儿童医院多药耐药菌分布及耐药性变迁

目的监测多药耐药菌(MDRs)在儿童医院的分布及其耐药性变化,为临床合理使用抗菌药物及采取有效的预防控制措施提供依据。方法收集2010年1月-2012年12月7个临床重点科室住院患者的各类阳性标本5 904份,分离到MDRs776株,采用美国BD公司生产的phoenix 100全自动分析仪进行微生物菌株鉴定及药敏分析。结果 MDRs在临床科室分布广泛,MDRPA主要分布在急救内科,占33.9%,MDRAB主要分布在新生儿科,占45.1%,MRSA主要分布在普外科,占46.2%;MDRs在不同的标本中所占比例不同,其中MDRPA、MDRAB在痰液中分布最高,分别占77.4%、91.8%,MRSA在脓液分布最高,占46.2%;MDRPA对磺胺甲噁唑/甲氧苄啶、氯霉素、头孢曲松的耐药率>80.0%,MDRAB对大多数抗菌药物耐药率均>50.0%,其中对头孢类抗菌药物的耐药率>70.0%,MRSA对万古霉素、磺胺甲噁唑/甲氧苄啶、庆大霉素等耐药率<40.0%,但由于有些药物的不良反应不能用于儿童,应慎用或禁用。结论在不同科室多药耐药菌分布存在差异性,因此要根据科室特点有针对性加强多药耐药菌的管理,促进抗菌药物临床合理应用能力和管理水平持续提高。     

Influences of diet on caries activities and caries-risk grouping in children,and changes in parenting behavior

BackgroundDental caries incidence in early childhood is known to influenced by the behavior of parent with their children, and clinicians and dental staff are advised to provide parents with effective oral health instructions. The objectives of this study were to identify the influence of diet of 18- and 24-month-old children on caries activities and investigate changes related to the behavior of their parents after receiving health instructions regarding caries risk for 2-year-old children.MethodsThe subjects were 1,206 child-parent pairs. The children participated in 18-, 24-, and 42-month-old health examinations at Kurashiki City Public Health Center in Kurashiki City, Japan. Cariostat, a caries activity test (Dentsply-Sankin Co., Tokyo), was conducted and the children were then classified into 6 caries-risk groups based on the 42-month-old predictive cutoff points. Their parents were given oral health instructions on caries prevention by dental hygienists of the Kurashiki City Public Health Center. In addition, a questionnaire regarding diet was given to identify its influence on caries activities in 18- and 24-month-old caries activities in 18- and 24-month-old children, as well as the influence of changes in parenting behavior.ResultsA significant number of children in the high-risk group received breast feeding or bottle-feeding with liquids other than water at 18 months of age. Also total time for sucrosecontaining food intake was significantly associated with increased caries activity at 18 months of age. After giving oral health instructions to parents of the 18-month-old children dietary habits significantly correlated with the high-risk group at 24 months of age were breast feeding or bottle-feeding with liquid other than water, total intake time of sucrose-containing food, and frequency of sucrose-containing foods intake. Furthermore, parents whose children were in the higher caries-risk group at 18 months of age showed a lower level of change in parenting behavior as compared to those with children in the lower caries-risk group.ConclusionIt is important to assess problematic dietary habits in accordance with caries-risk in young children and change parent behavior through effective oral health instructions.Clinical ImplicationClinicians can identify problematic dietary habits in children based on caries-risk and provide effective oral health instructions to parents, which may influence.     

鹰潭市1957-2009年甲乙丙类传染病流行趋势分析

目的掌握鹰潭市自成立防疫机构以来法定甲乙丙类传染病的流行趋势,为制定传染病防控策略与措施提供科学依据。方法采用描述流行病学和COX-Stuart趋势检验方法进行资料分析。结果年均发病率、死亡率和病死率1957-2009年总体都呈下降趋势(均n=26,P<0.01),且近10年比50年代均下降85%以上,但2000年后又有所上升。呼吸道传染病年均发病率1997年后13年明显呈上升趋势(n=6,P>0.25),血源及性传染病年均发病率近20年总体呈上升趋势(n=10,P>0.25)。构成比分析:20世纪50~80年代呼吸道传染病最高>63.36%,90年代代之肠道传染病最高63.74%,近10年以肠道(36.65%)和呼吸道(34.94%)传染病为主,血源及性传染病已升至27.79%。发病谱分析:在前10位不重名的20个病种中,有65%的病种随年代顺位变迁处于下降及趋于下降趋势。结论鹰潭市甲乙丙类传染病53年总体呈下降趋势,但呼吸道和血源及性传染病近些年来呈上升趋势,它应是鹰潭市现阶段传染病防控工作的重点。     

大鼠增龄中胰腺超微结构的变化及胰岛的分布

目的 观察胰腺超微结构的增龄变化及胰岛的分布.方法 幼年、青年、老年SD大鼠各10只,每只取胰头、体、尾行光镜和透射电镜观察.结果 老年鼠胰腺外分泌部的腺细胞线粒体脱嵴肿胀,粗面内质网扩张;内分泌部B细胞分泌颗粒数量减少,粗面内质网脱粒,线粒体减少.光镜观察幼鼠胰头、胰体、胰尾胰岛的数目是(2.323±0.036)个、(7.661±0.196)个和(15.293±0.821)个(P＜0.01);老年鼠、青年鼠、幼鼠胰尾胰岛的数目是(1.875±0.021)个、(2.838±0.067)个和(15.293±0.821)个(P＜0.01).结论 胰腺细胞和B细胞呈现与年龄相关的结构变化,胰岛的分布以幼鼠胰尾数目为最多,提示胰腺移植的供体以幼年胰尾为佳.

Abstract：

Objective To study the changes of the ultrastructure of pancreas and distributive pattern of islet with age, to supply reference for the pancreas transplantation. Methods The 30 healthy SD rats were divided into 3 groups: young group, adult group and aged group. The pancreas heads, body and tail of each rat were observed under the light microscope and transmission electron microscope. Results In aged rats, the mitochondria of gland cell of the exocrine portion were hypertrophic and their cristae fell off, the rough surfaced endoplasmic reticula were dilated. In the endocrine portion, the numbers of B cell were reduced, the granules of rough surfaced enjoplasmic reticulum fell off and the mitochondria were reduced. The numbers of B cell in pancreatic head, body and tail of young rat were 2. 323 ±0. 036, 7. 661 ±0. 196 and 15.293 ±0. 821 ( P ＜0. 01 ). The numbers of B cell in pancreatic tail of young rat, adult group and aged group were 1. 875 ± 0. 021,2. 838 ± 0. 067 and 15.293 ± 0. 821 ( P ＜ 0. 01 ). Conclusion The gland cell of exocrine and the B cell of endocrine of pancreas occurred in the structural change correlated to the age. The distribution of pancreas islet was large in number in pancreatic tail of young rat. It is suggested that in the donor for pancreas transplantation the tail from young rat is preferable to that of the aged.     

可吸收腰椎间融合器的生物力学研究

目的通过动物实验观察可吸收材料聚-D,L-乳酸﹙PDLLA﹚腰椎间融合器植入椎体后,在降解过程中的变生物力学变化规律。方法将可吸收腰椎间融合器通过手术植入到犬椎体,经过12、24和36周后分别取材,测定不同时间椎体的轴向抗压强度和抗扭转强度。结果轴向压缩载荷实验显示术后12周,实验组抗压强度明显高于对照组﹙<0.05﹚;术后24周显示,实验组的抗压强度显著下降﹙<0.05﹚,对照组的抗压强度有所上升,但不显著﹙>0.05﹚,实验组的抗压强度明显高于对照组﹙<0.05﹚;术后36周显示实验组抗压强度无显著性下降﹙>0.05﹚,实验组的抗压强度与对照组相比无显著性差异﹙>0.05﹚。抗扭转实验显示,术后12周,实验组的抗扭转强度明显高于对照组﹙<0.01﹚;术后24周显示,实验组的抗扭转强度显著下降﹙<0.01﹚,对照组的抗扭转强度有所上升,但不显著﹙>0.05﹚,实验组的抗扭转强度明显高于对照组﹙<0.01﹚;术后36周显示实验组抗扭转强度无显著性下降﹙>0.05﹚,实验组的抗扭转强度与对照组相比无显著性差异﹙>0.05﹚。结论高分子材料PDLLA的椎间融合器在植骨融合过程中,其力学强度逐渐下降,但在植骨融合部位获得牢固融合前,能维持较高的力学强度,保证了植骨融合的顺利实现,同时由于其最终降解吸收,不会对骨的生长产生应力遮挡,具有一定的积极意义。     

胸内结节病的MSCT诊断与鉴别诊断

目的 探讨胸内结节病的CT表现,提高对胸内结节病的影像学认识.方法 采用GEPROSPEED FⅡ双排CT机,回顾性分析近年来收集到的10例结节病患者的MSCT表现,全部病人均行常规平扫及增强扫描.所有病人经临床规范激素治疗有效或活检证实.结果 10例中3例为双侧肺门淋巴结肿大,6例为肺门淋巴结肿大伴肺内间质改变,1例...     

长春西汀与奥扎格雷联合治疗急性脑梗死疗效观察

目的：探讨长春西汀联合奥扎格雷治疗急性脑梗死的临床疗效。方法：分析80例急性脑梗死患者的资料,根据其治疗方式分为对照组及治疗组各40例,两组均给予奥扎格雷注射液治疗,观察组加用长春西汀,连续治疗2周,采用NIHSS评分系统对两组患者神经功能进行评价,Baethel指数对日常生活能力进行评价,治疗前后测定患者血液流变水平。结果：观察组患者NIHSS评分、Baethel评分、血液流变指标改善均优于对照组,两组比较差异有统计学意义（P〈0．05）。结论：长春西汀联合奥扎格雷治疗急性脑梗死可显著提高神经功能,改善血液流变指标,效果满意。     

2型糖尿病视网膜病变中医证候学研究

目的：本研究针对2型糖尿病视网膜病变开展临床证候学研究,为2型糖尿病视网膜病变临床规范化辨证和治疗提供参考依据。方法：调查北京中医药大学东直门医院肾病内分泌科确诊为2型糖尿病视网膜病变的患者104例,采集信息,录入数据,对资料进行统计学分析。结果：104例DR患者中,证候出现频率：痰湿证〉血瘀证〉阴虚证〉气郁证〉湿热证〉气虚证出现频率均超过50％,表明此次研究样本在证候分布上正虚以阴虚、气虚为主,标实以痰湿、血瘀、气郁、湿热为主。结论：1）DR病情与患者年龄关系不大,而与DM病程长短呈密切相关性。2）糖尿病肾病、高血压病、高尿酸血症与DR的发生发展关系密切,具有重要的提示意义。3）多证组合、虚实夹杂是DR显著的证候特点。证候演变符合阴虚一气阴两虚一阴阳两虚,阴虚贯穿病变的始终。4）糖化血红蛋白水平与DR痰湿证、湿热证程度有正向联系,尿微量白蛋白水平与DR患者阳虚证、痰湿证程度有正向联系。出血、硬渗、软渗眼底微观改变与阳虚证表现程度呈正向相关。     

慢性心力衰竭患者血浆NT-proBNP的变化及其意义

目的:探讨慢性心力衰竭患者血浆N末端B型利钠肽原( NT - proBNP)的变化及其临床意义.方法:选取CHF患者60例,于治疗前后分别测定血浆NT- proBNP水平,并对其进行为期1年的随访,记录心血管事件.结果:在正规抗心衰治疗症状明显改善后,NT-proBNP水平较治疗前明显下降(P＜0.05);发生心血管事件的患者(18例)血浆NT - proBNP( 5548.11±1575.17) pg/ml,明显高于未发生心血管事件组(42例)(3245.26±1502.45) pg/ml(P＜ 0.05);未发生心血管事件组的患者较发生心血管事件组的患者在心衰症状明显改善后的血浆NT - ProBNP水平下降更明显(3030.38±1390.86,2221.89±1471.31)pg/ml(P＜0.05).结论:血浆NT-proBNP是心功能紊乱时最敏感和特异的指标之一,我们用NT - proBNP来诊断心衰和评估心功能状态的同时还可以用它来判断预后和指导治疗.