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不吻合血管的复合组织瓣移植修复手指皮肤肌腱缺损一例

婴幼儿结节性硬化症眼底改变一例

The disinfection effect of peracetic acid versus glutaraldehyde in disinfection of flexible endoscope: a Meta-analysis

ObjectiveTo compare the disinfection effect of peracetic acid versus glutaraldehyde in disinfection of flexible endoscope, and provide suggestions for choosing endoscopic disinfectant.MethodsWe searched literatures in PubMed, Embase, Cochrane Central Library, China National Knowledge Infrastructure, Wanfang database and VIP database, with the retrieval time from the establishment of each database to July 2017, screening and comparing the disinfection qualification rate of peroxyacetic acid versus glutaraldehyde in immersion disinfection of flexible endoscope. The number of flexible endoscopies after disinfection was the main effect index, and a fixed effect model analysis was performed.ResultsSix comparative studies were enrolled in this Meta-analysis, with a total of 786 flexible endoscopes. The result of Meta-analysis showed that the qualification rate of disinfection of peracetic acid was higher than that of glutaraldehyde with the same disinfection time [relative risk=1.09, 95% confidence interval (1.06, 1.13), P<0.000 01].ConclusionThe disinfection effect of peroxyacetic acid immersion method is better than that of glutaraldehyde.

A research for reasonable configuration standard of electrocardiogram monitors in surgical nursing units of a large public hospital based on analytic hierarchy process

ObjectiveTo find out the influencing factors of electrocardiogram (ECG) monitor configuration decision in surgical nursing units and form a scientific configuration standard, so as to provide a basis for the reasonable configuration of ECG monitors.MethodsFrom May to June 2018, the indexes and weights affecting the configuration of ECG monitors in surgical nursing units of a large public hospital were determined by interview survey method and analytic hierarchy process.ResultsThe influencing factors for configuration of ECG monitors in surgical nursing units were the number of operations, number of rescues, number of emergencies, number of deaths, and number of patients transferred to and out of intensive care unit, and the weights were 0.459 7, 0.224 9, 0.155 3, 0.111 2, and 0.049 0, respectively. The classification of nursing units was taken as plan, and the configuration standard of ECG monitors was established.ConclusionThe configuration model of ECG monitors in surgical nursing units based on analytic hierarchy process realizes the combination of qualitative and quantitative analysis, which provides scientific and reasonable reference for the configuration of ECG monitors.

康复治疗延髓梗死后呼吸及吞咽功能障碍一例

Analysis of virulence genes of 376 Klebsiella pneumoniae strains

ObjectiveTo study the distributions of virulence genes of Klebsiella pneumoniae (KP) and the distribution of hypervirulent KP (HvKP), and assess the performance of a single gene to predict HvKP.MethodsPolymerase chain reaction (PCR) method was used to analyze 12 virulence-related genes (entB, irp2, iroN, iucA, mrkD, fimH, c-rmpA, p-rmpA2, p-rmpA, wzy-K1, allS and peg-344) and drug-resistance gene blaKPC among 376 clinical KP strains collected from January 2016 to December 2018. Sequence types (ST) of KP were determined after sequencing and comparison, following the detection of 7 house-keeping genes (gapA, infB, mdh, pgi, phoE, rpoB and tonB) by PCR method. Statistical analyses were made for the distributions of virulence genes of KP and the distribution of HvKP with GraphPad Prism 8 software.ResultsAmong the 376 KP strains, the positive rates of entB, irp2, iroN, iucA, mrkD, fimH, c-rmpA, p-rmpA2, p-rmpA, wzy-K1, allS and peg-344 were 100.0%, 76.9%, 22.1%, 28.2%, 97.6%, 97.1%, 1.6%, 24.5%, 21.0%, 7.4%, 4.8% and 31.6%, respectively. The positive rates of the aforementioned virulence genes in the blaKPC-positive group (n=167) were 100.0%, 94.0%, 7.2%, 16.8%, 97.0%, 96.4%, 0.0%, 15.0%, 6.6%, 0.0%, 0.0% and 21.0%, respectively, and those in the blaKPC-negative group (n=209) were 100.0%, 63.2%, 34.0%, 37.3%, 98.1%, 97.6%, 2.9%, 32.1%, 32.5%, 13.4%, 8.6% and 40.2%, respectively; there was no statistically significant difference in entB, mrkD or fimH between the two groups (P>0.05), the positive rate of irp2 was higher in the blaKPC-positive group than that in the blaKPC-negative group (P<0.05), and the positive rates of the rest virulence-related genes were lower in the blaKPC-positive group than those in the blaKPC-negative group (P<0.05). The rate of HvKP in the blaKPC-negative group was higher than that in the blaKPC-positive group (38.3% vs. 18.0%, P<0.05). As a marker of HvKP, iucA showed high sensitivity and specificity (90.9% and 97.7%), followed by p-rmpA2 (83.6% and 100.0%) and iroN (73.6% and 99.2%). ST11 accounted for 87.4% in the blaKPC-positive group, while ST23, ST20, ST54 and ST29 were the four primary types in the blaKPC-negative group, accounting for 23.4% totally.ConclusionsDifferent virulence genes mean different distributions in KP. blaKPC-negative KP is more virulent than blaKPC-positive KP. iucA and p-rmpA2 could serve as good predicators of HvKP. Armed with extreme virulence and drug-resistance, blaKPC-positive HvKP is of great clinical concern.

KL-6联合肺功能在多发性肌炎/皮肌炎合并间质性肺疾病中的应用价值

目的 探讨血清KL-6和肺功能检测在多发性肌炎（polymyositis，PM）/皮肌炎（dermatomyositis，DM）合并间质性肺疾病（interstitial lung disease，ILD）中的临床应用价值。方法 采用回顾性分析，纳入初发PM/DM患者（n=64）临床资料，分为间质肺组（n=40）和无间质肺组（n=44），另选健康对照组40例，比较三组患者血清KL-6水平及肺功能在两组的差异并分析其在PM/DM-ILD组中的应用价值。结果 间质肺组患者KL-6水平明显高于无间质肺组（P<0.01）；间质肺组患者VC%pred、MVV%pred、FEV1%pred、DLCO%pred、DLCO/VA%pred、TLC%pred均低于无间质肺组（P均<0.05）；ROC曲线分析得出PM/DM患者中血清KL-6诊断ILD敏感性为84%，特异性为87.5%，DLCO%pred诊断ILD的敏感性为97.7%，特异性为57.5%，而二者联合检测敏感性为90.5%，特异性为82.5%；间质肺组血清KL-6与VC%pred、MVV%pred、FVC%pred、FEV1%pred、DLCO%pred成反比，与FEV1/FVC%pred成正比（P均<0.05）；PM/DM发生ILD的危险因素：AST降低、KL-6升高及DLCO%pred降低。结论 PM/DM患者联合检测血清KL-6和肺弥散功能可提高ILD诊断效能，KL-6和肺功能可能预测ILD的发生及疾病活动度，可指导临床。