三种消毒剂对体检中心物体表面消毒效果与使用成本的比较研究

目的对3种消毒剂在体检中心物体表面消毒的消毒效果及使用成本进行比较,为体检中心优选合适的物体表面消毒方式提供依据。方法分别使用I型复合双链季铵盐卫生湿巾、500mg/L含氯消毒剂、75%乙醇擦拭消毒健康体检中心采血台、彩超机和乳腺红外线诊断仪的表面,在消毒前、消毒后即刻、消毒后30min及1h分别对各区域进行棉拭子涂抹采样及培养。结果受检物体表面细菌菌落数采血台为(78.4±6.2)cfu/cm2,彩超机为(36.2±2.1)cfu/cm2,乳腺红外线诊断仪为(45.9±3.0)cfu/cm2。3种消毒剂消毒后各时间点采样菌落数与消毒前比较,差异有统计学意义(均P0.01)。I型复合双链季铵盐卫生湿巾消毒效果在消毒后即刻、消毒后30min及1h优于500mg/L含氯消毒剂、75%乙醇(P0.05,P0.01);每次消毒成本I型复合双链季铵盐卫生湿巾最低。结论 3种消毒剂对各监测表面均有良好的消毒效果,但I型复合双链季铵盐卫生湿巾的消毒持续效果优于其他两种,且使用成本低,使用方便、侵蚀性小,适用于体检中心物表消毒。     

江苏省嗜人按蚊分布区环境特征的现场调查

目的 了解江苏省嗜人按蚊分布范围和分布区环境特征。方法 在原有嗜人按蚊分布及近年来以乡为单位疟疾发病率超过0．1％的县市，进行嗜人按蚊分布调查；在盱眙，六合2县每县选5个乡，每乡3个村进行嗜人按蚊分布区环境特征调查。结果 20世纪90年代以来嗜人按蚊分布于江浦，六合，2仪征，盱眙，洪泽5县。嗜人按蚊分布区植被为树林，灌木和农作物等；河流，湖泊，池塘，沟渠密布；土壤为黄沙（粘）土，黄棕壤土，黑土，灰土，潮土5种，其中黄沙（粘）土占66．7％，有机物含量1．8％－2．5％；水田面积占可耕地总面积的69．5％，100％种植单季稻，稻田农药年使用量平均为18.8kg/hm^2。结论 江苏省嗜人按蚊分布区范围正在逐渐减小，该蚊的种群比例也正在下降，但这些地区自然环境仍适宜嗜人按蚊孳生，因此在疟疾发病率较高和局部出现暴发点的地区，甩必须加强嗜人按蚊监测。     

55例脑型血吸虫病临床分析

目的提高脑型血吸虫病的正确诊断率,减少脑血的误诊。方法收集了1980年11月-1998年9月的脑型血吸虫病55例,对其临床表现进行分析。结果本组病例中,20岁-40岁31例(占56％),男性47例(占85 5％),慢性型52例(占94.5％),单纯癫痫型22例(占38.1％),伴癫痫发作的混合型12例(占21.8％)。血吸虫病 COPT 和 IHA 检查阳性率分别为89.5％和70.4％。所有病例 B 超检查均发现有血吸虫肝损害现象。CT 与 MRI 影像学检查显示,脑血病灶主要发生在大脑顶叶、枕叶、及额叶,以顶叶受累最多。96.4％的患者吡喹酮(PQT)治疗后显效。结论脑型血吸虫病以青壮年多见,男性多于女性,以慢性型多见,COPT 和 IHA 免疫学检查有助于脑血鉴别诊断,B 超、CT 与 MRI 影像学检查可作为重要的辅助诊断方法。     

Low frequency of p53 mutations observed in a diverse collection of primary hepatocellular carcinomas.

Recent studies of the p53 tumor suppressor locus (designated TP53) in primary hepatocellular carcinoma (PHC) have identified a high frequency of codon 249 mutations. Due to the geographic location from which the samples were obtained and the substitution observed, the mutation was suggested to be attributable to aflatoxin B1 (AFB1) exposure. To determine the generality of this phenomenon, we have examined PHC tissues from 107 geographically and ethnically diverse sources. The frequency of p53 gene mutations was evaluated by using PCR/restriction-digest methods, GC-clamp (G+C-rich sequence) denaturing gradient gel electrophoresis, and DNA sequencing. The mutation rate observed in tumors from high-AFB1-exposure regions (25%) was more than double the rate observed in low-exposure regions (12%) but lower than the 50% frequency previously reported. Codon 249 mutations occurred at a much lower frequency than previously reported (2 of 107 samples examined). These results suggest that changes in DNA encoding p53 may not represent primary oncogenic effects but instead represent genetic changes related to tumor progression. High AFB1 levels may facilitate the generation of these progressional changes, but not by inducing a specific p53 gene mutation at codon 249 as previously reported.     

Oxidized low-density lipoprotein induces differentiation of RAW264.7 murine macrophage cell line into dendritic-like cells

Dendtritic cells (DCs) are potent antigen-presenting cells and have an important role in the pathogenesis of atherosclerosis. Recent data suggests oxidized low-density lipoprotein (oxLDL) promotes the transition of a differentiating monocyte to a mature dendritic cell. In this study, we examined whether oxLDL could induce the differentiation of mature macrophages into DCs. After 48 h treatment with oxLDL, RAW264.7 cells increased in cell size and exhibited dendritic morphology. At the optimal oxLDL dose (10 μg/ml), approximately 74% of RAW264.7 cells differentiated into dendritic-like cells. Flow cytometric analysis detected dendritic cell surface markers (CD83, CD40, CD86, MHC Class II, and CD1d), and their expression increased in a dose- and time-dependent manner. Moreover, oxLDL-treated RAW264.7 cells showed functional changes including reduced endocytic activity, increased allostimulatory activity, and IL-12 production. The findings of the present work demonstrate that RAW264.7 cells, incubated with oxLDL, acquire some dendritic cell features.     

Antiidiotypic IgG crossreactive with Rh alloantibodies in red cell autoimmunity

IgG autoantibodies eluted from RBCs of antiglobulin positive normal blood donors contained at least two antibody populations, an IgG autoantibody (Ab 1), and an IgG population (Ab 2) that agglutinated RBCs coated with some Rh(D) alloantibodies. Eight of 24 autoantibody eluates tested agglutinated 3 of 10 anti-Rh(D) sensitized RBCs. The agglutinating activity was inhibited specifically by preincubation of the autoantibody eluate with the reactive anti-D. The reaction did not require the Fc domain of the anti-Rh(D), since autoantibody eluates agglutinated RBCs coated with F(ab')2 prepared from the reactive anti-D sera. These findings indicate that the RBCs of some antiglobulin- positive blood donors contain an immunoglobulin auto-antiidiotype (Ab 2) against the RBC autoantibody (Ab 1) which is demonstrable through its cross-reactivity with selected Rh(D) alloantibodies. Identification of auto-antiidiotypes in RBC autoimmunity lends support to the idiotype- antiidiotype network hypothesis of immune regulation and is consistent with the bizarre and complex serology of autoimmune hemolytic anemia. The absence of clinical hemolysis in antiglobulin-positive normal blood donors suggests that immunoglobulin idiotype-antiidiotype interactions may play a role in modulating the effects of RBC autoimmunity.     

Exacerbation of pulmonary lymphangioleiomyomatosis by exogenous estrogens

A 48-year-old woman with profound, rapidly progressive dyspnea requested a second opinion regarding the diagnosis and management of an undiagnosed interstitial process. One year prior to this evaluation, she had been placed on therapy with exogenous estrogens for the treatment of osteoporosis. During this therapy, she had a marked deterioration of her pulmonary status. Review of her open lung biopsy, which was obtained five years previously, revealed lymphangioleiomyomatosis. Discontinuation of estrogen therapy and treatment with tamoxifen were successful in stopping the progressive course. This patient's clinical course suggested an association between estrogen therapy and clinical deterioration during the menopause.     

A novel method for lymphadenectomy along the left laryngeal recurrent nerve during thoracoscopic esophagectomy for esophageal carcinoma

Background

Due to limited space in the left upper mediastinum, complete dissection of lymph nodes (LN) along left recurrent laryngeal nerve (RLN) is difficult. We herein present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position for esophageal carcinoma. The method, suspension the esophagus and push aside trachea, allows en bloc lymphadenectomy along the left RLN from the below aortic arch to the thoracic inlet.

Methods

Between September 2014 and September 2015, a total of 110 consecutive patients with esophageal carcinoma were treated with thoraco-laparoscopic esophagectomy with cervical anastomosis in the semi-prone position. Outcomes between those who received surgery with the novel method and conventional surgery were compared.

Results

Fifty patients underwent the novel method and sixty received conventional surgery. The operative field around the left RLN was easier to explore with the novel method. The estimated blood loss was less (23.7±8.2 vs. 34.2±10.3 g, P=0.001), and the number of harvested LNs along the left RLN was greater (6.4±3.2 vs. 4.1±2.8 min, P=0.028) in the novel method group, while the duration of lymphadenectomy along left RLN was longer in the novel method group (28.2±3.9 vs. 20.3±2.8 min, P=0.005). The rate of hoarseness in the novel and conventional groups was 10% and 16.7%, respectively. No significant difference in postoperative morbidity related to the left RLN was noted between the groups.

Conclusions

The novel method during semi-prone esophagectomy for esophageal carcinoma is associated with better surgeon ergonomics and operative exposure.