2016至2018年某医院真菌血流感染者流行病学特征及耐药性分析

目的分析真菌性血流感染的病原菌分布以及耐药特征，为真菌血流感染的早期合理用药提供理论依据。 方法回顾性分析武汉大学人民医院2016年1月至2018年12月收治的真菌性血流感染者的菌群、科室分布以及耐药性。 结果入组192例真菌血流感染者的血培养样本中共分离192株真菌，其中白色念珠菌检出率为31.77%（61/192），其次热带念珠菌检出率为18.75%（36/192）；重症医学科检出率最高为33.85%（65/192）。所有菌株均对两性霉素B敏感，对其他抗菌药物耐药率分别为5-氟胞嘧啶4.49%（9/192）、伊曲康唑5.73%（11/192）、氟康唑10.94%（21/192）和伏立康唑11.46%（22/192）；除两性霉素B外，2016至2018年真菌对其他抗菌药物的耐药率均逐年上升，其中2018年所分离192株光滑念珠菌对伊曲康唑耐药菌率达46.7%。 结论真菌血流感染病原菌以念珠菌属为主，对目前抗真菌药物具有较高敏感性，但耐药率逐年上升，加强监测血培养病原菌变化及耐药趋势对指导临床用药至关重要。     

Does a common pathophysiological basis exist in the association of ulcerative colitis and Takayasu's aortitis? Report of a case.

A case of a young Japanese woman with long-standing ulcerative colitis complicated by preinfarction angina due to Takayasu's aortitis is presented. Successful emergency aorto-coronary bypass operation was performed. Whether the association of these two diseases can be explained by a common mechanism is discussed.     

热分析中系列相关反应的补偿效应研究

根据热分析谱图峰顶的数学特征与Ｃｏａｔｓ－Ｒｅｄｆｅｒｎ方程，推得在一定实验条件下，在系列相关反应中，若峰顶温度相接近，则各反应的表观活化能Ｅ与指前因子Ａ之间存在着有动力学意义的补偿效应，即ｌｎＡ＝ａＥ＋ｂ。并经系列含水硫酸盐脱水反应实验验证。     

Microsurgical resection of ventral foramen magnum meningiomas via a far-lateral suboccipital approach

BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial. OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach. DESIGN: Retrospectively clinic case investigation. SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three. METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up. MAIN OUTCOME MEASURES: Operative effect. RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans. CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up.     

锰超氧化物岐化酶模型配合物的研究

为探索天然超氧化物岐化酶（ＳＯＤ）岐化超氧离子的机理，及用于临床的可能性，我们合成了乳酸、柠檬酸和酒石酸的锰（Ⅱ）配合物作为Ｍｎ－ＳＯＤ的模拟物，用光照法测定了它们的活性，得到了有意义的结果：锰配合物作为Ｍｎ－ＳＯＤ的模拟物，有肯定的活性，其中以乳酸锰配合物活性最高。     

氟康唑治疗念珠菌性龟头包皮炎53例疗效观察

目的　探讨氟康唑对念珠菌性龟头包皮炎的临床疗效。方法　将 98例患者随机分为两组 ,治疗组 ( 5 3例 )口服氟康唑 15 0mg ,qd× 5d ,用药期间停用其它的口服药及外用真菌药 ;对照组 ( 4 5例 )用霉克霜外搽患处 ,bid ,连用 2W ,用药期间停用口服药。结果　治疗组痊愈率为 90 .5 7% ,总有效率为 98.11% ;对照组痊愈率为 2 .2 2 % ,总有效率为 66.67% ,治疗组均显著高于对照组 (P均 <0 .0 1)。结论　氟康唑治疗念珠菌性龟头包皮炎疗效满意     

螺旋CT扫描与多模式三维重建诊断腰椎间盘突出症

目的 探讨螺旋CT扫描容积数据与三维重建诊断腰椎间盘突出症(LDH)的价值。资料与方法 94例行连续容积扫描：准直3～5mm，螺距1．5～3．0，以1．3～2．7mm间距后重建；源影像输入AW4．0工作站，应用多平面重建(MPR)、表面遮盖显示(SSD)和仿真内镜(VE)等软件显示病变，并与椎间盘镜(MED)诊治对照。结果 8例正常；LDH86例：中央型、侧旁、椎间管、椎管外、侧方及混合型分别为19、39、5、2、3、18例。三维重建显示LDH的立体结构为堤坡形、扁丘形、尖丘形、双(多)丘形及游离形分别为34、26、9、5、2例。VE诊断LDH的准确度、灵敏度、特异度分别为95％、100％、80％。VE能模拟MED效果。结论 容积数据与多模式三维重建能提供诊断LDH更全面的信息，并模拟微创手术治疗。     

噪声对耳蜗外淋巴中某些离子含量的影响

将１８只豚鼠分为１个对照组和２个暴露组，分别暴露于１１５ｄＢ（ＳＰＬ）、１２５ｄＢ（ＳＰＬ），１．５ｋＨｚ纯音０．５ｈ，以皮层听区诱发电位为检查指标，观察暴露前后动物听力的改变，并测定了耳蜗外淋巴中Ｎａ＋、Ｋ＋、Ｃａ２＋、Ｍｇ２＋离子含量的变化。结果表明，声暴露后各组动物听阈明显提高，且１２５ｄＢ组听力损失明显高于１１５ｄＢ组。１２５ｄＢ声暴露后，耳蜗外淋巴中Ｃａ２＋明显降低，而１１５ｄＢ组与正常对照组相比差异无显著性。声暴露对其它离子的含量没有影响。结果提示Ｃａ２＋可能与声损伤，特别是与永久性听力损失有关。