老年病房内80岁以上高龄患者的院内感染调查

目的调查老年病房内80岁以上老年患的院内感染。方法本对1989年1月～1994年12月期间老年病房共收治80岁以上高龄患266例进行回顾性调查。结果发现院内感染45例，院内感染率为16．9％。原发病严重程度与发生院内感染有密切关系，如晚期转移性肿瘤、慢性支气管炎、糖尿病、脑梗塞等患的院内感染发生率高。院内感染部位以呼吸道最常见，其次为胃肠道、秘尿道。院内感染致病菌以革兰氏阴性扦菌为主占42.3％，革兰氏阳性球菌占30．8％，真菌26.9％。院内感染病死率为17.8％，结论老年患医院内感染发病率高与住院天数，机体免疫状态等因素有关。     

老年病房患者医院感染的调查分析

目的研究老年病人与院内感染的关系。方法对我院1996年老年病房出院病人进行回顾性调查与分析研究，全院出院病例892例，院内感染76例。结果老年病房院内感染率为852％，感染部位以下呼吸道为主，占7526％，其次为上呼吸道，胃肠道．泌尿道。结论老年病人院内感染率高，可能与年老体弱、基础疾病多、免疫力低下及药物使用等因素有一定关系。     

结核病房医院感染监测分析与控制

目的探讨结核病房医院感染的相关因素。方法对2007年1月-12月住院患者进行前瞻性和回顾性调查,对病房消毒灭菌物品进行效果监测。结果收治结核病903人发生医院感染44例,感染率4．87％,感染部位以呼吸道为主占47．71％,感染病原菌以真菌为主,占53．45％,与上年比较感染率明显下降,消毒灭菌合格率97．66％,较上年明显提高。结论医院感染的发生与肺结核严重的基础病、环境空气污染、消毒灭菌、无菌技术操作不严、不合理使用抗菌药有关,通过采取控制措施,积极治疗基础病、合理使用抗菌药、加强空气消毒、严格无菌操作、做好基础护理、使感染率得到有效控制。     

呼吸内科病房医院获得性肺炎的病原学分析

目的探讨呼吸内科住院患者医院获得性肺炎（Hospital acquired pneumonia HAP）的临床和病原学特点。方法对呼吸内科普通病房及呼吸监护病房的2001年1月～2007年2月确诊并明确病原的HAP患者进行调查分析。结果HAP患者279例，明确病原学117例。老年患者（〉65岁）所占比例较高（82／117、70．1％），HAP的病原学以鲍曼不动杆菌、铜绿假单孢菌、肠杆菌及大肠埃希菌最常见，球菌和真菌所占比例较小，革兰阴性杆菌中肺炎克雷伯杆菌和大肠埃希氏菌中ESBLS检出率高达32．94％，在晚发HAP、呼吸机相关性肺炎（Ventilator—associated pneumonia，VAP）及合并慢性呼吸道疾病患者更为常见。结论呼吸内科病房的HAP病原以G-杆菌为主。耐药菌多，治疗难度大，应合理使用抗生素。     

肺炎克雷伯菌下呼吸道感染的耐药性及基因分型研究

目的 了解肺炎克雷伯菌下呼吸道感染株的耐药现状，监测耐药株的流行趋势。方法 采用微量稀释法对86株引起下呼吸道感染的肺炎克雷伯菌进行抗生素药敏试验和超广谱β－内酰胺酶（ESBLs)检测，并对产ESBLs菌株以随机扩增多态性DNA（RAPD）法进行基因分型。结果 产ESBLs肺炎克雷伯菌占20．9％，其中83．3％来源于呼吸科重症监护病房（RICU）。ESBLs阳性菌对10种抗生素的耐药性远远高于ESBLs阴性菌，并同时高耐氨基糖苷类、喹诺酮类抗生素。18株产ESBLs肺炎克雷伯菌分为12型。其中3株属于A型，5株属于B型，其它为不同类型。结论 RICU病房有产ESBLs肺炎克雷伯菌分为12型。其中3株属于A型，5株属于B型，其它为不同类型。结论 RICU病房有产ESBLs肺炎克雷伯菌同一克隆株集中分布，提示流行可能。     

ICU呼吸机相关肺炎性141例调查分析

目的探讨某院呼吸机相关肺炎性（VAP）的流行病学特点及危险因素,指导临床医生采取预防和控制措施。方法对2010年9月至2011年2月重症监护病房（ICU）907例患者中发生VAP感染的141例进行回顾性调查分析。结果该院ICU呼吸机相关性医院感染肺炎的感染率为27.60‰,呼吸机使用率为61.18%。多种侵入性操作及肺部疾病患者呼吸机相关肺炎发生率较高。主要致病菌为革兰阴性杆菌（85.03%）,以鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌为主。革兰阳性球菌占3.23%,主要为金黄色葡萄球菌。真菌占11.68%,主要为白色念珠菌和曲霉菌。结论该院ICU呼吸机相关的医院感染肺炎的感染率较高,这与呼吸机使用时间、使用呼吸机方式及基础疾病等多种危险因素相关。     

老年病房院内感染状况调查

目的 调查上海市某医院老年病房院内感染的发病率、临床特点等,为有效控制老年病房院内感染提供依据.方法 回顾性分析该老年病房2007年1月-2013年12月期间的所有出院患者的病史资料.结果 2007年1月-2013年12月间,该医院老年病房7 475例次出院患者中,发生院内感染597例次,院内感染总发生率为8.0％.597例次院内感染中,男性508例次,占85.1％.男性的院内感染发生率显著高于女性(分别为8.47％和6.02％).呼吸内科病房和心血管病房的院内感染发生率较高.感染部位以呼吸道和泌尿道最为多见,分别占75.7％和14.7％.呼吸道感染又主要集中在下呼吸道感染(占所有呼吸道感染的90.9％).结论 老年病房院内住院患者的院内感染发生率很较高,男性似更容易发生院内感染.呼吸病房和心血管病房的院内感染发生率相对较高,下呼吸道和泌尿道.是主要的感染部位.     

老年病房与普通病房病原菌调查分析

目的在于探讨老年病房与普通病房病原菌分布情况及其危险因素。方法通过对我院2000年～2001年老年病房出院病例1883例中送检各类标本检出阳性标本4175份、菌种61种、菌株4397株，普通病房出院病例8860例中送检各类标本中检出阳性标本1197份，菌种42种，菌株1205株，菌种以革兰氏阴性杆菌及真菌为主。结果显示老年病房与普通病房两者病原菌有明显差异，与住院时间，自身状况、基础疾病、环境、季节、药物等因素有一定关系。结论临床上加强对病原菌的及时了解，对预防和控制医院感染有着极其重要的意义。     

结缔组织病合并感染的病原学特征分析

目的探讨结缔组织病合并感染的病原学特征,以期为临床诊治提供依据。方法回顾性分析我科体液培养阳性的102例结缔组织病合并感染患者的病原学资料。结果本组疾病感染的病原体中,G杆菌感染已占绝对优势达62．75％,G^＋球菌感染率仅为37．25％。在菌种构成方面,大肠埃希氏菌占16．67％,铜绿假单胞菌占14．72％,肺炎克雷伯杆菌占9．80％,金黄色葡萄球菌占9．80％,凝吲阴性葡萄球菌占6．86％,表皮葡萄球菌占5．88％。感染的部位以呼吸道和泌尿道居多,分别为57．84％、16．66％,全身感染引起的败血症也占有较高的比率,为17．64％。对27株大肠埃希菌及肺炎克雷伯菌属进行ESBLs检测,阳性率为59．26％。结论G^-杆菌是结缔组织病合并感染的主要致病菌,感染菌株中ESBLs阳性率较高,全身感染引起的败血症的比率较高。     

普外科病房细菌分布及耐药性分析

目的观察普通外科病房常见细菌种类及其耐药情况,以指导临床合理用药。方法采用微生物自动分析系统对一市级医院普外科病房600份送检标本进行细菌鉴定及药敏试验。结果共检出细菌360株,其中G^＋球菌占39．7％,主要以金葡菌为主,其次为肠球菌、表皮葡萄球菌、凝固酶阴性葡萄球菌及链球菌;G^-杆菌占60．3％,主要为肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌。体外药敏试验显示G^＋球菌对万古霉素敏感,G^-杆菌对亚胺培南敏感,对第3代头孢菌素及左氧氟沙星部分敏感。结论普外科病房常见细菌为金葡菌、肺炎克雷伯菌和大肠埃希菌。应根据细菌培养与药敏试验结果选择敏感抗生素。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.