产超广谱β-内酰胺酶大肠埃希菌的耐药性分析

目的 了解大肠埃希菌产超广谱β-内酰胺酶(ESBLs)的流行情况,分析产ESBLs细菌的耐药性.方法 对154株大肠埃希菌用表型确证试验检测ESBLs,用Kirby-Bauer琼脂扩散法做药物敏感试验.结果 154株大肠埃希菌中共检出产ESBLs菌80株,检出率51.95%.在各类标本中,尿中产ESBLs菌株分离率最高(52.50%),其次是痰(22.50%).除亚胺培南、美罗培南、头孢西丁、哌拉西林/他唑巴坦和阿米卡星外,产ESBLs菌株对其他8种抗菌药物的耐药率明显高于非产ESBLs菌株(P<0.05).结论 该院产ESBLs大肠埃希菌株对多类药物表现出较高的耐药率,临床应加强对产ESBLs大肠埃希菌耐药性监测,严格掌握抗生素的使用指征,防止耐药菌株的传播流行.     

大肠埃希氏菌在临床中耐药性的动态监测

目的：了解产超广谱β-内酰胺酶（ESBLs）、头孢菌素（AmpC）酶的大肠埃希菌（EC）对抗菌药物的耐药性,为指导临床合理使用抗菌药物提供科学依据。方法：用纸片扩散法（K-B法）对大肠埃希菌进行14种抗菌药物的敏感性试验,产超广谱β-内酰胺酶（ESBLs）的筛选按美国临床实验室标准化委员会（NCCLS）推荐的纸片确证法进行,去阻遏持续高产AmpC酶的检测采用双抑制剂扩散协同纸片法检测。结果：2008～2010年从临床标本中共分离到大肠埃希菌176株,其中产ESBLs阳性58株,有1株同时产AmpC酶。除亚胺培南外对其他13种抗生素均有不同程度耐药,头孢类药物耐药率较高。结论：临床EC的耐药情况十分严重,应对EC进行耐药性动态监测,以指导临床科学使用抗菌药物。     

大肠埃希菌超广谱β-内酰胺酶基因型及耐药性研究

 目的 了解沈阳地区产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的流行和耐药特点,初步确定产ESBLs大肠埃希菌的基闪型.方法 收集沈阳地区大肠埃希菌临床分离株246株,通过CLSI确认试验确认产ESBLs大肠埃希菌,应用K-B纸片法进行药敏试验,采用PCR方法检测ESBLs的基冈型.结果 产ESBLs大肠埃希菌共127株(51.6%),对头孢噻肟、头孢曲松、氨曲南、头孢他啶、头孢两丁及阿莫西林/克拉维酸的耐药率分别是:68.3%、92%、43.1%、24.4%、10.5%及37.4%,亚胺培南和美洛培南的敏感率均为100%;在72株CTX-M型中53株(60.2%)为CTX-M-9型、15株(17%)为CTX-M-1型,4株(4.6%)同时携带了CTX-M-9及CTX-M-1两种基因.结论 产ESBLs大肠埃希菌具有多重耐药的特点,产ES-BLs的大肠埃希菌大都携带CTX-M型ESBLs基因.     

九种滇产药用植物体外抗菌作用及其活性部位的初步研究

目的测定9种滇产药用植物的80%乙醇提取物及石油醚、乙酸乙酯、正丁醇萃取部分体外抗菌活性。方法制备9种药材的80%乙醇浸膏及其石油醚、乙酸乙酯、正丁醇萃取物,对其进行抗菌活性的筛选。通过微量稀释法测定其最低抑菌浓度（MIC）和最低杀菌浓度（MBC）。结果 9种提取物的醇提物及萃取部分中,大叶藤黄和滇南红厚壳的乙酸乙酯部分、粗糠茶的乙醇浸膏及乙酸乙酯部分对标准金黄色葡萄球菌的活性最好,抑菌圈均为19 mm,MIC分别为128、1024、1024、256μg·ml-1;小叶藤黄的乙酸乙酯部分对铜绿假单胞菌活性最好,抑菌圈为20 mm,MIC为2048μg·ml-1;粗糠茶的乙酸乙酯部分对产超广谱β-内酰胺酶肺炎克雷伯菌的活性最好,抑菌圈为17 mm,MIC〉2048μg·ml-1;蓝叶藤的正丁醇部分对标准大肠埃希菌、产超广谱β-内酰胺酶大肠埃希菌、白假丝酵母菌、光滑念珠菌、热带念珠菌、烟曲霉菌的抑菌圈分别为26、28、34、30、15、38 mm,MIC分别为1024、256、512、1024、1024、128μg·ml-1。结论 9种中药中,蓝叶藤的正丁醇部分具有广谱抗菌活性,特别是对烟曲霉菌也有一定的抑制作用。     

泌尿道感染大肠埃希菌耐药性分析

目的：了解我院泌尿道感染大肠埃希菌耐药现状,为临床治疗提供参考。方法：对2006年5月-2007年12月我院住院及门诊病人送检尿培养采用法国梅里埃ATB分析仪进行细菌鉴定,用K—B法做药敏试验,并用纸片确证试验检测超广谱β-内酰胺酶（ESBLs）。结果：大肠埃希菌产ESBLs检出率为32．7％,药敏结果显示,大肠埃希菌对亚胺培南100％敏感,对其余抗生素出现不同程度的耐药,产ESBLs株耐药率明显高于非产ESBLs株。结论：大肠埃希菌耐药严重,临床应重视病原学检查,根据药敏结果合理选用抗生素。     

临床分离大肠埃希菌ESBLs的检出率与耐药性分析

目的了解临床分离大肠埃希菌超广谱β-内酰胺酶的检出率和耐药情况,为临床合理选用抗生素提供依据。方法根据NCCLS推荐的琼脂稀释法进行药敏试验 用双纸片协同试验检测产ESBLs菌。结果108株临床分离大肠埃希菌检出产ESBLs菌62株,检出率为57.4%。ESBLs菌株对15种常用抗菌药物耐药率,对亚胺培南的耐药率低于2%,对哌拉西林/他唑巴坦耐药率为35.5%,对头孢哌酮/舒巴坦的耐药率为45.2%,对头孢他啶的耐药率为46.8%,对其他药物的耐药率均较高。结论应加强对临床分离大肠埃希菌耐药性监测,指导临床合理使用抗生素,减少新的ESBLs的产生。     

28种云南中草药体外抗菌活性筛选

目的测定28种云南中草药乙醇提取物的体外抗菌活性。方法制备28种云南中草药80％乙醇提取物,采用常规琼脂扩散法进行体外抑菌试验,微量肉汤稀释法测定最低抑菌浓度（MIC）和最低杀菌浓度（MBC）。结果28种中草药乙醇提取物中,分别有14、1、15、6种对金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌、白色念珠菌有抑制作用;其中尤以紫金标的乙醇提取物抑制耐甲氧西林金黄色葡萄球菌（MRSA）活性最高,其MIC和MBC分别为32μg／ml和64μg/ml。结论紫金标乙醇提取物呈现广谱抗菌特性,且具有抗MRSA作用。     

尿路感染490例病原菌分布及耐药分析

目的探讨尿路感染患者病原菌分布及其耐药情况,为临床合理用药提供参考。方法对尿路感染患者中段尿培养分离出的490株病原菌进行鉴定和药敏分析,采用VITEK2系统鉴定细菌,药敏试验采用纸片扩散法。结果尿路感染比例最高病原菌为大肠埃希菌(34.5%)和肠球菌属(13.1%)。药敏结果显示,超广谱β-内酰胺酶(ESBLs)阳性大肠埃希菌(66.3%)对大部分抗菌药物具有较高的耐药率,ESBLs阴性菌株具有较低耐药率;屎肠球菌对大部分抗菌药物具有较高的耐药率,粪肠球菌有较低耐药率。结论尿路感染主要病原菌为大肠埃希菌和肠球菌属,其中ESBLs阳性大肠埃希菌和屎肠球菌有较高的耐药率,应引起临床足够重视。     

产超广谱β-内酰酶细菌检测及耐药性分析

目的:了解产超广谱β-内酰酶(ESBLs)肺炎克雷伯菌和大肠埃希菌在我院的分离、分布情况、耐药特点,以便及时监控和治疗.方法:先用纸片扩散初筛法从140株肺炎克雷伯菌和大肠埃希菌中筛选出38株可疑产ESBLs菌株,再用纸片扩散确证法确认.结果:ESBLs总阳性率为27.1%,以重症监护病房为最高.产ESBLs菌对头孢他啶、头孢噻肟、头孢曲松的耐药率高达83.3%～96.2%,对亚胺培南全部敏感.结论:纸片扩散法是一种有效地检测ESBLs的方法,治疗ESBLs细菌所致感染,可应用亚胺培南、头霉素类、含β-内酰胺酶抑制复合物及药敏显示敏感的药物.     

产超广谱β-内酰胺酶肠杆菌科细菌的耐药性分析

目的监测产超广谱β-内酰胺酶肠杆菌科细菌的耐药情况,提高治疗效果,控制感染传播。方法采用K-B药敏纸片法,对肠杆菌的耐药情况进行分析。结果产ESBLs的菌株主要为大肠埃希菌和肺炎克雷伯菌,约占61.23%。结论产ESBLs的肠杆菌引起的感染呈日益增多的趋势,实验室应加强对产β-内酰胺酶细菌的监测与报告,临床医生应合理应用抗生素,控制产ESBLs菌株的流行。     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

Temporal changes in the oxidation state in in vitro blood

The rates at which the paramagnetic compounds deoxyhemoglobin (Hb) and methemoglobin (MHb) form in vivo within an area of hemorrhage are unknown. The present experiment establishes the baseline concentrations and rates of change in paramagnetic hemoglobin concentrations, as well as the pH in normal heparinized and clotted human blood maintained in vitro at 37 degrees C under anaerobic conditions over 30 hours. There was a moderate increase in Hb concentration in normal heparinized blood (average increase was 15.5%, rate = 0.50%/hour) and a slight increase in MHb concentration in the heparinized blood and clots (average increase was 1.4%, rate = 0.044%/hour). A second experiment was done to verify the activity of the RBC systems responsible for maintaining the hemoglobin molecule in the reduced state. Conversion of MHb to Hb in these samples proceeded at a rate of 5.6%/hour. In a third experiment, blood from 11 normal subjects maintained at 4 degrees C 25 degrees C was analyzed for MHb concentration over the course of 28 days. The level of MHb formation remained in the range of normal for at least 11 days in all subjects. The authors conclude that at basal conditions created in vitro, the blood levels of both Hb and MHb remain at relatively low levels. Therefore, if the accumulation of Hb and/or MHb occurs in acute in vivo hematomas it must be driven by intrinsic tissue factors.     

Carcinoma in situ in cryptorchid testes in post-pubertal patients]

The pathohistologic analysis of testis sections of 37 postpuberty patients with different types of cryptorchism is performed. The tissue samples were taken during orchiopehy, fixed in Bouin's solution and treated by the standard histologic techniques. The morphologic criteria are presented for identification of the presence of the so called carcinoma in situ cells found in two cases. Besides, in 13 patients rare, mainly single, atypical germinative cells were found in a smaller number of the seminiferous tubules. It has been concluded that the presence of carcinoma in situ cells in undescended testes of some patients and considering the simple way of sampling, lack of complications and high reliability of the diagnostic procedure, it is absolutely justified to take routine biopsy of testes during orchiopexy in each postpuberty and perhaps prepuberty patient.     

新时期军医学院人才培养的思考

在新的历史条件下 ,军医学院迎接未来高技术局部战争的挑战 ,适应部队武器装备的不断更新以及医学科技、社会发展对人才素质提出的新要求 ,必须在更为广阔的时空背景下找准人才培养的着眼点 ,科学确立人才培养方向 ,提高人才培养质量。现就人才培养思考如下 :1　改变教育观念 ,     

成批煤气爆燃烧伤的救治体会

报道治疗因煤气泄漏爆炸烧伤病员7例，经应用MEBT技术积极救治，其中6例于伤后17天痊愈出院，另一例特重伤员也于伤后30天康复出院。作者认为：应严格按照MEBT／MEBO要求进行规范治疗，正确处理生命体征、休克、感染、脏器功能和创面的辨证关系。同时，不能忽视外科营养在过程中的重要作用，它是创面修复的物质保证。