广东省65株耶氏菌的系统鉴定与鼠疫疫源地性质的探讨

目的鉴定65株耶氏菌,了解菌株的生物学特性,抗原抗体与鼠疫菌的相关性,探讨疫源地的现状和性质。方法65株菌用3种致病性耶氏菌诊断血清,分别做玻片、试管凝集试验、生化试验、生长特性,挑选14株菌做毒力因子、毒力基因、致病性、交叉免疫原性、动物试验和血清学、药敏试验。结果 63株小肠结肠炎耶氏菌血清型42株O∶3、21株O∶9,中间型1株,假结核血清II型1株;VW+2株,VW±10株,VW-2株;14株菌F1Ag、F1Ab全阴;小肠结肠炎5株菌均有2个毒力基因(ail、ystA)阳性,VW+和VW±对小白鼠、家兔有致病性,动物感染一种耶氏菌后有交叉免疫力,抗原、活菌交叉吸收鼠疫抗血清后血清学IHA、RIHA没有交叉性,常用抗菌素敏感。结论目前动物感染小肠结肠炎菌普遍,猪感染最高,局部已爆发流行,假结核菌偏低,鼠疫处于静息期。     

耶氏菌属毒力株共同血清学特性

<正> 取氏菌属细菌(鼠疫耶氏菌、假结核耶氏菌和小肠结肠炎耶氏菌)对人和动物都能引起侵袭性疾病,他们的致病性与一分子量40～48Mdal的毒力质粒有关。该质粒编码VW抗原,自凝因子和特异外膜蛋白。我们对该属细菌毒力株的共同血清学特性进行了研究,发现采用小肠结肠炎耶氏菌酶免疫斑点试验,可以把这3种细菌的毒力株和无毒力株区别开来。     

耶氏菌毒力质粒与胞内寄生性的关系

本文比较小肠结肠炎耶氏菌毒力质粒阳性株与其阴性变异株在小鼠脾细胞和腹腔巨噬细胞内生长的能力。果表明小肠结肠炎耶氏菌质粒阳性株可在小鼠体内脾细胞中生长,阴性株则否。在腹腔巨噬细胞内,不论体内或体外,两种菌株均不能生长。假结核耶氏菌毒力质粒阳性株与小肠结肠炎耶氏菌相似,但它在脾细胞内的繁殖速度明显高于后者。这些结果提示,小肠结肠炎耶氏菌胞内寄生性与毒力质粒有关,但其胞内生长能力弱于其他种耶氏菌。     

利用J+H噬菌体鉴定小肠结肠炎耶氏菌的评价

使用J+H噬菌体检查192株通过生化反应作出鉴定的小肠结肠炎耶氏菌和类小肠结肠炎耶氏菌,其裂解率为77.1％,比血清定型率(73.5％)为高,属于致病性血清型的裂解率为95.7％,其中O:3和O:9血清型38株的裂解率为100％;属于非致病性血清型的裂解率为59.6 ％。实验证明这株J+H噬菌体用于临床和流行病学调查致病性小肠结肠炎耶氏菌,非常简便和实用。     

吉林省耶尔森氏菌O∶3和O∶9血清型主要毒力基因分布调查

目的了解吉林省致病性小肠结肠炎耶尔森氏菌血清型毒力基因的分布情况。方法利用聚合酶链反应(PCR)技术进行基因检测。结果实验证实在吉林省分离到的主要流行血清型O∶3和O∶9小肠结肠炎耶尔森氏菌毒力基因分布特征为:ail 、ystA 、ystB-、yadA 、virF 占60%;ail 、ystA 、ystB-、yadA-、virF-占26.2%;其他型占13.8%。结论血清型O∶3和O∶9小肠结肠炎耶尔森氏菌毒力基因的分布主要为ail 、ystA 、ystB-、yadA 、virF 型,其次是ail 、ystA 、ystB-、yadA-、virF-型,其他型很有可能是非致病的菌株。     

O:15型小肠结肠炎耶氏菌毒力株的发现与鉴定

从腹泻病人和猪各分离出1株O:15型小肠结肠炎耶氏菌,它们含有毒力质粒(45megadaltons)、VW抗原和Vi抗原,并与毒力因子血清发生凝集反应,在小鼠体内能大量繁殖。这些特征指出:这是两个典型的毒力株,这在该型中是少见的。     

小肠结肠炎耶氏菌毒力型测定法

<正> 小肠结肠炎耶氏菌广泛存在于自然界和动物肠道内,它们的型别很多,少数菌株有毒力,大多数没有致病力,对人畜不构成什么威胁。即使公认有致病力的O∶3,O∶8,O∶9,O∶5等血清型菌株,也有丢失毒力的无毒株,因此检出的菌株均应测定毒力,测定毒力的方法很多,这里介绍几种有实用价值的。 一、质粒测定:有毒株均有40～50×10~6道尔顿质粒,故称此为毒力质粒,其它大质粒均与致病力无关,但近年有人报告一个致病株的质粒为80×10~6道尔顿,这是例外,有待进一步研究,这里介绍两种比较简单的测定法:     

小肠结肠炎耶尔森氏菌主要毒力基因分析

目的了解南京地区从不同来源分离的小肠结肠炎耶尔森氏菌毒力基因的分布情况。方法聚合酶链反应(PCR)技术进行不同血清生物型菌株的毒力基因检测。结果从血清型来看,分离到的9株血清型O:3菌株有7株的基因型分布为ail+,ystA+,ystB-,virF+,yadA+。从生物型来看,共分离到致病生物型(3,4)菌株12株,其中9株毒力基因分布特征为ail+,ystA+,ystB-,virF+,yadA+。结论本市小肠结肠炎耶尔森氏菌血清型O:3菌均包含毒力基因,毒力基因主要分布特征为ail+,ystA+,ystB-,virF+,yadA+。所有的致病生物型(3,4)菌株,均包含染色体上的毒力基因ail,毒力基因主要分布特征亦为ail+,ystA+,ystB-,virF+,yadA+。ail与致病生物型之间存在明显关联。     

致病性小肠结肠耶氏菌DNA多态性及其毒力表达

目的：探讨致病小肠结肠耶氏菌（简称：耶氏菌）DNA特征及其表达。方法：用聚合酶链反应（polymerase Chain Reaction;PCR）、DNA序 列分析、随机扩增多态性DNA(Randomly Amplified Polymorphic DNA;RAPD）检测耶氏菌致病基因（adherent invasion locus;ail）,并用自凝试验、刚果红试验检测其毒力表达。结果：PCR和DNA序列分析证实致病性耶氏菌O：3、O：9、O：5,27血清型含有ail致病基因,而非致病型O：4,33、O：7,8血清型不含有ail基因。此外,O：22血清型也含有ail基因与文献报告ail核苷酸序更列同源性为88.3％。O：3、O：9、O：5,27致病血清型DNA指纹图谱相类似,O：22血清型部分DNA片段与0：3血清型相似,而非致病O：4,33血清型DNA指纹图谱完全不同。毒力试验显示致病性耶氏菌全部阳性,3株O：22血清型均有少数菌落刚果试验阳性。结论：致病性耶氏菌含有ail致病基因,DNA指纹图谱相似,但表现为多态性。O：22血清型含有ail基因,DNA指纹图谱部分与O：3血清型相似,少数菌落毒力试验呈阳性反应,该血清型可能存在潜在致病性。     

内蒙古敖汉旗首次发现O∶3血清型小肠结肠炎耶尔森菌

目的了解敖汉旗境内鼠类,家畜家禽携带小肠结肠炎耶尔森菌（以下简称为小肠结肠炎菌）情况,为疾病防治工作提供科学依据。方法在敖汉旗长胜乡随机采集鼠类、家畜家禽粪便等样品,对小肠结肠炎菌进行分离、培养、鉴定并分型,用PCR方法进行毒力因子测定。结果 2011~2012年共检验各类样品381份,检出小肠结肠炎菌7株,2011年检出的7株为生物1A和3型,生物3型的2株菌均为O∶3血清型,均携带ail,ystA,yadA,virF,rfbc毒力基因。结论猪是致病性小肠结肠炎菌重要的携带者,敖汉旗境内的猪体内具有携带O∶3血清型小肠结肠炎菌。     

Diagnostic value of the Widal test for typhoid fever in Singapore.

A study was conducted to assess the diagnostic value of the Widal test in patients with bacteraemic typhoid fever. The Widal test was carried out on 25 bacteriologically proven cases of typhoid fever and 50 patients with non-typhoid fever. All the patients with non-typhoid fever had an O agglutinin titre of less than 1:40, while 82% had an H agglutinin titre of less than 1:40. In the patients with typhoid fever, 56% had an O agglutinin titre of greater than or equal to 1:40 and 72% had an H agglutinin titre of greater than or equal to 1:40. Typhoid patients with titres greater than or equal to 1:40 for O and H antigens of Salmonella typhi were significantly different (P less than 0.01) from those with non-typhoid fever. The O agglutinin was highly specific (100%) in the diagnosis of the disease. The study shows that a single Widal test is useful in the diagnosis of typhoid fever in Singapore.     

Work-rate affects cardiopulmonary exercise test results in heart failure

AIMS: Cardiopulmonary exercise test (CPET) is used to evaluate patients with chronic heart failure (HF) usually by means of a personalized ramp exercise protocol. Our aim was to evaluate if exercise duration or ramp rate influences the results. METHODS AND RESULTS: Ninety HF patients were studied (peak V (O(2)): >20 ml/min/kg, n=28, 15-20 ml/min/kg, n=39 and <15 ml/min/kg, n=23). Each patient did four CPET studies. The initial study was used to separate the subjects into three groups, according to their exercise capacity. In the remaining studies, work-rate was increased at three different rates designed to have the subjects reach peak exercise in 5, 10 and 15 min from the start of the ramp increase in work-rate, respectively. The order was randomized. The work-rate applied for the total population averaged 22.7+/-8.0, 11.6+/-3.7, 7.5+/-2.9 W/min with effective loaded exercise duration of 5 min and 16 s+/-29 s, 9 min and 43 s+/-49 s and 14 min and 32 s+/-1 min and 12 s for the 5-, 10- and 15-min tests, respectively. Peak V (O(2)) averaged 16.9+/-4.3*, 18.0+/-4.4 and 18.0+/-5.4 ml/min/kg for the 5-, 10- and 15-min tests, (*=p<0.001 vs. 10 min). The shortest test had the lowest peak heart rate and ventilation and highest peak work-rate. Peak V (O(2)) and heart rate were lowest in 5-min tests regardless of HF severity. The DeltaV (O(2))/Deltawork-rate was lowest in 5-min tests and highest in 15-min tests. At all ramp rates, DeltaV (O(2))/Deltawork-rate was lower for the subjects with the lower peak V (O(2)). The V (e)/V (CO(2)) slope and V (O(2)) at anaerobic threshold were not affected by the protocol for any grade of HF. CONCLUSIONS: In chronic HF, exercise protocol has a small effect on peak V (O(2)) and DeltaV (O(2))/Deltawork but does not affect V (O(2)) at anaerobic threshold and V (e)/V (CO(2)) slope.     

The relationship between left ventricular function assessed by multigated radionuclide test and cardiopulmonary exercise test in patients with ischemic heart disease

STUDY OBJECTIVES: To compare the oxygen pulse curve (O(2)P-C) as measured during cardiopulmonary exercise testing (CPET) with left ventricular (LV) ejection fraction (LVEF) rest-exercise response as measured by multigated equilibrium (99m)Tc radionuclide cineangiography (MUGA) in patients with different degrees of ischemic heart disease (IHD). PATIENTS: Forty-six patients (39 men and 7 women; mean plus minus 1 SD age, 59.2 plus minus 11 years) with IHD, with no hypertrophic, valvular, or pericardial disease. METHODS: A supine bicycle ergometer with increments of 25 W every 2 min was used for MUGA, and an electronically braked cycle ergometer was used for upright symptoms-limited CPET. Exercise was increased by 10 to 20 W/min until the target heart rate (HR) was reached (similar peak HR for both studies). MEASUREMENTS AND RESULTS: The O(2)P-C was scored on a 10-point scale as follows: type A, normal curve (10 points); type B, normal-shaped curve with low values (8 points); type C, low and flat curve (5 points); type D, descending curve (3 points). Findings for the MUGA study were classified into four groups by the degree of ischemic response: group 1 (control), normal diastolic function (n = 10), LVEF > 55%, LVEF during exercise minus LVEF at rest [DeltaLVEF] greater-than-or-equal 5%; group 2, mild ischemia (n = 10), LVEF > 55%, < 0 DeltaLVEF < 5%, diastolic dysfunction at exercise (prominent "A" waves); group 3, LV dysfunction (n = 9), LVEF < or = 35% at rest; and group 4, significant ischemia (n = 17), LVEF > 55%, DeltaLVEF < 0, diastolic dysfunction. A highly significant relationship between the O(2)P-C score and the MUGA grouping was observed by Fisher's Exact Test and Pearson's linear regression line (p < 0.001; R = - 0.89). CONCLUSIONS: Exercise-responded O(2)P-C might serve as a good noninvasive, physiologically based, parameter to distinguish between IHD patients with normal and impaired LV function.     

Stair climbing test predicts cardiopulmonary complications after lung resection

STUDY OBJECTIVE: To evaluate the capability of the stair climbing test to predict cardiopulmonary complications after lung resection for lung cancer. DESIGN: A prospective cohort of candidates for lung resection. Spirometric assessment and the stair climbing test were performed the day before operation. Univariate and multivariate analyses were performed to identify predictors of postoperative complications. SETTING: Tertiary referral center. PATIENTS: A consecutive series of 160 candidates for lung resection with lung carcinoma from January 2000 through March 2001. RESULTS: At univariate analysis, the patients with complications were significantly older (p = 0.02), had a significantly lower FEV(1) percentage (p = 0.007) and predicted postoperative FEV(1) percentage (p = 0.01), had a greater incidence of a concomitant cardiac disease (p = 0.02), climbed a lower altitude at the stair climbing test (p < 0.0001), and had a lower calculated maximum oxygen consumption (O(2)max) [p = 0.03] and predicted postoperative O(2)max (p = 0.006) compared to the patients without complications. At multivariate analysis, the altitude reached at the stair climbing test remained the only significant independent predictor of complications. CONCLUSIONS: The stair climbing test is a safe and economical exercise test, and it was the best predictor of cardiopulmonary complications after lung resection.     

Normal standards for an incremental progressive cycle ergometer test

One hundred healthy subjects (50 male and 50 female), selected to provide an even distribution of age (15 to 71 yr) and height (165 to 194 cm in males and 152 to 176 cm in females), underwent a progressively incremental (100 kpm/min each min) exercise test to a symptom-limited maximum. Measurements were made of O2 intake and CO2 output, ventilation and breathing pattern, heart rate and blood pressure, and rating of perceived exertion. The ventilatory anaerobic threshold was identified. Predictive data were derived for measurements at maximal and submaximal exercise. Maximal power output (Wmax) and oxygen intake (VO2max) varied with sex (0, male; 1, female), age (yr), and height (Ht, cm): Wmax = 20.4 (Ht) - 8.74 (Age) - 288 (Sex) - 1,909 kpm/min (SEE, 216; r, 0.858); VO2max = 0.046 (Ht) - 0.021 (Age) - 0.62 (Sex) - 4.31 L/min (SEE, 0.458; r, 0.869). The extent of leisure time activity exerted a positive influence on VO2max (r, 0.47; p less than 0.001); VO2max was also related to lean thigh volume (r, 0.79). Maximal heart rate (HR) declined as a function of age: HRmax = 202 - 0.72 (Age) beats/min (SEE, 10.3; r, 0.72). Maximal O2 pulse (O2Pmax) was related to height and was systematically higher in males than in females: O2Pmax = 0.28 (Ht) - 3.3 (Sex) - 26.7 ml/beat (SEE, 2.8; r, 0.86). Ventilation was closely related to CO2 output, and the maximal tidal volume was related to vital capacity. The VO2 increased linearly with power throughout the test; in an individual subject, the intercept of this relationship was positively influenced by weight and height.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of QuantiFeron TB-2G test on high-risk groups for tuberculosis infection at our hospital

PURPOSE: To investigate the infection rate of tuberculosis in high-risk employees at our hospital. METHODS: We measured interferon gamma levels in 40 employees and evaluated the infection rate in doctors working in the Tuberculosis Ward (D group), nurses in the Tuberculosis Ward (N group), and other high-risk employees (O group). RESULTS: The overall infection rate including probable infection was 6/40 (15.0%). The infection rate in the N group was 0%, while those in the D and O groups were 27.3% and 20.0% respectively. No new infection of tuberculosis was observed after the introduction of tuberculosis infection measure manual of our hospital. CONCLUSION: Our hospital's tuberculosis infection measure manual was effective in decreasing the new tuberculosis infection despite a high infection rate in high-risk employees at our hospital.     

A step test to assess exercise-related oxygen desaturation in interstitial lung disease.

A 6-min step test (6MST) may constitute a practical method for routinely assessing effort tolerance and exercise-related oxyhaemoglobin desaturation (ERD) in the primary care of patients with interstitial lung disease. In total, 31 patients (19 males) with idiopathic pulmonary fibrosis (n = 25) and chronic hypersensitivity pneumonia were submitted, on different days, to two 6MSTs. Physiological responses were compared with those found on maximal and submaximal cycle ergometer tests at the same oxygen uptake (V'(O(2))). Chronic breathlessness was also determined, as measured by the baseline dyspnoea index (BDI). Responses to 6MST were highly reproducible: 1.3+/-2.0 steps x min(-1), +/-5 beats x min(-1) (cardiac frequency), +/-50 mL x min(-1) (V'(O(2))), +/-7 L x min(-1) (minute ventilation) and +/-2% (arterial oxygen saturation measured by pulse oximetry (S(p,O(2)))). The number of steps climbed in 6 min was correlated to peak V'(O(2)) and the BDI. There were significant associations among the tests in relation to presence (change in S(p,O(2)) between rest and exercise > or = 4%) and severity (S(p,O(2)) <88%) of ERD. Four patients, however, presented ERD only in response to 6MST. Resting diffusing capacity of the lung for carbon monoxide and alveolar-arterial oxygen tension difference were the independent predictors of the number of steps climbed. A single-stage, self-paced 6-min step test provided reliable and reproducible estimates of exercise capacity and exercise-related oxyhaemoglobin desaturation in interstitial lung disease patients.     

Early recovery of oxygen kinetics after submaximal exercise test predicts functional capacity in patients with chronic heart failure.

BACKGROUND: Oxygen (O2) uptake at peak exercise (VO2 peak) is an objective measurement of functional capacity in patients with chronic heart failure (CHF). The significance of recovery O2 kinetics parameters in predicting exercise capacity, and the parameters of submaximal exercise testing have not been thoroughly examined. METHODS AND RESULTS: Thirty-six patients (mean age = 48+/-14 years) with CHF and New York Heart Association functional class I, II, or III, and eight healthy volunteers (mean age = 39+/-13 years) were studied with maximal and submaximal cardiopulmonary exercise testing (CPET). The first degree slope of O2 uptake decay during early recovery from maximal (VO2/t-slope), and submaximal exercise (VO2/t-slope)(sub), were calculated, along with VO2 half-time (T(1/2)VO2). Patients with CHF had a longer recovery of O2 uptake after exercise than healthy volunteers, expressed by a lower VO2/t-slope (0.616+/-0.317 vs. 0.956+/-0.347 l min(-1) min(-1), P=0.029) and greater T(1/2)VO2 (1.28+/-0.30 vs. 1.05+/-0.15 min, P = 0.005). VO2/t-slope correlated with the VO2 peak (r = 0.84, P<0.001), anaerobic threshold (r = 0.79, P<0.001), and T(1/2)VO2, a previously established estimate of recovery O2 kinetics (r = -0.59, P<0.001). (VO2/t-slope)(sub) was highly correlated with VO2/t-slope after maximal exercise (r=0.87, P<0.001), with the VO2 peak (r=0.87, P<0.001) and with T(1/2)VO2 after maximal exercise (r=-0.62, P<0.001). VO2/t-slope after maximal and submaximal exercise was reduced in patients with severe exercise intolerance (F=9.3, P<0.001 and F=12.8, P<0.001, respectively). CONCLUSIONS: Early recovery O2 kinetics parameters after maximal and submaximal exercise correlate closely with established indices of exercise capacity in patients with CHF and in healthy volunteers. These findings support the use of early recovery O2 kinetics after submaximal exercise testing as an index of functional capacity in patients with CHF.     

心肺运动试验无创检测心肌缺血的价值

目的:观察心肺运动试验与心电图运动试验在检测肌心缺血方面的价值。方法:对68例胸痛患者行心电图运动试验、心肺运动试验和冠状动脉造影,根据心电图运动试验组与心肺运动试验的结果分别分为阳性组与阴性组,以冠状动脉造影结果为金标准,比较心肺运动试验与心电图运动试验对心肌缺血诊断的阳性率预测值、阴性率预测值、敏感度和特异度。结果:运动试验诊断心肌缺血的敏感性为51.28%,特异性为68.97%,阳性预测值为68.97%,阴性预测值为51.28%,以O2-pulsepeak比值作为诊断心肌缺血的一种预测指标,敏感性为51.28%,特异性为75.86%,阳性预测值为74.07%,阴性预测值为53.66%。结论:在检测缺血方面,心肺运动试验在特异度、阳性预测值和阴性预测值方面均要优于心电图运动试验。     

Evaluation of sympathetic tone in essential hypertension by the clonidine suppression test

Recent evidences suggest that the sympathetic nervous system plays a major role in the pathogenesis and maintenance of several clinical forms of hypertensive disease. The clonidine suppression test allows us to uncover the subtle changes in neuronal noradrenaline release in essential hypertension. To prove this possibility, we selected 16 patients: 7 borderline hypertensives (BH) (4 males and 3 females), mean age: 24 years; and 9 established hypertensives (EH) (6 males and 3 females), mean age: 25 years. In both groups, the heart rate (HR) and blood pressure (BP) were registered every 30 min and by intravenous catheter plasma catecholamines (PCA) and plasma renin activity (PRA) were measured before and after (180 and 240 min) one oral dosis of clonidine (300 mcg) had been administered. Patients remained in clinostatism for 180 and and orthostatism for 60 min. HR and BP diminished in BH and EH after clonidine during clinostatism in comparison to preclonidine period. PCA also showed reduction in 180 min with respect to the basaline period. PRA did not present change in 180 min in either groups in relation to time O. During orthostatism, HR increased in both groups with respect to the baseline period. BP remained low in relation to baseline time. PCA were increased with respect to preclonidine period. PRA showed a slight tendency to increase in relation to time O in both groups. CAP baseline level are not reliable indexes of the role of the sympathetic tone in maintenance of high BP values in hypertensive disease.(ABSTRACT TRUNCATED AT 250 WORDS)