeutic role of some dietary components in IBD,lessons should be drawn from the investigation of the primary therapeutic effect of enteral nutrition in CD.Low-fat diets seem to be particularly useful.Also,some lipid sources,such as olive oil,medium-chain triglycerides,and perhaps omega-3 fatty acids,might have a therapeutic effect.Fermentable fiber may have a role in preventing relapses in inactive UC.展开更多
基金Supported by An educational grant provided by FUJIFILM Medical Systems,USA,Inc.,Endoscopy Division(Wayne,NJUnited States)
文摘To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae(CRE) and their related superbugs during gastrointestinal(GI) endoscopy. Reports of outbreaks linked to GI endoscopes contami-nated with different types of infectious agents, includ-ing CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature(via the United States National Library of Medicine's "MEDLINE" database); the Food and Drug Administration's Manu-facturer and User Facility Device Experience database, or "MAUDE"; and the Internet(via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at "Hospital X" located in the sub-urbs of Chicago(IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Con-trol and Prevention(CDC), which published a report about this outbreak in Morbidity and Mortality WeeklyReport(MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's in-fection control practices following this CRE outbreak, were also reviewed. While this article focuses primar-ily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infec-tious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently as-sociated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, know
文摘目的探讨肠道病毒71型（enterovirus 71，EV71）感染所致重症病例的临床特征、病理生理变化，评估治疗效果。方法对2008年湖北省9家定点医院收治的EV71感染重症手足口病（hand，foot and mouth disease，HHMD）病例的临床资料进行回顾性分析。结果12例重症病例经RT—PCR检查EV71核酸阳性，其中男10例，女2例，中位数年龄1．96岁。发热持续时间6．5d，皮疹持续时间7d，起病至出现重症表现时间为3．7d。神经系统受累10例，合并呼吸循环衰竭5例。5例X线胸片显示两肺或单侧片状阴影，4例为肺部纹理增多。白细胞计数、血糖、血沉和C-反应蛋白无特征性变化。11例选择大剂量静脉注射丙种球蛋白，7例使用甲泼尼龙治疗；4例肺水肿-呼吸衰竭患儿经呼吸机辅助通气，平均支持72（48—96）h。11例治愈，1例死亡。结论EV71重症主要发生在年龄小于3岁患儿，以中枢神经系统感染为主，半数可发展为呼吸循环衰竭。早期使用呼吸机辅助呼吸对纠正呼吸循环衰竭，防止多脏器功能不全和降低死亡率尤为重要。
文摘Besides their possible effects on the development of inflammatory bowel disease(IBD),some environmental factors can modulate the clinical course of both ulcerative colitis(UC) and Crohn's disease(CD).This review is mainly devoted to describing the current knowledge of the impact of some of these factors on the outcome of IBD,with special emphasis on smoking and diet.Although the impact of smoking on the susceptibility to develop CD and UC is firmly established,its influence on the clinical course of both diseases is still debatable.In CD,active smoking is a risk factor for postoperative recurrence.Beyond this clinical setting,smoking cessation seems to be advantageous in those CD patients who were smokers at disease diagnosis,while smoking resumption may be of benefit in ex-smokers with resistant UC.The role of dietary habits on the development of IBD is far from being well established.Also,food intolerances are very frequent,but usually inconsistent among IBD patients,and therefore no general dietary recommendations can be made in these patients.In general,IBD patients should eat a diet as varied as possible.Regarding the possible therapeutic role of some dietary components in IBD,lessons should be drawn from the investigation of the primary therapeutic effect of enteral nutrition in CD.Low-fat diets seem to be particularly useful.Also,some lipid sources,such as olive oil,medium-chain triglycerides,and perhaps omega-3 fatty acids,might have a therapeutic effect.Fermentable fiber may have a role in preventing relapses in inactive UC.
