重症急性胰腺炎继发真菌感染的临床特点和相关因素分析

目的探讨重症急性胰腺炎(SAP)继发真菌感染的临床特点和相关危险因素分析。方法回顾性分析2013年1月至2018年6月收治的454例SAP患者,分析SAP继发真菌感染的临床特点和感染的相关危险因素。结果 86例患者继发真菌感染,发生率为18. 94%,其中14例死亡,死亡率为16. 28%。累计感染部位127个部位,主要部位包括腹腔感染41例次(32. 28%)、肺部感染34例次(26. 77%)、胰腺或胰周感染21例次(16. 54%)。检出时间7～34 d,平均(15. 7±4. 2) d。共分离出121株真菌菌株,念珠菌107株,毛霉菌14株,前者以白色念珠菌最多。单因素分析结果显示,真菌感染与入院时APACHEⅡ评分、持续高血糖、肠麻痹时间、多器官功能衰竭、抗生素使用时间、中心静脉导管留置时间和抗生素使用种类有关(P 0. 05)。多因素分析结果显示,肠麻痹时间≥7 d、多器官功能衰竭是SAP继发真菌感染的独立危险因素(P 0. 05),中心静脉导管留置时间14 d是SAP继发真菌感染的独立保护因素(P 0. 05)。结论 SAP继发真菌感染好发于腹腔,以白色念珠菌最为常见,发生率较高,尤其是合并肠麻痹时间过长、多器官功能衰竭和中心静脉导管留置时间过长的患者。     

抗生素使用与院内继发肺部真菌感染68例分析

目的探讨院内继发真菌肺部感染与抗生素使用的关系。方法对新疆医科大学第五附属医院呼吸科近期发生肺部真菌感染68例老年患者的临床资料进行回顾性分析。结果本组68例患者痰中共分离培养出真菌156株,其中念珠菌(未细分)39株,白色念珠菌35株,热带念珠菌13株,光滑念珠菌7株,未分型真菌46株,曲霉菌16株;继发下呼吸道真菌感染前2个月内使用抗生素最多达7种,感染前最近1个疗程选用的抗生素,以第三代头孢菌素为主,其余依次为半合成青霉素、氟喹喏酮类等。结论导致院内真菌肺部感染的主要原因是抗生素的不合理使用。     

老年危重症患者合并真菌感染的预后和相关因素分析

目的探讨老年危重症患者合并重要脏器严重真菌感染时的预后,并分析可能引起真菌感染的致病条件和因素等. 方法收集本院近些年来老年危重症感染患者共122例,按真菌混合感染和细菌感染分为2组,分析使用抗生素时其痰和血等培养出的致病菌种和构成. 结果真菌混合感染组真菌高达76株,白念珠菌50%和酵母菌1.6%,革兰阳性(G+)菌(41.3%,52/126株)较细菌组G+菌感染(56.9%,70/123株)低,t＝2.49,P＜0.01);而革兰阴性(G-)菌(60.3%,74/126株)较细菌组G-菌(43.1%,53/123株)高;t＝2.50,P＜0.01.可引起真菌感染的因素是感染器官/部位,导/引流管,急性生理评分和抗生素等.真菌出现时所用抗生素三代头孢菌素、氧哌嗪青霉素、喹诺酮类、美洛培南和万古霉素.2组中共死亡82例,真菌组死亡46例(74.2%),细菌组死亡36例(60%). 结论老年危重症患者真菌出现前后多伴有非常严重G-和G+菌混合感染,感染受累部位或器官和引流管或深静脉置管越多,以及多种超广谱抗生素应用等均可使其获得真菌感染的机会增加,且多预后不良.     

COPD患者肺部真菌感染菌株分布及相关危险分析

目的探索COPD患者院内肺部真菌感染菌株分布、耐药特点及分析可能的相关危险因素。方法对2009年1月-2011年12月297例COPD患者院内肺部真菌感染标本中161株真菌菌株进行鉴定和药物敏感试验。结果161株病原菌中,念珠菌占主要地位,占86．34％,其中白色念珠菌占65．47％,药敏试验结果表明：念珠菌中氟康唑的敏感性较高。广谱高效抗生素、糖皮质激素的应用和低蛋白血症、高龄等是COPD继发真菌感染的主要危险因素。临床表现无特异性,胸部x线表现以支气管肺炎为多见。结论我院COPD患者院内肺部真菌感染病原菌以念珠菌为主。降低其继发真菌感染发病率的主要途径是避免盲目使用高效、广谱抗生素及糖皮质激素,预防医源性感染,增加患者的免疫力。     

慢性阻塞性肺病继发肺部真菌感染41例临床分析

目的探讨慢性阻塞性肺病(COPD)继发肺部真菌感染的常见原因及对策。方法对41例COPD伴真菌感染病例进行回顾性分析。结果应用抗生素3种以上者23例(56.10%),5种以上者10例(24.39%),29例同时使用了糖皮质激素(70.73%),痰培养的真菌谱为:白念珠菌24例(58.54%),热带念珠菌5例,克柔念珠菌2例,酵母样菌7例,曲霉菌3例。治愈26例(63.41%),好转6例(14.63%),无变化4例(9.76%),死亡5例,病死率12.19%。结论广谱抗生素和糖皮质激素的广泛应用是COPD继发肺部真菌感染的主要原因,及时诊断和治疗可提高其治愈率。     

老年肺炎继发抗生素相关性腹泻患者的粪便病原学特点及相关危险因素分析

目的分析老年肺炎继发抗生素相关性腹泻(AAD)患者的粪便病原学特点及腹泻发生的危险因素。方法选取2019年1月-2019年12月本院收治的60例老年肺炎继发AAD患者为观察组,另选取同期收治的78例老年肺炎未继发AAD患者作为对照组。检测60例AAD患者的粪便病原菌分布以及耐药情况;通过Logistic回归分析法分析老年肺炎患者继发AAD的危险因素。结果 60例AAD患者的粪便中共分离出病原菌89株,其中革兰阴性菌58株(65.17%),以大肠埃希菌为主;革兰阳性菌26株(29.21%),以难辨梭状芽孢杆菌为主;真菌5株(5.62%),以白色念珠菌为主。58株革兰阴性菌对青霉素类、喹诺酮类、头孢菌素类药物均产生了不同程度的耐药性;白色念珠菌对两性霉素B和制霉菌素敏感率均为100%;难辨梭状芽孢杆菌对甲硝唑和万古霉素敏感率均为100%。多因素Logistic回归分析显示,重症肺炎、应用机械通气、抗生素持续应用超过7 d、联合应用抗生素以及禁食均是老年肺炎患者继发AAD的独立危险因素(P0.05)。结论老年肺炎继发AAD患者的粪便病原菌以大肠埃希菌和难辨梭状芽孢杆菌为主,临床应严格掌握抗生素的应用指征,合理应用抗生素,减少AAD的发生。     

卒中相关性肺炎患者感染病原菌种类及其与血清cf-DNA/NETs的相关性

目的分析卒中相关性肺炎(SAP)的病原学特点,以及患者血清游离DNA/中性粒细胞胞外诱捕网(cf-DNA/NETs)水平与痰培养结果的相关性。方法本院2018年6月-2020年6月收治的SAP患者78例,采集痰液标本进行病原菌培养。于抗生素治疗前采集患者血清标本,检测cf-DNA/NETs水平,分析其与病原学检查结果及预后的相关性。结果 78例SAP患者痰液标本共培养出9种病原菌,共156株,其中革兰阴性菌占78.85%,革兰阳性菌占19.23%,真菌占1.92%。SAP主要致病菌为肺炎克雷伯菌,占53.85%。78例患者中细菌感染75例,真菌感染3例。SAP患者血清cf-DNA/NETs水平显著高于对照组(P0.05),SAP细菌感染组显著高于真菌感染组(P0.05)。78例SAP患者中因感染控制不良死亡10例,死亡患者血清cf-DNA/NETs水平显著高于存活患者(P0.05)。结论 SAP主要为细菌性感染,少数为真菌性感染。血清cf-DNA/NETs对鉴别致病菌类型和患者预后评估有一定参考价值。     

COPD急性发作期下呼吸道病原菌感染分析

目的探索贵阳地区慢性阻塞性肺疾病(COPD)急性发作期患者下呼吸道病原菌感染情况。方法选2004年8月至2006年12月间住本院的COPD急性发作期患者,203例进行分析。本组男168例,女35例,年龄66±11岁。COPD病情严重分级:Ⅰ级12例,Ⅱ级31例,Ⅲ级27例,Ⅳ级133例。所有患者进行痰病原菌培养、菌型鉴定及药敏试验。结果203例COPD急性发作期患者有163例痰及纤支镜刷取下呼吸道分泌物病原菌培养阳性(80.29%),培养出细菌237株(73.14%)。真菌87株(26.86%)。细菌感染前6位依次是:卡他布兰汉菌106株(32.72%)、草绿色链球菌(15.74%)、大肠埃希菌22株(6.79%)、产气肠杆菌14株(4.32%)、肺炎链球菌8株(2.48%)及铜绿假单胞菌7株(2.16%)。细菌菌属分布表现为莫拉菌属、肠杆菌属及链球菌属为主。真菌感染为白色念珠菌及酵母样菌。药敏试验显示前6种细菌对青霉素等14种常用抗生素发生耐药较高。结论对COPD急性发作期患者,当选对革兰氏阴性菌为主的联合抗生素方案,同时警惕真菌感染可能。     

慢阻肺患者继发肺部真菌感染的危险因素及其痰培养结果分析

目的分析慢性阻塞性肺疾病(COPD)患者继发肺部真菌感染的危险因素及其痰培养结果。方法回顾性分析41例COPD继发肺部真菌感染的患者(研究组)和60例未发生肺部真菌感染的COPD患者(对照组)的临床资料,比较研究组的病原菌构成及耐药情况;通过多因素Logistic回归分析COPD患者继发肺部真菌感染的危险因素。结果研究组检出324株真菌,以白色念珠菌较常见(占63.58%)。分离菌对两性霉素B的耐药率较低(1.46%),而白色念珠菌对氟康唑等其它4种抗真菌药物的耐药性为1.46%~3.88%。研究组患者的年龄,合并肺源性心脏病、糖尿病、呼吸衰竭及机械通气的比例,抗菌药物和激素使用时间、ICU住院时间及血清白蛋白水平与对照组比较差异均有统计学意义(P0.05);多因素Logistic回归分析显示:高龄,合并肺源性心脏病、糖尿病、呼吸衰竭,机械通气,长期使用抗菌药物和激素及ICU住院时间长均是COPD患者继发肺部真菌感染的危险因素(P0.05),而血清白蛋白增高是COPD患者继发肺部真菌感染的保护性因素(P0.05)。结论 COPD患者继发肺部感染的真菌以白色念珠菌多见,两性霉素B治疗COPD继发肺部真菌感染的耐药率低。COPD患者发生继发肺部真菌感染的危险因素涉及高龄,合并肺源性心脏病、糖尿病、呼吸衰竭等多个方面。临床上应重视对上述危险因素的干预,提高真菌性肺炎的防治效果。     

慢加急性肝衰竭并发侵袭性真菌感染患者临床特点及其影响因素分析

目的 分析慢加急性乙型肝炎肝衰竭(HBV-ACLF)并发侵袭性真菌感染患者的临床特点及其影响因素。方法 2017年1月～2020年1月我院收治的HBV-ACLF患者130例,使用迪尔鉴定仪鉴定真菌种类,采用多因素Logistic回归分析影响ACLF患者并发侵袭性真菌感染的危险因素。结果 在本组130例HBV-ACLF患者中,并发侵袭性真菌感染50例(38.5%),其中,上呼吸道和肺部感染24例(48.0%),肠道感染14例(28.0%),泌尿道感染7例(14.0%),血流感染4例(8.0%),腹腔感染1例(2.0%);白色念珠菌26株(52.0%),另有热带念珠菌8株(16.0%),近平滑念珠菌6株(12.0%),季也蒙念珠菌5株(10.0%),黄曲霉菌3株(6.0%)和毛霉菌2株(4.0%);并发侵袭性真菌感染患者年龄≥40岁和长时间应用抗生素占比显著多于未并发真菌感染患者(P<0.05),血清总胆红素和凝血酶原时间显著高于或长于未并发患者,而血清白蛋白水平显著低于未并发真菌感染组(P<0.05);多因素Logistic回归分析显示,年龄≥40岁(OR=3.332)、血清总胆红素水平过高(OR=4.525)和长时间应用抗生素(OR=1.576)为ACLF患者并发侵袭性真菌感染的危险因素(P<0.05)。结论 HBV-ACLF患者存在容易并发侵袭性真菌感染的危险因素,了解感染的常见部位和常见菌株有助于临床早期预防,及时处理,提高生存率。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.