急性脑血管疾病医院感染调查分析

目的；了解急性脑血管疾病医院感染的发病情况及影响因素。方法；对226例急性脑血管疾病进行回顾性调查分析。结果：发生医院感染56例，感染率为24．78％，其中以尿道感染（51．79％）、下呼吸道感染（33．93％）和上呼吸道感染（14．92％）为多见。结论：急性脑血管疾病的医院感染主要与年龄、疾病的严重程度、侵袭性操作、抗生素的不合理应用有关。急性脑血管疾病患者应用为医院感染的重点监控对象，针对某些高危因素及薄弱环节，加强预防措施，减少医院感染的发生。     

院内感染报告不准确原因分析及预防对策

目的分析院内感染病例报告不准确的原因，探讨降低院内感染报告不准确的预防对策。方法回顾性分析2009年1月～2010年6月所有出院病历4540例份及现住院患者440例病历，根据“医院感染诊断标准”判断医院感染病例，并与实际上报医院感染进行比较，统计医院感染报告不准确的构成，并与病区监控医生沟通分析报告不准确的原因。结果调查4980份出院及现住院病历，发生院内感染310例次，医院感染率为6．22％，临床科室报告280例次，漏报30例次（9．67％，30／310）；临床科室报告280例次中错报28例次（9．03％，28／310），报告不全21例次（6．77％，21／310）。结论院内感染病例报告不准确较多，原因复杂，应针对不同原因采取相应的预防对策。     

某医院1994年出院患者院内感染率的调查

某医院１９９４全年出院患者９０６３例，发生院内感染５７５例次，总感染率为６．３４％，其中内科（７．０２％）外科（６．８９％）和儿科（５．９８％）感染率为高，内科以下呼吸道、泌尿道感染为主，外科、儿科和五官科均以下呼吸道感染为主，妇产科以泌尿道感染为主。感染部位主要为下呼吸道和泌尿道，其次为胃肠道、皮肤软组织。下呼吸道感染以一、二、四季度高发，皮肤软组织感染以二季度高发，其它部位感染在各季度的感染率     

加替沙星治疗急性下呼吸道感染的临床评价

目的：采用病例对照研究的方法评价加替沙星的治疗急性下呼吸道感染的临床疗效和安全性。方法：经临床确诊为急性下呼吸道感染的患者108例，随机分为治疗组和对照组，其中治疗组56例，口服加替沙星0．4g，每日1次；对照组口服环丙沙星0．2g，每日2次，疗程均为7－14d，所有病例治疗结束后随访7d，结果：治疗组和对照组的痊愈率分别为89．29％（50／56）和73．08％（38／52），有效率分别为98．21％（55／56）和80．77％（42／52），两组细菌清除率分别为100％（57／57）和82．61％（38／46），两组间临床和细菌学疗效有显著性差异（均P＜0．05），治疗组和对照组不良事件发生率分别为10．71％（6／56）和7．69％（4／52）（P＞0．05），且均为消化道反应。结合：加替沙星抗菌谱广，抗菌活性强，能安全有效地治疗急性下呼吸道感染。     

ICU医院感染目标性监测分析

目的：为了解本院重症监护病房（ICU）的医院感染发生情况,分析感染相关高风险因素,及时采取有效预防与控制措施,降低医院感染率。方法：依据《医院感染目标性监测规范》,对2011年1月-2012年12月ICU的患者进行医院感染发生情况进行监测。结果：463例患者中发生医院感染55例,共58例次,医院感染率11．88％,例次感染率12．53％;患者日感染率9．70％0,例次日感染率10．23％;调整日感染人次率2．59％,调整日感染例次率2．74％0。感染部位以泌尿道感染为主（53．45％）,其次为下呼吸道感染（34．48％）;病原菌以肺炎克雷伯菌为首（45．00％）。结论：通过目标性监测结果分析,采取有效地预防与控制措施,降低医院感染发生。     

妇保医院产妇及新生儿医院感染动态观察

为进一步控制医院感染发生率的相关高危因素，采取预防性措施，对1995－2000年住院产妇及新生儿35194例中获得医院感染的761例作回顾性调查。结果表明，6年间发生医院感染761例869例次，感染率为2．16％，例次感染率为2．47％。并呈逐年下降趋势（由1995年的3．27％降至2000年的1．32％）。感染部位以呼吸道为首位（占36．02％），其次为皮肤与软组织（21．52％）。感染细菌主要是肺炎克雷伯菌、大肠埃希菌，分别占28．30％和21．43％。医院内感染的疾病主要是新生儿肺炎，新生儿是控制医院感染的重点人群。     

神经内科脑卒中患者医院感染原因分析

目的了解急性脑卒中患者医院感染情况,探讨其相关因素,以采取有效的控制措施。方法采用目标性监测方法对2007年11月至2008年10月,神经内科住院脑卒中患者的医院感染发生情况进行监测与分析。结果目标性监测987例脑卒中患者共发生医院感染152例,173例次,医院感染率为15．4％,例次感染率17．52％;侵袭性操作、意识障碍、糖尿病、年龄、慢性支气管炎、高血压、心脏病、住院天数与医院感染的发生相关。结论急性脑卒中患者的医院感染发生率高,应积极重视与医院感染发生的相关因素,采取积极有效的防治措施,减少医院感染发生率,促进患者康复。     

重症监护病房医院感染因素分析

目的分析儋州市农垦那大医院重症监护病房（ICU）医院感染情况和因素。方法对2003年1月～2008年5月，在ICU住院时间〉48h患者的医院感染情况进行调查分析。结果共调查106例，其中21例ICU患者发生了26例次医院感染，感染率为19．81％，呼吸道感染（46．15％），泌尿系感染（38．46％），胃肠道感染（7．69％），是主要的感染。其感染因素与年龄、ICU住院时间（〉7d）、侵入性治疗和手术有关。结论应重视ICU医院感染的控制，加强监测，严格无菌操作和消毒，以达到降低医院感染。     

脑卒中患者223例院内感染分析

目的 预防脑卒中患者医院感染。方法 对223例脑卒中医院感染进行回顾性分析。结果 2000例脑卒中患者中，医院内感染223例，感染率为11％，分别为呼吸道感染，泌尿系感染。消化道感染，皮肤软组织感染。结论 脑卒中患者因自身特点，免疫力下降，侵入性操作．易发生医院感染。     

老年患者院内感染调查分析

了解正阳县人民医院老年患者院内感染情况，为有效预防和控制院内感染提供依据。我们采用回顾性调查的方法，查阅了正阳县人民医院2004年3月～10月院内感染监测月报表、登记表及病历。在229例老年患者中，发生医院感染35例，感染率为15．28％，其中原发病以脑血管疾病和呼吸系统疾病为多，分别占31．43％（11／35）和22．86％（8／35），感染部位以呼吸道感染最多，占65．71％（23／35），住院时间愈长，感染率愈高，长期应用免疫抑制剂及抗生素者感染率高。总之，加强医院感染管理尤其重要。针对老年患者院内感染特点，加强对院内感染的预防控制，降低医院感染的发病率。现将完整的资料总结报告如下：     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.