2012～2015年耐碳青霉烯鲍曼不动杆菌临床分布及耐药性

目的：探讨院内感染致耐碳青霉烯鲍曼不动杆菌（CR‐AB）的临床分布和耐药性。方法回顾性分析2012年1月至2015年6月该院住院患者CR‐AB院内感染情况，采用纸片琼脂扩散法对菌株进行药物敏感试验。结果共检出CR‐AB 130株，主要分布在ICU病房，占57．7％（75／130）。痰液是CR‐AB最主要的标本来源，占63．08％。CR‐AB对多数抗菌药物的耐药率均达到50．00％以上，但对米诺环素（27．69％）、丁胺卡那霉素（25．38％）、妥布霉素（16．15％）耐药率均低于30．00％，未发现耐多黏菌素的菌株。结论 CR‐AB耐药性较严重，应加强对重点科室的管理，合理选择有效的抗菌药物，防止CR‐AB传播。     

耐甲氧西林金黄色葡萄球菌的临床分布及耐药性分析

目的了解感染耐甲氧西林金黄色葡萄球菌（MRSA）的临床分布及对临床常用抗菌药物的耐药性。方法金黄色葡萄球菌（SA）采用ATB-Expression半自动细菌鉴定仪进行鉴定,采用头孢西丁纸片琼脂扩散法确定MRSA,药敏试验采用K—B纸片扩散法。结果185株SA中MRSA共计118株（63．78％）。MRSA病区分布以神经外科、肝胆烧伤外科、普外科和呼吸内科为主。118株MRSA对青霉素、氨苄西林、哌拉西林／他唑巴坦、头孢噻肟、美洛培南、环丙沙星、红霉素均耐药;对阿米卡星和利福平耐药率较高;没有发现耐万古霉素和替考拉宁的菌株。结论MRSA菌株表现为多重耐药性和高耐药性,万古霉素和替考拉林是有效控制MRSA感染的最佳抗茵药物。     

儿童烧伤患者感染MRSA的耐药性及分子流行病学研究

目的：调查儿童烧伤患者耐甲氧西林金黄色葡萄球菌（MRSA）的耐药性及分子流行病学情况,为控制感染提供科学依据。方法通过PCR扩增mecA基因鉴定 MRSA菌株,K-B纸片法检测菌株耐药性,随机扩增多态性DNA（RAPD）对其进行同源性分析。结果从住院烧伤儿童临床标本分离得到的52株金黄色葡萄球菌中 MRSA占44．2％（23/52）,且对多种抗菌药物均耐药。23株MRSA经RAPD分析可分为4型,以Ⅱ型为主。结论儿童烧伤患者分离MRSA菌株具有多重耐药性,应根据药敏试验结果合理选用抗菌药物进行治疗;RAPD技术能为控制感染提供分子流行病学依据。     

金黄色葡萄球菌的临床分布及耐药性分析

目的研究金黄色葡萄球菌尤其是耐甲氧西林金黄色葡萄球菌（MRSA）临床分布及耐药性分析,为有效控制感染提供科学依据。方法采用回顾性分析方法,对2007年6月至2009年3月检测的177株金黄色葡萄球菌的标本来源,科室分布及耐药性进行分析。结果177株金黄色葡萄球菌中MRSA135株占76．3％（135／177）,甲氧西林敏感金黄色葡萄球菌（MSSA）42株占23．7％（42／177）。标本来源以痰液最多106株,占59．9％（106／177）,其次为引流分泌物29株,占16．4％（29／177）,尿液为9．0％（16／177）;科室分布以重症监护室（Icu）、神经外科、呼吸科居多,分别占41．8％（74／177）、27．7％（49／177）、11．9（21／177）;MRSA科室分离率为ICU83．8％（62／74）,神经外科81．6％（40／49）,呼吸科66．7％（14／21）,普外科57．9％（11／19）。从耐药性来看,MRSA对β-内酰胺类、大环内酯类、喹诺酮类、氨基苷类等多种抗茵药物的耐药率均超过了80．0％,氯霉素、复方磺胺显示了较低的耐药率,利奈唑胺、奎奴普丁／达福普丁、万古霉素的耐药率均为0;MSSA对红霉素、头孢唑啉、氨苄西林、青霉素等的耐药率均在70％以上。结论金黄色葡萄球菌感染部位以呼吸道为主,其次为脓肿、泌尿系统感染;ICU、神经外科、呼吸科为感染的主要科室;MRSA分离率已达很高水平,MRSA的耐药性高于MSSA,应严格隔离、消毒,加强监测工作,合理选择抗菌药物。     

某教学医院近5年金黄色葡萄球菌的临床分布及耐药性分析

目的探讨该院近5年金黄色葡萄球菌(SA)的临床分离情况、科室和标本分布特点及其对抗菌药物的耐药性,为临床合理使用抗菌药物和减少耐药菌株提供依据。方法回顾性分析该院2014-2018年住院及门诊患者送检标本分离到的SA数据,采用WHONET 5.6和SPSS 17.0等软件对SA和耐甲氧西林金黄色葡萄球菌(MRSA)的科室分布、标本来源及耐药性等进行统计分析。结果该院5年内共分离到4453株SA,其中MRSA有1637株(占36.76%)。SA和MRSA检出率最多的科室是烧伤科(占19.96%和39.58%),其次是儿科(占17.25%和9.90%);SA和MRSA标本来源以伤口分泌物为主(占32.27%和43.62%),其次是痰液(占31.46%和23.46%)。SA和MRSA对青霉素G的耐药率均在94.1%以上,MRSA对苯唑西林的耐药率在97.1%以上,对替加环素和呋喃妥因的耐药率低,未检出对万古霉素、替考拉宁和利奈唑胺耐药的菌株。结论该院SA和MRSA检出率较高,应定期监测其临床分布和耐药性,强化临床合理使用抗菌药物管理,做好院内感染防控措施。     

ICU病房鲍曼不动杆菌的耐药特点及相关感染的护理干预

目的探讨ICU病房下呼吸道感染患者鲍曼不动杆菌（AB）的耐药特点,及其相关护理干预措施对控制ICU鲍曼不动杆菌感染的作用。方法对从26例ICU住院下呼吸道感染患者痰液标本中分离的26株AB分析耐药特性,并比较耐泰能鲍曼不动杆菌（IRAB）和泰能敏感的鲍曼不动杆菌（ISAB）的耐药性差别,及其ICU病房中分离的AB与非ICU病房分离的AB耐药性差别,总结相应的护理干预措施。结果ICU分离的26株鲍曼不动杆菌对15种抗菌药物的敏感性,AB对磷霉素的敏感性最强,为88．5％,对三代头孢菌素等其他种类的抗菌药物敏感性都很低;26株AB,IRAB15株,占57．7％;ISAB11株,占42．3％。IRAB与ISAB耐药性比较,IRAB对头孢曲松、四环素、哌拉西林、氨曲南、复方磺胺、左氧氟沙星的耐药率达到100％,其他种类的抗菌药物的耐药率也很强,要强于ISAB（P〈0．01或P〈0．05）。结论ICU病房鲍曼不动杆菌耐药性强,治疗较为棘手,因此在使用敏感抗菌药物治疗同时,必须对患者采取相应护理措施,加强医院感染管理力度,做好隔离措施,避免交叉感染,保护其他易感患者。     

杀白细胞素pvl基因阴性MRSA对抗菌药物的耐药性研究

目的研究杀白细胞素（PVL）pvl基因阴性耐甲氧西林金黄色葡萄球菌（MRSA）对多种抗菌药物的耐药性。方法采用头孢西丁纸片扩散法检测MRSA;用聚合酶链反应（PCR）检测m ecA基因及pvl基因;采用琼脂稀释法测定金黄色葡萄球菌最低抑菌浓度（M IC）并检测pvl基因阴性MRSA对12种抗菌药物的耐药性。结果 71株金黄色葡萄球菌中检测出33株pvl基因阴性MRSA,检出率为46.4%（33/71）;对青霉素类抗菌药物的耐药率为100.0%;对其他类抗菌药物呈多重耐药并以ECLOTGMP为主要耐药模式,占66.7%（22/33）;未发现对达托霉素、替考拉宁和万古霉素耐药的菌株。结论医院感染中以pvl基因阴性MRSA为主,并呈现多重耐药;pvl基因阴性MRSA主要耐药模式为对红霉素、环丙沙星、克林霉素、苯唑西林、四环素、庆大霉素、复方磺胺甲口恶唑和青霉素耐药,是主要流行株,要谨慎使用以上8种抗菌药物。     

168株金黄色葡萄球菌的临床分布与耐药分析

目的 了解该院金黄色葡萄球菌的临床分布特点及耐药情况,指导临床合理用药,减少耐药菌株的产生.方法 对临床送检的合格标本进行细菌培养,采用VITEK-2 Compact全自动微生物分析系统进行鉴定和药物敏感试验.结果 从各类标本中分离出金黄色葡萄球菌168株,其中耐甲氧西林的金黄色葡萄球菌（MRSA）59株,检出率为35.1%（59/168）,分离的金黄色葡萄球菌标本主要来源于分泌物51.2%（86/168）、痰液22.0%（37/168）、全血5.4%（9/168）、置管液5.4%（9/168）.MRSA分布的科室以神经科（30.5%）、普外泌尿科（22.0%）、骨科（15.2%）、心胸外科（8.5%）、呼吸科（8.5%）多见.对MRSA和非耐甲氧西林的金黄色葡萄球菌（MSSA）耐药率为0的抗菌药物有万古霉素、利奈唑胺、替考拉宁、奎努普汀/达福普汀、呋喃妥因,青霉素、复方磺胺甲噁唑对MRSA的耐药率分别为100%、6.8%,对MSSA的耐药率分别为91.7%、12.8%,其余9种抗菌药物对MRSA的耐药率均高于MSSA.结论 加强耐药菌株的监测,规范临床用药,有利于控制感染.     

结核病患者医院获得性金黄色葡萄球菌感染110例耐药性分析

目的分析结核痛患者医院获得性感染金黄色葡萄球菌（Staphylococcus aureus）的耐药情况。方法收集我院住院肺结核、结核性胸膜炎、结核性脑膜炎患者痰、胸水、脓汁、血液标本110例,进行培养、鉴定,以Kirby—Baure（K—B）法进行药敏试验,依据美国临床实验室标准化委员会（CLSI）2007版标准进行判断,以头孢西丁（30μg／片）纸片扩散法筛选耐甲氧西林金黄色葡萄球菌（methicillin resistant Staphyloococcus sureus MRSA）。结果110例金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌（MRSA）76株,检出率69．09％。所有分离菌株对万古霉索敏感、对青霉素耐药;阿奇霉素、红霉素、头孢西丁、克林霉素、妥布霉素、左氧氟沙星、庆大霉素、利福平、四环素、复方新诺明、阿米卡星、米诺环素的耐药率分别为85．71％、82．69％、69．09％、68．57％、65．63％、61．54％、56．00％、55．10％、48．78％、47．06％、35．90％、25．81％。耐甲氧西林金黄色葡萄球菌（MRSA）株耐药率明显高于甲氧西林敏感的金黄色葡萄球菌（MSSA）,差异有统计学意义。结论医院获得性感染金黄色葡萄球菌不容忽视,尤其是MRSA株,可同时对多种抗菌药物耐药,提示临床应该规范合理使用抗生素,加强耐药监测,发现MRSA株及时隔离,控制医源性感染。     

93株金黄色葡萄球菌分布及耐药性分析

目的分析近2年本院患者中分离的金黄色葡萄球菌的耐药情况,为临床合理使用抗菌药物提供依据。方法用湖南天地人公司TDR-200B微生物分析系统进行鉴定和药敏试验,WHONET5．3软件统计分析结果。结果93株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）59株（63．4％）,主要来源于伤口分泌物、痰、脓液等。检出的MRSA除对万古霉素敏感,对强力霉素和利福平耐药率较小（2．8％～7．5％）外,对其他抗菌药物耐药率均大于60．0％,且耐药率均高于甲氧西林敏感金黄色葡萄球菌。结论临床分离的金黄色葡萄球菌,MRSA对多种抗菌药物耐药率较高,许多MRSA菌株为多重耐药菌,实验室应加强对MRSA的耐药监测,以便合理使用抗菌药物。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.