阴道分泌物910例检验结果分析

目的通过对910例正常健康人群妇女体检中阴道分泌物涂片的检验结果分析,了解病原菌检出率、病原菌分布及阴道分泌物清洁度情况。方法将910例患者按年龄分为25～34、35～44、45～54、≥55岁等四组采集阴道分泌物行革兰染色在显微镜下查白假丝酵母菌、滴虫、加德纳菌。结果910例阴道分泌物涂片165例检出病原菌,阳性检出率18.13%;以加德纳菌为主,占14.07%,其次是假丝酵母菌和滴虫分别为3.74%和0.22%。各年龄组(25～34岁组,35～44岁组,45～54岁组,≥55岁组)合计阴道炎的发生率分别为28.95%(22/76)、45.14%(79/175)、57.60%(216/375)、67.61%(192/284),细菌性阴道病的发生率45～54岁组最高(16.80%),非特异性阴道炎的发生率≥55岁组最高(52.11%)。清洁度Ⅳ度时病原菌检出率最高,其次为Ⅲ度、Ⅱ度,清洁度为Ⅰ度时未检出病原菌。结论细菌性阴道病和非特异性阴道炎是常见阴道感染性疾病,围绝经期及绝经期女性多见。     

改良新鲜厚猪皮覆盖对烧伤创面感染影响的观察

目的:观察改良新鲜厚猪皮覆盖对烧伤创面感染的影响。方法:选择烧伤创面119例,随机分为猪皮覆盖治疗组(观察组)60例和常规治疗组(对照组)59例;着重对两组治疗期间创面分泌物标本细菌鉴定结果进行对比分析。结果:对照组培养出病原菌42例(61株),占71.2%;观察组培养出病原菌30例(36株),占50.0%。对照组病原菌培养阳性率及菌株数量均显著高于观察组(P<0.05)。两组病原菌种类均以金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌和表皮葡萄球菌为主,但对照组耐甲氧西林金黄色葡萄球菌所占比例为55.6%,显著高于观察组的28.6%(P<0.05)。结论:采用新鲜猪皮覆盖创面能够显著降低创面感染率,减少耐药菌株的产生。     

湿润烧伤膏联合LEEP刀治疗重度宫颈糜烂近期疗效观察

目的观察湿润烧伤膏(MEBO)联合高频电波刀(LEEP刀)治疗重度宫颈糜烂的临床效果。方法将174例重度宫颈糜烂患者分为治疗组(60例)、对照组Ⅰ(60例)和对照组Ⅱ(54例),治疗组采用MEBO联合LEEP刀治疗,对照组Ⅰ单纯采用LEEP刀治疗,对照组Ⅱ单纯采用MEBO治疗,观察创面愈合情况,对比、分析三组患者的治疗效果。结果治疗组和对照组Ⅰ总有效率均为100%,对照组Ⅱ总有效率为96.30%;治疗组治愈率高于对照组Ⅰ和对照组Ⅱ(P0.01);治疗组较对照组Ⅰ创面愈合快(P0.01),阴道排液时间短(P0.01),术后出血量少(P0.01)。结论MEBO联合LEEP刀治疗重度宫颈糜烂,疗效显著,创面愈合快,不适反应轻。     

小儿下呼吸道感染患者主要致病菌及药物的敏感性分析

目的:了解下呼吸道感染主要致病菌及药物敏感性,为合理使用抗生素提供依据。方法:对住院患者采集咽拭子标本310份,其中涂片染色镜检,其中300份咽分泌物标本进行病原学鉴定,并做药敏试验。结果:下呼吸道以G 细菌占首位,以肺炎链球菌为主,药物敏感试验结果显示,头孢曲松钠对G 细菌有效率达87%。鉴定出的G 菌对头孢菌素类,喹诺酮类敏感,对青霉素耐药。结论:肺炎链球菌是小儿下呼吸道感染主要致病菌,头孢曲松钠是治疗下呼吸道感染的有效抗生素。     

不同方法治疗腰肌劳损的近、远期疗效观察

目的比较不同方法治疗腰肌劳损的近、远期临床疗效。方法将2010年1月~2013年1月治疗的144例腰肌劳损患者随机分为银质针配合推拿治疗组(Ⅰ组)、针刺配合推拿治疗组(Ⅱ组)和单纯推拿治疗组(Ⅲ组),每组各48例。经过2个疗程治疗后,对3组治疗后1个月、1年的临床疗效及视觉模拟评分(VAS)进行统计对比。结果治疗后1个月,Ⅰ组、Ⅱ组、Ⅲ组的总有效率分别为100%、87.5%和70.8%,Ⅰ组明显高于Ⅱ组和Ⅲ组,Ⅱ组明显高于Ⅲ组(均P<0.05);治疗后1年,Ⅰ组、Ⅱ组、Ⅲ组的总有效率分别为87.5%、62.5%和47.9%,Ⅰ组明显高于Ⅱ组和Ⅲ组(P<0.05),Ⅱ组与Ⅲ组间未见显著差异(P>0.05)。治疗后1个月,Ⅰ组VAS评分明显低于Ⅱ组和Ⅲ组,Ⅱ组明显低于Ⅲ组(均P<0.05);治疗后1年,Ⅰ组VAS评分明显低于Ⅱ组和Ⅲ组(P<0.05),Ⅱ组与Ⅲ组相比未见明显差异(P>0.05)。结论针刺配合推拿治疗腰肌劳损具有较好的近期疗效,但远期疗效局限;银质针配合推拿治疗腰肌劳损具有较好的近、远期疗效,值得临床推广应用。     

烧伤感染病原菌的DNA微阵列检测研究

目的观察DNA微阵列检测烧伤感染病原菌的灵敏度和特异度。方法分别采用DNA微阵列法和常规培养分离鉴定法对不同含菌量的菌液进行检测,比较二者鉴定病原菌的灵敏度;采用微阵列法检测经常规方法鉴定明确的烧伤感染病原菌62株,观察二者的阳性符合率和阴性符合率;采用上述两种方法检测103份烧伤创面分泌物标本,观察其符合率。结果与常规方法相比,DNA微阵列检测烧伤创面细菌具有快捷、高通量的优势,鉴定单一菌株的灵敏度比常规方法高10~100倍,鉴定已知菌株与常规方法的阳性符合率和阴性符合率均为100%;在检测103份烧伤创面分泌物时,DNA微阵列除鉴定出常规方法鉴定出的所有菌株外,还检出了一些常规方法未检出的菌株。结论与常规方法相比,DNA微阵列检测烧伤感染常见病原菌的符合率和灵敏度均达到较高水平,具有良好的临床应用前景。     

我国东北地区某部队战士鼻腔内细菌定植情况及耐药性调查

目的了解某部队战士鼻腔分泌物中细菌的定植状况及耐药性。方法采集健康战士鼻腔分泌物标本进行细菌的培养与鉴定及抗菌药物的最低抑菌浓度(MIC)测定。结果从123名战士鼻腔分泌物中分离出机会致病菌56株,总携带率为45.53%,其中革兰阳性球菌占60.71%,革兰阴性杆菌占39.29%。检出率较高的机会致病菌,凝固酶阴性葡萄球菌为30.36%[耐甲氧西林葡萄球菌(MRCON)为58.82%],金黄色葡萄球菌为19.64%,肺炎克雷伯菌为14.29%,肺炎链球菌为7.14%。检出耐青霉素肺炎链球菌(PRSP)为25%,凝固酶阴性葡萄球菌对青霉素耐药100%,对红霉素、阿奇霉素耐药率为58.82%。结论部队战士鼻腔分泌物中机会致病菌携带率高,而且MRCON检出率偏高,呈多重耐药,加强检测对呼吸道疾病防治具有一定意义。     

海水浸泡动物外伤创面的细菌培养与分析

目的：探讨海水浸泡外伤创面分泌物的细菌种属及其抗生素敏感谱，为创口感染的治疗提供依据。方法：实验兔25只，致伤后随机分成5组，每组5只。2组港口码头处海水浸泡伤口，3组近海海水浸泡伤口。近海海水浸泡分别为不加处理、简单清创和清创并注射青霉素等3组。港口码头分别为不加处理和伤后处理组。各组于伤后0．5、1、2、3、4、5、6h取创面分泌物进行培养。结果：培养细菌以革兰阴性杆菌为主，弧菌属及肠杆菌属检出率较高，变形杆菌检出率亦较高，而革兰阳性球菌属检出率较低；细菌对亚胺培南、环丙沙星敏感性较高，对头孢唑啉、磺胺敏感性较低。结论：海水浸泡后的外伤创面感染以海水中细菌为主，且对抗生素敏感谱较广，耐药谱较窄。     

按摩前列腺前后尿道淋球菌和脲原体检出情况对比

目的 :了解按摩前列腺能否提高尿道分泌物内淋球菌和脲原体检出的阳性率。方法 :按摩前列腺前后分别进行尿道分泌物涂片镜检淋球菌及分泌物培养淋球菌和脲原体。结果 :按摩前尿道分泌物检出淋球菌 3例 ,按摩后检出 10例 ;按摩前淋球菌培养阳性 5例 ,按摩后阳性 11例 ;按摩前脲原体培养阳性 8例 ,按摩后 19例。经 χ2 检验均差异显著 ,或非常显著 (依次为P <0 0 5 ,P <0 0 5 ,P <0 0 1)。结论 :前列腺按摩取尿道分泌物镜检或培养 ,均可明显提高淋球菌和脲原体的阳性检出率。     

HPV检测和液基细胞学检查在宫颈病变筛查中的应用

目的 通过与病理组织学检查结果比较,评价高危型人乳头瘤病毒(HR-HPV)检测和液基细胞学检查在宫颈病变筛查中的应用价值.方法 对2004年12月～2006年12月在解放军总医院行HR-HPV和液基细胞学检查及电子阴道镜下宫颈活组织病理检查的690例患者的资料进行回顾性分析.结果 690例患者中液基细胞学与病理组织学检查的符合率为:低度鳞状上皮内病变(LSIL)22.34%(42/188),高度鳞状上皮内病变(HSIL)58.33%(56/96),宫颈癌100%(16/16).细胞学结果 示良性细胞改变75例;不典型鳞状细胞(ASC)、LSIL、HSIL和宫颈癌者分别为315、188、96、16例,其HR-HPV阳性率分别为53.96%(170/315)、77.12%(134/188)、80.21%(77/96)和100%(16/16).经阴道镜下多点活检病理组织学诊断为炎症、上皮内瘤变Ⅰ级和(或)湿疣(CIN Ⅰ/HPV)、CIN Ⅱ/CIN Ⅲ、宫颈浸润癌者分别为425、81、157和27例,其HR-HPV阳性率分别为43.29%(184/425)、74.93%(60/81)、91.72%(144/157)和92.5%(25/27).此外,413例HR-HPV阳性者中,病理学≥CIN Ⅰ/HPV者占55.45%(229/413);277例HR-HPV阴性者中,病理学为炎症者占87.01%(241/277),≥CIN Ⅰ/HPV者占12.99%(36/277),而36例≥CIN Ⅰ/HPV者中CIN Ⅱ/CIN Ⅲ和宫颈浸润癌仅占5.42%(15/277).315例ASC中,HR-HPV阳性者170例,病理学≥CIN Ⅰ/HPV占41.76%(71/170),其中CIN Ⅱ/CIN Ⅲ和宫颈浸润癌占69.01%(49/71);HR-HPV阴性145例,病理学≥CIN Ⅱ/CIN Ⅲ者仅占4.83%(7/145),炎症占90.34%(131/145).结论 HR-HPV和液基细胞学检查是筛查宫颈病变的有效方法 ,二者结合有利于宫颈病变的分流管理,提高宫颈癌及癌前病变的检出率.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.