Antiinflammatory but no neuroprotective effects of melatonin under clinical treatment conditions in rabbit models of bacterial meningitis

Neuronal injury is frequent in bacterial meningitis, resulting in a high rate of death and neurological sequelae. In a search of potential neuroprotective strategies for treatment of bacterial meningitis, the antioxidant melatonin was neuroprotective in cell culture experiments and in a rabbit Streptococcus pneumoniae meningitis model, when treatment was started at the time of infection. In the present study, adjunctive melatonin treatment applied from the beginning of antibiotic therapy 12 hr after infection at a dose of 1.67 mg/kg/hr resulted in plasma concentrations of 451 +/- 198 ng/ml, cerebrospinal fluid (CSF) concentrations of 154 +/- 57 ng/ml and a CSF-to-plasma ratio of 0.38 +/- 0.19 (mean +/- SD). Melatonin therapy had antiinflammatory effects but did not reduce neuronal injury in either a rabbit model of gram-positive Streptococcus pneumoniae or gram-negative Escherichia coli meningitis.     

2006—2010���ͯ����֧ԭ���Ⱦ���в�ѧ����

??Abstract??Objective To summarize the epidemiology of Mycoplasma pneumoniae??MP?? infection in children with acute respiratory tract infection??ARI????and to explore the changes of the epidemiological characteristics in the recent five years. Methods MP was detected using microparticle agglutination method in 183??841 children with ARI. We analyse distribution characteristics of MP by age?? season and gender. Results Among the 183??841 samples??the positive rate was 30.8%. There was significant difference in the infection rate between boys and girls??P??0.01????girls ??35.5%??higher than boys ??27.4%??. MP infection rate from 2006 to 2010 was 22.4%??16.8%??25.8%??29.9% and 39.2%??respectively. In 0-to-3-year-old-group??the positive rate for MP was 19.8%??while in 3-to-6-year-old-group and above 6-year-old-group?? 38.3% and 48.1% were positive?? respectively??Which showed a significant difference in the infection rate between the 3 groups. There were epidemiological differences in infection incidences by MP in different seasons??spring 26.9% ??summer 31.7%?? autumn 33.5% and winter 31.2%??. The MP infection incidences showed seasonal differences??P??0.01??. Conclusion The incidence of MP infection in the recent 5 years increased year by year??with 2010 as the highest. MP infection can occur through the whole year?? especially in autumn. School age children are still the vulnerable infected group with high incidence in girls than boys.     

儿童感染肺炎克雷伯菌的喹诺酮类耐药株gyrA及parC基因突变分析

目的 了解湖南地区儿童感染肺炎克雷伯菌的耐药趋势,以及由染色体介导喹诺酮类耐药基因gyrA及parC的流行及变异情况,为治疗儿童肺炎克雷伯菌感染提供依据.方法 以VITEK-2Compact全自动微生物系统检测分离菌株的耐药性,采用PCR法对36株耐喹诺酮类肺炎克雷伯菌进行gyrA及parC基因检测,PCR扩增产物经纯化后测序并进行序列分析.结果 发现36株耐喹诺酮类肺炎克雷伯菌均发生了gyrA基因耐药决定区的突变,其中33株有第83位丝氨酸的改变,3株发现有第87位氨基酸的改变,而parC基因在所有耐药株中均有第80、91位氨基酸的改变.结论 儿童感染肺炎克雷伯菌染色体介导喹诺酮类耐药基因gyrA及parC基因突变情况十分普遍,监测其突变频率、位点对指导临床用药及耐药机制研究十分重要.     

gyrA、parC及mdfA基因测序鉴定肺炎克雷伯菌

目的 探讨gyrA、parC和mdfA基因测序鉴定临床分离的泛耐药肺炎克雷伯菌的必要性.方法 采用gyrA、parC和mdfA基因测序方法对经法国生物梅里埃公司API 20 E系统(API LAB plus)和MicroScan WalkAway 96 Plus全自动细菌鉴定系统鉴定为克雷伯菌属或产气肠杆菌的19株临床分离株进行分子鉴定.结果 19株菌gyrA、parC、mdfA基因PCR扩增均阳性,基因序列经GenBank中的BLASTn程序进行同源性比较分析,表明与2株完成全基因组测序的肺炎克雷伯菌肺炎亚种NTUH-K2044(Accession:AP006725.1)和MGH 78578(Accession:CP000647.1)最为接近,均为99.0％同源,证实19株均为肺炎克雷伯菌.结论 采用gyrA、parC和mdfA基因测序鉴定肺炎克雷伯菌结果准确.     

ICU耐碳青霉烯类肺炎克雷伯菌感染患者的预后分析

目的 了解ICU耐碳青霉烯类肺炎克雷伯菌感染患者的预后并加以分析,为临床治疗提供可靠依据.方法 收集2009年1-12月浙江大学医学院附属第二医院中心ICU经细菌培养鉴定为肺炎克雷伯菌菌株82株,采用法国生物梅里埃公司的VITEK系统进行细菌鉴定,用琼脂稀释法进行药物敏感性试验;将肺炎克雷伯菌医院感染患者47例经药敏试验分耐碳青霉烯类患者组和非耐药组,对两组患者的病死率、入住ICU天数、使用呼吸机天数进行分析.结果 从痰中分离肺炎克雷伯菌菌株居首位,占54.88％,其余依次为引流液19.51％、血液15.85％、胆汁3.66％、伤口分泌物2.44％、深静脉导管尖端2.44％、穿刺液1.22％;肺炎克雷伯菌对美罗培南、亚胺培南的耐药率分别为54.88％、52.44％;与非耐药组比较,耐碳青霉烯类肺炎克雷伯菌感染患者的预后差、病死率高,达到76.19％,差异有统计学意义(P＜0.05);患者入住ICU天数延长(74.14±64.23)d,差异有统计学意义(P＜0.05);呼吸机使用天数延长(61.8±73.68)d,差异有统计学意义(P＜0.05).结论 ICU中耐青霉烯类肺炎克雷伯菌感染患者的预后差,病死率高,入住ICU天数及呼吸机使用天数明显延长;严格控制抗菌药物药物的使用,及时有效地细菌鉴定及药物敏感试验,尽早发现肺炎克雷伯菌的感染情况,为临床提供可靠的治疗依据.     

脑梗死患者肺炎衣原体感染与血清基质金属蛋白酶-9的关系分析

目的 通过观察脑梗死患者肺炎衣原体(CP)感染血清基质金属蛋白酶-9 (Matrix metallopeptidaseq,MMP-9)含量变化,以探讨CP感染与脑梗死的关系.方法 选择2012年1-7月脑梗死住院患者为脑梗死组,选择同期健康体检者为对照组,每组各76例;应用多聚合酶链反应(PCR)技术检测两组,同时用酶联免疫吸附测定法检测MMP-9.结果 两组在临床资料、基础疾病和吸烟等比较差异无统计学意义;脑梗死组阳性43例,阳性率为56.58％,对照组CP-DNA阳性16例,阳性率为21.05％,两组比较差异有统计学意义(x2=152.63,P＜0.05);脑梗死组MMP-9质量浓度为(651±89)ng/ml,对照组为(555±91)ng/ml,差异有统计学意义(t=5.83,P＜0.01);血清CP-DNA阳性脑梗死患者的MMP-9质量浓度为(470±98)ng/ml,高于CP-DNA阴性脑梗死患者的(305±60)ng/ml,差异有统计学意义(t=11.28,P＜0.01).结论 CP慢性感染与脑梗死发病有关,CP可能通过炎症反应在脑梗死的发生、进展中发挥重要作用.     

105例小儿肺炎克雷伯菌性肺炎临床分析

目的 探讨小儿肺炎产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌感染发生率及耐药特点,为临床合理选用抗菌药物提供依据.方法 对医院2009年1月-2011年12月收治的476例细菌性感染肺炎住院患儿痰标本中分离出的105株肺炎克雷伯菌及药敏结果进行回顾性分析.结果 检出肺炎克雷伯菌产ESBLs菌株33株,检出率为31.4％;肺炎克雷伯菌对亚胺培南敏感率为100.0％;对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的敏感率分别为77.1％、81.9％,显著高于其他β-内酰胺类抗菌药物;病程初次使用抗菌药物患儿产ESBLs检出率仅为17.1％,而非初次使用抗菌药物产ESBLs检出率高达38.6％,两者比较差异有统计学意义(x2=4.97,P＜0.05).结论 哌拉西林/他唑巴坦、头孢哌酮/舒巴坦可作为小儿克雷伯菌肺炎的首选药物,碳青霉烯类抗菌药物作为产ESBLs肺炎克雷伯菌严重感染者尤其是合并有基础疾病患儿治疗的首选药物.     

Protection against pneumococcal infection elicited by immunization with multiple pneumococcal heat shock proteins

Heat shock proteins (HSPs) play important roles in the pathogenesis of pneumococcal infection, and they are considered as potential protein vaccine antigens. In this study, we investigated the efficacy of immunization with pneumococcal HSPs, including ClpP (hsp100/Clp peptidase subunit), DnaJ (hsp40) and GroEL (hsp60), to protect against pneumococcal carriage, lung colonization and sepsis in mouse models using different serotypes of Streptococcus pneumoniae. In a nasopharyngeal colonization model by serotype 6B or 14 and in a lung colonization model by serotype 19F, immunization with pneumococcal HSPs could elicit effective protection. Likewise, vaccination with ClpP, DnaJ or GroEL allowed significantly longer mouse survival times after lethal intranasal challenge with serotype pneumococcal 2, 3 or 4. Interestingly, combinations of these HSPs could consistently enhance the protection against nasopharynx carriage, lung colonization as well as invasive infection caused by different pneumococcal serotypes. In an in vitro killing assay, anti-sera against ClpP, DnaJ or GroEL could kill S. pneumoniae by polymorphonuclear leukocytes in a complement-dependent way, and combinations of multiple anti-sera against these HSPs could increase the killing ability compared with single anti-sera. Finally, passive immunization studies with anti-sera against pneumococcal HSPs also demonstrated that an additive effect could be achieved by using multiple anti-sera when compared with single anti-sera. Thus, inclusion of multiple pneumococcal HSPs is important for the development of protein-based pneumococcal vaccines.     

清肺通络汤对儿童肺炎支原体肺炎血液流变学影响的研究

[目的]观察清肺通络汤对儿童肺炎支原体肺炎血液流变学的影响。[方法]对40例支原体肺炎患儿随机分成两组,各20例,对照组采用基础治疗,治疗组在基础治疗上加用清肺通络汤,观察治疗组、对照组两组治疗前后组内、组间血液流变学-全血低切黏度、血浆黏度、聚集指数、红细胞压积的变化。[结果]两组全血低切黏度、血浆黏度、聚集指数、红细胞压积组内、组间治疗前后数据比较,差异均有统计学意义(P<0.001或P<0.05)。[结论]清肺通络汤有降低调节儿童肺炎支原体肺炎全血低切黏度、血浆黏度、聚集指数、红细胞压积的作用。     

马鞍山市肺炎链球菌血清型分布及耐药性分析

目的了解马鞍山地区肺炎链球菌临床分离株的血清型分布及药物敏感性。方法应用奥普脱欣试验及胆汁溶解试验鉴定肺炎链球菌;采用荚膜肿胀试验进行肺炎链球菌血清学分型,计算PPV23价疫苗及PCV7疫苗覆盖率;K-B法测定8种药物的耐药试验。结果 80株肺炎链球菌共鉴定13种血清型,有5株不能定型或群,马鞍山地区相对的优势血清型以19F、19A、23F为主,PPV23价疫苗可覆盖本次测试株的86.42%,PCV7疫苗可覆盖测试株的55.56%血清型;75株测试菌对青霉素等药物耐药率较高,耐受四种以上药物的菌株达60株,占测试菌株的80.00%,所有测试菌对左氧氟沙星和万古霉素全部敏感。结论马鞍山地区肺炎链球菌临床分离株以19F、19A、23F血清型为主,PPV23价疫苗的预防作用更显著;绝大多数肺炎链球菌呈多药耐药趋势,应注意合理用药。