多指标联合检测在新生儿感染性肺炎诊断中的临床价值

目的探索降钙素原(PCT)、C反应蛋白(CRP)和白细胞(WBC)计数联合检测在新生儿感染性肺炎诊断中的临床价值。方法以确诊的137例新生儿感染性肺炎患儿为研究对象,其中细菌感染组72例、非细菌感染组65例;同期出生的63例健康新生儿纳入对照组。检测各研究组新生儿PCT、CRP及WBC水平。结果细菌感染组PCT、CRP及WBC水平和阳性率均高于非细菌感染组和对照组(P0.05)。PCT对细菌感染所致新生儿感染性肺炎的诊断灵敏度、特异度均高于CRP与WBC;三者联合检测可进一步提高诊断灵敏度。结论 PCT较CRP和WBC具有更高的诊断灵敏度和特异度;PCT、CRP和WBC联合检测对新生儿感染性肺炎的鉴别诊断及疗效评价具有重要的临床价值。     

血清降钙素原与C反应蛋白在细菌感染性疾病中的临床应用

目的对血清降钙素原（PCT）、C反应蛋白（CRP）试验在细菌或病毒感染中的鉴剐诊断中的价值进行评价。方法对该院住院的85例细菌感染患者血清PCT、CRP浓度进行检测,并与46例病毒感染患者进行分析比较。结果如以血清PCT≥O．5ng／ml。为阳性标准,则细菌感染组的血清PCT检测阳性率为94．12％,病毒感染组为10．87％,对细菌性感染诊断的灵敏度为94．12％,特异度为87．5％,阳性预测值为94．12％,阴性预测值为89．13％,诊断符合率为92．37％;以血清CRP≥8mg／L。为阳性判断标准,则细菌感染组CRP阳性率为29．41％,病毒感染组为23．91％,对细菌性感染诊断的灵敏度为29．41％,特异度为76．09％,阳性预测值为69．44％,阴性预测值为36．84％,诊断符合率为45.8％。结论血清PCT试验对于细菌或病毒感染性疾病的鉴别诊断作用明显优于血清CRP试验。     

PCT和CRP在小儿早期病毒性和细菌性呼吸道感染鉴别诊断中的应用研究

【目的】探讨降钙素原（PCT ）、C反应蛋白（CRP）在小儿早期病毒性和细菌性呼吸道感染鉴别诊断中的价值。【方法】选取本院2015年1月至2016年1月收治的经外周血、咽拭子、痰液三种标本进行细菌培养确诊的呼吸道细菌感染患儿180例（细菌组）及经呼吸道常见病毒核酸检测确诊的病毒感染患儿120例（病毒组）作为研究对象,选取同期健康儿童100例作为对照组,比较三组入院时的外周血 PCT、CRP水平。【结果】细菌组的PCT、CRP水平显著的高于病毒组和对照组;病毒组患儿的PCT、CRP水平显著的高于对照组,且差异均具有统计学意义（ P ＜00．5）。细菌组的PCT、CRP诊断阳性率分别为（744．4％）、（677．8％）显著的高于病毒组的（83．3％）、（17．50％）和对照组的（70．0％）、（9．00％）,且差异具有统计学意义（ P ＜0．05）。PCT鉴别诊断细菌感染的灵敏度为842．1％、特异度为850．3％、ROC曲线下面积Auc为08．62;CRP诊断细菌感染的灵敏度为893．6％、特异度为679．8％、ROC曲线下面积Auc为08．14;PCT＋ CRP诊断细菌感染的灵敏度为942．8％、特异度为926．1％、ROC曲线下面积Auc为09．40。【结论】PCT在鉴别诊断细菌感染方面略优于CRP ,二者联合检查鉴别诊断小儿细菌、病毒感染具有更高的临床价值。     

血清降钙素原在儿童细菌感染性疾病诊断中的意义

目的探讨血清降钙素原（PCT）测定在儿童细菌感染性疾病中的诊断意义。方法收集各种儿童感染性疾病患儿129例,将其分为细菌感染和非细菌感染组。采用半定量的胶体金免疫结合法检测PCT,免疫比浊法测定C-反应蛋白（CRP）。结果细菌感染组PCT、CRP阳性率分别为90．0％、80．0％,非细菌感染组阳性率分别为21．3％、65．2％,两组比较PCT差异有统计学意义（P〈0．01）;CRP差异无统计学意义（P〉0．05）。结论在儿童细菌感染性疾病诊断中,PCT检测可作为早期快速鉴别细菌感染的实验室新指标。     

降钙素原、C反应蛋白在社区获得性肺炎细菌感染的诊断价值

目的：探讨血清降钙素原（PCT）及C反应蛋白（CRP）在社区获得性肺炎（CAP）中的诊断价值。方法回顾性分析明确诊断为肺部疾病的患者122例,分为细菌感染组54例和非细菌感染组68例,并根据重症肺炎诊断标准,将细菌感染组分为重症肺炎18例,轻中症肺炎36例。记录并比较所有患者入院24 h内的血常规、PCT、CRP、病原学等指标,并描绘ROC曲线进行分析。结果 PCT及CRP在CAP患者中的水平高于非细菌感染的患者（t分别=3.62、7.25,P＜0.05）。重症组的PCT和CRP水平明显高于轻中症组（t分别=2.37、2.65,P均＜0.05）。 ROC曲线分析显示,所有患者PCT和CRP的ROC曲线下面积分别为0.89和0.88,PCT和CRP诊断CAP细菌感染的最佳诊断阈值分别为0.09μg/L、29.27 mg/L。重症细菌感染组PCT和CRP的ROC曲线下面积分别为0.80和0.74,PCT和CRP诊断重症细菌感染的最佳诊断阈值分别为0.17μg/L、85.17 mg/L,此时PCT、CRP的灵敏度分别为88.89%、66.67%,特异度分别为66.65%、80.55%,PCT对重症细菌感染具有高度灵敏度,在重症细菌感染中的敏感性较CRP高,特异性未见明显优势。结论CAP患者的PCT及CRP水平较非细菌感染肺疾病患者高;PCT联合CRP对诊断细菌性肺炎及重症细菌感染性肺炎具有更高的特异性,有助于提高诊断的准确性。     

联合检测C反应蛋白与血清降钙素原对小儿肠炎的鉴别诊断价值

目的分析联合检测C反应蛋白(CRP)与血清降钙素原(PCT)对小儿肠炎的鉴别诊断价值,以期为临床诊治、预后评估提供信息。方法将2017年1月至2018年10月于该院接受诊治的124例肠炎患儿作为观察对象,根据患儿的感染类型分成细菌性肠炎组(细菌组)63例、病毒性肠炎组(病毒组)61例。应用免疫比浊法对血清CRP表达情况进行检测,并选择定量胶体金免疫层析法对血清PCT表达情况进行检测;对比两组患儿血清CRP、PCT表达水平,同时对比分析两组患儿血清CRP、PCT检测的阳性率、灵敏度及特异度。结果细菌组患儿的血清CRP、PCT表达水平显著高于病毒组,差异均有统计学意义(P0.05);细菌组患儿的血清CRP、PCT单项检测及联合检测阳性率显著高于病毒组,差异均有统计学意义(P0.05);血清CRP单项检测诊断细菌性肠炎的阳性预测值、阴性预测值、灵敏度均略低于血清PCT单项检测及两项联合检测,但差异无统计学意义(P0.05);血清CRP单项检测诊断细菌性肠炎的特异度、准确度低于血清PCT单项检测及两项联合检测,差异均有统计学意义(P0.05);血清PCT单项检测诊断细菌性肠炎的阳性预测值、阴性预测值、灵敏度、特异度、准确度与联合检测对比,差异无统计学意义(P0.05)。结论血清CRP、PCT在肠炎患儿体内均呈高表达,且细菌性肠炎患儿的血清CRP、PCT表达水平显著高于病毒性肠炎患儿,联合检测CRP、PCT判定细菌性肠炎的特异度、准确度均高于单独检测,故联合检测血清CRP、PCT能帮助临床医师鉴别诊断小儿肠炎的类型,减少误诊、漏诊,提高诊断准确性。     

C反应蛋白及降钙素原对儿童细菌感染性肺炎的早期诊断价值研究

目的分析在对儿童细菌感染性肺炎患儿实施早期诊断的过程中C反应蛋白联合降钙素原的临床应用价值。方法本次实验将2013年10月-2015年10月在我院接受儿童细菌感染性肺炎治疗的患儿73例作为实验组,将同期在我院接受治疗的非细菌感染性肺炎患儿73例作为对照组,两组患儿均给予C反应蛋白和降钙素原检查。结果实验组患儿C反应蛋白与降钙素原水平均高于对照组,差异具有统计学意义(P0.05);实验组患儿PCT与CRP单独及联合检查阳性率比较存在明显差异,具有统计学意义(P0.05)。结论在对儿童细菌感染性肺炎患儿实施早期诊断的过程中,PCT和PCT/CRP序列实验联合运用是一种相对理想的检查手段,具有较高的诊断准确性,值得临床推广和运用。     

降钙素原在老年细菌性肺炎诊断中的临床应用价值

目的探讨降钙素原（PCT）在老年细菌性肺炎诊断中的临床应用价值。方法将2007年1月-2012年1月就诊的581例疑似细菌性肺炎老年患者,按出院（或死亡）诊断分为细菌性肺炎组和非细菌性肺炎组,对两组患者在应用抗生素前测定PCT、C反应蛋白（CRP）、外周血白细胞计数（wBc）、中性粒细胞百分比（N％）血沉及痰培养,并比较这些检验指标对细菌性肺炎诊断的灵敏度、特异度、阳性似然比、阴性似然比。结果血清PCT在细菌性肺炎组阳性率高于非细菌性肺炎组。PCT检测对细菌性肺炎诊断的灵敏度为54．45％,特异度为88．46％,阳性似然比为12．69％,阴性似然比为0．17％。CRP灵敏度为95．45％,特异度为8．33％;阳性似然比为4．58％,阴性似然比为3．17％。在各项指标中,PCT的特异度最高,CRP的灵敏度最高,阳性似然比最高为痰培养,阴性似然比最低为PCT。结论血清PCT可作为老年细菌性肺炎的检测指标,其作用优于CRP、WBC、N％、血沉、痰培养等指标;通过与CRP结合,可早期诊断、及时治疗细菌性肺炎。     

CRP、PCT联合IL-6动态检测在早期诊断新生儿感染中的应用分析

目的探讨降钙素原(PCT)、C反应蛋白(CRP)联合白细胞介素-6(IL-6)动态检测在早期诊断新生儿感染中的临床应用效果。方法选取我院于2020年8月至2021年9月收治的新生儿66例,根据有无发生感染将其分为感染组34例和非感染组32例。对比两组患儿入院时血清CRP、PCT、IL-6水平,并观察感染组患儿入院时、入院1 d、入院3 d以及入院5 d的CRP、PCT、IL-6水平变化情况,记录CRP、PCT、IL-6与三项指标联合诊断的特异度、灵敏度、阳性预测值以及阴性预测值。结果感染组患儿的血清CRP、PCT、IL-6水平明显高于非感染组,差异有统计学意义(P<0.05);入院1 d患儿的血清CRP、PCT、IL-6水平比入院时高,入院3 d和入院5 d时患儿的血清CRP、PCT、IL-6水平比入院时低,差异有统计学意义(P<0.05)。CRP、PCT与IL-6联合检测的特异度、灵敏度、阳性预测值和阴性预测值均比单独检测高,差异有统计学意义(P<0.05)。结论新生儿出现细菌感染后其血清CRP、PCT、IL-6水平呈现明显升高,因此CRP、PCT与IL-6可作为临床诊断新生儿感染的重要指标,联合动态检测诊断可进一步提升灵敏度和特异度,有利于临床的早期诊断和治疗,值得在临床上推广应用。     

PCT和SAA检测在学龄前儿童早期细菌性感染中的意义

目的探讨降钙素原(PCT)和血清淀粉样蛋白A(SAA)在学龄前儿童早期细菌性感染中的临床意义。方法选择67例细菌性感染患儿(细菌感染组)、62例病毒性感染患儿(病毒感染组)和60例健康儿童(健康对照组)作为研究对象,分别采用胶乳增强免疫比浊法检测SAA水平和免疫比浊法检测PCT水平,比较各组患者SAA和PCT水平及阳性率,并比较分析SAA和PCT对诊断细菌性感染的灵敏度、特异度、阳性预测值、阴性预测值和约登指数。结果细菌感染组治疗前SAA和PCT水平均明显高于病毒感染组和健康对照组,且差异具有统计学意义(P0.05),治疗7d后,SAA和PCT水平均显著下降,且差异具有统计学意义(P0.05);病毒感染组PCT水平与健康对照组比较,差异无统计学意义(P0.05),但SAA水平显著高于健康对照组,差异具有统计学意义(P0.05)。细菌感染组SAA和PCT的阳性率均明显高于病毒感染组和健康对照组,且差异具有统计学意义(P0.05);病毒感染组PCT的阳性率与健康对照组比较,差异无统计学意义(P0.05),但SAA的阳性率显著高于健康对照组,差异具有统计学意义(P0.05)。PCT对诊断学龄前儿童早期细菌性感染的灵敏度、特异度、阳性预测值、阴性预测值分别为92.5%、93.5%、93.9%、92.1%,SAA分别为97.0%、59.7%、72.2%、94.9%,二者的特异度、阳性预测值比较差异有统计学意义(P0.05)。结论检测SAA和PCT水平有助于学龄前儿童细菌性感染的早期诊断、鉴别诊断和预后判断。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.