岳阳地区266株淋球菌药敏结果分析

[目的]了解岳阳地区淋球菌对青霉素、环丙沙星、头孢曲松钠、壮观霉素的敏感性,指导临床用药.[方法]以琼脂稀释法测定266株淋球菌对青霉素、环丙沙星、头孢曲松钠、壮观霉素的最小抑菌浓度(MIC),以监测淋球菌对临床常用的抗生素的耐药状况.[结果]4种抗生素的MIC范围依次为0.06～64 mg/L、0.03～64 mg/L、0.00～0.5 mg/L及2～64 mg/L .266株淋球菌中分别有263株、262株对头孢曲松钠敏感、壮观霉素敏感,敏感率分别为98.5%和98.1%.266株淋球菌分别有251株、241株对青霉素和环丙沙星耐药,耐药率分别为94.3%、90.4%.[结论]头孢曲松钠及壮观霉素作为治疗淋病的一线药物对淋球菌临床分离株仍相当有效,青霉素及氟喹诺酮类药物因高耐药率已不再适宜作为治疗淋球菌感染常规药物.     

淋球菌对五种抗生素的耐药性连续六年监测结果分析

目的了解6年来广州地区淋球菌对5种抗生素的耐药趋势及产青霉素酶淋球菌(PPNG)和高水平耐四环素淋球菌(TRNG)的流行状况。方法用琼脂稀释法测定最低抑菌浓度(MICs)以及用纸片碘量法检测β内酰胺酶。结果719株淋球菌检出PPNG94株(131%)、TRNG119株(166%),6年来,PPNG、TRNG流行率及环丙沙星耐药率,经μ检验,P<001,差异有显著意义。头孢曲松、壮观霉素未发现耐药菌株,壮观霉素抗菌活性最强。结论壮观霉素在临床上可以作为治疗淋病的首选药物,具有良好疗效。     

某地区淋球菌对6种抗生素耐药性的结果分析

目的了解广州地区淋球菌对6种抗生素的耐药性及产青霉素酶的淋球菌(PPNG)和质粒介导的耐四环素的淋球菌(TRNG)的流行状况。方法用琼脂稀释法测定青霉素、四环素、环丙沙星、阿奇霉素、头孢曲松、大观霉素的最低抑菌浓度(MIC);用纸片碘量法检测β-内酰胺酶。结果 88株淋球菌检出PPNG 34株(38.6%)、TRNG 51株(60%)、环丙沙星耐药株87株(98.9%),同时检出PPNG、TRNG、环丙沙星高度耐药(MIC≥161 mg/L)菌株16株,占18.2%。阿奇霉素耐药株24株(27.2%),未发现头孢曲松、大观霉素的耐药菌株。结论推荐大观霉素和头孢曲松作为广州地区治疗淋病的首选药物,加强淋球菌耐药性的连续性监测十分重要。     

淋球菌临床分离株青霉素耐药性与β-内酰胺酶基因相关性探讨

目的　了解淋球菌临床分离株青霉素耐药性与β 内酰胺酶基因存在的相关性。方法　对2003年2~12月分离的128株淋球菌临床分离株用PCR法检测其特异的隐蔽质粒 CPPB基因和青霉素耐药菌的β 内酰胺酶基因;用琼脂稀释法测定其对青霉素的最小抑菌浓度(MIC)。结果　128株临床分离菌中CPPB基因阳性者125株,占97.7%。其中MIC≥1 mg/L的青霉素耐药菌86株,占CPPB基因阳性者的68.8%;MIC≥8 mg/L的高耐药菌59株,占耐药菌株总数的68.6%。86株耐药菌中β 内酰胺酶基因PCR扩增阳性者62株,占 72.1%,其中 58 株(67.4%)为高耐药菌。结论　研究表明,目前淋球菌临床分离株耐药情况较为严重,如果用青霉素治疗淋病需首先进行耐药检测。用PCR技术扩增CPPB基因有助于淋病的确诊。淋球菌的耐药性与β 内酰胺酶基因存在一定关系。β 内酰胺酶基因的检测对快速判断淋球菌是否高度耐受青霉素有临床指导意义。     

淋球菌临床分离株青霉素耐药性与β-内酰胺酶基因相关性探讨

目的了解淋球菌临床分离株青霉素耐药性与β-内酰胺酶基因存在的相关性。方法对2003年2～12月分离的128株淋球菌临床分离株用PCR法检测其特异的隐蔽质粒CPPB基因和青霉素耐药菌的β-内酰胺酶基因；用琼脂稀释法测定其对青霉素的最小抑菌浓度(MIC)。结果128株临床分离菌中CPPB基因阳性者125株，占97．7％。其中MIC≥1mg／L的青霉素耐药菌86株，占CPPB基因阳性者的68．8％；MIC≥8mg／L的高耐药菌59株，占耐药菌株总数的68．6％。86株耐药菌中β-内酰胺酶基因PCR扩增阳性者62株，占72．1％，其中58株(67．4％)为高耐药菌。结论研究表明。目前淋球菌临床分离株耐药情况较为严重，如果用青霉素治疗淋病需首先进行耐药检测。用PCR技术扩增CPPB基因有助于淋病的确诊。淋球菌的耐药性与β-内酰胺酶基因存在一定关系。β-内酰胺酶基因的检测对快速判断淋球菌是否高度耐受青霉素有临床指导意义。     

阿奇霉素耐药及头孢曲松低敏淋球菌基因分型与多态性研究

目的分析广州地区阿奇霉素耐药及广谱头孢菌素低敏淋球菌基因分型和基因多态性特征。方法检测阿奇霉素(AZM)和头孢曲松(CRO)最小抑菌浓度(MIC)。检测AZM耐药(AZM-R)淋球菌23SrRNA、多重可传递耐药调节(mtrR)基因和青霉素结合蛋白2(PBP2)编码基因(penA)突变类型。采用淋球菌多抗原序列分型法(NG-MAST)检测菌株基因型。结果共检测淋球菌485株,包括AZM-R菌株(MIC≥1mg/L)77株(15.9%),其中AZM低度耐药(AZM-LLR,MIC=1mg/L)菌株33株(6.8%)、AZM中度耐药(AZM-MLR,MIC≥2mg/L)菌株44株(9.1%)。AZM-MLR菌株中CRO低敏(MIC≥0.125mg/L)菌株19株(占43.2%),构成比高于AZM-LLR菌株中的CRO低敏株(18.2%,P0.05)。各类菌株间23SrRNA、mtrR、penA基因突变或联合突变检出率比较差异无统计学意义(P0.05)。AZM-LLR与CRO低敏菌株,以及AZM-MLR与CRO低敏菌株间各类突变检出率比较差异无统计学意义(P0.05)。未检出A2059G突变及AZM高度耐药株(MIC≥256 mg/L)。77株AZM-R菌株经NG-MAST检测,检出67株序列类型,其中30株有异常。多数序列类型表现为单一表型。结论该地区出现的AZM耐药及CRO低敏淋球菌值得持续监测和进一步研究,以明确其耐药机制。     

江门市淋球菌对7种抗菌药物耐药性的结果分析

目的了解江门市2013-2014年分离的淋球菌对青霉素、四环素、环丙沙星、壮观霉素、头孢曲松、头孢克肟和阿奇霉素的耐药性及产β内酰胺酶淋球菌和四环素高水平耐药淋球菌的流行状况。方法采用琼脂稀释法测定菌株对7种抗菌药物的最小抑菌浓度(MIC),耐药性按世界卫生组织西太平洋地区淋球菌耐药性监测规划推荐的标准判断。采用纸片酸度法检测产β内酰胺酶淋球菌菌株。结果108株淋球菌检出产β内酰胺酶淋球菌36株(33.33%),四环素高水平耐药淋球菌42株(38.89%)。其中环丙沙星、四环素、青霉素和阿奇霉素耐药率分别为95.37%、80.56%、71.30%和13.89%;同时对环丙沙星、青霉素和四环素三重耐药的有64株(59.25%)。头孢曲松、头孢克肟和壮观霉素的敏感度较高,分别为98.15%、97.22%和100.00%。结论淋球菌对环丙沙星、四环素和青霉素的耐药率较高,对头孢曲松、头孢克肟和壮观霉素的敏感度较高,可作为江门市治疗淋病的首选药,阿奇霉素不宜用于江门市淋病的治疗。     

某地区淋球菌对抗菌药物敏感性及质粒耐药流行状况研究

目的 了解珠海地区2011～2013年分离的淋球菌对青霉素、四环素、壮观霉素、头孢曲松、环丙沙星和头孢克肟的敏感性及产β内酰胺酶淋球菌（PPNG）和质粒介导的四环素高度耐药淋球菌（TRNG）的流行状况。方法 采用琼脂稀释法测定菌株对6种抗菌药物的最小抑菌浓度（MIC）,敏感性判断按世界卫生组织（WHO）西太区淋球菌耐药性监测统一标准,其中头孢克肟敏感性试验和判断标准按美国临床和实验室标准化研究所（CLSI）判断。使用纸片酸度法检测PPNG菌株。结果 192株淋球菌检出PPNG66株（34．4％）,TRNG94株（49．0％）。其对青霉素、环丙沙星和四环素耐药率分别为68．8％、100．0％和99．0％,其MIC50及MIC90均超过耐药标准;未发现壮观霉素、头孢曲松和头孢克肟耐药株,其敏感性分别为100．0％、66．7％和95．8％;但头孢曲松中敏率达到33．3％（64／192）,头孢克肟中敏率为4．2％（8／192）。结论 淋球菌对青霉素、四环素和环丙沙星的敏感性较差,壮观霉素、头孢曲松和头孢克肟可作为珠海地区治疗淋病的首选药物,该地区PPNG和TRNG仍处于高流行率,持续对淋球菌耐药监测具有临床意义。     

河北省奈瑟氏淋病双球菌耐药性分析

[目的]分析河北省奈瑟氏淋病双球菌耐药谱，指导临床用药。[方法]采用琼脂稀释法测定淋球菌分离株的最低抑菌浓度(MIC)。[结果]临床分离到的69株奈瑟氏淋病双球菌对6种抗生素的耐药率分别为：青霉紊97．10％，四环素79．7l％，环丙沙星55．07％，壮观霉素1．45％，阿奇霉素和头孢三嗪未发现耐药。[结论]多重耐药问题较为严重，50．72％菌株同时表现对青霉素、四环素、环丙沙星耐药。     

120株淋球菌对5种抗菌药耐药情况分析

目的了解2009年淋球菌对5种抗菌药的耐药性及产青霉素酶淋球菌(PPNG)和高水平耐四环素淋球菌(TRNG)的流行状况。方法用琼脂稀释法测定最低抑菌浓度(MIC)以及用纸片碘量法检测β-内酰胺酶。结果 120株淋球菌检出PPNG 33株(27.5%)、TRNG 52株(43.3%);环丙沙星的耐药率达95.8%,青霉素耐药率达95.0%;头孢曲松、壮观霉素没有发现耐药菌株,且抗菌活性最强。结论持续监测淋球菌的耐药性十分重要。     

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.