Proactive infection control measures to prevent nosocomial transmission of carbapenem-resistant Enterobacteriaceae in a non-endemic area

Background Identification of hospitalized carbapenem-resistant Enterobacteriaceae （CRE）-positive patient is important in preventing nosocomial transmission.The objective of this study was to illustrate the implementation of proactive infection control measures in preventing nosocomial transmission of CRE in a healthcare region of over 3200 beds in Hong Kong between October 1,2010 and December 31,2011.Methods The program included active surveillance culture in patients with history of medical tourism with hospitalization and surgical operation outside Hong Kong within 12 months before admission,and ＂added test＂ as an opportunistic CRE screening in all fecal specimens submitted to the laboratory.Outbreak investigation and contact tracing were conducted for CRE-positive patients.Serial quantitative culture was performed on CRE-positive patients and the duration of fecal carriage of CRE was analyzed.Results During the study period,a total of 6533 patients were screened for CRE,of which 76 patients were positive （10 from active surveillance culture,65 from ＂added test＂,and 1 secondary case from contact tracing of 223 patients with no nosocomial outbreak）,resulting in an overall rate of CRE fecal carriage of 1.2％.The median time of fecal carriage of CRE was 43 days （range,13-119 days）.Beta-lactam-beta-lactamase-inhibitors,cephalosporins,and fluoroquinolones were associated significantly with high fecal bacterial load when used 90 days before CRE detection,while use of cephalosporins,carbapenems,and fiuoroquinolones after CRE detection are significantly associated with longer duration of carriage.The duration of fecal carriage of CRE also correlates significantly with the initial fecal bacterial load （Pearson correlation：0.53; P=0.02）.Conclusion Proactive infection control measures by enhanced surveillance program identify CRE-positive patients and data obtained are useful for the planning of and resource allocation for CRE control.     

HERV-HLTR相关蛋白2在肝癌中的表达及其临床意义

目的 检测肝细胞癌组织中HERV-HLTR相关蛋白2(HHLA2)的表达及其与不同病理分级、临床分期、肝功能及甲胎蛋白(AFP)的关系.方法 采用免疫组化法检测150例肝癌石蜡包埋组织标本中HHLA2的表达阳性率,并以10例患者正常肝脏组织标本作为正常对照,比较在不同的病理分级、临床分期、肝功能分级及AFP水平情况下肝癌组织中HHLA2的表达差异.结果 肝癌组织中HHLA2的阳性表达率显著高于正常对照(P＜0.05),低分化肝癌HHLA2表达阳性率最高,低分化、中分化肝癌组HHLA2表达阳性率显著高于高分化组(P＜0.05);肝癌巴塞罗那分期C期、D期患者HHLA2阳性表达率显著高于A期、B期(P＜0.05);肝功能Child-Pugh A级的患者HHLA2阳性表达率明显低于B级及C级(P＜0.01);不同年龄、不同血清AFP水平患者肝癌组织中HHLA2的表达率差异无统计学意义(P＞0.05).结论 肝癌细胞癌患者癌组织中HHLA2的阳性表达率明显升高,HHLA2可能在肝癌的发生、发展、转移中具有一定的作用.     

自闭症的中医治疗研究进展

综述近10年来中医治疗自闭症的研究概况.自闭症的中药治疗多基于肾亏失养、脾虚痰阻、肝失疏泄、脾肾不合、心脾两虚等开展辨证论治,以口服用药为主;其非药物中医疗法有针刺、推拿、耳穴贴压等.近年来,中医基于"治未病""整体观""辨证论治"等原则,采用中药、针刺、推拿、耳穴贴压及相关联合疗法等治疗自闭症,在改善患儿症状等方面,...     

树突状细胞与Foxp3+细胞在瘢痕疙瘩中的免疫调节作用

目的 探讨树突状细胞与Foxp3+细胞(T调节细胞,regulatory T cell,Treg)在瘢痕疙瘩发病机制中的相互关系和免疫调节作用.方法 应用磁珠分离、流式细胞术和ELISA法检测瘢痕疙瘩患者(K组,15例)和正常人(N组,15例)外周血中Foxp3+细胞和成熟树突状细胞表面分子MHCII、CD83的表达和功能,分离外周血中树突状细胞分别与CD44 CD25-细胞共培养,测定Foxp3+细胞生成和IL-10的表达.结果 ①K组Foxp3+细胞占CD4+CD25+细胞的(1.45±0.22)%,细胞培养上清中IL-10的浓度为(一),明显低于N组[(5.63±0.95)%,(137±12)ng/L],P<0.05;②K组MHCⅡ+CD83+细胞占(85.47±4.13)%,培养上清中IL-12 p70的浓度为(263±21)ng/L,明显高于N组[(12.79±6.84)%,(一)],P<0.05;③K组DC与CD4+CD25-细胞共培养,3 d后诱导的Foxp3+细胞占CD4+细胞的(0.27±0.18)%,分泌的IL-10浓度为(一),明显低于N组DC与CD4+CD25-细胞共培养诱导的Foxp3+细胞含量和IL-10浓度[(2.53±0.72)%,(79.6±3.24)ng/L],P<0.05.结论 ①外周血中Foxp3+细胞的表达减少,功能降低提示瘢痕疙瘩患者可能存在外周的主动免疫抑制功能减弱;②瘢痕疙瘩患者中树突状细胞与Foxp3+细胞之间存在免疫调节作用;③Foxp3+细胞与瘢痕疙瘩的发病关系密切.     

尿中s-羟乙基半胱氨酸的OPA自动柱前衍生高效液相色谱法测定

目的：建立尿中s-羟乙基半胱氨酸的OPA自动性前衍生高效液相色谱法测定方法。方法：尿液经Sep-Pak C18小柱富集和纯化，样液中s-羟乙基半胱氨酸在HP1050高效液相色谱仪自动进样器中使用邻苯二甲醛（OPA）自动衍生，经Lichrospher 100RP-18e色谱柱分离，用DAD检测器在338nm波长下测定吸收值。结果：s-羟乙基半胱氨酸浓度范围0.0mmol/L-0.5mmol/L的校准曲线相关系数为0．9999，方法检出限为0．002mmol/L；s-羟乙基半胱氨酸浓度0．05mmol/L,0.30mmol/L,0.50mmol/L组内相对标准偏差（RSD）分别为1．67％、1．02％和1．40％（n=6);不同日期测定组间相对标准偏差（RSD）分别为4．78％、3．82％和3．74％（n=6)。尿中加标0．10mmol/L,0.30mmol/L的回收率分别为90％、93％。结论：方法线性好，精密度和回收率高，操作简便，自动化程度高，可用于测定尿中s-羟乙基半胱氨酸。     

广东汉族人群复杂短串联重复SE33(ACTBP2)位点的多态性

[目的]调查 SE33位点在广东汉族群体的扩增片段长度多态性.[方法]应用荧光标记的引物对 SE33位点进行 PCR扩增,采用 Prism ABI377 DNA自动测序仪分离 PCR产物,结合等位基因梯阶和分子量内标进行基因分型.[结果] 在 114名广东汉族无关个体中观察到了 35个等位基因, 87种基因型.个体识别能力( DP)值为 0.986 1,杂合度( H)为 0.912 3.[结论] 荧光标记 SE33扩增体系个体特异性强,识别力高,是个体识别和亲子鉴定的高效的检测体系.     

小鼠白细胞介素18真核表达质粒的构建及基因多态性分析

目的：构建小鼠白细胞介素18(mIL-18)的重组真核表达质粒，制备有效的免疫佐剂。 方法：通过RT-PCR分别从BALB/c小鼠和Swiss小鼠肝组织总RNA中扩增mIL-18，并将其连接于载体pcDNA3中，再用双酶切及测序方法鉴定重组质粒。 结果：构建出两组重组质粒，其中从BALB/c小鼠中获得的mIL-18序列与Genbank中序列完全一致，而从Swiss小鼠中获得的mIL-18序列有两个点突变。结论：重组质粒pcIL-18构建成功，且发现mIL-18具有未见报道的点突变，已登录于Genbank。这为研制抗肿瘤DNA疫苗，增强疫苗疗效奠定基础。     

AO微型钢板在指骨骨折中的应用

目的 探讨AO微型钢板内固定治疗指骨骨折的疗效。方法 2003年1月-2005年1月，对74例77指指骨骨折，采用AO微型钢板进行内固定治疗。术后第2天开始作主动功能锻炼。结果 术后随访8个月～2年，平均15个月。术后70指伤口I期愈合，7指伤口发生裂开或部分皮肤坏死，其中5指钢板外露，而行皮瓣修复。术后70例72指获得随访，4例失访。骨折愈合时间为10～15周，平均12周，均全部愈合。按手功能评定标准评定：优56指（77．8％），良6指（8．3％），可2指（2．8％），差8指（11．1％），总优良率为86．1％。结论 AO微型钢板在治疗指骨骨折中疗效显著，但钢板强度不足，其潜在断裂的可能性是其最大的缺点。     

三维ASL联合DWI评估急性脑梗死患者缺血性半暗带及预后

目的 观察三维动脉自旋标记（ASL）成像联合弥散加权成像（DWI）评估急性脑梗死（ACI）缺血性半暗带（IP）及预后的价值。方法 回顾性分析45例ACI患者的颅脑ASL图像及DWI，根据随访3个月末改良Rankin量表（mRS）评分结果，将患者分为预后好、中等和差组。测量病灶最大层面DWI高信号面积（S_DWI）和ASL异常灌注面积（S_ASL），评估患者是否存在IP；记录梗死病灶（IL）、近病灶边缘脑组织（BNL）及相应对侧区域脑血流量（CBF）和表观弥散系数（ADC）值，计算患侧/对侧相对值（rCBF和rADC）。比较不同预后组内IL与对侧CBF、ADC值差异及各组间rCBF及rADC差异，分析IL及BNL的rCBF对于ACI预后差的单独诊断效能和联合诊断效能，观察rCBF、rADC与mRS评分的相关性。结果 45例ACI中，40例IL区表现为低灌注，将其纳入研究；其中23例存在IP，与不存在IP患者预后差异有统计学意义（χ²=6.742，P=0.034）。不同预后组内IL的CBF和ADC值、预后好组及中等组BNL的CBF值均低于对侧（P均<0.05）。预后差组IL的rCBF与预后好组及预后中等组差异均有统计学意义（P均<0.05），而不同预后组间BNL的rCBF差异无统计学意义（F=3.20，P=0.05）。IL和BNL的rCBF评估ACI预后差的AUC分别为0.92和0.79，最佳界值分别为0.41和0.93，约登指数分别为0.72和0.57；两者联合AUC为0.94，约登指数为0.79。IL的rCBF与mRS评分呈负相关（r=-0.642，P<0.001）。结论 三维ASL联合DWI可用于评估ACI患者IP及预后，为制定ACI治疗方案提供参考。     

Electrophysiologic Characteristics and Radiofrequency Catheter Ablation in Atrioventricular Node Reentrant Tachycardia with Second-Degree Atrioventricular Block

Second-Degree AV Block During AVNRT. Introduction : Detailed electrophysiologic study of AV nodal reentrant tachycardia (AVNRT) with 2:1 AV block has been limited.
Methods and Results : Six hundred nine consecutive patients with AVNRT underwent electrophysiologic study and radiofrequency catheter ablation of the slow pathway. Twenty-six patients with 2:1 AV block during AVNRT were designated as group I, und those without this particular finding were designated as group II. The major findings of the present study were: (1) group I patients had better anterograde and retrograde AV nodal function, shorter tachycardia cycle length (during tachycardia with 1:1 conduction) (307 ± 30 vs 360 ± 58 msec, P < 0.001), and higher incidence of transient bundle branch block during tachycardia (18/26 vs 43/609, P < 0.001) than group II patients: (2) 21 (80.8%) group I patients had alternans of AA intervals during AVNRT with 2:1 AV block. Longer AH intervals (264 ± 26 vs 253 ± 27 msec, P = 0.031) were associated with the blocked beats. However, similar HA intervals (51 ± 12 vs 50 ± 12 msec, P = 0.363) and similar HV intervals (53 ± 11 vs 52 ± 12, P = 0.834) were found in the blocked and conducted beats; (3) ventricular extrastimulation before or during the His-bundle refractory period bundle could convert 2:1 AV block to 1:1 AV conduction.
Conclusions : Fast reentrant circuit, rather than underlying impaired conduction of the distal AV node or infranodal area, might account for second-degree AV block during AVNRT. Slow pathway ablation is safe and effective in patients who have AVNRT with 2:1 AV block.