阴沟肠杆菌敏感株与诱导耐药株药敏异同分析

目的 应用体外诱导耐药的方法,模拟临床上不合理使用抗生素过程,通过对阴沟肠杆菌敏感株与诱导耐药株药敏异同分析,为临床合理应用抗生素提供依据.方法 取临床分离对头孢他啶敏感的阴沟肠杆菌10株.应用不同浓度梯度头孢他啶逐级诱导成为耐药株,比较分析10株敏感茵和诱导后耐药菌药敏结果.结果 临床分离株大部分对头孢菌素类抗生素敏感:经头孢他啶诱导后,时大部分头孢菌素、青霉素类抗生素及氨曲南耐药,只对头孢吡肟仍保持敏感率达90%.此外.对亚胺培南,阿米卡星,复方新诺明,环丙沙星仍保持诱导前的敏感性.结论 长时间、不规范应用低于正常杀茵剂量的抗生素容易诱导出细菌的耐药性,临床抗感染治疗合理选择抗生素和足量地应用抗茵药物非常必要.     

阴沟肠杆菌的临床分布及耐药性分析

目的 分析2010至2012年广州医学院第二附属医院阴沟肠杆菌的临床分布及耐药情况.方法 收集2010年8月至2012年8月本院细菌室检测的痰、尿、脓液或创口分泌物、胆汁、血液及其他体液样本,从中分离出97株阴沟肠杆菌并经VITEK 2 Compact细菌鉴定仪鉴定.分析阴沟肠杆菌在各科的分布情况.采用K-B纸片法进行药敏试验,再用双纸片法检测超广谱β-内酰胺酶(ESBL).结果 阴沟肠杆菌主要分布于呼吸科、肝胆外科和新生儿科,分别占12.4％、11.34％、2.06％;其中46株来自于痰,占47.42％,其次为尿、脓液或创口分泌物,均为12株,各占12.37％.标本中阴沟肠杆菌ESBL阳性株对亚胺培南耐药率最低为0,对头孢吡肟、丁胺卡那耐药率为14.29％、4.76％,与ESBL阴性株耐药率差异无统计学意义;对氨苄西林、头孢噻肟、氨曲南耐药率为100％、95.24％、100％,明显高于ESBL阴性株的耐药率.结论 阴沟肠杆菌多药耐药现象较为严重,应加强耐药性监测,指导临床医师合理使用抗菌药物.     

烧伤创面细菌学检测及耐药性分析

目的本研究通过对烧伤创面细菌学调查及耐药性分析，为临床治疗提供参考。方法从2004年1月至2007年4月本院收治的69例烧伤患者创面细菌培养分离出细菌170株，用纸片琼脂扩散法进行药物敏感试验，就其中前5种细菌进行回顾性分析。结果在本组检出的细菌中，革兰阴性杆（G^-）菌122株（71．76％），革兰阳性（G^＋）菌48株（28．24％）。其中，数量较多的前5种细菌为鲍曼不动杆菌（17．00％），阴沟肠杆菌（11．18％），铜绿假单胞菌（10．00％），金黄色葡萄球菌（10．59％），肺炎克雷伯菌（8、82％）。鲍曼不动杆菌占G^-杆菌的23．77％，该菌对几乎所有抗菌药物耐药，对亚胺培南的耐药率高达75．86％。阴沟肠杆菌占G^-杆菌的15．57％，对抗菌药物的耐药率超过90％，对亚胺培南敏感。铜绿假单胞菌和肺炎克雷伯菌对抗菌药物的耐药率超过50％。金黄色葡萄球菌占G^＋菌的37．5％，对万古霉素的耐药率为17．65％。以上5种细菌对大多数常用抗菌药物表现出高耐药性。结论本组烧伤患者感染细菌以G^-杆菌为主，G^＋菌次之，这些细菌对常用抗菌药物有多重耐药性，亚胺培南对大多数G^-杆菌仍有较高的抗菌活性。G^＋菌对万古霉素敏感。     

临床分离4364株细菌的分布特征和耐药性变迁分析

目的了解2003—2005年分离的4364株细菌的分布特征及耐药性变迁，为合理使用抗菌药物提供依据。方法大多数分离细菌的鉴定和药敏试验利用BD Phoenix仪，少数利用手工鉴定和K-B法药敏试验。数据分析用WHONET5．0软件。结果葡萄球菌对万古霉素和替考拉宁的敏感率一直为100％，对其他抗菌药物的耐药率大多逐年上升，甲氧西林耐药率也逐年上升，金黄色葡萄球菌从40．8％上升到61．6％，表皮葡萄球菌从69．7％上升到79．8％。G^-杆菌合计，大多数抗菌药物的耐药率逐年升高，耐药率一直低于30％的为美洛培南、亚安培南、头孢哌酮／舒巴坦、哌拉西林-他唑巴坦和头孢他啶。大肠埃希菌和肺炎克雷伯菌体外产ESBLs的检出率一直居高不下，为29．5％～45．5％。结论本院肠杆菌科产ESBLs比例、葡萄球菌甲氧西林耐药率和非发酵菌碳青霉烯类耐药率均较高，应加强抗菌药物的合理使用和采取有效的隔离措施以降低耐药率及多重耐药菌的扩散。     

临床阴沟肠杆菌感染分布及耐药性分析

目的了解本院2006-2009年临床分离的阴沟肠杆菌的感染分布和耐药趋势特点,为临床合理应用抗生素提供依据。方法用MicroScanWalkAway40全自动细菌分析系统对临床分离的阴沟肠杆菌进行鉴定和药敏试验,并分析结果。结果 207株阴沟肠杆菌主要分布在呼吸科及ICU;标本的主要来源为痰及咽拭子（75.36%）;药敏试验结果显示,阴沟肠杆菌对亚胺培南、阿米卡星敏感性最高,对氨苄西林、阿莫西林/克拉维酸、头孢唑啉及头孢西丁的耐药性最严重,耐药率均〉80%。结论阴沟肠杆菌对β-内酰胺类抗生素耐药形势不容乐观,临床抗感染治疗应以分离菌株的体外抗菌药物敏感性为参考,同时注意分离菌株的流行趋势,合理选用抗生素,避免诱导性耐药的产生。     

20株阴沟肠杆菌耐药性及氨基糖苷类修饰酶基因分析

目的明确临床分离的20株阴沟肠杆菌耐药性及氨基糖苷类修饰酶基因存在状况。方法采用ATB药敏试验板微量肉汤法测定临床分离的20株阴沟肠杆菌对20种抗菌药物的敏感性，采用聚合酶链反应及序列分析的方法分析氨基糖苷类修饰酶基因型。结果该20株菌呈现多重耐药，对亚胺培南和美罗培南均敏感，对阿莫西林、阿莫西林／克拉维酸、头孢噻吩和头孢西丁完全耐药，对头孢吡肟及4种氨基糖苷类抗生素阿米卡星、庆大霉素、妥布霉素和奈替米星的耐药率分别为25．0％、60．0％、85．0％、90．0％和90．0％，其余9种的耐药率在80．0％～95．0％之间。19株(95．0％)检出氨基糖苷类修饰酶基因；aac(6′)-Ⅰ、aac(3)-Ⅱ、ant(3″)-Ⅰ、ant(2″)-Ⅰ和aph(3′)-Ⅵ基因的阳性率分别为80．0％、50．0％、40．0％、5．0％和5．0％；而aog2(3)-Ⅰ、aac(3)-Ⅲ、aac(3)-Ⅳ和aac(6′)-Ⅱ基因均阴性。结论临床分离的阴沟肠杆菌多重耐药严重，氨基糖苷类修饰酶基因携带率很高。     

儿科患者中对碳青霉烯类不敏感肠杆菌科细菌耐药性和耐药基因的研究

目的 研究儿科临床分离的对碳青霉烯类抗生素不敏感的肠杆菌科细菌耐药性和产生碳青霉烯酶的耐药基因特征.方法 收集2008年1月至2010年12月北京儿童医院住院患儿分离出的46株对碳青霉烯类抗生素不敏感的肠杆菌科细菌.使用琼脂稀释法进行药敏试验,测定抗菌药物的最低抑菌浓度(MIC)值,按照临床实验室标准化研究所(CLSI) 2011年推荐标准判断结果.使用改良Hodge试验和双纸片协同试验,进行产碳青霉烯酶的表型确证.使用PCR方法进行碳青霉烯酶相关耐药基因的检测.采用WHONET5.6软件进行数据分析.结果 46株对碳青霉烯类抗生素不敏感的肠杆菌科细菌,26株为肺炎克雷伯菌,占56.5％,13株为阴沟肠杆菌,占28.3％,7株为大肠埃希菌,占15.2％.对亚胺培南和美罗培南不敏感率分别为肺炎克雷伯菌69.2％和80.8％,阴沟肠杆菌76.9％和100％,大肠埃希菌85.7％和100％.46株肠杆菌科细菌,改良Hodge试验阳性40株(87.0％),双纸片协同试验阳性41株(89.1％).IMP基因阳性38株(82.6％),其余8株均未扩增出特异性条带检测均为阴性.结论 目前儿科临床分离对碳青霉烯类抗生素不敏感菌株中,肺炎克雷伯菌最多,占56.5％.肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌对碳青霉烯类抗生素亚胺培南不敏感程度低于美罗培南,对碳青霉烯不敏感肠杆菌科细菌主要产生B类金属酶,均为IMP基因型.     

2000年～2002年我院常见细菌的分离率与耐药监测

目的 :了解 2 0 0 0～ 2 0 0 2年常见菌的分布与耐药状况。方法 :采用上海新和公司实验室信息管理系统软件对分离的菌株和药敏试验结果进行分析。结果 :大肠埃希菌 ,铜绿假单胞菌 ,不动杆菌 ,肺炎克雷伯菌 ,金黄色葡萄球菌分离率占前五位 ,且有逐年增加趋势。大肠埃希菌对亚胺培南 ,头孢西丁 ,头孢他啶的耐药率在 30 %以下 ,铜绿假单胞菌对哌拉西林、头孢他啶、头孢吡肟、阿米卡星的耐药率在 30 %以下 ,不动杆菌对亚胺培南的耐药率低于 1 1 % ,其余抗生素耐药率均高于 30 % ;金黄色葡萄球菌对复方新诺明的耐药率在 1 0 %以下 ,对万古霉素耐…     

洋葱伯克霍尔德菌耐药性和金属β-内酰胺酶的检测

目的探讨洋葱伯克霍尔德菌耐药情况及其多重耐药特点。方法用微量琼脂稀释法检测2004年1月至2006年12月临床分离不重复75株洋葱伯克霍尔德菌对15种抗菌药物的抗菌活性及其产金属β-内酰胺酶情况，比较产酶株与非产酶株抗药活性。结果2004—2006年洋葱伯克霍尔德菌检出率呈上升趋势，痰标本分离率较高。感染者分布于临床各个科室，并患有各种严重基础疾病，并使用过抗菌药物。葱伯克霍尔德菌对多数抗菌药物耐药，仅对复方新喏明、美罗培南、头孢哌酮／舒巴坦、哌拉西林／他巴唑坦敏感，敏感率分别为95％、82．8％、74．7％、70．7％；而对头孢噻肟、头孢哌酮、头孢曲松、阿米卡星、氨曲南、哌拉西林耐药率超过50％。产金属β-内酰胺酶株与非产金属β-内酰胺酶株比较，产酶株对含酶抑制剂β-内酰胺类抗生素敏感性较高。结论洋葱伯克霍尔德菌对多数抗菌药物耐药，仅对复方新喏明、头孢哌酮／舒巴坦、美罗培南、哌拉西林／他巴唑坦敏感．建议临床医生根据药敏试验合理用药，以减少耐药菌株的产生。     

2014～2015年鲍曼不动杆菌的医院分离情况和耐药性分析

目的 了解2014年至2015年鲍曼不动杆菌在本院的分布情况,并对其耐药性进行分析,为临床合理使用抗菌药物及控制院内感染提供依据.方法 收集本院2014年1月至2015年12月间送检的各种临床标本,应用VITEK 2 Compact 全自动微生物分析系统对临床分离的病原菌进行鉴定,同时用K-B药敏纸片法测定抗菌药物敏感率,结果按照CLSI标准判定.利用WHONT 5.6软件分析鲍曼不动杆菌的耐药性及其分布.结果 重症监护病房(ICU)和呼吸科的鲍曼不动杆菌分离率最高,且以呼吸道标本为主,达90％以上;2014至2015年我院共分离出鲍曼不动杆菌212株,耐药结果显示,鲍曼不动杆菌对氨曲南、头孢他啶耐药明显,超过40％,对头孢呋辛钠表现出100％耐药,但亚胺培南、头孢哌酮-舒巴坦、复方磺胺甲恶唑对鲍曼氏不动杆菌仍有较好的抗菌作用(耐药率＜25％),其中鲍曼不动杆菌对头孢哌酮-舒巴坦的耐药率最低,耐药率小于5％.结论 鲍曼不动杆菌感染率不断上升,已成为ICU感染的主要病原菌,但由于其耐药性各不相同,对其进行耐药性分析,可以进一步指导临床合理使用抗生素,控制多重耐药鲍曼不动杆菌传播.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The case for allele‐specific recognition by the TCR

There is a sharp difference in how one views TCR structure–function–behaviour dependent on whether its recognition of major histocompatibility complex‐encoded restriction elements (R) is germline selected or somatically generated. The generally accepted or Standard model is built on the assumption that recognition of R is by the V regions of the αβ TCR, which is not driven by allele specificity, whereas the competing model posits that recognition of R is allele‐specific. The establishing of allele‐specific recognition of R by the TCR would rule out the Standard model and clear the road to a consideration of a competing construct, the Tritope model. Here, the case for allele‐specific recognition (germline selected) is detailed making it obvious that the Standard model is untenable.