哌拉西林与加替沙星联用对铜绿假单胞菌的联合药敏研究

目的　评价哌拉西林与加替沙星联合用药,对30株临床分离的铜绿假单胞菌的体外抗菌效应。方法　采用棋盘法设计,微量肉汤稀释法测定。测定不同浓度组合的抗菌药物对30株临床分离的铜绿假单胞菌的最低抑菌浓度,并计算FIC指数判定联合效应。FIC≤0 .5为协同作用,0 .5 2为拮抗作用。结果　哌拉西林与加替沙星联用后,其MIC50 显著降低。FIC指数分布:FIC≤0 .5占4 0 % ;0 .5 2为0。结论　结果表明两药联用,对铜绿假单胞菌表现为协同作用和相加作用,并以协同作用为主,无关作用较少,更无拮抗作用。     

头孢硫脒与三种氟喹诺酮类抗菌药物合用对革兰阳性球菌的抑制作用

目的　评价头孢硫脒分别与环丙沙星、左氧沙星和加替沙星 3种氟喹诺酮类抗菌药物联合用药 ,对于临床分离的 90株革兰阳性球菌的体外联合抗菌效应。方法　采用棋盘法设计 ,微量肉汤稀释法测定不同浓度组合的 3组抗菌药物对 90株临床分离的革兰阳性球菌 ,包括金黄色葡萄球菌 (Staphylococcusaureus,SA)、表皮葡萄球菌 (Staphylococcusepidermidis,SE)和粪肠球菌 (Enterococcusfaecalis,Ef)的抑菌浓度 ,并计算FIC指数。结果　头孢硫脒对金黄色葡萄球菌的MIC50 为 16mg·L-1,与环丙沙星、左氧沙星、加替沙星联合应用后 ,其MIC50 分别显著的降低至 2、0 .5和 1mg·L-1;头孢硫脒对表皮葡萄球菌的MIC50 为 1mg·L-1,与环丙沙星、左氧沙星、加替沙星等 3种抗菌药物联合应用后 ,其MIC50 降低至 0 .12 5、0 .2 5和 0 .12 5mg·L-1;头孢硫脒对粪肠球菌的MIC50 为 4mg·L-1,与环丙沙星、左氧沙星、加替沙星联合应用后 ,其MIC50 降低至 0 .2 5、0 .2 5和 0 .2 5mg·L-1。FIC指数分布 :FIC≤ 0 .5占 6 0 %～ 90 % ;0 .5 2为 0。结论　头孢硫脒与氟喹诺酮类 3种抗菌药物联合用药后 ,对革兰阳性球菌基本表现为协同作用和相加作用 ,并以协同作用为主 ,无关作用较     

头孢硫脒与万古霉素药物对革兰阳性球菌的联合药敏研究

目的评价头孢硫脒与万古霉素联合应用时金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌的体外抗菌效应。方法采用棋盘法设计,微量肉汤稀释法测定其MIC值,计算FIC指数。结果头孢硫脒与万古霉素联合应用后,2种抗菌药物对临床分离的革兰阳性球菌的最低抑菌浓度显著降低。FIC指数分布,FIC≤0.5占50%～83.3%,0.52占0%。结论头孢硫脒与万古霉素联合应用后,2种抗菌药联合应用后MIC明显降低,抗菌作用明显加强。     

头孢硫脒与阿米卡星对90株革兰阳性球菌的联合药敏研究

目的评价头孢硫脒与阿米卡星联合对于临床分离的90株革兰阳性球菌的体外联合抗菌效应。方法采用棋盘法设计,微量肉汤稀释法测定。测定不同浓度组合对90株临床分离的革兰阳性球菌的最低抑菌浓度,并计算FIC指数判定联合效应。结果表明二者联合用药后,头孢硫脒和阿米卡星对于90株革兰阳性球菌的MIC显著降低,抗菌作用显著增强。基本表现为协同作用或相加作用,占96．6％,并以协同作用为主,占76．6％,无关作用较少,占6．6％,无拮抗作用。结论头孢硫脒与阿米卡星联合应用后,对于90革兰阳性球菌抗菌作用显著增强,并基本呈协同和相加作用。     

加替沙星与盐酸克林霉素对凝固酶阴性葡萄球菌联合药敏分析

目的：观察加替沙星与盐酸克林霉素对凝固酶阴性葡萄球菌（CNS）的联合抗菌活性,为临床合理使用抗生素提供依据。方法：采用棋盘法、微量肉汤稀释法,测定不同浓度组合的2组抗菌药物对30株临床分离的CNS的最低抑菌浓度（MIC）,计算FIC指数,并判定联合效应;FIC≤0．5为协同作用,0．5〈FIC≤1为相加作用,1〈FIC≤2为无关作用,FIC〉2为拮抗作用。结果：加替沙星与盐酸克林霉素合用后,FIC指数分布：FIC≤0．5占53．3％～57．2％;0．5〈FIC≤1占26．7％-35．7％;1〈FIC≤2占6．7％;FIC〉2占7．1％-13．3％。结论：加替沙星与盐酸克林霉素联用后,以协同和相加作用为主,有少许无关和拮抗作用。     

烧伤患者血培养菌谱调查及耐药性分析

 目的 分析我院烧伤患者血培养阳性标本病原菌分布情况及主要病原菌耐药性特点,为临床合理应用抗菌药物提供依据.方法 采用细菌、真菌常规生化编码方法进行细菌、真菌鉴定,用K-B纸片法监测其耐药率.结果 送检的968例血培养标本中,检出病原菌149株,阳性率为15.39 %.其中,革兰阳性球菌83株,占55.70%,革兰阴性杆菌60株,占40.27%,真菌6株,占4.03%;分离出耐甲氧西林金黄色葡萄球菌(MRSA)57株,占93.44%;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)11株,占84.62%.金黄色葡萄球菌对青霉素、红霉素、复方磺胺甲唑及头孢类都有很高的耐用性;凝固酶阴性葡萄球菌(CNS)对万古霉素、阿米卡星有较好的敏感性.分离出的8株肠球菌中HLAR占87.50%,有很高的耐药性.非发酵菌对头孢菌素、庆大霉素、阿米卡星、复方磺胺甲唑都有很高的耐药性.结论 烧伤患者血培养病原菌主要有金黄色葡萄球菌、铜绿假单胞菌和凝固酶阴性葡萄球菌,且以耐药株为主.     

左氧氟沙星与头孢硫脒合用对金黄色葡萄球菌表皮葡萄球菌粪肠球菌体外抗菌活性研究

目的 评价左氧氟沙星与头孢硫脒联合应用对金黄色葡萄球菌、表皮葡萄球菌和粪肠球菌的体外联合抗菌作用。方法采用棋盘法设计,微量肉汤稀释法测定其MIC值,计算FIC指数。结果左旋氧氟沙星与头孢硫脒联合应用后,左旋氧氟沙星对金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、MRSA、MRSE的MIC50均有明显降低。同样,头孢硫脒对金色葡萄球菌、表皮葡萄球菌、粪肠球菌、MRSA、MRSE的MIC50亦显著下降,FIC指数范围主要在0—1。结论左氧氟沙星与头孢硫脒药物联合应用,对金黄色葡萄球菌、表皮葡萄球菌和粪肠球菌的体外联合抗菌作用以协同和相加为主。     

血培养标本中病原菌的种类分布及其药物敏感性的回顾性研究

 目的 了解我院血培养中分离到的病原菌菌种分布及其耐药状况.方法 利用Bact/Alert3D 全自动血培养仪培养血标本,阳性标本转种后用VITEK32 全自动细菌鉴定仪或传统常规方法鉴定到种,然后用K-B法进行药敏测试.结果 送检的773份血培养标本中,检出病原菌116株,其中革兰阳性球菌占48.3%,革兰阴性杆菌占45.7%,真菌占6.0%.感染率最高的细菌是凝固酶阴性葡萄球菌、大肠埃希菌和铜绿假单胞菌.革兰阳性球菌中未发现对万古霉素耐药的菌株,而且对替考拉宁和磷霉素呈高度敏感;肠杆菌科未发现对舒普深、美洛培南和特治星耐药的细菌;非发酵菌则仅对舒普深有较高的敏感性.结论 血培养中分离出的病原菌种类复杂,耐药率高,及时了解血培养的结果对临床采取有针对性的抗菌治疗,提高治愈率和控制院内交叉感染具有重要意义.     

2013—2014年50株鲍曼不动杆菌耐药性分析及联合药敏实验研究

目的分析鲍曼不动杆菌耐药情况及联合应用抗菌药物,筛选出优化治疗方案,制定广泛耐药鲍曼不动杆菌感染的有效治疗方法,为临床合理应用抗菌药物提供有效依据。方法收集2013—2014年中国医科大学附属第一医院住院患者标本,整理临床资料,对收集的标本进行细菌培养和分离,筛选出50株临床资料完善的鲍曼不动杆菌。采用美国临床和实验室标准协会(CLSI)推荐的琼脂二倍稀释法测定抗菌药物的最低抑菌浓度(MIC)值。根据《中国鲍曼不动杆菌感染诊治与防控专家共识》和《中国鲍曼不动杆菌感染诊治与防控专家共识解读》选择常用药物,并根据CLSI 2012年颁布的抗菌药物临界浓度标准进行耐药性分析。在耐药性分析的基础上,筛选出40株多重耐药鲍曼不动杆菌分离株,分别测定了7种抗菌药物和5种联合用药方案的药敏试验。联合用药方案为:替加环素+头孢哌酮/舒巴坦;多粘菌素+米诺环素;多粘菌素+亚胺培南;多粘菌素+多尼培南;替加环素+亚胺培南。比较联合用药与单独用药的抑菌效果。结果 50株鲍曼不动杆菌主要分布在重症监护室(ICU)、神经外科和普通外科。根据药敏值将50株鲍曼不动杆菌分成非多重耐药鲍曼不动杆菌10株、多重耐药鲍曼不动杆菌40株,其中,40株多重耐药鲍曼不动杆菌中包括广泛耐药鲍曼不动杆菌10株。分离株对米诺环素、替加环素耐药率最低,均为0,多粘菌素2年的耐药率分别为20%和16%。其他抗菌药物耐药率均在50%以上。左氧氟沙星的耐药率分别为56%和64%。2014年头孢哌酮/舒巴坦(2:1)和2013年亚胺培南的耐药率均为96%,为各种抗菌药物耐药率之最高值。联合用药结果显示,在替加环素+头孢哌酮舒巴坦组中,协同作用、相加作用和无关作用分别占7.5%、30.0%和62.5%;多粘菌素+米诺环素组中,协同作用、相加作用和无关作用分别占22.5%、27.5%和50.0%;多粘菌素+亚胺培南组中,协同作用、相加作用和无关作用分别占55.0%、22.5%和22.5%;多粘菌素+多尼培南组中,协同作用、相加作用和无关作用分别占12.5%,67.5%和20.0%;替加环素+亚胺培南组中,协同作用、相加作用和无关作用分别占32.5%、40.0%和27.5%。本研究未发现拮抗现象。除去广泛耐药鲍曼不动杆菌的30株多重耐药鲍曼不动杆菌单用和联合用药结果显示,联合用药组的MIC值与相应单用药物MIC值相比均有下降,差异有统计学意义(P<0.01)。对10株广泛耐药鲍曼不动杆菌单用和联合用药结果显示,除替加环素+头孢哌酮/舒巴坦组,其他联合用药组的MIC值均比相应单独用药MIC值下降,差异有统计学意义(P<0.01)。结论本研究药敏结果提示,我院2013—2014年的鲍曼不动杆菌分离株对替加环素、米诺环素均100%敏感,多粘菌素敏感率为82%,处于较高水平;阿米卡星、亚胺培南耐药率较高,分别达到56%和90%,头孢哌酮/舒巴坦(1:1)在对鲍曼不动杆菌的治疗上优于头孢哌酮/舒巴坦(2:1),但整体耐药性也较高。联合应用抗菌药物结果提示,多粘菌素+亚胺培南组、替加环素+亚胺培南组与其他联合用药组相比,FIC值更低,表现出更好的协同作用。     

白藜芦醇联合苯唑西林对耐甲氧西林金黄色葡萄球菌的抗菌作用

 目的 观察白藜芦醇单独或联合苯唑西林对耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)的体外抗菌活性,为临床应用提供实验依据.方法 采用微量肉汤稀释法测定不同浓度的白藜芦醇联合苯唑西林对MRSA临床株及WHO-2标准株的最低抑菌浓度,并计算部分抑菌浓度指数(fractional inhibitory concentration index,FIC),并绘制24 h内,以次最低抑菌浓度(minimum inhibitory concentration,MIC)的苯唑西林联合次MIC浓度的白藜芦醇作用后,两株细菌生长的动态生长曲线.结果 白藜芦醇联合苯唑西林后对MRSA临床分离株,FIC<0.5,显示出抗菌增敏作用;对于MRSA WHO-2标准株,0.5相似文献   

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.