Validation of Two Clinical Prognostic Models in Patients With Acute Symptomatic Pulmonary Embolism

ObjectiveThe aim of this study was to compare the predictive value of two clinical prognostic models, the Spanish score and the simplified Pulmonary Embolism Severity Index (sPESI), in an independent cohort of patients diagnosed of acute symptomatic pulmonary embolism (PE).MethodsWe performed a retrospective analysis of a cohort composed of 1447 patients with acute symptomatic PE. The Spanish score and the sPESI were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for 30-day mortality, and a composite of non fatal recurrent venous thromboembolism and non fatal major bleeding, using C statistic, which was obtained by means of logistic regression and ROC curves.ResultsOverall, 138 patients died (9.5%) during the first month of follow-up. Both scores showed an excellent predictive value for 30-day all-cause mortality (C statistic, 0.72 and 0.74), but the performance was poor for the secondary endpoint (C statistic, 0.60 and 0.59). The sPESI classified fewer patients as low risk (32% versus 62%; P<.001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the Spanish score (1.1% versus 4.2%), while the 30-day rate of non fatal recurrent VTE or major bleeding was similar (2.2% versus 2.3%).ConclusionsBoth scores provide excellent information to stratify the risk of mortality in patients treated of PE. The usefulness of these models for nonfatal adverse events is questionable. The sPESI identified low-risk patients with PE better than the Spanish score.     

康艾注射液联合化疗治疗老年肺癌临床疗效及不良反应观察

目的探讨康艾注射液联合化疗治疗老年肺癌临床疗效及不良反应发生情况。方法选取2013年1—12月收治的90例老年肺癌患者,随机分为两组,观察组和对照组,每组各45例。对照组患者采用单一化疗治疗,观察组患者联合应用化疗和康艾注射液,比较两组患者治疗2个月后的临床疗效和不良反应发生率。结果观察组治疗2个月后疾病控制率95.6%（43/45）,对照组为82.2%（37/45）,差异有统计学意义（P〈0.01）;两组患者在客观缓解率差异无统计学意义（P〉0.05）;观察组总稳定率（88.9%）明显高于对照组（60%）,差异有统计学意义（P〈0.05）;观察组共出现20例不良反应,对照组出现43例,差异有统计学意义（P〈0.05）。结论应用康艾注射液联合化疗治疗老年肺癌有助于提高临床疗效,有效控制疾病的稳定性,改善患者的生活质量,减少不良反应的发生,值得在临床上进一步推广。     

气道肿瘤造成气管狭窄经支气管镜介入治疗的临床疗效研究

目的:回顾性分析探讨肿瘤致气道狭窄的患者经气管介入治疗过程中该法的应用价值,为类似病情治疗提供理论参考。方法:收集76例我院2016年3月—2018年9月收治的气道肿瘤致气道狭窄并接受支气管镜介入治疗的病例资料,分析致使恶性气道狭窄的肿瘤类型成因,并分析评价其治疗前后气道内径、气促分级、治疗效果、术中并发症等临床资料,评估支气管介入治疗方式在该类病情治疗过程中的安全性及有效性。结果:均经病理证实的76例气道狭窄病例中,肺癌71例,肾癌肺转移2例,甲状腺癌气管侵犯3例。经支气管镜介入治疗气道狭窄,治疗前平均气道内径由0.57±0.18mm增至治疗后1.19±0.14mm,平均气道内径增加明显(P<0.05);平均气促分级由3.22±0.48降至治疗后1.52±0.79,气促分级降低明显(P<0.05);治疗总有效率达100%;患者术前平均KPS评分60.42±4.92,术后增至79.31±8.03,差异有统计意义(P<0.05);支气管镜介入治疗术中并发症多为出血、心律失常、一过性血氧低等,术中均得到有效控制。结论:肺癌中腺癌是导致气道狭窄的高发原因;支气管镜介导的手术治疗能直接可解除气道狭窄问题同时辅助其他放化疗,增强治疗效果。     

气管保存的实验研究

目的通过研究低温保存气管的组织形态学特点和免疫组织化学的状况，探讨气管的保存方法，保存后的组织形态学特点、功能及检测方法。方法将人的气管（支气管）分成3组，其中1组在-85℃低温保存，3组都进行光镜观察，用Envision二步法免疫组织化学方法检测抗胰糜蛋白酶抗体、肌动蛋白抗体、上皮特异抗原抗体在组织中的表达情况。结果大体上及光镜下见保存后的气管形态、结构同保存前；保存前后的气管的平均长度分别是2.07cm、2.0cm，差异无显著性（P〉0．05），免疫组化显示肌动蛋白抗体在3组中全是阳性，抗胰糜蛋白酶抗体和上皮特异抗原抗体染色结果分别是第1组19例（95％）、18例（90％），第2组17例（85％）、16例（80％），第3组7例（35％）、9例（45％）。第1组和第2组比较无显著差异（P〉0，05）。结论保存前后气管的长度、形态和功能无明显变化，说明可以低温保存气管并可以用免疫组织化学方法检测保存后的气管的状况。     

中药复方治疗病毒性心肌炎的用药规律

目的 :通过检索获取数据库中病毒性心肌炎中医文献信息,总结病毒性心肌炎中医用药规律。方法 :检索中国学术期刊网络出版总库、中国优秀硕士学位论文全文数据库所收录的病毒性心肌炎中医文献,建立病毒性心肌炎数据库,对文献数据库进行检索及统计分析。结果:共纳入文献3 256篇,涉及用药259味,中医治疗病毒性心肌炎的用药以补虚药、清热药和活血化瘀药的使用频率最高。结论:病毒性心肌炎治疗主要以益气养阴、清热解毒为主。     

结核杆菌异烟肼表型耐药与katG基因突变相关性研究

目的:探讨结核分支杆菌异烟肼(INH)表型耐药与KatG基因密码子315位和463位基因改变的相关性。方法:采用基因直接测序法对结核分支杆菌分离株KatG基因进行分析。结果:132株异烟肼耐药菌株中68株KatG基因密码子315位有基因突变,突变率51.52%(68/132),野生型密码子315AGC(Ser)突变成ACC(Thr)60株,AAC(Asn)6株,ACA(Thr)1株,GGC(GIy)1株。133株INH敏感菌株未发现KatG 315位基因突变。132株INH耐药菌株中123株KatG基因密码子463位有基因突变,突变率为93.18%,野生型密码子463CGG(Arg)突变成CTG(Leu)123株;133株敏感菌株中114株KatG基因密码子463位有基因突变,突变率为85.71%,野生型密码子463 CGG(Arg)突变成CTG(Leu)114株。结论:①KatG基因315位密码子突变是菌株异烟肼表型耐药的重要分子基础,以Ser315Thr错义突变为主。②KatG基因463位密码子突变与异烟肼耐药表型没有相关性,不是结核杆菌异烟肼耐药的分子标志。该位点突变可能是基因多态性,与结核菌治疗带来的选择性压力无关。     

11例胰岛素制剂过敏反应的临床分析

目的总结胰岛素制剂过敏反应的临床特点及探讨治疗方法。方法回顾性分析11例对胰岛素过敏的糖尿病患者的临床资料及采用免疫荧光法测定血清人胰岛素特异致敏IgE结果。结果胰岛素过敏反应多数表现为局部反应如注射部位丘疹、红晕、瘙痒症状,而表现为全身反应如荨麻疹、过敏性休克者很少。部分人胰岛素过敏患者测得血清人胰岛素特异致敏IgE呈中至重度过敏。1例患者使用胰岛素类似物Aspart治疗后过敏反应明显减轻。结论胰岛素制剂过敏的局部反应远较全身反应多见;血清人胰岛素特异致敏IgE阳性对诊断有一定价值,有过敏体质的糖尿病患者用胰岛素治疗时应选用人胰岛素;对人胰岛素仍发生过敏者可考虑用胰岛素类似物Aspart和L ispro。     

Evaluation of toxic and essential elements in whole blood from 0- to 6-year-old children from Jinan,China

ObjectiveThe aim of the study is to evaluate the distribution and correlation of toxic and essential elements in whole blood from 0- to 6-year-old children from Jinan, China.Design and methodsLevels of toxic and essential elements found in the whole blood of 1110 children were analyzed using an atomic absorption spectrometer. Distributions and correlations of trace elements in different age groups were analyzed and compared.ResultsThe overall mean blood lead (Pb) and cadmium (Cd) levels (49.42 ± 20.16 and 1.47 ± 1.08 μg/L, respectively) were relatively stable among different age groups. The prevalence of Pb and Cd intoxication in all children was 1.4% and 0.4%, respectively. Calcium (Ca) levels decreased gradually with age, with an overall concentration of 1.82 ± 0.15 mmol/L. Whole levels of copper (Cu) and magnesium (Mg) were 17.79 ± 4.22 μmol/L and 1.52 ± 0.14 mmol/L, respectively. While 7.6% of all children showed Cu levels below the normal threshold, the levels of Mg were stable in different age groups. Though the overall mean blood zinc (Zn) and iron (Fe) concentrations (59.59 ± 15.15 μmol/L and 7.39 ± 0.74 mmol/L, respectively) gradually increased with age and the overall deficiency levels (59.8% and 59.5%, respectively) decreased with age, Zn and Fe deficiencies were still very common. Significant positive correlations were found when comparing Cu to Zn, Ca, Mg, and Fe; Zn to Mg and Fe; and Mg to Ca and Fe. Additionally, minor positive correlations were found when comparing Pb to Zn and Fe.ConclusionThe degree of Pb and Cd intoxication in all the children studied was low; however, Pb and Cd exposure was still evident. The importance of Ca deficiency and supplementation is well recognized, but the severity of Fe and Zn deficiency is not as well documented.     

Species spectrum of nontuberculous mycobacteria isolated from suspected tuberculosis patients,identification by multi locus sequence analysis

Identification of Mycobacterium species is difficult due to a complex and rapidly changing taxonomy, the failure of 16S rRNA to discriminate many closely related species and the unreliability of phenotypic testing. We investigated a collection of nontuberculous mycobacteria (NTM) strains isolated from suspected tuberculosis patients at Tuberculosis Reference Centre (Ahvaz, Iran) and Masoud Laboratory (Tehran, Iran) during 2008–2012 to evaluate the species spectrum of NTM isolates.Based on phenotypic tests, the isolates were identified up to species or complex level; however they were heterogonous by hsp65-PCR restriction fragment length polymorphism analysis (PRA) method. Representative isolates from each hsp65-PRA pattern, were subjected to identification using single locus and multi locus sequence analysis (MLSA) based on 16S rRNA, rpoB, hsp65 and 16S–23S internal transcribes spacer (ITS) fragments to determine their taxonomic affiliations.All 92 NTM isolates from different clinical specimens were considered as etiological agents causing disease according to American Thoracic Society (ATS) guideline. Phenotypic evaluation alone assigned 66 (72%) isolates to a species or complex level and consequently 76 (82%) isolates showed previously reported hsp65-PRA patterns. Although sequence base identification using single locus such as 16S rRNA, rpoB, hsp65 or ITS identified the isolates up to species level, MLSA correctly identified 16 different species of NTM from clinical isolates. In summary, four-locus MLSA is a reliable method for elucidating taxonomic data and reliable species identification of Mycobacterium isolates and therefore, would be more feasible for routine use in Tuberculosis (TB) reference laboratory.