尿道炎后慢性前列腺炎病原体检测结果分析

目的了解尿道炎后慢性前列腺炎病原体感染情况。方法用淋病培养基、血琼脂培养基、解脲支原体培养基、纱保氏培养基分别对淋病双球菌、解脲支原体、霉菌在37℃培养箱中进行培养,并采用纸片扩散法进行药敏试验;衣原体采用抗原免疫试剂盒进行检测;白2003年6月～2005年5月对126例慢性前列腺炎患者,进行了病原体的检测。结果126例慢性前列腺炎患者中病原体检测的阳性率分别是金黄色葡萄球菌为18．32％、衣原体11．12％、解脲支原体16．7％、淋病双球菌10．3％、白色念珠菌4．8％、解脲支原体＋衣原体3．9％、淋病双球菌＋衣原体2．4％、其他细菌3．2％。井对病原体进行了头孢曲松钠、头孢唑啉、阿米卡星、红霉素、罗红霉素、交沙霉索、阿奇霉素、氧氟沙星、左氧氟沙星、多西环素和米诺环素药敏试验。结论淋病和非淋病尿道炎后慢性前列腺炎病原体感染70．6％,非病原体性前列腺炎为29．4％。     

泌尿生殖道4种病原体检测结果分析

目的研究该地区泌尿生殖道感染患者沙眼衣原体、解脲脲原体、人型支原体及淋病奈瑟菌4种病原体的阳性率,并对支原体做药敏分析,为临床诊疗和用药提供依据。方法对1 021份来自该院的门诊及住院泌尿生殖道疾病患者的标本分别做以上4种病原体检测、培养和药敏试验,并进行统计学分析。结果 4种病原体阳性率分别为:沙眼衣原体8.02%、解脲脲原体46.76%、人型支原体12.45%、淋病奈瑟菌1.19%。解脲脲原体对红霉素类、四环素类和氧氟沙星敏感率高于90%,人型支原体对四环素类敏感率100%。结论该地区泌尿生殖道感染的4种病原体中,解脲脲原体阳性率最高,淋病奈瑟菌阳性率最低,病原体检测及药敏试验对临床诊疗有重要意义。     

女性不孕不育患者解脲支原体感染临床观察及药敏分析

目的观察女性不孕不育患者解脲支原体感染的临床特征,检测临床常用抗生素对解脲支原体敏感性,以指导解脲支原体感染的治疗。方法纪录135例女性不孕不育患者解脲支原体感染的临床表现及合并症情况,并取宫颈分泌物进行解脲支原体培养及抗生素敏感试验。结果135例解脲支原体感染不孕不育患者中,临床症状、体征主要有：阴道分泌物增多113例（84％）、腰部酸痛不适81例（60％）、输卵管阻塞27例（20％）、盆腔积液100例（74％）、宫颈糜烂85例（63％）。其次,解脲支原体易与其他病原微生物合并感染：衣原体15例（11％）;其他阴道炎48例（35％）。10种抗生素药敏试验结果显示：强力霉素、美满霉素的耐药性最低,分别为7％和15％;而罗红霉素、环丙沙星耐药性最高,分别为68％和73％。结论解脲支原体是非淋病性泌尿、生殖系统的重要病原体,应重视对解脲支原体的筛查,对伴有阴道分泌物增加、腰腹不适及不孕不育的患者,应尽早进行解脲支原体的检查,并根据药敏试验选用抗生素。     

支原体487株药敏试验测定

目的 对泌尿生殖系感染患者行支原体检测及药敏分析以指导临床合理用药。方法 应用法国生物梅里埃公司IST试剂盒作支原体培养鉴定及药敏试验。结果 983例患者中分离到支原体487株，标本阳性率为49．5％，其中解脲脲原体（Uu）阳性率占74．7％，人型支原体（Mh）阳性率占18．1％，Uu＋Mh混合型阳性率占7．2％，药敏结果显示，支原体对多西环素最为敏感（98．1％），但对环丙沙星敏感度最低（17．3％）。结论 多西环素、交沙霉素、克拉霉素可作为目前治疗泌尿生殖系支原体感染的抗生素。     

泌尿生殖感染患者病原体检验结果分析

目的了解女患者对淋病奈瑟菌、沙眼衣原体、解脲支原体三种病原体的易感性是否存在差异以及淋病奈瑟菌、沙眼衣原体、解脲支原体三种病原体在可疑人群中的感染情况。方法对来自本门诊的640例女疑为泌尿生殖道感染的标本，用多聚酶链反应（PCR）分别检测淋病奈瑟菌、沙眼衣原体、解脲支原体。结果淋病奈瑟菌在可疑人中的感染率女性58／640（9．1％），沙眼衣原体感染率女性121／640（19．0％），解脲支原体感染率女性255／640（40％），三重复合感染0．7％，二重复合感染8.3％。结论淋病奈瑟菌、沙眼衣原体、解脲支原体三种病原体在可疑人中的感染率分别为8．8％、19．8％、32．1％，差异非常显著（P〈0．01）。     

常见性病病原体感染的流行趋势与相关性分析

目的研究本地区常见性病病原体的流行病学趋势,分析其合并感染的可能相关性。方法实时荧光PCR法检测临床送检标本,化学发光免疫分析法(CMIA)检测梅毒血清抗体。分析各年间病原体的感染流行情况与合并感染的相关性。结果2010年至2014年,共检出解脲支原体2 171例,沙眼衣原体1 195例,淋病奈瑟菌552例,人乳头瘤病毒1 835例,单纯疱疹病毒489例,梅毒抗体阳性816例。发现同一标本内存在感染多种病原体菌现象。解脲支原体、沙眼衣原体与人乳头瘤病毒检出率变化明显,χ2趋势检验分析显示沙眼衣原体与人乳头瘤病毒检出率呈增长趋势(P0.05)。淋病奈瑟菌、单纯疱疹病毒和梅毒检出率无显著变化。解脲支原体、沙眼衣原体和淋病奈瑟菌合并感染现象严重,Pearson相关显示解脲支原体与沙眼衣原体存在直线相关性(r=0.640,P0.05)。结论本地区解脲支原体与沙眼衣原体感染趋势日渐严重,积极开展性病防治教育活动,控制隐性性传播疾病合并感染现象。     

育龄期不孕症患者衣原体、支原体感染的现状及其临床意义

目的探究育龄期不孕症患者衣原体、支原体感染的现状及对常规抗菌药物的耐药情况,为临床控制衣原体、支原体感染及合理规范使用抗菌药物提供依据。方法选取2020年7月至2021年10月我院收治的育龄期不孕症患者74例进行宫颈分泌物衣原体、支原体培养及药物敏感试验,并进行统计分析。结果74例育龄期不孕症患者中,支原体感染19例,阳性率为25.68%。其中单纯人型支原体感染5例,阳性率为6.76%;单纯解脲支原体感染13例,阳性率为25.68%;人型支原体+解脲支原体感染1例,阳性率为1.35%。74例育龄期不孕症患者中,衣原体感染3例,阳性率为4.05%。药敏试验中,支原体菌株对红霉素、环丙沙星的耐药率较高,对交沙霉素、美满霉素、强力霉素敏感。结论育龄期不孕症患者衣原体、支原体感染率较高,耐药谱较为复杂。建议交沙霉素、美满霉素、强力霉素作为支原体感染的首选药物,临床应根据药敏试验结果合理规范选用抗菌药。     

泌尿生殖道支原体属感染特点及耐药性分析

目的探讨泌尿生殖道支原体属感染状况及对抗菌药物的耐药情况,指导临床合理用药。方法采用支原体培养药敏试验试剂盒,对临床收集的1852例泌尿生殖道感染患者标本进行支原体属培养及10种抗菌药物的体外药敏试验。结果在1852例受检患者标本中检出支原体阳性782例,总阳性率为42．2％。其中解脲脲原体（Uu）单一感染617例,占78．9％;人型支原体（Mh）单一感染28例,占3．6％;Uu和Mh混合感染137例,占17．5％。21～30岁年龄段患者支原体培养阳性率为42．9％,明显高于其他年龄段。药敏试验结果显示,Uu阳性者对交沙霉素、多西环素、米诺环素、克拉霉素较敏感,敏感率分别为95．7％、92．9％、92．8％和91．6％,而耐药率在70．0％以上的有大观霉素、阿奇霉素、环丙沙星、罗红霉素。结论治疗泌尿生殖道支原体属感染应首选交沙霉素和多西环素等敏感性高的药物,避免使用大观霉素、阿奇霉素等耐药性高的药物。临床上对疑似泌尿生殖道感染的患者进行支原体属的培养和药敏试验,对支原体属感染的抗菌治疗有重要的临床意义。     

102株解脲支原体耐药分析

目的了解女性生殖道支原体感染及耐药状况,为临床治疗提供依据。方法采用美国其昌达公司支原体计数鉴定药敏试剂盒,对240份患者阴道分泌物进行支原体培养、鉴定及药物敏感试验。结果110份标本培养出支原体,总检出率为42．8％。其中单纯解脲支原体感染阳性例数为102例,阳性率为42．5％;解脲支原体合并人型支原体感染例数为6例,阳性率为2．5％;单纯人型支原体感染例数为2例,阳性率为0．8％。药敏结果表明解脲脲原体对强力霉素、米诺环素敏感性高达99％;大环内酯类除克拉霉素有较高的敏感性（85．9％）外,其余药物的敏感性均较低;喹诺酮类药物的耐药现象严重。结论在女性生殖道支原体感染中解脲脲原体是主要病原微生物,强力霉素和米诺环素是治疗阴道支原体感染的首选药物。     

女性生殖道感染支原体属的分布及药敏结果分析

目的：探讨本地区女性生殖道支原体感染及对药物的敏感情况。方法：使用支原体培养及药敏试剂盒检测1435例女性生殖道的解脲支原体,并对10种抗生素的药敏试验进行分析。结果：698例检测出支原体属,阳性率为48．6％其中解脲脲支原体感染578例,占82．8％为最高。解脲脲支原体对多西环素、交沙霉素、克拉霉素较为敏感。而支原体属对氟喹诺酮类抗茵药物耐药率均高,因此本地区不宜选用。结论：本地区女性生殖道感染中支原体感染率为48．6％。多西环素、交沙霉素、克拉霉素是本地区女性生殖道支原体感染的首选药物。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.