心脏手术相关医疗纠纷的法医学分析

目的分析心脏手术相关医疗纠纷的临床及法医学特点,并就发生原因进行剖析及提出相应防范措施。方法对2002年1月-2011年12月四川华西法医学鉴定中心受理的四川省各级医疗机构发生的17例与心脏手术相关的医疗纠纷法医学鉴定资料进行回顾性分析。结果17例心脏手术相关医疗纠纷中,12例进行了尸体解剖死因鉴定,死亡原因有心脏传导系统出血,术后感染,低心排量综合症、肺动脉高压、失血性休克致死等。其余5例加上尸体解剖2例在内共7例进行了医疗过错鉴定,存在的医疗过错包括术前检查不完善,告知不充分,手术操作不细致,术后观察、处理不足,医疗记录不完整等。结论心脏手术相关医疗纠纷与术后并发症关系密切,医护人员应重视对心脏术后并发症的防治。尸体解剖对解决心脏术后死亡引起的医疗纠纷具有重要意义。     

RNA恒温扩增实时检测技术快速鉴定鸟分枝杆菌

目的建立RNA恒温扩增技术快速鉴定鸟分枝杆菌(RIARD-MA)的方法,评估鉴定分枝杆菌临床分离株的应用效果。方法以鸟分枝杆菌(MA)的16S rRNA的特异序列为检测靶标,设计RNA探针和带有T7启动子的逆转录扩增引物,42℃恒温扩增实时检测,对21种分枝杆菌标准株、4株非分枝杆菌和259株分枝杆菌临床分离株进行鉴别检测;同时以PCR测序结果为参考对照。结果 RIARD-MA可以在2 h内完成检测,能准确鉴定出21种分枝杆菌标准株及4株非分枝杆菌检测中的MA,检测灵敏度达103CFU/mL;检测分枝杆菌临床分离株中MA的敏感性、特异性均可达100%。结论 RIARD-MA鉴定MA具有较高的敏感性、特异性,检测快速,有望作为一种新的MA临床分离株鉴定方法。     

肝癌早期鉴定标志物研究进展

肝癌全球发病率不断增高,多数病人确诊时已不能进行有效的治疗。因此寻找能够早期鉴定肝癌的标志物成为降低肝癌致死率的重要举措之一。肝硬化病人传统的定期超声波检测以及血清AFP含量检测灵敏度和准确率有限。目前科学家正致力于寻找一系列高效的生物标志物检测早期肝癌,取得了一定的成效,为以后肝癌的早期鉴定提供了一种科学的方法。     

医院内假丝酵母菌感染的菌种构成和耐药性分析

目的 分析医院内感染假丝酵母菌菌种构成和耐药性。 方法 对临床标本分离的酵母样真菌,用VITEK-Ⅱ(生物梅里埃公司)生化鉴定仪、API20c生化鉴定试纸条和念珠菌显色琼脂以及聚合酶链反应(polymerase chain reaction, PCR)方法进行酵母样真菌菌种的鉴定,应用ATB Fungus3 进行药敏试验。 结果 96株酵母样真菌,可分为6个种,包括白色念珠菌40株 (41.7%)、热带念珠菌36株 (37.5%)、光滑念珠菌13株 (13.54%)、近平滑念珠菌5株 (5.21%)、克柔念珠菌1株 (1.04%)、挪威念珠菌 1株(1.04%)。各种假丝酵母菌对5种抗真菌药呈现不同的敏感性,对两性霉素B和5-氟胞嘧啶的敏感率为100%,而对氟康唑、伊曲康唑、伏立康唑则表现出一定的耐药性。 结论 基因间隔转录区分子生物学分析结合传统培养和生化方法,可有效提高假丝酵母菌鉴定的准确性。本研究结果提示医院内非白假丝酵母菌感染有增多趋势。重症监护病房(intensive care unit, ICU)是重要的假丝酵母菌来源科室。60岁以上的老龄患者是医院内真菌感染的高危人群。体外药敏试验提示部分假丝酵母菌出现了唑类药物(氟康唑和伊曲康唑)的耐药性。     

林县互隔交链孢霉素A的分离结构鉴定和致突变性研究

交链孢霉能够引起多种植物疾病,如烟草的棕色斑点症;土豆,西红柿的枯萎症;日本梨的黑点症等。其原因是由于交链孢霉能     

Identification of Actinobacillus actinomycetemcomitans: polymerase chain reaction amplification of IktA–specific sequences

Actinobacillus actinomycetemcomitans has been strongly implicated in the etiology of localized juvenile periodontitis. Techniques used in the identification of this periodontal pathogen include cultural, biochemical, immunological and DNA hybridization analysis. In this study, we report the use of polymerase chain reaction (PCR) to amplify unique sequences of A. actinomycetemcomitans. Specific oligo-nucleotide primers LKT2 and LKT3 were designed to hybridize to the A. actinomycetemcomitans lktA gene, which encodes leukotoxin, a putative A. actinomycetemcomitans virulence factor. The LKT2 and LKT3 primers amplified lktA-specific sequences from all 12 A. actinomycetemcomitans strains tested. In another set of experiments, 13 other bacterial species, most of which are normal residents of the oral cavity, were tested with these primers. These PCR amplifications also contained 2 additional primers, RRN4 and RRN5, which served as positive controls; RRN4 and RRN5 were designed to amplify specific sequences of eubac-terial 16S ribosomal DNA (rDNA). PCR amplifications of all bacterial species tested, including A. actinomycetemcomitans , yielded 16S rDNA-specific DNA fragments. Furthermore, each bacterial species tested, with the exception of A. actinomycetemcomitans , failed to amplify lktA sequences. The LKT and RRN primers were used in further PCR experiments to detect A. actinomycetemcomitans directly from gingival fluid samples. The results clearly demonstrate the simplicity, rapidity, specificity and accuracy of the LKT primers in the identification of A. actinomycetemcomitans.     

广州市一起志贺氏菌痢暴发的分子流行病学分析

本文对61株福氏2a(Shigella flexneri 2a)分离株进行了耐药谱、质粒图谱、菌落原位杂交和Southern blot分析。结果显示:从广州1992年暴发的一起菌痢流行中分离的30株暴发株和当年在广州分离的28株散发株的耐药谱和质粒图谱相同,而且菌落原位杂交证明它们均有4.7kb的ipaBC基因,Southern blot进一步指出了上述分离株的ipa BC基因位于7.6kb,2.5kb和1.6kb的EcoR Ⅰ片段。从分子水平证明了1992年广州市一起志贺氏菌痢(幅氏2a)暴发为单一克隆株引起,该克隆为当地1992年福氏菌的优势克隆。而福州1991年分离的3株同型菌分属不同的克隆。     

黄花败酱皂甙的分离鉴定

从黄花败酱根茎中用柱层析方法分离出一单体化合物，经化学反应和光谱分析鉴定为齐墩果酸－3－β－0－α－L－鼠李吡喃糖基（1→2）－α－L－阿拉伯吡喃糖甙，即β-常春藤素（β-hederin）．     

抗氧化性样品的剖析

从一份抗氧化性样品中分离出三个组分（Ⅰ、Ⅱ和Ⅲ）。组分Ⅰ经元素分析和ＩＲ光谱鉴定证明是双苯胺棉酚，这个鉴定结果和先前的１ＨＮＭＲ鉴定结果是一致的。组分Ⅱ通过元素分析、质谱和ＩＲ光谱鉴定证明是三聚氰胺。组分Ⅲ，ＩＲ光谱鉴定证明是次磷酸二氢纳。分离过程的平均回收率为（９７．２±３．２）％．     

Simple and rapid identification of low level hepatitis B virus DNA by the nested polymerase chain reaction

A rapid and sensitive method has been developed to detect hepatitis B virus DNA (HBV) by nested polymerase chain reaction (PCR) technique with primers specific for the surface and core regions in capillary thermal cycler within 80 min. The lower limit for detection by present PCR method is 10⁻⁵ pg of recombinant HBV DNA which is equivalent to that determined by one round of PCR amplification and Southern blot hybridization analysis. When boiled HBV positive serum was serially diluted 10-fold, HBV DNA was successfully determined in 1 μl≈10⁻³ μl of serum. HBV DNA was detected by present method in 69 clinical samples including HBsAg positives and negatives by enzyme-linked immunosorbent assay (ELISA). When serum samples were amplified by nested PCR using surface and core region primers, HBV DNAs were detected in 37 of 69 samples (53.6%) and 18 of 69 samples (26.1%), respectively. These results can inform the infectious state of HBsAg positive pateints. A simple and rapid nested PCR protocol by using boiled serum as DNA template has been described for the clinical utility to determine HBV DNA in human serum.