儿童分离流感嗜血杆菌的耐药性及β-内酰胺酶基因分型

目的探讨流感嗜血杆菌在儿童患者中的耐药情况和β-内酰胺酶基因分型。方法收集2016年上海市儿童医院临床分离流感嗜血杆菌316株;纸片扩散法检测细菌对抗菌药物的耐药性,头孢硝噻吩纸片法检测细菌β-内酰胺酶表型,PCR方法对细菌β-内酰胺酶进行基因分型。结果 316株流感嗜血杆菌对甲氧苄啶/磺胺甲噁唑、氨苄西林、阿奇霉素、头孢呋辛和氨苄西林/舒巴坦耐药率分别为67.7%、52.2%、28.5%、26.9%和10.8%,对头孢噻肟、阿莫西林/克拉维酸敏感率均 90%。41.1%(130/316)菌株检测到β-内酰胺酶基因,与表型一致,基因分型均为TEM-1型,未检测到ROB-1型。结论三代头孢和加酶抑制剂抗菌药物(头孢噻肟和氨苄西林/舒巴坦、阿莫西林/克拉维酸)对儿童感染流感嗜血杆菌有较好的抗菌活性;流感嗜血杆菌β-内酰胺酶基因分型均为TEM-1型。     

儿童呼吸道分离流感嗜血杆菌的耐药性和基因分型

目的研究儿童呼吸道分离流感嗜血杆菌的耐药性和该菌ftsI基因分型与耐药表型的关系。方法收集2016年第一季度住院患儿鼻咽吸出物中分离到的流感嗜血杆菌141株;用纸片扩散法检测细菌对抗菌药物的耐药性;用Nitrocefin纸片法检测细菌的β内酰胺酶;用PCR技术对分离菌株进行ftsI基因检测;比较不同基因型菌株对抗菌药物的耐药情况。结果141株流感嗜血杆菌β内酰胺酶检出率为40.4%(57/141)、氨苄西林耐药率为53.2%(75/141)。检出ftsI基因突变率为72.3%(102/141),以Ⅲ型为主(72/102,70.6%)。β内酰胺酶基因阴性氨苄西林耐药型菌株(g BLNAR)对氨苄西林和头孢呋辛的耐药率高于β内酰胺酶基因阴性氨苄西林敏感型菌株(g BLNAS)(P0.05)。结论儿童呼吸道分离流感嗜血杆菌ftsI基因突变率高,以Ⅲ型为主。ftsI基因突变增加了流感嗜血杆菌对氨苄西林和头孢呋辛的耐药性。     

二氧化碳嗜纤维菌对β-内酰胺类抗生素的耐药性分析及基因型检测

目的 通过检测二氧化碳嗜纤维菌对β-内酰胺类抗生素的耐药性,了解其耐药机制.方法 收集3株二氧化碳嗜纤维菌,用纸片扩散法和Etest法检测二氧化碳嗜纤维菌对抗菌药物的敏感性,以Nitrocefin纸片法、三维法和PCR方法检测其β-内酰胺酶.结果 3株二氧化碳嗜纤维菌中有2株生痰二氧化碳嗜纤维菌,1株牙龈二氧化碳嗜纤维菌.3株菌对青霉素、氨苄西林、氨曲南、头孢噻肟、头孢他啶、头孢唑啉、头孢呋辛、头孢吡肟、头孢哌酮耐药,但对哌拉西林、亚胺培南、美罗培南、头孢西丁、氨苄西林/舒巴坦、头孢哌酮/舒巴坦、阿莫西林/克拉维酸、头孢他啶/克拉维酸、头孢噻肟/克拉维酸敏感.三维法试验结果显示3株二氧化碳嗜纤维菌所产的β-内酰胺酶能水解青霉素、氨苄西林、头孢噻肟、头孢他啶、头孢唑啉、头孢呋辛和头孢吡肟,但不能水解头孢西丁、亚胺培南和阿莫西林/克拉维酸.经PCR方法检测,3株二氧化碳嗜纤维菌的β-内酰胺酶和AmpC酶耐药基因均为阴性.结论 二氧化碳嗜纤维菌对常用抗菌药物尤其是β-内酰胺类抗生素均存在较高的耐药性,且其β-内酰胺酶可能存在新的基因型.     

2010中国CHINET流感嗜血杆菌和卡他莫拉菌耐药性监测

目的了解2010年我国不同地区临床分离流感嗜血杆菌和卡他莫拉菌的耐药性。方法收集9所综合性医院和2所儿童医院临床分离的734株流感嗜血杆菌和214株卡他莫拉菌,分别采用Kirby-Bauer纸片法和琼脂稀释法作药敏试验,依照CLSI 2010版标准判断结果。头孢硝噻吩纸片法测定β内酰胺酶。结果 734株临床分离流感嗜血杆菌对甲氧苄啶-磺胺甲口恶唑的耐药率最高,达64.5%、其次对氨苄西林、氨苄西林-舒巴坦、氯霉素和环丙沙星的耐药率分别为31.7%、14.5%、12.5%和14.2%;该菌对头孢噻肟、阿莫西林-克拉维酸、阿奇霉素以及头孢呋辛的耐药率均在10%以下(4.2%～8.9%)。儿童分离株对氨苄西林的耐药率和产酶率(35.1%、30.1%)均高于成人分离株(26.6%、24.1%),对环丙沙星的耐药率(4.0%)低于成人分离株(17.0%),耐药率的差异均有统计学意义(P<0.05)。β内酰胺酶总检出率28.1%。39株为氨苄西林耐药而β内酰胺酶阴性。214株卡他莫拉菌对第二代和第三代头孢菌素、阿莫西林-克拉维酸、左氧氟沙星、甲氧苄啶-磺胺甲口恶唑均呈现高度敏感(96.7%～100%),但对阿奇霉素的耐药率为45.1%。该菌产β内酰胺酶的检出率为96.7%。结论流感嗜血杆菌和卡他莫拉菌对头孢菌素类、酶抑制剂复方制剂以及喹诺酮类抗菌药物保持高度敏感性;产β内酰胺酶仍是上述2种细菌对氨苄西林耐药的重要耐药机制;但氨苄西林耐药而β酰胺酶阴性的流感嗜血杆菌的分离株较前增多,其耐药机制有待进一步研究。     

流感嗜血杆菌氨苄西林耐药基因TEM-1、ROB-1的检测

目的探讨我国北京，上海，广州3地2000—2003年流感嗜血杆菌氨苄西林的耐药机制。方法选取2000—2003年上述3地上呼吸道感染患儿鼻咽部分离培养的899株流感嗜血杆菌，采用Etest法检测氨苄西林耐药情况。用头孢硝噻酚纸片进行β内酰胺酶检测，PCR方法检测产酶菌株TEM-1、ROB-1耐药基因携带情况。结果74株氨苄西林耐药菌株均产生β内酰胺酶，PCR检测均为TEM-1基因阳性，未发现ROB-1基因阳性菌株。结论我们研究的儿童上呼吸道携带流感嗜血杆菌对氨苄西林耐药的机制主要是TEM-1型β内酰胺酶的产生。     

厦门地区呼吸道感染患儿嗜血杆菌的临床分布及耐药性分析

目的了解厦门地区呼吸道感染患儿分离的嗜血杆菌对抗菌药物的耐药情况,为临床用药提供依据。方法收集2010年儿童患者下呼吸道标本分离的90株嗜血杆菌。细菌的鉴定采用VITEK-2 compact微生物分析系统及配套的鉴定卡,药物敏感试验使用ATB Haemo试条。β-内酰胺酶检测使用头孢硝噻吩纸片,数据录入WHONET 5.4软件分析。结果在患儿下呼吸道病原中,嗜血杆菌占第3位,主要包括流感嗜血杆菌和副流感嗜血杆菌。嗜血杆菌对复方新诺明和氨苄西林的耐药率相对较高,分别为38.9%和26.7%,对头孢克洛、四环素、利福平、氯霉素和头孢呋辛的耐药率分别为20.0%、20.0%、13.3%、13.3%和10.0%,对阿莫西林/克拉维酸、头孢噻肟、氧氟沙星的敏感率在95.0%以上。β-内酰胺酶阳性率为24.4%。结论嗜血杆菌是儿童呼吸道感染重要的病原菌之一,临床上应加强对其分离培养,其对氨苄西林、复方新诺明的耐药率高,已不宜再作为临床治疗的首选药物。     

儿童呼吸道流感嗜血杆菌的耐药性分析

目的了解儿童呼吸道流感嗜血杆菌的临床分布特征和耐药特点,为指导临床合理用药提供科学依据。方法收集儿童痰液标本进行培养并分离出流感嗜血杆菌,用K-B纸片扩散法进行抗菌药物敏感试验,并对其进行β内酰胺酶测定;数据用WHONET5.6统计软件统计分析。结果从12 374份痰液标本中共分离出1 256株流感嗜血杆菌,分离率为10.2%;1 256株流感嗜血杆菌对氨苄西林、甲氧苄啶-磺胺甲口恶唑和氨苄西林-舒巴坦的耐药率分别为37.8%、65.5%和16.5%,对其余测试的抗菌药物耐药率均〈10.0%;β内酰胺酶阳性率为33.5%。结论流感嗜血杆菌对氨苄西林和甲氧苄啶-磺胺甲口恶唑的耐药性较高;该菌对于头孢克洛、氨苄西林-舒巴坦、头孢他啶、头孢克肟、阿奇霉素、环丙沙星、美罗培南、利福平的敏感率均在80.0%以上。产β内酰胺酶是流感嗜血杆菌对氨苄西林的主要耐药机制。     

儿童呼吸道流感嗜血杆菌分离株耐药性与ftsI基因分型研究

目的调查呼吸道感染患儿流感嗜血杆菌分离株的耐药性与ftsI基因的关系。方法 2011年6月—2012年9月,收集呼吸道感染患儿呼吸道标本中分离到的流感嗜血杆菌,用微量肉汤稀释法测定常用抗菌药物最低抑菌浓度(MIC);用Nitrocefin纸片法检测细菌的β内酰胺酶;用聚合酶链反应(PCR)技术对分离株进行ftsI基因分型;比较不同ftsI基因型菌株对常用抗菌药物的耐药性。结果473株流感嗜血杆菌中产β内酰胺酶菌株占51.8%(245/473),ftsI基因突变率为33.4%(158/473);β内酰胺酶基因阴性氨苄西林耐药型菌株(gBLNAR)以GroupⅠ/Ⅱ型为主(113/154),68.1%(77/113)的该型菌株对氨苄西林敏感,85.4%(35/41)的gBLNAR GroupⅢ菌株对氨苄西林不敏感;gBLNAR菌株对头孢克洛、头孢呋辛、头孢曲松和阿莫西林-克拉维酸等β内酰胺类抗生素MIC90和耐药率明显高于gBLNAS(敏感)菌株(P0.01),对左氧氟沙星、阿奇霉素和甲氧苄啶-磺胺甲口恶唑等非β内酰胺类抗菌药物的MIC90和耐药率与gBLNAS菌株相比差异无统计学意义(P0.05);gBLNAR GroupⅢ菌株对β内酰胺类抗生素的MIC90和耐药率高于gBLNAR GroupⅠ/Ⅱ菌株(P0.01),两者对非β内酰胺类抗菌药物的MIC90和耐药率差异无统计学意义(P0.05)。结论呼吸道感染患儿呼吸道流感嗜血杆菌分离株发生ftsI基因突变的情况较为常见,突变以GroupⅠ/Ⅱ型为主,明显影响氨基青霉素类和某些第二代头孢菌素的抗菌活性。     

儿童患者中分离350株流感嗜血杆菌的分布和耐药性分析

目的研究儿童流感嗜血杆菌临床分布及耐药性,指导临床合理用药。方法对2014-2015年北京儿童医院住院患儿临床送检标本分离出350株流感嗜血杆菌的分布、产β内酰胺酶情况和药敏结果进行回顾性分析。药敏试验采用纸片扩散法,头孢硝噻吩纸片法测定β内酰胺酶,按照临床和实验室标准化协会(CLSI)2014年的标准进行药敏检测和结果判断。使用WHONET 5.6和SPSS15.0软件进行数据统计分析。结果流感嗜血杆菌感染多见于婴幼儿,常见合并其他病原感染。β内酰胺酶阳性率为53.1%,对甲氧苄啶-磺胺甲唑的耐药率最高,为76.9%,对环丙沙星、头孢唑肟、氯霉素、四环素、阿莫西林-克拉维酸、头孢呋辛、阿奇霉素、头孢克洛、氨苄西林敏感率分别为99.1%、98.9%、95.4%、88.3%、87.7%、74.9%、65.4%、56.6%、46.0%,未检出对头孢曲松、美罗培南不敏感的流感嗜血杆菌。结论儿童分离的流感嗜血杆菌产β内酰胺酶阳性率很高,是流感嗜血杆菌对氨苄西林耐药的主要机制,其高产酶特点使氨苄西林不能作为临床一线用药。流感嗜血杆菌对甲氧苄啶-磺胺甲唑的耐药率最高,对β内酰胺类以外抗菌药物,最敏感的是环丙沙星,其次为氯霉素。     

2006-2011年浙江省杭州市萧山区流感嗜血杆菌耐药性监测

目的 调查了解流感嗜血杆菌的临床分布及耐药情况,为临床用药提供依据。 方法 对2006年1月至2011年12月浙江萧山医院临床分离的流感嗜血杆菌,用ATB嗜血杆菌药敏板条测定抗菌药物的敏感性, 用头孢硝噻吩纸片法测定-内酰胺酶,所有数据用WHONET 5.6软件进行回顾性分析。 结果 共检出流感嗜血杆菌375株,对复方新诺明、氨苄西林耐药分别为248株(66.1%)和127株(33.8%),对氯霉素、头孢克洛和四环素耐药分别为38株(10.2%)、52株(13.8%)和55株(14.7%);其他几种常用药物阿莫西林/克拉维酸、头孢呋辛、头孢噻肟、利福平和氧氟沙星对流感嗜血杆菌保持较好的抗菌活性(耐药率5.0%);-内酰胺酶阳性菌株对多种药物的耐药率显著高于阴性菌株(P0.01)。 结论 复方新诺明耐药率高而不宜用于流感嗜血杆菌感染的治疗, 氨苄西林应慎重用于经验治疗;流感嗜血杆菌对氨苄西林耐药率呈下降趋势,对二代头孢菌素耐药率呈上升趋势,临床应根据药敏结果合理使用抗菌药物。     

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.