214例鲍氏不动杆菌的感染分布及耐药性

目的了解鲍氏不动杆菌感染的临床分布及其耐药特点.方法收集2003年1月～2004年12月从临床感染标本的214株鲍氏不动杆菌,了解其临床分布并做药敏试验,比较其耐药率.结果214株鲍氏不动杆菌临床分布以ICU最多（61株,28.5%）,且多见于老年患者（97株,45.3%）;对三代头孢及环丙沙星的耐药率均＞50.0%;对美罗培南,亚胺培南/西司他丁,头孢哌酮/舒巴坦的耐药性较低,分别为4.2%、7.9%、8.9%;发现131株（61.2%）多重耐药菌株.结论碳青酶烯类及头孢哌酮/舒巴坦对鲍氏不动杆菌感染仍有较强的活性,但不能忽视对这两类药物耐药的多重耐药菌株的出现,要减少多重耐药菌株的产生,应注意合理使用抗菌药物.     

常见念珠菌属的临床分布及对抗真菌药物敏感性研究

目的研究念珠菌属的临床分布及其对6种抗真菌药物的敏感性。方法对264株念珠菌属的临床分布进行分析,同时研究264株念珠菌属对两性霉素B、制霉菌素、氟康唑、咪康唑、克霉唑、酮康唑的敏感性。结果264株念珠菌属中,以白色念珠菌最常见占62.5%,其次为热带念珠菌占20.8%、光滑念珠菌占12.5%、近平滑念珠菌占1.9%、其他念珠菌占2.3%;念珠菌属感染的主要部位为肺、泌尿道、消化道;药物敏感试验显示:念珠菌属对制霉菌素、两性霉素B、氟康唑敏感性最高,对唑类药物存在不同程度的耐药。结论应加强对念珠菌属的鉴定及药物敏感性的检测,以指导临床抗感染治疗合理选择药物。     

174例细菌感染性疾病抗菌药物临床应用分析

目的了解某院治疗性抗菌药物应用及病原学送检现状。方法对该院2005年6月收治的细菌感染性疾病患者病历资料进行回顾性调查,并采用Excel软件进行数据处理。结果174例细菌感染性疾病患者以呼吸道感染为主(55.75%),其次为腹腔内感染(18.39%),病原学送检率为25.86%。入院初始抗菌药物经验治疗以第三、四代头孢菌素类比率最高(23.31%),青霉素类位居第2(18.41%);单一用药率为16.09%,二联用药占80.46%,三联用药占3.45%,未发现三联以上用药现象。给药剂量、次数、联合用药种类搭配不恰当、更换药间隔时间过短是主要不合理用药现象。结论该院最常见的细菌感染性疾病是呼吸道感染;抗菌药物应用总体较为合理,但病原学送检率较低,部分临床医师用药不规范,须加强培训。     

肿瘤坏死因子相关诱导凋亡配体与放化疗联用对喉癌细胞的协同杀伤效应及机制

Objective To determine the sensitivity of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) induced apoptosis in Hep-2 cells by means of systematically evaluating the cytotoxicity of TRAIL alone and TRAIL in combination with chemotherapeutic agents (cisplatin, paclitaxel) or radiation in Hep-2 cells in vitro, and whether the synergistic killing effects correlated with the expression level of TRAIL receptors and the activity of caspnse-8 or caspase-9. Methods The cytotoxicities of TRAIL, cisplatin and paclitaxel were investigated by cell counting kit-8 (CCK-8) assay. The expression levels of four TRAIL receptors in Hep-2 cells after treated by TRAIL, chemotherapeutic agents or radiation alone and by combined treatments were measured by flow eytometry and Western blotting respectively. The growth inhibition effects of caspase-8 or caspase-9 inhibitor on Hep-2 cells were determined by CCK-8 assay, and the activities of caspase-8, caspase-9 and caspase-3 were measured by Western blotting. Results The half maximal inhibitory concentration(IC50) of TRAIL to Hep-2 ceils on 24 h was 596. 92 μg/L Cisplatin, paclitaxel and radiation had synergistic inhibitory effects with TRAIL on the growth of Hep-2 cell line. After the activity of caspase-9 was inhibited by Z-LETD-FMK, the inhibition effects of TRAIL, cisplatin and paclitaxel on Hep-2 cells decreased significantly (all P < 0. 05). The expressions of caspase-8, caspase-9 and the death receptors (DR4 and DR5) increased significantly (all P < 0. 05) after combined administration. Conclusions Hep-2 cells are resistant to the apoptosis induced by TRAIL and TRAIL can induce the apoptosis of Hep-2 cells through the endogenous apeptotic pathway. The increase of death receptors expression by chemotherapeutic agents or radiation could enhance the sensitivity of Hep-2 cells to TRAIL and the synergistic killing effects.     

联合应用降压药物对防治高血压及其并发症的疗效观察

目的:探讨联合应用血管紧张素转换酶抑制剂和钙通道阻滞剂对防治高血压及其并发症产生的影响。方法:临床选取80例高血压患者,随机分为单独用药组和联合用药组,观察对血压、肝、肾功能、血脂、血糖、肾小球滤过率等的影响。结果:联合用药组用药后降压效果显著,分别与单独用药组相比存在显著性差异,P<0.05。而联合用药对肝肾功能、血脂、血糖等没有产生显著影响,但是可以看出联合用药后血肌酐较用药前有显著改善P<0.05,而且与单独用药组相比,对肾小球滤过率有显著升高的作用,P<0.05。结论:高血压患者以血管紧张素转换酶抑制剂为基础,联合应用钙通道阻滞剂,疗效十分理想。对靶器官具有较为理想的保护作用     

动态血压监测观察酰托普利的降压疗效

目的:观察酰托普利治疗轻、中度原发性高血压的疗效及安全性。方法:轻、中度原发性高血压病人22例,服用酰托普利片15mg,po,bid,连续服用2mo。治疗前后测24h动态血压。结果:经酰托普利片治疗2mo后,24hSBP血压下降了(2.3±s0.6)kPa,DBP下降了(1.8±0.5)kPa(均P<0.01),日间及夜间SBP与DBP均能等幅度的降低,总有效率为91%,所有受试病人未出现不良反应。结论:酰托普利是安全、有效的治疗轻、中度高血压病的一线降压药物。     

Effect of cigarette smoke on autoimmunity in murine and human systemic lupus erythematosus.

Several studies have found that smoking cigarettes is a risk factor for systemic lupus erythematosus (SLE). To examine this issue in a mouse model, we subjected pre-autoimmune MRL-lpr/lpr mice for 4 weeks to cigarette smoke to provide standardized smoke effluents equivalent to moderate or to heavy smoking habits for people. The spontaneous production of IgG anti-chromatin but not IgM anti-chromatin, anti-denatured DNA, or rheumatoid factor antibodies was lower in mice exposed to 250 mg/m3 particulates from mainstream smoke, and this suppression of autoimmunity was sustained for 8 weeks (p < 0.02). In contrast to control mice anti-chromatin activity in smoke-exposed mice began to increase in 16-week-old mice, reaching levels at 6 months that were two- to three-fold higher than controls for IgG (p < 0.03) and 10-fold higher for IgM (p < 0.001). There was no significant effect on total IgG or IgM. In newly diagnosed SLE patients, smoking was negatively correlated with IgG anti-DNA antibodies (p < 0.03). However, of nine patients who discontinued smoking prior to diagnosis, eight had elevated IgG anti-DNA compared to 29/79 never smokers and 9/31 smokers (p < 0.01 compared to former smokers). Inhaled cigarette smoke appears to have a long-lasting immunosuppressive effect on T-cell-dependent autoimmune responses, although autoantibodies increase to supra-elevated levels after the suppressive effect has abated.     

吉西他滨加卡铂与紫杉醇加顺铂治疗晚期鼻咽癌的疗效比较

目的：研究吉西他滨（GEM）加卡铂（CBP）与紫杉醇（DOC）加顺铂（DDP）治疗晚期鼻咽癌临床疗效及毒副反应.方法：GEM＋CBP组（1组）用GEM 1000 mg/m^2,静脉滴入,d1、d8;CBP 400mg/m^2,静脉滴入,d1,间隔21～28 d为1个周期.DOC＋DDP组（2组）用DOC 135 mg/m^2,静脉滴入,d1;DDP 30 mg/m^2,静脉滴入,d1～d3,间隔21～28 d为1周期;完成2个周期后评价疗效.结果：1组化疗30例,完全缓解（CR）3例,部分缓解（PR）18例,总有效率（CR＋PR）为70.0%（21/30）;2组CR 1例,PR 12例,总有效率为43.3%（13/30）,u=2.017,P=0.044.毒副反应主要表现为血液系统和消化系统,其中1组的骨髓抑制较重,而2组的消化系统反应较重,不良反应可耐受、可逆转.结论：对于在治疗后未控及复发的晚期鼻咽癌患者,两组均取得较好的疗效;GEM＋CBP组较DOC＋DDP组的缓解率高,患者耐受较好,较容易接受.     

NP与EP方案治疗晚期非小细胞肺癌的比较

为观察比较长春瑞滨（NVB）联合顺铂（DDP）组成的NP方案与依托泊苷（Vp-16）联合DDP组成的EP方案,治疗晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）的疗效和毒性反应,选取82例晚期NSCLC患者,随机分为NP和EP两组进行化疗.结果示,NP组有效率为52.5%（21/40）,EP组有效率为28.6%（12/42）,NP组疗效优于EP组,但差异尚无统计学意义,u=1.855,P=0.064.两组剂量限制毒性均为骨髓抑制,消化道反应可以耐受.初步研究结果提示,NP方案治疗晚期NSCLC的疗效高于EP方案.     

Synthesis and biological characterization of 99mTc(I) tricarbonyl cysteine complex,a potential diagnostic for assessment of renal function

Cysteine containing three functional groups, i.e. a carboxyl, sulfhydryl, and amino group, has been labelled with ^99mTc(I) tricarbonyl precursor ( 2 ) in order to study the renal characteristics of the resulting ^99mTc(I) tricarbonyl cysteine ( 3 ) versus the reference ^99mTc‐MAG₃ ( 1 ). The ^99mTc(I) tricarbonyl cysteine ( 3 ) was prepared in good yields and characterized by HPLC, eletrophoresis, and eletrospray mass spectrometry. The plasma protein binding rate of ^99mTc(I) tricarbonyl cysteine ( 3 ) was about 70 to 80%, and similar to that of ¹³¹I‐OIH (70%) but lower than that of ^99mTc‐MAG₃ (90%). The T_1/2 of ^99mTc(I) tricarbonyl cysteine (4.30±0.79 min) in the kidney was higher than the one of ^99mTc‐MAG₃ (2.43±0.70 min). The static image of ^99mTc(I) tricarbonyl cysteine at 5 min post injection showed high concentrated activity in the kidney. And in the 15, 30 min post injection images, most activity appeared in the bladder without a residue in other organs. The ^99mTc(I) tricarbonyl cysteine exhibited biological behavior comparable to ^99mTc‐MAG₃ and it is expected to have diagnostic potential for imaging renal function in nuclear medicine. Copyright © 2004 John Wiley & Sons, Ltd.