慢性阻塞性肺疾病的新定义及临床诊疗建议——基于2022年《柳叶刀》文件解读

慢性阻塞性肺疾病(以下简称慢阻肺)是一种常见的慢性气道异质性疾病。近年来,尽管国内外慢阻肺相关研究不断深入,管理日趋完善,但仍有许多难点亟待解决。2022年9月,《柳叶刀》杂志发布《消除慢阻肺之路》,该文件针对慢阻肺的认识、诊断、评估和个体化治疗等方面提出了新理念并提供临床诊疗指导。本文重点对该文件中慢阻肺的分类、诊断标准及诊断建议、慢阻肺的急性加重和迈向消除慢阻肺5个方面进行介绍和解读,以期为我国临床工作者开展慢阻肺相关研究和管理提供一定的参考及启示。     

Benzylpenicillin preparations can evoke a systemic anaphylactic reaction in guinea pigs

All of the five commercially available benzylpenicillin preparations obtained from different sources and a PcG preparation prepared by filtration of a commercial PcG on Sephadex G10 elicited the systemic anaphylactic reactions in guinea pigs which had been immunized with benzylpenicilloyl (BPO)-Ascaris extract conjugate (BPO-As) mixed with aluminum hydroxide gel. These preparations could evoke no such reactions in guinea pigs immunized with BPO-bovine gamma globulin conjugate (BPO-BGG) emulsified with complete Freund's adjuvant. The severity of the systemic anaphylactic reactions correlated significantly with the titers of either 8-day passive cutaneous anaphylactic (8-day PCA) reactions or 4-hr PCA reactions evoked with the same benzylpenicillin preparations. In vitro benzylpenicillin preparation contracted the tracheas of the guinea pigs immunized with BPO-As. These results indicated that the commercially available benzylpenicillin preparations have enough antigenicity to evoke systemic anaphylactic reactions in guinea pigs immunized with BPO-As mixed with aluminum hydroxide gel. Such guinea pigs represent an animal model for investigation of penicillin allergy.     

Development of a non-invasive treatment system for urinary incontinence using a functional continuous magnetic stimulator (FCMS)

A system composed of a functional continuous magnetic stimulator (FCMS) and a saddle-type coil has been developed for non-invasive treatment of urinary incontinence, especially stress incontinence and urge incontinence. The FCMS conditions were as follows: 2 kW maximum electrical power consumption, 800 V maximum capacitor voltage, 720 μs pulsewidth (180 μs rise time), and 5–30 Hz frequency. A frequency between 5 and 10 Hz is used to treat urge incontinence and a frequency between 25 Hz and 30 Hz is used to treat urge incontinence. The coil (120 mm long, 90 mm wide and 50 mm thick) fits the most suitable region for this treatment, the region from the anus to the perineum. The coil is cooled to maintain a coil temperature between 20 and 25°C so that it can be used efficiently and safely. In experiments with anaesthetised dogs, it was confirmed that the urethral pressure increased when the circumference of the perineum received continuous magnetic stimulation of 720 μs pulsewidth (180 μs rise time), 10Hz frequency and about 520 V capacitor voltage. This result suggests that magnetic stimulation can be effective as a urinary incontinence therapy.     

社区人群癫癎患者抗癫癎治疗现状及效果分析

目的：研究社区人群癫痫患者药物治疗现状及影响其效果的主要因素。方法：于2000年在上海市金山朱泾镇采用分层整群抽样完成5万人群的癫痫普查，并对癫痫患者进行药物治疗现状调查和对服药者的血药浓度进行测定。结果：癫痫患病率为3.11%，标化患病率为3.62%。癫痫患者中从未服药者33.1%，曾服药者66.9%，目前正在服药者占35.6%，以单药治疗为主。治疗后显效者51.5%，有效者40.6%，无效或恶化者7.9%。服用单药者显效和有效的比例明显高于服用二种药或三种药的效果。服药者血药浓度在有效范围者，仅占36.1%，其中服用苯巴比妥者血药浓度达标的比例（71.4%），明显高于其他药物。血药浓度在有效范围内的显效率为53.3%，明显高于未达有效范围者的显效率（23.8%）。非条件Logistic回归分析显示与治疗效果有关的主要因素为病程、发作年龄、现年龄、发作频率、教育程度、服药类型、血药浓度等。结论：社区人群癫痫患者接受治疗的比例和服药后血药浓度达有效范围的比例都降低。治疗效果受多种因素影响。     

认知暴露疗法治疗创伤后应激障碍的研究

目的 探讨认知暴露疗法治疗创伤后应激障碍(PTSD)的效果.方法 连续病例20名被随机分成两组,一组采取药物干预,另一组采用认知暴露疗法结合药物干预.疗效采用创伤后应激障碍症状清单量表(PCLS)、症状自评量表(SCL-90)、贝克抑郁问卷(BDI)、状态-特质焦虑问卷(STAI-Form Y)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)进行盲法评定.结果 药物治疗和结合治疗都在一定程度上改善了PTSD的症状,但是在再经历方面,结合治疗组下降稳定.其余各量表纵向效应明显.随访时用创伤后应激障碍症状清单量表(PCLS)进行测量,发现结合治疗组有两名被试已经不再符合PTSD诊断阶段,但是统计检验显示两治疗组之间并无差异.结论 认知暴露疗法有助于PTSD患者的心理康复.     

Intravenous teicoplanin does not prevent Clostridium difficile associated diarrhea

A 59-year-old man with the diagnosis of endocarditis of the mitral valve due to Streptococcus mitis was treated with penicillin G, gentamicin, and later with clindamycin as inpatient for 3 weeks. Thereafter outpatient therapy with parenteral teicoplanin 3 × per week was initiated. After 17 days of teicoplanin treatment he developed severe diarrhea, and stool samples were positive for Clostridium difficile toxin. In addition to the ongoing parenteral therapy with teicoplanin, oral teicoplanin was administered. On the third day of this regimen the diarrhea and other disabling symptoms subsided, and test results for C. difficile toxin became negative. Oral teicoplanin was continued for 10 days and cleared C. difficile effectively after treatment as assessed by consecutive stool cultures (until 60 days thereafter). The parenteral administration of teicoplanin could not prevent the onset of C. difficile associated diarrhea in this patient, who previously had been treated with clindamycin. Thus, the administration of parenteral teicoplanin does not seem to be a treatment option for C. difficile associated diarrhea in patients in which oral therapy is not possible.     

Antimicrobial resistance of Escherichia coli and therapeutic implications

Widespread antibiotic resistance has been recognized in Escherichia coli isolates from human, animal and environmental sources. Although prevalence rates for resistant E. coli strains are significantly distinct for various populations and environments, the impact of resistance to antimicrobial drugs is ubiquitous. This article provides information about the epidemiology, mechanisms and molecular principles of resistance, shows consequences for the antiinfective treatment of selected infections and describes measures to control the spread of antibiotic-resistant E. coli.     

生物蛋白胶联合大网膜包肾在门静脉高压症手术治疗中的应用

目的:评价医用生物蛋白胶(BFG)联合大网膜包肾(ORP)对门静脉高压症患者断流术后近期和远期疗效的影响。方法:将我院3年内(2003年11月～2006年5月)收治的118例门静脉高压症接受选择性贲门周围血管离断术(sPCDV)患者分成两组,即应用BFG联合ORP组(A组,n=72)和对照组(B组,n=46),比较两组手术后近期(一月)脾窝渗液、发热和远期上消化道再出血、肝性脑病和胃病等并发症的发生率。结果:A组手术近期脾窝渗液和发热率明显低于B组(P<0.05);A组和B组随访期间上消化道再出血率分别为1.3%和10.8%(P<0.05)、门静脉高压性胃病发生率分别为30.6%和65.2%(P<0.05);A组肝性脑病发生率与B组无明显差异(P>0.05)。结论:BFG联合ORP可有效降低选择性断流术后近期和远期并发症的发生,提高门静脉高压症患者断流术的疗效。     

音乐疗法治疗慢性精神分裂症疗效分析

目的 观察音乐疗法对慢性精神分裂症的治疗效果。方法 住院慢性精神分裂症患者64例，随机分为实验组和对照组，各32例，观察8周，以BPRS、SANS量表评定疗效。结果 两组患者BPRS、SANS评分差异均有显著性意义。结论 音乐疗法对慢性精神分裂症病人的康复治疗有一定疗效。     

免疫吸附疗法治疗高脂血症疗效观察

目的 观察低密度脂蛋白(LDL)免疫吸附疗法对高脂血症的治疗效果.方法73例高脂血症患者接受LDL免疫吸附治疗.比较1次治疗前后各项血脂指标的变化.部分病例1个月后复查血脂各项指标.总结LDL免疫吸附疗法的安全性和副作用.结果①所有患者经1次LDL免疫吸附后血甘油三脂、胆固醇和低密度脂蛋白均有明显下降(p<0.01).高密度脂蛋白略有下降(p>0.05).患者临床症状改善.②治疗后1个月复查,血脂各项指标恢复到治疗前水平(p>0.05).③3例药物治疗不能控制的乳糜微粒血症患者经LDL免疫吸附治疗后血脂明显下降,但仍达不到正常范围.其中1例治疗后继续服用原降脂药物,药物疗效较前提高.④30例患者治疗过程出现低血压.结论LDL免疫吸附能有效降低血甘油三脂、胆圃醇和低密度脂蛋白水平,对高密度蛋白无明显影响.1次治疗所能维持血脂于低水平的时间短暂.部分患者临床症状改善.低血压是主要并发症.