婴幼儿非发酵菌感染的临床特征和耐药分析

目的：对婴幼儿非发酵菌感染的临床特征和病情转归进行研究,分析感染婴幼儿非发酵菌的耐药情况,为医师识别非发酵菌感染的临床特征和及时治疗提供参考依据。方法：收集本院儿科各病区91例非发酵菌感染患儿资料,回顾性分析患儿基本临床资料及病情转归,检测非发酵菌菌株分布及耐药情况,并采用PCR法检测细菌耐药基因,对阳性结果进行基因测序分析。结果：近5年中本院儿科住院的患儿中非发酵菌感染者91例,其中新生儿35例（早产儿19例）,29日龄~1岁29例,1~3岁27例;男性60例,女性31例;有基础性疾病患儿41例（45.05%）,出现脏器功能损害16例（17.58%）,自动出院3例（3.29%）,死亡1例（1.09%）;分离非发酵菌102株,其中铜绿假单胞菌42株,鲍曼不动杆菌33株,嗜麦芽窄食单胞菌21株,其他非发酵菌6株;新生儿病区44株（43.13%）,小儿重症监护病房33株（32.35%）,普通儿科病区25株（24.50%）。呼吸道分泌物和血液占全部标本的84.31%;鲍曼不动杆菌和铜绿假单胞菌多重耐药（MDR）、广泛耐药（XDR）、泛耐药（PDR）分离率分别占63.63%和19.04%;铜绿假单胞菌对亚胺培南耐药率为40.48%,耐药基因检测阳性率最高的是blaPER（28.57%）;鲍曼不动杆菌对亚胺培南耐药率为36.36%,所有耐药株均携带blaOXA-51和blaOXA-23基因。结论：有基础性疾病或进行侵袭性诊治的患儿易感染非发酵菌,且多为耐药菌株,治疗困难,病程长,风险大。     

儿童呼吸机相关性肺炎的病原学分析

目的探讨儿童呼吸机相关性肺炎（VAP）的病原菌分布及耐药情况。方法总结2010年3月-2013年12月机械通气治疗113例患儿的临床资料,比较机械通气时间及重复插管等因素与VAP发生率的关系,对49例诊断为VAP患儿病原学资料进行回顾性分析。结果113例进行机械通气的患儿有49例发生了VAP,发生率43．36％,通过统计分析发现VAP的发生于插管次数、机械通气时间密切相关;49例VAP患儿检出病原菌57株,多为耐药菌,其中革兰阴性菌48株（84．21％）,主要为肺炎克雷伯菌（12株）,铜绿假单胞菌（11例）;革兰阳性菌9株（15．79％）,主要为金黄色葡萄球菌（7株）,其中耐甲氧西林株5株（8．77％）。结论VAP的病原以革兰阴性菌为主,细菌普遍耐药。     

ICU呼吸机相关肺炎病原菌检测和药敏分析

目的：探讨机械通气后呼吸机相关肺炎（VAP）的主要细菌分布与药敏分析,以减少发病率,提高治愈率。方法：回顾分析我院2011-2013年159例机械通气后确诊为呼吸机相关肺炎患者62例的相关资料,检测主要病原菌及其药敏。结果：共检出细菌86株,单一病原菌感染38例,混合菌感染24例,其中革兰阴性（G-）菌61株占70.9%,革兰阳性（G＋）菌14株占16.3%,真菌11例占12.8%,主要病原菌以非发酵菌为主。结论：本院呼吸机相关肺炎的病原菌主要以G-为主,耐药率高,应注意无菌操作,严密监控VAP的病原菌与药敏变化,选择恰当的抗菌药物避免增加耐药性。     

重症监护病房呼吸机相关性肺炎细菌分布及耐药性分析

目的 了解重症监护病房（ICU）呼吸机相关性肺炎（VAP）细菌的菌群分布及其耐药性状况。方法 对ICU61例VAP患者在病原学检查、细菌对抗生素耐药性作一回顾性分析。结果 61例检出82株致病菌，其中革兰阴性细菌（G^-菌）占69％（57／82），革兰阳性细菌（G^＋菌）占21％（17／82），真菌占12％（10／82），药敏结果显示这类菌株耐药现象严重。结论 VAP病原菌以G^-菌为主，呈多重耐药，应重视并强调对抗生素药物的合理应用。     

非发酵菌的临床分布与耐药情况分析

目的 探讨临床分离的非发酵菌菌株的分布及耐药情况，指导合理使用抗生素。方法 对本院2001年8月至2005年7月间临床标本培养分离出的108株非发酵菌临床分布和耐药情况进行分析。结果 108株非发酵菌中铜绿假单胞菌占60.2％（65／108），不动杆菌占21．3％（23／108），麦芽窄食单胞菌占8．3％（9／108），其它非发酵菌占10．2％（11／108）；非发酵菌分布部位以呼吸道分离率最高（95.3％），其次是创面分泌物3株（2．8％）和泌尿道2株（1．9％）；三种主要非发酵菌中除不动杆菌对大多数抗菌药物较敏感外，铜绿假单胞菌和麦芽窄食单胞菌对抗菌药物呈多重耐药。结论定期监测非发酵菌感染种类、耐药性变化对指导临床合理应用抗菌药物具有十分重要的意义。     

非发酵菌的抗菌药物敏感性分析

目的 了解非发酵菌的分布及耐药情况。方法 用K-B法检测1308株非发酵菌对11种抗菌药物的药物敏感试验结果,并按美国国家临床实验室标准委员会2004年标准进行判断。结果 从临床标本中分离出非发酵菌1308株,其中居前3位者依次为：铜绿假单胞曲570株（43．58％）,鲍曼不动杆菌223株（17．05％）,嗜麦芽窄食单胞菌195株（14．91％）。药物敏感试验显示非发酵菌对头孢噻肟已普遍有耐药,除铜绿假单胞菌和鲍曼不动杆菌外对亚胺培南也普遍耐药,对氨基糖苷类、喹诺酮类和哌拉西林的耐药率也较高,而对含酶制剂和复方磺胺甲曙唑多数较为敏感。结论 重视对非发酵菌耐药性监测,合理使用抗菌药物,以防止耐药菌株产生。     

重症监护病房呼吸机相关性肺炎的临床研究

目的 探讨重症监护病房(ICU)中呼吸机相关性肺炎(VAP)的病原菌组成及相关因素,为临床防治提供依据. 方法 分析137例ICU内确诊的VAP患者的临床资料及下呼吸道分泌物细菌培养的结果 .结果 VAP的发生率为53.10%;137例患者共检出334株致病菌,其中革兰阴性菌208株(62.28%),革兰阳性菌55株(16.47%),真菌71株(21.25%);铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷白菌和白色假丝酵母菌是VAP的主要致病菌;药敏结果 显示感染菌株多重耐药,肠杆菌科革兰阴性菌对碳青霉烯类抗生素无一耐药,非发酵菌革兰阴性菌对常用的抗生素均具有较高的耐药性,革兰阳性菌对万古霉素无一耐药. 结论 ICU内VAP病原菌以革兰阴性菌为主,真菌比例较高,混合致病菌感染比例高;积极预防和治疗可以有效降低VAP的发生.     

ICU呼吸机相关性肺炎病原学及耐药性分析

目的 探讨引起ICU呼吸机相关性肺炎病原菌菌种分布及耐药谱,为临床合理使用抗菌药物提供依据。方法 对重症监护病房近3年机械通气患者临床标本中分离的致病菌进行比较分析。结果 共检出致病菌205株,其中革兰阴性细菌145株（70.73％）,真菌38株,（18．54％）,革兰阳性细菌22株（10．73％）。非发酵菌和肠杆菌科细菌是主要病原菌。非发酵菌以铜绿假单胞菌、鲍曼不动杆菌和嗜麦芽窄食单胞菌较多见。肠杆菌科细菌以阴沟肠杆菌、肺炎克雷伯菌和大肠杆菌为多。所测定菌株均呈高度耐药。结论 革兰阴性菌是VAP的主要致病菌,真菌感染不容忽视。病原菌呈现出多重耐药现象,在经验性抗感染治疗时应考虑对常见致病菌有较好覆盖率且耐药性较低的抗生素,同时积极开展病原学检查,指导合理有效使用抗菌药物。     

重症监护病房患者下呼吸道标本非发酵菌构成及耐药性分析

目的观察综合性重症监护病房（ICU）患者下呼吸道标本非发酵菌的构成及耐药情况,为临床治疗提供科学依据。方法回顾性调查我院2006年11月1日～2008年11月1日期间综合性重症监护病房（ICU）下呼吸道标本中非发酵菌的构成及耐药率。结果共分离革兰氏阴性杆菌466株,其中非发酵菌298株,占63.95%（298/466）;非发酵菌主要为铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食假单胞菌,其中部分非发酵菌为多重耐药菌（MDR）,甚至为泛耐药菌（PDR）。结论综合性重症监护病房（ICU）下呼吸道标本中非发酵菌的所占比例较大,耐药率高,应定期监测其细菌构成及耐药率,为临床治疗提供指导。     

PICU呼吸机相关肺炎36例临床特征与病原学分析

目的分析小儿呼吸机相关肺炎(VAP)的临床和病原学特征。方法回顾我院PICU 4年来VAP患儿的临床和病原学特征。结果93例机械通气患儿有36例发生VAP,发生率为38.7%,死亡12例,共培养出致病的革兰氏阴性杆菌22株,革兰氏阳性菌9株,主要病原是铜绿假单胞菌。结论VAP感染的患儿临床预后相对较差,且VAP感染的细菌以革兰氏阴性杆菌为主。     

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.