Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting

The study presented here was performed in order to create a rule that identifies subjects at high risk for invasive candidiasis in the intensive care setting. Retrospective review and statistical modelling were carried out on 2,890 patients who stayed at least 4 days in nine hospitals in the USA and Brazil; the overall incidence of invasive candidiasis in this group was 3% (88 cases). The best performing rule was as follows: Any systemic antibiotic (days 1–3) OR presence of a central venous catheter (days 1–3) AND at least TWO of the following—total parenteral nutrition (days 1–3), any dialysis (days 1–3), any major surgery (days −7–0), pancreatitis (days −7–0), any use of steroids (days −7–3), or use of other immunosuppressive agents (days −7–0). The rate of invasive candidiasis among patients meeting the rule was 9.9%, capturing 34% of cases in the units, with the following performance: relative risk 4.36, sensitivity 0.34, specificity 0.90, positive predictive value 0.01, and negative predictive value 0.97. The rule may identify patients at high risk of invasive candidiasis. Results of this project were partially presented at Focus on Fungal Infections 14, New Orleans, LA, USA, 2004. Abstract no. 51.     

上唇短缩畸形的手术治疗

目的 针对微笑时鼻唇部出现上唇上提并短缩,鼻小柱下方褶沟,上唇牙龈外露等现象,探讨一种治疗上唇短缩畸形的手术方法.方法 采用经口或鼻前庭切口,将鼻小柱根部鼻中隔降肌肌纤维切断及部分切除,并广泛剥离使上唇下降.结果 共为27例上唇短缩畸形患者进行手术治疗.其中9例采用了双侧鼻小柱外侧与前庭基底贯穿切口,18例采用了上唇唇龈沟切口.通过手术,患者获得微笑时上唇中部适度降低,鼻小柱下方褶沟变浅或消失,上唇牙龈外露消失的效果.6例患者还在手术矫正上唇动态短缩畸形的同时,实施了鼻整形术.通过手术可矫正鼻唇牙龈部的综合动态缺陷,获得满意的美学效果.结论 手术方法治疗上唇短缩畸形,可改善患者微笑时的表情,是值得推广的治疗方法.     

乳腺癌新辅助化疗后动态增强MRI表现与病理反应性相关性研究

目的探讨乳腺癌新辅助化疗后动态增强MRI（DCE—MRI）表现的形态学和时间信号强度曲线（TIC）类型与病理学反应性的关系。方法45例乳腺癌患者经新辅助化疗结束后行乳腺DCE—MR检查及手术治疗。应用AW4．2图像工作站观察残余肿瘤强化的形态和TIC类型（共3型）。由病理科医师对乳腺癌化疗后手术标本的病理反应性进行评估，分为1～5级，5级为病理完全缓解，4级和5级为组织学显著反应。分析病理反应性级别与DCE—MRI残余强化的TIC类型、形态的关系，统计方法采用精确概率法。结果45例中病理反应性5级7例，4级16例，3级16例，1和2级共6例。20例I型曲线中组织学显著反应者占70．0％（14／20），而6例Ⅲ型曲线均为组织学反应不显著者。TIC类型在不同的病理反应级别分布差异有统计学意义（P=0．001）。组织学显著反应且有残余强化者共18例，其中非肿块性强化11例。残余强化的肿块（非肿块）形态表现在不同病理反应性分级中分布差异有统计学意义（P=0．012）。结论乳腺癌新辅助化疗后DCE—MRI的形态及血液动力学表现特点与化疗后病理反应性相关。非肿块性强化和I型TIC与组织学显著反应有关。     

1988～2004年广州市荔湾区居民意外伤害死亡分析

目的研究广州市荔湾区居民意外伤害死亡情况及对居民健康危害程度,为伤害的预防决策提供科学的依据。方法资料来源于居民病伤死亡报告系统,采用国际疾病分类法(ICD)进行编码。用人口统计学对1988~2004年广州市荔湾区居民意外伤害死亡进行流行病学分析,并计算潜在寿命损失年数(YPLL)。结果1988~2004年广州市荔湾区居民意外伤害平均死亡率为27.24/10万,标化死亡率为19.82/10万,意外伤害死亡人数占全部死亡人数的3.51%。意外死亡的男性多于女性,男女性别比为1.65∶1。意外伤害死亡在全死因中居第5位,但在YPLL顺位中居第2位。结论意外伤害已对该区居民健康构成了严重的危害,应根据不同年龄段的人群,制定不同的伤害预防措施。     

医院建筑的电气节能设计探讨

阐述了节能建筑的特点,分析了建筑节能设计规程及标准的特点,并结合中国的资源状况和北京的能耗现状,论述了医院建筑电气专业的具体设计做法。     

上唇短缩畸形的手术治疗

目的 针对微笑时鼻唇部出现上唇上提并短缩,鼻小柱下方褶沟,上唇牙龈外露等现象,探讨一种治疗上唇短缩畸形的手术方法.方法 采用经口或鼻前庭切口,将鼻小柱根部鼻中隔降肌肌纤维切断及部分切除,并广泛剥离使上唇下降.结果 共为27例上唇短缩畸形患者进行手术治疗.其中9例采用了双侧鼻小柱外侧与前庭基底贯穿切口,18例采用了上唇唇龈沟切口.通过手术,患者获得微笑时上唇中部适度降低,鼻小柱下方褶沟变浅或消失,上唇牙龈外露消失的效果.6例患者还在手术矫正上唇动态短缩畸形的同时,实施了鼻整形术.通过手术可矫正鼻唇牙龈部的综合动态缺陷,获得满意的美学效果.结论 手术方法治疗上唇短缩畸形,可改善患者微笑时的表情,是值得推广的治疗方法.     

Carinal resection and reconstruction for recurrent lung cancer

A patient with a recurrent tumor in the trachea adjacent to the right main bronchus was treated by surgical resection 19 months after undergoing surgery for the primary cancer. The patient had previously undergone right upper lobectomy for T1N0M0 stage I squamous cell carcinoma. A carinal resection was performed which included 4 rings of the trachea, 2 rings of the righ main bronchus, and 1 ring of the left main bronchus. Reconstruction consisted of an end-to-end anastomosis of the trachea and left main bronchus, and an end-to-side anastomosis of the right and left main bronchi. The postoperative course was uneventful, and at present the patient is healthy 12 months following reoperation.     

Detection of circulating antigen by McAb-AST for evaluating the efficacy of anti-Leishmania chemotherapy.

We have adapted the simple and sensitive McAb-antigen spot test (AST) for evaluating the efficacy of anti-Leishmania chemotherapy. Serum samples from 37 kala-azar patients were tested by McAb-AST, and all showed definite positive reactions before treatment. After a course of antimony treatment, 20 turned negative, coupled with the disappearance of clinical symptoms; another 12 cases responded with weak positivity accompanied by an improvement of clinical manifestations; and the remaining 5 antimony-resistant patients showed strong positive reactions, with their conditions gradually worsening. Furthermore, all 6 cases in which the diagnosis was missed by the bone marrow smear method turned McAb-AST negative after chemotherapy. These results suggest that McAb-AST can be used to evaluate the efficacy of chemotherapy as well as to avoid missed diagnosis by the bone marrow smear method.     

顽固性癫痫的组合手术治疗

目的对部分顽固性癫痫病人，在严格充分的术前评价之后．依据结果将几种手术方式适当的组合使用，并对其临床效果进行评价。方法对同济大学东方医院神经外科收治的116例顽固性癫痫中的25例病人施行联合手术的治疗方法。发作形式为全身强直一阵挛性发作、复杂部分性发作及失神发作等，其中有14例存在两种发作形式。术前均服过多种抗癫痫药．病程后期同时服用2～3种抗癫痫药。25例病人术前均行24h脑电监测及头颅MRI检查．有19例术前行硬膜下皮层电极和深部电极检测，其中1例行头颅PET检查。手术在皮层脑电及深部电极监测下进行。13例行额颢开颅，颞前叶及海马、杏仁核切除＋额部部分区域的软膜下横切术（MST），其中7例附加胼胝体前部切开术；11例行额部开颅，额部软化灶切除＋运动区MST，其中2例附加胼胝体前部切开术；1例行双侧枕顶部开颅，左枕叶萎缩皮层切除＋胼胝体后部切开＋右侧顶枕的MST。结果术后无死亡及严重并发症。术后抗癫痫药物使用减少，术后23例服用一种抗癫痫药，2例服用两种抗癫痫药。术后随访6～12个月，17例手术效果为Engel 1级，4例为Engel2级，4例为Engel3级。40岁以下的患者手术后癫痫控制的可能性显著大于40岁以上者（P〈0．05）；病程在10年以下的患者术后癫痫无发作的可能性显著大于10年以上者（P〈0．05）。头颅MRI上有无明显的结构异常对病人的预后没有影响（P〉0．05）。结论在严格术前评价的前提下，尤其是在有精通神经电生理知识的神经外科医生综合分析下，采用多种手术方式组合治疗顽固性癫痫效果显著。     

The prognostic significance of psychosocial factors in women with breast cancer

One hundred and thirty three recently diagnosed breast cancer patients completed a self-administered questionnaire which measured 16 psychosocial variables. After 4 years, three variables (expressive activities at home, extroversion, low anger) were significant prognostic factors for overall survival independent of clinical and other psychosocial factors; likewise three variables (expressive activities at home, expressive activities away from home, low cognitive disturbance) were significant independent prognostic factors for disease-free survival. These findings support the prognostic importance of the social emotional network.