应用BACTEC MGIT 960分析临床结核菌株耐药性分析

目的研究我院结核病患者的抗结核药物耐药特点。方法我院就医的结核病患者抗结核药物的敏感性试验结果,分析临床抗结核药物的耐药现状。结果 2008～2010年,耐药菌株为4825株(耐药率为66.68%,4825/7236,MDR为1142株,XDR为105株)。XDR-TB比例2008、2009、2010年分别为1.73%(30/1732)、1.33%(34/2548)、1.39%(41/2956)。结论结核病患者的抗结核药物的耐药形势依然严峻,加强抗结核药物的耐药性监测,合理使用药物非常必要。     

BACTEC MGIT 960培养及分子菌种鉴定技术在脊柱结核诊断中的应用

目的 探讨 BACTEC MGIT 960系统、分子菌种鉴定技术在脊柱结核诊断中的应用价值。方法 对31例脊柱结核标本分别应用 BACTEC MGIT 960及罗氏培养基培养,对所得分离株行IS986扩增及16S rRNA PCR-SSCP分析进行菌种鉴定,并与常规方法对照。结果 BACTEC MGIT 960系统、罗氏培养法分支杆菌培养阳性率分别为83.87％、61.29％,两者平均报告时间分别为11.3d、26.7d;分子菌种鉴定结果与常规方法一致。结论BACTEC MGIT960系统是临床脊柱结核病原菌分离培养的较好方法,快速培养与分子菌种鉴定联合应用可能是目前结核病临床细菌学诊断的较佳策略。     

Clinical picture of infectious syphilis

A generation ago, when syphilis was a clinical commonplace and a subject heavily stressed in the medical school curriculum, syphilologists were concerned that students preoccupied with the fascinating signs of the disease would forget that the diagnosis is properly made on the basis of laboratory findings. Today the pendulum has swung the other way. Exposure to the clinical aspects of syphilis is so limited during student years, and the teaching of the subject so erratic, that even the most classical and striking forms of the disease often go unrecognized. Laboratory tests are performed and requested when they are not indicated and overlooked when the need for them should have been obvious, particularly in the secondary and relapsing forms of the disease. That the diagnosis of syphilis in its early stages is a laboratory matter is as true now as ever, but the stimulus to perform the tests is provided by the clinical situation at hand. It is the purpose of this section to describe the signs and symptoms that ought to provide that stimulus.     

Serologic tests

It is useful to distinguish between those serologic tests employed in the diagnosis and control of syphilis that measure antibodies directed against T. pallidum (treponemal tests) and those that measure antibodies formed in response to products of tissue destruction (non-treponemal tests). Antibodies measured in the latter are called reaginic, an unfortunate term, because the syphilitic reaginic antibody (reagin) is then all too easy to confuse with the reaginic antibody (IgE) that occurs with regularity in association with the atopic or eczema-asthma-hay fever diathesis. It is too late in the day, however, to embark on quixotic campaigns to reform the literature by removing terms so long in universal use. In general, tests detecting and measuring syphilitic reagin are suited to the tasks of screening for the disease and monitoring response to treatment, while treponemal tests are best suited to confirmation of diagnosis.^1–3 It is the purpose of this section to trace the development of modern serologic thought—as it applies to syphilis—and to describe the mechanics and advantages of serologic tests in current use.     

Neurosyphilis

Virtually every general discussion dealing with neurosyphilis at any length opens with remarks confirming the ability of the disease to imitate other disturbances in the central nervous system in nearly every category. It is a useful literary gambit that has the added advantage of being true. These sentiments can be traced directly back to meticulous work at the bedside carried out by Jonathan Hutchinson, Alfred Fournier, and many other great clinicians of the 19th century, and, while we are cautioned properly by E van Thomas¹ to accept some of their sweeping assertations only with reservations, it is nevertheless a fact that no single disease has been responsible for so many different pathologic reactions in the brain and spinal cord as has syphilis. The purpose of this section is to outline briefly the clinical features of the various types of neurosyphilis and to consider the modifications in these states as they are seen in present-day practice. Current treatment recommendations are also given, and the controversies concerning the use and interpretation of serologic and other laboratory tests on blood and cerebrospinal fluid in the management of the disease are described.Because the course of the disease in the central nervous system does not lend itself readily to staging, and the clinical forms commonly overlap and interdigitate, classifications of neurosyphilis are uniformly unsatisfactory to the more compulsive minds of medicine. Nevertheless, the scheme developed by Merritt, Adams, and Solomon,^2,3 and adopted here, is practical and serviceable. It is shown in Table 15-1.     

Congenital syphilis

Congenital syphilis is syphilis transmitted from the mother to the fetus in utero. T. pallidum in the maternal circulation crosses the placental barrier to infect the fetus, which subsequently develops a series of signs and symptoms that resemble those seen in acquired syphilis in many instances and differ completely in others. These clinical manifestations may appear first during gestation, infancy, childhood, or even adult life.     

Mechanism of protective effect of fosfomycin against aminoglycoside ototoxicity

The purpose of this study was to clarify the mechanism of the protective effect of fosfomycin (FOM) against inner ear damage induced by an aminoglycoside dibekacin (DKB), when administered concurrently DKB and FOM. Rats were treated with 50 mg/kg of DKB with or without 500 mg/kg of FOM for short-term administration. No significant difference was seen in the serum peak level and in the area under the curve between the group receiving DKB alone and the combined administration group of DKB and FOM. On the other hand, the DKB level in the kidney was significantly lower in the combined administration group than in the group receiving DKB alone. The mechanism of protective effect of FOM against DKB-induced ototoxicity may be considered as follows: FOM inhibits the accumulation of DKB in the kidney and reduces its concentration in the kidney and serum. Consequently, the transferability of DKB into the inner ear is decreased, and finally inner ear damage is reduced.     

Hybrid Welding (Laser–Electric Arc MAG) of High Yield Point Steel S960QL

The article discusses the effect of the hybrid-welding process (laser–electric arc MAG Metal Active Gas) on the structure and properties of butt joints (having various thicknesses, i.e., 5 mm and 7 mm) made of steel S960QL. Welding tests were performed in the flat position (PA) and in the horizontal position (PC). Joints made of steel S960QL in the above-presented configuration are present in elements of crane structures (e.g., telescopic crane jibs). The welding tests involved the use of the G Mn4Ni1.5CrMo solid electrode wire and the Ar+18% CO₂ shielding gas mixture (M21) (used in the MAG method). Non-destructive visual and radiographic tests did not reveal the presence of any welding imperfections in the joints. The welded joints obtained in the tests represented quality level B in accordance with the requirements of the ISO 12932 standard. Microscopic metallographic tests revealed that the heat-affected zone (HAZ) contained the coarse-grained martensitic structure resulting from the effect of the complex welding thermal cycle on the microstructure of the joints. Destructive tests revealed that the joints were characterised by tensile strength similar to that of the base material. The hybrid welding (laser–MAG) of steel S960QL enabled the obtainment of joints characterised by favourable plastic properties and impact energy exceeding 27 J. The tests revealed the possibility of making hybrid-welded joints satisfying the quality-related requirements specified in the ISO 15614-14 standard.     

磁珠法在抗酸杆菌快速检测中可行性的研究

目的通过与BD960快速液体培养法、离心沉淀法的比较来评价磁珠法这一检测手段的优缺点和可行性。方法采用磁珠法检测108例痰液标本,并与BD960快速液体培养法和离心沉淀法的平行检测结果相比较。结果1）磁珠法和离心沉淀法仅需1天就可以得出结果,BD960快速液体培养法的阳性报告时间需要10．72±4．49天。2）磁珠法阳性占BD960快速液体培养法的88．8％（71／80）。3）离心沉淀法阴性的43例标本中磁珠法有6例标本为阳性,占离心沉淀法阴性标本的14．0％（6／43）,且磁珠法的浓集效果更好。结论磁珠法不仅操作简便、快速,其阳性率高,与BD960快速液体培养法有很高的可比性,适合结核诊断实验窜的开展。