59例艾滋病职业暴露分析及处理

目的了解艾滋病职业暴露现状,探讨职业暴露后实施预防措施的影响因素。方法对广州市第八人民医院2001-2008年发生的59例艾滋病职业暴露个案进行分析。结果59例艾滋病职业暴露个案中,暴露方式以针刺伤为主,有41例,占69.5%;其次是经皮肤或粘膜接触,有17例,占28.8%;仅有1例为抓伤,占1.7%。暴露级别一级23例,占39.0%;二级35例,占59.3%;三级1例,占1.7%。暴露源的病毒载量水平轻度2例,占3.4%;重度41例,占69.5%;暴露源不明16例,占27.1%。59例中26例(44.1%)采用药物进行预防用药,其中23例(39.0%)采用基本用药程序,3例(5.1%)采用强化用药程序。所有暴露者经6个月观察,随访检测结果均为阴性。结论医务人员对艾滋病患者和病毒携带者进行诊疗的过程中,应严格遵守安全防护措施,暴露后及时使用预防用药,可有效阻断发生艾滋病职业暴露后感染。     

广西灵山县艾滋病职业暴露情况分析

目的了解艾滋病职业暴露现状,探讨职业暴露后实施预防措施的影响因素.方法对灵山县2008—2011年发生的22例艾滋病职业暴露个案进行分析.结果22例艾滋病职业暴露个案中,其中医务人员15例,公安司法干警7例.暴露方式以针刺伤为主,有15例,占68.2%;其次是经皮肤或粘膜接触,有5例,占22.7%;有2例为抓伤,占9.1%.暴露级别一级3例,占13.6%;二级17例,占77.3%;三级2例,占9.1%.暴露源级别:重度6例,占27.3%;阴性8例,占36.4%;暴露源不明8例,占36.4%.22例中20例(90.9%)采用药物进行预防用药,8例(40%)全程服药.所有暴露者经6个月观察,随访检测结果均为阴性.结论医务人员和公安干警较容量发生HIV职业暴露,应加强职业暴露的宣传和培训,降低职业暴露发生,提高正确处理职业暴露的水平.     

艾滋病职业暴露防治的临床研究

目的 探讨艾滋病职业暴露防治对策。方法 制定《艾滋病职业暴露预防方案和处理流程》，参照艾滋病职业暴露处理DWDM模式，回顾性分析5例HIV感染职业暴露发生的类型、经过、暴露级别及用药预防效果。结果 354名医务人员在参与HIV感染病人的医治过程中，发生5例职业暴露事件，均实施了暴露后预防措施（PEP），并在暴露发生2h内用药预防HIV感染。经6mo的临床医学观察后，末发现1例HIV感染。结论 临床医务人员在医疗护理过程中易发生HIV感染职业暴露，《艾滋病职业暴露预防方案和处理流程》和艾滋病职业暴露处理DWDM模式对职业暴露预防和处理是有效的。     

艾滋病病毒职业暴露及暴露后预防

目的:探讨艾滋病病毒职业暴露后预防性用药及用药的必要性和可行性,为从事艾滋病防治工作的相关人员提供资料。方法:分析和总结该院9例HIV职业暴露后的处理措施和监测结果的情况。结果:9例医务工作人员、公安干警职业暴露后,经及时处理和预防性抗逆转录病毒药物治疗,在6个月的随访结果中均未发生血清阳转。结论:HIV职业暴露后及时处理,尽早联合应用抗HIV药物可降低HIV感染的危险。     

黔西南州2005年至2013年48例艾滋病职业暴露情况分析

目的分析本地艾滋病病毒职业暴露事件,探讨职业暴露后实施预防措施的影响因素。方法对黔西南州2005年至2013年发生的48例职业暴露个案进行分析。结果在分析的案例中,暴露方式以皮肤或黏膜接触为主,有21例（43．8％）,其次为针刺伤18例（37．5％）;咬伤、抓伤9例（18．8％）;暴露源不明11例（22．9％）。一级暴露12例（25％）;二级暴露16例（33．3％）;三级暴露2例（4．2％）,评定为一级以下18例（37．5％）。48例中23例进行了预防性服药处理（47．9％）,全部给予基本用药程序处理。所有病例均经过6个月的随访观察,检测结果均为阴性。结论在医疗人员和警察的工作中应强化艾滋病防护意识,严格各项操作规程,暴露后及时有效地进行处理,才能最大限度地减少因职业暴露而感染艾滋病病毒的机会。     

艾滋病病毒职业暴露9例分析

目的:探讨如何有效预防和控制医务人员在工作中发生职业暴露而感染艾滋病病毒。方法:对9例接触艾滋病患者出现职业暴露的工作人员的感染途径、暴露后的处理方式及工作人员身体状况、后期追踪随访进行调查分析。结果:职业暴露的主要途径是经皮肤损伤暴露,暴露后及时处理且追踪随访1～2年,HIV抗体检测均为阴性。结论:医务人员对艾滋病职业暴露危险性认知不够,职业防护能力较低,工作中应严格执行艾滋病医院感染管理中的防范和处理措施,就可以大大减少艾滋病职业暴露发生,确保医务人员职业安全。     

艾滋病病毒职业暴露15例调查

目的完善预防艾滋病病毒感染的防控措施，有效预防和控制医务人员因职业暴露感染艾滋病病毒。方法结合卫生部制定的《医务人员艾滋病病毒职业暴露防护工作指导原则》，对我院15例医务人员艾滋病病毒（HIV／AIDS）职业暴露类型、经过及暴露后的处理进行调查分析。结果暴露的原因是AIDS知识缺乏，普遍性防护意识淡薄；未严格执行安全操作规程；不太重视锐器损伤后的处理。结论临床医务人员在医疗护理过程中易发生HIV／AIDS职业暴露，因此应加强医务人员全面防护的相关教育和培训。[第一段]     

AIDS患者手术职业暴露风险及防范——264例AIDS患者手术麻醉的回顾性分析

目的 减少为艾滋病患者进行麻醉时医护人员的职业暴露和HIV感染的发生.方法 264例艾滋病手术患者手术前、手术中、手术后实行了科学的预防,对预防措施和发生职业暴露后的处理进行回顾性分析.结果 264例艾滋病患者手术麻醉过程顺利,参加艾滋病患者手术麻醉过程中发生7例职业暴露,经过紧急局部处理和及时服用抗病毒药物,未出现一例HIV感染.结论 科学合理的预防措施是减少职业暴露发生的有效方法;职业暴露发生后有效及时的处理是预防HIV发生的关键.     

护理人员艾滋病职业暴露的控制

目的探讨护理人员艾滋病职业暴露的预防与控制措施.方法回顾性分析2008年2月至2010年2月本院3名护理人员发生艾滋病职业暴露及加强预防与控制措施资料.结果发生3名护理人员发生艾滋病职业暴露后,重新修订护理人员艾滋病职业暴露的预防与控制措施后,2010年3月至2012年6月再未出现护理人员艾滋病职业暴露,同时也减少了艾滋病职业发生的几率.结论医院感染科加强管理,健全感染管理制度,进行护理人员艾滋病职业规范化操作及预防性培训,提高护理人员艾滋病职业暴露的防范意识,对减少或杜绝护理人员艾滋病职业暴露发生具有重要意义.     

165例医务人员职业暴露分析

目的了解我院医务人员职业暴露情况。方法对我院2005-2009年职业暴露的人员结构、暴露源、暴露时的情况(暴露方式、暴露地点、暴露时防护措施)、暴露后处理(包括紧急处理、上报、预防用药、监测)等情况进行回顾性调查。结果共发生职业暴露165例,其中护士94例,医师59例,保洁人员12例。暴露源为艾滋病病毒/艾滋病(HIV/AIDS)64例,乙肝30例,丙肝5例,梅毒21例,狂犬病40例。暴露方式:锐器伤73例,完整皮肤60例,破损皮肤、粘膜32例。职业暴露发生于临床各科室。暴露时无任何防护措施101例,戴手套64例,穿隔离衣8例。紧急处理64例;立即上报58例。预防用药HIV/AIDS3例,乙肝13例,梅毒8例,狂犬病40例。定期检测HIV/AIDS42例,乙肝30例,丙肝5例,梅毒21例。目前无一例感染发生。结论职业暴露的高危人群主要是低年资、低职称、临床一线医务人员,暴露源以血源性传染疾病为主,暴露方式以锐器伤为主,ICU、手术室、呼吸内科等为血源性疾病职业暴露发生较多的科室,部分医务人员防护意识薄弱、未严格执行标准预防,正确处理是职业暴露后的重要补救措施。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.