川崎病21例临床分析

目的探讨川崎病的临床特征及早期诊断依据。方法分析21例川崎病患儿的病历资料。结果本组病例早期均有持续发热,皮疹,双侧球结膜充血,口腔及咽部黏膜弥散充血潮红,唇红干裂,杨梅舌,肛周皮肤潮红、脱屑,其典型症状如较特异的手足硬肿出现较晚。结论川崎病急性期主要的临床表现是发热伴皮肤黏膜损害,肛周潮红脱皮有助于早期诊断。外周血中性粒细胞增高伴中毒颗粒。血沉及c反应蛋白明显增高对川崎病的早期诊断有重要的参考价值。     

川崎病产生冠状动脉损害的相关危险因素

目的探讨川崎病的早期诊断及发生冠状动脉病的危险因素。方法对在东莞市长安医院住院确诊为川崎病23例病例的年龄、性别、临床表现、血象、C反应蛋白（CRP）、血沉（ESR）及心脏彩超结果进行回顾性分析。结果发热、口腔粘膜改变、皮疹、非化脓性球结膜充血、淋巴结肿大、手足硬肿分别占100％、83％、78％、74％、28％、22％。白细胞总数升高、中性粒细胞分类升高、ESR加快、CRP升高，血小板升高分别占91．3％、86．9％、86．9％、82．6％、86．9％。结论发热患儿出现口唇充血皲裂及口腔粘膜充血、皮疹、球结膜充血，同时伴有白细胞升高，中性粒细胞分类升高，ESR加快、CRP升高要高度怀疑川崎病的诊断，发热时间超过7天，CRP超过30是发生冠状动脉损害的高危因素。     

川崎病早期诊断初探

目的：了解儿童川崎病（KD）的临床特点，探讨其早期诊断问题。方法：参照KD现行诊断标准统计分析32例KD患儿各种临床表现出现的时间及发生率。结果：在发病早期出现持续发热占100．0％，皮疹75．0％，口腔黏膜改变84．4％，眼结合膜充血81．3％，肛周红脱皮62．5％，卡介苗接种瘢痕周围红晕、肿胀（卡瘢红）43．7％，白细胞及C反应蛋白升高。结论：发热、皮疹、KD面容、卡瘢红、白细胞、C反应蛋白增高及肛周红、脱皮等有早期诊断意义,心脏彩超检查也是早期诊断KD有效的无创性检查。     

不典型川崎病的临床分析及早期诊治

目的探讨不典型川崎病的临床表现及实验室检查,提高对不典型川崎病的早期诊治。方法对我科2005年6月～2009年6月收治的19例不典型川崎病的早期表现及实验室指标进行回顾性分析。结果发热、指（趾）端脱皮、球结膜充血、颈部淋巴结肿大、口唇粘膜改变、手足硬性水肿、肛周潮红脱皮、皮疹的发生率依次为100％、89.5％、73.7％、42.1％、52.6％、31.6％、57.9％、31.6％。其中血小板升高、血沉增快、白细胞升高、CRP升高、血红蛋白下降、OKMB升高、冠状动脉改变的发生率分别为100％、84.2％、94.7％、68.4％、47.4％、42.1％、63.2％。结论不典型川崎病容易误诊,可结合实验室指标给予拟诊,尽早应用免疫球蛋白,以减少冠状动脉损害。某些实验室指标及临床症状对早期诊断不典型川崎病有重要参考价值。     

川崎病临床表现与早期诊断的探讨

目的：探讨早期诊断川崎病标准的可能性。方法：参照川崎病现行诊断标准，分析65例川崎病患儿临床资料。结果：本病早期临床表现发热(100％)，唇和口腔粘膜变化(92．3％)，眼结膜充血(76．92％)，大部分病例在发病3天内便出现。肛周皮肤潮红、脱皮76．92％，四肢末梢脱皮69．23％，肛周皮损较四肢末梢变化早。多形皮疹(70．76％)，颈部淋巴结肿大(49．23％)，血小板第一次检查均值增高70．75％。结论：川崎病患儿发热、唇和口腔粘膜改变是早期主要临床表现，有上述表现伴眼结膜充血时，应高度怀疑川崎病的可能。肛周皮损及血小板增高有早期诊断的价值。     

不典型川崎病的早期诊断探讨

目的：探讨川崎病（KD）不典型病例的早期临床诊断。方法：对40例患儿各种临床表现出现的时间及发生率进行分析。结果：本病早期发热，皮疹，结膜充血，口唇干红，皲裂，口腔粘膜充血，肛周脱皮的发生率分别为100%,77.5%,75%,92.5%,70%,77.5%,75%。血WBC增高，中性粒细胞比例增高并核左移，血沉增快，尿白细胞增多分别为100%，100%，100%，72.5%。结论：发热，皮肤粘膜病变为KD主要表现，当有发热，结膜充血，口唇干红皲裂，口腔粘膜充血高度疑诊KD。；肛周脱皮，血WBC改变，血沉增快有早期诊断价值。     

川崎病患者早期识别与诊断的临床分析

目的探讨川崎病（KD）患儿的早期临床诊断方法,提高早期确诊率。方法选取我院2008年5月～2012年3月期间收治的93例川崎病患儿为研究对象,按照分级标准分为典型KD组和非典型KD组,比较两组患儿的临床表现特征、实验室检查及冠状动脉损害情况,探讨早期诊断KD的方法。结果两组患儿均有不同程度发热表现,典型组患儿其他临床表现除肛周脱皮外发生率均高于非典型组,非典型组患儿肛周脱皮发生率明显高于典型组。两组患儿白细胞数值比较无明显差异,血红蛋白、血沉、血小板、心肌酶CK—MB及白蛋白比较均有显著差异,具有统计学意义（P〈0．05）。典型组患儿冠脉损害发生率为3．85％,非典型组患儿冠脉损害发生率为73.3％。两组患儿冠脉损害发生率比较差异有统计学意义（X2=19．436,P〈0．05）。结论KD临床以典型患儿为主,肛周脱皮、冠脉损害多见于非典型患儿,可据此对KD患儿进行早期识别与诊断,对提高后期治疗效果具有重要意义。     

南宁市30例婴幼儿非典型川崎病早期诊断Logistic回归浅析

目的通过对婴幼儿非典型川崎病的早期实验指标分析,寻找非典型川崎病的危险因素,指导早期诊断。方法对30例婴幼儿非典型川崎病与60例常见的呼吸道感染婴幼儿进行早期血常规白细胞、中性粒细胞、血红蛋白、血小板、血沉、C反应蛋白、肝功能总蛋白等指标,进行单因素分析与多因素Logistic回归分析,探讨婴幼儿非典型川崎病的早期诊断方法。结果单因素分析显示婴幼儿非典型川崎病与血白细胞、血红蛋白、血沉、CRP、AST、总胆红素等在两组中差异有统计意义,而中性粒细胞、血小板、血总蛋白在两组中差异无统计学意义。多因素Logistic回归分析显示婴幼儿非典型川崎病仅与外周血白细胞、血沉有关。结论发热≥5 d并有典型川崎病的2项主要诊断标准,结合血白细胞、ESR的异常升高,可作出非典型川崎病的早期诊断。     

川崎病48例临床分析

目的：探讨川崎病的临床特点，提高诊治水平。方法：对48例川崎病的临床表现、实验室辅助检查及治疗效果进行回顾性分析。结果：典型川崎病34例，非典型川崎病14例。对早期诊断具有提示价值的有发热、眼球结膜充血、唇红干裂、口腔黏膜表现、皮疹、指（趾）端硬肿，其中以发热（100％）、结膜充血（87.5％）、唇红干裂（85.4％）最常见。肛周皮肤脱皮、卡瘢红对川崎病特异性较高，可列为参考诊断指标之一。川崎病发病早期就可发现冠状动脉病变。单剂丙种球蛋白（IVIG）1 g/kg＋阿司匹林治疗效果好。结论：对于临床上出现发热，伴有川崎病部分临床诊断依据，尤其是呈现川崎病面容者，同时应注意寻找川崎病的其他指征，如肛周皮肤脱皮、卡瘢红。并尽早做超声心动图检查，一旦确诊，尽早使用单剂IVIG 1 g/kg＋阿司匹林以预防或减轻冠状动脉病变。     

川崎病早期诊断分析

目的:探讨川崎病(Kawasaki disease,KD)的早期诊断方法.方法:回顾性总结川崎病患儿40例,分析其急性期临床表现、实验室、UCG检查及诊断时间.结果:40例川崎病患儿,急性期典型病例25例(62.5%),不典型病例8例(20%),疑似病例7例(17.5%).急性期临床表现发生率:结膜充血80.0%,皮疹70.0%,淋巴结肿大67.5%,口腔黏膜改变95.0%,手足硬肿、膜状脱皮65.0%,卡介苗接种处再现红斑5.0%,肛周皮肤潮红脱皮12.5%.结论:川崎病急性期部分呈不典型病例及疑似病例,易延误诊断,KD面容,ESR、WBC显著升高、UCG、肛周皮肤潮红脱皮、卡介苗接种处再现红斑,可作为早期诊断的重要参考依据.     

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…