厄他培南治疗老年社区获得性肺炎的疗效观察

目的比较厄他培南与莫西沙星治疗老年社区获得性肺炎的有效性和安全性。方法 80例老年(≥65岁)社区获得性肺炎患者随机分为两组,治疗组给予厄他培南注射液(商品名怡万之,默沙东公司),每次1g,每日一次静脉滴注,总疗程5天;对照组给予莫西沙星(商品名拜复乐,拜尔公司)注射液400mg/250ml静脉滴注,每日一次,总疗程5天。进行治疗前后两组间的疗效比较。结果厄他培南组40例,治疗有效率为90.0%,细菌清除率为83.3%;莫西沙星组40例,治疗有效率为81.7%,细菌清除率为72.1%;两组间差异有显著性;两组均无不良反应发生,差异无统计学意义。结论厄他培南相比莫西沙星能更好地改善临床症状,厄他培南治疗老年社区获得性肺炎疗效良好,安全性高,不良反应较少,是治疗老年社区获得性肺炎的理想药物。     

头胞克肟颗粒治疗儿童社区获得性细菌性肺炎疗效观察

84例社区获得性肺炎患儿随机分为两组,治疗组39例口服头孢克肟颗粒每次1.5～3.0mg/kg,2次/d;对照组45例给予阿莫西林/克拉维酸30mg/kg静脉滴注,2次/d.两组疗程均为5～10d.结果 治疗组总有效率87.2%,总治疗时间(8.3±1.4)d,不良反应发生率5.1%;对照组总有效率80.0%,总治疗时间(7.9±1.1)d,不良反应发生率8.9%.两组比较差异均无统计学意义(P均>0.05).认为头孢克肟颗粒治疗儿童社区获得性细菌性肺炎安全、有效,且患儿用药依从性好,费用低.     

头孢吡肟治疗社区获得性肺炎的临床疗效分析

目的探讨头孢吡肟治疗社区获得性肺炎的的临床效果及安全性。方法对2007年12月至2009年6月新疆医科大学第五附属医院综合内科收治60例患者采用单盲、随机对照试验研究。将60例随机分为头孢吡肟治疗组(31例)及莫西沙星对照组(29例);所有研究均以7～10d为一个疗程。观察治疗组与对照组的临床疗效、不良反应。结果治疗组和对照组的临床有效率分别为90.3%和58.6%,不良反应发生率头孢吡肟高于莫西沙星(25.8%对24.1%),差异无统计学意义(P0.05),主要不良反应为消化道症状及头痛。结论头孢吡肟是治疗社区获得性肺炎安全有效的药物。     

头孢吡肟致尿毒症维持性血液透析患者抗生素脑病的临床分析

目的 分析不同剂量头孢吡肟对尿毒症维持性血液透析患者引起抗生素脑病的发生率并探讨可能的作用机制.方法 对103例尿毒症并行维持性血液透析治疗患者在使用头孢吡肟治疗时出现的神经精神异常的情况进行分析,探讨其与头孢吡肟剂量的关系及可能的发生机制.将103例患者按照头孢吡肟使用剂量分为3组,A组31例,剂量为每次0.5g,每天2次;B组37例,剂量为每次1.0g,每天2次;C组35例,剂量为每次2.0g,每天2次.其引起抗生素脑病的发生率分别为3.26％、18.92％和40.00％,总发生率为21.36％.结果 3组抗生素脑病的发生率随抗生素使用剂量的增加而增加,3组间发生率比较差异有统计学意义(P＜0.05).总发生率明显高于正常人群,差异具有统计学意义(P＜0.01).结论 头孢吡肟对尿毒症患者有着高于一般人群的致抗生素脑病危险性,其发生率随着使用剂量的增加而增加.     

头孢他啶及头孢吡肟对产超广谱β内酰胺酶肺炎克雷伯菌大鼠肺炎的治疗作用

目的评价头孢他啶及头孢吡肟对产超广谱β内酰胺酶(ESBL)肺炎克雷伯菌大鼠肺炎的治疗效果。方法选取产ESBL肺炎克雷伯菌3种菌株,建立3组大鼠肺炎模型(kpn1、kpn2、kpn3组)。3种菌体外试验对头孢噻肟耐药,对哌拉西林/他唑巴坦敏感,对头孢他啶、头孢吡肟为:1组均敏感;2组头孢他啶敏感,头孢吡肟耐药;3组头孢吡肟敏感,头孢他啶耐药。每组分5个治疗亚组(头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、头孢噻肟、生理盐水对照亚组),治疗96h后进行评价。结果kpn1组:哌拉西林/他唑巴坦、头孢他啶、头孢吡肟亚组生存率(75.0%、76.9%、80.0%)明显高于头孢噻肟、生理盐水对照亚组(36.0%、32.0%),前3组肺组织匀浆活菌计数[(10.8±2.8)、(11.1±3.2)、(11.0±3.7)lgCFU/g]明显低于头孢噻肟、生理盐水对照亚组[(15.7±5.6)、(16.0±5.5)lgCFU/g]。kpn2组:哌拉西林/他唑巴坦、头孢他啶亚组生存率(79.2%、73.1%)明显高于头孢噻肟、生理盐水对照亚组(42.3%、33.3%),前2组肺组织匀浆活菌计数[(10.7±2.3)、(11.0±2.7)lgCFU/g]明显低于头孢噻肟、生理盐水对照亚组[(15.5±5.4)、(15.8±4.6)lgCFU/g]。kpn3组:哌拉西林/他唑巴坦、头孢吡肟亚组生存率(80.8%、75.0%)明显高于头孢噻肟、生理盐水对照亚组(37.5%、34.6%)。结论体外敏感的头孢他啶、头孢吡肟治疗产ESBL肺炎克雷伯菌大鼠肺炎,可提高生存率,降低肺组织lgCFU/g,与哌拉西林/他唑巴坦作用相当。     

头孢他啶与头孢吡肟作为血液肿瘤感染的经验治疗的回顾性比较

目的 回顾性比较头孢他啶＋丁胺卡那与头孢吡肟＋丁胺卡那作为经验性方案治疗血液肿瘤合并感染的疗效，并初步对预后因素进行评价。方法 2002年1月-2004年12月接受头孢他啶＋丁胺卡那及头孢吡肟＋丁胺卡那的患者各80例入选研究，治疗方法为头孢他啶4g／d或头孢吡肟4g／d，丁胺卡那0．6g／d，静脉点滴。结果在入选的160例感染事件中，98例（61．3％）临床改善，62例（38．8％）临床无改善，其中15例死亡（9．4％）。头孢吡肟组53例（66．3％）获得临床改善。27例（33．8％）未获临床改善，其中8例（10．0％）死亡；头孢他啶组45例（56．3％）获得改善，两组比较差异无显著性。结论 年龄、肿瘤状态及粒细胞缺乏症（简称粒缺）发生明显与感染的预后有关，在粒缺患者中，粒缺持续天数（是否长于10天）也与预后有关。     

儿科重症监护病房先天性心脏病术后肺炎克雷伯杆菌感染临床特点及药敏分析

目的探讨儿科重症监护病房先天性心脏病术后肺炎克雷伯杆菌(Klebsiella pneumoniae,KP)-呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的临床特点及细菌耐药性分析。方法总结广东省人民医院儿科重症监护病房2014年1月至2015年12月先天性心脏病术后确诊KP-VAP患儿31例的临床资料及药物敏感试验结果。结果 2014年1月至2015年12月医院获得性肺炎患儿432例,先天性心脏病术后KP-VAP患儿31例(7.1%)。敏感抗生素分别为亚胺培南(泰能)(100.0%),头孢替坦(100.0%),厄它培南(100.0%),阿米卡星(100.0%),哌拉西林/他唑巴坦(87.2%),左氧氟沙星(87.2%),环丙沙星(87.2%);前5位耐药抗生素分别为氨苄西林(100.0%),氨苄西林/舒巴坦(84.0%),头孢曲松(80.7%),头孢唑啉(70.9%),呋喃妥因(58.1%),复方新诺明(51.6%)。结论先天性心脏病术后KP-VAP感染,在4个月龄以下婴儿感染率相对较高;经验性治疗可选用亚胺培南、厄它培南、哌拉西林/他唑巴坦、阿米卡星。     

阿奇霉素联合头孢曲松治疗门诊社区获得性肺炎的疗效观察

目的探讨降低门诊社区获得性肺炎(CAP)初始治疗失败率的方法。方法将582例门诊CAP患者按照指南分别给予青霉素,头孢唑啉,阿奇霉素,左氧氟沙星及头孢曲松联合阿奇霉素治疗。结果单药治疗组与联合治疗组的总有效率分别为62%~69%和78%,有显著性差异(P0.05)。结论阿齐霉素联用头孢曲松可降低门诊社区获得性肺炎(CAP)初始治疗失败率。     

阿奇霉素治疗儿童社区获得性细菌性肺炎临床观察

目的 观察阿奇霉素治疗轻、中度儿童社区获得性细菌性肺炎的疗效和安全性.方法 74例社区获得性肺炎患儿随机分为两组,治疗组34例口服阿奇霉素每日5 mg/kg,1次/d;连续5～7 d;对照组40例予阿莫西林/克拉维酸30 mg/kg静脉滴注,2次/d,连续应用5～7 d.结果 治疗组总有效率为85.3%,对照组总有效率80.0%,两组总有效率比较差异无统计学意义(χ2=0.36,P>0.05).结论 阿奇霉素是治疗社区获得性细菌性肺炎安全、有效的药物.     

头孢吡肟与头孢他啶随机对照治疗细菌性感染129例

目的 评价头孢吡肟治疗细菌性感染的疗效和安全性。方法 以头孢他啶为对照药,在下呼吸道感染,腹腔,胆道感染,败血症中进行随机对照观察。给药方案为头孢吡肟每次２ｇ,２次／ｄ,头孢他啶每次２ｇ,３闪／ｄ;治疗尿路感染头孢吡肟每次１ｇ,２次／ｄ,头孢他啶每头１ｇ,３闪／ｄ;均为静脉滴注,疗程均为７－１４ｄ。结果 头孢吡肟组６５例,头孢他啶组６４例。头孢吡肟组和头孢他啶组有效率分别为９２．３％及９０．６％,     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.