儿童细菌性脑膜炎与病毒性脑炎临床及实验室检查特点

目的研究儿童细菌性脑膜炎与病毒性脑炎临床特点及血清基质蛋白金属酶-9(MMP-9)、降钙素原(PCT)、β2-微球蛋白(β2-MG)及C-反应蛋白(CRP)水平,分析各指标对两者鉴别诊断价值。方法选取2017年10月-2019年10月郑州大学附属儿童医院细菌性脑膜炎和病毒性脑炎患儿共80例,其中细菌性脑膜炎组49例,病毒性脑炎组31例,观察患儿症状,同时检测血清MMP-9、PCT、β2-MG和CRP水平并进行比较,作受试者工作特征曲线(ROC)分析各指标对细菌性脑膜炎和病毒性脑炎鉴别诊断价值。结果细菌性脑膜炎组患儿意识障碍、囟门张力增加和肺炎发生率高于病毒性脑炎组,精神萎靡、嗜睡和皮疹发生率低于病毒性脑炎组,差异有统计学意义(P<0.05);细菌性脑膜炎组血清MMP-9、PCT、β2-MG和CRP水平高于病毒性脑炎组,差异有统计学意义(P<0.05);意识障碍、肺炎以及血清CRP和PCT水平对细菌性脑膜炎和病毒性脑炎患儿鉴别诊断的敏感度分别为46.93%、46.93%、75.51%和83.67%,特异度分别为77.42%、80.65%、83.87%和90.32%,各指标联合诊断的曲线下面积为0.917,敏感度为91.84%,特异度为83.87%。结论细菌性脑膜炎和病毒性脑炎患儿临床特点和血清MMP-9、PCT、β2-MG和CRP水平均存在明显差异,综合各项指标进行分析可为临床鉴别诊断提供参考信息。     

Sex differences in impulsive action and impulsive choice

Here, we review the evidence for sex differences in behavioral measures of impulsivity for both humans and laboratory animals. We focus on two specific components of impulsivity: impulsive action (i.e., difficulty inhibiting a prepotent response) and impulsive choice (i.e., difficulty delaying gratification). Sex differences appear to exist on these measures, but the direction and magnitude of the differences vary. In laboratory animals, impulsive action is typically greater in males than females, whereas impulsive choice is typically greater in females. In humans, women discount more steeply than men, but sex differences on measures of impulsive action depend on tasks and subject samples. We discuss implications of these findings as they relate to drug addiction. We also point out the major gaps in this research to date, including the lack of studies designed specifically to examine sex differences in behavioral impulsivity, and the lack of consideration of menstrual or estrous phase or sex hormone levels in the studies.     

Joint maximum likelihood estimation of activation and Hemodynamic Response Function for fMRI

Blood Oxygen Level Dependent (BOLD) functional magnetic resonance imaging (fMRI) maps the brain activity by measuring blood oxygenation level, which is related to brain activity via a temporal impulse response function known as the Hemodynamic Response Function (HRF). The HRF varies from subject to subject and within areas of the brain, therefore a knowledge of HRF is necessary for accurately computing voxel activations. Conversely a knowledge of active voxels is highly beneficial for estimating the HRF. This work presents a joint maximum likelihood estimation of HRF and activation based on low-rank matrix approximations operating on regions of interest (ROI). Since each ROI has limited data, a smoothing constraint on the HRF is employed via Tikhonov regularization. The method is analyzed under both white noise and colored noise. Experiments with synthetic data show that accurate estimation of the HRF is possible with this method without prior assumptions on the exact shape of the HRF. Further experiments involving real fMRI experiments with auditory stimuli are used to validate the proposed method.     

Melioidosis in a returned traveller

Melioidosis is an infection endemic to Southeast Asia and Northern Australia, and is associated with significant morbidity and mortality. The present report describes a case of chronic melioidosis in a returning traveller from the Philippines. Clinical suspicion of this illness is warranted in individuals with a history of travel to endemic regions. Safety in handling clinical specimens is paramount because laboratory transmission has been described.     

右美托咪定用于减轻颅内动脉瘤患者麻醉诱导期血流动力学波动的临床价值

目的 探讨右美托咪定在颅内动脉瘤介入手术全身麻醉诱导期减少血流动力学波动中的应用.方法 选择全身麻醉下行颅内动脉瘤介入手术的患者60例,采用随机数字表法分为低剂量芬太尼组、高剂量芬太尼组和低剂量芬太尼复合右美托咪定组(复合组),每组20例.麻醉诱导前,复合组经微量泵持续静脉注射右美托咪定,总量1μg/kg,泵注时间10 min;低剂量芬太尼组和高剂量芬太尼组注射等量0.9％氯化钠.麻醉诱导时,低剂量芬太尼组和复合组静脉注射芬太尼3μg/kg、高剂量芬太尼组静脉注射芬太尼5μg/kg,余用药相同.记录入手术室平静休息3 min (T0)、气管内插管前即刻(T1)、插管后即刻(T2)、插管后3 min (T3)的收缩压(SBP)、舒张压(DBP)、心率(HR).将每例患者麻醉诱导期间(T0～T3)SBP、DBP、HR最大值与最小值之差定义为各参数的波动值:△SBP、△DBP、△HR.记录诱导期间麻黄碱、阿托品的使用情况.结果 复合组△SBP、△DBP、△HR[(26.9±14.8) mm Hg(1 mm Hg =0.133 kPa)、(10.7±8.9) mm Hg、(12.5±4.3)次/min]均低于低剂量芬太尼组[(40.4±15.6) mm Hg、(20.3±9.4) mm Hg、(30.1±15.0)次/min](P＜ 0.05),高剂量芬太尼组△SBP、△HR [(29.8±16.8) mm Hg、(19.5±7.4)次/min]均低于低剂量芬太尼组(P＜0.05),复合组△HR低于高剂量芬太尼组(P＜0.05).麻醉诱导期三组阿托品使用率比较差异无统计学意义(P=0.364),高剂量芬太尼组麻黄碱使用率高于低剂量芬太尼组[30％(6/20)比5％(1/20),P=0.032].结论 麻醉诱导前应用1μg/kg右美托咪定,既能够良好抑制插管反应,又不会导致插管后血压严重下降,达到了稳定血流动力学的目标,特别适用于颅内动脉瘤患者的麻醉诱导.     

LIS系统与东方旗云软件联合用于细菌耐药性统计优势

目的寻找准确、便捷的细菌耐药性统计系统。方法通过东方旗云软件与实验室细菌鉴定仪的连接，将细菌药敏结果直接导如whonet系统。结果可以准确、简便、快捷的统计细菌耐药性，以便监测细菌耐药趋势，合理指导临床用药。结论东方旗云软件可LIS系统联合在实验室信息系统管理与细菌耐药性统计方面有重要实用价值。     

开展实验室认证认可全面提升实验室规范化管理水平

从实验室认证认可的起源与发展、异同、基本内容及其在实验室管理体系中的地位与作用,阐明了通过积极开展实验室认证认可对实验室规范化管理的作用与意义.     

Evaluation of the CDC proposed laboratory HIV testing algorithm among men who have sex with men (MSM) from five US metropolitan statistical areas using specimens collected in 2011

BackgroundUntil recently most testing algorithms in the United States (US) utilized Western blot (WB) as the supplemental test. CDC has proposed an algorithm for HIV diagnosis which includes an initial screen with a Combo Antigen/Antibody 4th generation-immunoassay (IA), followed by an HIV-1/2 discriminatory IA of initially reactive-IA specimens. Discordant results in the proposed algorithm are resolved by nucleic acid-amplification testing (NAAT).ObjectivesEvaluate the results obtained with the CDC proposed laboratory-based algorithm using specimens from men who have sex with men (MSM) obtained in five metropolitan statistical areas (MSAs).Study designSpecimens from 992 MSM from five MSAs participating in the CDC's National HIV Behavioral Surveillance System in 2011 were tested at local facilities and CDC. The five MSAs utilized algorithms of various screening assays and specimen types, and WB as the supplemental test. At the CDC, serum/plasma specimens were screened with 4th generation-IA and the Multispot HIV-1/HIV-2 discriminatory assay was used as the supplemental test. NAAT was used to resolve discordant results and to further identify acute HIV infections from all screened-non-reactive missed by the proposed algorithm. Performance of the proposed algorithm was compared to site-specific WB-based algorithms.ResultsThe proposed algorithm detected 254 infections. The WB-based algorithms detected 19 fewer infections; 4 by oral fluid (OF) rapid testing and 15 by WB supplemental testing (12 OF and 3 blood). One acute infection was identified by NAAT from all screened-non-reactive specimens.ConclusionsThe proposed algorithm identified more infections than the WB-based algorithms in a high-risk MSM population. OF testing was associated with most of the discordant results between algorithms. HIV testing with the proposed algorithm can increase diagnosis of infected individuals, including early infections.     

右室双部位起搏与双室同步起搏的急性血液动力学对比研究

比较右室双部位 (RV Bi)起搏和双室 (BiV)同步起搏对血液动力学的影响 ,并与右室心尖部 (RVA)、右室流出道 (RVOT)、左室基底部 (LVB)起搏相比较 ,明确双部位起搏是否优于单部位起搏。 15例患者中病窦综合征 8例、Ⅲ度房室阻滞 7例。分别行RVA、RVOT、LVB、RV Bi、BiV起搏 (VVI,6 0～ 90次 /分 ) ,测定心输出量 (CO)和心脏指数(CI)、肺毛细血管嵌顿压 (PCWP)和QRS波时限 (QRSd)。结果 :①与RVA起搏相比 ,RVOT、LVB、RV Bi、BiV起搏CI分别增加了 7.5 %、11.3%、15 .5 %和 17.2 % ,PCWP分别降低了 14.9%、10 .3%、2 1.7%和 2 0 .0 % (P均 <0 .0 1)。②RV Bi、BiV起搏较RVOT、LVB起搏的CO、CI增高而PCWP降低 (P均 <0 .0 5 )。③RV Bi与BiV起搏、RVOT与LVB起搏之间CO、CI和PCWP无显著差异。④RVOT、RV Bi、BiV起搏的QRSd(分别为 12 8± 11,111± 16 ,10 3± 13ms)较RVA起搏 (146± 18ms)时显著缩短 (P≤ 0 .0 0 1) ,而LVB起搏 (142± 15ms)与RVOT、RVA起搏时无显著差异。结论 :RV Bi起搏和BiV同步起搏的急性血液动力学效果无明显差异 ,但双部位起搏的效果明显优于单部位起搏 ;双部位起搏的QRSd也比单部位起搏明显缩短     

Preservation of myocardial compliance and reversal of contracture (“Stone heart”) during ischemic arrest by applied intermittent ventricular stretch

The hypothesis was tested that intermittent myocardlal stretch could prevent or reverse the increased stiffness or contracture that occurs during severe ischemia. Isolated rabbit hearts with a fluid-filled left intraventricular balloon underwent 90 minutes of ischemie arrest at 35 °C. In the “no stretch” group (n = 10), the intraventricular balloon remained collapsed during the period of arrest; in the “stretch” group (n = 10) the balloon was expanded every 5 minutes to apply intermittent stretch to the arrested myocardium. Intermittent stretching completely prevented contracture during ischemia. In the no stretch group severe ischemic contracture developed, which increased the pressure in the arrested ventricle to 110 ± 14 mm Hg (mean ± standard error of the mean) after 90 minutes of ischemic arrest; in contrast, no contracture (0 ± 1 mmHg) developed in the stretch group during the period of ischemic arrest (p <0.001 versus the no stretch group). After 60 minutes of reperfusion, the stretch group continued to have less contracture (20 ± 4 mmHg versus 42 ± 7 mmHg, p <0.001). Recovery of contractile function was not impaired by the application of intermittent myocardial stretch. Developed pressure and the first derivative of left ventricular pressure ($\text{dP}\text{dt}$) recovered to a greater extent in the stretch group (38 ± 3 versus 27 ± 5 percent and 54 ± 1 versus 35 ± 7 percent, respectively, in the stretch versus the no stretch group), although these differences were not statistically significant (p = 0.10 to 0.05). Both groups had the same degree of tissue lactate accumulation during the ischemic period and the same levels of tissue edema, adenosine triphosphate and creatine phosphate at the end of the reperfusion period. The results indicate that intermittent myocardial stretch during ischemic arrest can prevent a decrease in diastolic compliance without decreasing recovery of contractile function; the intermittent stretch probably ruptured the rigor or contracture bonds that form during prolonged ischemia.