饮食服务业从业人员乙型肝炎病毒感染动态研究

目的为了解泰安市饮食服务业从业人员乙型肝炎病毒感染状况。方法应用ELISA方法在1995～1999年对53434名饮食服务业从业人员进行了血清HBsAg、抗-HBc、HBeAg和抗-HBe检测。结果1995～1999年饮食服务业从业人员血清HBsAg、抗-HBc、HBeAg和抗-HBe总阳性率呈逐年下降趋势,依次为4.41%、3.88%、3.46%、2.86%和2.50%,其差异有显著意义（χ     

The implementation of an infection control bundle within a Total Care Burns Unit

AimTo evaluate the impact of the implementation of a best practice infection prevention and control bundle on healthcare associated burn wound infections in a paediatric burns unit.BackgroundBurn patients are vulnerable to infection. For this patient population, infection is associated with increased morbidity and mortality, thereby representing a significant challenge for burns clinicians who care for them.MethodsAn interrupted time series was used to compare healthcare associated burn wound infections in paediatric burn patients before and after implementation of an infection prevention and control bundle. Prospective surveillance of healthcare associated burn wound infections was conducted from 2012 to 2014. Other potential healthcare associated infection rates were also reviewed over the study period, including urinary tract infections, pneumonia, upper respiratory tract infections and sepsis. An infection prevention and control bundle developed in collaboration between the paediatric burn unit and infection control clinicians was implemented in 2013 in addition to previous standard practice.ResultsDuring the study period a total of 626 patients were admitted to the paediatric burns unit. Healthcare associated burn wound infections reduced from 34 in 2012 to 0 in 2014 following the implementation of the infection prevention and control bundle. Pneumonia and sepsis also reduced to 0 in 2013 and 2014, however one upper respiratory tract infection occurred in 2013 and urinary tract infections persisted in 2013.ConclusionThe implementation of an infection prevention and control bundle was effective in reducing healthcare associated burn wound infections, pneumonia and sepsis within our paediatric burns unit. Urinary tract infections remain a challenge for future improvement.     

Two‐Stage Revision Hip Arthroplasty with or without the Use of an Interim Spacer for Managing Late Prosthetic Infection: A Systematic Review of the Literature

The aim of the present paper was to identify, appraise, and synthesize the available evidence on two‐stage revision hip arthroplasty with or without the use of an interim spacer for managing late prosthetic infection. The review methodology was designed by referencing the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) checklist and flow diagram, and a Population, Intervention, Comparator, Outcomes and Study (PICOS) design framework was used to search for studies to incorporate within the review. Two independent investigators were involved in searching for relevant articles that fulfilled the inclusion criteria for the study. Critical appraisal of the selected articles was carried out using the relevant Critical Appraisal Skills Programme checklists. From an initial pool of 125 articles, four studies satisfied the inclusion criteria and quality assessment and were included for final review. Two patient groups were identified from within the selected studies: spacer and non‐spacer. Both groups were assessed in terms of functional outcome, infection cure rates, and technical difficulties encountered during treatment. Better functional outcome was reported in the spacer group, both in the interim period between the two stages and after completion of treatment. The use of spacers reduced operative difficulty during the second stage and accelerated patient discharge. Reinfection and infection persistence rates were higher in the non‐spacer group. Within the spacer group, articulated spacers performed better in all parameters. The results of this review reinforce the available evidence supporting the use of interim hip spacers in revision hip arthroplasty for managing prosthetic infection and also indicate that articulated hip spacers could be an attractive option going forward.     

Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation

IntroductionImplant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].Presentation of caseA 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.DiscussionFactors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.ConclusionIntermittent suction worked well in this patient and, thus, warrants further study.     

高山红景天多糖对小鼠抗柯萨奇B5病毒感染能力的研究

对感染柯萨奇Ｂ５病毒（ＣＶＢ）小鼠模型研究结果表明，高山红景天多糖对发病小鼠心肌功能改善和免疫功能提高均具有明显的促进作用。增强了小鼠抗ＣＶＢ５感染的能力，并对由ＣＢＶ感染性疾病也有一定的防治作用。     

Urinaryα 1 as an index of proximal tubular function in early infancy

Urinary ₁-microglobulin (U-A₁M) was measured in healthy term infants on days 1, 4, 7, 14, 28, 90 and 180 of life. U-A₁M was high until day 14 and declined thereafter. It was significantly correlated with urinary ₂-microglobulin (U-B₂M) throughout the study, but not with serum A₁M on days 1 or 7. Similar to U-B₂M, U-A₁M in the clinically stable term infants with intrauterine growth retardation (n=4–7) was not elevated on days 1–7. In the sick infants who needed immediate resuscitatio at birth (n=4–8), U-A₁M as well as U-B₂M was high on days 1–7 and then decreased to normal levels, suggesting that U-A₁M can be used as a sensitive marker of acute proximal tubular damage and its recovery. These observations indicate that U-A₁M is a useful index of proximal tubular function in early infancy.     

The vesicocavernosus reflex: Role in the act of micturition

The paper studies the action and clinical significance of a reflex termed vesicocavernosus in 24 healthy volunteers (mean age 44.6 years, 15 men and 9 women). A balloon-tipped catheter was introduced into the urinary bladder and inflated with air in increments of 50 ml up to 300 ml. The response of the two cavernosus muscles to rapid vesical inflation and deflation, as well as to interruption and termination of micturition, was displayed on an EMG apparatus. The muscles contracted upon rapid vesical inflation or deflation, and upon the interruption or termination of micturition. These results were reproducible. In the male, bulbocavernosus muscle contraction seems to compress and expel the urine into the bulbous urethra. Ischiocavernosus muscle contraction helps to elevate the penile shaft. The role of the cavernosus muscles at micturition in women is unknown. The vesicocavernosus reflex could be of diagnostic significance in neurologic conditions.     

Klinische und funktionelle Ergebnisse der abdominalen Rektopexie unter Verwendung verschiedener Fixierungsgrundlagen

Zusammenfassung 63 Patienten wurden wegen eines Rektumprolaps durch eine abdominale Rektopexie (Operationsverfahren nach Ripstein-Corman) therapiert. Als Rektopexienahtlagermaterial wurden lyophylisierte Dura-Streifen, ein Vicryl-Netz oder ein Dexon-Netz verwendet. 71,4% (n = 45 von 63) des Kollektivs konnten nachuntersucht wurden, der Nachbeobachtungszeitraum betrug im Mittel 52,5 Monate. Die postoperative verfahrensbedingte Mortalität betrug 0%, im 30-Tage-Intervall nur 1,6% wegen kardialer Komplikationen. Intraoperative Komplikationen traten in 4,7% der Fälle auf. Die postoperative Morbiditätsrate betrug 25,4% (n = 16 von 63), infektbedingte Komplikationen wurden in 12.7% (n = 8 von 63) der Fälle beschrieben, davon 1 Fall mit einer spontan ausgeheilten pelvikutanen Fistel. Ein Rektumprolapsrezidiv zeigte sich in 4,4% (n = 2 von 45) der Fälle (nur Dura-Rektopexie), ein Schleimhautprolaps trat bei 15,5% (n = 7 von 45) der Fälle auf. Postoperativ reduzierten sich Obstipationsbeschwerden um 28,6% (n = 18 von 63) auf 22,2%. Bei Patienten mit einer präoperativen Inkontinenz wurde eine Verbesserung in 60,7% (n = 17 von 28) der Fälle erreicht, 35,7% (n = 10 von 28) waren vollständig kontinent. Die Steigerung der Kontinenzgrade durch eine abdominale Rektopexie ist statistisch signifikant (Wilcoxon-Test, p = 0,05). Die Einflußgrößen hohes Lebensalter, Prolapsanamnesedauer, Geburtenzahl und präoperative Inkontinenzdauer

---

Clinical and functional results after abdominal rectopexy: a comparison of dura strips. Vicryl and Dexon gauze as fixation material and suture placement (Ripstein-Corman procedure)

We report our results with abdominal rectopexy (modified Ripstein procedure, Ripstein/Corman) without resection of the colon in 63 patients using lyophylized dura-strips, Vicryl gauze or Dexon gauze, as the underlying fixation material for the mobilized rectum, presacral fascia and fixation suture material. Forty-five of 64 patients (71.4%) were reevaluated by proctoscopic examination and questioning; the mean follow-up time was 52.5 months (range 3–136 months). Postoperative mortality due to the method was 0%; the mortality was 1.6% (n = 1/63) in general for the first postoperative 30-day period as a result of cardiac complications. There were three complications (4.7%) the durating operation. Postoperative morbidity was 25.4% (16/63); infectious complications occurred in 12.7% (8/63) of cases, with one case of spontaneous closure of a pelvicutaneous fistula after intraoperative injury to the rectal wall. Full-thickness rectal prolapse appeared after rectopexy in 4.4% (2/45) (dura material alone) and mucosal prolapse was seen in 15.5% (7/45) of the follow-up group. Constipation was reduced by 28.6% (18/63) to 22.2% during the follow-up. Seventeen of 28 patients (60.7 %) with incontinence showed an improvement; total continence was registered in 35.7% (10/28). The increase in continence as a result of abdominal rectopexy was significant (Wilcoxon, P = 0.05). The special aspects of being in an older age group, having a long history of procidentia, the number of deliveries, the length of the preoperative incontinence period all showed no influence on the postoperative degree of continence (Spearman's rank correlation). In 7/15 cases with persisting incontinence after rectopexy, postanal repair (Parks) was efficient in 7/7 cases leading to total or partial continence. Abdominal rectopexy with the Ripstein-Corman procedure is generally recommended for the treatment of procidentia. Absorbable material for the Ripstein sling is preferred because of the low prolapse recurrency rate and the low infection rate; the absorbability of Vicryl or Dexon gauze might be of advantage in cases of pelvic sepsis after rectopexy, as removal of the gauze is not necessary. Resection of the colon as a treatment for severe constipation is not generally recommended.

     

Risk infection factors in the total hip replacement

Infection is a complication that occurs in a considerable percentage of hip prostheses replacements, being in many cases necessary to retire them, which generates important health and economical problems. Objectives: To know the distribution of infection and its risk factors in total hip replacement. Material and methods: A four year prospective study was developed in the rehabilitation and orthopedic center of La Paz Hospital. A total of 873 patients were included. Patients were controlled by means of active epidemiological surveillance until the day of discharge, listing up their characteristics at admission and risk factors during their stay. A multivariant study was carried out to determine risk factors. Results: Patients, average age was 63 years, 3.4% of them suffered from diabetes and there were no inmunocompromised patients. The percentage of wound infection during the four years was 6%, being reduced to 1.2% in the last year. The risk factors found in the multivariant study were: incorrect prophylaxis (OR: 3.85), wrong scaring (OR: 14.06), suffering more than one intervention (OR: 7.31) and a hospitalization period longer than 30 days (OR: 2.84). Conclusion: We think that special attention in the care of the surgical wound, as well as the correct use of prophylaxis, can significantly collaborate to the reduction of infection.     

Analysis of the soluble organic matrix of five morphologically different kidney stones

Our aims were to analyze the protein composition of the organic matrix of urinary stones and to investigate the role of albumin in its constitution. Five different morphological types of stones were studied. Proteins extracted from the stone were submitted to sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and analyzed by immunoblotting with antibodies to 13 urinary proteins. Nine of the 13 proteins were found in all types of stone: human serum albumin (HSA), ₁-acid glycoprotein (₁-GP), ₁-microglobulin (₁-M), immunoglobulins (Igs), apolipoprotein A1 (apo-A1), transferrin (Tr), ₁-antitrypsin (₁-T), retinol-binding protein (RBP) and renal lithostathine (RL). The ₂-microglobulin (₂-M) was present only in calcium oxalate and uric acid stones. In contrast, ceruloplasmin, haptoglobin and Tamm-Horsfall protein (THP) were detected in none of them. Because HSA appeared as the major protein component in all stones, we wondered whether it might play a specific role in the constitution of the stone matrix. Association of HSA with urinary proteins that were present in stones was demonstrated by showing that proteins present in the matrix comigrated with HSA on gel filtration, whereas proteins that were absent did not. Moreover, HSA induced the binding of stone matrix proteins to an albumin-specific affinity column. Finally, we evidenced HSA binding to calcium oxalate monohydrate (COM) crystals in a solution similar to urine. It was concluded that (1) only a subset of urinary proteins is present in stone matrix, (2) the same proteins are found in all types of stones, (3) HSA shows significant affinity for several proteins of the matrix, but not for proteins absent from stones and, (4) HSA also displays significant affinity for COM crystals.