莫西沙星治疗支原体肺炎疗效观察

目的评价莫西沙星治疗支原体肺炎的临床疗效。方法在莫西沙星与阿奇霉素联合头孢曲松治疗社区获得性肺炎的随机对照临床研究中,对两组中诊断为支原体肺炎病例的疗效作对照分析。结果莫西沙星组和对照组有效率分别为96．4％、90．0%,细菌清除率分别为6／7和5／5,两组比较差异无统计学意义（P〉0．05）。体温降至≤37．5℃所需时间和住院时间莫西沙星组（3．2±1．5）d和（8．2±1．7）d较对照组（4．4士1．7）d和（10．0±2．4）d明显缩短（P〈0．05）。药物不良反应发生率莫西沙星组为14．3％,对照组为26．7％,两组比较差异无统计学意义（P〉0．05）。结论对于支原体肺炎的治疗,莫西沙星单药治疗与阿奇霉素联合头孢曲松疗效相当,在缩短退热时间和住院时间方面莫西沙星优于对照组。     

莫西沙星序贯治疗社区获得性下呼吸道感染

目的评价莫西沙星序贯治疗社区获得性肺炎(CAP)和慢性支气管炎急性加重期(AECB)等下呼吸道感染的疗效和安全性以及治疗费用。方法88例中、重度下呼吸道感染患者随机分为莫西沙星序贯治疗组(序贯组)和莫西沙星静脉滴注组(对照组),其中序贯组44例,于治疗当天开始,给予莫西沙星注射液400mg/250mL静脉滴注,每日1次,3~5d后,换用莫西沙星片剂400mg口服,每日1次,总疗程7~10d;对照组44例给予莫西沙星注射液400mg/250mL静脉滴注,每日1次,总疗程7~10d。结果①序贯组和对照组痊愈率分别为65.9%(29/44)和68.2%(30/44),临床有效率分别为88.6%(39/44)和90.9%(40/44);②细菌清除率分别为93.7%(30/32)和94.4%(34/36)。痊愈率和细菌清除率两组差异无统计学意义;③序贯组和对照组平均住院费用分别为(3658±456)元和(6825±387)元;序贯组和对照组平均住院日分别为(8.8±2.2)d和(13.7±1.5)d。两组间比较差异均有统计学意义;④不良反应发生率分别为序贯组11.4%(5/44)和对照组13.6%(6/44),均可耐受,无中途停药者,两组间差异无统计学意义。结论莫西沙星序贯治疗社区获得性呼吸道感染可以获得与莫西沙星全程静脉滴注给药相似的疗效,其不良反应少见,并且可以显著节省治疗费用,缩短住院时间,值得临床推广应用。     

莫西沙星短程治疗社区获得性肺炎

目的评价莫西沙星短程治疗社区获得性肺炎(CAP)的疗效及安全性。方法87例轻中度CAP患者随机分为两组。对照组(传统疗程组)予莫西沙星静脉治疗10 d;短程治疗组予莫西沙星静脉治疗5 d。结果①对照组和短程治疗组痊愈率分别为68.2%(30/44)和65.1%(28/43),临床有效率分别为90.9%(40/44)和88.4%(38/43),细菌清除率分别为88.2%(30/34)和87.9%(29/33);这三个指标中,两组间比较差异均无统计学意义。②对照组和短程治疗组不良反应发生率分别为9.1%(4/44)和7.0%(3/43),两组间比较差异无统计学意义。结论莫西沙星短程治疗社区获得性肺炎效果与莫西沙星传统疗程治疗相似,较安全。     

莫西沙星序贯治疗社区获得性肺炎住院患者疗效观察

目的 评价莫西沙星序贯治疗社区获得性肺炎(CAP)住院患者的疗效和安全性.方法 北京大学深圳医院2009年1月-2010年12月收治的186例CAP住院患者随机分为2组,莫西沙星序贯组(序贯组)和莫西沙星静脉滴注组(对照组),序贯组(86例)在治疗当天开始给予莫西沙星注射液400 mg/d静脉滴注,每日1次,3～5d后改为口服莫西沙星片剂400 mg/d,总疗程7～14 d;对照组(88例)给予莫西沙星注射液400 mg/d静脉滴注,每日1次,总疗程7～14 d.结果 经剔除部分患者后,两组均无严重不良反应,两组安全性比较差异无统计意义,临床疗效:序贯组有效率87.2%,对照组有效率89.8%.细菌学疗效比较:治疗后序贯组细菌清除率为92.1%,对照组细菌清除率为95.7%,两组差异无统计学意义(P>0.05).结论 莫西沙星对住院CAP患者疗效可靠,安全性好.序贯治疗组与全程静脉滴注相仿,对于可以口服的患者可以替代全程静脉滴注作为住院CAP患者的治疗方案.     

氨溴索联合莫西沙星治疗老年社区获得性肺炎的疗效观察——附37例报告

目的:评价氨溴索联合莫西沙星治疗老年社区获得性肺炎(CAP)的临床疗效。方法:74例老年CAP患者随机分为治疗组和对照组各37例。对照组仅予莫西沙星治疗,治疗组给予氨溴索联合莫西沙星治疗,治疗10 d后,观察两组临床疗效及不良反应发生情况。结果:治疗10 d后,治疗组的痊愈率、总有效率分别为78%(29/37)、92%(34/37),对照组为51%(19/37)、73%(27/37)。治疗组的痊愈率及总有效率均明显高于对照组(P<0.05)。用药过程中两组患者均未出现药物相关不良反应。结论:氨溴索联合莫西沙星治疗老年CAP优于单用莫西沙星,且并未增加不良反应,安全性高。     

莫西沙星治疗成人支原体肺炎的初步探讨

[目的]探讨莫西沙星对支原体肺炎的治疗作用.[方法]回顾性分析20例经莫西沙星治疗的支原体肺炎患者,通过患者体温变化、CT影像变化探讨莫西沙星对支原体肺炎的疗效.[结果]①患者入院时的平均体温为:(38.50±0.86)℃,治疗后d3和d5时,体温分别为:(37.18±0.61)℃和(36.77±0.35)℃,分别下降了(1.32±0.81)℃和(1.69±0.76)℃,与入院时比较均有显著的统计学差异(P均＜0.001).体温在治疗d3和d5之间,亦存在显著性差异(P＜0.01).②患者的平均住院时间为(13.56±3.96)d.③本组痊愈5例(5/13);显效6例(6/13);进步2例(2/13);无效0例(0/13).[结论]莫西沙星静脉滴注治疗成人支原体肺炎,在控制体温和炎症吸收上可能具有较好的疗效.     

莫西沙星注射剂治疗下呼吸道感染疗效观察

目的评价莫西沙星注射剂治疗下呼吸道感染的疗效及安全性。方法采用区组随机化、开放、左氧氟沙星对照和非对照试验设计。试验组（包括对照与非对照病例）均用莫西沙星400mg，静脉滴注，每日1次；对照组用左氧氟沙星200mg，静脉滴注，每日2次，疗程均为7～14d。结果临床痊愈率和有效率：治疗结束后第7天，总的莫西沙星临床痊愈率和有效率分别为33．3％和81．9％，其中对照病例和非对照病例分别为38．7％、87．1％和34．1％、78．0％；左氧氟沙星为43，3％和86，7％。细菌清除率：治疗结束后第7天，总的莫西沙星、对照组及非对照组莫西沙星、左氧氟沙星均为100％。安全性评价：莫西沙星及左氧氟沙星组药物不良反应发生率分别为14．9％和18．8％。两组差异无显著性。结论莫西沙星注射剂治疗敏感菌引起的下呼吸道感染的疗效确切，安全性好。     

莫西沙星序贯治疗社区获得性肺炎临床研究

目的研究莫西沙星治疗社区获得性肺炎的临床疗效、安全性。方法216例轻中度社区获得性肺炎患者随机分为3组。A组（观察组）予莫西沙星序贯治疗,B组（对照组）予左氧氟沙星序贯治疗,C组（对照组）予头孢曲松钠／头孢泊肟酯联合阿奇霉素常规序贯治疗。结果①A组、B组和C组痊愈率分别为70．3％（52／74）、67．1％（47／70）和47．2％（34／72）,临床有效率分别为86．5％（64／74）、82．9％（58／70）和72．2％（52／72）,细菌清除率分别84．8％（28／33）、82．1％（23／28）和58．1％（18／31）,3个指标中,A、B两组间差异均无统计学意义,A、C两组间差异均有统计学意义;②A组、B组和C组静脉注射时间分别为（2．27±1．14）d、（2．33±1．15）d和（3．03±1．08）d,A、B两组间差异无统计学意义,A、C两组间差异有统计学意义;③A组、B组和C组不良反应发生率分别为5．4％（4／74）、5．7％（4／70）和13．9％（10／72）,A、B两组间差异无统计学意义,A、C两组间差异有统计学意义。结论莫西沙星序贯治疗社区获得性肺炎效果更为确切、安全。     

莫西沙星序贯治疗频发加重表型慢性阻塞性肺疾病急性加重期的临床观察

目的:观察莫西沙星序贯治疗频发加重表型慢性阻塞性肺疾病急性加重期(AECOPD)的临床效果。方法:将106例频发加重表型AECOPD患者随机分成观察组和对照组各53例,观察组予莫西沙星针剂,400mg静脉滴注,1次/d,5 d后,改为口服莫西沙星片剂,400 mg,1次/d;对照组予莫西沙星针剂,400 mg静脉滴注,1次/d,两组疗程均为8-10 d。结果:观察组和对照组的临床有效率(87.5%vs 80.1%)、细菌清除率(81.8%vs 83.3%)均无显著性差异(P0.05);观察组与药物相关的副作用显著小于对照组(20.8%vs 45.3%,P0.05);观察组人均医疗成本费用明显低于对照组(2958.5±18.3元vs 4710.3±24.5元,P0.05)。结论:莫西沙星序贯治疗频发加重表型AECOPD疗效确切、副作用少、并可节省医疗费用。     

莫西沙星治疗老年糖尿病合并社区获得性肺炎

【目的】探讨莫西沙星对老年糖尿病合并社区获得性肺炎（community acquired pneumonia,CAP）患者的临床疗效。[方法]60例老年糖尿病合并CAP患者随机分为试验组对照组,每组30例,试验组采用莫西沙星治疗,对照组采用头孢呋辛治疗。观察并比较两组治疗效果和不良反应。【结果】治疗组的有效率（痊愈＋显效）为90．00％,对照组为66．67％,两组差异有统计学意义（P〈0．05）。两组共分离细菌34株,细菌清除率分别为88．89％和50．00％,差异有统计学意义（P〈0．05）。两组不良反应发生率差异无统计学意义（P〉0．05）。【结论】莫西沙星治疗老年社区获得性肺炎的疗效良好,使用安全,适合在临床应用。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.