肠炎沙门菌临床分离株耐药性与耐药基因分析

目的对分离自北京、广州、新疆3个地区腹泻病人粪便标本中的肠炎沙门菌菌株进行耐药性监测,并分析其耐药基因的变异情况。方法应用生化试验、血清凝集试验对分离的疑似沙门菌菌株进行鉴定。采用K-B药敏纸片法对鉴定出的肠炎沙门菌进行抗生素敏感性试验。利用PCR技术扩增其耐药基因DNA促旋酶gyrA基因和拓扑异构酶parC基因,同时进行测序。结果共分离鉴定出20株肠炎沙门菌,分离菌株对环丙沙星、庆大霉素、头孢他定、亚胺培南的敏感率为100%,对萘啶酸耐药;75%的菌株呈现多重耐药性(multidrug resistance,MDR)序列比对结果显示gyrA基因Asp87及Gly133密码子处发生了点突变,其中Gly133是新的突变点。未发现parC基因密码子突变。结论肠炎沙门菌临床分离株MDR情况比较严重,对萘啶酸普遍耐药,这可能与20株菌的gyrA基因QRDR的突变相关。为防止多重耐药现象的蔓延和加重,除了应加强耐药性及耐药性相关基因的实验室监测外,临床治疗沙门菌感染时需慎用抗生素。     

南京市白下区住宿业实施公共场所卫生监督量化分级管理效果评估

目的探讨上海市浦东新区祝桥镇公共场所卫生监督量化分级管理的效果,防止突发性公共卫生事件发生,提高公共场所的卫生监督效率。方法2018年在浦东新区祝桥镇随机抽取200家公共场所进行卫生监督量化分级分析。量化分级项目包含公共场所各项法规制度、控烟工作和用具清洗消毒规程等,根据得分结果将公共场所卫生评定为A、B或C级。采用单因素和多因素条件logistic回归模型找出影响公共场所卫生监督量化分级效果的相关因素。结果200家公共场所量化分级监督前后公共场所相关知识得到了提升。经单因素和多因素条件logistic回归分析,最终筛选出公共场所卫生监督量化分级管理效果的3个相关因素为未持有有效的健康证(OR=1.121,P=0.026)、公共场所内摆放烟灰缸(OR=1.012,P=0.032)、未做卫生检测报告(OR=1.412,P=0.012)。结论公共场所卫生监督量化分级影响因素主要与未持有有效的健康证、公共场所内摆放烟灰缸和未做卫生检测报告有关。今后要重点加强公共场所这几方面的卫生督导。     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

支持自然语言智能答疑系统的设计与实现

通过分析国内现有智能答疑系统存在的问题,提出了一个智能答疑系统的模型,并给出系统中的关键实现技术,同时指出支持自然语言提问的智能答疑系统是网络教育的发展方向。     

“8”字缝合法

在应用“8”字缝合方法中,各有特点。同济医科大学协和医院报告:用横直“8”字缝合法闭锁十二指肠残端746例,均未发生残端瘘。操作方法:在两把Kocher钳中间切断十二指肠后,于远端Kocher钳下,先作十二指肠两边牵引线,继之距钳下0.3～0.5cm处,以双股1号丝线行横“8”字缝合十二指肠。助手慢慢松钳,术者持续紧线打结,剪去线尾。随后再作直“8”字加固缝合打结,分开线尾,将其与两边牵引线打结,使十二指肠残端呈锥形。再以3号丝线行浆肌层荷包缝合包埋十二指肠残端,酌情加盖网膜或胰腺被膜。福建省仙游县医院报告用大“8”     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

胸骨体骨折1例

1　病例资料患者 ,男 ,30岁。因前胸部撞伤并疼痛、呼吸困难 2ｈ ,于 2 0 0 1年 5月 15日入院。患者在乘坐一载重约 10 0 0ｋｇ的农用三轮摩托车时 ,发生车祸 ,前胸部被车厢护栏撞伤 ,当即感前胸部疼痛 ,呼吸困难。入院查体 :前胸部有一横向带状淤血痕 ,压痛明显 ,叩击痛阳性 ,听诊双肺呼吸音明显减弱。胸骨Ｘ线侧位片见胸骨体中上 1/ 3处横形骨折 ,未见移位 (图 1) ,正侧位Ｘ线片无积气、积液表现。诊断 :胸骨体横断骨折。治疗 :平卧床束胸围外固定 2周及镇痛处理 ,于1周后出院休养 ,失访图 1　胸部侧位片胸骨体中上 1/3处横形骨折2　讨论…     

陕西省克山病与动物缺硒病分布关系的调查

<正> 在克山病水土病因和防治方法的研究中,曾注意到陕西、河北和黑龙江等省一些克山病病区有家畜白肌病(缺硒病)发生,并发现人克山病和家畜白肌病在流行病学、临床表现和病理变化等方面有不少类似之处。因而设想克山病可能是一种类似白肌病的地方性缺硒病。先后开展的口服亚硒酸钠预防克山病的试点工作,已取得了明显效果。硒分析研究结果表明     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.