心房颤动患者CYP2C9、VKORC1基因多态性与华法林药物敏感度的关系

目的分析心房颤动(AF)患者CYP2C9、VKORC1基因多态性与华法林药物敏感度的关系。方法根据华法林给药累计剂量,将27例AF患者分为低起效剂量组和高起效剂量组;根据达标时间,分为短起效时间组和长起效时间组。比较高、低起效剂量组和长、短起效时间组CYP2C9、VKORC1不同基因型华法林的起效剂量和起效时间。结果高、低起效剂量组rs1057910(CYP2C9*3)及长、短起效时间组VKORC1 rs9923231基因构成差异有统计学意义(P<0.05)。与AA基因型比较,CYP2C9 rs1057910 AC基因型华法林起效剂量降低,VKORC1 rs9923231 GA基因型华法林起效时间缩短(P<0.05)。华法林药物敏感度可分为低度敏感、中度敏感和高度敏感3种。结论应结合临床实际对口服华法林行抗凝治疗的AF患者进行CYP2C9、VKORC1基因多态性检测,以便从基因类型角度合理分配华法林剂量。     

宜昌地区泌尿道感染病原菌构成及抗菌药物敏感性分析

目的 为指导临床医师合理使用抗菌药物提供理论依据。方法 回顾性分析宜昌市中心人民医院2012年至2018年尿培养阳性的门诊及住院患者,按时间分为A组(2012—2014年)与B组(2015—2018年),对比分析两组主要病原菌分布情况,以及各病原菌抗菌药物敏感趋势。结果 ①共培养出6596株病原菌,其中A组1857株,B组4739株。A组与B组排名前5位细菌均为大肠埃希菌、粪肠球菌、屎肠球菌、肺炎克雷伯菌和铜绿假单胞菌。②B组中大肠埃希菌对常见抗菌药物敏感性均高于A组,且具有统计学意义。③A组中粪肠球菌对环丙沙星的敏感率高于B组,分别为45.2%和30.6%,B组粪肠球菌对其他抗菌药物敏感率均高于A组,且其中四环素、氨苄西林、万古霉素具有统计学意义。④B组中屎肠球菌对四环素的敏感率略高于A组,分别为42.4%和42.8%,B组屎肠球菌对其他抗菌药物敏感率则更低。结论 泌尿道感染最常见病原菌为大肠埃希菌及肠球菌,占病原菌的70%~80%。常用抗菌药物的敏感率呈上升趋势,临床上规范合理使用抗菌药物对减少病原菌耐药、治疗泌尿道感染具有重要意义。     

Validity of Chinese Version of the Composite International Diagnostic Interview-3.0 in Psychiatric Settings

Background:

The Composite International Diagnostic Interview-3.0 (CIDI-3.0) is a fully structured lay-administered diagnostic interview for the assessment of mental disorders according to ICD-10 and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The aim of the study was to investigate the concurrent validity of the Chinese CIDI in diagnosing mental disorders in psychiatric settings.

Methods:

We recruited 208 participants, of whom 148 were patients from two psychiatric hospitals and 60 healthy people from communities. These participants were administered with CIDI by six trained lay interviewers and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I, gold standard) by two psychiatrists. Agreement between CIDI and SCID-I was assessed with sensitivity, specificity, positive predictive value and negative predictive value. Individual-level CIDI-SCID diagnostic concordance was evaluated using the area under the receiver operator characteristic curve and Cohen''s K.

Results:

Substantial to excellent CIDI to SCID concordance was found for any substance use disorder (area under the receiver operator characteristic curve [AUC] = 0.926), any anxiety disorder (AUC = 0.807) and any mood disorder (AUC = 0.806). The concordance between the CIDI and the SCID for psychotic and eating disorders is moderate. However, for individual mental disorders, the CIDI-SCID concordance for bipolar disorders (AUC = 0.55) and anorexia nervosa (AUC = 0.50) was insufficient.

Conclusions:

Overall, the Chinese version of CIDI-3.0 has acceptable validity in diagnosing the substance use disorder, anxiety disorder and mood disorder among Chinese adult population. However, we should be cautious when using it for bipolar disorders and anorexia nervosa.     

Head-to-head comparison of the diagnostic accuracies of BD Veritor™ System RSV and Quidel® Sofia® RSV FIA systems for respiratory syncytial virus (RSV) diagnosis

BackgroundRespiratory syncytial virus (RSV) is one of the most common causes of severe lower respiratory tract disease among infants and young children. BD Veritor™ System RSV (BD) and Quidel^® Sofia^® RSV FIA (QD) are the new generation lateral flow digital immunoassay (DIA) tests with an instrumented read for the qualitative detection of RSV viral antigens.ObjectiveTo compare the diagnostic accuracies of BD and QD for RSV detection using fresh nasopharyngeal aspirates and nasopharyngeal swab specimens collected in universal transport media during 2013–2014 respiratory season.Study designThe two DIA tests were performed simultaneously on randomly selected specimens on a weekly basis during the RSV season until 200 fresh remnant specimens were enrolled. Real-time RT-PCR assay results were used to compare and evaluate the performance of both RSV DIA assays.ResultsAmong 200 specimens tested, RSV real-time RT-PCR assay detected RSV in 104 samples, while QD detected 84 samples and BD detected 74 samples as positive. The overall sensitivity for detection of RSV in comparison to PCR was 71.15% (61.3–79.4) for BD and 80.77% (71.6–87.6) for QD system (P = 0.36). The specificity was 100% (95.2–100) for both systems. The work flow analysis revealed that the overall specimen processing time was significantly lower for BD as compared with the QD assay.ConclusionsIn comparison with the real-time PCR, the QD system showed a higher sensitivity than that of the BD system, but the difference did not reach statistical significance (P = 0.36). Both BD and QD systems were found comparable in terms of specificity.     

Diagnostic validity (sensitivity and specificity) of panoramic X-rays in osteoarthrosis of the temporomandibular joint

Objective:

To establish the diagnostic validity of panoramic X-rays (PRx) in temporomandibular osteoarthrosis (OA) using the clinical and imaging criteria (magnetic resonance imaging, MRI) of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as gold standards.

Methods:

Eighty-four patients with full clinical records (RDC/TMD), PRx, and MRI scans were selected. Two stomatologists evaluated the PRx for OA. The MRI findings were derived from the radiologist report. Intra/inter-examiner concordance was established. The diagnostic concordance between clinical signs and MRI was determined. Both were used as gold standards to calculate the validity of PRx in OA.

Results:

The diagnostic validity of PRx with MRI as gold standard was sensitivity?=?69·0% and specificity?=?67·9%. The diagnostic validity of PRx with clinical criteria as gold standard was sensitivity?=?61·6% and specificity =?57·9%.

Discussion:

Panoramic X-rays have scant diagnostic validity in temporomandibular osteoarthrosis when taking MRI or clinical criteria of RDC/TMD as gold standards.     

慢性鼻窦炎患者鼻腔(脓性)分泌物的细菌谱及其药敏分析

目的:探讨慢性化脓性鼻窦炎的菌种分布情况及药物敏感性。方法:收集89例慢性化脓性鼻窦炎患者的鼻腔脓性分泌物,进行培养基培养,采用纸片扩散法(Kirby-Bauer,KB法)进行药物敏感性监测,分析这些菌株对头孢唑啉、头孢他啶、头孢吡肟、亚胺培南、美罗培南、头孢哌酮舒巴坦、环丙沙星等抗菌药物的敏感性,万古霉素用MIC法进行定量分析。结果:89例慢性化脓性鼻窦炎患者的鼻道黏脓性分泌物标本经送检分析发现,80例患者检出细菌,阳性检出率为89.89%(80/89);80例患者中共检出82株细菌,共计15种细菌,其中1例患者的鼻道黏脓性分泌物标本检出2株细菌。排除院内感染,在检出的15种细菌中金黄色葡萄球菌、大肠埃希杆菌、表皮葡萄球菌、铜绿假单胞菌、产气肠杆菌等5种细菌占据前5位,分别占18.29%、14.63%、14.63%、13.41%、10.98%。金黄色葡萄球菌的药敏检查结果显示所有的金黄色葡萄球菌对万古霉素敏感,敏感率为100.00%;而对头孢唑啉、头孢他啶、头孢吡肟、亚胺培南、美罗培南、头孢哌酮舒巴坦、环丙沙星等抗菌的敏感率均为0.00%。所有的表皮葡萄球菌对亚胺培南、美罗培南、万古霉素、头孢哌酮舒巴坦均敏感,敏感率为100.00%;其次是头孢唑啉,敏感率为83.33%,而对头孢他啶、头孢吡肟、环丙沙星的敏感率较差,均在30.00%以下。大肠埃希杆菌、铜绿假单胞菌及产气肠杆菌等革兰氏阴性菌均对亚胺培南、美罗培南敏感,敏感率为100.00%。结论:慢性化脓性鼻窦炎患者多伴有细菌感染,主要致病菌包括表金黄色葡萄球菌、大肠埃希杆菌、表皮葡萄球菌、铜绿假单胞菌、产气肠杆菌等,细菌培养阳性对万古霉素、亚胺培南、美罗培南、头孢哌酮舒巴坦、头孢唑啉等抗菌药物敏感,在进行抗菌治疗前应密切监测抗菌谱的改变,以便及时调整用药。     

中医舌象特征与体质类型关联系统的设计与实现

针对中医舌象特征与体质类型之间可能存在着某些关联这一重要问题,本文设计并实现了一个中医舌象特征与体质类型关联系统,为揭示其中的内在关联规律提供科学有效的方法和技术手段。本文从系统结构、系统功能和系统特点等方面详细介绍了系统的设计与实现。系统利用计算机对受检者的体质信息和舌象信息进行采集和自动分析识别,并利用特异性和敏感性分析找出舌象特征与体质类型之间的内在关联。该系统的识别和分析结果可作为中医临床诊治的一项科学、可靠的实践依据,同时该系统能够为中医诊断研究者提供一个研究中医舌象与中医体质内在关联的综合软件平台。     

Foxp3表达与老年颈动脉粥样硬化的关系

目的　探讨老年颈动脉粥样硬化与外周血叉头翼状螺旋转录因子p3（Foxp3）表达以及高敏C反应蛋白（hs-CRP）之间的关系。方法　对66例老年颈动脉粥样硬化患者和51例健康对照者分别利用流式细胞仪检测外周血Foxp3,速率散射比浊法检测hs-CRP。结果　老年颈动脉粥样硬化患者外周血CD4^＋CD25^＋Foxp3^＋调节性T淋巴细胞显著减少,经瑞舒伐他汀钙治疗后较治疗前明显增加;颈动脉粥样硬化患者血清hs-CRP明显高于对照组,有颈动脉斑块的患者血清hs-CRP显著高于颈动脉内中膜增厚患者;将CD4^＋CD25^＋Foxp3^＋与hs-CRP进行相关性分析,两者之间呈负相关。结论　老年颈动脉粥样硬化与外周血Foxp3表达、hs-CRP密切相关。外周血Foxp3表达、hs-CRP在老年人颈动脉粥样硬化、斑块形成的发生发展中起着重要的作用,控制这些危险因素有益于控制和减少脑卒中的发生。     

血清细胞黏附分子对脓毒症急性肾损伤的预测价值研究

背景　细胞黏附分子是急性重症脓毒症造成器官功能障碍（例如肾损伤）的生物标志物,但目前尚不明确血清细胞黏附分子是否对脓毒症急性肾损伤（AKI）的预测有临床价值。　目的　研究血清细胞黏附分子对脓毒症AKI的预测价值。方法　选择2016年1月—2017年12月南通大学附属医院急诊重症监护室（EICU）的84例脓毒症患者为研究对象,根据AKI的诊断标准将患者分为AKI组和非AKI组。入院后24 h内收集患者的临床资料,计算患者急性生理学和慢性健康状况（APACHE）Ⅱ评分、序贯器官衰竭评估（SOFA）评分、查尔森共病指数（CCI）评分,检测患者炎性指标〔C反应蛋白（CRP）、降钙素原（PCT）、乳酸（LAC）〕及血清细胞黏附分子〔细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、血小板选择素（P-selectin）、内皮选择素（E-selectin）〕表达水平。采用Pearson相关分析探讨炎性指标、血清细胞黏附分子与AKI严重程度的关系,采用受试者工作特征（ROC）曲线下面积（AUC）评价炎性指标、血清细胞黏附分子对脓毒症AKI的预测价值。结果　AKI组患者入院后24 h内出现休克、需要机械通气治疗的比例、APACHE Ⅱ评分、SOFA评分、血清肌酐（Scr）、LAC、ICAM-1、VCAM-1、E-selectin水平高于非AKI组（P<0.05）。Pearson相关分析结果显示,E-selectin与Scr呈正相关（r=0.223,P=0.041）。CRP、PCT、LAC、ICAM-1、VCAM-1和E-selectin预测脓毒症AKI的AUC分别为0.523〔95%CI（0.421,0.687）〕、0.637〔95%CI（0.435,0.618）〕、0.609〔95%CI（0.529,0.781）〕、0.702〔95%CI（0.619,0.846）〕,0.661〔95%CI（0.503,0.794）〕、0.774〔95%CI（0.623,0.871）〕,其中,E-selectin的诊断效能最高,其预测脓毒症AKI的最佳截断值为117.2 μg/L（灵敏度79.8%,特异度71.0%）。结论　脓毒症AKI的患者病死率高于脓毒症患者,而E-selectin与AKI的严重程度相关,是预测脓毒症AKI的重要临床标志物。