980例泌尿生殖道支原体培养及药敏分析

目的:了解开封地区泌尿生殖道支原体感染对12种抗生素的体外敏感性。方法:使用支原体培养、药敏鉴别试剂盒对980例生殖道感染患者的分泌物标本进行支原体的培养鉴定及药敏试验。结果:980例标本中,474例阳性,检出率为48.4%;解脲支原体对交沙霉素、环脂红霉素、克拉霉素、阿齐霉素和四环素类抗生素较为敏感;人型支原体对强力霉素、美满霉素、甲砜霉素较为敏感;解脲支原体合并人型支原体感染对交沙霉素、强力霉素、美满霉素较为敏感。结论:解脲支原体与人型支原体有不同的耐药谱,二者混合感染使抗生素的耐药性普遍增强,单纯解脲支原体感染与混合感染对抗生素敏感性有明显差异。     

67例解脲和人型支原体合并感染对10种抗生素药敏结果分析

【目的】了解解脲支原体和人型支原体合并感染对抗生素的敏感情况及其特点,以指导临床合理用药。【方法】统计67例解脲支原体和人型支原体合并感染的患者对10种抗生素的药敏结果。【结果】10种抗生素的药物敏感性分别是:美满霉素(91%)、强力霉素(91%)、阿奇霉素(89.5%)、交沙霉素(88%)、克林霉素(86.5%),左氧氟沙星(79.1%)、司巴沙星(77.6%)、罗红霉素(76.1%)、氧氟沙星(73.1%)及环丙沙星(70.1%)。【结论】治疗解脲支原体和人型支原体双重感染的患者,目前比较理想的药物是:美满霉素、强力霉素、阿奇霉素、交沙霉素、克林霉素等;药物敏感性都在80%以上。     

泌尿生殖道支原体感染及药物敏感试验结果分析

目的：分析非淋菌性尿道炎患者支原体感染率及其对常用药物的敏感性。方法：解脲脲原体和人型支原体分离鉴定、计数、药敏试剂盒检测 3 776例疑诊非淋菌性尿道炎患者泌尿生殖道分泌物。结果：3 776例患者解脲脲原体、人型支原体以及人型支原体+解脲脲原体混合感染率分别为37.4％,1.2％,9.5％。解脲脲原体感染患者对强力霉素、美满霉素敏感性高,其次为大环内酯类的交沙霉素、克拉霉素、阿奇霉素,对罗红霉素敏感性较低。人型支原体感染患者对四环素类药物、交沙霉素敏感;人型支原体+解脲脲原体混合感染患者对交沙霉素敏感。结论：支原体是引起非淋菌性尿道炎的主要病原体,临床应根据药物敏感试验结果合理、规范用药。     

普洱地区解脲和人型支原体对抗生素的敏感性分析

目的 了解普洱地区解脲支原体（Uu）与人型支原体（Mh）对抗生素的体外敏感性。方法 收集我院皮肤科、妇科门诊患者121例采用液体培养法鉴定Uu与Mh并应用该方法作抗生素敏感试验。结果 药物的敏感性显示，以交沙霉素、强力霉素、美满霉素、司帕沙星敏感性最强，左氧氟沙星、阿齐霉素、克林霉素为次之。结论 Uu与Mh的性传播疾病病原体对症选择有效的药物，控制支原体传播和蔓延，提高治愈率显得尤为重要。     

浏阳地区支原体临床分离株对抗生素耐药性监测

目的比较四环素类、大环内酯类和喹诺酮类三类抗菌药物对解脲脲原体(Uu)和人型支原体(Mh)的抗菌作用,为临床用药提供参考依据。方法采用直接肉汤药盘法测定临床标本中195株Uu和118株Mh及960株混合感染的Uu Mh对三类抗菌药物中的8种抗生素的敏感性。结果195株Uu对四环素、多西环素、米诺环素、罗红霉素、阿齐霉素、交沙霉素、氧氟沙星、司帕沙星的敏感率分别为21.0%、48.2%、39.5%、79.0%、88.7%、74.9%、28.2%和64.6%。118株Mh对四环素、多西环素、米诺环素、罗红霉素、阿齐霉素、交沙霉素、氧氟沙星、司帕沙星的敏感率分别为5.1%、33.9%、26.3%、0.0%、0.0%、89.8%、70.3%和64.4%。960例混合感染的Uu Mh,对交沙霉素最敏感(79.2%)。结论阿齐霉素抗Uu的作用最强,其次为罗红霉素;而抗Mh活性最强的为交沙霉素,其次为氧氟沙星;Mh对阿齐霉素和罗红霉素天然耐药;临床上在治疗Uu单独感染时,可使用阿齐霉素、罗红霉素和交沙霉素;治疗Mh单独感染,可使用交沙霉素和氧氟沙星;对Uu和Mh混合感染者,可使用交沙霉素。结论泌尿生殖道支原体的耐药性监测对指导临床治疗具有重要意义。     

泌尿生殖道支原体感染现状及药物敏感性分析

目的了解本地区泌尿生殖道支原体感染情况及其对抗菌药物的敏感性,为临床提供抗感染治疗的科学依据。方法采用液体培养法,对本院皮肤科和妇产科门诊共635例就诊患者的分泌物做支原体培养鉴定,并同时做药物敏感性试验。结果 635例患者共检出支原体阳性417例,检出率为65.7%;其中解脲脲原体(Uu)、人型支原体(Mh)、混合型(Uu+Mh)支原体检出率分别为64.0%、2.9%、33.1%。药物敏感性情况为:Uu对交沙霉素、强力霉素、美满霉素敏感率高,分别为89.9%、85.0%、84.6%;混合感染对美满霉素、强力霉素敏感率高,分别为75.4%、70.3%。结论本地区支原体感染率较高,所分离出支原体对四环素类药物、大环内酯类药物中的交沙霉素敏感性高,喹诺酮类药物如左氧氟沙星、氧氟沙星、环丙沙星等敏感性均较低。     

性病支原体对12种抗生素的耐药性研究

目的 :调查本市性病支原体 [解脲支原体 (Uu) ,人型支原体 (Mh) ]对 12种抗生素的药敏情况 ,并进行分析。方法 :用支原体药敏试剂盒对 5 93例确诊Uu、Mh阳性患者做体外药敏试验。结果 :Uu对交沙霉素的敏感率为 99 1% ,对阿齐霉素、克拉霉素的敏感率都为 95 3 % ,对司巴沙星的敏感率为 91 6% ,其次是强力霉素和美满霉素 ,敏感率都为 84 1% ;Mh对强力霉素和美满霉素最敏感 ;Uu +Mh混合感染以强力霉素、美满霉素和交沙霉素最敏感。Uu和Mh无论是单一敏感还是混合感染 ,对乙酰螺旋霉素和红霉素的耐药性最高。结论 :性病支原体治疗以四环素类及大环内脂类药物最为敏感 ,而单一感染可以交沙霉素、强力霉素、美满霉素、阿齐霉素为首选     

男性生殖道解脲脲原体感染与不育症

目的：研究解脲脲原体（Ureaplasma urealyticum，Uu）感染在男性生殖道炎中病原学作用以及解脲脲原体的耐药情况。方法：将98例生殖道感染并发不育患者的精液做解脲脲原体培养和药物敏感性试验；液化后的精液进行常规、精子形态学分析。结果：不育患者的98例精液中Uu检测阳性率为56．1％，Uu感染的精液精子密度下降、活动率％降低、精子畸形率％升高、精原细胞％增多。药物敏感性Uu感染对四环素类的强力霉素、美满霉素的高度敏感，其次是大环内酯类的罗红霉素、阿齐霉素、交沙霉素、克拉霉素，但对喹诺酮类的司帕沙星，还有氨基糖甙类的大观霉素、还有林可霉素等耐药率达80％以上。结论；男性不育的生殖道感染的主要病原体是解脲脲原体，可引起精液的质量下降，精原细胞增多，从而生育能力降低：解脲脲原体对四环素类和大环内酯类的抗生素敏感，对喹诺酮类的抗生素高度耐药。     

解脲支原体和人型支原体对14种抗生素的耐药性分析

[目的]为了观察解脲支原体和人型支原体的药敏情况，以提高治疗支原体感染的疗效。[方法]用珠海益明生物工程制品厂生产的集培养鉴定药敏一体的试剂盒对631例患者进行解脲支原体和人型支原体的检测。[结果]测出支原体阳性株502例，其中单纯解脲支原体阳性360例，解脲支原体与人型支原体混合感染142例。单纯解脲支原体株对抗生素的敏感性依次为交沙霉素、美满霉素、强力霉素、克拉霉素、罗红霉素等。混合感染株对抗生素的敏感性依次为交沙霉素、强力霉素、司帕沙星、美满霉素等。[结论]药敏试验显示大部分菌株都产生耐药性，混合性感染的耐药性更严重，提示临床应合理使用抗菌素，防止耐药株的增加，以提高疗效。     

654例解脲支原体药敏结果分析

目的分析支原体耐药现状,指导临床合理用药.方法对本院近三年间分离出的654例解脲支原体进行药敏试验.结果十种抗生素对解脲支原体的敏感率分别为美满霉素61.3%,交沙霉素32.4%,强力霉素41.1%,环丙沙星28.7%,氧氟沙星36.4%,罗红霉素47.9%,阿齐霉素36.7%,螺旋霉素14.2%,壮观霉素;48.6%,司帕沙星42.7%.结论解脲支原体对各种抗生素均有一定的耐药性,其耐药性应广泛关注,其临床用药应在严格的体外抗生素敏感试验指导下进行,美满霉素可作为治疗解脲支原体的首选药.     

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.