细菌性尿路感染易感因素、菌种及耐药性研究

目的探讨尿路感染的病原种类及耐药性,提高尿路感染的临床诊治水平.方法分析了230例尿路感染患者临床资料、菌种及耐药资料.结果①清洁中段尿培养阳性率低(36.5%).②尿路感染病原菌分布占前几位的细菌分别是大肠埃希菌(50.6%),变形杆菌(15.6%),肺炎克雷伯菌(12.2%),肠球菌(12.1%),假单胞菌(6.5%);产超广谱β-内酰胺酶(ESBLs)大肠埃希菌检出率13.6%,产ESBLs肺炎克雷伯菌的检出率是18.2%.③G-杆菌对复方新诺明、氨苄西林、环丙沙星耐药率较高,对亚胺培南、头孢三嗪耐药率低;G+球菌对红霉素、青霉素耐药性高,万古霉素耐药性最低;产ESBLs大肠埃希菌及肺炎克雷伯菌对氨基糖甙类、第三代头孢菌素、氨苄西林耐药性较高,而对亚胺培南及酶抑制剂的复方制剂敏感.④尿路感染常规治疗后尿菌检出率为15.4%.结论临床上要重视尿路感染的病原菌药敏检测,经验一线选药广泛耐药,合理使用抗生素,对预防产ESBLs细菌的产生,提高尿路感染治愈率十分重要.     

尿路感染的病原菌种类及耐药性分析

目的探讨尿路感染的病原菌种类,分析其耐药性,提高尿路感染的临床治疗水平。方法对386例尿路感染患者的清洁中段尿细菌培养及耐药性结果进行回顾性调查分析。结果清洁中段尿细菌培养阳性率为23.8%。其中大肠埃希菌占62.0%,克雷伯菌占13.0%,变形杆菌占6.5%,假单胞菌占5.4%,葡萄球菌占7.6%,肠球菌占5.4%。产超广谱β-内酰胺酶(ESBLs)菌平均检出率为11.6%。革兰阴性杆菌对复方新诺明、氨苄西林和环丙沙星的耐药率较高,对亚胺培南、阿米卡星、头孢三嗪的耐药率低。革兰阳性球菌对红霉素、青霉素耐药率高,对万古霉素敏感率为100%。产ESBLs大肠埃希菌及肺炎克雷伯菌对氨基糖苷类、第三代头孢菌素和氨苄西林耐药率较高,而对亚胺培南及酶抑制剂的复合药敏感。结论引起尿路感染的主要病原菌为大肠埃希菌;临床上要特别重视尿路感染的病原菌检查及药敏试验,合理使用抗生素,以减少产ESBLs细菌的产生,提高治愈率。     

大肠埃希菌的耐药特性及其产超广谱β-内酰胺酶的分析

观察大肠埃希菌的耐药特性及产超广谱β-内酰胺酶(ESBLs)的情况，为临床正确选择抗生素提供药敏依据。用微量稀释法测定最低抑菌浓度(MIC)，用ESBLs表型确证试验检测出产ESBLs的大肠埃希菌。共检出314株大肠埃希菌。对其中298株大肠埃希菌进行了ESBLs检验，检出产ESBLs菌81株，检出率为27．2％；81株产ESBLs菌对多种药物耐药率较高，除亚胺培南、头孢哌酮，舒巴坦、庆大霉素和阿米卡星外，大肠埃希菌产ESBLs株对其他9种抗生素的耐药性明显高于非产ESBLs株。大肠埃希菌产ESBLs率高，应引起临床高度重视，对检测出的大肠埃希菌均应进行ESBLs检测，产ESBLs细菌有较高的交叉耐药性和多重耐药性，对亚胺培南和头孢哌酮，舒巴坦的敏感性好。     

儿童产超广谱β-内酰胺酶细菌感染的检测与分析

目的　了解儿童感染性疾病中肺炎克雷伯菌和大肠埃希菌感染时产生超广谱 β -内酰胺酶 (ESBLs)的情况及其耐药特点 .方法　对 2 0 2株肺炎克雷伯菌和 134株大肠埃希菌应用双纸片协同试验进行ESBLs的测定 ,纸片扩散法进行常规药敏试验 ,按照NCCLS的标准判读结果 .结果　对 336株儿童患者感染菌株试验 ,共检测出 81株ES BLs菌株 ,ESBLs总产生率为 2 4 .1% ;其中肺炎克雷伯菌产ESBLs率为 2 9.7% ,大肠埃希菌产ESBLs率为 15 .7% .产ESBLs菌株的耐药率显著高于不产ESBLs菌株 (t=6 .6 0 3,p <0 .0 1) ,对氨苄西林、氨曲南、头孢他定和头孢噻肟耐药 ,对复方新诺明、氨苄西林 /舒巴坦的耐药率也较高 (耐药率高于 6 0 % ) ,且多为多重耐药株 ,对丁胺卡那霉素、诺氟沙星、头孢哌酮 /舒巴坦敏感率较高 (耐药率低于 30 % ) ;所有被测菌株对亚胺培南的耐药率为 0 .结论　儿童感染细菌ESBLs发生率相当高 ,产ESBLs菌株已成为引起医院感染的重要病原菌 ,耐药高且多重耐药情况严重 ,治疗较困难 ,需加强ESBLs检测 ,以合理使用抗生素 ,延缓和防止ESBLs的发生和播散     

产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌遗传标记和耐药基因的研究

目的了解产超广谱β-内酰胺酶（extended spectrum beta-lactamases,ESBLs）大肠埃希菌和肺炎克雷伯菌的遗传标记基因（整合子qacE△1、转座子tnpU）、氨基糖苷类修饰酶编码aac（6′）-Ib基因和喹诺酮类药物耐药qnrA基因分布状况,为临床使用药物治疗感染和消毒灭菌工作提供参考。方法收集本院的产ESBLs大肠埃希菌和肺炎克雷伯菌共60株,采用PCR方法检测这些菌株中qacE△1、tnpU、aac（6′）-Ib和qnrA基因,MIC法药物敏感试验分析菌株的耐药性。结果 60株产ESBLs的大肠埃希菌和肺炎克雷伯菌中qacEΔ1基因检出率61.7%,tnpU基因检出率7.6%,aac（6′）-Ib检出率为11.7%,qnrA基因检出率3.3%。60株菌中有38株含1种或以上基因,其药敏敏感度最高的是亚胺培南、厄它培南、哌拉西林/他唑巴坦,敏感率均为97.4%,而对氨苄西林和头孢唑啉完全耐药。结论产ESBLs大肠埃希菌和肺炎克雷伯菌的耐药与耐药基因传递机制整合子和转座子系统密切相关,分离株携带qacE△1、tnpU、aac（6′）-Ib和qnrA基因是细菌呈多重耐药的主要原因,提示临床应慎重用药。     

儿童产超广谱β-内酰胺酶细菌感染的检测与分析

目的了解儿童感染性疾病中肺炎克雷伯菌和大肠埃希菌感染时产生超广谱β-内酰胺酶(ESBLs)的情况及其耐药特点.方法对202株肺炎克雷伯菌和134株大肠埃希菌应用双纸片协同试验进行ESBLs的测定,纸片扩散法进行常规药敏试验,按照NCCLS的标准判读结果.结果对336株儿童患者感染菌株试验,共检测出81株ESBLs菌株,ESBLs总产生率为24.1%;其中肺炎克雷伯菌产ESBLs率为29.7%,大肠埃希菌产ESBLs率为15.7%.产ESBLs菌株的耐药率显著高于不产ESBLs菌株(t＝6.603,p<0.01),对氨苄西林、氨曲南、头孢他定和头孢噻肟耐药,对复方新诺明、氨苄西林/舒巴坦的耐药率也较高(耐药率高于60%),且多为多重耐药株,对丁胺卡那霉素、诺氟沙星、头孢哌酮/舒巴坦敏感率较高(耐药率低于30%);所有被测菌株对亚胺培南的耐药率为0.结论儿童感染细菌ESBLs发生率相当高,产ESBLs菌株已成为引起医院感染的重要病原菌,耐药高且多重耐药情况严重,治疗较困难,需加强ESBLs检测,以合理使用抗生素,延缓和防止ESBLs的发生和播散.     

艾滋病相关机会性感染病原菌分布及耐药性分析

目的 调查艾滋病相关机会性感染病原菌分布及耐药性,为临床经验性使用抗菌药物提供理论依据.方法 回顾性分析首都医科大学附属北京佑安医院2018年1月至2021年6月期间确诊艾滋病患者的临床资料、病原菌类型及药敏试验结果.结果 共纳入252例艾滋病患者,分离出病原菌381株,其中革兰阴性菌161株(42.26％)、革兰阳性菌87株(22.83％)、真菌76株(19.95％)、分枝杆菌57株(14.96％).排前5位的病原菌为结核分枝杆菌、铜绿假单胞菌、肺炎克雷伯氏菌、新型隐球菌、大肠埃希氏菌.革兰阴性菌以铜绿假单胞菌、肺炎克雷伯氏菌、大肠埃希氏菌为主,非发酵革兰阴性菌占15.00％(57/381).革兰阳性菌以金黄色葡萄球菌、屎肠球菌、粪肠球菌为主.白色念珠菌对氟康唑、伊曲康唑和伏立康唑的耐药率均为21.43％,热带念珠菌对氟康唑、伊曲康唑和伏立康唑的耐药率均为62.50％.大肠埃希氏菌对左氧氟沙星和环丙沙星的耐药率最高,分别为85.19％、81.48％.肺炎克雷伯氏菌、沙门氏菌对氨苄西林的耐药率分别为54.55％、73.33％.肺炎克雷伯氏菌对亚胺培南和美罗培南的耐药率分别为15.15％和21.21％,大肠埃希氏菌对亚胺培南和美罗培南的耐药率分别为14.81％和11.11％.铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为41.67％、25.00％.鲍曼氏不动杆菌对碳青霉烯类的耐药率为50.00％.屎肠球菌对青霉素和氨苄西林的耐药率(86.36％,86.36％)明显高于粪肠球菌(0％,36.36％)(P均<0.01).金黄色葡萄球菌及粪肠球菌普遍对万古霉素和利奈唑胺敏感.不同水平CD4+T淋巴细胞计数之间,菌株耐药率差异有统计学意义(P<0.01).结论 艾滋病患者感染病原菌分布较广,耐药率较高,为避免广谱抗菌药物的长期应用造成细菌耐药,需加强对艾滋病机会性感染病原菌耐药性的动态监测.     

重症监护病房下呼吸道感染的病原菌分布及耐药性分析

目的探讨重症监护病房（ICU）患者下呼吸道感染病原菌的分布及耐药性,为临床防治提供科学依据。方法整理分析我院ICU2003年1月至2007年12月下呼吸道感染患者痰培养的1146株病原菌．采用CLSI推荐的K．B法进行药敏试验。并对其耐药性进行分析。结果分离出的1146株病原菌中。革兰阴性杆菌占64．1％,革兰阳性球菌占28．4％。前5位病原菌依次为金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、洋葱伯克霍尔德菌、肺炎克雷伯菌。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南耐药率分别为37．8％、10．6％,肺炎克雷伯菌、大肠埃希菌产超广谱β内酰胺酶（ESBLs）的检出率分别是68．5％、83．7％,肠杆菌科菌对亚胺培南全部敏感。未检出耐万古霉素的革兰阳性球菌。结论ICU下呼吸道感染以革兰阴性杆菌为主,病原菌耐药性严重。临床治疗应根据药敏试验结果。合理应用抗生素。     

糖尿病合并尿路感染患者致病菌及耐药性分析

目的：探讨糖尿病合并尿路感染患者的常见致病菌,分析其耐药性。方法回顾2012年4月~2014年4月在我院接受治疗的160例糖尿病合并尿路感染患者的临床资料,对患者的尿液进行致病菌鉴定以及药敏实验,分析耐药性。结果160例尿液样本中总共分离出137株病原菌,分离检出率85.6%,其中革兰氏阴性菌检出率为74.5%,革兰氏阳性菌检出率为20.4%,真菌检出率为5.1%;大肠埃希菌对亚胺培南的耐药率最低为3.1%,其次为头孢他啶19.1%,而对阿莫西林、庆大霉素、氧氟沙星、复方新诺明、氨苄西林等耐药性较高,均在50%以上。肺炎克雷伯菌与大肠埃希菌对亚胺培南的耐药性相近,为4.1%,对庆大霉素和头孢他啶的耐药性在50%以下,而对其它药物耐药性均在60%以上。结论糖尿病合并尿路感染中以革兰氏阴性菌为主,耐药性较高,临床中应特别注意抗菌药物的合理使用。     

产超广谱β-内酰胺酶大肠埃希氏菌临床分离株药敏分析

目的了解郑州地区临床分离大肠埃希氏菌产超广谱β-内酰胺酶情况和耐药特征。方法双纸片法筛选及确证实验检测超广谱β-内酰胺酶(ESBLs),琼脂二倍稀释法对大肠埃希氏菌进行MIC检测。结果产ESBLs大肠埃希氏菌检出率为57.4%,产ESBLs菌株多数呈多重耐药,仅亚胺培南的耐药率在10%以下。结论本地区临床分离大肠埃希氏菌具有较高的产ESBLs流行率,对于产ESBLs大肠埃希氏菌应以亚胺培南为首选药物。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.