常州市疟疾镜检人员现状调查

目的 目的 了解常州市消除疟疾行动初期各级卫生机构疟疾镜检人员的现状, 为全市实现消除疟疾目标提供参考依 据。方法 方法 采用问卷调查、 疟疾理论知识和镜检操作考试的形式, 对常州市各级医疗机构和疾病预防控制中心疟疾镜检 人员进行现状调查, 并对所得数据进行统计学分析。结果 结果 共调查95名疟疾镜检人员, 其中大专、 本科及以上学历分别占 40.0%和45.3%; 从事检验工作年限1年以内的占18.9%, 2 ~ 5年的占40.0%, 6 ~ 10年的占18.9%, 10年以上的占22.1%; 上 一年度参加省 （市） 级、 区 （县） 级和单位内培训的人均次数分别为0.57、 0.59次和0.14次; 工作中有发现疟原虫经历的人数 占18.9%; 认为疟疾血检工作非常有必要和有必要的占97.9%; 认为疟疾镜检工作增加工作负荷、 增加工作难度的分别占 57.9%和8.4%; 培训前后的疟疾相关知识平均正解率分别为72.5%和91.6%, 差异有统计学意义 （χ2 = 314.3, P < 0.05）; 疟 疾镜检操作考试平均分为25.3分 （满分50分）, 及格 （≥ 30分） 率为58.9%。结论 结论 常州市医疗机构的疟疾镜检人员岗位培 训工作不到位, 工作经验相对薄弱, 需进一步加强培训, 以提高疟疾镜检的实际操作能力。     

2011年南通市疟疾镜检能力建设分析

目的了解南通市消除疟疾项目启动初期各级医疗卫生机构疟疾镜检能力建设状况。方法调查全市2011年各级医疗卫生机构疟疾镜检站建设、镜检人员和硬件配备、镜检技能培训等情况;调查各级医疗卫生机构开展"三热"病人血片疟疾镜检工作开展情况等镜检站镜检工作运行状况;调查各县(市、区)和市级疾病预防控制机构开展疟疾镜检员培训考核及血片抽查复检工作等。结果2011年,全市9个县(市、区)共建有204家疟疾镜检站,镜检员228人,显微镜255台;98.68%(225/228)的镜检员接受了疟原虫检验理论和操作技能培训,培训考核合格率为98.67%;共开展疟疾血检57 893人,全年人群总血检率为0.76%。抽查复检乡(镇)门诊镜检站的血片制作、染色和清洁度平均合格率分别为87.14%、86.69%和85.61%,57家医疗机构平均合格率分别为86.82%、86.01%和84.97%;个别乡(镇)和县级疾病预防控制机构未设镜检站,少部分乡(镇)门诊镜检站未开展血检工作或血检质量不符合要求。结论南通市各级镜检站大部分能按要求开展疟疾镜检工作,运行良好。但对照江苏省消除疟疾行动计划要求,仍需加强镜检站能力建设,加强督查,提高血检覆盖率和血检工作质量,确保全市2017年达到消除疟疾标准。     

凉山彝族自治州医务人员对艾滋病的认知与防护行为

摘要：目的了解凉山州医务人员对艾滋病知识的认知及职业防护行为的现状,分析影响因素,为艾滋病相关知识培训及艾滋病防控工作提供指导依据。方法自制问卷,采用分层抽样方法,对凉山州78家医疗机构当日在岗的医务人员进行现场问卷调查,使用SAS9．1软件进行统计描述。结果共回收有效问卷2525份,艾滋病知识总得分为（32．11±6．47）分,高水平者占7．76％,中水平者占55．64％,低水平者占36．59％;艾滋病职业防护行为总得分为（34．96±12．23）分,高水平者占15．13％,中水平者占35．76％,低水平者占49．11％。年龄、工作年限、学历、既往是否接受艾滋病培训、接诊或护理过艾滋病病毒（HIV）感染者／病人等,是影响医务人员艾滋病知识认知的因素（P〈0．0001）;学历、专业、既往接受过艾滋病相关知识培训及接诊或护理过HIV感染者／病人,是影响医务人员职业防护行为的主要原因（P〈0．0001）;年龄、职称、工作年限对其职业防护水平差异无统计学意义。结论凉山州医务人员艾滋病相关知识和防护行为总体水平不高,与多种因素有关。各级医疗机构应加强艾滋病相关知识和职业防护培训,采取多样化培训方式,并为医务人员提供必要的防护用品。     

江苏省基层专业技术人员疟疾快速诊断试纸条相关知识 态度 行为调查

目的 了解江苏省基层专业技术人员快速诊断试纸条（RDT）相关知识、态度与行为（KAP）现状并分析其影响因素。方法 采用典型抽样方法,在江苏省选取4个设区市开展针对基层专业技术人员的RDT相关KAP及工作满意度调查,并采用多元logistic回归模型分析基层专业技术人员RDT相关KAP的影响因素。结果 共发放调查问卷1 150份,回收有效问卷949份,问卷总体有效回收率为82.52%;其中来自检验人员问卷453份,来自临床医师问卷466份,来自疾控机构疟疾防治人员30份。83.98%的受调查者对RDT技术基础知识掌握不够。52.17%的检验人员认为RDT技术的开展能够改善基层疟疾诊断工作,其对于RDT技术优势的认可程度高于临床医师;79.25%的检验人员自评能够规范完成RDT检测操作,84.55%的临床医师自评具有规范疟疾临床诊断行为。受调查检验人员性别、学历、所在单位级别、职称、从事镜检工作年限以及受调查临床医师单位级别是影响其RDT技术相关KAP的关键因素。结论 江苏省基层专业技术人员对疟疾RDT技术接受度较好,但RDT相关知识掌握程度相对不足。应进一步开展针对性培训和宣传,从而为更好地发挥RDT在消除疟疾工作中的作用提供保障。     

武汉市东西湖区疟原虫镜检能力建设分析

目的对武汉市东西湖区医疗卫生机构疟原虫镜检能力建设情况进行调查分析,为实现消除疟疾目标及今后疟疾防治工作提供科学依据。方法收集2010-2015年东西湖区15家疟原虫镜检站硬件设施情况以及镜检人员基本信息,并进行统计分析;此外,对该阶段全区阴性血片制作、染色、清洁度合格情况进行评价,对阳性血片进行复核。结果 15家疟疾镜检站有镜检人员28人,合格显微镜9台;一、三级医疗卫生机构镜检人员年龄以40~50岁为主,二级医疗卫生机构以20~30岁为主;一、三级医疗卫生机构镜检人员从事镜检工作年限多在15年以上,二级医疗卫生机构则多在10年以下;一级医疗卫生机构镜检人员学历以大专为主(占50.00%),二、三级医疗卫生机构以本科为主。2010-2015年全区共血检8 561例,复核阴性和阳性血片539张,符合率均为100%,血片制作、染色、清洁度平均合格率分别为82.08%、79.92%、83.33%。2015年血片制作合格率(χ~2=26.45,P0.01)、染色合格率(χ~2=16.85,P0.01)、清洁度合格率(χ~2=13.93,P0.01)均高于2010年。结论东西湖区疟原虫镜检能力建设已明显提高,但应进一步推进区内疟原虫镜检站人才梯队建设和硬件投入,坚持基层镜检质控考核工作,以保障疟疾防治工作持续健康发展。     

云南省临床医生疟疾诊治知识远程培训及其效果

目的介绍云南省临床医生疟疾诊治知识远程培训情况,并评价其效果。方法应用医博士网(www.yiboshi.com)平台,对云南省省、州、县级及边境25个边境县乡(镇)医疗和卫生技术人员进行疟疾防治知识培训,并通过考核、问卷调查及访谈评价教学效果。结果此次共培训学员7 152人,全省平均参培率为95.26%,培训完成率为98.55%,合格率为97.30%。学员主要学习了消除疟疾政策、疟疾流行病学及诊断治疗3方面知识。95.94%的学员认为理论和技能水平有提高,97.30%的学员对培训内容感兴趣,93.24%的学员认为培训时间较为合理,91.89%的学员对平台服务满意。结论云南省疟疾诊治知识远程培训取得了较好的效果,此种培训方式符合当前消除疟疾和消除后监测阶段需要大量培训医疗卫生人员的实际工作。     

杭州市疟原虫镜检人员实践能力调查

杭州市疟原虫镜检人员的实践能力较低，能正确进行疟原虫分型者只占47．8％，98．9％的镜检人员要求开展疟原虫镜检专项培训以提高自身实践能力。     

镇江市丹徒区消除疟疾达标考核评估分析

目的 对镇江市丹徒区消除疟疾达标考核评估结果进行分析,为巩固消除疟疾防治成果提供依 据。 方法 查阅 ２０１０ ～ ２０１６ 年区级消除疟疾相关资料,核实国家疾病监测信息报告管理网报和寄生虫病信 息专报系统疟疾疫情资料;现场血片复检并考核临床医生疟疾诊治知识和检验人员疟原虫镜检技能。 结果 镇江市丹徒区 ２０１０ ～ ２０１６ 年网报和专报疟疾实验室确诊病例 ３ 例,均为境外感染的输入病例,７ 年间未发 生本地疟疾病例;共血检发热病人 ２４ ２１９ 人次,血检率为 １． ２３％ ,血检阳性 ３ 人,阳性率为 ０． ０１％ ;血片复 检 ３ ９２１ 张,复检率为 １６． ２０％ 。 现场考核,血片复核得分 ９． ７５ 分（１０ 分制）,疟疾诊治知识和镜检技能考核 合格率 １００％ ,消除疟疾考核总得分为 ９９ ４５ 分。 结论 镇江市丹徒区通过消除疟疾达标考核,在今后巩固 消除疟疾的防治成果工作中需继续抓好血检质量、主动病例侦查和输入性疟疾的防治等工作。     

元江县热带经济作物开发区流动人员疟疾监测

元江县东峨乡为热带经济作物开发区,近年大量流动人员涌入,疟疾发病率上升。1991年和1992年对流动人员进行了疟疾监测。流动人员发热病人血检各诊疗所均对发热病人血涂片送乡卫生院镜检疟原虫。1991年发热病人原虫率45.66％(100/219),间日疟占94％,恶性疟占6％,1992年原虫率38.89％(84/216),间日疟占95.24％,恶性疟4.76％。流动人员带虫率 1991和1992年5和6月血检来自浙江、四川及本省红河县、墨江县民工共578人,带虫率为:修水电者13％(49/377),修路者4.12％(7/170),建房者9.69％(3/31),平均带虫     

非洲学员对我国援非疟疾防治培训的需求分析

目的了解非洲学员对我国援非疟疾防治培训的需求,为援非培训班的对象选择和课程设置提供参考。方法采用整群抽样调查方法,对2014年和2015年参加江苏省寄生虫病防治研究所疟疾防治研修班的4期非洲学员进行问卷调查,对调查对象基本情况、从事疟疾工作情况和培训需求关系等进行统计分析。结果共调查培训学员161人,其中法语培训班学员占41.6%,英语培训班学员占58.4%。培训班学员构成以男性为主(69.3%),受教育专业背景以临床类专业为主(40.0%),工作年限在10年以内居多(56.4%)。48.2%的调查对象平时从事的疟疾预防和控制工作占总工作量的76%以上,80%以上的调查对象在市级及以上机构工作。调查对象工作类型集中在临床类(41.4%)和官员类(29.9%),其他为研究类职位(11.9%)。调查显示,非洲亟需的培训以疟疾防控策略为主(65.5%),对象以临床类人才(39.2%)为主。从语种上看,法语班学员更希望得到策略类培训(χ~2=12.528,P0.01);从工作级别看,在国家级机构工作的学员也更希望得到策略类培训(χ~2=10.508,P0.05)。结论目前我国援非疟疾防治培训项目可基本满足学员的需求,但应进一步根据学员职业背景、国家情况、参加疟疾工作年限和级别来制定有针对性的课程。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.