脑血管意外患者院内呼吸道感染高危因素分析

目的探讨神经内科脑血管意外患者并发院内呼吸道感染的高危因素及预防措施。方法回顾性分析38例并发院内呼吸道感染的神经内科脑血管意外住院患者的临床资料,探讨其高危因素及病原体。结果38例发生院内呼吸道感染的患者中,大于60岁的老年患者22例;11例气管切开患者中有7例（63．6％）发生呼吸道感染,多发生于气管插管或气管切开的3—6d;重症监护病房患者12例中有8例（66．7％）发生呼吸道感染。革兰氏阳性球菌分离率为31．9％,革兰氏阴性菌分离率为53．2％,真菌培养分离率为14．9％。结论老年、气管切开、重症监护病房是神经内科院内呼吸道感染的高危因素,主要病原体为铜绿假单胞菌、鲍曼不动杆菌等。药敏仍以敏感菌株为主,但耐药菌株有增多趋势。     

肺结核病人院内感染病原菌及其耐药性检测分析

目的探讨肺结核院内感染患者的病原菌分布特点及其耐药情况,指导临床合理用药。方法对住院肺结核合并下呼吸道感染病人作痰普通菌培养,对获得阳性结果的139株细菌进行总结,并与同期非肺结核患者痰液普通细菌培养209例结果对比分析。结果普通致病菌培养阳性139例（株）病例中,革兰阴性菌86株（61．9％）,依次为铜绿假单胞菌（22．3％）、肺炎克雷伯菌（13．7％）,不动杆菌（10．8％）,大肠埃希菌（6．5％）,嗜麦芽窄食单胞菌（3．6％）阴沟肠杆菌（2．1％）;革兰阳性菌32株（23．0％）,依次为金黄色葡萄球菌（12．2％）、肠球菌（5．8％）、表皮葡萄球菌（2．1％）,真菌21株（15．1％）。肺结核病人合并糖尿病、COPD、支气管扩张以及结核双肺病灶者,并下呼吸道感染率较高,感染率依次为65．6％、87．5％、64．7％和57．4％。非肺结核并下呼吸道感染组病人,并革兰阳性菌感染者占34．0％,并真菌感染者6．4％。肺结核病人合并革兰阳性菌感染者所占比例下降（23．0％）,且合并真菌感染者增加（15．1％）。结论肺结核合并下呼吸道感染与多种因素相关,且细菌耐药性严重,临床制定感染防控措施十分必要。     

老年PTCA术后合并医院感染的分析及防护

目的：了解老年经皮冠状动脉腔内成形术（PTCA）后合并医院感染的特点,以便加强医院感染的防治。方法：对我院心血管监护室1998年1月以来的收治的302例老年PTCA术后患进行回顾性调查。结果：医院感染的发生率为15．9％,感染部位以呼吸道为首位,45．8％,其次为泌尿道感染（29．2％）,胃肠道感染（14．6％）,皮肤软组织感染（8．3％）,结论：老年PTCA术后发生医院感染与患的年龄,病情,使用气管插管,尿管等管道以及特殊卧位,术前禁食等有关,应重视危险因素的矫正,避免术后感染。     

老年食管、贲门癌患者围手术期的治疗策略(附1160例报告)

回顾性分析手术治疗的1160例老年食管、贲门癌患者的临床资料。术前营养不良者250例，术后发生并发症304例（26．2％），其中呼吸道并发症236例（77．6％），死亡24例（2．07％），治愈出院1126例，随访940例，3、5a生存率分别为48．7％、36．8％。认为老年食管、贲门癌围手术期营养支持、严格的呼吸道管理及术后正确治疗呼吸道并发症是手术成功的关键，可提高临床治愈率和患者生存率。     

老年患者结肠切除围手术期医院感染易感因素分析

目的 了解老年患者结肠切除围手术期医院感染（NI）情况，探讨其危险因素。方法 对2000～2003年间行结肠切除术的患者291例进行回顾性调查，其中老年（〉60岁）患者199例，并对老年患者围手术期NI易感因素进行分析。结果 本组共发生围手术期NI42例次，总感染例次率14．43％，其中老年患者围手术期NI31例次，感染例次率15．58％；感染部位依次是呼吸道、手术切口、泌尿道；手术持续时间〉3h占57．29％；Ⅱ类切口NI率为6．53％；围手术期抗菌药物使用率100％。结论 围手术期NI发生率与侵袭性诊疗操作、糖尿病、H2受体拮抗剂、手术切口污染程度、手术持续时间长和住院时间长等因素有关。     

老年腹膜透析患者难治性腹膜炎病原学分析及预后

目的探讨老年腹膜透析患者发生难治性腹膜炎的致病菌谱及预后。方法回顾性分析2005年1月至2008年12月本院腹透中心22例老年腹透患者中发生的26例次难治性腹膜炎。结果（1）致病菌分布：26例次老年难治性腹膜炎中,培养阳性20例次（76．9％）,革兰阳性（G^＋）球菌感染发生率为23．1％,革兰阴性（G^-）杆菌感染发生率为30．8％,其中铜绿假单孢菌感染发生率为11,5％,真菌性腹膜炎发生率为19．2％。（2）预后分析：26例次老年难治性腹膜炎中,死亡5例次,5例次改行血透,总退出率为38．5％,其中真菌性腹膜炎退出率为80％,铜绿假单孢菌感染退出率为33．3％,培养阴性腹透感染退出率为33．3％。结论真菌感染仍是老年难治性腹膜炎退出的重要原因,培兼阳忡的膀诱感漆不容勿棚．     

住院老年肿瘤患者185例死亡病例分析

目的探讨老年恶性肿瘤住院患者死亡情况及危险因素。方法对1993年1月1日至2006年12月31日期间住院的老年恶性肿瘤死亡病例进行回顾性分析。结果（1）14年间因恶性肿瘤死亡患者185例，其中以肺癌59例（31．9％）、肝癌31例（16．8％）、结直肠癌1例（11．4％）为前三位主要死因。1993～1999年因恶性肿瘤死亡患者62例（33．5％），2000-2006年死亡肿瘤患者123例（66．5％）。（2）合并感染病例126例，占全部肿瘤死亡病例的67．7％，104例患者的死亡与感染有关，感染直接引起死亡13例（7．0％），间接引起死亡91例（49．2％）。（3）恶性肿瘤合并老年多脏器功能衰竭（MOF）91例（49．2％），各脏器出现功能衰竭的时间顺序依次为呼吸系统、肾脏、肝脏、血液系统、神经系统、胃肠系统、心血管系统。各脏器功能衰竭的频率顺序为肺脏、心脏、肝脏、神经系统。（4）分析住院天数、是否合并感染、感染部位数目、感染次数、转移部位数目、合并基础疾病数目等因素对MOFE的影响中，显示基础疾病数目、感染部位数目是MOF的危险因素。结论恶性肿瘤患者死亡人数逐年上升，感染、MOF等并发症已成为肿瘤患者死亡的主要原因。     

莫西沙星序贯治疗老年急性下呼吸道感染的疗效观察

目的观察莫西沙星序贯治疗老年急性下呼吸道感染的疗效。方法选取60例老年中重度急性下呼吸道感染的老年患者,随机分组后,分别给予莫西沙星序贯治疗、莫西沙星静脉治疗及头孢呋辛序贯治疗,比较其临床疗效、细菌清除率及不良反应。结果莫西沙星序贯治疗组与莫西沙星静脉治疗组相比,总有效率（85％与90％）、治愈率（75％与75％）及细菌清除率（88．23％与87．5％）无显著差异（P〉0．05）,但显著优于头孢呋辛序贯治疗组（65％、50％和68．8％,P〈0．05）。3组不良反应发生率均较低,无显著性差异（P〉0．05）。结论莫西沙星序贯治疗临床抗感染疗效确切,不良反应轻微,是治疗老年人急性下呼吸道感染较为理想的治疗方法。     

老年慢性肺心病患者下呼吸道不动杆菌感染34例临床分析

目的了解老年慢性肺心病患者下呼吸道不动杆菌感染的致病特点和对抗生素的敏感性。方法对３４例老年慢性肺心病患者的临床特点、痰细菌培养及药敏试验进行回顾性分析。结果老年慢性肺心病下呼吸道不动杆菌感染居同期１３６例肺心病下呼吸道感染的首位，老年、有较严重基础病和并存症、有多种抗生素、激素或免疫抑制剂的应用史是引起不动杆菌下呼吸道感染的危险因素，其临床症状严重，混合感染率高（５２．９％），院内感染率高（２９．４％），病死率高（２６．５％）。不动杆菌对多种抗生素有不同程度的耐药性，硝酸盐阴性不动杆菌比洛菲不动杆菌的致病性强。结论老年肺心病患者下呼吸道不动杆菌感染的预后不良，治疗的关键应根据细菌培养和药敏试验选择敏感抗生素     

老年反流性食管炎113例对照研究

目的：探讨老年人反流性食管炎（RE）的相关危险因素和临床特点。方法：观察113例老年RE患者的吸烟史、饮烟史、非甾体类抗类药物（NSAID）、钙离子拮抗剂（CCB）和硝酸甘油类（NGs）药物服用史及幽门螺杆菌（HP）感染状态，同时记录酸反流、烧心、胸骨后灼痛和呼吸道症状（如咳嗽、喘鸣等）。结果：老年RE组吸烟、饮酒、服用NSAID、CCB、NGs分别占24．8％、23．9％、10．6％、16．8％、9．7％，而非老年RE组则分别为17．2％、13．8％、3．4％、8．6％、6．8％，2组有显著差异（P＜0．05）；老年RE组HP感染率为34％，非老年RE组HP感染率为52．6％（P＜0．05）；老年RE组酸反流、呼吸道症状分别占67．3％和54．9％，而非老年RE组分别为47．7％和25％（P＜0．05和P＜0．01），烧心和胸骨后灼痛发生率老年组为41．6％和28．3％，而非老年RE组分别为70．4％和56．8％，2组有显著差异（P＜0．01）。结论：老年人饮酒、吸烟、服用NSAID、CCB、NGs是RE发生的相关危险因素；其临床症状老年人以酸反流和呼吸道症状为常见，而烧心、胸骨后灼痛相对少见；HP感染在老年人可能减少RE的发生。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.