外科Ⅰ类切口手术预防用抗菌药物使用情况分析

目的 调查Ⅰ类切口手术预防用抗菌药物使用情况,使临床医师合理使用抗菌药物.方法 对北京友谊医院2007年～2008年出院的普外、骨科、神经外科、胸外科、眼科、口腔科、泌尿科、耳科的456份Ⅰ类切口手术病例进行回顾性调查,剔除术前因感染而治疗性应用抗菌药物的病例,对其中使用预防用抗菌药物的331例进行分析.结果 通过调查存在用药种类、用药时机、用药时间不合理的现象,导致医疗费用上涨,耐药菌种增加.结论 临床医师应深入学习<抗菌药物临床应用指导原则>,根据各手术科的特点,对原则进行细化,使各手术科形成有自身特点的手术预防性应用抗菌药物的临床实施细则,并采取必要的行政手段进行监督管理,促进抗菌药物在外科手术预防感染中的合理应用.     

脓毒症的基因多态性研究

尽管脓毒症的诊断和治疗取得了长足进步,但严重脓毒症和脓毒性休克的病死率仍居高不下.社会人口统计学和临床风险因素预测模型不能完全解释为什么在遭受相似程度打击后,有些人群易于发生脓毒症和多器官功能障碍综合征,有的患者却病情较轻而易于恢复.近年来,人们认识到遗传因素会影响脓毒症的易感性和预后.随着人类基因组计划和国际人类基因组单体型图计划的完成,脓毒症的遗传易感基因研究成为当前国内外研究的热点和焦点.基因多态性研究可以加深对脓毒症的发生、发展机制的认识,提供更精确的个体化靶向治疗措施.本文就基因多态性研究的相关概念、方法和在脓毒症基因关联研究中的策略及存在的问题作简要概述.     

Antifungal susceptibility analysis of berberine, baicalin, eugenol and curcumin on Candida albicans

Objective： To analyze the antifungal effects of Chinese herb monomers, i.e. berberine, baicalin, eugenol and curcumin, on Candida albicans. Methods： After Candida albicans strain Y01-09 was incubated for 48 h in YEPD broth which contained different concentrations of Chinese herb components, the cell cycle, fluorescent intensity and the size of cell volume were detected by flow cytometry. Results： The 4 Chinese herb monomers could affect the cell cycle of Candida albicans in different ranges. The ratio of cells in S-G2-M period decreased as the agents concentration increased, indicating that the cell division was inhibited. The fluorescent intensity of Candida albicans cells became weaker after being incubated, which reflected the loss of DNA fragments. The higher the concentration was, the weaker the fluorescent intensity became. The cell size, cell diopter and particle size changed much as the agents concentration increased. Conclusion： Chinese herb monomers play the antifungal role in inhibiting cell division. FCM could be used to determine the susceptibility of antifungal agents.     

Photodynamic antimicrobial chemotherapy (PACT) with methylene blue increases membrane permeability in Candida albicans

Photodynamic antimicrobial chemotherapy (PACT) is a potential antimicrobial therapy that combines light and a photosensitizing drug, promoting a phototoxic effect on the treated cells, in general via oxidative damage. In this work we studied the effect of PACT, using methylene blue (MB), on the permeability of Candida albicans membrane. Our results demonstrated that the combination of MB and laser (684 nm) promoted a decrease in Candida growth. The inhibition was more pronounced in the presence of 0.05 mg/ml MB and with an energy density of 28 J/cm². The decrease in Candida growth was associated with an increase in membrane permeabilization. Thus, we suggest that a PACT mechanism using MB can be related to damage in the plasma membranes of the cells.     

应用流式细胞术检测结核分枝杆菌药敏试验

目的建立流式细胞术检测结核分枝杆菌药敏试验的方法。方法利用结核分枝杆菌水解FDA的特点,选用FDA作为荧光染料,用流式细胞术检测H37Rv标准株,临床分离到的20株结核分枝杆菌对RFP、INH、SM和EMB的敏感性,根据细菌培养物在不同浓度药物作用后所检测到的平均荧光强度与阳性对照的比值,从而推断MIC值,并于传统的绝对浓度法检测结果进行比较。结果20株结核分枝杆菌的流式细胞术所得药敏试验结果与绝对浓度法基本一致。结论所建立的流式细胞术检测结核分枝杆菌药敏试验可以应用于临床,并有快速、准确、方便的优点。     

富组蛋白-5表达质粒构建及抗菌功能研究

目的 构建富组蛋白-5(histidine-rich protein-5,HRP-5)重组表达载体,表达并纯化HRP-5蛋白,观察其抗菌作用.方法 用基因克隆的方法构建pET-32a-HRP-5重组表达质粒,经IPTG诱导表达后,用亲和层析的方法纯化HRP-5融合蛋白,Tricine-SDS-PAGE电泳鉴定其分子量,琼脂糖弥散法检测其抗菌功能.结果 成功构建了pET-32a-HRP-5表达质粒并表达、纯化出HRP-5融合蛋白,融合蛋白对致病性大肠杆菌54299和绿脓杆菌PAO1有抗菌活性.结论 HRP-5是一种抗菌分子,参与了机体的天然免疫防御功能.     

Epidemiology, clinical characteristics and antimicrobial resistance patterns of community-acquired pneumonia in 1702 hospitalized children in Singapore

OBJECTIVE AND BACKGROUND: Childhood community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality worldwide. The features of childhood CAP vary between countries. The aim of this study was to delineate the clinical characteristics, complications, spectrum of pathogens and patterns of antimicrobial resistance associated with hospitalized cases of childhood CAP in Singapore. METHODS: A retrospective study was conducted of patients discharged from Singapore's only children's hospital over a 3-year period with a principal diagnosis of CAP. RESULTS: A total of 1702 children, with a median age of 4.2 years (range: 1 month-16.3 years) were enrolled. A pathogen was identifiable in 38.4% of cases, including Mycoplasma pneumoniae in 20.3%, typical respiratory bacteria in 10.3% (64.6%Streptococcus pneumoniae; 21.7% non-typeable Haemophilus influenzae), viruses in 5.5% and mixed bacterial/viral infections in 2%. The majority of M. pneumoniae infections were in school-aged children (>5 years). Severity of infection was greater in CAP caused by typical bacteria, as reflected by length of hospital stay, CRP level, white cell and absolute neutrophil counts. Mortality from typical bacterial infections (8.9%) exceeded that from M. pneumoniae (0.3%) and viral pneumonias (0%) (P < 0.001). Aminopenicillins were often prescribed empirically for suspected S. pneumoniae and H. influenzae infections; however, resistance to these agents was frequently documented among S. pneumoniae (58.5%) and H. influenzae isolates (51%). CONCLUSION: In Singaporean children hospitalized with CAP, M. pneumoniae is the most commonly identified causative organism, followed by common respiratory viruses, S. pneumoniae and H. influenzae. Streptococcus pneumoniae and H. influenzae are associated with greater severity of infection than other organisms, and have high levels of resistance to commonly prescribed antibiotics.