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    美国肝病研究协会（The American Association for the study of liver diseases， AASLD）第59次年会于2008年10月31日—11月4日在美国旧金山召开。丙型肝炎的抗病毒治疗和新型抗丙型肝炎病毒（HCV）药物的研究是本次大会病毒性肝炎研究报告的主要内容之一。本文就此作如下主要介绍。

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    ObjectiveTo require hemagglutinin (HA) proteins  for the study on the relationships between two kinds of amino acid alterations (H5 I151F, H5 I151F+A134V+E186D) and human receptor binding characteristics. MethodsVector pRB21’ was constructed, vp37-vaccinia virus vRB12 and pRB21’ were coinfected and transfected. Recombinant vaccinia viruses (re VV) were generated through homologous recombination, expressing HA proteins, which were identified with Western Blotting. ResultsThe vector pRB21’ within full length of H5 HA segments were obtained. Two kinds of HA proteins (re VV H5 I151F, re VV H5 I151F+A134V+E186D) were expressed by recombinant vaccinia viruses.ConclusionFor the first time recombinant vaccinia viruses were generated to express hemagglutinin of the avian influenza virus subtype H5N1, which pave the way for further studying the possibilities of human to human transmission caused by avian influenza viruses.

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    ObjectiveTo study the effects of interferonalpha (IFNα) on apolipoprotein B mRNAediting enzyme catalytic polypeptidelike 3G （APOBEC3G） expression by stimulating HepG2 2.2.15 cells with IFNα, and to preliminarily investigate whether Janus kinasesignal transduction and activators of transcription (JAKSTAT) signal pathway participates in the regulation of APOBEC3G gene transcription. MethodsHepG2 2.2.15 cells were treated with various concentrations of IFNα (0, 1, 101, 102, 103, 104 U/mL) for 8 hours, or with IFNα of 103 U/mL for 2, 4, 6, 8, 10, 12 hours. In the abovementioned time, cells or cultural supernatants were collected. The mRNA and protein expression levels of APOBEC3G and STAT1 in HepG2 2.2.15 cells were detected by realtime fluorescent quantitation RTPCR and Westernblot respectively. The levels of HBsAg and HBeAg in the cultural supernatant of HepG2 2.2.15 cells were detected by ELISA. The levels of HBV DNA in supernatant and HBV mRNA in cells were determined by realtime PCR and RTPCR respectively. ResultsThe expression level of APOBEC3G was very low in HepG2 2.2.15 cells untreated with IFNα (0 U/mL). With the rising of IFNα concentration, APOBEC3G mRNA and protein level rose progressively. When IFNα concentration was 104 U/mL, the expression level of APOBEC3G was the highest. Moreover, the expression level of STAT1 mRNA and protein also rose progressively, which appeared with APOBEC3G expression amount parallelly and relevantly. With the extension of time with IFNα stimulation, APOBEC3G expression level rose obviously, which reached the highest at the 8 hours, and thereafter dropped gradually. When IFNα of 104 U/mL stimulated 8 hours, the level of HBsAg, HBeAg, HBV DNA in cultural supernatant and the level of HBV mRNA in HepG2 2.2.15 cells were obviously lower than the cells untreated with IFNα. ConclusionIFNα can induce HepG2 2.2.15 cells to express APOBEC3G. Within the certain limits, APOBEC3G expression presents positive correlation with IFNα dosage and action time. The expression of APOBEC3G induced by IFNα may be one of antiviral mechanisms of IFNα. Whether JAKSTAT signal pathway participates in the expression of APOBEC3G induced by IFNα need further study.

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     ObjectiveTo study the relationship between HBV genotypes and nucleolide analogues drugresistance mutations. MethodsOne hundred and twentytwo patients with chronic hepatitis B were treated with lamivudine 100mg/d for 48~96 weeks, patients who developed lamivudineresistance mutations used  adefovir dipivoxil  10mg/d for 96 weeks instead of lamivudine. HBV genotypes, lamivudine, adefovir dipivoxil and entecavir resistance mutations were determined by DNA  sequencing. ResultsAmong  122 cases, 86 (70.49%) were genotype B, 24 (19.67%) were genotype C, and 12(9.84%) were not classified. 42 lamivudineresistance mutants (32 mutants of genotype B, and 10 mutants of genotype C) were found in 122 cases. The incidence of mutations was 37.21%(32/86)  and 41.67%(10/24) in HBV genotypes B and C, respectively,there was no significant difference between the two (χ2=0.16,P=0.69). The incidence of mutations was 0.00%(0/42) and 2.38%(1/42) in 42 patients treated  with adefovir dipivoxil for 48 and  96 weeks, respectively, the incidence of adefovir dipivoxil mutations  was 3.13%(1/32) and 0.00%(0/10) in genotypes B and C, respectively. The  main types of lamivudineresistance mutations  were rtM204V+rtL180M(35.71%) and rtM204I(38.10%);  Lamivudineresistance mutation types showed no significant difference between HBV genotypes B and C(χ2=17.44,P=0.23). ConclusionHBV genotype B is the most prevalent, and genotype C is the second in Hengyang of  Hunan. HBV genotypes have no obvious influence on the incidences and types of mutation during lamivudine therapy.

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ObjectiveTo investigate the effect of lentinan on the therapeutic effect of chronic hepatitis B patients treated with adefovir (ADV).MethodsSixtysix patients with chronic hepatitis B were randomly divided into  lentinan plus ADV treatment (34 cases) and only ADV  treatment (32 cases) groups, all patients received treatment  for 12 months. Patients’ normalization of the alanine aminotransferase(ALT), negative conversion rate of   HBeAg, HBeAg/antiHBeAg seroconversion rate, serum HBV DNA decreasing levels and side effect were observed. ResultsAt 6 and 12 month of treatment, negative seroconversion rate of HBeAg in combination treatment group was 35.48% and 61.29% respectively, which was significantly higher than 10.34% and 34.48% of single treatment group (χ2=5.29, P=0.02; χ2=4.31, P=0.04, respectively); At 12 month of treatment, HBeAg/antiHBeAg seroconversion rate  in combination treatment group was 48.39%, which was significantly higher than 24.14% of single treatment group (χ2=3.79, P=0.05). At 1,3,6 month of treatment, normalization of ALT in combination group was 54.84%, 67.74% and 77.42% respectively, which was significantly higher than 24.14%, 41.38% and 51.72% of single treatment group (χ2=5.88, P=0.02; χ2=4.21, P=0.04; χ2=4.35, P=0.04 respectively).  At 1,3,6 month of treatment , serum HBV DNA negative conversion rate in combination group was 41.94%, 61.29% and 70.97% respectively, which was significantly higher than 13.79%, 34.48 and 44.83% of single treatment group(χ2=5.84, P=0.02; χ2=4.31, P=0.04; χ2=4.21, P=0.04, respectively). Both groups had no side effect. ConclusionLentinan can  enhance the shortterm therapeutic effect of chronic hepatitis B patients treated with ADV，especially the negative conversion rate of HBeAg and HBeAg/antiHBeAg seroconversion rate; ADV can efficiently decrease the replication levels of HBV DNA.

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ObjectiveTo monitor and evaluate  disinfection and sterilization quality in medical institutions in  different levels of   hospitals in  Zhuzhou city between 2003—2008, so as  to improve infection control management.MethodsOnthespot sampling and laboratory examination methods were used to carry out survey of the medical institutions, samples included air, surface of objects, inuse disinfectants, hospital contaminated water, sterile medical instruments.The comprehensive qualities of the hospitals of classⅠandⅡwere evaluated by TOPSIS based on coefficient of entropy. ResultsThe total qualified rate of disinfection and sterilization in medical institutions in the city between 2003—2008 was 91.79%, which rose year by year (χ2=66.45, P=0.00); There was significant difference in the total qualified rate of disinfection and sterilization between different levels of hospitals(χ2=60.14, P=0.00), the lowest rate was in individual clinics; The qualified rate of inuse disinfectant, transfusion material, autoclaves were all >90.00%. There were 4 levels in the order of the  evaluated objects, the constituent ratio in 4 levels was different.ConclusionThe disinfection and sterilization  quality in the medical institutions in the city  improved year by year, but some technical advices should be given, especially for individual medical institutions.

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ObjectiveTo evaluate the impact of prophylactic administration of antimicrobials in cesarean section on controlling surgical site infection (SSI) and  postpartum endometritis. MethodsComprehensive Chinese randomized controlled trials retrieval about preventing postpartum infection related to cesarean section by antimicrobial prophylactic use was performed via searching electronic database, hand searching bibliographies of books and relevant journals. ResultsCompared with longterm antimicrobial prophylaxis started after operation,  shortterm antimicrobial prophylaxis started 0.5~2 hours before operation or started after clamping of umbilical cord showed lower SSI rate (OR=0.34，95%CI 0.24～0.48,P<0.05) and puerperal morbidity (OR=0.40，95%CI 0.32～0.48,P<0.05), and there was no significant difference in lowering postpartum endometritis incidence between  selective cesareansection (OR=0.45，95%CI 0.11～1.83,P>0.05) and selective/unselective cesareansection (OR=0.55，95%CI 0.16～1.96,P>0.05). ConclusionShortterm antimicrobial prophylaxis started 0.5 to 2 hours before operation or after clamping of umbilical cord is a recommendable strategy for preventing SSI and puerperal morbidity.

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ObjectiveTo investigate the occupational exposure to bloodborne pathogens in operationrelated  health care workers (HCWs), so as to provide evidence for the occupational preventive measures. MethodsSurveillance reporting system for exposure to bloodborne pathogens was established, occupational exposure to bloodborne pathogens in operationrelated  HCWs was surveyed. ResultsFrom January 1, 2005 to December 31, 2008,197  operationrelated  HCWs were reported to be exposed to bloodborne pathogens, 41 of whom had ruptured skin or mucosa exposure, 156 had sharp injuries. Doctors had the highest occupational exposure rate, which was up to 78.05%; the rate of occupational exposure in HCWs with short length of service(0~10 years) was 70.73%; the rate of blood or body fluid splash exposure was 92.68%, 92.68% of which was blood splash ; among sharp injuries, 58.33% were caused by suture needles; 60.91% of bloodborne pathogen was HBsAg. Intervention in HCWs who had occupational exposure were  taken, followup survey showed that no one were infected due to exposure. ConclusionTraining on occupational exposure should be strengthened, awareness of use of goggles should be enhanced, eyewashing service should be provided in operating room, the use, delivery and handling  of sharp objects should be correct, initiative intervention after exposure should be taken, so as to protect the safety of HCWs.

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ObjectiveTo detect the disinfection and sterilization effect of  A/B type ultraviolet (UV) lamp on closestool. MethodsCarrier quantitative germicidal test  was performed, according to explaination of the  product, UV lamp irradiated for 15, 20, 25, 30, 35 minutes respectively on Staphylococcus aureus, Escherichia coli, Candida albicans and Bacillus subtilis on the carriers; onthespot disinfection test was also performed, before and after turning on the VU lamp for scheduled  time, samples were taken with cotton swab smear method, live bacterial counts were calculated.ResultsCarrier quantitative germicidal test showed that the average killing logarithm value of Staphylococcus aureus, Escherichia coli, Candida albicans and Bacillus subtilis were all≥3.00.  Onthespot disinfection test of 30 samples showed that the average killing logarithm value was 3.57, killing logarithm value of natural bacteria were all ＞1.00. ConclusionThe disinfection and sterilization effect of the  UV lamp on the A/B  type  closestool  is qualified.

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ObjectiveTo evaluate the clinical characteristics of  handfootmouth disease caused by enterovirus 71(EV71). MethodsClinical data of 70 cases of handfootmouth disease admitted in a hospital from May, 2008 to August, 2008 were analysed. ResultsAmong 70 cases, 48(68.57%) were simple handfootmouth disease,18 cases(25.71%) had central nervous system symptoms, 3 (4.29%)had respiratory system symptoms,1 (1.43%) had circulatory system symptoms; 64 cases(91.43%) were ≤3 years old; 63 cases (90.00%) were positive in specific nucleic acid detection of EV71, 70 cases  were all positive in specific antibody detection of EV71. All  patients were improved and discharged after treatment. One month followup showed that no patient had discomfort and sequelae. ConclusionClinical manifestations of handfootmouth disease caused by EV71 are serious, and can cause multiorgan impairment.The main patients were preschool children,especially children≤3 years old.

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ObjectiveTo evaluate the clinical value of laparoscopic operation in treating pelvic abscess.MethodsClinical data of 40 pelvic abscess patients who  received different laparoscopic operations from June,2005 to June, 2008 were analysed retrospectively. ResultsAmong 40 patients, 10 cases were found abscess of fallopian tube and ovary and pelvic cavity adhesion, 18 were  pyosalpinx, and 12 were rectouterine excavation abscess. All patients were operated successfully under laparoscope, their body temperature returned to normal after 2~3 days of operation,and blood routine value returned to normal after 4 days of operation.Thirty patients preserved ovaries, 18 patients  underwent tubal patent test by liquid instillation showed unobstructed ovries.One year followup of 32 patients showed no recurrent,8 patients were pregnant. ConclusionLaparoscopic operation is one of the ideal therapy for treating pelvic abscess, which is beneficial to the pretecting of  reproductive function,especially for unmarried  patients.

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ObjectiveTo evaluate the improvement of hand hygiene in medical institutes after the carrying out of “monthly activity of hand hygiene”,  the knowledge of hand hygiene among health care workers (HCWs), and the improvement of HCWs’compliance with hand hygiene. MethodsCompliance with hand hygiene  before and after the carrying out of  “monthly activity of hand hygiene” was supervised by experts, evaluation was performed according to  uniformed  standard. ResultsBefore and after the carrying out of  “monthly activity of hand hygiene”, The putting up of standard hand washing figures in key departments rose from 37.95% to 93.37% （χ2=113.07, P＝0.00）, the change of nontouching faucets from  21.08% to 60.84% （χ2=54.25, P＝0.00）, the supply of rapiddry hand disinfectant from 15.66% to  56.63% （χ2=60.34, P＝0.00）, the handdrying method against a  second contamination from  9.04% to 45.18% （χ2=54.88,  P＝0.00）, the correct hand washing methods of doctors and nurses from 17.39%,19.57% to  89.13%, 93.48% （χ2=69.57，P＝0.00；χ2＝78.10, P＝0.00）, the differences were significant, respectively. Conclusion“Monthly activity of hand hygiene” promoted the improvement of hand hygiene installation, hand hygiene knowledge is  popularized among all levels of persons in hospital, and hand hygiene awareness and compliance are enhanced.

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ObjectiveTo investigate the disinfection and sterilization state of equipment, personal protection and instrument in institutions of oral cavity treatment in Hangzhou city. MethodsQuestionnaires about all oral institutions in the city were made and filled out, and onthespot samples were taken. ResultsTwo hundred and sixty one oral cavity treatment institutions were checked, 127 of which were stomatology departments in general hospitals, 134 were outpatient departments in oral cavity clinics. The qualified rate of rational distribution and supply of medical instrument of oral cavity clinics was 91.04% and 97.01% respectively, which were higher than 73.23% and 87.40% in  stomatology departments in general hospitals (χ2=14.26，P＝0.000；χ2＝8.52，P＝0.004, respectively); 79.53% of general hospitals provided goggles, which was higher than 62.69%  in outpatient departments in oral cavity clinics (χ2=8.96, P=0.003); 83.46% of stomatology departments in general hospitals performed hand washing and changed gloves between patients when medical treatment were undertaken, which was lower than 100.00% of outpatient departments (χ2=24.09, P=0.000); The qualified rate of hand hygiene of health care workers and sterilized objects in general hospitals was 71.23% and 65.38% respectively, which were higher than 54.10% and 32.50%  of oral cavity clinics (χ2=4.21,P=0.004; χ2=9.78, P=0.002, respectively). ConclusionThe disinfection and sterilization state of oral cavity equipment, personal protection and  instruments in different level oral institutions are different, it is important to strengthen the administration.

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ObjectiveTo investigate the detection and change in drugresistance of  extendedspectrum βlactamase (ESBLs)producing Escherichia coli, so as to provide reference for the rational use of antimicrobial agents in clinic.MethodsEscherichia coli isolated from clinic in a hospital between January~December, 2006 were collected, the detection of ESBLs  and drugresistance were compared with those of 2002. ResultsThe rate of ESBLsproducing Escherichia coli isolated in 2006 was 65.54% (175/267), which increased obviously compared with 47.92% (46/96) isolated  in 2002 (χ2=9.21, P<0.05). The susceptibility rate of ESBLsproducing Escherichia coli to imipenem in 2006 was 24.00%, which decreased obviously compared with 52.17% in 2002 (χ2=13.80, P<0.05); The susceptibility rates to the other antimicrobial agents had no statistic significance, imipenem still had ideal activity against ESBLsproducing Escherichia coli. ConclusionThere is increasing tendency in the detection of ESBLsproducing Escherichia coli, and drugresistance is high, which should be paid attention.

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ObjectiveTo improve the technical level of making hand lotion to reduce the expense of hospital. MethodsHand lotion were prepared with the multifunction mixer, then the efficacy and skin irritation of selfmade hand  lotion were compared  with the outpurchased  Jiefurou antibacterial hand lotion. ResultsBoth selfmade hand lotion and Jiefurou antibacterial hand lotion meet the standard in the efficacy of washing hand and the skin irritation, there are no significant difference (P>0.05).According to the amount of hand lotion 60 L used daily, 900 yuan can be saved daily, and 300 000 yuan can be saved every year. ConclusionIt is  simple,effective and feasible to prepare and use selfmade hand lotion. It can reduce the cost of hospital and play active role in preventing and controlling nosocomial infection.

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比较不同消毒剂对血管留置针注射帽的消毒效果，探索简单有效的消毒方法。采用实验方法，将临床分离的金黄色葡萄球菌实验性污染血管留置针注射帽，分1.0×102 CFU、5.0×103CFU及1.0×105CFU 3个数量级；设乙醇棉签、碘伏棉签和洗必泰乙醇棉签消毒3个实验组，同时设生理盐水组为对照组，每组40份样本。采样后所有标本接种于血平板，37℃培养48 h，计算菌落数。当金黄色葡萄球菌污染量为1.0×102 CFU时，对照组细菌生长量为（52.12±4.31 ）CFU，实验组3种消毒方法消毒后注射帽均无细菌生长；污染量为5.0×103CFU时，对照组细菌生长量为（116.25±10.52） CFU，洗必泰乙醇组和乙醇组所有注射帽无细菌生长，碘伏组注射帽细菌生长量为（6.78±3.60） CFU，碘伏组与洗必泰乙醇组和乙醇组消毒后注射帽细菌数量间差异有统计学意义（F=1.84，P＜0.05）；污染量为1.0×105CFU时，对照组细菌生长量为（283.34±16.41）CFU，洗必泰乙醇组无细菌生长，乙醇组细菌生长量为（10.12±3.42）CFU，碘伏组细菌生长量为（63.26±10.63）CFU，三组间细菌数量差异有统计学意义（F=4.23，P＜0.01）。提示洗必泰乙醇组对血管留置针注射帽的消毒效果最好，是最佳选择。

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目的方法结果结论收集2006年1月—2007年12月间临床各科门诊和住院泌尿系感染患者的尿标本微生物病原学检测及药敏试验资料。自512份尿标本分离出161株细菌，其中革兰阴性（G-）杆菌118株（73.29%），革兰阳性（G+）球菌28株（17.39%），真菌6株（3.73%），L型细菌9株（5.59%）。G-杆菌以大肠埃希菌为主， 达87株（54.04%）；大肠埃希菌产ESBLs率为24.14%。G+球菌中，葡萄球菌属细菌14株（8.78%），以凝固酶阴性葡萄球菌为主（13株，8.08%）。G-杆菌对氨苄西林耐药率最高，为88.98%；对美罗培南和亚胺培南敏感，耐药率分别为1.98%和2.98%。G+球菌对青霉素G的耐药率最高，为90.00%；对万古霉素敏感，未发现耐药株。除L型细菌外的所有菌株对环丙沙星、氧氟沙星、左氧氟沙星耐药率分别为44.35%、37.39%、33.04%。提示泌尿系感染以G-杆菌为主，且各类病原菌对各种抗菌药物的耐药率不同，临床医生应及时了解泌尿系感染病原菌种类和药敏试验结果，合理使用抗菌药物。

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目的方法结果结论自制问卷调查表以无记名方式对84名参加“消毒员上岗证培训班”的消毒员进行调查。结果显示，高中及以下学历者占60.72%；未接受医学和机械维护知识培训率分别为60.71%、100.00％；职业安全知识76.19%源于护士长培训和工作经验积累，戴隔热手套者仅2.38%；掌握紧急处理知识者占38.10%；每日对灭菌器进行维护者占48.81%，安全阀检查者占7.14%。提示消毒员学历偏低，医学及机械维护知识匮乏，安全防护意识淡薄，应急处理技术亟待提高。

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目的方法结果结论收集威海市肿瘤医院2004年1月—2007年12月698份法定传染病报告卡资料进行分析。共报告法定传染病13种：肠道传染病399例（57.17%），包括细菌性痢疾、甲型肝炎、戊型肝炎及感染性腹泻；血源及性传播传染病206例（29.51%），包括乙型肝炎、丙型肝炎和淋病，其中乙型肝炎病例数最多（182例）；呼吸道传染病92例（13.18%），包括结核、流行性感冒、流行性腮腺炎、风疹及水痘；其他传染病（急性出血性结膜炎）1例（0.14%）。成人以血源、性传播及肠道传染病为主，儿童以肠道及呼吸道传染病为主。肠道传染病主要发生于7～9月，呼吸道传染病多发生于12～3月。流动人口所占比率与前3年相比显著增加（均P＜0.001）。提示应加强对流动人口的管理，对婴幼儿及时接种相关疫苗，并针对季节特点采取措施，以减少传染病的发生。

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目的方法结果结论2007年1月，对某医院160名护理人员发放针刺伤问卷调查表，根据问卷调查结果，循证护理小组汇总与针刺伤发生相关联的因素，确定循证问题，系统查询文献，制订最佳干预方案。通过增设职业防护课程，进行医院感染与职业防护、知识技能培训，强化循证护理，针刺伤发生率由干预前的90.63%降低至干预后的61.88%，两者比较，差异有高度显著性（χ2=105.99，P＜0.01）。提示应用循证护理可提高护理人员职业防护依从性，降低针刺伤发生率。

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目的方法结果结论调查一起血液透析中心患者的发热事件: 2008年10月26日—11月1日，4例经锁骨下深静脉置管建立透析通路的患者均在透析开始30～45 min后或透析结束后出现＞38℃的体温（最高达40.8℃），且均畏寒、寒战。经血液培养和导管尖端培养检出阴沟肠杆菌，在透析机连接桥出入口也检出阴沟肠杆菌，本案例诊断为医院内颈静脉导管相关血流感染。通过采取暂停收治新患者，开展全面现场调查，设置隔离病房，对透析水处理系统、送水管道各接口、透析机及相关配套设施进行全面彻底地清洁消毒，严格规范血液透析中心的管理，严格进行手处理等措施，未发生二代感染病例，感染得到及时有效控制。

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真菌感染在临床上颇为常见,它不仅包括侵犯表皮角质层、毛发和甲板的浅部真菌感染，也包括侵犯真皮、皮下组织和内脏器官的深部真菌病。近20年来，在临床上随着广谱抗菌药物、免疫抑制剂、细胞毒药物的广泛应用；器官移植、导管技术及静脉高营养等技术的开展；严重疾病如恶性肿瘤、糖尿病和艾滋病等使免疫缺陷宿主不断增多；真菌感染率，特别是系统性条件致病性真菌的感染率在不断上升［1］。实验室检查是临床诊断真菌感染的重要依据，常规的实验室诊断方法包括直接镜检法和培养法、病理学方法、血清学方法和分子生物学方法。本文就这几方面的研究进展进行综述。

Abstract:

树突状细胞（dendritic cell，DC）是机体内专职的抗原提呈细胞（antigen presenting cell，APC），免疫应答的始动者，处于免疫反应的控制位置。DC特异性细胞间黏附分子3结合非整合素因子（dendritic cellspecific intercellular adhension molecule3grabbing nonintegrin, DCSIGN, CD209）是DC表面特异性的识别受体与黏附受体。 1992年Curtis等［1］在研究人免疫缺陷病毒（HIV）时首先发现DCSIGN。1999年Geijtenbeek等［2-3］利用ICAM3Fc荧光磁珠在DC外膜上也筛选出了DCSIGN。本文就DCSIGN的特征及其与微生物感染的关系进行综述。