下呼吸道标本苛养菌的分离培养及耐药性研究

目的：了解呼吸道感染住院病人流感嗜血杆菌、副流感嗜血杆菌及肺炎链球菌的感染和耐药性以及流感嗜血杆菌和副流感嗜血杆菌β-内酰胺酶的产生率。方法：收集呼吸道感染患者的痰标本共1263份，按细菌学常规方法进行分离培养、鉴定和药敏试验，以Nitroceiin纸片法测定β-内酰胺酶的产生率。结果：1263份痰标本中共分离出流感嗜血杆菌139株，副流感嗜血杆菌85株，肺炎链球菌228株。139株流感嗜血杆菌产β-内酰胺酶51株(36．69％)，85株副流感嗜血杆菌产β-内酰胺酶32株(37．65％)。139株流感嗜血杆菌对氨苄西林、四环素、SMZ高度耐药，对利福平和阿奇霉素的耐药率为0．00％。85株副流感嗜血杆菌对氨苄西林、四环素和氧氟沙星耐药严重，对利福平的耐药率为0．00％。228株肺炎链球菌对红霉素、克林霉素、四环素、SMZ耐药率相当高，对青霉素中介率高达23．25％。结论：呼吸道苛养菌对多种抗生素具有较明显的耐药性，临床微生物室应加强对呼吸道标本中苛养菌的常规分离培养及药敏试验，指导临床医生合理使用抗生素以延缓耐药率的快速上升。     

2006～2010年武汉同济医院呼吸道苛养菌的耐药性分析

目的了解2006～2010年武汉同济医院呼吸道标本中苛养菌的分离情况及耐药性,为临床合理用药提供依据。方法对2006年～2010年呼吸道标本分离的肺炎链球菌、流感嗜血杆菌以及卡他布兰汉菌,用Kirbry-Bauer法进行药敏试验,E-test法检测肺炎链球菌对青霉素的敏感性。以头孢硝噻吩纸片测定β-内酰胺酶。结果共收集到肺炎链球菌503株,流感嗜血杆菌658株以及卡他布兰汉菌142株。5年总的青霉素不敏感肺炎链球菌(PNSSP)为22.5%(113/503),其中青霉素耐药肺炎链球菌(PRSP)为4.7%。肺炎链球菌对克林霉素及红霉素高度耐药,尤其是儿童分离株敏感性不足10%;但对莫西沙星及左氧氟沙星敏感性良好,达90%以上,未出现耐万古霉素肺炎链球菌。流感嗜血杆菌对复方磺胺甲噁唑的敏感率最低,仅40.6%;对氨苄西林的敏感性也只有60%左右。但对头孢呋新、头孢噻肟、阿奇霉素、环丙沙星和左氧氟沙星的敏感性均在85%以上。卡他布兰汉菌产β-内酰胺酶率高达98.6%。以上苛养菌对各种抗菌药物敏感性均呈逐年下降趋势。结论大多数抗菌药物对呼吸道苛养菌仍然保持较好的抗菌活性,但青霉素类抗菌药物对上述3种细菌不敏感率已超过30%,尤其是卡他布兰汉菌。应加强细菌耐药性监测并根据药敏结果合理选用抗菌药物进行治疗。     

2009～2011年武汉大学人民医院感染肺炎链球菌的耐药性分析

目的监测武汉大学人民医院肺炎链球菌的耐药趋势,为临床合理应用抗菌药物提供依据。方法采用K-B法和E-test法对137株肺炎链球菌进行药敏试验,用K-B法测定耐红霉素菌株的耐药表型,并分析药敏结果。结果 137株肺炎链球菌对红霉素、复方磺胺甲口恶唑的耐药率较高,分别为94.2%(129/137)和74.5%(102/137),且有逐年升高的趋势。129株红霉素耐药株中,内在型耐药(cMLSB)占70.5%,诱导型耐药(iMLSB)占19.4%,M型耐药占10.1%。红霉素耐药株对克林霉素、复方磺胺甲口恶唑共同耐药率及多重耐药率分别为66.7%、74.4%、60.5%,显著高于红霉素敏感组,差异有统计学意义(P<0.05)。结论 2009～2011年武汉大学人民医院分离的肺炎链球菌对红霉素耐药率较高,对克林霉素及复方磺胺甲口恶唑的耐药率呈逐年上升趋势,尤其是儿童对这两种抗菌药物的耐药性明显高于成人,耐药表型以cMLSB为主,且多重耐药现象严重。     

儿童呼吸道感染病原菌分布与耐药性研究

目的 探讨儿科患者呼吸道感染主要病原菌分布及其对常用抗菌药物的耐药情况.方法 对2007年11月-2008年5月冬春季节北京大兴区人民医院儿科呼吸道感染患儿鼻咽分泌物分离的49株肺炎链球菌、35株流感嗜血杆菌和27株卡他莫拉菌,采用Kirby-Bauer(KB)法进行抗菌药物敏感性检测.结果 3种细菌检出率比较,差异有统计学意义(P＜0.05,).49株肺炎链球菌对红霉素的耐药率高达91.8%(45/49),对青霉素不敏感菌9株,不敏感率为18.4%,多重耐药率高达53.0%;35株流感嗜血杆菌对复方磺胺甲口恶唑耐药率为85.7%(30/35),对氨苄西林和氯霉素敏感.卡他莫拉菌产酶率为66.7%,对氨苄西林和红霉素的耐药率均达到77.8%(21/27).结论 儿童呼吸道感染常见致病菌中肺炎链球菌对红霉素的耐药性很高;流感嗜血杆菌对氨苄西林敏感;卡他莫拉菌对氨苄西林和红霉素的耐药性很高.儿童呼吸道细菌感染时,应尽量避免使用非β-内酰胺类抗菌药物.应尽量根据药敏结果合理使用抗菌药物.     

手足口病患儿咽部流感嗜血杆菌分离及体外药敏结果分析

目的了解手足口病患儿呼吸道流感嗜血杆菌分离状况及耐药性。方法3985例手足口病患儿,取咽拭子进行流感嗜血杆菌培养、分离鉴定、药敏试验以及β一内酰胺酶检测。结果检出流感嗜血杆菌347株,分离率为8．7％。药敏试验显示,347株流感嗜血杆菌对复方磺胺甲恶唑、氨苄西林、四环素耐药率〉60％,头孢噻肟、利福平、氧氟沙星耐药率〈10％。β-内酰胺酶阳率为47．6％,β一内酰胺酶阴性氨苄西林耐药菌25株。结论手足口病患儿呼吸道流感嗜血杆菌分离率低,但耐药率高,近半数菌株可产B．内酰胺酶,B．内酰胺酶阴性氨苄西林耐药株占一定比例,应引起临床重视。     

2005年至2006年南京地区儿童流感嗜血杆菌耐药性分析

目的:研究我院2005年至2006年儿童感染流感嗜血杆菌(Hi)对常用抗生素的敏感性、产β-内酰氨酶情况,以有效指导临床合理用药和预防。方法:临床标本进行流感嗜血杆菌分离培养,用Kirbry-Bauer(K-B)法和Etest法测定203株流感嗜血杆菌对8种抗生素的耐药率,以Nitrocefin纸片法测定β-内酰氨酶。结果:流感嗜血杆菌β-内酰氨酶总产生率为44.83%;流感嗜血杆菌对头孢他啶、头孢噻肟、头孢曲松、美洛培南、氧氟沙星、阿奇霉素耐药率分别为7.87%、10.34%、7.39%、7.87%、2.96%和7.39%;对氨苄西林、复方磺胺甲基异噁唑的耐药率分别为49.75%和51.23%。结论:南京地区儿童呼吸道感染流感嗜血杆菌耐药形势严峻,与该地区前2年资料比较,流感嗜血杆菌对氨苄西林和复方新诺明耐药率明显升高,产β-内酰氨酶是流感嗜血杆菌对氨苄西林耐药的重要机制。对头孢他啶、头孢噻肟、头孢曲松、美洛培南、阿奇霉素有较高的敏感性。     

老年呼吸道感染病人流感和副流感嗜血杆菌检测及耐药性分析

目的了解老年呼吸道感染病人流感、副流感嗜血杆菌临床分离菌株的耐药状况,为临床合理用药提供指导。方法收集老年病人痰液及咽拭子标本408份,用手工法和MicSCAN4半自动细菌分析仪对菌株进行分离与菌种鉴定,用纸片琼脂扩散(K-B)法进行药敏试验,采用头孢硝噻吩滤纸片法进行β-内酰胺酶检测。结果临床分离嗜血杆菌135株,其中流感嗜血杆菌61株,副流感嗜血杆菌74株,β-内酰胺酶产酶率分别为52.5%和51.4%,对氨苄西林敏感率分别为42.6%和48.6%,对复方磺胺甲唑的敏感率分别为31.1%和27.0%。流感嗜血杆菌对头孢噻肟、头孢呋辛、阿奇霉素、左旋氧氟沙星、氯霉素的敏感率均达80%以上,副流感嗜血杆菌对头孢噻肟、头孢呋辛、阿奇霉素、氯霉素的敏感率均达80%左右。结论老年病人呼吸道嗜血杆菌感染中副流感嗜血杆菌高于流感嗜血杆菌,两者均有较高的产酶率,首选药物为头孢噻肟、头孢呋辛。氨苄西林、复方磺胺甲唑已不适用于经验治疗。     

2013-2015年深圳市宝安区流感嗜血杆菌药敏监测与分析

目的 了解流感嗜血杆菌临床分离菌株的分布及敏感性,指导临床合理用药.方法 对467株分离自患者呼吸道标本的流感嗜血杆菌采用纸片扩散法(K-B法)进行药敏试验,并用头孢硝噻酚纸片检测β-内酰胺酶.结果 临床分离流感嗜血杆菌467株,检出率为4.26%;主要分离自痰标本(326株,69.8%);儿科病区分离率最高(265株,56.7%);儿童感染率显著高于成人(P<0.05).分离出的流感嗜血杆菌对氨苄西林、复方新诺明、四环素的敏感率分别为58.5%、40.7%、41.5%,已经不适合作为临床经验用药;而对β-内酰胺酶抑制剂、头孢类抗生素、阿奇霉素、美洛培南、环丙沙星等仍然保持高度活性,可作为治疗流感嗜血杆菌的首选用药.结论 耐药基因是流感嗜血杆菌对多种抗菌药物敏感性下降的主要机制,临床应考虑首选药物或联合用药及其抗生素的敏感性,参考药敏试验结果,尽量使抗生素的使用合理化、规范化,减缓耐药菌株的增长速度.     

儿童上呼吸道感染副流感嗜血杆菌的鉴定及耐药性分析

目的：了解儿童上呼吸道感染副流感嗜血杆菌的耐药情况,指导临床合理用药。方法：收集急性上呼吸道感染儿童鼻咽分泌物进行培养,采用APINH鉴定卡和ATBNH药敏条进行细菌鉴定和抗生素试验,β-内酰氨酶试验采用Cefinase纸片法。结果：呼吸道感染患儿咽部嗜血杆菌共检出121株,其中副流感嗜血杆菌50株,占嗜血杆菌的41.4%。8个生物型中,以Ⅱ、Ⅲ型为主,Ⅱ型占副流感嗜血杆菌的22.0%,Ⅲ型占副流感嗜血杆菌的32.0%。检测菌株对氨苄西林和复方新诺明耐药率较高,分别为54.0%和62.0%,检出β-内酰胺酶11株,产酶率为22.0%。结论：上呼吸道感染副流感嗜血杆菌的生物型以Ⅱ、Ⅲ型为主。对副流感嗜血杆菌引起的感染应首选头孢噻肟、头孢呋辛、头孢克洛;对产酶菌株的抗生素使用,临床应考虑复方阿莫西林或联合用药,以使抗生素的使用合理化、规范化。     

痢疾杆菌51株耐药性分析

目的：观察痢疾杆菌的耐药性,指导临床医师选择合理、有效的抗生素。方法：选择细菌性痢疾患者分离出的痢疾杆菌51株,K-B法检测细菌的药物敏感性。结果：痢疾杆菌对磺胺甲口恶唑、氨苄西林、诺氟沙星、头孢曲松等抗生素有较高的耐药性,耐药率分别为78.4%、60.8%、29.1%及23.5%;而对阿米卡星、磷霉素、氧氟沙星、哌拉西林、头孢哌酮及呋喃唑酮等抗生素较敏感,敏感性分别为78.4%、88.2%、84.3%、86.3%、92.2%及94.1%。结论：痢疾杆菌对磺胺甲口恶唑、氨苄青霉素及诺氟沙星耐药性较高,临床使用无效,而对三代头孢菌素、磷霉素、阿米卡星及氧氟沙星等敏感,可用于细菌性痢疾的治疗;另外呋喃唑酮对痢疾杆菌的敏感性明显增加,可以选用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.