院内感染新生儿肺炎病原菌分布特点及干预对策

目的了解院内感染新生儿肺炎病原菌分布的特点,并分析原因和探讨干预对策。方法回顾性分析义乌市中心医院新生儿监护病房（NICU）2012年6月至2013年6月发生的60例院内感染新生儿肺炎患儿的痰液标本细菌培养及药敏资料,了解病原菌分布的特点,分析引起院内感染新生儿肺炎的原因,并采取相应的干预对策。结果60例患儿样本共培养出病原菌72株,其中革兰阳性菌20株,占27．8％,主要是金黄色葡萄球菌、草绿色链球菌与表皮葡萄球菌,革兰阴性菌52株,占72．2％,主要是肺炎克雷伯菌、大肠埃希菌和鲍曼不动杆菌。金黄色葡萄球菌中6株为耐甲氧西林金葡菌（MRSA）,占50％,肺炎克雷伯菌中13株为多重耐药菌,占56．5％,大肠埃希菌中6株为多重耐药菌,占46．2％,鲍曼不动杆菌中4株为多重耐药菌,占66．7％,铜绿假单胞菌中2株为多重耐药菌,占50％,嗜麦芽类单胞菌与阴沟肠杆菌均为多重耐药菌。结论院内感染新生儿肺炎病原菌分布以革兰阴性菌为主,多重耐药菌比例较高,通过有效的干预措施,可以降低院内感染新生儿肺炎的发病率。     

407例老年肺癌下呼吸道感染患者病原菌分布及耐药分析

目的 分析老年肺癌下呼吸道感染患者痰培养物的病原菌分布及耐药状况.方法 回顾性分析407例老年肺癌下呼吸道感染患者痰标本细菌培养、鉴定及药敏结果.结果 共分离出病原菌238株,革兰阴性菌163株,占68.49％;革兰阳性菌33株,占13.87％;真菌42株,占17.65％.主要病原菌为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、表皮葡萄球菌和金黄色葡萄球菌.其中,肺炎克雷伯菌和大肠埃希菌ESBLs阳性菌株的比例分别为36.73％、28.85％.结论 老年肺癌患者因长期使用抗生素,呼吸道菌群失调,不同病原菌对抗菌药耐药率均较高,以革兰阴性菌感染为主,肺炎克雷伯菌和大肠埃希菌产ESBLs的菌株有较高比例,二重感染比例较高;革兰阳性菌均对万古霉素敏感,未发现耐药菌株.因此临床医生根据药敏结果合理选用抗生素,对于改善患者肺部微生态失衡,延长生存时间具有重要指导意义.     

尿培养中病原菌分布及耐药性分析

目的研究大连市中心医院2007年1月至2012年9月尿培养中常见病原菌（真菌除外）的分布及其耐药性,为临床治疗尿路感染提供诊断及用药依据。方法采用MicroScan—Walkaway40全自动微生物鉴定药敏分析仪和ATBExpression自动细菌鉴定仪及K—B纸片法药敏试验,应用WHONET5．4软件对结果进行回顾性统计分析。结果五年间尿培养中共分离出病原菌1012株（真菌除外）,其中革兰阴性菌802株（79．2％）,主要是大肠埃希菌538株（53．2％）、肺炎克雷伯菌95株（9．5％）、铜绿假单胞菌51株（5．1％）、奇异变形杆菌30株（2．9％）、鲍曼不动杆菌26株（2．6％）。革兰阳性菌210株（20．8％）,主要是粪肠球菌86株（8．6％）,屎肠球菌83株（8．2％）,凝固酶阴性葡萄球菌21株（2．1％）,金黄色葡萄球菌13株（1．3％）。抗生素敏感试验中碳青霉烯类（亚胺培南及美洛培南）对肠杆菌科细菌大肠埃希菌、肺炎克雷伯菌及奇异变形杆菌抗菌活性最强,无耐药菌株,对非发酵菌中铜绿假单胞菌和鲍曼不动杆菌耐药率为30％～40％,革兰阳性菌对糖肽类（万古霉素、替考拉宁）和利奈唑胺等抗菌药物高度敏感。结论应当根据主要易感菌种类及其抗生素敏感试验结果指导临床合理使用抗生素。     

28 179例血培养病原菌分布及耐药性分析

了解2009年至2012年中国医科大学附属第一医院血培养标本常见病原菌的分布和耐药性。采用美国BD公司BACTEC9240型全自动血培养仪及其配套血培养瓶,所有分离病原菌采用法国生物梅里埃公司Vitek-2或BD Phonenix 100进行细菌鉴定和药敏试验,应用WHONET5．6软件进行细菌菌谱和耐药性分析。28179例血培养标本共分离出3295株病原菌,阳性率为11．69％,其中革兰阳性球菌1649株,占50．05％;革兰阴性杆菌1331株,占40．39％;真菌112株,占3．4％。分离率最高的细菌是凝固酶阴性葡萄球菌（34．26％）,其次是大肠埃希菌（10．44％）、肺炎克雷伯菌（8．22％）、鲍氏不动杆菌（5．13％）、金黄色葡萄球菌（4．8％）、铜绿假单胞菌（3．28％）、屎肠球菌（3．28％）;葡萄球菌属对利奈唑胺、万古霉素、替考拉宁高度敏感,金黄色葡萄球菌中耐甲氧西林菌株占46．20％,凝固酶阴性葡萄球菌中耐甲氧西林菌株占85．74％;革兰阴性杆菌（除鲍氏不动杆菌）对碳青霉烯类药物敏感性较好,对头孢菌素类和喹诺酮类耐药率较高;大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶株分别占57．56％、36．9％。引起菌血症的病原菌种类复杂,多种菌株耐药率较高,临床应根据病原菌变化及耐药性及时调整抗菌药物用药。     

医院内4种主要革兰阴性菌分布及耐药率分析

摘要：目的 分析大连某三甲医院4种主要革兰阴性病原菌的分布及细菌耐药性变迁,为抗菌药物的合理使用提供依据。方法 回顾性分析2012?2015年住院患者中分离的4种革兰阴性菌临床分布及每年的耐药率,利用WHONET 5.6软件进行统计分析。结果 4年分离致病菌28 485株,其中大肠埃希菌2 994株,肺炎克雷伯菌1 375株,鲍曼不动杆菌1 079株,铜绿假单胞菌1 998株,共占分离致病菌总数的26.1%。4种菌对哌拉西林的耐药率最高（37.2%~78.2%）,对头孢哌酮/苏巴坦耐药率最低（6.7%~39.1%）。2012?2015年,大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌的抗生素耐药率有下降趋势,鲍曼不动杆菌对多数抗生素耐药率都高,且逐年上升。结论 本院4年感染中4种主要革兰阴性菌占主导地位。4种菌对不同抗生素耐药率和变化不同,鲍曼不动杆菌耐药最严重。4种菌对于头孢哌酮/苏巴坦均比较敏感,对哌拉西林耐药严重。在临床治疗中应有针对性加强管理和用药。     

常见革兰阴性杆菌的分布及耐药性分析

目的分析目前医院内常见革兰阴性杆菌的分布状况及其耐药特点,为临床合理使用抗生素和经验用药提供依据。方法对2005年中山大学附属第一医院门诊及住院患者标本,严格按操作规程采集、接种、培养、分离、鉴定菌种作药敏试验。血液及部分体液标本用BactALERT-120血培养仪培养,用VITEK-60全自动细菌鉴定仪鉴定菌种,药敏试验采用K-B法,用WHONET5．0软件进行数据分析。结果共分离出672株革兰阴性杆菌占52．9％,常见者依次为：大肠埃希菌182株,铜绿假单胞菌177株,鲍曼不动杆菌72株,肺炎克雷伯菌64株,嗜麦芽窄食单胞菌36株,阴沟肠杆菌29株。ICU、呼吸内科感染多见。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶株检出率为48．8％,对哌拉西林、头孢呋辛钠、头孢哌酮、头孢曲松、氧氟沙星、庆大霉素的耐药率显著高于非产酶株（P〈0．01）。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮-舒巴坦的耐药率较低,嗜麦芽窄食单胞菌对头胞哌酮-舒巴坦和头孢他啶的耐药率较低,阴沟肠杆菌对亚胺培南、美罗培南耐药率较低。结论革兰阴性杆菌已成为医院主要感染病原菌,且多重耐药株上升趋势明显,加强院内感染菌的耐药监控对合理选用经验用药及减缓耐药菌的发生尤为关键。     

住院患者革兰阴性杆菌的耐药性分析

目的了解临床分离的革兰阴性杆菌的分布及耐药性变迁。方法2001—2003年临床分离革兰阴性杆菌1710株。排除同一患者的重复菌株,按统一方案用K—B纸片扩散法,按美国国家临床实验室标准委员会（NCCLS）2000年版标准判读结果。结果住院患者最常见的临床分离菌株为铜绿假单胞菌（8．3％）、不动杆菌属（12．8％）、大肠埃希菌（9．5％）和沙雷菌属（13．6％）,革兰阴性杆菌占总分离率的62．4％。亚胺培南、头孢哌酮-舒巴坦和哌拉西林-他唑巴坦对革兰阴性杆菌抗菌活性好。产超广谱β-内酰胺酶（ESBLs）大肠埃希菌占其总株数的15．8％。结论近年来革兰阴性杆菌的耐药性呈上升趋势,特别对第3代头孢菌素耐药性上升最快,临床上应关注细菌耐药性变化,合理使用抗菌药物。     

无多重耐药危险医院获得性肺炎病原菌分布特点与耐药性分析

目的分析温州医科大学附属义乌医院无多重耐药危险医院获得性肺炎（HAP）病原菌分布特点及耐药性。方法人选无多药耐药危险因素的医院获得性肺炎（HAP）患者352例,按照发病时间分为早发HAP组与晚发HAP组,采集合格痰标本,进行细菌分离、鉴定和药敏试验,并分析比较患者病原菌分布特点及耐药性。结果人选的352例患者共分离m393株病原菌,HAP最常见的病原菌排名前五位的分别是为肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌及鲍曼不动杆菌,早发HAP排名前五位的分别是肺炎克雷伯杆菌、大肠埃希菌、金黄色葡萄球菌、肺炎链球菌和铜绿假单胞菌,晚发HAP排名前五位的分别是肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌,两组患者革兰阳性菌与革兰阴性菌所占比例差异无统计学意义（P〉0．05）,78株革兰阳性菌对常用抗生素的耐药率早发与晚发HAP差异无统计学意义（P〉0．05）,296株革兰阴性菌对常用抗生素的耐药率,早发HAP与晚发HAP除了对哌拉西林和阿莫西林克拉维酸钾的耐药率差异有统计学意义（P〈0．05）,其余的差异有统计学意义（P〉0．05）,但是晚发HAP中检出耐甲氧西林金葡菌（MRSA）、产ESBLs肺炎克雷伯杆菌及耐碳青霉烯鲍曼不动杆菌（CR—AB）比例增高。结论无多重耐药危险因素的医院获得性肺炎（HAP）患者,早发与晚发HAP感染病原菌差别不大,虽晚发HAP的耐药率相对较高,但对大部分抗菌素敏感,所以适当使用抗菌素,对于减轻选择抗菌药物的压力、减少耐药菌株的产生和二重感染有重要意义。     

重症监护病房革兰阴性菌分布及耐药性分析

目的：了解我院重症监护病房革兰阴性菌的分布和耐药情况。方法：WHONET5.6分析585例的革兰阴性菌的细菌培养和药物敏感试验结果。结果：585例革兰阴性菌标本中,排名前五位的是铜绿假单胞菌菌152株（25.98%）,鲍曼不动杆菌111株（18.97%）,肺炎克雷伯菌98株（16.75%）,大肠埃希菌49株（8.38%）,洋葱伯克霍尔德菌39株（6.67%）。这五种病原菌对14中抗生素的药敏试验发现,除了对头孢哌酮/舒巴坦耐药率较低外,对其他抗生素都有不同程度的耐药。结论：革兰阴性菌在感染的病原菌中仍占主要地位,耐药性也很严重,应及时检测病原菌变化及耐药趋势,指导临床合理使用抗生素。     

婴儿泌尿道感染的病原菌分布及耐药性分析

目的探讨婴儿泌尿道感染的病原菌构成及其耐药情况,以指导临床合理用药。方法对2012年5月至2013年7月某院门诊及住院婴儿送检的尿标本进行分离培养,用全自动微生物鉴定／药敏系统进行菌种鉴定和药敏试验,同时对大肠埃希菌和肺炎克雷伯菌进行超广谱β-内酰胺酶检测。结果婴儿泌尿道感染以大肠埃希菌检出率最高（46．24％）,其余依次是粪肠球菌（22．04％）、肺炎克雷伯菌（7．80％）、屎肠球菌（5．37％）、铜绿假单胞菌（4．30％）。大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶检出率分别为46．51％和58．62％。革兰阴性菌对亚胺培南、美罗培南的耐药率为0,对氨苄西林耐药率最高（〉80％）。革兰阳性菌对万古霉素耐药率为0,对苯唑西林、妥布霉素的耐药率100％。结论婴儿泌尿道感染病原菌以大肠埃希菌为主;大肠埃希菌、肺炎克雷伯菌超广谱β-内酰胺酶检出率高,应引起重视;临床医师要根据药敏结果指导用药,对危重病例和存在泌尿道畸形反复发作病例,革兰阴性菌可选用亚胺培南、美罗培南,革兰阳性菌可选用万古霉素。     

Relative and combined effects of ethanol and protein deficiency on strontium and barium bone content and fecal and urinary excretion

To elucidate accumulation of minerals in human iliac arteries with aging, the content of minerals was analyzed by inductively coupled plasma atomic emission spectrometry. Bilateral common, internal, and external iliac arteries of 16 men and 8 women, ranging ages from 65 to 93 yr, were examined. It was found that an extremely high accumulation of calcium and phosphorus occurred in the common iliac artery at old age, being higher than that of the internal and external iliac arteries. It should be noted that the accumulation of calcium and phosphorus is the highest in the common iliac artery among the human arteries examined to date. Regarding sexual differences, the content of calcium and phosphorus in the common and internal iliac arteries was higher in women than in men, whereas their content in the external iliac artery was lower in women than in men.     

白蚁与动物及微生物的共生类型及其机制

综述了白蚁螱客的主要种类、共生关系及相关机制的研究进展。白蚁螱客中,已报道的动物种类达170种。在与动物的共生关系中存在偏利共生（宾主共栖和异种共栖）、互利共生和无关共生三种;在与微生物的共生关系中,存在与内生菌（原生动物、细菌、真菌和放线菌）和外生菌（蚁巢伞菌等）间的互利关系。指出了白蚁与螱客研究中存在的问题,给出了解决方案,并提出了今后可能的研究热点或方向,为白蚁的综合利用（如纤维素酶）及今后研究物种间的协同进化提供了基础资料。     

New amino-dithiaphospholanes and phosphoramidodithioites and their rhodium and iridium complexes

New sulfur derivatives of phosphoramidite ligands were synthesized and the impact of the sulfur unit on the spectroscopic properties of their rhodium and iridium complexes was investigated. The new ligands Bn₂NPSCH₂CH₂S^a(P-S^a) (Bn = benzyl, 4), Bn₂NPSCHCHS^a(CH₂)₃C^aH₂(P-S^a)(C^a-S^a) (6) and Bn₂NP(4-XC₆H₄OMe)₂ (X = S, 7a; X = O, 7b) were converted to the rhodium and iridium complexes trans-[Rh(CO)Cl(L)₂] (L = 4, 6, 7), [RhCl(COD)(L)] (L = 4, 6, 7), [IrCl(COD)(7a)] and [IrCl₂Cp∗(6)]. For comparison, some phosphoramidite complexes of these formulations also were synthesized. The new metal complexes were spectroscopically analyzed. For the carbonyl complexes, the ν_CO IR stretching frequencies were lower than for the corresponding phosphite and phosphoramidite ligands. The ¹J_PRh coupling constants for the rhodium complexes with the new ligands were also smaller than for the respective phosphoramidite and phosphite complexes. Finally, the ¹J_PSe coupling constants of the selenides of the new ligands were lower than those of the phosphoramidite ligands but higher than for PPh₃. The spectroscopic data reveal that the new thio ligands 4, 6 and 7a are more electron donating than phosphites and phosphoramidites but less electron donating than PPh₃.     

Astrocytes and Synaptosomes Transport and Metabolize Lactate and Acetate Differently

Astrocytes transport the monocarboxylate acetate, but synaptosomes do not. The reason for this is unknown, because both preparations express monocarboxylate transporters (MCT). The transport and metabolism of lactate, another monocarboxylate, was examined in these two preparations, and the results were compared to those for acetate. Lactate transport is more rapid in astrocytes than in synaptosomes, but of lower affinity (Kms of 17 and 4 mM, respectively). Lactate (0.2 mM) is metabolized to CO2 more rapidly in synaptosomes than in astrocytes (rates of 0.37 and 0.07 nmol x mg protein(-1) x min(-1), respectively). The reason for this is unclear, but cellular differences in lactate dehydrogenase isotype expression may be involved. Acetate is metabolized to CO2 more rapidly in astrocytes than in synaptosomes (rates of 0.43 and 0.02 nmol x mg protein(-1) x min(-1), respectively). This is likely due to cellular differences in the expression of monocarboxylate transporter subtypes.     

Rapporteur report: Basics and technology and metrology and standards

The first and second sessions of the Workshop focussed on the basics of ultrasound and infrasound, their applications in both industry and medicine, and metrology and protection standards for ultrasound applications.     

Prostaglandin and thromboxane production by human and guinea-pig macrophages and leucocytes

The ability of partially purified human and guinea-pig haematogenous cell populations, when cultured in vitro, to metabolise arachidonic acid (AA) has been studied. Supernatants from 24 hour cell culture have been subjected to analysis for products of AA metabolism by gas chromatography with electron-capture detection.The cell types studied were human peripheral blood monocytes (both glass adherent and non-adherent), neutrophils, eosinophils and leukemic leucocytes; thoracic duct lymphocytes and lung alveolar macrophages. From the guinea-pig, induced and non-induced macrophage or neutrophil enriched peritoneal exudate populations, lymph node cells, peritoneal eosinophils and peripheral blood platelets were examined. Supernatants were assayed for the presence of PGE₂, PGD₂, PGF_2α, TXB₂ and 6-keto-PGF_1α. In all types studied PGE₂ and TXB₂ were the major products formed. The identification of PGE₂ and TXB₂ was confirmed by GC/MS with multiple ion monitoring.The results have been compared with other reports and their possible significance discussed in relation to the proposed role of prostaglandins as mediators and modulators in immunopathology.     

人血管能抑素基因的克隆、表达及其表达产物的纯化和生物活性测定

以人胎盘脐带组织为材料,提取组织总RNA,用netRTPCR方法合成人血管能抑素cDNA基因,将该cDNA克隆进pSP72载体获得重组质粒pSP72C, DNA序列分析结果与预期序列一致。用BamHⅠ和NdeⅠ双酶切,切下pSP72C上的血管能抑素cDNA,插入pET3c载体的相应位点获得重组表达质粒pETC, 转化E. coli BL21(DE3), SDSPAGE分析显示：在IPTG诱导下,血管能抑素基因获得了高效表达,表达量约占菌体总蛋白的 27.9 %,主要以包涵体形式存在。包涵体经过洗涤、裂解、蛋白复性以及Sephadex G75凝胶过滤层析等步骤后,获得了纯度达91.4 %的人血管能抑素。CAM实验证明10 μg纯化蛋白就能显著抑制鸡胚新生血管生成。     

Cytoskeleton and mitochondrial morphology and function

It has been well established that the cytoskeleton is an essential modulator of cell morphology and motility, intracytoplasmic transport and mitosis, however cytoskeletal linkage to the organelles has not been unequivocally demonstrated. Indeed, cytoskeleton appears to be essential in determining and modulating gene phenotype as a function of cellular environment. According to recent studies, the organization of the cytoskeleton network together with associated protein(s) could be essential in regulating mitochondrial function and particularly the permeability of the mitochondrial outer membrane to ADP. The aim of this chapter is to summarize the main properties of the cytoskeletal environment of mitochondria and the possible role(s) of this network in mitochondrial function in myocytes.