目的 了解医院感染现患率及危险因素，及时调整医院感染预防控制措施。 方法 医院感染管理专职人员与临床医师共同调查2010年12月15日0：00～24：00所有住院患者，查阅病历和床旁调查相结合，填写统一的现患率调查个案登记表和床旁调查表，对调查结果进行统计分析。 结果 医院感染现患率2.49%；科室主要分布在综合重症监护病房（ICU）和内三科（肿瘤和内分泌专业）；部位主要分布在下呼吸道、泌尿道、血液；导管相关感染有增加趋势，不合理使用抗菌药物问题较突出。 结论 综合ICU和内三科是新津县人民医院的重点科室；下呼吸道、泌尿道、中心静脉置管部位是重点部位；侵袭类操作及不合理使用抗菌药物是危险因素；该院医院感染预防控制工作重点：加强导管相关感染监测，增加耐药菌监测，加强对综合ICU、内三科的管理，加强对侵袭性操作及合理使用抗菌药物的管理，提高病原学送检率。
目的 了解综合重症监护病房（ICU）呼吸机相关性肺炎（VAP）感染率、危险因素、病原菌分布及其耐药情况，探讨有针对性的预防控制措施。 方法 2009年1月－12月综合ICU共收治患者447例，采用主动监测方法，由ICU医务人员和专职人员每日对综合ICU病房住院时间≥48 h且撤停机械通气后48 h内的患者进行VAP监测。 结果 447例患者中住院时间≥48 h的患者168例，96例患者使用呼吸机，使用呼吸机时间182 d，ICU住院总日数1 339 d，发生VAP 17例，呼吸机使用率13.59%，VAP感染率93.4例/1 000机械通气日，根据平均病情严重程度（ASIS法）调整后的VAP感染率为2.38%。呼吸机使用方式与VAP发生有关联。检出病原菌18株，全部为Gˉ杆菌，其中鲍曼不动杆菌4株，对包括硫霉素、氨曲南在内的多种抗菌药物耐药。 结论 综合ICU病房VAP感染率为2.38%，呼吸机使用不当是VAP的危险因素，VAP致病菌为Gˉ杆菌，其中鲍曼不动杆菌耐药率达100%，并呈多重耐药性；抗生素使用时间过长，预防性使用不当是致病菌产生多重耐药的重要原因。
Objective To evaluate the effects and the molecular mechanism of Liuwei dihuang pills in preventing steroid-induced osteonecrosis of the femoral head (ONFH) so as to provide an expremental basis for preventing ONFH cl inically. Methods Thirty-six adult Kunming mice (weighing 40-50 g, 46 g on average) were randomly divided into three groups (n=12): group A (control group), group B (model group) and group C (prevention group). In groups B and C, ONFHmice models were produced by intraperitoneal injection of horse serum at first (10 mL/kg) and a second injection of horse serum intraperitoneally (5 mL/kg) and prednisolone intramuscularly [45 mL/(kg•day), for 5 days] 2 weeks later. At the same time, the mice in group C were given Liuwei dihuang pills intragastrically [2 g/(kg•day)] and were given normal sal ine [10 mL/(kg•day)] in group B. In group A, mice were given normal sal ine intramuscularly and intragastrically as controls. The animals were sacrificed 2, 4, and 8 weeks after first treatment with prednisone, and femoral heads and l ivers were harvested to do histopathology analysis and apoptosis assay. Results Other mice survived throughout the experiment period except two death at 7 and 11 days after second injection of horse serum intraperitoneally in group B and one death at 24 hours after second injection of horse serum intraperitoneally in group C. The appearance and shape of the femoral head and the surface of cartilages were all normal. The histological observation showed: normal structures of l iver and femoral head were seen in group A at each time point; swell ing l iver cells with small fat vacuole, unclear structure of hepatic cords and narrower sinus hepaticus were seen, the bone trabeculae of femoral head was thin, sparse and collapsed in some regions and the changes became more obvious with time in group B; group C had similar results to group A. The percentage of empty osteocyte lacunae was significantly higher in group B than in groups A and C (P lt; 0.01). The osteoprotegrin expression significantly decreased and the osteoprotegrin l igand expressionsignificantly increased in group B when compared with groups A and C (P lt; 0.01). Apoptosis analysis showed that the apoptosis index in group B was significantly higher than that in groups A and C (P lt; 0.01). Conclusion Liuwei dihuang pills can prevent steroid-induced ONFH by improving l ipid metabol ism, releiving bone lesion, and protecting against cell death.
ObjectiveThe antifriction and antiwear effects of gelatin nanoparticles (GLN-NP) on artificial joint materials in bionic joint lubricant were investigated to provide a theoretical basis for the development of new bionic joint lubricant. MethodsGLN-NP was prepared by cross-linking collagen acid (type A) gelatin with glutaraldehyde by acetone method, and the particle size and stability of GLN-NP were characterized. The biomimetic joint lubricants with different concentrations were prepared by mixing 5, 15, and 30 mg/mL GLN-NP with 15 and 30 mg/mL hyaluronic acid (HA), respectively. The friction reduction and antiwear effects of the biomimetic joint lubricants on zirconia ceramics were investigated on a tribometer. The cytotoxicity of each component of bionic joint lubricant on RAW264.7 mouse macrophages was evaluated by MTT assay. ResultsThe particle size of GLN-NP was about 139 nm, and the particle size distribution index was 0.17, showing a single peak, indicating that the particle size of GLN-NP was uniform. In complete culture medium, pH7.4 PBS, and deionized water at simulated body temperature, the particle size of GLN-NP did not change more than 10 nm with time, indicating that GLN-NP had good dispersion stability and did not aggregate. Compared with 15 mg/mL HA, 30 mg/mL HA, and normal saline, the friction coefficient, wear scar depth, width, and wear volume were significantly reduced by adding different concentrations of GLN-NP (P<0.05); there was no significant difference between different concentrations of GLN-NP (P>0.05). Biocompatibility test showed that the cell survival rate of GLN-NP, HA, and HA+GLN-NP solution decreased slightly with the increase of concentration, but the cell survival rate was more than 90%, and there was no significant difference between groups (P>0.05). ConclusionThe bionic joint fluid containing GLN-NP has good antifriction and antiwear effect. Among them, GLN-NP saline solution without HA has the best antifriction and antiwear effect.