Microbiological understandings and mysteries of noma (cancrum oris)

The microbiologic history of noma was reviewed. Studies have associated the disease process with large numbers of fusiform bacilli and spirochetal organisms. In order to study the microbiology of the staging and infection periods of noma 62 Nigerian children, aged 3-14 years, 22 children had acute necrotizing ulcerative gingivitis (ANUG) and were also malnourished, 20 exhibited no acute necrotizing ulcerative gingivitis but were malnourished and 20 were free of acute necrotizing ulcerative gingivitis and in good nutritional state) were evaluated for the presence of viruses and oral microorganisms. The ANUG cases in the malnourished children had a higher incidence of Herpesviridae, the main virus being detected was cytomegalovirus. There were more anaerobic microorganisms recovered, with Prevotella intermedia as the predominant isolate, in the malnourished children as compared to the healthy children. A study of the predominant microflora in active sites of noma lesions was carried out in eight noma patients, 3-15 years of age, in Sokoto State, northwestern Nigeria. Fusobacterium necrophorum was recovered from 87.5% of the noma lesions. Oral microorganisms isolated included Prevotella intermedia, alpha-hemolytic streptococci and Actinomyces spp. which were isolated from 75.0, 50.0 and 37.5% of the patients, respectively. Peptostreptococcus micros, Veillonella parvula, Staphylococcus aureus and Pseudomonas spp. were each recovered from one lesion. All strains were observed to be sensitive to all of the antibiotics tested with the exception of one strain of P. intermedia which showed resistance to penicillin. The pathogenic mechanisms of F. necrophorum as a trigger organism were discussed. The isolation from human noma lesions of F. necrophorum, a pathogen primarily associated with animal diseases, may have important etiologic and animal transmission implications.     

Variability in annual Mini-Mental State Examination score in patients with probable Alzheimer disease: a clinical perspective of data from the Consortium to Establish a Registry for Alzheimer's Disease.

OBJECTIVE: To determine the variability in annual Mini-Mental State Examination scores of patients with Alzheimer disease enrolled in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). PATIENTS: A total of 372 patients with probable Alzheimer disease with 1 or more years of follow-up. SETTING: Twenty-one CERAD clinical sites throughout the United States. RESULTS: An average annual decline of 3.4 points in CERAD patients returning for longitudinal reassessments was close to the SD of the measurement error of 2.8 points for the Mini-Mental State Examination. There was wide variability in individual rates of decline. Even with 4 years of follow-up, 15.8% of the patients had no clinically meaningful decline in Mini-Mental State Examination score (defined as a change in initial score >3, ie, 1 SD of measurement error). Validity of measurements of the rate of change in Mini-Mental State Examination scores improved with longer observation intervals and was reliable for most patients when observations were separated by 3 or more years. CONCLUSIONS: Although the Mini-Mental State Examination is a useful screening instrument to assess level of cognitive function, it has limited value in measuring the progression of Alzheimer disease in individual patients for periods less than 3 years because of a large measurement error and substantial variation in change in annual score.     

Childhood Abuse and Sexual Revictimization in a Female Navy Recruit Sample

To examine effects of childhood abuse on adult rape, 1,887 female Navy recruits were surveyed. Overall 35% of recruits had been raped and 57% had experienced childhood physical abuse (CPA) and/or childhood sexual abuse (CSA). Controlling for CPA, rape was significantly (4.8 times) more likely among women who had experienced CSA than among women who had not. In contrast, CPA (controlling for CSA) was unrelated to likelihood of adult rape. Alcohol problems and number of sex partners were examined as mediators. Although both variables predicted rape, their effects were independent of the effects of CSA. Finally, despite ethnic group differences in the prevalence of victimization, the predictors of rape did not differ significantly across ethnic groups.     

宫腔镜下子宫内膜电切术对围绝经期功血患者内分泌激素的影响

目的探讨宫腔镜下子宫内膜电切术(TCRE)对围绝经期功血患者内分泌激素水平的影响。方法选取2011年9月至2013年9月商洛市第二人民医院收治的围绝经期功血患者98例,所有患者均行宫腔镜下TCRE,比较分析患者治疗前后促卵泡激素(FSH)、促黄体素(LH)、睾酮(T)、雌二醇(E2)、孕酮(P)及催乳素(PRL)水平的变化情况。结果经宫腔镜下TCRE治疗后,患者的治疗总有效率达96.94%;且治疗前后患者的FSH、LH、T、E2、P及PRL水平比较差异均无统计学意义(P0.05)。结论利用宫腔镜下TCRE治疗围绝经期功血可以获得良好的疗效,且不会对患者的内分泌激素水平产生较大的影响,是一种安全、可靠的治疗方式。     

丙型肝炎病毒基因型与慢性丙型肝炎患者病情严重程度之间关系的研究

目的分析丙型肝炎病毒(HCV)基因型与慢性丙型肝炎患者病情严重程度之间关系,为慢性丙型肝炎患者的临床诊断和治疗提供依据。方法采用直接测序法对HCV进行基因分型,并测量患者未治疗前HCVRNA水平、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、清蛋白(ALB)、血红蛋白(Hb)、血小板计数(PLT)水平。结果共对321株HCV进行基因分型,其中1a型占1.2%,1b型占78.5%,2a型占8.7%,3a型占2.2%,3b型占4.7%,6a型占2.8%,6b型占1.9%。HCV1型患者ALT、HCV-RNA、AST/PLT比值指数(APRI)水平明显高于非1型患者,差异有统计学意义(P值分别为0.009,0.01,0.036);而AST、ALB、Hb、PLT、AST/ALT水平两者并无明显差异。结论 HCV1型患者HCV-RNA水平高于非1型患者,肝脏功能损害较非1型患者严重。     

泌尿生殖道沙眼衣原体、支原体感染特征及耐药性分析

【目的】了解本地区泌尿生殖道沙眼衣原体（CT ）和支原体感染特征及耐药性,以指导临床合理用药。【方法】对本院2012年1月至2013年12月妇科、男性科、泌尿科、体检中心526份泌尿生殖道标本使用支原体培养鉴定药敏试验试剂盒和沙眼衣原体抗原检测试剂盒进行检测。【结果】526份泌尿生殖道标本中检出C T、支原体334株（63．5％）,其中C T 59株（11．2％）,支原体275株（52．3％）。感染前3位病原菌依次是解脲脲原体（Uu）（26．8％）、Uu＋CT（16．9％）、CT（11．2％）;支原体对美满霉素、强力霉素、交沙霉素、四环素的敏感性均在90％以上。【结论】泌尿生殖道不同类型的支原体感染对抗生素的耐药性也各不相同,临床应根据药敏试验结果选择有效的抗生素进行治疗。     

Surgical smoke: modern mobile smoke evacuation systems improve occupational safety in the operating theatre

Open in a separate window OBJECTIVESEvaluation of smoke capture efficiency of different mobile smoke evacuation devices with respect to volatile organic compounds and their noise emission.METHODSElectrosurgical incisions were performed on fresh porcine liver in an operating room with vertical laminar flow. The generated surgical smoke was analysed with proton-transfer-reaction mass spectrometry with and without the use of a mobile smoke evacuation system consisting of a smoke evacuator machine, a suction hose and a handpiece. The inlet of the mass spectrometer was positioned 40 cm above the specimen. Various devices were compared: a hard plastic funnel, a flexible foam funnel, an on-tip integrated aspirator of an electrosurgical knife and a standard secretion suction (Yankauer). Also, sound levels were measured at a distance of 40 cm from the handpieces’ inlet.RESULTSThe smoke capture efficiency of the secretion suction was only 53%, while foam funnel, plastic funnel and integrated aspirator were all significantly more effective with a clearance of 95%, 91% and 91%, respectively. The mean sound levels were 68 and 59 A-weighted decibels with the plastic and foam funnel, respectively, 66 A-weighted decibels with the integrated aspirator and 63 A-weighted decibels with the secretion suction.CONCLUSIONSCarcinogenic, mutagenic and reprotoxic volatile organic compounds in surgical smoke can be efficiently reduced by mobile smoke evacuation system, providing improved protection for medical personnel. Devices specifically designed for smoke evacuation are more efficient than standard suction tools. Noise exposure for the surgeon was lowest with the flexible foam funnel and higher with the other handpieces tested.     

mTOR抑制剂雷帕霉素对早期肝硬化门静脉高压症大鼠的治疗作用

目的:研究雷帕霉素阻断mTOR信号通路在早期肝硬化门静脉高压症中的治疗作用,并探讨其可能机制。方法:雄性SD大鼠30只,随机分为假手术组、模型组和模型干预组。采用胆道结扎离断3周制备早期肝硬化门静脉高压症模型,模型干预组于术后1周给予雷帕霉素[2 mg/(kg·d)]腹腔注射2周。通过组织病理学、形态学和血流动力学评估肝纤维化和门静脉压力。应用RT-PCR测定肝纤维化基因PC-α_1、α-SMA、TGFβ_1和PDGF的转录,采用Western印迹法测定mTOR信号通路标志物P70S6K和磷酸化P70S6K(p-P70S6K)的表达。结果:模型组大鼠肝内胆管细胞和α-rSMA阳性细胞活化增殖显著,肝脾明显增大,门静脉压力也显著增高;肝脏促纤维化基因明显上调,prP70S6K蛋白表达量明显增高;而雷帕霉素通过阻断mTOR信号通路显著改善了肝功能、肝纤维化、门静脉压力及脾肿大。结论:mTOR信号通路是早期肝硬化门静脉高压症形成的重要调控机制,阻断该通路可能成为早期肝硬化门静脉高压症治疗的新靶点。     

PMA及PNA在预测2型糖尿病并发肾病变中的实用价值

目的探讨血小板-中性粒细胞聚集体(PNA)、血小板-单核细胞聚集体(PMA)检测在预测2型糖尿病并发症中的实用价值。方法应用流式细胞仪检测2型糖尿病并发肾病变患者血浆的PMA、PNA,并以无并发症的2型糖尿病患者和健康人作为对照,比较上述三组PMA、PNA的水平,用ROC曲线评价此试验的临床应用价值。结果 2型糖尿病并发肾病变组PMA、PNA水平显著高于无并发症组,而后者又显著高于健康对照。ROC曲线显示,PMA对2型糖尿病患者并发肾病变诊断临界值灵敏度为96.7%,特异性为100.0%,截断点为40.12%;PNA灵敏度为96.7%,特异性为88.3%,截断点为26.98%,可见PMA优于PNA。曲线下面积分别为0.986和0.963。结论 PMA、PNA可以预测2型糖尿病肾病变,应用流式细胞法检测其灵敏度和特异性均较满意,PMA特异性优于PNA。     

Disseminated histoplasmosis in AIDS patients in Maryland.

These patients demonstrate the difficulty in arriving at the diagnosis of disseminated histoplasmosis. The diagnosis in two of the three patients also served as the initial AIDS case-defining opportunistic infection. In each of these patients, the clinical presentations were atypical and in only one patient was a positive exposure history elicited. Recurrent bowel obstruction was the presenting complaint in the first patient and the diagnosis was made only on pathologic exam of the resected small bowel. The second patient's diagnosis was made on biopsy of the colon via colonoscopy. The third patient's diagnosis also eluded an extensive FUO workup; he was diagnosed by bone marrow culture and silver stain of a mediastinal lymph node biopsy, despite serial negative serologic tests for histoplasmosis. The first two patients had significant gastrointestinal disease which is a relatively unusual manifestation for disseminated histoplasmosis. The third patient illustrates the limited diagnostic usefulness of serologic testing in AIDS patients and the continued usefulness of bone marrow analysis in an FUO evaluation. In conclusion, these case presentations demonstrate that disseminated histoplasmosis in patients with HIV infection can present with unusual manifestations, outside of the typical endemic arca, without a positive exposure history or positive serologic test, and may be the initial AIDS case-defining opportunistic infection in these patients. Consequently, a disseminated histoplasmosis should be considered in all AIDS patients with perplexing clinical presentations.