L型菌慢性泌尿系感染诊断及抗生素运用

目的 探讨L型细菌在泌尿系的感染情况及其抗生素的耐药性,为临床诊治提供科学依据.方法 用改良Kagan培养基(L型平板)对临床泌尿系感染者的尿液进行分离培养,并对所获得的L型细菌进行药物敏感试验.结果 从128例患者的尿液标本中,检出L型伴细菌型感染率为82.8％ (106/128),普通培养细菌检出率为66.4％ (85/128).其中,慢性泌尿系感染L型伴细菌型分离率93.8％ (90/96),L型细菌分离率19.8％ (19/96),共19株,细菌型分离率为74.0％ (71/96).结论 对抗生素而言,耐药性最高的是青霉素类(青霉素G),其次依次为头孢菌素类(头孢三嗪、头孢唑啉、头孢噻肟)、氨基糖苷类(庆大霉素、阿米卡星、妥布霉素)和红霉素；而万古霉素、氯霉素、新生霉素呈低耐.临床对慢性泌尿系感染者应同时检测细菌及其L型,并根据药敏试验结果联合用药,以杀菌并阻止其变为L型.     

Hospital Technology Breeds Pathology

Electronic fetal monitoring. Oxytocin challenge tests and Cesarean sections are all examples of the technological deviations from the natural processes of birth. Obstetrical care in the United States has evolved into a technology of scientitic and active management which obviates the natural processes and the normal physiology of birth. As this deviation continues, birth naturally will continue to be the perverted and pathological product of modern technology.     

Emerging drugs for biliary cancer

Biliary cancer comprise carcinoma of the gallbladder as well as the intrahepatic, hilar and extrahepatic bile ducts. Furthermore, many different etiologies and risk factors are contributing to the inhomogeneity of this disease. It is often diagnosed at an advanced stage when potentially curative resection is not feasible. Due to the lack of randomised Phase III studies, there is no standard regimen for chemotherapy in biliary cancer. Recent investigations into the underlying molecular mechanisms involved in biliary carcinogenesis and tumour growth have contributed greatly to our understanding of biliary cancer. Through a better understanding of these mechanisms, improved and more specific diagnostic, therapeutic and preventive strategies may be developed. Although fluoropyrimidines and gemcitabine remain the backbone of routine chemotherapy in advanced disease, new agents such as epidermal growth factor receptor blockers and angiogenesis inhibitors may hold promise for improving the outcome for patients with biliary cancer.     

Translating vaccine policy into action: A report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings

Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life.     

Prolonged respiratory viral shedding in transplant patients

Respiratory viral infections are frequent causes of morbidity in transplant patients. We screened symptomatic adult transplant recipients for respiratory viruses in a cohort of patients attending a referral medical center in Brazil. The duration of viral shedding and the prevalence of viral codetections were also determined. During a 1‐year period (2011–2012), swabs were obtained from 50 patients. An in‐house polymerase chain reaction panel designed to detect 10 viruses was used. Viruses were identified in 19 (38%) patients, particularly parainfluenza III (32%) and the respiratory syncytial virus (20%); multiple viruses were identified in 26% of patients. Prolonged viral shedding was observed with 60% of individuals excreting viruses for >10 days. The clinical and epidemiologic relevance of prolonged viral shedding remains to be determined.     

Community‐acquired infections associated with increased risk of lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia

Emerging evidence supports the role of immune stimulation in the development of lymphoplasmacytic lymphoma/Waldenström Macroglobulinaemia (LPL/WM). Using the population‐based Surveillance, Epidemiology End Results‐Medicare database we investigated the exposure to 14 common community‐acquired infections and subsequent risk of LPL/WM in 693 LPL/WM cases and 200 000 controls. Respiratory tract infections, bronchitis [odds ratio (OR) 1·56], pharyngitis (OR 1·43), pneumonia (OR 1·42) and sinusitis (OR 1·33) and skin infection, herpes zoster (OR 1·51) were all significantly associated with subsequent increased risk of LPL/WM. For each of these infections, the findings remained significantly elevated following the exclusion of more than 6 years of Medicare claims data prior to LPL/WM diagnosis. Our findings may support a role for infections in the development of LPL/WM or could reflect an underlying immune disturbance that is present several years prior to diagnosis and thereby part of the natural history of disease progression.     

家兔右室流出道细胞双孔钾通道电流特性的分析研究

目的已知特发性室速主要起源于右室流出道(RVOT),由于技术上的困难,目前对特发性右室流出道室速(RVOT-VT)的离子通道机制研究很少,本实验意在探索右室心室肌(RV)和RVOT的双孔钾通道电流(IK2p)的特性及其在RVOT-VT发生机制中可能参与的作用。方法采用全细胞膜片钳技术记录右室和右室流出道心肌细胞的单细胞电流。结果 RVOT的稳态外向电流较右室的小。对稳态电流进一步研究发现,右室流出道和右室心肌细胞上均存在IK2p。右室流出道细胞的IK2p电流密度明显小于右室细胞。结论首次在电生理水平上,证实了家兔右室心肌细胞上存在IK2p,RVOT心肌细胞的IK2p电流密度小于RV心肌细胞,是构成右室流出道APD离散度增大及外向电流降低的基础,从而易出现EAD,进而促进RVOT-VT的发生。     

China's unbalanced sex ratio at birth,millions of excess bachelors and societal implications

Between the 1960s and the 1990s China experienced a rapid fertility reduction, from more than six children per woman in the early 1960s to fewer than two children per woman in the 1990s. Since the 1980s this fertility reduction, one of the most rapid fertility declines in recorded human history, has resulted in significantly more boys being born each year than girls. In this article, we first develop estimates of how many extra boys have already been born in China as of 2010. We then project under two different assumptions how many extra boys will have been born in China by the year of 2020. One contribution of our article is methodological: we show exactly how our numbers of bachelors are generated. A second contribution of our article is substantive: we provide a count of the number of extra males in China for 2010 and two projected counts for 2020; the counts of excess males provided elsewhere are not this current. A third contribution of our article is our discussion of two of the key societal and international consequences of the excess boys of China. We focus on war and issues of national security, and on the transmission of sexually transmitted infections (STIs). These two implications extend beyond China itself and also have grave consequences for other countries of the world.     

单用B超引导经皮肾镜碎石术治疗上尿路结石318例分析

目的探讨单用B超引导经皮肾镜碎石术治疗上尿路结石的临床疗效。方法总结分析我院单用B超引导经皮肾镜下应用第三代气压弹道碎石治疗上尿路结石318例的临床资料。结果 318例均一期成功建立皮肤肾脏通路。平均手术时间85min,术中出血平均100mL,术后平均住院时间5.5d,1次取净结石286例,2次取净4例,总结石清除率为91.2%,无气胸、腹腔脏器损伤等并发症发生。结论单用B超引导经皮肾镜碎石术是治疗上尿路结石的一种微创、安全、有效的方法。     

卵巢过度刺激综合征相关因素分析及中西医结合护理体会

目的 探讨卵巢过度刺激综合征（OHSS）相关因素及中西医结合护理体会.方法 选择2011年5月～2013年5月江苏省中医院采用辅助生殖技术的患者393例,分析并比较OHSS在年龄、体重指数、不孕时间、不孕原因、促排卵方案、HCG当日＞12 mm卵泡数等因素间的分布情况;采用Logistic回归分析对OHSS相关因素进行分析.结果 本组发生OHSS共11例,发生率为2.9％.OHSS患者及无OHSS患者在多囊性卵巢综合征（PCOS）或多囊卵巢（PCO）改变、人体绒膜促性腺激素（HMG）＋人绝经促性腺素（HMG）方案、HCG当日雌激素（E2）值、HCG当日＞12 mm卵泡数等方面差异有统计学意义（P＜0.05）.PCOS或PCO改变（OR=6.226,P＜0.05）、HCG＋HMG方案（OR=5.475,P＜0.05）、HCG当日E2值（OR=1.480,P＜0.05）、HCG当日＞12 mm卵泡数（OR=2.148,P＜0.05）与OHSS发生相关,且均为危险因素（OR＞1.000）.结论 OHSS是多种因素共同作用的结果,中医特色的舒适护理模式可提高护理服务质量,节约医疗成本,体现以人为本的护理内涵.