Objective:Analysis of bacteria and drug susceptibility test of recurrent urinary tract infection for treatment effect and discusses treatment countermeasures.Methods:Analysis of 86 cases of recurrent urinary tract infection patients with urinary bacterial culture and drug sensitive situation,And the patients into culture positive group and negative group,analysis the influence of the treatment.To employ installment long course of treatment and to choose antibiotics according to the urinary bacterial culture and sensitive test and clinical verification,and to observe its efficacy.Results:Among 86 patients,urine germiculture of 30 cases(34.9%) turned out positive,including 24 cases of escherichia coli(80%) .77 cases(89.5%) were cured.Cure patients 26 cases of germiculture positive group and 51 cases of bacterial culture negative group in the treatment period,consolidate period,maintain period and total treatment are no statistical difference.A total of 587 medicine times of drug sensitive test,which can be used for oral agent 137 medicine outpatient program again,including test and the intermediary of medicine sensitive 68 times,clinical manifestations of sensitive only 58 medicine times(9.88%).Conclusion:Because of urine culture and drug susceptibility limitations for Recurrent urinary tract infection,should according to antimicrobial susceptibility test and clinical verification method is used for antibiotics.

Objective:To explore the method for bacterial detection and antibacterial solution in recurrent urinary tract infection.Methods:A total of 86 patients with recurrent urinary tract infection were randomly divided into two groups,43 in Chinese and Western medicine group while 43 in Western medicine group.Long-course treatment was carried out by different stages which were treatment stage,consolidation stage(reducing drug dose),maintenance stage(once every night) and observation stage(drug suspension).According to urine germiculture,susceptibility test and clinical verification,antibiotics were selected.For Western medicine group,a variety of antibiotics were used alternatively,while patients in Chinese and Western medicine group were given Ningmitai as a plus.Results: Among 86 patients,77 cases(89.5%)were cured.The cure rates of the two groups had no significant difference.The consolidation stage and the overall treatment time in medicine group were significantly shorter than those in Western medicine group(P0.05).In both groups,there were no significant changes in the result of blood routine tests,liver and renal functions before and after the treatment.Conclusions: Treatment according to different stages,combination of traditional Chinese and Western medicine,alternative medicine have good curative effects for recurrent urinary tract infection.

Primers were designed based on the reported sequences of alliinase(S73324)in GenBank.The cDNA gene encoding alliinase protein was extracted from Zhejiang garlic bulb by reverse transcription polymerase chain reaction(RT-PCR).PCR product was about 1 523 bp DNA segment.The sequence was submitted to GenBank(accession number:FJ786257),named Zhejiang alliinase(ZJ alliinase).ZJ alliinase was compared with the other alliinases reported in aspect of homology and evolution,the protein structure and the enzyme active center were also predicted by bioinformatics softwares.The Alliinase gene was cloned to the pPICZaC vector to construct the Pichia pastoris expression plasmid.The results showed the high similarity and approximation to those sequences of alliinase such as garlic,onion,scallion,allium ascalonicum and chive,the target gene was successfully inserted to the pPICZaC vector.The three dimensional structure of ZJ alliinase was arborization.A EGF-like domain was in the ZJ alliinase N-terminal,and an aspartate aminotransferase(AAT)superfamily domain was in its center.The amino acid residue Lys-277 could be the combining site of pyridoxal phosphate,and the sequence around it could be the potential enzyme active center.The pPICZaC-alliinase recombination plasmid was completely accurate by using restrictional enzyme assay,plasmid PCR identification and recombinant plasmid sequence analysis.

重症肺炎致急性呼吸窘迫综合征(ARDS)病情重、进展迅速、病死率高,是肾移植患者死亡的重要原因.我们回顾性分析以霉酚酸酯联合环抱素治疗的肾移植患者术后发生ARDS的临床情况.

目的:探讨彩色多普勒超声、核素动态显像在肾移植术后早期并发症诊断与鉴别诊断中的应用价值.方法:收集肾移植术后肾功能恢复不佳且行彩色多普勒超声和核素肾动态显像检查的患者59例,分为3组:急性排斥反应组18例,加速性排斥反应组12例、急性肾小管坏死组29例,同时收集术后肾功能恢复良好的正常组20例,分剐统计上述4组彩色多普勒的阻力指数(RI)、移植肾体积、血流分布,分析彩色多普勒在鉴别诊断中的价值.计算核素肾动态显像的指标:灌注相内1 min时腹主动脉放射性计数与移植肾放射性计数比值(K1 minA1 min),功能相20 min时膀胱/移植肾放射性计数比值(B/K),分析其诊断价值.结果:彩色多普勒检查指标中,当移植肾体积增大、血流减少、阻力指数升高均提示移植肾病变,以阻力指数较敏感,但特异性不高.根据核素肾动态显像指标的计算数据,K1 min/A1 min比值联合B/K比值在诊断排斥反应与肾小管坏死方面准确性较高,分别达到96.7%和89.7%;K1 min/A1 min<4和B/K<1提示排斥反应,K1 min/A1 min≥4和B/K<1提示肾小管坏死.结论:彩色多普勒联合核素动态显像对于肾移植术后排异、急性肾小管坏死、移植肾功能延迟恢复的诊断与鉴别诊断具有很好的临床价值,二者联合应用,互补长短.

目的:比较硫唑嘌呤(azathioprine,Aza)或霉酚酸酯(mycophenolate mofetil,MMF)联合环孢素+激素两种免疫抑制方案的肾移植患者,在术后并发症方面的差异,探讨较理想的免疫抑制方案。方法:收集两组肾移植患者249例:Aza组(即应用Aza+CsA+激素)、MMF组(MMF+CsA+激素),统计两组患者在术后1年内各种并发症(包括排斥反应、各种感染、肝损害、白细胞减少等)的发生。结果:Aza组与MMF组术后1年急性排斥反应的发生率差异显著;两组总的感染率、肺部感染率相近,但发生急性呼吸窘迫综合征(ARDS)及肺部感染病死率后者明显高于前者。在肝损害、白细胞减少、糖尿病等方面,两组也无统计学差异。结论:MMF组在减少急性排异方面优于Aza组,但增加重症肺部感染机会,肺部感染的病死率升高,且费用贵,故临床上应根据具体情况选择。

Objective The aim of this study was to investigate which parameter used in radionu- clide renography would benefit in early detecting and differentiating complications after renal transplantation. Methods Seventy-nine patients who had radionuclide renography within 72 h after renal transplantation were included.Of the 79 patients,20 were normal(control),18 were acute rejection(AR),12 were ac- celerated acute rejection(AAR)and 29 were acute tubular necrosis(ATN).Factors including changes of peffusion and(or)function of the kidney allograft and outcome after AR,AAR and ATN were evaluated u- sing the parameters of the ratio of graft maximal count in perfusion scintigraphy to that of lilac artery(K_(max)/ A_(max))and the ratio of graft count at 1 min to that of iliac artery(K_(1min)/A_(1 min)).Results Among the pa- rameters used in this study,K_(1 min)/A_(1 min)was significant lower in AR and AAR(2.54±1.59 and 2.04± 0.94)than in control(9.29±1.63,P<0.01)and ATN(5.74±2.35,P<0.01)groups.The diagnos- tic accuracy of ATN with K_(1 min)/A_(1 min)was higher than with K_(max)/A_(max)(89.7% vs 55.2% ).Moreover,the results showed that K_(1 min)/A_(1 min)<4 and the ratio of bladder count to that of graft at 20 min(B/K)<1 sug- gested rejection.For those with≥4,B/K<1 suggested ATN and>1 indicated to be normal.Conclusion Combination of parameters including K_(1 min)/A_(1 min)and B/K,diuretic renography would be helpful in early detecting and differentiating AR,AAR and ATN after renal transplantation.

OBJECTIVE To compare mycophenolate mofetil(MMF) with azathioprine(AZA) addition to ciclosporin-prednisone protocol after kidney transplantation in aspect of infections,and to study the etiology of pulmonary infection and urinary tract infection in the two groups.METHODS Totally 249 patients with kidney transplantation were analyzed retrospectively.These patients were divided into two groups according to the immunosuppressive regimen: AZA group(89 patients),and MMF group(160 patients).The various infectious complications were analyzed during a 1-year follow-up,and the etiology of pulmonary infection and urinary tract infection was studied in the two groups.RESULTS The total incidence of the infections,the incidences of the pulmonary infection,urinary tract infecion,wound infection,and so on,during a 1-year follow-up,were equivalent between the two groups.But the incidence of ARDS and the mortality of patients with lung infection was significantly different.The etiology of pulmonary infection was different between the two groups.Cytomegalovirous and fungal infections were higher in MMF group than those in AZA group.Also the etiology of urinary tract infection was different,the incidences of Gram-positive bacterial and fungal infections were higher in MMF group than those in AZA group.CONCLUSIONS Comparing with AZA,MMF increased the opportunity of serious lung infection.The incidences of opportunistic infection and fungal and viral infections increased obviously in MMF group.So therapy should be individualized and aimed.

目的 探讨放射性核素肾动态显像的半定量参数对肾移植术后早期并发症诊断与鉴别诊断的价值,并评价其对患者预后判断的意义.方法 回顾性分析79例肾移植术后行放射性核素肾动态显像的患者资料,分为4组:急性排斥反应(简称急排)组18例,加速性排斥反应(简称加排)组12例、急性肾小管坏死(ATN)组29例,肾功能正常(对照)组20例,分别计算灌注相腹主动脉放射性高峰时间(A峰时)、移植肾放射性高峰时间(K峰时)、移植肾放射性高峰计数与腹主动脉高峰计数比值(Kmax/Amax)及1 min计数比值(K1 min/A1 min),功能相移植肾20 min计数/3 min计数(K20min/K3 min)、K20 min/高峰计数(K20 min/Kpeak)、20 min时膀胱/移植肾放射性计数比值(B/K).分析并比较各参数尤其是Kmax/Amax和K1 min/A1 min诊断与鉴别诊断肾移植术后早期并发症的价值;对ATN组K1 min/A1 min进行分区,分析K1 min/A1 min大小与患者预后之间的关系.结果 各参数中,以K1 min/A1 min、B/K临床价值较大.急排、加排组K1 min/A1 min分别为2.54±1.59和2.04±0.94,较对照组(9.29±1.63)明显下降(P均＜0.01),ATN组K1 min/A1 min为5.74±2.35,与急排、加排组差异有统计学意义(P均＜0.01),急排与加排组间差异无统计学意义(P＞0.05).K1 min/A1 min诊断ATN的准确性为89.7%,高于Kmax/Amax(55.2%).K1 min/A1 min≥4及B/K＞1,为肾功能正常;K1 min/A1 min≥4及B/K＜1为ATN;K1 min/A1 min＜4及B/K＜1为出现排斥反应.K1 min/A1 min与ATN预后及并发症间存在一定联系.结论 K1 min/A1 min结合B/K比值有助于肾移植术后早期并发症的诊断与鉴别诊断,且K1 min/A1 min可用于移植肾病变预后的监测。

<正>我们比较了不同抗排斥方案的肾移植患者在预后、术后各种并发症等方面的情况,旨在探讨理想的免疫抑制方案。1．对象和方法:收集自1993年至2003年成功实施肾移植患者249例,根据免疫抑制方案的不同分为两组:硫唑嘌呤(Aza)组(应用Aza+环孢素A+激素)与霉酚酸酯(MMF)组(MMF+环孢素A+激素),其中Aza组89例,