DOCSLIB.ORG

Article/27/9/20-3642-App1

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Article/27/9/20-3642-App1 RESEARCH LETTERS Prevalence of mcr-1 in To counteract the high prevalence of mcr-1 and align with One Health principles, the government Colonized Inpatients, China, in China formally banned colistin as an animal feed 2011–2019 additive on April 30, 2017 (6). Previous research demonstrated that colistin resistance rates and mcr-1 prevalence in Escherichia coli from human and animal Cong Shen,1 Lan-Lan Zhong,1 Zhijuan Zhong,1 samples declined substantially in China, according Yohei Doi, Jianzhong Shen, Yang Wang, Furong Ma, to a regional study conducted in Guangzhou during Mohamed Abd El-Gawad El-Sayed Ahmed, 2015–2019 (p<0.0001). These data suggest the effec- Guili Zhang, Yong Xia, Cha Chen, Guo-Bao Tian tiveness of colistin stewardship in reducing colistin Author affiliations: Sun Yat-sen University Zhongshan School of resistance in both livestock and humans (4,5). Howev- Medicine, Guangzhou, China (C. Shen, L.-L. Zhong, er, the sampling strategy of these studies was limited M.A.E.-G.E.-S. Ahmed, G. Zhang, G.-B. Tian); Sun Yat-sen to evaluating only several cross-sectional timepoints University Key Laboratory of Tropical Diseases Control, from before and after the ban, resulting in uncertainty Guangzhou (C. Shen, L.-L. Zhong, M.A.E.-G.E.-S. Ahmed, about the exact timing of the effect. G. Zhang, G. Tian); Guangzhou University of Chinese Medicine To characterize the complete prevalence dynam- The Second Clinic Medical College, Guangzhou (C. Shen, ics of human mcr-1 colonization, including the periban C. Chen); The Second Affiliated Hospital of Guangzhou University period, we constructed a 9-year monthly time series for of Chinese Medicine, Guangdong Provincial Hospital of Traditional April 2011–December 2019, over which time 13,630 fe- Chinese Medicine, Guangzhou (C. Shen, C. Chen); Sun Yat-Sen cal samples from colonized inpatients were previously University The Fifth Affiliated Hospital, Zhuhai, China (Z. Zhong); taken, by further evaluating mcr-1 prevalence of 3,823 University of Pittsburgh School of Medicine, Pittsburgh, stored fecal samples collected during April–September Pennsylvania, USA (Y. Doi); Fujita Health University School of 2016, January–September 2017–2018, and January–De- Medicine, Aichi, Japan (Y. Doi); China Agricultural University, cember 2019. We combined these data with those from College of Veterinary Medicine, Beijing, China (J. Shen, Y. Wang); our previous studies (3,5) (Appendix Table 1, https:// China Agricultural University, College of Animal Science and wwwnc.cdc.gov/EID/article/27/9/20-3642-App1. Technology, Beijing (J. Shen, Y. Wang); Third Affiliated Hospital of pdf). We used a 3-month moving average approach Guangzhou Medical University, Guangzhou (F. Ma, Y. Xia); to remove noise and substituted missing data for 7 Misr University for Science and Technology, Cairo, Egypt months of the time series by using the mean values of (M.A.E.-G.E.-S. Ahmed); Xizang Minzu University School of the 2 months flanking any month with missing data Medicine, Xianyang, China (G. Tian) (Appendix). Through changepoint analysis (Appen- dix) (7), we identified 5 changepoints, dividing the DOI: https://doi.org/10.3201/eid2709.203642 time series into 6 periods (Figure). In response to the spread of colistin resistance gene mcr- We observed that mcr-1 prevalence in human fe- 1, China banned the use of colistin in livestock fodders. cal samples was low (<3%) in the early period, before We used a time-series analysis of inpatient colonization October 2013, demonstrating that the mcr-1 gene was data from 2011–2019 to accurately reveal the associ- circulating to a limited extent in human populations ated fluctuations of mcr-1 that occurred in inpatients in before late 2013 in period 1 (P1). We observed a signif- response to the ban. icant increase in mcr-1 colonization prevalence after eavy use of antimicrobials in agricultural, hu- November 2013 in period 2 (P2) that lagged behind Hman, and veterinary applications correlates increases of mcr-1 prevalence observed in livestock directly with emergence and spread of antimicro- from 2011 (2) and was consistent with dissemination bial resistance, thereby threatening the effective from this reservoir. The third period (P3) showed a management of clinical infections (1,2). An exam- sharp increase in mcr-1 human colonization preva- ple of this association is the global dissemination lence, followed by a peak in October 2016, suggest- of the antimicrobial resistance gene (ARG) mcr-1, ing that mcr-1 was rapidly spreading in human set- conferring resistance to the last-line antimicrobial tings, potentially attributable to an extremely high drug colistin. The mcr-1 gene has been prevalent mcr-1 prevalence (>60%) in livestock around the time in ecosystems that use colistin as a growth pro- (4,5,8). Beginning in November 2016, in period 4 (P4), moter in food-producing animals, as seen in China pilot decreases in colistin use as an animal feed addi- before 2017 (2–5). tive were already being implemented (4) before the complete ban in 2017. We observed declines in hu- 1These authors contributed equally to this article. man mcr-1 colonization prevalence during this period 2502 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 27, No. 9, September 2021 RESEARCH LETTERS Figure. Time series of monthly mcr-1 prevalence in colonized inpatients, China, April 2011–December 2019. The mcr-1 prevalence was recorded each month in observed data (blue histogram) and 3-month moving average data (solid red line). Vertical dashed lines indicate significant changepoints identified in the changepoint analysis: November 2013, May 2015, November 2016, May 2017, andAugust 2018. The government of China formally banned colistin as an animal feed additive on April 30, 2017. P, time period. that were temporally consistent with declines in mcr-1 significantly and immediately reduced mcr-1 preva- prevalence observed in livestock (8). The fifth period lence to near pre-2015 levels. Of interest, however, the (P5) showed a dramatic decline in human mcr-1 colo- background mcr-1 prevalence in 2019 was still higher nization prevalence, correlating with the complete than that observed during 2011–2013, perhaps asso- ban of colistin in animal feed (6). The rapid impact of ciated with the approval of colistin for human clini- this intervention is indicative of the dramatic effect cal use in China in January 2017 (9). As a result of that curtailing a selection pressure can have in con- our findings, we strongly encourage interdisciplinary straining ARG prevalence and could be a template for surveillance involving clinicians, veterinary special- combatting other ARGs. In the last period evaluated, ists, and environmentalists to further investigate and period 6 (P6), mcr-1 prevalence fluctuated at a low evaluate changes in ARG prevalence across different level (monthly average 5.3%), in accordance with the human, animal, and environmental niches to improve mcr-1 prevalence observed in healthy human carriers, holistic understanding of the impact and timeframe pigs, and chickens after the colistin ban (5). Alhough of different stewardship interventions. currently at low levels, mcr-1 prevalence should be monitored continually to detect any signs of its resur- Acknowledgments gence, particularly given that colistin was approved We thank Nicole Stoesser for helpful discussions and for human clinical use in China in January 2017 (9). review of this manuscript. In conclusion, we characterized the dynamic landscape of mcr-1 over a 9-year period in China and This work was supported by the National Natural Science found that colistin stewardship interventions in live- Foundation of China (grant nos. 81722030, 81830103, stock were reflected in themcr-1 prevalence in human 8201101256), National Key Research and Development fecal colonization samples within a month of a large- Program (grant no. 2017ZX10302301), Guangdong Natural scale, national ban on colistin usage. Partial reduc- Science Foundation (grant no. 2017A030306012), project of tions in colistin use beginning in November 2016 rap- high-level health teams of Zhuhai at 2018 (The Innovation idly reduced the mcr-1 prevalence and turned around Team for Antimicrobial Resistance and Clinical Infection), the alarming increases observed during 2015–2016. 111 Project (grant no. B12003), and a project funded by China The complete ban implemented on April 30, 2017, Postdoctoral Science Foundation(BX20200394,2020M683068). Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 27, No. 9, September 2021 2503 RESEARCH LETTERS About the Author Haemophilus influenzae Mr. Shen is a doctoral student at Zhongshan School of Type a Sequence Type 23, Medicine, Sun Yat-sen University, Guangzhou, China. His primary research interests include infectious disease Northern Spain epidemiology, antimicrobial resistance, microbial population genomics, and genomic epidemiology. Maddi López-Olaizola, Amaia Aguirre-Quiñonero, Andrés Canut, José Luis Barrios, Gustavo Cilla, Diego Vicente, José María Marimón References 1. Tang KL, Caffrey NP, Nóbrega DB, Cork SC, Author affiliations: Biodonostia Health Research Institute, Ronksley PE, Barkema HW, et al. Restricting the use of Infectious Diseases Area, Osakidetza Basque Health Service, antibiotics in food-producing animals and its associations Donostialdea Integrated Health Organization, San Sebastián, Spain with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis. (M. López-Olaizola, G. Cilla, D. Vicente, J.M. Marimón); Lancet Planet Health. 2017;1:e316–27. https://doi.org/ Osakidetza Basque Health Service, Araba Integrated Health 10.1016/S2542-5196(17)30141-9 Organization, Vitoria-Gasteiz, Spain (A. Aguirre-Quiñonero, 2. Shen Z, Wang Y, Shen Y, Shen J, Wu C. Early emergence of A. Canut); Osakidetza Basque Health Service, Ezkerraldea- mcr-1 in Escherichia coli from food-producing animals. Lancet Infect Dis. 2016;16:293. https://doi.org/10.1016/ Enkarterri-Cruces Integrated Health Organization, Bilbao, Spain S1473-3099(16)00061-X (J.L. Barrios) 3. Zhong LL, Phan HTT, Shen C, Vihta KD, Sheppard AE, Huang X, et al.
Load more

Recommended publications
  • Sacred Concerto No. 6 1 Dmitri Bortniansky Lively Div
    Sacred Concerto No. 6 1 Dmitri Bortniansky Lively div. Sla va vo vysh nikh bo gu, sla va vo vysh nikh bo gu, sla va vo Sla va vo vysh nikh bo gu, sla va vo vysh nikh bo gu, 8 Sla va vo vysh nikh bo gu, sla va, Sla va vo vysh nikh bo gu, sla va, 6 vysh nikh bo gu, sla va vovysh nikh bo gu, sla va vovysh nikh sla va vo vysh nikh bo gu, sla va vovysh nikh bo gu, sla va vovysh nikh 8 sla va vovysh nikh bo gu, sla va vovysh nikh bo gu sla va vovysh nikh bo gu, sla va vovysh nikh bo gu 11 bo gu, i na zem li mir, vo vysh nikh bo gu, bo gu, i na zem li mir, sla va vo vysh nikh, vo vysh nikh bo gu, i na zem 8 i na zem li mir, i na zem li mir, sla va vo vysh nikh, vo vysh nikh bo gu, i na zem i na zem li mir, i na zem li mir 2 16 inazem li mir, sla va vo vysh nikh, vo vysh nikh bo gu, inazem li mir, i na zem li li, i na zem li mir, sla va vo vysh nikh bo gu, i na zem li 8 li, inazem li mir, sla va vo vysh nikh, vo vysh nikh bo gu, i na zem li, ina zem li mir, vo vysh nikh bo gu, i na zem li 21 mir, vo vysh nikh bo gu, vo vysh nikh bo gu, i na zem li mir, i na zem li mir, vo vysh nikh bo gu, vo vysh nikh bo gu, i na zem li mir, i na zem li 8 mir, i na zem li mir, i na zem li mir, i na zem li, i na zem li mir,mir, i na zem li mir, i na zem li mir, inazem li, i na zem li 26 mir, vo vysh nikh bo gu, i na zem li mir.
    [Show full text]
  • 1 Phün Tsok Ge Lek Che Wai Trün Pey Ku Thar
    SONGS OF SPIRITUAL EXPERIENCE - Condensed Points of the Stages of the Path - lam rim nyams mgur - by Je Tsongkapa 1 PHÜN TSOK GE LEK CHE WAI TRÜN PEY KU THAR YE DRO WAI RE WA KONG WEY SUNG MA LÜ SHE JA JI ZHIN ZIK PEY THUK SHA KYEY TSO WO DE LA GO CHAK TSEL Your body is created from a billion perfect factors of goodness; Your speech satisfies the yearnings of countless sentient beings; Your mind perceives all objects of knowledge exactly as they are – I bow my head to you O chief of the Shakya clan. 2 DA ME TÖN PA DE YI SE KYI CHOK GYAL WAI DZE PA KÜN GYI KUR NAM NE DRANG ME ZHING DU TRÜL WAI NAM RÖL PA MI PAM JAM PAI YANG LA CHAK TSEL LO You’re the most excellent sons of such peerless teacher; You carry the burden of the enlightened activities of all conquerors, And in countless realms you engage in ecstatic display of emanations – I pay homage to you O Maitreya and Manjushri. 3 SHIN TU PAK PAR KAR WA GYAL WAI YUM JI ZHIN GONG PA DREL DZE DZAM LING GYEN LU DRUB THOK ME CHE NI SA SUM NA YONG SU TRAK PEY ZHAB LA DAG CHAK TSEL So difficult to fathom is the mother of all conquerors, You who unravel its contents as it is are the jewels of the world; You’re hailed with great fame in all three spheres of the world – I pay homage to you O Nagarjuna and Asanga.
    [Show full text]
  • 19700016069.Pdf
    in the De3pWms& of Mechntcal Bngineerin8 CoU@geof Engineering . U&wr&%y of acma cw*ara COlWibi%> C!. @238 This report i.s based on the thesf s suldtted by Mr o CI E. arby . in pmtiRX. fulfillment of the requirments for the Degree of Doctor of PhiLosopby In the CaUege of En@userfng, University of South Carolinap Columbia, II. The work was supported by Picatimy Arsenal through the Arnry Research Office - Durham, Gxant No. 11A-ARO-F)-p.-22k7~3120. The au2;hors axe grateful for the mapport. N. P. stih Project, Dfrector Page XI- DJ!l%ODUCTZOm ....... .'............; Nc AR~~JS~ORY.................. V*. MSEIRlNE39TAL APPAM3mTS NXD PROCEDURE .em..... A. Description of the lkstment ...... 2l 3. Modificac%ionsfor Righ h-easuzle . Mesmments .............. 24 C. Sample &&paration and 'E3qperhental l?rocedkure ............. 25 A. Vaporization 09 Nitra&cel,?Lrs@ fim Propell-t. .............. 34 B. He& of Remt&om Vespnzs Presswe ....= 36 C* Httrqlycesbe Freazix~$P~B% Meeam150Bnfs ............... AjePEDDXX A - SWC'1;E: VALCULI1TIORY . c e - . a 1. C&datio~of Acii5va$;ion an& Frequency Factor Energy from D8C Data . 2- Order of Reaction tqr Man&-J. Procedure . 3. Order of Reac%ianby Computer Program . 4. Computer Progre far DSC Simulation . MPIEKDIX 13 - E'OBTFIAN 5alATEMQE!S AND SUl3RQWINES * * 1 104 An bwperimentel study of the heat of reaction' versus pressure for the f1meles.s combustion of M-2 double-base propellant at low pre same has been perTomeil. Experimental evtdence is preaentcd which hdAceb2;es tha% the main heat-producing reactions ape gas phase reactfans which occw very near the surfme, and heterogeneous reactions occurring at external sur- faces or bslw the gas-sol6 interface at surf aces of voids &/or crhcks.
    [Show full text]
  • La Grève Des Battus
    NUBIALAWO DZE AGL& E~L$LA AMINATA SAW FALL EG$ME@ELA Edoh TORGAH 1 @EKA ~ di sia h7 wogade wo5e nyawo nyadz4dz4gbal8awo me. Wo5o nu tso ale si abl4awo dzi y4 f[u kple nubiala siawo la `uti. Bok4vi siawo, kpon4 siawo kpakple bun4 siawo, ame 5a57 siawo kat7 5e nya n4 nyadz4dz4gbal8awo me. Ele be woa2e ame siawo t4gbe d42e2ee ado go le Tox4dua me, elabena wonye `ukpe kple nuny4nu na amegbet45omea kat7. Ame mademade s-` ye wonye. Aha57me siwo 2ena kpena na ame le afi siaa afi yakatsy-e la, ele be woa2e wo 2a le dua me godoo. Woawo ta la, ne èyina 2e d4 me la, nàn4 gbe dom 2a be dzodz8a negalé yè yèat4 2e m4dzekliwo nu o. Nenye be ète `u do go le dzodz8a nu la, an4 na wò be nàgakpe fuwo 5e fu hafi a2o d4n4k-dzi l45o, nàdzewo abe avetsu ene hafi age 2e wò d4w45e. Avu kple k4 hafi nàdo go le ba`kix4 me. Nàtr4 ato me, atr4 to me zi gb4 zi nane be womagakp4 yè le asi me o. Ml4ebea la, ele na wò be nana z7nu hafi age 2e Gbedox4 me. Oh! Nu ka gbee nye esia! Ame mademade siawo, wotéa nu me `ut4, nu ma tae wole te5e siaa te5e 2o. Tox4dua le avi dzi be wone2e yè le ame manyatale`u siawo 5e asi me. Nenye be medze Keba Dabo `u ts7 be ele be woanya ame siawo 2a le dua me o la, fifia la, 2ikeke a2eke magan4 eme 2e af4 sia 2e2e `uti o.
    [Show full text]
  • Pri Kaz Ge Ne Ral Nih Re Šen Ja Od Vo Đen Ja Upo Treb Lje
    UDK: 628.3(497.11) Ljil ja na Jan­ko­vić*, Mo mči lo Dra­ku­lić**, Mi loš Sta­nić*, Du šan Pro­da­no­vić*, Žel jko Va­si­lić* Pri­kaz ge­ne­ral­nih RE šen­ja od­vo­đen­ja upo­treb­lje­nih I KI šNIH vo­da na­sel­ja Brus I Bla­ce Display OF general solutions FOR DISPOSAL OF WASTE AND STORM waters IN THE villages Blace AND Brus Re­zi­me U ovom radu su pri ka za na ge ne ral na re šen ja od vo đen ja upo treb lje ne i at mo sfer ske vo de na sel ja Brus i Bla ce ko ji su pri pre ma ni u ok vi ru IPA III kom po nen te PPF4 - Pro ject Pre pa ra tion Fa ci lity 4, IPA 2010. Za kon ska re gu la tiva ko ja se od nosi na od vo đen je upo treb- l j e n i h v o d a - D i r e k t i v e E U , u k l j u č u j u ć i i D i r e k t i v u o g r a d s k i m o t p a d n i m v o d a m a , u s m e r a v a k a o d a b i r a n j u s e p a r a c i o n i h s i s t e m a z a p r i k u p l j a n j e i o d v o đ e n j e u p o t r e b l j e n i h i a t m o s f e r s k i h v o d a i p r e č i š ć a v a n j e u p o t r e b l j e n i h v o d a u p o s t r o j e n jima za pre č i š ć a v a n j e p r e i s p u š t a n j a u p r i j e m n i ke.
    [Show full text]
  • Cyrillic # Version Number
    ############################################################### # # TLD: xn--j1aef # Script: Cyrillic # Version Number: 1.0 # Effective Date: July 1st, 2011 # Registry: Verisign, Inc. # Address: 12061 Bluemont Way, Reston VA 20190, USA # Telephone: +1 (703) 925-6999 # Email: [email protected] # URL: http://www.verisigninc.com # ############################################################### ############################################################### # # Codepoints allowed from the Cyrillic script. # ############################################################### U+0430 # CYRILLIC SMALL LETTER A U+0431 # CYRILLIC SMALL LETTER BE U+0432 # CYRILLIC SMALL LETTER VE U+0433 # CYRILLIC SMALL LETTER GE U+0434 # CYRILLIC SMALL LETTER DE U+0435 # CYRILLIC SMALL LETTER IE U+0436 # CYRILLIC SMALL LETTER ZHE U+0437 # CYRILLIC SMALL LETTER ZE U+0438 # CYRILLIC SMALL LETTER II U+0439 # CYRILLIC SMALL LETTER SHORT II U+043A # CYRILLIC SMALL LETTER KA U+043B # CYRILLIC SMALL LETTER EL U+043C # CYRILLIC SMALL LETTER EM U+043D # CYRILLIC SMALL LETTER EN U+043E # CYRILLIC SMALL LETTER O U+043F # CYRILLIC SMALL LETTER PE U+0440 # CYRILLIC SMALL LETTER ER U+0441 # CYRILLIC SMALL LETTER ES U+0442 # CYRILLIC SMALL LETTER TE U+0443 # CYRILLIC SMALL LETTER U U+0444 # CYRILLIC SMALL LETTER EF U+0445 # CYRILLIC SMALL LETTER KHA U+0446 # CYRILLIC SMALL LETTER TSE U+0447 # CYRILLIC SMALL LETTER CHE U+0448 # CYRILLIC SMALL LETTER SHA U+0449 # CYRILLIC SMALL LETTER SHCHA U+044A # CYRILLIC SMALL LETTER HARD SIGN U+044B # CYRILLIC SMALL LETTER YERI U+044C # CYRILLIC
    [Show full text]
  • GE Lighting Catalog
    SHOWBIZ™ FOR STAGE, STUDIO, DISCO AND PHOTOGRAPHIC LIGHTING www.GELighting.com e GE Consumer Products Lighting and General Electric are both registered trade marks of the General Electric Company, USA © General Electric Company (USA) 2003 ENT.CAT. - 02/2003 e SHOWBIZ™ FOR STUDIO, DISCO AND PHOTOGRAPHIC LIGHTING STAGE, Introduction Welcome to this new updated catalogue. Under the SHOWBIZ™ brand GE Lighting will continue to be a leading supplier to the various sectors which make up the entertain- ment lighting industry. GE Lighting have an ongoing strategy of product innovation and improvement to meet the demands and applications of O.E.M.s and end users. This updated catalogue shows those lamps, from the extensive range of entertainment lighting products, which are currently in popular use. Please note the many new products including a more comprehensive range of discharge range. Certain other USA manufactured lamp types may be available to special order. Please contact your local GE Lighting Sales Office for details. Notes Contents A Hemispherical shield in front of filament masking all direct light Symbols 2 - 3 B Operate at or near horizontal C Protect from moisture. Safety screening techniques recommended PAR Lamps 4 - 17 D Replace broken lamp immediately. Inner bulb pressurised and could shatter unexpectedly Single Ended Halogen Lamps 18 - 35 E Use safety screen external to lamp F Operate BDTH Linear Halogen Lamps 36 - 43 G Operate BD ±30° Specialist Projector Lamps 44 - 61 H 100V rating available to order J 120V rating available to order Discharge Lamps 62 - 81 K Specially designed for searchlight applications Technical Information 82 - 117 L Twin filament lamp.
    [Show full text]
  • Glossary of Soviet Military and Related Abbreviations
    DEPARTMENT OF THE ARMY TECHNICAL MANUAL GLOSSARY OF SOVIET MILITARY AND RELATED ABBREVIATIONS DEPARTMENT OF THE ARMY FFEBRUARY 1957 TM 30-546 TECHNICAL MANUAL DEPARTMENT OF THE ARMY No. 30-546 WASHINGTON 25, D. C., 31 December 1956 GLOSSARY OF SOVIET MILITARY AND RELATED ABBREVIATIONS Page Transliteration table for the Russian language ......................-.. ii Abbreviations for use with this manual .......-.........................- ...... iii Grammatical abbreviations ...----------------------.....- ---- iv Foreword --------------------- -- ------------------------------------------------------- 1 Glossary of Soviet military and related abbreviations-.................-......... 3 TRANSLITERATION TABLE FOR THE RUSSIAN LANGUAGE The Russian alphabet has 33 letters, which are here listed together w [th their transliteration as adopted by the Board on Geographic Names. A a AG a P pd C °c C B B 3 e T T cAl/ r rJCT y A D d B cSe ye,et X xZ "s ts ch )K3J G "0 sh 314 C ' shch b b hi bi 'b *i, H H KG 10 10j Oo (90 51 31 1L / p ye initially, after vowel. andl after 'b, b; e e1~ewhere. When written as a in Rusoian, transliterate a5~ yii or e. Use of diacritical marks is. preferred, but such marks may be omitted when expediency (apostrophe), palatalize. a preceding consonant, giving a sound resembling the consonant plus y!, somewhat as in English meet you, did you. 3The symbol " (double apostrophel, not a repetition of the line above. No sound; used only after certain prefixe.- before the vowvel letter: c. e. 91. 10. ii ABBREVIATIONS USED IN THIS
    [Show full text]
  • Ge,Neral Concepts and Basic Principles of Magne,Tic Resonance Imaging
    CHAPTER 47 GE,NERAL CONCEPTS AND BASIC PRINCIPLES OF MAGNE,TIC RESONANCE IMAGING Michelle Buttenaortb. D.P.M. Magnetic Resonance Imaging, MRI, is rapidly gyromagnetic ratio (GMR). The GMR is a fixed becoming the imaging modality of choice for many number, specific for each individual proton. It is pathologies of the foot and ankle. Since podiarric determined by the Larmor equation: physicians are utilizing MRI on a frequent basis, we (,)=Yxp must become proficient in reading MR images. o = Precessional (Larmor) Frequency Confidence in readrng imaging studies takes time y: Gyromagnetic Ratio and experience, and can be very challenging. The : Strength of External Magnet key is to first understand basic principles and B general concepts of MR imaging. This paper From this equation, the precessional includes a brief review of MRI physics and a frequency, the speed at which the proton spins description of basic imaging equipment and around its axis when placed in a magnetic field, technical staff responsibilities. A brief description of can be determined. Since hydrogen has the largest all of the pulse sequences is also included. One GMR, it precesses at the highest frequency. should be more concerned with the appearance of Atoms with an odd number of protons and different anatomical structures on the various pulse neutrons in their nucleus are small, rotating sequences than the physics of how the images are magnets. Until an external magnetic field is created. Once a physician possesses general applied, these atoms are randomly oriented. Once knowledge of MR rmaging, the remainder of the a magnetic field is applied, the atoms align learning cule is dependent on repetition.
    [Show full text]
  • Foreign Languages for the Use of Printers and Translators
    u. Gmm^-mi'mr printing office k. K GIEGJij^^a^GlI, Public Pbinter FOREIGN LANG-UAGI SUPPLEMENT TO STYLE MANUAL JIICVISED EDITION FOREIGN LANGUAGES For the Use of Printers and Translators SUPPLEMENT TO STYLE MANUAL of the UNITED STATES GOVERNMENT PRINTING OFFICE SECOND EDITION, REVISED AND ENLARGED APRIL 1935 By GEORGE F. von OSTERMANN Foreign Reader A. E. GIEGENGACK Public Printer WASHINGTON, D. C. 1935 For sale by the Superintendent of Documents, Washington, D. C. Price $1.00 (Buckram) PREFACE This manual relating to foreign languages is purposely condensed for ready reference and is intended merely as a guide, not a textbook. Only elementary rules and examples are given, and no effort is made to deal exhaustively with any one subject. Minor exceptions exist to some of the rules given, but a close adherence to the usage indicated will be sufficient for most foreign-language work. In the Romance languages, especially, there are other good forms and styles not shovm in the following pages. It is desired to acknowledge the assistance and cooperation of officials and members of the staff of the Library of Congress in the preparation of these pages and, in particular. Dr. Herbert Putnam, Librarian of Congress; Mr. Martin A. Roberts, Superintendent of the Reading Room; Mr. Charles Martel, Consultant in Cataloging, Classification, and Bibliography; Mr. Julian Leavitt, Chief of Catalog Division; Mr. James B. Childs, Chief of Document Division; Dr. Israel Schapiro, Chief of the Semitic Division; Mr. George B. Sanderlin; Mr. S. N. Cerick; Mr. Jens Nyholm; Mr. N. H. Randers-Pehrson; Mr. Oscar E.
    [Show full text]
  • \ Should Be Carried G E 0 . W Y M M & 6 0 . J.W. Richards
    j '* Published ^kfce All the Home t e s / \ Bach Week. Latest Styles / Established 1 8 6 6 . '{■ Job F’I'IeMmoJo \ VOLUME XXXIX. BUCHANAN, BERRIEN CO., MICH., FRIDAY, MARCH Hi, 1905. N U M B E R 1 9 . ill Extraordinary Attraction - at The Ben Shetterly. BUSINESS CARDS Grand Opera House, Chicago Mrs. Frank Shaw and children ^R . L. E. P eck, Homeopathic Physicianan. “San Toy,” full of tuneful gayety, expect to go to Lapeer Saturday, J Surgeon, Office and Residence onMalnSfc hu mor of a kind that is entitled to be where Mr. Shaw is employed as but-' uehanan, Mich. classed, as genuine comedy, with a termaker in the creamery. rvileee Curtis, M. D. Physician and Surgeon O Office over R o e’s H ardw are. Telephone 32 We pffer Carpets, Rugs and Linoleums at special prices The Amendment to be Voted on production representing the invest­ Mrs, Austin Adams spent Tuesday^^fiananifich. ment of a fortune and a company in St. Joseph, during March. This will he your opportunity for spring. | Next Monday that is without a peer, is the attrac­ Mrs. Florence Kempton and Mrs. CARPETS HOSIERY tive announcement which is made for the Grand Opera House, Chicago, for Martha . Shaw attended the L. O, T. J.W. We offer: We offer ladies’, men’s and children’s M. M. initiatory work in Galien last Yard wide' Sultana' Cottage carpets 25c stockings at 10c a pair, the best we ever SHOULD BE CARRIED two weeks commencing Monday, PHYSICIAN AND S O f f f l l yard.
    [Show full text]
  • Xue-Qing Yu, MD, Phd Kdigofellowship Training Under Prof Robert C Atkins in 1996 and Senior Visiting Scholarship Under Prof Richard Johnson in 2002
    Ø Dr. Xue-Qing Yu is the Director of Institute of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. He is Changjiang Scholarship Professor, Ministry of Education. Ø His academic positions include President of Chinese Society of Nephrology, Chairman of Membership Committee of ISPD, Executive Member of APSN, Associate Editor of AJKD, and Subject Editor of Nephrology. He received his Xue-Qing Yu, MD, PhD KDIGOfellowship training under Prof Robert C Atkins in 1996 and senior visiting scholarship under Prof Richard Johnson in 2002. CKD-MBD in China Current and Perspective Xueqing YU, MD PhD Department of Nephrology The First AffiliatedKDIGO Hospital of Sun Yat-sen University Guangzhou, China KDIGO • P ↑, FGF-23 ↑, PTH ↑ • 1, 25 (OH) 2D3 ↓ , Ca ↓ Kidney International (2009) 76 (Suppl 113), S3-S8. CKD-MBD: Common Cause of Death on dialysis patients CKD MDBKDIGO Anemia Inadquency a serum P ≥5 mg/dL, serum calcium ≥10 mg/dL, PTH≥600 pg/mL中的一项或多项 A retrospective study with 40,538 MHD patients and followed up 12-18 M Conclusion: CKD-MBD caused detah: 17.5%，3 times higher than inadequacy and 1.5 times than anemia Block GA, Klassen PS, Lazarus JM, et al. J Am Soc Nephrol. 2004;15(8):2208-2218. Phosphate Level on All cause and CVD mortality （2008） 925 units, 25,588 ESRD received dialysis more than 180 days KDIGO Tentori F, et al. Am J Kidney Dis. 2008;52:519-530. Vascular calcification remarkably increases the mortality of dialysis patients KDIGO Block GA, Raggi P, Bellasi A, et al. Kidney Int.
    [Show full text]