Effect of individualized diabetes education for type 2 diabetes mellitus: a single-center randomized clinical trial.

BACKGROUND: To evaluate the effect of individualized education for patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 280 patients (158 males, mean age 63 ± 10 years) with T2DM were randomly divided into study and control group. Eysenck Personality questionnaire was used to assess the personality of the patients in the study group, which was provided us one-on-one counseling and individualized management plan. Group education was provided to the control group. RESULTS: At the end of the study, the body mass index (21.5±2.5 vs 23.6±1.6 kg/m2, P =0.002), waist circumference (83.7±6.4 vs 85.7±7.7 cm, P =0.03), fasting blood glucose (6.0±0.8 vs 6.9±2.1 mmol/L, P =0.004), HbA1c (6.2±0.6% vs 6.9±3.1%, P =0.03), systolic blood pressure (130.1±8.8 vs 135.1±8.4 mmHg, P =0.003),triglyceride (1.21±0.66 vs 1.46±0.58 mmol/L) and low-density lipoprotein (2.36±0.44 vs 2.84±0.64 mmol/L, P =0.03) in the study group was lower than in the control group. CONCLUSION: Individualized diabetes education is more effective than group education in facilitating the control of type 2 diabetes.

[Comparison of anorectal pressure after procedure for prolapse and hemorrhoids versus Doppler-guided hemorrhoidal artery ligation for grade III hemorrhoids].

OBJECTIVE: To compare the long-term anorectal manometry of patients with grade III hemorrhoids treated by procedure for prolapse and hemorrhoids (PPH) or Doppler-guided hemorrhoidal artery ligation (DGHAL). METHODS: A total of 114 patients with grade III hemorrhoids in our department in 2010 were prospectively enrolled, and divided into PPH group (63 cases) and DGHAL group (51 cases) according to patient preference. Patients received anorectal pressure examination 2, 6, 12, 18 months after operation, including rectal resting pressure, anal resting pressure, maximal anal contractive pressure and length of high-pressure band. Anorectal manometries between two procedure groups were compared. RESULTS: In every time point of follow-up, as compared to PPH group, DGHAL group presented higher anal resting pressure[postoperative 2 months: (56.2±2.6) mmHg vs. (43.2±3.1) mmHg, postoperative 6 months: (55.2±2.1) mmHg vs. (45.1±2.5) mmHg, postoperative 12 months: (53.2±3.0) mmHg vs. (40.2±3.2) mmHg, postoperative 18 months: (55.3±2.6) mmHg vs. (43.2±2.5) mmHg, all P<0.01], and longer length of high-pressure band [postoperative 2 months: (3.45±0.14) cm vs. (2.95±0.22) cm, postoperative 6 months: (3.46±0.12) cm vs. (2.94±0.26) cm, postoperative 12 months: (3.45±0.12) cm vs. (3.01±0.21) cm, postoperative 18 months: (3.56±0.12) cm vs. (3.02±0.23) cm, all P<0.01]. While no significant differences of maximal anal contractive pressure and rectal resting pressure were found between the two groups. CONCLUSION: Both PPH and DGHAL are safe procedures and have similar efficacy in the treatment of grade III hemorrhoids, while DGHALpossesses better efficacy in the time of anal function recovery and the maintenance of anal function.

[The action of active efflux system on multi-drug resistance in methicillin resistant Staphylococcus aureus].

OBJECTIVE: To study the active efflux gene qacB, qacJ and smr in methicillin resistant Staphylococcus aureus (MRSA) and to investigate their effect on the multi-drug resistance (MDR) of MRSA. METHODS: The three pairs of ideal primers of active efflux gene qacB, qacJ and smr were designed by computer with Primer Premier 5.0 software. A total of 124 clinical isolates of MRSA were amplified respectively by polymerase chain reaction (PCR) with above mentioned primers. The PCR products were separated by electrophoresis on an 1.5% agarose gel with 0.5 microg/ml ethidium bromide. Reserpine inhibition test was used to observe the changes of the susceptibility to antibiotics of MRSA which had qacB, qacJ and smr genes separately. RESULTS: Of the 124 strains of MRSA, 86 strains had qacB, 45 strains had qacJ and 32 strains had smr gene. Reserpine inhibition test showed that the minimal inhibitory concentration (MIC) decreased 2 to 32 times for MRSA to levofloxacin and rifampin. CONCLUSION: MRSA have qacB, qacJ and smr active efflux systems, which play a very important role in multiple antibiotic resistance.

[A multicentre study on the pathogenic agents in 665 adult patients with community-acquired pneumonia in cities of China].

OBJECTIVE: To investigate the pathogenic causes of community-acquired pneumonia (CAP) in adult patients in China, the relation of previous antibiotic use and the Pneumonia Patient Outcome Research Team (PORT) classification to microbial etiology, and the prevalence of drug resistance of common CAP bacteria. METHODS: A prospective study was performed on 665 consecutive adult patients with CAP at 12 centers in 7 Chinese cities during one year. The etiology of pneumonia was considered if one of the following criteria was met: (1) valid sputum sample yielding one or more predominant strains; (2) blood cultures yielding a bacterial pathogen; (3) seroconversion, a > or = 4-fold increase or decrease titers of antibodies to Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila. Minimum inhibitory concentration (MIC) of respiratory tract isolates was determined using the agar dilution method. RESULTS: Pathogens were identified in 324/610 patients (53.1%) with valid serum samples and sputum cultures as follows: Mycoplasma pneumoniae (126, 20.7%), Streptococcus pneumoniae (63, 10.3%), Haemophilus influenzae (56, 9.2%), Chlamydia pneumoniae (40, 6.6%), Klebsiella pneumoniae (37, 6.1%), Legionella pneumophila (31, 5.1%), Staphylococcus aureus (23, 3.8%), Escherichia coli (10, 1.6%), Moraxella catarrhalis (8, 1.3%), Pseudomonas aeruginosa (6, 1.0%). Of 195 patients with a bacterial pathogen, an atypical pathogen was identified in 62 (10.2%) cases. The non-susceptibility rate of Streptococcus pneumoniae to penicillin, azithromycin, and moxifloxacin was 20.3%, 75.4% and 4.3% respectively. CONCLUSIONS: Atypical pathogens have important role in CAP, with Mycoplasma pneumoniae being the most common pathogen, and mixed infection of atypical pathogens with bacteria was found in 10.2% of the cases. Streptococcus pneumoniae and Haemophilus influenzae remain the most important bacteria for CAP. More than 75.0% of Streptococcus pneumoniae was resistant to macrolides and 20.3% was resistant to penicillin.

[A retrospective cohort study of the influence of time of hospital-acquired pneumonia onset on pathogen constitution].

OBJECTIVE: To study the influence of duration of hospitalization on etiologic agent and antibiotic-resistance of hospital-acquired pneumonia (HAP). METHODS: Cases of HAP were patients hospitalized in Fudan University Zhongshan Hospital, Ruijin Hospital, Beijing Hospital, Zhongshan University Affiliated Third Hospital, Guangzhou Medical College Affiliated Hospital and Guangdong People's Hospital. These patients were hospitalized from January 2001 to December 2003, and the diagnosis of HAP was made based on positive respiratory specimen cultures. Clinical data including time of HAP onset, severity of illness, risk factors, isolated bacteria and antimicrobial susceptibility were collected and analyzed. Statistical analysis was performed with the SPSS 12.0 software. RESULTS: A total of 562 cases of HAP were recruited, including 136 cases of early-onset pneumonia (time of onset < or = 5 d), 326 cases of middle-onset pneumonia (time of onset 6 - 14 d) and 100 cases of late-onset pneumonia (time of onset > or = 15 d). The rate of prior antibiotic use increased from 68.4% in the early-onset group to 88.0% in the late-onset group (P = 0.002); ICU admission increased from 29.4% to 46.0% (P = 0.03), and immunosuppression increased from 1.5% to 15% (P = 0.001). A total of 918 strains of bacteria were isolated, the most common pathogens being Pseudomonas aeruginosa (18.6%), Staphylococcus aureus (16.1%), Acinetobacter spp (16.1%), Klebsiella spp (14.4%) and Enterobacter spp (8.8%). Early-onset HAP were more commonly caused by Klebstella (18.3%), while the main etiologic agents for late-onset HAP were Pseudomonas aeruginosa (24.2%) and Methicillin-resistant Staphylococcus aureus (19.3%). The rates of pneumonia caused by Haemophilus and Streptococcus were 4.3% and 2.4% respectively in the early-onset cases, but none was found in late-onset cases. The antibacterial activity of ceftriaxone was influenced by duration of hospitalization, risk factors and severity of the disease. In less severe early-onset cases without risk factors, the sensitivity of ceftriaxone was 80%. But in severe late-onset cases, it was only 50%. CONCLUSIONS: There was significant difference in the pathogen constitution and antibiotic-resistance among early-onset, middle-onset and late-onset cases of HAP. The sensitivity of ceftriaxone was high in less severe early-onset cases without risk factors.

[An experimental study of the therapeutic effect of interleukin-2 and interleukin-12 with and without amphotericin B on pulmonary fungal infection].

OBJECTIVE: To study the therapeutic effect of interleukin-2 (IL-2) and interleukin-12 (IL-12) with and without amphotericin B on pulmonary fungal infection of mice. METHODS: A mouse model of pulmonary invasive aspergillus fumigatus (IPA) infection was established and the mice were divided into different groups, treated with IL-2 and IL-12 with and without amphotericin B. The survival number of mice in 15 days and the colony count of lung tissue in the different groups were observed. RESULTS: IL-2, IL-12 and amphotericin B showed synergistic effect in prolonging the survival of the infected mice and reducing the colony count in the lung tissue. CONCLUSION: IL-2 and IL-12 are effective adjuvant therapeutic agents in the immunosuppressed hosts.

[Study on the molecular mechanism of transferable multiple-antibiotic resistance in extended-spectrum beta-lactamase-producing clinical isolates].

OBJECTIVE: To investigate the molecular mechanism of transferable multiple-antibiotic resistance in extended-spectrum beta-lactamases (ESBLs) producing isolates. METHODS: Antibiotics susceptibility was tested by E-test method, and multi-resistance plasmids were screened and isolated by extracting transformant plasmids. Inserted gene Cassettes of class 1 integron were amplified and analyzed by polymerase chain reaction (PCR) and DNA sequencing. RESULTS: Eight of the nine ESBL-producing plasmids were found to comprise class 1 integron sequence, of them 7 harbored 1 or 2 antibiotic resistant gene cassettes which encoding resistance to aminoglycosides (aacA4, aadA2 or aadA5), trimethoprim (dhfrA12 or dfrA17), rifampicin (arr-3) and chloramphenicol (cmlA6). The function of these gene cassettes corresponded to the resistance profiles of their electro-transformants. CONCLUSION: Multi-resistance gene cassettes located on plasmids and mediated by class 1 integron may play an important role in causing the development and dissemination of multiple-antibiotic resistance in ESBL-producing clinical isolates.

[Study of susceptibility and genotype characterization of plasmid-mediated class I cephalosporinase in gram-negative bacteria].

OBJECTIVE: To investigate the susceptibility and genotype characteristics of gram-negative bacteria producing plasmid-mediated class I cephalosporinase (AmpC beta lactamase) epidemic in Southern China. METHODS: A total of 1,187 clinical isolates of nonrepetive gram-negative bacteria were collected from different cities in Southern China. AmpC beta lactamase producing isolates were identified by cefoxitin three-dimensional test, and antimicrobial susceptibility test was identified by Kirby-Bauer agar diffusion test; plasmid conjugation, plasmid extraction, universal PCR for gene amplication of corresponding group was done, and the PCR products were sequenced subsequently. RESULTS: The positive rate of cefoxitin three-dimensional test in gram-negative bacteria was 5.9% (70/1,187), and the prevalence of plasmid-mediated AmpC beta lactamase was: E. coli: 4.2% (19/451), Klebsiella: 4.7% (16/339), Enterobacter: 2.1% (4/190), Alcaligenes: 5.3% (1/19), Acinetobacter: 2.2% (1/45) and the total positive rate was: 3.5% (41/1,187). The susceptibility test showed that compared with the clinical isolates, the transconjugations remained resistance to cephamycins and ampicillin, and susceptible to cefepime and imipenem. PCR amplication and sequencing confirmed them to be bla(DHA-1) gene and bla(ACT-1) gene, and they were mainly distributed in Klebsiella and Escherichia. CONCLUSIONS: DHA-1 and ACT-1 were the most common genotypes in plasmid-mediated AmpC beta-lactamase produced by clinical isolates in Southern China. Fourth-generation cephalosporins and carbapenems could be better choices for the treatment of infection caused by AmpC betalactamase producers.