导尿管抑菌涂层的研究进展

由导尿管引发的尿路感染(CAUTI)是医院常见的感染,在各种院内感染中的占比高达20%~30%,极大地影响了病人的生命健康。目前,基于导尿管表面生物膜生成及无机盐沉积等问题,研究人员提出了多种方法来预防或改善,以实现导尿管的抗菌和抗阻塞性能,如导尿管表面涂层构建、改进导尿管的结构设计、缩短临床使用时间等。综述了近年来导尿管表面抗菌涂层的研究进展,主要从物理改性和化学改性等方面展开。物理改性方法一般通过将聚乙二醇、聚两性离子、抑菌酶等沉积在导管表面,或在导管表面进行仿生微纳结构修饰等,以达到润滑和降低细菌黏附的效果。化学改性方法主要通过将可直接作用于细菌的药物或者因子(包括分子泵抑制剂、抗生素、一氧化氮、抗菌肽等)附着在导尿管表面,以达到抑菌、延长导管堵塞时间等目的。在此基础上,通过对当前导尿管研究趋势的总结及思考,对未来导尿管的功能、抑菌机制及验证等方面进行展望,以期为导尿管抑菌材料的选择和设计提供一定的指导。     

婴幼儿巨细胞病毒肝炎相关因素的调查分析

目的了解婴幼儿巨细胞病毒肝炎的相关因素。方法对215例巨细胞病毒肝炎患儿及其父母亲采用自行设计的调查表进行问卷调查。其内容包括：年龄（1~3个月4、~12个月）、性别（男、女）、居住地（城市、农村）及父母亲的文化程度（初中及以下、高中及以上）、有无母亲人巨细胞病毒感染情况等。采用荧光定量-聚合酶链反应（FQ-PCR）法检测215例患儿及其母乳人巨细胞病毒-DNA水平。Logistic回归分析婴幼儿巨细胞病毒肝炎的相关因素。结果母乳人巨细胞病毒-DNA检测阳性161例（74.9%）,其中患儿尿人巨细胞病毒-DNA检测阳性118例（73.3%）;母乳人巨细胞病毒-DNA检测阴性54例（25.1%）,其中患儿尿人巨细胞病毒-DNA检测阳性25例（46.3%）,二者患儿尿人巨细胞病毒-DNA检测阳性率比较差异有统计学意义（P〈0.05）。Logistic回归分析结果显示,患儿年龄及居住地、父母亲的文化程度、母亲人巨细胞病毒感染情况均为巨细胞病毒肝炎的相关因素。结论改善生活条件,提高父母素质,尽早做孕前巨细胞病毒感染诊断与治疗,是降低巨细胞病毒肝炎发生率的有效的防治措施。     

小麦霉菌侵染程度电子鼻快速检测方法的初步研究

本研究利用电子鼻气体传感器技术,初步建立了小麦霉菌侵染程度定性定量同步分析方法。小麦样品经辐照杀菌后接种5种谷物中常见有害霉菌,于85%相对湿度和28℃的环境中储藏至重度霉变。在样品储藏的不同阶段,选取时间节点0、1、3、5和7 d采集其电子鼻气味响应信息,建立了其响应信号和霉菌侵染程度的相关关系模型。结果显示,依据带菌量的不同,基于电子鼻信号的主成分分析法(PCA)可成功区分未霉变[2.7 log(CFU/g)]、轻度霉变[2.7～4 log(CFU/g)]与重度霉变[4 log(CFU/g)]的小麦样品;线性判别分析(LDA)对受单一霉菌侵染的小麦样品霉变程度的识别率达90.0%以上,对所有小麦样品的识别率达84.0%。偏最小二乘回归模型(PLSR)对小麦菌落总数的模型决定系数(R_p~2)和预测误差(RMSEP)及相对分析偏差(RPD)分别为0.852,0.504 log(CFU/g)和2.30。结果表明,利用电子鼻技术实现小麦霉菌侵染程度的快速识别是可行的。下一步应不断补充不同来源的小麦样品,以不断提高模型的精度和适用性。     

Short communication: Effect of subclinical mastitis on proteolysis in ovine milk

The aim of this work was to evaluate the effect of intramammary infection (IMI) on the endogenous proteolysis of milk. Four control checks were carried out in the half-udder milk of 10 ewes that acquired unilateral subclinical mastitis. Two of these checks were conducted before the infection was established and 2 after. Ten healthy ewes were tested as a control group. The presence of a subclinical IMI involved an increase of the products of casein hydrolysis, the proteose-peptone (p-p) fraction and minor (m) caseins, and a decrease of β-casein. As a result, a significant increase in the proteolysis index (PI), calculated as the ratio of m-casein to the sum of caseins (α + β + κ), took place. α-Casein and κ-casein were not significantly affected by IMI. Correlations confirmed the scenario: log₁₀ of somatic cell count (SCC) was positively correlated with p-p content and negatively with β-casein, whereas log₁₀ SCC was not correlated with α-casein or κ-casein. On the other hand, p-p content was positively correlated with m-casein and PI and negatively with β-casein, but no correlation was detected between p-p content and α- or κ-casein. Furthermore, between casein fractions, m-casein was only significantly correlated with β-casein. These results suggest that use of indices of proteolysis of caseins such as p-p, m-casein, and PI, could be applied together with SCC to evaluate the cheese-making quality of milk.     

Identification of Human Adenovirus in Respiratory Samples with Luminex Respiratory Virus Panel Fast V2 Assay and Real-Time Polymerase Chain Reaction

In order to compare the last version of the Respiratory Virus Panel (RVP) Fast assay for human Adenovirus (hAdv) detection with a specific real-time polymerase chain reaction (qPCR), which is considered the gold standard for hAdv detection, nasopharyngeal samples collected from 309 children (age range, four months to eight years) with respiratory tract infection were tested using the RVP Fast v2 assay (Luminex Molecular Diagnostics, Inc., Toronto, ON, Canada) and a specific TaqMan qPCR to identify hAdv DNA. The RVP Fast v2 assay detected 30/61 (49.2%) hAdv infections that had been identified by real-time qPCR, demonstrating a significantly lower detection rate (p < 0.001). The sensitivity of the RVP Fast v2 assay in comparison to qPCR was lower in younger children (42.9% vs. 57.7%; Cohen’s kappa coefficient, 0.53); in samples with co-infections (40.0% vs. 56.7%; Cohen’s kappa coefficient, 0.52); and in samples with hAdv type C (45.9% vs. 57.1%; Cohen’s kappa coefficient, 0.60). Samples with lower viral loads were associated with a significantly lower sensitivity of the RVP Fast v2 assay (35.1% vs. 68.2%, p = 0.01; Cohen’s kappa coefficients, 0.49). The RVP Fast v2 assay has important limitations for the detection of hAdv and cannot be used to evaluate whether hAdvs are the main etiologic agent responsible for an outbreak or when epidemiological studies are performed.     

Indoor exposure to particulate matter and the incidence of acute lower respiratory infections among children: A birth cohort study in urban Bangladesh

Approximately half of all children under two years of age in Bangladesh suffer from an acute lower respiratory infection (ALRI) each year. Exposure to indoor biomass smoke has been consistently associated with an increased risk of ALRI in young children. Our aim was to estimate the effect of indoor exposure to particulate matter (PM_2.5) on the incidence of ALRI among children in a low‐income, urban community in Bangladesh. We followed 257 children through two years of age to determine their frequency of ALRI and measured the PM_2.5 concentrations in their sleeping space. Poisson regression was used to estimate the association between ALRI and the number of hours per day that PM_2.5 concentrations exceeded 100 μg/m³, adjusting for known confounders. Each hour that PM_2.5 concentrations exceeded 100 μg/m³ was associated with a 7% increase in incidence of ALRI among children aged 0–11 months (adjusted incidence rate ratio (IRR) 1.07, 95% CI 1.01–1.14), but not in children 12–23 months old (adjusted IRR 1.00, 95% CI 0.92–1.09). Results from this study suggest that reducing indoor PM_2.5 exposure could decrease the frequency of ALRI among infants, the children at highest risk of death from these infections.     

浙江省数字医院系统建设的现状及其发展

笔者对浙江省已建成的200多家医院进行了智能化建设的基础调查，并在此基础上阐述了数字医院系统的设计理念、组成以及建设中存在的问题。     

人工气道内持续湿化护理观察

目的探讨气道内持续湿化方法对人工气道建立患者预防肺部感染的护理治疗效果。方法 35例进入急诊科和重症监护室的人工气道建立患者随机分成实验组20例和对照组15例,实验组患者采用微量注射泵持续湿化的方法对人工气道进行护理,对照组采用常规护理方法间断给予气道内湿化的方法对人工气道进行护理,分别观察记录2组患者体温、吸痰间隔时间、拔管时间并进行痰液细菌培养,主要以体温和痰液细菌培养结果判断是否有肺部感染的发生评价疗效,卡方检验方法对临床采集数据进行统计学处理。结果实验组与对照组比较,实验组发生肺部感染例数明显减少,统计学处理差异有显著性。结论与传统的间断气道湿化相比,采用微量注射泵持续气道湿化操作简单,安全可靠,效果确切,并发症少。     

大型医院内计算机的维护心得

现在的医院信息化水平越来越高，特别是大型的三甲级别医院，更是达到无纸化的水平，曾经的手写处方单和钢笔，被高配置的计算机和打印机所代替。因此，对这些促进医院信息化的计算机进行维护是医院日常工作的重点部分。     

The ideal reporting interval for an epidemic to objectively interpret the epidemiological time course

The reporting interval of infectious diseases is often determined as a time unit in the calendar regardless of the epidemiological characteristics of the disease. No guidelines have been proposed to choose the reporting interval of infectious diseases. The present study aims at translating coarsely reported epidemic data into the reproduction number and clarifying the ideal reporting interval to offer detailed insights into the time course of an epidemic. We briefly revisit the dispersibility ratio, i.e. ratio of cases in successive reporting intervals, proposed by Clare Oswald Stallybrass, detecting technical flaws in the historical studies. We derive a corrected expression for this quantity and propose simple algorithms to estimate the effective reproduction number as a function of time, adjusting the reporting interval to the generation time of a disease and demonstrating a clear relationship among the generation-time distribution, reporting interval and growth rate of an epidemic. Our exercise suggests that an ideal reporting interval is the mean generation time, so that the ratio of cases in successive intervals can yield the reproduction number. When it is impractical to report observations every mean generation time, we also present an alternative method that enables us to obtain straightforward estimates of the reproduction number for any reporting interval that suits the practical purpose of infection control.