儿童难治性肺炎支原体肺炎危险因素及支原体耐药的相关性分析

目的儿童难治性肺炎支原体肺炎的危险因素及支原体耐药情况进行分析。方法采用回顾性对照研究,2010年至2013年我院住院的肺炎支原体肺炎患儿为研究对象,其中72例符合难治性肺炎支原体肺炎诊断标准为病例组,随机选取同期我院相似年龄、性别的76例一般肺炎支原体肺炎患儿为对照组,对特应性体质、临床表现、实验室检查(CRP、血沉、痰培养、咽拭子快速支原体培养及药敏)、胸部影像学检查等危险因素进行比较,对肺炎支原体进行药物敏感性分析,并对难治性肺炎支原体肺炎相关临床因素进行Logistic回归分析。结果病例组较对照组在特应性体质、发热持续10天以上、全身皮疹、CRP≥40mg/L、血沉≥50mm/h、痰细菌培养阳性、肺部大片状高密度均匀一致实变阴影、支原体对大环内酯类耐药的病例数明显增加,差异具有统计学意义(P0.05);病例组中14例患儿家长拒绝应用激素等药物,结果 12例发热时间15天,5例遗留肺不张,2例肺坏死;药敏实验结果显示,病例组对红霉素、阿奇霉素等药物具有较高的耐药率。对两组病例进行Logistic回归分析,发现特应性体质、发热持续10天以上、CRP≥40mg/L、血沉≥50mm/h、肺部大片状高密度实变影≥2/3肺叶,这些因素影响明显(分别为P=0.000;P=0.011;P=0.000;P=0.003;P=0.004)。结论特应性体质、发热持续10天以上、CRP≥40mg/L、血沉≥50mm/h、肺部大片状高密度实变影≥2/3肺叶,是难治性肺炎支原体肺炎的危险因素;难治性肺炎支原体肺炎对红霉素、阿奇霉素等大环内酯类药物具有较高的耐药率。     

肺炎支原体肺炎92例分析

目的探讨分析肺炎支原体肺炎患儿的临床发病特点及相关诊断、治疗体会。方法分析我院儿科就诊治疗的92例支原体肺炎患儿的临床资料,对此92例患儿的临床特点,诊断及治疗结果进行总结分析。结果支原体肺炎常好发于2-10岁的儿童,早期无特异性临床表现,以发热、咳嗽、呼吸困难症状居多,采用阿奇霉素及红霉素治疗效果较好。结论支原体肺炎患儿早期无特殊性临床表现,胸部X线及支原体体抗体检查可以协助诊断,大环内酯类药物治疗效果较好,但需要注意使用红霉素时所产生的不良发应。     

56例儿童肺炎支原体肺炎的临床分析

目的探讨儿童肺炎支原体肺炎(Mp)的临床特点。方法回顾分析2003年9月~2005年4月收治的56例儿童支原体肺炎的情况,了解其临床症状、X线表现、Mp-IgM抗体检查及其治疗药物。结果儿童支原体肺炎主要表现为咳嗽、咳痰、发热、肺X线阴影及心肌损害。治疗以阿奇霉素或红霉素为主,全部患儿均治愈。结论儿童肺炎支原体肺炎发病率在增加,应引起高度重视,进行支原体抗体检查,提高诊治水平。     

沐舒坦联合阿奇霉素序贯疗法治疗肺炎支原体肺炎疗效分析

2001年1月至2002年7月,我们采用沐舒坦联合阿奇霉素序贯疗法治疗肺炎支原体肺炎患者32例,取得良好效果。现报告如下。1 资料与方法1.1 临床资料 本文57例肺炎支原体肺炎患者,其中男30例,女27例;年龄(52.6±8.6)岁。发病季节在冬春季44例,夏秋季13例。临床表现为发热40例,阵发性刺激性咳嗽52例,咳痰19例,咯血5例,恶心、纳差10例,单肺或双肺干罗音12例,单肺或双     

阿奇霉素序贯疗法治疗小儿肺炎支原体肺炎的疗效观察

目的观察阿奇霉素序贯疗法治疗小儿肺炎支原体肺炎的临床疗效。方法选取我院2011年1月—2013年11月收治的肺炎支原体肺炎患儿84例,采用随机数字表法将所有患儿分为观察组和对照组,每组42例。两组患儿入院后均给予常规治疗,包括退热、止咳、祛痰等,并为患儿创造良好的住院环境。观察组患儿给予阿奇霉素序贯疗法,对照组患儿给予乳酸红霉素静脉滴注。观察两组患儿临床疗效、临床症状或体征(发热、咳嗽、肺部啰音)消失时间及住院时间、治疗期间不良反应情况等。结果观察组患儿总有效率为97.62%,高于对照组的80.95%(P0.05)。观察组患儿发热、咳嗽、肺部啰音消失时间及住院时间均短于对照组(P0.05)。观察组患儿治疗期间局部疼痛、皮疹、胃肠道反应、ALT升高、肝功能异常发生率均低于对照组(P0.05)。结论阿奇霉素序贯疗法治疗小儿肺炎支原体肺炎疗效较好,不良反应少,安全性较高,值得临床推广应用。     

大环内酯类抗生素在社区获得性肺炎治疗中的应用价值

大环内酯类抗生素是一类分子结构中具有12一16碳内酯环的抗菌药物的总称,主要通过抑制细菌蛋白质的合成而产生抑菌效应.其抗菌谱覆盖了社区获得性肺炎(CAP)最常见的致病原,包括肺炎链球菌、流感嗜血杆菌(仅限于阿奇霉素及克拉霉素等新一代大环内酯类抗生素)以及肺炎支原体、肺炎衣原体和嗜肺军团菌等非典型致病原,具有组织穿透力强、肺组织中药物浓度高、过敏反应和不良反应少、安全性较高、价格相对便宜等特点,在CAP的治疗中一直扮演着非常重要的角色.     

小儿肺炎支原体感染并中枢神经系统受累的临床治疗研究

目的阿奇霉素联合丙种球蛋白与阿奇霉素单药治疗肺炎支原体感染合并中枢神经系统受累的患儿临床比较。方法针对我院2012年1月至2014年3月间54例肺炎支原体感染合并中枢神经系统受累的患儿,采用完全随机分组分为观察组(阿奇霉素联合丙种球蛋白实验组)30例和对照组(阿奇霉素单药实验组)24例,观察两组治疗效果。结果观察组治疗有效率96.7%显著高于对照组75.0%,两组比较有统计学意义(P0.05);观察组患儿发热、头痛呕吐、嗜睡、抽搐消失时间均低于对照组,两组比较有统计学意义(P0.05);观察组平均住院时间(17±4.78)天,较对照组(22±5.91)天明显缩短,且差异均有统计学意义(P0.05)。结论对于肺炎支原体感染并中枢神经系统受累的患儿,阿奇霉素联合丙种球蛋白治疗效果优于单用阿奇霉素。故确诊患儿应当在早期联用阿奇霉素与丙种球蛋白,改善预后。     

中西医结合治疗小儿支原体肺炎的疗效分析

目的分析采用咳平汤联合阿奇霉素治疗小儿支原体肺炎的疗效。方法选取2012年3月~2014年6月我院收治的支原体肺炎患儿96例作为研究对象,将其按照数字法分为对照组和观察组,各48例。其中对照组患儿单独采取阿奇霉素治疗,观察组患儿在对照组患儿的基础上加用咳平汤治疗,比较两组患儿的退热时间、肺啰音消失时间、咳嗽消失时间以及复发率。结果观察组患儿的退热时间、肺啰音消失时间和咳嗽消失时间均少于对照组患儿,且其复发率更低,差异有统计学意义(P0.05)。结论在对小儿支原体肺炎的治疗中,咳平汤联合阿奇霉素治疗可加速患儿病情缓解,降低复发率。     

氨溴索联合阿奇霉素治疗小儿支原体肺炎的疗效观察

目的 探讨小儿支原体肺炎的治疗方法,观察盐酸氨溴索注射液联合阿奇霉素治疗小儿支原体肺炎的疗效.方法 小儿支原体肺炎患儿96例,随机分为两组,治疗组48例,给予大环内酯类药物阿奇霉素10mg·kg-1·d-1加入5%葡萄糖50～100ml中静脉滴注,联合盐酸氨溴索注射液1.5mg·kg-1·d-1,加入5%葡萄糖50～100ml静脉点滴,1次/d;对照组48例,每日给阿奇霉素静脉滴注.两组均以5～7d为1个疗程,同时都给予退热、止咳、化痰、平喘等对症支持治疗.结果 治疗组和对照组有效率分别为95.3%和83.3%,治疗组明显高于对照组,差异有统计学意义（P＜0.05）.结论 氨溴索联合阿奇霉素治疗小儿支原体肺炎,临床效果显著,较单用阿奇霉素疗效好,疗程短.     

成人社区获得性肺炎中肺炎支原体的耐药性探讨

目的 采用肺炎支原体（MP）分离培养-药敏法初步探讨住院成人社区获得性肺炎（CAP）中MP的耐药状况,为临床抗菌药物选择提供依据.方法 选取住院的成人CAP患者2859例,取咽拭子标本培养检测MP;对MP阳性标本行药敏检测,观察MP对红霉素、罗红霉素、阿奇霉素、四环素、米诺环素、多西环素、环丙沙星、左氧氟沙星、加替沙星、莫西沙星等10种药物的耐药情况.结果 咽拭子培养MP阳性575例,占20.11％;MP对红霉素等大环内酯类药物耐药率达54.9％ ～ 62.0％,对加替沙星、莫西沙星耐药率为10.0％ ～21.3％.结论 MP是成人CAP的重要病原体,应加强耐药性监测,合理选择抗菌药物.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

岳阳市城区小学生血吸虫病防治健康教育现状调查

目的 调查湖南省岳阳市城区小学生血吸虫病防治知识、行为现状及健康教育需求情况,为制定科学有效的小学生血吸虫病健康教育方案提供参考依据。方法 采用分层整群抽样方法,抽取岳阳市城区洞庭湖湖畔学校和中心城区学校各2所,每所再从五、六年级分别抽取2个班的学生,通过调查问卷了解小学生血吸虫病相关知识、预防行为及健康教育需求,并进行统计分析。结果 共调查湖畔小学353人、中心城区小学363人,两组学校小学生年龄、性别、年级构成差异无统计学意义（t=-0.494,χ²_性别=1.615,χ²_年级=2.152;P均>0.05）。学生血吸虫病防治知识总知晓率为42.60%（305/716）,其中,湖畔学校小学生血防知识知晓率（52.97%）高于中心城区（32.51%）,差异有统计学意义（χ²=30.661,P<0.05）;学生行为正确率为76.68%（549/716）,血防知识知晓组行为正确率（81.31%）高于不知晓组（71.24%）,差异有统计学意义（χ²=6.384,P<0.05）。学生血防知识主要来源于老师（47.49%）;91.90%的学生愿意了解更多的血防知识,最喜欢的血防知识学习方式是参加课外活动（50.42%）。结论 岳阳市城区小学生的血防知识知晓率及行为正确率偏低,对血吸虫病防治健康教育需求较高。建议针对学生开展形式多样的血防健康教育,以增强学生的血吸虫病防护意识,提高自我防护能力。     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.