兴化地区住院腹泻患者艰难梭菌感染的流行病学研究

目的 了解兴化地区艰难梭菌的感染情况，为预防艰难梭菌感染的暴发流行提供参考依据。方法 收集2018年5月至2021年4月兴化市某医院住院腹泻患者(年龄≥18岁)的粪便标本229例，进行艰难梭菌毒素基因检测(Xpert实时荧光PCR法，赛沛公司)、艰难梭菌谷氨酸脱氢酶抗原(glutamate dehydrogenase antigen, GDH)和毒素检测(酶联免疫层析法，美艾利尔公司)。结果 229例腹泻患者粪便标本，Xpert法检出艰难梭菌阳性19例(tcdB阳性，未检测到cdtA和tcdC缺失)、酶联免疫层析法检出艰难梭菌阳性19例(GDH阳性15例、毒素阳性3例、2者同时阳性1例),诊断为艰难梭菌感染19例(感染率8.30%)。结论 兴化地区住院腹泻患者存在艰难梭菌感染病例，应做好相关预防控制工作。     

重症医学临床救治措施中的热点与争议

重症医学以其对脏器功能监测与支持的强大能力,显著提高了重症患者的生存率.以重症医学为主导的多学科“集中救治”模式在突发公共卫生事件及自然灾害救治中发挥了极大的作用,脏器监测与支持措施及重症救治理念的争论贯穿着重症医学发展的始终.本专题就其中ICU病房临床救治中的几项热点问题进行了讨论.液体治疗是ICU中最核心的救治措施,但积极的液体治疗与重症患者受损脏器代偿能力之间存在着显著的矛盾,合理液体治疗的前提是持续而准确的判断患者的循环状态,超声监测颈总动脉峰流速变异能够较准确的反映患者的容量状态,而且此项技术能够被没有超声经验的ICU住院医生快速掌握.非艰难梭菌相关性医院感染腹泻中产毒的产酸克雷伯菌感染和产毒的产气荚膜梭菌感染可引起严重的腹泻甚至是致死性的肠炎,虽然这两种细菌在ICU患者中的检出率很低,但是它们往往和严重疾病、预后不良有密切联系,仍然值得临床医生予以适当的警惕.已在ICU中广泛开展的镇痛镇静治疗在镇静程度、是否需要唤醒等措施上仍有较大的争议,但越来越多的循证医学证据支持以个体化为目标的恰当镇静方案,这一方案应兼顾疼痛,躁动和谵妄三方面的整体化评估与管理.     

非食源性腹泻中产气荚膜梭菌的毒力型分布特征

目的 探讨非食源性腹泻患者中分离的产气荚膜梭菌毒力型分布特征。方法 选取2020年1月1日至12月31日清华大学附属北京清华长庚医院收治的非食源性腹泻住院患者粪便样本分离的86株产气荚膜梭菌,其中59株分离于抗生素相关性腹泻（antibiotic-associated diarrhea, AAD）患者,27株分离于非AAD患者。采用实时荧光聚合酶链反应（polymerase chain reaction, PCR）检测菌株的6种毒素基因,即产气荚膜梭菌alpha毒素（cpa）、beta毒素（cpb）、epsilon毒素（etx）、iota毒素（ι-iap）、肠毒素（cpe）和坏死性肠炎B毒素（netB）,依据毒素类型将菌株分为A～G 7种毒力型,分析毒力型分布以及AAD组和非AAD组间毒力型的差异。结果 86株产气荚膜梭菌中,毒素基因cpa、cpb、etx、ι-iap、cpe和netB的检出率分别为100.0%、5.8%、0.0%、0.0%、18.6%和2.3%;A～G毒力型分别占74.4%、0.0%、5.8%、0.0%、0.0%、17.4%和2.3%。A毒力型在AAD组和非AAD组的...     

艰难梭菌感染患者的临床特征分析

目的：研究艰难梭菌感染患者的临床特征,为临床对此类感染患者的诊断及治疗提供依据。方法回顾性分析感染性腹泻患者的艰难梭菌分离情况以及临床感染特点。结果从291份感染性腹泻标本中分离出33株艰难梭菌,阳性率为10.3％（18／174）,其中26株为产A／B毒素菌株（12例患者）。艰难梭菌主要分离自老年男性,均具有严重基础疾病,且使用过质子泵抑制剂和多种广谱抗菌药物;粪便常规和血液学相关指标对艰难梭菌感染及产毒与否具有一定的指示作用。结论严重的艰难梭菌感染患者病死率高,且易引起院内感染的播散,医院可以根据此类患者的临床特征进行规范干预,从而有效地控制院内感染的爆发。     

重症肺炎患儿继发抗生素相关性腹泻病原菌检测与肠镜观察

目的:探讨重症肺炎患儿继发抗生素相关性腹泻(Antibiotic-associated diarrhea,AAD)的肠道病原菌及肠镜情况。方法:回顾性分析本院2012年3月-2014年3月本院内科重症监护室283例重症肺炎继发AAD患儿的临床资料,检测肠道病原菌,电镜观察肠道病理变化。结果:283例患儿的粪便检出艰难梭菌(Clostridium difficile,CD)毒素阳性标本48例,283例患儿的粪便培养后检出优势生长的白色假丝酵母菌127例、大肠埃希氏菌114例、金黄色葡萄球菌43例、产气荚膜梭菌35例、产酸克雷伯菌26例、阴沟肠杆菌19例、肺炎克雷伯菌16例、铜绿假单胞菌8例。电镜检查CD相关性AAD(CDAD)26例有黄白色伪膜斑,其他病原菌相关性AAD 67例显示有炎性变化。结论:重症肺炎继发AAD患儿的病原菌种类较复杂,以优势生长的白色假丝酵母菌、大肠埃希氏菌检出率最高。肠镜检测CDAD与其他病原菌相关性AAD显示出不同的炎症变化。     

基于线粒体功能障碍探讨补肾健脾化湿法对PCOS-IR作用的研究进展

]艰难梭菌是医院感染性腹泻的主要病原菌。艰难梭菌感染严格依赖于艰难梭菌产生的蛋白质毒素。近年来对艰难梭菌毒素的进一步研究有了新的发现,也发展和建立了一些新的艰难梭菌毒素检测方法。本文对艰难梭菌毒素的生物学和艰难梭菌毒素及其基因检测方法的研究进展做一综述,旨在为艰难梭菌感染防治提供参考。     

细菌培养法、ELFIA和PCR检测恶性肿瘤化疗期腹泻患者艰难梭菌的比较

目的比较细菌培养法、酶联荧光免疫分析技术（ELFIA）检测艰难梭菌毒素A/B、PCR检测肠毒素（tcd）A/B对恶性肿瘤化疗期腹泻患者的艰难梭菌检出率,并分析艰难梭菌感染患者的临床特征。方法选择212例行恶性肿瘤化疗的腹泻患者为研究对象,分别采用粪便艰难梭菌培养、ELFIA检测艰难梭菌毒素A/B、PCR检测tcdA/B等3种方法,比较其艰难梭菌阳性检出率,并分析艰难梭菌感染患者的临床特征。结果粪便艰难梭菌培养、ELFIA检测艰难梭菌毒素A/B、PCR检测tcdA/B的阳性检出率分别为12.7%、10.4%和31.6%;PCR的阳性检出率明显高于其他2种方法（均P＜0.05）。PCR检测艰难梭菌阳性的67例患者中男36例,女31例;年龄46~89（67.2±10.8）岁;合并心血管疾病或糖尿病等基础性疾病占86.6%;所有患者使用过广谱抗生素、质子泵抑制剂（PPIs）;粪便潜血试验阳性占95.5%;平均血浆白蛋白浓度为37.92g/L,C反应蛋白为30.25mg/L。结论PCR的阳性检出率最高。恶性肿瘤化疗患者若年龄较高、使用过广谱抗生素或PPIs和粪便潜血试验阳性合并腹泻时,应考虑艰难梭菌感染。     

住院腹泻患儿粪便艰难梭菌毒素检测与分析

目的对住院腹泻患儿的粪便标本进行艰难梭菌毒素筛查,以了解患儿艰难梭菌的感染情况,为院内感染的防控提供基础数据。方法采用VIDAS艰难梭菌AB毒素(CDAB)检测试剂对2013年6月~11月收集的146例住院腹泻患儿粪便标本进行毒素检测,并结合其他实验室检测结果及临床资料进行综合分析。结果 146例患儿中有10例检出CDAB,阳性率6.8%。10例CDAB阳性患儿均使用过美洛西林/舒巴坦、头孢他啶、头孢克洛等抗生素,占抗生素相关性腹泻患者(56例)的17.9%。结论住院患儿艰难梭菌相关性腹泻感染率较高,抗菌药物的使用是诱使艰难梭菌感染的重要因素,年幼体弱的儿童更容易感染艰难梭菌。     

抗生素相关性腹泻临床实验室检测结果分析

目的分析233例使用抗生素期间不明原因发生腹泻患者粪便标本的实验室检测结果,明确抗生素相关性腹泻（AAD）实验室诊断价值,为临床提供有效地防控措施。方法收集我院2011年1月-2012年12月期间住院患者233例使用抗生素期间不明原因发生腹泻的非重复粪便标本,进行实验室常规检测、涂片革兰氏染色镜检及病原体相关检测等。结果 233例腹泻病例中AAD患者178例,均存在菌群失调,63例检出病原菌,分别检出病原菌1～3株,其中真菌感染率最高（36.5%）,其次是克雷伯菌属（28.6%）和厌氧菌（艰难梭菌14.3%、产气荚膜梭菌7.9%）。结论 AAD为抗生素使用不当至菌群失调性腹泻,病原菌及其肠道正常菌群破坏有关的实验室检查是确诊的关键。     

食品中产气荚膜梭菌的分离鉴定与基因分型

目的调查广州地区食品中产气荚膜梭菌的污染水平及菌型分布。方法参照国家标准方法进行产气荚膜梭菌的分离鉴定,采用针对产气荚梭菌α、β、ε、ι、CPE和β2六种毒素的基因cpa、cpb、etx、iA、cpe和cpb2序列的6对特异性引物,用多重PCR方法对分离菌株进行基因分型鉴定。同时用产气荚膜梭菌A型参照株NCTC64609作为阳性对照。结果从142份食品中分离到21株产气荚膜梭菌,以冷冻肉的带菌率最高,为19.6%;鲜肉和速冻肉饺分别为12.2%和11.9%。经多重PCR方法鉴定,均扩增出预期大小为324bp的cpa基因片段的特异性条带,未扩增出针对cpb、etx和iA基因的特异性条带,证实均为A型产气荚膜梭菌。携带β2毒素基因的产气荚膜梭菌共19株(占总分离株的90.4%),其中1株为肠毒素基因阳性的A型菌株。结论初步调查表明广州地区食品中存在可致人食物中毒的肠毒素阳性A型产气荚膜梭菌污染,为进一步建立广州地区食品中及与食物中毒有关的厌氧菌分子分型数据库奠定了基础。     

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.