5类呼吸道病毒对不同年龄段儿童的感染情况

目的统计5类呼吸道病毒特异性IgM在呼吸道感染(RTI)患儿中的检出情况,分析不同年龄段儿童RTI情况,用以指导临床诊断与治疗。方法收集2017年该院收住0～14岁患儿血清共1 287例,采用间接免疫荧光法分别检测乙型流感病毒(IVB)、副流感病毒(PIV)、甲型流感病毒(IVA)、呼吸道合胞病毒(RSV)和腺病毒(ADV)特异性IgM。结果 1 287例标本中IVB检出率最高为50.58%,其余分别为PIV(3.42%)、IVA(25.17%)、RSV(2.87%),以及ADV(2.10%)。在新生儿中均未检出5类呼吸道病毒阳性标本;随着儿童年龄增长IVA和IVB阳性检出率逐渐增高(χ~2=145.24、357.97,P0.05),均在学龄期儿童检出率最高;PIV和IVA随着儿童年龄增长检出率差异无统计学意义(P0.01);RSV在婴儿期阳性检出率最高,随着儿童年龄增长阳性检出率下降(χ~2=102.83,P0.05)。结论该院IVB特异性IgM阳性检出最高,检出率为50.58%,新生儿因免疫功能未完善,使用间接免疫荧光法未检出阳性标本,5类呼吸道病毒特异性IgM在不同年龄段儿童检出率均有差异。     

2016年九江地区儿童呼吸道病毒感染病原学分析

目的 分析九江市妇幼保健院儿科呼吸道感染住院患儿常见病毒感染状况,为临床诊疗提供指导.方法 收集2016年1-12月九江市妇幼保健院呼吸道感染的住院患儿6070例,用直接免疫荧光法检测其鼻咽深部分泌物中7种常见病毒:呼吸道合胞病毒(RSV),甲型流感病毒(IVA),乙型流感病毒(IVB),副流感病毒Ⅰ型(PIVⅠ),副流感病毒Ⅱ型(PIVⅡ),副流感Ⅲ型(PIVⅢ),腺病毒(ADV).结果 患儿阳性1145例,阳性率18.86%.其中单病毒感染1132例,混合感染13例;单病毒感染中呼吸道病原体的阳性率依次为RSV 13.82%(839/6070),PIVⅢ1.86%(113/6070),ADV 0.89%(54/6070),IVB 0.77%(47/6070),PIVⅠ0.64%(39/6070),IVA 0.54%(33/6070),PIVⅡ0.12%(7/6070);在春夏秋冬四季中阳性率分别为,15.16%(241/1590)、9.26%(97/1047)、12.62%(160/1268)、29.88%(647/2165)以冬季阳性率最高.结论 本地区儿童呼吸道感染以RSV为主,冬季病毒阳性率最高.     

上海崇明地区0～12岁儿童呼吸道病原体抗体检测分析

目的了解上海市崇明区0~12岁儿童8种常见呼吸道病原体特异性IgM的检测情况,指导临床治疗及合理用药。方法收集2015年4月至2018年11月上海交通大学附属新华医院崇明分院,因呼吸道感染的0~12岁患儿4272例血清标本,采用间接免疫荧光法同时检测呼吸道合胞病毒(RSV)、腺病毒(ADV)、嗜肺军团菌(LP)、肺炎衣原体(CP)、肺炎支原体(MP)、流感病毒A(IVA)、流感病毒B(IVB)、副流感病毒(PIV)8种呼吸道病原体的IgM抗体,比较不同季节和不同年龄段感染率。结果4272例样本中共检出IgM抗体阳性939例(21.98%),其中单一病原体感染773例,占82.32%(773/939),混合感染166例,占17.68%(166/939)。所调查样本中,阳性被检者中MP阳性率最高,占40.15%,其次为IVB、IVA、CP、PIV、LP、RSV、ADV,分别占35.68%、22.47%、10.44%、4.15%、2.24%、2.02%、1.60%。不同年龄段儿童,CP、MP、IVA、IVB、PIV感染率有显著性差异。其中学龄期组CP和MP阳性率最高,学龄前期组IVA和IVB阳性率最高,幼儿组IVB、MP和IVA阳性率最高。该地区不同季节的病原体感染率差异有统计学意义(P<0.05),主要表现为CP、IVA和IVB。CP感染率夏秋高于冬春季节,IVB冬春季节高于夏秋,IVA感染率秋冬季高于春夏。女童总体阳性率为25.98%(489/1882),高于男童18.83%(450/2390),差异有统计学意义(P<0.001)。结论掌握该地区0~12岁儿童呼吸道病原体感染的流行病学特点,有助于提高医生的诊断和治疗。     

急诊病房呼吸道感染患者呼吸道病毒IgM抗体检测分析

目的了解该院急诊病房呼吸道感染患者呼吸道病毒感染分布情况。方法收集2014年1月至2015年12月大连医科大学附属第一医院急诊科收治的成人呼吸道感染患者5种病毒[呼吸道合胞病毒(RSV),流感病毒A型(IVA),流感病毒B型(IVB),副流感病毒1、2、3(PIV1、PIV2、PIV3)和腺病毒(ADV)]间接免疫荧光法检测结果资料,分析不同病毒的流行特征。结果384例标本中208例呼吸道病毒IgM抗体阳性,病毒感染阳性率为54.17%,以混合病毒感染和IVB感染最为常见,其病毒感染阳性率分别为26.56%和23.44%。混合病毒感染中以IVA和IVB混合感染阳性率最高,占87.25%,高于其他混合感染类型。不同性别患者之间病毒感染阳性率差异无统计学意义(P0.05)。秋、冬两季病毒感染率较高,分别为66.06%、68.37%,高于夏、秋两季的42.31%和34.25%,差异有统计学意义(P0.05)。青年(18~45岁)和中年(45~60岁)病毒感染阳性率分别为64.94%和63.86%,高于老年前期(60~75岁)、老年(75~90岁)和长寿老人(90岁)的48.45%、44.92%、55.56%,差异有统计学意义(P0.05)。结论该院急诊病房呼吸道感染患者混合病毒感染和IVB感染最为常见,且病毒感染情况呈现季节和年龄特征,但不受性别因素影响。     

儿童呼吸道感染9项呼吸道病原体IgM抗体检测分析

目的分析成都地区儿童急性呼吸道感染的常见病原体特异性IgM抗体的检出情况,以利于临床诊断与治疗。方法收集3 623例患呼吸道感染患儿的血清,采用间接免疫荧光法检测嗜肺军团菌血清1型(LP1)、肺炎支原体(MP)、Q热立克次体(COX)、肺炎衣原体(CP)、腺病毒(ADV)、呼吸道合胞病毒(RSV)、甲型流感病毒(IVA)、乙型流感病毒(IVB)、副流感病毒的特异性IgM。结果 9种呼吸道病原体只检出7种。3 623例患儿检出阳性标本805例(占22.22%),其中以IVB的阳性检出率最高,MP次之,阳性率分别是10.18%和9.41%。发病高峰期为1-2月和9-12月。不同年龄组检出率不同,婴儿组小于或等于1岁为5.57%,检出率最低,幼儿组检出率最高(38.31%)。结论成都地区9种呼吸道病原体检出阳性率达22.22%,以IVB的阳性检出率最高,MP次之;呼吸道病原体感染存在季节流行,在春秋冬检出率较高;不同年龄组的患儿检出率不同,婴儿组最低,幼儿组最高。     

上海市松江区0～12岁上呼吸道感染患儿7种常见病毒流行病学特征

目的分析上海市松江区儿童常见上呼吸道感染病毒流行病学特征,为临床治疗提供参考依据。方法采用直接免疫荧光法(DFA)检测2016—2018年分离自上海交通大学附属第一人民医院南院2 242例上呼吸道感染患儿鼻咽分泌物样本的流感病毒A型(IVA)、流感病毒B型(IVB)、腺病毒(ADV)、副流感病毒1型(PIV1)、副流感病毒2型(PIV2)、副流感病毒3型(PIV3)及呼吸道合胞病毒(RSV),并进行统计学分析。结果 2 242例上呼吸道感染患儿中,7种病毒阳性427例(19.05%),28 d、29 d～2岁、3～5岁患儿病毒感染阳性率居前3位,分别为28.57%、25.66%、24.56%。门诊和住院患儿中,RSV的检出率均最高,分别为10.19%和16.26%;季节相关性分析结果表明,RSV多发于秋、冬季,PIV3多发生于春、夏、秋季,ADV四季均有发生,IVA和IVB多发生于春、冬季。结论上海市松江区0～12岁儿童7种常见上呼吸道感染病毒中RSV最为常见,病毒感染具有明显季节特征,临床应根据病毒流行病学特征做好防控工作。     

儿童呼吸道病原体急性感染流行病学分析

目的分析儿童急性呼吸道感染(ARI)病原体特异性Ig M抗体检出情况,为该地区儿童ARI的早期诊断、治疗提供参考依据。方法对选择的1928例ARI行呼吸道病原体特异性Ig M抗体检测,包括嗜肺军团菌(LPN)、肺炎支原体(MP)、Q热立克次体(COX)、肺炎衣原体(CPN)、腺病毒(ADV)、呼吸道合胞病毒(RSV)、甲型流感病毒(IVA)、乙型流感病毒(IVB)及副流感病毒(PIV),比较不同年龄段及季节的病原体感染情况。结论本组MP特异性Ig M抗体阳性检出率最高,其次为IVB和PIV。与3~≤6岁组比较,≤3岁组MP阳性率、≤3岁组和6~≤16岁组IVB和PIV阳性率均明显降低,差异有统计学意义(P0.05)。呼吸道感染病原体特异性Ig M抗体阳性率以冬季最高,且MP阳性率冬季明显高于春季和夏季(P0.05),IVB阳性率冬季明显高于夏季和秋季(P0.01),PIV阳性率秋季明显高于春季和冬季,差异均有统计学意义(P0.01)。结论本地区患儿ARI以MP、IVB、PIV感染为主,且不同年龄和季节病原体感染存在明显差异。     

10832例呼吸道感染患者病原体IgM抗体检测结果分析

目的 统计该院呼吸道感染常见的8种呼吸道病原体抗体免疫球蛋白(Ig)M的阳性检出率,分析阳性检出率在不同性别、年龄、季节就诊人群之间的差异,为临床诊断和治疗提供依据.方法 对来该院就诊的门诊及住院共10832例出现呼吸道感染症状的患者的8种呼吸道病原体IgM抗体检测结果进行回顾性分析.结果 总体阳性检出率为34.05％(混合感染重复计算),以乙型流感病毒(IVB)、甲型流感病毒(IVA)、肺炎支原体(MP)感染为主.MP和IVB在女性患者中的阳性检出率明显高于男性患者,差异有统计学意义(P<0.05).副流感病毒(PIV)在13～<18岁组的阳性检出率最高,46～<70岁组的阳性检出率最低,差异有统计学意义(P<0.05).MP在13～<18岁组的阳性检出率最高,在46～<70岁组的阳性检出率最低,差异有统计学意义(P<0.05).IVB在0～<7岁组、70～102岁组的阳性检出率较高,在13～<18岁组的阳性检出率最低,差异有统计学意义(P<0.05).PIV、MP在秋、季的阳性检出率最高,IVA在秋、冬季的阳性检出率明显高于春、夏季,IVB在冬季的阳性检出率最高,与其他季节比较差异有统计学意义(P<0.05).门诊患者IVA和IVB的阳性检出率明显高于住院患者(P<0.05).结论 女性更易感染MP和IVB,13～<18岁较≥18岁者更易感染PIV和MP,0～<7岁和70～102岁是流感病毒的易感人群,在呼吸道病毒感染高发季节应加强重点人群的防护措施.     

常德地区小儿呼吸道病毒性感染病原学分析

目的探讨常德地区小儿呼吸道病毒性感染的病原学概况,为临床诊治工作提供参考.方法应用免疫荧光法检测患儿早期咽拭子标本中7项病毒[合胞病毒(RSV)、腺病毒(ADV )、流感病毒 A (FLuA )、流感病毒B(FLuB)、副流感病毒1(PIV1)、副流感病毒2(PIV2)、副流感病毒3(PIV3)],以了解病原学分布.结果从2778例患儿咽拭子标本中,检出相关病毒阳性1260例,总阳性率为45.4%.含单项病毒感染占89.0%,2项混合感染占11.0%.单一病毒感染中 RSV 占首位(57.40%),其余依次为 PIV1(11.31%)、PIV2(8.91%)、FLuB(6.33%)、ADV(5.97%)、PIV3(5.53%)、FLuA(4.55%).结论RSV 、PIV1、PIV2为常德地区致小儿呼吸道感染的主要流行病原体.对疑似病例早期进行7项呼吸道病毒检测,尽早为临床提供病原学诊断,使患儿得到及时诊治.     

急性呼吸道感染住院小儿的多病原联合检测分析

目的了解淄博市博山区因急性呼吸道感染(ARI)住院小儿的病原体情况。方法取526例住院小儿的急性期静脉血标本,用间接免疫荧光技术检测病毒有呼吸道合胞病毒(RSV)、腺病毒3型(AV-3)、流感病毒A(IVA)、B型(IVB)及副流感病毒1、2、3型(PIV1、2、3)等7种常见呼吸道病毒;非典型病原有肺炎支原体(MP)、肺炎衣原体(CP)、嗜肺军团菌1型等;细菌有肺炎克雷伯杆菌、流感嗜血杆菌等共12种病原体组合的特异性IgM抗体。结果 526例ARI的住院小儿中,病毒病原检测的总阳性率为44.11%,检测阳性率最高的为IVB(23.95%),以秋冬季节感染为多,好发于学龄前期和学龄期儿童;非典型病原的总阳性率为24.14%,MP12.93%为最高,以冬春季节感染为多,好发于学龄期儿童;细菌病原中流感嗜血杆菌阳性率为11.60%,以夏秋季节感染为多,好发于学龄前期和学龄期儿童。结论 IVB是淄博市博山区ARI住院患儿秋冬季节的首要病毒病原,也是ARI住院学龄前期和学龄期儿童的首要病毒病原。MP是ARI住院患儿冬春季节的首要非典型病原,也是学龄期儿童的首要非典型病原。间接免疫荧光技术行多病原组合特异性抗体IgM测定,从而进行病原学的早期诊断,值得国内临床推广应用。     

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.     

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.     

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.     

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.