486例泌尿生殖道患者支原体检测及耐药性分析

【目的】了解湖南省岳阳地区泌尿生殖道感染者的支原体感染情况及对抗生素耐药性,指导临床用药。【方法】采用法国生物梅里埃公司IST2支原体试剂盒对486例泌尿生殖道感染者进行解脲脲支原体（Uu）和人型支原体（Mh）的检测及药敏试验。[结果]486例患者中,共检出196例支原体阳性,检出率为40．3％,其中Uu阳性者146例（占74．5％）,Mh阳性34例（17．3％）,Uu和Mh同时阳性16例（8．2％）。Uu对9种抗生素敏感性最高为交沙霉素（91．1％）,其次是原始霉素（88．4％）和多西环素（81．5％）;Mh对9种抗生素敏感性最高为多西环素（91．2％）,其次是原始霉素（88．2％）和交沙霉素（82．4％）。【结论】支原体是引起泌尿生殖系感染的重要原因,对多种抗生素具有耐药性,交沙霉素、多西环素和原始霉素是本地区治疗支原体感染的首选药物。     

524株解脲脲原体及人型支原体药物敏感性分析

目的了解女性患者解脲脲原体（Ureaplasma urealyticum,Uu）和人型支原体（Mycoplasma hominis,Mh）对目前常用具有抗支原体活性抗菌药物的耐药情况。方法采用支原体鉴定药敏试剂盒,对1238例女性疑似泌尿生殖道感染标本进行培养及药敏试验。结果1238份标本中Uu阳性492份（39．7％）,Uu＋Mh阳性31份（2．5％）,Mh阳性1份（0．4％）,总检出率42．3％（524份）。药敏试验结果显示,Uu和Mh对交沙霉素、多西环素、米诺环素敏感率高,对红霉素、阿奇霉素、氧氟沙星耐药率较高。结论Uu和Mh对常用抗支原体药物耐药率增高,经验治疗应首选交沙霉素、多西环素或米诺环素。     

泌尿生殖道支原体属感染特点及耐药性分析

目的探讨泌尿生殖道支原体属感染状况及对抗菌药物的耐药情况,指导临床合理用药。方法采用支原体培养药敏试验试剂盒,对临床收集的1852例泌尿生殖道感染患者标本进行支原体属培养及10种抗菌药物的体外药敏试验。结果在1852例受检患者标本中检出支原体阳性782例,总阳性率为42．2％。其中解脲脲原体（Uu）单一感染617例,占78．9％;人型支原体（Mh）单一感染28例,占3．6％;Uu和Mh混合感染137例,占17．5％。21～30岁年龄段患者支原体培养阳性率为42．9％,明显高于其他年龄段。药敏试验结果显示,Uu阳性者对交沙霉素、多西环素、米诺环素、克拉霉素较敏感,敏感率分别为95．7％、92．9％、92．8％和91．6％,而耐药率在70．0％以上的有大观霉素、阿奇霉素、环丙沙星、罗红霉素。结论治疗泌尿生殖道支原体属感染应首选交沙霉素和多西环素等敏感性高的药物,避免使用大观霉素、阿奇霉素等耐药性高的药物。临床上对疑似泌尿生殖道感染的患者进行支原体属的培养和药敏试验,对支原体属感染的抗菌治疗有重要的临床意义。     

949例泌尿生殖道支原体培养及药敏分析

目的通过分析我院2008年10月至2009年10月间泌尿生殖系支原体感染及耐药性变迁情况，为临床正确用药提供参考。方法应用法国Myeoplasma lsT2试剂盒进行支原体培养及药敏实验，并统计分析结果。结果本组949例泌尿生殖系患者中，360例支原体培养阳性，阳性率37．9％。其中，解脲支原体（Uu）占81．9％，人型支原体（Mh）占13．9％，Uu＋Mh占4．2％。药敏结果表明：支原体对9种抗菌药物耐药率环丙沙星（98，8％）、氧氟沙星（95．52％）、阿奇霉素（47．9％）、红霉素（42．85％）。敏感率最高的药物有原始霉素（99．3％）、强力霉素（98．4％）、交沙霉素（97．7％）、四环素（96．9％）。结论泌尿生殖系统支原体感染主要以Uu为主，应重视培养、鉴定及药敏结果，以合理选择药物进行治疗。     

泌尿生殖道支原体检测及其耐药性分析

目的研究泌尿生殖道感染患者标本中支原体阳性率及支原体对抗生素的耐药性。方法采用支原体培养及药敏试剂盒，对641例泌尿生殖道标本进行支原体分离培养、鉴定和抗生素敏感性检测。结果641例标本中支原体总阳性率为40．9％。其中解脲脲原体（Uu）、人型支原体（Mh）、解脲脲原体和人型支原体混合感染（Uu＋Mh）阳性率分别为30．1％、1．9％、8．9％。女性支原体阳性率明显高于男性。药敏结果显示，交沙霉素、克拉霉素、罗红霉素对Uu耐药率低，分别为0．5％、3．1％、4．1％；交沙霉素、强力霉素、美满霉素对Mh、Uu＋Mh耐药率均较低。结论泌尿生殖道感染患者中支原体是重要病原体。监测支原体的耐药性对指导临床治疗具有重要意义，交沙霉素可作为治疗支原体感染的首选药物。     

504例泌尿生殖系统支原体培养及药敏结果分析

目的探讨解脲脲原体（Uu）和人型支原体（Mh）在泌尿生殖系统感染中的致病作用及其药敏情况。方法504例泌尿生殖系统感染患者进行支原体培养和9种抗生素的药敏试验。结果504例患者中支原体阳性264例,感染率为52.4%,其中Uu、Mh以及Uu＋Mh混合感染的阳性率分别为40.5%、2.2%和9.7%,女性Uu感染率明显高于男性（χ^2=21.9,P〈0.05）,支原体对9种抗生素的敏感性最高的是交沙霉素（99.6%）,其次是米诺环素（98.1%）、多西环素（98.1%）和氧氟沙星（88.3%）。Uu＋Mh混合感染的耐药率明显高于单一Uu感染（χ^2=25.3,P〈0.05）。结论泌尿生殖道系统感染主要由解脲脲原体引起,占77.3%,交沙霉素为首选治疗药物。     

性病门诊泌尿生殖道支原体感染及耐药趋势分析

目的：分析性病门诊泌尿生殖道解脲脲原体（Uu）和人型支原体（Mh）的感染及药敏情况,为临床提供最新用药依据。方法采用支原体培养、鉴定、药敏试剂盒,对2008～2012年性病门诊4229例疑诊患者进行 Uu 和 Mh 检测及药敏试验。结果4229例标本中检出支原体1171例,总阳性率27．69％,其中单纯 Uu 感染1058例（90．36％）,单纯 Mh 感染38例（3．24％）,Uu 和 Mh 混合感染75例（6．40％）。单纯 Uu 感染对交沙霉素、克拉霉素、罗红霉素的耐药率较低,依次为1．04％、5．10％、5．19％;单纯 Mh 感染对交沙霉素、多西环素、四环素的耐药率较低,依次为0、2．63％、7．89％;Uu 和 Mh 混合感染对环丙沙星和红霉素耐药率最高,分别为84．00％和73．33％。2008年支原体感染率最低（25．50％）,2011年最高（29．10％）。10种药物的5年耐药率差异不具有统计学意义（P ＞0．05）。结论Uu 是支原体感染的主要病原体;交沙霉素、多西环素可以作为该地区支原体混合感染的首选药物;近5年支原体感染有上升趋势,但支原体耐药性得到一定的控制,应在此基础上加强对耐药菌株的控制,增加药敏检测,为进行耐药监测、临床合理使用抗菌药物,提高疗效据。     

212例支原体感染的药敏结果分析

目的了解泌尿生殖道支原体感染的现状及对抗菌药物的敏感性。方法对212例疑为支原体感染的泌尿生殖道感染的患者进行支原体培养和药敏试验。结果 212例患者中,支原体阳性者113例,阳性率为53.3%。其中,男41例（36.3%）,女72例（63.7%）,女性支原体阳性率显著高于男性（P〈0.05）;在所有患者中解脲支原体（Uu）阳性者93例,阳性率为43.9%,人支原体（Mh）阳性者13例,阳性率为6.1%,Uu＋Mh阳性者7例,阳性率为3.3%。药敏实验结果显示：对支原体敏感性较高的抗菌药物有米诺环素和多西环素,环丙沙星的敏感性最差。结论泌尿生殖道支原体感染主要以Uu感染为主,对支原体感染的治疗应根据药敏试验结果合理用药。     

汕头地区泌尿生殖道感染解脲脲支原体和人支原体检测情况及耐药性分析

目的：探讨汕头地区泌尿生殖道解脲脲支原体（Uu）和人支原体（Mh）感染情况及耐药情况。方法随机抽取855例泌尿生殖道感染病例,采用药敏试剂盒进行 Mh、Uu 培养、鉴定,并与9种抗菌药物进行药敏试验,分析其耐药情况。结果855例病例标本中,检测出 Uu 阳性307例（35．9％）,Mh 阳性15例（1．8％）,Mh 与 Uu 混合阳性76例（8．9％）。Uu 与 Mh 药敏率较高的是普那霉素、交沙霉素、多西环素和四环素等抗生素,耐药率较高的抗生素是环丙沙星、氧氟沙星等。结论汕头地区泌尿生殖道 Uu 和 Mh 病原体感染率较高,并且对多种抗生素耐药,临床用药时应根据药敏试验结果合理选择。     

680例女性泌尿生殖道支原体和沙眼衣原体感染及耐药性分析

目的了解女性泌尿生殖道支原体（Mycoplasma）,沙眼衣原体（C.trachomatis）感染及耐药情况。方法采用单克隆抗体胶体金法检测沙眼衣原体抗原,采用培养法检测支原体及其药敏试验。结果 680例标本检出沙眼衣原体35例,阳性率5.2%,检出支原体320例,阳性率47.1%,其中解脲脲原体（Urealyticum ureaplasma,Uu）255例,阳性率为37.5%,人型支原体（Mycoplasma hominis,Mh）17例,阳性率2.5%,Uu＋Mh混合感染48例,混合感染率7.1%;Uu与Mh对交沙霉素、多西环素、米诺环素较为敏感,对氧氟沙星左氧氟沙星、司巴沙星和克林霉素耐药率最高。结论女性泌尿生殖道以Uu感染为主,呈多重耐药现象,临床应参照药敏结果选用抗菌药物,以减少耐药株的产生,交沙霉素、多西环素、米诺环素可作为临床支原体感染者首选药。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。