Infestation of sand lizards (<Emphasis Type="Italic">Lacerta agilis</Emphasis>) resident in the Northeastern Poland by <Emphasis Type="Italic">Ixodes ricinus</Emphasis> (L.) ticks and their infection with <Emphasis Type="Italic">Borrelia burgdorferi</Emphasis> sensu lato

Sand lizards (Lacerta agilis) were trapped and examined for ticks from May to September in 2002 and 2003 in Northeastern Poland. A total of 233 Ixodes ricinus (L.) ticks (76 larvae and 157 nymphs) was found on 31 of 235 captured lizards (13.2%). The tick infestation is relatively low compared to that of mammals and passerine birds from the same area (Siński et al. 2006, Gryczyńska et al. 2002). Tick infestation depended on the month of capture, being the highest in spring. In autumn no ticks were recorded on any of the captured lizards. The oldest lizards carried the highest number of ticks but no differences related to sex of the host were found. All the collected ticks were analysed by PCR for the presence of Borrelia burgdorferi sensu lato, the etiological agents of Lyme disease. Spirochetes were detected in 11 out of 233 (4.7%) ticks tested. Genetic analysis confirmed that the spirochetes are members of the Borrelia afzelii, B. garinii and B. burgdorferi sensu stricto genospecies. Mixed infection were not detected. The prevalence of infection was analysed in relation to months of the capture, age and sex of the lizards, but differences were not statistically significant. The obtained results suggest that lizards are probably not B. burgdorferi reservoirs, but further studies are required to confirm this.     

Wilms tumor in patients with osteopathia striata with cranial sclerosis

Germline pathogenic variants in AMER1 cause osteopathia striata with cranial sclerosis (OSCS: OMIM 300373), an X-linked sclerosing bone disorder. Female heterozygotes exhibit metaphyseal striations in long bones, macrocephaly, cleft palate, and, occasionally, learning disability. Male hemizygotes typically manifest the condition as fetal or neonatal death. Somatically acquired variants in AMER1 are found in neoplastic tissue in 15–30% of patients with Wilms tumor; however, to date, only one individual with OSCS has been reported with a Wilms tumor. Here we present four cases of Wilms tumor in unrelated individuals with OSCS, including the single previously published case. We also report the first case of bilateral Wilms tumor in a patient with OSCS. Tumor tissue analysis showed no clear pattern of histological subtypes. In Beckwith–Wiedemann syndrome, which has a known predisposition to Wilms tumor development, clinical protocols have been developed for tumor surveillance. In the absence of further evidence, we propose a similar protocol for patients with OSCS to be instituted as an initial precautionary approach to tumor surveillance. Further evidence is needed to refine this protocol and to evaluate the possibility of development of other neoplasms later in life, in patients with OSCS.Subject terms: Genetics, Clinical genetics, Disease genetics     

Interaction between KIR3DL1 and HLA-B*57 supertype alleles influences the progression of HIV-1 infection in a Zambian population

KIR and HLA loci are both highly polymorphic, and some HLA class 1 products bind and trigger cell-surface receptors specified by KIR genes. We examined whether KIR genes act in concert with HLA-B locus to control HIV-1 infection in a sample of Zambian patients. DNA samples from 88 Zambian patients with HIV-1 were examined. Patients were classified as either slow progressors (SP; n = 54) or rapid progressors (RP; n = 34) to AIDS. All were typed for HLA-B and KIR genes. Our results reveal an association between B*57 supertype (B*57s, which includes B*57 and B*58 alleles) and delayed progression to AIDS (p = 0.0007 by pc = 0.015; OR = 5.25). We also observed an increase incidence of Bw4-I80 in patients with slow progression (p = 0.001 by pc = 0.003, OR = 5). This increase was found to be secondary to B*57s. The presence of both KIR3DL1 and B*57S has a significant effect on progression to AIDS (p = 0.0008; OR = 5.61). B*57s genotypes with another HLA-B allele different from those in the trans position, which also had a specificity different to Bw4-I80 (Bw4-T80 or Bw6), was also greater in the SP than in the RP group (p = 0.00003; OR = 10.11). The presence of the inhibitory allele KIR3DL1 in combination with the HLA-B*57s alleles that contain the Bw4-I80 epitope, has a highly protective effect against progression to AIDS in Zambian patients.     

Differences in gallstone structure in primary common bile duct lithiasis and gallbladder lithiasis

Summary Some differences between gallbladder lithiasis and primary common bile duct lithiasis are described. Microbiological cultures and biochemical analyses were carried out on the bile of two groups of patients: 27 suffering from gallbladder and 5 from primary common duct lithiasis. The microstructure and composition of gallstones were also examined by polarized light microscopy and X-ray diffraction. Women predominated in gallbladder lithiasis but not in primary common duct lithiasis group (P<0.05) and body weight was higher in the former group (P<0.02). Primary common duct lithiasis patients had a higher, although not significant, incidence of duodenal diverticulosis (P=0.15), and a higher incidence ofE. coli-positive cultures in bile (P<0.001). No significant difference in the biochemical composition of the bile was found between the groups. Brown pigment stones predominated in primary common duct lithiasis, while cholesterol stones did in gallbladder and secondary common duct lithiasis (P<0.0001). Stones formed in the gallbladder generally show linear, radial growths of cholesterol crystals, while those from the common duct present a polystratified, concentric deposition of microgranules composed mainly of pigmentary salts.These differences should be taken into account as additional criteria in the differential diagnosis between primary and secondary common duct lithiasis, as the classical criteria for diagnosing of the former greatly underestimate its actual incidence. The distinction between primary and secondary common duct lithiasis is of practical significance, since each entity requires different treatment.Abbreviations CBD common bile duct - CBDL common bile duct lithiasis - ERCP endoscopic retrograde cholangiopancreatography - GBL gallbladder lithiasis - HDL high density lipoproteins - PCBDL primary common bile duct lithiasis - SCBDL secondary common bile duct lithiasis - SGOT serum glutamic-oxalacetic transaminase - SGPT serum glutamic-pyruvic transaminase     

江苏省大型医院患者就医特征调查研究△

目的：基于对江苏省大型三甲医院医患群体的调查,从患者总体就医认知、就医心理和期望、就医行为与感受等方面,研究患者就医特征,并对构建理性就医行为提出参考建议。方法：采用随机抽样方法,对苏北、苏中及苏南9家医院的医患群体进行问卷调查,采用描述性分析和卡方检验等方法对医患双方的回答进行处理。结果：在患者总体就医认知方面,大部分患者缺乏对就医义务的认知和担当;患者对医学带教和医学发展认知存在局限,对就诊结果期望过高是造成医患纠纷的主要原因;对暴力伤医的犯罪行为存在错误认知。在就医心理和期望方面,患者在就诊时最关注与疾病诊疗相关内容,最担心出现医疗过失或差错;但医方认为患者更关注诊疗费用。患者的心理压力负担普遍超过了身体疾病带来的痛苦,医务人员的服务态度对患者的心理影响较大。在就医行为与感受方面,患者的就医选择与国家政策不契合;患者对良好医患关系、服务态度的期望值较高;医患双方倾向形成若朋友般的关系;患者在医患沟通中往往处于被动,医方良好的倾听和解释技巧可以让患者获得良好的沟通感受。结论：患者群体的就医认知存在缺陷,非理性就医思维与行为表现明显,医患双方的信息不对称和角色差异使得医患关系和医患信任度面临较大挑战。政府部门、教育与卫生行政部门应尽早从完善法律、普及患者公众教育、加强医生培训等方面帮助患者群体回归理性就医行为。     

静脉用药调配中心干预不合理医嘱的效益分析

目的对静脉用药调配中心(pharmacy intravenous admixture services,PIVAS)干预临床不合理用药产生的经济效益、社会效益、人力资源效益进行分析,促进临床合理、安全、经济用药。方法采用回顾性分析方法,调取2018年10月1-31日山东大学齐鲁医院PIVAS接收的全部静脉用药医嘱及对不合理用药医嘱的干预结果,分析PIVAS干预不合理用药医嘱产生的药品资源、人力资源节约情况。结果2018年10月1-31日PIVAS药师共审核用药医嘱412782组,其中不合理医嘱1967组,占0.417%,包括不规范、不适宜及超常医嘱等类型。通过PIVAS药师干预不合理用药医嘱,及时纠正医师用药医嘱错误,节约了药品资源及护理工时。结论PIVAS进行用药医嘱审核对于保障患者临床合理用药具有积极意义,有利于节约医疗资源。     

泌尿道感染常见菌群分布及耐药谱分析

目了：了解泌尿道感染常见菌群分布及其对抗生素的耐药性。方法：分析474例从临床尿标本分离出的菌株并测定其对常见抗生素的耐药性。结果：泌尿道感染常见致病菌是大肠杆菌,绿脓杆菌和肺炎克雷伯氏杆菌,大肠杆菌地阿莫西林／棒酸,哌拉西林／他唑巴坦的耐药率为24％－38％,对第3代头孢菌素的耐药率为12－22％,绿脓杆菌和阴沟肠杆菌耐药率较高,且多重耐药。结论：定期系统的细菌耐药性监测对临床用药具有重要意义。     

吸烟与女性乳腺癌关系的Meta分析

目的 探讨吸烟与乳腺癌关系。方法 采用Meta分析的方法,对我国学 者在公开发表的8篇有关吸烟与乳腺癌关系的病例对照研究文献进行综合定量分析。根据资料一致性检验,采用随机效应模型（D－L法）计算合并比值法（OR）及其95％的可信区间（95％CI）。结果 吸烟与乳腺癌之间总的合并OR为1．56,其中95％CI1．09－2．24,按主动吸烟和被动吸烟与乳腺癌关系合并的OR值及95％CI分别为1．67（0．45－6．22）和1．65（1．10－2．30）,但主动吸烟与乳腺癌的联系无统计学意义（P＞0．05）。结论 吸烟是乳腺癌的危险因素。     

骑自行车人与行人车祸伤害的流行病学特征

目的 :为控制和预防骑自行车人与行人的车祸伤害提供依据。方法 :采用描述流行病学方法 ,对 1996年郑州市机动车与骑自行车人和行人相撞的车祸资料进行分析。结果 :骑自行车人与行人的车祸伤害人数占该年总车祸伤害人数的 37.1% ,死亡人数占总死亡人数的 46 .6 % ,伤亡人员多为青壮年。骑自行车人与行人的车祸伤害主要发生在城市主干道、混合式道路、无交通控制方式的交通环境中 ;引起这类伤害的主要原因是驾驶员疏忽大意 ,骑自行车人抢道行驶和突然猛拐 ,行人违章穿行车行道。结论 :骑自行车人与行人车祸伤害是车祸伤害的重要组成部分。致伤原因是人们的交通安全意识差 ,没有按照交通规章行驶。因此 ,应加强交通法规的宣传和教育 ,提高人们的交通安全意识     

4NQO诱发A／J系小白鼠肺腺癌的研究

目的：通过A／J系小鼠肺腺癌模型,探讨肺肿瘤细胞的起源和恶性转化过程。方法：应用4－氮喹啉1－氧化物（4QO）化学物质为促癌剂,建立A／J系列小鼠肺癌的模型。观察诱发肿瘤时间、肿瘤数目及与类型的关系。结果：RNQO诱发5个月时,共发现肺肿瘤17处,其中肺泡上皮增生（AP）6处。肺泡腺瘤（AA）9处,乳头状腺瘤（PA）2处;诱发7个月时共发现肺肿瘤19处,AP为7处,AA为11处,PA为1处,诱发9个月时共发现肺肿瘤27处,AP为5处,AA为17处,PA为3处,发现乳头状腺癌（PC）2处。结论：4NQO能诱发A／J系小鼠肺腺癌。诱发肿瘤的时间长短与发生肿瘤的组织学类型有密切关系。