丁苯酞对急性缺血性脑卒中患者淋巴细胞亚群的影响研究

目的 探讨丁苯酞对急性缺血性脑卒中患者淋巴细胞亚群变化情况的影响。方法 选取2017年1月～2018年12月期间在本院就诊的99例急性缺血性脑卒中患者,分为对照组(n=48)和研究组(n=51),对照组接受常规治疗,研究组在常规治疗基础上联合使用丁苯酞软胶囊。于治疗前后测定淋巴细胞亚群变化情况,同时对脑梗死面积、Barthel指数、美国国立卫生研究院脑卒中量表(NIHSS)评分进行比较,计算不良反应发生率。结果治疗后两组CD3+、CD4+、CD4+/CD8+水平较治疗前明显上升(P0.05),且治疗后研究组CD3+、CD4+、CD4+/CD8+水平明显高于对照组(P0.05);治疗后两组脑梗死面积较治疗前均明显变小(P0.05),Barthel指数评分较治疗前均明显增大(P0.05),NIHSS评分较治疗前均明显减小(P0.05),且治疗后研究组脑梗死面积小于对照组(P0.05),Barthel指数评分大于对照组(P0.05),NIHSS评分小于对照组(P0.05);研究组不良反应发生率(1.96%)与对照组不良反应发生率(4.17%)比较,差异无统计学意义(P0.05)。结论 急性缺血性脑卒中使用丁苯酞,则CD3+、CD4+、CD8+水平改善程度更加明显,细胞免疫功能恢复良好,缩小脑梗死面积,改善神经功能缺损,恢复日常生活能力,安全性好。     

Differences Between the East and the West in Managing Advanced-Stage Non-small Cell Lung Cancer

Lung cancer is a common cancer associated with high mortality rates worldwide. Unfortunately, it usually presents at a late stage, precluding the chance of curative therapy. The discovery of oncogenic driver mutations in patients with non-small cell lung cancer over the past 20 years has led to new molecular targeted therapies that have dramatically improved treatment efficacy and quality of life. New generations of therapy that target the drug-resistant mutations have also quickly evolved, benefiting patients who are refractory or intolerant to first-line targeted therapy. Eastern patients, from Southeast Asia, Japan and China, are known to have a higher incidence of epidermal growth factor receptor mutation. Therefore, compared with the West, more patients would benefit from these recent advances. In contrast, survival of patients without driver mutations has benefited from advances in novel therapeutics, including the immune checkpoint inhibitors. The current review aims to highlight the recent developments in the management of advanced-stage non-small cell lung cancer and to compare the differences in clinical practice between Eastern and Western countries.     

Anti-complement factor I antibody associated atypical hemolytic uremic syndrome – A new insight for future perspective!

Atypical hemolytic uremic syndrome (aHUS) is caused mainly by complement dysregulation. Although various defects in the complement system explaining pathophysiology have been described in recent years, the etiology still remains unclear in about thirty percent of cases. In exploring other causes, similar to anti- complement factor H (anti-CFH) antibody associated HUS, we hypothesized that anti-complement factor I (anti-CFI) antibody could play a role in aHUS. Further, we tried to describe the clinical profile and outcome of those with high anti CFI antibody titers. Eleven of thirty five children (31 %) diagnosed with aHUS from July 2017 to December 2018 had high IgG anti-CFI antibody titers. Median age was 10 months (6, 33) with no sex difference. Thirty-six percent (4/11) had nephrotic-range proteinuria. C3 was low in 8 children (72.7 %) with mean C3 (68.1 ± 14.7 mg/dL). Plasmapheresis was done in 2 children who promptly responded, suggesting the possible role of anti-CFI antibody in pathogenesis of aHUS in these patients. Further studies examining role of anti-CFI antibodies in aHUS is warranted with longitudinal and genetic studies.     

Acute eosinophilic pneumonia caused by composter vapor inhalation: A case report

A 65-year-old woman presented to a local hospital with a 4-day history of cough, fever, and dyspnea. She had started using a composter and had been exposed to the vapor for 18 days before her first visit. She was diagnosed with acute eosinophilic pneumonia (AEP) based on her symptoms, the presence of bilateral pulmonary opacities on computed tomography, and alveolar eosinophilia confirmed by bronchoalveolar lavage. Inhalation of the composter vapor was thought to be the cause of AEP. Aspergillus fumigatus was cultured from the composter soil and the bronchoalveolar lavage fluid. She fully recovered without systemic corticosteroid administration by avoiding the composter.     

舒芬太尼联合瑞芬太尼对小儿七氟醚全麻扁桃体手术血流动力学和苏醒期躁动的影响舒芬太尼联合瑞芬太尼对七氟醚全麻小儿扁桃体摘除术的影响

目的分析舒芬太尼联合瑞芬太尼对七氟醚全麻小儿扁桃体摘除术的效果以及对患儿血流动力学和苏醒期躁动的影响。方法选取2016年10月~2017年12月于新疆喀什地区第一人民医院行扁桃体摘除术的患儿106例，按照随机数字表法将患儿分为两组，观察组53例，采用舒芬太尼联合瑞芬太尼进行诱导麻醉；对照组53例，采用瑞芬太尼进行诱导麻醉。比较两组患儿的手术时间、麻醉时间、停药至拔管时间、苏醒时间、自主呼吸恢复时间、出麻醉恢复室时间等指标，记录并比较两组患儿在麻醉诱导前、插管时、插管后5 min、拔管后5 min的心率（HR）、平均动脉压（mean arterial pressure， MAP）和血氧饱和度（saturation of blood oxygen，SpO2），比较两组患儿Aono’s评分、小儿麻醉后苏醒期躁动评分（paediatric anesthesia emergence delirium， PAED）和术后疼痛评分（children and infants postoperative pain scale， CHIPPS），并比较两组患儿麻醉后不良反应发生率。结果观察组患儿苏醒时间（8.2±2.7）min、自主呼吸恢复时间（115.7±32.4）s和出麻醉恢复室时间（28.4±6.3）min均低于对照组，差异具有统计学意义（P<0.05）。观察组患儿插管后5 min、拔管后5 min的HR和MAP均低于对照组，差异具有统计学意义（P<0.05）。两组患儿插管后5 min、拔管后5 min的SpO2比较，差异无统计学意义（P>0.05）。观察组患儿术后Aono’s评分、PAED评分和CHIPPS评分均低于对照组，差异具有统计学意义（P<0.05）。观察组恶心呕吐发生率和总不良反应发生率低于对照组，差异具有统计学意义（P<0.05）。结论舒芬太尼联合瑞芬太尼麻醉能够提高小儿麻醉效果，改善血流动力学水平，减轻患儿苏醒期躁动，降低不良反应反生率。     

Utilidad de las determinaciones analíticas en sangre y líquido cefalorraquídeo para predecir meningitis bacterianas en el servicio de urgencias

Introduction

The classic clinical presentation of bacterial meningitis (BM) is observed in less than half of the cases in adults, and symptoms are less specific in children, the elderly or immunocompromised, and other chronic patients. The usual signs and symptoms do not provide optimal sensitivity and specificity for distinguishing possible BM from viral meningitis (VM), which may lead to a delay in the appropriate antimicrobial therapy. Society therefore stands to benefit from the development of effective, objective, and rapid tools able to predict and identify patients with BM. These tools include laboratory tests for blood and cerebrospinal fluid (CSF). The aim of this review is to summarise recently published scientific evidence in order to clarify existing controversies and compare the usefulness and diagnostic ability of the different parameters used to predict BM.

Pharmacoeconomic impact of an alternative workflow process for stroke

Objective

The objective of this study was to evaluate a new multidisciplinary process in which intravenous alteplase (tPA) waste, used for acute ischemic stroke (AIS), was salvaged in an attempt to maximize cost effectiveness without impacting door-to-needle (DTN) administration times.

Hereditary persistence of hemoglobin F is protective against red cell sickling. A case report and brief review

Fetal hemoglobin (HbF) is a physiologic protein tetramer that is crucial for a developing fetus to survive in utero. Maternal hemoglobin has a relatively lower affinity for oxygen, and thus allows for an efficient transfer of oxygen from maternal to fetal blood. In addition to fulfilling a critical physiologic role, HbF is also known to alleviate symptoms of sickle-cell disease (SCD). The concentration of HbF depends on several factors. HbF is elevated in inherited conditions, such as hereditary persistence of HbF, hereditary spherocytosis, and thalassemia. The level of HbF is also increased in acquired states, such as pregnancy, aplastic anemia, thyrotoxicosis, hepatoma, myeloproliferative disorders, or hypoplastic myelodysplastic syndrome. It has been identified that some genetic loci have significant influence on HbF levels. The XmnI polymorphism, the HMIP locus, and the BCL11A gene are responsible for 45% of variations in HbF levels. Although SCD has been well described in the subpopulations of Africa, it is less common in the subpopulations of India. We describe a case of SCD, in which a patient with high HbF level presented at a very late age (27 years old). We presume the patient’s inherently elevated HbF levels were able to compensate for the hypoxic episodes associated with SCD. The onset of symptoms was delayed as a result of elevated HbF levels.