三代喹诺酮类药物的不良反应及其预防

三代喹诺酮类（quinolones）抗菌药，具有扰菌谱广、抗菌作用强、口服吸收好等优点。目前，国内常用的品种有诺氟沙星、环丙沙星、氧氟沙星、左氧氟沙星、洛美沙星、氟罗沙星、依诺沙星、培氟沙星等。本类药物用于治疗严重感染及反复发作的慢性感染，特别是泌尿系统感染，有效率达到84％，对淋菌性尿道炎有效率达100％。     

差示分光光度法测定司帕沙星片的含量

司帕沙星 (Ｓｐａｒｆｌｏｘａｃｉｎ)化学名为 5-氨基 -1 -环丙基-6,8-二氟 -1 ,4 -二 -7-(顺 -3 ,5-甲基 -1 -哌嗪基) -4 -氧喹啉 -3 -羧酸[1] ,是日本制药株式会社首先研制并于 1 993年批准上市的氟喹喏酮类广谱抗菌药。司帕沙星抗菌谱广 ,抗菌活性强 ,对绝大多数革兰氏阳性球菌的外体活性强于环丙沙星、氧氟沙星和诺氟沙星 ;在动物感染模型中对革兰氏阳性菌和革兰氏阴性菌的体内抗菌活性强于环丙沙星[2 ] 。本文利用司帕沙星在 0 .1ｍｏｌ/Ｌ氢氧化钠溶液和 0 .1ｍｏｌ/Ｌ盐酸溶液中紫外光谱发生变化的特征 ,试用差示分光光度法 ,通过测…     

泌尿生殖道支原体培养及耐药结果分析

目的通过分析我院患者泌尿生殖道支原体感染情况及耐药情况,指导临床合理用药。方法对514例疑似支原体感染患者采用珠海丽拓发展有限公司试剂盒进行支原体培养及药敏试验。结果支原体阳性患者332例检出率64.6%,其中单纯Uu(解脲支原体)感染30.2%,混合感染34.4%;男性支原体阳性检出率35.5%,女性为75.3%。药敏结果显示:敏感性较高的抗生素为强力霉素和美满霉素,耐药性较高的抗生素有诺氟沙星、氧氟沙星、红霉素、司帕沙星、左氧氟沙星、阿奇霉素、罗红霉素。结论泌尿生殖道感染的主要病原菌为Uu或Uu+Mh(人型支原体)混合感染,单纯Mh感染临床少见。支原体耐药情况十分普遍,为减少耐药菌株的产生,临床治疗应尽量进行支原体培养及药敏试验,选用敏感抗生素并足疗程正规使用。     

头孢硫脒与三种氟喹诺酮类抗菌药物合用对革兰阳性球菌的抑制作用

目的　评价头孢硫脒分别与环丙沙星、左氧沙星和加替沙星 3种氟喹诺酮类抗菌药物联合用药 ,对于临床分离的 90株革兰阳性球菌的体外联合抗菌效应。方法　采用棋盘法设计 ,微量肉汤稀释法测定不同浓度组合的 3组抗菌药物对 90株临床分离的革兰阳性球菌 ,包括金黄色葡萄球菌 (Staphylococcusaureus,SA)、表皮葡萄球菌 (Staphylococcusepidermidis,SE)和粪肠球菌 (Enterococcusfaecalis,Ef)的抑菌浓度 ,并计算FIC指数。结果　头孢硫脒对金黄色葡萄球菌的MIC50 为 16mg·L-1,与环丙沙星、左氧沙星、加替沙星联合应用后 ,其MIC50 分别显著的降低至 2、0 .5和 1mg·L-1;头孢硫脒对表皮葡萄球菌的MIC50 为 1mg·L-1,与环丙沙星、左氧沙星、加替沙星等 3种抗菌药物联合应用后 ,其MIC50 降低至 0 .12 5、0 .2 5和 0 .12 5mg·L-1;头孢硫脒对粪肠球菌的MIC50 为 4mg·L-1,与环丙沙星、左氧沙星、加替沙星联合应用后 ,其MIC50 降低至 0 .2 5、0 .2 5和 0 .2 5mg·L-1。FIC指数分布 :FIC≤ 0 .5占 6 0 %～ 90 % ;0 .5 2为 0。结论　头孢硫脒与氟喹诺酮类 3种抗菌药物联合用药后 ,对革兰阳性球菌基本表现为协同作用和相加作用 ,并以协同作用为主 ,无关作用较     

泌尿生殖道支原体感染耐药性分析

目的：了解解脲支原体（Uu）和人型支原体（mh）的感染情况及其对环脂红霉素（ECC）强力霉素（DOX）交沙霉素（JOS）甲砜霉素（THI）克拉霉素（CLA）红霉素（ERY）环丙沙星（CPF）罗红霉素（ROX）可乐必妥（CRA）美满霉素（MIN）阿歧霉素（AZI）司帕沙星（SPA）12种药物的耐药情况。方法：采用珠海浪峰生物技术有限公司生产的支原体培养、鉴别、计数、药敏试剂盒进行试验。结果：488例患者中检出支原体阳性145例占27．7％，其中单一Uu感染82例占56．6％单一mh感染6例占4．1％Uu、mh混合感染57例占39．3％。结论：本地区感染支原体经Uu单独感染及Uu、mh混合感染为主，单独mh感染较少，其耐药性表现为对强力霉素、交沙霉素、克拉霉素等较为敏感，而对阿歧霉素、司帕沙星、环丙沙星不敏感，mh对强力霉素敏感。     

妇科门诊泌尿生殖道支原体感染及药敏分析

目的：分析泌尿生殖道系统中支原体感染及药物敏感情况,指导临床合理用药。方法：用支原体培养及药敏试剂盒检测泌尿生殖道分泌物。结果：支原体检出阳性率为44.59%（305/684）,其中Uu阳性百分率为69.51%（212/305）,Mh阳性率为10.16%（31/305）,两者混合感染阳性率为20.33%（62/305）。支原体对交沙霉素、强力霉素、克拉霉素较敏感,其敏感率〉80%;对司帕沙星、氧氟沙星、左旋氧氟沙星、环丙沙星较不敏感,其敏感率〈45%。结论：支原体感染以Uu为主,治疗以交沙霉素、强力霉素、克拉霉素为首选药物,临床还需根据支原体培养药敏结果个性化用药治疗。     

2004年度我院细菌检测结果及耐药性分析

目的监测我院2004年临床可疑细菌感染标本的分离培养及细菌耐药状况。方法对我院从2004年1月19日—2004年12月31日分离的235株细菌,按常规操作规程进行,必要时应用BD公司的BBLCRASTAL鉴定系统。药敏试验采用WHO推荐的K-B纸片扩散法测定细菌对药物的敏感性。结果培养率最高的细菌为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌、白色假丝酵母菌等。碳青霉烯类是革兰阴性杆菌(除嗜麦芽窄食单胞菌)抗菌作用最强的抗生素。头孢哌酮/舒巴坦、头孢他啶、左氧氟沙星对革兰阴性杆菌也有很好的抗菌活性。但仍有40%~55%的大肠埃希菌对氟喹诺酮类耐药。结论头孢哌酮/舒巴坦、左氧氟沙星、环丙沙星、庆大霉素和妥布霉素对非发酵阴性杆菌的抗菌谱较广,抗菌作用也较好,另外一些耐药菌株的出现应引起我们注意。     

多重耐药鲍曼不动杆菌耐药机制及不同抗菌药物组合对其作用

目的分析多重耐药鲍曼不动杆菌（MDRAB）的耐药机制及抗菌药物组合对其的体外抗茵效应。方法收集2013年1月～2013年6月分离非重复鲍曼不动杆菌共30株,利用脉冲凝胶电泳（PFGE）进行分型。测定抗茵药物单药及组合用药的抑茵浓度,判别药物作用类型。结果30株MDRAB根据PFGE条带分析发现属于同一克隆A。体外联合作用中利福平＋多粘菌素B,亚胺培南＋庆大霉素,头孢吡肟＋左氧氟沙星协同比例大。米诺环素＋利福平,氨苄西彬舒巴坦＋妥布霉素、头孢他啶＋环丙沙星有较高的相加作用。有些出现协同拮抗作用。结论30株MDRAB根据PFGE条带分析发现属于同一克隆A,说明为同一克隆株的播散流行。利福平＋多粘菌素B存在较高的协同作用,在严重MDRAB感染情况下可以考虑应用。亚胺培南＋庆大霉素。头孢吡肟＋左氧氟沙星也有较高的协同作用,部分菌株的试验中有拮抗作用,可能由于存在adeS基因,应用这两类组合时要考虑茵株的个体差异。     

985例泌尿生殖道支原体培养及药敏分析

目的：了解我院就诊人群中泌尿生殖道解脲支原体（UU）和人型支原体（MH）的感染情况及其对九种抗生素的药物敏感性,为临床合理用药提供依据。方法收集2012年11月-2013年11月我院妇科、皮肤科及泌尿外科门诊就诊泌尿生殖道感染患者的分泌物标本。采用支原体培养、鉴定、药敏一体化试剂盒,对分泌物标本进行培养鉴定,对结果进行统计分析。结果985例检测标本中,阳性患者505例,总检出率为51.27%,男性阳性检出率为34.75%,女性阳性检出率为53.52%,女性显著高于男性（P＜0.01）。我院以单独UU阳性患者居多,其阳性检出率为40.10%,女性阳性检出率高于男性,其差异有统计学意义（P＜0.05）。药敏结果显示,UU和MH对美满霉素、强力霉素最为敏感,其中UU对这两种抗生素的敏感率分别为93.33%,93.13%, MH对这两种抗生素的敏感率均为80.91%。UU对氧氟沙星的耐药率最高,为53.13%,其次为罗红霉素,耐药率为51.72%,UU对阿奇霉素、司帕沙星的耐药率均较高,在40.00%以上;MH对罗红霉素的耐药率最高,达98.18%,其次为阿奇霉素,为97.27%,MH对氧氟沙星,左旋氧氟沙星、克拉霉素的耐药率均较高,都在80.00%以上。结论我院支原体感染阳性检出率较高,以UU为主,男女检出率存在差异。建议临床用药可首选美满霉素、强力霉素等四环素类药物;对于喹诺酮类药物,UU和MH普遍耐药率较高,不建议临床选用。     

济源市人民医院烧伤科患者病原菌分布特点及抗菌药物使用情况分析

目的研究济源市人民医院烧伤科患者的病原菌分布特点,分析其抗菌药物使用情况。方法将2013-2015年济源市人民医院烧伤科收治的375例烧伤患者作为研究对象,每周收集1次创面分泌物进行细菌培养,对其中检出的部分细菌做抗菌药物敏感性检测,并对部分抗菌药物的使用情况予以分析。结果 2013-2015年病原菌阳性检出率呈逐年下降趋势;铜绿假单胞菌对阿米卡星、氨曲南、庆大霉素、亚胺培南、左氧氟沙星、美罗培南及妥布霉素等抗菌药物的敏感性呈逐年增高趋势,对头孢替坦、头孢曲松及头孢唑啉则呈现出较高的耐药性;鲍曼不动杆菌对一、二代头孢菌素及环丙沙星等抗菌药物的耐药性较高,对亚胺培南、阿米卡星、美罗培南等抗菌药物的敏感性较高;金黄色葡萄球菌与表皮葡萄球菌对克林霉素和红霉素的耐药性较高,对其他抗菌药物的敏感性较高;环丙沙星、头孢吡肟、头孢他啶、庆大霉素及四环素的使用强度呈逐年下降趋势,而左氧氟沙星与利奈唑胺的使用强度则呈逐年升高趋势。结论医生在治疗过程叶中,应遵循早期、联合、足量的用药原则,根据药物敏感试验结果进行抗感染治疗;医院应高度重视感染的控制工作,定期开展感染隐患排查,结合病原菌分布特点,及时阔整抗菌药物使用强度,以减少和避免耐药菌的产生。     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme