临床药师会诊1例产后胎盘植入并感染浅析

目的:通过总结分析临床药师在临床会诊的病例,逐渐培养临床药师的临床思维,找到在临床工作中药师的切入点,使之成为临床治疗团队中不可或缺的一员。方法:对临床药师参与会诊1例产后胎盘植入并感染进行回顾性分析。结果:通过会诊,临床药师不但给临床医师提供了合理的药物选择,同时也为患者提供了必要的用药教育。结论:临床药师可以在药物治疗学方面给予临床医师和患者不可或缺的帮助。     

β-glucans as potential immunoadjuvants: A review on the adjuvanticity,structure-activity relationship and receptor recognition properties

β-glucans, a group of polysaccharides exist in many organism species such as mushrooms, yeasts, oats, barley, seaweed, but not mammalians, have a variety of biological activities and applications in drugs and other healthcare products. In recent years, β-glucans have been studied as adjuvants in anti-infection vaccines as well as immunomodulators in anti-cancer immunotherapy. β-glucans can regulate immune responses when administered alone and can connect innate and adaptive immunity to improve immunogenicity of vaccines. When β-glucans act as immunostimulants or adjuvants, a set of receptors have been revealed to recognize β-glucans, including dectin-1, complement receptor 3 (CR3), CD5, lactosylceramide, and so on. Therefore, this review is mainly focused on the application of β-glucans as immune adjuvants, the receptors of β-glucans, as well as their structure and activity relationship which will benefit future research of β-glucans.     

儿童脓毒性休克诊治专家共识--我们需要关注哪些变化

《儿童脓毒性休克（感染性休克）诊治专家共识（2015版）》已发表,是在国际指南的引领下,并结合国内外大量研究文献,在2006年制定的《儿科感染性休克（脓毒性休克）诊断治疗推荐方案》基础上,主要就儿童脓毒性休克定义、诊断和早期集束化治疗方案进行了部分修订。《儿童脓毒性休克（感染性休克）诊治专家共识（2015版）》的制定旨在指导临床一线医师对儿童脓毒性休克早期识别和早期积极干预,并进一步降低病死率和改善预后。     

口腔单纯疱疹的临床表现与治疗分析

目的：观察口腔单纯疱疹在临床中的主要表现，并探讨相应的治疗方法。方法：选取2012年3月～2013年4月期间我院收治的100例口腔单纯疱疹患者作为本组研究的观察对象，将所有患者随机分为观察组与对照组各50例，治疗期间给予观察组患者综合治疗方法，给予对照组患者过氧化氢基础治疗，并分别于治疗第3天、5天、7天进行复诊，综合比较2组患者的治疗情况。结果：所有观察组患者在经过综合治疗后，临床表现均在7天内有所改善或者痊愈，总有效率高达100％；对照组患者中有27例临床表现有所改善或者痊愈，其余23例治疗无效，后期给予综合治疗，总有效率为54％。结论：6岁以下幼儿是口腔单纯疱疹的高发人群，临床表现比较明显，通过给予全身抗感染治疗、外用思密达、雾化吸入α干扰素等疗法手段治疗效果非常理想，值得在临床中推广使用。     

Epidemiological study of community- and hospital-acquired intraabdominal infections

Purpose: To investigate and analyze the clinical and etiological characteristics of community-acquired intraabdominal infections (CIAIs) and hospital-acquired or nosocomial intraabdominal infections (NIAIs) in a comprehensive hospital, to understand the characteristics, pathogen composition, and drug resistance of CIAIs as well as NIAIs, and to provide a reference for clinical treatment. Methods: We collected the clinical data of patients with intraabdominal infections admitted to our hospital from June 2013 to June 2014. In vitro drug sensitivity tests were conducted to separate pathogens, and the data were analyzed using the WHONET 5.4 software and SPSS 13.0 software. Results: A total of 221 patients were enrolled in the study, including 144 with CIAIs (55 mild-moderate and 89 severe) and 77 with NIAIs. We isolated 322 pathogenic strains, including 234 strains of gramnegative bacteria, 82 strains of gram-positive bacteria, and 6 strains of fungi. Based on clinical features, NIAIs and severe CIAIs presented significantly higher values in age, length of hospital stay, mortality, and the incidence of severe intra-abdominal infection than mild-moderate CIAIs (p < 0.05). There was no significant difference in the prognosis between NIAIs and severe CIAIs. Primary diseases leading to CIAIs and NIAIs mostly were hepatobiliary diseases and gastrointestinal diseases respectively. Bacteria isolated from various types of IAIs mainly were Enterobacteriaceae; mild-moderate CIAIs mostly were mono-infection of gram-negative bacteria; NIAIs mostly were mixed infections of gram-negative and gram-positive bacteria; and severe CIAIs were from either type of infection. The rate of Extended Spectrum b-Lactamase-producing Escherichia coli and Klebsiella pneumoniae was much higher in NIAIs than in CIAIs (p < 0.05). The antimicrobial drug sensitivity of gram-negative bacteria isolated from NIAIs was significantly lower than that of CIAIs. Conclusion: CIAIs and NIAIs have their own unique clinical features and epidemiological features of pathogens which should be considered during the initial empiric therapy for the rational use of antimicrobial drugs. Regional IAIs pathogenic bacteria have their own features in drug resistance, slightly different from some recommendations of 2010 Infectious Diseases Society of America guidelines.     

2005-2007年我院抗感染药物应用分析

目的通过对本院2005-2007年抗感染药物使用情况的调查分析,评价本院近三年内抗感染药物的应用状况和用药的合理性。方法回顾性分析本院2005-2007年抗感染药物的年销售金额、用药频度（DDDs）及日用药金额（DDDc）等资料。结果本院2005-2007年药物的年销售金额逐年增加,年销售金额排在第一位的分别是2005年头孢哌酮钠-舒巴坦钠,2006年头孢哌酮钠-舒巴坦钠,2007年头孢替安,其中头孢哌酮钠-舒巴坦钠连续2年都排在第一,排列第二位的分别为：头孢他啶、头孢呋辛钠、头孢米诺;DDDs排名第一的分别是：2005年头孢呋辛钠、2006年头孢呋辛钠、2007年左氧氟沙星。DDDc排名第一的分别是：2005年头孢唑肟钠、2006年头孢吡肟、2007年阿莫西林舒巴坦钠。药物的序号比大部分接近或大于1。结论本院抗菌药物的应用基本合理。     

小鼠白细胞介素17A的原核表达及对RAW264.7细胞分泌炎症因子的影响

目的 在大肠杆菌中高效表达与纯化小鼠白细胞介素17A(mIL-17A),并研究其对巨噬细胞分泌炎症因子的影响.方法 以活化的脾细胞为模板,通过RT-PCR法扩增小鼠IL-17a基因的编码序列,构建重组表达质粒pET28a/mIL-17a,并在大肠杆菌(E.coli)中诱导表达,经亲和层析获得纯化的mIL-17A蛋白.以mIL-17A蛋白刺激体外培养的鼠巨噬细胞RAW264.7,72 h后应用realtime PCR法分析IL-6、巨噬细胞炎症蛋白1(Ccl3)、巨噬细胞炎症蛋白2(Cxcl3)、β防御素2(defensinβ2)的mRNA表达量,并用ELISA法检测培养上清中Ccl3、Cxcl3、IFN-γ、IL-4及IL-6的蛋白质表达水平.结果 在E.coli中成功高效表达了有生物活性的IL-17A蛋白,可促进体外培养的RAW264.7细胞IL-6、Cxcl3、defensin β2 mRNA的表达,并能促进Ccl3、Cxcl3、IFN-γ、IL-4以及IL-6蛋白的表达.结论 成功表达并制备了具备生物学活性的mIL-17A,该蛋白具有刺激巨噬细胞表达趋化因子、防御素及细胞因子的能力.     

中医药抗感染研究的困惑与复杂性科学分析

在对中医药抗病原体最低有效浓度普遍太高,而其对机体免疫功能调节及其诱导干扰素生成的结果又与临床脱节等困惑进行综述分析的基础上,采用复杂性科学"非线性理论"对病原微生物感染多因素综合作用、辨证施治与复杂性科学"初始条件"等进行了探讨,认为中医药乃至整个生物医药抗感染研究都要转变科学观念,以复杂性科学为指导,重视各种因素的综合作用及其各自作用的初始条件;中医药辨证施治(状态分析与处理)实质上就是一种多因素综合分析法,应该强化对它的认识与临床研究。     

医院临床药师在抗感染中的药学服务

目的：探讨抗感染专业临床药师介入临床药物治疗的切入点和方法。方法：通过具体病例介绍临床药师在查房及会诊中发挥的作用,并进行分析。结果：在用药指征、多重耐药菌的诊治及不良反应等方面,抗感染专业临床药师在一定程度上能对临床疑难病例提出用药建议,尤其在不良反应和给药剂量计算方面。结论：抗感染药师参与临床查房、病例讨论和会诊,能够促进抗菌药物合理使用,但需要不断学习及注意沟通方法。     

151份糖尿病足患者药敏报告及指导用药情况分析

目的:分析糖尿病足感染病原菌及药敏检查结果指导抗生素运用情况,为选择最优的抗感染方案提供参考。方法:收集、对比某医院内分泌科2012年6月-2013年6月糖尿病足分泌物病原菌培养及药敏结果的处理情况,发现其中的问题并进行探讨与分析。结果:糖尿病足分泌物感染革兰阳性菌以金黄色葡萄球菌、溶血葡萄球菌、类香味菌为主;革兰阴性菌以鲍曼不动杆菌、大肠埃希菌、变形杆菌为主。以金黄色葡萄球菌耐药情况尤为突出。常用抗生素以氨曲南、左氧氟沙星、头孢哌酮/他唑巴坦为主。临床运用抗生素时药敏试验的覆盖率达51.56%,未做细菌培养及药敏试验的患者多以病情较轻(0¹级)或无分泌物为主。药敏结果敏感占78.15%,耐药占12.58%,中介占5.96%。预后良好占93.38%,预后不好占6.62%。结论:糖尿病足感染的患者在该院临床抗生素使用及预后结果情况较好。由于影响糖尿病足感染的病原菌及药敏的因素是多方面的,认真地对待每一个细节是提高疗效的基础,尤其是处理好"耐药""中介"情况下抗生素的调整。