妊娠合并右心感染性心内膜炎的临床特征及母婴结局的文献分析

目的探讨妊娠合并右心感染性心内膜炎的临床特征、处理策略和母婴结局,为疾病的诊断和治疗提供理论依据。方法在中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、OVID、EMbase、ScienceDirect数据库检索相关文献,提取临床资料,分析妊娠合并右心感染性心内膜炎的临床表现、危险因素、赘生物位置、血培养结果、治疗策略和母婴结局等。结果纳入15篇文献,共18例患者。患者年龄为(27.7±4.8)岁,发病孕周为(27.8±6.9)周。发热(14例)、咳嗽(12例)、贫血(8例)、气短或呼吸困难(8例)是最常见的症状。心脏听诊时7例可闻及杂音,其中6例为收缩期杂音,1例未明确杂音类型,5例明确心脏听诊无杂音。9例合并肺栓塞和5例合并心力衰竭。危险因素主要为先天性心脏病(10/18)和静脉药瘾史(6/18)。赘生物附着位置以三尖瓣居多(10/18),其次为肺动脉瓣(4/18)。血培养阳性率高(15/16),主要包括葡萄球菌(9/15)及链球菌(3/15)。处理策略上,多以剖宫产适时终止妊娠,针对心内膜炎方面,在应用足量足疗程抗生素的基础上,11例患者行心脏手术,术式主要包括赘生物清除术、瓣膜修复或置换术以及先天性心脏病的手术等,根据患者的孕周、病情和心肺功能等具体情况决定手术在终止妊娠之前、之后或同期进行。18例患者全部存活,新生儿1例死亡(妊娠28周时行剖宫产分娩,因重度窒息死亡)。产妇随访情况基本良好。结论妊娠合并右心感染性心内膜炎临床少见且病情复杂,需及早诊断并实施个体化治疗方案。给予足量足疗程抗生素、选择合适的手术方案以及终止妊娠的时机,对于母婴结局具有重要意义。     

Cleaning,Shaping, and Disinfecting Abilities of 2 Instrument Systems as Evaluated by a Correlative Micro–computed Tomographic and Histobacteriologic Approach

IntroductionThis study assessed the cleaning, shaping, and disinfection abilities of 2 instrumentation systems in molar root canals using a novel correlative analytical approach.MethodsThe root canals from extracted mandibular and maxillary molars with apical periodontitis were pair matched according to anatomic similarities as determined by micro–computed tomographic analysis and prepared with either XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland) (n = 16) or Reciproc Blue (VDW, Munich, Germany) (n = 16) instruments and 2.5% sodium hypochlorite irrigation. Pre- and postpreparation micro–computed tomographic scans were used to identify and calculate the unprepared surface areas (shaping), which were histobacteriologically evaluated for the presence of residual bacteria (disinfection) and pulp tissue remnants (cleaning) in each canal third.ResultsUnprepared canal surface areas for XP-endo Shaper and Reciproc Blue in the full canal length were approximately 26% and 19% (P < .05), respectively (30% and 23% in the apical part of the canal, P > .05). Preparation with Reciproc Blue resulted in 37.5% canals free of bacteria in all sections examined and 56% in the apical sections only. XP-endo Shaper resulted in 44% canals free of bacteria in all sections, and 56% in the apical part of the canal only. Pulp tissue remnants were not observed in 31% (all canal sections) and 50% (apical canal sections) of specimens from both instrument systems. No significant differences were observed between instruments when comparing the amount of pulp tissue remnants and the number of cases negative for bacteria and tissue remnants (P > .05).ConclusionsAlthough the Reciproc Blue instrument had superior shaping ability in comparison with XP-endo Shaper, both systems performed similarly in cleaning and disinfecting root canals. Irregular canals and difficult-to-reach areas were not thoroughly cleaned and disinfected by any of the tested systems.     

白内障围手术期结膜囊菌群分布及药敏试验

目的 分析白内障围手术期结膜囊菌群的分布及药敏试验结果。方法 选取264例白内障患者,分别在患者入院后、手术消毒前、手术消毒后、手术结束后四个时间点取样,进行细菌培养及药敏试验,比较不同时期的细菌培养结果和药敏结果。结果 入院后结膜囊细菌培养阳性率明显高于手术消毒前、手术消毒后及手术结束后;入院后结膜囊细菌培养以表皮葡萄球菌为主;革兰氏阳性球菌对头孢西丁、加替沙星、左氧氟沙星等敏感性较高。结论 表皮葡萄球菌是结膜囊最常见的细菌,术前应常规应用抗生素点眼,聚维酮碘冲洗结膜囊等来预防术后感染性眼内炎。     

小儿化脓性脑膜炎76例临床分析

目的：探讨小儿化脓性脑膜炎的临床疗效和临床观察。方法回顾分析76例小儿化脓性脑膜炎患者的临床资料。结果76例患儿中，54例患儿治愈,16例患儿好转,6例患儿转科治疗。治疗前患儿脑脊液检查外观混浊的检出率和球蛋白阳性的检出率分别为73.7%和92.1%,显著高于治疗后的外观混浊的检出率7.9%和球蛋白阳性的检出率5.3%，治疗前后对比差异具有统计学意义（P<0.05）。结论对接诊的疑似化脓性脑膜炎的患儿及早地诊断、治疗，可以有效减少患儿并发症及后遗症的发生，提高患儿的治愈率。     

贵阳地区儿童重症社区获得性肺炎肺泡灌洗液病原及药敏分析

目的分析贵阳地区儿童重症社区获得性肺炎支气管肺泡灌洗液（BALF）病原学分布及耐药特点。方法收集989例重症社区获得性肺炎患儿临床资料，将支气管肺泡灌液采用支气管镜取出进行细菌培养、病毒以及肺炎支原体(MP)检测。结果（1）989例重症社区获得性肺炎患儿病原检出阳性716例，阳性率72.40%，细菌、病毒、支原体检出率分别33.27% （329例）、22.45%（222例）、31.45%（311例）。（2）细菌感染中的肺炎链球菌、金黄色葡萄球菌为最为常见的革兰阳性菌株(G+)；而肺炎克雷伯菌、大肠埃希菌为最为常见的革兰阴性菌株(G-)。培养菌株对青霉素类、红霉素、第1、2、3代头孢类抗生素有较高的耐药性，对头孢吡肟、拉氧头孢、哌拉西林、左氧氟沙星有较高的敏感性，对亚胺培南、万古霉素、利奈唑烷均无耐药发生。（3）病毒感染检出222例，其中呼吸道合胞病毒131例，腺病毒检测49例，流感病毒6例（A型2例，B型4例），副流感病毒36例（1型3例、2型4例、3型29例），病毒检出率以0～12月龄组最高，RSV、ADV感染主要集中在冬春季节。（4）肺炎支原体检出阳性率31.45%（311例），肺炎支原体检出率以3～5岁组最高。结论贵阳地区重症肺炎中肺炎克雷伯杆菌、肺炎链球菌、大肠埃希菌、金黄色葡萄球菌为重要的细菌病原。重要病毒为腺病毒和呼吸道病毒为主，1～12月龄组的病毒感染检出率比较高。     

Ischemic Stroke in the Setting of Tuberculous Meningitis

The clinical syndrome of tuberculous (TB) meningitis leading to ischemic strokes is rarely seen today in immunocompetent adults native to North America. This entity is also notoriously difficult to diagnose because the presenting symptoms are often nonspecific. The authors describe a case of a man with TB meningitis which progressed to recurrent ischemic cerebral infarcts.     

新型隐球菌脑膜炎的诊断探讨及文献复习

目的:探讨新型隐球菌脑膜炎(CNM)的临床特点及诊断方法。方法:对18例CNM患者的临床资料进行回顾性分析并文献复习。结果:18例患者均经病原学确诊。大部分CNM患者为亚急性起病,临床表现无特异性,误诊率高,首诊误诊率为72％,其中误诊为结核性脑膜炎的占69％。结论:脑脊液中找到新型隐球菌是诊断该病的重要依据,多种快速检测手段结合可提高早期诊断率。