肠杆菌科细菌产超广谱β-内酰胺酶的检测及耐药性分析

目的：探讨我院产超广谱β内酰胺酶（ESBLs）肠杆菌的临床分布及耐药情况,为临床治疗和控制医院内感染及流行病学调查提供依据。方法：用生物梅里埃公司ATB细菌鉴定仪及药敏专家系统对ESBLs进行检测。并用NCCL推荐的确认试验进行比较。结果：产超广谱β内酰胺酶肠杆菌的检出率为49．26％,ESBLs阳性菌对多数抗菌药物的耐药率明显高于ESBLs阴性菌。结论：应用ATB专家系统能及时、有效的检测ESBLs。亚胺培南是治疗产ESBLs细菌感染的首选药物。     

老年病房肠杆菌科细菌耐药性监测分析

目的:分析2000-2004年在老年病房分离的肠杆菌科细菌菌种分布及耐药特征变迁,以指导临床合理用药。方法:采用美国梅里埃公司生产的全自动微生物鉴定系统VITEK-60进行菌种鉴定及体外药敏试验。结果:老年患者35.2%的细菌感染由肠杆菌科细菌引起,其中,5种主要的细菌为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、奇异变形杆菌、产气肠杆菌。在所测试的十四种抗菌药物中,喹诺酮类药物的体外抗菌活性下降最快。第三、四代头孢菌素有一定敏感程度,敏感率介于50%~70%。亚胺培南一直保持优秀的体外抗菌活性,耐药率不足3%。结论:肠杆菌科细菌是老年患者感染常见致病菌,追踪其对常用抗菌药物的耐药性变迁,对临床准确、合理使用抗菌药物具有指导意义。     

234株大肠埃希菌的临床分布与耐药性分析

目的:了解我院大肠埃希菌的分布情况、耐药性以及用药频度,为临床合理使用抗菌药物提供依据。方法:对我院2010年送检标本进行细菌培养分离,分离株鉴定使用法国生物梅里埃Vitek ATB系统,药敏试验使用法国生物梅里埃ATB试条,药敏结果根据美国国家临床实验室标准化委员会(NCCLS)标准进行判读。结果:全年总计分离出234株大肠埃希菌,主要来源于痰标本(35%)和血标本(31%),其中以泌尿外科、肝胆外科最多。对大肠埃希菌最为敏感的药物是美洛培南、亚胺培南,使用最多的抗菌药物是头孢西丁。结论:大肠埃希菌对临床常用抗菌药物的耐药问题突出,必须加强对该菌感染治疗药物的合理选择。     

儿科137株产超广谱β-内酰胺酶耐药菌的耐药性分析

目的 研究儿科病房产超广谱β-内酰胺酶(ESBLs)细茵的耐药性.方法 对2004年1月～2004年12月分离的肠杆菌科细菌,用生物-梅里埃ATB药敏系统进行鉴定和药物敏感试验.结果 543株肠杆菌科细菌共检出137株产ESBLs细菌(检出率25.2%),其中大肠埃希茵61株(29.0%),肺炎克雷伯菌48株(43.6%).产ESBLs菌对18种抗生素的耐药率与不产ESBLs菌相比差异有显著性.结论 产ESBLs茵对大多数抗生素耐药性严重,应加强对产ESBLs细茵耐药性的监测;及时准确地检测病原菌,指导临床合理用药,减少耐药茵株产生.     

我院2010-2012年肠杆菌科细菌耐药性研究

目的：了解某儿童医院2010-2012年临床分离的肠杆菌科菌群分布及其耐药性。方法：收集2010-2012年该院临床分离的肠杆菌科细菌2494株,对其药敏试验结果进行统计、分析。结果：2494株肠杆菌科菌株中,分离最多的是肺炎克雷伯菌1069株（42．9％）,其次是大肠埃希菌1044株（41．9％）和阴沟肠杆菌134株（5．4％）。肠杆菌科细菌对常用抗菌药物均有不同程度耐药,对哌拉西林／他唑巴坦、头孢噻肟、头孢他啶、头孢吡肟的耐药率较低（〈27．7％）,对亚胺培南、美罗培南的耐药率最低（〈1．3％）。结论：肠杆菌科细菌对多数抗菌药物有不同程度的耐药,对碳青霉烯类抗菌药物最为敏感。定期进行耐药性监测有助于了解医院细菌耐药性变迁,为临床经验用药提供依据。     

国产某真菌药敏试剂盒误鉴定热带念珠菌药敏结果原因探究

目的探讨国产某真菌药敏试剂盒测定热带念珠菌药物敏感性试验结果错误的原因。方法收集30株国产真菌药敏试剂检测结果为对唑类药物耐药的热带念珠菌。另外再收集30株唑类药物敏感的热带念珠菌为对照菌株,用法国生物梅里埃ATB真菌药敏试剂盒复核国产试剂盒的鉴定结果,并自行配制系列药敏稀释液替代国产试剂中原有药敏稀释液,对上述热带念珠菌进行药物敏感性测试。结果国产试剂盒和自行配制试剂的检测结果分别与法国生物梅里埃ATB真菌药敏试剂盒检测结果比较,国产试剂(100%)与ATB(0%)检测的唑类药物敏感的热带念珠菌耐药率有统计学意义,x2=28.03,P<0.01;自配试剂(10%)与ATB(0%)检测的唑类药物敏感的热带念珠菌耐药率无统计学意义,x2=1.33,P>0.05。结论该国产真菌药敏测定试剂盒对部分热带念珠菌对氟康唑药物敏感性检测结果不准确,通过改进药敏稀释液配方,其准确性得到保证。     

2009年10月-2012年6月我院ICU患者感染革兰阴性杆菌分布及产酶、耐药相关性分析

目的：了解重症监护病房（ICU）患者感染革兰阴性杆菌分布及产酶、耐药情况,指导临床合理用药。方法：对2009年10月-2012年6月我院ICU送检的临床标本进行培养、分离、鉴定,采用手工法及法国生物梅里埃全自动细菌鉴定系统对菌种进行鉴定,采用K-B琼脂扩散法进行药敏试验,采用改良三维试验对细菌超广谱β-内酰胺酶（ESBLs）、Amp C酶进行检测,根据美国临床实验室标准化协会（CLSI）2008年标准进行判读。结果：送检的临床标本中分离出194株革兰阴性杆菌,其中鲍曼不动杆菌41株、铜绿假单胞菌48株、阴沟肠杆菌29株、肺炎克雷伯菌24株、大肠埃希菌16株、枸橼酸杆菌属12株、嗜麦芽窄食单胞菌11株、粘质沙雷菌7株、产气肠杆菌6株。194株革兰阴性杆菌中共检出单产ESBLs菌株59株（30.4%）,单产Amp C酶菌株57株（29.4%）,同时产ESBLs和AmpC酶菌株11株（5.7%）。所有病原菌对抗菌药物均有不同程度的耐药,对亚胺培南/西司他丁、阿米卡星的敏感性高,产酶菌株的耐药率高于不产酶菌株。讨论：ICU患者革兰阴性杆菌耐药性呈上升趋势,对亚胺培南/西司他丁、阿米卡星敏感性高;应根据药敏试验结果选择抗菌药物,以减少耐药菌株的产生。     

肠杆菌属细菌的临床分布及耐药特性分析

目的：了解肠杆菌属细菌的临床分布和耐药状况,为临床治疗提供依据。方法采用法国生物梅里埃公司VITEK-2型全自动细菌分析系统,配合GN鉴定卡和AST-GN13药敏检测卡对细菌进行鉴定和药敏试验,应用Whonet5.5软件进行统计分析。结果506株肠杆菌属细菌中阴沟肠杆菌占78.3%、产气肠杆菌占16.8%。标本主要来自痰267株（52.8%）、创面69株（13.6%）、尿液53株（10.5%）、血液47株（9.3%）。肠杆菌属细菌对头孢唑啉、头孢西丁、氨苄西林、头孢替坦、氨苄西林/舒巴坦耐药率最高,均高于95%,对头孢吡肟、厄他培南、左氧氟沙星、头孢哌酮/舒巴坦、美洛培南耐药率较低,均在5%-10%,对亚胺培南、阿米卡星耐药率最低,分别为0.8%和3.0%。结论肠杆菌属细菌对抗菌药物的耐药情况严重,临床应根据药敏结果合理使用抗菌药物。     

肠杆菌科细菌的耐药性变迁

目的探讨本院近两年来肠杆菌科细菌的耐药性变迁,以指导临床合理使用抗生素。方法细菌的鉴定及药敏试验是采用美国Microscan autoSCAN-4细菌鉴定仪进行鉴定和检测,检测产超广谱β-内酰胺酶(ESBLs)的大肠埃希氏菌和肺炎克雷氏菌属细菌的检测是采用NCCLS推荐的纸片扩散确证法。结果本院2002年、2003年共检出肠杆菌科细菌509株,其中最常见的是大肠埃希氏菌、克雷伯氏菌属和阴沟肠杆菌。药敏试验证明亚胺培南对肠杆菌科细菌的耐药率最低。结论尽管亚胺培南对肠杆菌科细菌的抗菌活性最强,但其耐药率已有所上升,临床还需加强对感染病例进行微生物学的检测,并做好药物敏感试验,以及时合理使用抗生素,延缓耐药菌株的产生和漫延。     

某院假丝酵母菌感染的临床特点及药物敏感性分析

目的了解医院假丝酵母菌感染特点及药物敏感情况,为临床抗真菌治疗提供依据。方法收集医院2011年1月至2012年12月临床送检标本中分离的假丝酵母菌,采用法国梅里埃公司生产的ATB微生物鉴定仪、ID32C真菌鉴定板、ATBFUNGUS3药敏板进行真菌鉴定和药物敏感性试验。结果在标本分离的351株假丝酵母菌中,以白色假丝酵母菌为主（74．93％）,其次是光滑假丝酵母菌（14．53％）。检出的真菌标本以痰所占比例最高（61．54％）．尿液次之（22．79％）。分离的假丝酵母菌对各类抗真菌药物的敏感性以两性霉素B、5-氟胞嘧啶敏感性最高,对氟康唑、伏立康唑、伊曲康唑有不同程度的耐药。结论医院真菌感染以白色假丝酵母菌为主,在临床医疗中应重视真菌的培养鉴定和药物敏感性试验,以指导合理选用抗菌药物,延缓耐药菌的产生。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

---

Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.