陕西省首株福氏4c志贺菌的发现及其耐药性和毒力基因型分析

[目的]报道陕西省首株福氏4c志贺菌的发现,并分析其耐药性和毒力基园型.[方法]生化反应、血清凝集试验、噬菌体裂解试验鉴定菌株,抗生素敏感试验采用生物梅里埃GNS药敏卡,PCR法检测ipalH、shet1、ial、sen基因.[结果]该株细菌生化反应及噬菌体裂解试验菌结果均为志贺菌,血清凝集反应特殊,确定为福氏4c志贺菌;对阿莫西林、培氟沙星、替卡西林等少数抗生素耐药,对复方新诺明等敏感;该菌4种毒力基因都阳性,属Ⅰ型福氏4c志贺菌.[结论]福氏4c志贺菌在陕西首次发现,属毒力较强的Ⅰ型福氏4c志贺菌,目前尚没有形成多重耐药.应加强对这类菌株的监测,以防其继续发生甚至流行.     

福氏2c(新菌型)和福氏2a志贺菌生物学关系实验研究

目的：探讨F2c(shigella flexneri 2c,F2c)与F2a志贺菌间的相互关系（异同点），了解新菌型的各种生物学特性。方法：对上述两株志贺菌进行生化、噬菌体裂解、药敏试验及血清学凝集.结果：两株细菌生化反应、噬菌体裂解试验结果均相同。F2c同时含有群抗原3，4和7，它对庆大霉素、妥布霉素、卡那霉素、乙基西梭霉素、氧哌嗪青霉素耐药，而F2a则对以上五种药均敏感。结论：新发生的F2c与F2a在药物敏感性上存在着很大差异。     

2005～2007年郑州市腹泻患者志贺菌监测结果分析

[目的]了解郑州市志贺菌的菌型分布,为防控菌痢流行提供可靠数据。[方法]按照《全国细菌性痢疾监测工作方案》对郑州市市辖医院20052007年腹泻患者粪便标本进行志贺菌分离培养、生化鉴定和血清学分型以及药敏试验。[结果]20052007年郑州市共检测1 321份标本,检出志贺菌116株,检出率为8.78%。志贺菌分布在福氏和宋內氏2个群,未检出A群和C群。不同年份间菌株均以B群志贺菌为主,分别为39、37和21株,分别占当年阳性菌株的92.86%、77.08%、80.77%;福氏志贺菌以F4c（47株）为主,占48.45%,其次是F1a（21株）、F2a（17株）,分别占21.65%和17.53%;志贺菌对萘啶酸和四环素100.00%耐药。[结论]各年优势菌群均为福氏志贺菌,F4c为优势菌型,多种菌型并存,临床治疗要根据耐药情况合理使用抗生素。     

福氏2c(新菌型)和福氏2a志贺菌生物学关系实验研究

目的：研究福氏志贺菌2c与2a之间的生物学关系。了解新菌型的生物学特性。方法：对前述2株菌进行生化试验、噬菌体裂解试验、药物敏感试验和血清凝集试验。结果：2株菌的生化反应、噬菌体裂解模式均相同。福氏志贺菌2c同时含有群抗原3，4和7，对乙基西羧霉素、庆大霉素、卡那霉素耐药，而福氏志贺菌2a则对以上3种药物敏感。结论：新发现的福氏志贺菌2c与福氏志贺菌2a在药物敏感性上存在较大的差异。     

福氏志贺菌4c亚型深圳分离株的生物学和分子特性分析

[目的]对深圳市首次分离的福氏志贺菌4c亚型菌株进行生物学和分子特性分析,了解该类新菌型生物学特征及分子特征。[方法]采用生化反应、血清学分型、刚果红侵袭试验、药敏分析等方法对患者、厨工肛拭及物体表面的17株福氏志贺菌分离株进行病原学分析,采用质粒图谱和毒力基因分析方法进行分子特性分析。[结果]所得到的福氏志贺菌4c亚型分离菌均分解葡萄糖产酸不产气,甘露醇阳性,血清学鉴定为福氏志贺菌IV型,7群菌株;刚果红侵袭试验均阳性;对氨卞西林、四环素、甲氧苄啶、阿莫西林耐药,而对阿米卡星、环丙沙星、庆大霉素、头孢噻肟、头孢噻吩和诺氟沙星敏感;所有菌株的质粒电泳图谱相同,但与F4a、F4b质粒电泳图谱差异较大;所有菌株均携带ipaH和set1基因,而仅有23.5%(4/17)的菌株携带ial和sen基因。[结论]该福氏志贺菌4c亚型深圳分离株的的生化、血清学鉴定结果与现有报道基本相符,该菌具备一定毒力。所有菌株均为同一来源,但4c亚型并非变异于F4a和F4b。ipaH和set1毒力基因携带情况与相关报道相符,ial和sen基因携带情况低于现有报道。     

一株类志贺邻单胞菌的检出报告

[目的]了解类志贺邻单胞菌生物学特性. [方法]采用生化反应、血清学凝集、药敏试验对所检菌株进行分析. [结果]检出株菌确诊为类志贺邻单胞菌. [结论]类志贺菌应与肠杆菌科志贺菌加以鉴别.     

生化反应属于大肠埃希菌而血清学符合鲍氏Ⅱ型志贺菌株的初探

对从健康人群身上分离到的一株生化反应属于大肠埃希菌而血清学符合鲍氏Ⅱ型志贺菌的菌株的生物学性状进行初步研究。健康人群粪便样本经增菌、分离培养后挑取可疑菌株作培养、生化反应、血清学鉴定。“K-B”法检测细菌对抗生素敏感性。该菌为G-杆菌、生化性状符合大肠埃希菌,药敏试验对多种抗生素耐药,同时,对氯霉素、丁胺卡那敏感。血清学鉴定符合鲍氏Ⅱ型志贺菌。该菌株从生化反应,血清学两方面来看,需进一步研究。     

福氏志贺菌4c亚型深圳分离株的病原特性及毒力基因分析

目的对深圳市首次分离的福氏志贺菌4c亚型菌株进行病原学分析,了解该类新菌型特征。方法采用生化反应、血清学分型、刚果红侵袭试验、药敏分析等方法对从患者、厨工肛拭及物体表面等样本中分离的17株福氏志贺菌分离株进行病原学分析,并对ipaH、ial、sen、set4个毒力基因进行PCR检测。结果所得到的17株福氏志贺菌4c亚型分离茵均分解葡萄糖产酸不产气,甘露醇阳性,血清学鉴定均为福氏志贺菌IV型、7群菌株,刚果红侵袭试验均阳性,均对氨卞西林、四环素、红霉素、甲氧苄啶、阿莫西林耐药,而对阿米卡星、环丙沙星、庆大霉素、头孢噻肟、头孢噻吩和诺氟沙星敏感,所有菌株均携带ipaH和set基因,而仅有23．53％（4／17）的菌株携带ial和sen基因。结论该福氏志贺菌4c亚型深圳分离株的生化、血清学鉴定结果与报道福氏志贺菌4c亚型基本相符,该菌具备一定毒力,ipaH和set毒力基因携带情况与相关报道相符,ial和sen基因携带情况低于现有报道。     

滨海县2006—2008年食品从业人员志贺菌感染和耐药分析

[目的]了解滨海县2006—2008年食品从业人员志贺菌感染情况及菌株耐药特性。[方法]对健康体检检测到的57株志贺菌进行菌型分析和药敏试验。[结果]57株志贺菌中,福氏志贺菌44株,宋氏志贺菌10株,痢疾志贺菌2株,鲍氏志贺菌1株。药敏结果:90%以上菌株对氨曲南、亚胺培南、阿莫西林/克拉维酸、环丙沙星、头孢他定、头孢曲松、头孢吡肟敏感;50%以上对氨苄西林、青霉素、萘啶酸、复方磺胺甲恶唑、四环素、氯霉素、哌拉西林产生耐药。[结论]2006—2008年滨海县食品从业人员志贺菌感染以B群为主,由于抗生素的广泛使用,志贺菌的耐药性越来越严重。     

三株肠致病性大肠杆菌O128:K67(B12)生物学关系实验研究

目的：了解从不同时间、不同地点食物中毒标本中分离到的3株肠致病性大肠杆菌（EPEC）O128：K67（B12）是否存在着种间生物学差异。方法：用同批试剂，对上述3株细菌进行生化反应、噬菌体裂解及药敏等各种生物学试验。结果：3株EPECO128：K67（B12）存在着四项生化反应差异；噬菌体裂解模式也不同；药敏试验结果亦存在着差异。结论：同一血清型EPEC O128：K67（B12）存在着种间生物学差异。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

西林瓶装注射用水的装量检查分析

为了检查西林瓶装注射用水的实际分装量是否符合2005年版《药典》三部要求,按照2005年版《药典》三部中“生物制品分装和冻干规程”,分装规格为0．8ml的西林瓶装注射用水10000瓶,随机在分装过程的前、中、后阶段共抽取100瓶,轧盖、目检。分别用1ml标定注射器及1ml普通无菌注射器抽取每瓶注射用水的实际体积,以t检验法对实际抽取量与标示量的差值进行统计学分析,结果显示其与2005年版《药典》三部要求分装附加量为0．1ml相比有显著性差异（P〈0．001）。