急性白血病住院患者院内感染情况及危险因素分析

目的探讨急性白血病住院患者院内感染情况及危险因素分析。方法选择本院2018年2月至2019年7月收治的100例急性白血病住院患者作为研究对象,收集患者所有临床资料,回顾性分析患者院内感染发生情况,经单因素和多因素回归分析急性白血病住院患者发生院内感染的危险因素。结果 100例急性白血病住院患者中发生院内感染的有32例,院内感染率为32.00%;经非条件多因素Logistic回归模型分析可知,年龄、住院时间、住院期间侵入性操作、合并其他疾病为急性白血病住院患者发生院内感染的独立危险因素(P0.001)。结论急性白血病住院患者院内感染率为32.00%,年龄、住院时间、住院期间侵入性操作、合并其他疾病为急性白血病住院患者发生院内感染的独立危险因素。针对这些危险因素采取相应措施,可有效降低急性白血病住院患者院内感染发生率,改善患者预后。     

外科ICU医院感染临床特点和护理措施

目的分析ICU住院患者医院感染临床特点,为临床护理提供参考。方法将2011年1月至2013年6月我院外科ICU发生的116例医院感染病例作为观察组,外科住院患者发生的72例医院感染病例为对照组,采取回顾性调查方法分析医院感染危险因素,并对护理相关问题进行讨论。结果 ICU患者发生医院感染率为8.44%,同期普通病房患者医院感染率为4.43%,ICU医院感染发生率明显高于普通病房(P0.05)。无论ICU患者还是普通病房患者,呼吸道和泌尿道都是医院感染常发生部位。ICU医院感染病死率9.48%,高于外科普通病房的4.17%,P0.05。ICU和普通病房医院感染与患者年龄、住院时间、接受损伤性操作、抗菌药物或免疫抑制剂使用和意识障碍有明显关系(P0.01)。结论 ICU医院感染率明显高于普通病房,感染部位主要是呼吸道和泌尿道;医院感染与多种因素有关,关键是要建立有效的防治机制和护理措施。     

体外膜肺氧合相关院内感染的危险因素分析与预测模型构建

目的:探讨体外膜肺氧合(Extracorporeal Membrane Oxygenation,ECMO)治疗患者相关院内感染的危险因素,并建立风险预测模型.方法:回顾性分析 2020 年 12 月至 2023 年 6 月在我院接受ECMO治疗的 153 例患者的临床资料.根据术后感染诊断标准,分为感染组(71 例)和未感染组(82)例.收集对比两组患者的基线资料和ECMO相关参数.应用多元Logistic回归分析方法研究ECMO病人发生院内感染的独立危险因素并建立预测模型.运用倾向评分匹配法和边际分析法评估院内感染所造成的患者及医院经济损失.结果:153 例 ECMO 患者中 71 例(46.41％)发生了医院感染.多因素Logistic回归分析结果显示,急性生理与慢性健康评分第Ⅱ版评分、总住院时间、ECMO运行时间、ECMO撤离前机械通气时间均是ECMO患者医院感染的危险因素(P<0.05).根据Logistic回归结果建立风险预测模型,经Hosmer-Lemeshow检验模型的拟合度较高(χ2=4.124,P=0.776).ROC曲线分析结果显示,ECMO相关感染的风险预测模型预测使用ECMO治疗后发生院内感染的AUC为0.911(95％CI(0.852,0.970),P<0.001).结论:本研究构建的预测模型可作为制定有效措施预防ECMO相关院内感染的参考依据.     

慢性乙型肝炎合并医院感染的临床特点及其感染危险因素探讨

目的分析慢性乙型肝炎合并医院感染的临床特点及其感染危险因素。方法选取本院2017年5月～2019年5月收治的92例慢性乙型肝炎患者作为研究对象,收集其临床资料,分析出现院内感染情况及感染危险因素。结果 92例慢性乙型肝炎患者中有18.47%(17/92)出现院内感染;腹腔感染率最高,为35.29%,其次为肺部感染3例(17.64%);病原菌共36株,其中革兰阴性菌22株,革兰阳性性菌9株,真菌5株;革兰阴性菌大肠艾希杆菌所占比最高(33.33%)。多因素结果显示,年龄≥60岁、住院时间≥35d、有基础疾病、临床分期为晚期是慢性乙型肝炎患者发生医院感染的独立危险因素(P0.05)。结论对于慢性乙型肝炎患者需要早发现早治疗,对于年龄大、身体素质低、存在基础疾病、病情较严重住院患者需要引起重视,避免出现院内感染。     

呼吸内科医院感染危险因素分析及管理对策制定

目的探讨呼吸内科患者医院感染发生的危险因素以及管理对策的制定。方法选择2018年3月至2019年12月期间在我院呼吸内科接受治疗并发生医院感染的80例患者作为研究组,选取同一时间段内在我院呼吸内科接受治疗但并未发生医院感染的80例患者作为对照组,回顾性分析两组患者的一般资料、疾病情况等,采用单因素分析、多因素Logistic回归分析方法分析导致医院感染发生的危险因素,并提出针对性的管理对策。结果单因素分析结果显示,年龄、住院时间、侵入性操作、慢性基础疾病、激素使用史、抗菌药物使用史是导致呼吸内科患者发生医院感染的危险因素(P0.05);多因素Logistic回归分析结果显示,年龄、住院时间、侵入性操作、慢性基础疾病、抗菌药物使用史是导致呼吸内科患者发生医院感染的独立危险因素(P0.05)。结论年龄、住院时间、侵入性操作、慢性基础疾病、抗菌药物使用史是导致呼吸内科患者发生医院感染的独立危险因素,针对上述原因制定管理对策并实施,可实现呼吸内科医院感染发生率的降低。     

慢性肾功能衰竭患者血液透析发生院内感染的临床分析

目的分析慢性肾功能衰竭患者血液透析发生院内感染的临床特点以及相关危险因素。方法回顾性分析2005年5月至2010年5月期间在我院长期行血液透析的383例患者的相关临床资料,将其中160例患者出现了不同程度的院内感染设为感染组,223例患者未出现院内感染为未感染组。结果血液透析患者发生院内感染的发生率为41.78%,其中以肺部感染最为常见;感染组与未感染组患者之间的相关临床指标相比较,年龄、住院天数、是否左心衰、是否有糖尿病、是否存在低蛋白血症、插管时间以及C反应蛋白具有统计学差异（P〈0.05或0.01）,而性别、血肌酐、甘油三脂不具有统计学差异（P〉0.05）。结论对于长期血液透析患者,我们应该控制好各个危险因素,规范化管理防治院内感染的相关制度,对患者采取正规的营养支持、纠正贫血、抗感染等支持治疗,及时的作相关病原学检查,严防滥用抗生素。     

ICU治疗结局的影响因素及远程ICU监护在延迟收住患者中的应用初探

目的:分析重症监护病房患者治疗结局的影响因素,初步探讨远程重症监护对延迟收住患者死亡率的影响。方法:以2017年5月至2019年9月ICU收治的481例患者作为研究对象,其中2017年5月至2018年6月期间收治的248例患者均为常规收住和监护模式,回顾性分析ICU治疗期间存活和死亡患者的临床资料,采用二元Logistic回归分析法分析ICU患者死亡的危险因素;根据死亡危险因素制定远程监护措施,以2018年7月至2019年9月收治的233例患者作为研究对象,以急性生理与慢性健康评分Ⅱ(Acute physiology and chronic health evaluation,APACHEⅡ)≥16分作为ICU入住标准,实施ICU远程监护措施,分析两种模式下对ICU延迟入住患者治疗时间及死亡率的影响。结果:常规ICU收住模式下的248例患者中,存活172例,死亡76例,死亡率为30.65%;经二元Logistic回归分析显示,入院时血WBC、中性粒细胞、PCT水平以及ICU住院时间、急诊住院时间均是影响ICU不良治疗结局的独立危险因素(P<0.05)。与常规ICU收住模式相比,经远程ICU监护下的患者ICU住院时间缩短,ICU患者死亡率降低(P<0.05)。结论:在ICU资源配置不足的情况下,ICU延迟收住所致患者急诊住院时间过长是影响患者不良治疗结局的独立危险因素。通过建立并实施远程ICU监护措施对于强化急诊治疗,改善患者治疗结局有积极的作用。     

呼吸内科病人院内感染的临床分析

目的:研究呼吸内科病人院内感染的临床特征。方法:选取我院2011年5月至2015年5月1263例住院病人为研究对象,对病例资料进行回顾性分析,确定院内感染的诊断。经统计分析,比较感染组和非感染组的病例资料在性别、住院时间、有创操作以及病原学各方面的差异性。结果:1263例呼吸内科住院病人发生院内感染121例,院内感染发生率为9.58%。呼吸内科院内感染的部位以呼吸系统为主,其构成比为59.5%(72例)。感染组与未感染组的年龄,住院时间和有创操作比较有显著性差别(P0.05)。121例院内感染病人共检出病原菌187株。其中革兰氏阳性菌均占22.31%,革兰氏阴性菌占77.69%。结论:呼吸内科患者院内感染发生率较高。年龄、住院时间和有创操作为院内感染的危险因素。     

65例院内肺真菌感染的临床探讨

目的 了解院内肺部真菌感染的发病情况、相关因素、菌株分布及治疗现状.方法 对 2006年1月-2010年6月期间诊断的院内肺部真菌感染患者的临床资料进行分析.结果 共诊断院内肺部真菌感染65例;慢性阻塞性肺疾病是最常见的呼吸系统基础疾病,占76.7%;56例患者(86.2%)具有肺部真菌感染的危险因素.抗真菌治疗的有效率为87.2%.结论 呼吸科病房患者院内肺部真菌感染以念珠菌感染所占比例最高,应早期采用有效的干预措施.     

特重度烧伤合并吸入性损伤患者血流感染的临床特征及其主要风险因素分析

目的通过研究特重度烧伤合并吸入性损伤患者临床特征和风险因素,为未来构建特重度烧伤合并吸入性损伤患者血流感染风险模型提供依据。方法回顾性分析上海交通大学医学院附属瑞金医院灼伤整形科2010年1月1日至2019年12月31日收治的符合入选标准的185例患者的病历资料。分析其基本特征、烧伤情况、转运情况、血流感染的特点、治疗及结局。根据其是否发生血流感染将患者分为感染组62例(33.51%)和未感染组123例(66.49%),分析该类患者血流感染的临床特征及发生血流感染的危险因素,并行单因素分析和Logistic回归分析。结果 185例特重度烧伤合并吸入性损伤患者中有62例发生血流感染。检出阳性率从高到低的前3位细菌分别是肺炎克雷伯菌(36.25%),铜绿假单胞菌(28.75%),鲍曼不动杆菌(13.75%)。感染组烧伤总面积、Ⅲ度烧伤面积均显著高于非感染组,差异均有统计学意义(Z=4.361、4.652,P0.05);感染组ICU住院时间、住院时间显著长于非感染组,差异均有统计学意义(Z=4.297、 2.769,P0.05)。感染组和非感染组男女构成比差异有统计学意义(χ~2=4.237,P0.05)。感染组和非感染组接受机械通气的患者构成比差异有统计学意义(χ~2=13.788,P0.05)。最终Logistic回归结果显示ICU住院时间为独立危险因素(OR=1.035,95%CI=1.014～1.057,P0.05)。结论特重度烧伤合并吸入性损伤患者具有血流感染高风险,其中肺炎克雷伯杆菌、铜绿假单胞菌、鲍曼不动杆菌等革兰氏阴性菌为主要致病菌,ICU住院时间为特重度烧伤合并吸入性损伤患者发生血流感染的独立危险因素。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.