食管癌根治术后肺部感染的病原菌与耐药性分析

目的:探讨食管癌根治术后肺部感染的病原菌及耐药性,为临床合理应用抗菌药物提供依据。方法:选择2009年1月-2017年12月在我院行食管癌根治术的764例患者作为研究对象,记录患者临床基本资料,采集肺部感染患者深部痰液标本进行细菌培养,并对病原菌进行药物敏感性试验,分析其病原菌分布和耐药性。结果:764例食管癌根治术后患者肺部感染146例,感染率为19.11%;肺部感染患者痰液标本培养获得病原菌185株,其中革兰阴性菌116株,占62.70%,以铜绿假单胞菌和肺炎链球菌最多,分别占18.38%和14.05%;革兰阳性菌40株,占21.62%,以金黄色葡萄球菌最多,占8.65%;真菌29株,占15.68%,以白假丝酵母菌最多,占9.19%。铜绿假单胞菌、肺炎链球菌、鲍氏不动杆菌、大肠埃希菌对美洛西林的耐药率最高,分别占70.59%、73.08%、86.96%、62.50%,对亚胺培南耐药率最低,分别占5.88%、3.85%、26.09%、12.50%。金黄色葡萄球菌、表皮葡萄球菌对头孢唑林的耐药率最高,分别占81.25%、63.64%,溶血葡萄球菌对头孢唑林、阿奇霉素、环丙沙星的耐药率最高,均占71.43%,肠球菌对头孢唑林、环丙沙星耐药率最高,均占100.00%;黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌、肠球菌对万古霉素耐药率最低,均为0.00%。结论:食管癌根治术后肺部感染以革兰阴性菌为主,病原菌主要对美洛西林、头孢唑林、阿奇霉素、环丙沙星产生耐药性,对亚胺培南、万古霉素耐药性较低,临床应合理选用抗菌药物进行治疗。     

慢性化脓性中耳炎患者耳道分泌物的病原菌检测及药物敏感性分析

目的分析慢性化脓性中耳炎(CSOM)患者耳道分泌物的病原菌分布及其药敏情况,为临床合理应用抗菌药物提供参考。方法收集浙江省立同德医院100例(116耳)CSOM患者耳道分泌物标本进行常规病原菌分离、鉴定及药敏试验。结果 116耳中有97耳培养出病原菌,检出率为83.6%。共检出病原菌103株,其中革兰阳性菌占53.4%(55/103),革兰阴性菌占41.7%(43/103),真菌占4.9%(5/103)。金黄色葡萄球菌和表皮葡萄球菌对青霉素和磺胺甲唑/甲氧苄啶耐药性较高,对利福平和莫西沙星敏感性较高,对呋喃妥因和万古霉素完全敏感。铜绿假单胞菌和肺炎克雷伯菌对头孢唑啉、氨苄西林、头孢吡肟、头孢曲松、哌拉西林/舒巴坦耐药性均较高,对妥布霉素、氨曲南、哌拉西林/他唑巴坦敏感性较高,对阿米卡星、美罗培南及亚胺培南完全敏感。真菌对氟胞嘧啶、两性霉素B及制霉菌素均敏感,而对酮康唑和氟康唑有一定的耐药性。结论 CSOM患者耳道分泌物中病原菌以金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌及肺炎克雷伯菌为主,这4种病原菌对多数常用抗菌药物有较强的耐药性,治疗时需根据细菌培养及药敏分析结果合理选用抗菌药物。     

外科ICU中心静脉导管相关性血流感染病原菌分布及耐药性分析

目的了解本院外科ICU(SICU)中心静脉导管相关性血流感染(CRBSI)患者病原菌分布及其药敏特点,为临床合理防治提供依据。方法采用前瞻性监测方法,对2010年1月-2014年12月间SICU住院的CRBSI患者的中心静脉导管进行培养,用法国梅里埃VITEK-32细菌鉴定仪进行菌种鉴定,用K-B纸片法进行细菌药敏试验,并用WHONET 5.4软件对数据进行统计分析。结果共分离出病原菌413株,其中革兰阴性菌219株(53.03%),前四位为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌和铜绿假单胞菌;革兰阳性菌174株(42.13%),前三位为表皮葡萄球菌、金黄色葡萄球菌和溶血葡萄球菌;真菌20株(4.84%),以白色假丝酵母菌为主。药敏结果显示,主要革兰阴性菌对阿米卡星、左氧氟沙星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南耐药率较低,主要革兰阳性菌对利福平、呋喃妥因、利奈唑胺、替考拉宁和万古霉素耐药率较低。结论本院SICU内CRBSI患者病原菌以革兰阴性菌为主,加强消毒隔离,合理应用抗菌药物是控制和降低CRBSI的关键。     

静脉留置部位导管相关菌血症的病原学研究

目的调查静脉留置导管相关性血流感染病原学特点。方法回顾性调查杭州医学院附属第一医院2003年1月至2005年9月静脉留置治疗患者感染的发生情况,并对其病原菌及耐药特点进行分析。结果165例患者共送检留置导管标本184份,140份标本检有病原菌,检出率为76.1%(140/184)。在165例患者中有150例进行了血液培养,发生血流感染的有103例,感染率为68.7%(103/150)。从140份静脉留置导管标本中共分离出171株病原菌,主要为表皮葡萄球菌、金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌等。有44例患者静脉留置导管和血液培养出同一种病原菌,主要为表皮葡萄球菌。导管留置后到第一次血液培养出现阳性的时间大约为4~8d。同时从静脉留置导管和血液分离的21株表皮葡萄球菌全部对呋喃妥因和万古霉素敏感,除对利福平的耐药率较低外,对其它抗生素的耐药率都超过50%。结论静脉留置导管较易引起血流感染,引起血流感染病原菌主要以表皮葡萄菌为主,且耐药性严重。     

医院血流感染病原菌分布及耐药性分析

目的了解医院血流感染病原菌的分布及其耐药性,为临床治疗提供参考。方法收集2013年1月至12月浙江中医药大学附属第一医院患者血培养标本,采用WHONET 5.6软件对所分离的病原菌及药敏结果进行统计分析。结果 2 017份血培养标本共检出病原菌370株,阳性率为18.34%,其中革兰阳性菌142株占38.38%,革兰阴性菌213株占57.57%,真菌15株,占4.05%。排名前5位病原菌依次是凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、肠球菌属和金黄色葡萄球菌,分别占19.73%、17.03%、13.51%、6.22%和4.59%。除哌拉西林/他唑巴坦对大肠埃希菌和铜绿假单胞菌仍保持较高的抗菌活性外,革兰阴性菌尤其是肺炎克雷伯菌对多种药物均产生了严重耐药性,其中产ESBLs大肠埃希菌和肺炎克雷伯菌分别占46.80%和20.00%。革兰阳性菌对利奈唑胺100%敏感,检出耐甲氧西林金黄色葡萄球菌(MRSA)4株,占25.00%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNs)占92.00%,耐万古霉素的表皮葡萄球菌1株和耐万古霉素的粪肠球菌3株。结论血流感染病原菌分布复杂,以革兰阴性菌为主,耐药率高,且已出现耐万古霉素的表皮葡萄球菌和粪肠球菌,因此,进行早期监测和耐药性分析非常必要,对控制感染、指导合理使用抗菌药物,减缓耐药菌株的出现具有重要的临床意义。     

ICU患者中心静脉导管相关性血流感染病原菌分布及耐药性分析

目的了解舟山市普陀区人民医院重症监护室（ICU）中心静脉导管相关性血流感染（CRBSI）患者病原菌分布及其药敏特点,为临床预防诊疗提供依据。方法收集2010年1月至2013年12月间在ICU住院的CRBSI患者的中心静脉导管进行培养,用法国梅里埃VITEK-32细菌鉴定仪进行菌种鉴定,用K-B纸片法进行细菌药敏试验,并用WHONET 5.4软件对耐药数据进行统计分析。结果共分离出病原菌310株,革兰阴性杆菌占50.97%,前四位为鲍氏不动杆菌、铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌,占比分别为14.19%、12.26%、9.35%和7.10%;革兰阳性球菌占41.61%,前三位为表皮葡萄球菌、金黄色葡萄球菌和溶血葡萄球菌,占比分别为18.06%、7.42%和6.77%;真菌占7.42%,以白假丝酵母菌为主。药敏结果显示,主要革兰阴性杆菌对阿米卡星、左氧氟沙星、妥布霉素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南耐药率较低,主要革兰阳性球菌对左氧氟沙星、利福平、呋喃妥因、替考拉宁、万古霉素和利奈唑胺耐药率较低。结论 CRBSI的中心静脉导管培养的病原菌种类分布广泛,部分病原菌对常用抗菌药物的耐药率较高。临床医护人员应规范操作,减少耐药株的产生。     

NICU与综合性ICU感染金黄色葡萄球菌的耐药性对比分析

目的比较新生儿重症监护病房(NICU)与综合性重症监护病房(ICU)金黄色葡萄球菌的耐药性,为临床合理选用抗菌药物提供依据。方法对2011年6月—2015年7月NICU与综合性ICU患者临床标本中分离的金黄色葡萄球菌278株的耐药性比较,药敏试验采用纸片扩散法,采用WHONET5.6和SPSS 20.0软件进行数据分析。结果 278株金黄色葡萄球菌对青霉素G、氨苄西林、美洛西林、头孢西丁等大部分抗菌药物的耐药率已较高,分别为100.00%、93.88%、80.94%、51.08%;综合性ICU感染金黄色葡萄球菌对克拉霉素、万古霉素、利奈唑胺、呋喃妥因等耐药率较低,分别为7.81%、0.00%、0.00%、0.00%;NICU与综合性ICU病房耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为34.88%和51.04%,NICU病房MRSA检出率低于ICU(P0.05);头孢唑林及头孢噻肟在NICU与综合性ICU病房中的耐药率分别为19.77%,33.33%;13.95%,40.10%;NICU分离出的金黄色葡萄球菌对头孢唑林和头孢噻肟耐药率低于综合性ICUU,差异有统计学意义(P0.05);万古霉素及呋喃妥因在NICU与综合性ICU金黄色葡萄球菌中的耐药率分别为2.33%,0.00%;0.00%,0.00%;耐药率均较低(P0.05)。结论临床选用抗菌药物应根据不同病区感染病原菌的耐药性和患者不同生理特点,本地区治疗NICU金黄色葡萄球菌感染可选头孢唑林和头孢噻肟,综合性ICU可选利奈唑胺和克拉霉素作为首选药。     

骨科患者医院感染与社区感染金黄色葡萄球菌的耐药性分析

目的比较医院骨科感染与社区感染金黄色葡萄球菌的耐药性,了解骨科患者感染金黄色葡萄球菌的药敏变化,分析其耐药性差异及原因,为临床合理选用抗菌药物提供参考。方法对贵州医科大学第三附属医院骨科2010年1月至2015年12月各类临床标本中分离出的金黄色葡萄球菌139株进行分析,样本区分医院感染和社区感染,对二者进行比较分析。病原菌鉴定采用VITEK-32微生物分析系统,药敏试验采用K-B纸片法,统计分析使用SPSS 19.0软件。结果骨科患者医院感染金黄色葡萄球菌检出率为19.76%,社区感染检出率为10.76%,医院感染患者检出率高于社区感染患者(χ2=8.10,P=0.004)。两种患者所检出的金黄色葡萄球菌对万古霉素(0.77%)、阿米卡星(1.96%)、利福平(4.19%)、替考拉宁(2.16%)、米诺环素(0.00%)和利奈唑胺(0.00%)等11种抗菌药物耐药率较低,可作为治疗的首选药。医院感染与社区感染的金黄色葡萄球菌对苯唑西林、头孢唑林、阿莫西林/克拉维酸、克林霉素、红霉素、阿奇霉素、庆大霉素、氧氟沙星、呋喃妥因、复方新诺明、罗红霉素、吗啉噁酮、奎奴普汀/达福普汀等17种抗菌药物的耐药率分别为70.97%、20.22%,50.00%、15.79%,50.00%、9.62%,53.13%、23.66%,82.76%、43.01%,83.33%、38.30%,22.22%、3.95%,19.05%、6.78%,21.74%、7.81%,41.38%、17.50%,66.67%、30.77%,14.29%、0.00%,14.29%、0.00%,医院感染金黄色葡萄球菌的耐药性高于社区感染的,差异具有统计学意义(P0.05)。结论骨科医院感染患者金黄色葡萄球菌感染率和耐药率均高于社区感染患者,制订治疗方案时应区别医院感染与社区感染,合理使用抗菌药物,从而减少抗菌药物的滥用和细菌耐药性的产生。     

后路脊柱术后切口感染病原菌特征及不同治疗方案的疗效观察

目的:探讨后路脊柱术后切口感染病原菌分布特征及不同治疗方案的治疗效果,为临床治疗提供参考。方法:选择32例2015年8月-2019年12月于我院进行后路脊柱术治疗且术后切口出现感染的患者,对其标本进行细菌分离培养鉴定,分析病原菌分布情况并测定细菌药敏性。对浅层切口感染患者采用常规换药治疗,而深部感染者在早期进行扩创冲洗引流,并根据药敏结果选用抗生素治疗,观察不同治疗方案的治疗效果。结果:32例术后切口感染患者中,共检出36株病原菌,革兰阴性菌17株,占47.22%,革兰阳性菌19株,占52.78%。前四位病原菌分别为金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌、溶血葡萄球菌。大肠埃希菌及铜绿假单胞菌对亚胺培南全部敏感,耐药率为0.00%;黄色葡萄球菌及溶血葡萄球菌对万古霉素、替考拉宁全部敏感,耐药率均为0.00%。浅层切口感染及深部切口感染患者全部治愈,所有患者愈后均随访3个月,未见复发感染病例。结论:后路脊柱术后切口感染以金黄色葡萄球菌为主,临床应对深部切口感染患者行早期行扩创冲洗引流,并根据耐药性结果合理选用抗生素。     

肿瘤患者经外周放置中心静脉导管相关性感染的病原菌分布、耐药性及影响因素分析

目的:研究肿瘤患者经外周放置中心静脉导管(PICC)相关性感染的病原菌分布、耐药性,并分析其影响因素。方法:以2016年1月～2019年3月于我院行PICC置管的肿瘤化疗患者450例为研究对象,分析其PICC相关性感染发生情况。采集感染患者标本进行病原学检查,并分析感染病原菌种类、分布情况以及耐药性。同时对PICC相关性感染的影响因素进行分析。结果:450例患者发生PICC相关性感染的人数为40例,占比8.89%。共检出病原菌40株,其中革兰阳性球菌12株,革兰阴性杆菌28株。革兰阳性球菌对万古霉素、利奈唑胺和呋喃妥因均不耐药(0.00%),而对青霉素耐药率最高(100.00%)。鲍曼不动杆菌、铜绿假单胞菌对头孢吡肟、四环素的耐药率最高(100.00%),而鲍曼不动杆菌、铜绿假单胞菌和洋葱伯克霍尔德菌对呋喃妥因、头孢唑林的耐药率最低(0.00%)。经单因素分析发现:穿刺次数、导管留置时间、免疫功能、化疗次数以及是否合并糖尿病均与肿瘤患者PICC相关性感染有关(均P0.05)。经多因素Logistic回归分析显示:穿刺次数≥2次、免疫功能低下、化疗次数≥5次以及合并糖尿病均是肿瘤患者PICC相关性感染的独立危险因素(均P0.05)。结论:PICC相关性感染病原菌分布主要包括革兰阳性球菌与革兰阴性杆菌,临床应针对各病原菌的耐药性合理选择抗菌药物,同时加强对危险因素的干预,以降低PICC相关性感染的发生率。     

六种藓类植物茎的比较解剖学研究

通过对6种藓类植物,即褶叶青藓(Brachythecium salebrosum(Web.et Mohr.)B.S.G.)、湿地匐灯藓(Plagiomnium acutum(Lindb.)Kop.)、侧枝匐灯藓(Plagiomnium maximoviczii(Lindb.)Kop.)、大凤尾藓(Fissidensnobilis Griff.)、大羽藓(Thuidium cymbifolium(Doz.et Molk.)B.S.G.)和大灰藓(Hypnum plumaeforme Wils.)嫩茎和老茎的石蜡切片和显微观察发现,同一藓类植株的嫩茎和老茎,茎结构稳定,不同种藓类植物茎横切面具有不同特征.植物体茎横切面形状、表层细胞的层数、细胞大小和细胞壁厚薄、皮层细胞大小和形状、中轴的有无以及比例等特征可以作为藓类植物的分科分类依据之一.     

Photoregulation of seed germination of wild-type and of an aurea-mutant of tomato

Seed germination of an aurea mutant of tomato ( Lycopersicon esculentum Mill.) is promoted by continuous irradiation with red, far-red or long-wavelength far-red (758 nm) light as well as by cyclic irradiations (5 min red or 5 min far-red/25 min darkness). Far-red light applied immediately after each red does not change the germination behaviour. Seed germination of the isogenic wild-type, cv. UC-105, is promoted by continuous and cyclic red light while it is inhibited by continuous and cyclic far-red light and by continious 758 nm irradiation. Far-red irradiation reverses almost completely the promoting effect of red light. The promoting effect (in the aurea mutant) and the inhibitory effect (in the wild-type) of continuous far-red light do not show photon fluence rate dependency above 20 nmol m⁻² s⁻¹. It is concluded that phytochrome controls tomato seed germination throgh low energy responses in both the wild type and the au mutant. The promoting effect of continuous and cyclic far-red light in the au mutant can be attributed to a greater sensitivity to P_fr.     

Cause of Senescence of Nine Sorts of Flowers

The levels of endogenous phytohormones and respiratory rate in nine sorts of flowers such as Cymbidium faberi Rolfe, Nopalxochia ackermannii Kunth and others were investigated both at full bloom and senescence and meanwhile the effect of exogenous phytohormones on prolonging the blossoms and promoting ethylene production were tested. There is a high content of endogenous ethylene in all the long-lived flowere, about 3–16 folds higer than the short-lived ones. There is a high level of ABA at full blooming flowers of short-lived flowers, in which there is no or only some cytokinins in it, but the ratio of CTK (6BA+zeatin)/ABA is smaller(l.7). The endogenous ABA reached a much higher level at senescence in all nine sorts of flowers, so it is reasonable to consider that it is ABA which plays an important role of regulation in controlling flower's senescence. There is a much higher level of GA3 and zeatin in the long-lived flowers which is not demonstrated in the shortlived ones. The respiratory rate is one of the factors controtling the longevity of flowers, but it does not play a decided role. Application of 6BA and zeatin prolongs distinctly orchid’s longevity, however exogenous IAA through the promotive action on ethylene production, evidently extends the longevity of the flowers of the Nopalxochia ackermannii Kunth.     

Interconnection of parameters of regulation system of lipid peroxidation and of morphophysiological parameters of mouse liver

A complex analysis of seasonal fluctuations of the mean group parameters of the system of regulation of lipid peroxidation has been performed in liver of Balb/c mice. Association of lipid characteristics and morphophysiological parameters is studied in the Balb/c mouse liver. An inter-connection is revealed between the liver index and the amount of lysoforms of phospholipids, the scale and character of the interconnection differing essentially depending on proportion of phos-phatidylcholine in mouse liver phospholipids.     

龙胆科药用植物化学成分的研究现状

龙胆科植物在我国的分布范围很广,且多数为药用植物,其多数种属的药用植物,至今其化学成分尚未被系统研究。综述了目前龙胆科药用植物的化学成分的研究现状及一般提取方法,对近年来发现的环烯醚萜及裂环烯醚萜类化合物进行了总结,为本科药用植物的更深入研究提供了参考。     

Physiological characteristics of various species of strains of carboxydobacteria

Seven strains of aerobic carbon monoxide-oxidizing bacteria (carboxydebacteria) when growing on CO as sole source of carbon and energy had doubling times which ranged from 12–42 h. The activity profiles obtained after discontinuous sucrose density gradient centrifugation indicated that the CO-oxidizing enzymes are soluble and the hydrogenases are membrane-bound in all strains examined. The CO-oxidizing enzymes of Pseudomonas carboxydohydrogena, Pseudomonas carboxydoflava, Comamonas compransoris, and the so far unidentified strains OM2, OM3, and OM4 had a molecular weight of 230,000; that of Achromobacter carboxydus amounted to 170,000. The molecular weights of the CO-oxidizing and H₂-oxidizing enzymes turned out to be identical. The cell sonicates were shown to catalyze the oxidation of both CO and H₂ with methylene blue, thionine, phenazine methosulfate, toluylene blue, dichlorophenolindophenol, cytochrome c or ferricyanide as electron acceptors. Methyl viologen, benzyl viologen, FAD⁺, FMN⁺, and NAD(P)⁺ were not reduced. The spectrum of electron acceptors was identical for all strains tested. Neither free formate, hydrogen nor oxygen gas were involved in the CO-oxidation reaction. Methylene blue was reduced by CO at a 1:1 molar ratio. The results indicate that CO-oxidation by carboxydobacteria is catalyzed by identical or similar enzymes and that the reaction obeys the equation CO+H₂OCO₂+2H⁺+2e^- as previously shown for Pseudomonas carboxydovorans.Dedicated to Otto Kandler remembering almost three decades of enjoyable cooperation     

Modulation of allostery of pyruvate kinase by shifting of an ensemble of microstates

Since the introduction of the concepts of allostery about four decades ago, much advancement has been made in elucidating the structure-function correlation in allostery. However, there are still a number of issues that remain unresolved. In this review we used mammalian pyruvate kinase (PK) as a model system to understand the role of protein dynamics in modulating cooperativity. PK has a triosephosphate isomerase (TIM)(α/β)₈ barrel structural motif. PK is an ideal system to address basic questions regarding regulatory mechanisms about this common (α/β)₈ structural motif. The simplest model accounting for all of the solution thermodynamic and kinetic data on ligand-enzyme interactions involves two conformational states, inactive E^T and active E^R. These conformational states are represented by domain movements. Further studies provide the first evidence for a differential effect of ligand binding on the dynamics of the structural elements, not major secondary structural changes. These data are consistent with our model that allosteric regulation of PK is the consequence of perturbation of the distribution of an ensemble of states in which the inactive E^T and active E^R represent the two extreme end states. Sequence differences and ligands can modulate the distribution of states leading to alterations of functions. The future work includes: defining the network of functionally connected residues; elucidating the chemical principles governing the sequence differences which affect functions; and probing the nature of mutations on the stability of the secondary structural elements, which in turn modulate allostery.     

（鱼句）亚科花（鱼骨）型鱼类骨骼系统的比较

对我国花型Hemibarbuspattern鱼类作了骨骼系统比较,结果表明,此类型鱼类脑颅较长,副蝶骨平直或稍弯曲,眶蝶骨腹纵嵴发达(铜鱼Coreius septentrionalis例外),下颞窝和咽突中等大,基枕骨后突发达;脑颅中的上筛骨的后突、侧筛骨的外筛突,蝶耳骨的外突、上耳骨的后突、围眶骨和后颞窝等均有明显的差异;咽颅中的舌颌骨、尾舌骨、鳃盖骨和下咽齿的列数等又有显著的区别;附肢骨骼中的腰带骨、脊椎骨中的复合神经骨和第4椎骨腹侧的悬器等也有不同之处。据此,这些差异和区别可作为属间或种间的分类依据。