诺沃克病毒合并金黄色葡萄球菌引发某小学食物中毒的调查

目的 查找某小学82名师生出现以呕吐、腹痛、腹泻和发热为主要症状的群发性疾病的原因。方法 用流行病学疾病暴发调查方法，结合逆转录聚合酶链反应(RT—PCR)、DNA序列测定和食物中毒常规致病菌检测方法检测可疑食品、病人呕吐物及粪便。结果 82名患都有在学校食堂食用早餐或午餐的共同进餐史；在12名患的粪便中检出诺沃克病毒阳性11份，对其中5份进行诺沃克病毒核酸序列测定，结果4份呈阳性；2份患的呕吐物和1份厨工肛拭子检出金黄色葡萄球菌-肠毒素试验皆呈强阳性．结论 本次食物中毒可能由诺沃克病毒和金黄色葡萄球菌共同引起。     

一起诺瓦克样病毒暴发流行的快速RT-PCR检测

目的：应用引物P289、P290对诺瓦克样病毒进行快速RT—PCR检测，为疾病预防控制提供准确可靠的实验数据。方法：从17份病人粪便、4份病人肛拭子、10份健康人粪便中提取核酸RNA，采用Takara的One Step RNA PCR Kit进行RT—PCR，对产物电泳，紫外灯下观测结果，同时用R—biopharm AG公司的ELISA试剂检测，比较结果，评价RT—PCR的特异性和灵敏度。结果：RT—PCR检测有10份病人粪便、2份肛拭子阳性，健康人标本全为阴性，ELISA检测有5份病人粪便、3份健康人粪便阳性，4份病人肛拭阴性。结论：用引物P289、P290对诺瓦克样病毒进行RT—PCR，特异性好，灵敏度高，结果准确可靠，ELISA试剂特异性、灵敏度不理想．有假阳性．难以为疾病预防控制提供准确可靠的实验数据。     

广州市1起诺如病毒急性胃肠炎暴发的实验室检测

目的确定1起学校急性胃肠炎暴发原因。方法采集病例粪便标本,直饮水标本,采用实时荧光定量(Real-time)PCR和RT-PCR方法检测病毒核酸,阳性标本测序分析。结果 5份粪便标本中3份呈诺如病毒阳性,2份直饮水标本均呈诺如病毒阳性。3份病例粪便标本病毒株核苷酸序列一致,均为GⅡ-4型,提示病毒同源。结论对诺如病毒进行核酸检测,证实该疫情为一起诺如病毒GⅡ-4型引起的急性胃肠炎暴发。     

一起急性胃肠炎聚集性疫情的病原学诊断及基因型分析

目的 了解合肥市某工地一起急性胃肠炎聚集性疫情的病原及其基因型。方法 采用实时荧光PCR方法对16份肛拭子标本和7份水样标本进行诺如病毒、札如病毒和星状病毒核酸筛查,对诺如病毒核酸阳性标本采用RT-PCR扩增Rd Rp-VP1区基因,并进行基因序列测定,在线比对确定病毒基因亚型,运用MEGA软件构建基因进化树,进行基因比对和进化分析。结果 14份肛拭子和2份水样标本诺如病毒核酸阳性,札如病毒和星状病毒核酸均阴性,获得9条诺如病毒Rd Rp-VP1区基因序列,均为GⅡ. P17-GⅡ. 17型。结论 这是一起因饮用水污染GⅡ. P17-GⅡ. 17型诺如病毒引发的急性胃肠炎暴发疫情。     

安徽省GII.P16-GII.2诺如病毒暴发疫情的基因特征分析

目的了解2018年安徽省一起感染性胃肠炎暴发疫情的病原学特征。方法收集2018年10月一起急性胃肠炎病例粪便/肛拭子12份标本,采用Real-time PCR检测诺如病毒GII基因组,阳性标本经RT-PCR扩增聚合酶区和衣壳蛋白区部分基因序列,进行核苷酸序列测定和遗传进化树分析。结果 12份急性胃肠炎病例标本,荧光PCR检出诺如病毒核酸均为阳性,测序获得10条序列。遗传进化树显示:10条GII.2型间核苷酸序列同源性为100%,与台州参考株GII.2(GenBank登录号:MH806429,MH842206)同源性最高(同源性最高为99.47%),且处于同一分支。结论此次急性胃肠炎暴发疫情由GII.P16-GII.2诺如病毒引起,鉴于它在中国的广泛流行,应重视GII.P16-GII.2重组株在本地区诺如病毒的监测。     

黄山市2018年两起暴发疫情诺如病毒分子分型与基因特征分析

目的了解黄山市暴发疫情诺如病毒分子分型与基因特征。方法收集黄山市2018年两起暴发疫情中具有胃肠炎症状患者的肛拭子标本37份,采用实时荧光定量聚合酶链式反应(Real-time PCR)对采集的标本进行诺如病毒核酸检测,检出的阳性标本,采用逆转录-聚合酶链式反应(RT-PCR)扩增病毒衣壳区和聚合酶区,并对PCR产物进行基因测序及分子分型鉴定,测序结果使用Mega 6.0软件构建进化树进行遗传进化分析。结果 37份标本中,16份标本诺如病毒核酸阳性,其中11份测序成功,BLAST比对结果显示11条序列均为诺如病毒GII.P16-GII.2基因型。两起疫情中检出的诺如病毒序列与福建泉州、江苏泰州、南京和安徽宿州的毒株序列同源性较高。结论 GII.P16-GII.2基因型诺如病毒是引起黄山市黟县两起急性胃肠炎暴发疫情的主要病原体。     

一起胃肠炎疫情的实验室检测

目的 为判断一起胃肠炎疫情的病因提供实验室依据.方法 对发生胃肠炎学生的肛拭子、食堂食品、宿舍和食堂饮用水、食堂环节拭子和二次供水泵房涂抹拭子等进行诺如病毒、轮状病毒和致病菌检测.采用Real-time PCR方法和全自动细菌鉴定仪鉴定.结果 22份肛拭子中,诺如病毒阳性5份,轮状病毒阴性;其他标本诺如病毒和轮状...     

一起学校诺瓦克样病毒性胃肠炎暴发

目的分析1起学校学生诺瓦克样病毒性胃肠炎暴发的流行病学特征，为制定防制措施提供科学依据。方法开展现场流行病学调查并对采集标本进行实验室检测。结果共发生病例27例，罹患率3．87％；采集17份肛拭子和2份粪便标本，2份粪便样品检测出诺瓦克样病毒。结论此次疫情为感染诺瓦克样病毒而引起的1起群体性急性胃肠炎暴发。     

一起老人护理院诺如病毒急性胃肠炎暴发的调查

目的调查分析1起某老人护理院诺如病毒急性胃肠炎暴发的原因,为今后老年人此类疾病的防控提供参考依据。方法采用个案调查收集病例资料,采集部分病例和工作人员肛拭子标本,运用实时荧光定量RT-PCR进行诺如病毒核酸检测。结果 21份肛拭子样本中,19份诺如病毒GⅡ犁核酸阳性,其中11份阳性为发病老人肛拭子样本,8份为工作人员肛拭子样本。结论该疫情是一起由GⅡ型诺如病毒引起感染性腹泻暴发疫情,密切生活接触及未能及时消毒是疫情暴发的主要原因。     

江苏省传染性非典型肺炎病原学检测研究

目的:建立传染性非典型肺炎(SARS)实验室检测方法,为SARS病例诊断和现场防治提供依据。方法:用逆转录套式PCR、实时荧光定量PCR检测SARS病毒核酸;酶联免疫法检测血清标本SARS病毒IgM抗体;部分PCR检测阳性或SARS病毒IgM抗体阳性病例的标本进行直接电镜观察;简并引物PCR检测冠状病毒属病毒核酸;鉴别诊断IFA检测血清中肺炎支原体等9种常见呼吸道感染病原IgM抗体,PCR检测军团菌以及甲、乙型流感病毒核酸。结果:检测各类临床标本506份。2003年全省报告临床诊断病例7例,5例检测结果阳性;逆转录套式PCR检测各类标本132份,阳性8份;对其中4份PCR扩增产物(108bp)进行了序列分析,与SARS病毒序列100%同源;实时荧光定量PCR检测各类标本30份,阳性3份;酶联免疫法检测血清标本101份,SARS病毒IgM抗体阳性4份;3个诊断病例的各类标本电镜检查发现冠状病毒样颗粒;IFA检测血清标本75份,嗜肺军团菌IgM抗体阳性9份,乙型流感IgM抗体阳性11份,两者同时阳性3份,其他病原体IgM抗体均为阴性。不明发热病例的标本21份简并引物PCR检测冠状病毒,2份咽拭子标本阳性;漱口液、尿液标本各15份PCR检测军团菌、漱口液25份PCR检测甲、乙型流感病毒结果均为阴性。结论:本研究建立的检测方法与临床诊断有比较好的符合性,对于临床诊断和防治工作具有重要的参考价值。PCR检测SARS-CoV特异性较好,而敏感性有待提高。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

244株真菌鉴定结果分析

目的 了解某院2000～2001年各类真菌的检出率。方法 用酵母样真菌同化试验编码鉴定板TH-15进行编码鉴定。结果 真菌分离率为8．85％；244株真菌分为10种，其中以白色念珠菌和热带念珠菌较高，分别占真菌总数的75．41％和11．47％；检出真菌的主要标本是痰和阴道分泌物。结论 及时进行真菌培养，有利于合理使用抗菌药物和控制真菌感染。