外科危重病并发深部真菌感染的防治

深部真菌感染大多发生在免疫缺陷或罹患严重基础疾病的病人,外科危重病病人毫不例外地成为深部真菌感染的易感人群。以美国NNIS的统计报告为例,1980～1990年美国的医院获得性真菌感染由2.0‰增至3.8‰,其中在外科的发生率由2.5‰增至5.4‰[1]。在欧美,真菌在医院获得性感染中已成为第四或第五位常见的致病菌。在我国的某些教学医院中,深部真菌感染已占据医院获得性感染的第5位,而外科是发生率最高的科室。由于深部真菌感染严重影响危重病预后,为减少外科危重病真菌感染的发生率,提高治愈率,本文试对外科危重病深部真菌感染防治中几个值得…     

肝移植术后患者ICU真菌感染及影响因素分析

感染是肝移植围术期的第一死亡原因,有文献报道肝移植术后深部真菌感染的发生率在30%~40%之间[1]。由于术中侵袭性操作,术后免疫抑制药和广谱抗生素的应用,使受体术后早期深部真菌感染的发生率较高,尤以院内获得性真菌感染为主。肝移植术后侵袭性真菌感染常起病隐匿,后果严重,缺乏特异性临床表现,诊断较为困难。念珠菌感染死亡率在40%以上,深部曲霉菌感染的死亡率达到了90%[2]。本文通过回顾本院6年来183例次肝移植术后患者在ICU行监护治疗期间的临床资料,探讨发生于肝移植术后ICU真菌感染的病原学特征及相关危险因素。资料与方法一般资…     

路邓葡萄球菌引起青少年特发性脊柱侧凸术后感染1例报告

正手术部位感染(SSI)是脊柱内固定术后较为严重的并发症之一,发生率为0.3%～20.0%[1]。青少年特发性脊柱侧凸(AIS)术后SSI的发生率为1%～7%[2],术后90 d内SSI发生率为1.6%[2],常由表皮葡萄球菌和痤疮丙酸杆菌等皮肤菌群引起,影响患者生活质量的同时也给患者带来一定的经济负担。路邓葡萄球菌感染最早由Freney等[3]于1988年提     

烧伤侵袭性真菌感染诊断与防治指南(2012版)

烧伤尤其是严重烧伤患者,是侵袭性真菌感染的高发人群[1-6].由于机体免疫功能紊乱、皮肤屏障破坏、气管切开插管、机械通气、广谱高效抗生素和 肠外静脉营养的长期应用、有创监测措施的强化、医院感染等原因,烧伤后真菌感染发生率明显增高[7-12].另一方面,医务人员对侵袭性真菌感染的重视以及微生物等实验室检测技术的发展,使烧伤侵袭性真菌感染(invasive fungal infection after burn injury)的检出率明显增加[13-18].为进一步明确烧伤侵袭性真菌感染的概念、诊断标准、预防与治疗措施,由本刊编辑委员会组织相关专家多次讨论形成本指南,以规范和指导烧伤医师的临床实践.     

血浆（1→3）-β-D-葡聚糖检测诊断侵袭性真菌感染的临床研究

目的。探讨血浆（1→3）-β-D-葡聚糖对侵袭性真菌感染患者的临床检测价值。方法应用MB．80微生物快速动态检测系统及GKT-5M set动态真菌检测试剂盒检测14例侵袭性真菌感染患者（诊断组）和13例健康志愿者（对照组）血浆（1→3）-β-D-葡聚糖浓度,并将两者进行统计学分析。结果14例侵袭性真菌感染患者中有8例为支气管．肺真菌感染,6例为真菌血症;真菌菌种分别为念珠菌感染11例（混合感染1例）,曲霉感染2例,卡氏肺孢子菌感染2例（其中1例为临床诊断无病原学证据）。诊断组血浆（1→3）-β-D-葡聚糖平均浓度为（105．02±82．22）ng／L,明显高于对照组（6．65±1．01）ng／L（P〈0．01）。血浆（1→3）-β-D-葡聚糖诊断阈值为≥20ng／L时,灵敏度、特异度、阳性预测值和阴性预测值分别是92．86％、89．58％、72．22％、97．73％。结论血浆（1→3）-β-D-葡聚糖的检测可作为诊断侵袭性真菌感染的重要依据。     

颈腰综合征手术治疗的研究进展

正随着人口老龄化加剧,脊柱退行性疾病发生率增加,颈腰综合征发生率也随之增加。典型的颈腰综合征指颈椎和腰椎串联性椎管狭窄(TSS)[1],表现为诊断颈椎病的同时伴有马尾神经受累症状,或诊断腰椎椎管狭窄的同时存在颈脊髓和/或神经根受压症状,近年发现胸椎也可累及,甚至同时存在颈椎、胸椎和腰椎的三联椎管狭窄[2]。目前,TSS是指同时存在至少2个不同脊柱区域(颈椎、胸椎和     

颈椎后路单开门椎管扩大椎板成形术后感染解甘露醇罗尔斯顿菌1例报告并文献复习

解甘露醇罗尔斯顿菌是一种非发酵革兰阴性杆菌,属于罗尔斯顿菌属,是院内感染中比较少见的一种机会致病菌[1].解甘露醇罗尔斯顿菌主要生存于不同种类的水资源之中[2],其引起的感染常常较为严重.医院注水瓶中分离出的条件致病菌中,以解甘露醇罗尔斯顿菌最多[3].近年,关于脊柱外科术后感染的报道[4-6]较为常见,但解甘露醇罗尔斯顿菌感染却鲜有报道.本院2020年12月22日收治1例颈椎后路单开门椎管扩大椎板成形术后解甘露醇罗尔斯顿菌感染患者,现将诊疗过程进行总结并结合文献加以分析,以提高脊柱外科医师对解甘露醇罗尔斯顿菌感染的认识及诊治水平.     

踝关节和Pilon骨折术后感染处理

感染是骨折手术治疗常见又很严重的并发症,不仅直接影响手术效果,还会增加治疗费用.2004年,Darouiche[1]在新英格兰杂志上报道,美国每年应用内固定物治疗骨折约200万例,内固定物相关感染发生率为5％,约10万例.用于治疗骨折术后感染的费用,平均每例约15 000美元.     

脊柱手术硬脊膜破裂的诊断及治疗进展

<正>硬脊膜破裂(incidental durotomy,ID)是脊柱手术中最常见的并发症之一。脊柱手术硬脊膜破裂的整体发生率为1%~17%[1]。其中腰椎手术硬脊膜破裂发生率最高,Kalevski等[2]报道其发生率为12.66%。早期、准确的诊断是成功处理的关键。在硬脊膜破裂的治疗方面缺乏系统的治疗原则,从而导致并发症的增多[3]。笔者就脊柱手术硬脊膜     

全膝置换术后光滑假丝酵母菌感染1例报告

<正>假体周围感染(periprosthetic joint infection,PJI)是人工关节置换术后最多见也是最严重的并发症之一^[1],其发生率为1%～4%,严重影响预后^[2]。其中大部分感染病原菌为革兰阳性菌,特别是葡萄球菌^[3]。相比之下,真菌感染比较罕见,但其导致的后果更为严重^[4]。     

VEGF, FGF1, FGF2 and EGF gene polymorphisms and psoriatic arthritis

Background  

Angiogenesis appears to be a first-order event in psoriatic arthritis (PsA). Among angiogenic factors, the cytokines vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and fibroblast growth factors 1 and 2 (FGF1 and FGF2) play a central role in the initiation of angiogenesis. Most of these cytokines have been shown to be upregulated in or associated with psoriasis, rheumatoid arthritis (RA) or ankylosing spondylitis (AS). As these diseases share common susceptibility associations with PsA, investigation of these angiogenic factors is warranted.     

Analysis of Association of LRP5, LRP6, SOST, DKK1, and CTNNB1 Genes with Bone Mineral Density in a Slovenian Population

The Wnt pathway has a bifunctional role in bone mass regulation, influencing osteoblasts and osteoclasts. The Wnt pathway genes are therefore candidate genes for susceptibility to osteoporosis. In our study, we focused on the effects of polymorphisms in selected Wnt pathway genes: low-density lipoprotein receptor-related proteins 5 and 6 (LRP5 and LRP6), Dickkopf1 (DKK1), sclerostin (SOST), and β-catenin (CTNNB1). We genotyped 652 subjects for the following polymorphisms: A1330V in LRP5; I1062V in LRP6; E232K in DKK1; D32Y, G34V, and N287S in CTNNB1; and -1397_-1396insGGA in SOST. Bone mineral density (BMD) was also measured. The allele frequencies were as follows: for A1330V C:T = 87%:13%, for I1062V C:T = 20%:80%, and for -1397_-1396insGGA-:GGA = 64%:36%. The studied nucleotide changes in the DKK1 and CTNNB1 genes were shown not to be polymorphic. In a Slovenian population, no association was shown between lumbar spine and femoral neck BMD in A1330V (P = 0.151 and 0.243) and in I1062V (P = 0.209 and 0.405). We observed a difference between SOST genotypes, corresponding to an allele dose effect, which was borderline significant for lumbar spine and femoral neck BMD (P = 0.047 and 0.085); but this did not survive the adjustment for multiple testing. These results indicate that a larger sample size would be necessary to detect these subtle effects. Our results suggest that A1330V in LRP5, I1062V in LRP6, and -1397_-1396insGGA in SOST are not associated with BMD in the Slovenian population.     

Transient isolation of Burkholderia multivorans and Burkholderia cenocepacia from a Brazilian cystic fibrosis patient chronically colonized with Burkholderia vietnamiensis

Fifteen serial Burkholderia cepacia complex isolates recovered over a period of 4 years from a single cystic fibrosis patient were analysed for genomovar status by means of recA sequence determination, and genetic relatedness by RAPD-PCR. Twelve isolates were assigned as Burkholderia vietnamiensis, two as Burkholderia cenocepacia and one as Burkholderia multivorans. B. vietnamiensis persisted in the airways during 4 years, except in three occasions when B. cenocepacia or B. multivorans were isolated. The patient was chronically colonized by B. vietnamiensis with the RAPD-profile 12 and transiently by the RAPD-profile 15.     

Successful management of Brucella mellitensis endocarditis with combined medical and surgical approach

Objectives: Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis. Patients and methods: Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer ≥1:320. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3–15 months) after surgery until the titers returned to a level ≤1:160. Results: There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7±13.2%. Conclusion: Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.