阴沟肠杆菌Ⅰ类整合酶基因及质粒AmpC酶基因检测

目的明确我院临床分离的阴沟肠杆菌中Ⅰ类整合酶基因(int Ⅰ 1)、qacE△1-sul Ⅰ基因和质粒AmpC酶基因(AmpC MIR、AmpC DHA)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(PCR)技术检测耐药基因.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,头孢吡肟和复方新诺明的耐药率分别为25.0%和85.0%,对氨基糖苷类抗生素的耐药率在60.0%～90.0%之间,其余的耐药率在80.0%～95.0%之间.int Ⅰ 1、qacE△1-sul Ⅰ、MIR和DHA基因的阳性株数(%)分别为19株(95.0%)、17株(85.0%)、17株(85.0%)、1株(5.0%).结论我院临床分离的阴沟肠杆菌多重耐药严重,int Ⅰ 1、qacE△1-sulⅠ和MIR基因携带率很高.在阴沟肠杆菌中检出intⅠ 1、qacE△1-sulⅠ以及质粒型AmpC MIR基因在我国大陆均属首次报道.     

铜绿假单胞菌亚胺培南及消毒剂耐药相关基因研究

目的了解临床分离的对亚胺培南耐药铜绿假单胞菌中金属β内酰胺酶基因(blaIMP和blaVIM)、外膜孔蛋白D2(OprD2)基因(oprD)、消毒剂-磺胺耐药相关基因(qacE△1-sulⅠ)存在状况。方法采用ATB PSE5药敏试验条板微量肉汤法测定28株铜绿假单胞菌对14种抗菌药物的敏感性．采用聚合酶链反应(PCR)技术及序列分析的方法检测耐药基因。结果该28株铜绿假单胞菌对亚胺培南、氨苄西林／舒巴坦、庆大霉素、妥布霉素和复方新诺明均完全耐药．对哌拉西林／他唑巴坦的敏感率最高为64-3％，其余的耐药率在57．1％．92．9％之间。28株Pa中blaIMP和blaVIM基因均阴性．25株(89．3％)oprD基因缺失．24株(85．7％)qacE△1-sulⅠ基因阳性。结论浙江湖州解放军第98医院临床分离的对亚胺培南耐药铜绿假单胞菌多重耐药严重，oprD基因缺失是其对亚胺培南耐药的重要原因．qacE△1-sulⅠ基因携带率很高。     

多重耐药鲍曼不动杆菌OXA-23基因与qacE△1基因检测的研究

目的对本院分离的多重耐药鲍曼不动杆菌(MRAB)OXA-23和qacE△1耐药基因进行检测分析。方法收集2009年1月至2010年12月分离的85株多重耐药鲍曼不动杆菌,用聚合酶链反应(PCR)方法检测OXA-23和qacE△1耐药基因并测序,序列与基因库比对。结果 85株耐药菌中OXA-23、qacE△1基因的阳性率依次为55.3%、81.2%。其中58株耐亚胺培南MRAB OXA-23、qacE△1基因的阳性率为75.86%、84.48%;而其余27株亚胺培南敏感MRAB两个基因的阳性率分别为11.11%、74.07%。结论 OXA-23基因存在与鲍曼不动杆菌耐亚胺培南密切相关,qacE△1基因检测结果提示这些菌株81.2%携带Ⅰ类整合子,是本组细菌多重耐药表型的主要原因之一。     

铜绿假单胞菌亚胺培南及消毒剂耐药相关基因研究

目的了解临床分离的对亚胺培南耐药铜绿假单胞菌中金属β内酰胺酶基因(blaIMP和blaVIM)、外膜孔蛋白D2(OprD2)基因(oprD)、消毒剂-磺胺耐药相关基因(qacE△1-sulⅠ)存在状况.方法采用ATB′PSE 5药敏试验条板微量肉汤法测定28株铜绿假单胞菌对14种抗菌药物的敏感性,采用聚合酶链反应(PCR)技术及序列分析的方法检测耐药基因.结果该28株铜绿假单胞菌对亚胺培南、氨苄西林/舒巴坦、庆大霉素、妥布霉素和复方新诺明均完全耐药,对哌拉西林/他唑巴坦的敏感率最高为64.3%,其余的耐药率在57.1%～92.9%之间.28株Pa中blaIMP和blaVIM基因均阴性,25株(89.3%)oprD基因缺失,24株(85.7%)qacE△1-sulI基因阳性.结论浙江湖州解放军第98医院临床分离的对亚胺培南耐药铜绿假单胞菌多重耐药严重,oprD基因缺失是其对亚胺培南耐药的重要原因,qacE△1-sulI基因携带率很高.     

铜绿假单胞菌氯已定—磺胺耐药基因型研究

目的探讨临床分离的铜绿假单胞菌耐药性和氯已定—磺胺耐药基因存在状况。方法测定临床分离的66株铜绿假单胞菌对6种抗菌药物的敏感性,采用PCR检测qacE△1-sulⅠ基因。结果66株PA菌对6种抗菌药物的不敏感率在12.5%~87.5%之间。qacE△1-sulⅠ基因阳性菌33株(阳性率50.0%)。结论铜绿假单胞菌具明显的多重耐药特征。qacE△1-sulⅠ基因携带率很高。     

多重耐药革兰阴性杆菌耐药谱及其抗消毒剂基因检测

目的了解临床感染标本分离的多重耐药革兰阴性杆菌对临床常用抗菌药物耐药谱及其抗消毒剂基因携带状况。方法采用K-B试验法和聚合酶链反应检测法,对临床分离的多重耐药革兰阴性杆菌进行了药敏试验和qacE△1-sul1基因检测。结果临床分离的252株革兰阴性杆菌对常用抗生素耐药率普遍较高,且耐药谱广。在252株革兰阴性杆菌中,有197株qacE△1-sul1基因检测阳性,总阳性率为78.71%。结论临床感染标本分离的多重耐药革兰阴性杆菌qacE△1-sul1基因携带率比较高,对临床常用抗生素普遍耐药,应加强防范。     

多重耐药鲍曼不动杆菌16S rRNA甲基化酶基因及qacE△1-sul1基因检测的研究

目的 了解新疆地区鲍曼不动杆菌（ABA）16S rRNA甲基化酶基因及qacE△1-sul1基因存在状况。 方法 对临床分离的40株ABA用PCR法检测16S rRNA甲基化酶基因及qacE△1-sul1耐药基因并与基因库比对。 结果 40株MDR-ABA 6种16S rRNA甲基化酶基因检出结果与美国GenBank登录的相同;40株ABA菌中qacE△1-sul1耐药基因阳性21株（52.5%）。 结论 本组40株ABA未检出16S rRNA基因甲基化酶基因,qacE△1-sul1基因检测结果提示这些菌株52.5%携带Ⅰ类整合子,是本组细菌多重耐药表型的原因之一。     

耐亚胺培南铜绿假单胞菌Ⅰ类整合子遗传标记及β-内酰胺类抗生素耐药相关基因研究

目的 了解临床分离的耐亚胺培南铜绿假单胞菌(IRPa)中Ⅰ类整合子及β-内酰胺类抗生素耐药相关基因存在状况.方法 自临床分离28株IRPa,采用聚合酶链反应及序列分析的方法检测Ⅰ类整合子遗传标记(intI1和qacE△1-sul1基因)及18种β-内酰胺类抗生素耐药相关基因.结果 28株中,intI1、qacE△1-sul1、blaTEM、blaOXA-10群和blaCARB基因阳性株数(%)分别为21株(75.0%)、24株(85.7%)、20株(71.4%)、1株(3.6%)和1株(3.6%),经序列分析分别确认为blaOXA-10(GenBank注册号:AY841859)和blaCARB-3.25株(89.3%)oprD基因缺失,blaIMP、blaVIM、blaSHV、blaPER、blaVEB、blaGES、blaMIR、blaDHA、blaSPM、blaGIM、blaOXA-1群、blaOXA-2群、blaBEL-1、blaCTX-M-1群基因均阴性.结论 临床分离的IRPa中Ⅰ类整合子携带率很高,至少存在blaTEM、blaOXA-10和blaCARB-3种β-内酰胺酶基因,oprD基因缺失突变是其对亚胺培南耐药的主要原因.     

医院感染铜绿假单胞菌耐消毒剂基因研究

目的:了解医院感染多重耐药铜绿假单胞菌的消毒剂与磺胺类抗生素耐药相关基因存在状况,探讨铜绿假单胞菌对医院常用消毒剂的耐药机制.方法;琼脂稀释法测定50株多重耐药铜绿假单胞菌及标准菌株对医院常用消毒剂的最低抑菌浓度,并用PCR法检测消毒剂耐药基因qacE△1-sul1.结果:50株多重耐药铜绿假单胞菌对医院常用消毒剂苯扎溴铵的最低抑菌浓度为8～32 pg/mL,高于标准菌株最低抑菌浓度(P<0.01);消毒剂耐药基因qacE△1-sul1阳性率100%.结论:铜绿假单胞菌对医院常用消毒剂苯扎溴铵耐药;消毒剂与磺胺类等抗生素耐药相关基因qacE△1-sul1携带率较高,细菌携带qacE△1-sul1基因是消毒剂耐药主要因素.     

产碳青霉烯酶阴沟肠杆菌耐药特性及耐药基因分析

目的调查某医院阴沟肠杆菌中产碳青霉烯酶菌株耐药性及基因型分布。方法分离鉴定2015年10月-2017年6月期间临床送检标本中阴沟肠杆菌,运用纸片扩散法(K-B法)检测抗菌药物敏感性;应用改良-Hodge试验检测阴沟肠杆菌产碳青霉烯酶表型,采用PCR方法检测阳性株携带相关酶基因情况。结果分离出的298株阴沟肠杆菌中33.2%来源于呼吸科,21.8%来源于重症医学科。共鉴定出26例产碳青霉烯酶的阴沟肠杆菌菌株。碳青霉烯酶阳性菌株对头孢拉定、头孢美唑等头孢类抗生素和亚胺培南、美罗培南等耐药率为100%;对哌拉西林/他唑巴坦复合制剂和阿米卡星耐药率较高,分别为88.5%和76.9%,对复方新诺明耐药率相对较低,为30.8%;26株产酶菌株携带的碳青霉烯酶基因以blaKPC为主,blaIMP和blaNDM-1也有检出。结论该院分离的产碳青霉烯酶阴沟肠杆菌主要为产KPC、VIM和NDM-1酶菌株,且耐药性较强,提示临床医生应重视抗菌药物合理应用,强化耐药菌监控。     

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.