系统性硬皮病抗核抗体谱的检测意义

目的探讨抗核抗体（ANA）和抗核抗体谱（ANAs）对系统性硬皮病的诊断意义。方法分别采用间接免疫荧光法（IIF）和免疫印迹法（IB）对64例SSc患者和30例健康对照者血清中6种自身抗体进行测定。结果IIF检测ANA结果显示,SSc患者中ANA的阳性率为98．4％（63／64）,其荧光染色模型主要为均质核仁型;IB检测6种ENA结果显示,SSc患者以抗Scl-70抗体、抗SS-A抗体和抗nRNP抗体为主,阳性率分别为65．1％（41／64）,29．7％（19／64）和6．3％（4／64）。结论多种自身抗体同时检出,可能提示SSc患者同时伴随有其他的自身免疫性疾病,或者有发生其他自身免疫性疾病的危险;此外,IB法对ANAs检测的阳性率和特异性均较高,对SSc的诊断帮助很大。     

电视腹腔镜下输卵管吻合手术治疗输卵管部分梗阻性不孕(附7例报道并文献复习)

目的探讨腹腔镜下进行输卵管部分炎症性梗阻吻合的具体方法。方法利用电视腹腔镜5mm器械、三切口的微创腹腔镜方法,对3例输卵管妊娠手术后患侧阻塞患者以及4例继发性不孕患者经子宫输卵管碘油造影显示伴有一侧或双侧输卵管病变患者行双层6/0尼龙线内缝吻合输卵管,其手术平均时间为63.6min。结果7例患者手术后通水均示通畅,5例患侧进行修复的输卵管经输卵管子宫碘油造影术显示均通畅,并且获得宫内妊娠3例,足月分娩1例。结论电视腹腔镜下采用显微吻合手术对输卵管局部炎症梗阻进行治疗,有助获得妊娠。     

产超广谱β-内酰胺酶肺炎克雷伯菌基因型研究

目的：研究医院感染超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌的基因型。方法：收集分离鉴定菌株，通过K—B法药敏实验初筛以确认产ESBLs菌株，并对ESBLs基因进行初步分型。结果：17株肺炎克雷伯菌产生的ESBLs以CTX-M-3、CTX-M-15、CTX-M-22为主要基因型，其中8株为CTX—M-3型；6株为CTX-M-22型；1株为CTX-M-15型；1株同时产CTX-M-3、CTX-M-22；1株同时产CTX-M-15、CTX-M-22型。结论：我院肺炎克雷伯菌临床分离株中的ESBLs基因型以CTX-M型酶为主。     

水疗对新生儿黄疸的影响

目的探讨水疗对新生儿黄疸的影响。方法将400例正常新生儿随机分为水疗组与对照组各200例，对水疗组新生儿于出生后24h～30d连续水疗，1次/d，15min／次。对照组单纯沐浴，于生后24h及第5，10，30天比较2组新生儿的胎便初排时间、胎便转黄时间、黄疸指数及高胆红素血症发生情况。结果水疗组新生儿胎便初排时间，胎粪转黄时间较对照组显著提前（P〈0．01）；生后第5，10，30天黄疸指数明显低于对照组，差异有统计学意义（P〈0．01）；水疗组高胆红素血症发生率也显著低于对照组（P〈0．01）。结论水疗可有效降低新生儿黄疸，预防核黄疸的发生。     

经尿道等离子双极电切术治疗腺性膀胱炎

目的探讨经尿道等离子双极电切术治疗腺性膀胱炎的价值。方法回顾性分析16例经尿道等离子双极电切术治疗的腺性膀胱炎患者的临床资料。结果16例均行4—12个月随访，平均8个月，其中治愈15例，1例6～9个月内复发。结论经尿道等离子双极电切术是治疗腺性膀胱炎的可靠方法，可作为替代传统经尿道电切术的新术式。     

引起儿童腹泻的沙门菌属临床分离株的耐药特点及分子流行病学研究

目的 研究儿童腹泻患者粪便分离的沙门菌属临床分离株的耐药特点及分子流行病学特征.方法 从儿童腹泻患者粪便中分离沙门菌72株,采用血清学凝集试验确定沙门菌血清型;采用K-B纸片扩散法检测抗菌药物的敏感性;采用琼脂稀释法测定头孢噻肟(CTX)和头孢他啶(CAZ)的MIC值;ESBL、ISEcpI和AmpC基因采用PCR法和DNA测序法;采用接合试验测定耐药基因的转移性;PFGE法测定鼠伤寒沙门菌的同源性.结果 从感染性腹泻患儿粪便中共分离出72株沙门菌,其中鼠伤寒沙门菌为主要血清型,占86%(62/72).鼠伤寒沙门菌和汤普森沙门菌通常对临床常用抗菌药物耐药.其中鼠伤寒沙门菌对氨苄西林的耐药率最高(90%,56/62),其次是四环素(81%,50/62),甲氧苄啶/磺胺甲基异(噁)唑(74%,46/62)和氯霉素(66%,41/62).17株(27%,17/62)鼠伤寒沙门菌和2株汤普森沙门菌对CTX耐药.对氨苄西林耐药的49株鼠伤寒沙门菌和2株汤普森沙门菌经PCR扩增后并测序为blaTEM-1b,62株鼠伤寒沙门菌中ESBL基因阳性的有13株(21%,13/62),且主要是blaCTX-M型,其中8株为blaCTX-M-14,3株为blaCTX-M-15,1株为blaCTX-M-55,另外1株为同时blaCTX-M-14和blaCTX-M-55阳性.所有blaCTX-M阳性的菌株均检测出存在上游的插入序列ISEcpl.在1株对头孢西丁耐药的汤普森沙门菌检测出blaDHA-1型AmpC.62株鼠伤寒沙门菌经PFGE分型,发现A型和D型是最主要两个克隆,分别占19%(12/62)和50%(31/62).7株产blaCTX-M型ESBL基因的菌株属于D型.结论 鼠伤寒沙门菌和汤普森沙门菌耐药性严重且blaCTX-M型ESBL基因检出率高;在沙门菌属中发现blaCTX-M-55,在汤普森沙门菌中发现blaDHA-1°克隆性传播是造成鼠伤寒沙门菌流行的主要原因.

Abstract：

Objective To investigate molecular epidemiology and antimicrobial susceptibility of Salmonella spp. isolates recovered from the stool samples of children with diarrhea. Methods Seventy-two isolates of Salmonella spp. were collected from children with diarrhea. The serum type of Salmonella spp.was determined by serology agglutinating method. Antimicrobial susceptibility was determined by K-B disk diffusion method and MICs of cefotaxime and ceftazidime were measured by agar dilution method for Salmonella spp. isolates. PCR and DNA sequencing were used for detecting ESBL, ISEcpl and AmpC genes; The transfer of cefotaxime resistance was determined by conjugation experiments. PFGE was performed for determining the homogeneity of the S. typhimurium isolates. Results A total of 72 isolates of Salmonella spp. were collected, among which S. typhimurium accounted for 86 % (62/72) and was the main serum type. S. typhimurium isolates and S. thompson isolates were often resistant to most of clinically used antimicrobial agents. Resistance of S. thompson isolates to ampicillin was the highest (90%, 56/62),followed by tetracycline (81%, 50/62), trimethoprim/sulfamethoxazole (74%, 46/62) and chloramphenicol (66%, 41/62). Seventeen S. typhimurium isolates (27%, 17/62) and two S. thompson isolates were resistant to cefotaxime. Forty-nine S. typhimurium isolates and two S. thompson isolates were positive for blaTEB-1b and resistant to ampicillin. Thirteen ESBL-producing S. typhimurium isolates (21%, 13/62) were positive for blaCTX-M (eight for blaCTX-M-14, three for blaCTX-M-15, one for blaCTX-M-55, one for both blaCTX-M-14 and blaCTX-M-55). All isolates harboring blaCTX-M genes were positive for upstream insert sequence ISEcpl. blaDHA-1was detected in a cefoxitin-resistant S. thompson isolate. Two main clones (PFGE type A and D) accounting for 19% (12/62) and 50% (31/62) respectively were found among 62 S. typhimurium isolates. Seven CTXM-producing isolates belonged to PFGE type D. Conclusions The multi-resistance to antimicrobial agents and high prevalence of blaCTX-M genes are found among S. typhimurium and S. thompson clinical isolates. blaCTX-M-55 is first found in S. typhimurium isolates and blaDHA-1 is found in S. thompson isolates. Clonal spread is responsible for the dissemination of S. typhimurium isolates.     

In Vitro Pharmacodynamics of Levofloxacin and Other Aerosolized Antibiotics under Multiple Conditions Relevant to Chronic Pulmonary Infection in Cystic Fibrosis

The inhalational administration of antibiotics can provide high concentrations locally in the lungs of cystic fibrosis patients and, thus, can be useful for the treatment of chronic bacterial infections. The present study evaluated the in vitro activities of levofloxacin, ciprofloxacin, tobramycin, amikacin, and aztreonam against clinical isolates of Pseudomonas aeruginosa, Burkholderia cepacia complex, Stenotrophomonas maltophilia, Alcaligenes xylosoxidans, and Staphylococcus aureus from cystic fibrosis patients. Levofloxacin was the most potent antibiotic against all cystic fibrosis isolates tested, with MIC₉₀s ranging from 8 to 32 μg/ml. Levofloxacin was more potent than the aminoglycosides and aztreonam against P. aeruginosa biofilms. Time-kill assays with drug concentrations achievable in sputum following aerosol administration showed that levofloxacin had the most rapid rate of killing among mucoid and nonmucoid isolates of P. aeruginosa. In contrast to tobramycin, the bactericidal activity of levofloxacin was not affected by sputum from cystic fibrosis patients. The results of the study show that the high concentrations of levofloxacin readily achievable in the lung following aerosol delivery may be useful for the management of pulmonary infections in patients with cystic fibrosis.Chronic bacterial infections of the airway are common in cystic fibrosis (CF) patients. It is the burden of these infections, particularly infections with Pseudomonas aeruginosa, that eventually lead to the accelerated morbidity and mortality of CF patients (10, 24). Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Alcaligenes xylosoxidans, Burkholderia cepacia complex, and Staphylococcus aureus are among the pathogens that are the most frequently isolated from the sputum of CF patients (2, 30). Bacterial isolates from CF patients can be more resistant to antibiotics and tend to mutate more readily than isolates from non-CF patients (4, 33, 35).The use of aerosolized antibiotics has emerged as an important strategy for the management of chronic lung infections in CF patients. Aerosol administration provides higher concentrations of drug to the site of infection than parenteral or oral administration. Studies of the pharmacokinetics (PKs) of antibiotics in CF patients demonstrate that aerosol doses achieve greater maximum concentrations (C_max) and areas under the concentration-time curve (AUCs) in sputum than systemic doses, which increase the PK-pharmacodynamic (PD) indices relative to the MIC (13, 14, 17).Over a decade ago, tobramycin solution for inhalation became the first antibiotic approved by the FDA for the management of CF patients. Aerosolized tobramycin reaches an average concentration of 1,240 μg/g in sputum (13); however, antimicrobial potency is reduced in sputum from CF patients (20, 28). The twice-daily administration of aerosolized tobramycin for 28 days in three on-off cycles over 6 months showed a reduction in the P. aeruginosa bacterial counts in sputum and an improvement in the lung function of CF patients, although these effects tended to decline with the use of repeated courses (36). The use of aerosolized tobramycin for the treatment of pulmonary infections has been associated with the selection of multiple-antibiotic-resistant strains of P. aeruginosa (29).In view of the reduction in the potency of tobramycin in sputum from CF patients and the limitation that tobramycin may be administered only every other month, additional antibiotics have been investigated for aerosol administration in CF patients. Levofloxacin, a fluoroquinolone with broad-spectrum activity, is bactericidal against P. aeruginosa (16) and is reported to have activity against P. aeruginosa isolates growing in biofilms (22, 31). Levofloxacin inhalation solution (MP-376) is a novel formulation of levofloxacin that is currently being evaluated in clinical trials and that may be safely and rapidly administered by the aerosol route. Following MP-376 administration, high levofloxacin concentrations are achieved in the sputum of CF patients, resulting in the high PK-PD exposures associated with bactericidal activity and a reduced possibility for the selection of resistance (8, 12, 23).The studies described here were designed to determine the in vitro activities of levofloxacin and other antibiotics currently under evaluation for aerosol administration in patients with CF. The in vitro activities of levofloxacin, ciprofloxacin, tobramycin, amikacin, and aztreonam against CF isolates, including P. aeruginosa isolates growing in biofilms, were determined. The bactericidal activities of levofloxacin, tobramycin, and aztreonam against mucoid and nonmucoid P. aeruginosa isolates from patients with CF were compared. Finally, the effect of sputum on the bactericidal activity of levofloxacin and tobramycin was evaluated.     

腹泻儿童沙门菌的耐药性研究及肠毒素基因与临床关系分析

目的研究近年来本地区沙门菌肠炎患儿的临床特征、耐药状况及肠毒素与临床特征的关系,为临床病情的判断与治疗提供依据。方法我院2004年4月至2009年12月从儿童腹泻患者粪便中分离的沙门菌80株,采用血清学凝集试验确定沙门菌血清型,再采用Kerby-Bauer纸片扩散法检测其对抗菌药物的敏感性;同时对肠毒素基因(spvA、spvB、rck)进行PCR检测,分析沙门菌肠炎患儿的临床特征与肠毒素的关系。结果发热、腹泻为本病的主要临床表现。鼠伤寒沙门菌是小儿沙门菌肠炎的主要血清型(70/80,87.5%),其他血清型的沙门菌呈散发。80株沙门菌均对亚胺培南、美罗培南敏感,但对其他抗生素均有不同程度的耐药。66株沙门菌为多重耐药菌株,17株为可疑产β-内酰胺酶(ESBLs)菌株,8株为可疑产头孢菌素水解酶(AMPC)菌株,鼠伤寒沙门菌的多重耐药率明显高于其他血清型的沙门菌(χ2=30.921,P=0.001)。所有沙门菌均含有spvA基因,少数沙门菌含有spvB及rck基因,spvB阳性者高热的比率较spvB阴性者高(χ2=7.544,P=0.006),spvB阳性者排黏液血便的比率较spvB阴性者高(χ2=6.163,P=0.013)。结论沙门菌肠炎患儿以发热、腹泻为主要临床表现,鼠伤寒沙门菌是其主要病原菌,鼠伤寒沙门菌的多重耐药率明显高于其他血清型的沙门菌,spvB阳性菌株临床上更易表现为高热及排黏液血便,临床上需根据药敏结果合理使用抗生素。     

饮热水联合硝酸异山梨醇酯对贲门失弛缓的治疗作用

  目的  探讨饮热水、含服硝酸异山梨醇酯及两者联合对贲门失弛缓是否具有治疗作用  目的  顺序纳入2012年10月至2013年5月在北京协和医院消化内科门诊就诊的初治贲门失弛缓患者, 随机分为两组, A组为饮水-联合药物治疗组, 20例; B组为药物-联合饮水治疗组, 22例, 疗程4周。A组患者第1周仅予饮水治疗, 第2~4周饮水联合药物治疗; B组第1周仅予药物治疗, 第2~4周药物联合饮水治疗。所有纳入患者于基线期(治疗前2周)、治疗1周及治疗4周均进行临床症状评估, 于基线期和治疗4周行食管动力监测及食管造影检查  结果  最终41例患者纳入分析, 其中A组19例, B组22例。两组患者性别、年龄及病程差异无统计学意义(P > 0.05)。与基线期比较, A组治疗1周和治疗4周症状明显改善(P < 0.05), 且治疗4周症状改善明显优于治疗1周(P < 0.05);与基线期比较, B组治疗4周症状明显改善(P < 0.05);A组和B组之间症状积分比较差异无统计学意义(P > 0.05)。与基线期比较, 两组患者治疗4周下食管括约肌压力(lower esophageal sphincter pressure, LESP)和吞咽时下食管括约肌综合松弛压(integrated relaxation pressure, IRP)无明显降低(P > 0.05);然而基线期和治疗4周, 饮热水或药物干预后LESP及IRP较干预前明显降低(P < 0.05)。与基线期比较, 两组患者治疗4周食管宽度无明显变化(P > 0.05)  结论  饮水或药物干预通过短暂降低下食管括约肌压力和提高下食管括约肌松弛功能改善临床症状, 两者联合干预效果更佳, 但饮水、药物或联合干预不能持续改善下食管括约肌压力或松弛功能。饮水联合药物为不能耐受或不接受有创治疗及有创治疗后复发的患者提供一个可供选择的保守治疗方法。     

三种仪器测量准分子激光原位角膜磨镶术前后中央角膜厚度的对比研究

目的对比A型超声角膜测厚仪、OrbscanⅡ眼前节分析仪和Pentacam眼前节分析仪测量准分子激光原位角膜磨镶术(LASIK)前后中央角膜厚度的差异。方法 2010年10月-2011年3月,分别使用A型超声角膜测厚仪、OrbscanⅡ和Pentacam眼前节分析仪测量137例(274只眼)近视患者LASIK前后中央角膜厚度,并对测量结果进行配对t检验和Pearson相关性分析。结果 LASIK术前A型超声、OrbscanⅡ和Pentacam测量值分别为(526.6±34.1)、(516.6±34.2)、(539.8±31.5)μm,Pentacam测量值较A型超声和OrbscanⅡ测量值高,差异有统计学意义(P<0.05),而A型超声和OrbscanⅡ测量值之间差异无统计学意义(P>0.05);LASIK术后6个月A型超声、OrbscanⅡ和Pentacam测量值分别为(448.2±48.5)、(391.9±58.5)、(451.5±46.4)μm,LASIK术后A型超声和Pentacam测量值无差异(P>0.05),而OrbscanⅡ测量值较A型超声和Pentacam低;Pearson相关分析显示,LASIK术后Pentacam和A型超声CCT测量值呈高度相关(P<0.05)。结论 3种仪器的中央角膜厚度测量值不可互换,LASIK术后A型超声和Pentacam量值较为准确。