单中心腹膜透析相关性腹膜炎致病菌谱及经验性用药选择的临床研究

目的探讨单中心腹膜透析（PD）相关性腹膜炎患者的致病菌谱、耐药状况及合理的经验性用药情况。方法选取PD相关性腹膜炎患者74例（共发生109例次PD相关性腹膜炎），记录其透析流出液培养结果、初始治疗方案、疗效和转归。结果共分离出103株病原菌，G+菌69株（67.0%），G-菌27株（26.2%），真菌7株（6.8%），培养阴性21例次（18.1%）。G+菌中以凝固酶阴性葡萄球菌为主（30株、29.1%）；G-菌中以大肠埃希菌为主（13株，12.6%）。金黄色葡萄球菌对头孢唑啉耐药率为100.0%，未发现耐万古霉素的G+菌；大肠埃希菌对头孢他啶的耐药率为20.0%。初始治疗方案含头孢唑啉和含万古霉素的疗效以及含左氧氟沙星/丁胺卡那霉素和头孢他啶的疗效均无明显差异（均P＞0.05）。结论腹膜炎的致病菌谱仍以G+菌为主。金黄色葡萄球菌对头孢唑啉耐药率达100%，不宜将头孢唑啉作为所有患者的经验性用药，头孢他啶、左旋氧氟沙星或丁胺卡那霉素均可作为初始用药。     

院内获得性肺炎呼吸道病毒病原分析

目的了解当前小儿院内获得性肺炎（HAP）病毒病原学的状况。方法收集251例HAP的患儿资料,对其中做痰液病毒分离,获得合胞病毒（RSV）、流感病毒、副流感病毒病原学检测阳性结果的病例进行分析。结果251例HAP患儿中141例做了痰液病毒检测,其中阳性67例,病毒检出率为47.52%（67/141）,其中以RSV肺炎最为多见。67例病毒性HAP均以喘息为主要临床表现,多数不发热或低热,少部分可以表现为高热,血常规、CRP基本正常。67例中22例有明确的诱因,其中以使用激素最为多见。67例患儿均治疗有效。结论251例住院患儿中HAP病毒检出以呼吸道合胞病毒为主,预后均良好。     

亚胺培南耐药鲍曼不动杆菌医院感染危险因素分析

目的 了解亚胺培南耐药鲍曼不动杆菌（CRAB）医院感染的危险因素,并探讨Ⅰ类整合子在鲍曼不动杆菌亚胺培南耐药中的作用。方法 选取确诊为CRAB 医院感染患者54 例作为病例组,按1:3 配对选择162 例亚胺培南敏感鲍曼不动杆菌（CSAB）医院感染患者作为对照组,采用单因素分析及多因素logistic 回归分析其危险因素,PCR 检测Ⅰ类整合酶基因。结果 单因素分析发现,与CRAB 医院感染相关的危险因素有病情危重、入住ICU 时间、住院时间≥14d、机械通气/ 人工气道、留置尿管、中心静脉置管、免疫抑制剂的使用、抗生素使用时间≥7d、抗生素药物种类≥3 种。多因素logistic回归分析发现,病情危重（OR:8.47;95% CI:1.56～46.0）、入住ICU 时间（OR:9.32; 95% CI:1.83～47.43）、住院天数≥14d（OR:13.89;95% CI:3.07～62.85）、机械通气/ 人工气道（OR:18.86; 95% CI:4.38～81.31）、抗生素使用种类≥3 种（OR:6.16;95% CI:1.85～20.51）、抗生素使用时间≥7d（OR:5.41; 95% CI: 1.36～21.58）是CRAB 医院感染的独立危险因素;CRAB 组中Ⅰ类整合酶基因检出率（59.3%）显著高于CSAB 组（34.6%）,差异有统计学意义（P＜0.001）。结论 病情危重、入住ICU 时间、住院时间、机械通气/ 人工气道、抗生素使用种类≥3种、抗生素使用时间≥7d 是CRAB 医院感染的独立危险因素,Ⅰ类整合子在CRAB 中普遍存在,需加强对相关危险因素的控制及耐药机制的研究,早期防治CRAB 医院感染的发生。     

替罗非班在老年STEMI患者PCI治疗中的作用

目的 观察小剂量替罗非班在老年急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入（PCI）术中的治疗效果, 并探讨其临床安全性。方法 选取急性STEMI并行急诊PCI治疗的老年患者150 例,使用随机数字表法分为替罗非班组（80 例）和对照组（70例）,两组患者术前均予以阿司匹林300mg 及氯吡格雷300mg顿服,术后长期服用阿司匹林100mg、氯吡格雷75mg,1 次/d,替罗非班组在常规治疗基础上给予替罗非班负荷量（5μg/kg）在3min内静脉推注后以0.075μg/（kg·min）静脉滴注维持24h。观察两组手术前后梗死相关动脉TIMI血流情况、术后心电图相关导联抬高的ST 段回落幅度、住院期间出血及继发血小板减少症等事件发生率、术后3个月左心室射血分数（LVEF）及主要不良心血管事件（MACE）发生情况。结果 PCI术后,替罗非班组TIMI 血流2～3 级者75例（93.75%）,ST 段回落幅度为（69.96±15.53）%,均显著高于对照组的58 例（82.86%）和（64.18±14.02）%,差异均有统计学意义（均P＜0.05）;住院期间替罗非班组出血事件发生6例（7.5%）,低于对照组（P＜0.05）,而血小板减少情况未见明显增多（P＞0.05）。3个月随访结果显示,替罗非班组LVEF改善情况显著优于对照组（P＜0.01）,而MACE 发生率则降低（P＜0.05）。结论 小剂量替罗非班能有效提高老年急性STEMI患者PCI术后冠状动脉血流灌注,且不增加出血及血小板减少的风险,同时可改善心功能、降低MACE的发生。     

免疫功能正常的进展性播散型组织胞浆菌病1例

患者男,75岁,农民。因“畏寒、发热伴咳嗽、胸痛1个月”入院。患者1个月前出现畏寒、发热伴咳嗽、胸痛,最高体温39℃,疼痛以胸骨下及左侧胸部为主,深呼吸加重。2012-12-04当地医院胸部CT检查示：右肺上叶纤维硬结灶、右下肺感染性病变,左上肺及右下肺可见散在小结节影;血常规：红细胞2.31×1012/L,血红蛋白69g/L。住院期间给予哌拉西林三唑巴坦针抗感染治疗,症状未见好转,2012-12-10转入我科,查体：T37.8℃、BP128/72mmHg;神志清晰,消瘦明显,全身皮肤黏膜无黄染及皮疹、出血点,浅表淋巴结无肿大,颈软,颈静脉无怒张,桶状胸,胸骨中段压痛明显,两肺未闻及干湿性啰音,心率96次/min,律齐,各瓣膜听诊区未闻及明显病理性杂音。腹平软,肝脾肋下未及,双肾区无叩痛,双下肢无浮肿,双侧巴氏征（-）。患者有吸烟史40年,1包/d,近来吸烟较前减少,有饮酒史,否认食物药物过敏史,否认肝炎及结核等传染病史,曾经从事山货贩卖数年。入院后给予头孢吡肟针静脉滴注抗感染治疗,同时联合化痰等对症支持治疗。入院后进一步完善相关检查,血常规：白细胞11.5×109/L,中性粒细胞68.20%,淋巴细胞14.50%,嗜酸性粒细胞6.80%,红细胞2.50×1012/L,血红蛋白74g/L,红细胞压积0.21;C 反应蛋白74.50mg/L;红细胞沉降率＞140mm/h;肝肾功能基本正常;白蛋白24.3g/L,球蛋白38.2g/L;抗结核抗体阳性;大、小便常规、急诊肌钙蛋白、血凝常规、肿瘤指标、抗核抗体、肝炎抗体、抗HIV抗体、梅毒抗体均无异常;总IgE 3765.00IU/ml;T淋巴细胞亚群CD4/CD81.90;腹部B超检查肝、脾未见肿大,肾上腺未见占位;心电图显示窦性心律。入院当天由于患者胸痛明显,急诊胸部增强CT检查显示：肺门及右下肺斑片影,肿瘤考虑;两肺感染性病变伴少量支气管扩张;双侧胸膜病变,右侧少量胸腔积液;右侧肩胛骨及胸骨中段骨质缺损,转移灶考虑（图1、2）。入院第2天行胸骨病变部位穿刺针吸涂片检查结果提示：涂片内大量脓性渗出组织中见小块状红染坏死样物及数个多核细胞,结核性炎首先考虑。由于入院后抗感染治疗1周体温未见明显下降,多次痰涂片找抗酸杆菌及癌细胞菌阴性,痰培养未见致病菌,于2012-12-17行纤维支气管镜检查,见右下叶支气管开口脓性分泌物,吸出后管腔通畅,分泌物及刷片、灌洗液检查未见异常;胸腰椎MRI检查示：胸腰骶椎及部分附件、双侧骶髂关节多发异常信号,转移首先考虑;头颅MRI检查显示老年性脑改变,骨骼ECT检查显示：胸骨、右侧锁骨、双侧多根肋骨、右侧肩胛骨、胸腰椎、右侧骶髂关节、右侧髋骨、左坐骨、右股骨上段示踪剂分布浓聚,提示骨转移灶存在。由于不能排除肺癌骨转移及血液系统恶性肿瘤,分别于19日、24日行经皮肺穿刺、右肩胛骨病变部位穿刺及骨穿检查。骨髓涂片显示：粒系增生活跃,红系增生减低;骨髓活检显示造血组织增生底下。肺穿刺及肩胛骨穿刺组织病理提示：肺组织内见多量泡沫状细胞聚集,胞浆内可见PAS染色阳性之红色小孢子（图4、5）,病变符合组织胞浆菌感染。2013-01-01给予伊曲康唑针静脉滴注（前3天0.2g,2次/d,此后0.2g,1次/d）抗真菌治疗;治疗后体温逐渐恢复正常,14d后复查血常规：白细胞8.0×109/L,中性粒细胞76.80%,淋巴细胞12.00%,嗜酸性粒细胞4.10%;14d后给予伊曲康唑片0.2g,2次/d口服治疗,服药时与可乐同服。患者出院后一直门诊随诊,体温正常,2013-03-14复查胸部CT显示右下肺病灶明显吸收,仅遗留少许纤维条索病灶（图3）,复查总IgE 2753.00I-U/ml,较前明显下降。     

CHILDREN INVENTING SIGNS FOR MENTAL NUMBER STRATEGIES

The research study described here was conducted with a small group of 5- and 6-year-old children in a 35-pupil rural school in the Langdale Valley (Lake District, UK) over a period of 14 weeks. It considers the theoretical implications of children inventing their own signs for their counting actions instead of using the culturally inherited signs of conventional arithmetic. It also raises questions concerning ‘transformational addition’ in which ordinals (‘position numbers’) are distinguished from cardinals (‘size numbers’), and suggests that the invented signs may have a consistency and validity comparable with the signs of conventional arithmetic.     

儿童额叶癫痫临床和长程视频脑电图特征

目的通过对46例儿童额叶癫痫患儿的临床表现、长程视频脑电图（VEEG）特点进行分析,提高对儿童额叶癫痫的认识。方法收集2008年12月至2014年8月儿科门诊及住院确诊的46例儿童额叶癫痫病例的资料,回顾性分析其临床表现、VEEG及神经影像学等特征。结果本组患儿发病年龄最小11个月,最大15岁。46例患儿共监测到临床发作258次,明确临床发作34例,14.7%仅于清醒期发作,61.8%仅在睡眠期发作,23.5%在清醒、睡眠中均有发作;临床发作形式包括额叶失神、局部阵挛发作、偏转性强直、姿势性强直、过度运动性自动症、口咽自动症、发声、发笑发作、临床下放电和自主神经性发作等。73.9%患儿记录到发作间期额叶为主的癫痫样放电,63.0%患儿记录到发作期额叶为主的癫痫样放电。结论儿童额叶癫痫临床发作频繁、短暂,以睡眠期发作为主,临床表现复杂多样,易漏诊;长程VEEG可监测到儿童额叶癫痫发作期临床及异常脑电图表现,可提供明确诊断率。     

隐马模型及其在基因识别中的应用

生物信息学是一门新兴交叉学科,隐马模型是广泛用于该学科的数学模型.简要介绍了隐马模型的数学原理,并以大肠杆菌和人的基因识别为例说明了它在基因识别中的应用.     

A distributionally robust optimization model for batch nonlinear switched time-delay system considering uncertain output measurements

In this paper, we consider a nonlinear switched time-delay (NSTD) system with unknown switching times and unknown system parameters, where the output measurement is uncertain. This system is the underling dynamical system for the batch process of glycerol bioconversion to 1,3-propanediol induced by Klebsiella pneumoniae. The uncertain output measurement is regarded as a stochastic vector (whose components are stochastic variables) and the only information about its distribution is the first-order moment. The objective of this paper is to identify the unknown quantities of the NSTD system. For this, a distributionally robust optimization problem (a bi-level optimization problem) governed by the NSTD system is proposed, where the relative error under the environment of uncertain output measurements is involved in the cost functional. The bi-level optimization problem is transformed into a single-level optimization problem with non-smooth term through the application of duality theory in probability space. By applying the smoothing technique, the non-smooth term is approximated by a smooth term and the convergence of the approximation is established. Then, the gradients of the cost functional with respect to switching times and system parameters are derived. A hybrid optimization algorithm is developed to solve the transformed problem. Finally, we verify the obtained switching times and system parameters, as well as the effectiveness of the proposed algorithm, by solving this distributionally robust optimization problem.     

Nonlocal problems in the theory of the motion equations of Kelvin-Voight fluids

For the motion equations of Kelvin-Voight fluids one proves: 1) a global theorem for the existence and uniqueness of a solution (v;{u_e}) of the initial-boundary value problem on the semiaxis t R⁺ from the class W ¹ (R⁺); W ₂ ² () H()) with initial condition v_o(x) W ₂ ² () H() when the right-hand side f(x, t) L(R ⁺; L₂()); 2) a global theorem for the existence and uniqueness of a solution (v; {u_l}) on the entire axisR from the classW ¹ (R; W ₂ ² () H()) when the right-hand side f(x, t) L(R; L₂()); 3) a global theorem for the existence of at least one solution (v; {u_l}), periodic with respect to t with period , from the class W ¹ (R ⁺; W ₂ ² () H()) when the right-hand side f(x, t) L(R ⁺; L₂()) is periodic with respect to t with period , and a local uniqueness theorem for such a solution; 4) a theorem for the existence and uniqueness in the small of a solution (v; {u_l}), almost periodic with respect to t R, from V. V. Stepanov's class S ¹ (R; W ₂ ² ()H()) when the right-hand side f(x, t) S(R; L₂()) is almost periodic with respect to t; 5) the linearization principle (Lyapunov's first method) is justified in the theory of the exponential stability of the solutions of an initial-boundary value problem in the space H() and conditions are given for the exponential stability of a stationary and periodic solution, with respect to t R, of the system (1).Translated from Zapiski Nauchnykh Seminarov Leningradskogo Otdeleniya Matematicheskogo Instituta im. V. A. Steklova Akademii Nauk SSSR, Vol. 181, pp. 146–185, 1990.     

M-curves of degree 10

The known restrictions on the disposition of ovals of a nonsingular projective real algebraic curve leave possible for M-curves of degree 10 about 70,000 real schemes. These schemes divide naturally into 18 families. Basic result: in each of these families there exist representatives realizing M-curves of degree 10. Using the method of O. Ya. Viro, based on perturbations of curves with involved singularities, there are constructed more than 500 M-curves of degree 10. Incidentally there are obtained a large number of perturbations of points of tangency of five branches.Translated from Zapiski Nauchnykh Seminarov Leningradskogo Otdeleniya Matematicheskogo Instituta im. V. A. Steklova AN SSSR, Vol. 122, pp. 146–161, 1982.In conclusion, I want to thank O. Ya. Viro for constant interest in my work and a series of important comments.     

Note on minimax distribution free procedure for integrated inventory model with defective goods and stochastic lead time demand

This note is a response to a paper of Ho that was published in Information and Management Sciences, 20 (2009), 161–171. We find two reasonable criteria to insure the existence and uniqueness of the optimal solution. Based on the same numerical examples, if we directly compare our results with that by Ho, then the improvement is about 30%. Meanwhile, after revising the computation errors, then our analytical approach improves 4%.     

Acting with systems intelligence: integrating complex responsive processes with the systems perspective

The systems thinking literature assumes that the concept of a system is useful in management and organizational research. Ralph D. Stacey and his collaborators, however, have questioned this. They have presented the theory of complex responsive processes (CRP) as an alternative to systems thinking. We argue that systems thinking and the CRP perspective are complementary. The CRP illuminates many of the micro-behavioural, local interaction and creativity-related organizational phenomena whereas the systems perspective is useful for other purposes. CRP misses the mark in its criticism of systems thinking. The insights of CRP should and could be incorporated, not switched, with the systems perspective. The systems intelligence perspective, proposed by Hämäläinen and Saarinen, provides a framework to accomplish that. By integrating systems thinking and the CRP model we hope to provide a platform from which it is possible to appreciate the relative merits of the two apparently conflicting strands of thought.     

Subdirectly irreducible state-morphism BL-algebras

Recently Flaminio and Montagna (Proceedings of the 5th EUSFLAT Conference, II: 201?C206. Ostrava, 2007), (Inter. J. Approx. Reason. 50:138?C152, 2009) introduced the notion of a state MV-algebra as an MV-algebra with internal state. We have two kinds: state MV-algebras and state-morphism MV-algebras. These notions were also extended for state BL-algebras in (Soft Comput. doi:10.1007/s00500-010-0571-5). In this paper, we completely describe subdirectly irreducible state-morphism BL-algebras and this generalizes an analogous result for state-morphism MV-algebras presented in (Ann. Pure Appl. Logic 161:161?C173, 2009).     

Zur Verteilung der Quadrate ganzer Zahlen in rationalen Quaternionenalgebren

For γ ∈ ?letQ 〈γ〉 = ?[i]+?[i]j. where j. is a hypercomplex number withj2 = γ, and define addition and multiplication formally with respect to $zj = j\overline z $ for all z ∈ ?[i], so thatQ〈γ〉 becomes a quaternion algebra over the rationals. Further fix γ s.t.Q 〈γ 〉 is a division algebra and define for real X ≥ 1 where |Re(α)|, |Im(α)|, |Re(β)|, |Im(ö)|≤ X and Generalizing former results concerning Hamilton’s quaternions (i.e. the case γ =- 1) we show that, as X → ∞, when γ < 0, when γ > 0, when γ < 0, wheny γ 0. Thereby δ(t) is any upper bound of the error term in Dirichlet’s divisor problem, e.g. δ(t) =t0.315, C_γ, D_γ > 0 are numerical constants, and c, d are given by c := π(1 + log 2 - 2η) and d := π2(1 + 4 log 4 - 4π)/8, where π = 0.577 … is Euler’s constant.