目的 探讨不同年份CLSI文件中头孢吡肟折点变化对肠杆菌科细菌药敏结果的影响,辅助临床合理调整用药。方法 应用2013年(S23)与2014年(S24)CLSI文件中的头孢吡肟折点回顾性分析我院2014年肠杆菌科细菌的药敏变化情况。结果 与S23折点相比,肠杆菌科细菌中大肠埃希菌、肺炎克雷伯菌对头孢吡肟的耐药率分别上升了2.6%、2.8%,耐药率差异有统计学意义(P<0.05);产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌以及非产ESBLs肺炎克雷伯菌对头孢吡肟的耐药率分别上升了3.8%、2.4%、2.0%,耐药率差异有统计学意义(P<0.05); 对于其它肠杆菌科细菌如非产ESBLs大肠埃希菌、阴沟肠杆菌等对头孢吡肟的耐药率变化无差异(P>0.05)。与S23相比,在S24中头孢吡肟MIC值分布在4 μg/mL、8 μg/mL、16 μg/mL时对细菌的药敏变化最为显著。结论 依照S24折点,肠杆菌科细菌对头孢吡肟的耐药率有不同程度的升高;尤其对产ESBLs菌株耐药率影响更大;临床应结合实验室报告合理调整用药。

Objective To investigate the change of the break point of the CLSI in different years on the drug sensitivity of Enterobacteriaceae bacteria. This is valuable for rational use of antibiotics. Methods To retrospective analyze 2014 Enterobacteriaceae bacteria susceptibility variation by CLSI file cefepime breakpoint of 2013(S23) and 2014(S24). Results Compared with breakpoint of S23, E. coli and Klebsiella pneumonia, cefepime resistant rate rose by 2.6% and 2.8% respectively, and the resistance difference was statistically significant (P<0.05); ESBLs-producing E. coli, ESBLs-producing Klebsiella pneumoniae and ESBLs non-producing Klebsiella pneumoniae toword cefepime resistant rate rose by 3.8%, 2.4% and 2.0% respectively, and the resistance difference was statistically significant (P<0.05); For other Enterobacteriaceae bacteria, such as ESBLs non-producing E. coli and Enterobacter cloacae with cefepime in drug resistance rate had no significant difference (P>0.05). Compared with S23, variety in drug susceptibility of bacteria was most significant in S24, during cefepime MIC of 4 μg/mL, 8 μg/mL, 16 μg/mL. Conclusion According to the S24 breakpoint, the drug resistance rates of the bacteria in the intestines of the bacteria is increasing, especially in ESBLs strain; antibiotics use should be following laboratory results.

目的 探讨糖尿病胃轻瘫大鼠不同血糖水平对Cajal间质细胞(ICC)的影响及其机制。方法 选择雌性Wista大鼠60只进行随机分组,实验组40只,对照组20只。实验组糖尿病Wista大鼠模型以单次腹腔注射链脲佐菌素法诱导。免疫组织化学荧光染色检测不同血糖浓度大鼠胃ICC数量及网络结构。结果 实验组大鼠血糖浓度高于对照组,ICC数量,低于对照组,且比较差异有统计学意义(P<0.05)。实验组大鼠中血糖浓度越高,ICC数量越低,说明血糖浓度升高可能与平滑肌及神经末梢之间缝隙连接的减少及其ICC网络的超微结构损伤及异常有关。结论 DM小鼠胃组织中血糖水平的升高,可能是DM胃中ICC数量减少的原因;外源性降低血糖能改善DM相关的胃肠道ICC病变。

Objective To observe the effects of glucose fluctuations on Cajal interstitial cells (ICC) of rats with diabetic gastroparesis(DGP) and its mechanistic. Methods 60 Wistar rats were selected and randomly divided into two groups. 20 rats in experimental group and 40 rats in control group. Used immunofluorescence staining to detect the amount of gastric ICC and network structure in DGP rats with different glucose levels. Results The blood glucose concentration in the experimental group was significantly higher than that in the control group, the amount of ICC in the experimental group was significantly lower than that in the control group(P<0.05). The amount of ICC decreased with the increase of glucose levels. In the experimental group, The gap junctions between smooth muscle and nerve endings, ultrastructural damage and abnormalities of the ICC network were probably related to glucose level. Conclusion The increase of glucose level was probably the cause of the decrease of the amount in ICC. Exogenousy decrease glucose levels probably can help to improve the lesion of ICC with DGP.

大数据时代的到来,给各行各业及整个社会文化带来了深刻变革。医学图书馆经受这一领域洗礼时,其数据处理方法和用户服务模式会发生显著变化,也对馆员素质提出了新的要求。文章就大数据时代医学图书馆馆员素质教育提出了几点建议。

目的 对中医治未病在社区孕妇孕期保健应用中效果进行探讨。方法 选取符合条件的300名社区孕妇,随机分为对照组和干预组,对照组不采取干预措施,干预组依据孕妇的中医体质判定表实施相应的中医干预方法,持续二个月,并对两组孕妇进行随访。对比分析两组孕妇的分娩和产后情况。结果 干预组孕妇自然分娩95例,剖宫产55例,自然分娩率高于对照组孕妇,差异有统计学意义(P<0.05);干预组新生儿巨大儿的发生率为6.7%,低于对照组的16.7%,差异有统计学意义(P<0.05);此外,干预组孕妇先兆流产、早产、妊娠期高血压和妊娠期糖尿病的发生例数低于对照组孕妇(P<0.05)。结论 应用中医治未病思想指导孕期保健,有助于减少孕产妇并发症和巨大儿发生率,保证母儿健康。

目的 了解2014年广州地区儿童专科医院的病原菌分布及耐药情况与全国细菌耐药监测网(CARSS)公布数据的异同点,并提出相关用药建议,为儿童临床合理应用抗生素提供科学依据。方法 将2014年本中心儿童院区检测的儿童细菌耐药数据与同期国家卫生计生委合理用药专家委员颁布的CARSS数据进行比较。结果 儿童医院与CARSS数据比较,革兰阳性菌比例较高(49.8% vs 28.5%),革兰阴性菌比例较低(50.2% vs 71.5%);肺炎链球菌、化脓性链球菌及流感嗜血杆菌检出率较高;耐药率明显升高的是肺炎链球菌对青霉素耐药率(33.2% vs 4.3％),耐药率明显降低的是鲍曼不动杆菌对碳青霉烯类耐药率(10.3% vs 57.0％),大肠埃希菌对喹诺酮类耐药率(27.6% vs 54.3％)。结论 广州地区儿童病原菌分布及耐药情况与CARSS数据比较有一定差异,特别是儿童主要致病菌肺炎链球菌对青霉素耐药的形势严峻,经验性抗感染治疗时需考虑本地及儿童的病原菌特殊性。

目的 分析个体化营养指导对双胎妊娠的结局影响。方法 将2014年2月—2015年12月在新疆喀什疏附县人民医院分娩的80例双胎妊娠,接受过个体化营养指导的42例为治疗组;未能或不自愿接受个体化营养指导的38例为对照组,观察比较对照组和治疗组的妊娠结局。结果 治疗组妊娠期糖尿病(GDM)、贫血、妊娠期高血压疾病、产后出血、新生儿窒息、低出生体重儿发生率小于对照组差异有统计学意义(P<0.05)。结论 利用个体化营养指导双胎妊娠孕妇饮食,可以减少并发症,取得理想的妊娠结局。

目的 探讨原发性肾上腺淋巴瘤的临床表现及诊疗方法。方法 总结我院收治的1例原发性肾上腺淋巴瘤患者的临床表现及诊疗方法,并回顾性分析国内外文献资料。结果 患者在全身麻醉下行右侧肾上腺肿瘤根治术+右叶肝部分切除术+膈肌修补术,取病理活检结果为(右肾上腺区、肝)弥漫性大B细胞淋巴瘤,术后使用R-CHOP方案规律化疗8次,随访1年患者已完全缓解,未见复发征象。结论 原发性肾上腺淋巴瘤是临床少见的恶性程度高的肿瘤,主要以弥漫大B细胞淋巴瘤多见,早期无明显特异性,且缺乏典型临床表现,临床上易误诊,一旦确诊,应及早手术并化疗以减缓疾病进展及减轻患者痛苦。

目的 了解长期低剂量辐射费放射工作人员健康状况的影响。方法 采用现况调查,按照国家卫生部发布健康监测标准对放射工作人员健康状况进行调查分析。结果 放射工作人员白细胞、血小板计数低于对照组,染色体畸形率、微核率高于对照组,差异有统计学意义(P<0.05)。随着工龄的增长,微核率呈上升趋势。结论 加强放射工作人员防护意识,缩短放射接触时间,加大设备保护力度,促进放射工作人员的健康。

Objective To study the health status of radiological workers who explore to long-term low-dose radiation.Methods A cross-sectional study had been investigated according to the National Ministry of Health monitoring standards of radiological workers. Results The white blood cell and platelet counts of radiological worker were less than the control group. There was a significant difference with the rate of chromosome abnormalities and the rate of micronucleus in the radiological workers(P<0.05). With the growth of length of service time, the micronucleus rate rose up. Conclusion We need to strengthen awareness of radiation protection, shorten the time of radiation exposure, increase equipment support level to protect the health of radiological workers.

目的 社区干预在颈动脉斑块伴脂代谢紊乱人群中的应用。方法 选取我院2012年3月—2014年3月186例颈动脉斑块伴脂代谢患者为研究对象,将患者抽签随机分为观察组与对照组,每组93例。对照组给予基础治疗及运动生活方式指导,观察组给予基础治疗以及强化社区健康管理综合干预,观察并记录两组Crouse积分,总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C )水平及遵医行为。结果 治疗1、2年后观察组颈动脉斑块积分(3.46±2.13)cm、(3.07±2.49)cm低于对照组(4.56±2.26)cm、(4.43±2.51)cm,两组差异有统计学意义(P＜0.05)。观察组治疗1年、2年后TC、TG、LDL-C水平低于对照组,HDL-C水平高于对照组,两组差异有统计学意义(P＜0.05)。观察组遵医行为优于对照组(P＜0.05)。结论 社区健康管理综合干预能显著提高患者遵医行为,改善生活方式,从而使血脂达到正常水平,延缓颈动脉斑块发展。

Objective To study the application of community intervention in population with carotid plaque complicated with dyslipidemia. Methods 186 cases of patients with carotid plaque complicated with dyslipidemia who were admitted in our hospital from March 2012 to March 2014 were selected as the study objects and were randomly divided into the observation group and the control group according to random sampling method, with 93 cases in each group. The control group was given basic treatment and guidance of exercise lifestyle. The observation group was given basic treatment and strengthened community health management integrated intervention. The crouse integral, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) levels and treatment compliance in the two groups were observed and recorded. Results After 1 and 2 years of treatment, the carotid artery plaque score in the observation group [(3.46±2.13) cm, (3.07±2.49) cm] was lower than that in the control group [(4.56± 2.26) cm, (4.43±2.51) cm](P<0.05). TC, TG and LDL-C levels in the observation group were lower than those in the control group while HDL-C level was higher than that in the control group (P<0.05). The treatment compliance in the observation group was significantly better than that in the control group (P<0.05). Conclusion Community health management integrated intervention can significantly improve the treatment compliance of patientsand their life style, so as to achieve the normal level of blood lipids and carotid plaque will be postponed.

目的 进一步提高宫腔粘连的超声诊断准确率。方法 对476例超声诊断的宫腔粘连病例进行回顾性分析。结果 476例经阴道彩超诊断的宫腔粘连患者,超声主要表现:内膜回声连续性中断,内膜厚薄不均。超声结合临床表现,将患者分成轻度粘连、中度粘连和重度粘连。71例重度粘连患者于我院行宫腔镜治疗。经阴道彩超结合临床,对宫腔粘连的诊断准确率达100%。结论 经阴道彩色多普勒超声是诊断宫腔粘连首选的检查手段。经阴道彩超结合临床,对宫腔粘连具有很大的诊断价值,对粘连的分级有助于指导临床制定治疗计划。

Objective To improve the ultrasound diagnostic accuracy rate of Intrauterine Adhesions. Methods Retrospectively analysis of 476 intrauterine adhesions cases were diagnosed by the transvaginal color ultrasound. Results Main imaging characteristics of 476 IUA cases were endometrial echo interruption, uneven thickness, et al. Combining ultrasound with clinical performance, the data was classified into three types: mild IUA, moderate IUA, severe IUA. 71 cases of severe IUA were treated with hysteroscopy surgery. Conclusion Transvaginal ultrasound with clinical data diagnosis for the intrauterine adhesions has higher practical value. The classification is helpful for making the treatment plan.