两出口的医院网络用户管理解决方案

目的：由于办公需要，将以前走电信出口的图书馆、医疗二系及研究生处的用户改道为走科研教育网出口，和华中科技大学校总部相连，并在不改变原来管理模式下同时管理两出口的用户信息。方法：通过配置流分类，规定重定向行为以及配置策略路由进行实现。结果：将认证流和数据流分开，成功实现了医院内部两出口的需求。结论：利用原有设备的流分类和重定向功能．既可解决两出口的内部需求，也能在不增加设备的情况下对用户信息进行管理，为医院节省了开支。     

左双腔支气管导管管端位置与吸气峰压变化的关系

目的 观测无隆突钩双腔支气管导管(DLT)管端位置与吸气峰压(Ppeak)以及肺顺应性环形状改变的关系，探讨用Ppeak和顺应性环的变化评估DLT管端位置的可行性。方法 拟行右侧剖胸手术的成年患者32例，静脉诱导后插入左Mallinckrodt DLT，吸入氧化亚氮和地氟醚维持麻醉。按纤维支气管镜(FOB)确认DLT管端位置和通气方式将观测过程分为四个阶段：第一阶段(S1)，管端位置正确的双肺通气；第二阶段(S2)，管端位置正确的左侧单肺通气；第三阶段(S3)，管端插入左下支气管(置管过深)的左侧单肺通气；第四阶段(S。)，管端处在左支气管开口(置管偏浅)的左侧单肺通气。每阶段均机械通气15min。结果 回归方程预计插管深度与FOB检查符合者占71．9％。S2时Ppeak值比S1时增加50．8％，肺顺应性(Cdyn)值减少36．2％；S3时Ppeak值比S1时增加87．4％，Cdyn值减少56．8％。PV环曲线斜率向右明显移位，环体显著延长。结论 用无隆突钩DLT行肺隔离，在无FOB定位的条件时，联合应用听诊法、回归方程预计插管深度、动态监测气道峰压和P-V环的变化综合评估，可提高DLT管端的正确到位率。单肺通气的气道峰压超过双肺通气时的1．65倍，且气道峰压超过25cm H2O．应高度怀疑DLT管端发生过深移位。     

A new hypothesis for the bone marrow edema pathogenesis during transient osteoporosis

Transient osteoporosis is an infrequent condition of uncertain etiology with pain, limited range of motion and radiographic evidence of osteoporosis affecting one or more joints. It is self-limited, reversible and can involve only the hip (transient osteoporosis of the hip, TOH) or, less frequently, one or more joints contemporaneously or at different times (regional migratory osteoporosis, RMO). We studied four men with transient osteoporosis, including two with TOH and two with RMO. All patients underwent a standard radiographic work-up of the affected joints, arteriovenous Doppler US, computed tomography, magnetic resonance imaging (MRI) and three-phase bone scanning. In all patients, symptoms were related to bone marrow edema demonstrated at MRI and to a transitory regional arterial hyperflow observed at the early scintigraphic analysis. On the basis of our observations, we hypothesize that regional arterial hyperflow may be the cause of the bone marrow edema and therefore of the transient osteoporosis.     

The adrenergic modulation of firings of respiratory rhythm-generating neurons in medulla-spinal cord preparation from newborn rat

We analysed the modulation of respiratory neurons by adrenaline or noradrenaline (NA) in a newborn rat brainstem-spinal cord preparation. Adrenaline or NA caused a dose-dependent depression of the respiratory rhythm and induced C4 spinal tonic discharges. The inhibitory effect of adrenaline (ED₅₀=0.5 μM) on the respiratory rhythm was stronger than NA (ED₅₀=5 μM). The adrenaline respiratory rhythm depression was partially blocked by the α₁-antagonist prazosin or by the α₂-antagonist yohimbine. The C4 tonic discharge elicited by adrenaline was blocked by the α₁-antagonist prazosin. The direct effects of adrenaline on pre-inspiratory (Pre-I) neurons were examined in a synaptic blockade solution (low Ca), and fifty-six percent of Pre-I neurons were found to continue firing. In low-Ca solution, Pre-I neurons were excited (n=29 of 39) or depressed (n=5 of 39) by adrenaline, and excited by α₁-agonist phenylephrine or depressed by α₂-agonist clonidine. These results suggest that the respiratory rhythm depression under intact network conditions is mediated by some other inhibitory system. The inhibitory effect of adrenaline on the respiratory rhythm was partially blocked by the GABA_A-antagonists bicuculline or picrotoxin, but not by the GABA_B-antagonist phaclofen. The present results suggest that: (1) respiratory rhythm generation is more sensitive to adrenaline than NA through α-adrenergic action of adrenaline; (2) the activity of Pre-I neurons could be directly regulated by excitation via α₁-receptors and inhibition via α₂-receptors; and (3) the depression of the respiratory rhythm by adrenaline is partly mediated by GABA_Aergic neurons. Received: 8 April 1997 / Accepted: 6 October 1997     

2016—2019年河北省儿童血培养检出病原菌及其耐药性变迁

 目的 了解河北省细菌耐药监测网74所医院2016—2019年儿童患者血培养病原菌的分布及耐药性变迁。方法 应用WHONET软件回顾性分析45所三级医院、29所二级医院儿童患者血培养病原菌分布及药敏特点;应用SPSS 19.0软件进行统计分析。结果 剔除重复菌株后,2016—2019年儿童住院患者血培养分离菌株共7 591株,革兰阳性菌占71.7%,革兰阴性菌占28.3%。在本研究定义的4个年龄段内,金黄色葡萄球菌、嗜麦芽窄食单胞菌所占比率随年龄增加而增多。肺炎克雷伯菌对亚胺培南、美罗培南的耐药率为7.8%~35.5%。4年间,耐碳青霉烯类肺炎克雷伯菌（CRKP）检出率呈上升趋势（由12.9%上升至30.1%）,耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率呈下降趋势（由81.7%下降至75.2%）。结论 河北省儿童住院患者血培养病原菌以革兰阳性菌为主,与成人血培养病原菌分布不同,病原菌存在年龄分布差异,临床经验性治疗儿童血流感染时应注意儿童血培养的特点。     

复数菌与单菌血流感染患者临床特征及预后影响因素

 目的 调查复数菌与单菌血流感染患者的临床特征及预后的影响因素。方法 回顾性分析某三甲医院2017年1月-2021年12月临床和病原学确诊的血流感染患者的病历资料,依据检出病原菌种数分为单菌组和复数菌组,研究结局为住院期间全因死亡率。比较两组患者的临床特征及复数菌患者预后的影响因素。结果 共有430例患者血培养阳性。单菌血流感染367例(85.3%),复数菌血流感染63例(14.7%)。复数菌组患者医院感染所占比率较单菌组高(76.2% VS 56.9%),差异有统计学意义(P=0.003);复数菌组患者下呼吸道感染比率较单菌组高(44.4% VS 29.2%),差异有统计学意义(P=0.018)。复数菌组患者住院时间较单菌组高[24(16~39) VS 19(13~26) d],差异有统计学意义(P=0.002)。复数菌组患者病死率高于单菌组(12.7% VS 3.8%),且住院时间延长,差异均有统计学意义(均P<0.05)。多因素分析显示,复数菌感染(OR=3.24,95%CI:1.20~8.75)、消化道肿瘤(OR=3.28,95%CI=1.21~8.84)、有创机械通气(OR=3.40,95%CI=1.22~9.42)、深静脉置管(OR=2.76,95%CI=1.00~7.64)、留置导尿管(OR=3.28,95%CI=1.04~10.40)是血流感染患者死亡的独立危险因素。相较于单菌组,复数菌组送检时间至出院时间间隔显著延长[20(15~36) d VS 16(10~22) d,P<0.001]。单菌组与复数菌组患者检出的金黄色葡萄球菌、溶血葡萄球菌和大肠埃希菌的构成比较,差异均有统计学意义(均P<0.05)。结论 住院患者复数菌血流感染死亡风险显著增加,消化道肿瘤、有创机械通气、深静脉置管、留置导尿管是血流感染患者死亡的独立危险因素,应引起临床的重要关注。     

恶性血液病合并血流感染患者病原菌分布及其预后影响因素

 目的 分析恶性血液病合并血流感染患者的病原学特征及其预后影响因素。方法 选取2016年1月-2022年5月遵义医科大学附属医院血液内科的恶性血液病合并血流感染的住院患者为研究对象。根据患者发生血流感染30 d内的治疗结局分为生存组和死亡组。分析患者的病原学特征及预后情况,并采用单因素及logistic回归分析影响恶性血液病合并血流感染预后的危险因素。结果 共纳入185例患者,基础疾病以急性白血病为主(125例,67.6%)。共分离197株病原菌,革兰阴性菌109株(55.3%),其中大肠埃希菌55株(27.9%);革兰阳性菌86株(43.7%),其中人葡萄球菌24株(12.2%);真菌2株(1.0%)。大肠埃希菌中产超广谱β-内酰胺酶(EBSLs)菌株28株(50.9%);肺炎克雷伯菌中产EBSLs菌株2株(10.0%);耐甲氧西林的人葡萄球菌、表皮葡萄球菌、金黄色葡萄球菌的检出率分别为70.8%、71.4%、36.4%。单因素分析表明,年龄≥70岁、粒细胞缺乏持续时间≥7 d、未合理使用抗菌药物、合并心功能不全、合并急性肾功能不全、感染性休克、肺部感染患者的30天病死率较高,差异均有统计学意义(均P<0.05)。多因素logistic回归分析表明,粒细胞缺乏持续时间≥7 d[OR=3.306,95%CI(1.224~8.927)]、合并心功能不全[OR=6.291,95%CI(1.930~20.508)]、合并急性肾功能不全[OR=8.419,95%CI(2.198~32.241)]、感染性休克[OR=22.150,95%CI(3.639~134.806)]均为恶性血液病合并血流感染患者30天内死亡的独立危险因素(均P<0.05)。结论 恶性血液病合并血流感染最常见的病原菌中,革兰阴性菌以大肠埃希菌为主,革兰阳性菌以人葡萄球菌为主。影响恶性血液病合并血流感染患者预后的危险因素较多,缩短粒细胞缺乏持续时间,改善心功能不全、肾功能不全,积极控制感染性休克是减少恶性血液病合并血流感染患者30天内死亡的有效措施。     

Evaluating the hazard of dodecyl alkyl sulphate to natural ecosystems using indigenous protistan communities

The effect of the surfactant dodecyl alkyl sulphate (C12AS) on the structure and function of lotic protistan assemblages was examined using the Experimental Stream Facility (ESF) operated by the Procter and Gamble Company. Population- and community-level responses to C12AS were monitored on introduced substrates placed in the channels 28 days prior to dosing (mature communities) as well as those placed in the channels on day 0 of dosing (immature communities), to allow for a broad assessment of the effect of the chemical on processes contributing both to community development and maintenance. C12AS appeared to elicit a subsidy response from the native protistan assemblage which may have resulted from both positive and negative responses at trophic levels above and below the assemblage. Protistan responses to the surfactant tended to occur more rapidly and be more sensitive than those documented for invertebrates and fish. C12AS elicited a modest response (i.e. a 20% change) from several reliable parameters including community respiration (reduced dissolved oxygen at 289 g per L), protozoan species richness (increased at 63 g per L) and protozoan community composition (increased dissimilarity at 1254 g per L). Responses to C12AS exceeded expected exposures in the real world by a factor of six or greater thereby indicating that the hazard of exposure to C12AS to stream communities is low. The results of this study support the use of mesocosms as decisive tools for evaluating the hazard posed by consumer product chemicals to natural communities and ecosystems     

Cyanide and migratory birds at gold mines in Nevada,USA

Since the mid-1980s, cyanide in heap leach solutions and mill tailings ponds at gold mines in Nevada has killed a large but incompletely documented number of wildlife (>9,500 individuals, primarily migratory birds). This field investigation documents the availability of cyanide at a variety of typical Nevada gold mines during 1990 and 1991, describes wildlife reactions to cyanide solutions, and discusses procedures for eliminating wildlife loss from cyanide poisoning. Substantial progress has been made to reduce wildlife loss. About half of the mill tailings ponds (some up to 150 ha) in Nevada have been chemically treated to reduce cyanide concentrations (the number needing treatment is uncertain) and many of the smaller heap leach solution ponds and channels are now covered with netting to exclude birds and most mammals. The discovery of a cyanide gradient in mill tailings ponds (concentration usually 2–3 times higher at the inflow point than at reclaim point) provides new insight into wildlife responses (mortality) observed in different portions of the ponds. Finding dead birds on the tops of ore heaps and associated with solution puddling is a new problem, but management procedures for eliminating this source of mortality are available. A safe threshold concentration of cyanide to eliminate wildlife loss could not be determined from the field data and initial laboratory studies. New analytical methods may be required to assess further the wildlife hazard of cyanide in mining solutions.     

Release of endogenous catecholamines in two different regions of the nucleus of the solitary tract as influenced by carotid occlusion

Summary The effects of carotid occlusion on the release of catecholamines in the nucleus of the solitary tract (NTS) were investigated in anaesthetized cats. Two aspects of the nucleus (rostral or intermediate NTS) were superfused bilaterally through push-pull cannulae with artificial CSF and the release of the endogenous dopamine, noradrenaline and adrenaline was determined in the superfusate radioenzymatically. The superfusion rate was 150 l/min or 800 l/min. In some experiments, superfusion of the intermediate NTS was carried out after denervation of the aortic arch.In the rostral NTS superfused at a rate of 150 l/min, bilateral carotid occlusion led to a rise in blood pressure and decreased the release rate of dopamine. These changes continued after occlusion termination. The release rate of noradrenaline was transiently diminished during occlusion. The release of this amine was also decreased after occlusion termination. The release rate of adrenaline was not influenced during carotid occlusion, but it was found to be diminished after termination of the occlusion. Superfusion of the rostral NTS at a rate of 800 l/min also reduced the release rate of adrenaline after termination of carotid artery occlusion. In the intermediate NTS (superfusion rate 150 l/min) similar effects of the carotid occlusion on the release rates of dopamine and noradrenaline were observed. In this aspect of the NTS, denervation of the aortic arch abolished the decrease in the noradrenaline release during carotic occlusion, while the release rates of dopamine and adrenaline were decreased during and after termination of the carotid occlusion.The results suggest that (a) the rise in blood pressure in the carotid sinus after termination of a carotid occlusion decreases the release rates of noradrenaline and adrenaline in the NTS, (b) the decrease in the release of noradrenaline during carotid occlusion is due to impulses originating from the baroreceptors of the aortic arch.Thus, impulses from carotid sinus and aortic arch modify the release rates of noradrenaline in the NTS so as to counteract blood pressure changes.Supported by the Fonds zur Förderung der wissenschaftlichen Forschung Send offprint requests to A. Philippu at the above address