冬春季肺炎链球菌感染及其耐药性分析

目的了解冬春季呼吸道感染肺炎链球菌的分离和耐青霉素肺炎链球菌的分离率，研讨肺炎链球菌对抗菌药物的耐药情况，为临床提供诊治依据。方法采取传统的肺炎链球菌鉴定方法和VITEK-32全自动细菌分析仪进行肺炎链球菌鉴定，ATB—STREP5肺炎链球菌药敏试条进行药敏试验。结果646份痰标本分离出肺炎链球菌47株（7．2％），其中耐青霉素肺炎链球菌16株（34．0％），中度耐青霉素肺炎链球菌10株（21.13％），耐青霉素肺炎链球菌对阿莫西林耐药率为（18．8％），对红霉素、磺胺、四环素、克林霉素耐药率分别为100％、73％、62．5％、62．5％，但对三代头孢耐药率为12．5％，万古霉素为0％。结论疑为肺炎链球菌感染时应进行病原学检测和药敏试验，作为治疗的依据。     

尿路感染B群链球菌的耐药特征与CAMP试验敏感性分析

目的 研究尿路感染B群链球菌的耐药特点、耐药基因分布情况及CAMP试验敏感性和编码CAMP因子的cfb基因的表达情况.方法 采用纸片扩散法和Vitek 2 Compact仪器法测定抗菌药物的敏感性,D试验检测红霉素诱导的克林霉素耐药,PCR法检测抗生素相关耐药基因;进行CAMP试验,通过检测16S rRNA基因片段及cfb基因、生化试验、基质辅助激光解吸电离飞行质谱(MALDI-TOF MS)鉴定菌株.结果 51株B群链球菌对氨苄西林、达托霉素、利奈唑胺、呋喃妥因、青霉素、奎奴普丁/达福普汀、替加环素、万古霉素耐药率为0,对红霉素、四环素、克林霉素、左氧氟沙星、莫西沙星、环丙沙星耐药率分别为66.7％、66.7％、49.0％、47.1％、49.0％、47.1％.红霉素和四环索主要耐药基因为ermB和tetM,喹诺酮类抗生素耐药基因gyrA和parC,它们的检出率均为78.4％.CAMP试验结果显示3株阴性、9株弱阳性、39株阳性,经生化试验、cfb基因、16S rRNA检测、MALDI-TOF MS鉴定,除2株阴性株及2株弱阳性株未检测出cfb基因,其余方法鉴定均符合为B群链球菌的特征.结论 尿路感染的B群链球菌对多种抗生素敏感,对红霉素、克林霉素、四环素、喹诺酮类抗生素耐药性高,耐药基因携带情况与耐药性具有一定相关性;CAMP试验及cfb基因对于B群链球菌的鉴定缺乏敏感性.     

南宁市孕妇B群链球菌携带情况调查

目的：调查南宁孕妇Ｂ群链球菌的携带情况。方法：采用阴道后穹隆拭子按常规法培养与鉴定Ｂ群链球菌并统计阳性率;用Ｋ－Ｂ法进行药敏试验并统计耐药率。结果：２０２份标本中有５９份检出Ｂ群链球菌,阳性率为２９．２％;对其中４６株Ｂ群链球菌进行药敏试验,青霉素、氨苄青霉素、红霉素和万古霉素的耐药率分别为６５．２％、４７．８％、４３．５％和０。结论：南宁市孕妇阴道Ｂ群链球菌携带率较高;抗生素的耐药情况严重。     

98株肺炎链球菌耐药性调查

目的了解本院住院患者鼻咽部链球菌耐药性。方法对本院2008年1—12月分离的98株肺炎链球菌进行药敏试验。结果青霉素耐药率8．2％,苯唑西林耐药率77．6％,耐苯唑西林同时也耐红霉素、林可霉素。结论肺炎链球菌耐药性上升迅速,且耐药程度高。加强对肺炎链球菌耐药性监测,采取合理有效的用药措施,减小耐药株的产生,是细菌检验工作与医院感染监测工作的重要内容。     

A群链球菌459株耐药性分析

目的了解A群链球菌对8种抗生素的耐药性。方法将标本接种于含5％去纤维羊血的哥伦比亚琼脂平皿中,在35．5℃、5％二氧化碳条件下培养,按鉴定手册操作程序进行。药敏试验用含5％去纤维羊血的M-H琼脂培养基,按K-B法进行,用参考菌株作质量控制。结果459株中有3株耐万古霉素,25株只对万古霉素敏感,其余均耐药;对8种抗生素全敏感的仅32株;对8种抗生素的耐药率分别为红霉素64．1％,林可霉素61．2％,青霉素65．8％,头孢曲松12．9％,头孢噻肟17．0％,头孢唑啉22．0％,万古霉素0．7％,苯唑西林77．6％。结论治疗本地区A群链球菌感染和对风湿热作一、二级预防宜首选头孢菌素类抗生素。     

应用实时荧光PCR技术快速检测B群链球菌

目的 建立一种能够快速、准确、特异的检测B群链球菌的实时荧光PCR检测技术。方法 以B群链球菌cfb基因的保守区为靶区域设计特异引物和TaqMan荧光探针,然后优化反应条件和反应体系,建立检测B群链球菌的实时荧光PCR方法,通过检测实验菌株,对照菌株以及模拟血液,尿液标本对该方法的特异性、敏感性以及灵敏度进行评价。结果 实验结果表明实时荧光PCR方法检测7株B群链球菌均为阳性,其他对照实验菌株均为阴性,且当菌液浓度为 20cfu//ml时,也能获得阳性结果,说明荧光定量PCR法敏感性、特异性以及灵敏度均较高。对模拟尿液标本进行检测时,其敏感性为90%,特异性为100%,检测下限约为2cfu/反应体系。由于标本类型和处理方式的不同,对模拟血液标本进行检测时,其检测灵敏度约为100cfu/mL,低于模拟尿液标本的检测灵敏度。结论 建立的荧光定量PCR技术方法为GBS的快速诊断以及更加准确有效的进行抗生素预防提供了依据,也为在新生儿中进行早发型GBS感染的快速准确诊断提供了新的思路。     

B群链球菌显色培养基性能评价

目的 评价B群链球菌(group B Streptococcus,GBS)显色培养基在孕产妇围产期GBS筛查中的敏感性、特异性和选择性能.方法 选取2019年1月至2019年6月在本院产科门诊就诊的35～37周孕妇阴道拭子标本1500例,已知GBS菌株10例,采用三区划线直接接种于血琼脂培养基(bood agar plate,BAP)和GBS显色培养基(chromogenic medium chromID Strepto B agar,STRB),记录鉴定结果.比较直接接种血琼脂培养基和显色培养基筛查GBS的敏感性、特异性及选择性能.结果 在BAP和STRB上接种的已知10例GBS菌株全部检出,检出率为100.0％.孕产妇标本共筛查出125例GBS,阳性率为8.3％(125/1500).其中培养24 h后,BAP与STRB阳性率分别为6.2％(94/1500)和8.1％(122/1500);培养48 h后,BAP与STRB阳性率均为8.3％(125/1500),高于24 h阳性率.STRB筛查GBS敏感性为97.60％,特异性为99.35％.STRB与BAP筛查GBS阳性率比较差异有统计学意义(c2=3.911,P<0.05).BAP上接种24 h及48 h后,分别有32.3％及31.8％的非目标菌群被完全抑制.STRB上接种24 h及48 h后,分别有72.6％及70.9％的非目标菌群被完全抑制.孵育24 h后,BAP与STRB非目标菌群生长密度比较差异有统计学意义(c2=32.684,P<0.05).结论 B群链球菌显色培养基对于临床GBS筛查有良好的敏感性和特异性,可较好的抑制非目标菌群,选择性能良好,结果易于判断,与直接使用普通血琼脂培养基相比可降低漏检率,值得临床推广运用.     

广东部分地区儿童肺炎链球菌携带株耐药性调查

目的：了解广东部分地区儿童肺炎链球菌的耐药性。方法;纸片法和Etest青霉素试条检测151株分离自广东云市和广州市儿童肺炎链球菌药敏。结果：纸片法测得72株菌苯唑西林耐药（≤19mm),对其再用Etest青霉素试条确证,只有22株菌达到中介或耐药以上（MIC≥0.125μg/mL),耐青霉素肺炎链球菌（PRP）为14．6％。纸片法测得151株菌对8种抗生素的敏感性:万古霉素（100％）＞氟嗪酸（90．7％）＞氯霉素（67．5％）＞苯唑西林（62．9％）＞阿齐红纱（48．8％）＞红霉素（41．1％）。复方新诺明（21．9％）＞四环素（16．6％）;此外,多重耐药和相似耐药模式株在同一群儿童流行的表现明显。结论：提示进行耐药临测尤其是采用MIC方法监测PRP的重要性及采取措施预防儿童携带耐药株的必要性。     

产妇阴道B群链球菌调查报告

配对调查116例产妇阴道标本及其112例新生儿外耳皮肤B群链球菌(GBS菌)携带情况,结果从阴道标本分离出链球菌18株,其中GBS8株(6.9％),从新生儿外耳皮肤分离出GBS2株(1.8％);并对分离菌株进行抗菌素敏感性试验,结臬GBS菌对青霉素、红霉素、先锋霉素、利福平、SMZ TMP敏感,对庆大霉素、链霉素、杆菌肽等耐药。     

黄芩对三种主要致龋菌生长、产酸及产胞外多糖的影响

目的 通过研究黄芩对致龋菌生长、产酸及产胞外多糖的影响，探讨黄芩是否能有效调节口腔菌群生态平衡。方法 首先测定黄芩对三种主要致龋菌-变形链球菌、粘性放线菌和血链球菌的最低抑菌浓度（MIC），再以低于MIC的4个浓度配制含药的TPY液体培养基，测定黄芩对上述三种细菌产酸及产生水不溶性多糖能力的影响。结果 黄芩对上述三种细菌的生长有一定的抑制作用。黄芩还能够有效抑制血链球菌、粘性放线菌产生不溶性葡聚糖。结论 上述结果提示，黄芩有可能是一种潜在天然防龋药物，值得进行更深入的研究。     

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.     

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…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.