生物被膜肺炎克雷伯菌超广谱β-内酰胺酶的检测

目的探讨生物被膜菌的耐药机制,为临床合理应用抗生素提供理论依据。方法对2004年4月至2005年11月中国医科大学附属第二医院应用改进的平板培养法建立的肺炎克雷伯菌生物被膜模型,用银染法和扫描电镜观察鉴定。以亚胺培南为诱导剂诱导生物被膜菌超广谱β-内酰胺酶的产生。采用标准纸片扩散确证法检测超广谱β-内酰胺酶,等电聚焦电泳测β-内酰胺酶的等电点。结果浮游肺炎克雷伯菌(A组)超广谱β-内酰胺酶的检出率为20.0%(8/40);生物被膜肺炎克雷伯菌(B组)超广谱β-内酰胺酶的检出率为42.5%(17/40);亚胺培南诱导生物被膜肺炎克雷伯菌(C组)超广谱β-内酰胺酶的检出率为65.0%(26/40)。对A组和B组的检出率,B组和C组的检出率进行χ2检验,结果差异均有显著性(P均<0.05)。结论生物被膜的形成和产生超广谱β-内酰胺酶的协同作用是肺炎克雷伯菌耐药的主要原因之一。     

产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的分布及耐药性分析

目的了解医院产超广谱β-内酰胺酶（ESBLs）大肠埃希菌和肺炎克雷伯菌的分布及耐药性特点。方法对我院2004年7月～2006年7月间各类临床标本分离出的大肠埃希菌307株和肺炎克雷伯菌202株，用CLSI／NCCLS推荐的表型确证法检测其ESBLs，采用K-B纸片琼脂扩散法进行药敏试验，分析产ESBLs菌株的分布及耐药性。结果大肠埃希菌和肺炎克雷伯菌产ESBLS菌株的检出率分别为38．4％（118／307）和31．7％（64／202），主要分布于尿和痰、咽拭子中，病区主要集中于肺科、神经外科、感染科、泌尿外科、ICU室。产ESBLs菌株对亚胺培南和美罗培南呈高度敏感，对哌托西林／三唑巴坦、头孢哌酮／舒巴坦、头孢西丁耐药率较低，对其他抗菌药物均出现较高耐药。结论产ESBLS的大肠埃希菌和肺炎克雷伯菌分布在不同病区的不同标本中，碳青霉烯类抗生素亚胺培南和美罗培南是治疗产ESBLS菌株感染的较佳药物。     

肺炎克雷伯菌体外耐药监测

目的 探讨肺炎克雷伯菌（KP）的分布、感染特点及其体外对抗生素的耐药情况。方法 采用纸片扩散法K-B法对武汉大学人民医院临床分离的130株KP进行耐药性检测，并用双纸片协同法初筛、确证法检测产超广谱β-内酰胺酶（ESBLs）菌。结果 130株KP主分布于呼吸内科，并以第二季度最多；对氨苄西林的耐药率高达95．31％，对第三代头孢菌素类抗生素的耐药率为41．27％～52．46％；最敏感抗生素为亚胺培南。产ESBLs肺炎克雷伯菌检出率为29．23％。结论 肺炎克雷伯菌对抗生素的耐药性日趋严重，临床实验室应常规检测其是否产ESBLs。     

肺炎克雷伯菌β-内酰胺酶耐药基因的临床研究

目的探讨肺炎克雷伯菌感染的药敏及β-内酰胺酶耐药基因的分布情况。方法对近2年分离的268株肺炎克雷伯菌培养阳性标本结果进行回顾性分析,并随机选择其中20株肺炎克雷伯菌进行p内酰胺酶基因（TEM、SHV、CTX-M-1群、CTX-M-2群、CTX-M-9群、OXA-1群、OXA-2群、0xA-10群、PER、GES、VEB、CARB、DHA、ACT-1）检测并分析。结果产超广谱β-内酰胺酶菌对多种抗生素的耐药性较非产酶株显著升高,对β-内酰胺类、喹诺酮类和青霉素类抗生素几乎全部耐药,但对亚胺培南的敏感性为100．0％;且肺炎克雷伯菌β-内酰胺类抗菌药物耐药与产β-内酰胺酶密切相关。结论近年来该菌感染率高,且产超广谱β-内酰胺酶肺炎克雷伯菌对多种抗生素的耐药性呈上升趋势,应高度重视,及时加强对该菌的药敏及耐药谱检测,具有十分重要的临床意义。     

基层医院大肠埃希氏菌和肺炎克雷伯杆菌的分布及耐药分析

目的探讨基层医院大肠埃希氏菌和肺炎克雷伯杆菌的分布和耐药性。方法采用常规方法进行菌株的分离和鉴定,根据美国临床实验室标准化委员会（NCCLS）相关文件判断结果。结果246株大肠埃希氏菌和152株肺炎克雷伯杆菌对常用抗菌药物产生了不同的耐药性,大肠埃希氏菌和肺炎克雷伯杆菌产超广谱β-内酰胺酶（ESBLS）率分别为30．8％和18．4％,大肠埃希氏菌对亚胺培南的耐药率为0．4％,对氨苄西林的耐药率为78．0％;而肺炎克雷伯杆菌对亚胺培南的耐药率为0．0％,对氨苄西林的耐药率达96．1％。结论基层医院大肠埃希氏菌和肺炎克雷伯杆菌耐药性已十分严重,应开展耐药性监测。     

生物被膜大膜杆菌β内酰胺酶活性的检测

目的：探讨生物被膜大肠杆菌的耐药机制。方法：用改进的平板培养法建立大肠杆菌生物被膜模型，用扫描电镜进行鉴定。分别检测浮游大肠杆菌（A组），生物被膜大肠杆菌（B组）及亚胺培南（C组）和头孢西丁（D组）诱导后生物被膜大肠杆菌产β内酰胺酶的活性。结果：生物被膜大肠杆菌产β内酰胺酶是浮游大肠杆菌的2．16倍，经亚胺培南和头孢西丁诱导后生物被膜大肠杆菌β内酰胺酶的活性分别是生物被膜大肠杆菌的1．30倍和1．05倍。结论：生物被膜大肠杆菌耐药与产生β,内酰胺酶有关。     

老年下呼吸道感染患者肺炎克雷伯菌和大肠埃希菌耐药性分析

目的：监测老年下呼吸道感染患者肺炎克雷伯菌和大肠埃希菌的耐药性。为临床合理应用抗生素提供依据。方法：对我院下呼吸道感染患者中分离出的肺炎克雷伯菌和大肠埃希菌240株，以Kirby-Bauer(K-B)琼脂扩散法作药敏试验；以美国临床实验室标准委员会（NCCLS）1999年推荐的表型确认试验检测超广谱β－内酰胺酶（ESBLs）。结果：老年组和非老年组肺炎克雷伯菌和大肠埃希菌对14例抗生素的耐药率分别为阿莫西林93．2％和87．3％，哌拉西林57．1％和42．9％、头孢呋新51．4％和33．3％、头孢噻肟40．1％和17．5％、头孢他啶13．6％和3．2％、头孢曲松39．0％和17．5％、头孢哌酮37．3％和15．9％，头孢吡肟10．2％和3．2％、阿米卡星47．5％和34．9％，环丙沙星54．2％和38．1％、亚胺培南15．9％、头孢吡肟10．2％和3．2％、阿米卡星47．5％和34．9％、环丙沙星54．2％和38．1％，亚胺培南0和0、头孢哌酮／舒巴坦0和0、哌拉西林／三唑巴坦1．1％和0、头孢美唑9．6％和4．8％。78株肺炎克雷伯菌和大肠埃希菌被证实为产ESBLs菌，ESBLs检测出率为32．5％（78／240），其中老年组ESBLs检出率为38．4％（68／177），非老年组ESBLs检出率为15．9％（10／63）。亚胺培南，头孢哌酮／舒巴坦，哌拉西林／三唑巴坦和头孢美唑对产ESBLs菌的耐药率最低，分别为0、0、2．6％和12．8％。结论：老年下呼吸道感染患者肺炎克雷伯菌和大肠埃希菌的耐药率和ESBLs检出率均显著高于非老年患者；亚胺培南，头孢哌酮／舒巴坦、哌拉西林／三唑巴坦和头孢美唑是治疗由产ESBLs菌引起感染的有效抗生素。     

下呼吸道产超广谱β-内酰胺酶肺炎克雷伯氏菌及大肠埃希氏菌的耐药性分析

目的分析临床分离的下呼吸道产超广谱β-内酰胺酶肺炎克雷伯菌及大肠埃希菌的耐药特点，从而掌握耐药菌株的流行状况。方法按常规方法进行细菌分离、培养和菌种鉴定。采用微量液体稀释与K—B法分别对常用抗生素和头孢哌酮／舒巴坦的耐药性进行检测。结果产ESBLs肺炎克雷伯菌和大肠埃希菌对AMP、AMP／SB、PIP、CF、CFZ、CRM、CPD、CAX、CAZ、CTX、CPE和AZT的耐药率高达90％以上；对含β-内酰胺酶抑制剂的复合制剂（PIP／TB和SCF）的耐药率分别是52．6％、34．6％和39．7％、19．8％；对环丙沙星、庆大霉素、妥布霉素的耐药率较高，分别是64％、88．8％，96．2％、75％和96％、87．9％，具有多重耐药特点，但对亚胺培南敏感。结论产ESBLs肺炎克雷伯菌和大肠埃希菌对多种不同种类抗生素耐药，且具有多重耐药的特点。尤其是对青霉素、头孢菌素类耐药率高，但对碳青霉烯类抗生素敏感。     

2000年武汉地区产超广谱β-内酰胺酶菌种的分布及药敏分析

目的 了解产超广谱β-内酰胺酶(ESBLs)的细菌分离、分布及对抗生素的敏感性。方法 用APl或V1TEK-AMS系统(Bio’Merieux，法国)鉴定菌种，用NCCLS推荐的初筛和确证法检测产ESBLs的细菌，并用K-B法测定其对14种抗生素的敏感性。结果 2000年武汉地区的269株大肠埃希菌、202株肺炎克雷伯菌、149株阴沟肠杆菌、67株费劳地枸椽酸杆菌、43株产酸克雷伯菌中：ESBLs的检出率分别为40．9％、29．2％、20．1％、29．9％、和23．3％。产ESBLs大肠埃希菌、肺炎克雷伯菌对亚胺培南全部敏感，产ESBLs的大肠埃希菌对阿米卡星的耐药率为22．4％，对其它抗生素有不同程度的耐药。结论 产ESBLs的菌株集中在肠杆菌科菌中，以大肠埃希菌、肺炎克雷伯菌、费劳地枸椽酸杆菌的ESBLs产出最高。阴沟肠杆菌、产酸克雷伯菌ESBLs的产出应引起重视。治疗其感染时应首选亚胺培南。     

产超广谱β-内酰胺酶大肠埃希菌及肺炎克雷伯菌对九种抗菌药物的耐药性分析

目的 了解肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBLs)菌株的检出率及耐药性。方法 采用琼脂稀释法对2001年4月～2002年2月四川大学华西医院从临床标本中分离的非重复大肠埃希菌和肺炎克雷伯菌进行产ESBLs株的初筛，用NCCLS推荐的纸片扩散法作确证试验，并测定产ESBLs株对9种抗菌药物的MIC值。结果 大肠埃希菌及肺炎克雷伯菌产ESBLs株的检出率分别为26．4％和18．2％。产ESBLs菌株多呈多重耐药，耐药性由高至低依次为环丙沙星(93．3％)、头孢噻肟(70％)、头孢哌酮／舒巴坦(66．7%)、氨曲南(63．3％)、阿米卡星(36．7％)、头孢西丁(20％)、头孢他定(16．7%)、头孢吡肟(10％)，亚胺培南100％敏感。结论 产ESBLs细菌多呈多重耐药。亚胺培南是治疗产ESBLs细菌感染的最可靠药物。     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

Weighing the QT Intervals with the Slope or the Amplitude of the T Wave

Objective: The reproducibility of QT interval measurements is low, even for the mean QT interval based on the standard ECG. In this study we analyzed whether the reproducibility of the mean weighed QT interval was better than the simple mean QT interval. The weighing was based on the amplitude of the T wave or the slope of the steepest tangent on the terminal part of the T wave. Material and methods: 12‐lead ECGs of 130 postmyocardial infarction patients were obtained. The QT intervals were measured by the tangent‐method on two occasions by the same observer Mismatch QT intervals were defined as QT intervals that were measured at only one occasion. Sixteen ECGs were rejected. The data were split into 34 and 80 ECGs for optimization and validation of the weighing, respectively. The weighed QT dispersion was calculated as the weighed mean of the three longest minus the weighed mean of the three shortest QT intervals. Results: Weighing with the slope increased the reproducibility by 41% (P = 3 10^‐6), but weighing with the amplitude reduced it by 20% (P = 0.02). However, if measurements with errors above 75 ms were rejected, weighing with the slope or the amplitude increased the reproducibility with 26% and 20% (P = 0.02), respectively. Weighing did not change the reproducibility of the weighed QT dispersion. Conclusion: Weighing with the slope improved the reproducibility of the mean weighed QT interval. However, if measurements with errors above 75 ms were rejected, weighing with the amplitude also increased the reproducibility. Weighing did not change the reproducibility of the weighed QT dispersion. Weighing is particularly efficient at reducing the negative impact of mismatch QT intervals on the reproducibility. A.N.E. 2002;7(1):4–9     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

大骨节病病区水,粮实验对动物的骨和软骨中化学元素组成的影响

用质子激发 X 线荧光分析方法(PIXE)测定了大骨节病病区和非病区的水、粮以及用该水粮喂养的大白鼠的肋软骨和硬骨中22种化学元素的含量。结果发现水粮中存在差异的元素反应在用该水粮喂养的大白鼠的骨、软骨中也存在差异,含量都低的元素有 P、Mn、Cu、As、Zn。都高的有铅。其中锌低在水、粮、硬骨和软骨中都完全一致呈非常显著性差异(p<0.01)。提示病区水、粮中化学元素对骨质的影响不是单一元素缺乏或过多所致,而是多种元素的复合因素。     

高胆红素血症对肿瘤标志物测定的影响探讨

目的探讨高胆红素血症对Ca19-9、Ca24-2和CEA检测的影响.方法对320例胆管、胆囊良恶性疾病病人,15例胆囊炎病人的胆汁和血清以及10例肝硬化、10例黄疸肝炎病人进行Ca19-9、Ca24-2和CEA检测.结果在良性胆管、胆囊疾病中,Ca19-9的假阳性最高;在胆红素增高的良性疾病中,Ca19-9假阳性率达46.7%;15例胆汁和血清以及10例肝硬化和10例黄疸肝炎病人中,Ca19-9的假阳性率分别为93%、20%、80%和80%.结论高胆红素血症对Ca19-9检测影响最明显,胆囊、胆管良恶性疾病鉴别时,以Ca24-2和CEA检测为佳.     

Assessment of the Soft-Tissue Seal at the Interface between the Base of the Fixed Denture Pontic and the Oral Mucosa

Fixed dentures (bridges) are often selected as a treatment option for a defective prosthesis. In this study, we assess the contact condition between the base of the pontic and oral mucosa, and examine the effect of prosthetic preparation and material biocompatibility. The molars were removed and replaced with experimental implants with a free-end type bridge superstructure after one week. In Experiment 1, we assessed different types of prosthetic pre-treatment: (1) the untreated control group (Con: mucosa recovering from the tooth extraction); (2) the laser irradiation group (Las: mucosa recovering after the damage caused by a CO₂ laser); and (3) the tooth extraction group (Ext: mucosa recovering immediately after the teeth extraction). In Experiment 2, five materials (titanium, zirconia, porcelain, gold-platinum alloy, and self-curing resin) were placed at the base of the bridge pontic. Four weeks after the placement of the bridge, the mucosa adjacent to the pontic base was histologically analyzed. In Experiment 1, the Con and Las groups exhibited no formation of an epithelial sealing structure on the pontic base. In the Ext group, adherent epithelium was observed. In Experiment 2, the sealing properties at the pontic interface were superior for titanium and the zirconia compared with those made of porcelain or gold-platinum alloy. In the resin group, a clear delay in epithelial healing was observed.