亚胺培南与美罗培南治疗血液肿瘤中性粒细胞缺乏伴发热对照研究

目的 评价两种碳青酶烯类抗生素亚胺培南与美罗培南治疗血液肿瘤患者中性粒细胞缺乏伴发热的疗效和安全性.方法 对2006年1月至2007年12月广州军区广州总医院血液科83例中性粒细胞缺乏伴发热患者,采用单盲、随机、对照方法分别接受亚胺培南和美罗培南治疗,亚胺培南组42例,美罗培南组41例,观察两组患者化疗后中性粒细胞缺乏伴发热的临床表现、退热时间、细菌学培养结果及不良反应;临床分离菌株分别进行亚胺培南、美罗培南的体外药敏试验.结果 经咽拭子、血、尿培养共获得102株病原茵,治疗后亚胺培南组病原菌清除率为87.27%,美罗培南组为85.11%,P＞0.05;两组临床总有效率分别为78.57%和70.03%,P＞0.05;但亚胺培南组体温由(39.1±0.73) ℃降至(37.1±0.52)℃时间为(1.8±0.6)d;而美罗培南由(38.7±0.96) ℃降至(37.3±0.65) ℃的时间为(3.3±0.9)d.二者差异具有统计学意义(P=0.002),亚胺培南组平均疗程亦较美罗培南组短[(6.1±2.0)d对(7.5±1.7)d,P=0.038)],两种药物使用中不良反应发生均较少而轻(11.90%对9.75%.P＞0.05).结论 亚胺培南与美罗培南治疗血液肿瘤患者中性粒细胞缺乏伴发热有效、安全;二者抗菌谱及临床疗效相近,亚胺培南在退热时间及平均疗程上优于美罗培南.     

亚胺培南与头孢哌酮舒巴坦治疗肝硬化自发性腹膜炎的疗效比较

目的比较亚胺培南与头孢哌酮舒巴坦治疗肝硬化自发性腹膜炎的临床疗效。方法 70例肝硬化自发性腹膜炎患者分成亚胺培南组(A组,35例)和头孢哌酮舒巴坦组(B组,35例),A组采用腹腔穿刺引流及亚胺培南治疗,B组采用腹腔穿刺引流及头孢哌酮舒巴坦治疗,两组疗程均为10 d。治疗结束后观察两组疗效及临床症状变化情况。结果 A组治疗总有效率(82.9%)明显优于B组(68.6%)(P<0.05);A组发热、腹胀、腹痛、腹部压痛和反跳痛等临床症状缓解时间明显早于B组(P<0.05)。结论亚胺培南治疗肝硬化自发性腹膜炎疗效显著,不良反应少,可明显缓解临床症状,值得临床推广应用。     

美罗培南在急性白血病并发感染中的应用

目的:评价美罗培南治疗急性白血病并发感染时的临床疗效及安全性。方法:采用随机对照试验方法,选用亚胺培南/西司他丁为对照药,其中美罗培南组与亚胺培南/西司他丁组分别为42例。结果:美罗培南组临床痊愈率为66.7%,有效率为85.7%,细菌清除率为81.3%;亚胺培南/西司他丁组相应为64.3%,83.3%,73.3%。统计学处理2组差异无统计学意义。本组美罗培南治疗的不良反应为9.5%(4/184)。结论:应用美罗培南治疗急性白血病并发感染的患者,具有疗效快、作用显著之特点,美罗培南在药效和不良反应方面与亚胺培南/西司他丁相似,治疗急性白血病并发感染效果明显且较安全。     

美罗培南治疗急性细菌性感染临床观察

目的：评价美罗培南治疗细菌性感染的安全性及有效性。方法：采用随机对照试验方法。试验组美罗培南500mg-1g,静脉点滴,每12h1次,对照组亚胺培南－西司他丁500mg/500mg-1g/1g,每12h1次,静脉点滴。疗效均为7－14d。结果：美罗培南组及亚胺培南－西司他丁组分别有42例及41例可评价疗效。两组有效率分别为88．1％（37／42）及85．4％（35／41）。对各种致病菌感染有效率分别为85．3％（29／34）和82．4％（28／34）。两组治疗前分离株分别为37株及38株。治疗后细菌清除率分别为81．1％（30／37）和84．2％（32／38）。两组安全性评价分别为44例及41例,不良反应发生率分别为13．6％（6／44）与12．2％（5／41）。两组经统计学处理差异无显著性（P＞0．05）。结论：美罗培南治疗急性细菌性感染疗效好,较安全。     

亚胺培南联合白介素2腹腔注射治疗肝硬化自发性细菌性腹膜炎疗效观察

目的:观察亚胺培南联合白介素2腹腔注射治疗肝硬化自发性细菌性腹膜炎的疗效。方法:本院2014年1月-2015年1月收治的40例乙型肝炎肝硬化并自发性细菌性腹膜炎患者为研究对象,按照随机数字表法将其分为治疗组和对照组,每组20例。在内科抗感染治疗的基础上,对照组患者单纯采取亚胺培南腹腔注射治疗,治疗组患者采取亚胺培南联合白介素2腹腔注射治疗,观察比较两组患者的临床治疗效果及并发症发生情况。结果:治疗1周后,治疗组的总有效率为95%(19/20)明显高于对照组的70%(14/20);肺部感染、肝肾综合征、肝性脑病、消化道出血等并发症总发生率15%(3/20)明显低于对照组35%(7/20),差异均有统计学意义(P0.05)。结论:亚胺培南联合白介素2治疗肝硬化自发性细菌性腹膜炎疗效显著,能降低并发症发生率。     

美罗培南治疗老年重症院内获得性肺炎的疗效分析

目的探讨美罗培南在治疗老年重症院内获得性肺炎中的疗效。方法随机选取我科老年重症肺炎患者189例,其中73例作为病例组采用美罗培南静脉注射治疗,美罗培南治疗方法和剂量为静脉滴注500 mg/次,每日3次;而116例设为对照组,使用亚胺培南-西司他丁静脉滴注500 mg/次,每日4次。疗程均为7~10 d。分析两组的临床疗效、细菌清除情况、不良反应。结果治疗组总有效率82.19%,细菌清除率87.93%,不良反应发生率5.48%;对照组总有效率为62.93%,细菌清除率68.35%,不良反应发生率6.03%。美罗培南组总有效率、细菌清除率均高于对照组,差异均有统计学意义(P0.05)。结论美罗培南更适用于老年重症院内获得性肺炎、老年重症感染、和或伴有中枢神经精神症状者的患者。     

杭州市区铜绿假单胞菌对亚胺培南与美罗培南耐药模式的研究

目的了解杭州市区铜绿假单胞菌对亚胺培南与美罗培南不同耐药模式菌株对临床常用其他抗菌药物的耐药情况。方法选取2006年8月至2007年1月杭州市4家医院分离的铜绿假单胞菌378株,对不同城区分离的铜绿假单胞菌进行药物敏感性检测,对亚胺培南与美罗培南不同的耐模式菌株进行分类统计,同时观察其对其他抗菌药物的耐药率。结果在378株细菌中观察到亚胺培南与美罗培南的8种耐药模式,分别为S/S,66.1%(250/378);R/R,20.6%(78/378);S/R,5.0%(19/378);R/S,3.4%(13/378);I/R,1.9%(7/378);R/I,1.3%(5/378);I/S,1.1%(4/378);S/I,0.5%(2/378)(S为敏感,I为中介,R为耐药)。对其他8种抗菌药物的敏感性检测结果显示,S/S与S/I及I/S模式耐药性最低,均低于10%,R/R最高,均高于44%。R/S与S/R模式对不同的抗菌药物耐药率有较大不同。结论杭州市区流行的菌株以S/S,R/R,S/R,R/S 4种模式为主,占所有模式中的95%以上,其中又以S/S模式最为多见,不同模式菌株对其他抗菌药物的耐药性有较大差异,临床可通过不同的耐药模式进行耐药机制推断,合理选用抗菌药物治疗。     

预防性应用美罗培南控制自体外周血造血干细胞移植患者早期感染的疗效

目的探讨预防性应用美罗培南对于自体外周血造血干细胞移植早期感染控制的疗效。方法选择既往常规化疗有明显细菌感染但移植前感染已经治愈患者36例,随机分为美罗培南组和常规对照组各18例,两组均在移植前1周起开始常规使用复方新诺明、诺氟沙星及氟康唑口服预防感染。当患者外周血WBC〈0.5×109/L时,美罗培南组即用美罗培南1.0 g静滴1次/8 h或0.5 g静滴1次/6 h。观察两组造血干细胞移植早期感染发生率、感染发生时间和感染持续时间。结果美罗培南组感染发生率明显低于常规对照组,首次感染发生时间较常规对照组明显推迟,感染持续时间较常规对照组明显缩短,两组比较差异均有统计学意义（P均〈0.05）。结论短期预防性使用美罗培南对于控制造血干细胞移植早期感染有良好效果。     

美罗培南联合孟鲁司特钠治疗细菌性支气管炎的疗效

目的:分析美罗培南联合孟鲁司特钠治疗细菌性支气管炎的疗效.方法:对我院收治的102例细菌性支气管炎患者进行研究,就诊时间为2019年10月至2021年1月,采用抛硬币方式进行分组,两组病例数一致.两组患者均接受了孟鲁司特钠治疗,研究组患者加用美罗培南治疗.对比两组患者治疗前后CRP、WBC、FEV1/FVC指标水平.结...     

比阿培南治疗急性继发性化脓性腹膜炎34例效果观察

目的观察比阿培南治疗急性继发性化脓性腹膜炎的疗效和安全性。方法将64例急性继发性化脓性腹膜炎患者随机分为观察组34例和对照组30例,分别予比阿培南和亚胺培南治疗7～10 d。观察两组临床表现变化、细菌学培养情况、退热时间、疗程及不良反应发生情况。结果观察组和对照组总有效率分别为80.0%、76.7%,病原菌清除率分别为82.0、82.8%（P均〉0.05）,退热时间分别为（2.0±0.8）、（3.2±0.5）d（P〈0.01）,疗程分别为（7.4±2.2）、（8.7±1.6）d（P〈0.05）;观察组和对照组均未见明显肝肾功能异常,不良反应发生率分别为5.9%、6.7%（P〉0.05）,但分别以消化系统症状和神经系统症状为主。结论比阿培南治疗急性继发性化脓性腹膜炎临床疗效确切,且神经系统不良反应发生率低。     

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.