耐药革兰阳性球菌肺炎的抗菌治疗

临床上重要的耐药革兰阳件球菌有青霉素耐药肺炎链球菌[PRSP,若包括中介则统称青霉素不敏感肺炎链球菌(PNSP)]、甲氧西林耐药金黄色葡萄球菌(MRSA)、甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS,以甲氧西林耐药表皮葡萄球菌,即MRSE为多且具代表性)以及万古霉素耐药肠球菌(VRE),导致肺部感染者以肺炎链球菌和会黄色葡萄球菌最常见,其中MRSA肺炎治疗困难,最具挑战性.     

呼吸道感染肺炎链球菌分离株的耐药性分析

目的研究呼吸道感染患者肺炎链球菌分离株的耐药情况。方法通过细菌培养获得肺炎链球菌，对获得的肺炎链球菌进行药敏实验。结果呼吸道分离肺炎链球菌中青霉素耐药(PRSP)占39．3％，对头孢哌酮／舒巴坦、头孢克洛、头孢呋辛、头孢噻肟、头孢曲松、环丙沙星、左氧氟沙星、红霉素、克林霉素、复方新诺明、万古霉素、利福霉素的耐药率分别为39．3％，13．8％，36．6％，17．2％，35．9％，16．6％，40．0％，36．6％．51．7％，38．6％，60．0％，0和17．2％。结论吉林省肺炎链球菌对青霉素的耐药率已经处于较高水平，耐青霉素菌株对其他抗生素普遍耐药．已经发现对三代头孢菌素耐药菌株，未发现万古霉素耐药菌株。     

重视肠道菌群失调与肠外疾病关系的研究

刚出生的新生儿肠道内是无菌的,但约2 h后,细菌迅速从口腔及肛门侵入肠道,肠道内很快就可检出肠球菌、链球菌、葡萄球菌等菌种.随着新生儿开始进食,肠道内有更多其他菌群植入,约3 d左右达到高峰.这些定植在宿主消化道、并为宿主所必需的微生物群落统称为肠道正常菌群.肠道菌群大致分为3类:(1)与宿主共生的生理性细菌,为专性厌氧菌,是肠道的优势菌群(双歧杆菌、类杆菌和消化球菌),具有肠道营养和免疫调节作用;(2)与宿主共栖的条件致病菌,以兼性需氧菌为主,为肠道非优势菌群(肠球菌和肠杆菌).     

济宁市某医院呼吸道感染患者病原菌分布及耐药性分析

目的了解济宁市第一人民医院呼吸道感染的病原菌菌群分布及耐药性,为临床治疗提供依据。方法采取生物梅里埃APISystem鉴定和VitekAmSystena微生物自动分析仪进行细菌鉴定,抗生素耐药性分析采用K—B纸片法,20eAUX酵母菌法测定真菌。MIC评价其耐药性。结果从148例呼吸道感染患者留取的痰标本中共分离出菌株120株,病原菌以革兰阴性菌为主,占66．7％,前5位分别为铜绿假单胞、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌及阴沟肠杆菌和嗜麦芽寡养单胞菌;革兰阳性菌占23．3％,主要为金黄色葡萄球菌、肺炎链球菌及粪肠球菌和肺炎链球菌;真菌占10．0％,以白念珠菌为主。大多数革兰阴性菌对头孢哌酮／舒巴坦、左氧氟沙星、亚胺培南的耐药率较低,耐药率为5．8％～33．3％;头孢唑林、头孢曲松、氨苄西林的耐药率较高,耐药率均在50％以上。革兰阳性致病菌对万古霉素较敏感,对其他抗菌药物耐药程度均较低。结论济宁市第一人民医院呼吸道感染的病原菌以革兰阴性杆菌为主,且耐药菌株所占比例较高,应合理地应用抗菌药物。     

873例肺部感染病原菌分布及耐药性分析

目的研究本地区肺部感染病原菌分布及耐药情况。方法对我院873株病原菌培养阳性患者菌群分布及药敏试验进行分析。结果 873株病原菌菌株分布G-杆菌464株(53.2%),以铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌感染多见;G+球菌355株(40.7%),以肺炎链球菌、金黄色葡萄球菌感染多见;真菌35株(4.0%),以白色念珠菌为主;肺部感染菌群分布G-杆菌感染呈上升态势;肺部感染病原菌对各种抗生素均有不同程度的耐药现象,亚胺培南对主要的G-杆菌及有较好的敏感性,万古霉素对主要G+球菌有较好的敏感性。结论临床抗生素的使用习惯与肺部感染菌群分布及耐药密切相关,根据药敏实验选择抗生素对临床耐药菌株的减少及治疗的有效性有重要的临床意义。     

高糖化血红蛋白糖尿病患者口咽部菌群紊乱分析

目的 观察糖尿病患者口咽部菌群分布状况及其与糖化血红蛋白(HbA1c)水平的关系,并探讨糖尿病患者血糖水平控制状态与口咽部正常菌群分布紊乱的相关性.方法 回顾性分析586例糖尿病患者住院初期、未使用抗菌素之前咽拭子培养中致病菌和条件致病菌的种类、数量及耐药状况.以患者糖化血红蛋白水平为标准,将586例患者分为A组(糖化血红蛋白≥7.0％)和B组(糖化血红蛋白＜7.00％),并对两组患者口咽部菌群分布状况进行比较.结果 586例糖尿病患者咽拭子培养中主要致病菌和条件致病菌共检出665株,主要检出菌分别为金黄色葡萄球菌74例、肺炎链球菌54例、肺炎克雷伯氏菌78例、铜绿假单胞菌59例、大肠埃希氏菌62例、白色念珠菌83例等；A组患者口咽部上述菌株构成比明显高于B组.A组患者同时检出非口咽正常菌株≥3株者占26.6％,明显高于B组的12.1％,两组比较差异有统计学意义(P＜0.05).A组各菌种耐药率高,多重耐药菌株多,耐甲氧西林金黄色葡萄球菌(MRSA)和产超广谱β-内酰胺酶菌株检出率高.结论 糖尿病患者长期血糖控制未达标可致口咽正常菌群紊乱,耐药菌株增多,增加呼吸道感染机率和治疗难度.     

对7 056份临床送检标本病原菌及耐药性的检测

对2000～2002年新疆维吾尔自治区人民医院临床送检标本感染菌群种类及主要致病菌耐药性进行检测，平均检出率为32．27％(2275／7056)，主要致病菌为大肠埃希菌(24．22％)、肺炎克雷伯杆菌(14．42％)、不动杆菌属(12．48％)、金黄色葡萄球菌(11．34％)、表皮葡萄球菌(11．21％)、铜绿假单胞菌(10．73％)；34种抗生素耐药性测定：9种细菌对氨苄讴林耐药率达83％～99％，对环内沙星的耐药率3年内上升了34％～78％，铜绿假单胞菌对头孢噻吩、头孢西丁、头孢噻肟、呋喃妥因的平均耐药率分别达99％，97％和99％，阴沟肠杆菌和不动杆菌属对头孢西丁、头孢噻吩的平均耐药率分别达89％和72％，99％和95％，产ESBLS菌株肺炎克雷伯杆菌高于大肠埃希菌，耐药株逐年上升17％～38％，屎肠球菌对青霉素、氨苄西林、四环素的平均耐药率高达88％～93％，对庆大霉素500和链霉素2000的耐药率分别高达79％和87％，9种细菌对31种抗生素(万古霉素、呋喃妥因、亚胺培南除外)耐药率有不同程度上升。     

3340例ICU患者的病原菌分布及耐药性分析

目的：回顾性分析3340例ICU患者的病原菌菌群分布及其耐药性,为临床治疗提供依据。方法选择3340例ICU患者,采集痰液、血液、尿液、脑脊液、引流液、穿刺液标本对感染菌的分布及耐药情况进行分析。结果共送检标本14391份,分离病原菌5893株,阳性率为40．94％。剔除同一患者的同种菌株后病原菌共2689株,其中革兰阴性杆菌2017株,革兰阳性球菌558株,真菌114株。革兰阴性杆菌中,鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌分别占27．96％、16．64％、15．40％,鲍曼不动杆菌对检测药物的耐药率均在50％以上。革兰阳性球菌中,凝固酶阴性葡萄球菌、屎肠球菌分别占28．85％、24．73％。耐甲氧西林金黄色葡萄球菌（MRSA）67株,耐万古霉素肠球菌（ VRE）5株。结论 ICU病原菌以非发酵杆菌为主,鲍曼不动杆菌和铜绿假单胞菌的耐药问题明显,多种细菌对常用抗菌药物均表现出多重耐药和高度耐药。     

加味胃苓汤对肝硬化腹水患者肠道菌群的影响

目的:观察加味胃苓汤对肝硬化腹水患者肠道菌群的影响。方法:70例肝硬化腹水患者随机分为治疗组与对照组,每组35例,另取35例健康医护人员作为健康组。对照组患者给予常规西药综合治疗,治疗组患者在常规西药综合治疗基础上,加服中药加味胃苓汤,疗程均为4周。观察两组患者治疗前后粪便细菌培养中常见细菌(肠杆菌、肠球菌、葡萄球菌、酵母菌、拟杆菌、双歧杆菌、梭菌、乳酸杆菌)的变化。结果:(1)与健康人比,肝硬化腹水患者肠道菌群肠杆菌、肠球菌、葡萄球菌、酵母菌数量显著增加(P 0. 01),拟杆菌、双歧杆菌、梭菌、乳酸杆菌数量显著下降(P 0.05)。(2)治疗组患者经加味胃苓汤治疗后肠道菌群肠杆菌、肠球菌、葡萄球菌数量显著下降(P 0. 05),拟杆菌、乳酸杆菌数量显著增加(P 0.05);4周治疗后,两组患者比较,治疗组肠道肠杆菌、肠球菌、葡萄球菌数量较对照组低,拟杆菌、乳酸杆菌数量较对照组高(P 0.05)。结论:肝硬化腹水患者存在肠道菌群失衡,表现为肠道肠杆菌、肠球菌、葡萄球菌、酵母菌数量增加,拟杆菌、双歧杆菌、梭菌、乳酸杆菌数量下降。加味胃苓汤可有效改善肝硬化腹水患者的肠道菌群失调情况。     

儿童社区获得性肺炎细菌病原学特点分析研究

目的：探讨儿童社区获得性肺炎（ CAP ）细菌病原学特点及药敏情况,指导临床肺炎诊治。方法系统分析956例住院CAP患儿的临床特征,细菌病原学特点和微生物敏感性试验情况。结果956例CAP患儿痰培养中革兰阴性（ G－）杆菌为653例,占68．3％;革兰阳性（ G＋）球菌为303例,占31．7％。主要有大肠埃希杆菌253例（26．5％）,肺炎克雷伯杆菌166例（17．4％）,流感嗜血杆菌78例（8．2％）,鲍曼不动杆菌53例（5．5％）,铜绿假单胞杆菌41例（4．3％）,肺炎链球菌47例（4．9％）和金黄色葡萄球菌41例（4．3％）。二级医院CAP常见病原为流感嗜血杆菌、卡他莫拉菌、肺炎链球菌;而三级医院则为大肠埃希杆菌、肺炎克雷伯杆菌、鲍曼不动杆菌、凝固酶阴性葡萄球菌。铜绿假单胞杆菌对泰能和美罗培南均有耐药,鲍曼不动杆菌对泰能有一定的耐药率。肺炎链球菌对青霉素、复方磺胺甲恶唑、克林霉素、红霉素及阿奇霉素均耐药。金黄色葡萄球菌对青霉素全耐药,对复方磺胺甲恶唑、氨苄西林、红霉素、阿奇霉素及四环素也有较高的耐药率。结论儿童CAP病原菌中革兰阴性杆菌并不少见,对抗菌药物耐药率高,需引起重视。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.