Technique of Tubularized Bladder Mucosa Method for Treating Recurrent Vesicoureteral Reflux

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Phylogenetic and Molecular Analysis of an H7N7 Avian Influenza Virus Isolated in East Dongting Lake in 2012

Objective In March 2012, an H7N7 subtype avian influenza virus (AIV) named A/wild goose/Dongting/PC0360/2012 (H7N7) (DT/PC0360) was recovered from a wild goose in East Dongting Lake. We performed whole-genome sequencing of the isolate, and analyzed the phylogenetic and molecular characterization.
Methods RNA was extracted from environment samples (including fecal samples from wild bird or domestic ducks, and water samples) for detecting the presence of Influenza A Virus targeting Matrix gene, using realtime RT-PCR assay. The positive samples were performed virus isolation with embryonated eggs. The subtype of the isolates were identified by RT-PCR assay with the H1-H16 and N1-N9 primer set. The whole-genome sequencing of isolates were performed. Phylogenetic and molecular characterizations of the eight genes of the isolates were analyzed.
Results Our results suggested that all the eight gene segments of DT/PC0360 belonged to the Eurasian gene pool, and the HA gene were belonged to distinct sublineage with H7N9 AIV which caused outbreaks in Mainland China in 2013. The hemagglutinin cleavage site of HA of DT/PC0360 showed characterization of low pathogenic avian influenza virus.
Conclusion Strengthening the surveillance of AIVs of wild waterfowl and poultry in this region is vital for our knowledge of the ecology and mechanism of transmission to prevent an influenza pandemic.     

2014年某儿童医院医院感染现患率调查

目的了解儿童医院医院感染现状及抗菌药物使用情况。方法采用床旁调查和查阅病历相结合的方法,调查某儿童医院2014年5月1日0∶00—24∶00住院患者的医院感染现患率及抗菌药物使用情况。结果共调查患者1 027例,发生医院感染8例(10例次),医院感染现患率为0.78%,例次现患率为0.97%。感染科室主要为血液中心(4例),感染部位主要为呼吸道(上、下呼吸道各2例),抗菌药物使用率为62.12%。各科室抗菌药物使用率、抗菌药物用药目的及联合用药方面比较,差异均有统计学意义(均P0.05)。抗菌药物使用率居前3位的科室为新生儿中心(89.69%)、急救中心(76.00%)、综合病房(73.91%);除五官科(预防用药占57.89%)、外科(治疗用药占26.32%),其他科室均以治疗用药为主;五官科、心脏中心及神经康复中心均以单一用药为主(均95%),新生儿中心二联用药率占48.28%,血液中心三联用药率占30.30%。结论儿童医院应重点加强感染高发科室和高发部位的日常监测,加强医护人员的医院感染相关知识培训,合理使用抗菌药物。     

丹红注射液Ⅳ期临床试验的数据与安全监察

 目的 探讨如何在临床试验中建立数据与安全监察委员会(DSMB)以及数据与安全监察委员会应该如何履行其职责。方法 依托丹红注射液Ⅳ期临床试验平台,根据美国FDA发布的《临床试验数据监查委员会的建立与工作技术指导原则》的要求,并结合丹红注射液的研究目的、方案设计以及数据与安全监察委员会赋予的职责,制定了丹红注射液数据与安全监察委员会的章程与操作程序。结果 丹红注射液Ⅳ期临床试验建立了由临床医生、统计学家和生物伦理学家组成的独立数据与安全监察委员会。数据与安全监察委员会制定了相应的操作规则、工作职责和委员会章程。其主要通过召开不同形式的会议来履行工作职责,采用临床电子数据采集系统(EDC)集中监察和现场监察的方式对试验执行情况进行审查和评价,制定并开展相应的期中分析,重估样本量并对方案进行适应性调整,提高试验的成功率,从而更好的保护受试者的安全与利益,保证临床试验数据的真实性和可靠性,进一步提高临床试验质量的可控性。结论 数据与安全监察委员会的建立不仅能保护受试者的安全与利益,同时也能保证试验结果的科学性。丹红注射液Ⅳ期临床试验数据与安全监察委员会的工作情况可为其他临床研究建立数据与安全监察委员会提供参考。     

彩色数码眼底照相在健康体检中的应用

目的探讨彩色数码眼底照相在健康体检中对眼底病的筛查及指导诊治的重要性。方法对50245例（100490只眼）健康受检者用Topcon TRCNW 100彩色数码眼底照相机进行照相后进行筛查分析。结果总检查人数50245例,其中正常者45373例,占90．3％,一般性描述者359例,占0．7％,阳性发现4513例,占9．0％。各年龄组男女之间阳性比较,差异均无统计学意义（P〉0．05）。阳性发现中视网膜动脉硬化的检出率7．4％、糖尿病型视网膜病变0．1％、黄斑病变0．1％、视网膜病变0．6％、视神经萎缩0．1％、视乳头C／D大于0．7％。对筛查出有阳性发现的受检者给予及时准确的诊断和合理的治疗建议。结论彩色数码底照相具有客观性、重复性及非创伤性特点,影像数据便于存储和交流,且视网膜微血管病变对心脑血管事件具有较好的预测作用,因此在健康体检领域具有重要的应用价值。     

体外循环期间肺动脉持续氧合血灌注对肺功能及细胞间黏附分子-1表达的影响

目的:探讨体外循环(CPB)期间肺动脉持续氧合血灌注对肺功能及肺组织内细胞间黏附分子-1(ICAM-1)表达的影响。方法:实验用健康小型猪随机分为两组,对照组常规行CPB,实验组行CPB期间肺动脉持续灌注氧合血。分别于不同时间点留取肺组织和血液标本,进行肺功能和肺含水率的测定以及肺组织的病理学观察,并采用逆转录聚合酶链反应(RT-PCR)方法检测肺组织ICAM-1mRNA的表达。结果:与对照组相比,实验组肺静态顺应性(Cstat)、肺氧合指数(OI)、呼吸指数(RI)等肺功能指标均有显著改善(P<0.05～0.01),肺含水率明显下降(P<0.05),肺组织损伤程度明显减轻;实验组ICAM-1mRNA的表达量也较对照组显著降低(P<0.01)。结论:CPB期间经肺动脉持续灌注氧合血可减轻肺损伤、保护肺功能,而ICAM-1可能参与了这种保护机制。     

Abdominal pain among children re-evaluation of a diagnostic algorithm

AIM：To re-evaluate the algorithm that has been used for over 40years for diagnosis of acute abdominal pain among children.METHODS:Among the 937cases admitted to the surgical emergency ward in 2000,656cases of acute appendicitis were studied to evaluate the usefulness of the present algorithm ofr its calculated accuracy,false positive and false negative rates,the sensitivity and specificity in the instant diagnosis of various types of acute appendicitis in different age groups.The algorithm used was established in 1958and reised for this study in 1999,It includes a 3-step analysis of clinical presentations,i.e:firstly,a diagnosis of surgical pain by edfinite organic abdominal signs;then a diagnosis of the subgroup of surgical condition by special signs;and finally the diagnosis of the present disease by specific signs.A footnote describes a “comparative technique”of abdominal examination in non-cooperative children.RESULTS:The general accuracy of diagnosis was92.8%,overall mortality0.1% amon973cases of abdominal pai in2000,373attending surgeons and 241 residents including trainees joined the diagnosis and treatment with no temarkable difference in the results.The incidence of acute appendicitis,656in973cases,was67.4%representing the majority of abdominal pain.In the series of 656cases,the accuracy of diagnosis of acute appendicitis was 93.6%,false positive 6.4%,false negative0.9%,sensitivity at first visit82.7%,specificity for appendicitis98.0%,no death or documentary complication.CONCLUSION:The present algorithm used for diagnosis of acute abdominal pain is effective and preferable in reducing misdiagnosis and maltreatme nt at emergency,The use of some modern technology should be further explored.     

专业学位硕士研究生小儿外科纵向临床实习模式探索

针对专业学位硕士研究生,改进小儿外科临床实习教学。在传统实习教学形式基础上,结合应用纵向跨专业小儿外科实习。让学生从门诊起跟踪病人,经过检查、治疗、随诊、总结等过程,扩展知识面,全面了解疾病特点,掌握正确、新颖的临床诊疗思路。该项措施的实行获得令人满意的教学效果。     

Clinical Features of Bone Complications and Prognostic Value of Bone Lesions Detected by X-ray Skeletal Survey in Previously Untreated Patients with Multiple Myeloma

Multiple myeloma is usually associated with the presence of lytic bone lesions. We reviewed the clinical and laboratory features of patients with newly diagnosed myeloma bone disease and evaluated the prognostic significance of different X-ray image patterns in symptomatic MM patients. We retrospectively reviewed 260 patients with newly diagnosed MM. X-ray image patterns of patients were correlated with hematologic parameters, therapeutic reaction and patient survival. Patients with the X-ray imaging pattern of grade 2–4 had significantly higher marrow plasma cells levels, marrow CD138⁺ D38⁺ cell percentage, ECOG performance score, and serum IL-6 level than grade 0–1. Univariate analysis demonstrated that skeletal lytic changes associated with rapid progression. There is a high incidence of myeloma bone disease (MBD) in patients of MM in China. Patients of extensive bone lesions have more severe alterations in hematologic parameters than do those without bone lesions and severe bone lesions is an important adverse prognostic factor associated with a short TTP.     

18岁以下1型糖尿病病人管理状况的评估

目的　了解和评估北京地区儿童青少年 1型糖尿病病人的控制和管理情况。　方法　北京儿童医院进行管理的 18岁以下的病程 1年以上 1型糖尿病病人 12 3例。采用国际糖尿病联盟儿童青少年糖尿病协会统一问卷和标准采血测量HbA1 c。　结果　该组 1型糖尿病病人控制状况并不满意 ,平均HbA1 c为 9.8%,在亚太地区排为中下水平 ,管理方法需要改进。病程长短不是糖尿病控制好坏的决定因素 ;学龄前发病的病人易于管理 ,青春期较差 ;女性较难控制。血糖自我检测次数少 ,每月约 2次 ;胰岛素注射次数 92 %以上为每日注射 2次 ,明显少于西太地区 (WPR)平均水平。胰岛素用量不足 ( 0 .77± 0 2 5U·kg- 1 ·d- 1 ) ,与控制水平呈正相关。　结论　血糖自我检测少 ,胰岛素用量不足是糖尿病控制不良的主要因素。增加血糖自我监测次数和及时、足量的胰岛素治疗是改善糖尿病控制的主要方面。学龄前发病的病人依从性好 ,糖尿病得到了满意的控制 ,说明对糖尿病病人的管理比疾病本身对胰岛素的依赖更重要。