念珠菌生物膜的结构、影响因素及其对抗真菌药的敏感性

目的建立念珠菌生物膜模型,探讨其形成的特点、超微结构,唾液及血清对生物膜活性的影响及其对抗真菌药物的敏感性。方法采用96孔微量培养皿,甲基四氮盐(XTT)减低的方法,评价念珠菌生物膜的体外生长动力学,唾液及血清对白念珠菌生物膜活性的影响及生物膜对抗真菌药物敏感性;共焦激光扫描显微镜观察念珠菌生物膜超微结构。结果念珠菌生物膜活性随培养时间延长而增强,血清具有明显增加白念珠菌生物膜活性的作用。念珠菌生物膜对常规抗真菌药物明显耐药。结论生物膜中粘附念珠菌与悬浮菌在形态学上有很大的差异,白念珠菌对常规的系统性抗真菌药物二性霉素B、氟康唑及伊曲康唑明显耐药。     

棘白菌素类抗真菌药物的临床应用进展

侵袭性真菌感染的发病率随着抗生素及免疫抑制剂的广泛使用而逐年升高,对患者危害性极大,病死率高。当前可选用的抗真菌药物较少,棘白菌素是目前最新型的抗真菌药物,其靶向作用于真菌细胞壁,具有独特的抗真菌效应,且安全性高,对念珠菌属、曲霉菌属及部分对唑类耐药的真菌类均有抗菌活性。现已获得批准上市的棘白菌素类药物包括卡泊芬净、米卡芬净和阿尼芬净。深入了解棘白菌素类药物的作用特点可更好地指导临床应用,对提高临床抗真菌感染的疗效至关重要。     

新型三氮唑类化合物的抗念珠菌属真菌的活性

目的：研究一类新型的三氮唑化合物对念珠菌属真菌的抗真菌活性。方法：采用体外抗真菌活性试验, 测定化合物的最低抑菌浓度(MIC),从而评价化合物的生物活性作用。结果：所有24个新的化合物对念珠菌属真菌均有不同的抑制作用,其中对白念珠菌的活性最好。化合物12对白念珠菌的活性最强,是标准对照品氟康唑的256倍。化合物17对耐氟康唑的白念珠菌的活性最强,是标准对照品氟康唑的16倍。结论：化合物12和17可以作为两个潜在的药物进一步进行研究。     

纳米银和唑类药物联用抗耐药白色念珠菌作用及机制研究

【目的】 白色念珠菌是临床最常见的条件致病性真菌,能够引起多种疾病,然而随着唑类等药物长期大量使用,导致真菌耐药性普遍产生,成为临床治疗失败的主要原因。纳米银已经被证明具有抗菌活性,但是对白色念珠菌耐药菌株抗菌作用有限,因此本项目主要目的在于研究纳米银和唑类药物联用抗白色念珠菌耐药菌株作用及其作用机制。 【方法】 用电镜方法、紫外全波长扫描及zeta电位测定分析加入唑类药物对纳米银溶液稳定性的影响,体外抗菌实验采用微量稀释法,两药之间关系采用棋盘式微量稀释法并用FICI指数评价,用琼脂扩散法和杀菌曲线来进一步验证两药作用关系。细胞学作用机制解析包括从细胞学水平研究纳米银对白色念珠菌出芽及唑类药物促进纳米银粘附于白色念珠菌表面效应。分子机制解析包括从基因水平研究纳米银和唑类药物联用对麦角甾醇生物合成途径相关基因及细胞膜外排泵基因表达的影响。 【结果】 唑类药物的加入对纳米银系列物理化学表征没有明显影响。纳米银单用MIC是16~32 μg/mL,氟康唑及伏立康唑单用抗耐药白色念珠菌MIC分别是≥64和8 μg/mL。而当联合应用时,纳米银MIC是0.125~0.25 μg/mL,氟康唑MIC是0.125~1 μg/mL,伏立康唑MIC是0.125~0.5 μg/mL,FICI指数均<0.5。琼脂扩散法和杀菌曲线测定进一步确认纳米银和唑类联用抗白色念珠菌耐药菌株具有协同作用。细胞学机制方面联合用药减少了白色念珠菌出芽率,增加纳米银对白色念珠菌的粘附;分子机制方面,发现联合用药能显著降低麦角甾醇含量,并能增加ERG5、ERG6基因的表达。降低外排泵基因CDR1的表达。 【结论】 纳米银和唑类药物联用对耐药白色念珠菌具有显著的协同作用。本项目基于临床抗真菌耐药的现状,为寻找新的逆转真菌耐药的应对策略提供思路。     

我院近5年深部真菌感染与耐药现状调查

目的了解近5年来真菌感染及其耐药情况。方法收集5年来临床分离的真菌219株，对常见菌株进行5种抗真菌药物的体外敏感试验。结果临床真菌感染部位以呼吸道感染居多，为146株，其次来自泌尿道37株，肠道27株，口咽部6株，血液2株，脑脊液1株。菌种分布以白色念珠菌最多，占54．8％；其次为热带念珠菌，占15．5％，光滑念珠菌，占11．0％；其他真菌分离率均〈10．0％。对5种常用抗真菌药进行耐药分析显示氟胞嘧啶、两性霉素B对念珠菌相对3种唑类药物分别具有较低的耐药率（P〈0．01）。克柔念珠菌对氟康唑和酮康唑的耐药菌株均占到30％以上，是耐药性较强的念珠菌。结论深部真菌感染及耐药性呈逐年上升趋势，唑类抗真菌药物已呈明显耐药，采用有效防治措施刻不容缓。     

399株医院真菌感染的分布特点及耐药性分析

目的了解本院临床常见真菌的种类及常用抗真菌药物的耐药情况,为临床合理使用抗真菌药物提供依据。方法对2014年1月至2015年12月临床采集的标本进行真菌分离培养,采用科玛嘉念珠菌显色培养基及API 20C AUX酵母菌鉴定试剂盒进行真菌鉴定,ATB Fungus 3药敏试剂盒进行药敏试验,统计分析菌种的构成及其对5种抗真菌药物的敏感率。结果共收集培养得到399株真菌,标本类型以尿液为主,念珠菌中以白色假丝酵母菌为主,共188株,占47.1%;丝状真菌中以烟曲霉菌为主,共25株,占6.3%。白色念珠菌对抗真菌药物的敏感性较好,大部分在95%以上,但光滑念珠菌对唑类药物敏感性相对较低,对氟康唑的敏感性只有65.1%。曲霉菌对两性霉素B、伊曲康唑和伏立康唑均有着较高的敏感性。结论医院真菌感染以白色念珠菌为主,两性霉素B和5-氟胞嘧啶对其有较高的抗菌活性;光滑念珠菌对唑类药物有较高的耐药性,临床应根据药敏结果合理使用抗真菌药物。     

念珠菌对唑类药物的耐药情况

现如今,由于念珠菌的广泛存在,学术上对真菌药物耐受的念珠菌报道增多,已引起医学界和药学界广泛关注,许多学者对此进行了深入探讨和研究。现通过调查以往来念珠菌的耐要机制,来说明耐药念珠菌对唑类药物的耐药现象和耐药产生的相关因素,以及对耐药机理从基因水平进行研究的新进展。随着抗真菌药的临床应用,耐药菌株逐渐产生近年来有关对。     

白假丝酵母菌对唑类药物耐药机制的研究进展

近年来,真菌感染的发病率呈逐年上升趋势,抗真菌药物被广泛地应用于临床,同时耐药菌株的发生逐渐增多。白假丝酵母菌作为临床常见的病原真菌,对一线唑类抗真菌药物经常出现耐药。白假丝酵母菌基因多样性与其对抗真菌药物的耐受性有着密切的关系。白假丝酵母菌对唑类抗真菌药物产生耐药是治疗白假丝酵母菌感染失败的关键问题之一。目前认为假丝酵母菌耐药与多种分子机制有关,主要     

真菌对唑类抗真菌药物相关耐药基因的研究进展

近年来随着真菌感染频率的增高,唑类抗真菌药物随之被越来越多运用于临床治疗中,但耐药率逐年上升,成为困扰临床治疗真菌感染的难题之一。真菌对唑类药物耐药性的产生是多种复杂因素作用的结果,但主要是由于某些靶酶及耐药基因表达的增加造成的。文章着重介绍真菌唑类药物耐药性产生的机制以及相关耐药基因的研究进展,为临床合理使用唑类药物和研发新型抗真菌药物提供用药策略及理论指导。     

复发性外阴阴道假丝酵母菌病致病菌的耐药性监测和ERG11基因研究进展

复发性外阴阴道假丝酵母菌病(recurrent vulvovaginal candidiasis,RVVC)指1年中发生4次或以上的外阴阴道念珠菌病,引起RVVC的病原菌主要是假丝酵母菌属中的白假丝酵母菌。唑类抗真菌药物在临床上应用广泛,其耐药现象占酵母样真菌耐药首位。14α去甲基酶(14-α-Demethylase,14-DM)为白假丝酵母菌与唑类抗真菌药物作用的关键靶酶,羊毛固醇14α去甲基化酶(Lanosterol 14-α-Demethylase Gene,ERG11)基因是编码14-DM的基因,该基因突变和基因过度表达在介导白假丝酵母菌对唑类药物耐药中发挥了重要作用。本文就ERG11基因突变和基因过度表达在RVVC患者白假丝酵母菌对唑类药物耐药做一综述。     

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.