Synergistic Activity of Trovafloxacin with Other Agents Against Gram-positive and -negative Organisms

The synergistic activity of trovafloxacin with other agents against 55 Gram-positive and -negative bacteria was determined by checkerboard titration. Synergistic fractional inhibitory concentration (FIC) indices (≤0.5) were seen in two methicillin-susceptible and one methicillin-resistant Staphyloccocus aureus with teicoplanin, one of each of the latter two with vancomycin; one methicillin-resistant coagulase-negative Staphylococcus with rifampin and one with fusidic acid; five Stenotrophomonas maltophilia with cefoperazone; three Pseudomonas aeruginosa with ticarcillin/clavulanate, four with aztreonam, two with ceftazidime, one with tobramycin, one with cefoperazone, and one with ceftriaxone; one pneumococcus with ceftriaxone; one Enterococcus faecalis with ceftriaxone, and one with vancomycin; two Bacteroides fragilis with metronidazole, two with clindamycin, and one with cefoxitin; and one Clostridium perfringens with metronidazole and one with clindamycin. All other FIC indices were additive/indifferent (0.51–2.0), and no antagonistic FIC indices (>4.0) were observed.     

Association of diet alone, insulin, sulfonylureas, metformin, and thiazolidinediones with the severity of coronary artery disease in patients with diabetes mellitus

Coronary angiography was performed in 152 men and 163 women with diabetes mellitus, mean age 55 +/- 8 years, because of chest pain. Of 67 patients with 3-vessel or 4-vessel coronary artery disease (CAD), 17 (25%) were treated with diet alone, 29 (43%) with insulin, 18 (27%) with sulfonylureas, 12 (18%) with metformin, and 6 (9%) with thiazolidinediones. Of 76 patients with 2-vessel CAD, 20 (26%) were treated with diet alone, 36 (47%) with insulin, 21 (28%) with sulfonylureas, 21 (28%) with metformin, and 11 (14%) with thiazolidinediones. Of 40 patients with 1-vessel CAD, 15 (38%) were treated with diet alone, 11 (28%) with insulin, 8 (20%) with sulfonylureas, 12 (30%) with metformin, and 4 (10%) with thiazolidinediones. Of 132 patients with 0-vessel CAD, 18 (14%) were treated with diet alone, 21 (16%) with insulin, 7 (5%) with sulfonylureas, 75 (56%) with metformin, and 35 (26%) with thiazolidinediones. Cochran-Armitage trend tests were used to examine whether the use of treatment significantly increases or decreases as the number of arteries with CAD increases (P = 0.036 for diet alone; P < 0.0001 for insulin, for sulfonylureas, and for metformin; P = 0.002 for thiazolidinediones).     

高频彩色多普勒超声在阴囊、睾丸疾病中的诊断价值

目的探讨高频彩色多普勒超声在阴囊、睾丸疾病中的诊断价值。方法对151例经手术及病理证实的阴囊、睾丸疾病声像图和彩色血流进行回顾性分析。结果151例中包括:睾丸肿瘤6例(其中精原细胞瘤3例、胚胎细胞癌1例、畸胎瘤1例、恶性淋巴瘤1例);睾丸囊肿1例;睾丸微石症4例;睾丸炎5例;睾丸结核4例;睾丸扭转5例;睾丸创伤10例;附睾肿块35例(其中附睾囊肿21例、附睾炎性结节11例、附睾结核3例);鞘膜积液39例(其中睾丸鞘膜积液27例、精索鞘膜积液4例、精索睾丸鞘膜积液6例、交通性鞘膜积液2例);隐睾6例(均为腹股沟型);精索静脉曲张36例(其中21例为左侧、7例为右侧、8例为双侧);均经手术及病理证实。结论高频彩色多普勒超声能显示各种阴囊、睾丸疾病的声像图和血供特点,为临床诊断提供了重要价值。     

Reduced level of non-esterified fatty acids in sera from patients with infectious respiratory disease

Sera from 103 fasting individuals 3 to 76 years of age and free of clinical infectious disease and sera from 183 patients with infectious disease were assayed for serum total non-esterfied fatty acids (tNEFA) and compared. Data were also separated into five groups according to age of donor: 3--7, 8--19, 20--35, 36--60, and 61--76 years. The mean group serum levels of tNEFA increased with age. Among patients with infectious diseases sixty-five were diagnosed as having hepatitis, 41 with infectious mononucleosis, 18 with cellulitis, 12 with pulmonary tuberculosis, 11 with non-pneumococcal pneumonia, 9 with pneumococcal pneumonia, 8 with pharyngitis, 6 with pyelonephritis, 6 with aseptic meningitis, 4 with Gram-negative sepsis, and 3 with encephalitis. The sera from 23 non-fasting patients with gonorrhea were also tested. The serum tNEFA levels were found to be altered, in fact depressed from normal group values, only in patients with pneumonia or tuberculosis. This depression may be related to aberrant pulmonary metabolism during pneumonia.     

Surgical Treatment of Supraventricular Tachycardia: A Five-Year Experience

Two hundred and eight patients underwent operative therapy of supraventricular tachycardia between June 1984 and June 1986. There were 196 patients with Wolff-Parkinson-White syndrome, one with AV nodal reentry, two with atrial flutter, one with ectopic atrial tachycardia, three with paroxysmal sinus tachycardia, and five with atrial fibrillation. Map guided or direct surgery was performed in all patients except the three with atrial fibrillation. Direct surgery was generally successful with failures including one patient with Wolff-Parkinson-White syndrome, one with atrial flutter, and the three patients with paroxysmal sinus tachycardia. There was no mortality. Major complications were uncommon and included three resternotomies for bleeding, one chylopericardium. Six patients required reoperation.     

2型糖尿病合并高血压患者胰岛素低抗

The fasting glucose(FBG),TG,CHO,HDL,LDL,ApoA1,ApoB,FIn and insulin sensitiviry index in patients with with type II diabetes mellitus complicated with hypertension were evaluated in the current study.The relationship between hypertension and abnomal level of blood lipid and insulin resistance. 1 Subjects and methods 1.1 Subjects 114 patients with type II diabetes mellitus were selected according to the WHO standards.All the patients were divided into 2 groups,normal blood pressure gr…     

Quality of life of patients with cervicogenic headache: a comparison with control subjects and patients with migraine or tension-type headache

OBJECTIVE: To establish the health-related quality of life of patients with cervicogenic headache and to compare it with a random Dutch sample of control subjects and with patients with migraine without aura or with episodic tension-type headache. METHODS: Thirty-seven patients with cervicogenic headache, 42 patients with episodic tension-type headache, and 39 patients with migraine without aura completed a Medical Outcomes Study 36-Item Short Form questionnaire. RESULTS: Domain scores for "physical functioning" of patients with cervicogenic headache were worse than those of patients with migraine or tension-type headache. Physical functioning scores were lower for patients with tension-type headache than for those with migraine. Migraineurs reported a diminished score for "social functioning" compared to patients with tension-type headache. All Medical Outcomes Study 36-Item Short Form domain scores were significantly lower for patients with cervicogenic headache relative to the control group. CONCLUSIONS: Patients with cervicogenic headache have a quality of life burden that is substantial. Although impairment in the quality of life of patients with cervicogenic headache is comparable to patients with migraine without aura and those with episodic tension-type headache, there are some specific differences.     

Urban/rural differences in health insurance coverage among people with multiple sclerosis

PURPOSE: To present urban/rural analyses of health insurance coverage among people with multiple sclerosis (MS). This research also combined all survey respondents from each urban/rural area into one group of people with MS in health maintenance organizations (HMOs)/managed care and another group of people with MS who have other health insurance plans to compare any differences in coverage. METHODS: We interviewed 1,518 people with MS living in all 50 states. Survey results were analyzed using SPSS. RESULTS: Most people with MS in each urban/rural area had health insurance coverage (92-95%), with significant urban/rural differences observed in HMO/managed care enrollments. We found no urban/rural differences among people with MS in HMOs/managed care, or among people with MS with other health insurance plans, in satisfaction with coverage of routine care and MS-focused care, or with perceptions of how coverage enables utilization of health services. However, we found that people with MS in HMOs/managed care were more satisfied than people with MS with other health insurance with their coverage of routine care and perceived that their coverage enabled greater utilization of routine care and needed medications. CONCLUSIONS: We found no significant differences in satisfaction with MS-focused care or with perceptions of how well coverage enables utilization of MS-focused care or needed assistive devices between people with MS in HMOs/managed care and people with MS who have other health insurance.     

Specificity of commercially available antibodies used for gastrin measurement

We examined the specificity of commercially available antibodies used in measurement of serum gastrin. Antibodies were obtained from five commercial laboratories, and antibody immunoreactivity with gastrin and cross-reactivity with cholecystokinin (CCK) were determined. All antibodies were equally immunoreactive with gastrin, and cross-reactivity of three antibodies with CCK was minimal (less than 5%). In contrast, substantial cross-reactivity with CCK was found with two antibodies. To determine the clinical significance of cross-reactivity with CCK, secretin injection tests were performed in 24 individuals: seven in normal health, four with Zollinger-Ellison syndrome, three with antral gastrin cell hyperfunction, six with ordinary duodenal ulcer disease, and four with atrophic gastritis. Serum gastrin levels were measured with all five gastrin antibodies. The response to secretin was negative in all normal subjects and in those with duodenal ulcer and antral gastrin cell hyperfunction. The response to secretin was positive in all four patients with gastrinoma with use of the five antisera. All four patients with atrophic gastritis had normal responses to secretin when antibodies with minimal CCK cross-reactivity were used; however, two of four had false positive secretin test results when serum gastrin levels were measured with the two antibodies with a high degree of cross-reactivity with CCK. These studies indicate that significant cross-reactivity of gastrin antibodies with CCK can result in false positive secretin injection test results and can lead potentially to the erroneous diagnosis of Zollinger-Ellison syndrome.     

微卫星多态性和多位点序列分析技术在光滑念珠菌基因分型中的应用评估

目的评估微卫星多态性分析技术在临床光滑念珠菌基因分型中的作用。方法收集2011年1月至2012年12月仁济医院和东方医院临床分离的光滑念珠菌59株,采用多位点序列分析(MLST)和微卫星多态性分析技术进行基因分型,比较2种基因分型方法的结果和分辨力。结果 59株光滑念珠菌经MLST分型得到6个序列型,其中ST-7型43株、ST-10型7株、ST-15型和ST-55型各3株、ST-3型2株、ST-43型1株,鉴别力指数(DP)为0.456;经微卫星多态性分析方法分为10型,其中A型25株、B型10株、C型8株、D型6株、E型3株、F型和G型各2株、H~J型各1株,DP为0.770。结论微卫星多态性分析方法简便、快速,分辨力高于MLST技术,可作为实验室基因分型的首选方法。     

Neoplastic vs. traumatic spinal cord injury: an inpatient rehabilitation comparison

OBJECTIVE: To compare demographics, injury characteristics, and functional outcomes of patients with neoplastic spinal cord compression with those with traumatic spinal cord injuries. DESIGN: A prospective 5-yr comparison was undertaken comparing 34 patients with neoplastic spinal cord compression with 159 patients with traumatic spinal cord injury. RESULTS: Patients with neoplastic spinal cord compression were significantly older, more often female, and unemployed than patients with traumatic spinal cord injury. Neoplastic spinal cord compression presented more often with paraplegia involving the thoracic spine, and injuries were more often incomplete compared with traumatic spinal cord injury. Patients with neoplastic spinal cord compression had a significantly shorter rehabilitation length of stay compared with those with traumatic spinal cord injury. The neoplastic group had significantly lower FIM change scores. Both groups had similar FIM efficiencies and discharge to home rates. CONCLUSIONS: Patients with neoplastic spinal cord compression have different demographic and injury characteristics but can achieve comparable rates of functional gains as their traumatic spinal cord injury counterparts. Although patients with traumatic injuries achieve greater functional improvement, patients with neoplasms have a shorter rehabilitation length of stay and comparable FIM efficiencies and home discharge rates.     

Childhood Epilepsy: Child Adaptation and Family Resources

The purpose of the study was to (a) compare children with epilepsy and children with asthma in regard to psychosocial adaptation and family characteristics; and (b) compare family characteristics for children with epilepsy with good and poor psychosocial adaptation. Subjects were 111 children (54 with epilepsy and 57 with asthma) and their mothers. Children with epilepsy were found to have significantly lower self-concepts, more behavior problems at school, and more depression than children with asthma. In the epilepsy sample, family resources and adaptation were significantly lower for children with poor psychosocial adaptation when compared with children with good psychosocial adaptation.     

老年人房颤与NT-ProBNP、左房大小的关系及抗凝现状分析

目的观察老年人房颤与N-末端脑钠肽前体(NT-proBNP)及左房大小的关系,并分析其抗凝现状。方法对120例老年房颤患者的临床资料进行回顾性分析,包括初发、阵发、持续性、持久性、长期持续性房颤患者的NT-proBNP水平、左房内径和抗凝方法。结果 120例老年房颤患者中,初诊房颤占15.0%,阵发性房颤占30.0%,持续性房颤、持久性房颤、长期持续性房颤占55.0%。使用华法林抗凝治疗占41%,房颤发生脑栓塞占9.1%。持续性房颤、持久性房颤、长期持续性老年房颤的患者NT-proBNP明显高于阵发性、初诊房颤患者,其左房内径明显大于阵发性、初诊房颤患者的左房内径。抗凝治疗中华法林组栓塞事件发生率(2.08%)低于阿司匹林组(13.89%),而两组出血事件发生率无显著差异。结论持续性房颤、永久性房颤、长期持续性房颤在老年患者中占主导地位。房颤时间越长,左房内径越大,NT-proBNP也越高。华法林抗凝效果优于阿司匹林,且获益超过出血风险。     

Autonomic neuropathy and chronic liver disease

Autonomic neuropathy has been reported in association with alcoholic cirrhosis but there is no information on its occurrence in non-alcoholic liver disease. We have examined autonomic function in 64 patients with biopsy-proven liver disease (22 with alcoholic liver disease and 42 with non-alcoholic liver disease) together with 29 age-matched controls. Forty-five per cent of patients with alcoholic liver disease and 43 per cent with non-alcoholic liver disease showed evidence of parasympathetic damage; 11 per cent of patients with alcoholic liver disease and 12 per cent with non-alcoholic liver disease had sympathetic damage. Forty-five per cent of patients with alcoholic liver disease and 22 per cent with non-alcoholic liver disease had peripheral neuropathy on clinical examination. Sixty-eight per cent of those with peripheral neuropathy also had autonomic neuropathy. This study confirms that autonomic neuropathy is common in alcoholic patients but the fact that it is found with comparable frequency in non-alcoholic liver disease suggests that the neurological defect may be secondary to the disturbed liver function. The implications of these observations with regard to prognosis of chronic liver disease are discussed.     

Synergy with cefsulodin or piperacillin and three aminoglycosides or aztreonam against aminoglycoside resistant strains of Pseudomonas aeruginosa

Fifty-one strains of Pseudomonas aeruginosa, with resistance to one or more amino-glycosides, were tested for synergy with cefsulodin or piperacillin plus amikacin, tobramycin, gentamicin or aztreonam by the agar dilution technique. Cefsulodin plus any one of the three aminoglycosides regardless of the degree of resistance to the aminoglycoside was synergistic against P. aeruginosa for two thirds of the isolates. In contrast, synergy rates with piperacillin were much less uniform. The highest rate of synergy with piperacillin (90.0%) was observed with gentamicin for the gentamicin resistant strains. The lowest rate of synergy was observed with piperacillin plus amikacin (32.2%) for isolates with moderate resistance to amikacin. Synergy for strains with moderate resistance to amikacin was observed more commonly with cefsulodin than with piperacillin. Synergy for strains with a known mechanism of resistance to amikacin was more common with cefsulodin regardless of the mechanism of resistance. Cefsulodin or piperacillin in combination with aztreonam was rarely synergistic (less than 12%).     

机械通气时人机对抗的原因分析及防治策略

目的探讨机械通气患者发生人机对抗的原因和防治对策。方法对在机械通气过程中出现人机对抗78例患者的临床资料进行回顾性分析。结果78例发生人机对抗的机械通气患者中,其发生原因包括：气道阻塞27例,不能耐受插管16例,分钟通气量不足9例,支气管痉挛7例,持续高热4例,急性肺水肿4例,单肺通气3例,抽搐、肌肉痉挛3例,管道漏气2例,呼吸机故障2例,气胸1例。结论人机对抗的发生均有其诱发因素。气道阻塞、不能耐受插管、潮气量不足、支气管痉挛等是主要原因。加强气道管理、设置合适的通气模式和（或）参数、解除气道痉挛、祛除诱因等综合有效防治措施,可避免和减少人机对抗的发生。     

孤独症、肢体残疾、智力残疾儿童家庭经济负担调查

目的评估孤独症、肢体残疾和智力残疾儿童的家庭经济负担。方法对此三类残疾儿童和普通儿童家长(共227名)以访谈的形式进行关于家庭经济负担的调查。结果残疾儿童的医疗支出、看护支出明显多于普通儿童,而教育支出、衣着支出、游乐支出明显少于普通儿童。儿童家庭人均收入仅受父母文化程度影响。除孤独症儿童外,肢体残疾、智力残疾儿童的家庭经济援助明显多于普通儿童。家庭儿童个数越多,经济援助越少。与普通儿童相比,三类残疾儿童的抚养负担依次为：孤独症儿童(19582.4元/年)、肢体残疾儿童(16410.1元/年)、智力残疾儿童(6391.0元/年)。结论相比普通儿童,肢体残疾、智力残疾和孤独症儿童的家庭有着较大的经济负担。     

剖宫产瘢痕部位妊娠的治疗方法探讨

目的探讨剖宫产瘢痕部位妊娠(CSP)发生的高危因素及治疗方法。方法回顾性分析78例CSP患者的临床资料,分析各种治疗方案。结果甲氨蝶呤治疗11例;米非司酮联合甲氨蝶呤治疗4例;米非司酮治疗4例;子宫动脉栓塞术的综合治疗40例;药物预处理后予以清宫术5例;直接清宫术1例;经腹疤痕处妊娠物祛除术7例;全子宫切除术1例;其他5例。结论 CSP的治疗应根据患者具体情况个体化治疗。介入+清宫术治疗是一种较安全、有效的方法,术中出血少,术后住院时间短,值得临床推广。     

MRI评价胎儿胼胝体缺如及其合并畸形

目的 利用MRI评价胎儿胼胝体缺如及其合并畸形。方法 对81胎MRI诊断胼胝体缺如胎儿，分析胼胝体缺如类型，观察其合并颅脑畸形类型及数目。结果 81胎中，单纯胼胝体缺如47胎、合并畸形34胎；合并蛛网膜囊肿12胎，Dandy-Walker畸形7胎，小脑发育不良5胎，神经元移行异常5胎，大枕大池4胎，室管膜下囊肿4胎，脑实质出血2胎，脑裂畸形、脑穿通畸形及脑膜膨出各1胎。结论 MRI可显示胼胝体缺如胎儿及其合并其他颅脑畸形，为评估胎儿预后提供更多信息。     

冠心病患者血浆TF、TFPI水平的变化及其临床意义

目的　观察冠心病患者血浆组织因子 (TF)、组织因子途径抑制物 (TFPI)水平的变化及其临床意义。方法　 79例临床确诊的冠心病患者 ,其中急性心肌梗死 (AMI组 ) 32例、不稳定型心绞痛 (UAP组 ) 2 7例、稳定型心绞痛 (SAP组 ) 2 0例 ,15例健康对照组作为对照组。采用发色底物法测定血浆TF、TFPI活性。结果　与对照组、SAP组比较 ,AMI组血浆TF、TFPI显著增高 ,三组差异具有显著性意义 (P<0 0 5 ) ;AMI组血浆TF活性与UAP组比较差异无统计学意义 (P >0 0 5 ) ,但TFPI活性较UAP组明显升高 ,两者差异具有显著性意义 (P <0 0 5 )。UAP组血浆TF活性较健康对照组及SAP组明显升高 ,三组间差异具有显著性意义 (P <0 0 5 ) ,UAP组血浆TFPI活性较健康对照组及SAP组差异无统计学意义 (P >0 0 5 ) ;SAP组血浆TF、TFPI活性较健康对照组差异无统计学意义 (P >0 0 5 )。结论　 (1)AMI、UAP患者存在异常激活的高凝状态 ,TF触发的外源性凝血途径在冠脉内血栓形成上发挥重要作用。 (2 )AMI、UAP患者体内TF、TFPI系统存在严重失衡