氟脲苷肝动脉持续灌注联合草酸铂静脉化疗治疗肝转移癌

目的观察经肝动脉灌注氟脲苷(FUDR)同时联合草酸铂(OXA)静脉化疗治疗肝转移癌的疗效及毒副反应.方法 28例结直肠癌或胃癌肝转移患者,经肝动脉灌注FUDR,静脉输入OXA治疗2～6个周期.所有病例均行术前术后CT扫描评价治疗效果.随访44个月,评价疗效、生存期及毒副反应.结果总有效率为42.8%,中位生存时间(MST)为25个月,出现肝转移后的MST为15.5个月,1,2,3年生存率分别为89.3%、67.8%和25.0%.结论采用新的化疗方案FUDR加OXA局部联合全身同时化疗安全有效,患者生存期得以延长.     

耐碳青霉烯类鲍曼不动杆菌的OXA酶基因研究

目的 研究广东省中山市中医院分离耐碳青霉烯类鲍曼不动杆菌(CRAB)耐药性、苯唑西林(OXA)酶基因及流行特性。方法 收集广东省中山市中医院2012年7月至2013年12月临床分离40株CRAB,采用纸片扩散法(K-B法)药敏试验,改良Hodge试验筛查碳青霉烯酶;用聚合酶链式反应(PCR)法对β-内酰胺酶基因oxa-23、oxa-24、oxa-51和oxa-58进行扩增、序列分析。结果 40株CRAB对16种药物中,对多黏菌素和米诺环素敏感性最高,耐药率小于或等于5.0%;改良Hodge试验阳性29株(占72.5%);所有菌株均被检测到含有oxa-51基因(占100.0%),oxa-23基因为38株(占95.0%),未检出oxa-24和oxa-58基因。结论 oxa-51及oxa-23基因是广东省中山市中医院流行CRAB的主要基因型。     

Molecular and Epidemiological Characterization of Carbapenem-Resistant Acinetobacter baumannii in Non-Tertiary Korean Hospitals

Purpose

The increasing prevalence and global spread of carbapenem-resistant Acinetobacter baumannii (A. baumannii) has become a serious problem. The aim of this study was to investigate molecular and epidemiological characteristics of carbapenem-resistant A. baumannii isolates collected from Korean non-tertiary hospitals.

Materials and Methods

Thirty six non-duplicated carbapenem-resistant A. baumannii isolates were collected from 17 non-tertiary hospitals in Korea between 2004 and 2006. Isolates were typed by multilocus sequence typing and repetitive-sequence-based PCR (rep-PCR). Detection of genes encoding OXA carbapenemase and their relationship with ISAba1 was performed by PCR.

Results

Two clones were prevalent among 36 isolates: ST69 (17 isolates, 47.2%) and ST92 (19 isolates, 52.8%). Rep-PCR patterns were diverse and revealed that all isolates were clustered into eight band patterns. The ISAba1-activated blaOXA-23-like and ISAba1-activated blaOXA-51-like genes were prevalent among the carbapenem-resistant A. baumannii isolates.

Conclusion

The class D β-lactamase genes of A. baumannii were distributed nationwide in non-tertiary Korean hospitals.     

Protein tyrosine phosphatase conjugated with a novel transdermal delivery peptide,astrotactin 1–derived peptide recombinant protein tyrosine phosphatase (AP-rPTP), alleviates both atopic dermatitis–like and psoriasis-like dermatitis

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奥沙利铂联合氟尿嘧啶和亚叶酸钙治疗晚期结直肠癌的疗效观察

目的探讨奥沙利铂、5-氟脲嘧啶和亚叶酸钙联合治疗晚期结直肠癌的疗效及不良反应。方法 40例晚期结直肠癌患者均采用奥沙利铂联合5-氟尿嘧啶和亚叶酸钙治疗,治疗方案为:奥沙利铂130mg/m2静脉滴注4h,第1天;亚叶酸钙200mg/m2静脉滴注2h,第1～5天(在静脉滴注5-氟尿嘧啶之前),5-氟尿嘧啶400mg/m2静脉滴注4～6 h,平均用药4周期,2周期后进行疗效评价。结果 40例晚期结直肠癌患者中,完全缓解(CR)4例(10%),部分缓解(PR)18例(45%),稳定(SD)10例(25%),进展(PD)8例(20%),总有效率(ORR)为55%。不良反应为厌食疲乏、皮肤色素沉着、神经毒性、手足综合症、腹泻、恶心呕吐、肝功损害、白细胞下降,多数患者能耐受。结论奥沙利铂联合5-氟尿嘧啶和亚叶酸钙治疗晚期结直肠癌的疗效肯定,毒副反应小,患者能耐受,值得推广。     

奥沙利铂、顺铂与5-Fu联合对胃癌细胞的生长抑制作用研究

目的观察奥沙利铂（OXA）、顺铂（DDP）与5-Fu联合对胃癌细胞BGC．823的体外生长抑制,探讨其药物联合的效果。方法使用MTT法测定不同浓度下奥沙利铂与顺铂联合,奥沙利铂、顺铂与5．Fu联合对胃癌细胞株的体外抑制作用。结果在同一时间,2药及3药联合对BGC．823细胞生长抑制作用随着浓度的增加逐渐增强（P均〈0．01）,3药抑瘤作用较2药明显增强（P〈0．01）,差异具有统计学意义。结论奥沙利铂、顺铂与5-Fu2药及3药联合对胃癌细胞均有良好的抑制作用,在相同浓度下,3药组抑瘤率明显高于2药组。     

Detection of OXA-type carbapenemases and integrons among carbapenem-resistant Acinetobactor baumannii in a teaching hospital in China

The increasing trend of carbapenem‐resistance (CR) and multi‐drug resistance (MDR) in A. baumannii worldwide has limited the therapeutic effectiveness of antibiotic therapy. The study was conducted to determine the prevalence of carbapenemases and integrons among the isolates of imipenem‐resistant A. baumannii (IRAB). A total of 71 non‐repetitive imipenem‐ resistant A. baumannii isolates were collected and tested for susceptibility to 17 antimicrobials. The modified Hodge test and EDTA‐disc synergy test were performed for the screening of carbapenemases and metallo‐β ‐lactamases (MBLs) production, respectively. Isolates were then subjected to multiplex‐PCR targeting genes encoding for OXA‐type carbapenemase, MBLs and integrases. Random amplified polymorphic DNA (RAPD) genotyping was performed to assess genetic relatedness. All isolates exhibited multi‐drug resistant phenotype. Colistin was the most active antimicrobial agent tested. Seventy‐one isolates (100%) demonstrated positive in the modified Hodge test. Thirty‐nine isolates showed positive in the EDTA‐disc synergy test, however, no MBL genes were detected. All strains possessed a bla_OXA‐51‐like gene. The co‐exis‐tence of bla_OXA‐51‐like/bla_OXA‐23‐like/intI1, bla_OXA‐51‐like/bla_OXA‐23‐like, bla_OXA‐51‐like/bla_OXA‐24‐like was detected in 91.6% (n = 65), 5.6% (n = 4), 2.8% (n = 2), respectively. Analysis of the genetic con‐text of bla_OXA‐23 showed the presence of ISAba1 upstream of bla_OXA‐23. No ISAba1 was detected upstream of bla_OXA‐51. Two different gene cassettes were found in these strains, and a high prevalence of aacA4, aadA1 and catB8 genes was observed. RAPD of 71 isolates showed 7 genotypes. The strains were mainly recovered from patients in intensive care unit, neurosurgery and department of respiratory disease. These ?ndings show that multi‐drug resistance in A. baumannii is a common problem. This study also shows a high distribution of bla_OXA‐23‐like and intI1 genes in imipenem‐resistant A. baumannii isolates. The clonal spread played an important role in the increase of OXA‐23 producing IRABs in the hospital environment. (© 2011 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

下呼吸道感染广泛耐药鲍曼不动杆菌耐药性分析和部分碳青霉烯酶基因检测

目的 分析我院下呼吸道感染广泛耐药鲍曼不动杆菌(XDRAB)的耐药性及其OXA-23、OXA-51基因携带情况.方法 用K-B纸片扩散法测定42株XDRAB对11种抗菌药物的耐药性;用PCR法检测OXA-23、OXA-51基因存在情况,并对部分基因进行测序.结果 42株XDRAB对多黏菌素B无耐药,对米诺环素耐药率低,为2.4％,对头孢哌酮/舒巴坦中介率为16.7％.42株XDRAB中OXA-23和OXA-51基因的携带率均为100％.结论 多黏菌素B、米诺环素和大剂量头孢哌酮/舒巴坦是治疗XDRAB感染的有效药物.产OXA-23碳青霉烯酶是我院下呼吸道感染的XDRAB对碳青霉烯类抗菌药物耐药的重要机制之一.     

复方五味子素B对人结肠癌细胞多药耐药性逆转作用及其机制研究

目的：研究复方五味子素B（γSC）对耐奥沙利铂人结肠癌细胞（THC-8307/OXA）多药耐药性的逆转作用及作用机制.方法：采用噻唑蓝（MTT）比色法检测奥沙利铂（OXA）和γSC的细胞毒性;碱性磷酸酶免疫组织化学法和Western blot检测γSC对THC-8307/OXA细胞GST-п蛋白水平的影响.结果：γSC（6.0,12.5,25 μg·ml-1）对人结肠癌细胞（THC-8307）和THC-8307/OXA无显著毒性作用（P＞0.05）,OXA对THC-8307的IC50为0.06 μg·ml-1,而对THC-8307/OXA的IC50为2.32 μg·ml-1,THC-8307/OXA较THC-8307耐药性提高39倍,γSC（6.0,12.5,25 μg·ml-1）能使OXA对THC-8307/OXA细胞的IC50从2.32 μg·ml-1依次下降至0.370,0.128,0.057 μg·ml-1,逆转倍数分别为6.2,18.1,40.7倍.碱性磷酸酶免疫组织化学法和Western blot检测γSC（12.5 μg·ml-1）处理48 h后,THC-8307/OXA细胞GST-n蛋白表达明显降低（P＜0.01）.结论：γSC具有逆转耐奥沙利铂人结肠癌细胞的MDR作用,其作用机制与下调GST-п表达有关.