2011年南京医科大学第一附属医院老年科感染病原菌分布及耐药性分析

目的:分析2011年老年科住院患者感染病原菌的分布规律及耐药性,以指导临床合理用药?方法:采用API或Vitek2compact鉴定系统鉴定细菌及真菌;纸片扩散法测定细菌药物敏感性;WHONET5.6软件进行统计分析?结果:老年科住院患者感染病原菌临床分离共993株,其中革兰阴性菌657株(66.2%),革兰阳性菌124株(12.5%),真菌119株(12.0%),其中检出率最高的病原菌是铜绿假单胞菌,共254株,占25.6%,其次是不动杆菌属(19.0%)和克雷伯菌属(12.7%)?耐药性分析结果显示:非发酵菌中,铜绿假单胞菌对大部分抗菌药的耐药率> 60.0%;不动杆菌属对大部分抗菌药的耐药率> 70.0%,其中对亚胺培南和美罗培南的耐药率分别为88.7%和91.1%;大肠埃希菌对头孢菌素类抗菌药的耐药率> 75.0%,对亚胺培南和美罗培南耐药率分别为0.0%和1.5%;克雷伯菌属对头孢菌素类抗菌药的耐药率在80.0%左右,对亚胺培南和美罗培南耐药率高达35.2%和42.3%;葡萄球菌属尚未发现对万古霉素耐药的菌株,但对其他多种抗菌药的耐药率较高,如对青霉素G?哌拉西林/他唑巴坦和头孢西丁的耐药率均> 65.0%?结论:2011年老年科感染病原菌分布已发生变迁,各种细菌对多种抗菌药的耐药率不断上升,尤其不动杆菌和肠杆菌科细菌对碳青酶烯类药物耐药严重,应引起高度重视?     

Slowly Progressive Amnesia without Dementia

This report concerns longitudin's investigations with comprehensive neuropsychologic's assessments and precise morphologic's, CT and MRI scan-based, and function's, SPECT scan-based brain imaging examinations of seven patients who had selective progressive amnesia on their initi's visit. Progressive loss of recent memory remained for sever's years the single most s'sient feature in six of them. The atrophy of the hippocamp's region was observed morphologic'sly, and dysfunction confined to the bilater's medi's tempor's lobe involving the hippocamp's area was demonstrated function'sly. These findings are consistent with recently reported atypic's cases of 'Szheimer's disease with unique neur-opathologic's changes, namely the presence of numerous neurofibrillary tangles and few plaques in the hippocamp's region only.     

Ornithine aminotransferase in Huntington's disease

Ornithine aminotransferase (Orn-T) activities in Huntington's disease (HD) brains were found to be reduced, when compared to age-matched control brains, by 34–49% in the frontal cortex, parietal cortex, caudate nucleus and putamen. Such changes were not observed in senile dementia of Alzheimer type or schizophrenia. Alterations in choline acetyltransferase activities were consistent with previous findings for these disorders. If Orn-T is involved in the synthesis of neurotransmitter glutamate, the reported losses of Orn-T activity may reflect deterioration of the corticostriatal glutamatergic neurons in HD.     

Amyloid in central nervous system disease

A review is presented of diseases of the central nervous system associated with amyloid deposition. The name amyloid is given to substances with particular physical characteristics which are independent of the chemical constitution of the proteins in the substance. Ideally, a classification of amyloid diseases should be based on the chemical composition of the amyloid deposits; this has only been partially realized. The best documented group of diseases with amyloid deposition in the central nervous system is the group of ‘cerebral β amyloid diseases’, characterized by the deposition of β-protein. This group includes: Alzheimer's disease, sporadic cerebral amyloid angiopathy, Down's syndrome, Parkinson-dementia of Guam, hereditary cerebral hemorrhage with amyloidosis-Dutch type and age-related asymptomatic amyloid angiopathy.     

Retinal vessels of canine eyes at different ages--a qualitative and quantitative study.

Diameter and number of cells per unit length of vessel wall and endothelial cell frequency were determined in capillaries of trypsin-digested Foxhound retinas from different age groups. Capillary diameters increased and number of cells per unit length of capillary wall decreased with age and distance from the optic disc. Endothelial cell frequency was constant at approximately 79% of the total cells in capillary walls in all areas measured. Peripheral cystoid degeneration and peripheral annular and focal degeneration were found in aged dog retinas. Sclerosis of retinal arterioles was observed ophthalmoscopically, histologically, and in trypsin-digested retinas from aged dogs. The significance of this change in relation to the peripheral retinal degeneration is undetermined. It is proposed that thickening of basement membranes observed in peripheral capillaries of retinas causes chronic, low-level hypoxia leading to peripheral retinal degeneration in aged retinas.     

中医药治疗老年类风湿性关节炎所致骨质疏松症的临床研究

本文选取老年类风湿关节炎患者有骨质疏松征象之病例,分三型治疗：脾肾阳虚型,治以益肾温阳,健脾利湿方；肾虚瘀滞型,治以益肾祛瘀、蠲痹活络方；肝肾阴虚型,治以滋肝填髓通络清火方。总有效率为93.1%。对照组总有效率为80.0%。两组相比,疗效有显著不同(P<0.05).     

Synaptic pathology in Alzheimer's disease: Relation to severity of dementia,but not to senile plaques,neurofibrillary tangles,or the ApoE4 allele

Summary Alzheimer's disease (AD) is characterised by an increased number of senile plaques (SP) and neuroflbrillary tangles (NFT) as compared with that found in non-demented individuals of the same age, and a marked degeneration and loss of synapses. One of the main risk-factors for the disorder is inheritance of the apolipoprotein E4 (ApoE4) allele. To further study the relation between these pathogenetic substrates for AD, we quantified the synaptic vesicle membrane protein rab3a in brain tissue from 19 patients with AD and 9 age-matched control subjects. Rab3a levels were reduced in AD, both in the hippocampus (60% of control level, p < 0.0001), and in the frontal cortex (68% of control level, p < 0.01), but not in the cerebellum (92% of control level). Within the AD group, lower rab3a levels were found both with increasing duration and severity of dementia. These findings further support that synaptic pathology is closely correlated to the clinical dementia in AD. In contrast, no significant correlations were found between SP counts and duration or severity of dementia, while higher NFT counts in the frontal cortex were found with increasing severity of dementia (r=0.54, p < 0.05). There were no significant correlations between the rab3a level and SP or NFT counts, and by immunohistochemistry, reduced rab3a immunostaining was found throughout the neuropil in AD brain, without relation to SP or NFT. These findings suggest that the synaptic pathology in AD is not closely related to the presence of SP and NFT. No significant differences in rab3a levels were found in any brain region between AD patients possessing different numbers of the ApoE4 allele, suggesting that, although ApoE4 is a risk factor for earlier development of AD, the degree of synaptic pathology does not differ between patients with or without the ApoE4 allele.     

微化地奥司明治疗老年下肢慢性静脉机能不全的有效性和安全性研究

[目的] 研究微化的地奥司明(爱脉朗)治疗老年下肢慢性静脉机能不全的有效性和安全性。 [方法] 将下肢慢性静脉机能不全的老年患者随机分成2组,每组33例。A组口服微化的地奥司明60 d,B组穿医用弹力袜治疗60d,然后对2组患者下肢腿围和症状变化进行对照研究。 [结果] A组下肢腿围平均减小值与B组差异无显著性(踝周径比较:左踝P=0.31,右踝P=0.88;腓肠肌周径比较:左侧P=0.19,右侧P=0.85)。主要症状变化两组问差异无显著性(P>0.05),两组均有良好的耐受性。 [结论] 微化的地奥司明是安全而有效的治疗老年下肢慢性静脉机能不全的药物。     

双极人工股骨头置换治疗高龄股骨转子间骨折48例

选择2004-08/2008-04海南省人民医院骨病外科收治的股骨转子间骨折患者48例，男20例，女28例；年龄70~93岁。全部为行走跌倒致伤，骨折类型按Evans分类：Ⅱ型18例，Ⅲ型10例，Ⅳ型18例，Ⅴ型2例，均为不稳定性骨折。全部患者均采用双极人工股骨头置换，置换前患髋Harris评分为差。记录置换时间，置换过程中出血量，Harris评分及围置换期并发症。48例患者中42例获得随访，6例失访。置换时间50~88 min，平均78.5 min。42例患髋均无明显疼痛，无髋关节脱位和假体松动，再骨折等，置换后并发下肢深静脉血栓4例，一过性精神障碍3例，肠道菌群失调3例，6例双下肢不等长，髋臼磨损2例。置换后1年Harris评分优22例，良18例，优良率达83.3%。置换后1周开始扶拐或在助行器帮助下下地行走，3周后基本能弃拐行走，置换过程中输血200~1 400 mL，平均600 mL，伤口均Ⅰ期愈合。提示对于高龄股骨转子间骨折选择双极人工股骨头置换疗效可靠，但应注意预防并发症的发生。     

Aging of the human limbic system: Observations of centenarian brains and analyses of genetic risk factors for senile changes

The purposes of the study are to elucidate the ultimate stage of aging of the limbic system with observations of centenarian brains compared with dementia of the Alzheimer type (DAT), and to search for genetic factors that may influence formations of the senile changes in the limbic system. Neocortical as well as limbic regions of the brains from 13 centenarians were studied with younger control groups (average age about 80 years), that is 20 nondemented (ND) individuals and 20 patients with DAT. No centenarian subjects were clinically diagnosed as having DAT or satisfied neuropathological criteria for DAT. The densities of senile plaques (SP) in the centenarian brains tended to be higher than the ND subjects, but significantly lower than the DAT patients. The densities of neurofibrillary tangles (NFT) in the hippocampal region were significantly higher in the centenarians compared with the ND subjects. Five centenarian brains had an especially large number of NFT in the hippocampal region, which were comparable with DAT; however, NFT in the neocortical areas of the centenarians were scarce in contrast with DAT. The results suggest that DAT would not be an accelerated condition of the aging process represented by the centenarian brains, but a disease caused by a different pathological process. Further, a study was conducted to determine whether the polymorphisms of the apolipoprotein E (ApoE) and presenilin-1 (PS-1) genes were associated with SP and NFT in the limbic and neocortical areas of the brains from the 122 autopsy cases, including 36 DAT patients and 86 ND subjects. ApoEε4 allele frequency was significantly higher in the DAT patients (22.2%) compared with the ND subjects (7.6%) (P= 0.001), and individuals with the ε4 allele had higher densities of SP and NFT in the hippocampus. Further, ND elderly subjects without senile changes in the neocortical as well as limbic areas showed a significantly lower frequency of the ε4 allele and a significantly higher frequency of the ε2 allele compared with the other subjects. The PS-1 polymorphism was not associated with DAT, SP or NFT. The genetic polymorphisms of the other molecules may also contribute to expression of the age-related changes of the limbic system.