小儿咳嗽变异性哮喘54例临床分析

咳嗽变异性哮喘（CVA）是一种特殊类型的哮喘,临床上常以慢性咳嗽为惟一的表现形式。早期易发生漏诊或误诊,现将我院2007—02—2009—05诊治的54例患儿资料分析如下。     

1例丛集性头痛的护理体会

丛集性头痛是一种较少见的头痛,其特点是密集、短暂、剧烈爆炸样锐痛,位于一侧眼眶、球后、额颗部,伴有同侧眼球结合膜充血、流泪、鼻塞及(或)Honer's综合征,常于夜间规律性发作.严重影响患者的生活质量[1].我院于2005年收治了一例外伤后出现丛集性头痛的患者,经过特殊的护理措施,收到了满意的效果,减轻了患者的痛苦.     

Correlation analysis on clinical effects of acupuncture for elderly patients with sensorineural deafness and ear distending sensation

Objective

To investigate the relationship between clinical effects of acupuncture for elderly patients with sensorineural deafness and ear distending sensation.

Methods

A total of 120 elderly patients with sensorineural deafness were randomly divided into a comprehensive treatment group, an acupuncture group and a Western medicine group, with 40 cases in each group. The acupuncture group received acupuncture treatment, the Western medicine group received oral mecobalamin tablets and the comprehensive treatment group received acupuncture plus acupoint injection and auricular acupoint sticking. The values of pure tone hearing threshold test of the three groups were observed before and after treatment, and the relationship between clinical effects and ear distending sensation was compared.

Results

The total effective rate of the comprehensive treatment group was 82.5% versus 67.0% in the acupuncture group and 62.5% in the Western medicine group. The inter-group comparisons showed statistically significant differences in the comprehensive treatment group versus the Western medicine group (P<0.01) and the acupuncture group (P<0.05). In the comprehensive treatment group, there were 23 cases (57.5%) with ear distending sensation, the clinical total effective rate was 86.9%; there were 17 cases (42.5%) without the sensation, the clinical total effective rate was 76.5%. In the acupuncture group, there were 24 cases (60.0%) with ear distending sensation, the clinical total effective rate was 71.0%; there were 16 cases (40.0%) without the sensation, the clinical total effective rate was 63.0%. In the Western medicine group, there were 21 cases (52.5%) with ear distending sensation, the clinical total effective rate was 66.7%; there were 19 cases (47.5%) without the sensation, the clinical total effective rate was 57.9%. The total effective rate of patients with ear distending sensation were higher than the rates of those without ear distending sensation in the three groups, but the differences were insignificant (all P>0.05).

Conclusion

The comprehensive therapy is one of the effective methods to treat elderly patients with sensorineural deafness. In the three groups of elderly patients with sensorineural deafness, the relief of ear distending sensation and the hearing loss were basically simultaneous, and the hearing recovery in the patients with ear distending sensation may be slightly better than that in those without ear distending sensation. Nevertheless, further research is needed.

     

542名临床护士早餐行为调查

目的: 调查上海瑞金医院集团闵行区中心医院临床护士早餐状况,为正确指导护士健康饮食提供依据。方法: 自行设计问卷,对542名在职临床护士进行早餐营养状况和饮食行为调查。结果: 96.9%护士认为早餐对一天工作很重要,84.7%护士能做到每天吃早餐,有时吃有时不吃者仅占14.2%。早餐食物主要为泡饭、牛奶、面包、包子、蛋糕,其中碳水化合物和优质蛋白质摄入少,几乎不含水果和蔬菜。上午有饥饿感的护士占82.7%,发生在10:00~11:00占57.8%,曾出现低血糖反应占14.6%。结论: 上海瑞金医院集团闵行区中心医院护士早餐进食单一,营养不足,需要重视并合理调整早餐膳食结构。     

弯套针旋转法注射臭氧治疗腰椎间盘突出症

目的:观察弯套针旋转注射臭氧治疗腰椎间盘突出症(LDP)的疗效.方法:150例LDP患者分成2组,均注射臭氧15～30 ml(60 μg/ml),观察组85例采用弯套针旋转法注射;对照组65例采用常规方法注射.结果:治疗6个月后2组LDP评价表各项目评分均高于治疗前(P<0.01);2组间比较.观察组高于对照组(P<0.05或0.01).复发率比较,观察组明显低于对照组(8.2%与20.0%,P<0.05),治疗后观察组起效时间明显短于对照组(P<0.01).结论:弯套针旋转法与传统注射方法比较疗效更明显,复发降低,而且无需反复多次穿刺,明显减轻患者的痛苦和经济负担.     

湖沼垸内型流行区外出务工人员血吸虫感染调查

目的掌握湖沼垸内型重度流行区农村外出务工人员血吸虫感染情况,为制定有针对性防制措施提供科学依据。方法对疫区农村外出务工人员进行问卷调查和血清免疫学检测,分析不同性别、年龄、外出地区和外出期限等人群血吸虫感染情况,同时开展血防健康教育、查治病和建立血防健康档案等措施。结果疫区农村外出务工人员占农村总人口的33.39%,血检阳性率为20.94%,男、女性阳性率分别为23.30%和18.99%,男性高于女性。在本市企业务工者和在广东、上海及江浙等沿海地区务工者的阳性率分别为24.31%和17.79%;40～岁年龄组感染率最高为24.92%,小学以下和高中以上文化程度的感染率分别为23.78%和19.11%。结论由于漏查漏治,湖沼垸内型疫区农村外出务工人员血吸虫感染严重。疫区政府和血防主管部门要加强对该类人群的管理和查治力度,杜绝和控制其传染源向非疫区扩散和传播。     

基于彩色眼底像和深度学习的视神经炎及非动脉炎性前部缺血性视神经病变的筛查诊断系统的构建

目的构建并评估基于彩色眼底像和人工智能(AI)辅助筛查视神经炎(ON)及非动脉炎性前部缺血性视神经病变(NAION)的筛查诊断系统。方法诊断性试验研究。2016年至2020年于中山大学中山眼科中心检查确诊的NAION患者178例267只眼(NAION组)、ON患者204例346只眼(ON组), 以及2018年至2020年经视力、眼压及光相干断层扫描(OCT)检查为眼底正常的健康者513名1 160只眼(正常对照组)共2 909张彩色眼底像作为筛查诊断系统的数据集, 其中NAION组、ON组、正常对照组分别为730、805、1 374张。将正确标注后的彩色眼底像作为输入数据, 选用EfficientNet-B0算法进行系统训练并验证, 最终构建是否存在异常视盘、是否存在ON和是否存在NAION的3个筛查系统(二分法)。采用受试者工作特征(ROC)曲线、ROC下面积(AUC)、准确度、灵敏度、特异性和热力图作为诊断效能和科学性的判断指标。结果测试集中, 诊断是否存在异常视盘、是否存在ON、是否存在NAION的AUC分别为0.967 [95%可信区间(CI)0.947～0.980]、0.96...     

玻璃体内注射康柏西普治疗早产儿视网膜病变的血管化过程

目的：评价玻璃体内注射康柏西普在治疗I型(阈值期和阈值前期)和A-ROP(急进性ROP)的早产儿视网膜病变(ROP)的一系列病例中引起的视网膜血管化过程。方法：回顾性研究2017-07/2020-03在厦门市儿童医院眼科通过玻璃体腔注射康柏西普(IVC)治疗的ROP患者34例67眼。再活化是指急性期特征的复发，发生在疾病的任何阶段，无论是否存在其他疾病。结果：患儿34例的平均胎龄为28.82±2.32wk。平均出生体质量为1155.18±398.22g。19例37眼的病变区域为Ⅰ区。10例20眼的病变位于Ⅱ区，5例10眼的病变位于Ⅱ区后部。一次IVC治疗的ROP患儿疾病控制总有效率为73.1%(49/67)，且Ⅱ区血管化均完成。患者在Ⅲ区的血管化完成率出现差异。在接受过一次治疗且未再复发的患者中，Ⅰ型ROP血管化时间平均为9.11±2.49wk，A-ROP为13.40±4.04wk。A-ROP的血管化完成时间明显比Ⅰ型ROP的时间长，且结果有统计学差异。结论：IVC治疗后的病变为Ⅱ区的患儿均具有较高的血管完成率。     

非动脉炎性前部缺血性视神经病变危险因素及预防措施

非动脉炎性前部缺血性视神经病变(NAION)是50岁以上人群最常见的急性视神经病变, 是由于睫状后短动脉低灌注导致筛板前视神经供血不足, 视神经纤维缺血坏死造成不可逆性大范围视野缺损, 目前尚无有效的治疗方法, 预后不佳, 因此预防NAION是当务之急。本文针对NAION的局部和全身危险因素以及易感基因进行阐述, 希望帮助眼科医师深入认识NAION发生的危险因素, 对NAION的发病机制展开深入研究, 为患者提供有效的防治措施。     

视神经脊髓炎谱系疾病相关视神经炎治疗研究进展

视神经脊髓炎谱系疾病相关视神经炎是一种累及视神经的脱髓鞘性炎症疾病，视力损伤严重，预后差，复发率高。及时控制急性发作和有效预防复发是治疗的关键。目前治疗主要包括糖皮质激素、血浆置换、免疫吸附、免疫抑制剂、靶向单抗类药物。特别是近年来依库丽单抗、萨特利珠单抗、及依那利珠单抗取得重大进展。该文综述视神经脊髓炎谱系疾病相关视神经炎近年治疗研究进展，期望为临床决策提供有益参考。