脊柱后路内固定术后迟发性感染的治疗

目的：探讨脊柱后路内固定术后迟发性感染的发生原因和有效治疗方法。方法：12例患者分别在术前和术中窦道分泌物取样行细菌培养，培养时间为7d以上。3例先行抗炎、窦道搔刮或切开清理、置管冲洗引流，均未见效而改行内固定物取出术。另9例在明确诊断后即行积极的内固定物取出术。术中仔细观察软组织和骨质的变化，术后抗炎。结果：7例细菌培养阳性。3例为微球菌，4例为粪链球菌。另5例为阴性。术前和术中2次取样培养结果一致。3例先行保守治疗者改行内固定物取出术后伤口及窦道顺利愈合，平均住院时间40d。另9例在明确诊断后即行内固定物取出术，术后伤口及窦道顺利愈合，平均住院时间14d。术后抗生素的应用时间为12－14d。随访3－12个月感染无复发。术中发现9例窦道与椎弓根螺钉属部相通，原发病灶仅为在该处的局限性肉芽病灶、有少许脓块，该钉尾的固定螺帽有松动。病灶不向深处累及椎弓根和椎板，椎弓根钉本身无松动；另3例窦道与横向连接杆的一端相通，原发病灶亦为一小的局限肉芽组织团块。结论：脊柱后路内固定术后发生的迟发性感染通常是由低毒性细菌引起的局部软组织感染，骨质未受侵蚀，对这一感染引起的窦道、流脓采取抗炎、局部处理效果差，而积极的内固定物取出术是有效的控制感染的手段。     

Malaria and haemoglobin A2 levels in northern Liberia.

The influence of malaria on HbA2 levels was investigated in two groups of children aged two to nine years from the Mano tribe of northern Liberia. One group, 174 children living in a town where there is malaria control, had a parasite rate of 6.5%, only a few having palpable spleens, but 282 children living in an area of intense malaria transmission had a parasite rate of 92%. All but one child in this group had enlarged spleens. However, the difference in proportions of elevated HbA2 values within the limits for beta-thalassaemia, 8% and 10.3% respectively, was not statistically significant (0.5 greater than P greater than 0.1). It was concluded that the influence of malaria on HbA2 levels is not significant and that this parameter is valid for detecting beta-thalassaemia trait in this population. Further, iron deficiency may be a more important factor than malaria to consider when assessing the results of HbA2 estimations.     

Development of the serological response in rabbits infected with Toxocara canis and Toxascaris leonina

The indirect fluorescent antibody test using frozen sections of infective Toxocara canis and Toxascaris leonina eggs, and the enzyme linked immunosorbent assay using homogenized Toxocara canis embryonated egg extract and T canis excretory-secretory products as adsorbed antigens were used to determine the specificity and development of circulating antibodies in rabbits. Frozen sections were subdivided into four morphologically distinct compartments for analysis of the development of the circulating antibody response. The fluid surrounding the larva was the most reactive up to 21 days after infection, and this material was found to be predominantly excretory-secretory in nature. As the infection progressed antibodies directed against ‘somatic’ tissue materials increased. Cross reactions between sera from rabbits infected with T. canis eggs and Toxascaris leonina frozen sections, and rabbits infected with T. leonina eggs and Toxocara canis frozen sections occurred between both the excretory-secretory fluid and somatic components of the infective eggs. These results were substantiated using the enzyme linked immunosorbent assay. When T. canis excretory-secretory antigen was used, an earlier response (peak day 21) was detected than when using T. canis embryonated egg extract (peak day 35). However, cross reactions between T. canis excretory-secretory antigen and sera from rabbits infected with Toxascaris leonina occurred, indicating that the serodiagnosis of visceral larva migrans using Toxocara canis excretory-secretory antigen may still prove unsatisfactory when considering the role of Toxascaris as a possible causative agent.     

半导体激光模拟根管内照射抗菌效应的实验研究

目的评价半导体激光对三种细菌的杀菌效果。方法用2mW的半导体激光对三种细菌悬液分别照射1、3、5分钟后，计算其杀菌率。结果激光对各菌种的杀菌率依次为产黑色素杆菌48．26％、70．37％和90.65％；消化链球茵为57．04％、74．50％和90．69％；核梭杆菌为52．43％、78．14％和90．23％。结论半导体激光对三种细菌均有一定的杀灭作用，激光杀菌率随照射时间的增加而增强。     

四种口罩的临床评价和细菌学研究

研究了不同材料和层厚口罩的透气舒适度和抗菌性能。选用４层抗菌纱布口罩、无纺布纸质口罩、８层普通纱布口罩和对照用４层普通纱布口罩。３０名病房护士４天轮流戴４种口罩，进行临床应用评价和细菌学实验研究。结果：透气度、抗湿度、舒适度评价以４层纱布最好；细菌学指标以抗菌口罩组最好，而纸质口罩不够理想。结论：抗菌口罩效果良好；纸质口罩需注意防潮，不宜长时间使用；口罩层厚有利于阻隔细菌，不利于透气舒适等感受指标。     

手术室医护人员手卫生调查分析与对策

目的：对手术室医护人员手污染的细菌学进行调查。方法：随机选取上班后1—2h间的手术室医务人员96名进行手部采样。结果：20名医护人员手细菌菌落数≥5cfu/cm^2，其中麻醉医师13名，占13．54％，护士7名，占7．29％。结论：医护人员应强化洗手意识，正确的洗手方法是最基本、最简便易行和必要的预防和控制病原体传播的有效手段，是减少院内感染有效的措施之一。     

2型糖尿病患者记忆功能障碍及健康教育对策

2型糖尿病患者人数正随着人民生活水平提高、人口老龄化、生活方式的改变而迅速增加，2型糖尿病患者即使不发生脑卒中或严重的低血糖，仅持续的高血糖即可导致中枢神经系统功能损伤而影响大脑认知功能，甚至发生痴呆，从而降低了患者的生活自理能力、糖尿病自我监测能力及生活质量。所以，对2型糖尿病患者日常生活记忆能力的监测非常重要。     

Changing Patterns of Bacterial Strains in Adults and Children With Otitis Media in Korean Tertiary Care Centers

Objectives

Otitis media (OM) is an infectious disease that affects all age brackets. Aural discharge is a typical symptom, occurring in all subtypes of OM. We have compared the identity and antibiotic sensitivity of bacteria isolated from aural discharges of adults and children with various types of OM, including acute OM (AOM), OM with effusion (OME), chronic OM (COM), and cholesteatomatous OM (CSOM).

Methods

The study involved 2,833 patients who visited five tertiary hospitals between January 2001 and December 2010 and were diagnosed with AOM, OME, COM, or CSOM. The patients were divided into a pediatric group and an adult group, and the distribution of cultured bacteria and their antibiotic sensitivity were compared in the two groups.

Results

Bacterial detection rates were higher in adults than in children with OME and COM (P=0.000 each). The majority of the bacteria cultured from patients with AOM and OME bacteria were methicillin-susceptible Staphylococcus aureus (MSSA) and Streptococcus pneumoniae. Bacteria cultured from children were more susceptible to antibiotics (P=0.002) and had higher antibiotic sensitivity (P=0.001) than were bacteria cultured from adults. The majority of bacteria culture from patients with COM and CSOM were MSSA and pathogenic Pseudomonas aeruginosa. The frequency of methicillin-resistant Staphylococcus aureus was significantly higher in adults than in children, and more strains of bacteria isolated from adults were sensitive to the antibiotics septrin, vancomycin, and teicoplanin.

Conclusion

Bacteria cultured from children were more susceptible to antibiotics and had higher antibiotic sensitivity than did bacteria cultured from adults.