HIV感染真的被“治愈”了吗？

人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染靶细胞需要识别细胞表面CD4分子及其辅助受体, C-C趋化因子受体5(C-C chemokine receptor type 5, CCR5)和C-X-C趋化因子受体4(C-X-C-motif receptor 4, CXCR4)是HIV识别靶细胞的两种重要辅助受体。CCR5Δ32基因突变使得HIV无法识别CCR5受体, 从而阻止嗜CCR5的HIV病毒株入侵靶细胞。"柏林病人"和"伦敦病人"正是利用这一原理, 通过移植携带纯合子CCR5Δ32突变基因的异基因骨髓, 实现了停用抗病毒药物后病毒无反弹的目标, 故而被誉为HIV感染"治愈"案例。然而, 这一成功是否存在偶然性?事实上, 人群中携带CCR5Δ32纯合子基因突变概率极低、异基因骨髓配型十分困难、骨髓移植医疗费用昂贵、移植后HIV病毒株嗜性迁移等客观因素的存在, 使得通过携带纯合子CCR5Δ32基因突变异基因骨髓移植法实现HIV感染者停用抗病毒药物且保持病毒不反弹的目标困难重重。因此, "柏林病人"和"伦敦病人"的成功经验为治疗HIV感染提供了新的方向和希望, 但如认为HIV感染已被"治愈"为时尚早, 需进一步研究证实。     

77例念珠菌感染患者尿沉渣检测结果分析

目的通过对感染念珠菌阴道炎患者的尿沉渣检查,观察其红细胞、白细胞和上皮细胞的变化情况。方法随机抽取某妇科诊所2011年1月至2012年1月所有就诊进行尿沉渣检测的患者154例,将其分为两组:真菌阳性组(77例)和真菌阴性组(77例),对其念珠菌感染进行全自动尿沉渣检查,对比分析真菌阳性组与真菌阴性组患者尿沉渣的红细胞、白细胞以及上皮细胞的变化情况。结果真菌阳性组的患者尿沉渣的红细胞、白细胞及上皮细胞的数量分别是(13.89±7.38)个、(12.10±4.50)个、(10.11±3.39)个;真菌阴性组的患者尿沉渣的红细胞、白细胞及其上皮细胞的数量分别是(4.19±2.86)个、(3.34±2.19)个、(3.37±2.45)个,从对比结果来看,两组比较差异有统计学意义(P<0.05)。结论通过试验对比观察得知,念珠菌感染患者的尿沉渣中的红细胞和白细胞以及上皮细胞的数量明显比没有感染念珠菌的患者多。也从侧面说明感染念珠菌阴道炎的患者要早发现、早治疗,否则可能引起尿道感染等并发症。     

院内深部真菌感染的耐药性监测

目的 了解医院内深部真菌感染的分布及其耐药性。方法收集病房各类感染标本中分离出的161株真菌,采用sensititre Yeast two微量稀释显色真菌药敏试剂板检测其耐药性。结果 161株真菌中白色念珠菌68株,近平滑念珠菌33株,热带念珠菌20株,季也蒙念珠菌15株,皱折念珠菌14株,克柔氏念珠菌6株等。对两性霉素、氟康唑、伊曲康唑、酮康唑、5-氟胞嘧啶的耐药率分别为3.1％、7.8％、18.7％、9.4％、4.7％。结论真菌的感染日趋严重,且呈不同程度的耐药,应建立真菌常规耐药监测方法,指导临床合理用药。     

临床真菌血流感染的菌株分布及耐药性分析

目的 分析临床真菌血流感染的病原菌分布及耐药特征,为真菌血流感染的诊治提供理论依据。方法 回顾性分析2015年1月～2017年12月临床真菌血流感染的菌株分布及药敏试验结果。结果 共分离264例真菌。近平滑念珠菌检出率最高(53.79%),其次是角膜假丝酵母(13.63%)和白念珠菌(7.58%)。检出念珠菌数前三位科室依次为普外科(32.58%)、心血管外科(21.59%)和胸外科(8.33%)。对氟康唑、伊曲康唑和伏立康唑的敏感率,白念珠菌均为100%; 近平滑念珠菌分别为100%,99.3%和100%; 角膜假丝酵母分别为94.4%,19.4%和97.2%。对于5-氟胞嘧啶,白念珠菌敏感率100%,近平滑念珠菌和角膜假丝酵母的敏感率仅为70.4%和11.1%。三者对两性霉素B的敏感率≥95%。结论 近平滑念珠菌是该院临床血流感染最常见的真菌,绝大部分念珠菌对抗真菌药物的敏感率较高。要高度重视病原学监测,规范临床抗真菌药物的合理应用。     

深部真菌感染治疗的现状与对策

深部真菌感染指真菌侵犯皮下组织、黏膜和内脏所引起的感染性疾病,包括限局性的单一器官感染和2个或2个以上器官(组织)侵犯的系统性真菌感染。前者如肺念珠菌病、上颌窦曲霉病等,后者如播散性念珠菌病、真菌血流感染等。近20年来深部真菌感染呈持续增多趋势,美国国家医院感染监     

伏立康唑对念珠菌属不同菌种生物膜形成的抑制作用

生物膜是附着于受感染组织或植入物表面,由微生物及其自身产生的多聚糖、蛋白等细胞外基质构成。念珠菌属尤其白念珠菌是医院获得性真菌感染的主要病原真菌,很多念珠菌感染与医疗植入材料表面生物膜形成有关。存在于生物膜的念珠菌表现出更强的耐药性,且传统的抗真菌药难以清除生物膜,很多情况下不得不移除医疗植入材料,因此给     

生物样本库知情同意书规范化设计

知情同意书的签署是生物样本库伦理建设的核心, 其结构包括"知情告知"和"自主同意"两部分主体内容。本文依据现阶段生物样本库的特点, 提出生物样本库知情同意书的规范化设计, 具体描述从"生物样本库完备告知"到"捐赠者充分知情"两部分核心内容和要求, 以供生物样本库实践者参考和借鉴。     

老年病区489株念珠菌分离及耐药性分析

目的 了解老年人院内念珠菌感染及其耐药状态。方法 对2001年－2002年老年患者的血液,痰液,尿液,粪便等标本中分离的489株念珠菌进行鉴定,用真菌药敏卡作念珠菌对10种抗真菌药物的药敏试验,结合临床资料综合分析。结果 痰液标本念珠菌检出率最高,达84．7％,其次是粪便标本为7．5％;共分离白色念珠菌348株,占71．2％,热带念珠菌64株,占13．2％,敏感性较高的药物是5－氟胞嘧啶,两性霉素B,氟康唑,制霉菌素,灰黄霉素耐药率最高,达到80％左右。结论 老年病区念珠菌感染仍以白色念珠菌为主,严重基础病及长期使用抗生素是老年人真菌感染的主要原因,真菌药敏试验可为临床治疗提供依据。     

187株真菌的鉴定及耐药情况分析

目的 了解本院真菌的感染及耐药现状,为临床合理用药提供依据.方法 对2005年1月至2007年6月本院门诊和住院患者标本中分离出的187株真菌进行鉴定,并用9种抗真菌药物做药敏试验,其结果结合临床综合分析.结果 痰液标本真菌检出率最高,达92%,患者年龄大部分为60岁以上老人.共分离出白色念珠菌145株,占77.5%;热带念珠菌12株,占6.4%;光滑念珠菌10株,占5.3%.对两性霉素B、咪康唑的药物敏感性较高,耐药率较高的是氟康唑、氟胞嘧啶.结论 临床标本中真菌分离以白色念珠菌为主,长期应用广谱抗生素及机体免疫力低下是患者感染真菌的主要原因,真菌药敏试验可为临床合理用药提供依据.     

耳念珠菌感染现状与研究进展

耳念珠菌作为一类重要的感染性病原微生物,自2009年首次报道以来,世界多地不断有新的检出病例报道。耳念珠菌感染呈全球流行趋势,严重威胁人类生命健康,已引起各国重视。其作为一类很重要的医院获得性感染的新发病原微生物,容易造成院内爆发和感染事件的发生。该文探讨了当前耳念珠菌感染的现状与研究进展,希望能够引起有关学者和相关部门重视,及时制定感染预防策略和治疗方案,加强耳念珠菌感染的诊断、治疗和预防的措施。     

Clinical aromatherapy and AIDS.

Clinical aromatherapy is the use of essential oils for expected outcomes that are measurable and is a therapy that is used as part of nursing care in Switzerland, Germany, Australia, Canada, the United Kingdom, and, more recently, the United States. Essential oils are steam distillates obtained from aromatic plants. These volatile extracts have been used for many years by French hospitals against airborne bacteria and fungi. As antimicrobial agents, essential oils may be appropriate in HIV/AIDS for specific opportunistic infections. Aromatherapy can also alter perceptions of chronic pain, help maintain skin integrity, and is useful in stress management. Methods of application vary depending on the site of infection and the psychological profile of the patient and can include inhalation, compresses, baths, massage, and the "m" technique. This article will explore the potential use of essential oils in HIV/AIDS focusing on four opportunistic infections: Cryptococcus neoformans, Candida albicans, methicillin-resistant Staphylococcus aureus, and herpes simplex types I and II.     

A case of fungal otitis externa caused by coinfection of Candida auris and Aspergillus flavus

Fungal otitis externa is a disease encountered occasionally and is caused mostly by Aspergillus or Candida spp. We report a woman with fungal otitis externa who also had typical findings in the external auditory canal. The results of a culture showed coinfection with Candida auris and Aspergillus flavus. Identification of both species was performed by sequencing analysis of the 26S rDNA (D1/D2) and β-tubulin regions. Additionally, the newly developed CHROMagar™ Candida Plus medium was a useful tool for the easy and rapid identification of C. auris. To the best of our knowledge, this is the first report of fungal otitis externa caused by coinfection with C. auris and A. flavus. This case showed good susceptibility to many antifungal drugs and fortunately had a good clinical course with 1% bifonazole cream, which was applied to the fungal coinfection. Notably, C. auris is a multidrug-resistant yeast-like fungus. The increase in drug-resistant fungi and co-infections caused by these pathogens can make the diagnosis and treatment more complex and difficult. To solve these problems, performing rapid and accurate identification and susceptibility testing using chromogenic medium and molecular biological analysis would be useful.     

National representation in the emergency medicine literature: a bibliometric analysis of highly cited journals

Objective

In recent years, significant growth has been seen in the field of emergency medicine. However, the national productivity to the field of emergency medicine remains unknown. This study aimed to reveal the national contributions in the field of emergency medicine.

Methods

Articles published in 13 highly cited journals in emergency medicine in 2006 to 2010 were retrieved from PubMed and Science Citation Index. The number of total articles, the per-capita numbers, impact factors (IFs), and citations were tabulated to assess the contribution of different countries.

Results

A total number of 9775 articles were published in the 13 journals from 2006 to 2010 worldwide. West Europe, North America, and East Asia were the most productive regions. High-income countries published 87.9% of the total articles. United States published the most number of articles in 2006 to 2010 (4523/9775, or 46.3%), followed by United Kingdom, Australia, China, and Canada. Besides, United States also had the highest total IFs (8729.73) and total citations (22?117). When normalized to population size, Australia had the highest number of articles per million persons (26.00). Germany had the highest mean IF (2.27) and mean citations (6.87).

Conclusions

United States is the most productive country in the field of emergency medicine.     

Fungal peritonitis in peritoneal dialysis patients.

Peritonitis is one of the most frequent complications of peritoneal dialysis (PD) and 1% - 15% of episodes are caused by fungal infections. The mortality rate of fungal peritonitis (FP) varies from 5% to 53%; failure to resume PD occurs in up to 40% of patients. The majority of these FP episodes are caused by Candida species. Candida albicans has historically been reported to be a more common cause than non-albicans Candida species, but in recent reports a shift has been observed and non-albicans Candida may now be more common. Unusual, often "nonpathogenic," fungi are being increasingly reported as etiologic agents in FP. Clinical features of FP are not different from those of bacterial peritonitis. Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and delayed. New molecular diagnostic techniques (e.g., polymerase chain reaction) are being developed and evaluated, and may improve diagnosis and so facilitate early treatment of infected patients. Abdominal pain, abdominal pain with fever, and catheter left in situ are risk factors for mortality and technique failure in FP. In programs with high baseline rates of FP, nystatin prophylaxis may be beneficial. Each program must examine its own history of FP to decide whether prophylaxis would be beneficial. Catheter removal is indicated immediately after fungi are identified by Gram stain or culture in all patients with FP. Prolonged treatment with antifungal agents to determine response and attempt clearance is not encouraged. Antifungals should be continued for 10 days to 2 weeks after catheter removal. Attempts at reinsertion should be made only after waiting for 4 - 6 weeks.     

国内外假肢的发展历程

背景:假肢问题是康复工程研究中的重要内容之一。目的:综述国内外假肢的发展历史。方法:应用计算机检索2001-01/2011-01中国期刊全文数据库相关文章,检索词为"假肢,假肢发展,分类,产品",并限定文章语言种类为中文。同时计算机检索1980-01/2011-01IEEE/IETE lectronic Library(IEL)数据库相关文章,检索词为"prosthetics,prosthetic development,product",并限定文章语言种类为English。共检索到文献206篇,最终纳入符合标准的文献16篇。结果与结论:20世纪前半期,以美国为代表的工业发达国家对假肢技术开展了大规模的研究,使得假肢的理论和实践都有了重大进展。随着工业的发展,采用合金、塑料等新型材料成功研制了各式现代假肢。由于起步较晚,中国假肢产品与国外相比还有一些差距。且由于其行业的特殊性,要求假肢工作人员必须要在多学科的协作组里与外科医生、物理治疗师、作业治疗师、心理治疗师、社会工作者等其他专业人员一起工作,从而更好的为患者服务。     

白色念珠菌在义齿软衬材料表面黏附的研究与进展

目的:综合分析白色念珠菌在义齿软衬材料表面黏附的影响因素及主要防治措施.资料来源:文献检索时限为1995/2009;检索的中文关键词包括:义齿,软衬材料,白色念珠菌,黏附;英文关键词包括:denture,soft liningmaterial,candida albicans,adherence.文献来源数据库:中国期刊全文数据库,网址http://ckrd.cnki.net;PubMed数据库,网址http://www.ncbi.nlm.nih.gov/PubMed.资料选择:纳入具有原创性的研究论文,其研究材料或方法具有代表性.排除重复性研究及与课题相关性较弱的文献.结局评价指标:白色念珠菌在义齿软衬材料表面黏附的各种影响因素以及防治白色念珠菌黏附的主要措施.结果:①不同化学组成的义齿软衬材料对白色念珠菌黏附有一定影响,丙烯酸酯类软衬材料在使用过程中有增塑剂和乙醇析出,容易导致材料逐渐变硬而失去功效,另外可能对人体造成危害.硅橡胶类材料生物相容性好,细胞毒性小,对微生物的毒性也小.但表面为多孔性,易于滋生真菌.含氟弹性体材料长期吸水率低于硅橡胶类,但是不易滋生真菌.②目前材料的表面粗糙度或表面自由能与念珠菌附着之间的相关性并不能确定.③白色念珠菌的生物膜形成还与唾液、底物环境和口腔共生菌丛有关.④目前预防控制义齿软衬材料表面白色念珠菌黏附的方法主要有:材料中添加抗真菌剂、选择与软衬材料匹配的义齿清洁剂、用义齿封闭剂处理软衬材料表面、抗真菌剂口服治疗、微波消毒.结论:目前白色念珠菌对软衬材料的黏附仍然是一个常见而严重的问题.通过改善软衬材料性能,减少微生物黏附,延长材料的使用寿命,从而控制义齿性口炎的发生.     

Assessing the national productivity in subspecialty critical care medicine journals: A bibliometric analysis

Purpose

In recent years, significant growth has been seen in the subspecialty critical care medicine. However, the national productivity to the subspecialty critical care medicine remains unknown. We therefore intended to reveal the national contribution in the subspecialty critical care medicine journals.

Materials and Methods

Articles published in 20 highly cited journals in subspecialty critical care medicine from 2006 to 2010 were retrieved from Web of Science and PubMed. The number of total articles and randomized, controlled trials, the per capita numbers, total impact factors (IFs), and citations were tabulated to assess the contribution of different countries.

Results

A total number of 17 667 articles were published in the 20 journals from 2006 to 2010 worldwide. North America, West Europe, and East Asia were the most productive regions. High-income countries published 89.68% of the total articles. The United States published the most number of articles in 2006 to 2010 (6659/17 667, or 37.69%), followed by United Kingdom, Germany, France, and Australia. Besides, the United States also had the most number of randomized, controlled trials (260), the highest total impact factors (27 206.55), and the highest total citations (84 170). When normalized to population size, Australia had the highest number of articles per million population, followed by Netherlands, Switzerland, Austria, and Belgium.

Conclusion

The United States is the most productive country in the subspecialty critical care medicine. When normalized to population size, Australia and some European countries might be more productive.     

常见病原真菌鉴定基因芯片方法的建立

目的 建立临床常见的病原真菌的基因芯片检测体系.方法 选取8种临床常见真菌,包括白色假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌、近平滑假丝酵母菌、土曲霉、黄曲霉、米根霉和烟曲霉.根据真菌ITS区设计引物和探针,进行扩增和芯片制备.通过将待检真菌的PCR产物变性后与点布探针的芯片杂交,观察并分析荧光信号强度,进行对真菌的快速检测.并选取临床真菌阳性标本和细菌阳性标本共25份进行验证.结果 25份临床阳性标本的芯片检测结果显示,10份细菌阳性的标本,经真菌基因芯片检测,全部为阴性,无荧光信号.其余15份真菌标本中,12份临床真菌阳性标本均鉴定出芯片中的某一种真菌的结果.另外采用克柔假丝酵母菌人为制备的3份待检样本,经检测,芯片中8种真菌位点无荧光信号,为阴性,仅有真菌通用探针得到荧光信号,表明该标本中有真菌存在,但无法确认是哪一种.结论 本研究建立的基因芯片可对常见病原真菌进行快速准确的鉴定,为基因芯片应用于临床奠定了基础.     

Optimal use of existing and new antifungal drugs

Clinicians are increasingly aware that fungal pathogens are a significant cause of morbidity and mortality in hospitalized patients. Historically, these infections occurred in severely immunocompromised patients who were undergoing treatment for hematological malignancy or solid organ transplantation. Currently, however, systemic fungal infections are commonly seen in debilitated patients who are being nursed in intensive care or high-dependency units. These infections are mostly caused by Candida albicans but there is a growing proportion of strains of non- albicans Candida spp, some with reduced susceptibility to commonly used antifungals. The limited armamentarium of antifungal agents to date has meant that amphotericin B continues to be considered the most effective therapeutic agent albeit with a poor record of treatment-limiting side effects. The past decade has seen some encouraging developments in antifungal therapy. Three lipid formulations of amphotericin B showing reduced toxicity compared with the desoxycholate formulation are now licensed. There are three investigational triazoles currently undergoing evaluation that should prove important additions to existing members of this class. The echinocandin caspofungin is the first of a new class of antifungal agents with a novel mode of action, which has recently been approved for use in the United States.     

Maduromycosis (Madura foot) in Kentucky.

The first case of proven maduromycosis originating in the state of Kentucky, and the 21st case reported in the United States, is described. The disease, which involved the foot, was caused by Monosporium apiospermum. The importance of suspecting and culturing for fungal organisms in cases of chronic or recurrent infections of the extremities is stressed. The method of treatment was experimental; whether true cure was accomplished may not be known for years. Although many fungi, including Monosporium apiospermum, are relatively resistant to all forms of chemotherapy, some types of fungi readily respond to easily administered antibiotics. Specific fungal identification by trained mycologists is important in all cases of mycetoma.