深圳市龙华区2017-2018年新报告HIV/AIDS病例晚发现情况及影响因素

  目的  描述2017-2018年深圳市龙华区医疗机构新报告HIV感染和AIDS病例晚发现基本情况及分析晚发现的可能影响因素。  方法  数据来源于中国疾病预防控制信息系统中的艾滋病防治信息系统,选择2017-2018年新报告的成年HIV/AIDS病例为研究对象。计量资料采用(x±s)描述,计数资料采用率、构成比描述,并用Logistic回归分析模型分析HIV/AIDS晚发现的影响因素。  结果  795例新报告HIV/AIDS病例的平均年龄为(32.6±10.2)岁,HIV/AIDS晚发现比例为39.1%,26.0%来源于艾滋病自愿咨询检测(HIV voluntary counseling and testing, VCT),22.5%来源于性病门诊。在多因素分析中,＞30岁(OR=0.67, 95% CI: 0.46~0.97, P=0.032)与＞40岁(OR=0.55, 95% CI: 0.32~0.93, P=0.026)人群比 < 30岁人群出现晚发现病例的风险更低,常住人口(OR=2.37, 95% CI: 1.49~3.79, P < 0.001)发生晚发现病例的风险较流动人口更高。而与其他途径检测相比,性病门诊(OR=2.21, 95% CI: 1.22~4.01, P=0.009)、术前检测(OR=1.66, 95% CI: 1.09~2.53, P=0.019)、专题检查(OR=2.59, 95% CI: 1.71~3.91, P < 0.001)与VCT(OR=2.23, 95% CI: 1.13~4.42, P=0.021)出现晚发现的可能性更高。  结论  2017-2018年深圳市龙华区HIV/AIDS晚发现比例为39.1%,年龄、是否为流动人口和样本来源是晚发现的影响因素。     

亚低温对脑外伤急性期一氧化氮含量的影响及意义

目的 探讨亚低温治疗对脑外伤患者急性期脑脊液NO含量变化的影响及其意义。方法 42例各种颅脑损伤患者 分为亚低温治疗组24例,常规治疗组18例,Griess法测定受伤1、 3、7d脑脊液中NO含量变化。结果 亚低温组NO峰值(9.95± 4.01)μmol/L,明显低于常规组的(13.26±5.27)μmol/L;亚低温 组NO含量于第1d达到高峰,第3d降低并明显低于常规组,第7d 降至基本正常;常规治疗组NO含量在受伤第1d开始升高,第3d 达到高峰后开始下降,至第7d仍高于正常对照组。结论 亚低温能够降低脑外伤急性期脑脊液NO含量,亚低温抑制颅脑损伤后 NO的过量生成是其脑保护机制之一,这对探索颅脑损伤新的治疗途径具有重要意义。     

血清降钙素原预测危重患者院内感染的临床价值

目的评估危重患者的降钙素原(PCT)、C反应蛋白(CRP)、白细胞(WBC)水平预测院内感染的临床价值。方法纳入年龄大于18岁、手术或创伤后需要进入ICU监护的患者80例,监测PCT、CRP WBC水平及院内感染情况。结果PCT≥0.5μg/L时预测院内感染的敏感度91.84%,特异度67.74%;PCT≥2.00μg/L时预测院内感染的敏感度65.31%,特异度96.77%;而WBC的敏感性和特异性最低。结论PCT测定有助于早期发现危重患者院内感染,对PCT≥0.5μg/L的危重患者进行PCT动态监测有助于发现院内感染高危患者,而对PCT≥2.0μg/L的危重患者建议及时选用有效的抗生素进行治疗,以提高危重患者的抢救成功率。     

正畸治疗与口腔卫生的护理

目的：研究正畸治疗对于口腔卫生的影响。方法186例患者被随机分为研究组与对照组．研究组95例,牙齿2600颗,在正畸治疗的同时严格控制口腔卫生的状况;对照组91例,牙齿2522颗,进行常规的正畸治疗。结果：研究组患龋牙数、龈炎牙数均少于对照组。结论：严格的口腔卫生措施在正畸治疗是必不可少的。     

预测瘢痕子宫阴道试产失败的风险列线图模型建立

目的:建立预测瘢痕子宫阴道试产失败的风险列线图模型.方法:回顾性分析2017年12月至2019年12月我院收治的剖宫产术后瘢痕再次妊娠的163例孕妇的临床资料,分析阴道试产失败的独立危险因素,建立风险列线图模型,并对模型的预测性及准确度进行验证.结果:年龄≥35岁(OR=2.983,95％CI:1.108～8.026)...     

Pulmonary Penetration of Dirithromycin in Patients Suffering From Acute Exacerbation of Chronic Bronchitis

Summary: The aim of this study was to evaluate the concentrations of dirithromycin, a new macrolide antibiotic, in bronchial secretions (BS), bronchial mucosa (BM), epithelial lining fluid (ELF) and serum in 25 patients with acute exacerbation of chronic bronchitis after a 5-day, once-daily, dirithromycin regimen. All patients received dirithromycin, 500 mg (two 250 mg tablets) given orally once daily at 08.00 fasted, for 5 consecutive days. They were divided into five groups (n=5 in each group) according to sampling time (24, 48, 72, 96 and 120 h after the last dose). Mean serum concentrations remained low throughout the study (0.44 μg/ml at 24 h, 0.31 μg/ml at 48 h, 0.33 μg/ml at 72 h, 0.12 μg/ml at 96 h and 0.11 μg/ml at 120 h, respectively), although they were higher than the MICs for Moraxella catarrhalis for up to 72 h and than that for Streptococcus pneumoniae for up to 120 h after the last dose. By contrast, in all other samples, mean concentrations were higher than the MICs for many relevant respiratory pathogens for at least 3 days, and higher than that for S. pneumonia and M. catarrhalis for up to 120 h (mean concentrations measured 2.67, 2.15, 1.74, 0.27 and 0.17 μg/ml, respectively, in BS; 2.59, 2.59, 1.96, 0.41 and 0.27 μg/g, respectively, in BM; 2.21, 2.25, 1.57, 0.22 and 0.15 μg/ml, respectively, in ELF). These findings demonstrate that dirithromycin is concentrated in each of these potential sites of infection for up to 3 days after a 5-day course of therapy. Therefore, short-term therapy with dirithromycin may be useful for many respiratory infections.     

银杏叶提取物联合泼尼松对慢性阻塞性肺疾病小鼠Ghrelin-Obestatin信号通路的影响

目的 研究银杏叶提取物联合泼尼松对慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）小鼠Ghrelin-Obestatin信号通路的影响。方法 40只健康SPF小鼠随机分为5组。空白组不做处理，其余4组均诱导造COPD小鼠模型，在造模第8天开始，3组治疗组分别灌胃银杏叶提取物（0.4 mL·kg^-1·d^-1）、泼尼松（10 mg·kg^-1·d^-1）、联合药物治疗（0.4 mL·kg^-1银杏叶提取物+10 mg·kg^-1泼尼松），空白组、模型组予以生理盐水，连续给药28 d，采用Buxco系统检测小鼠肺功能PIF、PEF、MV后处死小鼠，采血样及肺组织样本。HE染色考察肺组织病理学变化；RT-PCR检测肺组织Ghrelin、GHSR、GPR39 mRNA表达；Western blotting检测肺组织Ghrelin、GHSR、Obestatin、GPR39蛋白含量；ELISA检测血清TNF-α、IL-6、IL-8水平。结果 与模型组相比，不同给药组均减轻COPD小鼠肺组织病理损伤，联合用药组效果最佳；联合用药组肺功能PIF、PEF、MV较模型组明显升高（P<0.05）；联合用药组Ghrelin、GHSR、GPR39 mRNA及蛋白表达较模型组明显升高（P<0.05），Obestatin蛋白表达较模型组明显升高（P<0.05）；仅联合用药组血清TNF-α、IL-6、IL-8含量较模型组明显降低（P<0.05），效果优于单一药物组。结论 银杏叶提取物联合泼尼松可影响Ghrelin-Obestatin信号通路，减轻炎症反应，改善肺功能，且较单一用药效果更佳。     

抗病毒治疗男男性行为人群HIV感染者对“检测不到等于无传染性”理念的认知调查

目的了解深圳市抗病毒治疗MSM HIV感染者(MSM感染者)对"检测不到等于无传染性"("U=U")理念的认知状况, 并分析影响其认知的因素, 为制定针对该理念的宣传和倡导策略提供依据。方法结合HIV感染者日常随访, 在深圳市通过方便抽样招募抗病毒治疗MSM感染者为研究对象, 开展横断面调查, 估算样本量为475例。利用调查问卷收集研究对象的社会人口学、性行为、抗病毒治疗、病毒载量检测信息, 以及对"U=U"理念的认知情况等内容, 并采用logistic回归模型分析影响研究对象接受"U=U"理念的相关因素。结果共490例抗病毒治疗MSM感染者, 其中知晓"U=U"理念的占60.2%(295/490), 接受"U=U"理念的占50.6%(248/490)。多因素logistic回归分析结果显示, 大专及以上文化程度(aOR=1.76, 95%CI:1.12～2.75)的研究对象更可能接受"U=U"理念;无本地户籍(aOR=0.51, 95%CI:0.29～0.92)、最近1次病毒载量检测结果>0拷贝数/ml(aOR=0.61, 95%CI:0.38～0.98)和不知晓"U=U"理念...     

Timing of minimally invasive step-up intervention for symptomatic pancreatic necrotic fluid collections: A systematic review and meta-analysis

Background and AIMSMinimally invasive step-up interventions are now the standard treatment recommended by current guidelines for symptomatic pancreatic necrotic fluid collections (PNFC); however, it is controversial whether delayed treatment after four weeks should always be used in patients who have failed conservative treatment and whose condition has not improved or worsened. The aim of this meta-analysis was to evaluate the impacts of the different timing of interventions on the clinical outcomes and prognosis of patients with symptomatic PNEC requiring intervention.MethodsWe searched Embase, Cochrane Library, PubMed and Web of Science databases to identify comparative studies assessing the safety and efficacy of early and postponed interventions in treating symptomatic PNFC. Primary outcome: Mortality. Secondary outcomes included some major complications, need for further minimally invasive necrosectomy and length of hospital stay.ResultsThis meta-analysis included ten studies (2 RCTs and 8 observational studies) with a total of 1178 symptomatic PNFC patients who required intervention. Pooled results showed that there was no significant difference between early minimally invasive intervention and postponed intervention in mortality(OR 1.41, 95%CI 0.93–2.12;p = 0.10) and the incidence of early and late complications, but the early intervention group had a significantly increased need for further minimally invasive necrosectomy compared with postponed intervention (OR 2.04,95%CI 1.04–4.03; p = 0.04). There was no increase in length of stay for patients who received early intervention compared to postponed drainage (MD 3.53, 95% CI -4.20, 11.27; p = 0.37).ConclusionIntervention before four weeks should be considered for patients with PNFC complicated by persistent organ failure or infections, who have been treated conservatively to the maximum extent possible.