尿道下裂患者术前术后尿道细菌的研究

目的了解尿道下裂患者尿道修复前后尿道及其周围细菌的分布,为临床预防尿道下裂术后感染提供依据。方法采集30例尿道下裂患者术前尿道、会阴部,术后重建尿道、会阴部皮肤作细菌分离、培养、鉴定、统计分析、药敏试验。结果术前术后尿道与会阴部细菌分布差异无显著性（P〉0．05）,有革兰阳性菌表皮葡萄球菌、肠球菌等,革兰阴性菌变形杆菌、阴沟肠杆菌、大肠埃希菌等,以表皮葡萄球菌占多数。结论术后重建尿道内存在的细菌由会阴部皮肤表面细菌转移而入。菌株以革兰阳性菌表皮葡萄球菌占多数,菌株耐药率较高,临床选择药物要慎重。     

苦参碱对表皮葡萄球菌生物被膜作用初探

通过中药有效成分苦参碱对表皮葡萄球菌生物被膜抑制作用的研究,为表皮葡萄球菌生物被膜引起的相关感染提供新的治疗途径。利用XTT减低法评价苦参碱对表皮葡萄球菌初始粘附及生物被膜内细菌代谢的影响,镜下观察该药对表皮葡萄球菌生物被膜的形态学影响。结果表明:苦参碱对表皮葡萄球菌生物被膜菌的SMIC50和SMIC80分别为62.5 mg/L和500 mg/L;1 000 mg/L浓度的苦参碱对表皮葡萄球菌早期粘附有抑制作用;250 mg/L浓度的苦参碱对表皮葡萄球菌生物被膜的形态有显著影响。因此可见,苦参碱对表皮葡萄球菌生物被膜的形成与粘附均有抑制作用。     

桑螵蛸挥发油对金黄色葡萄球菌生物被膜形成的体外抑制效应的初步探究CSCD

目的研究桑螵蛸挥发油提取物对金黄色葡萄球菌生物被膜形成的体外抑制效应。方法采用六孔板为载体培养细菌生物被膜,在刚果红平板鉴定使用的金黄色葡萄球菌菌株为生物被膜阳性菌株的基础上,再采用银染后通过倒置显微镜观察法来观察桑螵蛸挥发油提取物及其他药物对金黄色葡萄球菌生物被膜形成的体外抑制效应。结果空白对照组细菌生物被膜明显,药物实验组细菌生物被膜受到抑制,且桑螵蛸挥发油实验组抑制效果最明显。结论桑螵蛸挥发油提取物对金黄色葡萄球菌生物被膜的形成有明显的抑制效应,为下一步研究其详细有效成分及开发提供基础数据和理论依据。     

桑螵蛸挥发油对金黄色葡萄球菌生物被膜形成的体外抑制效应的初步探究

目的研究桑螵蛸挥发油提取物对金黄色葡萄球菌生物被膜形成的体外抑制效应。方法采用六孔板为载体培养细菌生物被膜,在刚果红平板鉴定使用的金黄色葡萄球菌菌株为生物被膜阳性菌株的基础上,再采用银染后通过倒置显微镜观察法来观察桑螵蛸挥发油提取物及其他药物对金黄色葡萄球菌生物被膜形成的体外抑制效应。结果空白对照组细菌生物被膜明显,药物实验组细菌生物被膜受到抑制,且桑螵蛸挥发油实验组抑制效果最明显。结论桑螵蛸挥发油提取物对金黄色葡萄球菌生物被膜的形成有明显的抑制效应,为下一步研究其详细有效成分及开发提供基础数据和理论依据。     

十二烷基苯磺酸钠对引发内置物感染表皮葡萄球菌生物被膜的作用

【背景】随着医用内置物的广泛使用,由表皮葡萄球菌生物被膜导致的医院获得性感染不断增多,目前鲜见关于表面活性剂针对表皮葡萄球菌生物被膜作用的报道。【目的】通过研究阴离子型表面活性剂十二烷基苯磺酸钠(sodium dodecyl benzene sulfonate,SDBS)分别对ATCC 35984 (产膜表皮葡萄球菌标准株)生物被膜的清除、生物被膜内细菌代谢和形成生物被膜的关键物质多糖胞间黏附素(polysaccharide intercellular adhesion,PIA)产生的影响,为临床使用SDBS防治由表皮葡萄球菌生物被膜引起的相关感染提供可靠的理论及实践依据。【方法】利用XTT减低法,评价SDBS对ATCC 35984已形成生物被膜的清除效率及对生物被膜内细菌代谢的影响;激光共聚焦显微镜观察SDBS对生物被膜作用的效果;采用刚果红培养基观察SDBS对PIA产生的影响。【结果】浓度为256、128、64、32、16 mg/L的SDBS在作用6、12、24 h时,对ATCC 35984的生物被膜均有显著的清除效率(P<0.01);浓度为32 mg/L时对生物被膜内细菌的...     

葡萄糖对表皮葡萄球菌生物被膜形成的影响及调节机制的研究

生物被膜(Biofilm)是条件致病菌表皮葡萄球菌(Staphylococcusepidermidis)的主要致病因素,生物被膜的形成依赖多糖PIA合成,合成PIA的糖基转移酶由icaADBC基因编码。以生物被膜形成能力不同的菌株为对象,通过研究不同环境对生物被膜形成、细菌总糖量及相关基因表达的变化,探索外界环境对生物被膜形成的影响及葡萄糖对生物被膜诱导的分子机制。有利于生物被膜形成培养条件促进生物被膜形成及多糖的表达,葡萄糖能诱导ica基因的表达和生物被膜形成,ica基因的反义寡核苷酸(ODN)能对抗葡萄糖的作用;葡萄糖作用下不同生长周期生物被膜形成相关基因ica、icaR、AtlE表达不同。表皮葡萄球菌生物被膜的形成与细菌糖代谢有关,葡萄糖通过上调ica表达诱导生物膜形成,但不需要ica基因的持续表达;葡萄糖的诱导作用不是直接通过调节AtlE和icaR基因来实现的     

黄芩素抑制金黄色葡萄球菌生物被膜的形成

细菌生物被膜的形成是导致细菌耐药和引起持续性感染的主要原因之一。本文通过检测黄芩素对金黄色葡萄球菌26112菌株（Staphylococcus aureus 26112,SA26112）多糖细胞间黏附素（polysaccharide intercellular adhesion, PIA）的合成和胞外DNA（extracellular DNA,eDNA）释放量的影响,及其对icaA和cidA基因表达量的影响,探讨黄芩素对金黄色葡萄菌生物被膜形成的抑制作用及其机制。结果显示,黄芩素能抑制SA26112生物被膜的形成,其抑杀SA26112的最低抑菌浓度和最低杀菌浓度均为0.04 mg/mL。0.16 mg/mL黄芩素和256 μg/mL环丙沙星单独作用时,均不能杀死其成熟生物被膜内的SA26112细菌,而当二者联用时则可杀死成熟生物被膜内的细菌。黄芩素能显著抑制SA26112菌株PIA的合成、eDNA的释放量及icaA和cidA基因的相对表达量。其中,0.04 mg/mL黄芩素作用SA26112菌株24 h,与对照组相比,eDNA的释放量减少97%,icaA和cidA基因的相对表达量分别减少62%和41%。上述结果表明,黄芩素能抑制SA26112菌株生物被膜的形成,其作用机制可通过降低icaA和cidA的基因表达量,进而影响PIA的合成和eDNA的释放,来抑制金黄色葡萄球菌生物被膜的形成。     

表皮葡萄球菌vraSR-srrAB突变株的构建及生物学表型

【背景】形成生物被膜是表皮葡萄球菌的主要致病方式,双组分系统(two-component regulatory system, TCS) VraSR和SrrAB与细菌的生长、生物被膜形成等多种生物学表型密切相关。敲除表皮葡萄球菌SE1457 vraSR后细胞壁变薄,生物被膜形成量降低,而敲除srrAB后生长进入稳定期的时间延长,生物被膜形成量也降低,且TCS-VraSR和SrrAB均通过ica途径调控表皮葡萄球菌生物被膜的形成。ica操作子是表皮葡萄球菌生物被膜形成的重要调节元件,由icaADBC这4个开放阅读框(openreadingframe,ORF)和1个转录方向相反的icaR组成,IcaR是icaADBC的抑制子。【目的】探索TCS-VraSR和SrrAB协同调控表皮葡萄球菌生长及生物被膜形成中的作用,为防控表皮葡萄球菌引起的持续性感染奠定基础。【方法】构建pKOR1-ΔvraSR重组质粒,经大肠杆菌DC10B修饰后转入ΔsrrAB,通过同源重组在ΔsrrAB突变株的基础上进一步敲除vraSR基因,疑似ΔvraSR-srrAB突变株经PCR、RT-PCR和测序验证。检测Δvra...     

218例表皮葡萄球菌的耐药性分析

目的了解3年内218例表皮葡萄球菌的耐药性,指导临床合理使用抗生素,方便临床采取更有效的治疗措施。方法对2007年1月至2009年12月间盛泽医院218例感染患者的各个感染部位进行表皮葡萄球菌的分离和耐药性检测,根据药物敏感试验结果来分析其耐药性的变化。结果 218株分离的表皮葡萄球菌中,耐甲氧西林菌株(MRSE)160株,占总数的73.4%,甲氧西林敏感菌株(MSSE)58株,占26.6%,未发现对万古霉素耐药的菌株,MRSE对大部分抗生素有较高的耐药率,MSSE则对大多数抗生素保持较低的耐药率。结论表皮葡萄球菌的分布广泛,耐药情况日趋严重,合理使用抗菌药物以延缓细菌耐药性的产生非常重要。     

血流感染葡萄球菌菌种分布及耐药特性分析

目的了解血流感染中葡萄球菌的菌种分布及其耐药特性,以指导临床合理使用抗菌药物。方法回顾性分析南昌大学第二附属医院2013年1月至2013年8月期间临床各科室送检的血培养标本中葡萄球菌的菌种分布和耐药特性。采用BACT/ALERT 3D全自动血培养仪进行培养,VITEK2-compact全自动细菌分析仪进行菌种鉴定和药敏试验。WHONET 5.6软件分析数据。结果共分离获得176株葡萄球菌,其中金黄色葡萄球菌24株,占13.6%;路邓葡萄球菌1株,占0.6%;凝固酶阴性葡萄球菌(CNS)151株,占85.8%,人葡萄球菌53株、溶血葡萄球菌32株、表皮葡萄球菌23株及头状葡萄球菌15株居前四位。最常见的葡萄球菌分别为人葡萄球菌、溶血葡萄球菌、金黄色葡萄球菌及表皮葡萄球菌。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林CNS(MRCNS)检出率分别为29.2%和85.4%,对青霉素耐药率均100.0%,磺胺甲噁唑对MRSA(耐药率仅14.3%)有较强的体外抗菌活性,利福平对MRCNS(耐药率仅18.2%)有较强的体外抗菌活性,均未发现耐万古霉素、利奈唑胺和替加环素的菌株。结论葡萄球菌引起的血流感染菌种分布较广,以人葡萄球菌、溶血葡萄球菌、金黄色葡萄球菌及表皮葡萄球菌为主,人葡萄球菌较金黄色葡萄球菌耐药及多重耐药性严重,但均仍对万古霉素、利奈唑胺、替加环素保持高度敏感。     

Femoral vein thrombosis and total hip replacement.

Of 160 patients who underwent total hip replacement, 81 developed venographic evidence of thrombi in the operated leg. In 46 cases (57%) the thrombus originated from the femoral vein, and in 43 of these the exact site of origin was defined by venography. In 34 cases (74%) the thrombus arose from the wall of the femoral vein at the level of the lesser trochanter. This region was studied by intraoperative venography in eight patients undergoing total hip replacement, and in every case severe distortion of the common femoral vein was observed, producing almost total occlusion. We suggest that intraoperative damage to the femoral vein results from manipulation of the leg, and that this is one reason why the operation is followed by a high incidence of deep vein thrombosis in the upper femoral region.     

全髋和半髋置换治疗老年股骨颈骨折的临床对比分析

目的:探讨全髋和半髋关节置换术治疗老年股骨颈骨折的临床疗效。方法:选择本院收治的70例老年股骨颈骨折患者,采用随机数字表法将其分为观察组和对照组各35例,观察组给予全髋关节置换术,对照组予以半髋关节置换术,对比两组所用手术时间、术中出血量、术后Harris评分及髋关节功能、术后并发症、疼痛率及翻修率。结果:观察组手术时间为(113.6±19.3)min,术中出血量为(432.1±32.7)ml,均显著高于对照组的(73.1±10.2)min、(201.3±30.1)m L,两组比较差异均有统计学意义(均P0.05);观察组髋关节功能总优良率、Harris评分分别为91.43%,(91.13±5.09)分,显著优于对照组的77.14%、(80.15±4.71)分,两组比较差异均有统计学意义(均P0.05);观察组不良反应发生率及翻修率分别为20.00%、0.00%,低于对照组的22.85%、5.71%,但差异均无统计学意义(均P0.05);观察组疼痛率为5.71%,显著低于对照组的25.71%,两组比较差异有统计学意义(P0.05)。结论:两种术式对股骨颈骨折的老年患者均能起到有效的治疗,均有各自的优缺点,对疼痛较为敏感和活动较多的老年患者而言,宜采用全髋关节置换术。     

Quality of the blood sampled from surgical drainage after total hip arthroplasty

Several methods have been found to be successful in reducing the need for allogeneic transfusion among the patients undergoing total hip replacement. The purpose of this prospective study was to analyse the quality and evaluate the effect of postoperative autotransfusion on the need for allogeneic transfusion following total hip replacement. The prospective study was performed in two groups of patients undergoing total hip replacement. Before the operative procedure all patients in both groups predonated two doses of autologous blood. In GROUP 1. the system for postoperative collection and transfusion of shed blood was used. In GROUP 2. the patients underwent total hip replacement without blood salvage system. Standard suction collection sets were used postoperatively. In this group shed blood was not transfused to the patients. The samples of preoperative donated autologus blood, allogeneic blood and postoperative collected autologous blood were analysed for number of red cells, hemoglobin, hematocrit, platelets, white blood cells, values of potassium, sodium, free hemoglobin and acid base status. The postoperatively blood salvage significantly reduced the use of allogeneic transfusion among patients managed with total hip replacement (allogeneic transfusion received 12% patients in Group 1 and 80% patients in Group 2; p<0.001). The values of red blood cells are significantly lower in postoperative collected autotransfusion blood compared with preoperative collected autologous blood and allogeneic blood (p<0.001). The values of potassium and acid base status were in normal range in postoperatively collected autotransfusion blood. These values in preoperatively collected autologous blood and allogeneic blood were out of normal range; (p<0.001). In addition to reducing the risk of complications that are associated with allogeneic transfusion, postoperative blood salvage may offer benefits including reducing the need for allogeneic blood. Our study confirmed that postoperative collection and transfusion of drainaged blood is simple and safe method that significantly reduce the need for allogeneic transfusion in patients underwent total hip replacement. The blood collected and transfused postoperatively has lower values of red blood cells and normal values of potassium and acid base balance. The transfusion of this blood caused no complications in our patients.     

人工全髋关节置换治疗成人髋关节发育不良并骨性关节炎的临床分析

目的:探讨人工全髋关节置换治疗成人髋关节发育不良并骨性关节炎的临床疗效。方法:对2009年7月至2012年7月入住我院的60例成人髋关节发育不良并骨性关节炎患者行人工全髋关节置换术治疗。分析治疗优良率、手术前后不同Crowe分型Harris评分、手术前后行走及疼痛情况、手术前后生活质量。结果:1根据Harris评分,本组治疗优良率91.67%(55/60);2术后各Crowe分型患者Harris评分均显著高于术前,差异均具有统计学意义(P<0.05);3本组术前自行行走及辅助行走例数分别为23及37例,术后分别为39例及21例;术前疼痛情况:无、轻、中及重度疼痛例数分别为1例、6例、22例及31例,术后分别为18例、28例、12及2例,手术前后行走情况及疼痛情况差异均具有统计学意义(P<0.05);4根据SF-36生活质量评价标准,术后生活质量评分为(142.16±10.32)分,显著高于术前(115.24±7.34)分,差异具有统计学意义(P<0.05)。结论:人工全髋关节置换治疗成人髋关节发育不良并骨性关节炎的临床疗效显著,术后患者髋关节功能及生活质量明显改善,应在临床上加以推广。     

老年股骨颈骨折患者行全髋关节置换术后麻醉恢复期躁动的影响因素

目的:探讨老年股骨颈骨折患者行全髋关节置换术后麻醉恢复期发生躁动的影响因素。方法:回顾性分析我院老年股骨颈骨折行全麻全髋关节置换术患者46例,根据躁动情况分为躁动组和平静组,每组各23例。比较两组患者术前白蛋白、血红蛋白、白细胞、总胆红素、谷草转氨酶、丙氨酸转氨酶水平;术中失血量、尿量、麻醉时间、心率、舒张压、收缩压水平;躁动组患者各种不良刺激的比例。结果:术前,与平静组相比,躁动组白蛋白、血红蛋白水平较低(P0.05),白细胞计数、总胆红素水平较高(P0.05),谷草转氨酶、丙氨酸转氨酶差异无统计学意义(P0.05);术中,与平静组相比,躁动组尿量水平较低(P0.05),失血量、心率、麻醉时间、收缩压水平较高(P0.05),舒张压差异无统计学意义(P0.05);躁动组不良刺激影响中尿管刺激占比例最高,疼痛刺激其次。结论:老年股骨颈骨折患者行全髋关节置换术后麻醉恢复期躁动与术前白蛋白、血红蛋白、白细胞计数水平,术中失血量、尿量、麻醉时间、心率、收缩压水平,尿管刺激、疼痛刺激、气管导管刺激及体位不当刺激有关。     

Primary osteoarthritis of the hip in monozygotic and dizygotic male twins.

Population and total hip replacement surveys show that primary osteoarthritis of the hip is uncommon in African Americans and rare in Asians, suggesting a genetic basis for this disease. We studied genetic influences on primary osteoarthritis of the hip by estimating monozygotic (MZ) and dizygotic (DZ) twin correlations using a two-stage data collection. A total of 6419 male veteran twins of the NAS-NRC Twin Registry, born between 1917 and 1927, were contacted by telephone (first stage). Telephone interview determined that 2% reported a total hip replacement for arthritis rather than fracture. X-rays of twin pairs in which one twin had undergone total hip replacement were sought and reviewed (second stage), and concordance for primary arthritis was determined based on x-ray diagnosis. Heritability of primary osteoarthritis, Kellgren & Lawrence Grade II and higher, was estimated using a covariance structure analysis for 2-stage data. The best-fitting model included only components for additive genetics and for unique environment. Additive genetics accounted for 53% (95% confidence interval 30-72%) in the liability for self reported hip replacement surgery and unique environment for the remaining 47% (95% confidence interval 28-70%). Additive genetics accounted for 61% (95% confidence interval 18-86%) of the variance in liability for x-ray determined primary osteoarthritis with unique environment accounting for the remaining 39%. These data establish a genetic influence on primary osteoarthritis of the hip in male twins and suggest that further work is indicated to isolate the genes responsible for this disease.     

Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study

Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003–2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001–2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00–1.49). Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25–12.02). The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured neck of femur may be due to an increased prevalence of fractures in those with poor central vision associated with the late complications of age-related macular degeneration.     

Outcome of Hemiarthroplasty and Total Hip Replacement for Active Elderly Patients with Displaced Femoral Neck Fractures: A Meta-Analysis of 8 Randomized Clinical Trials

Background

Displaced fracture of the femoral neck has been a common clinical problem, especially in aged patients. However, the optimal treatment choice remains controversial. The purpose of this study is to conduct a systematic review of randomized clinical trials assessing the results of hemiarthroplasty and total hip replacement in patients undergoing either alternative using meta-analysis.

Methods

A literature search for randomized clinical trials was conducted through Medline, Embase and Cochrane library between 1969 and 2013 with no restrictions. Additional relevant articles were referred as source of information by way of manual searches on major orthopedic journals. Upon the search, two authors independently evaluated study quality and relevant data was extracted.

Results

A total of 8 studies with 983 patients were included in this meta-analysis. After pooling the available data, a significant dominance of Harris hip score was found for total hip replacement compared with hemiarthroplasty (SMD: −7.11, 95%:−10.70,−3.53) one year postoperatively and the advantage kept over (SMD: −6.91, 95%:−12.98, −0.85) two years after surgery. A trend toward a higher dislocation rate was found in total hip replacement group (RR: 0.46, 95%: 0.21, 1.02), of which the difference was considered insignificant. The risk of revision in group hemiarthroplasty appeared to be more than two folds higher than that after total hip replacement (RR: 4.14, 95%CI: 2.09, 8.19).

Conclusion

Even though there is a higher rate of dislocation after total hip replacement, this disadvantage could be accounted for, on the basis of a better functional score and the lower revision rate. However, from the results, it stands to reason that total hip replacement should be strongly suggested in elderly active patients with femoral neck fracture.     

两种不同术式对老年股骨颈骨折治疗对比

目的：探讨全髋关节置换术与股骨头置换术治疗对比。方法：回顾性的分析对2007年1月-2008年12月年我院接收的70例60岁以上的老年股骨颈骨折的进行股骨头置换和全髋关节置换两组不同手术方式的临床资料。结果：两组股骨颈骨折治疗的手术时间、住院时间及术后并发症及治疗效果无明显统计学差异,两组术后半年到一年半的Harris评分较术前评分有显著的统计学意义。结论：人工股骨头置换术和髋关节置换是治疗老年股骨颈骨折的有效方法,可根据患者的自身情况、疾病特点等选择不同术式。     

人工股骨头置换术与空心加压螺钉固定治疗老年股骨颈骨折的疗效比较

目的:探讨人工股骨头置换术与空心加压螺钉固定治疗老年股骨颈骨折的临床疗效。方法:选取2013年2月到2016年2月在我院接受治疗的老年股骨颈骨折患者50例,采用空心加压螺钉固定治疗的25例患者记为对照组,采用人工股骨头置换术治疗的25例患者记为观察组,对比两组患者的卧床时间、手术时间、术中出血量、再手术率、术后并发症发生率,治疗后随访3个月,对比两组患者的髋关节功能优良率。结果:观察组的术中出血量、手术时间显著高于对照组,卧床时间显著低于对照组,差异有统计学意义(P0.05),观察组的再手术率低于对照组,但差异无统计学意义(P0.05)。观察组术后总并发症发生率为8.00%(2/25),显著低于对照组的32.00%(8/25),差异有统计学意义(P0.05),观察组治疗后3个月髋关节功能优良率为88.00%(22/25),高于对照组的72.00%(18/25),但差异无统计学意义(P0.05)。结论:人工股骨头置换术和空心加压螺钉固定均能较好的治疗老年股骨颈骨折,前者手术时间长、术中出血量多,但卧床时间和总并发症发生率更少,临床上可根据患者的病情和身体状况来选择合适的手术方式。