Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia

For patients with community-acquired pneumonia (CAP), clinical response during the first days of treatment is predictive of clinical outcome. As risk assessments can improve the efficiency of pneumonia management, a prospective cohort study to assess clinical, biochemical and microbiological predictors of early clinical failure was conducted in patients with severe CAP (pneumonia severity index score of >90 or according to the American Thoracic Society definition). Failure was assessed at day 3 and was defined as death, a need for mechanical ventilation, respiratory rate >25/min, PaO2 <55 mm Hg, oxygen saturation <90%, haemodynamic instability, temperature >38 degrees C or confusion. Of 260 patients, 80 (31%) had early clinical failure, associated mainly with a respiratory rate >25/minute (n = 34), oxygen saturation <90% (n = 28) and confusion (n = 20). In multivariate logistic regression analysis, failure was associated independently with altered mental state (OR 3.19, 95% CI 1.75-5.80), arterial PaH <7.35 mm Hg (OR 4.29, 95% CI 1.53-12.05) and PaO2 <60 mm Hg (OR 1.75, 95% CI 0.97-3.15). A history of heart failure was associated inversely with clinical failure (OR 0.30, 95% CI 0.10-0.96). Patients who failed to respond had a higher 28-day mortality rate and a longer hospital stay. It was concluded that routine clinical and biochemical information can be used to predict early clinical failure in patients with severe CAP.     

SARS与细菌性典型肺炎的胸部CT特征对比分析

目的：探讨重症急性呼吸综合征(SARS)与细菌性典型肺炎胸部CT特征的异同．方法：回顾性分析28例SARS胸部CT表现与细菌性典型肺炎做对比结果：本组28例患者肺部病变初期多为单发病灶，在右侧外带胸膜下常见。片状磨玻璃样密度病变影存在于各期，而细菌性典型肺炎未见、发病初期和进展期肺容积变小?而细菌性典型肺炎多无此特点。进展期大多数发展为双肺由下至上痛变、恢复期病变由最晚受侵部位消退，遗留纤维化多为最早发生病变部位?而典型肺炎多从近肺门侧开始吸收，进展期局限的肺段、肺叶发展至多个肺叶、肺段，进展较迅速。而细菌性典型肺炎多为单独的肺叶、肺段．恢复期由弥漫性多发病变转变为局限病变，部分病人有肺部纤维化发生，而细菌性典型肺炎大多数吸收较完全，不遗留肺纤维化。结论：SARS所存在的急性间质性肺炎和急性肺炎可利用CT动态检查较准确地与细菌性典型肺炙加以区别。     

重型病毒性肝炎合并急性胰腺炎的临床分析

目的通过对重型病毒性肝炎合并急性胰腺炎的病例进行分析,以找出其临床特点.方法对上述病例的临床症状、实验室检查、治疗情况、病情的发生发展及预后进行分析.结果少数患者表现不典型或胰腺炎的症状被重型肝炎的严重症状所掩盖,容易发生漏诊及误诊;且病情发展快、预后差.结论只有对相应患者尽早做血、尿淀粉酶的测定并反复复查,才能做到及时诊断和治疗.     

L'adolescence dans l'histoire de la psychanalyse

The concept of adolescence emerged progressively during the twentieth century. At the onset psychoanalysis focused on puberty as a second stage in the sexual maturity of Man, before it considered adolescence as an active process in the psychic life of the human being. The present article reexamines the development of this concept in the history of ideas in general in order to demonstrate its importance in the history of psychoanalysis. The themes that are sucessively covered include the precursors of the concept in the nineteenth century, the birth of its theorization, the Aichhorn years, and adolescence identified as a psychic process, which participates to a significant degree in subjectivization.     

哌拉西林/他唑巴坦治疗呼吸机相关性肺炎的临床疗效观察

目的 评价哌拉西林／他唑巴坦治疗呼吸机相关性肺炎的安全性和有效性。方法 对33例呼吸机相关性肺炎患者采用哌拉西林／他唑巴坦治疗，每次4．5g,q8h～q12h静脉滴注，疗程7～14d。结果 治疗总有效率84．85％，细菌清除率88．23％，不良反应率3．03％。结论 哌拉西林／他唑巴坦具有安全、低毒、抗菌谱广的特点，是治疗呼吸机相关性肺炎的良效药物。     

血清乙型肝炎病毒标志物不同表现模式及肝功能异常对肾移植受者存活率的影响

目的　探讨血清乙型肝炎病毒标志物不同表现模式对肾移植受者长期存活的影响。方法　对 62例血清乙型肝炎病毒标志物阳性者及 1 96例血清乙型肝炎病毒标志物全阴性者肾移植术后的肝功能、人肾均存活的存活率等指标进行随访和回顾性分析。结果　术后早期血清乙型肝炎病毒标志物阳性组与血清乙型肝炎病毒标志物阴性组比较 ,肝功能异常发生率的差异无显著性 (P >0 .0 5) ;术后中远期 ,HBsAg、HBeAg及抗 HBc阳性者的肝功能受损率明显高于血清乙型肝炎病毒标志物阴性组及HBsAg、抗 HBe、抗 HBc阳性者 (P <0 .0 5) ,其人肾均存活的存活率也最低 (P <0 .0 5)。结论　对HBsAg、抗 HBe及抗 HBc阳性者进行肾移植应慎重 ,而HBsAg、HBeAg及抗 HBc阳性者则不适宜接受肾移植     

五型病毒性肝炎的暴露因素与临床表现的比较

比较急性病毒性肝炎患者感染打危险因素，同时比较五型肝炎的症状和体征。连续收集急性病毒性肝炎患者血清２９３份，用ＥＬＩＳＡ法检测了五型肝炎病毒的病原学指标，并进行了流赞美同学调查。暴露因素：丙肝的肠道外暴露外明显多于甲肝；甲肝和戊肝有较高的“甲肝”患者接触史；乙肝，丙肝和丁肝有高的“乙肝”接触史，与甲肝，戊肝相比差异显著。     

人乳头瘤病毒16型DNA转化人胚肺细胞的实验研究

人乳头瘤病毒(HPV)的16,18,31,33型等与宫颈癌的发病有关,其中HPV16与宫颈癌关系密切。为进一步研究HPV16的致癌性,我们用克隆的HPV16 DNA(2μg/10~5细胞)转染体外培养的人胚肺细胞,并进行了细胞存活时间、血清依赖性、着壁依赖性、间接免疫酶检测、HPV16 DNA、同源序列检测、染色体核型等生物学的研究。结果表明,转染细胞存活时间延长、在软琼脂培养基中形成集落、HPV16特异抗原得以表达、HPV16 DNA的同源序列存在于细胞中。表明本实验用HPV16DNA转染的人胚肺细胞具备转化细胞的某些特征,HPV16有使人胚肺细胞转化的作用。     

A controlled trial of dapsone versus pyrimethamine-sulfadoxine for primary prophylaxis of Pneumocystis carinii pneumonia and toxoplasmosis in patients with AIDS

Pneumocystis carinii pneumonia (PCP) is the most common opportunistic human immunodeficiency virus (HIV)-related infection, occurring in 85 % of HIV infected patients without prophylaxis. Preventive treatment is required when CD₄ cell count falls below 200 cells per cubic millimeter. Cotrimoxazole has been shown to be highly effective but alternative drug regimens are often necessary because of the frequent drug hypersensitivity exhibited by HIV infected patients. The aim of this prospective, open, randomized, one-site study, involving HIV-infected patients with a CD₄ cell count below 200/mm³, or a percentage under 20%, randomly assigned to receive either dapsone 50 mg daily or Fansidar^® one tablet weekly, was to compare the efficacy and safety of these drugs in the primary prophylaxis of PCP. Both dapsone and Fansidar^® appear to be safe and effective alternative agents for the prevention of PCP. Their role in Toxoplasma gondii prophylaxis requires further evaluation.