不动杆菌临床分离株的分布及耐药性分析

目的 了解不动杆菌的分布及耐药情况,为临床合理使用抗菌药物提供依据.方法 收集2008年1月至2010年7月临床各类标本中分离出(非重复)的不动杆菌,采用美国德灵MicroScan autoSCAN4全自动细菌鉴定仪及纸片扩散法进行细菌鉴定与药敏试验.结果 分离出124株不动杆菌,其中鲍曼不动杆菌75株,占60.48%.标本主要来源于痰液、咽拭子和伤口分泌物,主要发生在呼吸科、重症监护病房和神经科,其中耐亚胺培南不动杆菌(IRAB)20株,占16.13%.IRAB与非IRAB对常用抗菌药物的耐药率相比,差异有统计学意义(P<0.05).IRAB对比阿培南的耐药率高达60.0%.结论 不动杆菌在解放军第四五四医院耐药情况比较严重,其耐药机制复杂,有多重耐药性,临床应根据药敏结果合理使用抗菌药物.     

鲍曼不动杆菌131株临床分布特征及耐药性分析

目的了解鲍曼不动杆菌临床分布及其耐药性特征,为临床有效治疗感染性疾病提供依据。方法采用Walk-Away 96全自动微生物分析仪进行鉴定和药敏分析。结果鲍曼不动杆菌在痰液中检出为主,占63.3%;其次为多种组织分泌物(12.3%)和尿液(6.9%)。临床科室分布以脑外科为最多,其次是呼吸科和ICU病房。鲍曼不动杆菌对临床常用抗菌药物均存较大的耐药性,除亚胺培南外其他抗菌药物的菌株耐药率均>50%,对亚胺培南耐药率为24.1%。结论鲍曼不动杆菌对抗菌药物耐药率高,且多重耐药,应定期监测其分布和耐药情况,为临床合理使用抗菌药物提供依据。     

鲍曼不动杆菌临床分布及耐药性分析

目的了解鲍曼不动杆菌的临床分布特征及耐药性,为临床经验性选择抗菌药物及控制感染提供依据。方法收集2008年1月至2011年12月从临床分离所得鲍曼不动杆菌519株,均采用VITEK-32自动微生物分析系统进行细菌鉴定和药敏试验。结果分离的519株鲍曼不动杆菌主要集中在重症监护病房和呼吸内科、神经外科等科室;该菌对头孢哌酮/舒巴坦的耐药率最低为18.0%,对阿米卡星、亚胺培南的耐药率最低分别为52.3%和28.4%;其他药物则有较高的耐药率。结论临床在合理使用抗菌药物的同时应对鲍曼不动杆菌的耐药性监测,减少多重耐药鲍曼不动杆菌的传播和暴发流行;对于多重耐药鲍曼不动杆菌的治疗,可经验性的选择头孢哌酮/舒巴坦。     

鲍曼不动杆菌感染分布及耐药性分析

目的了解鲍曼不动杆菌的感染分布及其耐药性变化。方法对达州市中心医院2007年1月至2009年12月从临床患者标本中分离的377株鲍曼不动杆菌进行耐药性分析,并用WHONET软件进行数据处理。结果分离的鲍曼不动杆菌主要分布在重症监护病房(ICU)(38.5%),痰标本中分离的鲍曼不动杆菌最多见(74.3%)。鲍曼不动杆菌除对亚胺培南和多黏菌素敏感率较高外,对临床常用的头孢3代和氟喹诺酮类抗菌药物的耐药率大于55.0%。ICU分离株耐药率明显高于普通病房。结论鲍曼不动杆菌对多种抗菌药物耐药,且以ICU分离株最为明显,应加强细菌耐药性监测,合理使用抗菌药物,有效预防和控制感染。     

477株鲍曼不动杆菌耐药性分析

目的分析477株鲍曼不动杆菌临床分布特征及耐药性,为临床合理使用抗菌药物提供依据。方法对按常规送检的患者的各类标本进行培养、分离、鉴定。对分离出的477株鲍曼不动杆菌的药敏结果进行分析。结果 477株鲍曼不动杆菌（非重复菌株）的标本分布以呼吸道分泌物为主。重症监护（ICU）病房216株鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦的耐药率分别为28.9%、32.7%、25.5%、61.9%,对3类或以上抗菌药物多重耐药菌45株。非ICU病房261株鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦的耐药率分别为17.9%、19.0%、11.3%、35.0%,多重耐药菌6株。结论自ICU病房分离的菌株对大部分抗菌药物的耐药性比非ICU分离株高,多重耐药菌株多。     

1685株鲍曼不动杆菌的临床分布及耐药性研究

目的探讨川北医学院附属医院鲍曼不动杆菌感染的临床分布和耐药特点,为该菌的感染治疗与预防提供依据。方法该院2011~2014年住院患者送检标本中分离的1 685株鲍曼不动杆菌的分布及耐药性检测。结果鲍曼不动杆菌主要分离自痰液标本,占73.1%;以重症监护病房和神经外科病房检出率最高;该菌仅对头孢哌酮/舒巴坦和米诺环素耐药率低,分别为27.9%和26.9%;对亚胺培南、美罗培南的耐药率分别为77.4%、73.9%;对其余多种抗菌药物耐药率在62.0%以上。结论鲍曼不动杆菌的耐药率较高并具有多重耐药性,临床治疗应及时进行细菌耐药性监测并根据药敏试验结果选择合适的抗菌药物。     

老年患者下呼吸道感染鲍曼不动杆菌检测及耐药性分析

目的研究老年患者下呼吸道感染鲍曼不动杆菌及其耐药现状,为临床合理用药提供参考。方法采用细菌培养鉴定技术和药敏试验方法,对某医院老年下呼吸道鲍曼不动杆菌感染状况及其耐药性进行了调查与分析。结果 2010年4-10月,该医院从住院下呼吸道感染患者标本中检出病原菌911株,其中分离出鲍曼不动杆菌114株,构成比为12.5%。下呼吸道鲍曼不动杆菌感染患者主要分布于呼吸内科,占36.8%;其次是ICU和老年病房,分别为24.6%和18.4%。临床分离的鲍曼不动杆菌对常用抗菌药物耐药率均>43.0%,只对亚胺培南和阿米卡星耐药率较低。结论该医院老年患者下呼吸道感染病原菌中鲍曼不动杆菌分离率较高,且对常用抗菌药物呈多重耐药性,应加强标本送检和药敏试验,科学选择抗菌药物。     

痰标本分离149株鲍曼不动杆菌对抗菌药物的耐药性分析

目的调查某医院住院患者下呼吸道标本分离鲍曼不动杆菌对常用抗菌药物的耐药性,为临床合理用药提供依据。方法对住院患者下呼吸道标本中分离出的149株鲍曼不动杆菌对抗菌药物的耐药性进行统计分析。结果鲍曼不动杆菌感染病区主要分布于重症监护病房和呼吸科。药敏结果显示,鲍曼不动杆菌对氨苄西林、复方磺胺甲噁唑、哌拉西林及头孢噻肟的耐药率在80.0%以上,对阿米卡星及亚胺培南的耐药率低于30.0%。结论鲍曼不动杆菌是引起下呼吸道感染的重要病原菌,其对现有多种抗菌药物耐药严重,临床应依据药敏结果合理使用抗菌药物。     

2011至2015年某院临床分离的鲍曼不动杆菌耐药性变迁及标本分布

目的 了解临床分离的鲍曼不动杆菌对常用抗菌药物的耐药性变迁及标本分布,为临床合理选用抗菌药物提供依据。方法 回顾性分析本院2011年1月至2015年6月临床分离的鲍曼不动杆菌对亚胺培南等7种抗菌药物耐药性变迁及其标本分布,采用WHONET5.6软件进行数据分析。结果 临床分离的鲍曼不动杆菌对亚胺培南等7种抗菌药物的耐药率分别为2011年60.0%-74.7%;2012年24.3%-100.0%;2013年34.0%-100.0%;2014年35.4%-99.6%;2015年31.8%-98.6%。亚胺培南、庆大霉素、哌拉西林/他唑巴坦、头孢吡肟、头孢他啶耐药率均有逐年下降趋势。鲍曼不动杆菌对左旋氧氟沙星的耐药率在2012年有较明显下降,但是2013-2015年有增长趋势。2011至2015年分离的鲍曼不动杆菌73.68%-85.28%来源于痰液标本。结论 2011至2015年本院临床分离鲍曼不动杆菌对多数监测抗菌药物的耐药率均有下降趋势。通过近几年的抗菌药物临床应用管理工作以及加强医院感染的控制,减少了鲍曼不动杆菌耐药性的产生和传播。     

福建医科大学附属第一医院2008—2010年鲍曼不动杆菌耐药性分析

目的了解福建医科大学附属第一医院2008—2010年临床分离鲍曼不动杆菌对各类抗菌药物的耐药性,以指导临床规范用药及防止耐药性增加。方法按统一方案、采用统一的材料、方法和判断标准(CLSI 2010年版)进行鲍曼不动杆菌耐药性监测(头孢哌酮-舒巴坦采用K-B制片法)。结果该院2008—2010年住院患者鲍曼不动杆菌临床分离株共923株,最常见的分离部位为下呼吸道;鲍曼不动杆菌主要来源于ICU和神经外科、神经内科患者,该菌对米诺环素、阿米卡星耐药率低;2009—2010年分离菌对头孢哌酮-舒巴坦的耐药率比2008年下降,差异有统计学意义;2009—2010年对美罗培南、亚胺培南、妥布霉素、甲氧苄啶-磺胺甲口恶唑、哌拉西林-他唑巴坦、替卡西林-克拉维酸、头孢曲松、头孢吡肟和左氧氟沙星耐药率比2008年显著升高,差异有统计学意义;其中对美罗培南的耐药率逐年升高达59.2%;对亚胺培南的耐药率2009年64.7%,2010年为57.9%,差异有统计学意义。结论鲍曼不动杆菌对多种抗菌药物耐药率高,应加强鲍曼不动杆菌耐药性监测,隔离鲍曼不动杆菌感染者,防止医院内传播。     

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.