大环内酯类药物与环丙沙星,头孢他啶联合用药对铜绿假单胞菌生物膜价值

目的观察大环内酯类药物与环丙沙星,头孢他啶对铜绿假单胞菌生物膜的影响。方法平板培养法制备细菌生物被膜,银染法初步鉴定生物膜、番红精染色测定生物膜的粘附性,分别在生物膜形成不同时间单独或联合加入不同浓度大环内酯类药物、环丙沙星、头孢他啶,菌落计数法计数加药后生物膜内细菌数量,并与不加药物所形成的生物膜做比较。结果1/16MIC的红霉素、阿齐霉素单独或与3MIC环丙沙星,头孢他啶联合作用后可减少细菌的粘附和被膜存活菌数(P<0·05、P<0·01)。48h生物膜较24h生物膜耐药性更强。结论红霉素、阿齐霉素减少细菌的粘附、预防或抑制细菌生物被膜的形成;与环丙沙星,头孢他啶联合用药能增强其杀菌作用。成熟的生物膜更具有耐药性。     

阿奇霉素和克拉霉素对铜绿假单胞菌生物膜形成的作用

目的研究阿奇霉素和克拉霉素对铜绿假单胞菌生物膜形成的作用。方法微量肉汤稀释法测定阿奇霉素、克拉霉素、头孢他啶、环丙沙星和庆大霉素对4株铜绿假单胞菌的最低抑菌浓度(MIC);银染法鉴定使用医用微孔滤膜建立的铜绿假单胞菌生物膜体外模型的生物膜形成情况;结晶紫染色法检测阿奇霉素和克拉霉素对生物膜粘附性的影响;噻唑蓝法检测阿奇霉素和克拉霉素分别与头孢他啶、环丙沙星或庆大霉素的协同作用。结果铜绿假单胞菌ATCC 27853、PA1、PA2和PA3对阿奇霉素、克拉霉素、头孢他啶、环丙沙星和庆大霉素的MIC值分别为(32,64,1,≤0.125,0.25μg/m L)、(32,256,8,0.25,1μg/m L)、(64,128,256,32,2μg/m L)和(64,128,8,2,0.25μg/m L);银染法发现4株铜绿假单胞菌的培养微孔滤膜表面覆盖物均为灰黑色,浓厚致密,呈棉絮状膜样;与不加抗菌药物对照组相比,加入1/16 MIC或1/4 MIC的阿奇霉素以及1/16 MIC或1/4 MIC的克拉霉素均可显著降低4株菌生物膜的粘附性(P均0.05);与单独使用1 MIC头孢他啶、环丙沙星和庆大霉素相比,各抗菌药物联合1/16 MIC的阿奇霉素或1/16 MIC的克拉霉素均可分别降低以上4株菌生物膜中的活菌数量,差异有统计学意义(P均0.01)。结论阿奇霉素和克拉霉素可有效抑制铜绿假单胞菌生物膜的形成,并与头孢他啶、环丙沙星或庆大霉素联合应用有协同作用。     

钙离子对铜绿假单胞菌生物膜形成的影响

目的了解钙离子对铜绿假单胞菌生物膜形成过程的影响和冰乙酸对形成的生物膜清除效果。方法在铜绿假单胞菌的液体培养基中加入不同浓度的钙离子、EDTA,定量检测铜绿假单胞菌的菌落数,形成生物膜后再滴加冰乙酸。结果随着钙离子浓度的增加,铜绿假单胞菌的菌落数也随之增加,形成的絮状生物膜也越大;加入冰乙酸后,颗粒形絮状生物膜分散崩解。结论钙离子可以促进铜绿假单胞菌生物膜的形成;冰乙酸对铜绿假单胞菌形成的生物膜有明显的清除作用。     

不同清洗剂对软式内镜铜绿假单胞菌生物膜去除效果的研究

摘要 目的 研究不同医用清洗剂对人工模拟铜绿假单胞菌生物膜的去除效果,为建立软式内镜生物膜清除方法提供参考。方法 采用人工生物膜和细菌定量检测方法,对不同清洗剂清除生物膜效果进行观察。结果 连续培养6 d的铜绿假单胞菌生物膜黏附稳定性最好,膜中细菌浓度可达107 cfu/cm2。采取蠕动泵清洗法,使用水洗、普通清洗剂、单酶清洗剂和多酶清洗剂进行清洗,对铜绿假单胞菌生物膜清除对数值依次为0.91、1.30、1.32和1.41。采用软式内镜手工清洗槽自动灌流泵清洗法,上述4种清洗介质清除生物膜中细菌对数值依次为0.89、1.99、2.25和2.99。结论 铜绿假单胞菌在聚四氟乙烯管管腔模拟培养6 d可形成成熟的生物膜,对生物膜的清除效果最好者为多酶清洗剂。     

体外诱导铜绿假单胞菌对环丙沙星及亚胺培南交叉耐药

目的 :研究环丙沙星及亚胺培南体外对铜绿假单胞菌的耐药诱导作用及铜绿假单胞菌对环丙沙星及亚胺培南交叉耐药机制。方法 :用含药琼脂平板法 ,以临床分离的对环丙沙星及亚胺培南敏感铜绿假单胞菌PA5筛选交叉耐药菌 ,计算耐药突变频率及交叉耐药率。应用聚合酶链反应单链构象多态性分析 (PCR SSCP)、膜蛋白电泳及细菌对药物摄取分析 ,对体外诱导交叉耐药菌进行耐药机制研究。结果 :环丙沙星在 1×MIC、2×MIC浓度时诱导耐药突变频率分别为 170× 10 -9及 2 6 0× 10 -9,交叉耐药率 9.2 % ;亚胺培南在 1×MIC及 2×MIC浓度时诱导耐药突变频率分别为 40× 10 -9及 2 0 0× 10 -9,交叉耐药率 2 0 .8%。 9株体外诱导交叉耐药菌旋转酶 gyrA基因PCR SSCP检测分析发现 ,与敏感菌PA5比较 ,仅 1株环丙沙星诱导交叉耐药菌的DNA条带相对位置发生改变 ;4株交叉耐药菌相对分子质量为 430 0 0～ 6 70 0 0的外膜蛋白带消失 ;细菌对环丙沙星摄取分析表明 ,9株交叉耐药菌胞内的药物浓度仅为PA5的 1/ 2～ 1/ 3,加入氰氯苯腙 (CCCP)后 ,胞内药物浓度上升至PA5水平。结论 :环丙沙星与亚胺培南在体外均可诱导铜绿假单胞菌交叉耐药菌 ;其机制以药物主动外排为主 ,外膜蛋白通透性改变对部分耐药菌亦有一定的作用     

甜菜碱对铜绿假单胞菌生物膜形成与分散及耐药性的影响

目的探讨甜菜碱对铜绿假单胞菌生物膜形成抑制及分散的作用,及其生物膜的形成与抑制对铜绿假单胞菌耐药性的影响。方法收集20株临床铜绿假单胞菌,采用结晶紫染色法进行生物膜形成能力试验及甜菜碱对铜绿假单胞菌的生物膜抑制与分散试验,并比较铜绿假单胞菌在生物膜形成与抑制情况下对环丙沙星的最低抑菌浓度(MIC)变化。结果 20株铜绿假单胞菌均形成生物膜,24 h时即可形成成熟生物膜,吸光度(A_(590 nm))为1.90±0.66。与对照组比较,甜菜碱作用24 h则可明显抑制铜绿假单胞菌生物膜形成(t=4.36,P0.01),48 h可达最大抑制作用,_(590 nm)为1.12±0.60;甜菜碱对铜绿假单胞菌的成熟生物膜分散作用24 h即可达最大分散作用。环丙沙星对20株铜绿假单胞菌MIC范围0.03~4μg/mL,MIC_(50)为0.25μg/mL,MIC_(90)为2μg/mL,甜菜碱抑制生物膜后环丙沙星MIC无变化。形成成熟生物膜后环丙沙星MIC均大于16μg/mL。结论甜菜碱可有效抑制铜绿假单胞菌生物膜的形成并能分散成熟生物膜,为临床感染的治疗带来更多选择。环丙沙星在有甜菜碱参与抑制时,对产膜细菌杀菌效果无变化。     

大环内酯类联合左氧氟在治疗结核病人引起的粘液型铜绿假单胞菌感染的临床研究

目的：探讨大环内酯类药物阿奇霉素联合左氧氟沙星治疗粘液性铜绿假单胞菌感染的结核病人。方法：对2012年-2013年间我院肺结核住院患者的痰标本。分离出的粘液性铜绿假单胞菌，做细菌分离鉴定与药敏实验。并进行统计学分析。结果：联合用药前后发生了显著变化。采用χ2检验，以P〈0.05为差异有统计学意义。结论：大环内酯类药物阿奇霉素与氟喹诺酮类药物联合应用比单独使用左氧氟沙星的效果好，与研究相同。     

亚抑菌浓度阿奇霉素与妥布霉素联合应用对铜绿假单胞菌疗效的分析

目的探讨阿奇霉素(AZM)与妥布霉素(TOB)联合应用对铜绿假单胞菌浮游菌和生物膜的抑制作用。方法采用棋盘稀释法检测AZM与TOB联合应用对铜绿假单胞菌标准菌株PAO1及2株临床分离株PA0121和PA1324浮游菌的抗菌活性;通过96孔板构建生物膜结合结晶紫染色法检测2种抗菌药物联合应用对铜绿假单胞菌生物膜形成的抑制作用。结果 AZM与TOB联合应用对3株铜绿假单胞菌浮游菌的抑菌指数(FIC)均为2.0,联合应用效果表现为无关作用。1μg/mL AZM能明显促进0.25、0.5及1μg/mL TOB抑制PAO1生物膜的作用(P0.05),且当AZM浓度升高到2μg/mL时,其协同作用更明显。亚抑菌浓度的AZM也能促进TOB抑制临床分离株PA0121和PA1324生物膜的形成(P0.05)。结论 AZM与TOB联合应用对铜绿假单胞菌浮游菌的抑制效果表现为无关作用,但能协同抑制生物膜的形成。     

人工生物膜的制备及其清洗消毒特性的研究

目的研究人工生物膜的制备方法,建立管腔生物膜生成模型,观察其清洗消毒效果评价技术。方法采用持续灌流培养技术和活菌计数及扫描电镜技术,对人工生物膜及其清洗消毒效果进行了观察。结果经连续培养6d,灌流污染在聚四氟乙烯管内壁的铜绿假单胞菌形成了粘附稳定性较好的生物膜,膜中含细菌浓度达105cfu/cm2,不易被水成片冲脱。扫描镜下观察可见,用水洗生物膜清除量较少,清洗液清洗去除生物膜量较多。用水洗加邻苯二甲醛消毒清除生物膜效果不如用清洗液清洗加邻苯二甲醛的清除效果好。结论铜绿假单胞菌在聚四氟乙烯管腔培养6d可形成生物膜,并且可用于管腔生物膜清洗消毒效果评价;用清洗液清洗可有效去除管壁上生物膜。     

生物膜与铜绿假单胞菌耐药相关性研究进展

侵入性治疗手段的应用使得生物膜感染日益广泛，铜绿假单胞菌黏附在组织器官或生物材料表面形成的生物膜，不仅为该菌提供了庇护所，而且清除十分困难。而铜绿假单胞菌是临床最常见多重耐药菌，生物膜的形成使得铜绿假单胞菌感染的治疗更加困难。现就生物膜形成与铜绿假单胞菌耐药的关系作一综述。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.