手足口病并发中枢神经系统感染危险因素的回顾性分析

目的 探讨重症手足口病的高危因素及早期发现的临床意义.方法 对554例手足口病患儿的临床表现及实验室检查进行回顾性分析.结果 单因素回归分析示发热峰值≥38.5℃、呕吐、惊跳、精神差、四肢抖动、血糖高等6项差异有显著性.多元回归分析表明发热峰值≥38.5℃(OR=2.954,95%CI 1.387～6.295)、惊跳(OR=118.000,95%CI 28.500～488.563)、精神差(OR=59.487,95%CI 13.683～258.626)、四肢抖动(OR=13.803,95%CI 3.504～54.378)是增加并发中枢神经系统感染的危险因素.结论 发热峰值≥38.5℃、惊跳、精神差、四肢抖动是手足口病并发中枢神经系统感染的危险症状,确定这些危险症状有助于早期识别,早期治疗,改善预后.     

合并神经系统受累的手足口病患儿52例临床分析

目的探讨合并神经系统受累手足口病重症患儿的临床特点。方法对宁夏医科大学总医院儿科2011年5-10月收治的52例手足口病重症患儿进行回顾性分析。结果 52例患儿中男38例,女14例,<3岁45例(86.5%),发热52例(100%)、典型皮疹45例(86.5%)。神经系统受累表现在病程的第2～5天出现,合并神经系统受累表现:精神差(100%)、惊跳或肢体抖动(73.1%)、嗜睡(51.9%)、呕吐(36.5%)、脑膜刺激征(34.6%)、呼吸节律不齐(28.8%)。辅助检查:WBC>10.0×109.L-126例(50%)、血糖升高10例(19.2%)、脑脊液检查细胞数均有不同程度的增高。52例进行病原学检查,有35例(67.3%)证实为肠道病毒71型感染。51例治愈或好转出院,死亡1例(1.9%),3例(5.8%)留有肢体软瘫,随访1～2个月恢复。结论手足口病重症多发生于3岁以下患儿,病情进展迅速,均有发热、皮疹。合并神经系统受累表现以精神差、惊跳或肢体抖动、嗜睡、呕吐多见。手足口病重症多由肠道病毒71型感染所致,神经系统受累是重症患儿最早期的表现,早期诊断,积极干预,防止发生神经源性肺水肿,改善预后。     

18F-FDG符合线路显像对分化型甲状腺癌复发转移的应用价值

目的:探讨18F-FDG符合线路(DHC)显像对分化型甲状腺癌(DTC)手术和131I治疗后复发转移的临床随访价值.方法:对28例临床经手术和131I清甲治疗后的DTC患者行18F-FDG DHC显像及131I全身显像,计算其诊断复发转移灶的灵敏度、特异性和准确性、阳性预测值、阴性预测值,并与甲状腺球蛋白检查结果相比较.结果:28例患者中DHC显像真阳性8例,真阴性13例,假阳性1例,假阴性6例,其诊断甲状腺癌复发转移的灵敏度、特异性和准确性、阳性预测值、阴性预测值分别为57.1%、92.8%、75.0%、88.9%、68.4%.当HTg≥10 ng/ml,DHC显像探测复发转移灶以颈淋巴结、骨灵敏度较高.结论:18F-FDG DHC显像对术后和131I清甲治疗后的DTC复发转移诊断有较高的临床价值.     

武汉市武昌区手足口病控制图法预警模型研究

目的 基于控制图法构建武汉市武昌区手足口病预警模型,确定最佳预警界值,为该区手足口病监测工作提供数据支持.方法 从国家传染病报告系统中整理2009-2014年武昌区手足口病数据并建立数据库,采用移动百分位数法建立预警模型,通过筛检试验方法对模型进行评价,计算出灵敏度、特异度、阳性预测值和阴性预测值,绘制ROC曲线并找出最佳预警界值.结果 武汉市武昌区手足口病最佳预警界值为P90,其灵敏度、特异度、阳性预测值和阴性预测值分别为75.00％、93.88％、50.00％和97.87％.结论 手足口病预警界值的确定应根据发病特点结合当地疫情优选,注重地区特异性,提高传染病疫情监测能力.     

18F-FDG PET/CT显像在CA153升高的乳腺癌患者术后复发和转移监测中的临床价值

目的:探讨18F-FDG PET/CT显像联合肿瘤标志物检测在乳腺癌术后复发和转移监测中的临床应用价值?方法:65例乳腺癌术后患者,年龄25~71岁?肿瘤标志物CA153均高于正常值上限?所有患者均行18F-FDG PET/CT检查,与病理学检查及临床随访结果进行比较,得出18F-FDG PET/CT显像诊断的灵敏度?特异性?准确性?阳性预测值及阴性预测值?结果:18F-FDG PET/CT显像发现了256个放射摄取异常浓聚灶,其中206个浓聚灶判断为恶性,50个浓聚灶判断为良性?根据病理学及临床随访分析,18F-FDG PET/CT显像发现假阳性4例,假阴性3例?以病灶分析,18F-FDG PET/CT显像发现假阳性病灶21个,假阴性病灶10个?以患者分析18F-FDG PET/CT诊断灵敏度?特异性?准确性?阳性预测值及阴性预测值分别为:93.33%?80.00%?89.23%?91.30%及84.21%?结论:18F-FDG PET/CT显像对血清CA153升高的乳腺癌患者复发和转移监测具有一定的临床价值?     

重型手足口病临床特征及预警指标分析

目的:探讨手足口病重型的临床特征及预警指标。方法:选取手足口病2期患儿30例作为重型组,手足口病1期患儿38例作为普通组,回顾性分析2组患儿临床表现和相关指标。结果:2组患儿性别分布差异无统计学意义（P>0.05）,年龄<3岁患儿例数差异亦无统计学意义（P>0.05）。重型组患儿热峰明显高于普通组,热程明显长于普通组（P<0.01）。重型组患儿精神差、嗜睡和易惊、肢体抖动、呕吐率均高于普通组（P<0.05~P<0.01）。2组患儿白细胞计数、中性粒细胞计数差异均无统计学意义（P>0.05）,2组EV71抗体阳性率差异亦无统计学意义（P>0.05）,重型组血糖水平高于普通组（P<0.05）。结论:热峰高、热程长,精神差、嗜睡,易惊、肢体抖动、呕吐为重型手足口病主要临床特征,年龄<3岁、血糖高是其危险因素,而白细胞及中性粒细胞计数对手足口重症重型早期识别意义较小。     

不同血浆D-二聚体检测方法在血栓性疾病诊断中的应用

目的:研究血浆D-二聚体的不同检测方法在血栓性疾病诊断中的应用。方法:选取2016年7月至2017年7月南京市第二人民医院门诊和住院的确诊或疑似血栓性疾病131例患者作为研究对象,所选患者均采用免疫比浊法与胶体金免疫渗透试验法检测血浆D-二聚体,比较两种检测方法的结果并分析。结果:取cutoff值为0.50mg/L时,结果显示免疫比浊法的灵敏度、特异性、阳性预测值、阴性预测值以及假阴性率分别为76.47%、81.48%、83.87%、73.33%、23.52%,胶体金法的灵敏度、特异性、阳性预测值、阴性预测值以及假阴性率分别88.24%、85.19%、88.24%、85.19%、7.46%。免疫比浊法与胶体金法灵敏度、特异性、阳性预测值以及阴性预测值未见明显差异(p0.05);免疫比浊法的假阴性率明显高于胶体金法,差异显著(p0.05)。结论:两种检测方法各有优势,实验室应该根据具体情况选择最适宜的检测方法。     

螺旋CT与核素肺通气/灌注显像对肺动脉栓塞的诊断价值

目的 评价螺旋CT肺动脉造影(CTPA)与核素肺通气/灌注(V/Q)显像在诊断肺动脉栓塞中的价值.方法 临床疑似肺栓塞(PE)的患者84例,均完成CTPA和V/Q显像,所有检查均在3-5 d内完成,依照最终临床诊断评价两种方法诊断PE的临床价值.结果 CTPA正确诊断PE 35例,假阳性2例,假阴性5例,诊断PE的灵敏度、特异性、准确性、阴性预测值、阳性预测值分别为:87.50%,95.45%,91.67%,89.36%,94.59%;肺V/Q显像正确诊断PE 33例,假阳性3例,假阴性7例,诊断PE的灵敏度、特异性、准确性、阴性预测值、阳性预测值分别为:82.50%,93.18%,88.10%,85.41%,91.67%.结论 CTPA在灵敏度、特异性及准确性诊断比率方面均较V/Q显像的价值高,可作为临床疑诊肺栓塞病例的有效检查方法.     

海南省手足口病移动百分位数法预警技术研究

目的探索移动百分位数法在海南省手足口病预警工作中的应用,为其预防和控制提供依据。方法收集2009~2011年海南省手足口病各市县每周疫情资料,以移动百分位数法建立预警模型,将P5、P10、P15、P20、……P85、P90、P95作为侯选的19个预警界值,计算比较其预警2012年手足口病灵敏度、特异度、阳性预测值、阴性预测值、约登指数及绘制ROC曲线,优选出最佳预警界值。结果 P90为海南省手足口病最佳预警界值,拟合预警信号389条,其预警灵敏度、特异度、阳性预测值、阴性预测值和约登指数分别为92.92%,90.17%,80.98%,96.59%和0.8309,其预警功效最好。结论移动百分位数法能较好的对海南省手足口病发病情况进行预警。     

小儿重型手足口病312例临床分析

目的探讨重型手足口病患儿的临床特点,特别是神经系统的早期表现,以提高早期诊断率。方法回顾性分析2011年1～12月收治的312例重型手足口病患儿的临床表现、检查结果及诊断情况。结果 67.6%的患儿为1～3岁。97.1%的患儿在病程1～5天发展成重症,尤以病程2～4天（77.2%）更明显。绝大部分患儿出现精神差（99.0%）、惊跳（95.8%）、激惹（94.9%）、呕吐（38.5%）、肢体抖动（30.1%）、嗜睡（10.6%）、头痛（8.3%）、惊厥（2.2%）、颈阻阳性（16.0%）,巴氏征阳性（11.9%）、膝反射活跃或亢进或减弱（16.6%）、心率增快（83.3%）、血压增高（42.3%）;61.2%的患儿外周血白细胞计数增高,34%的患儿血糖增高,34.6%的患儿血乳酸增高;脑脊液检查（34/40例）阳性率高,为病毒性脑炎改变;脑CT（0/21例）、脑MRI（0/11例）检查阳性率低。312例均临床治愈,无1例发展为危重型及死亡。结论重型手足口病早期临床表现较隐匿,精神差、惊跳、激惹为神经系统最主要表现,呕吐、肢体抖动提示病情较重,头痛不是神经系统主要表现,较少出现惊厥、昏迷。持续发热、心率增快、血压增高、外周血白细胞计数增高、血糖增高、血乳酸增高为诊断重型手足口病的重要依据,神经系统体征、脑CT、脑MRI检查不能作为诊断依据。早期诊断,及时治疗,则预后良好。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…