海南地区类鼻疽假单胞菌感染的临床研究

目的 探讨类鼻疽病的临床特征及诊治经过,以提高对该痛的诊断治疗水平.方法 分析1996～2009年在海南省人民医院治疗的63例类鼻疽假单胞菌感染者的临床特征、诊断方法及治疗过程.结果 类鼻疽假单胞菌易感染糖尿病等基础病患者,临床表现多样,误诊率高,可选用敏感药物少.亚胺培南或美洛培南对多数患者具有较好的效果,而部分患者可采用头孢他啶、复方新诺明及氯霉素等抗生素联合用药,均能取得较好的疗效.结论 早期采集标本进行细菌培养和药敏检查,以便提高类鼻疽假单胞菌感染病的诊断率,并且尽早使用敏感药物,使患者能够得到有效的治疗.     

类鼻疽假单胞菌肺炎32例临床分析

目的了解类鼻疽假单胞菌肺炎的临床特点,探讨早期诊断及其治疗。方法采用回顾性分析1996年1月~2005年12月住院32例类鼻疽假单胞菌肺炎的发病、胸部X线表现、细菌的耐药性及其治疗。结果患者多见于男性,以农民发病最多,临床表现为寒战、发热、咳嗽、咳痰。胸部X线发现肺部病变32例,其中被误诊为肺结核的10例;类鼻疽假单胞菌对抗生素具有多重耐药性,但未发现对亚胺培南的耐药菌株。结论类鼻疽假单胞菌肺炎临床表现无特殊性,误诊率高,X线可早期发现肺野病变,该病确诊依靠细菌学检测。亚胺培南对类鼻疽假单胞菌敏感,应作为治疗类鼻疽假单胞菌肺炎首选用药。     

恶臭假单胞菌感染至婴儿肺炎合并急性心力衰竭1例报告及文献复习

目的 探讨恶臭假单胞菌感染的发病原因、临床表现、治疗及预后.方法 报道1例恶臭假单胞菌感染至婴儿肺炎合并急性心力衰竭的临床资料,并复习相关文献.结果 恶臭假单胞菌感染近年来呈上升趋势,多为院内感染,病情重,可致中毒症状、多系统感染、败血症甚至感染性休克,耐药菌株多.结论 对于反复感染抵抗力差的患儿需注意假单胞菌感染,尽早做培养明确病原菌及敏感药物;主张应用加酶抑制剂的β-内酰胺类抗生素,亦主张大环内酯类和β-内酰胺类联合应用以提高治愈率.     

104例类鼻疽伯克霍尔德菌感染与耐药性分析

目的 分析类鼻疽伯克霍尔德菌感染的临床特征,探讨其耐药性及治疗.方法 回顾性分析本院2000年1月至2009年1月住院的104例类鼻疽伯克霍尔德菌感染者的临床表现、细菌的耐药性及其治疗.结果 患者多见于男性,以农民发病最多,临床表现均有畏寒或寒战、发热.类鼻疽伯克霍尔德菌对抗菌药物具有多重耐药性,对氨苄西林、庆大霉素、妥布霉素、头孢唑啉耐药率为100%,阿米卡星95.2%,氨苄西林/舒巴坦79.8%,环丙沙星77.8%,左氧氟沙星70.2%,复方新诺明64.4%,头孢曲松70.2%,头孢他定24%,哌拉西林/他唑巴坦18.3%,未发现对亚胺培南耐药.结论 类鼻疽伯克霍尔德菌感染临床表现无特殊性,误诊率高,确诊依靠细菌学检测.亚胺培南对类鼻疽伯克霍尔德菌敏感,应作为治疗类鼻疽首选用药.     

类鼻疽伯克霍尔德菌败血症25例临床分析

目的探讨类鼻疽伯克霍尔德菌败血症临床特点，总结诊断和治疗经验，提高诊疗水平。方法回顾性分析25例类鼻疽伯克霍尔德菌败血症的临床表现、诊疗经过和转归。结果类鼻疽伯克霍尔德菌败血症临床表现多样化，多合并有糖尿病，误诊率高，病情凶险，且可选用的有效抗生素较少，疗程长。结论加强认识，早期诊断，尽早使用敏感抗生素，是治疗成功的关键。     

铜绿假单胞菌在碳青霉烯类治疗过程中由敏感株发展为耐药株的机制研究

目的 研究1例铜绿假单胞菌感染患者在接受抗菌药物治疗过程中其感染病原菌铜绿假单胞菌对碳青霉烯类抗菌药物由敏感株发展为耐药株的耐药机制.方法 收集感染患者治疗过程中分离的铜绿假单胞菌敏感株和耐药株共2株,查阅病史并对该2株菌进行:①PFGE分析其同源性,②SDS-PAGE分析外膜孔蛋白oprD2的改变,③泵抑制剂MC20...     

鼻疽假单胞菌与类鼻疽假单胞菌的基因分类

目的：对鼻疽假单胞菌和类鼻疽假单胞菌进行基因分类研究。方法：应用16SrDNA扩增，基因测序及微孔板定量杂交技术，从基因水平对具有不同生物学特性的鼻疽假单胞菌和类鼻疽假单胞菌两个标准菌株进行同源性分析。结果：尽管两种细菌在生物学特性上有着明显的差异。但其16SrDNA序列相似度达99%以上，且染色体DNA定量杂交也显示大于70%的同源性。结论：鼻疽假单胞菌和类鼻疽假单胞菌的系统发育关系十分密切，应归属于同一种，是否妥当仍待进一步考证。     

铜绿假单胞菌下呼吸道感染的临床特点和药物敏感性

目的：分析和总结下呼吸道铜绿假单胞菌感染的临床特点和抗生素敏感性的分布情况。方法：对70例铜绿假单胞菌下呼吸道感染的临床资料进行统计分析。采有irby-Bauer)测定该菌的体外药物敏感性。结果：70例中83%（58/70）患有基础疾病,其中慢性阻塞性肺疾病（COPD）合并呼吸衰竭最常见,临床表现为发热、咳嗽、咳痰。胸部X线多表现为双下肺斑片状阴影,药敏监测谝力对复达欣、环丙沙星、多粘菌素B、氨基糖甙类等药物敏感。结论：铜绿假单胞菌下呼吸道感染多有基础疾病,抵抗力低下,临床表现中毒症状严重,诊断与治疗有赖于细菌培养和药物敏感性。     

96例铜绿假单胞菌药敏结果分析

目的:分析铜绿假单胞菌对常用抗菌药物的药敏结果,为临床预防感染和合理选择抗菌药物提供依据。方法:对呼和浩特市第一医院2006年1月~2008年12月从下呼吸道感染的标本中分离的铜绿假单胞菌进行体外12种抗菌药物的药敏试验。结果:96例铜绿假单胞菌药敏结果主要对碳青霉烯类,氨基糖甙类保持较低耐药率,但对三代头孢抗菌敏感率较低。结论:铜绿假单胞菌对多种抗生素耐药率高本院铜绿假单胞菌对碳青霉烯类,氨基糖甙类保持较低耐药率,但对三代头孢抗菌率高,在治疗时应根据药敏结果选用抗菌药物,以达到有效治疗及减缓耐药株的产生。     

类鼻疽假单胞菌败血症20例临床分析

类鼻疽假单胞菌败血症引起的一种人畜共患的地方性传染病。该病主要分布于南北纬20°之间的热带地区,亚洲以东南亚高发,主要分布于海南,广东、广西。主要与环境因素有关,包括温度、湿度、雨量、土壤和水的性状及生物群落等。类鼻疽假单胞菌败血症的临床表现为非特异性,若缺乏警     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.