小儿感染性心内膜炎治疗的现状

Objective During recent years several changes have occurred in the clinical characteristics of infective endocarditis (IE) which has made a new challenge in the management of this disease. This study aimed to understand current practice pattern in the management of pediatric IE in China. Methods This retrospective, multicenter study was conducted in 13 hospitals. Clinical data of 268 patients diagnosed as IE according to the new IE criteria (trial) between 2000 and 2006 were analysed, focusing particularly on management and outcome of patients. The mean age of patients was 8.94 years (18 d-18 years). Results Except for one patient who died after admission without treatment, 56 antimicrobial agents were used in the management of this disease in the 267 patients, including cephalosporin group (15), penicillin group (8), beta-lactamase inhibitor combination (8), aminoglycosides (4), glycopeptide agents (3) etc. The most commonly used antibiotics were as follows: penicillin G (125 cases/times), cefotaxime (113), vancomycin (78), ceftriaxone (73), ampicillin (66), cefuroxime (56), piracillin (48), amikacin (39) etc. For management of this disease, only one antibiotic agent was used in 33 (12.3%) patients, two antibiotic agents in 83 (31.1%) patients, 3 antibiotic agents in 44 (16.5 %) patients, 4 antibiotic agents in 57(21.3%) patients, 5 antibiotic agents in 25(9.4%) patients, 6 or more antibiotic agents in 25 (9.4%) patients. The most commonly used antibiotic agents in patients with streptococci detected in blood culture were penicillin G, cephalosporins, vancomycin, beta-lactamase inhibitor combination, and aminoglycoside, in patients with staphylococcus detected in blood culture were cephalosporins, oxicillin, vancomycin, aminoglycoside, and quinolones. Duration of antibiotic treatment was from 1 day to 98 days, less than 2 weeks in 19 (7%) patients, 2 weeks to less than 4 weeks in 74 (27.7%) patients, 4-6 weeks in 122 (45.7%) patients, more than 6 weeks in 52 (19.4%) patients; 123 patients simultaneously underwent surgical management (for removal of vegetations and intracardiac defects or residual shunt repair 105, and valve repair 8, valve replacement 6, intracardiac defect repair 4) .Of the 268 patients, 186 patients were cured, 4 patients were referred to surgery, 18 patients died and 60 patients refused medical advice. In antibiotics and surgical treatment group (123 patients), 111 patients were cured, 4 patients were referred to surgery, 5 patients died, 3 patients refused medical advice, in antibiotics treatment group (145 patients), 75 patients were cured, 13 patients died, 57 patients refused medical advice. The outcomes were significantly different between the two groups (χ2=61.7, P=0.000). The results of multivariate logistic regression analysis showed that Staphylococcus aureus as a pathogen (χ2=4.40,P=0.036,OR=9.78,95% CI 1.16-82.26), children with repaired congenital heart disease (χ2=9.4,P=0.002,OR=9.8,95% CI 2.28-42.16), and complicated with heart failure (χ2=10.36,P=0.001, OR=0.075,95% CI 0.16-0.36) were risk factors related to death. Conclusion This study revealed the current status in the management of pediatric IE in China. Wide range antibiotic agents and diverse regimens are used to manage children with IE. For improving management of pediatric IE, there is an urgent need for guidelines or recommendations or consensus for management of pediatric IE stipulated by multidiscipline specialists, and randomized controlled clinical trials are required to provide evidences.     

广东省糖尿病流行病学调查中血糖测定的质量控制

目的：以广东省14个地区随机抽样的11742名居民糖尿病流行病学调查者的血糖测定为例，详细介绍了糖测定全程质控的步骤和重要性。方法：血糖测定技术人员技术考核合格后，通过MONICA质控图，对血糖测定进行质量监控，并用方差分析对数据进行评价，结果：IGT调查者重复调查时的2次血糖结果，个体内相关系数P＝0．8783，较接1，数据折可靠度高。结论：严格执行血糖测定的全程质控，可得到糖密可靠的数据。     

上海地区慢性肾功能衰竭患者心血管并发症的调查

目的：调查上海地区1998．1－2000．3间慢性肾功能衰竭（CRF）患者心血管疾病（CVD）流行状况，方法：多中心，回顾性横断面研究，结果：CRF病例1093例，非透析组（ND）320例，血透组（HD）613例，腹透组（PD）160例，86．0％CRF存在各种类型CVD，以缺血性ST－T变化，心力衰竭（心衰），心律失常等为常见，61．1％有阳性主诉，46．7％伴阳性体证，79．7％实验室检测异常，34．1％患者有心衰史，感染，无节制饮水，血压控制不良，严重贫血未纠正为常见诱因，心脏超声检测以左室功能异常为主，CVD相关死亡人数占CRF总死亡人数44．2％，心衰，脑血管意外，心律失常等多见，结论：CRF属CVD高危人群，维持性透析前部分患者已存在CVD基础病变，早期把握血透时机可改善远期预后，超声心动图检查为心功能检测重要指标。     

山区学前教育感言

在山区执教8年的生涯中,我深深地感受到老师与家长作为孩子成长路上影响最大的两个群体,本有着相同的责任与使命——让孩子成才.可是许多家长将自己孩子的一切交给老师,特别是山区寄宿制学生的家长更是认为将孩子送进学校大门就万事大吉了,其实是极其不负责任的表现.一个好的老师或许能够影响孩子三年五年,但是家长的影响力却是一辈子的.父母的言传身教永远大于老师的40分钟的课堂教育,想要让孩子有良好的品行,家庭教育才是关键.     

双虎清肝方加一贯煎加减及药渣育蘑菇治疗慢性乙肝临床研究

目的 本研究旨在探索双虎清肝方加一贯煎加减及药渣育蘑菇食疗对慢性乙肝患者的临床疗效.方法 对我院确诊为慢性乙肝患者42例,均给予双虎清肝方加一贯煎加减治疗3个月,后改用上方药渣培育蘑菇食疗6个月,对其临床疗效及肝功情况进行统计学分析.结果 显效25例,占59.5%,有效15例,占35.7%,总有效率95.2%,且治疗6个月复查稳定,复发率低.结论 双虎清肝方加一贯煎加减及药渣育蘑菇治疗慢性乙肝有明确疗效,安全稳定,副作用少,价格低廉,值得临床推广.     

利迈先片的生物利用度测定

利迈先［（克拉霉素）（Ｃｌａｒｉｔｈｒｏｍｙｃｉｎ，ＣＬＭ）］是一种新的大环内酯类抗生素，化学名称为６—Ｏ—甲基红霉素Ａ，由红霉素分子中６位的羟基被甲氧基取代而成。这一结构变化使得ＣＬＭ与红霉素相比，胃酸稳定性增加，口服吸收良好，血浆和组织中浓度较高，生物利用度改善，消除半衰期延长，其抗菌谱广，因此治疗临床感染疗效满意。本文采用微生物法测定了健康志愿者ＣＬＭ的血清浓度，并对利迈先及进口克拉仙２个厂家的制剂进行了生物等效性评价。１材料和方法１－１仪器与试药ＤＧ－２Ａ多功能恒温箱（上海医疗仪器厂）；…     

肥厚型梗阻性心肌病室间隔心肌消融术的疗效及术后左心房容积的变化特点

目的评价肥厚型梗阻性心肌病（HOCM）患者经皮室间隔心肌消融术（PTSMA）的疗效,并应用三维超声心动图（3DE）探讨术后左心房容积的变化特点。 方法34例HOCM患者入选此研究。于术前1周、术后1周及术后1年行超声心动图检查。经常规超声获取左心室舒张末期前后径（LVd）、左心房最大前后径（LAd）、左心室射血分数（LVEF）、室间隔基底段舒张末期最大厚度（IVSd）、左心室后壁舒张末期厚度（LVPWd）、左心室流出道压差（LVOT-PG）等,经3DE获取左心房时间-容积曲线,测量左心房最大容积（LAVmax）、左心房最小容积（LAVmin）及左心房收缩前容积（LAVp）,计算左心房排空分数（LAEF）、左心房被动排空分数（LAPEF）及左心房主动排空分数（LAAEF）及左心房扩张指数（LAEI）,比较术前、术后各参数的变化特点。 结果与术前相比,术后1周LVOT-PG（54.5±34.5）mmHg（1 mmHg=0.133 kPa）、LVEF（71.4±5.7）%、LAVmax（90.2±36.5）ml、LAVp（73.0±34.0）ml及LAVmin（53.2±28.8）ml均明显减低,差异具有统计学意义（t=4.002、3.234、3.502、3.611、2.253,P值均<0.05）;术后1年LVOT-PG（38.3±31.7）mmHg、IVSd（16.7±8.3）mm、LVPWd（11.0±1.9）mm、平均E/e′ 12.0±4.6、LAVmax（80.9±24.8）ml、LAVp（61.3±23.1）ml、LAVmin（42.6±19.5）ml、MI 1.46±1.06均明显减低,差异具有统计学意义（t=5.371、4.165、3.473、3.940、3.655、4.046、4.046、Z=-2.873,P值均<0.01）,而LAPEF（25.1±5.1）%升高,差异具有统计学意义（t=-3.270,P<0.01）。与术后1周比较,术后1年LVOT-PG、IVSd、LVPWd、LAVmax、LAVp、LAVmin、MI均明显减低,差异值有统计学意义（t=2.256、5.067、3.137、2.200、2.740、2.016、Z=-2.003,P值均<0.05）,而LVd（41.6±4.0）mm、LAEF（48.3±7.9）%及LAPEF升高,差异有统计学意义（t=-2.288、-2.725、-2.907,P值均<0.05）。 结论HOCM患者PTSMA术后左心室流出道梗阻减轻,左心室充盈压降低,二尖瓣反流改善。3DE用于评估左心房大小较二维超声准确而敏感,HOCM患者PTSMA术后各时相LAV逐渐缩小。     

上海地区成人获得性再生障碍性贫血患者诊断和治疗现状——附142例分析

临床上,典型获得性再生障碍性贫血(AA)诊断并不困难,但不典型AA极易误诊,特别和低增生性骨髓增生异常综合征(MDS)之间极易混淆,造成误诊.为提高成人获得性AA诊断正确率,我们收集上海市中美联合白血病协作组采用细胞形态学、细胞遗传学、流式细胞术、骨髓病理学综合诊断方法和随访后确诊的142例AA和22例低增生性MDS的临床和实验室资料进行比较,对AA诊断和治疗中若干问题进行探讨,旨在提高临床AA诊断水平.     

2009年湖南口岸艾滋病防治政策策略与行动计划研究

目的通过对湖南口岸艾滋病预防与控制策略和行动进行分析,为实现《口岸艾滋病预防与控制行动计划》的目标和制定《湖南口岸艾滋病预防与控制行动计划(2011-2016)》提供依据和方向。方法采取问卷调查、交流与座谈、个别访谈和与专家咨询相结合的方式。结果湖南出入境检验检疫局工作取得了较为明显的效果;出入境人员艾滋病防治知识、中国艾滋病防治政策知晓率低于《行动计划》的目标;文化程度与年龄和知晓率有关联,婚姻、性别与知晓率无相关性。结论在目前基础上,应继续加大对出入境人员的艾滋病知识教育,大力宣传中国艾滋病防治政策,全面落实《行动计划》的目标。下一个行动计划可在继续宣传的基础上加大出回国人员自愿检测和关怀活动,并在适当时候,取消艾滋病作为禁止入境传染病。