耳道分泌物分离出氟康唑不敏感西弗射盾子囊霉1例报道

<正>西弗射盾子囊霉是一种临床少见真菌,常在恶性肿瘤、粒细胞减少症或糖尿病等免疫力低下患者体内被检出,可引起患者深部感染,甚至系统性感染,导致严重后果~([1])。本研究报道1例分离自耳鸣患者耳道分泌物中的西弗射盾子囊霉,并从该菌的形态学、培养特性、生化反应及分子生物学特征等方面进行阐述。1病例1.1临床资料患者,男,28岁,因双耳无明显诱因耳鸣     

西弗射盾子囊霉引起中耳炎1例

<正>中耳炎是临床常见的感染性疾病。随着广谱抗生素和免疫抑制药物的应用等,真菌性中耳炎的感染率逐年上升,真菌病原谱也发生了很大变化,给临床诊断和治疗增加了难度。因此,对真菌的鉴定要从各种生化反应上力求鉴定到种。本实验室从1例中耳炎患者耳道脓性分泌物中分离出西弗射盾子囊霉(Stephanoascus ciferrii),也称Candida ciferrii,从形态学、培养特性以及生化反应来说明基本检验     

西弗射盾子囊霉引起外耳道炎1例

<正>西弗射盾子囊霉属子囊菌类酵母菌,其可通过有性繁殖在子囊中产生子囊孢子,虽与孢子丝菌属和念珠菌属同源,但二者形态与生长属性有明显区别^[1]。西弗射盾子囊霉是一种少见的机会致病真菌,目前对其致病性的研究较少^[2-3]。相关文献报道,西弗射盾子囊霉可能为人体表面或肠道中的正常菌群,当机体免疫力低下时,可引起甲沟、外耳道等部位的感染,严重时可导致患者腹膜、脑膜等部位的深部感染和系统性感染^[4-5]。     

脑脊髓液中培养出西弗射盾子囊霉一例并文献复习

脑膜炎是脑膜或脑脊髓膜的感染性疾病,随着广谱抗生素、免疫抑制药、抗癌药物的应用,器官移植术等患者的免疫功能低下,使真菌性脑膜炎的感染率逐年上升,真菌谱也发生了很大变化[1],给临床诊断和治疗增加了难度.因此,在工作中对于少见真菌所致的难治性感染应引起高度重视,对真菌的鉴定不仅从形态学、免疫学、分子生物学上鉴定,更要从各种生化反应上力求鉴定到种.本研究介绍了1例吉核性胸膜炎合并HIV患者,脑脊髓液中分离出西弗射盾子囊霉(Stephanoascus ciferrii),并从形态学、培养特性以及生化反应来说明基本检验技术对临床少见病原菌菌种鉴定和治疗的重要性.     

Vitek 2 Compact GN卡用于不同培养基生长类鼻疽伯克霍尔德菌鉴定结果分析

目的评估不同培养基生长类鼻疽伯克霍尔德菌在Vitek 2 Compact中的鉴定结果。方法收集2010年6月至2017年5月海南省人民医院分离的类鼻疽伯克霍尔德菌127株,分别接种于哥伦比亚羊血平板(CBA)、麦康凯平板(MAC)和流感嗜血巧克力平板(CHA)上,以多位点序列分型(MLST)为金标准,评估Vitek 2 Compact VT2.R7.01版GN卡对不同培养基上生长的类鼻疽伯克霍尔德菌的鉴定准确性。结果 CBA平板上生长的类鼻疽伯克霍尔德菌鉴定准确率最高,为98.4%,2株被错误鉴定为洋葱伯克霍尔德菌;MAC次之,准确率为94.5%,其中4株被错误鉴定为洋葱伯克霍尔德菌,2株为伯克霍尔德菌某种,1株被错误鉴定为铜绿假单胞菌;CHA鉴定准确率最低,为91.3%,其中4株被错误鉴定为洋葱伯克霍尔德菌,2株为伯克霍尔德菌某种,5株无鉴定结果。结论 Vitek 2 Compact GN卡对不同培养基上类鼻疽伯克霍尔德菌鉴定准确率不同,建议优先选择CBA平板上菌落。     

科玛嘉显色法与Vitek—32YBC卡法鉴定念珠菌的比较

目的：了解法国科玛嘉(CHROMagar)念珠菌显色培养基鉴定念珠菌的实际应用情况并探讨其与生物梅里埃Vitek—32YBC卡念珠菌鉴定的符合率。方法：对我院临床送检细菌培养标本接种于科玛嘉念珠菌显色琼脂平板，经培养后根据科玛嘉念珠菌显色琼脂平板上生长菌落的颜色和形态直接肉眼鉴定，而后再挑取显色平板上生长菌落用生物梅里埃Vitek—32YBC卡上机生化鉴定。结果：对占临床分离念珠菌90％以上的白色念珠菌、热带念珠菌、克柔念珠菌等两法鉴定符合率较好，对临床较少见的念珠菌则显色法鉴定有待研究。结论：科玛嘉念珠菌显色培养基与YBC卡鉴定念珠菌符合率高，操作简便，鉴定快速，适合推广使用。     

70株室间质量评价菌株鉴定差异及其纠正方法探讨

目的探讨对经过全自动微生物分析仪Vitek 2 Compact、基质辅助激光解吸飞行时间质谱仪Vitek MS鉴定为“不确定”菌,以及在不同显色平板上产生类似色素菌的进一步鉴定方法,以明确病原学诊断。方法对来自国家卫生健康委临床检验中心与广东省临床检验中心室间质量评价菌株中的“不确定”菌70株,使用不同的鉴定系统结合表型特征、血清学试验进行鉴定,并对显色平板上产生类似色素的菌株做补充鉴定。结果自动化微生物鉴定系统报告的32株“不确定”菌中,Vitek 2 Compact有65.6%(21/32)需要进一步鉴定,Vitek MS有59.4%(19/32)需要进一步鉴定,部分菌株在2种自动化微生物鉴定系统间的鉴定结果存在差异;32株“不确定”菌经不同鉴定系统、表型特征、血清学试验鉴定,全部鉴定到种/型水平。对念珠菌平板等3种不同显色平板上产生类似色素的38株菌的补充鉴定,结果全部为非目标菌。结论通过不同鉴定方法的互补,可以提高临床微生物鉴定的质量。     

某真菌快速培养鉴定药敏试剂盒的临床应用评价

目的评价某种真菌快速培养鉴定药敏试剂盒在检测中的可靠性与实用性。方法以梅里埃Vitek 2Compact YST微生物鉴定系统和ATB-FUNGUS 3酵母菌药敏试剂盒为标准参照,采用真菌快速培养鉴定药敏试剂鉴定120株临床分离的酵母菌及其对5种常用抗真菌药物的敏感度。采用WHONET5.6和SPSS22.0软件对结果进行统计分析,比较真菌快速鉴定药敏试剂盒与Vitek 2Compact YST和ATB-FUNGUS 3结果间的一致性。结果 Vitek 2Compact YST与快速培养法对酵母菌的总体鉴定一致率为95.8%(115/120)。ATB-FUNGUS 3与快速培养法检测5氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑和伏立康唑药敏结果一致率分别为96.7%、100.0%、90.0%、97.5%、98.3%。结论在酵母菌鉴定和药敏方面,快速培养法与Vitek 2 Compact YST和ATB-FUNGUS 3的一致性较好。该试剂盒可用于检测临床样本。     

自动细菌鉴定仪对布鲁菌误鉴定原因及临床影响分析

目的探讨Vitek Compact微生物自动鉴定仪器对1例布鲁菌误鉴定原因及临床影响分析。方法 1例无明显诱因发热患者血培养分离菌株,采用Vitek Compact细菌鉴定系统,形态学、传统手工生化对分离株进行鉴定。采用PCR扩增16S rRNA基因并测序,对所测得的核酸序列进行同源性比对分析。结果从该患者血液中分离到1株缓慢生长的革兰阴性短小杆菌,Vitek Compact鉴定仪器,GN鉴定卡首次鉴定为支气管炎鲍特菌,基于16S rRNA基因序列分析表明,菌株与马耳他布鲁菌或人苍白杆菌核酸匹配度高达100%,完全排除支气管炎鲍特菌的可能。将保存的菌株用Vitek Compact鉴定仪器,GN鉴定卡复检,结果为马耳他布鲁菌。结论 16S rRNA基因序列分析是鉴定临床非发酵革兰阴性杆菌的最有效手段,微生物自动鉴定仪器鉴定慢生长细菌如布鲁菌等有明显局限性,对布鲁菌病等传染病的临床治疗及流行病学调查可产生误导。     

Vitek 2 Compact系统鉴定临床少见疑难细菌的应用及评价

目的回顾分析室间质评1304号菌株的鉴定过程,评价Vitek 2 Compact全自动微生物分析系统(简称Vitek 2 Compact系统)在临床少见疑难细菌鉴定中的应用。方法采用传统的细菌形态学检查、手工生化反应及Vitek 2 Compact系统等多种手段对1304号菌株进行鉴定分析,同时用基质辅助激光解吸-电离飞行时间质谱(MALDI-TOF MS)仪对最终鉴定结果进行佐证。结果 1304号菌株为革兰阴性小杆菌,氧化酶试验阳性,初次上机鉴定结果为支气管炎鲍特菌,鉴定率99%,转种分纯后2次上机鉴定结果为低分辨,粪产碱杆菌占51%,类产碱假单胞菌占49%,补充硝酸盐还原试验,结果为阴性,报告最终鉴定结果为粪产碱杆菌,质谱鉴定得分值为2.158,与最终结果相符。结论 Vitek 2 Compact系统鉴定临床少见疑难细菌有一定局限性,遇到少见疑难细菌应该用多种方法加以确定,综合分析以免造成错误鉴定。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.