基层医院ICU与非ICU主要革兰阴性杆菌分布与耐药性差异

目的了解医院重症监护室(ICU)与非ICU主要革兰阴性(G-)杆菌的分布及耐药性,为临床合理使用抗菌药物提供依据。方法对某院2011—2013年住院患者送检标本中培养分离的G-菌标本来源及耐药性进行统计分析,比较ICU与非ICU的差异。结果 25 153份标本共分离G-菌3 875株,分离率15.41%;其中ICU1 121份标本中分离G-菌527株,分离率47.01%,非ICU24 032份标本分离G-菌3 348株,分离率13.93%,两者比较差异有统计学意义(χ2=899.32,P0.001)。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)菌株检出率:ICU分别为56.00%(28/50)、70.65%(65/92),非ICU分别为52.81%(517/979)和40.37%(241/597)。ICU中铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌对亚胺培南的耐药率分别为36.59%、88.54%、10.00%、10.87%,均高于非ICU同类菌的耐药率,分别为20.21%、61.15%、1.74%、2.85%。结论 ICU主要G-杆菌的耐药率高于非ICU,且以多重耐药的非发酵菌为主。临床治疗应区别对待,以减少耐药菌的产生。     

The trichloroethylene metabolite S-(1,2-dichlorovinyl)-l-cysteine but not trichloroacetate inhibits pathogen-stimulated TNF-α in human extraplacental membranes in vitro

Extraplacental membranes define the gestational compartment and provide a barrier to infectious microorganisms ascending the gravid female reproductive tract. We tested the hypothesis that bioactive metabolites of trichloroethylene (TCE) decrease pathogen-stimulated innate immune response of extraplacental membranes. Extraplacental membranes were cultured for 4, 8, and 24 h with the TCE metabolites trichloroacetate (TCA) or S-(1,2-dichlorovinyl)-l-cysteine (DCVC) in the absence or presence of lipoteichoic acid (LTA) or lipopolysaccharide (LPS) to simulate infection. In addition, membranes were cocultured with DCVC and Group B Streptococcus (GBS). DCVC (5–50 μM) significantly inhibited LTA-, LPS-, and GBS-stimulated cytokine release from tissue cultures as early as 4 h (P ≤ 0.05). In contrast, TCA (up to 500 μM) did not inhibit LTA-stimulated cytokine release from tissue punches. Because cytokines are important mediators for host response to infectious microorganisms these findings suggest that TCE exposure could potentially modify susceptibility to infection during pregnancy.     

Hepatitis G virus: a suitable marker of in vivo efficacy for pathogen inactivation

Being an orphan virus despite a large number of investigations, hepatitis G virus is a blood-borne agent for which screening is not required in blood donations. The in vivo efficacy of pathogen inactivation methods could be assessed by the absence of hepatitis G virus markers after transfusion of pathogen-inactivated blood products, in recipients susceptible to infection before the transfusion.     

复方莪术油栓联合克霉唑阴道片治疗老年性阴道炎的临床研究

目的研究复方莪术油栓联合克霉唑阴道片治疗老年性阴道炎的临床疗效。方法选取2018年6月—2019年6月在平顶山市第二人民医院治疗的120例老年性阴道炎患者为研究对象,将所有患者随机分为对照组和治疗组,每组各60例。对照组给予克霉唑阴道片,1片/次,1次/d;治疗组在对照组治疗的基础上给予复方莪术油栓,1枚/次,1次/d。两组患者持续治疗10 d。观察两组患者临床疗效,比较两组临床症状缓解时间、阴道p H值、病原菌检出率、生活质量综合评定问卷(GQOLI-74)量表评分、阴道灌洗液炎性因子水平。结果治疗后,治疗组总有效率为95.00%,显著高于对照组的83.33%(P0.05)。治疗后,治疗组白带减少时间、外阴瘙痒、外阴阴道疼痛、黏膜充血消失时间明显短于对照组(P0.05)。治疗后,两组患者阴道酸碱度(p H)值、病原菌检出率均显著降低,GQOLI-74量表评分显著升高(P0.05);且治疗组指标改善较多(P0.05)。治疗后,两组患者阴道灌洗液白细胞介素-8(IL-8)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平显著降低(P0.05);并且治疗组阴道灌洗液中细胞因子水平降低较多(P0.05)。结论复方莪术油栓联合克霉唑阴道片治疗老年性阴道炎具有较好的临床疗效,可缓解临床症状,提高患者生活质量,降低患者阴道灌洗液中细胞因子水平。     

从《脾胃论》气火学说探讨小儿反复呼吸道感染之乳蛾病

通过梳理李东垣在《脾胃论》气火学说中的理论,从气火关系角度探讨了小儿反复呼吸道感染之乳蛾病的病因病机为气虚火旺、正虚邪恋,所用方剂为当归六黄汤、补脾胃泻阴火升阳汤,其组方原则以温补与清火并用,并随症加减。