西藏阿里地区土拉菌病血清学调查

１９９２～１９９３年对西藏阿里部分地区进行了土拉菌病的血清流行病学调查，采自５个县的人、畜血清检测表明，人土拉感染阳性检出率为１．２％（４／３４９）；羊检出率为２１．２％（９０／４２５），检出率随年龄增大而呈上升趋势。在银盾革蜱春季活动高峰期，羊带蜱率几达１００％，带蜱指数为４０～７０。羊土拉感染水平与暴露机会密切相关。     

粤东丰溪林场斑点热疫源地

本文采用现场调查方法、血清学方法、病原分离方法和分子流行病学方法在广东省大埔县丰溪林场进行了斑点热疫源地调查,共调查了７个自然村,２８２个健康人,３０头牛,２只羊、７个品种共５３只野鼠及从野外和动物体表收集３个品种共４９４只蜱。结果表明：大埔县林区的优势鼠种为褐家鼠和黄毛鼠;鼠的带蜱率为１５．０９％（８／５３）;牛和羊的带蜱率均为１００％（３０／３０,２／２）;解剖后观察脏器有病变的鼠占鼠总数的４９．０５（２６／５３）。优势蜱种为金泽革蜱、豪猪血蜱和台湾角血蜱。健康人群血清中西伯利亚立克次体抗体阳性率为１０．２８％（２９／２８２）;康氏立克次体抗体阳性率为３．９０％（１１／２８２）;小蛛立克次体阳性率为５．６７％（１６／２８２）。鼠血清中三种立克次体抗体阳性率分别为１３．３３％（４／３０）、３．３３％（１／３０）和１０．００％（３／３０）。牛血清中三种立克次体抗体阳性率分别为８．００％（２／２６）、４．００％（１／２５）和４．００％（１／２５）。     

3268份血培养中常见病原菌及耐药性分析

目的了解我院2006年7月～2007年6月血培养中分离出的菌种分布及耐药情况。方法用BacT／ALTER3D全自动血培养仪对血培养标本进行检测。阳性的标本用VITEKAMS60全自动微生物鉴定仪进行细菌鉴定和药敏试验。结果3268份血培养标本，分离出病原菌344株，阳性率为10．5％。其中革兰阴性杆菌211株（61．3％），革兰阳性球菌99株（28．8％），真菌34株（9．9％）。革兰阴性菌以大肠埃希菌、铜绿假单胞菌、嗜麦芽窄食单胞菌、肺炎克雷伯菌检出率最高，革兰阳性菌以凝固酶阴性的葡萄球菌、金黄色葡萄球菌检出率最高，真菌感染以白色念珠检出率最高。大肠埃希菌、肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）菌株分别占67．2％、61．1％，金黄色葡萄球菌、凝固酶阴性葡萄球菌耐甲氧西林菌株分别占66．7％、72．6％。结论血培养中分离出的菌种多、分布广泛，且产ESBLs、耐甲氧西林的菌株检出率相当高，耐药菌株多，因此通过对血培养分离菌的耐药监测，可以指导临床合理应用抗菌药物。     

新疆温泉县土拉菌病调查报告

<正> 土拉菌病又称野兔热病,病原体是土拉伦斯杆菌。我国自1957年首次从黄鼠中分离出土拉伦斯杆菌后,近几年又从野兔、硬蜱和病人中得到证实。我们于1986年4～10月份对温泉县部份地区进行了土拉菌病流行病学、病原学及血清学调查,现报告如下。     

BACTEC法检测分支杆菌的临床应用分析

本文对１９９３年４月～１９９４年５月间３００份临床标本的检测结果进行分析。结果：分支杆菌检测阳性率２５．０％，培养阳性平均报告时间为８．４天，两周内报告阳性的病例占８１．４％；污染率为４．０％。在检出的７５株分支杆菌中结核分支杆菌占６８株（９０．７％），非结核分支杆菌７株（９．３％），平均报告时间为４．２天。药敏试验采用最低抑菌浓度法，其平均报告时间为４．６天，本文结果表明ＢＡＣＴＥＣ法快速检测分支杆菌与常规法相比具有初代分离率高、快速、简便、易于操作及质控等特点，是目前分支杆菌快速培养、鉴定和药敏试验的优选方法。     

临床标本病原菌分布及药敏试验分析

了解不同临床标本病原菌的分布情况，以及主要致病菌的药物敏感性，为合理使用抗生素提供依据。方法统计分析四川省人民医院2006—01／12分离的主要病原菌种类及药敏试验结果。结果检出的2494株病原菌中，主要病原菌依次为大肠埃希菌（17．8％），克雷伯菌属（15．8％），金黄色葡萄球菌（15．2％），真菌（14．8％），凝固酶阴性葡萄球菌（13．3％），假单胞菌属（10．3％）。革兰阳性球菌对万古霉素、替考拉宁的耐药率较低，革兰阴性杆菌耐药率最低的是亚胺培南和美洛培南。结论耐药菌株不断增加，细菌耐药性问题日趋严重，真菌检出率增高，应加强临床抗生素合理使用，以减少耐药菌及耐药菌感染的发生和发展。     

蚤、蜱中巴尔通体的分离培养及检测鉴定

目的了解蚤、蜱在我国作为巴尔通体传播媒介的可能性，获得其自然状态下存在于吸血节肢动物中的证据。方法采集家猫、狗、牛及鼠类动物体表寄生蚤、蜱，采用含5％去纤维兔血脑心浸液（brain heart infusion，BHI）培养基置于35℃含5％ CO2培养箱中从蚤、蜱中分离巴尔通体，疑似菌落应用聚合酶链反应技术（Polymerase Chain Reaction，PCR）扩增巴尔通体特异基因片段，阳性产物测序并用同源性比较及系统发育分析等方法分析确定巴尔通体的亲缘关系。结果分别从猫栉首蚤、微小牛蜱中各分离出1株巴尔通体，用5对巴尔通体属特异性引物进行PCR反应，扩增产物均产生阳性目标带，证实为巴尔通体属微生物。序列同源性比较发现蚤、蜱分离株之间同源性较小，tRNA^Ile-tRNA^Ala地基因间隔区序列为58．2％、ftsZ基因序列为72．8％；这两株菌分别与云南鼠类宿主血液中分离的巴尔通体菌株RT222SM、RT221SM同源性最大，与其它已知巴尔通体同源性均较小。蚤培养物与RT222SM的tRNA^Ile-tRNA^Ala基因间隔区的同源性是77．9％、与ftsZ是96．2％；蜱培养物与RT221SM的tRNA^Ile-tRNA^Ala基因间隔区的同源性是99．4％，与云南鼠血中分离的Rf1561yn的gltA基因338bp核酸序列同源性为99．1％，基于gltA种系发育分析提示与Rfl561yn亲缘关系最近。结论从猫栉首蚤、微小牛蜱中分离培养出巴尔通体，为蚤、蜱作为巴尔通体传播媒介提供了线索，同时为在我国进一步开展媒介生物中巴尔通体感染情况调查提供了实验方法的参考依据。同源性搜索、比较及系统发育分析支持这2株巴尔通体与中国云南分离的巴尔通体基因型相似，而与国外的巴尔通体分离株亲缘关系较远。     

我国部分地区猪源大肠杆菌LEE和HPI毒力岛相关基因的检测

目的 采用PCR方法检测我国江苏等9个省市部分地区分离的1007株猪源大肠杆菌中肠细胞脱落位点毒力岛（LEE）和强毒力岛（HPI）。方法 对LEE毒力岛检测其核心区的衙和eaeA基因，对HPI毒力岛检测其irp2和fyuA基因。同时对LEE和／或HPI阳性大肠杆菌进行了O血清型的鉴定。结果 在分离的猪源大肠杆菌中。LEE毒力岛基因检测结果为：2．2％（22／1007）的菌株let和eaeA基因的扩增阳性，0．5％（5／1007）的菌株eaeA阳性。HPI毒力岛基因检测结果为：10．6％（107／1007）的菌株irp2和fruA基因扩增阳性，2．1％（21／1007）的菌株irp2阳性；其中有2株irp2和ler基因扩增阳性，有3株irp2、ler和eaeA基因扩增阳性，1株irp2、fyuA、ler和eaeA基因扩增都为阳性；在128个HPI阳性分离株中，093和0107血清型菌株分别占定型菌株的15．7％（13／83）和12．0％（10／83）。结论 2．7％的猪源大肠杆菌携带LEE．12．7％的菌株携带耶尔森菌HPI，O93和O107为猪源HPI大肠杆菌常见血清型。     

闽东农村小儿大肠杆菌肠炎病原学调查

本文报告了闽东农村婴幼儿大肠杆菌性腹泻的病源学调查结果。从６０４例腹泻患儿中检出ＥＴＥＣ８４株（１３．９％）、ＥＰＥＣ７２株（１１．９％）、ＥＩＥＣｌ９株（３．２％），检出率为２８．９％，占检出致泻病原菌的６７．８％。提示ＥＴＥＣ、ＥＰＥＣ、ＥＩＥＣ是该地区农村此次婴幼儿引起腹泻的主要菌群。３种病原性大肠杆菌在各年龄组中均有检出，ＥＴＥＣ、ＥＰＥＣ以１岁３组和岁组检出率最高，分别为２２．４％和１４．９％。１２个月的观察结果以７～９月份检出最高，表现出明显的季节性。     

1510株肠道杆菌大肠菌素调查及其检测方法的研究

对７个菌属１５１０株肠道杆菌进行了大肠菌素检测，宋内氏菌Ｃｏｌ质粒检出率最高为７８．１８％，其次为普通大肠杆菌３３．４７％，福氏志贺氏菌、克雷伯氏菌、伤寒沙门氏菌分别为８．０％、３．５％、２．３２％，不同种属菌株大肠菌素检出率差异悬殊。药敏试验证明，９０．５％（１０５／１１６）Ｃｏｌ＋大肠杆菌具有耐药性，在接合实验中，２６．２％（１６／６１）大肠杆菌能传递Ｃｏｌ质粒。将Ｃｏｌ＋菌株接种保种半固体置室温２年，１９．９％（３１／１５６）的菌株丢失Ｃｏｌ质粒。本实验同时建立一种直接覆盖指示菌──插种受检菌以检测大肠菌素的方法。通过大量菌株考核，结果与Ｍｏｎｋ法基本一致，而且比后者简单、快速。在细菌素的调查研究中具有广泛的应用价值。     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.     

Dénervation rénale pour HTA réfractaire sans anesthésie générale : intérêt d’un protocole MEOPA Morphine. Expérience préliminaire

Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1 mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA < 5), in three cases intense (EVA > 5) pain leading to increasing doses of morphin, (total dose of 0.25 mg/kg in two cases, 0.17 mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17 mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17 mg/kg in group 1, 0.11 mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. Conclusion: regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.     

Scale‐up of TB and HIV programme collaborative activities in Zambia – a 10‐year review

Objective To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. Methods Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000–2010. Results The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti‐retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV‐infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co‐trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. Conclusions The scale‐up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti‐retroviral (ARV) rollout with improved treatment outcomes among TB patients co‐infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA).     

C-MET在非小细胞肺癌对表皮生长因子受体酪氨酸激酶抑制剂耐药中的作用研究进展

以表皮生长因子受体(EGFR)为靶点的酪氨酸酶抑制剂(TKI)是近年来非小细胞肺癌(NSCLC)治疗的重大突破.但是随着临床的广泛应用,耐药成为新的难点.新近研究已发现对EGFRTKI的耐药产生主要涉及原癌基因C-MET的扩增突变.C-MET是原癌基因,是蛋白产物肝细胞生长因子/离散离子(HGF/SF)的受体,具有酪氨酸酶活性,C-MET基因扩增激活ErbB3-PI3K信号途径导致NSCLC对EGFR-TKI产生耐药,大量研究证实NSCLC患者对EGFR-TKI耐药约20％归因于C-MET基因扩增.     

Artificial intelligence in pancreaticobiliary endoscopy

Artificial intelligence (AI) applications in health care have exponentially increased in recent years, and a few of these are related to pancreatobiliary disorders. AI‐based methods were applied to extract information, in prognostication, to guide clinical treatment decisions and in pancreatobiliary endoscopy to characterize lesions. AI applications in endoscopy are expected to reduce inter‐operator variability, improve the accuracy of diagnosis, and assist in therapeutic decision‐making in real time. AI‐based literature must however be interpreted with caution given the limited external validation. A multidisciplinary approach combining clinical and imaging or endoscopy data will better utilize AI‐based technologies to further improve patient care.