利奈唑胺体外诱导粪肠球菌中介耐药及机制研究

目的 研究利奈唑胺对粪肠球菌中介耐药的体外诱导作用并探讨其耐药机制.方法 采用多步诱导法对4株临床分离粪肠球菌以及质控菌株进行体外诱导耐药试验,采用琼脂平皿二倍稀释法测定诱导前后的MIC值,采用PCR测序法检测粪肠球菌4个23S rRNA V区基因的变异.结果 4株临床分离粪肠球菌和质控菌株均诱导出中介株和稳定耐药株,在中介株和耐药株中均检测到了G2576U、G2505A和C2424U变异,2株中介株和耐药株还同时存在G2576U和C2424U变异.结论 利奈唑胺可体外诱导粪肠球菌产生中介株和稳定性耐药株,粪肠球菌中介株即可出现23S rRNA V区基因变异.     

细菌直接PCR和双引物策略鉴定16S rRNA基因技术的建立

目的探索一种基于16S rRNA基因的快速鉴定细菌方法,为临床诊断治疗及耐药菌的分子遗传分析提供科学依据。方法对卫生部室间质评菌株和临床病人标本分离培养纯菌落,用双蒸水稀释菌落,然后直接以菌液为模板优化反应体系PCR扩增16S rRNA基因片段,再测序扩增片段。将测序结果在细菌Ribosomal数据库中进行同源性比对,根据序列同源性鉴定病原细菌。结果本实验鉴定的卫生部质评菌株结果与卫生部报告结果一致。本实验能够一次性鉴定出临床病人标本分离的菌株。结论本研究优化了一种免纯化细菌核酸直接PCR鉴定细菌16S rRNA基因的方法。本研究建立的基于病原细菌16S rRNA基因鉴定方法可用于细菌的快速诊断。     

粪肠球菌对10种抗生素的耐药分析

肠球菌是人、动物肠道的正常菌群 ,异位寄生时可引起败血症、尿路感染、呼吸道感染、心内膜炎等。其对抗生素有天然耐力。近几年由于广谱抗生素的大量使用 ,使肠球菌的感染发生率及耐药菌株日益增多。所以对其耐药性的监测分析成为重点工作之一。粪肠球菌是肠球菌属中的主要成员占90 %。本文对我院 1996— 1998年临床分离的 6 2株粪肠球菌对 10种抗生素的耐药性进行了分析 ,现报告如下。1　材料和方法1.1菌株　来自我院临床分离的 6 2株粪肠球菌。用常规法鉴定部分菌株采用ＡＰＩ系统。痰标本分离 2 2株 ,尿分离 15株 ,创面感染 15株 ,胆汁 …     

致病性粪肠球菌YN771的分离鉴定及其生物学特性

目的从临床再治疗根管中分离出致病性粪肠球菌,鉴定种属并分析研究其生物学特性。方法通过稀释涂布平板阀对细菌进行分离,对致病菌进行革兰氏染色、透射电镜观察、16S rRNA基因序列分析、同源系统发育进化的构建和生物学特性研究。结果分离得到一株G+菌,菌体圆形或椭圆形,链状排列,直径0.9～1.1μm。经16S rRNA基因测序分析初步鉴定为粪肠球菌的菌株,命名为Enterococcus faecalis YN771。该菌的最适生长条件为:BHI培养基,37℃,pH 7,在此条件下代时约18 min耐药性实验表明该菌对克林霉素耐药、奎奴普丁药敏性不高,而对青霉素G等10种抗生素敏感。结论成功分离鉴定一株致病性粪肠球菌YN771并开展其生物学特性研究,为临床治疗难治性根尖周炎提供研究材料。     

40株肠球菌应用两种仪器鉴定结果的比较研究

目的 比较VITEK-32与VITEK 2 compact两种仪器对肠球菌鉴定的准确性.方法 分别应用VITEK-32与VITEK 2 compact 对40株临床标本分离的肠球菌同时鉴定,用多重PCR技术对鉴定结果有差异的菌株进行种的检测并对产物测序.结果 40株肠球菌中,32株用两种仪器鉴定结果完全相同,86株鉴定结果不一致.8株菌的PCR产物测序结果与GenBank中的屎肠球菌比较有97%～98%同源性,与VITEK2 compact鉴定结果完全相同.结论 VITEK 2 compact鉴定屎肠球菌的准确性优于VITEK-32.     

肠球菌的感染特征及耐药现状调查

目的 了解肠球菌的感染特征及对常用抗生素的耐药情况。方法 所试验菌株均按操作规程分离鉴定，部分采用API系统鉴定，以K-B法行药物敏感试验。以金黄色葡萄球菌标准菌株ATCC25923作为质控菌株。结果 329株肠球菌从尿中分离出226株，肺部和伤口感染分别为52株和32株，其他标本为12株，其中粪肠菌占78.6%，屎肠球菌占19.7%。结论 肠球菌的感染以泌尿系为主。女性感染率高于男性。临床应根据感染的特征及菌株的耐药特点采取合理的治疗方案。     

16S rRNA基因序列分析鉴定非典型细菌的实验研究

目的建立以16S rRNA基因序列分析为基础的细菌鉴定方法,并初步将其应用于临床常规细菌的鉴定。方法选择临床微生物实验室不能准确鉴定的细菌,以16S rRNA为靶序列,在两端保守区设计引物,PCR反应扩增目的片段,测序后与数据库中已知细菌的16S rRNA序列进行序列比对。结果 13株菌中,有11株与数据库中的已知16S rRNA序列相似性达99.0%以上,成功鉴定到种的水平。结论 16S rRNA基因序列分析的方法可快速、准确地鉴定不典型菌株,可作为细菌常规鉴定的补充方法。     

102株肠球菌的鉴定及药敏分析

收集临床标本中分离的肠球菌102株,按肠球菌属新的分类方法重复鉴定。其中粪肠球菌76株(74.5%),屎肠球菌10株(9.8%),孤立肠球菌6株(5.9%),坚忍肠球菌3株(2.9%),鸟肠球菌2株(2.0%)。并对常用10种抗生素作药敏试验,讨论了种别与标本的来源,医原性感染及药敏的关系。     

肠球菌的临床感染种类及耐药性分析

目的探讨引起医院感染常见肠球菌种类及其耐药特点,为临床感染性疾病提供病原学诊断和合理使用抗菌药物的依据。方法采集2002-3005年门诊及住院患者标本,分离培养出肠球菌161株;采用血平板培养,法国梅里埃公司的API 20 sTREP鉴定系统及VITEK 32鉴定仪进行菌株鉴定。采用K- B法进行细菌的药敏试验。结果161株肠球菌中粪肠球菌132株(82％),屎肠球菌16株(9．9％),鸡肠球菌10株(6．2％),其他肠球菌3株(1．9％)。对临床常用抗菌药物均有较高的耐药率。并出现耐万古霉素肠球菌(VRE)及高水平氨基糖苷类抗菌药物耐药的肠球菌菌株(HLAR)。结论目前引起我院患者肠球菌感染的仍以粪肠球菌为主,其次是屎肠球菌及鸡肠球菌;这些肠球菌对红霉素、苯唑西林、复方新诺明、四环素、克林霉素、庆大霉素、氯霉素产生了较强的耐药性。     

652株肠球菌的分布及其耐药性分析

目的 了解临床标本分离的肠球菌菌群分布及其耐药性情况。方法 用Vitek-AMS-60全自动细菌鉴定仪对肠球菌进行鉴定，用K-B法进行药敏试验。结果 652株肠球菌中粪肠球菌占81．7％，屎肠球菌占15．5％，其它肠球菌占2．8％；肠球菌的检出率以胆道最高(22．6％)，呼吸系统次之(19．2％)，泌尿系统为15．8％。肠球菌对抗生素的敏感率以替考拉宁最高(99．2％)，其次为万古霉素(98．9％)，屎肠球菌的耐药性明显高于粪肠球菌。结论 肠球菌以引起胆道系统感染最常见，对常用抗生素的敏感性以替考拉宁最高，其次为万古霉素。庆大霉素高水平耐药菌株(HLAR)耐药率明显高于低耐株。     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.