Congenital diaphragmatic hernia: associated anomalies and antenatal diagnosis

This retrospective study reviews the medical records of 77 fetuses and babies with congenital diaphragmatic hernia (CDH) referred to two hospitals in Detroit from 1986 through 2000. The aims were to examine the effects on outcome of multiple variables, especially the type of CDH, associated anomalies, and ultrasound prognostic parameters. Ultrasound measurements of head (HC), chest (CC), and abdominal circumferences (AC) were obtained from videotapes. ANOVA and chi-square analysis were used to determine statistical significance between groups and proportions. Eighty-nine percent (65/73) of pregnancies resulted in live births, and 54% (35/65) of patients survived past 30 days. Liveborn patients with low APGAR scores were less likely to survive. Forty-three percent (30/70) had major associated anomalies, with cardiac anomalies constituting about 52% (33/64) of the major associated anomalies. Seventy percent of patients with isolated CDH survived versus 36% of patients with both CDH and cardiac anomalies. Sixty-seven percent (8/12) of fetuses antenatally diagnosed before 25 weeks of gestation survived past 30 days of birth. The survival rate of right-sided CDH with liver herniation was 80% (8/10), compared with 29% (4/14) for left-sided CDH with liver herniation (p=0.088). There was a significant linear relationship (r=0.603, p =0.029) between CC/AC and CC/HC among patients with CDH; survivors had higher CC/AC and CC/HC values than nonsurvivors. These results support the utility of CC/AC and CC/HC measurements and the presence of liver herniation as important prognostic factors that can be used in antenatal counseling and in planning clinical trials.     

帕金森病抑郁状态相关因素分析

目的研究帕金森病伴发抑郁状态(Parkinson disease with depression,PDD)的患病情况及影响因素。方法选择82例帕金森病(PD)患者,先用抑郁自评量表(SDS)进行初步筛查,然后应用汉密尔顿抑郁量表(HAMD)将帕金森病患者划分为抑郁组和非抑郁组,对各组患者的发病年龄、性别、文化程度、经济状况、有无照料人、Hoehn-Yahr分期、PD统一评分量表(UPDRS)、Webster评分等进行比较,并进一步利用Logistic回归分析筛选出可能的危险因素。结果有无照料人、Webster评分、Hoehn-Yahr分期及UPDRSⅡ在抑郁组与非抑郁组间差异有统计学意义(P<0.05),其他各项指标两组之间差异均无统计学意义(P>0.05)。回归分析发现有无照料人与UP-DRSⅡ综合评分,尤其是床上翻身是PD患者伴发抑郁的危险因素。结论PD患者中抑郁发生率较高,是几种因素共同作用所致,要注意及时予以干预治疗。     

Laryngoceles - presentations and management

Introduction  Laryngoceles usually present as cervical masses with or without hoarseness of voice. They are mostly unilateral and may be symptomatic or asymptomatic. They are classified as internal, external or combined. They have been described to be an occupational hazard among wind instrument players or glass blowers. They also occur in association with neoplasms of the larynx. Materials and methods  Here we report five patients with laryngoceles of whom two had bilateral laryngoceles, which are very rare. One patient had associated laryngeal malignancy for which total laryngectomy was performed. Two cases underwent excision via cervical approach. The rest were managed conservatively. Conclusion  Symptomatic cases have to be managed surgically while asymptomatic ones may be managed conservatively.     

无烟医院政策执行的障碍

目的了解无烟医院政策执行的障碍,为发展干预策略提供科学的背景资料。方法联合应用专题小组访谈和个人深入访谈对医务人员进行调查。结果无烟医院政策执行的障碍有:①倾向因素:医务人员吸烟严重,上班时间吸烟常见;医务人员对吸烟和被动吸烟的危害认识不清;对创建无烟医院没有足够的信心;②促成因素:医院执行政策的能力不足;③强化因素:吸烟是个人的生活权利;吸烟受社会风俗的影响;领导不重视控烟;担心劝烟会影响同事关系或医患关系。结论研究结果表明,倾向因素不是阻碍医院执行无烟政策的主要因素,强化和促成因素才是主要障碍。采取综合性的干预措施,营造良好的控烟氛围,促进社区参与,提高医院控烟能力,效果或许更理想。     

Evaluation of a reporting system for bacterial contamination of blood components in the United States

BACKGROUND: The transfusion of blood components contaminated with bacteria may have serious clinical consequences, but few data are available on the incidence of these events. A national effort to assess the frequency of blood component bacterial contamination associated with transfusion reaction (the BaCon Study) was initiated to better estimate their occurrence. STUDY DESIGN AND METHODS: Standard reporting criteria, data collection forms, and a standardized reporting protocol were developed in collaboration with the American Red Cross, AABB, and the Department of Defense. Episodes reported to the BaCon Study were compared with those reported to the FDA's national reporting systems to estimate the extent to which all serious reactions associated with bacterial contamination were captured. RESULTS: During the first 2 years, 38 episodes meeting study criteria were reported; 21 were laboratory-confirmed. The estimated proportion of episodes reported to the BaCon Study (i.e., completeness of coverage) was lower than that reported to the FDA during the same period (0.33 vs. 0.68), but the positive predictive value was higher (0.66 vs.0.28). CONCLUSION: Despite the complexity of obtaining reports from a large number of United States hospitals and transfusion centers, the feasibility and usefulness of the BaCon Study were shown. This study was the only national study in the United States to monitor adverse clinical events associated with bacterial contamination of blood components. By building on hospital-based reporting of transfusion-related adverse events, the BaCon Study serves as a model for the study of other complications associated with blood and blood components.     

Cross-resistance and associated resistance in <Emphasis Type="Italic">Escherichia coli</Emphasis> isolates from nosocomial urinary tract infections between 2004–2006 in a Turkish Hospital

In this study, antimicrobial resistance profiles were determined for 748 isolates of Escherichia coli from patients with acute nosocomial urinary tract infections (UTIs) at a Turkish Training Hospital. Thirteen antibiotics were included. Resistance to ampicillin alone (45.1%) and ciprofloxacin alone (20.6%) were the most commonly identified ‘single resistances’. Multiple resistance was found in 49.7% of the strains. The most common multiple antibiotic resistance profiles included ampicillin-sulbactam/amoxycilline-clavulonate (4.0%) and ampicillin-sulbactam/trimethoprim-sulfamethoxazole/amoxycilline-clavulonate (2.8%). From 2004 to 2006, ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin resistant strains increased to 76% from 57%, 53% from 43% and 55% from 41%, respectively. The percentage of extended-spectrum β-lactamase (ESBL) producing strains was 7.8% and imipenem resistance was seen in 5.2% of ESBL positive strains. We conclude that clinically important E.coli strains have now emerged with broader multidrug resistance. Periodical evaluation of laboratory results and clinical surveillance are crucially important for optimal antibiotic management of UTIs and infection control policies.     

低温等离子髓核成形术治疗神经根型颈椎病的临床观察

目的:评估低温等离子髓核成形术治疗神经根型颈椎病的临床疗效并探讨其作用机制。方法 :2015年1月至2017年1月应用低温等离子髓核成形术治疗神经根型颈椎病21例,男8例,女13例;年龄43~61岁,平均49.6岁;病程1~6个月,中位数4个月;单节段病变3例,双节段9例,3节段7例,4节段2例。比较手术前后椎间盘压力、VAS评分;通过影像学资料测量手术椎体角度位移和椎体水平位移,观察颈椎的稳定性;采用改良Mac Nab评定标准评定疗效。结果:20例患者均获得随访,时间6~12个月,平均8.6个月。术前及术后即刻椎间盘内压力分别为(32.0±5.26)cm H2O和(21.0±7.18)cm H2O,差异有统计学意义(P=0.003)。术前椎体角度位移、椎体水平位移为(3.85±1.26)°和(1.23±0.58)mm;术后6个月为(4.18±1.31)°和(1.69±0.46)mm,差异无统计学意义(P0.05)。术后3 d、3个月和6个月VAS评分分别为3.51±0.49、2.63±0.61、2.56±0.71,较术前的7.49±0.53明显改善(P0.05)。术后3 d、3个月、6个月采用改良Mac Nab评价疗效,优分别为6、10、12例,良分别为7、5、6例,可分别为4、3、1例,差分别为3、2、1例。术后6个月疗效优于术后3 d和术后3个月(P0.05),术后3个月优于术后3 d(P0.05)。结论 :低温等离子髓核成形术治疗神经根型颈椎病可以有效缓解颈肩臂痛,并可以缓解头痛、头晕等伴随症状。     

Prevalence of carriage of extended-spectrum β-lactamase-producing enterobacteria and associated factors in a French hospital

ObjectivesOur aim was to evaluate the prevalence and associated factors for carriage of extended-spectrum β-lactamase-producing enterobacteria (ESBL-PE) in a healthcare facility.MethodsIn 2016 a serial cross-sectional survey of ESBL-PE carriage in a French university hospital was conducted. All patients present on the day of the survey were screened for ESBL-PE carriage. Demographic characteristics and risk factors for ESBL-PE carriage were collected.ResultsIn all, 146/844 patients (17%) were digestive carriers of ESBL-PE; of these, 96 (66%) had not previously been identified. Among patients carrying ESBL-PE, Escherichia coli (62%) and CTX-M type (94%) predominated. Greater age, recent travel abroad, receipt of antibiotic, and prolonged hospitalization were associated with ESBL-PE carriage.ConclusionGiven the high prevalence of ESBL-PE and the high proportion of unknown carriers, our results strongly suggest reinforcing standard precautions rather than contact precautions for controlling the spread of ESBL-PE.     

Survivin在喉鳞癌的表达及其临床意义

目的:探讨survivin在喉鳞癌(LSCC)组织中的表达及与喉鳞癌的生物学行为的关系。方法:应用原位分子杂交方法,检测survivin mRNA在47例喉鳞癌组织、癌旁组织及14例正常喉组织中的表达。结果:(1)Survivin在正常喉组织中不表达;在喉癌组织、癌旁组织中阳性表达率分别为59.6%(28/47)、25.5%(12/47),其差异有显著性(P<0.05);组织分化程度越低、TNM分期越晚、淋巴结转移率越高,则survivin mRNA表达越强(均P<0.05)。结论:Survivin可能成为LSCC基因治疗的新靶点;其高表达预示肿瘤有较高的侵袭性和不良预后。