抗菌药物临床应用指导原则（3）各类抗菌药物的适应证和注意事项

1 青霉素类抗生素。本类药物可分为：(1)主要作用于革兰阳性细菌的药物，如青霉素(G)、普鲁卡因青霉素、苄星青霉素、青霉素V(苯氧甲基青霉素)。(2)耐青霉素酶青霉素，如甲氧西林(现仅用于药敏试验)、苯唑西林、氯唑西林等。(3)广谱青霉素．抗菌谱除革兰阳性菌外，还包括：①对部分肠杆菌科细菌有抗菌活性者，如氨苄西林、阿莫西林；②对多数革兰阴性杆菌包括铜绿假单胞菌具抗菌活性者，如哌拉西林、阿洛西林、美洛西林。     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

仙人掌粉对糖尿病大鼠血糖的影响

目的　研究仙人掌对糖尿病血糖的影响。方法　采用四氧嘧啶造成大鼠实验性糖尿病模型 ,然后将高、中、低 3种剂量的仙人掌粉加入到基础饲料中进行实验观察。结果　仙人掌粉高 (10g kg·d)、中 (5 .0g kg·d)剂量组均可显著降低糖尿病大鼠空腹血糖 ,并且高剂量组具有显著改善糖尿病大鼠尿量增加的作用。各剂量组对正常大鼠血糖无明显影响。结论　仙人掌粉能有效降低四氧嘧啶所导致的糖尿病大鼠的血糖、尿量     

医院变压吸附式制氧设备的使用和管理

本文结合医院情况简述了变压吸附式制氧设备的安装质量控制、安全操作和维护保养,指出变压吸附式制氧是今后医院制氧方式的一个发展方向.     

海绵体平滑肌细胞内钙释放的调节：一氧化氮与cGMP的协同作用

阴茎海绵体平滑肌细胞的紧张性收缩维持着阴茎的松驰状态；而由NO启动的海绵体平滑肌细胞舒张则引发了阴茎的勃起。Williams BA等人研究了NO在海绵体平滑肌细胞对肾上腺素刺激反应中所起的作用。用Fura-2荧光标记从小鼠和人体中新分离出的平滑肌收缩物质内的钙浓度。新福林（去氧肾上腺素PE）能短暂的升高细胞内钙浓度而降低细胞外钙浓度，这是钙从细胞内贮藏库释放所致。     

8-甲氧沙林对黑素细胞内游离钙浓度及细胞骨架蛋白形成的影响

目的：观察8-甲氧沙林对体外培养黑素细胞内游离钙浓度、细胞骨架蛋白形成的影响。方法：正常人黑素细胞取自包皮环切术切取的包皮，用激光共聚焦扫描显微镜检测细胞内游离钙浓度，用罗丹明结合毒伞素对细胞骨架蛋白进行特异性染色。结果：8-甲氧沙林可使细胞内游离钙离子浓度升高，促进黑素细胞骨架蛋白合成。结论：8-甲氧沙林可能通过诱导黑素细胞内钙离子浓度升高和细胞骨架actin蛋白生成，从而影响黑素细胞的迁移。     

有氧抗癌操之“经络健身法”

本人从事肿瘤事业多年，创建四位一体疗法，有氧抗癌操的体疗便是其中之一，作为早期预防及癌友的康复体疗也卓有成效。现详其端倪，以资热爱健康事业的大众。     

细菌性皮肤病

20072791临床结合疱顶表皮病理鉴别诊断葡萄球菌性烫伤样皮肤综合征/赵国庆(四川大学华西医院皮肤科),李薇,冉玉平…∥中华皮肤科杂志.-2007,40(7).-399~402观察并比较12例葡萄球菌性烫伤样皮肤综合征患者及6例中毒性表皮坏死松解症患者的临床表现和治疗情况,并利用患者皮损的疱顶表皮切片染色,了解其组织学表现。结果葡萄球菌性烫伤样皮肤综合征的疱顶表皮组织病理均表现为疱顶表皮由角质层和小部分残余颗粒层细胞组成,均未见表皮其他层次细胞;中毒性表皮坏死松解症患者的疱顶表皮组织病理均表现为疱顶表皮由表皮全层组成,角质形成细胞呈明…     

动脉路去白细胞滤器在体外循环中的临床应用

目的　观察常规瓣膜手术患者体外循环 (CPB)中应用动脉路去白细胞滤器的临床使用效果及对炎症介质的影响。方法　 30例风心病患者随机分为试验组和对照组 ,各 15例 ,试验组使用动脉路去白细胞滤器LG6 ,对照组使用常规的国产动脉过滤器。测定血细胞计数及分类、血浆丙二醛 (MDA)、髓过氧化物酶 (MPO)、白介素 - 1β(IL - 1β)和白介素 - 8(IL - 8) ,动脉血气分析。观察两组术前、注射鱼精蛋白后和术后 4h的氧合指数及气道压力。用Swan -ganz导管监测肺血管压力及阻力。结果　白细胞计数 :实验组 -右房 (8.4 7± 2 .0 1)× 10 9/L、左房(7.96± 2 .2 7)× 10 9/L(P >0 .0 5 ) ,对照组右房 (10 .6 9± 2 .4 7)× 10 9/L、左房 (9.6 7± 1.98)× 10 9/L(P <.0 0 1)。血小板和红细胞压积两组无差异。术后肺氧合指数 (PaO2 /FiO2 × 10 0 )两组间无统计学差异。术后其它肺参数如肺血管阻力 (PVR)、平均肺动脉压 (MPAP)、肺毛细血管楔压 (PCWP)和气道压力等两组间无统计学差异。血浆MDA ,MPO ,IL - 1β和IL - 8两组间无统计学差异。结论　CPB中应用动脉路去白细胞滤器可暂时减少循环血液中的白细胞和中性粒细胞数量 ,减少再灌注过程中白细胞的肺内滞留 ,对术后肺功能没有明显的保护作用。