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91.
目的 比较老年社区获得性吸入性肺炎(CAP)、医疗相关性吸入性肺炎(HCAP)及医院获得性吸入性肺炎(HAP,包括呼吸机相关性吸入性肺炎)三者病原学、抗生素应用及治疗转归的关系.方法 收集2005年1月一2010年12月北京二炮总医院呼吸科住院的216例老年吸人性肺炎患者病例,分析其病原学结果、抗生素应用的及治疗转归.结果 三种吸入性肺炎的病原学有显著差异,与CAP和HCAP相比,HAP患者G-杆菌的感染比例明显增多(P<0.001);抗生素应用方案有明显差异,CAP组病人未调整抗生素应用比率明显高于HCAP组与HAP组(P<0.001);抗生素应用策略不同,所致死亡率有明显差异,以升阶梯方案为最高,以降阶梯治疗为最低(P=0.03).结论 三种吸入性肺炎在感染病原菌种类、抗生素应用策略及治疗转归上有明显差异,应根据不同类型的老年吸入性肺炎特点合理经验性使用抗菌药物. 相似文献
92.
Objective To assess the secular trends in the etiology and comorbidity of patients hospitalized with congestive heart failure (CHF).Methods Data of 7319 patients (mean age 59.6 years, 62.1% male) with a primary discharge diagnosis of CHF, hospitalized from January 1, 1993, to December 31, 2007, at the Chinese People’s Liberation Army (PLA) General Hospital were extracted and analyzed. These patients were divided into three groups according to hospitalization period: 1993–1997 (n = 1623), 1998–2002 (n = 2444), and 2003–2007 (n = 3252). The etiological characteristics and comorbidities were assessed. Results Over the study period, the proportion of patients with ischemic heart disease (IHD) increased from 37.2% during the period 1993–1997 to 46.8% during the period 2003–2007, while that with valvular heart disease (VHD) decreased (from 35.2% during the period 1993–1997 to 16.6% during the period 2003–2007, both P < 0.05); Atrial fibrillation (AF) was the most common comorbidity of heart failure (23.2%, 23.0% and 20.6%, respectively, in the three periods); Compared to that of the period of 1993–1997 with that of, the proportion of patients with myocardial infarction, pneumonia, renal function impairment and hepatic cirrhosis of the period of 2003–2007 increased significantly (P < 0.05) and the proportion of patients with chronic obstructive pulmonary disease and atrial fibrillation decreased significantly (P < 0.05). Conclusions This study implies that IHD has became a more common etiology of CHF, while VHD has deceased as an etiology of CHF in Chinese patients during the last two decades. 相似文献
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94.
Steven A. Kahn Derek E. Bell Paige Hutchins Christopher W. Lentz 《Burns : journal of the International Society for Burn Injuries》2013
Introduction
The National Burn Repository (NBR) currently only contains inpatient data from participating United States burn centres. However, the majority of the patients treated in burn centres are managed as outpatients. Unfortunately, this significant demographic is not represented in the NBR annual report. The purpose of this study is to compare the difference in aetiology and demographics between inpatient and outpatient burn patients. In addition, the workload demands for data entry of inpatient and outpatient records in the burn registry will be compared.Methods
Outpatient and inpatient burn data at an American Burn Association-Verified Burn Center were prospectively collected during fiscal year 2008. Data collected included age, burn size and aetiology of burn. Aetiology was also stratified by age group. Inpatient data were compared with outpatient data with Fisher's exact test. The amount of time taken to enter inpatients’ and outpatients’ data parameters in the TRACS v5.0 database was also recorded.Results
Data were collected for 241 inpatients and for 543 outpatients during fiscal year 2008. No significant differences in gender or race were found between the two groups. When comparing demographics, outpatients tended to be younger (26 ± 19 years vs. 32 ± 22 years, p = 0.01) with a smaller burn size (2.5 ± 7% vs. 6.8 ± 12%, p < 0.001) and a lower frequency of full-thickness burns (17% vs. 41%, p < 0.001).Of the patients managed as an outpatient, a total 29.7% were eventually admitted to the hospital. Just over half of those (16.7%) initially managed in the outpatient setting were admitted for a planned surgical procedure. The other 13% were admitted for pain control and wound-care issues.Injury was more likely to be caused by flame in inpatients (p < 0.001). Scald injuries were more common in the outpatient setting (34% vs. 27%), but this difference did not reach statistical significance (p = 0.079). Outpatients were more likely to be injured with a contact burn (p < 0.0001). Outpatient injury was more likely to be work-related than inpatient injury (p = 0.0497), but less likely to be related to recreational activity (p = 0.006) or arson/abuse/assault (p = 0.0158). An experienced TRACSv5.0 user required 11 ± 0.6 min to enter an inpatient record and 6 ± 0.6 min to enter an outpatient record in the system (p = 0.002).Conclusions
Inpatient injury is more likely to be caused by flame, whereas outpatient injury is more likely to be caused by scald and contact burns. Work-related burn is more likely to be treated in the outpatient setting. Outpatient burn data also take less time to enter. Since significant differences in aetiology exist, outpatient data should be reported separately from inpatient data in order to understand the full spectrum of burn aetiology. The NBR and other registries should be modified to track outpatient burn data and outcomes. 相似文献95.
Charlotte E. S. Hoogstins Stéphanie J. E. Becker David Ring 《Hand (New York, N.Y.)》2013,8(4):434-438
Background
We hypothesized that electrodiagnostic evidence of carpal tunnel syndrome (CTS) on the contralateral, less-severe side correlates with disease severity.Methods
We retrospectively reviewed 285 adults that had bilateral electrodiagnostic testing and a median distal sensory latency (DSL) greater than 3.6 ms on at least one side. Variables associated with abnormal contralateral median DSL were analyzed in bivariable and multivariable analysis.Results
Patients with a nonrecordable median DSL on the worst side were significantly more likely to have electrodiagnostic evidence of contralateral CTS compared to patients with a prolonged DSL on the worst side (90 versus 65 %, respectively; p < 0.001). Bilateral symptoms were reported by 75 % of patients. The best logistic regression model for electrodiagnostic evidence of contralateral CTS included nonrecordable median DSL of the worst side and polyneuropathy (p < 0.001 and p = 0.14, respectively).Conclusions
The finding that disease severity relates to the probability of contralateral abnormalities is consistent with the concept that CTS is typically bilateral. Patients with CTS on one side should be advised of the likelihood that it can be present or may develop on the other side. 相似文献96.
目的:研究成都地区2010至2012年手足口病的流行病学、病原学及临床特征,为防治该病提供依据。方法回顾性分析本院2010至2012年住院治疗的2686例患儿的流行病学、病原学及临床特征。结果本组病例中,年龄为2个月~16岁,平均年龄(1.87±3.21)岁,以婴幼儿(≤3岁)最多见(2463/2686,91.70%),且男童︰女童(1.55︰1);散居儿童(2034/2686,75.73%)多于幼托儿童(635/2686,23.64%)和学生(17/2686,0.63%),城区(2145/2686,79.86%)多于乡村(541/2686,20.14%)。发病高峰在4~7月份(1533/2686,57.07%)。本组病例以轻症为主,重症较少(268/2686,9.98%)。主要临床表现为皮疹和发热,所有患儿均出现皮疹,皮疹以手、足掌、口腔黏膜或臀部等部位多见;1934例(1934/2686,72.0%)患儿有发热,多呈不规则热型,以低中热为主(2413/2686,89.84%),发热持续时间多为1~3 d(2517/2686,93.71%)。经咽拭子病原学检查,重症病例以感染EV71为主(187/268,占69.78%),柯萨奇病毒A 16共11株,其他肠道病毒27株。经治疗后,好转1810例(1810/2686,67.39%),治愈871例(871/2686,32.43%),死亡5例(5/2686,0.19%)。结论手足口病发病与年龄、季节、地区有关,经过早隔离、早治疗后,预后较好。 相似文献
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98.
Avinash Pillutla Mack P. Hendrix Jonathan Ha 《Journal of vascular and interventional radiology : JVIR》2019,30(7):1075-1080
A retrospective analysis of endovenous glue-closure therapy (EVGC) performed in 76 greater saphenous veins (GSVs) from February 2016 to December 2017 was conducted to assess the incidence and characteristics of endovenous glue-induced thrombosis (EGIT), a phenomenon unique to nonthermal EVGC for GSV insufficiency. Kabnick and Lawrence classifications for endovenous heat-induced thrombosis were adopted. Seven instances of EGIT were detected among 54 patients (13%), with median/mode Kabnick and Lawrence classifications of 2/2 and 4/5, respectively. EGIT resolved with observation within an average of 5.2 wk after detection (range, 2–8 wk) without deep vein thrombosis or pulmonary embolism. EGIT was associated with significantly greater mean age (+7.75 y; P = .0308). 相似文献
99.
《Annales médico-psychologiques》2022,180(9):915-921
In the Eighties, Benjamin Libet demonstrated that we become aware of an action that happens several hundred milliseconds after the onset of the brain activity, suggesting that our voluntary decisions escape to our consciousness. This original experimental study has been replicated several times with the same results-even if their interpretations differ, which challenges scientifically the issue of free will. Thus, criminal Intentionality of psychopathic individuals could be re-examined. Using Edelman‘s Neural Darwinism, we developed the hypothesis that free will materializes in neural networks and we illustrate this by clinical case analysis. These have developed and perpetuated during the child development via their sensory experiences indexed with emotional values. These networks are stored in memory, and constitute a collection of our own individual habits which serve as a model for all our future decisions. General human and particularly psychopathic criminals would have even less latitude to act freely since their complexes have developed uniformly and rigidly during their childhood. 相似文献
100.