胸腺肽α1对多重耐药鲍曼不动杆菌肺炎的临床疗效

目的研究胸腺肽α1对多重耐药鲍曼不动杆菌肺炎患者临床疗效的影响。方法将40例多重耐药鲍曼不动杆菌肺炎患者随机分为治疗组和对照组,对照组给予常规治疗,治疗组在常规治疗的同时,加用胸腺肽α1,皮下注射1.6 mg,每天1次,应用一周后,改为2次/周,应用4周。统计两组的机械通气时间、ICU住院时间、评价临床疗效;测定两组降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、白细胞数(WBC)水平。结果与对照组相比,治疗组机械通气时间VS、ICU住院时间VS明显缩短;总有效率提高,病死率降低(P<0.05);在炎症指标方面,胸腺肽治疗组PCT、hs-CRP、WBC值均低于对照组,差异有统计学意义。结论胸腺肽α1可以改善多重耐药鲍曼不动杆菌肺炎患者的自身免疫状况,降低炎症水平,提高抗感染治疗的效果。     

铜绿假单胞菌注射液胸腔灌注治疗恶性胸腔积液的临床分析

目的观察铜绿假单胞菌注射液胸腔灌注治疗恶性胸腔积液的临床疗效及毒副反应。方法将70例晚期非小细胞肺癌伴恶性胸腔积液患者随机分为观察组和对照组,每组各35例。对照组在常规辅助治疗的基础上予以洛铂胸腔灌注治疗,观察组在对照组的基础上辅以铜绿假单胞菌注射液胸腔灌注,观察比较两组患者治疗后的临床疗效及毒副反应。结果治疗疗程结束后,多数患者胸腔积液情况得到了有效的控制,两组治疗的总有效率分别为77.1%和48.6%(P0.05)。两组患者治疗过程中的毒副反应主要以发热、胃肠道反应及骨髓抑制为主,两组比较差异无统计学意义(P0.05)。结论洛铂联合铜绿假单胞菌注射液比单独洛铂胸腔灌注治疗恶性胸腔积的疗效显著,毒副反应相当,可推荐临床应用。     

益气健脾化痰法治疗脑梗死后多重耐药铜绿假单胞菌肺部感染的临床观察

目的研究益气健脾化痰法治疗脑梗死后多重耐药铜绿假单胞菌肺部感染的临床效果。方法将92例脑梗死后多重耐药铜绿假单胞菌肺部感染患者随机分为两组,每组46例。对照组单用亚胺培南西司他丁钠(泰能)治疗,治疗组使用泰能配合中药益气健脾化痰法治疗。比较两组患者症状积分、血降钙素原变化情况,并评价疗效。结果两组治疗前后症状积分、血降钙素原比较,差异统计学意义(P0.05);两组治疗后症状积分、血降钙素原差异有统计学意义(P0.05)。治疗组治疗总有效率为91.3%,高于对照组的73.9%,差异有统计学意义(P0.05)。结论对脑梗死后多重耐药铜绿假单胞菌肺部感染患者采用益气健脾化痰法治疗,疗效显著。     

胸腔灌注铜绿假单胞菌注射液治疗非小细胞肺癌患者恶性胸腔积液的临床观察

目的观察胸腔灌注铜绿假单胞菌注射液治疗非小细胞肺癌(NSCLC)患者恶性胸腔积液的临床疗效及毒副反应。方法将65例NSCLC伴恶性胸腔积液患者随机分为实验组和对照组,其中实验组32例,对照组33例。实验组予以胸腔灌注铜绿假单胞菌注射液治疗,对照组予以胸腔灌注洛铂治疗,比较两种药物胸腔灌注治疗NSCLC伴恶性胸腔积液患者的临床疗效及毒副反应。结果治疗后,两组患者中大多数胸腔积液情况均得到了改善,但实验组和对照组治疗总有效率分别为75.0%和54.5%(P0.05),且胃肠道反应及骨髓抑制等毒副反应也明显较对照组少(P0.05)。结论胸腔灌注铜绿假单胞菌注射液治疗NSCLC患者恶性胸腔积液比胸腔灌注洛铂的疗效好,毒副反应少,可考虑临床推广应用。     

铜绿假单胞菌耐药机制研究现状

铜绿假单胞菌是院内获得性感染的重要致病菌,在医院获得性肺炎（HAP）中占第二位,铜绿假单胞菌存在天然耐药,抗菌药物的应用及机械通气等环境的改变使铜绿假单胞菌出现获得性耐药及适应性耐药等复杂的耐药机制,并且产生多重耐药甚至泛耐药铜绿假单胞菌[1],显著增加了患者病死率及住院费用[2,3].     

糖尿病足创面感染铜绿假单胞菌的耐药性及其毒力基因分析

目的了解糖尿病足创面感染铜绿假单胞菌耐药特点并分析其与毒力基因的关系。方法连续收集2018-01-01～2018-12-31在天津医科大学代谢病医院糖尿病足病科住院的糖尿病足患者中54株细菌培养报告为铜绿假单胞菌的菌株,在药物敏感试验及菌落复种培养后,交南开大学微生物实验室逐一进行铜绿假单胞菌固有pcrV基因检测,以明确铜绿假单胞菌。另收集非糖尿病创面感染铜绿假单胞菌21株作为对照组。对铜绿假单胞菌的3型分泌系统中毒力基因exoS和exoU进行检测及分析其与耐药的关系。对创面中连续2次(每次间隔1个月)及以上培养出的铜绿假单胞菌进行随访。结果 54株中筛查出8株不是铜绿假单胞菌,46株明确为铜绿假单胞菌。糖尿病足组与对照组中,主要致病基因均为含有exoS的铜绿假单胞菌,糖尿病足组为91.3%(42/46),耐药率为11.9%;对照组为76.2%(16/21),耐药率为6.3%。含有exoU的铜绿假单胞菌在糖尿病足组与对照组中均占比较少,糖尿病足组中为8.7%(4/46),耐药率为25.0%;对照组中为23.8%(5/21),耐药率为20.0%。在糖尿病足组中,有6例患者连续2次及以上培养出铜绿假单胞菌,合计19株。有5例患者感染含有exoS的铜绿假单胞菌,其中有2例培养出耐药铜绿假单胞菌,耐药率为23.5%(4/17),均出现在治疗的初期和中期,在末次培养时均转为敏感铜绿假单胞菌,有1例患者创面中含有exoU的铜绿假单胞菌,耐药率为50.0%(1/2),首次培养为耐药菌,末次培养为敏感菌。结论糖尿病足创面中取得的铜绿假单胞菌中,以含有exoS的铜绿假单胞菌为主,但是在耐药菌方面,含有exoU的铜绿假单胞菌的耐药率更高。同一患者创面的铜绿假单胞菌不会因为耐药与否出现exoS或exoU基因型改变。     

老年铜绿假单胞菌肺炎临床分析

目的分析老年铜绿假单胞菌肺炎临床特征、药敏试验结果及治疗结果。方法对皖南医学院第二附属医院呼吸内科发生的37例老年铜绿假单胞菌肺炎病例的临床资料及治疗结果进行分析。结果37例患者的临床表现无特异性,患者均伴有基础疾病或危险因素。药敏表明,铜绿假单胞菌对亚胺培南、美洛培南、左氧氟沙星、头孢哌酮/舒巴坦最敏感,敏感率分别为91.2%、81.1%、67.6%、78.4%。结论铜绿假单胞菌好发于老年、有基础疾病及免疫功能低下者,其耐药率高,病死率高,早期合理的经验性抗感染治疗可缩短疗程、降低病死率。     

气管内给药治疗老年人耐药菌肺炎的疗效分析

目的观察持续气管内滴入多粘菌素E治疗泛耐药铜绿假单胞菌所致的老年人重症肺部感染的疗效和不良反应。方法对收治的9例泛耐药铜绿假单胞菌所致的老年重症肺部感染患者,经多种抗生素治疗无效,药敏试验提示这些耐药菌仅对多粘菌素B敏感的前提下,选用多粘菌素E持续气管内滴入治疗,观察其临床疗效及不良反应。结果 9例患者均取得有效临床效果,临床总有效率为100%,未发现明显肾脏毒性、神经毒性和其他严重不良反应。结论多粘菌素E是治疗泛耐药铜绿假单胞菌所致的重症肺部感染的有效药物,采用气管内给药,可以得到理想的临床疗效并减少严重不良反应的发生,且适用于老年患者。     

铜绿假单胞菌注射液胸腔注射治疗肺腺癌恶性胸水疗效观察

目的观察铜绿假单胞菌胸腔注射治疗肺腺癌恶性胸腔积液的临床疗效。方法 61例肺腺癌合并中到大量胸腔积液患者随机分成三组,以培美曲塞联合顺铂全身化疗作为基础治疗,分别接受胸腔内注射铜绿假单胞菌注射液、香菇多糖及顺铂治疗。观察胸水疗效及不良反应。结果铜绿假单胞菌注射液治疗组有效率85.7%。香菇多糖治疗组有效率59.1%,顺铂治疗组有效率47.1%。铜绿假单胞菌治疗组疗效好于其它两种药物(χ2=6.73,P0.05)。铜绿假单胞菌注射液治疗组不良反应发生率低,反应轻微。结论铜绿假单胞菌胸腔注射治疗肺腺癌所致恶性胸腔积液疗效显著,副反应发生少且轻微。     

不动杆菌和铜绿假单胞菌肺炎46例分析

目的调查不动杆菌和铜绿假单胞菌肺炎的临床特点及细菌耐药。方法回顾性分析46例不动杆菌和铜绿假单胞菌引起的肺炎的临床资料和细菌耐药。结果这两种细菌引起的肺炎无特异性。两者基础疾病,主要为慢性阻塞性肺疾病（COPD）,其次为恶性肿瘤、心功能不全、脑中风及支气管扩张。两者主要症状是发热（73％）,咳嗽（92％）,氯急。胸部X线表现肺部间质病变13例。药敏结果显示出这两种细菌多重耐药,但阿米卡星,哌拉西林、环丙沙星、诺氟沙星、头孢曲松、头孢哌酮为较敏感的抗生素。结论不动杆菌和铜绿假单胞菌引起的肺炎之间无特异性临床特点。两菌肺炎患者的气急病人因以控制感染为主,诊断依靠病原学并结合临床及X线检查,治疗应根据药敏并联合应用抗生素。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.