鲍曼不动杆菌感染的呼吸机相关肺炎20例

目的 了解我院NICU内鲍曼氏不动杆菌感染呼吸机相关肺炎的情况,探讨有效预防和控制的该类感染的措施。方法 收集我院NICU内2006.1-2007.2之间发生呼吸相关肺炎病通过细菌培养确定为鲍曼氏不动杆菌感染的患儿的临床资料以及该菌的药敏试验结果进行分析。结果 鲍曼氏不动杆菌是呼吸机相关肺炎的主要致病菌之一,其流行情况复杂,并且出现了耐碳青酶烯类的菌株感染,可造成严重的不良后果。结论 预防该菌在NICU内导致感染需要引起临床工作者更多的重视,加强对其定植情况的监测是预防其感染和流行的重要措施,对该菌开展及分子流行病学的深入研究将有助于指导NICU内NI防治。     

新生儿重症监护病房内耐甲氧西林金黄色葡萄球菌感染

耐甲氧西林金黄色葡萄球菌（Methicillin-resistant Staphylococcus aureus,MRSA）是影响新生儿重症监护病房（neonatal intensive care unit,NICU）内早产儿和新生儿感染的一个常见原因。新生儿特别容易定植及感染MRSA,这可能与其生理特性和某些潜在的危险因素相关。此外,MRSA菌株的特性及其传播模式的改变也对NICU易感MRSA产生了一定的影响。尽管积极的预防措施和先进的诊疗手段已用于临床的治疗,但是MRSA仍是导致NICU发病率和死亡率较高的显著因素。     

马拉色菌引起乳房垢着病1例并文献分析

皮肤垢着病(cutaneous dirt-adherent disease,CDAD)是一种临床少见皮肤病,其中单独发生在乳房部位的,临床称之为"乳房垢着病",更是罕见。目前,国内外文献报道约15例,但均为个案报道,对该病的临床特点及诊疗方案缺乏系统性分析。     

从发热的鉴别诊断思路谈实习医师的临床思维培养

目的目的建立发热性疾病的鉴别诊断思路,指导实习医师的临床实践。方法回顾性分析我院1997年1月至2003年3月收住的以发热为主要临床表现的患者706例,进行鉴别诊断思路研究。结果感染性疾病550例(81.12%),其中,局灶感染203例(29.94%),多系统性感染347(51.18%),非感染性疾病107例(15.78%)。结论对临床思维的训练实行归纳演绎式的教学方法,取得了良好的教学效果。     

NICU与综合性ICU感染金黄色葡萄球菌的耐药性对比分析

目的 比较新生儿重症监护病房（NICU）与综合性重症监护病房（ICU）金黄色葡萄球菌的耐药性,为临床合理选用抗菌药物提供依据。方法 对2011年6月-2015年7月NICU与综合性ICU患者临床标本中分离的金黄色葡萄球菌278株的耐药性比较,药敏试验采用纸片扩散法,采用WHONET 5.6和SPSS 20.0软件进行数据分析。结果 278株金黄色葡萄球菌对青霉素G、氨苄西林、美洛西林、头孢西丁等大部分抗菌药物的耐药率已较高,分别为100.00%、93.88%、80.94%、51.08%;综合性ICU感染金黄色葡萄球菌对克拉霉素、万古霉素、利奈唑胺、呋喃妥因等耐药率较低,分别为7.81%、0.00%、0.00%、0.00%;NICU与综合性ICU病房耐甲氧西林金黄色葡萄球菌（MRSA）检出率分别为34.88%和51.04%,NICU病房MRSA检出率低于ICU（P＜0.05）;头孢唑林及头孢噻肟在NICU与综合性ICU病房中的耐药率分别为19.77%,33.33%;13.95%,40.10%;NICU分离出的金黄色葡萄球菌对头孢唑林和头孢噻肟耐药率低于综合性ICU,差异有统计学意义（P＜0.05）;万古霉素及呋喃妥因在NICU与综合性ICU金黄色葡萄球菌中的耐药率分别为2.33%,0.00%;0.00%,0.00%;耐药率均较低（P＞0.05）。结论 临床选用抗菌药物应根据不同病区感染病原菌的耐药性和患者不同生理特点,本地区治疗NICU金黄色葡萄球菌感染可选头孢唑林和头孢噻肟,综合性ICU可选利奈唑胺和克拉霉素作为首选药。     

第三期不明原因发热诊治进展学习班（会议预告）

由首都医科大学附属北京友谊医院感染内科主办的“第三期不明原因发热诊治进展学习班”将于2015年6月6日（星期六）在北京友谊医院召开。我们诚挚邀请您前来参加此次学习班。
　　不明原因发热的诊治是临床难题之一,给患者带来极大的痛苦;诊治过程涉及临床各科,是对医务人员和医疗机构诊治疑难疾病能力的巨大挑战。本次学习班将围绕不明原因发热诊治的最新进展和疑难病例报告及文献复习,从现代医学和中医学两个角度对不明原因发热诊治的相关问题进行详细的阐述和讲解,促进各位同道的交流,促进中西医结合。我们将努力把此次学习班打造成一个良好的学习交流平台。     

飞行质谱鉴定临床分离真菌准确度的Meta分析

目的基于循证医学系统性评价飞行质谱鉴定临床分离真菌的准确度,并与常规方法准确度进行比较。方法检索主要英文数据库PubMed、Cochrane、Web of Science,以及中文数据库CBM、万方、维普、知网数据库,检索飞行质谱鉴定临床分离真菌的原始文献。结果经筛选后纳入19篇文献(6609株真菌),Meta分析结果显示飞行质谱鉴定真菌至种水平正确率为0.9368(95%CI=0.9091～0.9598),常规方法鉴定真菌至种水平正确率为0.9104(95%CI=0.8874～0.9340);对结果进行了亚组分析,主要包括:菌株类型、研究类型、样本处理方法、金标准检测范围、鉴定阈值等;敏感性分析表明结果稳定可靠,Begg和Egger’s结果表明飞行质谱鉴定真菌不存在发表偏倚,常规方法鉴定真菌存在一定发表偏倚。结论基质辅助激光解吸电离-飞行时间质谱系统(MALDI-TOF MS)方法对鉴定临床致病性真菌准确率较高,是临床常规方法的可靠替代方法。     

在传染病患者发热时降温措施的选择

人之所以会发热是由致热源与非致热源两种情况所致。临床上最常见的是致热源所致的发热。与人体有关的热源有病原体致热源,类固醇致热源与组织致热源等。这些致热源先激活中性粒细胞与单核细胞,使其释放出白细胞致热源,而白细胞致热源可直接作用体温调节中枢,使热敏神经的阈值升高,调定点上移从而兴奋产热中枢,抑制散热中枢,使体温升高而引起发热。因此,发热是疾病的信号,它反映机体病变的存在和暗示病情的演变过程,发热是传染病最为突出的症状之一,临床上可作为诊断、治疗、观察疗效和预后的重要参考资料。传染病患者临床上发热特点常有一…     

蝮蛇抗栓酶的临床副作用

蝮蛇抗栓酶是一种从蝮蛇毒中提取的酶制剂。是以精氨酸酯酶为主有去纤、溶栓、解聚,扩血管、改善微循环,抗肿瘤等多功能抗凝作用的新药。经临床观察对脑血栓、脉管炎、冠心病和心肌梗塞等20多种疾病有较好的疗效,以往认为其副作用发生率低,随着抗栓酶临床应用的日趋广泛,发现它有一定的不良反应,现结合文献概述如下.1 一过性反应,可有发热,出汗、头痛、头胀、头晕、嗜睡、肢痛、肢体水肿、肢体发热等,一般不须任何处理可自行消退.魏氏等治疗冠心病50例,仅2例出现头晕、头痛.毕氏治疗冠心病50例有3例出现头晕,5例出现胸闷、气促、韩氏治疗脑血栓100例,有8例出现面部浮肿、陈氏等治疗脑血栓184例,有56例出     

系统性种痘水疱病样皮肤T细胞淋巴瘤1例及文献复习

目的:通过分析系统性种痘水疱病样淋巴瘤病例1例,结合文献回顾,分析其临床特点、诊断治疗进展及预后,以提高临床医生对该病的认识。方法:报道1例有7年种痘水疱病史并转化为系统性T细胞淋巴瘤病例,通过皮肤活检、病理及免疫组化、TCR基因重排、实验室、MRI及影像学检查,确定诊断及治疗方案,并观察预后。后进行文献回顾。结果:本例患者的主要临床表现为多年的面部红斑、丘疱疹及水疱改变,最初诊断为"种痘水疱病",初期治疗有效,病情反复并进展,皮肤改变加重,病变逐渐累及鼻中隔及下鼻甲,出现坏死及缺损,同时伴有发热及淋巴结肿大等系统症状。皮肤病理及免疫组化提示真皮弥漫性淋巴细胞、浆细胞浸润,CD3+,CD4+,CD8散在细胞+,CD30局部细胞+,CD56局部细胞+,EBER杂交(+),Ki-67增殖指数为60%。TCR基因克隆性重排。经干扰素及激素治疗初期病情控制尚可,持续约7年时间,后病情进行性加重,表现系统性种痘水疱病样皮肤T细胞淋巴瘤症状,给予MESA方案化疗1次。化疗后病情稳定,鼻部症状明显改善。后病情进展,患者出现神经系统症状并死亡。结论:种痘水疱病样淋巴瘤早期临床表现易与种痘样水疱病相混淆,但根据其病变部位病理活检及免疫组化分析可得到确诊,早期单纯皮肤病变期可持续数年,部分对激素及干扰素治疗有效。当发展为系统性种痘水疱病样淋巴瘤期时,病情进展迅速,常可累及中枢神经系统,对于化疗反应差,预后不佳,死亡率极高。化疗对于该病的有效性有待进一步观察。     

CMA-cosponsored conference raises many questions about future of regionalized health care.

Is regionalization better because it''s cheaper? Or because it provides better outcomes? Or simply because it''s different from whatever went before? Those were some of the questions asked during a recent conference cosponsored by the CMA and Queen''s University. With each successive speaker, says Charlotte Gray, the message became clearer: there are more muddled theories behind the trend and more pitfalls ahead than planners ever expected when they embarked on the exercise to decentralize health care in Canada and elsewhere.     

Traumatic Fibromyositis: A Critical Review of an Enigmatic Concept

Traumatic fibromyositis is not an inflammation; there is no fever, leukocytosis or increased sedimentation rate; electrical characteristics and serum enzyme levels are within normal limits, and there are no observable pathologic alterations, although they have been carefully searched for. Recent attempts to express the effects of muscular sprain or strain as a biochemical disturbance expressed in an unusual pattern of lactate dehydrogenase isoenzymes appear not only to be technically flawed but inconsistent with results of conventional enzyme studies on other muscle and interstitial inflammations. In the author''s view, “traumatic” fibromyositis is no more than a verbal construct arrived at by adding an adjectival modifier to the old terms for idiopathic rheumatic disorders. An examination of the evolution of the concept of traumatic fibromyositis shows that it lacks validity as a clinical diagnosis and ought to be abandoned.     

脊柱损伤的法医临床学鉴定研究进展

随着社会和现代交通、建筑事业的发展,脊柱损伤的病人发病率呈上升趋势,尤其道路交通事故为其损伤的首要原因。脊柱损伤的现场急救、临床诊断与治疗为人们所关注。然而,伴随着事件的进一步处理,对病人的损伤进行法医学鉴定显得尤为重要。目前,有关脊柱损伤的鉴定标准仅仅是确定的标准,没有规定标准的适用条件。同时,也易导致鉴定人对标准的理解与应用存在差异,由此导致了鉴定结论的争议。本文对脊柱损伤的法医临床学应用研究进展作一综述。     

如何学好人体断层解剖学

断层解剖学作为解剖学与医学影像学等学科相结合的交叉学科,对现代化的影像技术及临床应用具有非常重要的意义。要学好断层解剖学:必须明确断层解剖学的重要性;培养学习的兴趣,注意临床针对性;抓好学习的重点,注意学习方法;打好局部解剖学知识的基础,始终贯彻断层标本与影像相结合的原则;并高度重视现代化多媒体资料的应用。     

人组织激肽释放酶4在激素依赖性肿瘤中的研究进展

人组织激肽释放酶基因家族由KLK1-KLK15构成,编码一组丝氨酸蛋白酶。研究发现KLK基因家族涉及癌细胞的多种生物学功能,且其表达受类固醇激素的调节。人组织激肽释放酶4是丝氨酸蛋白酶家族的一个成员,在多种激素依赖性肿瘤如卵巢癌、前列腺癌、乳腺癌、子宫内膜癌中高表达,且表达量受雌激素、孕激素、雄激素不同程度的调节。近年来很多文献报道人组织激肽释放酶4涉及癌细胞的增殖、上皮间质转化及细胞外基质的降解等过程,可能促进了肿瘤的发生、发展,且与激素依赖性肿瘤的预后不良有关。这些研究显示人组织激肽释放酶4与激素依赖性肿瘤关系密切,是其潜在的肿瘤标记物和治疗靶点,随着研究的进一步深入,有望应用于激素依赖性肿瘤的早期诊断、病程监测和治疗。     

CD147 与MMPs、VEGF在肿瘤发生发展中相互作用的研究进展

细胞外基质金属蛋白酶诱导因子(CD147)是一种高度糖基化的跨膜蛋白,属于免疫蛋白超家族成员。CD147 为多功能型蛋 白，可以参与人体的多种病理生理机制，其通过调节血管内皮生长因子（VEGF）和基质金属蛋白酶（MMPs）的表达参与恶性肿瘤的新生血管的生成及多重耐药性的产生。近年来随着对CD147 在肿瘤发生发展中的研究不断深入，越来越多的发现使得CD147在肿瘤进展中的作用日益凸显。已经明确了其对肿瘤的进展及治疗的作用，在多种肿瘤中高表达，并随着肿瘤的恶性程度增高而 增加，可以作为某些恶性肿瘤治疗的靶点。然而，CD147 其他的功能包括充当T 细胞的活化剂、神经识别分子和受体伴侣亲环素A的生理和病理机制还未明确。因此，有必要探索CD147 在肿瘤中的特定功能，并阐明其产生机制是至关重要的。在此研究的基础上，现就CD147 与MMPs、VEGF之间相互作用对肿瘤的转移和浸润的影响作一综述。     

Le paradoxe des fièvres prolongées inexpliquées

Fever of unknown origin are defined by a fever greater than 38.3 °C evolving during at least three weeks and without diagnosis despite appropriate explorations. Despite medical advances, they remain unexplained in 20 to 50% of cases after exhaustive explorations and the proportion is increasing in the literature. More than 200 diseases have been reported as a cause. The infectious (viral disease, tuberculosis…) and neoplastic causes (mainly lymphomas) seemed to be reduced to the benefit of noninfectious inflammatory diseases (Still's disease, giant cell arteritis…). Drug fever and factitious fever are also common. Genetic recurrent fevers form a special group, which benefit of recent advances in genetics. Diagnosis of these fevers of unknown origin is based on clinical examination and laboratory and radiologic investigation. Despite prospective protocols, it is difficult today to provide recommendations on the management and to suggest a hierarchy of tests. The role of modern explorations as FDG–PET remains to be clarified. The overall prognosis of these fevers of unknown origin remains good and the use of empirical therapeutic trials must remain exceptional.     

Die Taube – eine Erfolgsgeschichte. Vom Liebling der Götter zur Eroberung der Städte

The pigeon – a success story The pigeon is one of the first animals that man domesticated and it holds a special place in man's affections. The pigeon is far more than an ordinary bird since it is a symbol of different gods and human virtues. In the beginning, the pigeon used to be an ordinary biological creature until it found it's way into man's spiritual world. These associations contribute to man's love and admiration of pigeons. The feral pigeon is a wild descendant of dovecote pigeons and domestic breeds. All experiences up to now lead to the conclusion that reduction of pigeon populations can only be achieved by reducing their food supply. Because of the enormous reproduction rate of the pigeons, killing attempts without any simultaneous food reduction do not have any influence on the number of birds in the population.     

A Reassessment of Bergmann's Rule in Modern Humans

It is widely accepted that modern humans conform to Bergmann''s rule, which holds that body size in endothermic species will increase as temperature decreases. However, there are reasons to question the reliability of the findings on which this consensus is based. One of these is that the main studies that have reported that modern humans conform to Bergmann''s rule have employed samples that contain a disproportionately large number of warm-climate and northern hemisphere groups. With this in mind, we used latitudinally-stratified and hemisphere-specific samples to re-assess the relationship between modern human body size and temperature. We found that when groups from north and south of the equator were analyzed together, Bergmann''s rule was supported. However, when groups were separated by hemisphere, Bergmann''s rule was only supported in the northern hemisphere. In the course of exploring these results further, we found that the difference between our northern and southern hemisphere subsamples is due to the limited latitudinal and temperature range in the latter subsample. Thus, our study suggests that modern humans do conform to Bergmann''s rule but only when there are major differences in latitude and temperature among groups. Specifically, groups must span more than 50 degrees of latitude and/or more than 30°C for it to hold. This finding has important implications for work on regional variation in human body size and its relationship to temperature.     

Sphingolipidoses

Sphingolipidoses are an heterogeneous group of inherited disorders of lipid metabolism affecting primarily the central nervous system. These disorders occur chiefly in the pediatric population, and the degenerative nature of the disease processes is generally characterized by diffuse and progressive involvement of neurones (gray matter) with psychomotor retardation and myoclonus or of fiber tracts (white matter) with weakness and spasticity.Biochemical research has identified the defects in the sphingolipidoses to specific lysosomal enzymes. For example, Niemann-Pick disease lacks sphingomyelinase; Krabbe''s disease lacks galactocerebrosidase; Gaucher''s disease lacks beta-D-glucosidase; metachromatic leukodystrophy lacks sulfatase; Tay-Sachs disease lacks hexosaminidase A; and generalized gangliosidosis lacks beta-galactosidase.Although there are no currently available modes of rendering corrective therapy in these disorders, a definitive diagnosis is possible both antepartum as well as postpartum. This information provides a sound and accurate basis for genetic counseling.