Correlation between the intensity of cytomegalovirus infection and the amount of perivasculitis in aortic allografts

Abstract  We previously demonstrated that cytomegalovirus (CMV) infection enhanced perivascular inflammation in rat aortic allografts. In this study, we investigated the relationship between the CMV infection load and the magnitude of perivasculitis (chronic rejection) in aortic transplants. Rats received or-thotopic abdominal aortic grafts, different degrees of total body irradiation (TBI) for immunosuppres-sion and CMV inoculation. The spleens of the rats receiving 5 Gy of TBI contained more infectious virus and viral antigens than those of rats receiving 3 Gy of TBI or no TBI. Although the number of inflammatory cells infiltrating the perivascular area was decreased after TBI, CMV infection resulted in increased perivasculitis in rats that received 5 Gy of TBI as compared to non-infected animals. This virus-induced effect was characterized predominantly by an increased T-cell infiltration, including CD4 and CD8 T-cells. It is concluded that an enhanced systemic CMV infection during severe immunosuppressive therapy can accelerate the development of chronic rejection, which seems to be mediated mainly by T-cells.     

载银磷酸锆纱布对烧伤创面常见细菌作用的实验研究

目的 了解载银磷酸锆纱布对烧伤大鼠创面感染常见细菌的抗菌效力。方法制作Wistar大鼠烫伤(以下称烧伤)感染模型，采用试管双倍稀释法测定载银磷酸锆及磺胺嘧啶银的最低抑菌浓度(MIC)及最低杀菌浓度(MBC)。观察大鼠创面用磺胺嘧啶银纱布、普通尢菌纱布、载银磷酸锆纱布(小水洗及水洗20次)后痂下组织的细菌计数和对创面愈合的作用。结果载银磷酸锆对金黄色葡萄球菌、铜绿假单胞菌、大肠竹菌的MIC各为8、8、16mg／L，MBC各为16、8、32mg／L，为磺胺嘧啶银的2～8倍?大鼠创面用未水洗的载银磷酸锆纱布覆盖后，痂下细菌计数比用磺胺嘧啶银纱布低91％，比普通无菌纱布低99％未水洗的载银磷酸锆纱布对创面愈合的作用明显优于其他两种纱布，且其痂下组织细菌计数与水洗20次的效银磷酸锆纱布比较，差异无显著性意义(P＞0．05)。结论载银磷酸锆埘烧伤创面感染常见细菌有较强的抑制和杀灭作用，其敷料可作为治疗措施中新的选择。     

Potential risk factors for infection with Candida spp. in critically ill patients

The incidence, risk factors and prognostic factors for candidal infection were determined in a prospective study of 280 infected patients. Thirty-one (11%) patients were infected with Candida spp., sub-divided into 18 (58%) with C. albicans, and 13 (42%) with non-albicans spp. (six C. glabrata, three C. parapsilosis, and one each of C. krusei, C. tropicalis, C. guilliermondii and C. lusitaniae). Infection with Candida spp. was always associated with concurrent bacterial infection. By univariate logistic regression analysis, the degree of morbidity and the duration of mechanical ventilation were independent predictive factors for death, but infection with Candida spp., was not. Factors associated with Candida spp. infection were the degree of morbidity, intensive care unit length of stay, alterations of immune response, and the number of medical devices involved. By multivariate logistic regression analysis, the only independent risk factor for candidal infection was intensive care unit length of stay.     

Does previous infection protect against atopic eczema and recurrent wheeze ininfancy?

BACKGROUND: Frequent infection in infancy and early childhood has been hypothesized to explain the low prevalence of asthma and other atopic disease among children in developing countries (the so-called 'hygiene hypothesis'), but the low prevalence in Eastern Europe remains unexplained. OBJECTIVE: To test the hygiene hypothesis in the Republic of Belarus by examining the relationship between gastrointestinal (GI) and respiratory infection and two potentially atopic outcomes in the first 12 months of life: atopic eczema and recurrent wheeze. METHODS; We carried out two case-control studies nested within a large (n=17 046) randomized trial in Belarus, with cases defined as (1) first occurrence of atopic eczema (n=819) and (2) second episode of wheezing (n=112). Incidence density sampling was used to select four matched controls born within 1 month at the same hospital as the case. Exposure was defined as one or more episodes of GI or respiratory infection (examined separately) with onset >7 days before onset of the case's atopic outcome. Analyses controlled for family atopic history, duration of exclusive breastfeeding, sex, birth weight, maternal education, and (for recurrent wheeze) maternal smoking. RESULTS: For atopic eczema, prior GI infection occurred in 7.4% of cases vs. 6.0% of controls [adjusted OR=1.27 (0.94-1.72)] and prior respiratory infection in 35.2% vs. 32.6% [adjusted OR=1.14 (95% CI=0.94-1.37)]. For recurrent wheeze, prior GI infection occurred in 9.8% of cases vs. 7.4% of controls [adjusted OR=1.30 (0.60-2.82)]. CONCLUSION: Our results do not support the hypothesis that infection protects against atopic eczema or recurrent wheezing in the first 12 months of life.     

1515例精神科住院患者医院感染调查与分析

目的：了解精神科住院患者医院感染情况，以利采取切实可行的预防控制措施，降低感染率。方法：对我院两年半间住院患者进行有关医院感染的调查，逐份查阅原始记录，填写统一表格，将所得资料进行相关分析。结果：医院感染72例，感染率为4．75％；感染多发生在20～29岁和30—39岁组：精神分裂症为医院感染例数最多的病种(占68．06％)；皮肤及软组织和下呼吸道感染为主要感染部位，分别为23．61％和22．22％；男女两性在年龄和病程方面差异均无显著性。结论：预防及控制精神病患者的医院感染应从病人初入院时即开始；在积极控制精神症状的同时，采取多方面措施，尽可能去除医院感染的易感因素；合理规范使用抗生素，增强患者体质等，这些均有助于预防及控制医院感染。     

三联疗法根除幽门螺杆菌治疗对肠道微生态的影响

目的 探讨抗幽门螺杆菌(Hp)治疗对患者肠道菌群状态(肠道微生态)及耐药性的影响。方法 分别称取60例患者治疗前后新鲜粪便0．5g，选择肠道菌群中具代表性的4种需氧菌和6种厌氧菌分别进行需氧和厌氧培养，从培养出的菌落中挑选相同的菌株进行治疗前后药敏试验。结果 (1)治疗后肠道菌群中肠杆菌、葡萄球菌、拟杆菌、双歧杆菌、消化球菌、梭菌、乳杆菌、真杆菌均较治疗前明显降低(P＜0．05)；(2)治疗后肠道菌群中大肠埃希氏菌、消化链球菌、赛氏葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、产气真杆菌等对庆大霉素、红霉素、环丙沙星、特美丁、头孢噻肟钠等药耐药率明显增加，且存在多重耐药(P＜0．05)；(3)治疗后超广谱β—内酰氨酶阳性的消化链球菌、表皮葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、赛氏葡萄球菌等较治疗前分别增加26．2％、33．3％、28．6％、35．3％、28．6％。结论 三联抗Hp治疗后肠道菌群失调、耐药菌株的增加、传播与扩散对广大人群存在潜在危险。     

Closed suction drainage after orthopaedic surgery: evidence versus practice

Abstract Closed suction drainage systems are commonly used in orthopaedic surgery, particularly in joint arthroplasty. The rationale for the use of drains is a theoretical reduction of wound haematomas and infection. However the benefit of using drains after total hip or knee arthroplasty is controversial. Several reports have shown that the use of drains does not reduce infection and morbidity and is an unnecessary and potentially dangerous practice. In fact most studies highlighted that at best their use appears to make no difference to important clinical outcomes. Recently a metaanalysis raised the question about the usefulness of closed suction drainage again, concluding that it has no major benefits. The purpose of this study was to review the evidences available concerning the utility of closed suction drainage outlining that this practice is not supported by clinical evidence.     

Inhibition of hepatitis B virus DNA replicative intermediate forms by recombinant interferon-γ

AIM: To evaluate the in vitro anti-HBV activity of recombinant human IFN-γ, alone and in combination with lamivudine. METHODS: A recombinant baculovirus-HBV/HepG2 culture system was developed which could support productive HBV infection in vitro. Expression of HBsAg and HBeAg in infected HepG2 culture medium was detected by commercial enzyme immunoassays. HBV DNA replication intermediates were detected in infected cells by Southern hybridization and viral DNA load was determined by dot hybridization. RESULTS: IFN-γat 0.1 to 5μg/L efficiently down regulated HBsAg expression in transduced HepG2 cells. At 5μg/L, IFN-γalso suppressed HBV DNA replication in these cells. While treatment with a combination of lamivudine and IFN-γshowed no additive effect, sequential treatment first with lamivudine and then IFN-γwas found to be promising. In this culture system the best HBV suppression was observed with a pulse of 2μmol/L lamivudine for two days, followed by 1μg/L IFN-γfor another four days. Compared to treatment with lamivudine alone, the sequential use of 0.2μmol/L lamivudine for two days, followed by 5μg/L IFN-γfor six days showed a 72% reduction in HBV cccDNA pool. CONCLUSION: This in vitro study warrants further evaluation of a combination of IFN-γand lamivudine, especially in IFN-αnon-responder chronic hepatitis B patients. A reduced duration of lamivudine treatment would also restrict the emergence of drug-resistant HBV mutants.     

医院感染流行病学监测分析

介绍了我院１９９３年７月１日～１９９３年１２月２０日出院的１０３１例病人医院感染病率的监测分析，半年中感染率为８．４％，妇产科疗区发病率高于外科疗区，感染部位以泌尿道、下呼吸道、手术伤口为最多，侵袭性操作及易感因素引起的感染在感染病例中分别占４０．２％和５９．８％。     

胃镜检查与幽门螺杆菌感染关系的初步探讨

本文用前瞻性连续检测方法，对２６９例患者作胃粘膜ＨＰ检测，且同步对消毒前后的胃镜、有关器械和操作者手套采样，作ＨＰ检测。结果发现，消毒前镜端（含弯曲部）、活检钳、清洁刷、器械管道插口和操作者手套采样标本的ＨＰ阳性率分别达６９．５１％、７３．６０％、８１．６２％、８７．７３％和９７．７２％。目前常规的清洗消毒虽能清除ＨＰ对胃镜的大部分污染，但还存在一些易忽视的环节，这可能在检查中引起医源性感染，应予高度重视。