抗生素的使用new
兽医临床对抗生素的规范使用
兽医临床对抗生素的规范使用作者：国辉来源：《吉林农业·下半月》2013年第06期摘要：抗生素在兽医对畜禽临床治疗中具有重要作用，使动物的感染类疾病以及传染类疾病治疗和控制显现出其卓越的成效，促进了畜禽的健康成长。
本文主要提出了兽医临床对抗生素的使用。
关键词：兽医临床；抗生素；抗生素的使用中图分类号： S854 文献标识码： A 文章编号： 1674-0432（2013）-12-87-10引言抗生素在兽医对畜禽临床治疗中具有重要作用，使动物的感染类疾病以及传染类疾病治疗和控制显现出其卓越的成效，促进了畜禽的健康成长。
然而，兽医临床在使用抗生素的过程中，也要合理使用，避免对抗生素的不规范、不合理使用。
临床兽医对抗生素的不合理、不规范使用主要表现在盲目使用抗生素、剂量和配伍不当、给药途径错误等，这些不合理、不规范抗生素使用往往导致畜禽二次感染、对抗生素产生耐药性等问题，甚至对畜禽类食品安全造成影响，威胁着食用畜禽类产品的身体健康。
为了保证畜禽类食品安全和畜禽产业的发展，必须对畜禽抗生素的使用问题加以重视。
1 抗生素的适应症及特性抗生素的规范使用要依据兽医的准确诊断，只有兽医准确诊断病症，并准确分析出致病的细菌种类，才能选用正确的抗菌药物。
通常来讲，对于致病菌的种类越多，抗生素药物的选择越复杂，反之，致病菌的种类单一，则抗生素药物的选择也相对比较单一。
对于复杂致病菌应采用联合用药，而对于病毒和真菌则不应选择抗生素药物。
抗生素的有效浓度维持时间、用法、用量应根据抗生素作用的靶器官而定，靶器官的不同也使抗生素药物使用也有所区别，兽医在制定用药方案时，除了考虑动物种类、年龄等方面的因素，还要考虑用药的剂量、给药的途径、治疗的疗程长短等，将这些因素综合全面考虑，之后制定出合理的用药方案。
在抗生素用药剂量上要把握适度原则，剂量不能过大，也不能过小，过大造成药物浪费，甚至引起中毒反应，过小导致治疗效果无法达标。
青霉素的使用和发现英语作文
青霉素的使用和发现英语作文Penicillin, a powerful antibiotic, has revolutionized the field of medicine since its discovery in the early 20th century. This remarkable drug has saved millions of lives by effectively treating various bacterial infections that were once considered fatal. The journey of penicillin from its accidental discovery to its widespread use is an extraordinary tale that highlights the importance of scientific curiosity and perseverance.The story begins in 1928, when Alexander Fleming, a British bacteriologist, was working on a culture of Staphylococcus aureus, a common bacteria that can cause severe infections. Fleming noticed that a mold growing nearby had produced a substance that inhibited the growth of the bacteria. Intrigued by this observation, he conducted further experiments to isolate and study the mold and its antibacterial properties.The mold was identified as Penicillium notatum, and the substance it produced was named penicillin. Flemingrealized that this substance had the potential to revolutionize the treatment of bacterial infections.However, the road to its clinical use was fraught with challenges. Penicillin was difficult to isolate in pure form, and it was unstable and easily destroyed by heat and acids.Despite these obstacles, Fleming's work caught the attention of other scientists, and a collaboration between the University of Oxford and the pharmaceutical company Boots led to the development of a purer and more stable form of penicillin. In 1942, during the height of World War II, penicillin was first used to treat a patient with a severe infection, and its effectiveness was remarkable. The drug quickly became a staple in hospitals and clinics worldwide, saving countless lives.The discovery and use of penicillin marked asignificant milestone in the history of medicine. It marked the beginning of the antibiotic era, which has transformed the way we treat infectious diseases. Penicillin and other antibiotics have saved millions of lives by eradicating once-fatal infections. However, the widespread use of antibiotics has also led to the emergence of resistantbacteria, a global health challenge that requires urgent attention.The story of penicillin reminds us of the importance of scientific curiosity and perseverance in推动科学进步. Fleming's accidental discovery led to a revolution in medicine, and the collaborative efforts of scientists and pharmaceutical companies resulted in the development of a drug that has saved millions of lives. The challenges faced in the process also highlight the need for continuous research and innovation to address new health challenges. As we look forward, it is crucial that we continue to invest in scientific research and innovation to address the ever-evolving health challenges of our time. The discovery and use of penicillin have taught us that the power of science can transform lives, and it is up to us to harness this power to create a healthier and safer world.**青霉素的发现与使用：医学的革命**自20世纪初被发现以来，青霉素这一强大的抗生素彻底改变了医学领域。
抗生素中英文对照表
抗生素中英文对照表1来源：食品伙伴网抗生素分类及名称表1。
β-内酰胺类抗生素分类及名称表 2. 非β-内酰胺类AE自带特效中英文对照表3D Channel三维通道特效--3d chanel extract 提取三维通道--depth matte深度蒙版--depth of field场深度--fog 3D雾化--ID Matte ID蒙版Blur & Sharpen模糊与锐化特效--box blur方块模糊--channel blur通道模糊--compound blur混合模糊--directional blur方向模糊--fast blur快速模糊--gaussuan blur高斯模糊--lens blur镜头虚化模糊--radial blur径向模糊--reduce interlace flicker降低交错闪烁--sharpen锐化--smart blur智能模糊--unshart mask反遮罩锐化Channel通道特效--alpha levels Alpha色阶--arithmetic通道运算--blend混合--calculations融合计算--channel combiner复合计算--invert反相--minimax扩亮扩暗--remove color matting删除蒙版颜色--set channels设置通道--set matte设置蒙版--shift channels转换通道--solid composite实体色融合Color correction 颜色校正--auto color自动色彩调整--auto contrast自动对比度--auto levels自动色阶--brightness & contrast亮度核对比度--broadcast colors播放色--change color转换色彩--change to color颜色替换--channel mixer通道混合--color balance色彩平衡--color blance(HIS)色彩平衡(HIS)--color link色彩连接--color stabilizer色彩平衡器--colorama彩光--curves曲线调整--equalize均衡效果--exposure多次曝光--gamma/pedestal/gain伽马/基色/增益--hue/saturation色相/饱和度--leave color退色--levels (individual controls)色阶(个体控制) --photo filter照片过滤--PS arbitrary Map映像遮罩--shadow/highlight阴影/高光--tint 浅色调/色度--tritone三阶色调整Distort扭曲特效--bezier warp贝赛尔曲线弯曲--bulge凹凸镜--corner pin边角定位--displacement map置换这招--liquify像素溶解变换--magnify像素无损放大--mesh warp液态变形--mirror镜像--offset位移--optics compensation镜头变形--polar coordinates极坐标转换--puppet木偶工具--reshape形容--ripple波纹--smear涂抹--spherize球面化--transform变换--turbulent displace变形置换--twirl扭转--warp歪曲边框--wave warp波浪变形Expression Controls表达式控制特效--angel control角度控制--checkbox control检验盒控制--color control色彩控制--layer control层控制--point control点控制--slider control游标控制Generate 生成--4-ccolor gradient四色渐变--advanced lightning高级闪电--audio spectrum声谱--audio waveform声波--beam声波--beam光束--cell pattern单元图案--checkerboard棋盘格式--circle圆环--ellipse椭圆--eyedropper fill滴管填充--fill填充--fractal万花筒--grid网格--lens flare镜头光晕--lightning闪电--paint bucker颜料桶--radio waves电波--ramp渐变--scribble涂抹--stroke描边--vegas勾画--write-on手写效果Keying 抠像特效--color difference key色彩差抠像--difference matte差异蒙版（已淘汰）--extract提取（已淘汰）--inner/outer key轮廓抠像--luma key亮度抠像--color key色彩抠像（效果差）--color range色彩范围（效果较差）--linear color key线性色彩抠像（与spill suppressor配合使用，效果可以接受）--spill suppressor溢色控制常用的抠图滤镜keylight(1.2)，通过调节Screen color，Screen Gain, Screen Balance三个参数调节，简单方便效果不错Matte 蒙版特效--matte choker蒙版清除--simple choker简单清除--Noise & Grain 噪波和杂点特效--add grain添加杂点--dust & scratches杂点和划痕--fractal noise不规则噪波--match grain杂点匹配--median中性--noise杂点--noise alpha alpha通道杂点--noise HLS HLS通道杂点--noise HLS auto自动生成HLS通道杂点--remove grain减弱杂点Paint 绘画--paint绘画工具--vector paint矢量绘画perspective 透视--3D glasses立体眼镜--basic 3D基础三维--bevel Alpha 斜面Alpha--vevel edges边缘导角--drop shadow阴影--radial shadow放射状的投影simulation 仿真特效--CC Ball Action CC 滚珠操作--CC Bubbles CC 吹泡泡--CC Drizzle CC 细雨滴--CC Hair CC 毛发--CC Mr.Mercury CC 水银滴落--CC Particle Systems Ⅱ CC 粒子仿真系统--CC Particle World CC 粒子仿真世界--CC Pixel Polly CC 像素多边形--CC Rain CC 下雨--CC Scatterize CC 散射效果--CC Snow CC 下雪--CC Star Burst CC 星爆--card dance碎片飘移--caustics焦散--foam泡沫--particle playground粒子--shatter爆碎--wave world波纹抖动stylize 风格化特效--brush storkes画笔描边--color emboss彩色浮雕--emboss浮雕--find edges查找边缘--glow辉光--mosaic马赛克--motion tile运动拼贴--posterize多色调分离--roughen edges粗糙边缘--scatter扩散--strobe light闪光灯--texturize纹理化--threshold对比度极限text 文字特效--basic text基本文字--numbers数字--path text路径文字--timecode时间码time 时间特效--echo重影--psterize time招贴画--time difference时间差异--time displacement时间置换--timewarp时间收缩transition 转场特效--block dissolve快面溶解--card wipe卡片擦除--gradient wipe渐变擦拭--iris wipe星形擦拭--linear wipe线性擦拭--radial wipe径向擦拭--venetian blinds百叶窗utlity 实用特效--cineon converter Cineon转换--color profile converter色彩特性描述转换--grow bounds范围增长--HDR compander HDR压缩扩展--HDR Highlight compression HDR高光压缩Audio音频特效--backwards倒播--bass & treble低音和高音--delay延迟--flange & chorus变调和合声--high-low pass高低音过滤--modulator调节器--parametric EQ EQ参数--reverb回声--stero mixer 立体声混合--tone音质AE的FOAM特效介绍在AfterEffect中有一组滤镜叫做Simulation，这是一组仿真滤镜，利用它可以来模拟自然界中的泡沫、光的反射、爆炸、水纹等效果，下面我们通过实例来介绍一下其中的Foam特效的使用。
妇产科围手术期抗菌药物合理使用
AKI
Duration ＞24h
CDI
Branch-Elliman W, O’Brien W, Strymish J, et al. Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events[J]. JAMA surgery, 2019, 154(7): 590-598.
0 类切口
I或II类
体表无切口或经人体自然腔道进行的操作以及经皮腔镜操作
I类切口
Ⅰ类切口( 清洁手术)
不涉及炎症区，不涉及泌尿生殖道等人体与外界相通的器官， 经过完整 皮肤的手术
II类切口 Ⅱ类切口( 清洁-污染手术)
泌尿生殖道手术， 或经泌尿生殖道手术，可能污染
II类切口
Ⅲ类切口( 污染手术)
手术部位严重污染的手术
器官或腔隙：盆腔或阴道残端蜂窝 织炎或脓肿，子宫内膜炎
三、哪些手术需要用抗菌药物
1. 手术切口类别
手术切口的类型及患者自身具备的感染危险因素决定了是否需要抗菌药物
病案首页切 口类别
指导原则切口类别
妇产科手术
无切口
非切口手术
经血管介入诊断手术、子宫肌瘤-子宫动脉栓塞术、羊膜腔注射引产术以 及羊膜腔穿刺术
备备选
多数II、III类切口妇 第一、二代头孢菌
科手术
素±甲硝唑， 或头
霉素类
克林霉素0. 6 -0. 9 g/次，q8-12 h 头孢曲松 1- 2g·/次， q24 h
+ 氨基糖苷类（如庆大霉素
合理使用抗生素
头霉素类
▪ 二代头孢特点＋抗厌氧菌 ▪ 头孢美唑： ▪ 头孢西丁：
▪
20
氧头孢烯类
三代头孢＋抗厌氧菌
拉氧头孢 出血倾向 氟氧头孢 血浓度高、未见出血倾向
21
碳青霉烯类
G+ 肠杆菌科 绿脓杆菌 厌氧菌 对去氢肽酶稳定性 中枢毒性
亚胺培南 泰能 Lmipenem
++
+++
++~+++
+++ 不稳
的抗菌活性
在第三代的基础上增强了 对抗G+菌活性，增加了 对厌氧菌的抗菌活性
31
五：抗菌素联合治疗的适应症
病因未明的严重感染 单一药物不能控制的严重感染 单一抗菌药物不能有效控制的混合感染 较长期用药细菌有产生耐药的可能 联合用药使毒性较大的 药物剂量得以减少
32
33
干扰细菌细胞壁合成 -内酰胺类 磷霉素 万古霉素 杆菌肽 环丝氨酸
其它 磺胺类和对氨基水杨酸 （抑制细菌叶酸代谢） 异烟肼类 （抑制结核环脂酸合成）
损伤细菌细胞膜 两性霉素B、制霉菌素 唑类抗真菌药 多粘菌素B和E 烯丙胺类
6
抗生素可分为
浓度依赖性
即抗菌药物的抗菌活性随药物浓度增加而加强， 只要细菌与超过MIC浓度的抗菌药物接触，短时 间即现杀菌作用，并且可维持一定时间。
▪ 头孢克罗：对G+菌抗菌活性较头孢氨苄强，对大 肠、肺炎杆菌，奇异变形杆菌与头孢羟氨苄相仿
15
第3代头孢菌素
▪ 对多种青霉素酶稳 ▪ 对革兰阴性菌的抗菌作用强 ▪ 某些品种对绿脓杆菌有效 ▪ 某些品种的血清半衰期较长
▪ 头孢噻肟： 对肠杆菌科有极强的抗菌活性，对不动杆菌， 绿脓杆菌，厌氧菌无效，对阴沟杆菌，产气肠杆菌较差。
八年级下册生物抗生素知识点
八年级下册生物抗生素知识点Antibiotics are medicines that are used to treat infections caused by bacteria. 抗生素是一种用于治疗细菌感染的药物。
These medications work by killing or inhibiting the growth of harmful bacteria in the body. 这些药物通过杀灭或抑制体内有害细菌的生长来发挥作用。
Antibiotics are commonly prescribed by doctors to help fight bacterial infections and save lives. 医生常开抗生素来帮助对抗细菌感染并挽救生命。
However, the misuse and overuse of antibiotics have led to the development of antibiotic resistance, a major global health threat. 然而，抗生素的滥用和过度使用已导致耐药性的发展，成为全球重要的健康威胁。
Antibiotic resistance occurs when bacteria mutate and become resistant to the effects of antibiotics. 抗生素耐药性发生在细菌突变并对抗生素的影响产生耐药性时。
This means that the antibiotics no longer work to kill or inhibit the growth of the resistant bacteria. 这意味着抗生素不再能够杀灭或抑制这些耐药性细菌的生长。
As a result, infections caused by antibiotic-resistant bacteria are harder to treat and can lead to serious complications or even death. 因此，由抗生素耐药细菌引起的感染更难治疗，可能导致严重并发症甚至死亡。
抗菌药物经验性治疗的原则
Meningitis
S. pneumoniae N. meningitidis H. influenza Group B Strep E. coli Listeria
经验性抗感染治疗－药物选择
－能够覆盖可能病原体的抗菌药物（Abx requirements）
• 抗菌谱(coverage)－通读药物说明书和相关资料 • 组织穿透性(tissue penetration)
考虑病人生理和病理生理状态( physiologic and pathophysiology)
其它因素(other considerations)
-considerations in choosing antibiotic for empiric therapy
经验性抗感染治疗－药物选择
喹诺酮类、利福平等
抗菌药物在脑脊液中分布
脑膜炎 症或无炎症时 csf 浓度均可达到抑菌 水平（>MIC) 仅在脑膜炎症时 csf 浓 度均可 达到抑菌水平 （>MIC） 脑 膜 炎 症 时 csf 可 达 一定浓度 脑膜炎 症 时 csf 浓度仍 呈微量者（<MIC） 脑膜炎症时 csf 浓度仍不能 测到者
Fighting infection in the first hours
经验性治疗和目标治疗的统一
•留取标本进行微生物学检查 •开始经验性抗感染治疗
Drain purulent collection
Sampling
Including invasive procedures when needed (BAL…) Rapid tests
Lower Respiratory Community
S. pneumoniae H. influenzae K. pneumoniae Legionella pneumophila Mycoplasma, Chlamydia
一种新的抗生素联合用药方案清除细胞支原体污染的研究
现代医院2021年2月第21卷第6期Modern Hospitals Fed2000Vot21No6一种新的抗生素联合用药方案清除细胞支原体污染的研究黎少梁永康冯思桦彭青高毅【摘要】目的支原体污染是细胞培养过程中最为常见也较为棘手的问题，因此，解决细胞支原体污染问题存在必要性和迫切性。
但是目前可用的商品化去除支原体试剂选择少，价格贵，本研究拟探索一种操作简单，成本低且去除支原体效果佳的抗生素联合用药方案。
方法选取四种抗生素药物联合用药：红霉素、氯霉素、泰乐菌素和环丙沙星，连续2天处理培养支原体污染的C5A肝癌细胞。
首先通过倒置显微镜观察加药处理后，C5A细胞内颗粒、形态等变化；加药处理C3A细胞后通过CCK-8法检测其活率。
其次,进行支原体聚合酶链式反应(PCR)检测和荧光染色，评价抗生素联合用药方案去除支原体的有效性。
最后，实时荧光定量PCR(qPCR)方法检测C3A细胞主要功能基因角蛋白(CK18)、白蛋白(ALB)、氨甲酰磷酸合成酶l(CPSl)和细胞色素P454酶系1A2(CYP1A2)等功能基因的表达恢复情况。
结果经抗生素联合用药处理后，细胞形态更为规整，胞内颗粒显著减少，形态透亮折光度增强等特征变化，对C3A细胞活率无明显影响，抗生素联合用药组PCR电泳结果显示没有支原体DNA条带，同时荧光结果表明没有出现其余点状或者串点的支原体荧光，支原体去除后功能基因CK18、ALB、CPS1和CYP1A6相对表达量均升高。
结论新的抗生素联合用药方案能够达到支原体去除效果,C3A细胞活率维持较好,去除支原体后细胞主要功能基因表达可得到恢复提升。
【关键词】抗生素处理；支原体去除；支原体检测；基因表达中图分类号：R678.1；R375+.3文献标志码：A doi：10.3969/j.issn.271-332X.2021.02.041A new cambination of antibiotics heytmeet for cellular mycoplasma cantaminationLA SUan*,LIANG Yonzkan,,FENG SiOua,PENG Qin,,GAO Y,[Abstract]Objective Mycoplasma contamination can cousc c wiUe range of WouUlesome podlems associateX with celt cu U uo in bioloyy oseaoO,it is tbeoforo necessay to Veep celt cu U uo free of mycoplasma contamination.However,tbero are few options to cOooso the cvvilaPte commeoict mycoplasma omovct Uogs wOicO are also expensive.It is Oope to explore c new antibiotic toatwext wOicO is l ow cost；simple-opeotion,an)eXective in mycoplasma removal.Methods A new antibiotic toct-mext was combineX with four antibiotic Uogs incluUing eothomyciu,cOloompOexicot,tylosiu anU cipo2oxcciu,wOicO was ap-plieX in C3A celt Une contaminateX by mycoplasma for16days.First of alt,we odseoeX the cOanges of the paOicles anU moo of C3A celt afer treatment of the new combination antibiotic Uogs thouah an inveOeX microscope；the viaPility of C3A celt was UetecteX by celt connting Vit-8(CCK-8)assay afer toatwext.Moreover,polymerase cOain reaction(PCR)Uetec-tion an)fnooscext staininu of mycoplasma were peOormeX to evaluate wOetbes the new combination antibiotic Uoas could remove mycoplasma contamination.Finally,oct-tine quantintive PCR(qPCR)metboP was useX to Uefine the recovery of the main functional uenes expression incluUing cytoPeotin13(CK13),albumin(ALB),ccmamoyl pOospUate syptheWse I(CPS1)anU Cuman cytocOome P4501A6(CYP1A2).RescUs Ates the treatment of new combination antibiotic Uoas,more oyulcs an)uniform celt momholoyicct cOanges were showeX,the suUsequext oXuctions in intocellulcs paOicles an)exUanceX momholoyicct transpaoxey were odseoeX,furthermore no sipnificant eXect on the C3A celt viaPility occoroX.Mycoplasma DNA ban)was no-posexteX by PCR Uetection,anU the fnooscence results inUicateX that the C3A celt Vept away from othes spots os cross-points of mycoplasma2uorescexcc•Ater the removal of mycoplasma,the relative expression level of CK13,ALB,CPS1an)CYP1A6 incoaseX.Conclcsion T0e result of mycoplasma removal could be acOieveX by the new combination antibiotic Uoas toatmext with welt-maintaineX viaPility an)restoration of functional uenes expression in C3A celt.[Key words”Antibiotic toatwext；Mycoplasma removal；Mycoplasma Uetection；Gene expression[Author's address]*ZOujiang Hospital of Sontbern MeXicct University,Guangzhon514230,COinc支原体污染是细胞培养、基础研究和生物制品生产等主要问题［一2。
2021届全国普通高等学校招生统一考试上海英语模拟试卷1
2021届全国普通高等学校招生统一考试上海英语模拟试卷1学校_________ 班级__________ 姓名__________ 学号__________一、用单词的适当形式完成短文1. Directions: After reading the passage below, fill in the blanks to make the passage coherent and grammatically correct. For the blanks with a given word, fill in each blank with the proper form of the given word; for the other blanks, use one word that best fits each blank.Exploring BeyondFollowing the call of our restless genes has not ended well forall explorers. The British explorer Captain James Cook died in afight with Hawaiians ten years after he received the precious mapfrom Tupaia. His death, some say, brought to a close 【小题1】Western historians call the Age of Exploration. Yet it hardly【小题2】（end）our exploring. We have remained enthusiastic about fillingin the Earth's maps; reaching its farthest poles, highest peaks, and deepest trenches（海豹）; sailing to its every corner and then flying off the planet entirely. With the NASA Rover Curiosity now【小题3】（stir）us all as it explores Mars, some countries and private companies are preparing to send humans to the red planet as well. Some visionaries even talk of having a spacecraft【小题4】（send）to the nearest star.NASA's Michael Barratt—a doctor, diver, and jet pilot; a sailor for 40 years; an astronaut for 12—is among those【小题5】ache to go to Mars. Barratt consciously sees himself as an explorer Cook and Tupaia. "We're doing what 【小题6】did," he says. "It works this way at every point in human history. A society develops an enabling technology, 【小题7】it's the ability to preserve and carry food or build a ship or launch a rocket."Not all of us【小题8】ride a rocket or sail the infinite sea. Yet, 【小题9】a species, we're curious enough and interested enough bythe prospect to help pay for the trip and cheer at the voyagers return. Yes, we hope to find a better place to live or acquire alarger territory or make a fortune. But we also explore simply【小题10】（discover）what's there.二、选用适当的单词或短语补全短文2. Directions: Complete the following passage by using the words in the box. Each word can only be used once. Note that there is one wordUndercover WingsThe nocturnal（夜间活动）dot-underwing moth（蛾）may use shape -shifting patterns on its wings as a way to attract mates in the dark. In a study published last September in Current Biology, scientists report the【小题1】on males' forewings of three patches（色斑）that change darkness and size when viewed from particular angles. In females, the entire forewing darkens.Although butterfly and moth species that are active during the day are known to employ visual effects to communicate, researchers had thought their nocturnal cousins relied almost【小题2】on chemical signals because of the lack of light. But these【小题3】wing patterns, now found for the first time in a nocturnal moth, suggest the insects may also use visual signals. Because only the males have this pattern, researchers say it is likely a（n）【小题4】selected mechanism.Jennifer Kelley, an ecologist based at the University of Western Australia, and her colleagues first noticed the visual phenomenon while looking at museum moth specimens（标本）for another project. "As soon as we figured the effect was angle-【小题5】, we knew that to understand how it works, we had to understand the【小题6】physics," Kelley says. The group contacted Gerd Schröder-Turk and Bodo Wilts, who are physicists at Murdoch University in Perth and the Adolphe Merkle Institute in Switzerland respectively.Together the researchers found that when the wings are viewed from above, they【小题7】available light directly, like a dull mirror. When viewed from an angle, however, they let some of thelight through to reveal a deeper layer of darkness, which【小题8】as patches on the male's wings. If the insects were to beat their wings 【小题9】—a common behavior among males approaching potential mates—the patches would flash on and off, creating a striking signal even in very【小题10】light.三、完形填空3. When you are stuck on a problem, sometimes it is best to stop thinking about it—consciously, anyway. Research has shown that taking a break or a nap can help the brain create_________to a solution. Now a new study_________on the effect of this so-called incubation（潜伏期）by using sound cues to focus the sleeping mind on a targeted problem.When humans sleep, parts of the brain replay certain memories, strengthening and transforming them. About a decade ago researchers developed a technique, called targeted memory reactivation（TMR）, aimed at further enhancing_________memories: when a sound becomes associated with a memory and is later played during sleep, that memory gets_________. In a study published last November in Psychological Science, scientists tested whether_________the memory of a puzzle during sleep might also improve problem-solving.About 60 participants visited the laboratory before and after a night of_________. First, they_________spatial, verbal and conceptual puzzles, with a distinct music clip repeating in the background for each, until they had worked on six puzzles they could not solve. Overnight they wore electrodes（电极）to detect slow-wave sleep, which may be important for memory enhancement—and a device played the sounds _________to three of the six unsolved puzzles. The next day, back at the lab, the participants attempted the six puzzles again.（Each repeated the experiment with a different set of puzzles the following night.） All told, the subjects solved 32 percent of the sound-stimulated puzzles compared with 21 percent of the_________puzzles.The researchers "very bravely went for quite complex tasks that involved a lot of complex processing, and remarkably they found these really strong effects in all of their __________." says Penny Lewis,a psychologist at Cardiff University, who was not involved in the research. "These are supercool results. Now we need to go out and try to understand them by firstly replicating（复制）them and secondly trying to __________the component processes that are actually being influenced."Beyond providing new evidence that humans restructure memories while sleeping, the research may have __________implications. "In a futuristic world, maybe TMR could help us use sleep to work on our problems," says lead author Kristin Sanders, who was a graduate student at Northwestern University during the study. Sleep-monitoring technology is increasingly accessible—and even without devices, prospective solvers can focus on important problems before __________.Still, sleep is not __________; people need to do their homework and load their heads with the puzzle pieces involved. "I'm not goingto solve cancer with this technique," Sanders says, "because I am totally __________cancer research."【小题1】A．applications B．commitment C．attention D．pathways【小题2】A．counts B．expands C．insists D．passes【小题3】A．treasured B．selected C．devoted D．shortened 【小题4】A．dimmed B．stored C．reactivated D．researched 【小题5】A．neglecting B．examining C．erasing D．revisiting 【小题6】A．sleep B．experiment C．training D．relaxation 【小题7】A．created B．solved C．attempted D．classified 【小题8】A．assigned B．transformed C．explained D．introduced 【小题9】A．unsettled B．untargeted C．unstated D．untested【小题10】A．puzzles B．brains C．processes D．tasks【小题11】A．work out B．turn to C．take on D．bring about 【小题12】A．individual B．conceptual C．practical D．collective 【小题13】A．dinner B．dawn C．bed D．schooling 【小题14】A．significant B．magic C．fixed D．possible【小题15】A．dependentonB．curiousaboutC．interestedinD．ignorant of四、阅读选择4. I confess I hesitated when the editor in chief of The New York Times Magazine told me in late 2014 that I would be editing a new front-of-book column called Letter of Recommendation, about stuff people really like. The column was the brainchild of our staff writer, Sam Anderson, he explained. Sam figured that there was no shortage of places to find out what writers hate but few spaces for writers to talk about what they love. We would push against this trend, 900 words a week, 40-something times per year.The reason for my hesitation was a simple, unfortunate fact about writing. Writing about things you hate is easy: not just fun, but generative. The criticism tends to entertain, even if you disagree, but the ode doesn't. The writerly tone is well-suited to our age, but it's hard not to see it as a collective defense mechanism—as if revealing your true feelings exposes your unmentionable secrets to the public. Obsessions（喜欢）, meanwhile, are inseparable from our peculiarities as people—we come to love things for often weird reasons. When the column really works, it's as revealing about the author as it is its subject. One writer, a man in his late 30s, for example, recommended Pedialyte, which he drinks to balance theeffects of both drinking and exercise, and to cheat his way back to youth.I probably see somewhere between three and five Letter of Recommendation pitches a day. It's a great spot for trying out new writers in the magazine, so I try my best to keep up with all the email, but I often fail.（I feel genuinely terrible about this every day of my life.） Determining which to assign involves seeing how it meets the various criteria we've settled on over the years. We don't like the column to be timely—everything else in the world is timely. But on the other hand, we need to put a headline on the thing that people might reasonably recognize, stop and read about. There should be a personal angle to the recommendation, but also some universally recommendable aspect. But then again, it shouldn't be too recommendable; this isn't a column for lifehacks. The recommendation itself should be attractively unexpected—"sideways," as editors are perhaps too fond of saying—but really, it's just an excuse to cut brilliant writers loose to amuse or inspire us.【小题1】Sam Anderson proposed a column called Letter of Recommendation because he found ________.A．the fashion trend was not easy to push againstB．there was a shortage of good quality columnsC．writers could hardly find a place to share their likesD．his brainchild could sometimes increase readership【小题2】The word "ode"（in paragraph 2）is closest in meaning to________.A．praise B．blame C．hesitation D．determination 【小题3】Why is the writer in his late 30s mentioned in paragraph 2? A．To give an example of the writerly tone.B．To highlight the way that the column selects writers.C．To show how a collective defense mechanism works.D．To illustrate how writers reveal themselves in the column.【小题4】The writer hopes that in the column, ________.A．the recommended items are quite familiar to readersB．the recommended items should follow the latest trendC．readers can learn about life skills from the recommendations D．readers will find the recommendations beyond their expectation5. LilyStudying abroad is an area that is becoming increasingly interesting for researchers, as more students are choosing to do a semester, a year or even a degree in another country. In my research, I set out to establish whether young people attending a course abroad acquire more global awareness than students enrolled on similar courses in their home country, Using a comparative study of 50 Canadian undergraduates, half of whom studied abroad for varying lengths of time, there were shown to be considering gains in global awareness and these were not only noted by the students themselves but also their tutors.ThomasMy research project asked ten students starting a year of study abroad to keep a daily record of their experiences. Having begun the diary a month before leaving home they continued it for a month after they returned. The primary reason for studying abroad in all cases was to polish their language skill. The students were allowed towrite as freely as they wished by were asked to include comments on their language learning experience as well as on the strategies they used to cope with living in a new culture. Analysing the diaries, we found remarkably similar patterns. All the participants demonstrate a gradual recognition and acceptance of difference in other cultures and a new objectivity about their own culture as a result of their experience.JasmineThis paper reports on some research carried out last year into why students choose a period of study abroad, their reasons for selecting a specific destination, their behaviour when abroad and the extent to which the experience matches their expectations. Having administered a questionnaire to 1,000 international students studying at a number of universities in Australia, we got 696 responses. An initial analysis of the responses has revealed some interesting data suggesting that the key factor affecting all the areas we were investigating was the individual's personality and study interests. Country of origin and 'gender proved less significant than expected.JimmyThis research looked at the career paths of 35 young business people who had spent part of their university course at a foreign educational institution in order to ascertain whether those people had acquired greater cross-cultural perspectives through their experience of study abroad. Concerned about the lack of cultural awareness of their staff, a group of US business corporations proposed the research. The results are less conclusive than expected, but they do suggest that a period of study in a foreign country may help students to develop the cross-cultural awareness that US employers currently seek.【小题1】The passage is mainly about four researchers' findings on________.A．the reasons for young students to study abroadB．the impact and effects of studying in another countryC．the trend of more students furthering their study abroadD．the interest of students who once studied in another country【小题2】________used the subjects' personal account as the research material.A．Lily B．Thomas C．Jasmine D．Jimmy【小题3】According to the passage, which of the following statements is true?A．Most of the researchers found the students global awareness increased.B．All of the researchers took a reserved attitude towards studying abroad.C．None of the researchers thought gender played a role in students' choice.D．Only one of the researchers did research on the subjects' career development.6. When antibiotics（抗生素）first became available,farmers used them freely. Now scientists know that the overuse of antibiotics can cultivate drug-resistant bacteria that are dangerousto human health. Among debates over what kinds of restrictions should be put in place, figuring out how antibiotic-resistant bacteriaevolve and make their way to humans remains an area of intense interest.Jo Handelsman is tracing one such pathway that, as she puts it, travels from "farm to table."Handelsman, a microbiologist who is now associate director for science at the White House Office of Science and Technology Policy, looked into dairy cows, which are oftentreated with antibiotics and produce manure（排泄物）that farmers use on their crops. In addition to nutrients, that fertilizer may harbor antibiotic-resistant bacteria—a problem because the bacteria can come into contact with plants that are finally shipped to supermarkets and sometimes eaten raw.To find out how those antibiotic-resistant bacteria come to exist, Handelsman and her colleagues at Yale University added manure from a nearby Connecticut farm to raised beds of soil in 2013. In this case, the manure specifically came from cows that were not treated with antibiotics. The researchers unexpectedly found that there were more soil bacteria carrying antibiotic-resistant genes when they were grown with the manure than when they were grown with syntheticnitrogen-based fertilizer—even though the cows were drug-free.Previous research has found that manure from pigs treated with antibiotics contains resistant bacteria, but the cow-pie results suggest there are more factors promoting resistance besidesantibiotic use. Something about manure itself may encourage naturally resistant bacteria to increase.The findings should not, however, give the impression that resistance is everywhere, notes Lance Price, a microbiologist at George Washington University（who was not involved in the study）. "We can control this. There's very clear evidence that when we turnoff the antibiotic tap, we bring down drug-resistant bacteria," says Lance.Next on the farm-to-table schedule, Handelsman will test whether radishes grown in soil treated with cow manure are capable of taking up resistant genes from bacteria through their vascular system（循环系统）. "They have veins（血管）just like us," she says. "We don'thave any evidence yet that they're taking up the bacteria, but it's a really interesting possibility."【小题1】What does Jo Handelsman's research focus on?A．How antibiotics makes its way onto our table.B．What restrictions should be put to antibiotics use.C．How antibiotics-resistant bacteria reach human beings.D．What damage the overuse of antibiotics does to humans.【小题2】What did Jo's research find?A．Drug-free cows produced manure with antibiotic-resistant bacteria. B．Synthetic nitrogen-based fertilizer did more good to the environment.C．Soil bacteria carrying antibiotic-resistant genes were increasing with time.D．Manure from pigs treated with antibiotics contained fewerresistant bacteria.【小题3】Lance Price is quoted in the passage in order to ________. A．provide more evidence that drug-resistance bacteria are dangerous B．suggest another possible explanation to the antibiotics problems C．emphasize the importance of feeding cows with no antibiotics D．show that the research findings may not be that worrisome【小题4】Which of the following statements is Jo most likely to agree with?A．It is very likely that widespread resistance to antibiotics is not inevitable.B．Plants grown in soil fertilized with cow manure may contain drug-resistant genes.C．There is possibility that radishes take up resistant genes wherever they are planted.D．The vascular system plays a key role in guarding radishes against bacteria.五、六选四7. Washing the dishes can help you live longer in later yearsEven a small increase in light activity, such as washing dishesor a little gentle gardening, might help lower the risk of an early death among older adults, researchers say.“It is important for elderly people, who might not be able to do much moderate intensity activity, that just moving around and doinglight intensity activity will have strong effects and is beneficial,” said Ulf Ekelund, a professor and first author of the study at the Norwegian School of Sport Sciences. However, the study finds that there is more “bang for your buck” if you engage in intense activity compared with light activity. 【小题1】Published in the BMJ, the latest research involved a review of eight studies encompassing a total of more than 36,000 people with an average age of almost 63 years. Participants were followed for five to six years; 2,149 deaths were recorded. Crucially, all of the studies involved monitoring the physical activity of individuals who had activity trackers. 【小题2】For each study participants were split into four equal-sized groups, based on the total amount of time spent active, and the risk of death assessed, taking into account factors such as age, gender, body mass index, and socioeconomic status. This was then repeated for an amount of activity at different levels of intensity. The results were analysed together to give an overview. 【小题3】The resultsheld for different intensities of activity. The team said the study supported the message “sit less and move more and more often.”【小题4】It only looked at the situation for middle age and older adults, most of whom lived in the US or Europe, and some of theeffect could be due to those people with a higher risk of death being less likely to engage in physical activity. Physical activity levels also were only measured over one period of time.A．It is said that higher levels of any physical activity help keep off an early grave.B．The studies did not rely on self-reporting, which, the experts noted, could be unreliable.C．The latest study backs up previous research suggesting reducing time spent sitting still is beneficial.D．However, the study had limitations.E．A short period of intense activity is viewed as beneficial as much longer periods of lesser activity.F．The team found a greater volume of activity overall was linked to a lower risk of death.六、概要写作8. Directions: Read the following passage. Summarize in no more than 60 words the main idea of the passage and how it is illustrated. Use your own words as far as possible.The Useful BeanDo you know what the common factor in bee food, vinyl plastic, and tofu is? It is the soybean. Some part of the soybean is used in these products as well as many other edible（可以食用的）and nonedible products.The soybean is also considered to be one of the multipurpose and hardy plants. It can grow in low-quality soil. Throughout the life of the plant, a release of nutrients throughout plant roots makes soil more fertile. Soybeans are also very high in protein. With its hardiness, soil benefits, high-protein content, and various uses, some people believe the soybean will become the greatest weapon against world hunger.There are three standard procedures taken from the soybean plant—oil, protein, and whole soybeans. Oil is used for edible purposes such as cooking oil and salad dressing. Industries make nonedible use of soybean oil by adding to antistatic sprays, printer ink, and shampoo. One significant nonedible use of soybean oil is the making of vinyl plastics. Vinyl is used to make everything fromcredit cards and garden hoses to computer parts.Protein from the soybean is also used in edible and nonedible products. Edible uses for the protein include baby foods and hypoallergenic milk. Even animals benefit: bee food and fish food contain protein from the soybean. Some industries use the protein for nonedible purposes such as cosmetics, adhesives, yarn, and water-based paints.Items made using whole soybeans are the most commonly recognized product of the soybean plant. Whole soybeans are used to make foodfor people and animals. Grocery stores carry a variety of foods made with whole soybeans. Some of these items are pancake flour, coffee, soymilk, soy sauce and tofu.As the versatility（多用途）and hardiness of this bean gains popularity, more uses of soybean products will certainly be discovered._____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ______________________七、汉译英（整句）9. 在他看来，值得投资的是体验，而不是物品。
外科临床诊疗指南2020
外科临床诊疗指南2020Introduction.Surgical Clinical Practice Guidelines (SCPGs) are evidence-based recommendations for the optimal management of surgical conditions. They are developed by multidisciplinary teams of experts and are designed to improve the quality and consistency of surgical care. The Surgical Clinical Practice Guidelines 2020 (updated June 2023) are the most recent iteration of these guidelines.Key Updates.The SCPGs 2020 include several significant updates from the previous version. These include:New guidelines on the management of breast cancer, colorectal cancer, and lung cancer.Revised guidelines on the management of acuteappendicitis, cholecystitis, and diverticular disease.Updated recommendations on the use of antibiotics in surgery.New sections on the management of patients with complex medical comorbidities.A greater focus on patient-centered care and shared decision-making.Benefits of Using SCPGs.SCPGs offer several benefits for surgeons and patients alike. These include:Improved patient outcomes: SCPGs help surgeons to provide the best possible care to their patients by ensuring that they are following the latest evidence-based practices.Reduced variation in care: SCPGs help to reducevariation in surgical care by providing a standardized approach to the management of common surgical conditions.Improved communication between surgeons and patients: SCPGs can help surgeons to communicate more effectively with their patients about their treatment options and expected outcomes.Reduced costs: SCPGs can help to reduce the costs of surgical care by promoting the use of cost-effective treatments.Implementation of SCPGs.SCPGs should be implemented in all surgical settings. The process of implementation can be challenging, but there are several strategies that can be used to increase the likelihood of successful adoption. These include:Engaging surgeons and other healthcare professionals in the development and implementation of SCPGs.Providing education and training on the use of SCPGs.Developing tools and resources to support the implementation of SCPGs.Monitoring the impact of SCPGs on patient outcomes and costs.Conclusion.Surgical Clinical Practice Guidelines 2020 are an essential resource for surgeons and other healthcare professionals involved in the management of surgical conditions. They provide evidence-based recommendations for the optimal management of these conditions and can help to improve patient outcomes, reduce variation in care, and reduce costs.中文回答：2020年外科临床诊疗指南。
1浙江省人民医院抗生素合理应用20130903
西力欣1.5g, Bid/3.0g, qd 西力欣1.5g, q8h
如果医生完全规范给药，实际上有阻力： •造成护士的工作量增加 •门急诊的病人顺应性差
一天一剂使用的药物---方便，有效，经济
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不规范的给药方式给临床带来的危害
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临床不规范的给药方式将导致
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药物浓度长时间低于细菌MIC值
• 耐药菌的传播
T>MIC<30-40%
耐药菌持续存在并繁殖
敏感菌
临床显效不等于细菌学治愈
Dagan et al. Pediatr Infect Dis J 1998;17:776–782
耐药菌
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不规范的给药方式
--不足量抗生素治疗的结果
对于临床医生的潜在威胁： – 病人治疗失败的可能性明显增加
浓度
MIC
Total 时间
抗菌药物在体内的作用主要决定 于药代动力学和 MIC.
Dudley MN, Griffith D. Animal models of infection. In: Nightingale CH, Murakawa T, Ambrose PG, eds. Antimicrobial Pharmacodynamics in Theory and Practice. 1st ed. New York, NY: Marcel Dekker; 2001.
24小时AUC（浓度时间曲线下面积)/MIC、峰浓度/MIC
是疗效相关的主要参数
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抗菌药物在体内起效的过程
剂量 药动学 药效学 起效
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关于青霉素的使用的发现与应用英语作文
关于青霉素的使用的发现与应用英语作文全文共5篇示例，供读者参考篇1大家好!我是小学六年级的小明。
今天我要给大家讲述一个了不起的发现——青霉素!大家都生过病吧?比如感冒、发烧或者肚子疼。
这些病都是由细菌引起的哦。
在过去,这些病很严重,有时甚至会导致死亡!你们知道为什么吗?因为当时人们还没有发现抗生素来对抗细菌。
幸运的是,在1928年,一位叫亚历山大·佛莱明的科学家无意中发现了青霉素。
佛莱明博士正在研究一种细菌,不小心把实验室的窗户打开了。
第二天,他发现那些细菌周围长出了一种奇怪的绿色物质。
原来是窗外飘进来的一种青霉菌孢子,它们释放出一种物质阻止了细菌的生长。
佛莱明很聪明,马上意识到这种物质可能就是杀死细菌的"武器"!经过多年努力,他最终从青霉菌中提取出了青霉素。
青霉素是人类历史上第一种抗生素。
它对治疗许多细菌感染非常有效,例如肺炎、脑膜炎等。
在第二次世界大战期间,青霉素拯救了数以百万计士兵的生命。
真是一个伟大的发现!后来,科学家们又发现了更多其它的抗生素,极大地提高了人类的生存率。
不过,我们也要警惕抗生素滥用的问题。
有些人感冒或小病时就乱吃抗生素,这很不好,会让细菌变得更强壮、更难对付。
我们只有在医生的指导下正确使用抗生素,它们才能继续发挥良好作用。
总之,青霉素的发现让人类能有效对抗细菌感染,这是一个了不起的贡献。
让我们感谢佛莱明博士,也珍惜抗生素这个宝贵的礼物,为人类的健康多加小心!篇2亲爱的小朋友们,大家好!今天我要给大家讲一个关于"青霉素"的发现和应用的故事。
你们知道青霉素是什么吗?青霉素是一种非常神奇的药物,它可以帮助我们治疗很多由细菌引起的疾病。
在青霉素被发现之前,许多人因为感染而死去,因为那时还没有可以治疗细菌感染的药物。
青霉素是如何被发现的呢?这真是一个很有趣的故事!1928年,一位名叫亚历山大·佛兰明的科学家在做实验的时候,无意中发现了一种奇怪的绿色霉菌。
关于青霉素的使用的发现与应用英语作文
The Discovery and Application of Penicillin: A Revolutionary AntibioticPenicillin, discovered by Alexander Fleming in 1928, revolutionized the field of medicine and saved millions of lives worldwide. Fleming's accidental discovery marked the beginning of a new era in antibacterial therapy, changing the course of history and the way we treat infectious diseases.The journey of penicillin began with a simple observation. Fleming noticed that a mold growing on a Petri dish had killed the surrounding bacteria. He realized that the mold was producing a substance that had antibacterial properties. This substance, later named penicillin, proved to be effective against a wide range of bacterial infections.The development of penicillin was not without its challenges. Initially, it was difficult to isolate and purify the antibiotic in sufficient quantities for clinical use. However, through meticulous research and dedication, scientists were able to overcome these obstacles and produce penicillin on a large scale.The impact of penicillin on medicine was immense. It became a crucial tool in the fight against many life-threatening infections, including pneumonia, syphilis, and gonorrhea. Penicillin's efficacy was particularlysignificant during World War II, when it was used to treat soldiers wounded on the battlefield, reducing mortalityrates significantly.Today, penicillin and its derivatives are still widely used to treat a variety of bacterial infections. However,the rise of antibiotic resistance has become a global concern. The overuse and misuse of antibiotics have led to the development of resistant strains of bacteria, which are becoming increasingly difficult to treat.Despite these challenges, the discovery and application of penicillin remain a remarkable milestone in the historyof medicine. It has saved countless lives and continues to serve as a foundation for the development of newantibiotics and antimicrobial agents. As we face thegrowing threat of antibiotic resistance, it is crucial that we continue to research and innovate, ensuring that we have effective tools to combat infectious diseases in the future.**青霉素的发现与应用：革命性的抗生素**1928年，亚历山大·弗莱明发现了青霉素，这一发现彻底改变了医学领域，并在全球范围内拯救了数百万人的生命。
geneticin(遗传霉素-新霉素)使用说明书-20210121zjr1
遗传霉素（Geneticin）使用说明书◼产品包装和保存条件注：a. 建议分装保存，避免反复冻融，否则活性受到影响。
b. 遗传霉素为了达到最理想的稳定状态和最长的保质期，最好存放于-20°C，保质期为1年。
◼产品简介遗传霉素（Geneticin，G418）是一种氨基糖苷类抗生素，在分子遗传试验中，是稳定转染最常用的抗性筛选试剂之一。
它通过抑制转座子Tn601，Tn5的基因,干扰核糖体功能而阻断蛋白质合成，对原核和真核等细胞产生毒素，包括细菌、酵母、植物和哺乳动物细胞，也包括原生动物和蠕虫。
当neo基因被整合进真核细胞DNA后,则能启动neo基因编码的序列转录为mRNA，从而获得抗性产物氨基糖苷磷酸转移酶的高效表达，使细胞获得抗性而能在含有G418的选择性培养基中生长。
G418的这一选择特性，已在基因转移、基因敲除、抗性筛选以及转基因动物等方面得以广泛应用。
不同细胞对G418的敏感度不同，在筛选之前，要通过预实验确定G418的最佳筛选浓度，G418推荐用100~1000 μg/mL的范围筛选合适的浓度，G418最常用的工作浓度为100~700 μg/mL，G418的作用时间是10-14天，可参考文献并进行预实验摸索。
◼产品使用使用步骤：（哺乳动物细胞筛选）►遗传霉素杀灭曲线的确定（目的稳定转染细胞株，仅作参考）为了筛选得到稳定表达目的细胞株，需要确定能够杀死未转染宿主细胞的抗生素最低浓度，可通过建立杀灭曲线来实现，至少选择6个浓度。
处理分裂期的细胞时G418的活性最强，因此在添加G418之前需要让细胞培养一段时间。
（1）Day0：未转化细胞按照20-25%的细胞密度铺在合适的培养板上，37℃，CO2培养过夜。
（2）根据细胞类型，设定合适范围内的浓度梯度。
以哺乳动物细胞为例，可设定0，50，100，200，400，800，1000 μg/mL。
（3）Day1：去除旧的培养基，换用新鲜配制的含有相应浓度药物的培养基。
约翰斯·霍普金斯指南：抗生素指南说明书
Nursing Central™Your complete mobile andweb solution for nursing!The Johns Hopkins Guides are a series of comprehensivereferences, created by the experts at Johns HopkinsMedicine. Each of the resources can be downloadedas a mobile app to tablets and smartphones and containfrequently updated, evidence-based recommendationsthat help raise the standard of care.Johns Hopkins ABX Guide is the#1 Ranked Infectious Disease App– Clinical Infectious DiseasesJohns Hopkins ABX GuideThe official ABX (Antibiotic) Guide contains quick-to-read,detailed coverage of infectious diseases including drugs,vaccines, specific infections, pathogens, and more.NEW! Johns Hopkins Psychiatry GuideConsult the Psychiatry Guide for disease, drug, and treatmentdetails. Review recommendations from the renowned PHIPPSClinic consistent with the latest diagnostic criteria.From the Johns Hopkins POC-IT Center. For more information go to .© 2014 Unbound Medicine, Inc. All rights reserved.Subscriptions to any of the mobile guides include web access, allowing you to find the answers you need using any web browser.The official Johns Hopkins Guides website features the same evidence-based information contained in the apps along with access to selected MEDLINEJournals, the Johns Hopkins CME program, medical news, and more.Experience the official Johns Hopkins Guides at: The Johns Hopkins POC-IT ABX GuideEditor In Chief: John G. Bartlett, MD Managing Editor: Paul G. Auwaerter, MD Pharmacology Editor: Paul Pham, PharmD, BCPSThe Johns HopkinsPOC-IT Psychiatry GuideEditors In Chief:J. Raymond DePaulo, Jr., MD O. Joseph Bienvenu, MD, PhD Managing Editors: Paul Kim, MD, PhD Paul Nestadt, MD Matthew Peters, MD Traci Speed, MD, PhDPharmacology Editor:Sujin Lee Weinstein, PharmD, BCPPThe Johns Hopkins POC-IT Diabetes GuideEditor In Chief:Rita Rastogi Kalyani, MD, MHS Co-Editor: Thomas Donner, MDThe Johns Hopkins POC-IT HIV GuideEditor In Chief: Joel E. Gallant, MD, MPH Pharmacology Editor: Paul Pham, PharmD, BCPSGroup discounts and site licenses are available.For more information: *************************1.800.230.2423。
抗生素分类进展
抗生素分类进展引言抗生素是一类用于治疗细菌感染的药物，自20世纪初开始广泛应用。
在过去的几十年里，抗生素的分类和使用经历了许多变化和进展。
本文将对抗生素分类的最新进展进行综述。
基础分类抗生素可以按照其化学结构、作用机制和抗菌谱进行分类。
化学结构根据化学结构的不同，抗生素可分为以下几类：1. 青霉素类：包括青霉素G、青霉素V等，具有β内酰胺环结构。
2. 大环内酯类：如红霉素、克拉霉素等，结构中含有大环内酯环。
3. 氨基糖苷类：如庆大霉素、链霉素等，结构中含有氨基糖苷基团。
4. 四环素类：如土霉素、多西环素等，结构中含有四环芳烃。
5. 强大环类：如利福霉素、喹诺酮类抗生素等，结构中含有强大环。
作用机制抗生素根据其作用机制的差异，可分为以下几类：1. 细胞壁合成抑制剂：如β-内酰胺类抗生素，抑制细菌的细胞壁合成。
2. 核酸合成抑制剂：如喹诺酮类抗生素，抑制细菌的核酸合成。
3. 蛋白质合成抑制剂：如氨基糖苷类抗生素，抑制细菌的蛋白质合成。
抗菌谱抗生素根据其对细菌的杀菌谱范围，可分为以下几类：1. 苯唑啉类：对革兰氏阳性菌有较高的活性，如头孢菌素C。
2. 氨基糖苷类：对革兰氏阴性菌有较高的活性，如庆大霉素。
3. 红霉素类：对革兰氏阳性菌和革兰氏阴性菌均具有活性，如红霉素。
4. 头孢菌素类：对革兰氏阳性菌和部分革兰氏阴性菌具有活性，如头孢菌素C。
近年来的分类进展抗生素的分类在近年来有了较大的进展，主要体现在以下几个方面：1. 抗生素的目标特异性：随着对细菌作用机制的深入研究，人们开始将抗生素按照其目标的特异性进行分类，例如，将抗生素分为靶向细胞壁的药物、靶向核酸的药物等，这种分类方法更有助于医生选择合适的抗生素治疗不同类型的细菌感染。
2. 新型抗生素的发现：近年来，科学家们通过不断探索抗生素的多样性，发现了许多新型抗生素，如青霉素类的新成员和新型碳青霉烯类抗生素。
这些新型抗生素具有较高的效力，对抗多重耐药菌株具有重要意义。
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内酰胺类/ 四、β内酰胺类/β内酰胺酶抑制剂
• 阿莫西林/克拉维酸 阿莫西林/ • 替卡西林/克拉维酸 替卡西林/ • 氨苄西林/舒巴坦 氨苄西林/ • 头孢哌酮/舒巴坦 头孢哌酮/ • 哌拉西林/三唑巴坦 哌拉西林/
（一）适应症
1.适用于产β内酰胺酶而对β 1.适用于产β内酰胺酶而对β内酰胺类药物耐药 适用于产 的细菌感染。 的细菌感染。不推荐用于对复方制剂中抗生 素敏感的细菌感染和非产β 素敏感的细菌感染和非产β内酰胺酶的耐药 菌感染。 菌感染。
八、万古霉素和去甲霉素
（一）适应症
1.耐药G 1.耐药G+，特别是甲氧西林耐药金葡菌 耐药 MRSA）、 ）、甲氧西林耐药凝固酶阴性葡萄球 （MRSA）、甲氧西林耐药凝固酶阴性葡萄球 MRCNS）、 ）、肠球菌属和耐青霉素肺炎链球 菌（MRCNS）、肠球菌属和耐青霉素肺炎链球 菌所致的感染。 菌所致的感染。 2.粒细胞缺乏高度怀疑 感染。（ 粒细胞缺乏高度怀疑G 。（G 2.粒细胞缺乏高度怀疑G+感染。（G-对万古霉 素通常耐药）。 素通常耐药）。 3.口服可用于甲硝唑无效的艰难梭菌所致的假 3.口服可用于甲硝唑无效的艰难梭菌所致的假 膜性肠炎。 膜性肠炎。
2.抗菌谱 2.抗菌谱
β内酰胺类/β内酰胺酶抑制剂 产β内酰胺酶的细菌 内酰胺类/ 阿莫西林/ 阿莫西林/克拉维酸 流感嗜血杆菌 卡他莫拉菌 大肠埃希菌等肠杆菌科细菌 甲氧西林敏感金葡菌 氨苄西林/ 氨苄西林/舒巴坦 头孢哌酮/ 头孢哌酮/舒巴坦 替卡西林/ 替卡西林/克拉维酸 哌拉西林/ 哌拉西林/三唑巴坦 同上 大肠埃希菌等肠杆菌科细菌 铜绿假单胞菌 拟杆菌属等厌氧菌
(二)注意事项
1.不宜用于轻症感染,不可作为预防用药。 1.不宜用于轻症感染,不可作为预防用药。 不宜用于轻症感染 2.亚胺培南可引起癫痫、肌阵挛、 2.亚胺培南可引起癫痫、肌阵挛、意识障碍 亚胺培南可引起癫痫 等中枢不良反应,故不适用于中枢感染。 等中枢不良反应,故不适用于中枢感染。 美罗培南、帕尼培南无此副作用，但原有 美罗培南、帕尼培南无此副作用， 癫痫者使用， 癫痫者使用，仍需严密观察抽搐等中枢不 良反应。 良反应。 3.肾功能↓ 3.肾功能↓和老年人使用时应根据肾功能酌 肾功能 情减量。 情减量。
（二）注意事项
1.有肾、耳毒性和神经肌肉阻滞作用， 1.有肾、耳毒性和神经肌肉阻滞作用，故用药期间应监测 有肾 肾功能、听力和神经肌肉症状。 肾功能、听力和神经肌肉症状。 2.对社区获得性感染的主要致病菌 肺炎球菌、 对社区获得性感染的主要致病菌（ 2.对社区获得性感染的主要致病菌（肺炎球菌、溶血性链 球菌）作用差，故门急诊呼吸道感染不宜选用。 球菌）作用差，故门急诊呼吸道感染不宜选用。因其肾 毒性，也不宜用于尿路感染。 毒性，也不宜用于尿路感染。 3.老人、儿童尽量避免使用，必需用时应监测血药浓度。 3.老人、儿童尽量避免使用，必需用时应监测血药浓度。 老人 4.妊娠期妇女避免使用 妊娠期妇女避免使用， 4.妊娠期妇女避免使用，哺乳期妇女避免使用或用药期间 停止哺乳。 停止哺乳。 5.不宜与其他有肾 不宜与其他有肾、 5.不宜与其他有肾、耳、神经肌肉毒性药物或强利尿剂同 用。 6.眼内或结膜下禁用 因可能引起黄斑坏死。 眼内或结膜下禁用， 6.眼内或结膜下禁用，因可能引起黄斑坏死。
第四代ቤተ መጻሕፍቲ ባይዱ金葡
（一）适应症
主 要 抗 菌 谱 第一代 甲氧西林敏感葡萄球菌， 甲氧西林敏感葡萄球菌， 溶血性链球菌， 溶血性链球菌，肺炎球菌 所致呼吸道感染， 所致呼吸道感染，尿路感 血液感染， 染，血液感染，软组织感 染 同上 +脑膜炎球菌 脑膜炎球菌 流感嗜血杆菌 大肠埃希菌 奇异变形杆菌
第二代
3.广谱青霉素 3.广谱青霉素 氨苄西林、阿莫西林、哌拉西林、阿洛西林、 氨苄西林、阿莫西林、哌拉西林、阿洛西林、 美洛西林 • 抗菌谱除G+菌外，还包括部分肠杆菌科细菌 抗菌谱除G 菌外， （流感嗜血杆菌、大肠埃希菌、奇异变形杆 流感嗜血杆菌、大肠埃希菌、 ），其中哌拉西林 阿洛西林、 其中哌拉西林、 菌），其中哌拉西林、阿洛西林、美洛西林 对铜绿假单胞菌亦有良好的抗菌作用
（二）注意事项
1.必须询问有无青霉素过敏史，必须先做青霉 1.必须询问有无青霉素过敏史， 必须询问有无青霉素过敏史 素皮试。 素皮试。 2.一旦发生过敏性休克 必须就地抢救。 一旦发生过敏性休克， 2.一旦发生过敏性休克，必须就地抢救。 3.大剂量可引起青霉素脑病 腱反射↑ 大剂量可引起青霉素脑病（ 3.大剂量可引起青霉素脑病（腱反射↑、肌肉痉 抽搐、昏迷等中枢神经系统反应）， ），易 挛、抽搐、昏迷等中枢神经系统反应），易 出现在老年和肾功能↓ 出现在老年和肾功能↓者。 4.不用于鞘内注射 不用于鞘内注射。 4.不用于鞘内注射。 5.青霉素钾盐不可静脉注射 5.青霉素钾盐不可静脉注射 6.在碱性溶液中易失活 在碱性溶液中易失活。 6.在碱性溶液中易失活。
（二）注意事项
1.副作用：假膜性肠炎，神经肌肉阻滞作用， 1.副作用：假膜性肠炎，神经肌肉阻滞作用， 副作用 尿潴留（老年男性须注意）。 尿潴留（老年男性须注意）。 2.不推荐用于新生儿。 2.不推荐用于新生儿。 不推荐用于新生儿 3.妊娠妇女确有指征时方可慎用， 3.妊娠妇女确有指征时方可慎用，哺乳期妇女 妊娠妇女确有指征时方可慎用 用药期间暂停哺乳。 用药期间暂停哺乳。 4.静脉给药应缓慢滴注，不可静脉推注。 4.静脉给药应缓慢滴注，不可静脉推注。 静脉给药应缓慢滴注
各类抗生素的适应症和注意事项
一、青霉素类
（一）适应症
1.青霉素 1.青霉素 青霉素G、普鲁卡因青霉素、苄星青霉素、 青霉素G 普鲁卡因青霉素、苄星青霉素、 青霉素V 苯氧甲基青霉素） 青霉素V（苯氧甲基青霉素） • 主要作用于G+菌（链球菌、不产青霉素酶金葡菌、肠 主要作用于G 链球菌、不产青霉素酶金葡菌、 球菌、淋球菌、放线菌、梅毒螺旋体等） 球菌、淋球菌、放线菌、梅毒螺旋体等）
抗菌活性 有效血浓度时间 青霉素G 青霉素G 普鲁卡因青霉素 苄星青霉素 青霉素V 青霉素V 强 中 中 弱 6-8h 1212-24h 4周 6-8h 用法 v m m po
2.耐青霉素酶青霉素 2.耐青霉素酶青霉素 甲氧西林（现仅用于药敏试验）、苯唑西 甲氧西林（现仅用于药敏试验）、苯唑西 ）、 林、氯唑西林 • 主要作用于产青霉素酶的G+菌 主要作用于产青霉素酶的G
六、林可霉素类
• 林可霉素 • 克林霉素
（一）适应症
1.林可霉素： 1.林可霉素： 林可霉素 • 肺炎链球菌 • 其他链球菌属（肠球菌属除外） 其他链球菌属（肠球菌属除外） • 甲氧西林敏感金葡菌 2.克林霉素 2.克林霉素 • 抗菌谱同林可霉素，抗菌活性优于林可霉素 抗菌谱同林可霉素， • 厌氧菌
主 第三代
要
抗
菌
谱
肠杆菌科细菌 • 他啶及哌酮对铜绿假单胞菌有效 • 三代比较 感染 适宜 肠道 胆道 泌尿道 铜绿假单胞菌 噻肟 哌酮 曲松 他啶
第四代
同第三代 • 对第三代耐药的阴沟、产气、沙雷可能有效 对第三代耐药的阴沟、产气、 • 可用于中性粒细胞缺乏伴发热的经验治疗
(二)注意事项 1.禁用于对任何一种头孢菌素有过 1.禁用于对任何一种头孢菌素有过 敏史和青霉素过敏性休克的患者。 敏史和青霉素过敏性休克的患者。 2.第三代主要经肾排泄 肾功能↓ 第三代主要经肾排泄, 2.第三代主要经肾排泄,肾功能↓时 须调整剂量, 须调整剂量,哌酮及曲松部分经胆 道排泄,肝功能↓时须调整剂量。 道排泄,肝功能↓时须调整剂量。 3.第一代与氨基糖苷类合用加重肾 3.第一代与氨基糖苷类合用加重肾 毒性。 毒性。 4.哌酮可导致凝血酶原 而出血， 哌酮可导致凝血酶原↓ 4.哌酮可导致凝血酶原↓而出血，合 用维生素K可预防。 用维生素K可预防。
二、头孢菌素
抗菌活性 G+ 第一代 第二代 第三代 ++ + G+ ++ ++ 阴沟+++ 阴沟+++ 产气+++ 产气+++ 沙雷+++ 沙雷+++ 静 脉 用 法 口 服
唑林、噻吩、 唑林、噻吩、拉定 呋辛、 呋辛、替安 噻肟、曲松、他啶、哌酮 噻肟、曲松、他啶、 头孢吡肟 拉定、氨苄、 拉定、氨苄、羟氨苄 克洛、呋辛、 克洛、呋辛、丙烯 克肟、泊肟 克肟、
（二）注意事项 1.询问青霉素过敏史 包括β内酰胺酶抑制剂） 询问青霉素过敏史（ 1.询问青霉素过敏史（包括β内酰胺酶抑制剂）并 进行青霉素皮试，有过敏者禁用青霉素类/ 进行青霉素皮试，有过敏者禁用青霉素类/β内 酰胺酶抑制剂。 酰胺酶抑制剂。 2.有头孢菌素或舒巴坦过敏史禁用头孢哌酮 有头孢菌素或舒巴坦过敏史禁用头孢哌酮/ 2.有头孢菌素或舒巴坦过敏史禁用头孢哌酮/舒巴 有青霉素过敏史者慎用， 坦，有青霉素过敏史者慎用，有青霉素过敏性 休克史者禁用。 休克史者禁用。 3.发生过敏反应须立即停药 发生过敏反应须立即停药， 3.发生过敏反应须立即停药，发生过敏性休克应 立即抢救。 立即抢救。 4.有肾功能不全者应根据肾功能 程度调整剂量。 有肾功能不全者应根据肾功能↓ 4.有肾功能不全者应根据肾功能↓程度调整剂量。 5.本类药物不推荐用于儿童 本类药物不推荐用于儿童。 5.本类药物不推荐用于儿童。
五、氨基糖苷类
常用： 常用： 阿米卡星 庆大霉素 妥布霉素 奈替米星 异帕米星 依替米星
（一）适应症
1.肠杆菌科细菌感染。 1.肠杆菌科细菌感染。 肠杆菌科细菌感染 2.铜绿假单胞菌 葡萄球菌、肠球菌， 铜绿假单胞菌、 2.铜绿假单胞菌、葡萄球菌、肠球菌，但常与 其他抗生素联合应用。 其他抗生素联合应用。 3.属浓度依赖性抗菌药 每日剂量一次给予。 属浓度依赖性抗菌药， 3.属浓度依赖性抗菌药，每日剂量一次给予。 4.链霉素可用于结核病的联合疗法 链霉素可用于结核病的联合疗法。 4.链霉素可用于结核病的联合疗法。 5.新霉素口服可用于结肠术前准备或局部。 5.新霉素口服可用于结肠术前准备或局部。 新霉素口服可用于结肠术前准备或局部 6.巴龙霉素可用于肠道隐孢子虫病 巴龙霉素可用于肠道隐孢子虫病。 6.巴龙霉素可用于肠道隐孢子虫病。 7.大观霉素仅用于单纯性淋病 大观霉素仅用于单纯性淋病。 7.大观霉素仅用于单纯性淋病。