医院临床用血现状调查分析

目的 了解医院临床用血合理性情况。方法 随机抽取本院2006～2008年有输血治疗的病历700份,其中外科病历500份,内科病历200份。依据《临床输血技术规范》中“手术及创伤输血指南”和“内科输血指南”对病例输血合理性进行分析评估。结果 700例病例中,合理用血占44％,部分合理用血占40％,不合理用血占16％。内科合理输血比例显著高于外科（χ^2=91．827,P〈0．01）。结论 不合理用血现象在医院中普遍存在,外科占有较大比例。     

THE TETANUS BACILLUS AS AN INTESTINAL SAPROPHYTE IN MAN

1. The only reliable method that can be used for the detection of tetanus bacilli is the culturing of the suspected material, the isolation of tetanus-like organisms and the demonstration that the pure cultures form a spasm-producing toxin that is neutralized by tetanus antitoxin. 2. Using this method we have demonstrated tetanus bacilli in 34.7 per cent of stools from 78 individuals in Peking. 3. The tetanus bacillus is growing in the digestive tract, for it is present in individuals who have been on a practically sterile diet for a month or more, and one individual may eliminate several million spores of tetanus bacilli in a single stool.     

STUDIES ON THE RELATION OF TETANUS BACILLI IN THE DIGESTIVE TRACT TO TETANUS ANTITOXIN IN THE BLOOD

1. The sera of twenty-six individuals who carried tetanus bacilli in their digestive tracts all contained appreciable amounts of antitoxin. 2. The sera of thirty individuals in whose stools no tetanus-like organisms were found were, with two exceptions, free from tetanus antitoxin. 3. Although we have been unable to measure accurately the antitoxin content of these human carriers of tetanus bacilli, 0.1 cc. of serum neutralizes 10 or more M.L.D. of toxin and it is evident that they have acquired an active immunity due to the bacilli in the intestinal tract. 4. These results definitely prove that tetanus bacilli grow in the intestinal tract of man. 5. Many of the individuals who have no tetanus bacilli in their intestinal tracts and whose serum is free from antitoxin show agglutinins to tetanus bacilli. It is probable that they have been carriers of the bacilli in the past and that the agglutinins have persisted longer than the antitoxins. It seems likely, therefore, that these individuals are potentially immune to tetanus. 6. If tetanus bacilli can be established in the digestive tract of man we have a means of immunization which might be useful in armies or in regions where tetanus infections are common, though we do not recommend this method of immunization at present.     

MENTAL HEALTH STATUS IN REFUGEES: AN INTEGRATIVE REVIEW OF CURRENT RESEARCH

The purpose of this integrative review was to assess the results of current published quantitative research about refugees and their mental health status. An extensive literature review using several approaches was performed. A group of 12 articles met inclusion criteria for this study sample (N = 12). All 12 studies showed negative mental health status in the refugees sampled. Mental health outcomes included posttraumatic stress disorder, depression, anxiety, psychosis, and dissociation. This review revealed a lack of culturally sensitive understandings and diagnostic measures in the majority of current published quantitative research on refugees. The scope of this research for health professionals is broad, as the number of refugees continues to rise. Recommendations for clinicians include an expanded range of practice to incorporate refugee-specific assessment and treatment.     

A CEREBELLAR DISORDER IN CHICKS,APPARENTLY OF NUTRITIONAL ORIGIN

Growing chicks maintained on a diet consisting of milk powder, casein, starch, yeast, cod liver oil, salts and filter paper develop ataxia, tremors, retraction or twisting of the head, clonic spasms of the legs, and stupor. These symptoms may appear suddenly, usually between the 18th and 25th day, and may end in death. If recovery takes place, the chicks may go on to normal development. Definite lesions are found in the cerebellum of the affected chicks. These consist of edema, necrosis and hemorrhages. Hyaline thrombi are found in the capillaries in and about the degenerated areas.     

AN AUDIT OF PHYSICAL HEALTH NEEDS OF ADULTS WITH PROFOUND LEARNING DISABILITY IN A HOSPITAL POPULATION

This paper highlights the potential physical health problems of people with profound learning disability in a hospital population. Assessments were made under seven probable health care needs of this population. Uncomplicated Body Mass Index (BMI) <20 (underweight) was a common finding, but low Body Mass Index alone was of little significance in this population. The majority of participants had well controlled epilepsy, were vulnerable to pressure sores, and prone to constipation. The number of consultations with a doctor were similar to the general population, but all had regular annual physical examinations. A small but significant number of people required a high level of health care which can only be provided with a high level of nursing care and regular medical support. The implications of the recent shift of focus of the National Health Service and its effect on this population is discussed.     

AN ELECTROPHORETIC STUDY OF IMMUNE SERA AND PURIFIED ANTIBODY PREPARATIONS

1. Antibody produced in the horse migrates as a new serum component between the β and γ components, whereas rabbit antibody is electrophoretically identical with the γ globulin component of the serum. 2. In rabbit and monkey antisera the percentage of antibody in the serum and in the γ globulin fraction can be determined by integration of the electrophoresis diagrams of unabsorbed and absorbed sera. Antibody solutions of high purity can be obtained by electrophoretic isolation of the γ globulin of rabbit antisera in which the percentage of antibody to total γ globulin is high. 3. The isoelectric points of pig, cow, horse, and rabbit antibodies have been determined. 4. In horse sera prolonged immunization is accompanied by the formation of another antibody component of lower mobility.     

SUPPRESSION OF THE FIRST ATTACK WITH SUBSEQUENT RELAPSE: AN IMMUNE PHENOMENON IN EXPERIMENTAL RELAPSING FEVER

In five splenectomized squirrels and chipmunks which were reinoculated with a strain of Spironema recurrentis which had previously been present in their blood, the first attack was entirely suppressed because the animals were immune to the strain of spirochetes inoculated; but after the interval which usually occurred between attacks, a relapse ensued, in which the strain of spirochetes present in the blood was different from the strain inoculated.     

CHARACTERISTICS OF AN IMMUNE SYSTEM COMMON TO CERTAIN EXTERNAL SECRETIONS

The γ₁A present in saliva and colostrum exists largely in the form of higher polymers, the major component of which has a sedimentation coefficient of 11S. The 11S γ₁A in these fluids differs from the polymers found in normal and myeloma sera both immunologically and by the fact that their sedimentation coefficients are unaffected by disulfide bond reduction in the absence of urea. However, like other γ-globulins the 11S γ₁A molecules consist of multiple polypeptide chains linked by disulfide bonds. Local synthesis of γ₁A in the salivary gland has been shown by fluorescent and autoradiographic studies, although the fraction of the total salivary γ₁A which is derived from local production is uncertain. No evidence of transport of intravenously administered I¹³¹-labeled 7S γ₁A from serum to saliva was obtained. Immunological specificity has been demonstrated in the salivary and colostral γ₁A. Whether that portion of the γ₁A which is immunologically specific is a piece incorporated during the local synthesis of γ₁A in the gland or is added by the epithelial cell in the process of transport remains to be determined. Antibody activity (isohemagglutinins) have been demonstrated in saliva and colostrum and have been shown to be of the γ₁A-type. In both of these fluids activity is associated primarily with γ₁A-polymers of 11S and 18S sizes. There appears to be an immunological system which is characteristic of certain external secretions. Its properties including the local production of a distinctive type of antibody separate it from the "systemic" system responsible for the production of circulating antibody. This system may play a significant role in the body's defense mechanisms against allergens and microorganisms.     

Lymphocyte Transformation during Dinitrochlorobenzene Contact Sensitization. AN IN VITRO AND IN VIVO EVALUATION OF THE PRIMARY IMMUNE RESPONSE IN MAN

An evaluation of cell-mediated immunity in man is described that combines the advantages of an in vitro technique, lymphocyte transformation, with the use of contact sensitization to a primary immunogen, dinitrochlorobenzene (DNCB). DNCB, when coupled to autologous or allogeneic peripheral blood leukocytes, forms a complex, DNCB-antigen, that induces lymphocyte transformation specifically in leukocyte cultures from subjects sensitized to DNCB. Sequential studies of lymphocyte transformation to DNCB-antigen show that specifically reactive lymphocytes are first detected at about 10 days after in vivo application of a sensitizing dose of DNCB and reach a peak at about 14-21 days.     

ICU医院感染目标性监测结果比较

目的了解医院重症监护病房医院感染情况,为医院感染防控提供科学依据。方法通过目标性监测,对某医院重症监护病房医院感染情况及其相关危险因素进行了监测分析。结果该医院重症监护病房610例住院患者,发生医院感染249例次,例次感染率为40.82%,患者日感染发病率40.29‰,调整感染发病率10.89‰。105例使用呼吸机的住院患者中,发生医院感染69例次,例次感染率为65.71%,其中40.63%为呼吸机相关肺炎。结论该重症监护病房医院感染发生率较高,使用呼吸机的病人呼吸机相关肺炎发病率也较高,应有针对性地加强防控措施。     

妊娠期妇女健康教育状况及社会支持因素调查分析

目的调查妊娠期妇女孕期保健、心理卫生、孕期营养等知识的需求和掌握情况，探索最佳的健康教育方法。方法选择首次妊娠孕20周以内的健康孕妇400例，根据其个人的基本条件、孕妇心理状况、社会支持情况、最喜爱和乐于接受的教育方式和对健康知识掌握的情况等因素进行问卷调查，分析其问卷情况。结果400例孕妇在心理健康教育措施方面，最喜爱的措施是面对面咨询，占84．5％；认为有必要参加孕妇学校者占87．5％；认为有必要参加孕期心理健康教育者占86．5％；对健康教育相关内容正确率方面排序依次是：孕期保健（92．8％）、孕产妇心理卫生（91．3％）、孕产妇营养（87．3％）和孕期口腔保健（64．8％）。结论对妊娠期妇女实施健康教育和心理支持是必要的，应建立一套科学化、系统化、整体化的孕妇学校健康教育体系，使孕妇处于最佳身心和护理状态，以顺利度过妊娠期及产育健康的后代。     

重症监护室医院感染目标监测结果

目的了解医院重症监护室医院感染发病情况,加强医院感染管理措施。方法采取目标监测的方法 ,对2009年1-3月本医院重症监护室住院患者医院感染发病情况进行了监测。结果该医院重症监护室在3个月内共入住1 501例患者,发生医院感染63例,70例次,医院感染发生率3.95%,例次感染率4.95%。同期住在ICU日数7 236 d,千日感染率8.71‰。感染部位以下呼吸道为主,占85.71%;其次是泌尿系统感染,占10.0%。呼吸机的使用,尿道插管和血管插管留置是医院感染主要危险因素。结论该医院重症监护室医院感染以呼吸道感染为主,各种插管是引发感染的主要危险因素。     

ALTERED FUNCTIONAL PROPERTIES OF THE RENAL GLOMERULUS IN AUTOLOGOUS IMMUNE COMPLEX NEPHRITIS : AN ULTRASTRUCTURAL TRACER STUDY

The altered functional properties of the glomerular capillary wall in a model of autologous immune complex disease (Heymann's nephritis) was studied by electron microscopy using intravenously injected protein tracers of varying molecular weight. There was an increase in the permeability of the glomerular basement membrane (GBM) itself to large molecules; this change was focal and was found in those areas where the GBM contained immune complex deposits. Both ferritin and catalase, tracers normally restricted from passing the glomerular filter, were present in the urinary space within minutes of injection. No evidence was obtained for increased glomerular epithelial transport in this disease. Foot process swelling and "close" junction formation was moderate, even in animals with marked degrees of proteinuria. Indirect evidence, therefore, makes an alteration in the slit pore complex likely. In addition, there was immediate and selective concentration of all tracers within deposits, though ferritin was partially excluded from some deposits. This phenomenon may be of significance in the perpetuation of the disease.     

IMMUNITY STUDIES OF ROCKY MOUNTAIN SPOTTED FEVER : I. USEFULNESS OF IMMUNE SERUM IN SUPPRESSING AN IMPENDING INFECTION.

From the results of the experiments presented it is evident that in guinea pigs an early administration of immune rabbit serum will suppress the infection; that is, if it is given within the period of incubation, the effect being proportionately greater the earlier the serum is administered. Almost no beneficial effect is observed when the serum is given after the onset of the disease. In the animals inoculated with 10 to 100 M.L.D. the incubation period is shorter than when 1 M.L.D. is injected; nevertheless 1 cc. of the immune serum saved the animals as late as 96 hours from the time of the introduction of the virus into the system. When administered within 24 hours in the case of 100 M.L.D. and within 48 hours in the case of 10 M.L.D., the serum completely neutralized the virus, and the animals escaped infection altogether. On the other hand, the same quantity of the serum only modified the infection into a non-fatal one when given a day or two later. In the animals which were inoculated with 1 M.L.D. the incubation period was a day or two longer, and the neutralizing effect of the serum was much more powerful. Here animals were saved as late as 5, 6, and 7 days and with a much smaller quantity of the serum (0.1 cc.). As to the usefulness of such an immune serum in human cases, the relative susceptibility of man and the guinea pig must first be considered. In a large number of experimental infections carried out with guinea pigs in the past 6 years almost never has a naturally refractory animal been encountered. The mortality is nearly 80 per cent with most strains, although as low as 50 per cent with some. The strain used in the present study caused death in nearly 80 per cent of the animals. Hence the susceptibility of guinea pigs is at least as great as that of man, in whom the mortality in the Bitter Root Valley is estimated to be about 70 per cent. The relative length of the incubation period in guinea pig and in man is another point which requires analysis. In guinea pigs it varies somewhat according to the number of passages, being as short as 3 days when 100 M.L.D. or more of an adapted virus are inoculated. On the other hand, when the infection is the result of 1 M.L.D. or the bite of an infected tick, the incubation period is much longer, being 5, 6, or 7 days in the former and 7 to 8½ days in the latter instance, as with the present strain. In man the infection is brought on by the bite of an infected tick, and the period of incubation varies from 3 to 10 days but is usually 7 days; i.e., it is about the same as in guinea pigs infected with 1 M.L.D. Hence we may regard the susceptibility of man and the guinea pig as nearly equal. The final point to be considered is the quantity of the immune serum that may be recommended for use in human cases. To prevent the infection in a guinea pig weighing 500 gm., 0.1 cc. of the serum was sufficient. This quantity protected the animal against 1 M.L.D. even as late as 5, 6, or 7 days. Calculated on this basis, 16 cc. of the serum would be required for a man weighing 80 kilos (about 160 pounds); that is, 16 cc. of an immune rabbit serum, administered before onset of the disease, should theoretically be sufficient to save a man of average weight against an infection brought about by the bite of an infected tick or by a laboratory accident. It would probably be best to administer the serum intravenously. The titer of the immune serum should be previously determined in guinea pigs, and 1 cc. should neutralize 100 M.L.D. completely and 0.1 and 0.01 cc. render the infection non-fatal. Such a serum is easily produced in rabbits (a rabbit weighing 2,500 gm. will yield 50 to 60 cc. of the serum) and probably will remain active a year or longer when kept at refrigerator temperature.     

MATURATION OF THE HUMORAL IMMUNE RESPONSE IN MICE

In spite of the prenatal appearance of immunoglobulin-bearing lymphocytes and θ-positive lymphocytes in the spleens of Swiss-L mice, these mice are not able to produce detectable levels of humoral antibodies in response to antigen until after 1 wk of age. Adult levels of response are not achieved until 4–8 wk of age. In the presence of bacterial lipopolysaccharides, which can substitute for or enhance T-cell function, the B cells from young Swiss-L mice were found to be indistinguishable in function from adult B cells, both with respect to the numbers of plaque-forming cells (PFC) produced in vitro in response to antigen and with respect to the kinetics of PFC induction. The spleen cells from young Swiss-L mice are significantly less sensitive than adult spleen cells, however, to stimulation by the T cell mitogens, concanavalin A (Con A) and phytohemagglutinin (PHA). Very few Con A-responsive cells could be detected at birth but the numbers increased sharply with age until 3 wk after birth. On the other hand, PHA-responsive cells could not be detected in the spleen until about 3 wk of age. The latter cells were found to respond also to Con A, but at a lower dose (1 µg/ml) than that required for the bulk of the Con A-responsive cells (3 µg/ml). The cells that respond both to PHA and to Con A appear in the spleen at about the time that Swiss-L mice acquire the ability to produce humoral antibodies, and these cells can be depleted from the spleen by the in vivo administration of antithymocyte serum. The development of humoral immune responses in these mice therefore appears to be correlated with the appearance of recirculating T lymphocytes that are responsive both to PHA and to Con A.     

INDUCTION AND REVERSAL OF IMMUNE PARALYSIS IN VITRO

Induction of the immune response can only be completed after antigen is removed from the cellular environment. Primed rabbit lymph node fragments were cultured in vitro with 5 mg/ml BSA. If antigen was removed from the fragments 2 hr later, they produced a normal anti-BSA response, which was first evident 5 days later. If antigen removal was delayed for 3 days, the onset of the response was postponed for 2 to 3 days. Pulses with BUDR marked the periods of cell proliferation in both sets of cultures, and established that the postponement of antibody production was preceded by a postponement in the wave of proliferation among precursors of antibody forming cells. The similarity in avidity of antibody-containing fluids from normal and postponed cultures support the idea that the same cell population produced the response in each case. It was concluded that a reversible state of paralysis could be instituted in antigen-responsive cells, and this state did not depend upon cell-killing. The widespread incidence of temporary paralysis as an early aspect of the immune response was discussed.     

IMMUNE RESPONSES IN VITRO : II. SUPPRESSION OF THE IMMUNE RESPONSE IN VITRO BY SPECIFIC ANTIBODY

The effects of hyperimmune anti-sheep erythrocyte (SRBC) antibody on the plaque-forming cell (PFC) response to SRBC by mouse spleen cells in vitro were studied. Anti-SRBC antibody specifically suppressed the PFC response against SRBC. The degree of suppression was directly related to the amount of antibody added and was overcome by large amounts of antigen. Suppressive activity was absorbed from the sera by SRBC and could be partially eluted from the antigen by heat. The PFC response in cultures stimulated with antigen-antibody complexes prepared with high concentrations of antibody were suppressed; however, some complexes prepared at lower antibody concentrations stimulated greater responses than SRBC alone. Antibodies collected after four immunizations had greater suppressive ability than those collected after two immunizations. The degree of suppression was as great whether antibody was added at the initiation of the cultures or 24 hr later, suggesting that during the first 24 hr the culture system was antigen-dependent. Incubation of separated lymphoid cells with antibody did not impair their ability to develop a PFC response in vitro. However, if macrophages were incubated with antibody either before or after incubation with SRBC, the subsequent PFC response by lymphoid cells was suppressed. The data are consistent with the conclusion that antibody suppresses the PFC response in vitro by neutralizing the antigenic stimulus at the macrophage-dependent phase of the response.     

A GROUP OF MICROORGANISMS TRANSMITTED HEREDITARILY IN TICKS AND APPARENTLY UNASSOCIATED WITH DISEASE

1. Pleomorphic, bacterium-like, Gram-negative, intracellular microorganisms, which stained much less intensely with ordinary dyes than most bacteria were found in sixteen species of ticks comprising examples of the Argasidæ and the Ixodidæ. 2. In six of these species studied intensively slight differences in the microorganisms were detected, sufficient to permit identification of the vectors by microscopic examination of the microorganism alone. 3. No evidence was seen of injury to the tissues of the arachnid hosts of the microorganisms other than that incident to mechanical distention of the cells containing them. 4. The detection of the microorganisms in the eggs of ten species, in the unfed larvæ of eight species, and at nearly related stages throughout the life cycle of three others leads to the conclusion that they are transmitted hereditarily.