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x^2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。     

肺结核伴肺炎克雷伯菌感染患者情况和耐药分析

目的了解本院肺结核患者肺炎克雷伯菌的感染情况和耐药性。方法收集经临床确诊为肺结核伴有肺炎克雷伯菌感染患者中分离出肺炎克雷伯菌的药敏数据,并对其耐药情况进行回顾性分析。结果 587株肺炎克雷伯菌检出241株产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌,检出率为41.1%,这三年的ESBLs肺炎克雷伯菌的检出率是逐年增高的,依次为36.9%,43.1%,43.3%。检出人群中以≤20岁和≥60岁年龄段所占的比例最高,产ESBLs肺炎克雷伯菌耐药性要高于非产ESBLs肺炎克雷伯菌,对头孢一代、二代、三代耐药,但对亚胺培南、美罗培南、头孢哌酮/舒巴坦保持高度敏感。结论应加强肺炎克雷伯菌耐药监测,以指导合理用药减少耐药菌的发生和医院感染。     

肺炎克雷伯菌产超广谱β-内酰胺酶检测及耐药性分析

目的探讨产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌感染的分布状况及耐药特点。方法对我院临床标本分离出的肺炎克雷伯菌用美国临床实验室标准化委员会(NCCLS)推荐的表型确证法检测ESBLs,K-B纸片琼脂扩散法进行药敏试验。结果肺炎克雷伯菌产ESBLs的检出率为34.4%,其主要以呼吸道感染为主。产ESBLs菌株对亚胺培南耐药率为0。产ESBLs菌株对抗生素的耐药率明显高于非产ESBLs菌株。结论产ESBLs菌对常用抗生素的耐药率明显高于非产ESBLs菌株,碳青霉烯类抗生素亚胺培南是治疗产ESBLs菌株感染的理想药物。     

生物被膜大肠杆菌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.     

产超广谱-β内酰胺酶肺炎克雷伯菌耐药性分析

目的了解产超广谱-β内酰胺酶(ESBLS)的肺炎克雷伯菌耐药性。方法对鉴定为产ESBLS肺炎克雷伯菌的耐药性进行分析。结果共分离出304株肺炎克雷伯菌其中产ESBLS阳性率为38.5%。药敏显示产ESBLS肺炎克雷伯菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/三唑巴坦耐药率较低分别为0.0%、18.7%、22.6%,其余呈不同程度耐药。结论产ES-BLS肺炎克雷伯菌耐药现象严重,应根据药敏结果结合临床感染情况合理使用抗菌药物,控制耐药率的增长。     

肺结核患者合并肺炎克雷伯菌感染的耐药监测分析

目的分析肺结核合并肺炎克雷伯菌感染患者的耐药性。方法对2009-2011年从我院临床确诊的肺结核患者痰培养标本中分离的317株肺炎克雷伯菌药敏试验结果进行分析。结果从317株肺炎克雷伯菌中检出产超广谱β-内酰胺酶肺炎克雷伯菌101株,检出率31.7%,产ESBLs菌株对大部分抗生素耐药,对亚胺培南、头孢哌酮/舒巴坦100%敏感。结论我院肺结核合并肺炎克雷伯菌感染患者产ESBL s株多种抗菌药物耐药,及时监测、合理选用抗菌药物对临床抗感染治疗有重要意义。     

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。     

443株肺炎克雷伯菌的耐药性分析

目的了解肺炎克雷伯菌对抗生素的耐药情况,为临床合理使用抗生素提供依据。方法对临床各种标本中分离得到的443株肺炎克雷伯氏菌进行药敏试验分析。结果从4 845份送检标本中共分离得到肺炎克雷伯菌443株(9.14%),主要来源于呼吸道标本。肺炎克雷伯菌耐药率最高的抗生素为氨苄西林(94.6%);对氨基糖苷类的阿米卡星耐药率较低,为14.67%;对庆大霉素耐药率为68.79%;对碳青霉烯类抗生素(亚胺培南,美洛培南)全部敏感。在443株肺炎克雷伯菌中,117株为超广谱β-内酰胺酶(ESBLs)阳性,阳性率为26.41%。结论肺炎克雷伯菌是产ESBLs条件致病菌之一,临床应加强对肺炎克雷伯菌耐药性的监测,预防耐药菌株的传播流行。     

广州地区脑血管病病人感染产超广谱β-内酰胺酶菌耐药性调查

目的了解广州地区脑血管病病人感染产超广谱β-内酰胺酶革兰阴性杆菌情况及对18种抗生素耐药性进行调查分析.方法对广州12家医院分离的3 499株革兰阴性杆菌,其中包括分离自神经内科、神经外科脑血管病病人389株,检测其超广谱β-内酰胺酶,并以K-B法检测所有菌对18种抗生素的敏感性.结果广州地区常见革兰阴性杆菌产超广谱β-内酰胺酶总体检出率38.4%(819/2134);神经科脑血管病病人超广谱β-内酰胺酶检出率5 5.5%(121/218);其中大肠埃希菌、肺炎克雷伯菌的检出率分别是53.1%、57.5%.结论广州地区脑血管病病人大肠埃希菌、肺炎克雷伯菌超广谱β-内酰胺酶检出率与总体检出率比较有统计学意义(P＜0.01),18种抗生素的耐药率所有产酶株与非产酶株比较有统计学意义.     

小儿肺炎产超广谱β-内酰胺酶细菌耐药性分析

目的了解肺炎患儿产超广谱β-内酰胺酶(ESBLs)病原菌感染情况和耐药特征,指导临床合理用药。方法对2007年1月～2010年12月住院治疗的肺炎患儿吸取下呼吸道痰液,做细菌培养,对产ESBLs肺炎克雷伯菌和大肠埃希菌进行药敏分析。结果共培养岀406株革兰阴性菌,检岀产ESBLs菌126株。肺炎克雷伯菌163株,ESBLs(+)58株,占35.6%;大肠埃希菌139株,ESBLs(+)56株,占40.3%;其他菌104株,ESBLs(+)12株,占4.5%。2007年～2010年革兰阴性菌产ESBLs菌株检岀率分别为29.3%、31.6%、30.7%和31.9%,差异无统计学意义(P>0.05)。<1岁患儿产ESBLs菌检出率为39.1%,1～3岁组为23.8%,>3岁组为20.8%,差异有统计学意义(P<0.05)。产ESBLs肺炎克雷伯菌和大肠埃希菌对大多数β-内酰胺类抗生素如青霉素类、头孢菌素类、氨曲南基本耐药,对头孢吡肟、氨基糖苷类中度敏感,对亚胺培南、哌拉西林/他唑巴坦、左氧氟沙星敏感。结论肺炎克雷伯菌和大肠埃希菌是产超广谱β-内酰胺酶(ESBLs)主要菌株,对大多数抗生素耐药明显。     

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。     

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.     

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.