体外循环围术期血清SIL－2R变化及临床意义

应用双抗体夹心ＥＬＩＳＡ法动态观察了２６例体外循环围术期患者血清ＳＩＬ－２Ｒ变化，结果显示：ＣＰＢ后ＳＩＬ－２Ｒ水平显著增高，第７天渐恢复，１４天仍未恢复至术前水平；术后并发感染组较无感染组ＳＩＬ－２Ｒ增高更显著，且持继高水平。提示：ＣＰＢ导致ＳＩＬ－２Ｒ增高是术后细胞免疫功能抑制的原因之一，且与感染发生有关；ＳＩＬ－２Ｒ可作为ＣＰＢ后感染监测指标。     

体外循环围术期血清SIL—2R变化及临床意义

应用双抗体平似ＥＬＩＳＡ法动态观察了２６例体外循环围术期患者血清ＳＩＬ－２Ｒ变化，结果显示：ＣＰＢ后ＳＩＬ－２Ｒ水平显著增高，第７天渐恢复，１４天仍未恢复术前水平；术后并发感染组较无感染组ＳＩＬ－２Ｒ增高更显著，且持继高水平。     

肝炎后肝硬化并发气单胞菌败血症12例报告

我院１９９５年１０月～２００１年９月收住肝炎后肝硬化并发败血症１４１例 ,其中１２例为肝炎后肝硬化并发气单胞菌败血症 ,现报告如下。１病例摘要男７例 ,女５例 ,发病年龄２６～６１岁 ,平均年龄４７．４岁。１１例为乙型病毒性肝炎后肝硬化失代偿 ,１例为乙型病毒性肝炎后肝硬化。其中９例曾经Ｂ超、胃镜或食道钡餐检查有门脉高压表现 ,２例有上消化道出血史。４例为院外感染 ,８例发生在入院后９～１５５天 ,其中１例院外感染豚鼠气单胞菌后相隔６８天院内再次感染亲水气单胞菌。１２例感染均发生在５～１１月 ,７、８、９月份各３例…     

72例医院内口腔真菌感染分析

近年来医院内真菌感染有逐年增高的趋势 ,其发病率仅次于Ｇ- 杆菌而列居第 2位。我院自 1997年 1月～ 1999年7月医院感染 783例 ,医院感染率为 6 % ,其中口腔真菌感染 72例 ,占 9 2 %。现将本院 72例院内口腔真菌感染分析报告如下。临床资料1　一般资料　 72例口腔真菌感染病人全部为住院后口腔感染。男 42例 ,女 30例 ,年龄最大 80岁 ,最小 3个月 ,平均 40 5岁 ,其中 6 0岁以上者 2 5例 (占 34 7% )。住院时间最长 2 30天 ,最短 10天 ,平均 6 5天。2　基础疾病　心脑血管病患者 2 0例 (占 2 8% ) ,恶性肿瘤术后 11例 (占 15 3% ) ,儿科患…     

病毒性心肌炎动物模型的建立及T细胞亚群检测

本文以柯萨奇病毒B_3(CVB_3)感染Balb/c小鼠建立心肌炎模型,检测了小鼠脾脏中T细胞亚群。结果显示,病毒感染后5天,脾脏中Thy1,2~ (T总)增高,7～15天降低,第21天恢复正常。L3T4~ (Th/Ti)于病毒感染后7天开始增高,直到21天均明显高于对照组。lyt 2~ (Tc/Ts)于病毒感染后5-21天均明显高于对照组,结果提示,病毒感染本身和T细胞介导的免疫均参与病毒性心肌炎的发病。     

56例新生儿尿路感染分析

新生儿尿路感染症状不一致,缺乏特异性,常容易漏诊。我科自1997年7月至2000年6月共收治新生儿尿路感染56例,现分析如下。 1 临床资料 1.1 一般资料本组56例中,男性34例,女性22例;年龄出生～7天23例,～14天18例,～21天9例,～28天6例;孕周:31W~(+2)～34W12例,～37W28例,～40W10例,～42W4例,>42W2例。 1.2 感染途径及临床特点本组病例中,绝大部分为血行感染所致,常见于败血症、化脓性脑膜炎、肺炎、坏死性小肠结肠炎、脓疱疮等过程中,亦可见于上行感染、淋巴感染或直接感染。见表1。临床上以全身症状为主,可表现为不规则     

骨科植入物感染的临床分析

目的探讨骨科植入物术后感染的防治措施。方法回顾性分析29例骨科植入物手术合并感染病例的临床表现、辅助检查结果以及治疗方法等临床资料。所有病例均行抗炎、清创、术区置管冲洗引流治疗,早期感染保留植入物,迟发感染取出植入物更换为外固定或假体替代物。结果术后置管冲洗、引流及应用抗生素时间17～41天,平均22天。1例早期感染患者治疗后复发,1例患者引流不畅．经再次手术治疗。所有病例感染均获得控制出院,其中27例患者获得随访,平均随访时间18个月（12～36月）,未见感染复发患者。结论骨科植入物术后感染的控制应重视感染预防,以术区局部症状作为早期诊断的主要线索．合理选择抗生素以及局部置管冲洗引流是控制感染的重要措施。     

纤支镜吸痰及支气管灌洗术在排痰困难患者的应用

本文将2000年1月-2003年7月我院行纤支镜吸痰及支气管灌洗病例进行总结,报告如下。1临床资料共77例,男63例,女14例,年龄12-78岁,涉及胸外科、神经内科、神经外科、脊柱骨科、急诊科。胸外科病例,共28例,闭合性多根肋骨骨折15例、血气胸6例、心脏术后合并肺部感染3例、肺部手术后合并肺部感染4例,均为外科治疗后第2或3天,胸片检查发现单侧肺或肺叶不张,纤支镜检查发现为大量血块或脓痰堵塞气道。神经内、外科病例,共22例,诊断脑卒中16例、脑外伤术后6例,气管切开16例,气管切开时间为入院后1h～10d,入院后发生肺部感染为第1～10天,并发肺部感染的诊断标准     

急性白毒伞蕈中毒致肝损伤的临床分析

目的 探讨自毒伞革中毒致肝损伤的临床特点,为白毒伞蕈中毒治疗提供参考依据.方法 对6例急性白毒伞蕈中毒患者的临床资料进行回顾性分析.结果 白毒伞蕈中毒后21～24h出现中毒症状,入院后第1天有明显胃肠炎症状,表现为呕吐、腹泻、腹痛.人院后第2天行血浆置换等治疗,第3天胃肠炎症状明显好转,但在第5天出现黄疸,肝功能损害,重症表现为谵妄、昏迷.2例死亡,4例存活.白毒伞蕈中毒死亡病例的丙氨酸转氨酶(ALT)和天冬氨酶转氨酶(AST)活力在入院后3～5 d持续增高,但在第7天下降;TBIL则持续增高.结论 白毒伞蕈中毒死亡病例的肝功能指标在入院后第7天时具有明显的"胆酶分离"特征.     

重症颅内感染临床用药途径的探讨

中枢神经系统感染是外科中最严重的感染 ,直接影响患者的预后。我院自 1990年 7月～ 1999年 10月 ,共收治严重颅内感染患者 5 2例。采用脑脊液置换 ,鞘内抗生素注入治疗取得满意疗效。现报告如下。临床资料1　一般资料　男 34例 ,女 18例 ,年龄 15～ 72岁 ,平均 45岁。其中开放性脑外伤 8例 ,颅底骨折继发感染 5例 ,脑出血术后 2 4例 ,颅内肿瘤术后 13例 ,脑室—腹腔分流术后感染 2例。患者均出现高热、颈项强直。伴严重意识障碍 7例。术后硬膜下或脑室内置管引流 2 5例 ,引流时间 1～ 14天 ,平均 3天。手术切口脑脊液漏 2例。2　实验室检查…     

Comparison of detection methods for Aspergillus fumigatus in environmental air samples in an occupational environment

Methods to study occupational exposures to fungi and fungal materials in facilities where the dominant exposure is the pathogenic and allergenic fungus Aspergillus fumigatus are lacking. Air samples were collected near a conveyor in a wood chip recycling plant to compare methods that might be used to assess exposure to A. fumigatus or suitable proxies. These included total dust mass, total intact spores, culturable propagules growing > 35 degrees C, ergosterol, A. fumigatus allergen Asp f1, and quantitative polymerase chain reaction for A. fumigatus. Of these measurements, Asp f1 showed the most promise based on its relative response to measurements where there is a long history of use in industrial hygiene practice (total mass, ergosterol, total intact spores, culturable propagules).     

血性腹水45例临床分析

目的 探讨血性腹水的临床特点，提高对该病的诊断水平。方法 收集我院资料较全、明确病因诊断的血性腹水病例，对其临床表现、实验室检查、影像学及内镜特点进行分析。结果 45例中，男性28例，女性17例。平均年龄44．5岁，各种恶性肿瘤引起者34例，占75．6％。非恶性肿瘤导致者ll例。占24．4％。结论 血性腹水以恶性肿瘤居多，非恶性肿瘤也不少见。     

Indoor exposure to mould allergens

Humid indoor environments may be colonised by allergenic filamentous microfungi (moulds), Aspergillus spp., Penicillium spp., Cladosporium spp., and Alternaria spp. in particular. Mould-induced respiratory diseases are a worldwide problem. In the last two decades, mould allergens and glucans have been used as markers of indoor exposure to moulds. Recently, mould allergens Alt a 1 (Alternaria alternata) and Asp f 1 (Aspergillus fumigatus) have been analysed in various environments (residential and occupational) with enzyme-linked immunosorbent assays, which use monoclonal or polyclonal antibodies. Household Alt a 1 and Asp f 1 levels were usually under the limit of the method detection. By contrast, higher levels of mould allergens were found in environments with high levels of bioaerosols such as poultry farms and sawmills. Data on allergen Alt a 1 and Asp f 1 levels in agricultural settings may provide information on possible colonisation of respective moulds and point out to mould-related diseases in occupants.     

乳腺导管造影钼/铑靶诊断乳头溢液性质的分析

目的:评估钼/铑双靶X线乳腺导管造影结果与乳头溢液性质的关系。方法:运用钼/铑双靶乳腺导管造影对300例乳头溢液患者进行照片检查。结果:乳腺癌21例(7%),乳头状瘤150例(50%),导管扩张81例(27%),炎症13例(4.3%),囊肿12例(4%),乳腺增生症14例(4.7%),阴性9例(3%)。结论:①乳头溢液是导管内乳头状瘤的特征性临床表现。②乳腺癌在血性溢液占比例最高,共18例(85.7%)。③血性、浆液性、清水样三类溢液中,乳头状瘤比例都最高,注意与乳腺癌鉴别。     

Dealing with diarrhoea

Children with severe dehydration, persistent diarrhea with dehydration, or bloody diarrhea with no signs of improvement must be hospitalized. In-patient care for a child with severe dehydration includes rapid intravenous (IV) fluid therapy. Children who can still drink should be given oral rehydration salts (ORS) solution while the health worker sets up the IV drip. Children with difficulty drinking should be given ORS as soon as the IV fluid therapy restores their ability to drink (within 3-4 hours for babies, or 1-2 hours for older children), since ORS amends mineral deficiencies more effectively than the IV fluids. The IV drip should be re-administered if the child still exhibits dehydration after 3 hours for older children or 6 hours for babies. If improvement is noted, health workers should encourage the mother to administer ORS and to breast feed frequently. Hospital personnel should observe the child for at least 6 hours before discharge. This allows them to be sure that mothers can maintain the child's fluid balance. Children with diarrhea for more than 14 days face malnutrition or death. Any child with persistent diarrhea who exhibits moderate or severe malnutrition and signs of dehydration and is less than 4 months old needs to be admitted to a hospital. Management of persistent diarrhea involves fluid replacement, appropriate diet, and treatment of associated infections, if needed. ORS is usually effective for persistent diarrhea, although in a few cases poor absorption of glucose may necessitate initial rehydration with IV therapy. Breast feeding is encouraged for infants. Older infants and young children should eat 6 times a day as soon as they are able to eat. Recommended diets for these children are a low lactose diet (milk, yogurt, or curds; cooked rice; oil; sugar/glucose) and a low starch and no lactose diet (eggs, chicken, or fish; cooked rice; oil; sugar/glucose). Children with serious infections may require nasogastric feeding at first. Shigella bacteria tend to be responsible for dysentery. Children with this bloody diarrhea should be treated with an antibiotic. If their condition does not improve and they are malnourished, less than 1 year old, were initially dehydrated, or have recently had measles, they need to be hospitalized. Drugs to reduce frequency of stools should never be given in cases of bloody diarrhea. Older babies and children should be given an extra meal and supplementary vitamins and minerals each day for two weeks.     

Disseminated aspergillosis after intra-articular corticosteroid infiltrations

Bone and joint infections due to Aspergillus are rare and occur more commonly in immunosuppressed patients. We report the case of an 84-year-old woman who developed septic arthritis caused by Aspergillus fumigatus after corticosteroid infiltration. This patient had presented with arthritis of the left knee for several months but no microorganism had been found despite numerous arthrocenteses. This arthritis was resistant to treatment by numerous corticosteroid infiltrations. During an arthroscopy, analysis of the synovial fluid yielded A. fumigatus. Thereafter, other explorations showed disseminated aspergillosis with osteo-articular destruction, blood and urinary dissemination. A systemic treatment by voriconazole associated to intra-articular injections and surgical debridement was initiated but the patient died. Septic arthritis caused by A. fumigatus is very rare but must be considered as a differential diagnosis of septic arthritis after corticosteroid infiltration. Their complications can be very important and destructive.     

Increased childhood morbidity after measles is short-term in urban Bangladesh

In a 1995-1996 cohort study in the city of Dhaka, Bangladesh, morbidity in 117 hospitalized and 137 acute measles cases compared with age-matched children without measles (unexposed) was determined by weekly interview for 6 months. Compared with unexposed children, there were higher incidences of hospitalization (adjusted rate ratio (RR) = 3.1, 95% confidence interval (CI): 1.3, 7.6) and bloody diarrhea (adjusted RR = 2.7, 95% CI: 1.4, 5.1) in hospital measles cases during the 6 weeks after recruitment. Among community cohorts, there were higher incidences of bloody diarrhea (adjusted RR = 4.1, 95% CI: 1.1, 14.6), watery diarrhea (adjusted RR = 1.6, 95% CI: 0.9, 2.7), fast breathing (adjusted RR = 3.8, 95% CI: 2.1, 6.9), and the weekly point prevalence of pneumonia (adjusted prevalence ratio = 3.1, 95% CI: 1.0, 9.8) in measles cases during the same period. All measles cases regained lost weight within about 6 weeks. The prevalence of anergy to seven recall antigens 6 weeks after recruitment was higher in both hospital (adjusted odds ratio = 2.8, 95% CI: 1.2, 6.4) and community (adjusted odds ratio = 3.1, 95% CI: 1.1, 8.9) measles cases. Morbidity increased during the first 6-8 weeks after measles, but the authors found no consistent evidence of longer-term morbidity or wasting. The results support recent findings that measles is not associated with increased delayed mortality.     

Polymorphisms in nucleotide excision repair genes, arsenic exposure, and non-melanoma skin cancer in New Hampshire

BACKGROUND: Arsenic exposure may alter the efficiency of DNA repair. UV damage is specifically repaired by nucleotide excision repair (NER), and common genetic variants in NER may increase risk for non-melanoma skin cancer (NMSC). OBJECTIVE: We tested whether polymorphisms in the NER genes XPA (A23G) and XPD (Asp312Asn and Lys751Gln) modify the association between arsenic and NMSC. METHODS: Incident cases of basal and squamous cell carcinoma (BCC and SCC, respectively) were identified through a network of dermatologists and pathology laboratories across New Hampshire. Population-based controls were frequency matched to cases on age and sex. Arsenic exposure was assessed in toenail clippings. The analysis included 880 cases of BCC, 666 cases of SCC, and 780 controls. RESULTS: There was an increased BCC risk associated with high arsenic exposure among those homozygous variant for XPA [odds ratio (OR) = 1.8; 95% confidence interval (CI), 0.9-3.7]. For XPD, having variation at both loci (312Asn and 751Gln) occurred less frequently among BCC and SCC cases compared with controls (OR = 0.8; 95% CI, 0.6-1.0) for both case groups. In the stratum of subjects who have variant for both XPD polymorphisms, there was a 2-fold increased risk of SCC associated with elevated arsenic (OR = 2.2; 95% CI, 1.0-5.0). The test for interaction between XPD and arsenic in SCC was of borderline significance (p < 0.07, 3 degrees of freedom). CONCLUSIONS: Our findings indicate a reduced NMSC risk in relation to XPD Asp312Asn and Lys751Gln variants. Further, these data support the hypothesis that NER polymorphisms may modify the association between NMSC and arsenic.     

实时定量PCR检测人全血标本中烟曲霉基因组载量的方法及临床应用

目的 建立实时定量PCR(RQ-PCR)快速检测人全血标本中烟曲霉基因组载量的方法及进行初步临床应用.方法 基于烟曲霉多拷贝基因ITS1-5.8S基因设计引物和TaqMan探针,用QIAamp(R)DNA Blood Mini Kit提取烟曲霉基因组DNA,建立20μl RQ-PCR反应体系,对含有不同载量烟曲霉基因组的模拟人全血标本和66份外科发热患者全血标本进行烟曲霉基因组的定量检测.结果 检测限为10-1基因组/μl上机待测液(即约78 CFU/ml全血);检测特异度和灵敏度分别为94.25%和99.04%,阳性预告值和阴件预告值分别为97.63%和97.62%;测定结果的平均相对误差为(3.67±13.19)%;批内及批间平均重复性变异系数分别为(12.38±1.53)%和(16.27±2.72)%;人血标本中烟曲霉基因组平均回收率为(107.81±25.92)%,回收率平均变异系数为(26.24±5.62)%.66份外科发热患者血标本中未检测出烟曲霉基因组.结论 RQ-PCR可以快速、特异、灵敏地定量检测人血标本中烟曲霉基因组的载量,且有着较好的准确度与精密度.本研究外科发热患者血中未检测到烟曲霉基因组.

Abstract：

Objective To establish a real-time quantitative polymerase chain reaction (RQ-PCR) assay for fast detection of Aspergillus fumigatus genome in human whole blood samples and explore its clinical application.Methods The primers and the TaqMan-probe were designed on the basis of the multi-copy ITS1-5. 8S region of the rDNA of Aspergillus fumigatus. The Aspergillus fumigatus genomic DNA were extracted with QIAamp(R) DNA Blood Mini Kit.A 20 μl RQ-PCR amplification system was established, and the simulated blood samples containing various given load of Aspergillus fumigatus genome and the 66 whole blood samples of the surgical febrile patients were examined. Results The detection limit of the RQ-PCR instrument is 10-1 genomes/μl DNA sample,namely 78 CFU/ml whole blood. The specificity and the sensitivity were 94. 25% and 99. 04% respectively; and the positive predictive value and negative predictive value were 97. 63% and 97. 62% respectively. The average relative error of the quantitative results was (3. 67 ±13. 19)%, and the intra- and the inter-assay average coefficients of variation were (12.38 ± 1. 53)% and (16. 27 ±2. 72)% , respectively. The average recovery rate of Aspergillus fumigatus genomic DNA in human whole blood samples was (107. 81 ±25. 92)% , and the average coefficient of variation of the average recovery rate was (26. 24 ± 5.62) % . No Aspergillus fumigatus genomic DNA was detected among the 66 blood samples of the surgical febrile patients. Conclusions The RQ-PCR assay for fast quantitative detection of Aspergillus fumigatus genome in human whole blood samples is of high sensitivity, specificity,accuracy and precision. The Aspergillus fumigatus genome was not detected in this group of surgical febrile patients.     

北京市海淀区2006年临床诊断与实验室确诊菌痢症状分析

目的探讨实验室确诊细菌性痢疾（简称菌痢）与临床诊断菌痢的症状差别,提供确诊菌痢症状特征,降低临床误诊率。方法菌痢检测应用国标GB16002-1995标准进行细菌培养鉴定,对实验室确诊菌痢、其他致病菌和未检出者个案资料进行对照分析。结果确诊菌痢发热占87.50%;恶心占81.25%;里急后重占56.25%;腹泻7次以上占68.75%,脓血便仅占12.5%。其他致病菌发热占29.41%;恶心占76.47%;里急后重占29.41%;腹泻7次以上占43.75%;脓血便仅占6.25%。未检出者发热占56.04%;恶心占69.23%;里急后重占29.44%;腹泻7次以上占46.74%;脓血便仅占3.30%。确诊菌痢均在第1天到医院就诊,有1例为外地带入性确诊菌痢。结论确诊菌痢非典型病例可占1/3左右,未检出者具有典型菌痢临床表现可占1/5的比例,其他致病菌也可占1/5的份额,总体临床诊断误诊率极高,须加强临床医生的综合业务培训。