2016-2019年南昌地区泌尿生殖道支原体感染现状及药敏分析

目的了解南昌地区泌尿生殖道支原体感染情况并进行药敏分析,为临床规范使用抗菌药物提供参考依据。方法对2016—2019年该院103254例疑似泌尿生殖道支原体感染患者的感染情况和药敏试验结果进行回顾性分析。结果103254例标本中共检出支原体阳性标本50970例,感染率为49.36%,其中解脲脲原体(Uu)感染41478例(40.17%),人型支原体(Mh)感染970例(0.94%),Uu+Mh混合感染8522例(8.25%);Uu感染率明显高于Mh和Uu+Mh,连续4年总体呈上升趋势,而Mh感染率呈下降趋势,Uu+Mh混合感染率相对稳定。女性Uu、Mh、Uu+Mh感染率分别为45.46%、1.08%、9.20%,明显高于男性的28.81%、0.64%、6.22%,差异有统计学意义(P<0.05)。≤20岁年龄段人群支原体感染率(51.32%)最高。Uu、Mh和Uu+Mh对强力霉素、美满霉素、四环素及交沙霉素敏感性较高,耐药率较低;Uu、Mh和Uu+Mh对喹诺酮类药物的敏感性均较低,耐药率较高;Uu对除交沙霉素外的大环内酯类药物阿奇霉素、克拉霉素和罗红霉素敏感性较高,对红霉素耐药率较高,而Mh和Uu+Mh对该类药物耐药率均较高;Uu、Mh和Uu+Mh对阿奇霉素、克拉霉素的耐药率连续4年逐年小幅下降。结论强力霉素、美满霉素、四环素及交沙霉素可首选用于该地区泌尿生殖道支原体感染的治疗。南昌地区Uu感染率总体呈上升趋势,应重视对该地区支原体感染的实时监控,加强临床对抗菌药物的合理使用。     

2744例泌尿生殖道感染患者解脲支原体和人型支原体分布及耐药性分析

目的分析本院泌尿生殖道解脲支原体(Ureaplasma urealyticum,Uu)及人型支原体(Mycoplasma hominis,Mh)分布情况及对常用抗生素的耐药性。方法采集2 744例泌尿生殖道感染患者泌尿生殖道标本,应用Uu和Mh培养、鉴定、药物敏感检测试剂盒进行培养和体外药物敏感试验,分析Uu及Mh感染率,统计Uu及Mh对9种常用抗生素的敏感率和耐药率。结果 2 744份标本中共分离出支原体菌株1 088株,其中Uu 956株、Mh 132株;共检出支原体感染患者982例(35.8%),女性支原体感染率(49.9%)高于男性(17.6%)(P0.05),Uu感染率(31.0%)高于Mh感染率(0.9%)、Uu+Mh感染率(3.9%)(P0.05);药物敏感试验结果显示,Uu及Mh对氧氟沙星、环丙沙星的耐药率≥85%,对原始霉素、强力霉素、交沙霉素、四环素的耐药性较低。结论泌尿生殖道感染患者尤其是女性患者支原体感染率较高,敏感度较高的原始霉素、强力霉素、交沙霉素等是治疗泌尿生殖道感染的首选药物。     

2017-2021年普宁地区泌尿生殖道支原体感染现状及药物敏感性分析

目的 了解广东省普宁地区泌尿生殖道支原体的感染情况及其对药物敏感性的变化,为临床的用药治疗提供参考依据。方法 收集普宁市人民医院2017-2021年的95 251例疑似泌尿生殖道感染患者的支原体检测结果及药物敏感试验结果进行回顾性分析。结果 在95 251例标本中,检出泌尿生殖道支原体37 926例,感染率为39.82%,其中单独解脲支原体(Uu)的感染率(29.50%)明显高于单独人型支原体(Mh)的感染率(1.58%)及解脲支原体和人型支原体(Uu+Mh)的混合感染率(8.73%),差异有统计学意义(P<0.05),且感染率总体呈逐年上升趋势(Z=6.52,P<0.05)。女性泌尿生殖道支原体感染率(41.41%)明显高于男性(22.60%),差异有统计学意义(P<0.05)。在药物敏感试验中,泌尿生殖道支原体对强力霉素、美满霉素和交沙霉素的敏感性较高,敏感率都≥92.23%,而对喹诺酮类药物的敏感性普遍偏低,敏感率都≤13.44%。此外2021年泌尿生殖道支原体对四环素、红霉素、交沙霉素的耐药率均明显高于2017-2020年(P<0.05)。结论 普宁地区...     

泌尿生殖道分离的313株支原体药敏结果分析

目的了解泌尿生殖道分离的支原体对抗生素的耐药性,为临床用药提供合理的依据。方法泌尿生殖道感染患者使用支原体鉴定、计数及药敏试剂盒进行试验。结果 468例中支原体阳性313株,感染率66.9%。Uu、Mh、Uu合并Mh感染分离率分别为42.1%、9.8%、14.95%。Uu、Mh、Uu合并Mh感染对强力霉素、美满霉素、交沙霉素均较为敏感,敏感率都在65%以上。结论泌尿生殖道感染患者Uu的感染率较高。强力霉素、美满霉素、交沙霉素这三种药可作为治疗支原体感染的首选物。     

812例泌尿生殖道支原体培养及药敏分析

目的分析泌尿生殖道感染患者中支原体的感染率及药敏试验结果的情况,为临床治疗提供可靠的依据。方法对812例未经用药的泌尿生殖道感染患者进行支原体培养及药敏试验。结果培养结果:支原体阳性301例,阳性率37.1%,其中单独解脲脲原体(Uu)阳性196例,占65.1%;单独人型支原体(Mh)阳性16例,占2.0%;Uu和Mh混合感染阳性89例,占11.0%。女性患者Uu感染率为29.7%,男性为13.0%,感染率女性明显高于男性,差异有统计学意义(P<0.05)。药敏试验结果:Uu对美满霉素、强力霉素、克拉霉素、阿奇霉素敏感率高,占85.1%～95.5%。Mh对强力霉素、交沙霉素、美满霉素敏感率高,占93.5%～99.6%。Uu和Mh混合感染对美满霉素、强力霉素、交沙霉素敏感率较高,占63.5%～90.1%。结论生殖道支原体是泌尿生殖道感染的重要病原,根据药敏试验结果合理使用抗菌药物有助于提高治疗效果。     

泌尿生殖道支原体感染及耐药性分析

目的：了解泌尿生殖道支原体感染的情况及其对抗生素的耐药性,为临床合理治疗泌尿生殖道支原体感染提供依据。方法采用液体培养法,对南昌市第二医院妇产科、皮肤科及泌尿科门诊就诊的910例疑似支原体感染患者的分泌物做支原体培养,并同时做药敏试验。结果910例患者中,支原体阳性498例（54.7%）,其中解脲支原体（Uu）阳性382例（76.7%）,人型支原体（Mh）阳性21例（4.2%）,Uu＋Mh 阳性95例（19.1%）。男性支原体阳性率为25.9%（65/251）,女性支原体阳性率为65.7%（433/659）,女性支原体阳性率明显高于男性（P＜0.05）。药敏试验结果显示,Uu阳性对交沙霉素、强力霉素、美满霉素和四环素敏感率高,其敏感率分别为97.6%、96.3%、95.8%和91.6%,而Uu阳性对环丙沙星、氧氟沙星、红霉素、司巴沙星和罗红霉素耐药率高,其耐药率分别为73.6%、49.2%、41.4%、42.4%和27.0%。Mh阳性对美满霉素、强力霉素、四环素和交沙霉素敏感率高,其敏感率分别为90.4%、85.7%、85.7%和80.9%,而Mh阳性对罗红霉素、阿奇霉素、克拉霉素、环丙沙星和红霉素耐药率高,其耐药率分别为85.7%、80.9%、76.2%、80.9%和80.9%。 Uu＋Mh阳性对交沙霉素、强力霉素、美满霉素和四环素敏感率高,其敏感率分别为85.3%、83.1%、77.9%和61.1%,而Uu＋Mh 阳性对罗红霉素、红霉素、阿奇霉素、环丙沙星和氧氟沙星耐药率高,其耐药率分别为89.4%、86.3%、78.9%、73.7%和67.4%。结论 Uu是泌尿生殖道主要的致病性支原体,女性感染率较男性高。培养出支原体对四环素类药物、大环内脂类药物中的交沙霉素敏感性高,而对喹诺酮类药物中的左氧氟沙星、氧氟沙星和环丙沙星等敏感性较低,不宜提倡首选使用。     

门诊支原体单一感染和混合感染现状及耐药分析

目的了解门诊患者支原体单一感染及混合感染现状以及对12种抗生素药敏试验的差异。方法采用珠海黑马生物技术有限公司的支原体培养药敏诊断试剂盒,对门诊664例支原体阳性患者构成比及药敏试验结果进行统计分析。结果门诊生殖道支原体感染者单一解脲脲原体(Uu)感染构成比为53.6%(356/664),单一人型支原体(Mh)感染构成比为3.0%(20/664),Uu与Mh合并感染构成比为43.4%(288/664)。药敏结果显示:单一Uu感染红霉素耐药率为70.8%,单一Mh感染红霉素耐药率为100%,混合感染红霉素耐药率为98.6%,三种感染敏感率较高的为强力霉素、交沙霉素、美满霉素、四环素。结论生殖道支原体感染中以Uu多见,混合感染较高,且单纯Uu、Mh及Uu+Mh的耐药率有显著差异。治疗支原体感染应以交沙霉素、强力霉素、美满霉素、四环素为首选药。     

593例泌尿生殖道支原体感染及耐药性分析

目的了解非淋菌性(NGU)泌尿生殖道支原体感染状况及对常用抗生素的耐药情况。方法使用支原体培养鉴别试剂盒对593例患者进行解脲支原体(Uu)、人型支原体(Mh)检查,对353例支原体患者进行药物敏感性检测。结果 353例支原体阳性标本中,Uu、Mh及Uu+Mh混合感染的阳性率分别为47.55%(282例)、1.69%(10例)、10.29%(61例)。女性感染率高于男性。支原体对交沙霉素、强力霉素、美满霉素和四环素最为敏感,而对环丙沙星、氧氟沙星、司帕沙星及红霉素的耐药最高。结论 Uu与Mh是泌尿生殖道的主要感染菌,其中Uu感染率最高,Uu与Mh有不同的耐药谱,Uu和Mh混合感染对抗生素的耐药性增强,对支原体感染患者应进行药物物敏感性检测指导临床治疗。     

821例男性泌尿生殖道支原体培养及药敏分析

目的分析本院男性泌尿生殖道感染患者支原体培养和药敏情况,为指导临床合理使用抗生素提供依据。方法对821例男性患者泌尿生殖道分泌物进行支原体培养、计数、鉴定及药敏试验,并回顾性统计分析支原体培养及药敏试验结果。结果 821例患者中支原体总检出率为16.81%(138/821),其中解脲脲原体(Uu)阳性率为80.43%(111/138),Uu与人型支原体(Mh)混合感染阳性率为15.22%(21/138),Mh阳性率为4.35%(6/138)。交沙霉素、克拉霉素、强力霉素、阿奇霉素、美满霉素和环酯红霉素对单纯Uu感染敏感性较高;强力霉素和美满霉素对Uu与Mh混合感染敏感性较高;强力霉素、交沙霉素对单纯Mh感染敏感性较高。结论男性泌尿生殖道支原体感染以Uu为主,强力霉素、美满霉素和交沙霉素可作为男性泌尿生殖道支原体感染治疗的首选药物。临床应积极进行病原学及耐药性监测,并在药敏试验结果指导下合理选用抗生素。     

泌尿生殖道支原体感染及药敏试验动态观察分析

目的动态观察并分析本院2007、2008年泌尿生殖道解脲支原体(Uu)、人型支原体(Mh)感染检出率及药物敏感性变化,为临床准确、合理地进行治疗提供依据。方法利用支原体培养和药敏试剂盒,对泌尿生殖道感染初诊可疑患者的尿道或宫颈分泌物进行Uu和Mh培养和药敏试验。结果泌尿生殖道支原体感染,女性感染率比男性高,以Uu单独感染为主。2008年与2007年相比,支原体阳性构成比有显著差异。Uu的感染率,2008年比2007年明显降低(P0.05),而Mh+Uu混合感染和Mh单独感染率2008年比2007年明显升高(P0.05);Uu对12种抗生素的敏感性除强力霉素、美满霉素、交沙霉素、环脂红霉素、克拉霉素外都明显降低。Mh+Uu对12种抗生素的耐药率普遍比Uu高。结论本地区泌尿生殖道支原体感染,Uu单独感染和Mh+Uu混合及Mh单独感染阳性构成比发生变化,后者的感染率明显上升,支原体对药物的敏感性下降。对泌尿生殖道感染患者及时进行支原体培养及耐药性监测,对指导临床选择高效药物治疗,降低耐药菌株的产生,提高治愈率具有重要意义。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.