Objective To investigate the homology of the multidrug-resistant organisms（MDROs） isolated from patients and environment of intensive care unit（ICU） in a hospital, and provide evidence for clinical prevention and control of MDRO infections.Methods MDROs isolated from patients and environment of ICU in a tertiary first-class hospital from November 17 to December 17, 2021 were collected. Antimicrobial susceptibility test, pulsed-field gel electrophoresis（PFGE） and cluster analysis were conducted on the isolated strains.Results A total of 22 MDROs were collected, including 6 carbapenem-resistant Klebsiella pneumoniae（CRKP） strains, 11 multidrug-resistant Acinetobacter baumannii（MDR-AB） strains and 5 methicillin-resistant Staphylococcus aureus（MRSA） strains. 11 strains each were isolated from clinical patients and environment. Some of the environmental strains were highly homologous to the clinical strains. MDROs were isolated from ICU environment such as the surfaces of objects in the staff’s living area, microwave oven buttons, switches, etc. CRKP and MDR-AB were isolated even after disinfection of patient bedside tables and sinks. MRSA identical to that from the stethoscope used by patient was isolated from nurses’ hands after hand washing. CRKP was resistant to all commonly used antimicrobial agents（except ceftazidime/avibactam）. MDR-AB clinical strains showed a resistance rate of 40.0% to minocycline, and resis-tance rates ≥60% to other antimicrobial agents; while environmental strains of MDR-AB had a lower resistance rate than the clinical strains.Conclusion Clinical MDRO strains from ICU are highly homologous to the environmental strains, suggesting the possibility of MDRO transmission and cross-infection through the hospital environment. Therefore, it is necessary to strengthen the implementation of environmental cleaning and disinfection measures, improve hand hygiene compliance, and cut off the transmission of pathogenic bacteria in hospital to reduce the incidence of MDROs.

目的:评价当代医学生基于现代化信息技术的自主学习效果.方法:以2015级医学生为对照组,2016级医学生为研究组;通过问卷调查,文献分析,访谈等形式探究医学生网络自主学习中遇到的问题,制订基于现代化信息技术的自主学习方案并予实施;采用独立样本t检验,对改革前后,医学生毕业成绩进行比较.结果:基于现代化信息技术的自主学习模式下,我校医学影像及口腔专业毕业生成绩显著提高(P<0.05),临床医学专业成绩无显著差异(P>0.05).结论:基于现代化信息技术的自主学习的开展能有效改善传统教学模式的局限性,促进医学生自主学习能力的提高,提高教学质量和学习效果.

目的:探讨细胞角蛋白19片段(cytokeratin-19-fragment,CYFRA21-1)的检测在慢性肾脏病(chronic kid-ney disease,CKD)诊断中的应用价值.方法:将2019年1—12月在南通大学附属医院行CYFRA21-1血清水平检测的患者13133例纳入研究组,另外取同年来院体检的健康受试者212例为对照组,检测两组血清CYFRA21-1水平,以2.08 ng/mL为诊断分界点,分析各疾病中CYFRA21-1水平异常率;将对照组CYFRA21-1血清浓度水平分别与CKD及其各期比较;应用受试者工作特征(receiver operating characteristic,ROC)曲线分析CYFRA21-1对CKD及其各期诊断曲线下面积(area under the curve,AUC)、敏感性和特异性.结果:CKD、胰腺癌、肺癌居CYFRA21-1检测结果异常率较高的前3位;CKD各期患者血清CYFRA21-1浓度水平均高于健康体检者(P<0.05);CKD 1期患者血清CYFRA21-1浓度与其他分期相比,差异有统计学意义(P<0.05),CYFRA21-1在CKD及CKD 1～5期中诊断的AUC值分别为0.895±0.024、0.787±0.033、0.886±0.019、0.914±0.017、0.923±0.021、0.958±0.007,敏感性分别为82.19％、85.37％、88.89％、87.30％、91.40％、96.87％,特异性分别为82.63％、64.05％、75.83％、75.08％、82.21％、84.29％.结论:CYFRA21-1水平的监测对CKD患者具有一定的临床价值,可为临床诊疗过程提供参考.

Objective To analyze the identification, drug resistance and clinical significance of a rare bacterium of Bordetella holmesii ( B. holmesii) to improve its detection and clinical diagnosis and treat-ment. Methods A strain isolated from a bacteremia case was identified by bacterial culture, biochemical tests and 16S rRNA gene sequencing. Mega 7. 0 software was used to conduct a similarity analysis of 16S rRNA gene sequences between the type strains of Bordetella spp. and the isolate, and then a phylogenetic tree was constructed. Antibiotic resistance of the isolate was determined by E-test. Changes in bacterial growth were measured after adding different concentrations of riboflavin or its inhibitor lumiflavin to the cul-ture medium. Results B. holmesii ABD2 was the pathogen causing bacteremia in the immunocompetent pa-tient. It was deposited under the number of CGMCC 1. 13721 in China General Microbiological Culture Col-lection Center (CGMCC), and the 16S rRNA gene sequences were deposited in National Center for Biotech-nology Information ( NCBI) with the accession number of KT828544. 1. Unrooted tree showed that the B. holmesii strain was highly homologous with B. pertussis. Antibiotic susceptibility test showed that the mini-mum inhibitory concentrations ( MIC) of piperacillin, ceftazidime, cefepime, imipenem, meropenem, cipro-floxacin, levofloxacin, gentamicin, amikacin, erythromycin, tetracycline and polymyxin B against the isolate were low, while the MIC values of cefazolin, cefuroxime, cefoxitin, cefotaxime, aztreonam and trime-thoprim-sulfamethoxazole were high. Riboflavin accelerated the growth of B. holmesii ABD2, while its inhibi-tor lumiflavin had an inhibitory effect. Conclusions As B. holmesii is hard to isolate and identify, limited clinical, microbiological and epidemiological data are available. It is an under-recognized pathogen with a considerable amount of information that remains to be studied.

目的 分析肺结核患者痰结核杆菌检验的方法及效果.方法 选择2016年1月-2016年12月在我院接受治疗的肺结核患者75例,分别经由PCR检查以及痰涂片检查,分析两种检查结果阳性率.结果 75例肺结核患者经痰涂片检出阳性20例,约占26.67％,经PCR检查,痰结核杆菌阳性者55例,约占73.33％;PCR检查结果阳性率明显高于对照组,差异显著,x2 =28.8235,P＜0.05.结论 肺结核患者经由PCR方法检验痰结核杆菌准确率较高,建议进一步在临床应用及推广.

应用有证参考物质(CRM)评定8个生化项目不确定度,将标准量值传递至常规测量系统中,通过对测量程序的标准化研究,使不同测量程序测量结果具有可比性.参照EP15-A2文件评定批间不精密度引入的不确定度相对值;应用8个项目CRM及常规校准品分别校准常规仪器,并分别检测20份标本,参照EP15-A2、EP29-A评定偏移引入的不确定度,并合成扩展不确定度U.研究发现:两种校准状态下测量值有较好的相关性及一致性;修正偏移时,Urea、TC、Cr、Glu、HDL-C、LDL-C、TG、UA低浓度时不确定度分别为2.18%、2.03%、3.21%、1.73%、4.27%、5.22%、2.59%、2.55%,高浓度时分别为2.05%、1.62%、2.50%、1.97%、3.17%、3.19%、2.26%、3.02%;未修正偏移时,低浓度不确定度分别为5.96%、4.77%、7.41%、4.60%、7.30%、10.07%、8.05%、3.70%,高浓度不确定度分别为5.91%、4.61%、7.13%、4.69%、6.71%、9.18%、7.95%、4.04%.结果表明:应用CRM校准常规测量程序,可避免直接测量CRM时存在的基质效应等问题,实现非配套系统量值溯源,理论上缩短溯源链,同时也为不确定度评定相关研究赋予了新的思路.

青光眼是全球第二大致盲性眼病,除了损伤视神经、视野外还会影响虹膜、晶状体.临床观察和实验研究都表明青光眼可引起角膜内皮细胞数量减少,从而导致角膜透明性下降.我国以原发性闭角型青光眼患者居多,约占世界闭角型青光眼患者的一半,本文从原发性闭角型青光眼疾病本身、抗青光眼药物、手术及激光治疗等方面对角膜内皮细胞的影响进行综述.

目的 探讨米诺环素滴眼液对苯扎氯铵诱导的小鼠干眼的疗效及可能机制.方法 BALB/c雄性小鼠50只(100眼)使用0.2％的苯扎氯铵滴眼液滴眼诱导干眼.选择严重程度相似的干眼小鼠随机分为A、B、C、D4组,分另为0.1％米诺环素滴眼液组、0.5％米诺环素滴眼液组、溶剂组及空白组.在治疗前及治疗后第1、3及5天,行泪膜破裂时间(BUT)、角膜炎症指数、角膜上皮荧光素钠染色检查.治疗结束后摘取小鼠眼球,行HE及过碘酸-希夫染色(PAS),免疫组织化学及免疫荧光检测角膜组织角蛋白10(K10)的表达,Western blot检测角组织中白细胞介素-1β(IL-1 β)及肿瘤坏死因子-α(TNF-α)的表达水平,并分析各组的差异.结果 共40只小鼠(80眼)入选进行治疗实验,每组10只(20眼).用药前各组小鼠BUT、角膜炎症指数、角膜上皮荧光素钠染色差异无统计学意义(F =0.19、0.24和0.81;P=0.902、0.869和0.493).用药后第3天及第5天,A、B组较C、D组角膜炎症程度明显减轻(F =6.57及10.17;P=0.001和0.000),泪膜破裂时间延长(F=5.71及5.36;P=0.003及0.004).治疗第3天,A、B组较C、D组角膜荧光素钠染色轻(F =4.42,P=0.009).HE染色结果显示A、B组角膜上皮细胞形态较C、D组规整.PAS染色显示A、B组杯状细胞数量多于C、D组(F=15.36,P=0.007).免疫组织化学及免疫荧光结果均显示A、B组较C、D组K10表达减少(F =162.50,p=0.000).Western blot显示A、B组较C、D组IL-1 β、TNF-0表达明显降低(F=6.84及11.60;P =0.006及0.001).结论 米诺环素对苯扎氯铵诱导的小鼠干眼有一定的治疗作用,其机制可能与其抑制眼表炎症及鳞状上皮化生有关.

目的 以14项临床生化指标为例,探讨评定分析前不确定度的方法.方法 招募25名志愿者,各采集左右手臂共7管血,按照设定的参照方法及常规检验所用方法处理标本血清,于同一批内将结果配对计算分析.结果 LDH对每个因素都最敏感,分析前相对不确定度为12.01％;其次为AST、Glu,大于6.00％;Urea、TC分别为1.05％、1.61％;ALT、ALP、GGT、Cr、UA、TG、HDL-C、LDL-C、CK为2.5％～5.0％.AST、ALP、Urea、Cr、TC、TG因采血手臂不同带来的不确定度大;ALT、LDH、GGT、Glu由凝血时间不同带来的不确定度较大;LDL-C受运输方式的影响较大;UA、HDL-C、CK受真空管类型不同影响较大.结论 通过计算各分析前不确定度,说明采取相应对策从源头上减小不确定度值的必要性;其计算方式有望应用于其他指标与因素.