The radiological diagnosis of infection

Musculoskeletal infections can involve bone, joints, muscles and soft tissues. The interpretation of imaging in musculoskeletal infections can be a diagnostic challenge and requires an integrated approach with clinical details and blood inflammatory markers. Imaging also plays a vital role in treatment planning and follow up. Conventional plain film radiography is still the cornerstone, which provides an overview of the bone and surrounding soft tissue pathology and should routinely be the first imaging procedure in patients with suspected musculoskeletal infection. The sensitivity of radiographs for the detecting of acute osteomyelitis is limited. Ultrasound can be used to assess soft tissue collections, joint effusions, and foreign body localization. It is invaluable in providing guidance for diagnostic joint aspiration, biopsy or therapeutic drainage of a soft tissue abscess/collection. CT scans are useful in providing bony detail and are particularly useful for evaluation of presence of sequestrum and in cases where MRI is contraindicated. MRI provides excellent anatomical details and evaluates both the soft tissues and bones and is the most sensitive and specific imaging modality for evaluating musculoskeletal infection. Radionuclide imaging can be helpful in cases of acute osteomyelitis and multifocal infection and has a high negative predictive value when normal.     

胆管空肠Roux-en-y吻合术后逆行性胆管感染的相关临床因素分析

目的：探讨胆管空肠Roux-en-y吻合术后逆行性胆管感染的相关临床因素。方法选择本院收治并实施胆管空肠Roux-en-y吻合术患者134例，分析糖尿病病史（有或无）、吻合口直径（≤2 cm或＞2 cm）、吻合方式（侧侧吻合、端侧吻合）、术前黄疸持续时间（≤7 d或＞7 d）、术前胆红素水平（≤171μmol/L或＞171μmol/L）、术中抗菌药物（有或无）对术后逆行性胆管感染的影响。结果合并糖尿病患者发生逆行性胆管感染发生率高于无糖尿病患者，差异有统计学意义（P＜0.05）；吻合口直径≤2 cm患者发生逆行性胆管感染发生率高于吻合口直径＞2 cm患者，差异有统计学意义（P＜0.05）；侧侧吻合患者的逆行性胆管感染发生率高于端侧吻合患者，差异有统计学意义（P＜0.05）。结论胆管空肠Roux-en-y吻合术后逆行性胆管感染与患者是否合并糖尿病、吻合口大小及吻合方式有关，值得临床借鉴。     

河南省新报告HIV感染者中丙型肝炎病毒感染状况及其影响因素分析

目的 了解河南省新报告HIV感染者中丙型肝炎病毒（HCV）感染情况及其相关影响因素。方法 对2012年7月1日至2013年6月30日河南省所有新确证上报的HIV-1感染者进行信息整理、HIV-1 BED新发感染检测和HCV抗体检测。结果 河南省该期间新确证上报2 049例HIV-1感染者中HCV抗体阳性率为14.87%（271/1 887），BED阳性比例（新发感染比例）为26.34%（497/1 887）。新发HIV-1感染者中HCV抗体阳性率较既往HIV-1感染者低，20～39岁组HIV-1感染者的HCV抗体阳性率较其他年龄组低，个别地区HIV-1感染者的HCV抗体阳性率较高，经注射吸毒感染HIV-1者中HCV抗体阳性率较高。结论 新发感染、年龄、传播途径和地区分布是河南省新报告HIV-1感染者中HCV感染率的影响因素，应有针对性地开展此人群的丙型肝炎防治工作。     

锐利器械不同保护法的效果研究

目的:研究尖锐器械在低温灭菌过程中的保护方法。方法:将2012年9月~201 3年6月供应室清洗后的再生穿刺针类器械741个,随机分为头皮针软管组、尿管组,分别使用头皮针软管、尿管做成保护帽,对锐利器械采取保护措施,并与2010年1月~3月使用纱布保护套的335个尖锐器械作对比,对其保护效果进行研究。结果:头皮针软管组包装及器械完好性达100%;尿管组纸塑袋包装破损32个,破损率8.7%,10个器械发生损坏占2.7%;纱布组管纸塑袋破损71个,破损率21.2%,器械损坏29个,破损率8.66%;三组包装破损率比较P<0.05,头皮针软管组、尿管组器械破损率分别与纱布组比较P<0.05,差异均有统计学意义。结论:头皮针软管能保护尖锐器械及包装的完好性,可根据器械的规格型号及数量选取相应的保护措施,以达院感要求。     

413例医院感染患者调查分析

目的了解医院感染发生的现状,以便采取有效措施防控医院感染发生。方法对20161例出院患者进行回顾性调查分析。结果发生医院感染413例,感染率为2.05%(1.73%～2.29%),科室以神经外科感染率较高,感染部位以呼吸道感染占首位,疾病以神经系统疾病患者为高发人群,病原体种类以革兰氏阴性杆菌为主。结论医院感染的发生主要与患者基础疾病特点相关,应根据具体情况采取有效措施,尽可能地预防医院感染发生。     

医院感染监测系统的开发与应用

通过与软件公司联合开发满足医院要求的感染管理软件,实现感染管理的信息化.其功能包括疑似病例智能筛查、多重耐药菌监测、抗菌药物监测、专职人员与临床医生交互平台等.结果表明运用该软件系统能及时提供医院感染动态信息,提高工作效率,改善医院感染管理水平.     

卫生检验与检疫专业病毒学检验实验教学改革探索

“病毒学检验实验”是卫生检验与检疫专业必修的专业实践课，它注重培养学生在病毒学检验中的实践能力和解决问题能力。因此，本研究结合当前公共卫生需要，以提高学生实践综合能力为目标，进行实验教学改革与探索。本文对病毒学检验实验课程体系中的教学方法和手段、实验考核方法进行改革探索，提出研究型、实战式、案例式病毒学检验实验教学模式；受新冠疫情影响，采用线上线下混合式教学，并在原有实验基础上，新增虚拟仿真实验，打破时空限制，帮助学生掌握实验技能。此外，采用综合实验考核方案，构建适合于卫生检验与检疫专业病毒学检验的实验教学体系。     

不同胰岛素对口腔颌面部多间隙感染合并糖尿病的治疗体会

目的:探索口腔颌面部多间隙感染合并糖尿病患者的最佳胰岛素治疗方案。方法:将2006年1月~2012年12月在我科住院的57例口腔颌面部多间隙感染合并糖尿病患者随机分为3组。A组:"三短一长"强化注射组;B组:预混胰岛素组;C组:中性胰岛素组。同时给予切开引流、抗感染、全身营养支持治疗,比较治疗后实验室检测血糖达标时间、伤口平均愈合时间、低血糖发生次数。结果:采用"三短一长"强化注射组其血糖达标时间及平均愈合时间明显少于其它两组(P0.05),而低血糖发生次数三组间无显著差异(P0.05)。结论:对口腔颌面部多间隙感染合并糖尿病患者采用"三短一长"强化注射胰岛素法控制血糖,能明显缩短治疗疗程及住院时间,降低死亡率,提高治疗效果。     

Evaluation of nosocomial infection risk using APACHE II scores in the neurological intensive care unit

To evaluate the feasibility and accuracy of using the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system for predicting the risk of nosocomial infection in the neurological intensive care unit (NICU), 216 patients transferred to NICU within 24 hours of admission were retrospectively evaluated. Based on admission APACHE II scores, they were classified into three groups, with higher APACHE II scores representing higher infectious risk. The device utilization ratios and device-associated infection ratios of NICU patients were analyzed and compared with published reports on patient outcome. Statistical analysis of nosocomial infection ratios showed obvious differences between the high-risk, middle-risk and low-risk groups (p < 0.05). The area under the receiver operating characteristic curve of the APACHE II model in predicting the risk of nosocomial infection was 0.81, which proved to be reliable and consistent with the expectation. In addition, we found statistical differences in the duration of hospital stay (patient-days) and device utilization (device-days) between different risk groups (p < 0.05). Thus the APACHE II scoring system was validated in predicting the risk of nosocomial infection, duration of patient-days and device-days, and providing accurate assessment of patients’ condition, so that appropriate prevention strategies can be implemented based on admission APACHE II scores.