肺炎克雷伯菌质粒介导的β-内酰胺酶的筛选及其耐药性检测

目的 了解对头孢类抗生素耐药的肺炎克冒伯菌(Kpn)中超广谱β-内酰胺酶(ESBL)和AmpC酶的分布及其对抗生素的敏感性，寻求检测肺炎克雷伯菌质粒β-内酰胺酶的最佳方法。方法 收集临床分离的肺炎克雷伯菌182株，采用双纸片协同试验和三维试验检测ESDL，表型筛选法和头孢西丁三维试验检测AmpC酶。结果 双纸片协同试验检测出产ESDL株78株，占42．85％(78／182)，三维试验显示产ESBL株82株，占45．05％(82／182)，两者相比总符合率为95．12％(78／82)。AmpC酶表型筛选法结果显示可疑产AmpC酶株9株，占4．9％(9／182)。三维试验显示产AmpC酶为7株，占3．8％(7／182)；同时产ESBL和AmpC酶菌株为2株，占1．1％(2／182)。产酶株对三代头孢高度耐药，对喹诺酮类、复方新诺明交叉耐药率也很高，对氨基糖苷类抗生素有一定敏感性，尚未发现亚胺培南耐药株。结论 双纸片协同试验为检测ESDL最常用方法，AmpC酶表型筛选法只可作为初步筛查．确证时采用三维试验。产ESDL和(或)AmpC酶的Kpn对多种抗生素耐药，需及时监测药敏结果。     

肠杆菌属细菌高产AmpC酶检测方法的比较研究

目的评价纸片耐药表型推断法和双纸片邻氯西林增效试验应用于临床实验室检测肠杆菌属细菌高产AmpC酶的可行性。方法采用头孢西丁三维试验、纸片耐药表型推断法和双纸片邻氯西林增效试验对104株临床分离的肠杆菌属细菌进行高产AmpC酶检测,以头孢西丁三维试验为标准,与后两种方法进行比较,计算两种方法的灵敏度和特异性。结果经头孢西丁三维试验检测,104株肠杆菌属细菌中高产AmpC酶有15株,其中阴沟肠杆菌11株,产气肠杆菌3株,河生肠杆菌1株,总检出率为14.4％。纸片耐药表型推断法的符合率为91.3％,灵敏度为86.7％,特异性为92．1％。双纸片邻氯西林增效试验的符合率95.1％,灵敏度为93.3％,特异性为95.5％。结论纸片耐药表型推断法和双纸片邻氯西林增效试验与三维试验相比有较高的符合率,且操作简便,适合在临床实验室检测肠杆菌属细菌高产AmpC酶中应用。     

AmpC酶检测方法的探讨

目的:比较头孢西丁三相试验和双纸片协同试验检测AmpC酶的可靠性与临床应用。方法:采用头孢西丁三相试验、双纸片协同试验同时对268株革兰阴性杆菌进行AmpC酶检测,将两种检测方法的结果分别与三维试验的结果加以比较。结果:在268株革兰阴性杆菌中,3种方法的AmpC酶的检出率分别为22.0%、16.0%、14.9%。头孢西丁三相试验和双纸片协同试验与三维试验的总符合率分别为92.9%、98.9%。结论:头孢西丁三相试验可以作为AmpC酶的筛选试验。双纸片法协同试验具有操作简便、结果可靠等优点,与三维试验有较高的符合率,可作为AmpC酶检测常规试验。     

EDTA纸片法检测大肠埃希菌和肺炎克雷伯菌高产AmpC酶的探讨木

目的 分析EDTA纸片法与头孢西丁三维试验检测大肠埃希菌和肺炎克雷伯菌高产AmpC酶的符合程度,探讨应用EDTA纸片法检测高产AmpC酶在临床实验室应用的可行性.方法 从临床菌株中筛选出头孢西丁耐药的大肠埃希菌和肺炎克雷伯菌,应用EDTA纸片法和头孢西丁三维试验分别对头孢西丁耐药的大肠埃希菌和肺炎克雷伯菌是否高产AmpC酶进行检测,并进行方法学比较.结果 174株细菌中,用EDTA纸片法和三维试验检测为阳性的分别为16株和15株,两种方法阳性符合率为93.8%,阴性符合率为100%,总符合率为99.4%.结论 EDTA纸片法与头孢西丁三维试验的符合率很高,且EDTA纸片法操作简便、成本低廉且不需特殊仪器设备,适合于临床实验室推广应用.     

EDTA纸片法检测大肠埃希菌和肺炎克雷伯菌高产AmpC酶的探讨

目的 分析EDTA纸片法与头孢西丁三维试验检测大肠埃希菌和肺炎克雷伯菌高产AmpC酶的符合程度,探讨应用EDTA纸片法检测高产AmpC酶在临床实验室应用的可行性。方法 从临床菌株中筛选出头孢西丁耐药的大肠埃希菌和肺炎克雷伯菌,应用EDTA纸片法和头孢西丁三维试验分别对头孢西丁耐药的大肠埃希菌和肺炎克雷伯菌是否高产AmpC酶进行检测,并进行方法学比较。结果 174株细菌中, 用EDTA纸片法和三维试验检测为阳性的分别为16株和15株,两种方法阳性率符合率为93.8%,阴性率符合率为100%,总符合率为99.4%。结论 EDTA纸片法与头孢西丁三维试验的符合率很高,且EDTA纸片法操作简便、成本低廉且不需特殊仪器设备,适合于临床实验室推广应用。     

三种检测阴沟肠杆菌AmpC酶方法的比较

目的:以三维实验结果为标准,比较表型筛选法和双抑制剂扩散协同法试验检测产AmpC酶阴沟肠杆菌的可靠性。方法:收集2011年2月-2012年12月我院临床分离的阴沟肠杆菌39例,分别用三维实验、表型筛选法、双抑制剂扩散协同法试验检测产AmpC酶阴沟肠杆菌。结果:39株阴沟肠杆菌经三维试验检测出高产AmpC酶的阴沟肠杆菌10株,检出率为25.6%。表型筛选法特异性为69.0%,灵敏度为90.0%,检出效率为76.9%。双纸片协同试验特异性为93.1%,灵敏度为80.0%,检出效率为89.7%。结论:双抑制剂扩散协同法具有较高的灵敏度和特异性,且与三维试验阳性检出率相当,是一种可靠的方法。     

三种检测AmpC β-内酰胺酶方法的比较及其临床应用

目的：评价表型筛选法和双纸片协同试验检测产AmpCβ-内酰酶肠杆菌的可靠性与临床应用。方法：采用表型筛选法、双纸片协同试验和三维试验同时对98株肠杆菌进行AmpC酶检测，将2种检测方法的结果分别与三维试验的结果加以比较，并调查了我院呼吸内科肠杆菌中AmpC酶的流行情况。结果：三维试验结果显示98株肠杆菌中高产AmpC酶的菌株共有19株（阴沟肠杆菌16株、弗劳地枸椽酸杆菌2株=产气肠杆菌1株），检出率为19.39％。2种试验方法的敏感性分别为84.2％，94.7％，特异性分别为98.6％，97.3％，与三维试验的总符合率分别为90.8％，91.8％。结论：表型筛选法和双纸片协同试验可以替代三维试验在各级医院常规应用，双纸片协同试验具有操作简便、结果可靠等优点。     

耐药不动杆菌AmpC酶及其相关基因分析

目的 了解不动杆菌产AmpC酶的情况,研究AmpC酶的调控基因AmpD、AmpR对产酶的影响.方法 126株不动杆菌,用Nitrocefin显色法、头孢西丁纸片筛选法和三维试验进行AmpC酶的检测,AmpC基因引物对提取的质粒DNA和染色体DNA进行PCR扩增并测序,对AmpC基因扩增阳性菌株进行AmpR、AmpD基因的扩增.结果 本组不动杆菌总β-内酰胺酶的检出率为78.6%(99/126).AmpC基因引物对质粒DNA和染色体DNA进行PCR扩增并测序显示,染色体DNA中存在AmpC基因,质粒DNA中未检测出AmpC基因.三维试验与PCR法相比,假阳性率为54.7%,假阴性率为17.4%.结论 不动杆菌产AmpC酶率较高,AmpC基因位于染色体上,在质粒上未发现.不动杆菌中AmpD、AmpR基因的改变导致AmpC酶表达水平的变化.AmpD的改变比AmpR改变更多见.三维试验与PCR法扩增AmpC基因检测方法相比,有一定的假阳性.除了亚胺培南外,产AmpC酶菌株的耐药率较不产AmpC酶株为高.     

产AmpC酶细菌的检测及耐药性分析

目的:了解我院产AmpC酶细菌的发生率及耐药性,指导临床合理用药。方法:收集G-杆菌848株,用头孢西丁纸片对产AmpC酶菌株进行初筛,用氟氯西林双纸片协同法进行确认,用K-B法测定18种抗菌药物的耐药性。结果:848株G-杆菌经头孢西丁纸片筛选产AmpC酶菌株阳性率为14.3%(121/848),经氟氯西林双纸片协同法试验确认为7.8%(66/848),标本来源以痰液为主,占89.4%(59/66);产AmpC酶菌与非产AmpC酶菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和头孢吡肟的耐药率均较低(7.3%~34.8%),非产AmpC酶菌对头孢西丁、头孢他啶、氨曲南、阿米卡星、呋喃妥因的耐药率低于产AmpC酶菌的耐药率,二者差异有统计学意义(P<0.05)。结论:产AmpC酶细菌呈多重耐药,应高度重视和控制,亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和头孢吡肟对产AmpC酶细菌的敏感性较好。     

海南地区产质粒介导AmpC酶大肠埃希菌基因型研究

目的 了解海南地区产质粒介导AmpC酶大肠埃希菌基因型特点.方法 收集来自海南地区8所医院2009年度不重复临床分离的大肠埃希菌540株,分别采用纸片扩散法和三维试验进行表型筛选和AmpC酶检测,用接合试验证实酶基因型的转移性,通过PCR检测及序列分析进行质粒AmpC酶基因型确定,用E-Test法对产质粒AmpC酶株进行MIC测定.结果 540株大肠埃希菌中,头孢西丁抑菌环直径≤17mm的占22.8%(123/540),除五指山市菌株全部对头孢西丁敏感外,其他医院均有对头孢西丁的耐药株.酶提取物三维试验检测阳性的占1.90%(10/540),以PCR方法 对10株三维试验阳性大肠埃希菌进行基因检测,结果 6株在约462 bp处扩增出条带,经测序和比对结果 证实为CMY-2型质粒AmpC酶.10株产AmpC酶大肠埃希菌接合试验有2株接合阳性,接合子均扩增出CMY-2型条带.药敏结果 显示6株产质粒AmpC酶大肠埃希菌对3代头孢菌素、氨曲南和含酶抑制剂的敏感性极低,对亚胺培南和美罗培南均敏感.结论 海南地区存在产质粒介导的CMY-2型AmpC酶大肠埃希菌,药敏结果 显示对3代头孢菌素耐药率极高,但对亚胺培南和美罗培南均敏感.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.