福建省闽西地区维持性血液透析患者病因及贫血状况的多中心调查

目的 了解福建省闽西地区终末期肾病(ESRD)患者的病因构成及其贫血状况。 方法 回顾性分析闽西地区11家医院2014年1-12月因ESRD行维持性血液透析的858例患者的临床资料,比较患者的血红蛋白水平与铁缺乏、营养状况、甲状旁腺激素、透析充分性、促红细胞生成素(EPO)治疗之间的关系。 结果 ESRD的病因中,前3位分别为慢性肾小球肾炎(458例,52.79%)、糖尿病肾病(143例,16.67%)和高血压肾病(128例,14.92%)。使用EPO治疗775例,治疗率90.33%,贫血治疗达标率42.87%。血红蛋白越低,EPO治疗的比例越高,用量也越大。与贫血治疗达标患者比较,贫血治疗不达标患者血清铁蛋白、转铁蛋白饱和度、血清白蛋白水平明显低下(均为P<0.05),血甲状旁腺素、肌酐、尿素氮水平明显升高(均为P<0.05),每周3次透析的患者所占比例明显下降(P<0.05)。 结论 闽西地区ESRD的病因主要是原发性肾小球肾炎、糖尿病肾病和高血压肾损害; 维持性血液透析患者贫血治疗率高,但达标率仍偏低,主要影响因素是铁缺乏、营养不良、继发性甲状旁腺功能亢进和透析不充分。     

夫妻癌的中医病因病机

夫妻双方生活在一处,形成了一个特殊的人文小社会。夫妻癌,是夫妻双方俱患癌,或同时发病、或先后发病,或患同癌、或患异癌。在异癌方面,或表里隶属,或无牵无联。夫妻癌发病的病因主要是性情相激、摄生相染、处境相仿;病机主要为气滞久矣、邪毒流注、阴阳失和。     

中医治疗干燥综合征的研究进展

中医药治疗干燥综合征,从病因病机、辨证论治、专方治疗、中药复方治疗、针灸治疗、实验研究等方面均取得了较大进展。干燥综合征多以阴虚津亏为本,燥热瘀毒为标。中医辨证施治可调节机体免疫力及各脏腑间的功能,中医针灸治疗取穴方便、灵活,且无不良反应,能显著改善干燥综合征的临床症状。     

夏芩颗粒降压作用机理研究

夏芩颗粒是金东明教授治疗高血压病肝火亢盛证的经验方,肝藏血,主疏泄,木气条达则血脉通畅,肝参与了心主血脉。肝气不舒,最易化火,肝火上炎,是导致血压升高的最常见情志因素。夏芩颗粒由夏枯草、黄芩、泽泻、牛膝、淫羊藿组方,既能清肝泻上炎之火、降肝经气血上逆,又能引火（血）下行利于祛邪,还能防苦寒伤正。各药均有不同程度的降压作用。     

脐静脉推注缩宫素联合舌下含化卡孕栓对剖宫产产后出血的疗效观察

目的探讨缩宫素联合卡孕栓对剖宫产产后出血的疗效。方法将剖宫产的180例产妇随机分为两组。观察组104例在胎儿娩出后脐静脉给缩宫素20 U,同时产妇含舌下化卡孕栓1 mg;对照组76例在胎儿娩出后均子宫体注射缩宫素10 U,同时产妇舌下含化卡孕栓1 mg。比较不同时段剖宫产产后出血量,所获数据采用方差分析、t检验和X2检验。结果子宫收缩效果、止血效果、术中、术后及总出血量比较P均<0.005。结论剖宫产术中脐静脉推注缩宫素联合舌下含化卡孕栓,预防剖宫产术后出血效果显著。     

《黄帝内经》论失眠

对《黄帝内经》眠梦理论进行整理,探讨失眠的病因病机及临床治疗。认为失眠的病机为气血盛衰、厥气客入、客邪阻遏等。治疗应补虚泄实,和合阴阳;通达经络,调和营卫;驱逐邪气,安神定志。     

Characteristics of etiological diagnostic workup across the past 10 years in patients with spontaneous intracerebral hemorrhage in a large general hospital

Objective: A swift and accurate diagnosis of etiology would lay the foundation of targeted management for patients with spontaneous intracerebral hemorrhage (SICH). It is unclear what the status of diagnostic workup related to etiology is in Chinese hospitals which treat the majority of the hemorrhagic patients in the world. We aim to demonstrate characteristics on diagnostic workup implemented routinely in both departments of Neurology and Neurosurgery in patients with SICH.

Methods: We enrolled patients with SICH from March 2002 to December 2011 from Chengdu stroke registry. Data on diagnostic workup were extracted.

Results: A total of 2264 patients diagnosed as SICH with rapid neuroimaging (computed tomography (CT) or magnetic resonance imaging (MRI)) scan were included. Patients in the department of Neurosurgery had a lower median Glasgow Coma Scale (GCS) score and a longer median length of stay. They had a significantly lower proportion of hyperlipidemia and heart disease, but a higher proportion of hypertension, alcohol consumption and history of stroke (all p?<?0.05). Following diagnostic workups were more frequently undertaken in the Neurological Department than in the neurosurgical Department: digital subtraction angiography (DSA), plain CT, plain MRI, carotid duplex ultrasound (all p?<?0.001). However, computed tomography angiography (CTA), contrast-enhanced MRI, and brain biopsy (all p?<?0.001) were implemented more in the Neurosurgical Department. While no difference in the proportion of magnetic resonance angiography (MRA) was found between the two departments, the intracranial vascular imaging (workup contains at least one of CTA, MRA and DSA) was performed more frequently in the Department of Neurosurgery (29.8% vs. 9.1%, p?<?0.001). The independent predictors contribute to the implementation of vascular examinations were gender, age, GCS score on admission, department of patients admitted in and the year patients were hospitalized in (all p?<?0.05).

Conclusions: Younger patients, females, with severe stroke onset (evaluated by GCS score), admitted in Department of Neurosurgery and hospitalized in recent years had undertaken more examinations on intracranial vascular. It is an urgency to explore a practical scheme of diagnostic workup for the etiology of SICH.     

Exchange transfusion for neonatal hyperbilirubinemia: an 8-year single center experience at a tertiary neonatal intensive care unit in Turkey

Objective: The aim of present study was to evaluate the indications and the complications associated with neonatal exchange transfusion (ET) performed for hyperbilirubinemia.

Methods: This study included overall 306 neonates who underwent ET between 2005 and 2012. The demographic characteristics of patients, causes of jaundice and adverse events occurred during or within 1 week after ET were recorded from their medical files. Those newborns that underwent ET were classified as either “otherwise healthy” or “sick” group.

Results: Of the 306 patients who underwent ET, 244 were otherwise healthy and had no medical problems other than jaundice. The remaining 62 patients were classified as sick that had medical problems other than jaundice ranging from mild to severe. The mean gestational age was 37.6?±?2.5 weeks and the mean peak total bilirubin levels was 25.8?±?6.6?mg/dl. The mean age at presentation was 5.4?±?3.8?d for all infants. The most common cause of hyperbilirubinemia was ABO isoimmunization (27.8%). None of newborns died secondary to ET. Three infants had had necrotizing enterocolitis, and also three infants had had acute renal failure. The most common encountered complications of ET procedure were hyperglycemia (56.5%), hypocalcaemia (22.5%) and thrombocytopenia (16%).

Conclusions: Our data showed that ABO isoimmunization was the most common cause of hyperbilirubinemia. Even mortality was not seen, very rare but major gastrointestinal and renal complications were associated with ET. The majority of adverse events associated with ET were laboratory abnormalities mainly hyperglycemia, hypocalcaemia and thrombocytopenia which were asymptomatic and treatable.     

5种病原学检测方法在肺结核病诊断中的应用评价

目的 评价涂片法(AFS)、罗氏培养法(L-J)、环介导等温扩增法(LAMP)、多色半巢式荧光定量PCR(Xpert MTB/RIF)、线性探针技术(LPA)对肺结核病的诊断价值。方法 选取2016年1月— 2018年3月陕西省结核病防治研究所和汉中市第二人民医院就诊的258例肺结核可疑症状者作为研究对象,同时应用AFS、L-J、LAMP、Xpert MTB/RIF、LPA对所有研究对象的同一份痰样本进行检测,以临床诊断为标准,分组计算5种病原学检测方法的阳性率;以培养和鉴定为金标准,计算4种方法的敏感度和特异度,并结合受试者工作特征 (ROC)曲线进行分析比较。结果 在肺结核病组中LAMP(73.30%)、Xpert MTB/RIF(77.27%)、LPA(70.45%)的阳性率均显著高于AFS(46.02%)和L-J(58.52%),差异均有统计学意义;以培养和鉴定为金标准,AFS、LAMP、Xpert MTB/RIF、LPA的敏感度分别为68.93%、93.20%、97.09%、92.23%;特异度分别为93.55%、74.84%、75.48%、83.23%;ROC曲线下的面积分别为0.812、0.840、0.863、0.877,P均< 0.05。结论 5种病原学检测方法对肺结核病的诊断均具有较好的辅助作用;与AFS和L-J相比,LAMP、Xpert MTB/RIF、LPA具有较高的阳性检出率,有助于传染源的早期发现。