特发性血小板减少性紫癜的中医药研究与进展

特发性血小板减少性紫癜临床主要表现为肌衄，其病位可涉及肝、脾、心、肾、肺等脏，病理多责之火、瘀、虚三种，临床分型为热盛破血证，阴虚火旺证，气不摄血证，瘀血内阻证等，本文对其运用中医药治疗进行了综述。     

弥漫性脑损伤后低血压及高热对鼠脑血栓素 A_2 与前列环素代谢的变化

目的：探讨二次脑创伤（如低血压与高热）后大鼠脑血栓素Ａ２（ＴＸＡ２）与前列环素（ＰＧＩ２）的代谢变化及意义。方法：在Ｍａｒｍａｒｏｕ弥漫性脑损伤模型基础上，采用抽血造成低血压，及高热形成二次脑创伤。３２只ＳＤ大鼠随机分为假手术对照组、单纯脑损伤组、单纯二次脑创伤组及脑损伤合并二次脑创伤４组。所有动物均实施同步生理监护，伤后４小时检测脑内ＴＸＡ２与ＰＧＩ２的稳定代谢产物血栓素Ｂ２（ＴＸＢ２）及６酮前列腺素Ｆ１α（６ｋｅｔｏＰＧＦ１α）含量。结果：伤后４小时，与假手术组比较，脑损伤组ＴＸＢ２及６ｋｅｔｏＰＧＦ１α含量无明显变化；单纯二次脑创伤组仅６ｋｅｔｏＰＧＦ１α含量升高（Ｐ＜０．０５）；合并二次脑创伤组ＴＸＢ２及６ｋｅｔｏＰＧＦ１α含量均显著升高（Ｐ均＜０．０５），但ＴＸＢ２／６ｋｅｔｏＰＧＦ１α比值下降。结论：原发脑损伤后，合并低血压与高热可使ＴＸＡ２大量生成，通过引起脑血管痉挛及微血栓形成，增加脑微循环阻力，导致脑缺血、缺氧而加重原发性脑损伤。     

清热祛瘀法并早期脑超声治疗脑出血临床观察

目的:观察清热祛瘀中药联合早期脑超声治疗急性少量脑出血的疗效.方法:90例脑出血患者被随机分为治疗组60例、对照组30例.对照组采用甘露醇脱水控制血压等常规治疗,并加用清开灵注射液静脉滴注.治疗组在对照组常规治疗基础上于发病后第1～3 d开始静脉滴注脉络宁注射液20 ml,每日1～2次;在生命体征平稳的条件下,于发病第3～5 d开始使用脑超声治疗,每次30 min,每日1～2次.观察两组患者治疗20 d后血肿吸收情况和神经功能缺损评分.结果:治疗组总有效率为91.7%,对照组总有效率为73.3%,两者比较有显著性差异(P<0.01).治疗组神经功能缺损评分减少的程度明显好于对照组(P<0.05);脑出血吸收量也明显大于对照组(P<0.05).结论:应用清热、祛瘀并脑超声三联疗法治疗脑出血较单纯使用清热的清开灵注射液能明显促进血肿吸收,改善神经功能,提高临床疗效,降低致残率.     

Pharmacotherapy of fever control among hospitalized adult patients

Introduction: Fever is common and associated with increased mortality among hospitalized adults. This article will review the pharmacotherapy of commonly prescribed antipyretic drugs including the rationale for and against temperature control in febrile adults, as well as the evidence associated with fever control in specific patient populations.

Areas covered: Though fever is common, the molecular basis of pyrexia, and the interaction of these pathways with commonly prescribed antipyretic drugs are not fully understood. Furthermore, while experimental and clinical studies clearly demonstrate that pyrexia is harmful in select patients, available clinical trial data are unable to suggest an evidence-based approach to the treatment of fever. Interestingly, this also applies to patients with an acute neurologic injury wherein the treatment of fever with antipyretic therapy has become a common management strategy.

Expert opinion: Few adequately powered clinical trials have investigated temperature control strategies in febrile patients. Therefore, it is not possible to define an evidence-based approach to the control of fever in hospitalized adults. Further clinical and translational research is required to identify the patients most likely to benefit from a strategy of fever control versus permissive hyperthermia, and to determine the antipyretic therapies associated with the greatest improvement in outcome.     

Mixed epithelial and stromal tumor of the kidney in a puerperal woman

Puerperal pyrexia is still rampant, especially in third world countries, and is usually due to puerperal sepsis, urinary tract infections, upper respiratory infection, and breast infection. Rarely, in third world countries like India, it may be due to tuberculosis, malaria, typhoid, and so on, which are also rampant in the general population. Mixed epithelial and stromal tumor of the kidney (MESTK) is a recently recognized subset of renal tumors composed mainly of smooth muscle cells in which epithelial structures are embedded. It usually occurs in middle aged and older women. In the present case report, a 36-year-old woman presented with puerperal pyrexia, possibly due to tuberculosis and with an incidental mixed epithelial and stromal tumor of the kidney causing complex ascitis and fever, which required nephrectomy that was followed by full recovery. This case report highlights the importance of keeping MESTK in mind even in younger women with asymptomatic renal mass. It also highlights the importance of keeping renal tumors in mind as a possibility and to perform proper investigations for adequate treatment and recovery.     

A rare case of seronegative culture--proven infection with Brucella suis

Brucellosis is a chronic infection produced by members of the Brucella family. Diagnosis of this condition requires either isolation of the organism in culture or positive serological tests.We describe a 27-year-old male admitted as a case of pyrexia of unknown origin (PUO), who tested negative for Brucella IgM ELISA test on preliminary evaluation but was subsequently diagnosed on the strength of positive blood and bone marrow cultures to be a case of brucellosis secondary to Brucella suis infection. In addition to highlighting the pathogenic potential of an unusual organism, this case demonstrates the unreliability of standard serological tests based on the Brucella melitensis antigen for infection with other species of Brucella.     

肝动脉化疗栓塞术治疗原发性肝癌158例围治疗期副反应观察

目的：观察肝动脉化疗栓塞术（TACE）治疗原发性肝癌的术后副反应,探讨其治疗措施。方法：通过临床查房及实验室检查,监测158例原发性肝癌患者373人次TACE术后围治疗期不良反应,分析常见不良反应的临床特征,计数罕见及严重并发症例数。结果：发热、腹痛与消化道症状为TACE术后最常见的不适症状。部分患者出现一过性的轻度肝功能损伤和白细胞增高。严重肝肾功能损伤及脏器栓塞少见,围手术期死亡率低。结论：TACE用干治疗原发性肝癌的术后不良反应较为常见。但通过内科综合治疗多可好转。严重副反应个别发生,可危及生命。     

Analgesic,anti-inflammatory,and antipyretic activities of the ethanol extract from Desmodium caudatum

Context: In folk medicine in China, Desmodium caudatum (Thunb.) DC (Leguminosae) has been used to treat febrile diseases, rheumatic arthritis, and bacillary dysentery; nevertheless, there have been no reports on the analgesic, antipyretic, and anti-inflammatory effects of this plant in animals.

Objective: To investigate the analgesic, anti-inflammatory, and antipyretic activities of D. caudatum extract (DCE) in animals.

Materials and methods: The analgesic effect of DCE was measured in mice using the acetic acid-induced writhing test and the hot-plate test. The anti-inflammatory activity was assessed using the carrageenan-induced rat paw edema model and the dimethylbenzene-induced mouse inflammation model. The antipyretic effect was estimated using the lipopolysaccharide (LPS)-induced rat fever model. In addition, the acute oral toxicity of DCE was studied.

Results: DCE significantly and dose-dependently inhibited the writhing responses in mice, increased reaction time in mice in the hot-plate test, reduced carrageenan-induced paw edema in rats and the dimethylbenzene-induced ear edema in mice, and attenuated LPS-induced fever in rats. Furthermore, no death was observed when mice were orally administered DCE up to 40?g/kg.

Discussion and conclusion: DCE possesses evident analgesic, anti-inflammatory, and antipyretic activities, and has a favorable safety, which supports the use of D. caudatum as an analgesic, anti-inflammatory and antipyretic drug in folk medicine.     

Routine Workup of Postoperative Pyrexia Following Total Joint Arthroplasty Is Only Necessary in Select Circumstances

Background

It is unclear when routine workup of postoperative pyrexia (POP) following total joint arthroplasty (TJA) should be performed.

银莱汤对发热大鼠血清IL-1β、TNF-α、IL-6含量的影响

目的 研究银莱汤对发热大鼠体温和血清IL-1β、TNF-α、IL-6含量的影响.方法 90只SD大鼠连续测温3次,选取合格大鼠背部皮下注射20%干酵母混悬液10 mL/kg建立大鼠发热模型,随机平均分为正常组、模型组、阿司匹林组、银莱汤高剂量组、银莱汤中剂量组、银莱汤低剂量组共6组,每组8只大鼠.分别于造模前0.5 h和造模后5 h两次灌胃给药,造模后每小时测温一次,于末次给药后3 h取血,通过ELISA和RIA方法检测血清中炎性介质白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)含量水平.结果 银莱汤各剂量组体温均低于模型组(P<0.01),银莱汤各剂量组血清中IL-1β、TNF-α、IL-6含量均低于模型组(P<0.05).结论 银莱汤对发热大鼠具有明显的退热效果,其作用机制可能与降低机体炎症反应,减少血清中IL-1β、TNF-α、IL-6的产生或加速降解相关.