儿科下呼吸道感染铜绿假单胞菌的耐药性分析

目的：比较分析2012年和2013年儿科下呼吸道感染铜绿假单胞菌的耐药性,为I晦床合理应用抗菌药物提供科学依据。方法：对本院2012年和2013年儿科下呼吸道标本中分离的铜绿假单胞菌进行比较分析,用VITEK2微生物分析系统进行病原菌鉴定和药敏分析。结果：儿科下呼吸道标本共分离出82株铜绿假单胞菌,其中2012年分离出35株,多重耐药铜绿假单胞菌检出率为2．9％;2013年分离出47株,多重耐药铜绿假单胞菌检出率为4．3％。2013年儿科下呼吸道感染铜绿假单胞菌对环丙沙星、环丙沙星和氨曲南等8种抗菌药物的耐药率高于2012年,其耐药率均低于10％。结论：2013年儿科下呼吸道标本分离的铜绿假单胞菌对常用8种抗菌药物耐药率高于2012年,应用抗菌药物治疗儿科下呼吸道感染时,临床医师在经验用药后应根据致病菌的耐药特点和药敏结果,合理选用抗菌药物,从而有效控制和减缓细菌耐药性的发生。     

延边大学附属医院2010～2012年铜绿假单胞菌感染分布及耐药性分析

目的 了解铜绿假单胞菌临床感染现状及其耐药性情况. 方法采用phonix-100对395株铜绿假单胞菌进行鉴定,用纸片扩散法进行药敏试验. 结果共分离出395株铜绿假单胞菌,标本来源以痰为主;科室分布主要分布在重症监护病房、呼吸内科和骨科;铜绿假单胞菌对亚胺培南、美洛培南、阿米卡星耐药率＜10%. 结论不同标本来源的铜绿假单胞菌耐药性不同,应根据药敏试验结果合理选择抗菌药物.     

铜绿假单胞菌对18种抗菌药物的耐药性变迁

目的调查铜绿假单胞菌的临床分布及耐药性变迁,为临床合理选用抗菌药物提供依据。方法采用VITEK-32全自动微生物鉴定系统鉴定细菌,参照美国临床和实验室标准化协会推荐的方法,应用K-B法进行药物敏感(药敏)试验,用WHONET 5.4软件分析铜绿假单胞菌的耐药性。结果 382株铜绿假单胞菌主要分布在重症监护病房(36.9%),标本主要来自痰液标本(69.9%);药敏试验结果显示:铜绿假单胞菌对18种临床常用抗菌药物的耐药率呈逐年上升的趋势;耐药率<30.0%的抗菌药物有多黏菌素E、环丙沙星、左氧氟沙星、亚胺培南、美罗培南、头孢曲松和头孢他啶;耐药率>50.0%的有庆大霉素、替卡西林、氨苄西林和复方新诺明。结论铜绿假单胞菌耐药性比较严重,应对其加强耐药性监测,根据药敏试验结果合理谨慎地使用抗菌药物。     

82株铜绿假单胞菌的分布及耐药性分析

目的 回顾分析82株铜绿假单胞菌的临床分布和对12种常用抗菌药物的耐药情况,从而更好地指导临床合理使用抗菌药物.方法 对2006年1月至2007年12月住院病人标本进行常规细菌培养及分离鉴定,对分离出的82株铜绿假单胞菌采用KB纸片扩散法进行药敏试验,并进行临床分布分析和耐药性分析.药敏结果的判定依据美国国家临床实验室标准化委员会(NCCLS)标准.结果 铜绿假单胞菌导致感染的主要部位为呼吸道,其次为伤口及手术切口.临床科室分布显示主要分布于神经内科、ICU和呼吸内科.病种分布显示主要为心脑血管疾病和肺部疾病.药敏结果显示,对铜绿假单胞菌耐药率最高的抗菌药物为复方新诺明,其次为头孢哌酮、庆大霉素、左氧氟沙星,耐药率小于20%的抗菌药物有亚胺培南、哌拉西林/他唑巴坦、阿米卡星、头孢哌酮/舒巴坦.结论 铜绿假单胞菌在医院内分布广泛,易导致呼吸道等部位感染,并且对多种抗菌药物表现出耐药性,需要加强对铜绿假单胞菌的耐药性监测,加强相关科室的消毒隔离,根据药敏试验结果选用抗菌药物,控制耐药菌株产生.     

分离铜绿假单胞菌耐药性及相关耐药基因分析

目的了解铜绿假单胞菌（PAE）的分布和耐药情况,为临床合理选用抗菌药物治疗提供参考依据。方法用ATBPSE-5药敏实验进行抗茵药物的耐药情况进行分析。结果 132株铜绿假单胞菌主要分离于呼吸道标本（痰及咽拭子）;耐药率最高为替卡西林,对阿米卡星耐药率最低,多重耐药菌株共27株,占20.4%。结论了解铜绿假单胞菌的耐药性分布及耐药相关基因分析意义重大。临床医生应根据药敏结果合理使用抗菌药物,减缓耐药菌株的产生。     

临床感染铜绿假单胞菌的分布及耐药性分析

目的 分析铜绿假单胞菌的临床分布及耐药谱的变迁,为临床合理选用抗菌药物提供指导依据.方法 应用ATB细菌鉴定药敏系统鉴定细菌,K-B法做体外药敏试验,统计分析医院2008-2009年铜绿假单胞菌的检出率和耐药情况.结果 244株铜绿假单胞菌主要分布在重症监护病房(ICU), 来自痰标本的有192株(占78.7%),两年的分离率有逐年增加的趋势,对抗生素的耐药性也有 逐年上升的趋势.结论 铜绿假单胞菌是临床感染的主要病原菌之一,应对其加强耐药性监测,合理使用抗菌药物.     

铜绿假单胞菌临床分布及耐药性分析

目的:探讨医院临床分离的铜绿假单胞菌感染的分布及对抗菌药物的耐药情况,为临床医师合理用药提供科学依据。方法:327株铜绿假单胞菌分离、鉴定严格按照《全国临床检验操作规程》进行;药敏试验采用K-B法,按照CLSI规定标准进行判断。结果:铜绿假单胞菌在临床科室中ICU检出率最高,占39.1%;临床标本中痰液检出率最高,达65.7%;铜绿假单胞菌对常用抗菌药物有较高的耐药性,耐药率较低的是亚胺培南、美罗培南和头孢哌酮/舒巴坦,耐药率分别为19.3%、19.0%和19.9%。结论:应加强医院感染管理,重视感染性疾病的病原学检查,根据药敏试验合理使用抗菌药物。     

重症监护病房铜绿假单胞菌的耐药性分析

目的 了解重症监护病房铜绿假单胞菌的耐药情况,为临床合理用药提供实验室依据.方法 对本院2008年7月～2009年10月各重症监护病房各类送检标本常规进行病原菌培养、鉴定和药敏试验,统计分析铜绿假单胞菌的临床分离株的标本分布及耐药情况.结果 从临床送检的各类标本中分离出铜绿假单胞菌101株,其中痰标本65株,占64.3%,该菌对氨苄西林的耐药率最高(98%),对多粘菌素E的耐药率最低(8.9%),其次对美罗培南的耐药率较低(33.7%),对于其它的抗菌药物均呈现不同程度的耐药.结论 重症监护病房铜绿假单胞菌的感染率很高,其耐药性严重,临床应根据药敏结果合理用药.     

多重耐药铜绿假单胞菌医院感染分布及耐药性分析

目的：分析多重耐药铜绿假单胞菌临床感染分布及多重耐药特征,为临床合理选用抗菌药物提供依据。方法回顾性分析2008年8月-2013年9月我院检验科分离的140株铜绿假单胞菌的分布情况及药敏结果。结果140株铜绿假单胞菌株中痰液分离率最高,为94株占67.14%;耐药菌株主要集中在ICU、呼吸科,分别占35.00%和22.14%;铜绿假单胞菌对环丙沙星耐药率最高,为45.00%,对美罗培南和亚胺培南的耐药率均为7.86%。结论铜绿假单胞菌耐药性较强,临床应根据药敏试验选择合适的抗菌药物,以减少耐药菌株的产生和传播。     

ICU铜绿假单胞菌感染与耐药性分析

目的 分析ICU铜绿假单胞菌感染与耐药情况,为临床预防医院感染以及合理应用抗生素提供依据.方法 收集2009年1月～2010年12月医院ICU收治的患者痰标本,监测出20株铜绿假单胞菌,采用K-B纸片扩散法对临床标本监测的铜绿假单胞菌进行抗菌药物敏感性测定,对检测结果进行对比统计分析;采用微量生化反应管鉴定系统鉴定菌种.结果 铜绿假单胞菌所致的呼吸道感染是医院感染的重要途径,其对抗菌药物表现为多药耐药性;敏感率最高的抗菌药物是环丙沙星(9090%),其次是头孢哌酮/舒巴坦(8421%);而耐药率最高的是头孢西丁(100%),其次是亚胺培南(80%).结论 通过健全医院消毒隔离制度、无菌操作规程,药敏试验结果合理选用抗菌药物以及医务人员观念的转变和行为改变,对遏制铜绿假单胞菌耐药率的攀升和提高治愈率有重要意义.     

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.     

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.     

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.