获得性感染金黄色葡萄球菌耐药的现状及治疗对策

目的：分析医院与社区获得性感染金黄色葡萄球菌（SAU）耐药现状,给临床合理用药提供参考。方法：收集2005年～2007年临床分离的金黄色葡萄球菌,培养鉴定,采用纸片扩散法（K—B法）测定16种抗菌药物的敏感情况。用WHONET5软件进行分析。结果：440株金黄色葡萄球菌,其中耐甲氧西林金黄色葡萄球菌（MRSA）为260株,占59．1％：甲氧西林敏感金黄色葡萄球菌（MSSA）为180株,占40．9％;SAU对16种抗菌药物的耐药率最高的是青霉素G为85．5％、万古霉素耐药率为0。结论：MSSA对大部分抗菌药物仍保持较好的敏感性。而MRSA表现为多重耐药性．但万古霉素例外。所以对耐万古霉素金黄色葡萄球菌（VISA及VRSA）的连续监测、了解葡萄球菌属的耐药机制具有重要的临床意义。     

2010-2012年院内金黄色葡萄球菌的耐药情况分析

目的 对本院3年来金黄色葡萄球菌的耐药情况进行分析,并且对耐甲氧西林金黄色葡萄球菌（MRSA）与甲氧西林敏感金黄色葡萄球菌（MSSA）的耐药性差异做对比,为临床合理使用抗生素提供依据.方法 对临床分离的442株金黄色葡萄球菌,采用PHOENIX100全自动微生物分析仪和WHONET软件,按照美国实验与临床标准协会（C LSI）的标准对金黄色葡萄球菌的耐药情况进行回顾性分析.结果 3年内共分离金黄色葡萄球菌442株,其中耐甲氧西林金黄色葡萄球菌（MRSA）281株.分离出金黄色葡萄球菌的标本中以痰标本为主,占68.0％,其次为分泌物和血液.除万古霉素、利奈唑胺、奎奴普丁/达福普丁外,耐甲氧西林金黄色葡萄球菌（MRSA）对其余抗菌药物的耐药率均高于甲氧西林敏感金黄色葡萄球菌（MSSA）,差异有统计学意义（P＜0.05）.除万古霉素、利奈唑胺、奎奴普丁/达福普丁保持较低的耐药率外,其余常规抗生素的耐药率均保持在30％以上.结论 耐甲氧西林金黄色葡萄球菌（MRSA）对大部分抗菌药物仍维持较高的耐药率,应定期监测临床标本中分离的金黄色葡萄球菌耐药率,合理使用抗菌药物,延缓金黄色葡萄球菌临床株耐药性的增长,控制医院感染的发生及暴发.     

金黄色葡萄球菌167株耐药性分析

目的分析金黄色葡萄球菌的耐药性,为临床合理使用抗菌药物提供依据。方法对临床标本分离的金黄色葡萄球菌167株,采用K—B纸片法进行药敏试验,耐甲氧西林的金黄色葡萄球菌（MRSA）检测采用头孢西丁纸片扩散法。结果MRSA141株占84．4％,甲氧西林敏感金黄色葡萄球菌（MSSA）26株占15．6％。MRSA对万古霉素、呋喃西林的耐药率为0、18．4％,对其他抗菌药物呈多重耐药;除万古霉外,MRSA对其余11种抗菌药物的耐药率均高于MSSA,差异均有统计学意义（P〈0．05或P〈0．01）。结论MRSA已成为医院感染的重要病原菌,万古霉素、呋喃西林对MRSA有较高活性。重视临床微生物学检查,依据药敏结果优化选择抗菌药物,是提高感染治愈率的关键。     

对108株金黄色葡萄球菌的耐药性分析

目的了解我院金黄色葡萄球菌临床分离株对抗菌药物的耐药性及感染现状,以指导临床医生更科学合理用药。方法收集我院2009年11月-2011年9月间住院及门诊患者的标本,对分离出的108株金黄色葡萄球菌进行药敏试验。结果对甲氧西林耐药的金黄色葡萄球菌（MRSA）有76株,占70．4％;对甲氧西林敏感的金黄色葡萄球菌（MSSA）有32株,占29．6％。菌株主要分离于痰液／咽拭子,占42．6％;其次是分离于脓液／创面,占36．1％;其他的菌株分离于阴道分泌物、血液、尿液和精液,占21．3％。金黄色葡萄球菌中MRSA对16种抗菌药物的耐药率最高的是青霉素和苯唑西林,均为100．0％,而MSSA仅对青霉素的耐药率较高,达83．2％,对其余15种药物的耐药率都低于50％。万古霉素、呋喃妥因、替考拉宁耐药率在两者均为0。结论甲氧西林敏感金黄色葡萄球菌除了青霉素外对大多数的抗菌药物有较好的敏感性,而耐甲氧西林金黄色葡萄球菌的检出率仍然很高且多为多药耐药性。     

夫西地酸对耐甲氧西林葡萄球菌的体外抗菌活性研究

目的:了解夫西地酸对多重耐药的耐甲氧西林葡萄球菌临床分离株的体外抗菌活性。方法:采用血浆凝固酶、金黄色葡萄球菌单克隆抗体及Vitek-32型仪进行菌株鉴定,纸片琼脂扩散(K-B)法进行药物敏感性试验,头孢西丁纸片法检测耐甲氧西林葡萄球菌。结果:97株金黄色葡萄球菌中,检测到耐甲氧西林金黄色葡萄球菌(MRSA)56株,占57.7%;119株凝固酶阴性葡萄球菌中,检测到耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)77株,占64.7%。全部菌株均对万古霉素敏感,MRSA及MRCNS对夫西地酸的耐药率分别为1.8%和7.8%,耐甲氧西林葡萄球菌对其它抗菌药物的耐药率在25%～100%之间。结论:夫西地酸对耐甲氧西林葡萄球菌有较强的体外抗菌活性。     

金黄色葡萄球菌的分离鉴定及耐药性分析

目的：了解金黄色葡萄球菌感染的分布与耐药情况,为临床合理使用抗菌药物提供病原学调查及实验室依据。方法：收集临床分离的金黄色葡萄球菌,培养鉴定按《全国临床检验操作规程》进行,药敏试验采用纸片扩散法（K-B法）。结果：检出的金黄色葡萄球菌以痰标本为主,其中耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为66.4%,甲氧西林敏感金黄色葡萄球菌（MSSA）为33.6%;MRSA对常用抗菌药物的耐药率明显高于甲氧西林敏感金黄色葡萄球菌,未检出耐万古霉素金黄色葡萄球菌。结论：加强临床金黄色葡萄球菌耐药情况监控,根据药物敏感试验合理用药十分重要。     

湖北地区2003-2004年葡萄球菌临床分离株的耐药性监测

目的：了解湖北地区葡萄球菌临床分离株的分布及其对常用抗菌药物的耐药率。方法：采用纸片扩散法检测1600株金黄色葡萄球菌和2596株凝固酶阴性葡萄球菌对11种抗菌药物的耐药性。结果：共检出甲氧西林耐药金黄色葡萄球菌824株，分离率为51．5％；检出甲氧西林耐药凝固酶阴性葡萄球菌1896株，分离率为73．03％。耐甲氧西林对庆大霉素、环丙沙星、克林霉素的耐药率分别为77％、91％、88％，比耐甲氧西株凝目酶阴性葡萄球菌对上述3种抗菌药物的耐药率28％、66％、56％均高，而耐甲氧西林凝固酶阴性葡萄球菌对复方磺胺甲嗯唑及氯霉素的耐药率较金黄色葡萄球菌为高。甲氧西林敏感的凝固酶阴性葡萄球菌对环丙沙星、复方磺胺甲嗯唑、四环素、氯霉素的耐药率较甲氧西林敏感的金黄色葡萄球菌为高。但仍对庆大霉素、环丙沙星、氯霉素、克林霉素表现出较好的抗菌活性。结论：湖北地区葡萄球菌耐药现状不容忽视，加强对葡萄球菌耐药性的监测，并根据药敏试验结果合理使用抗菌药物对控制感染及防治耐药菌的传播非常必要。     

夫西地酸和万古霉素对耐甲氧西林金黄色葡萄球菌体外抗菌活性的研究

目的了解耐甲氧西林金黄色葡萄球菌对夫西地酸和万古霉素的耐药率动态变化。方法应用回顾性调查方法,对本院从2004年1月至2008年12月间临床样本分离的耐甲氧西林金黄色葡萄球菌夫西地酸和万古霉素药敏试验进行统计分析。结果所分离出的耐甲氧西林金黄色葡萄球菌772株,占金黄色葡萄球菌的78．1％,耐甲氧西林金黄色葡萄球菌对万古霉素高度敏感,夫西地酸耐药率有整体上升趋势。结论本地区耐甲氧西林金黄色葡萄球菌检出率维持在较高水平,夫西地酸和万古霉素是治疗MRSA感染的理想药物,但要注意耐夫西地酸菌株的爆发流行和耐万古霉素菌株的出现。     

夫西地酸和万古霉素对耐甲氧西林金黄色葡萄球菌体外抗菌活性的研究

目的了解耐甲氧西林金黄色葡萄球菌对夫西地酸和万古霉素的耐药率动态变化。方法应用回顾性调查方法,对本院从2004年1月至2008年12月问临床样本分离的耐甲氧西林金黄色葡萄球菌夫西地酸和万古霉素药敏试验进行统计分析。结果所分离出的耐甲氧西林金黄色葡萄球菌772株,占金黄色葡萄球菌的78．1％,耐甲氧西林金黄色葡萄球菌对万古霉素高度敏感,夫西地酸耐药率有整体上升趋势。结论本地区耐甲氧西林金黄色葡萄球菌检出率维持在较高水平,夫西地酸和万古霉素是治疗MRSA感染的理想药物,但要注意耐夫西地酸菌株的爆发流行和耐万古霉素菌株的出现。     

耐甲氧西林葡萄球菌耐药性分析

为了解耐甲氧西林葡萄球菌的耐药状况，并为临床预防与治疗提供依据，我们对６１株葡萄球菌进行耐甲氧西林及１４种常用抗菌素的耐药率测定。结果：耐甲氧西林金黄色葡萄球菌检出率为５２．６％；耐甲氧西林凝固酶阴性葡萄球菌检出率为４７．６％；耐甲氧西林葡萄球菌对１４种抗菌素的耐药率及多重耐药性均高于甲氧西林敏感葡萄球菌。耐甲氧西林葡萄球菌对万古霉素敏感，提示该药可作为临床治疗这类细菌感染的首选药物     

Effects of methysergide, pizotifen and ergotamine in the monkey cranial circulation.

Internal and external carotid vascular resistances were measured, in anaesthetized monkeys, to asses the direct cranial vascular effects of i.v. methysergide, pizotifen and ergotamine, and their effects on the cranial vascular responses to the constrictors 5-hydroxytryptamine and noradrenaline and the dilators histamine, prostaglandin E1 and bradykinin. Methysergide reduced responses to 5-HT, and tended to potentiate the external carotid responses to noradrenaline. Pizotifen blocked responses to histamine; it tended to reduce internal carotid responses to 5-HT, but it potentiated external carotid 5-HT responses. Ergotamine reduced responses to 5-HT and noradrenaline, but this was probably related to its cranial vasoconstrictor effects, especially in the external carotid circulation. Methysergide induced weak transient cranial vasoconstriction and pizotifen had no direct effects. These findings may be relevant to the therapeutic actions of these drugs in migraine, since the doses used approximated to those used clinically.     

The treatment of epilepsy in pregnancy: The neurodevelopmental risks associated with exposure to antiepileptic drugs

A number of antiepileptic drugs (AEDs) have been confirmed as teratogens due to their association with an increased malformation rate. The majority of research to date does not find an association between prenatal exposure to monotherapy carbamazepine, lamotrigine or phenytoin and neurodevelopmental outcome in comparison to control children and noted higher abilities in comparison to children exposed to valproate; but further work is needed before conclusions can be drawn. Data for levetiracetam was limited to one study, as was the evidence for topiramate. Sodium valproate exposure appeared to carry a dose dependent risk to the developing brain, with evidence of reduced levels of IQ, poorer verbal abilities and increased rate of autistic spectrum disorder both in comparison to control children and children exposed to other AEDs. The severity of the neurodevelopmental deficits associated with prenatal exposure to valproate highlight the critical need to consider neurodevelopmental outcomes as a central aspect of teratological research.     

The use of fluoroquinolones in gonorrhoea: the increasing problem of resistance

The recent re-emergence of gonorrhoea in developed countries has been accompanied by the rise and spread of gonococcal resistance to the fluoroquinolones. In the 1980s fluoroquinolones were considered an important addition to the arsenal of agents used to treat gonorrhoea. They proved to be excellent drugs for this indication, including infections caused by penicillinase-producing and tetracycline-resistant strains of Neisseria gonorrhoeae. However, as gonococci have a well-recognised potential to develop resistance to antibiotics, the first reports of reduced susceptibility to fluoroquinolones appeared a few years after their introduction. Gonococcal resistance to fluoroquinolones is now well-established in the Far East, from where it has spread to Australia, Hawaii, California and Europe. In Africa and Latin America, gonococci continue to be susceptible to fluoroquinolones.     

Basal and zinc-induced metallothionein in resistance to cadmium, cisplatin, zinc, and tertbutyl hydroperoxide: studies using MT knockout and antisense-downregulated MT in mammalian cells.

Metallothioneins (MTs) mediate resistance to metal and non-metal toxicants. To differentiate the role of MTs from other protective factors, resistance to zinc (Zn), cadmium (Cd), tertbutyl hydroperoxide (tBH), and cisplatin (CDDP) was compared in renal cell lines from wild type (MT-WT) and MT-1/MT-2 knockout (MT-KO) mice. MT-WT cells were more resistant to tBH than MT-KO cells but, unexpectedly, were more sensitive to Zn, Cd, and CDDP. Thus, basal expression of MT conferred resistance to tBH, but not to Cd or CDDP. Pretreatment with Zn increased MT expression and enhanced resistance to Cd and CDDP only in MT-WT cells, indicating a critical role for MT in this form of resistance. By contrast, Zn-pretreatment increased resistance to subsequent Zn exposure, but did not alter resistance to tBH, regardless of MT-status. Therefore, Zn-induced resistance to subsequent exposure to Zn (but not to Cd or CDDP) was mediated by non-MT factors, and neither Zn-induced MT nor other factors affected tBH sensitivity. Furthermore, antisense down-regulation of MT in human HeLa cells reduced basal MT levels and resistance to TBH, but not to Cd or CDDP. Therefore, basal MT alone can mediate resistance to TBH (but not to Cd or CDDP) in mouse and human cells. These data suggest that MT can mediate resistance to toxicants by different mechanisms, some of which correlate with the cellular content of MT protein. Moreover, resistance to some agents (Cd and CDDP) can be enhanced by inducing MT. Resistance to other agents (tBH) requires only basal (non-induced) MT levels.     

Four Rights of the Pharmacy Educational Consumer

Professional students and their families invest a significant amount of time and finances to obtain a degree. While education is not a typical consumer good and should not be treated as such, there are certain expectations that colleges and schools should be prepared to meet. This article contrasts academic entitlement issues with 4 fundamental rights underpinning colleges’ and schools’ fiduciary responsibilities to students. The authors submit that students, in their roles as higher education consumers, have the following rights: (1) to have the opportunity to learn, (2) to learn from faculty members dedicated to best teaching practices, (3) to learn within a curriculum designed to prepare them for the profession, and (4) to have access to resources necessary to succeed.     

Chemotherapy individualization

The current practice of dosing patients with anticancer drugs based on body size, leads to a large degree of inter-patient variation in clinical outcome following standard doses of chemotherapy. Some patients may fail to respond to treatment, whilst others experience unacceptable side effects. Recent studies have identified more rational approaches to drug dosing, based on patient characteristics such as renal function, pharmacogenetic factors, and drug metabolizing activity. These can be used together with therapeutic drug monitoring and adaptive dosing to achieve a targeted systemic drug exposure in each patient, which may lead to more consistent clinical outcomes in patients receiving comparable chemotherapy dosing regimens. The purpose of this review is to present some approaches to chemotherapy individualization, examples of how this might be applied, and speculation as to how recent advances in pharmacogenetics may lead to further dose-optimization.Whilst it is hoped that the design of new agents, targeted to specific genes involved in oncogenesis, will lead to increased success in the treatment of cancer patients, it is essential that the drugs currently available are used to their maximum potential.     

Readiness to change smoking behavior in adolescents with psychiatric disorders

There has been recent increased interest in utilizing motivational interviewing (MI) to increase adolescent readiness to quit smoking, but attempts to impact quit rates have thus far been discouraging. A better understanding of factors associated with adolescent readiness to quit smoking prior to receiving any intervention may provide guidance when tailoring future MI interventions in order to increase their effectiveness with this population. Adolescent smokers (N=191) who had been admitted to a psychiatric hospital and enrolled in a clinical trial evaluating MI completed questionnaires that assessed smoking behavior and variables thought to be related to smoking. Confidence to quit smoking and negative beliefs about smoking were significant predictors of adolescents' baseline readiness to quit smoking. The failure to demonstrate relationships between health consequences and readiness suggest that caution may be warranted in the use of feedback, a common component of MI-based interventions. Such feedback tends to focus on health consequences, which was unrelated to adolescent baseline readiness to change smoking behavior in the current study. Parallels between current results and the Theory of Planned Behavior are discussed in consideration of developing more effective MI-based interventions for adolescent smokers.     

The role of biomarkers in the future of drug development

Biomarkers are beginning to be used earlier in drug development, thus allowing the pharmacodynamic effects of targeted therapeutics to be explored before clinical signs and symptoms can be evaluated. This trend will continue and ultimately may enable pharmacodynamic biomarkers to be commonly used to determine therapeutic dosing based on these more accurate measures of human physiological responses. At the same time, biomarkers are also beginning to be used to determine which patients will be likely to respond to the therapeutic, thus avoiding administration to those who will not be likely to benefit. The strategy to achieve these aims and how this can lead to information that can be fed back into drug discovery is described in this perspective.     

产科因素导致子宫切除的临床分析

目的探讨产科因素导致子宫切除的相关危险因素以及如何降低其发生率进行临床分析,从而及时有效的降低危险因素的发生来指导临床。方法回顾性的分析本院2003年3月至2013年3月由于产科因素导致子宫切除的38例患者的临床资料。结果子宫切除的指证主要是由于产后大出血导致的,具体以胎盘因素为主,其次是子宫收缩乏力,子宫破裂等因素。结论由于产科因素导致大出血的最有效的措施就是行子宫切除术。是抢救孕产妇生命的有效途径,但是要严格掌握剖宫产手术指征,产前有效的诊断以及孕期检查能够有效地降低产科因素导致子宫切除发生的可能,从而降低孕产妇和胎儿的死亡率。     

Development of in vitro systems for nanotoxicology: methodological considerations

Due to the rapid development of a diverse array of nanoparticles, used in a wide variety of products, there are now many international activities to assess the potential toxicity of these materials. These particles are developed due to properties such as catalytic reactivity, high surface area, light emission properties, and others. Such properties have the potential to interfere in many well-established toxicity testing protocols. This article outlines some of the most frequently used assays to assess the cytotoxity and biological reactivity of nanoparticles in vitro. The article identifies key issues that need to be addressed in relation to inclusion of relevant controls, assessing particles for their ability to interfere in the assays, and using systematic approaches to prevent misinterpretation of data. The protocols discussed range from simple cytotoxicity assays, to measurement of reactive oxygen species and oxidative stress, activation of proinflammatory signaling, and finally genotoxicity. The aim of this review is to share knowledge relating to nanoparticle toxicity testing in order to provide advice and support for guidelines, regulatory bodies, and for scientists in general.