耳念珠菌在医院感染控制中的研究进展

耳念珠菌(Candida auris)作为一类重要的感染性病原微生物,能够广泛定植于黏膜和皮肤上。自2009年首次报道以来,世界多地不断有新的耳念珠菌检出,呈现出全球流行趋势,严重威胁人类生命健康,已引起各国重视[1]。随着免疫抑制药物、抗真菌药物的广泛使用,加之各类有创性操作、器官移植和基础疾病缺陷患者的增加,使机会性致病真菌成为具有较高病死率的病原。     

成人耳念珠菌感染诊治防控专家共识

耳念珠菌是近期临床微生物学领域、感染性疾病领域的研究热点。该菌可以引起严重的侵袭性感染,容易漏检,部分多重耐药菌治疗困难,能引起院内感染暴发。中华医学会检验分会临床微生物学学组组织专家形成专家组,对耳念珠菌的病原学、流行病学、鉴定、抗真菌药物敏感性试验、同源性,以及耳念珠菌感染的诊断、处置、预防、控制进行了共识性建议,望引起国内业界对该菌的重视,助力该菌感染诊治防控难题的解决。     

染色体微阵列分析联合核型分析在胎儿轻度脑室增宽中的应用

摘要：耳念珠菌是近期临床微生物学领域、感染性疾病领域的研究热点。该菌可以引起严重的侵袭性感染，容易漏检，部分多重耐药菌治疗困难，能引起院内感染暴发。中华医学会检验分会临床微生物学学组组织专家形成专家组，对耳念珠菌的病原学、流行病学、鉴定、抗真菌药物敏感性试验、同源性，以及耳念珠菌感染的诊断、处置、预防、控制进行了共识性建议，望引起国内业界对该菌的重视，助力该菌感染诊治防控难题的解决。     

检验科医院感染管理现状及预防策略探讨

目前，预防控制医院感染是当前医院管理和治疗质量中的一个重要内容。住院患者的医院感染已经引起高度重视，但医务人员发生的医院感染往往被忽视。检验科是临床重要的医技科室，承担着患者的血液、尿液、粪便、痰液等临床标本的检验工作。很多临床标本中含有病原微生物，且具有很强的传染性，检验过程的每一个环节都有被病原微生物污染的可能。检验科通常是医院感染管理的重要对象。检验科的实验室工作人员不慎被病原菌感染的情况已有报道。因此，探讨医院感染管理的预防策略，对做好实验室医院感染的管理、预防检验科人员感染、保证医疗质量安全具有重要意义。     

不同护理措施对新生儿脐部感染的影响

新生儿由于缺乏抗病原微生物定植能力,机体防御功能不全,为医院易感人群[1],而新生儿脐部是病原微生物入侵的特殊门户,加之医护人员对脐部处理不规范,易引起新生儿脐部感染[2].为控制与预防新生儿脐部感染,江苏省苏北人民医院妇产科于2000年重视沐浴间消毒隔离,改进护理方法,取得满意效果,报道如下.……     

不同护理措施对新生儿脐部感染的影响

新生儿由于缺乏抗病原微生物定植能力，机体防御功能不全，为医院易感人群，而新生儿脐部是病原微生物入侵的特殊门户，加之医护人员对脐部处理不规范，易引起新生儿脐部感染。为控制与预防新生儿脐部感染，江苏省苏北人民医院妇产科于2000年重视沐浴间消毒隔离，改进护理方法，取得满意效果，报道如下。     

浅谈检验科人员医院感染的预防

由于传染病种类及流行趋势不断更新和变化,医务人员在医院感染也引起各界的关注和重视.检验科作为医技科室在医疗诊治中起着重要的作用.他们每天要处理大量临床标本,近距离接触病人的血液、体液、分泌物等,工作的每一环节都有被病原微生物污染的可能.如何预防检验科人员院内感染,保障医疗安全是医院感染管理的重要课题,不容忽视.     

女性泌尿生殖道疾病病原微生物感染分析

目的探讨女性泌尿生殖道疾病中支原体合并其他病原微生物感染的情况。方法对妇科门诊就诊的女性泌尿生殖道标本进行病原微生物检测和支原体培养检测，并对其合并其他病原微生物感染情况进行统计分析。结果支原体阳性675例，同时伴有其他病原微生物感染285例（42．2％），病原菌以肠杆菌为主（44．6％），其次为表皮葡萄球菌（32．2％）和金黄色葡萄球菌（20．4％），少见白色念珠菌（2．8％）和腐生葡萄球菌（1％）。结论女性泌尿生殖道支原体感染多合并其他病原微生物感染；应该重视对女性泌尿生殖道疾病的防治。     

导管相关血流感染的急诊临床诊治

<正>随着医疗技术进步,侵入性操作日趋普遍,各种导管相关感染的发生机会随之增多。目前导管相关感染的诊治及预防已成为院内感染防控的重要工作内容。血流感染是严重的全身感染性疾病,而导管相关血流感染(catheter related blood stream infection,CRBSI)则特指血管内置管引起的血流感染并发症[1]。1 导管相关感染病原微生物和危险因素1.1 常见病原微生物导管相关血流感染常见病原微生物有金黄色葡萄球菌     

中国耳念珠菌临床感染现状

耳念珠菌是近年新发现的念珠菌种, 在部分国家尤其是美国呈现耐药性及院内感染暴发态势。"超级病原"及其引申出来的"超级真菌"在真菌领域罕被提及, 但近来"耳念珠菌是超级真菌"的言论却在互联网上广为流传。现有报道及其流行病学监测数据显示, 中国耳念珠菌临床发生发展情况与美国不同, 其所引发的感染仍属个案, 且药物敏感度高, 致病性不强于常见非-白念珠菌。因此, 公众无需过度解读, 以致产生不必要的恐慌。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.