160例阴道分泌物检验结果分析

目的 通过对阴道分泌物检验结果的统计分析,了解妇科阴道感染性疾病的病原体分布情况及相关影响因素,对妇科阴道疾病的诊断和治疗具有重要意义。方法 回顾性分析2018年3~9月在本院妇科门诊就诊的160例患者的阴道分泌物的检验结果 ,根据年龄将160例患者分为<20岁组(15例)、20~29岁组(50例)、30~39岁组(40例)、40~49岁组(40例)、≥50岁组(15例)5组。结果 160例患者中,阴道清洁度:Ⅰ度14例(8.75%),Ⅱ度62例(38.75%),Ⅲ度48例(30.00%),Ⅳ度36例(22.50%)。阴道清洁度Ⅰ和Ⅱ度患者中白假丝酵母菌、滴虫和加特纳球菌的检出率明显均低于Ⅲ和Ⅳ度,差异具有统计学意义(P<0.05)。30~39岁组、40~49岁组患者中白假丝酵母菌、加特纳球菌和滴虫的检出率明显高于<20岁组和20~29岁组,差异均具有统计学意义(P<0.05)。结论 阴道感染性疾病与阴道清洁度、年龄等因素相关,阴道分泌物检查对于妇科阴道感染性疾病的鉴别诊断和治疗具有重要意义。     

749例社区获得性肺炎儿童的病原体分布特点

【摘要】目的 探讨南充地区儿童社区获得性肺炎（CAP）的病原学分布特点。方法 选取2017 年 1 月～12 月于南充市中心医院儿科病房住院的749例CAP患儿，根据年龄分为婴儿组(319例)、幼儿组(217例)、学龄前组(154例)、学龄组(59例)，回顾性分析患儿咽深部呼吸道分泌物的细菌培养和呼吸道 11 种病原体IgM抗体血清学检测结果。结果 749例患儿中,310例检出细菌阳性,阳性率41.39%，其中肺炎链球菌82株(26.45%)，大肠埃希菌63株(20.32%)，流感嗜血杆菌39株(12.58%)； 220例检出病毒阳性,阳性率为29.37%，其中IVB208株(65.00%)，IVA41株(12.81%)，PIV39株(12.19%)；102例检出非典型肺炎病原阳性，阳性率13.62%，其中MP74株(62.18%)，CP30株(25.21%)，LP15株(12.60%)；混合病原体检出阳性者有177例，阳性率15.62%，其中细菌、病毒混合感染60例(33.90%)，细菌、非典型肺炎病原体混合感染56例(31.64%)，病毒混合感染30例(16.95%)。结论 肺炎链球菌是南充地区CAP住院患儿的首要细菌病原，IVB是首要病毒病原，MP是首要非典型肺炎病原，混合感染以细菌、病毒混合感染为主。     

Exon skipping in Duchenne Muscle dystrophy due to a silent p.Ser443= mutation in the DMD gene

Duchenne Muscle dystrophy (DMD) is a X-linked inherited disease predominantly caused by severe mutations in DMD gene leading to absence of dystrophin protein. Here we report a 14-year-old Mongolian boy suffering from proximal muscle weakness, pseudohypertrophic deltoid and gastrocnemius muscles since early childhood. Lactate dehydrogenase (LDH) and creatine kinase (CK) levels were elevated. Mutation analysis including MLPA and sequencing of the DMD gene revealed a hemizygous silent variant, c.1329C>T (p.Ser443=) in exon 11. This silent mutation, listed in the SNP database (rs1060502631), was described as a variant of unknown significance (VUS) in ClinVar database. cDNA analysis demonstrated partial skipping of exon 11 due to this mutation. Although silent mutations are usually considered non-pathogenic, our case emphasizes that silent mutations can be potentially pathogenic. Hence, if silent variants are not annotated in database or not known to be benign, they should be analysed further at cDNA level.     

2016至2018年某医院真菌血流感染者流行病学特征及耐药性分析

目的分析真菌性血流感染的病原菌分布以及耐药特征，为真菌血流感染的早期合理用药提供理论依据。 方法回顾性分析武汉大学人民医院2016年1月至2018年12月收治的真菌性血流感染者的菌群、科室分布以及耐药性。 结果入组192例真菌血流感染者的血培养样本中共分离192株真菌，其中白色念珠菌检出率为31.77%（61/192），其次热带念珠菌检出率为18.75%（36/192）；重症医学科检出率最高为33.85%（65/192）。所有菌株均对两性霉素B敏感，对其他抗菌药物耐药率分别为5-氟胞嘧啶4.49%（9/192）、伊曲康唑5.73%（11/192）、氟康唑10.94%（21/192）和伏立康唑11.46%（22/192）；除两性霉素B外，2016至2018年真菌对其他抗菌药物的耐药率均逐年上升，其中2018年所分离192株光滑念珠菌对伊曲康唑耐药菌率达46.7%。 结论真菌血流感染病原菌以念珠菌属为主，对目前抗真菌药物具有较高敏感性，但耐药率逐年上升，加强监测血培养病原菌变化及耐药趋势对指导临床用药至关重要。     

Corynebacterium species as one of the major causative pathogens of bacterial pneumonia

Recent advances using molecular methods, matrix-assisted laser desorption ionization time of flightmass spectrometry, and next-generation sequencers enable rapid and precise detection of bacterial species in the clinical samples, revealing bacterial diversities in the human body. Corynebacterium species are Gram-positive bacilli, which can cause pneumonia and have been reported as causative pathogens of lower respiratory tract infections since the 1970's. However, Corynebacterium spp. may be recognized and sorted as part of normal respiratory flora on Gram staining and culture, resulting in clinical under-recognition as pathogenic bacteria.The results of the clone library method using bacterial 16S ribosomal RNA gene sequence analysis in Japanese patients with hospital-acquired pneumonia revealed that bronchoalveolar lavage fluid obtained from the lung lesions contained 11.8% Corynebacterium spp., which was the second most predominant bacterial phylotype. Additionally, among patients in whom Corynebacterium spp. were detected, C. simulans was most commonly detected followed by C. striatum. In addition, almost half of the patients in whom C. simulans was detected was monophylotypic infection and/or co-detection of C. simulansand C. striatum. Further clinical information is expected on corynebacteria as pathogens of lower respiratory tract infection.