2014年天津市血流感染细菌耐药监测

目的：研究天津市血流感染细菌耐药分布及耐药性。方法：收集2014年度天津市45家医院血标本来源细菌药敏结果,用CLSI 2014年标准判读,WHONET 5.6进行药物敏感性分析。结果：分离共计4 772株细菌,其中革兰阳性菌2 038株,占42.7%,革兰阴性菌2 734株,占57.3%,葡萄球菌属1 409株,占29.5%,肠球菌属335株占7.0%,肠杆菌科细菌2 248株,占47.1%,非发酵菌438株,占9.2%,肺炎链球菌35株,占0.7%。最常见细菌依次为大肠埃希菌（27.3%）、凝固酶阴性葡萄球菌（23.8%）、肺炎克雷伯菌（12.1%）、金黄色葡萄球菌（5.6%）、铜绿假单胞菌（4.1%）。耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）和耐甲氧西林金黄色葡萄球菌（MRSA）的检出率分别为78.5%和25.3%。MRSA和MRCNS的耐药率明显高于甲氧西林敏感金黄色葡萄球菌（MSSA）和甲氧西林敏感凝固酶阴性葡萄球菌（MSCNS）。未发现对万古霉素耐药的葡萄球菌。粪肠球菌和屎肠球菌对万古霉素敏感率分别为100%和98.1%,共检出耐万古霉素的屎肠球菌（VRE）3株。大肠埃希菌对亚胺培南的敏感率为98.7%,肺炎克雷伯菌对亚胺培南的敏感率为95.3%。大肠埃希菌和肺炎克雷伯菌中产ESBLs株分别占60.1%和33.3%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为21.6%和17.5%。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为39.6%和49.3%。结论：本年度所分离血培养细菌的耐药较为普遍,加强耐药性监测,指导临床合理使用抗菌药物十分重要。     

大鼠头端延髓腹外侧区NMDA受体在动脉压力感受器反射中的作用

目的：研究大鼠头端延髓腹外侧区（ＲＶＬＭ）谷氨酸ＮＭＤＡ受体在介导动脉压力感受器反射（ＡＢＲ）中的作用。方法：在氨基甲酸乙酯麻醉的大鼠ＲＶＬＭ双侧各微注射０．１μ１的５０ｍｏｌ／Ｌ,氯胺酮,观察动脉血压,心率以及ＡＢＲ的变化。结果：双侧ＲＶＬＭ内微注射氯胺酮后动脉血压和心率明显下降（Ｐ〈０．０５）,同时能部分或完全阻断ＡＢＲ（Ｐ〈０．０５）。结论：谷氨酸ＮＭＤＡ受体在维持交感心血管活动的紧张性兴奋     

分隔膜无针输液接头预防导管相关血流感染的Meta分析

目的 系统性评价分隔膜无针输液接头与肝素帽预防导管相关血流感染发生率的差异。方法 检索万方数据库、中国知网(CNKI)、维普数据库(VIP)、PubMed、CINAHL Complete、Cochrane Library建库至2018年1月1日以来国内外有关分隔膜无针输液接头与肝素帽的所有随机对照试验;对符合纳入标准的文献进行质量评估后使用ReVMan5.3进行Meta分析。结果导管相关血流感染发生率:OR=0.13,5%CI(0.06,0.27),P＜0.000 01;静脉炎发生率:OR=0.10,5%CI(0.03,0.34),P=0.000 20;堵管发生率:OR=0.12,5%CI(0.07,0.19),P＜0.000 01。结论 分隔膜无针输液接头与肝素帽相比较,分隔膜无针输液接头可明显减少导管相关血流感染、静脉炎、堵管发生率。     

创伤危重患者静脉留置导管相关性血流感染的危险因素及护理对策

目的 探讨为创伤危重患者行静脉留置导管抢救时,预防导管相关性血流感染的护理对策. 方法 对医院2007年1月-2008年12月的创伤危重患者静脉置管抢救情况进行回顾性分析与总结. 结果 对转送专科治疗的1032例创伤危重患者,随机追踪观察406例,其中经四肢静脉置管334例,锁骨下静脉置管62例及股静脉置管10例,未发现1例导管相关性血流感染病例. 结论 重视创伤危重患者静脉留置导管的无菌操作、护理和监控,可杜绝导管相关性血流感染的发生,是降低患者死亡率和致残率的关键措施之一.     

Can we increase the speed and efficacy of antidepressant treatments? Part II. Glutamatergic and RNA interference strategies

In the second part we focus on two treatment strategies that may overcome the main limitations of current antidepressant drugs. First, we review the experimental and clinical evidence supporting the use of glutamatergic drugs as fast-acting antidepressants. Secondly, we review the involvement of microRNAs (miRNAs) in the pathophysiology of major depressive disorder (MDD) and the use of small RNAs (e.g.., small interfering RNAs or siRNAs) to knockdown genes in monoaminergic and non-monoaminergic neurons and induce antidepressant-like responses in experimental animals.The development of glutamatergic agents is a promising venue for antidepressant drug development, given the antidepressant properties of the non-competitive NMDA receptor antagonist ketamine. Its unique properties appear to result from the activation of AMPA receptors by a metabolite [(2 S,6 S;2 R,6 R)-hydroxynorketamine (HNK)] and mTOR signaling. These effects increase synaptogenesis in prefrontal cortical pyramidal neurons and enhance serotonergic neurotransmission via descending inputs to the raphe nuclei. This view is supported by the cancellation of ketamine's antidepressant-like effects by inhibition of serotonin synthesis.We also review existing evidence supporting the involvement of miRNAs in MDD and the preclinical use of RNA interference (RNAi) strategies to target genes involved in antidepressant response. Many miRNAs have been associated to MDD, some of which e.g., miR-135 targets genes involved in antidepressant actions. Likewise, SSRI-conjugated siRNA evokes faster and/or more effective antidepressant-like responses. Intranasal application of sertraline-conjugated siRNAs directed to 5-HT_1A receptors and SERT evoked much faster changes of pre- and postsynaptic antidepressant markers than those produced by fluoxetine.     

Pathologic Changes in Wild Birds Infected with Highly Pathogenic Avian Influenza A(H5N8) Viruses,South Korea, 2014

In January 2014, an outbreak of infection with highly pathogenic avian influenza (HPAI) A(H5N8) virus began on a duck farm in South Korea and spread to other poultry farms nearby. During this outbreak, many sick or dead wild birds were found around habitats frequented by migratory birds. To determine the causes of death, we examined 771 wild bird carcasses and identified HPAI A(H5N8) virus in 167. Gross and histologic lesions were observed in pancreas, lung, brain, and kidney of Baikal teals, bean geese, and whooper swans but not mallard ducks. Such lesions are consistent with lethal HPAI A(H5N8) virus infection. However, some HPAI-positive birds had died of gunshot wounds, peritonitis, or agrochemical poisoning rather than virus infection. These findings suggest that susceptibility to HPAI A(H5N8) virus varies among species of migratory birds and that asymptomatic migratory birds could be carriers of this virus.     

两种血培养瓶在昆明市某医院近5年艾滋病患者血流感染病原分析中的应用

目的了解昆明某医院近5年住院艾滋病患者血流感染病原分布。对比两种血培养瓶对不同病原菌的检出情况。 方法对2013-2017年住院艾滋病患者使用两种血培养瓶(普通血培养和分枝杆菌/真菌血培养)的培养结果进行回顾分析。 结果普通血培养阳性率5.8%,病原菌前5位为马尔尼菲篮状菌、新生隐球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌、大肠埃希菌。分枝杆菌/真菌血培养阳性率12.8%,病原菌前5位为分枝杆菌、马尔尼菲篮状菌、新生隐球菌、大肠埃希菌、凝固酶阴性葡萄球菌。 结论2013-2017年艾滋病患者血流感染病原菌以真菌为主,马尔尼菲篮状菌和新生隐球菌为真菌感染的主要菌种;应用分枝杆菌/真菌血培养瓶,分枝杆菌检出率4.8%,分枝杆菌是引起艾滋病患者血流感染仅次于真菌的病原菌,分枝杆菌引起的血流感染不容忽视;普通血培养瓶配合分枝杆菌/真菌血培养瓶的使用可以增加艾滋病患者血流感染病原菌检出机会。     

针刺曲池穴对健康青年大脑中动脉血流动力学影响的研究

目的:探讨针刺曲池穴对青年健康人大脑中动脉(MCA)血流动力学的影响.方法:选取青年健康志愿者40例,针刺被测者的双侧曲池穴,在针刺前、入针时、行针时、出针时、出针后分别应用经颅多普勒超声诊断仪(TCD)检测大脑中动脉(MCA)的血流动力学的变化,并记录TCD各参数变化情况.结果:针刺曲池穴,入针时和行针时收缩期血流速度(Vs)、舒张期血流速度(Vd)、平均血流速度(Vm)均较针刺前显著增快,但出针时、出针后血流速度无显著变化,搏动指数(PI)的变化总体上无统计学意义.结论:针刺曲池穴能增加大脑中动脉血流量,但其后遗效应不明显.     

Harmful effects of silver nanoparticles on a complex detrital model system

The rapid proliferation of silver nanoparticles (AgNP) in industry and the environment requires realistic toxicity assessments based on approaches that consider the biological complexity of ecosystems. Here we assessed the acute toxicity of carbonate-coated AgNP and, for comparison, AgNO₃ (Ag⁺) by using a model system consisting of decomposing plant litter and the associated fungal and bacterial decomposers as central players in the functioning of stream ecosystems. Little variation in size and surface charge during the experiment indicated that the AgNP used were essentially stable. AgNP disrupted bacterial growth (≤83% reduction in protein biosynthesis, EC_50?=_?0.3?μM), clearly affected fungal growth (≤61% reduction in ergosterol synthesis, EC_50?=_?47?μM) with both endpoints more sensitive to AgNP than to Ag⁺. Fungal reproduction, in contrast, was stimulated by AgNP, but not Ag⁺, at concentrations up to 25?μM. Both AgNP and Ag^+?also stimulated extracellular alkaline phosphatase but reduced leucine aminopeptidase, whereas β-glucosidase was stimulated by AgNP and reduced by Ag⁺. Importantly, the provision of cysteine, a chelating ligand that complexes free Ag⁺, failed to alleviate AgNP toxicity to microbial growth, clearly demonstrating particle-mediated toxicity independent of the presence of ionic silver. This contrasts with the observed inhibition of leucine aminopeptidase by Ag⁺, which accounted for 2–6% of the total silver in treatments receiving AgNP. These results show that although outcomes of AgNP and Ag^+?exposure assessed by different functional endpoints vary widely, AgNP strongly interferes with bacterial growth and a range of other microbial processes, resulting in severe consequences for natural microbial communities and ecosystem functioning.     

某院2008至2011年血流感染病原菌的临床分布特征及耐药性分析

目的了解引起血流感染病原菌的临床分布特征及耐药性,为指导临床合理用药提供依据。方法用BacT/ALERT 3D微生物全自动检测系统对血标本进行培养检测,用VITEK-2全自动微生物鉴定仪对病原菌进行鉴定及药物敏感性检测,WHONET5.4软件进行数据的统计及分析。结果 2008至2011年共收检血培养标本10462份,检出病原菌966株,阳性率为9.23%。其中革兰阴性杆菌442株,占53.3%,以大肠埃希菌为主,占33.7%;革兰阳性球菌275株,占33.2%,以凝固酶阴性葡萄球菌(CoNS)为主,占44.4%;真菌112株,占13.6%。引起血流感染的病原菌中,大肠埃希菌居首位(18.0%),其次为凝固酶阴性葡萄球菌(CoNS)14.7%、肺炎克雷伯菌8.2%。产ESBLs大肠埃希菌和肺炎克雷伯菌分别为67.5%和49.1%,MRSA和MRCoNS的检出率分别为53.2%和88.5%,未发现耐万古霉素革兰阳性球菌。临床科室分布以ICU、儿科和血液科为主,分别为25.5%、22.2%和12.4%。血流感染患者基础疾病以恶性实体肿瘤、血液病多见,分别为26.8%、20.6%。结论及时了解血培养结果可以对临床抗菌治疗提供依据,提高治愈率,对控制医院血流感染具有重要意义。