Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

In view of the demographic changes and projected increase of arthroplasty procedures worldwide, the number of prosthetic joint infection cases will naturally grow. Therefore, in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance. In the absence of a "miracle weapon" priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks, the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen. Instead of a "one size fits all" philosophy, it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors. A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre. The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.     

Pulmonary Lophomonas blattarum infection in patients with kidney allograft transplantation

The aim of the study was to analyse the clinical manifestation and management of pulmonary Lophomonas blattarum infection in four allograft transplantation recipients retrospectively. Four patients with pulmonary L. blattarum infection were diagnosed by using Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) examination. Their clinical manifestation and management are summarized. Four cases of pulmonary L. blattarum were found during the period from the second month to the third month after transplantation. Concurring infection by other pathogens was found in three of them. Common initial symptoms included fever (>38 degrees C) without cough and breathlessness. Lower lobe shadowing could be found on chest X-ray. Body temperature decreased to the normal range in three patients and to 37.5 degrees C in the other one, after intravenous injection of metronidazole and tapering immunosuppressant. Radiological examination confirmed improved health condition of the patients afterwards. Two patients received repeated FOB and only dead L. blattarum was found. Pulmonary L. blattarum infection in allograft transplant recipients carry relatively obscure initial symptoms. Possible L. blattarum infection needs to be screened in post-transplantation pulmonary infection patients with similar symptoms, especially in those who respond poorly to anti-infection treatment. Microscopic examination of BAL fluid can help to identify pulmonary L. blattarum infection and metronidazole is an ideal treatment choice.     

聚合酶链反应检测尖锐湿疣皮损内人乳头瘤病毒

１３个皮损组织取自１３例尖锐湿疣（ＣＡ）患者，１３例基底细胞上皮瘤（ＢＣＣ）组织作为对照，用溴化钠液分离表真皮，从组织中提出的 ＤＮＡ和溴化钠液分别用聚合酶链反应检测 ＨＰＶ ＤＮＡ。１１例ＣＡ表皮中检出 ＨＰＶ ＤＮＡ，ＨＰＶ６有７例，ＨＰＶ１１有４例。３例ＣＡ真皮中发现有ＨＰＶ ＤＮＡ，ＨＰＶ６有２例，ＨＰＶ１１有１例。２例标本因溴化钠液被ＨＰＶ污染未作统计。在ＢＣＣ组织中未发现有ＨＰＶ ＤＮＡ。在某些ＣＡ真皮内含有 ＨＰＶ ＤＮＡ可以解释散发病例的复发性。     

河南省驻马店地区HIV感染率的调查分析

目的　通过对来我院就医的抗 HIV阳性患者的定群分析 ,初步了解驻马店地区HIV的感染率和传播方式。方法　应用抗 HIVELISA试剂盒进行抗 HIV检测。结果　 3年半来共检测标本 12 980例其中检出阳性标本 15 0例 ,阳性率为 1 15 % ,经过调查发现 84%的阳性患者 1995年以前有过卖血或血浆史。结论　我区HIV感染者正处在发病阶段 ,并且感染疫情有爆发的潜在危险。     

某航校1991年-1999年乙型病毒性肝炎流行病学调查分析

目的;以某航运学校1991－1999年入校新生为对象,试图为以农村学生为主要生源的学校,提供乙型病毒性肝炎预防和控制的一些依据。方法：采用ELISA法进行HBs Ag检测。结果：航校HBsAg阳性率明显高于全国乙肝现象患病率,乙肝的发病率逐年下降,尤其是1999年乙肝的发病率下降比较显著。结论：本调查认为;应严格体检制度,发现具有HBV感染者,及时予以隔离,对于易感人群应进行乙肝疫苗的预防接种。     

乙型肝炎病毒逆转录酶区基因序列准种与变异研究

以乙型肝炎病毒（HBV）多聚酶（P）和逆转录酶（RT）区及表面抗原主蛋白（HBsAg)序列异质性来探讨HBV准种群状态。用多聚酶链反应（PCR）方法,自3例慢性HBV患者血清中扩增靶基因,克隆入T载体。随机挑选13株克隆测序,发现2株克隆出现大段缺失,另11株序列之间总差异率为5．1％;RT和HBsAg氨基酸序列差异率分别为4．9％和7．5％;并发现缺失突变、终止突变等多种突变类型。结果提示,HBV慢性患者体内有HBV准种群,并存在缺陷型HBV病毒。     

登革病毒的感染及复制研究进展

登革病毒属于黄病毒科黄病毒属,是具包膜的单股正链RNA虫媒病毒。其包膜蛋白E与细胞受体的结合介导病毒进入细胞,随后在感染细胞浆内复制。随着对非结构蛋白的深入研究,发现NS1、NS2A、NS3、NS4A及NS5蛋白均参与了病毒复制合体的形成,在成熟病毒颗粒的最终形成过程中,需要NS2B／NS3蛋白酶对C蛋白前体的切割及缩主细胞的糖基转移酶对prM、E蛋白糖侧链的正确加工。本文综述了登革病毒受体、病毒的复制及装配过程等方面的最新研究进展。     

Pseudomonal breast infection

Breast infection and breast sepsis secondary to Pseudomonas aeruginosa is uncommon. We report two cases of pseudomonal breast infection leading to septic shock and abscess formation in women with non-responding breast infection. The management of breast infection is broad-spectrum antibiotics and ultrasound with aspiration of any collection. To treat breast infection effectively, the causative organism must be isolated to enable appropriate antibiotic therapy.     

One‐year vaccination against hepatitis B virus with a MPL‐vaccine in liver transplant patients for HBV‐related cirrhosis

Conflicting results have been reported on vaccination against hepatitis B virus (HBV) as a prophylaxis against viral recurrence after liver transplantation. We investigated the efficacy of 1‐year, monthly vaccination using an adjuvant 3‐deacylated monophosphoryl‐lipid‐A (MPL) recombinant S vaccine initially administered together with hepatitis B immunoglobulins (HBIg) in 18 patients transplanted for HBV‐related cirrhosis. All received 12 vaccine doses (HBsAg, 20 mcg plus MPL, 50 mcg): the initial six doses (phase I) were administered within 7 days after intravenous HBIg (2000 IU), while the last 6 (phase II) following HBIg withdrawal. All patients received lamivudine during the study. Anti‐HBs titers were determined before each dose and then for 1 year after vaccination. After phase I anti‐HBs titers were greater than 100 IU/l in all patients and in three (16.6%) were greater than 500 IU/l. After phase II 10 patients (55.5%) achieved anti‐HBs titers greater than 100 IU/l and five (27.7%) greater than 500 IU/l. One year after vaccination eight patients (44.4%) maintained anti‐HBs titers greater than 100 IU/l, with a median titer of 234 IU/l (102–1205), and 2 (11.1%) greater than 500 IU/l. One‐year extended monthly vaccination with a MPL‐adjuvant recombinant vaccine induces a sustained protective anti‐HBs response in approximately half of transplant recipients.     

腰椎术后切口积液的探讨

[目的]分析后侧入路腰椎术后切口积液产生的原因，探讨积液的分型并确定相应的治疗策略。[方法]白2001年6月～2006年6月本院共开展1986例经后侧入路的腰椎手术。使用内固定的手术877例，未使用内固定手术1109例，比较两组间切口积液的发生率。将发生积液的病人分为Ⅲ型：Ⅰ型：病因明确型，共28例；Ⅱ型：感染型，共11例；Ⅲ型：病因不明确型，共14例。Ⅰ型病人给予穿刺抽液，对因治疗，营养疗法。Ⅱ型病人给予穿刺抽液，清创，手术灌洗和按药敏给予抗生菌治疗。Ⅲ型病人给予穿刺和预防应用抗生素。[结果]使用内固定组的切口积液率（4．33％）高于未使用内固定组（1．35％）P〈0．01。平均住院日：Ⅰ型14．7d，Ⅱ型：87．6d。Ⅲ型：15．6d。[结论]伴随手术过程的复杂化切口积液率明显增高。给积液分型有助于确定有效的治疗方案。Ⅰ型病人予以穿刺抽液和对因治疗。Ⅲ型治疗的关键是防止转化为Ⅱ型。Ⅱ型治疗比较困难，积极的手术干预和按药敏给予抗生菌是两个关键的治疗方法。