中山市部分地区金黄色葡萄球菌感染的临床分布及耐药基因研究

目的 了解中山市7家医院金黄色葡萄球菌感染的临床分布,并对耐药基因进行检测,为临床经验治疗金黄色葡萄球菌感染提供用药及分子生物学依据.方法 收集2015年1月—2015年6月中山市7家医院分离到的金黄色葡萄球菌,使用ATB半自动细菌鉴定及药敏分析仪(法国梅里埃)对分离到的菌株进行鉴定及药敏试验,使用PCR技术对耐甲氧西林金黄色葡萄球菌(MRSA)的耐药基因进行检测.结果 7家医院共分离到89株金黄色葡萄球菌,其中MRSA检出33株,检出率为37.1%.金黄色葡萄球菌主要来源于呼吸内科(32株,36.0%)、 骨科(20株,22.5%),主要分离自痰(41株,46.1%),伤口分泌物(16株,18%),对万古霉素、 替考拉宁、 奎奴普丁/达福普丁、 复方新诺明、 左氧氟沙星、 诺氟沙星具有较高敏感性,MRSA对常用抗菌药物耐药率高于甲氧西林敏感金黄色葡萄球菌.共有32株MRSA检出blamecA基因,检出率为97%.结论 MRSA耐药情况较为严峻,临床科室应根据微生物培养报告合理使用抗菌药物.blamecA基因在MRSA检出较高,是MRSA主要的耐药机制.     

儿童764株金黄色葡萄球菌的耐药性监测

目的了解临床分离的金黄色葡萄球菌对常用抗生素的耐药趋势，以指导临床合理使用抗生素。方法常规方法分离、培养细菌，应用WalkAway-40细菌鉴定仪对金黄色葡萄球菌进行细菌鉴定和药敏实验。结果764株金黄色葡萄球菌中，MSSA 314株，MRSA 450株，MRSA的分离率为58．9％；金黄色葡萄球菌对红霉素、青霉素、复方新诺明、阿莫西林，棒酸的总耐药率分别为63．4％、95．6％、5．8％、11．0％，未发现耐万古霉素的金黄色葡萄球菌。结论金黄色葡萄球菌的检出率逐年上升，但对常用抗生素的耐药率有下降趋势。     

PCR扩增法检测耐甲氧西林金黄色葡萄球菌的mecA基因

[摘要] 目的 应用mecA基因PCR扩增法检测耐甲氧西林金黄色葡萄球菌(MRSA)。方法 对临床分离的84株金黄色葡萄球菌,应用mecA基因PCR扩增法鉴定MRSA,并与苯唑西林纸片扩散法和头孢西丁纸片扩散法进行比较。结果 84株金黄色葡萄球菌中, 41株金黄色葡萄球菌的mecA基因扩增呈阳性,其中有1株表现为对苯唑西林敏感;苯唑西林纸片扩散法检出42株阳性,其中有2株mecA基因呈阴性. 头孢西丁纸片扩散法与PCR扩增法的试验结果完全符合。结论 mecA基因PCR扩增法可以准确、快速判定MRSA。     

异质性万古霉素中介金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌的临床特征及耐药分析

目的 分析异质性万古霉素中介金黄色葡萄球菌(hVISA)和耐甲氧西林金黄色葡萄球菌(MRSA)的临床特征以及对常用抗菌药物的耐药情况,为临床用药以及控制MRSA和hVISA感染提供依据。方法 采用VITEK-2 Compact全自动细菌鉴定和药敏分析仪对临床分离的263株金黄色葡萄球菌进行药敏分析,MRSA菌株的鉴定根据CLSI规则进行;分别采用2、3和4μg/ml的万古霉素脑心浸液琼脂平皿(BHIA2V、BHIA3V和BHIA4V)对263株金黄色葡萄球菌进行筛选,对筛选阳性的菌株用菌群分析-曲线下面积法(PAP/AUC法)进行确认;回顾性分析263名感染金黄色葡萄球菌患者的临床资料。结果 263株金黄色葡萄球菌中hVISA共22株,检出率为8.4%;MRSA共60株,检出率为22.8%。临床资料显示：与甲氧西林敏感金黄色葡萄球菌组(MSSA组)和万古霉素敏感金黄色葡萄球菌组(VSSA组)相比,MRSA组和hVISA组在不同性别、年龄和科室中的检出均无统计学意义(P>0.05),在不同来源标本中的检出有统计学意义(P<0.05),且都是在血液标本中检出率最高。药敏结果显示...     

医务人员工作制服细菌污染状况分析

目的了解医务人员工作制服的细菌污染状况.方法对医务人员工作制服标本中分离的细菌进行鉴定,对分离的金黄色葡萄球菌进行抗菌药物敏感试验及耐甲氧西林金黄色葡萄球菌(MRSA)检测.结果180份标本中分离出7种细菌共233株,金黄色葡萄球菌占58株,其中MRSA14株,占金黄色葡萄球菌的24.14%.MRSA对多种抗菌药物具有较高的耐药性.结论医务人员工作制服存在不同程度的细菌污染,应加强医务人员工作制服的管理和清洗,以减少医院感染的发生和传播.     

金黄色葡萄球菌RAPD基因分型研究

目的了解医院内金黄色葡萄球菌RAPD基因分型,分析MRSA的流行传播情况。方法应用K-B纸片扩散法和随机多态性扩增DNA技术（Randomly amplified polymorphic DNA,RAPD）对医院分离的金黄色葡萄球菌进行MRSA鉴定和基因分型。结果 57株金黄色葡萄球菌中有MRSA31株,经RAPD扩增后,扩增产物在2~6条带之间,通过聚类分析57株菌产生10个基因型。结论Ⅵ型为本院金黄色葡萄球菌的流行优势基因型,不同来源菌株基因型分布有明显差异。RAPD分型技术简便、快速,在医院感染流行病学研究具有很大的应用前景。     

101株葡萄球菌的药敏结果及统计分析

目的了解101株葡萄球菌属的细菌感染和耐药情况。方法对临床标本分离的葡萄球菌属细菌以血浆凝固酶做初步鉴定,然后以ATB微生物半自动鉴定仪进行鉴定确定菌名,同时对分离菌株做体外药敏试验。结果 101株葡萄球菌属细菌,其中金黄色葡萄球菌54株,耐甲氧西林的金黄色葡萄球（MRSA）9株,占17.6%,凝固酶阴性葡萄球菌47株,耐甲氧西林的凝固酶阴性葡萄球菌（MRCNS）25株,占53.2%,并且出现多种药物的耐药,如金黄色葡萄球菌对青霉素的耐药高达94.3%,对红霉素的耐药达到75%,凝固酶阴性葡萄球菌对青霉素的耐药达到95.7%,对红霉素的耐药达到79.5%,对左旋氧氟沙星的耐药达到42.6%。结论由于葡萄球菌属中的金黄色葡萄球菌和凝固酶阴性葡萄球菌是医院重要的致病菌,特别是MRSA和MRCNS不但引起医院的院内感染,而且还可以造成传播,致病性强,耐多种药物,为临床的治疗带来很多困难,因此,加强MRSA和MRCNS的耐药监测尤显重要。     

耐甲氧西林金黄色葡萄球菌引起老年人呼吸道感染的探讨

目的了解老年人呼吸道感染耐甲氧西林金黄色葡萄球菌(MRSA)的分离率及耐药情况。方法对我院60岁以上的老年患者痰标本分离出的金黄色葡萄球菌进行MRSA的鉴定,并对其发生率及耐药性展开讨论。结果老年患者痰标本分离出的金黄色葡萄球菌178株,其中MRSA检出164株,检出率为90.2%。MRSA对多种抗生素的耐药率均在以上,对复方新诺明和四环素的耐药率均为24%,对万古霉素100%敏感。结论老年人呼吸道感染金黄色葡萄球菌的发生率较高,尤其MRSA检出率极高。结合老年患者的临床特点,并根据流行病学调查及药物敏感试验数据合理应用抗生素,可有效控制MRSA的暴发流行。     

317株金黄色葡萄球菌耐药性分析

目的 分析金黄色葡萄球菌的临床分布及耐药现状,为临床抗感染治疗提供理论依据.方法 API系统鉴定细菌,采用纸片扩散法对金黄色葡萄球菌进行药敏试验,用头孢西丁纸片扩散法筛选耐甲氧西林金黄色葡萄球菌(MRSA).结果 共检出金黄色葡萄球菌317株,其中MRSA有178株,甲氧西林敏感金黄色葡萄球茵(MSSA)139株.除青霉素、红霉素及克林霉素外,MSSA对其它抗生素均有较好的敏感性,而MRSA除对万古霉素、利奈唑胺、替考拉宁、呋喃妥因、氯霉素及复方新诺明敏感外,对其它抗生素均耐药.没有发现对万古霉素及利奈唑胺耐药的菌株.结论 MRSA多重耐药,应加强对其耐药率监测,有效地预防及控制其感染.     

耐甲氧西林金黄色葡萄球菌的检测及药敏结果分析

目的了解耐甲氧西林金黄色葡萄球菌（MRSA）的感染情况及对临床常用抗生素的耐药性,指导临床合理使用抗生素。方法应用琼脂筛选法,纸片（K-B）法,美国德灵WalkAway40SI全自动细菌鉴定药敏仪器法三种方法进行MRSA检测,应用美国德灵WalkAway40SI全自动细菌鉴定药敏分析系统进行细菌鉴定及药敏分析。结果三种方法检测MRSA,以苯唑西林盐琼脂法为标准,纸片法,仪器法与其比较,204株金黄色葡萄球菌检出121株耐甲氧西林金黄色葡萄球菌（MRSA）,阳性率（59.31%）仪器法118株完全符合,符合率为97.52%（118/121）,K-B法119株完全符合,符合率为98.34%（119/121）。118株MRSA对万古霉素全部敏感,对青霉素、苯唑西林、氨苄青霉素、头孢唑林、亚胺硫霉素、阿莫西林/棒酸全部耐药。结论万古霉素是有效控制MRSA感染的最佳抗生素,临床治疗葡萄球菌感染时应进行MRSA的检测,合理使用抗生素。     

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.