目的 了解ICU细菌感染的病原菌分布,并分析其耐药性,为合理使用抗菌药物提供依据.方法 收集2019年1-12月我院重症监护室内分离的病原菌并分析其耐药性.结果 分离的1222株病原菌中,常见革兰阴性杆菌占70.0％,常见革兰阳性球菌占30.0％.阴性杆菌以鲍曼不动杆菌(16.6％)、肺炎克雷伯杆菌(14.3％)、铜绿假单胞菌(12.0％)、大肠埃希菌(9.9％)为主,产超广谱β-内酰胺酶肺炎克雷伯杆菌、大肠埃希菌株分别为23.4％、56.2％.阳性球菌以金黄色葡萄球菌、屎肠球菌、凝固酶阴性葡萄球菌为主,三者占比依次是9.2％、9.1％、6.1％;耐苯唑西林金黄色葡萄球菌与耐苯唑西林的凝固酶阴性葡萄球菌检出率分别为46.4％和89.0％.耐药性监测的结果显示,鲍曼不动杆菌对不包括替加环素在内的其他抗生素的耐药率均在50％以上.肺炎克雷伯菌对碳青霉烯类的耐药率超过40％,对替加环素、阿米卡星敏感性较高.大肠埃希菌对碳青霉烯类抗生素耐药率为5.1％.革兰阳性球菌对万古霉素、利奈唑胺保持较好敏感性.结论 ICU分离的病原菌以阴性杆菌为主,且对抗菌药物耐药率高.应提高标本送检率,加强细菌耐药性的检测,指导抗菌药物的合理运用.

目的:探讨伏立康唑治疗慢性阻塞性肺疾病(COPD)伴肺曲霉菌病的效果及对炎性因子的影响.方法:将2017年5月至2019年5月收治的COPD伴肺曲霉菌病患者65例按随机数字表法分为两组,即对照组(31例)和观察组(34例),分别予以伊曲康唑治疗与伏立康唑治疗(应对将伏立康唑与其他种类抗生素疗效进行对比,如伊曲康唑、两性霉素B、卡泊芬净等),检测治疗前、治疗5周炎性因子[白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]水平,评估治疗效果.结果:治疗5周,两组IL-8、TNF-α水平较治疗前显著降低,观察组炎性因子水平较对照组更低(P<0.05).观察组与对照组总有效率(94.12％vs74.19％)相比,存在显著差异(P<0.05).结论:伏立康唑是治疗COPD伴肺曲霉菌病的可靠药物,能降低炎症反应,疗效确切.

目的 研究高表达Six1对人结肠癌细胞株HT-29增殖能力的影响.方法 运用慢病毒构建高表达Six1的HT-29稳定细胞株,应用Western blot方法、MTT比色法、BrdU法检测Six1的蛋白表达.结果 成功构建Six1表达的HT-29Six1+细胞,实验组HT-29Sux1+细胞Six1蛋白表达量为对照组HT-29con的4.3倍;采用MTT法,以第1天的吸光度A值作为参照标准,HT-29Six1+组高于HT-29con组(第2天为2.35±0.68 vs 1.03±0.67,第3天为6.33±0.60 vs 2.44±1.01,第4天为14.70±1.40 vs4.60±1.30,第5天为20.60±2.40 vs 9.25±1.60),从第3天开始,差异有统计学意义(P＜0.05).采用BrdU法HT-29Six1+组的比例高于HT-29con组[(45.97±1.21)％ vs (29.56±1.05)％],差异有统计学意义(P＜ 0.05).结论 HT-29Six1+细胞株稳定高表达Six1,高表达Six1可以增强HT-29细胞的增殖能力.

目的：探讨 ICU罹患重症肺炎患者的危险因素及其预后。方法对我院 ICU 197例肺炎患者的临床资料进行回顾性分析。采用病例对照研究，将其中符合重症肺炎诊断标准的92例设为重症组，余105例非重症肺炎为非重症组，对相关资料作单因素及多因素 Logistic回归分析。结果年龄>75岁、合并呼吸衰竭、PT延长、需机械通气为 ICU 罹患重症肺炎患者的主要危险因素。凝血异常、有否合并慢性肺病、神经系统疾病、有否机械通气、感染性休克是影响重症肺炎的独立预后因素。结论 ICU重症肺炎患者影响预后的因素众多，基础病多、并发感染性休克、需要机械通气往往提示预后不良。

Objective To investigate the influence of Six1 on cell proliferation and migration in A549 cell line and its mechanism.Methods Six1 specific Si-RNA was transfected into human lung carcinoma cell line A549.We detected the efficien-cy of transfection by Western blot.The effects of si-Six1 on A549 cell growth was by means of MTT and cell count assay;The effects of Six1 on A549 cell migration was by means of cell scratch test and transwell assay;The protein expression of PI3K Sig-nal pathway was detected by western blot.Results In A549 cell line,the expression of Six1 was knocked-down by specific si-RNA,and down-regulation of Six1 decreased the expression of p-AKT,which led to decrease of the ability of proliferation and migration of A549.Conclusion Six1 inhibits the proliferation and migration of A549 cells through PI3K pathway.

OBJECTIVE:To investigate the spectrum of common pathogenic bacteria of low respiratory tract infection by loop-mediated isothermal amplification (LAMP) of nucleic acid test and to prove the clinical significance of this method.METHODS:A total of 289 qualified sputum samples from patients with lower respiratory tract infections in Fujian Province were detected by LAMP technique, and then the distribution of pathogenic bacteria was analyzed. The positive cases (the patients whose specific bacterial copies in their sputum samples > 1×10(3) copies/ml) were divided into 2 groups according to whether their treatment had covered this pathogen or not. The underlying diseases, duration of anti-bacterial treatment, the hospital days, and the effectiveness of initial treatment and cure rate were compared.RESULTS:The culture method in the 289 patients showed that 44 (15.2%) were positive. Tests by the LAMP method with a bacteria concentration > 1×10(3) copies/ml as cutoff value, showed positive results in 124 patients (43.0%). The lower respiratory tract pathogens included 144 strains of bacteria (77.8%), and 41 strains of atypical pathogens (22.2%). Gram-negative bacteria were the predominant pathogens, such as Pseudomonas aeruginosa, H. influenzae, Klebsiella pneumoniae, and Streptococcus pneumoniae. In 95 cases the initial therapy had covered the pathogens, while in 29 cases the initial therapy had not. The effectiveness of the initial treatment (χ(2) = 31.0, P < 0.01) and the total days of hospital stay (t = -2.083, P = 0.039) in the group whose antibiotics had covered the pathogens were significantly higher than those of the other group. However, there were no significant difference in duration of anti-bacterial treatment (t = -1.073, P = 0.285)and cure rates (χ(2) = 0.6, P = 0.4) between the 2 groups.CONCLUSIONS:LAMP method can detect the nuclear acid of the bacteria in the sputum much more rapidly and sensitively than the routine culture method. LAMP technique may be helpful to know the pathogenic bacteria before treatment, and therefore may improve the choice of initial antibiotic therapy.

The inhibitor of apoptosis protein (IAP) plays an important role in tumorigenesis and may be a potential target for cancer therapy. Livin, which belongs to this family, is highly expressed in various tumors. The previous study demonstrated that silencing Livin gene promoted lung cancer cell apoptosis; however, the effects on tumor growth suppression by targeting this gene in vivo, to thereby determine the efficacy of targeting Livin for patient therapy, have not been determined. This study injected lentivirus-delivered livinshRNA into established xenograft tumors derived from the lung adenocarcinoma cell line SPC-A-1 in BALB/C nude mice, the result showed that LivinshRNA down-regulated Livin expression effectively, induced tumor cell apoptosis, reduced tumor cell proliferation, and suppressed tumor growth dramatically, with a tumor volume inhibitory rate of (58.65±4.82)% and a tumor weight inhibitory rate of (47.44±1.64)%, but with less severe adverse reaction to the mouse. This study further demonstrated that Livin gene silencing induced a G0/G1-phase cell cycle arrest and cyclin D1 downregulation, which is a key regulator of the G0/G1- to S-phase transition. These findings suggest that LivinshRNA local injection may serve as a therapeutic method for patient treatment, and that LivinshRNA may suppress tumor growth by arresting the cell cycle in the G0/G1-phase.

<正>呼吸道感染和肿瘤,是威胁人类健康的主要疾病之一,其死亡率居高不下,而肺癌常与某些疾病共存或其影像学形态与某些疾病类似,故易误诊或漏诊。呼吸道疾病传统诊断方法慢、敏感度低下,亟待一种快速,敏感、准确的诊断方法面世。2000年Notomi等[1]首先发布环介导等温扩增技术,

Objective To inhibit the livin gene expression in nude mice by lentiviral vector carrying livin shRNA,and observe its effect on transplanted tumor growth and Ki67 expression.Methods SPC-A1 was injected into nude mice to form subcutaneous lung adenocarcinoma model.Lentiviral vector with livin shRNA was injected into tumor to induce RNAi when the volume of tumor reached 100 mm3,meanwhile the tumor growth was observed.The expression of Livin and Ki67 protein were detected by immunochemistry to analyse the correlation of the livin and ki67 gene expression.Results The study showed a slower tumor growth and a lighter tumor weight in experimental group than the blank and negative control groups.Livin and Ki67 protein expression level were significantly lower than the blank group and the negative group,and the 2 proteins had positive correlation.Conclusion RNA interference targeting livin inhibits tumor growth and decreases the expression of Livin and Ki67 protein.At the same time the 2 proteins have a significantly positive correlation.

Objective To study elderly patients with severe pneumonia risk factors and prognostic factors.MethodsBy a case-control study,collection 101 case from Fujian Provincial Hospital ICU in June 2007 ~ December 2008 of elderly(≥65 years) pneumonia patients,62 cases are elder severe pneumonia,set it to case group,and the remained 39 cases of elder non-severe pneumonia as the control group.Univariate analysis(chi-square test and rank sum test) and multivariate Logistic regression were used for statistics analysis.ResultsThe average age of patients is [mean age(79.32±6.71) years],the total number of hospitalization days is [mean(53.53±60.12) days],the number of hospitalization days in ICU is[mean(33.08±48.77) days],fatality rate is 32.25%.The main pathogen is gram negative bacilli(62.69%),acinetobacter baumannii occupied 25.37%.Multivariable logistic regression analysis showed that: Fine ⅣⅤ,respiratory failure,PT13.0S and TBIL17.0 μmol/L are the independent risk factors of occurred elderly severe pneumonia.Haemoglobin 90 g/L,mechanical ventilation and FineⅤ are independent predictive factor.ConclusionFine ⅣⅤ,respiratory failure,PT13.0S and TBIL17.0 μmol/L are the independent risk factors of occurred the elder severe pneumonia.Haemoglobin90 g/L,mechanical ventilation and FineⅤare independent predictive factor.Fine′s risk classification has great value in elderly patient′s condition assessment and prediction of prognosis.

Objective To detect nucleic acids of 11 common pathogenic bacteria in lower respiratory tract from pneumonia patients by loop-mediated isothermal amplification(LAMP) and evaluate its clinical application.Methods Qualified sputum samples from 289 patients with lower respiratory infections were collected during 2009-2010 in Fujian provincial hospital and were detected by LAMP method.Comparing with routine sputum culture,the sensitivity and specificity of LAMP method were analyzed.Results It took 2~3 hours only for one LAMP assay,significantly shorter than that for sputum culture method.With1×103 copies of bacteria as a positive threshold,the sensitivity was 74.0% and specificity 95.3%.The sensitivity for LAMP was significantly higher than sputum culture.The positive rate was 42.9%(124/289).Conclusion LAMP method is a convenient and rapid assay for detecting common pathogens of lower respiratory tract infections.The sensitivity of LAMP were higher than that of conventional culture method for clinical diagnosis.

目的 了解我院重症监护病房耐碳青霉烯鲍曼不动杆菌肺炎的临床特点及对常用抗生素的耐药性.方法 收集177例耐碳青霉烯的鲍曼不动杆菌肺部感染病例的临床资料及药敏实验结果,回顾分析其临床特点和耐药性特点.结果 177例患者中,80％患有严重的基础疾病,50％以上患者进行过侵人性的操作.药敏结果对头孢他定、新诺明、替卡西林耐药率为100％.对头孢吡肟、庆大霉素、左氧氟沙星、妥布霉素、哌拉西林的耐药率为95％～100％.对头孢哌酮/舒巴坦的耐药率最低,为10.2％,其次为米诺环素23.7％.结论 ICU分离的耐碳青霉烯的鲍曼不动杆菌多重耐药严重,极少数几乎全耐药,仅对头孢哌酮/舒巴坦和米诺环素较为敏感.

Objective To establish a nude mouse model by subcutaneous injection of SPC-A-1 cell line,it was a useful tool for the in vivo research of lung adenocarcinoma.Methods 2×106 SPC-A-1 cell suspention was subcutaneously injected into the armpit of five BALB/c nude mice in each mouse,then the formation of transplanted tumors was studied,its glowth velocity,weight of transplanted tumors and the morphous were closely observed.Results Transplanted tumors were formed in all nude mice.The average time of their formation was about 7 days.The average long diameter and short diameter of these tumors were about(19.20±3.85)mm and(14.94±2.78)mm respectively 28 days later,and the average volume of them was calculated to be about(2 144.10±1 237.72)mm3.The average weight was calculated to be about(1.37±0.6)g.Most transplanted tumors showed a continuous membrane,the tumor cells showed a same morphology of adenocarcinoma cells,and focal necrsis was found in some transplanted tumors by microscope.Conclusion The nude mouse model were successfully established by subcutaneous injection of SPC-A-1 cell line,it would provide a useful tool in the following research in vivo.