血培养病原菌耐药性分析及葡萄球菌mecA基因检测

目的:分析中日友好医院血培养中病原菌的构成与耐药情况,明确血液感染的病原菌分布和耐药模式,为合理使用抗菌药物提供参考。方法:应用WHONET 5.3进行耐药率统计;采用微量肉汤稀释法测定最低抑菌浓度;PCR检测葡萄球菌mecA基因。结果:革兰阳性球菌比革兰阴性杆菌分离率高。mecA基因阳性率在金黄色葡萄球菌和凝固酶阴性葡萄球菌中分别为32.3%和95.8%;革兰阴性杆菌中分离率较高的是大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌。超广谱-β内酰胺酶(ESBLs)菌株分别占大肠埃希菌和肺炎克雷伯菌的10.4%和11.2%。结论:血培养苯唑西林耐药葡萄球菌菌株分离比例较高,ESBLs菌株在大肠埃希菌和肺炎克雷伯菌中占一定比例。     

下呼吸道感染病原体流行和耐药现状分析

目的:了解下呼吸道感染病原体的流行情况、主要流行病原体的耐药现状以及一些特殊病原体[如耐甲氧西林的葡萄球菌(MRS)、超广谱β-内酰胺酶(ESBLs)菌株等]的流行和耐药现状,为临床合理应用抗菌药物提供依据。方法:用WHONET5软件统计分析2004年南京医科大学第一附属医院住院患者3863份痰液标本培养及药敏结果。结果:下呼吸道感染病原体中,革兰阴性菌居首位,占所有阳性标本的50%;其次为真菌占33%。所有致病菌中,白色念珠菌位居第一(14%),铜绿假单胞菌位居其次(11%),不动杆菌属(8%)、肺炎克雷伯菌(8%)、热带念珠菌(7%)亦较为常见,耐药菌株比例较高。产ESBLs菌检出率为12%,对三、四代头孢菌素及氟喹诺酮类耐药比例较高。MRS占所有葡萄球菌的65%,以表皮葡萄球菌为主,对大环内酯类、氟喹诺酮类及头孢菌素类呈现高度耐药。结论:目前下呼吸道感染病原体中条件致病菌比例在逐年上升,多药耐药菌比例增加。针对产ESBLs菌株建议选用碳青霉烯类、哌拉西林/他唑巴坦,对MRS推荐用万古霉素,其他药物耐药率均较高。     

泌尿道感染病原菌构成及其耐药性变迁

目的 了解泌尿道感染的病原菌构成及其耐药性变化,为临床合理使用抗菌药物提供依据。方法 收集我院2013年3月至2014年6月清洁中段尿分离的病原菌作细菌药敏及耐药分析,并与2005年3月至2006年6月的资料比较。结果 8年后,大肠埃希菌构成比仍占首位,但有下降趋势(50.2%降至30.3%),肠球菌仍为第2位(14.4%升至18.5%),白色念珠菌上升至第3位(1.1%升至9.8%),肺炎克雷伯菌无明显变化(7.3%～7.8%),金黄色葡萄球菌有下降趋势(8.7%降至1.2%)。大肠埃希菌(41.4%升至64.5%)、肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)(31.3%升至52.9%)上升。产ESBLs的大肠埃希菌和肺炎克雷伯菌对β-内酰类、喹诺酮类和磺胺类药物耐药率高,且对头孢菌素类抗生素的耐药性有上升趋势,并出现亚胺培南耐药菌。肠球菌对青霉素、红霉素、喹诺酮类、氨基糖甙类抗生素耐药率仍维持在较高水平,对呋喃妥因,万古霉素较敏感。结论 尿路感染常见病原仍为大肠埃希菌和肠球菌,真菌感染不容忽视。应重视产ESBLs菌株的检测。常见的病原菌的耐药现象较为严重。应定期分析泌尿道感染病原菌分布及耐药性的变化以指导抗生素的合理应用。     

大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶的检测及耐药性分析

目的探讨大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的发生率及其耐药性。方法对中铁十二局集团中心医院2007年1月至2009年9月从各种临床标本中分离出的315株大肠埃希菌和247株肺炎克雷伯菌,进行ESBLs测定及其药敏试验。根据美国临床实验室标准化研究所(CLSI)文件,产ESBLs细菌的检测采用双纸片确证法,抗生素敏感测定采用K-B琼脂扩散法。结果检出大肠埃希菌ESBLs阳性菌164株,检出率52.06%,检出肺炎克雷伯菌ESBLs阳性菌158株,检出率63.97%。检出的ESBLs阳性菌株对所有青霉素类、头孢菌素类及氨曲南耐药,对氨基糖苷类、喹诺酮类耐药率也在60%以上。结论该院大肠埃希菌和肺炎克雷伯菌产ESBLs发生率较高,且对多种抗生素呈交叉耐药和多重耐药。及时正确报告产ESBLs菌株,对指导临床合理用药、延缓细菌耐药性的产生、抑制耐药菌株的播散具有重要意义。     

尿路感染病原菌分布及耐药性分析

目的:通过对尿路感染病原菌回顾性分析,了解尿路感染的病原菌构成及其对抗菌药物的耐药性,为抗菌药物的合理应用提供依据?方法:回顾性调查2006~2009年本院微生物室的所有清洁中段尿培养的真性菌尿药敏试验结果,药敏试验采用纸片扩散法检测?结果:清洁中段尿和导管尿培养的真性菌尿菌株共3 380株?革兰阴性菌检出率为60.6%,其中大肠埃希菌为最主要的革兰阴性菌,占总菌株的44.8%;革兰阳性菌的检出率为32.0%?革兰阴性菌对左氧氟沙星?头孢唑啉?头孢呋肟耐药严重?产超广谱β-内酰胺酶(ESBLs)菌占总致病菌的16.5%,对头孢菌素类及氟喹诺酮类高度耐药,对碳青霉烯类?哌拉西林/他唑巴坦及阿米卡星耐药率低?耐甲氧西林葡萄球菌(MRS)占所有葡萄球菌的41.3%,其对大环内酯类?头孢菌素类及氟喹诺酮类呈现高度耐药?结论:尿路感染病原体仍以大肠埃希菌最常见,耐药现象较为严重,应及时检测病原菌及耐药情况,指导抗菌药物的合理应用?     

肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶菌株的临床特点及感染的危险因素

目的探讨2012—2014年肺炎克雷伯菌（KPN）和大肠埃希菌（ECO）产超广谱β-内酰胺酶（ESBLs）菌株的临床分布、耐药性及危险因素,为临床合理使用抗生素及医院感染防控提供依据。方法采用双纸片协同试验确认产ESBLs菌株,法国生物梅里埃ATB细菌鉴定仪对临床分离的病原菌进行菌种鉴定及药敏试验。采用多因素logistic回归分析评估产ESBLs耐药菌感染的独立危险因素。结果2012、2013、2014年肺炎克雷伯菌检出率分别为13.7%、19.3%、21.4%;大肠埃希菌检出率为34.5%、41.2%、49.6%,呈逐年上升的趋势,且大肠埃希菌产ESBLs的检出率明显高于肺炎克雷伯菌（均P＜0.05）;产ESBLs肺炎克雷伯菌主要从痰液中检出,产ESBLs大肠埃希菌主要从尿液中检出;产ESBLs菌株对常用抗菌药物的耐药率普遍高于非产ESBLs菌株（均P＜0.05）。产ESBLs菌株对青霉素类耐药率为92.5%~100.0%、对除头孢西丁外的头孢菌素类、喹诺酮类、磺胺类的耐药性超过50%,产ESBLs肺炎克雷伯菌和大肠埃希菌菌株对阿米卡星的耐药率分别为6.3%、5.2%,对哌拉西林/他唑巴坦的耐药率分别为15.6%、13.3%,对亚胺培南和美罗培南的耐药率最低;影响产ESBLs菌株感染的因素为：年龄≥55岁（OR=3.02,P=0.012）、住院≥15d（OR=3.76,P=0.008）、侵入性置管（OR=6.30,P=0.001）、使用糖皮质激素（OR=4.23,P=0.003）、使用喹诺酮类药物（OR=4.62,P=0.002）、使用第三代头孢菌素（OR=4.51,P=0.004）。结论产ESBLs肺炎克雷伯菌和大肠埃希菌耐药现象严重,呈多重耐药,临床上应加强监测产ESBLs菌株的耐药情况,减少产ESBLs菌株的危险因素,科学合理应用抗菌药物,延缓细菌耐药性的变迁。     

肺炎克雷伯菌和大肠埃希菌超广谱β-内酰胺酶的检测

目的　了解肺炎克雷伯菌和大肠埃希菌超广谱 β -内酰胺酶 (ESBLs)的产生情况及耐药特点 ,以指导临床用药。方法　用双纸片协同试验法对 171株肺炎克雷伯菌和大肠埃希菌进行ESBLs检测 ,并用K -B法进行 10种常用抗生素的耐药性研究。结果　ESBLs阳性率为 33.3% ,其中肺炎克雷伯菌 4 0 % ,大肠埃希菌 31.3%。产ESBLs菌对头孢菌素类的耐药率高达 81.2 % - 10 0 % ,与不产ESBLs菌相比有显著性意义 (P <0 .0 1)。对氨基糖甙类、喹诺酮类及磺胺类有不同程度的耐药 ,所有试验菌株对亚胺培南均敏感。肺炎克雷伯菌对环丙沙星的耐药率较低 ,且产ESBLs菌 (37.5 % )与不产ESBLs菌 (12 .5 % )比较无显著性意义 (P >0 .0 5 )。大肠埃希菌对阿米卡星的耐药率较肺炎克雷伯菌低。结论　治疗ESBLs菌引起的感染可用亚胺培南、β -内酰胺抑制剂、复合抗生素及其它敏感的抗生素     

新生儿病房常见病原菌及耐药性分析

目的 了解新生儿病房常见病原菌的种类及其耐药情况,为合理使用抗生素提供依据.方法 对该院新生儿病房2004年1月至2005年12月各类标本培养分离、鉴定出的前7种病原微生物进行病原学分析.结果 677株病原菌中革兰阳性球菌198株,其中凝固酶阴性葡萄球菌140株,是新生儿菌血症或败血症的主要病原菌;革兰阴性杆菌479株,以肺炎克雷伯菌居多,大肠埃希菌次之.凝固酶阴性葡萄球菌对青霉素、苯唑西林及红霉素、头孢他啶等具有较高耐药性,MRS发生率为57.6%,对万古霉素、丁胺卡那霉素等敏感性较高;革兰阴性杆菌对亚胺培南、丁胺卡那、环丙沙星、庆大霉素、头孢哌酮/舒巴坦具有很高的敏感性,而氨苄西林、头孢他啶、头孢曲松、头孢噻肟、阿莫西林/克拉维酸等耐药率较高.肺炎克雷伯菌和大肠埃希菌ESBLs的产生率分别为31.9%和23.5%,产ESBLs的肺炎克雷伯菌、大肠埃希菌仅对碳青霉烯类、氨基糖甙类以及喹诺酮类少数抗菌药物敏感,而对第三代头孢菌素耐药率很高.结论 凝固酶阴性葡萄球菌、肺炎克雷伯菌及大肠埃希菌等是新生儿病房中检出率最高的几种病原菌,其耐药形势不容乐观,多重耐药相当严重,合理使用抗生素是有效抗感染和遏止耐药性蔓延的重要手段.     

新生儿吸入性肺炎102例的病原菌分布及耐药性分析

目的 探讨新生儿吸入性肺炎病原菌分布及耐药性.方法 用常规方法对我院儿科新生儿病房培养获得的102株呼吸道病原菌进行鉴定和药敏试验.结果 G 菌36株(占35.3%),其中以金黄色葡萄球菌(15株)、表皮葡萄球菌(13株)和溶血葡萄球菌(5株)为主;G-菌59株(占57.8%),其中以大肠埃希氏菌(27株)、肺炎克雷伯氏菌(21株)和鲍曼不动杆菌(7株)为主;真菌7株(占6.9%).耐甲氧西林金黄葡萄球菌(MRSA)3株,占金黄色葡萄球菌的20%.产超广谱β-内酰胺酶(ESBLs)的大肠埃希氏菌占40.7%,产ESBLs菌株肺炎克雷伯菌占42.9%.结论 及时检测病原菌,并对耐甲氧西林的金黄色葡萄球菌株和ESBLs菌株进行监测,有利于临床医师合理使用抗生素,减少耐药菌株产生,缩短病程.     

Analysis of Antibiotic Resistance to Change of Extended Spectrum β-lactamases Producing Escherichia Coli Isolates Nearly 6 Years

目的 了解我院自2005年以来,近6年产超广谱β内酰胺酶大肠埃希菌的耐药变化情况,从而为临床合理使用抗生素提供指导.方法 对2005~2010年,6年间临床分离的大肠埃希菌共计619株菌进行药敏分析,采用K-B法进行药敏试验,ESBLs筛选试验及确认试验按照美国CLSI相关标准进行,结果用WHONET 5.4软件进行数据统计分析.结果 6年来,大肠埃希菌产ESBLs阳性率从45.5%上升至68.4%.6年分离的大肠埃希菌合计产ESBLs率为56.1%.产ESBLs株对头孢菌素类、氟喹诺酮类等常用抗生素药物的耐药率明显高于非产ESBLs株,对碳青霉烯类抗菌药物敏感,氨基糖苷类抗生素在所有大肠埃希菌中耐药率呈增长趋势.结论 6年来,大肠埃希菌中ESBLs阳性率逐年升高,并呈现出多重耐药性,对产ESBLs菌株的治疗应首选碳青霉烯类抗生素药物.虽然这次监测没有发现耐碳青霉烯类的菌株,但是也应引起重视.氨基糖苷类抗生素在所有大肠埃希菌中耐药率呈增长趋势,这需要我们进一步研究是否有新的耐药机制存在.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.