美罗培南耐药铜绿假单胞菌多药外排泵研究

目的 研究美罗培南耐药铜绿假单胞菌的多药外排泵机制.方法 采用琼脂稀释法测定美罗培南对141株铜绿假单胞菌的最低抑菌浓度(MIC),同时观察加入泵抑制剂MC207110后的美罗培南对141株铜绿假单胞菌MIC变化,检测多药外排泵机制.实时定量PCR检测外排泵mRNA水平的表达.PCR扩增外排泵编码基因及调控基因并测序分...     

美罗培南和其他4种β内酰胺类抗生素体外抗菌活性的研究

目的 :调查美罗培南和其他 4种 β内酰胺类抗生素的体外抗菌活性。 方法 :采用Etest法测定美罗培南、亚胺培南、头孢吡肟、头孢他啶和头孢哌酮 舒巴坦对 5 5 4株临床分离菌株的最低抑菌浓度 (MIC) ;检测肺炎克雷伯菌和大肠埃希菌中产超广谱 β内酰胺酶 (ESBLs)。 结果 :11.5 %的大肠埃希菌和 2 9%的肺炎克雷伯菌产生ESBLs。头孢吡肟、头孢哌酮 舒巴坦和头孢他啶对ESBLs阳性菌的MIC值明显高于ESBLs阴性株 ;而美罗培南和亚胺培南对产ESBLs株和不产ESBLs株的MIC值没有明显差别。对于肠杆菌属细菌 ,美罗培南的活性最高 (敏感率 95 % ) ,其次是亚胺培南 (82 % )、头孢吡肟 (71% )、头孢他啶、头孢哌酮 舒巴坦 (5 7%～ 5 9% )。美罗培南对于铜绿假单胞菌的MIC仅为亚胺培南的 1/ 8;对于不动杆菌属、肠球菌属 ,这 2种碳青霉烯类的MIC值分布相似。美罗培南对流感嗜血杆菌、肺炎链球菌和苯唑西林敏感的葡萄球菌的抗菌活性很高。结论 :5种β内酰胺类抗生素类的活性依次是美罗培南 (敏感率 94 .6 % )、亚胺培南 (90 .1% )、头孢吡肟 (77.6 % )、头孢哌酮 舒巴坦 (77.5 % )及头孢他啶 (76 .6 % )。     

耐亚胺培南革兰阴性杆菌产碳青霉烯酶研究

目的 了解细菌产碳青霉烯酶及其对亚胺培南、美罗培南等碳青霉烯类抗生素耐药性之间的关系。方法 应用改良Hodge Test和乙二胺四乙酸（EDTA）协同试验法对2003．6～2004．5收集自复旦大学华山医院的耐亚胺培南革兰阴性杆菌进行碳青霉烯酶筛选。blaVIM-1、blaVIM-2、blaIMP-2、blaIMP-2、blaSPM、blaOXA-23为引物进行PCR扩增，并对PCR扩增阳性产物进行DNA测序分析。结果 在75株耐亚胺培南的铜绿假单胞菌中，共检出产VIM-2型金属13内酰胺酶菌株2株（2／75），在10株耐亚胺培南的假单胞菌属细菌中检出2株产VIM-2型金属13内酰胺酶（2／10），均为恶臭假单胞菌；耐亚胺培南的8株弗劳地柠檬酸杆菌和6株不动杆菌中全部分别检出IMP金属酶新亚型和OXA-23型碳青霉烯酶。结论 细菌产碳青霉烯酶是不动杆菌和弗劳地柠檬酸杆菌对亚胺培南和美罗培南等碳青霉烯类抗生素耐药的主要原因之一，但对铜绿假单胞菌而言，产碳青霉烯酶不是导致其对亚胺培南耐药的主要原因。     

比阿培南和亚胺培南对呼吸道和泌尿道致病菌的体外抗菌活性比较

目的研究比阿培南和亚胺培南对呼吸道和泌尿道致病菌的体外抗菌活性。方法采用琼脂二倍稀释法，测定比阿培南和亚胺培南对294株呼吸道和泌尿道致病菌的MIC。结果比阿培南对所有测试菌的MIC价MIC90和敏感率范围分别为≤0．03～4μg／ml、0．06～〉128μg／ml及90％～100％，亚胺培南为≤0．03—2μg／ml、0．06～〉128μg／ml及86．7％～100％。比阿培南对金黄色葡萄球菌、表皮葡萄球菌的MIC90（4，1μg／ml）是亚胺培南MIC90（2，0．25μg/ml）的2—4倍，对大肠埃希菌、阴沟肠杆菌、奇异变形杆菌、铜绿假单胞菌、鲍曼不动杆菌的MIC90（0．125—4μg／ml）是亚胺培南MIC90（0．5～8μg／ml）的1／4～1／2，对肠球菌属、肺炎链球菌、肺炎克雷伯菌、流感嗜血杆菌的MIC90与亚胺培南相当，分别为〉128、0．06、0．5、2μg／ml。结论比阿培南对革兰阳性菌和革兰阴性菌均具有广谱抗菌活性，其中对革兰阴性菌的作用优于亚胺培南，对革兰阳性菌的作用稍差于亚胺培南。     

2006/2008年革兰阴性杆菌对亚胺培南的耐药性调查

目的：分析革兰阴性杆菌对亚胺培南的耐药性变化。方法：对3a来从住院患者各种临床标本中分离的革兰阴性杆菌,进行回顾性分析。结果：3a共分离出5695株细菌,27个细菌种,肠杆菌科细菌3795株,占65．9％;非发酵菌1941株,占34．1％;分离率前3位的病原菌分别是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌;2008年肠杆菌科细菌对亚胺培南的耐药率为0％;2008年嗜麦芽寡养单胞菌对亚胺培南的耐药率分别为100．0％。结论：亚胺培南对肠杆菌科细菌的体外抗菌活性强,醋酸钙不动杆菌和鲍氏不动杆菌对亚胺培南的耐药率呈上升趋势。     

比阿培南和亚胺培南对464例临床分离病原菌的体外抗菌敏感性比较分析

随着碳青霉烯类抗菌素、尤其是亚胺培南和西司他丁复合制剂的临床应用以来,产ESBLs大肠埃希菌和肺炎克雷伯菌、多重耐药的鲍曼不动杆菌和铜绿假单胞菌等的感染得到了有效的控制,然而亚胺培南所致的肾毒性副作用愈来受到高度关照,     

鱼腥草联合亚胺培南对碳青霉烯耐药铜绿假单胞菌杀菌效果的体外研究

目的　探究鱼腥草联合亚胺培南对碳青霉烯耐药铜绿假单胞菌（carbapenem resistant pseudomonas aeruginosa，CRPA）的体外杀菌效果，为合理使用抗生素、预防和控制医院感染提供参考。方法　样本取自上海市某医院收治患者送检的痰、尿、创面等液体标本中分离到的 50 株 CRPA，观察单药使用亚胺培南、鱼腥草及二者联合使用时对铜绿假单胞菌（PA）的最低抑菌浓度（MIC）、分级抑菌浓度（FIC）指数和对浮游菌的时间杀菌曲线。结果　亚胺培南单用的 MIC50(32 mg/L) 和 MIC90(128 mg/L) 均高于鱼腥草单用 (MIC502 mg/L, MIC904 mg/L) 及两者联合使用 (MIC500.25 mg/L,MIC901 mg/L)，且鱼腥草单用的 MIC50 和 MIC90 均高于两者联合使用。分级抑菌浓度指数显示 12 株（24.0%）亚胺培南和鱼腥草联用后呈现协同作用，30 株（60.0%）表现相加作用，8 株（16.0%）表现无相关作用，未发现拮抗作用。随机选取 2 株菌株观察浮游菌的时间杀菌曲线，单独使用亚胺培南 6~12h 后，菌株均出现细菌恢复生长的现象；鱼腥草联合亚胺培南使用时，菌株的浮游菌数量降低均＞ 6log CFU/L，且 24h 时均无细菌生长现象。结论　鱼腥草联合亚胺培南优于单药亚胺培南的抗 CRPA 效率。     

比阿培南和亚胺培南对464例临床分离病原菌的体外抗菌敏感性比较分析

随着碳青霉烯类抗菌素、尤其是亚胺培南和西司他丁复合制剂的临床应用以来,产ESBLs大肠埃希菌和肺炎克雷伯菌、多重耐药的鲍曼不动杆菌和铜绿假单胞菌等的感染得到了有效的控制,然而亚胺培南所致的肾毒性副作用愈来受到高度关照,尤     

五官科患者铜绿假单胞菌对亚胺培南的耐药水平分析

目的 分析五官科患者感染铜绿假单胞菌对亚胺培南的耐药水平,并分析亚胺培南耐药株对其他常用抗菌药物的敏感性.方法 采用常规方法对五官科送检的500份标本进行分离,共分离出105株铜绿假单胞菌,并采用琼脂扩散法（K-B）对亚胺培南及其它抗菌药物进行敏感性试验,若结果判定为耐药和中介,则进一步采用琼脂倍比稀释法检测对亚胺培南及其它抗菌药物的最低抑菌浓度（MIC）.结果 铜绿假单胞菌对亚胺培南的耐药率为11.4%（12株/105株）,并耐亚胺培南株对哌拉西林/他唑巴坦、哌拉西林、头孢哌酮、头孢他啶、头孢吡肟和美罗培南等有一定敏感性.结论 五官科患者铜绿假单胞菌对亚胺培南的耐药率较高,应引起高度重视,但对其它常用抗菌药物有一定敏感性,可作为临床用药选择时的参考.     

亚胺培南耐药铜绿假单胞菌的整合子检测及其与多重耐药相关性的研究

目的调查亚胺培南耐药的铜绿假单胞菌携带整合子情况,了解其与多重耐药的相关性。方法采用Mi—croWlkway-96全自动细菌鉴定仪进行细菌鉴定和药敏试验,PCR法对临床分离的120株亚胺培南耐药和80株亚胺培南敏感的铜绿假单胞菌进行整合子检测。结果120株亚胺培南耐药的铜绿假单胞菌中I类整合子的检出率为81．7％（98／120）、Ⅲ类整合子检出率为1．7％（2／120）,未检出Ⅱ类整合子;80株亚胺培南敏感的铜绿假单胞菌中I类整合子的检出率为21．3％（17／80）,未检出Ⅱ、Ⅲ类整合子。整合子阳性的铜绿假单胞菌对临床常用抗菌药物的耐药率明显高于整合子阴性的铜绿假单胞菌,并且前者多重耐药现象较为严重。结论I类整合子广泛存在于亚胺培南耐药的铜绿假单胞菌中,并与其多重耐药性密切相关。     

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.