血清IgM、IgG 及D-LA 水平联合检测在手足口病患儿病情评估中的应用价值

目的:分析血清IgM、IgG及D-乳酸(D-LA)水平联合检测在手足口病患儿病情评估中的应用价值。方法:选取我院2014年1月~2016年6月收治的手足口病患儿92例为观察组,同期健康体检者46例为对照组,其中观察组根据病情分为轻症组(46例)、重症组(46例)。比较各组血清IgM、IgG及D-LA水平,分析各指标在患儿病情评估中的应用价值。结果:观察组IgM、D-LA水平高于对照组,IgG水平低于对照组(P<0.05);重症组患儿血清IgM、D-LA水平高于轻症组,IgG水平低于轻症组(P<0.05)。结论:血清IgM、IgG、D-LA水平联合检测,有利于评估手足口病患儿病情严重程度,具有较高的临床应用价值。     

手足口病患儿免疫球蛋白与超敏C反应蛋白水平变化及临床意义

目的：探讨手足口病患儿免疫球蛋白与高敏C反应蛋白(hs-CRP)水平变化及临床意义。方法选取60例急性期手足口病患儿(手足口病组)与60例体检儿童(对照组),以免疫比浊法检测血清hs-CRP与免疫球蛋白(IgG、IgA、IgM)水平。结果手足口病组入院时hs-CRP、IgM水平高于对照组(P<0.05),IgG、IgA水平低于对照组(P<0.05);手足口病组轻症型、重症型hs-CRP、IgM水平均高于对照组(P<0.05),IgG、IgA水平均低于对照组(P<0.05);手足口病组重症型hs-CRP、IgM水平均高于轻症组(P<0.05),IgG、IgA水平低于轻症组(P<0.05)。结论手足口病患儿患病后hs-CRP、IgM升高,IgG、IgA下降,检测免疫球蛋白与hs-CRP能作为手足口病诊断与判断病情严重程度的辅助指标。     

重症手足口病患儿血清前清蛋白、血糖和外周血白细胞的变化及意义

目的探讨重症手足口病患儿血清前清蛋白(PA)、血糖和外周血白细胞计数的变化规律及其诊疗价值。方法手足口病普通病例50例纳入普通手足口病组,手足口病重症病例50例纳入重症手足口病组,以及健康体检儿童50例纳入健康对照组,检测入院时血清PA、血糖和外周血白细胞水平,以及手足口病儿童治疗后的水平,并进行比较。结果治疗前重症手足口病组患儿血糖、白细胞计数均高于健康对照组,PA低于健康对照组,差异有统计学意义(P0.05);治疗前重症手足口病组患儿血糖、白细胞计数明显高于普通手足口病组,PA明显低于普通手足口病组,差异均有统计学意义(P0.05)。治疗前普通手足口病组患儿血糖高于健康对照组,PA低于健康对照组,差异有统计学意义(P0.05)。治疗前重症手足口病组PA、血糖、白细胞计数异常率明显高于普通手足口病组,差异有统计学意义(P0.05)。结论血清PA值降低,血糖、白细胞计数升高提示手足口病病情加重,PA、血糖和外周血白细胞检测在判断病情变化和预后方面有重要的意义。     

小儿支原体肺炎相关血清炎性因子的临床意义

[目的]探讨支原体肺炎(MPP)患儿血清中细胞因子白细胞介素-8(IL-8),白细胞介素-12(IL-12)水平以及高敏C-反应蛋白 (hs-CRP)、免疫球蛋白(Ig)和血清补体(C)的变化及其临床意义.[方法]收集MPP患儿50例,分为重症组、轻症组.健康儿童42例作为对照组;用ELISA法测定MPP患儿急性期、恢复期及对照组儿童血清IL-8、IL-12的水平,用血浆蛋白分析仪速率散射比浊法测定hs-CRP,Ig和C含量.[结果]在急性期和恢复期MPP患儿血清IL-12含量明显低于正常对照组(P<0.05);而血清IL-8含量在急性期明显高于正常对照组(P<0.01).重症组患儿血清中IL-12明显低于轻症组,而血清中IL-8较轻症组高(P均<0.01).急性期MPP患儿血清IgM,IgG与对照组相比明显升高(P均<0.01);而IgA明显降低(P<0.05).急性期MPP患儿hs-CRP、C3、C4与对照组比较显著升高(分别为P<0.01、P<0.01、P<0.05).重症组患儿血清中IgM,IgG与轻症组相比明显升高(P均<0.01);IgA与轻症组相比明显降低(P<0.05);重症组患儿血清中hs-CRP、C3、C4与轻症组相比明显升高(P均<0.01).[结论]检测相关血清炎性细胞因子对判定MPP患儿的病情和预后有较高的临床应用价值.     

血清降钙素原、乳酸与小儿危重病例评分的相关性分析

目的:探讨血清降钙素原(procalcitonin,PCT)、血乳酸与小儿危重病例评分的相关性及临床意义。方法:对33例休克患儿入住危重监护病房时立即进行小儿危重病例评分,根据评分分为极危重组(3例)、危重组(14例)、非危重组(16例)。同时检测血清PCT、乳酸,并进行相关性分析。结果:极危重组血清PCT、乳酸水平及病死率均明显高于危重组和非危重组(均P<0.01),而小儿危重病例评分均明显低于其他两组(均P<0.01)。血清PCT、乳酸水平与危重病例评分的相关系数分别为-0.621(P<0.05)和-0.890(P<0.01)。结论:危重监护病房休克患儿血PCT、乳酸水平与小儿危重病例评分呈明显负相关,检测PCT及乳酸对判断预后有重要意义。     

血清降钙素原、乳酸与小儿危重病例评分的相关性分析

目的:探讨血清降钙素原(procalcitonin,PCT)、血乳酸与小儿危重病例评分的相关性及临床意义.方法:对33例休克患儿入住危重监护病房时立即进行小儿危重病例评分,根据评分分为极危重组(3例)、危重组(14例)、非危重组(16例).同时检测血清PCT、乳酸,并进行相关性分析.结果:极危重组血清PCT、乳酸水平及病死率均明显高于危重组和非危重组(均P＜0.01),而小儿危重病例评分均明显低于其他两组(均P＜0.01).血清PCT、乳酸水平与危重病例评分的相关系数分别为-0.621(P＜0.05)和-0.890(P＜0.01).结论:危重监护病房休克患儿血PCT、乳酸水平与小儿危重病例评分呈明显负相关,检测PCT及乳酸对判断预后有重要意义.     

有效阻断手足口病病情向危重症转化的临床研究

收集2009年1～10月在聊城市传染病医院住院的手足口病2234例完整资料,随机抽取轻症和重症各80例,回顾性分析手足口病流行中轻症与重症的差异,探讨早期鉴别重症患儿的包括临床症状、体征、血WBC、血糖、血清肌酸激酶同工酶(CK-MB)及X线胸片检测指标,采取积极干预和有效阻断措施及临床转归情况.结果重症组持续高热、呼吸心率增快、食欲不振显著、神经系统受累发生率较轻症组显著升高(P<0.05);重症组血WBC、CK-MB、血糖检测指标均显著高于轻症组(P<0.05);重症组X线胸片显示肺纹理明显增多模糊发生率显著高于轻症组(P<0.05).重症组患儿采取有效阻断措施后治愈率97.5%,转ICU率2.5%,未出现死亡病例.提示早期发现高危因素,及时阻断病情向危重症转化是提高抢救成功率、降低死亡率的关键.     

肺炎支原体肺炎患儿血清IL-6,IL-8,IFN-γ和TNF-α水平及其临床价值

目的:探讨肺炎支原体肺炎(MPP)患儿血清白介素-6(IL-6)、白介素-8(IL-8)、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)水平及其对病情严重程度评估的临床价值。方法:以2019年1月至2019年12月广东省东莞市滨海湾中心医院收治的31例重症MPP(重症组)、64例轻症MPP(轻症组)和45例健康儿童(对照组)为研究对象,比较各组急性期和恢复期血清IL-6、IL-8、IFN-γ、TNF-α的水平。结果:急性期和恢复期重症组和轻症组患儿的血清IL-6、IL-8、IFN-γ、TNF-α水平均明显高于对照组(P均0.05),且重症组明显高于轻症组(P均0.05)。结论:MPP患儿血清IL-6、IL-8、IFN-γ、TNF-α水平与疾病严重程度有关,可作为评估MPP患儿疾病进展与预后的指标。     

毛细支气管炎患儿血清TNF-α、VEGF、CK-MB及血浆D-二聚体水平的变化及临床意义

目的探究检测毛细支气管炎患儿血清肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)、血清肌酸激酶同工酶(CK-MB)、血浆D-二聚体水平变化与毛细支气管炎的关系及临床意义。方法 2015年10月至2016年10月于该院治疗的80例毛细支气管炎患儿及30例体检健康婴幼儿作为研究对象,80例毛细支气管炎患儿根据病情严重程度分为重症组(44例)与轻症组(36例),30例体检健康婴幼儿设为对照组。两组患儿均给予抗感染、化痰、平喘等常规治疗。分别于治疗前、治疗6d后采用酶联免疫吸附试验(ELISA)检测血清TNF-α、VEGF,乳胶增强免疫比浊法检测血浆D-二聚体水平,全自动生化分析仪检测CK-MB水平。结果治疗前,轻症组和重症组患者血清TNF-α、VEGF、CK-MB、D-二聚体表达水平均显著高于对照组,差异有统计学意义(P0.05),Spearman等级相关性分析显示,血清TNF-α、VEGF、CK-MB、D-二聚体表达水平与毛细支气管炎密切相关,VEGF与毛细支气管炎的相关性最大(r=0.882,P=0.000),CK-MB、D-二聚体、TNF-α表达水平与毛细支气管炎的相关性分别为:r=0.844、0.798、0.678,P0.001。治疗6d后,重症组和轻症组患儿血清TNF-α、VEGF、CK-MB、D-二聚体表达水平均显著低于治疗前(P0.05)。其中重症组36例患儿病情缓解,各指标均显著低于治疗前(P0.05),仅有8例患儿病情未缓解,上述各指标仍呈高表达状态,TNF-α、VEGF、CK-MB、D-二聚体表达水平均显著低于治疗前(P0.05);轻症组所有患儿症状均得到缓解。治疗6d后,重症组TNF-α、VEGF、CK-MB、D-二聚体表达水平仍显著高于对照组(P0.05)。结论患儿血清TNF-α、VEGF、CK-MB、血浆D-二聚体表达水平与毛细支气管炎的发生发展密切相关,病情严重时上述指标均呈高表达状态,病情缓解时上述指标表达水平下降,其水平的动态监测可用于毛细支气管炎病情严重程度及预后评价,具有一定的临床意义。     

IL-12及NK细胞检测在手足口病诊治中的价值

目的:检测手足口病患儿外周血细胞因子IL-12及NK细胞水平,探讨其免疫功能变化及临床意义。方法:根据病情将手足口病患儿分为轻症组、重症组,以健康儿童作为对照;采用流式细胞术检测患儿外周血CD16+CD56+细胞的相对计数;采用ELISA方法检测血清中IL-12水平。结果:重症组患儿血清中IL-12水平显著高于轻症组和对照组(P<0.01,P<0.05),重症组患儿IL-12水平治疗后显著降低(P<0.05);重症组患儿外周血CD16+CD56+细胞的相对计数虽然低于轻症组和对照组,但差异无统计学意义(P﹥0.05),而经治疗后显著降低(P<0.05)。结论:手足口病患儿外周血IL-12和NK细胞水平随患儿的免疫功能紊乱而发生变化,观察外周血IL-12和NK细胞的变化在手足口病的诊断、治疗和病情转归方面具有一定的参考价值。     

Cancer, pancreatitis, and the detection of the isoenzymes of DNAase, RNAase and amylase.

Substrate films of starch, RNA, and DNA were used to identify the isoenzymes of amylase, RNAase, and DNAase found in human ductal pancreatic juice subjected to isoelectric focusing. The pancreatic secretions from 15 patients were shown to contain as many as four isoenzymes of RNAase; the two major forms had isoelectric points of 7.87 and 7.52, and the two minor forms, of 7.25 and 6.90. Six DNAase bands were detected; the major bands had pI values of 4.86 and 4.79, and sometimes appeared as one band. The minor bands had pI values of 5.08, 5.00, 4.68, and 4.58. Purified bovine DNAase I, analyzed similarly, showed four bands (5.29, 5.19, 5.04 and 4.96). Nine isoenzymes of alpha-amylase were observed in the secretions from 15 patients. The major alpha-amylase isoenzyme had a pI value of 6.84 in 14 patients and of 7.04 in 1 patient. Secondary bands were seen with pI values of 6.23, 6.53 and 6.69. Additional isoenzymes were found with pI values of 7.16, 6.39, 6.00 and 5.78. The amylase isoenzyme with a pI value of 6.39 was found in 7 of the 8 patients with a normal pancreas or carcinoma of the pancreas, and in only 1 of 7 patients with acute or chronic pancreatitis.     

The good, the bad, and the ugly of sunscreens

Sunscreens protect against sunburn, but there is no evidence that they protect against basal cell carcinoma or melanoma. Problems lie in the behavior of individuals who use sunscreens to stay out longer in the sun than they otherwise would. Vitamin D inhibition is, at this stage, unlikely due to insufficient use by individuals. Safety of sunscreens is a concern, and sunscreen companies have emotionally and inaccurately promoted the use of sunscreens.     

Health,healing, and the myth of the hero journey

The purposes of this article are to examine the epistemic nature of myth and its relationship to nursing ontology, practice, and knowledge development, and to interpret the myth of the hero journey as it relates to the meaning of health and healing within the unitary-transformative paradigm. A discussion of the qualities of myth as a path toward understanding is followed by an analysis of the relationship of myth to nursing's ontology within the unitary-transformative paradigm. Joseph Campbell's depiction of the myth of the hero journey is elaborated and related to literature on health and healing. Reflections on possible implications for nursing practice and knowledge development are shared. The mythic hero journey calls for a particular way of being a nurse. Nurse as guide, sojourner, and midwife are offered as metaphors for this way of being.     

AIDS, ethics, and the blood supply. A report of a conference of the American Blood Commission and the Hastings Center, Institute of Society, Ethics and the Life Sciences, January 29 and 30, 1985

Although the conference was not held to determine policy, certain issues emerged which should be of interest to all involved with the initiation of anti-HTLV-III testing. First, there was a consensus that an implementation period during which donors will not be notified of the test results is essential. During this period, test proficiency, data confidentiality safeguards, and positive donor counseling procedures can be established. Also, during this period alternative test sites can be established; this was considered a critical step to maintain the safety of the blood supply. Second, there was a perceived need for legislation to protect the confidentiality of sensitive test data, whether in the laboratory or as part of a deferral list system, from subpoena. Third, there was not agreement about whether inventory should be tested; donors who provided that inventory did not know it was to be tested, and might not have consented if the implications of testing had been known. But, inventory testing is clearly in the interest of the recipient. Finally, there was an awareness in the blood banking community of their new role in monitoring a public health menace, and a beginning acceptance of this role emerged.