2004～2005年同济医院表皮葡萄球菌耐药性分析

目的 研究武汉同济医院2004～2005年检出的表皮葡萄球菌的耐药情况,分析耐药趋势.方法 对检出菌株复苏、培养,进行常用抗生素的药物敏感性试验,分析药敏结果.结果 共检出表皮葡萄球菌61株,全部复苏、培养成功.苯唑西林耐药41株(占67.21%),苯唑西林敏感20株(占32.79%).苯唑西林耐药的表皮葡萄球菌(MRSE)组的多重耐药率及总耐药率均显著高于苯唑西林敏感的表皮葡萄球菌(MSSE)组.在体外药敏试验中,对头孢唑啉、头孢呋新、庆大霉素及氨苄-舒巴坦保持较低的耐药率(＜30%),而对SMZ-TMP、青霉素、红霉素、克林霉素及左氧沙星耐药率较高(＞50%),没有发现对万古霉素耐药的菌株.结论 表皮葡萄球菌耐药情况严重,MRSE的多重耐药率、总耐药率较高.     

溶血葡萄球菌的感染分布及耐药分析

目的 了解溶血葡萄球菌的临床感染分布及其耐药特性。方法 采用法国生物梅里埃ATB细菌鉴定和药敏分析系统，对142株溶血葡萄球菌进行鉴定和16种常规抗生素进行耐药分析，同时分析对红霉素、庆大霉素、左旋氧氟沙星、四环素、克林霉素5种非β-内酰胺类抗生素多重耐药性。结果 在临床分离到的319株凝固酶阴性葡萄球菌(CNS)中，溶血葡萄球菌有142株，占44．5％，居CNS分离菌种首位。溶血葡萄球菌标本检出率最高为前列腺液(占45％)，其次为精液(占26．2%)和尿道分泌物(占25．1％)。抗生素耐药分析显示，溶血葡萄球菌对青霉素、红霉素、诺氟沙星、庆大霉素表现出高度耐药性，耐药率分别为98．6％、93．7％、76．8％、74．7％。溶血葡萄球菌对苯唑西林的耐药率为82．4％。117株耐苯唑西林溶血葡萄球菌(MRSH)对3种以上非β-内酰胺类抗生素多重耐药率达82．9％；25株苯唑西林敏感溶血葡萄球菌(MSSH)对3种以上非β-内酰胺类抗生素多重耐药率达已52．0％。结论 溶血葡萄球菌所致临床感染日趋严重，检出率不断增加，提示综合性医院应加强对溶血葡萄球菌的监测与药敏分析，建议为了减少新的耐药株出现，临床医生应多做感染样本的细菌培养和药敏试验，依据检验结果合理使用抗生素。     

耐苯唑西林凝固酶阴性葡萄球菌的检测

目的 研究我院耐苯唑西林凝固酶阴性葡萄球菌的感染现状和耐药情况,为临床医生合理使用抗生素提供实验依据.方法 按照<全国临床检验操作规程>进行常规细菌分离培养,应用湖南天地人生物科技有限公司提供的微生物生化药敏试剂卡片进行菌种鉴定,药敏试验采用纸片扩散(K-B)法,苯唑西林琼脂筛选法确证试验.结果 共检测CNS206株,以溶血葡萄球菌和表皮葡萄球菌为主要菌种,耐苯唑西林株检出率56.9%.结论 加强MRCNS的分布及耐药性的监控,对临床治疗及抗生素的合理应用意义重大.     

儿童中分离的金黄色葡萄球菌耐药性分析

目的 了解自儿童中分离的金黄色葡萄球菌对常用抗生素的体外药敏情况.方法 用金黄色葡萄球菌乳胶凝集试验检测凝固酶,用vitek系统GPI卡鉴定金黄色葡萄球菌,用纸片扩散法和E-test法进行药敏试验.结果 141株菌株药敏结果显示,95.7%菌株产生β内酰胺酶,仅4.3%的菌株对青霉素敏感.92.2%的菌株对苯唑西林敏感,对头孢曲松、头孢噻肟、甲氧苄啶-磺胺甲基异恶唑、利福平、氧氟沙星、氯霉素的敏感率分别为92.2%、91.5%、88.0%、98.6%、97.2%、91.5%.对四环素和红霉素的耐药率分别为70.2%和41.9%,所有菌株均对万古霉素敏感.结论 本研究中金黄色葡萄球菌儿童株对苯唑西林的敏感率高,临床上应根据药敏结果合理选择抗生素.     

新生儿血培养凝固酶阴性葡萄球菌的耐药性分析

目的 分析新生儿血培养中凝固酶阴性葡萄球菌(CNS)的耐药情况,加强院感监测,指导临床合理用药.方法 采用ATB-Expression细菌鉴定系统对本院2009年1月-2011年1月血培养分离的266株CNS进行鉴定,用K-B纸片法检测其对苯唑西林等10种抗菌药物的敏感度.结果 266株CNS菌耐甲氧西林(MRS)的发生率分别为:溶血葡萄球菌93.61%,表皮葡萄球菌83.08%,人型葡萄球菌84.96%.对青霉素、红霉素耐药率较高,分别为89%和82%以上;对左氧氟沙星、克林霉素耐药性次之;未检出对万古霉素、替考拉宁耐药菌株.结论 我院新生儿血培养分离的CNS耐药严重,MRS发生率超过80%,对红霉素、克林霉素高度耐药,临床应尽量减少这些药物的经验性用药,应依据药敏结果合理选用抗菌药物治疗.     

新生儿血培养的菌谱调查及药敏结果分析

目的了解2008—2010年浙江省慈溪市妇幼保健院新生儿血培养病原菌的分布及耐药性分析。方法对124株病原菌的菌谱和主要病原菌的药敏结果进行分析。结果新生儿血培养中革兰阳性球菌占73.4%,革兰阳性杆菌占8.1%,革兰阴性杆菌占18.5%;其中居前3位的分别为表皮葡萄球菌、人葡萄球菌和溶血葡萄球菌。表皮葡萄球菌、人葡萄球菌和溶血葡萄球菌对苯唑西林的耐药率均高于77.8%。结论表皮葡萄球菌、人葡萄球菌和溶血葡萄球菌是本院新生儿血培养中检出的主要病原菌。临床应根据血培养结果和患儿的情况,合理使用抗生素。     

哺乳期乳腺炎患者临床分离株的病原调查及耐药性分析

目的 了解哺乳期乳腺炎患者临床分离株的病原分布及感染状况,来指导临床用药.方法 以无菌穿刺获得乳腺炎开放性脓液和封闭性脓肿标本,行需氧和厌氧培养,采用VITEK-2compact全自动微生物鉴定仪,用GPI、GNI、ANC鉴定卡、AST-GN13、AST-GP61药敏卡进行菌株的鉴定和药敏试验,以苯唑西林最低抑菌浓度（MIC）来判断耐甲氧西林/苯唑西林的金黄色葡萄球菌（MRSA）.结果 270例标本共分离细菌70株,其中G＋菌61株,厌氧菌4株,G＋杆菌3株,G-杆菌2株.G＋球菌中以葡萄球菌属细菌为主,其中金黄色葡萄球菌（SA）分离最多占46株.SA中34.8%产β内酰胺酶,对青霉索的耐药率为89.1%.MRSA检出率为10.8%.凝固酶阴性葡萄球菌中100%产β-内酰胺酶,对苯唑西林的耐药率为78.6%.结论 哺乳期乳腺炎患者以SA检出率最高,对青霉素有较高的耐药性,MRSA发生率较低.其次以凝固酶阴性葡萄球菌的检出率为高,对青霉素及苯唑西林均有较高的耐药性.未发现利奈唑烷、万古霉素和替考拉宁的耐药株.     

凝固酶阴性葡萄球菌医院感染的研究

目的 :防治凝固酶阴性葡萄球菌医院内感染。方法 :用经典生理生化鉴定方法 ,对各种临床标本分离到的96株凝固酶阴性葡萄球菌 (CNS)进行种的鉴定、药敏试验和葡萄球菌粘质的检测。结果 :分离到 7种CNS ,其中表皮葡萄球菌占 5 5 .2 % ,溶血葡萄球菌占 2 9.2 %。青霉素耐药率为 6 9.8% ,甲氧西林耐药凝固酶阴性葡萄球菌占CNS的5 8.3 % ,产葡萄球菌粘质菌株占 84.4%。结论 :临床感染CNS中表皮葡萄球菌和溶血葡萄球菌占绝大多数。CNS对多种抗生素耐药 ,治疗其感染应以药敏结果为依据。可选用万古霉素、利福平、丁胺卡那霉素、环丙沙星等药物治疗。     

380株血培养的病原菌分布及耐药性分析

目的了解血培养病原菌临床分布、种类及耐药情况。方法对2010年11月1日-2011年10月31日的5257份血培养检出的380株病原菌及其药敏情况进行统计分析。结果 380株病原菌中,分离率从高到低依次是大肠埃希菌/ESBLs阳性（63/16.58）、MRSE/耐甲氧西林表皮葡萄球菌（54/14.21）、大肠埃希菌（45/11.84）、甲型副伤寒沙门氏菌（30/7.89）、人葡萄球菌人亚种（21/5.53）、屎肠球菌（17/4.47%）、克雷伯氏菌/ESBLs阳性（16/4.21%）、MRSA/耐甲氧西林金黄色葡萄球菌（14/3.68%）、溶血葡萄球菌（14/3.68%）和其他病原菌。这些菌株主要分布在ICU、呼吸内科和儿科。药敏结果分析显示：革兰阳性球菌中,未发现利奈唑胺和万古霉素耐药株。耐甲氧西林表皮葡萄球菌和耐甲氧西林金黄色葡萄球菌对青霉素的耐药率为100%,对苯唑西林的耐药率分别为98.1%和85.7%;对其他多种抗菌药物的耐药率也达80%,屎肠球菌对头孢曲松、头孢唑啉、头孢噻肟、氯林可霉素的耐药率均为100%。革兰阴性杆菌中,大肠埃希氏菌/ESBLs阳性和克雷伯氏菌/ESBLs阳性对氨苄青霉素的耐药率为100%。结论血培养检出菌种复杂,耐药率高,应加强血培养中致病菌及其对抗生素的耐药性监测。     

金黄色葡萄球菌儿童株耐药性分析

目的 了解儿童中金黄色葡萄球菌所致疾病的分布及其对常用抗生素的敏感情况。方法 收集连续12个月的临床致病株，根据菌落形态、革兰染色特点和乳胶凝集实验对金黄色葡萄球菌进行初步筛选，用细菌自动鉴定系统Vitek GPI卡和GPS-101卡进行菌株鉴定和药敏试验。结果 分离到金黄色葡萄球菌145株，其中来自呼吸道感染患儿痰或咽拭子培养109株，占75．17％，来自血培养16株，占11．03％，来自脓液、阴道分泌物培养分别占6．21％和5．51％。药敏试验显示92．4l％的菌株产生β-内酰胺酶，96．55％的菌株对青霉素耐药，但耐苯唑西林的仅占6．21％。99．31％和100％的菌株分别对利福平和万古霉素敏感，对环丙沙星、阿莫西林／棒酸、头孢唑林、复方新诺明、庆大霉素和林可霉素的敏感率分别为95．86％、93．10％、92．41％、86．21％、84．83％和80．69％，37．93％的菌株对红霉素耐药。结论金黄色葡萄球菌常引起儿童呼吸道感染，对苯唑西林的耐药率低．该药仍是治疗小儿会黄色葡萄球菌感染的有效药物。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.