华西医院重症监护病房连续两年院内感染革兰阴性杆菌的耐药性监测

目的调查分析我院重症监护病房（ICU）医院感染革兰阴性杆菌的菌群分布和耐药现状及耐药变迁，指导临床合理使用抗生素。方法采用E—test药敏试验测定我院重症监护病房连续两年分离的200株院内感染革兰阴性杆菌对12种抗生素的最低抑菌浓度（MIC）。结果ICU病房分离率最高的院内感染革兰阴性杆菌依次为大肠埃希菌（34％），不动杆菌属细菌（18％）,铜绿假单胞菌（15．5％），克雷伯菌属细菌（15．5％），肠杆菌属细菌（13％）；两年中总耐药率最低的是亚胺培南；呼吸道标本中最常见的为不动杆菌属细菌（23％），铜绿假单胞菌（18．7％），克雷伯菌属细菌（18．7％），大肠埃希菌（17％）；尿标本中主要分离菌为大肠埃希菌（81％）；血液标本中主要分离菌为大肠埃希菌（73％）。呼吸道标本中,2004年铜绿假单胞菌的分离率25％明显高于2003年1．4％；大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶（ESBLs）的发生率从2003年的47％和35．7％升高到2004年的50％和53％。结论亚胺培南对大肠埃希菌和肠杆菌属细菌均保持很高的敏感性，铜绿假单胞菌对头孢他啶和阿米卡星的敏感性最高，不动杆菌属细菌对头孢哌酮／舒巴坦、亚胺培南的敏感性最高,但对亚胺培南的耐药率呈上升趋势。因此，进行本医院、本地区的细菌耐药动态监测对指导临床抗感染经验用药是非常必要的。     

乌梅丸的组方配伍特点与慢性肝病的治疗

通过分析《伤寒论》厥阴病篇的条文，得出厥阴病的病机是寒热夹杂、上热下寒；厥阴病主方是乌梅丸；乌梅丸的组方配伍特点是：辛酸温为主，佐以苦甘，寒温并用，辛开苦降，刚柔共济，有收有发，攻补兼施，体用同调，和水火而顺阴阳。比较慢性肝病与厥阴病的临床表现及病机，二者有相通之处，认为乌梅丸可以用于指导慢性肝病的治疗。     

中药药效/药动学(PK/PD)研究进展

综述了中药药效/药动学(PK/PD)近十几年来的研究进展,包括其研究目的和内容、研究方法等,以及所面临的问题。     

Suppression of lung tumor growth and metastasis in mice by adeno-associated virus-mediated expression of vasostatin.

PURPOSE: Angiogenesis inhibitors have strong therapeutic potential as antitumor agents in suppressing tumor growth and metastatic progression. Vasostatin, the N-terminal domain of calreticulin, is a potent angiogenesis inhibitor. In this study, we determined the effectiveness of vasostatin delivered by recombinant pseudotype adeno-associated virus 2/5 (rAAV2/5-VAS) as a gene therapy approach for lung cancer treatment. EXPERIMENTAL DESIGN: We used rAAV2/5 to deliver vasostatin intratumorally or systemically in different mouse lung tumor models--subcutaneous, orthotopic xenograft, and spontaneous metastasis lung tumor models. The therapeutic efficacy of rAAV2/5-VAS was determined by monitoring tumor volume, survival rate, and degree of neovascularization after treatment in these models. RESULTS: Mice bearing subcutaneous tumor of rAAV2/5-VAS pretreated Lewis lung carcinoma cells showed >50% reduction in primary tumor volume and reduced spontaneous pulmonary metastases. The tumor-suppressive action of rAAV2/5-VAS in subcutaneous human lung tumor A549 xenograft correlated with a reduced number of capillary vessels in tumors. In the orthotopic xenograft model, rAAV2/5-VAS suppressed metastasis of A549 tumors to mediastinal lymph nodes and contralateral lung. Furthermore, treatment of immunocompetent mice in the spontaneous lung metastases model with rAAV2/5-VAS after primary tumor excision prolonged their median survival from 21 to 51.5 days. CONCLUSION: Our results show the effectiveness of rAAV2/5-VAS as an angiogenesis inhibitor in suppressing tumor growth during different stages of tumor progression, validating the application of rAAV2/5-VAS gene therapy in treatment against lung cancer.     

Classification based on the combination of molecular and pathologic predictors is superior to molecular classification on prognosis in colorectal carcinoma.

PURPOSE: Classification based on a combination of molecular and pathologic predictors had never been done using hierarchical cluster analysis. For this purpose, we identified prognostic classification based on molecular predictors, pathologic and molecular predictors, and compared their respective prognostic efficacy together with that of tumor-node-metastasis (TNM) stage. Moreover, we investigated the prognostic significance of molecular classification in different TNM stage. EXPERIMENTAL DESIGN: Six pathologic predictors (p) and 13 immunohistochemical predictors (m) were investigated in 221 colorectal carcinomas. Unsupervised hierarchical clustering analysis was done to group the data. Survival analysis was done by Kaplan-Meier method and log-rank test, and by multivariate COX proportional hazard model. RESULTS: Six pathologic predictors and four molecular predictors were of significant prognostic value (P 相似文献   

Ⅰ期乳腺癌保乳手术并腋窝放疗的临床观察

目的 探讨Ⅰ期乳腺癌保乳手术时不行腋窝淋巴结清扫而术后根治性放疗的疗效.方法 回顾性分析我科136例Ⅰ期乳腺癌临床资料,其中58例行保乳手术,术中不行腋窝淋巴结清扫,术后第1天开始用CMF方案化疗6周期,术后3周开始根治性术后放疗.78例行改良根治术,术后常规放化疗.结果 保乳手术 腋窝放疗组与改良根治术组相比,二者在生存率及局部复发率上差异无统计学意义(P＞0.05),而上肢水肿及功能障碍发生率差异有统计学意义(P＜0.05).结论 Ⅰ期乳腺癌保乳手术并腋窝单纯放疗优于腋窝淋巴结清扫.     

颜面部皮肤肿瘤的切除与整形修复

目的探讨面部肿瘤的手术治疗和相关整形修复问题。方法综合分析2002年1月至2004年12月收治的217例面部皮肤肿瘤患者的临床资料。结果面部良性肿物在年轻人以皮脂腺囊肿多见,老年人则以色素痣和脂溢性角化为主。恶性肿瘤多见于老年人,以基底细胞癌和鳞状细胞癌为主。治疗以直接切除缝合、转移皮瓣和植皮修复,术区外形和功能良好。结论将整形治疗原则应用于面部肿物的治疗,根据患者具体情况制定个体化的治疗方案,可以取得良好的治疗效果。     

Abrogation of MAPK and Akt signaling by AEE788 synergistically potentiates histone deacetylase inhibitor-induced apoptosis through reactive oxygen species generation.

PURPOSE: To evaluate the effects of combining the multiple receptor tyrosine kinase inhibitor AEE788 and histone deacetylase (HDAC) inhibitors on cytotoxicity in a broad spectrum of cancer cell lines, including cisplatin-resistant ovarian adenocarcinoma cells. EXPERIMENTAL DESIGN: Multiple cancer cell lines were treated in vitro using AEE788 and HDAC inhibitors (LBH589, LAQ824, and trichostatin A), either alone or in combination. Effects on cytotoxicity were determined by growth and morphologic assays. Effects of the combination on cell signaling pathways were determined by Western blotting, and the results were confirmed using pathway-specific inhibitors and transfection of constitutively active proteins. RESULTS: Cell treatment with AEE788 and HDAC inhibitors (LBH589, LAQ824, and trichostatin A) in combination resulted in synergistic induction of apoptosis in non-small cell lung cancer (MV522, A549), ovarian cancer (SKOV-3), and leukemia (K562, Jurkat, and ML-1) cells and in OV202hp cisplatin-resistant human ovarian cancer cells. AEE788 alone or in combination with LBH589 inactivated mitogen-activated protein kinase (MAPK) and Akt cascades. Inhibition of either MAPK and/or Akt enhanced LBH589-induced apoptosis. In contrast, constitutively active MAPK or Akt attenuated LBH589 or LBH589 + AEE788-induced apoptosis. Increased apoptosis was correlated with enhanced reactive oxygen species (ROS) generation. The free radical scavenger N-acetyl-l-cysteine not only substantially suppressed the ROS accumulation but also blocked the induction of apoptosis mediated by cotreatment with AEE788 and LBH589. CONCLUSION: Collectively, these results show that MAPK and Akt inactivation along with ROS generation contribute to the synergistic cytotoxicity of the combination of AEE788 and HDAC inhibitors in a variety of human cancer cell types. This combination regimen warrants further preclinical and possible clinical study for a broad spectrum of cancers.     

HPLC法同时测定银黄制剂中的绿原酸和黄芩苷含量

目的:建立同时测定银黄制剂中绿原酸和黄芩苷的 HPLC 方法。方法:色谱柱为 Waters Symmetry C_(18)(3.9 mm×150mm,5μm)柱,以甲醇-0.4%磷酸水溶液为流动相,梯度洗脱(0→15 min,甲醇15%→55%;15→25 min,甲醇55%;25→28min,甲醇55%→15%)。流速为0.8 mL·min~(-1),检测波长为320 nm,0.02 AUFS。结果:绿原酸的线性范围为6.88～110.08μg·mL~(-1)(r=0.9996),平均回收率为97.4%,RSD 为2.2%(n:5);黄芩苷的线性范围为13.40～214.40μg·mL~(-1)(r=0.9998),平均回收率为96.7%,RSD 为2.0%(n=5)。结论:该方法简单、快速、准确,可为银黄制剂的质量控制提供实验依据。     

福建畲族人群15个短串联重复序列的遗传多态性及法医学应用

目的对福建畲族群体15个短串联重复序列等位基因遗传多态性进行分析,探讨其种族特异性及其在法医学个体识别和亲权鉴定的中的应用。方法荧光标记15个短串联重复序列(STR)位点和一个性别位点并进行PCR复合扩增,用ABI遗传分析仪以毛细管电泳技术对100例福建畲族无血缘关系健康个体PCR产物进行电泳分离基因,并以分析软件进行基因分型。结果共检出126个等位基因,基因频率范围在0.0050～0.5550。15个STR基因座的基因型分布均符合Hardy-Weinberg平衡。15个STR位点的HET在0.6300～0.8900之间,DP在0.7680～0.9590之间,EPP在0.3280～0.7750之间,PIC在0.5200～0.8600之间。累积DP和EPP分别达到0.99999999和0.99999288。结论15个STR位点均有较高的遗传多态性,并有丰富的信息含量,适合作为福建畲族地区的遗传标记,可用于个体识别和亲权鉴定。