Abstract:

药品是一类用于诊断、治疗、预防人体疾病或改善人体生理功能的特殊物质，用药的目的在于既要充分发挥其药物的有效性，也要注意避免药物不良反应，即合理用药。

Abstract:

发热是临床最常见的症状之一，也是许多疾病的共同临床表现，据统计约有200多种疾病可引起发热［1］。虽然发热是人类在探索疾病过程中最先了解的症状之一，也是临床工作中最常遇见的临床表现，但是，迄今为止“发热待查”仍为临床的难点和研究中的热门课题。

Abstract:

)［Abstract］ObjectiveTo study the effect of cryoprotectant Ⅰon the cryopreservation of mice hepatocytes，so as to explore a cryoprotectant with better effect for improving the cryopreservation quality of hepatocytes．MethodsKunming mice weighting 20～30g were as donors, an improved collagenase perfusion technique was established to isolate the mice hepatocytes. The isolated mice hepatocyte were cryopreserved respectively with cryoprotectant  Ⅰ( trial group) and the standard cryoprotectant ( control group) in nitrogen liquid. Cryopreserved mice hepatocytes were thawed at  0.5 month,1 month, 1.5 months, 2 months respectively.  The viability,  function and morphology of hepatocytes were observed. ResultsAfter 2 months cryopreservation,  the viability of thawed hepatocytes in trial group were (80.18±2.44)% with trypanblue staining, while the control group were (49.71±3.51)%, there was significant difference between two groups (t=23.64, P＜0.05）; the leakage rate of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) of trial group were(14.03±2.21)U/L,  (15.14±3.03)U/L, and (15.11±2.10)U/L respectively, and the control group were (24.28±1.96)U/L, (25.44±2.06)U/L and  (26.22±3.23)U/L respectively, there were significant differences between two groups respectively (t=8.84, 8.58,8.32;  all  P＜0.05）; the synthesis of albumin (ALB) of the trial group and  control group were  (3.24±0.18)g/L and  (2.56±0.33)g/L respectively, there was significant differences between two groups (t=9.25, P<0.05).There were no obvious differences in the same group of its viability, the leakage rates of ALT, AST and LDH and synthesis of ALB at each stage of thawing ( all P＞0.05). ConclusionIn this research,  compared with standard cryoprotectant, the cryoprotectant Ⅰcan effectively protect the mice hepatocytes from cryopreserved injury,  mice hepatocytes can be cryopreserved in nitrogen liquid for two months with no changes in viability.

Abstract:

ObjectiveTo investigate the AmpC enzyme production in Enterobacter cloacae (E. cloacae) of a hospital, and drug resistance of E.cloacae to 10 kinds of commonly used antimicrobials, so as to guide clinical rational choice of antimicrobials. MethodsNinetyeight strains of nonrepeat clinical isolated E.cloacae were collected from the hospital from August 2007 to July 2008,  cefoxitin disk diffusion method was used to screen AmpC enzyme, AmpC enzyme of E.cloacae was confirmed by enzyme extract threedimensional highyield tests, the AmpC enzyme gene was detected with polymerase chain reaction. Resistance of drugs was detected by KirbyBauer agar diffusion method．ResultsAmong 98 clinical isolated E.cloacae，36 strains produced AmpC βlactamases,the detection rate was 36.73%. In 36 AmpCpositive strains, 6 only carried DHA gene (16.67%); 20 only carried ACC gene (55.56%);  8 carried ACC and MIR gene together (22.22%); 2 carried ACC, MIR and FOX genes together (5.56%). AmpCpositive strains were almost resistant to cefoxitin, and were sensitive to third generation cephalosporins, enzyme inhibitors, aztreonam, amikacin and ciprofloxacin with varying degrees(44.44%~91.67%), but sensitive to cefepime and imipenem, drug resistant rate was 27.78% and 0.00% respectively. ConclusionE.cloacae carries high rate of AmpC enzyme, which is the main cause of drugresistance to the third generation  cephalosporins, treatment of  E.cloacae infection should be based on the results of antimicrobial susceptibility test.

Abstract:

ObjectiveTo evaluate the risks of bloodtransmitted HBV through blood donors with  HBsAg(-)/antiHBc(+),so as to improve  better blood screening mode and ensure blood safety in clinical application. MethodsBlood HBV DNA in serologically screened negative blood samples  pooled at 8×45 μL size were detected by realtime fluorescence PCR, and  PCR negative samples were tested for HBsAg, antiHBs, HBeAg, antiHBe and antiHBc by ELISA. All HBsAg(-), HBV DNA(-) and antiHBc positive samples were detected by  realtime fluorescence PCR individually for HBV DNA, HBV DNA positive samples were analysed by quantitative fluorescence PCR.ResultsAmong 12 552 seronegative samples, 2 were detected HBsAg(-)/HBV DNA(+), the positive rate was 0.02%. Among 614 PCR negative samples, 320 were positive antiHBc, and one of which was positive HBV DNA, the positive rate was 0.31%. ConclusionDonors with HBsAg(-)/antiHBc(+) remain potential risk for HBV transmission, and nucleic acid amplication technique can  implement  and improve blood safety.

Abstract:

ObjectiveTo study the hepatitis B virus basic core promoter (BCP) mutation in HBV infected patients.MethodsThe serum samples from 132 HBV infected patients (all were HBV DNA positive) were collected. The gene covered HBV BCP were amplified by nested polymerase chain reaction (nPCR). The PCR products were sequenced directly, and the mutations in BCP T1762/A1764 were determined by sequence analysis. HBV genotypes were also detected by restriction fragment length polymorphism based on S gene PCR products.ResultsThe mutation rates of BCP T1762/A1764 were 27.45 % in 51 cases of HBV infected patients with HBeAg(+)，62.96% in 81 cases of HBV infected patients with HBeAg(-). The mutation of patients with HBeAg(-)was significantly higher than those with HBeAg(+)（χ2=15.79, P=0.00）.The detection rate of B gene mutation of BCP T1762/A1764 in HBV infected patients was 33.85%, which was obviously lower than 66.15% of C gene mutation (χ2=24.25, P=0.00）.ConclusionThe mutation in BCP T1762/A1764 generally exist in HBV infected patients and common in genotype C.

Abstract:

ObjectiveTo study the influencing factors for hollow process challenge devices (PCDs) in steam sterilization. MethodsTwo hollow PCDs were tested in a vacuum steam sterilizer (XHJCA BD resistance comprehensive detector) under different vacuum depths and vacuum rates. ResultsTo the same type of PCD, the deeper the vacuum depth, the less the pulse times; To the same vacuum depth, long  hollow PCD was more difficult to pass than short hollow PCD. When the vacuum rate was 50~100 kpa/min, the long hollow PCD was more difficult to pass than the short hollow PCD. ConclusionThe vacuum depth and vacuum rate of steam sterilizer can influence the monitoring result and the sterilization quality.

Abstract:

ObjectiveTo study the value of procalcitonin (PCT) in the prediction and differentiation of peripancreatic infection in severe acute pancreatitis (SAP) patients. MethodsOne hundred and two SAP patients were divided into  infected pancreatic necrosis group  (IPN group, n=18) and noninfection group (NI group, n=84) according to whether peripancreatic infection developed during the first 2 weeks of hospitalization. Serum PCT values of patients were monitored daily by quantitative (RIA) and semiquantitative (PCT QUEST)  methods. The peak values of PCT before the infection were recorded and analyzed. ResultsSerum PCT level of IPN group was (17.78±3.61)ng/mL, which  was significantly higher than  (11.74±3.25)ng/mL  of NI group (t=7.19,  P<0.01).  If the threshold value of serum PCT was set as 15ng/ml, the sensitivity and specificity of detecting infection was 83.33% and  77.38% respectively. Semiquantitative test of PCT showed a significant difference between the two groups, setting “++” as the threshold, the sensitivity and specificity of detecting infection were 94.44% and 39.29% respectively (χ2=6.17, P<0.05); and setting “+++” as the threshold, they were 61.11% and 96.43% respectively (χ2=36.73, P<0.01). ConclusionPCT detection is of great value in the prediction and differentiation of early peripancreatic infection in SAP patients.

Abstract:

［Abstract］ObjectiveTo investigate the occurrence, prognosis and pathogenic distribution of  infections associated with hematological malignancies.MethodsInfections  in  980 inpatients with hematological malignancies between  January，2000 and August， 2008 were analyzed retrospectively. ResultsAmong 980 inpatients,463(47.24％ )cases of infections developed，138 (29.81%) of which were communityacquired infections, 325(70.19%) were  nosocomial infections (NI). Among pathogens causing NI, 387 (55.68%) strains  were gramnegative bacilli, 194 (27.91%)   were grampositive cocci,114(16.40%) were  fungi. Infections occurred most frequently in upper respiratory tract(35.06%) and lower respiratory tract(16.36%). The fewer neutrophil counts were, the more infections developed (P<0.05); infection increased with the  prolongation of hospital stay (P<0.05). ConclusionPatients with hematological malignancies have high infection rates, the majority are NI; the main pathogens are  gramnegative bacilli ;infections are associated with neutrophil counts and hospital stay.

Abstract:

ObjectiveTo study the risk factors for infection with extendedspectrum βlactamases (ESBLs)producing gramnegative bacilli in  a general traditional Chinese medicine hospital.MethodsGramnegative bacilli isolated from specimens of inpatients between  October 2006 and October 2008 were performed   ESBLs confirmatory test, and the risk factors of ESBLsproducing strain infection were analysed by χ2 test and Logistic  regression method. ResultsA total of 567 strains were collected, 137 (24.16%) of which produced ESBLs. The ESBLsproducing strain infection had a relationship with length of hospitalization  in ICU for more than 3 days, indwelling urinary catheter, tracheal intubation, bad ward environment and using the third generation cephalosporins. ConclusionThis hospital has an average level in ESBLsproducing gramnegative bacilli infection. Length of hospitalization  in ICU for more than 3 days, invasive operation, bad ward environment and the third generation cephalosporin application are the risk factors for ESBLsproducing strain infection.

Abstract:

ObjectiveTo evaluate the impact of intrahepatic cholestasis of pregnancy (ICP) with HBV infection on prognosis of perinatal infants.MethodsBy retrospective investigation, 78 cases whose mothers with ICP and  HBV infection and 62 cases  whose mothers with ICP but without HBV infection were compared and analyzed, the weight of perinatal infants, incidence of preterm delivery, cesarean delivery, fetal distress, asphyxia of perinatal infants were analysed.  ResultsThe incidence of  preterm delivery whose mothers with ICP and HBV infection was 64.10% (50/78), and whose mothers with ICP but without  HBV  infection was 38.71% (24/62), there was  significant difference between the two groups（χ2＝8.94, P<0.01）,whereas the incidence of cesarean delivery, fetal distress, asphyxia  and  weight of perinatal infants had no statistical difference（All P>0.05）.ConclusionICP with HBV infection can increase the  incidence of  preterm delivery. Monitoring and treatment should be strengthened for HBV infected pregnant women with ICP, so as to ensure the safety and health of perinatal infants.

Abstract:

ObjectiveTo evaluate injuries in orthopedic doctors by surgical instruments. MethodsForms about professional exposure filled by orthopedic doctors between January, 2005 and December, 2008 were analysed retrospectively. ResultsNinetyseven doctors suffered 104 times of orthopedic injuries. The incidence of injuries in 2005,2006, 2007 and 2008 were 19.07%(37/194), 12.75%(26/204), 10.23%(22/215) and 8.05%(19/236) respectively, there was a tendency of decrease; compared with 2005, the incidence of injuries decreased obviously in 2008 (χ2=8.72，P=0.00). The main surgical instruments causing injuries were scalpel (26.93%), rongeur (25.96%) and steel needle for internal fixation(21.15%). The main period of injuries was 12∶00~16∶00(32.69%) and 16∶00~18∶00(28.85%). ConclusionOccupational education should be enhanced, administration should be improved and precaution measures should be perfected, so as to reduce the incidence of  injuires by surgical instruments in orthopedic doctors.

Abstract:

ObjectiveTo realize the current situation about nosocomial infection (NI) in a hospital，so as to provide reference for making the prevention and control measures.MethodsPrevalence rates of NI in patients who were hospitalized on October 25, 2008 were investigated by the combination of bedside examination and medical records checking.ResultsA total of 727 patients were surveyed, prevalence rate was 2.06%, case prevalence rate was 2.20%; the main infection site was  respiratory tract, and constitutional ratio of upper respiratory and lower respiratory tract were both 18.75%; and the usage rate of antimicrobial agents was 26.82%, infected  patients’ pathogenic detection rate was 58.87%, infected  patients’ pathogenic detection rate before using antimicrobial agents was 35.48%.Risk factors for NI were intravenous catheter, application of respirators, underlying diseases and surgical operation.ConclusionSurvey of prevalence rates of NI can promote the realization of patients with NI and provide evidence of NI control.

Abstract:

ObjectiveTo investigate antimicrobial resistance and the prevalence of AmpC βlactamases and extendedspectrum βlactamases(ESBLs)producing gramnegative bacteria from specimens of a respiratory intensive care unit(RICU)．MethodsAmpC βlactamasesproducing and AmpC βlactamases combined with ESBLsproducing strains were detected by threedimensional test, ESBLsproducing isolates were identified with the method recommended by the National Committee for Clinical Laboratory Standard(NCCLS). Antimicrobial susceptibility of AmpC βlactamases and ESBLsproducing strains were detected by KirbyBauer and Etest methods. ResultsAmpC βlactamases, ESBLs and AmpC βlactamases combined with ESBLsproducing strains were found in 28(16.67%), 71 (42.26%)and 12(7.14%) strains respectively. The most common AmpC βlactamasesproducing strains was Enterobacter cloacae (57.14%);  Among ESBLsproducing strains, the most common isolates were Klebsiella pneumoniae (71.70%)and Escherichia coli (55.81%). The AmpC βlactamasesproducing strains were more susceptible to imipenem and cefepime, the resistant rate of which was 3.57% and 28.57% respectively. The  resistant rate of ESBLsproducing strains  to imipenem，piperacillin/tazobactam and cefoperazone/sulbactam was  2.82%, 32.39% and 25.35% respectively. AmpC βlactamases combined with ESBLsproducing strains were only sensitive to imipenem, imipenemresistant strain was not found.ConclusionAmpC βlactamases and ESBLsproducing gramnegative strains are common in clinical isolates from RICU, and resistance to the majority of  new broadspectrum βlactamas, but sensitive to imipenem.

Abstract:

ObjectiveTo evaluate  drug resistance and risk factors of pandrug resistance of Pseudomonas aeruginosa (PDRPA)  isolated from clinical specimens in a hospital.MethodsFive hundred and thirtyeight strains of Pseudomonas aeruginosa(PA) were isolated from a hospital between January 1st,2008 and May 1st, 2009, the results of susceptibility test of PA to 18 kinds of antimicrobial agents were analyzed  retrospectively. The clinical data of patients with  PDRPA infections (PDRPA infection  group,28 cases) were compared with that of patients without PDRPA infections( control group, 48 cases) during the same hospitalization period. ResultsAmong 538 strains of nonrepeated PA, resistance to amikacin and piperacillin/tazobactam was low, which was 18.40% and 27.70% respectively; resistance to imipenem, meropenem, ceftazidime and ciprofloxacin  was 69.52%, 56.88%, 45.91% and 56.88% respectively.28 (5.20%) strains was PDRPA.  Risk factors for PDRPA infections were tracheal intubation, long time hosptalization in ICU and longterm combination of  antimicrobial application. ConclusionDrugresistant rates of PA to multiple antimicrobial agents  are  very high, especially resistance to imipenem,which should be paid attention to. Patients hospitalized in ICU and using multiple antimicrobial agents, especially those with mechanical ventilation, should be paid attention to PDRPA infection.

Abstract:

ObjectiveTo study resistance of clinical isolated Neisseria gonorrhoeae to ciprofloxacin in Nanning area. MethodsNine hundred and seventy strains of Neisseria gonorrhoeae isolated from urogenital system in patients in a dermatology institute between January 1996 and December 2008, minimum inhibitory concentrations (MICs) of ciprofloxacin were determined by agar dilution method. ResultsThe total resistant rate of Neisseria gonorrhoeae to ciprofloxacin was 81.96%, there was obviously increased tendency in resistant rate (χ2=394.49, P<0.005) with each year; drug resistant rate in 1996, 2000, 2005 and 2008 was 19.56%, 93.81%,98.75% and 100.00% respectively, drug resistant rate increased rapidly before 1999, and remained high level after 2000. The MIC50 increased from  0.125mg/L in 1996 to 4mg/L in 2000 and 8mg/L in 2006; MIC90 was also at high level. ConclusionResistance of Neisseria gonorrhoeae to ciprofloxacin is very serious in Nanning area,  fluoroquinolones such as ciprofloxacin is not suitable as the  firstline drugs for treating patients with gonorrhea in Nanning area, it is important to survey successively antimicrobial resistance of Neisseria gonorrhoeae.

Abstract:

目的方法结果结论回顾性分析某院2004年1月—2006年12月下呼吸道感染患者病原菌分布及耐药趋势。共分离病原菌4 563株，以革兰阴性（G-）菌为主，占60.55％（2 763株）；2004—2006年G-菌检出数依次为728、1 005、1 030株；居前3位的细菌依次为铜绿假单胞菌（36.58%）、大肠埃希菌（8.24%）、肺炎克雷伯菌（6.00%）。真菌占19.99％（912株），2004—2006年检出数依次为261、334、317株。革兰阳性（G+）菌检出率为19.46％（888株），2004—2006年检出数依次为241、301、346株；居前3位的细菌依次为肺炎链球菌（5.41%）、凝固酶阴性葡萄球菌（5.22%）、金黄色葡萄球菌（4.36%）。除肺炎链球菌外的G+菌和G-菌对大多数β内酰胺类抗生素的耐药率＞30％；G+菌均对万古霉素敏感，G-菌对亚胺培南耐药率低。病原菌检出数日趋增多，且耐药严重，医务人员应依据药敏结果合理使用抗菌药物。

Abstract:

目的方法结果结论了解介入术后发热的流行病学特点及危险因素。采用回顾性调查方法，对某院2005年接受介入术检查和治疗的142例患者病历资料进行发热流行病学调查与分析。142例患者中，介入术后发热28例（19.72％），其中有4例（占14.29%）确定为医院感染，医院感染率为2.82%。年龄≥65岁（33.33%）、恶性肿瘤（34.48%）、植入和灌注栓塞术（34.72%）、抗菌药物应用达2～3种（52.38%）、住院时间≥7 d（56.10%）者发热率显著高于年龄＜65岁（13.40%）、其他疾病（9.52%）、其他介入方法（4.29%）、使用1种抗菌药物（14.05%）、住院时间＜7 d（4.95%）者，两两比较，差异均有显著性（P＜0.01～0.005）。提示高龄、恶性肿瘤、植入和灌注栓塞术、抗菌药物应用种数、住院时间长是介入术后发热的主要危险因素。

Abstract:

目的方法结果结论对辖区内19所医院97名产房助产人员的手消毒效果进行监测。手消毒总合格率为84.54%，其中公立医院助产人员手消毒合格率为91.55%，显著高于民营医院的65.38%（χ2=9.966，P＜0.05）。城区医院助产人员手消毒合格率为90.00%，稍高于农村医院助产人员手消毒合格率78.72%，但两者差异无显著性（χ2=2.357，P＞0.05）。所调查的一般情况中（医院是否具有健全的手卫生制度；洗手设施是否符合要求；医院是否对助产人员定期进行手卫生知识培训；助产人员洗手方法是否正确；医院是否有手消毒监测记录；使用消毒剂是否合格）每项内容，公立医院与民营医院差异均无显著性（均P＞0.05）。提示应加强产房助产人员手消毒工作，改善洗手设施，改进手消毒方法，有效预防经手导致产房交叉感染。

Abstract:

目的方法结果结论探讨除锈剂在提高医疗器械清洗质量中的作用。随机抽取同质锈污的医疗器械360件，分成实验组和对照组，每组180件。实验组器械浸泡在3M除锈剂1∶7溶液中15 min后取出，对照组器械用硬毛刷蘸去污粉刷洗，之后均用流动水冲净。实验组器械清洗合格率为98.89%（178/180），对照组为84.44%（152/180），两组比较，差异有高度显著性（χ2=24.58，P＜0.01）。提示对有锈迹的医疗器械，使用除锈剂清洗效果优于传统方法。

Abstract:

目的方法结果结论采用PDCA循环法，即计划（P）、执行（D）、检查（C）、处理（A）4个阶段管理，半年内将医院所有重复使用医疗器械、器具、物品收回消毒供应中心集中处置。自此消毒供应中心建立了各类制度、措施、工作流程、质量控制体系等管理文件30余份；器械、器具、物品日处理量平均增加3.71倍，器械处理种类从过去几十种到现在百种以上；器械处理质量稳步提高，在定期与不定期的抽查和检查中，清洗、消毒、灭菌质量均达卫生部规范及标准要求。PDCA循环体现了质量管理的前馈控制、过程控制、反馈控制，其科学性、系统性、彻底性使质量在不断循环往复中提高，达到质量持续改进的目的，并具较好实用价值。

Abstract:

血吸虫（Schistosome）是一种流行广泛并严重危害人类健康的病原体，寄生于人体的主要有日本血吸虫（Schistosoma japonicum，S.j）、曼氏血吸虫（Smansoni，S.m)和埃及血吸虫（S. haematobium，S.h）3种。据估计,全球约有6亿人受到威胁，2亿人受感染，成为世界性的公共卫生问题。目前，对血吸虫病的防治方法主要靠吡喹酮（PZQ）化疗和易感地带灭螺。PZQ尽管对人低毒而杀虫高效，但它既不是万能药也不能阻断血吸虫病流行传播。因此，探索药物靶位和发展有效疫苗已成为控制血吸虫病研究的首要问题。

Abstract:

人巨细胞病毒（human cytomegalovirus, HCMV）属于疱疹病毒属β疱疹亚科，是广泛存在于自然界中的一种机会致病性病毒。欧美等发达国家人群HCMV抗体阳性率在50%左右，我国人群HCMV抗体阳性率为86%～96%［1］。宫内感染常造成严重的先天感染,与异常妊娠和先天畸形有着密切的关系。先天HCMV感染可导致新生儿黄疸性肝炎、胆道闭锁、先天性巨结肠等消化系统疾病及畸形,也可引起血小板减少性紫癜、溶血性贫血等血液系统疾病和小头畸型、智力发育迟缓、脉络膜视网膜炎、视神经萎缩等不同程度的神经系统病变和畸形,严重者在孕期可导致胎儿生长迟缓以及流产或死胎。约5％～10％的先天感染患儿出现典型全身播散性疾病，即巨细胞包涵体病。母亲原发感染（初次感染外源性病毒）和再发感染（潜伏病毒被激活或再次感染外源性不同病毒株或更大剂量的同株病毒）HCMV都能引起胎儿宫内感染,原发感染传播率约为40％,而复发感染传播率为0.5%～1.0%,这可能与原发感染存在病毒血症有关［2］。近年来对于新生儿先天HCMV感染，临床有2种策略，即HCMV感染的产前治疗和产后早期干预。本文就此两方面进行综述。