DNA探针在呼吸机相关性肺炎病原学检测中的诊断价值

目的建立一种早期、快速检测呼吸机相关性肺炎致病菌的分子生物学方法。方法采用聚合酶链反应合成铜绿假单胞菌、甲氧西林耐药金黄色葡萄球菌、大肠杆菌、肺炎克雷伯杆菌和流感嗜血杆菌这5种细菌的特异DNA探针和细菌16SrRNA的通用探针,分别与生物素标记的细菌、病毒和真菌DNA杂交。杂交法和培养法同时检测100份痰液标本。结果所合成的DNA探针具有高度特异性,与其他细菌、病毒、真菌间无交叉反应。该方法可检测出1 ng细菌DNA。杂交法阳性率显著高于培养法。结论所合成的DNA探针敏感性高,特异性强,具有较高的应用价值,可应用于临床标本检测。     

重型颅脑损伤开颅术后早期气管切开对防治肺部感染的影响

目的研究重型颅脑损伤术后早期气管切开对防治肺部感染的影响。方法选择重型颅脑损伤经手术治疗者,开颅术后≤24h行气管切开患者68例,另急诊开颅手术治疗重型颅脑损伤术后未行气管切开或切开时间>24h的患者68例。所有患者均以三代头孢及半合成青霉素静滴预防感染,出现肺部感染者均行痰液培养及药敏试验,选择敏感抗生素进行治疗。结果68例出现肺部感染,其中实验组35例有20例控制,感染控制时间4~11(平均7.1)d;对照组53例,有21例控制,感染控制时间9~21(平均16.9)d;重型颅脑损伤患者术后早期气管切开肺部感染和控制感染平均时间均显著低于未行早期气管切开患者(P<0.01),而感染控制率明显高于未早期切开者(P<0.05)。结论早期气管切开能有效防治重型颅脑损伤术后并发的肺部感染。     

论诗歌文体与小说文体的亲缘关系

诗歌是人类最早的文学形式，是人类文体中的高雅文体，具有极大的文体优越性，对后来产生的其他文体一直存在着影响。小说是叙述性文体在特征上和诗歌差异甚大，但随着现代小说的发展出现小说文体有着很强的诗歌文体的特征的现象，诗歌文体与小说文体的亲缘关系是小说诗歌化的潜在原因。     

非小细胞肺癌相关抗原血清水平与老年重症肺炎预后关系的探讨

目的探讨老年重症肺炎(SAP)患者非小细胞肺癌相关抗原(CYFRA21-1)血清水平变化及其对临床转归的影响。方法28例老年SAP患者分为存活组(13例)与死亡组(15例),另选26例老年健康者作为对照组。一旦确诊为SAP,分别于入院当天、治疗后5d及治愈出院或死亡时测血清CYFRA21-1水平,并动态观察神志、血压、SaO2、白蛋白、白细胞计数、PaO2、PaCO2及急性生理和慢性健康状况(APACHEⅡ)评分等指标。结果神志、血压、SaO2、白蛋白、白细胞计数、PaO2、PaCO2及APACHEⅡ评分差异无统计学意义(P>0.05)。治疗第5天血清CYFRA21-1水平死亡组高于存活组(P<0.05),存活组治愈后如仍高,有反复发作肺炎的可能;两组血清CYFRA21-1水平均高于健康对照组。结论老年SAP患者血清CYFRA21-1的水平升高程度与病死率密切相关,和反复发作也有一定的关系,说明血清CYFRA21-1在老年SAP发生及发展过程中有一定作用。     

呼吸机相关肺炎的病因及防治对策

目的探讨呼吸机相关肺炎(VAP)的发病原因,以便采取对策进行防治. 方法对185例呼吸机使用患者采用第2、5、7天,第2、3周分别做细菌培养,观察呼吸机运用时间与VAP发病的相关性,并将病原菌加以统计与分析. 结果 VAP发病率为28.1%,使用呼吸机2、5、7 d、第2、3周VAP发病率分别为7.6%、13.5%、21.2%、32.7%、25.0%;52例VAP病原菌共7个种别58株,大多数为耐药菌. 结论使用呼吸机时间长短与VAP发病率密切相关,使用时间愈长发病率愈高,各病区应采取有效对策严密控制VAP的发生与扩散.     

妊娠合并肺炎的临床观察与护理

目的观察妊娠合并肺炎的临床治疗、护理经过与转归。方法抽取于我院治疗的妊娠合并各型肺炎孕妇42例,经过积极的降温、消炎、抗感染、纠正电解质紊乱及生活、用药、对症、心理护理等一系列治疗护理措施后,观察孕产妇的转归及预后。结果 42例孕妇28例经积极治疗后治愈出院,继续待产。10例孕妇经积极治疗体温降至正常后自行经阴道分娩。4例因高热,胎心持续160bpm以上,给予剖宫产术结束妊娠,新生儿生后5minApgar评分8～10分2例,7～9分1例,5～6分1例,立即进行新生儿复苏抢救后生后10min评9分。结论加强妊娠合并肺炎的治疗与护理,是促使病情早日康复、降低母儿损伤的的重要环节。     

Allergenic potential of novel proteins – What can we learn from animal production?

Currently, risk assessment of the allergenic potential of novel proteins relies heavily on evaluating protein digestibility under normal conditions based on the theory that allergens are more resistant to gastrointestinal digestion than non-allergens. There is also proposed guidance for expanded in vitro digestibility assay conditions to include vulnerable sub-populations. One of the underlying rationales for the expanded guidance is that current in vitro assays do not accurately replicate the range of physiological conditions. Animal scientists have long sought to predict protein and amino acid digestibility for precision nutrition. Monogastric production animals, especially swine, have gastrointestinal systems similar to humans, and evaluating potential allergen digestibility in this context may be beneficial. Currently, there is no compelling evidence that the mechanisms sometimes postulated to be associated with allergenic sensitization, e.g. antacid modification of stomach pH, are valid among production animals. Furthermore, examples are provided where non-biologically representative assays are better at predicting protein and amino acid digestibility compared with those designed to mimic in vivo conditions. Greater emphasis should be made to align in vitro assessments with in vivo data.     

It is time to shift the treatment paradigm in myelodysplastic syndromes: A focus on novel developments and current investigational approaches exploring combinatorial therapy in high-risk MDS

Higher risk myelodysplastic syndromes are defined as a subset of disease with higher risk of AML transformation and poor overall survival. For decades, therapeutic options for high-risk MDS have been limited to allogeneic stem cell transplant (the only option for cure but limited to only a handful of patients) or hypomethylating agents, with the goal to alter the natural history of disease, delay progression and improve survival, while addressing cytopenias, transfusion requirements and improving quality of life. Recent developments in DNA sequencing and other technologies have shed significant light into the pathogenesis of MDS and led to rational and targeted drug development across a variety of therapeutic vulnerabilities, including disruption of protein ubiquitination through NAE inhibition, selective modulation of macrophage activity and immune checkpoint inhibition through blockade of TIM-3. This review highlights some of the most promising agents in recent drug development and their therapeutic efficacy in the management of high-risk MDS, and further explores the rationale behind potential combinatorial approaches using an HMA backbone to synergistically improve treatment outcomes.     

Association between gastrointestinal heat retention syndrome and respiratory tract infections in children: A prospective cohort study

ObjectiveTo explore the relationship between gastrointestinal heat retention syndrome and the incidence of pneumonia and recurrent respiratory tract infections (RRTIs) in children.MethodsA prospective cohort study was conducted in the pediatric outpatient department of Beijing Dongfang Hospital. Children without respiratory tract infections (RTIs) were consecutively recruited according to the selection criteria. A semi-structured questionnaire was used to record traditional Chinese medicine (TCM) symptoms and demographic and physiological characteristics. Gastrointestinal heat retention syndrome was considered to be a predisposing factor and was diagnosed according to a scale with reliability and validity. The participants were followed up for 12 months. Participants and their parents or guardians were contacted via clinical interviews and telephone every 6 months. Episodes of pneumonia and RTIs were recorded in detail.ResultsA total of 420 children were included. Of participants, 370 (88.10%) were followed up for 12 months. The mean number of RTI episodes per participant was 5.37 (95% CI: 5.14 to 5.60). In total, 186 participants in the gastrointestinal heat retention syndrome group and 184 participants in the non-gastrointestinal heat retention syndrome group completed the 12-month follow-up period. The baseline of both groups was comparable. The incidence of RRTIs in children with gastrointestinal heat retention syndrome was 1.27 (95% CI: 1.01 to 1.59) times that in children without gastrointestinal heat retention syndrome. Logistic regression analysis revealed that abnormally increased appetite with frequent hunger, foul breath, dry stools, and dark red or purple fingerprints were positively correlated with the incidence of pneumonia. Irascibility and feverish feelings in the palms and soles were positively correlated with the occurrence of RRTI.ConclusionsGastrointestinal heat retention syndrome is a risk factor for RRTIs in children. Studies with larger sample sizes and longer follow-up time are warranted to confirm the degree of causal risk associated with RTIs.