4种抗菌药物对幽门螺旋菌体外抗菌活性的测定

本文采用琼脂倍比稀释法测定了４种抗菌药物对幽门螺旋菌（ＨｅｌｉｃｏｂａｃｔｅｒＰｙｌｏｒｉ，ＨＰ）的ＭＩＣ。枸橼酸秘对４２株ＨＰ的ＭＩＣ范围为５－１００μｇ／ｍｌ，ＭＩＣ＿（５０）为２０μｇ／ｍｌ，ＭＩＣ＿（９０）为５０μｇ／ｍｌ；氨苄青霉素和先锋霉素Ｖ对３２株ＨＰ的ＭＩＣ范围分别为０．００３９－０．１２５μｇ／ｍｌ及０．００２０－０．２５μｇ／ｍｌ，ＭＩＣ＿（５０）分别为０．０１５６μｇ／ｍｌ及０．０３１３μｇ／ｍｌ，ＭＩＣ＿（９０）为０．０６２５μｇ／ｍｌ；氟哌酸对２６株ＨＰ的ＭＩＣ范围为０．５－１６μｇ／ｍｌ，ＭＩＣ＿（５０）为２μｇ／ｍｌ，ＭＩＣ＿（９０）为１６μｇ／ｍｌ。枸橼酸铋对ＨＰ的ＭＩＣ范围较大，５％菌株ＭＩＣ为１００μｇ／ｍｌ。对其它三药ＭＩＣ范围较小，浓度较低，说明ＨＰ对以上药物均敏感，但对枸橼酸铋可能存在耐药菌株。     

216例烧伤创面感染菌株调查及药敏分析

目的：对216例烧伤感染患者创面分泌物进行细菌培养及药敏分析，以指导临床合理使用抗生素，方法：细菌培养、分离与鉴定按卫生部《临床细菌操作规程》进行，药敏试验采用K－B法，结果：共检出250株细菌，其中非发酵菌100株（40％）；革兰氏阳性球菌74株（29．6％）；肠杆菌科细菌57株（22．8％）；复合感染50例（20％）。结论：铜绿假单胞菌和金黄色葡萄球菌感染为烧伤感染的两个主要菌株，铜绿假单胞菌感染首选药为环丙沙星（CIP），金黄色葡萄球菌感染首选药物为万古霉素（VAN），不宜使用氨苄青霉素（AMP）。     

肠道致病菌分离鉴定及其部分细菌的药敏试验分析

目的 探讨闸北区2003年肠道致病菌菌群分布情况及细菌药敏特点，为疾病控制和临床用药提供依据。方法 粪便病原菌分离培养、生化鉴定、血清学分型由细菌室按常规方法进行，药敏试验为K-B纸片法。结果 118例腹泻病人粪便标本病原菌阳性63例，其中志贺氏菌所占比例最高，为44．44％。28株志贺氏菌中福氏志贺菌群占67．86％，宋内氏志贺菌占32．14％。志贺菌对复方新诺明和氨苄青霉素耐药，耐药率分别为96．43％和71．43％。宋内氏志贺菌和福氏志贺菌对复方新诺明的耐药性无显著性差异，对氨苄青霉素的耐药性有显著差异。儿童标本志贺菌和成人标本志贺氏菌的耐药率及多重耐药率无显著性差异。结论 2003年本区肠道传染病以福氏和宋内氏志贺菌感染为主，头孢菌素类、氨基糖甙类、喹诺酮类药物可作为首选药物。     

铜绿假单胞菌及其L型医院感染180例分析

目的：了解铜绿假单胞菌及其Ｌ型在院内感染的情况，以引起重视，方法：应用常规培养和Ｌ型菌的特殊检测方法，对收集的２２７８份标本进行培养和细菌鉴定，采用Ｋ－Ｂ法做药敏试验，结果：１８０例铜绿假单胞菌占各种感染的７．９％，Ｌ型菌２５例，占检出菌的１３．９％，普通菌对氟哌酸，头孢哌酮药敏率最高，分别为８２．８％和７０．６％，其次为丁胺卡那霉素（５０．６％）；对新青霉素Ⅱ，氨苄青霉素的耐经率最高，分别为９８     

卡他莫拉氏菌在下呼吸道感染中的发病情况和对抗生素的敏感性

本文报告了１９９２年４月～１９９２年１２月在我院呼吸病房住院诊断为下呼吸道感染的２０３例，分离出致病菌１３５株，其中莫拉氏菌３０株，占２２．２％，仅次于绿脓杆菌（２３．７％），居第二位。３０例莫拉氏菌感染中，２１例有原发疾病，其中１８例为ＣＯＰＤ。对３０株莫拉氏菌进行药敏感试验，结果表明其对麦迪霉素、红霉素、青霉素、氨苄青霉素、先锋Ｖ、磺苄青霉素的耐药率达５０％以上。对头孢噻肟钠、庆大霉素的耐药率分别为３３．３％与４０％。而对优立新（氨苄青霉素／青霉烷砜）、噻比达（先锋必／青霉烷砜）、环丙沙星、头孢哌酮和丁胺卡那的耐药率＜２０％。     

老年中-重度COPD患者下呼吸道感染菌株的耐药性分析

目的：探讨老年中－重度COPD患者下呼吸道感染菌株的分布及耐药性，为临床合理用药提供依据。方法：随机选择我院2006年4月-2008年1月收治的老年中-重度COPD患者合并下呼吸道感染152例，对检验分离获得的178株细菌以纸片扩散法（KB法）行药敏测定分析。结果：178株细菌中主要致病菌依次为铜绿假单胞菌、不动杆菌、肺炎克雷伯菌、阴沟杆菌、粪肠球菌、金黄色葡萄球菌居分离菌前6位。13.8％的患者合并有真菌感染，药敏结果表明：亚胺培南、头孢他啶、头孢哌酮／舒巴坦、阿米卡星为大多数细菌敏感，但对青霉素类及头孢菌素类抗生素耐药性明显增强。结论：老年中－重度COPD患者下呼吸道感染以G-菌为主，其中铜绿假单胞菌、不动轩菌、肺炎克雷伯菌为多，部分患者合并真菌感染。     

367例老年呼吸道感染病原菌检测及耐药性分析

目的探讨老年呼吸道感染病原菌的分布及药物敏感性的情况,为临床诊断与治疗提供依据。方法将367例老年呼吸道感染患者痰和咽分泌物标本接种于血液琼脂平板培养基作细菌培养,采用VITEK-60型全自动细菌鉴定仪鉴定细菌,按临床实验室标准化协会推荐的K-B纸片法测定药敏结果。结果 367例痰或咽分泌物标本共分离到病原菌213株,以革兰阳性菌为主,占68.3%,革兰阴性菌占27.8%,同时还分离到真菌12株。药敏试验显示,耐药较广泛,分离菌对青霉素、氨苄青霉素耐药率均在50%以上,对第3代头孢菌素、氨基糖苷类抗生素及喹诺酮类抗生素大都有较高敏感率。结论表皮葡萄球菌、A群链球菌、肺炎链球菌、金黄色葡萄球菌、肺炎克雷伯菌及大肠埃希菌等为老年呼吸道感染中常见病原菌。并且耐药性较为广泛,临床应及早做病原学检测,并作药敏试验,以免滥用抗生素造成不良后果。     

1680株医院感染细菌的分布特点及耐药性分析

目的探讨我院两年来医院感染致病菌的临床分布特点及耐药现状,为临床用药提供参考。方法用API鉴定系统及K—B纸片扩散法对2002—2003年我院检出的1680株医院感染细菌的分布特点及药敏结果进行统计学分析。结果在检出的医院感染细菌中占临床分离率前几位的菌种从高到低依次为：真菌、大肠埃希氏菌、铜绿色假单胞菌及金黄色葡萄球菌,且这几种细菌均高于全国网络资料;从药敏结果分析显示：医院感染菌对常用抗生素耐药情况严重,革兰氏阳性菌对青霉素、红霉素、氯苄青、复方新诺明、苯唑青的耐药率达75．2％-94．1％,革兰氏阴性菌对氨苄青霉素、复方新诺明、头孢唑林、庆大霉素的耐药率达65．1％-97．6％,与临床用药呈正相关。产ESBLa菌株呈逐年上升,对各种抗生素的耐药率也显著增高．使此类感染的治疗十分困难。结论院内细菌耐药情况不容乐观,应积极采取有效措施控制细菌耐药性的产生及蔓延。     

197株引起肺部感染的病原菌及耐药性分析

目的：了解拉萨地区肺部感染的病原菌种类及耐药情况；方法：对痰培养阳性的细菌种类及药敏情况进行统计分析；结果：456标本检出197株病原菌，检出率43．2％。其中革兰氏阳性球菌99株占（99／197）50．25％，革兰氏阴性杆菌65株占（65／197）32．99％，革兰氏阳性杆菌18株占（18／197）9．14％，酵母样真菌15株占（15／197）7．61％；革兰氏阳性菌以金黄色葡萄球菌为主42株占（42／197）21．32％，革兰氏阴性杆菌以肺炎克雷伯氏菌为主13株占（13／197）6．6－％； 金黄色葡萄球菌对头孢三素、头孢哌酮、头孢唑啉、环丙沙星敏感率较高，对复方新诺明、氨苄青霉素、青霉素G、氨苄青霉素、链霉素等我院常用抗生素耐药率较高；丁胺卡那、环丙沙星、头孢哌酮、头孢三嗪、头孢唑啉对革兰氏阴性杆菌敏感率较高；结论：本地区引起肺部感染的主要病原菌为：革兰氏阳性菌以金黄色葡萄球菌为主，革兰氏阴性杆菌以肺炎克雷伯氏菌为主，主要病原菌对头孢类抗生素敏感率较高，对我院常用抗生素：复方新诺明、青霉素、氨苄青霉素、四环素、红霉素耐药率较高，临床医生应根据病原菌特点及药敏结果选择用药。     

新生儿感染性疾病的病原药敏分析及抗生素的合理选择

了解新生儿感染的病原菌分布及其抗生素的敏感性情况，指导星夜合理选用抗生素。方法用改良Ｋ－Ｂ法对８５例感染性疾病新生儿留取的２００份标本培养出的８９株细菌进行药敏试验。结果①共送检标本２０６份，培养出细菌８９株，其中Ｇ＾－菌５１株，＾＋菌３８株；（２）８９株细菌分别为大肠埃希菌２６株，葡萄菌菌属２１株，肺炎克雷伯杆菌１４株，粪肠球菌１０株，阴沟肠杆菌８株，其他细菌１０株；（３）新生儿感染病原菌败血症     

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.