重症急性胰腺炎合并腹腔感染患者病原菌分布、药物敏感性分析及其院内死亡的危险因素探讨

摘要 目的：观察重症急性胰腺炎（SAP）合并腹腔感染（IAI）患者病原菌分布,分析药物敏感性,同时探讨其院内死亡的危险因素。方法：本研究纳入2017年1月~2022年1月期间来解放军联勤保障部队第九二二医院接受治疗并确诊的SAP合并IAI患者100例,采集患者腹水标本,观察其病原菌分布,分析药物敏感性。入院后收集患者人口学特征、实验室检查等资料,探讨患者院内死亡的危险因素。结果：100例SAP合并IAI患者腹水标本中,分离出186株病原菌,其中革兰阴性菌有108株,占比58.06%。革兰阳性菌51株,占比27.42%。真菌27株,占比14.52%。鲍曼不动杆菌对不同抗菌药物的敏感性均较低,大肠埃希菌对厄他培南、亚胺培南、哌拉西林／他唑巴坦、庆大霉素、美罗培南的敏感性较高,肺炎克雷伯菌对亚胺培南、美罗培南的敏感性较高,葡萄球菌属对替加环素、万古霉素、利奈唑胺的敏感性较高,屎肠球菌对替加环素、利奈唑胺的敏感性较高,粪肠球菌对氨苄西林、万古霉素、环丙沙星、替加环素的敏感性较高。单因素分析显示,SAP合并IAI患者院内死亡与器官障碍数目、膀胱压、入院时急性生理学与慢性健康状况评分（APACHE II）评分、白细胞计数（WBC）、血钙、红细胞压积（HCT）、总胆固醇（TC）、甘油三醋（TG）、降钙素原（PCT）、C反应蛋白（CRP）、动脉二氧化碳分压（PaCO₂）、动脉氧分压（PaO2）有关（P<0.05）。多因素Logistic回归分析结果显示：器官障碍数目偏多、血钙偏低、CRP偏高、APACHE II评分偏高、膀胱压偏高、PaO₂偏低、WBC偏高是导致SAP合并IAI患者院内死亡的危险因素（P<0.05）。结论：SAP合并IAI患者病原菌分布以革兰阴性菌为主,主要的革兰阴性菌、革兰阳性菌耐药率高。此外,器官障碍数目偏多、血钙偏低、CRP偏高、APACHE II评分偏高、膀胱压偏高、PaO₂偏低、WBC偏高是影响SAP合并IAI患者院内死亡的危险因素。     

Full-Length and Truncated Alzheimer Amyloid Precursors in Chromaffin Granules: Solubilization of Membrane Amyloid Precursor Is Mediated by an Enzymatic Mechanism

Abstract: The amyloid β peptide (Aβ) of Alzheimer disease is derived from the proteolytic processing of the amyloid precursor proteins (APPs), which are considered type I transmembrane proteins. Here we report that the soluble fraction of isolated adrenal medullary chromaffin granules (CG), a model neuronal secretory vesicle system, contains an antigen that immunochemically and on sodium dodecyl sulfate-polyacrylamide gel electrophoresis was indistinguishable from full-length APP. A truncated APP fragment with intact Aβ sequence was also detected in the soluble fraction of CG. In vitro experiments showed that full-length APP was solubilized from CG membranes at 37°C as a function of pH, with a peak of activity between pH 8.5 and pH 9.0. Solubilization of full-length APP was inhibited by several protease inhibitors, including aprotinin, cystatin, and iodoacetamide, by the divalent cations Ca²⁺ and Zn²⁺, and by preheating of the membranes. These results are consistent with and suggest the involvement of an enzymatic mechanism in the solubilization of potentially amyloidogenic full-length APP. Production of Aβ from a transmembrane APP predicts a proteolytic cleavage within the lipid bilayer, a site relatively inaccessible to proteases. Thus, the detected soluble, potentially amyloidogenic, full-length APP may be a substrate for the proteases producing Aβ. The detection of soluble APP with intact Aβ sequence in secretory vesicles is consistent with the extracellular topology of amyloid depositions.     

Interaction of chlorpromazine with phospholipid membranes

The interaction of chlorpromazine (CPZ) with artificial membranes (egg-yolk phosphatidylcholine liposomes) has been studied. Measurements of the surface electric potential, which is modified in the presence of the ionized form of the drug, were obtained by electron paramagnetic resonance spectroscopy (EPR) using a positively charged amphiphilic spin-probe. This probe partitions between the aqueous and lipidic phases depending on the surface potential and on the structural state of the membrane. The surface potential was measured as a function of drug concentration in the range where the spectral line-shapes are not affected by the incorporation of the drug. From these experimental results and through an appropriate formalism we obtain information on the binding of the drug to the lipid bilayer and on the ionization of the drug in the lipidic phase. Correspondence to: C. Anteneodo     

Inward rectifier potassium channels in plants differ from their animal counterparts in response to voltage and channel modulators

We have investigated the electrophysiological basis of potassium inward rectification of the KAT1 gene product from Arabidopsis thaliana expressed in Xenopus oocytes and of functionally related K⁺ channels in the plasma membrane of guard and root cells from Vicia faba and Zea mays. The whole-cell currents passed by these channels activate, following steps to membrane potentials more negative than –100 mV, with half activation times of tens of milliseconds. This voltage dependence was unaffected by the removal of cytoplasmic magnesium. Consequently, unlike inward rectifier channels of animals, inward rectification of plant potassium channels is an intrinsic property of the channel protein itself. We also found that the activation kinetics of KAT1 were modulated by external pH. Decreasing the pH in the range 8.5 to 4.5 hastened activation and shifted the steady state activation curve by 19 mV per pH unit. This indicates that the activity of these K⁺ channels and the activity of the plasma membrane H⁺-ATPase may not only be coordinated by membrane potential but also by pH. The instantaneous current-voltage relationship, on the other hand, did not depend on pH, indicating that H⁺ do not block the channel. In addition to sensitivity towards protons, the channels showed a high affinity voltage dependent block in the presence of cesium, but were less sensitive to barium. Recordings from membrane patches of KAT1 injected oocytes in symmetric, Mg²⁺-free, 100 mM-K⁺, solutions allowed measurements of the current-voltage relation of single open KAT1 channels with a unitary conductance of 5 pS. We conclude that the inward rectification of the currents mediated by the KAT1 gene product, or the related endogenous channels of plant cells, results from voltage-modulated structural changes within the channel proteins. The voltage-sensing or the gating-structures appear to interact with a titratable acidic residue exposed to the extracellular medium. Correspondence to: R. Hedrich     

Thermodynamically specific gating kinetics of cardiac mammalian K (ATP) + channels in a physiological environment near 37°C

Elementary K⁺ currents through isolated ATP-sensitive K⁺ channels from neonatal rat cardiocytes were recorded to study their temperature dependence between 9°C and 39°C. Elementary current size and, thus, K⁺ permeation through the open pore varied monotonically with temperature with a Q₁₀ of 1.25 corresponding to a low activation energy of 3.9 kcal/mol. Open-state kinetics showed a complicated temperature dependence with Q₁₀ values of up to 2.94. Arrhenius anomalies of _open(1) and _open(2) indicate the occurrence of thermallyinduced perturbations with a dominating influence on channel portions that are involved in gating but are obviously ineffective in altering pore-forming segments. At 39°C, open-state exit reactions were associated with the highest activation energy (O₂ exit reaction: 12.1 kcal/ mol) and the largest amount of entropy. A transition from 19°C to 9°C elucidated a paradoxical kinetic response, shortening of both O-states, irrespective of the absence or presence of cAMP-dependent phosphorylation. Another member of the K⁺ channel family and also a constituent of neonatal rat cardiocyte membranes, 66 pS outwardly-rectifying channels, was found to react predictably since _open increased on cooling. Obviously, cardiac K _(ATP) ⁺ channels do not share this exceptional kinetic responsiveness to a temperature transition from 19°C to 9°C with other K⁺ channels and have a unique sensitivity to thermally-induced perturbations.     

Physicochemical characterization and in vitro interaction with brain capillary endothelial cells of artificially monoacylated ribonucleases A

Acylated proteins play a crucial role in cellphysiology because of their increased interaction withmembranes. Their isolation is difficult as aconsequence of their low cellular concentration andtheir chemical preparation is problematic due tosolubility problems. Through the use of reversedmicelles, we produced tens of milligrams of acylatedribonucleases A, chosen as a model, purified them bysemi-preparative high performance liquidchromatography (HPLC) and characterized them by analyticalHPLC, capillary electrophoresis, mass spectrometry, peptide mapping, Edman degradation and enzyme activity. We nextscrutinized the interaction with an in vitro blood–brainbarrier model and demonstrated that palmitoylated andstearoylated ribonucleases A are transported from onecompartment to the other across the cellular monolayer,in contrast to the native enzyme.     

杨树光肩星天牛种群空间格局的地统计学研究

根据在宁夏青铜峡市４块不同类型样地上收集到的光肩星天牛卵、幼虫和成虫的数量和位置资料,应用地统计学方法对其处群的空间格局进行了研究,结果表明,在各种林型中天牛卵和幼虫的数量具有明显的空间依赖性,其变程分别为２０－４０ｍ和２８－１７０ｍ,局部空间连续性强度分别为０．２６－０．４７和０．１４－０．５５５;而成虫的数量没有表现出空间依赖性,在空间呈随机分布。对不同样方大小的变异曲线图进行比较得知;在一定     

Cooperativity and effects of ionic strength on the binding of sodium n-dodecyl sulphate to lysozyme

The binding of sodium n-dodecyl sulphate to lysozyme has been measured by equilibrium dialysis at 25°C and pH 3.2 over a range of ionic strengts from 0.0119 to 0.2119. Binding isotherms in the region corresponding to ionic binding between the surfactant anions and cationic amino acid residues on the protein have been interpreted in terms of the Hill equation and exhibit positive cooperativity with Hill coefficients in the region of 7–11. The Gibbs energies of binding have been calculated from the Hill binding constants and from the Wyman binding potentials. The stability of the surfactant-protein complexes is discussed in relation to the stability of surfactant micelles. Ionic binding of the surfactant is weakened and hydrophobic binding strengthened by increasing ionic strength.