小儿手足口病行综合护理的效果

目的分析综合护理对促进小儿手足口病病情恢复的效果观察。方法手足口病患儿作为本次研究的主要对象,总例数(选取人数)200例,患者收取时间在2018年10月-2019年10月,研究对象200例使用电脑随机分配方式分为两组,其中100例作为观察组(实施综合护理)、100例作为对照组(实施常规护理),将两组的口腔糜烂愈合时间、住院时间、皮疹消退时间、家属焦虑评分和抑郁评分进行比较。结果观察组手足口病患儿护理后口腔糜烂愈合时间、住院时间、皮疹消退时间显著优于对照组(P<0.05)。观察组患儿家属护理后焦虑(46.25±1.64)分、抑郁(52.03±1.21)分均低于对照组(P<0.05)。结论综合护理在小儿手足口病病情恢复中具有良好的护理效果。     

基于集中度和圆形分布法的上海市郊区某镇手足口病流行特征分析

目的分析上海市郊区某镇2012—2018年手足口病流行病学特征和季节性分布规律,为制定有效的防控策略提供科学依据。方法通过中国疾病预防控制信息系统,收集2012—2018年现住址为上海市郊区某镇的手足口病发病资料,采用描述性流行病学方法进行分析。结果上海市郊区某镇2012—2018年共报告手足口病病例538例,年平均报告发病率为186.27/10万,各年发病率差异有统计学意义(χ2=107.95,P<0.05);发病年龄以5岁以下儿童为主;发病高峰在5~9月份;职业以散居儿童为主;手足口病疫情主要发生在托幼机构和学校,占总疫情数的60.53%。结论2012—2018年上海市郊区某镇手足口病发病具有季节性,建议在高发期来临前针对重点人群、重点场所进行手足口病防控措施的落实,减少手足口病重症病例和疫情的发生。     

青黛表面改性对口腔溃疡双层膜质量与药效的影响

目的 采用溶剂浇铸法制备口腔溃疡双层膜剂,研究青黛表面改性前后对膜剂质量与药效的影响。方法 通过单因素实验设计和响应面优化法优选膜剂最佳处方,并对膜剂表面形貌、黏附时间、抗拉强度、含量测定以及体外药物释放等性能进行评估。进一步采用化学灼烧法建立大鼠口腔溃疡模型,考察膜剂对溃疡组织肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素-1β（interleukin-1β,IL-1β）、IL-6以及口腔溃疡组织形态的影响。结果 空白隔离层确定为25 mg/mL的乙基纤维素乙醇溶液,载药膜最佳处方为63 mg/mL PVA17-88、55 mg/mL PVP K30、3.0 mg/mL明胶与0.047 mL/mL甘油。青黛表面改性后,双层膜剂比未改性双层膜剂具有更加光滑均一的外观、更高的含量均匀性和有效成分靛蓝释放率。药效学结果表明,与模型组相比,阳性组与青黛改性膜剂组显著降低了溃疡组织TNF-α、IL-1β、IL-6的含量（P＜0.05）,并减少了炎症细胞的浸润,溃疡组织愈合程度较高。结论 青黛改性之后的口腔溃疡双层膜剂具有更好的质量与更佳的疗效,具有较好的应用前景。     

2011-2018年中国手足口病发病的时空特征及影响因素研究

目的 分析我国手足口病的时空特征,探讨社会、经济、人口和卫生服务等因素对我国手足口病发病的影响,为手足口病疫情防控提供参考依据。方法 采用贝叶斯时空模型对手足口病数据进行拟合,评估手足口病的时空变化,并识别手足口病发病风险与社会、经济、人口和卫生服务等因素的潜在关联。结果 2011-2018年,我国共报告手足口病例17 118 050例,死亡2 283例,2011-2014年报告发病率呈波动上升趋势,2014-2018年报告发病率呈波动下降趋势,报告死亡率一直呈波动下降趋势。手足口病的发病具有空间聚集性,报告发病率最高的地区为华南地区且为热点区域及高风险区域,报告发病率最低的为西北地区,冷点区域及低风险区域也集中在其部分区域。手足口病发病风险与人均地区生产总值（RR=3.54）、每万人规模以上工业企业单位数（RR=1.61）、城市化率（RR=3.00）、人口出生率（RR=2.36）、每万人医疗机构床位数（RR=3.40）和人均公园绿地面积（RR=0.57）有关。结论 2011-2018年我国手足口病防控重点区域为东南沿海地区,在加快城市化进程的同时需考虑增加人均公园绿地面积,以降低手足口病的发病率。     

205例手足口病合并惊厥患儿的病原学及临床特征

目的探讨手足口病(HFMD)合并惊厥患儿的病原学及临床特征。方法选择西安市儿童医院2019年1月至12月收治的手足口病合并惊厥的患儿为研究对象,收集患儿的年龄、性别、个人史、症状、体征与临床转归等临床资料,采集其肛拭子,应用逆转录聚合酶链式反应PCR(RTPCR)对患儿标本进行病毒检测。结果2019年本院共收治手足口病合并惊厥的患儿205例,其中重症病例34例,普通病例171例(包括热性惊厥单纯型134例、复杂型30例、癫痫7例)。肛拭子病原学核酸检测肠道病毒核酸阳性195例(95.1%),其中血清学分型CA6患儿124例(60.5%),EV71分型患儿7例(3.4%),CA16分型患儿7例(3.4%),CA10分型患儿5例(2.4%),其他肠道病毒感染患儿52例(25.4%)。34例重症患儿中,CA6感染23例(67.6%),EV71感染2例(5.9%,其中1例放弃治疗后死亡),CA10感染2例(5.9%),CA16感染1例(2.9%),其他肠道病毒感染4例(11.8%),肠道病毒阴性2例(5.9%)。CA6分型患儿皮疹形态以大疱样皮疹为主,恢复期可出现脱皮、脱甲,EV71病例皮疹表现为小、厚、硬、少;入组病例经镇静止惊及对症支持治疗后仅1例因放弃治疗后死亡,余患儿均临床治愈出院。结论2019年本院手足口病合并惊厥患儿病原以CA6为主,其所致手足口病皮疹以大疱表现为主,恢复期可出现脱皮、脱甲;死亡病例仍为EV71所致。     

2018年济南市14株柯萨奇病毒A组6型VP1基因特征分析

目的 分析济南市导致手足口病(hand, foot and mouth disease, HFMD)的柯萨奇病毒A组6型(Coxsackievirus A6, CVA6)分离株VP1基因特征及氨基酸变异。方法 2018年济南市HFMD常规监测病例样本经实时荧光RT-PCR检测,随机选择部分CVA6核酸阳性样本进行细胞分离鉴定,扩增阳性分离株VP1基因序列并进行同源性比较、氨基酸变异及系统进化分析。结果 2018年共检测652份样本,其中CVA6核酸阳性率为47.85%（312/652）,远高于人肠道病毒A组71型（human enterovirus A 71, EV71）（7.06%, 46/652）和柯萨奇病毒A组16型(Coxsackievirus A16, CVA16)（8.44%,55/652 ）,为济南市HFMD最主要病原体。通过细胞分离成功获得14株CVA6病毒,经VP1基因系统进化分析显示,济南市CVA6分离株均为基因D5亚型,VP1基因核苷酸及氨基酸序列同源性分别为94.2%~100%和98.0%~100%,与2017年广东株（GenBank 登录号MG385796、MG385815）、广西株（GenBank 登录号MH018512）、云南株（GenBank 登录号LC413143）及2014年江西株（GenBank 登录号KY913482）等亲缘关系较近。VP1蛋白主要存在V174I等位点变异,与国内流行的D5亚型基本一致。结论 2018年CVA6病毒为导致济南HFMD的主要病原,与广东、广西、云南和江西等省分离株亲缘关系较近,属于我国目前流行的基因D5亚型。     

Analysis of Treatment Results for Floor‐of‐Mouth Cancer

Objective This study reports the results of treating floor‐of‐mouth cancer with five different treatment modalities with long‐term follow‐up. Study Design Retrospective study of 280 patients with floor‐of‐mouth cancer treated in the Department of Otolaryngology—Head and Neck Surgery at Washington University Medical School (St. Louis, MO) from 1960 to 1994. Methods Patients with biopsy‐proven squamous cell carcinoma of the floor of mouth who were previously untreated were treated with curative intent by one of five modalities and were all eligible for 5‐year follow‐up. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance. Results The overall 5‐year disease‐specific survival (DSS) was 56% with death due to tumor in 44% of patients. The 5‐year cumulative disease‐specific survival (CDSS) was 0.61 (Kaplan‐Meier probability) with a mean of 8.3 years and a median of 9.7 years. The DSS by treatment modality included local resection (76%), composite resection (63%), radiation therapy (43%), local resection with radiation therapy (61%), and composite resection with radiation therapy (55%). Overall, there was no significant difference in DSS by treatment modality. Recurrence at the primary site (41%) was the most common site of treatment failure. Nineteen percent of patients had recurrence in the neck. Eighty‐eight percent of initial recurrences occurred within 60 months after the onset of treatment. Metastasis to a distant site occurred in 30% of patients. Twenty percent of these patients had second primary cancers, and 53% of these patients died of their second primary cancers. Conclusions Significantly improved 5‐year DSS was seen in the patients with clear margins, early clinical tumor stage, and negative nodes. Significantly decreased 5‐year survival was seen in the patients with involved margins, advanced clinical tumor stage, positive nodes, and tumor recurrence. Patients with no clinically positive nodes (cN0) can be observed safely for regional nodal disease and subsequent positive nodes can be treated as they occur with no adverse affect on survival. Because of high recurrence rates at the primary site and neck, and an increased rate of both distant metastasis and the development of second primary cancers, patients should be monitored closely for a minimum of at least 5 years.     

Clinical classification of Swedish snuff dippers'' lesions supported by histology

From a total material of 184 Swedish users of loose packed moist snuff and 68 users of portion-bag packed moist snuff, cases were selected from subgroups based on a four-point clinical grading scale. The selected material for the study comprised 70 cases (ten from each clinical grade group, no Degree 4 lesion was found among portion-bag users). Features recognized in biopsies from these cases together with findings in previous studies correlated well with the use of a four-point scale for the grading of clinical changes, especially in the context of discriminating lesions for which special efforts should be undertaken to make the patient stop or change the snuff dipping habit and for selecting patients in whom regular clinical follow-up including a biopsy should be carried out. In this article is also discussed the labeling of the clinical oral mucosal changes seen at the site where a quid of snuff is regularly placed. The conceptual use of "snuff dippers' lesions" is recommended instead of e.g. snuff-induced leukoplakia.     

Changes in blood flow and vasculature of the dog kidney undergoing normothermic and hypothermic ischaemia

Summary In 11 mongrel dogs both kidneys have been subjected to a 2 h ischaemic period. One kidney was cooled by perfusing the renal artery at 4°C while the contralateral normothermic kidney was clamped for 2 h. Studying the renal blood flow using the Xenon wash out technique, sequential renal scanning and angiography, marked differences between hypo- and normothermic ischaemia kidneys were observed. One or two hours following hypothermic perfusion a marked decrease of blood flow in the first compartment and vasoconstriction was evident, while within this period following normothermic ischaemia an enhanced renal blood flow was observed. After 24 h renal blood flow and renal function tested by ¹³¹I-Hippuran clearance returned to normal values. Angiographic studies corresponded to the preoperative findings. In contrast, normothermic ischaemia kidneys showed a decreased renal blood flow, impairment of kidney function in isotope studies and pathological angiographic changes.Supported by Deutsche Forschungsgemeinschaft