卫生部办公厅关于印发《基孔肯雅热诊断和治疗方案》的通知

各省、自治区、直辖市卫生厅局,新疆生产建设兵团卫生局:基孔肯雅热是由基孔肯雅病毒引起、经伊蚊传播、以发热、皮疹及关节疼痛为主要特征的急性传染病。为保证人民群众的身体健康和生命安全,在借鉴其他国家和地区基孔肯雅热防治经验的基础上,我部委托中华     

头孢曲松致寒战高热2例

例1女,20岁,因周身肌肉关节疼痛13年,加重8个月,伴面部皮疹,于2002年7月24日诊为类风湿性关节炎收入院。患者于13年前因上感引起发热,伴周身关节肌肉疼痛,在当地医院给予口服及静滴抗生素(具体不详)治疗,1月后症状消失。1996年3月再次发病,在北京某医院确诊为类风湿性关节炎,给予口服萘普生等药物治疗后,症状消失。2001年11月因再次出现发热、肌肉关节疼痛及面部皮疹等症,且较前明显加重,持续口服甲氨喋呤,每次10mg,每周1次治疗至今。入本院时患者四肢关节疼痛,畏寒恶风,多汗。查体:T37.2℃,P80次·min-1,R18次·min-1,BP130/80mmHg。双…     

开瑞坦联合万乃洛韦治疗生殖器疱疹的临床研究

目的 观察分析开瑞坦联合万乃洛韦治疗生殖器疱疹的临床疗效.方法 选取龙川县计划生育服务站在2013年2月～2016年1月期间收治的98例生殖器疱疹患者作为研究对象,根据随机数表法将所有患者分为对照组和观察组,每组49例.对照组患者给予万乃洛韦治疗,观察组患者在对照组治疗基础上联合服用开瑞坦治疗.治疗4周后,比较两组患者的治疗总有效率、症状消失时间、止疱时间、结痴时间、皮疹平均消退愈合天数和一年内复发情况.结果 治疗后,对照组患者的治疗总有效率、症状消失时间、止疱时间、结痴时阃、皮疹平均消退愈合天数分别为69.4％ (34/49)、(6.97±1.36)d、(3.36±0.85)d、(6.54±1.23)d和(9.93±2.31)d;观察组的治疗总有效率、症状消失时间、止疱时间、结痴时间、皮疹平均消退愈合天数分别为93.9％ (46/49)、(4.25±0.69)d、(2.12±0.35)d、(4.02±0.54)d和(6.86±1.26)d,差异具有统计学意义(P＜0.05);治疗后1年内,对照组患者中未出现复发患者比例为28.6％,观察组患者未出现复发比例为67.3％,差异具有统计学意义(P＜0.05).结论 开瑞坦联合万乃洛韦治疗生殖器疱疹,可以显著提高患者治疗有效率,减轻患者临床症状和复发率,具有临床推广应用价值.     

痰热清注射液对急性支气管炎伴发热的治疗效果

目的探讨痰热清注射液在急性支气管炎伴发热中的应用效果。方法我院2012年1月~2013年12月间收治的急性支气管炎伴发热患者86例,按照治疗方案分为对照组和观察组,对照组患者给予阿奇霉素治疗,观察组在对照组基础上给予痰热清注射液,比较两组治疗总有效率、患者症状体征消失时间及治疗过程中不良反应;随访3~6个月,观察复发情况。结果观察组43例患者治疗总有效率达到93.02%(40/43),明显高于对照组;患者发热、咳嗽气喘、肺部湿啰音消失及胸片恢复正常时间均明显短于对照组;治疗过程中不良反应发生率2.33%(1/43)明显低于对照组。结论急性支气管炎伴发热治疗中,应用痰热清注射液可有效地提高治疗效果,降低不良反应发生率及复发率,值得临床推广应用。     

丙种球蛋白联合中药汤剂治疗小儿川崎病68例临床观察

目的研究丙种球蛋白联合中药汤剂治疗小儿川崎病的临床效果。方法对2010年2月～2012年2月在本院入院治疗的136例川崎病患者进行了研究,随机分为两组,对照组给予常规丙种球蛋白,治疗组患者采用丙种球蛋白联合中药汤剂治疗,比较两组患儿临床症状改变时间及临床总有效率。结果治疗组患儿在发热症状消退的时间、淋巴结变小的时间以及黏膜充血症状消失的时间均明减少,少于对照组,两组比较差异有统计学意义（P〈0．05）;治疗组方案临床总有效率可达92．6％;对照组临床总有效率为70．6％,差异有统计学意义（P〈0．05）。结论丙种球蛋白联合中药汤剂治疗小儿川崎病临床效果显著,改善患儿发热、皮疹等临床症状更迅速,临床总有效率更高,值得临床推广应用。     

儿童急性荨麻疹的临床分析及糖皮质激素应用分析

目的:对儿童急性荨麻疹的临床分析及糖皮质激素的应用分析进行探讨,为临床治疗和诊断提供参考.方法:选择我院收治的儿童急性荨麻疹患者100例作为本次研究的对象,这100例患者的收治时间在2013年2月1日～2014年2月1日,对这100例患者的临床资料进行回顾性和系统性分析,探讨其临床特点,随机将这100例患者分成实验组和对照组,每组50例,对照组给予常规抗生素治疗,实验组给予糖皮质激素治疗,并在治疗结束后,对比分析两组的治疗总有效率、皮疹消失时间及腹痛消失时间.结果:①100例儿童急性荨麻疹患者中,上呼吸道感染41例,占41.00％;肺炎16例,占16.00％;扁桃体炎34例,占34.00％;急性胃肠炎6例,占6.00％;化脓性中耳炎3例,占3.00％.②100例儿童急性荨麻疹患者均表现出全身泛发性鲜红色风团或水肿性红斑症状,以发热、咽喉疼痛、浅表淋巴结肿大、咳嗽、腹痛、呕吐、胸闷等为主要临床表现,分别占46.00％、56.00％、32.00％、45.00％、47.00％、27.00％及23.00％.③100例儿童急性荨麻疹患者的血常规白细胞均伴有不同程度的升高,白细胞上升54例,占54.00％;中性粒细胞上升36例,占36.00％;淋巴细胞上升6例,占6.00％;淋巴细胞和白细胞均上升4例,占4.00％.④实验组治疗总有效率为96.00％(48/50),对照组治疗总有效率为78.00％(39/50),P＜0.05,差异具有统计学意义;实验组皮疹消失时间及腹痛消失时间均低于对照组(P＜0.05),差异具有统计学意义.结论:儿童急性荨麻疹以呼吸道感染为主,患者常伴发热、咽喉疼痛、浅表淋巴结肿大、咳嗽、腹痛、呕吐、胸闷等临床表现,实验室检查可见血常规白细胞伴有不同程度上升,给予糖皮质激素治疗具有积极的疗效,可有效提高治疗效果,缩短皮疹消失时间和腹痛消失时间,促进恢复健康.     

碘化钾治疗复发性结节性红斑

结节性红斑是一种病原菌变态反应性的疾病,发病原因目前认为与病毒、细菌、结核感染及肿瘤、自身免疫、药物有关,且其中以链球菌的致病比例最高[1].开发研制能够根治结节性红斑的特效药,有效预防结节性红斑的复发已成为临床关注的问题.本研究对近两年来收治的68例复发性结节性红斑患者进行碘化钾治疗,取得了理想的效果. 1资料与方法 1.1临床资料 选择2008年12月至2010年12月兴县人民医院门诊复发性结节性红斑患者68例.其中,女52例,男16例;年龄(26.61±0.97)岁;病程(5.41±2.37)年;皮损主要分布于小腿伸侧,两侧基本对称,其结节略高出皮面,大小约为0.52～3.16 cm,颜色为鲜红,患者可自觉疼痛.发病前均伴有咽喉疼痛、发热、关节疼痛等症状.所有患者的胫前均有皮疹存在(100.0％),单出现于胫前者有24例(35.3％),出现于胫前及小腿屈侧部位者21例(30.9％),小腿和大腿部位均出现皮疹者10例(14.7％),上、下肢均有皮疹存在者16例(23.5％).所有患者均符合《临床皮肤病学》的结节性红斑诊断标准.     

小儿复发及慢性过敏性紫癜的临床特点分析

目的：探讨小儿慢性过敏性紫癜的临床特点。方法选取2010年1月～2013年1月收治的153例小儿过敏性紫癜患者进行分析研究,随机分为3组,分别是皮疹复发及慢性过敏性紫癜组（A组）28例、肾炎复发及慢性过敏性紫癜组（B组）22例以及对照组103例。分析三组患者的临床表现和患儿紫癜性肾炎临床分型。结果患儿出现不同程度的关节疼痛、腹痛、消化道出血、肾炎以及持续性皮疹,且3组患儿的严重腹痛、持续性皮疹和肾炎的发生率差异有统计学意义（P＜0.05）。3组患儿紫癜性肾炎的临床分型差异无统计学意义。结论患儿临床出现不同程度的关节疼痛、腹痛、消化道出血、肾炎、持续性皮疹等症状,要进行必要的抗敏、输液、去病因、止痛以及对症处理,并进一步探讨更加有效的治疗措施,防止病情进一步扩大。     

蒲地蓝联合利巴韦林治疗小儿手足口病疗效观察

目的 观察蒲地蓝联合利巴韦林对手足口病的治疗效果.方法 手足口病患者70例,随机分为两组：治疗组（蒲地蓝联合利巴韦林）和对照组（单用利巴韦林）.观察两组患者的疗效、皮疹完全消失时间、发热消退时间及不良反应.结果 治疗组治愈率及有效率分别为57%、94%,对照组治愈率及有效率分别为43%、86%,两组治愈率及有效率比较差异有统计学意义（均P＜0.05）.治疗组较对照组在手足皮疹消失、口腔皮疹消失及发热消退时间明显缩短,差异有统计学意义（均P＜0.05）.两组患者均未发现明显不良反应.结论 较单用利巴韦林,蒲地蓝联合利巴韦林治疗手足口病明显提高了治愈率,缩短了皮疹完全消失时间及发热消退时间,是治疗手足口病的一种安全、有效的方法.     

重症手足口病的早期识别

目的分析重症手足口病的临床特征,识别其早期症状,为重症手足口病的防治提供依据。方法对2010年3月至8月收治的重症手足口病和普通手足口病患儿的临床资料作回顾性分析。结果重症手足口病与普通手足口病患儿相比发热持续时间长(≥72h()P<0.05);皮疹小,直径<3mm(P<0.05)。在发热持续≥72h和发热<72h的病例中,发展为重症手足口病的比例分别为24.71%和9.38%(P<0.01);在皮疹直径<3mm和≥3mm的病例中,发展为重症的比例分别为25.33%和10.71%(P<0.05);在发热≥72h同时皮疹直径<3mm和发热<72h同时皮疹≥3mm的病例中,重症的比例分别为36.36%和7.14%(P<0.001)。结论发热持续时间≥72h、皮疹直径<3mm是重症手足口病的早期特征,临床医师应高度重视这些临床特征,及早干预治疗。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.