代文胶囊治疗高血压病的疗效观察

目的：观察代文胶囊治疗高血压病的临床疗效。方法：60例高血压病患者停用其它降压药1周服用代文胶囊80mg．qd晨服，服药1周后若舒张压仍／〉90mmHg者剂量改为160mg／d，治疗前及治疗后4周分别行动态血压监测，并观察该药的副作用，治疗前后肝肾功能及电解质变化。结果：38例服用80mg／d，22例服用160mg／d，显效33例（55％）有效21例（35％）无效10例（10％），总有效率90％，治疗前后无肝肾功能，血电解质变化。结论：代文胶囊疗效确切，降压作用平稳，能防止晨问血压升高，降低心血管事件发生，值得临床推广应用。     

黏液纤维肉瘤7例临床病理分析

目的 探讨黏液纤维肉瘤临床病理特点。方法收集7例黏液纤维肉瘤患者的临床及病理资料，并对手术切除的标本进行多种抗体免疫组织化学染色，抗体包括CD117、CD34、CD99、actin、S-100蛋白、vimentin等。结果黏液纤维肉瘤多见于男性，年龄37～72岁，中位年龄52岁，主要以不完全纤维性间隔的多结节行为为特征性表现，黏液区与细胞密集区交错排列，细胞密集区可见特征性曲线型血管，肿瘤细胞围绕在其周围排列。免疫表型：vimentin、CD99阳性，其他抗体多呈阴性。结论黏液纤维肉瘤为一侵袭性较强的软组织肉瘤，与多种黏液性肿瘤需要鉴别，易局部复发，宜采取以手术切除为主的综合性治疗。     

莫达非尼联合BiPAP呼吸机治疗慢性阻塞性肺疾病合并睡眠呼吸暂停综合征的临床疗效

目的:评价莫达非尼联合双水平气道正压通气(BiPAP)在治疗慢性阻塞性肺疾病(COPD)合并睡眠呼吸暂停综合征(OSAS)的临床疗效。方法:选取在医院接受治疗的93例COPD合并OSAS患者,根据治疗方案的不同将其分为对照组(41例)和观察组(52例),对照组采用常规药物联合BiPAP治疗;观察组在对照组的基础上口服莫达非尼。记录两组正压通气时间及不良反应情况,比较两组治疗前后血氧分压(PaO₂)、血二氧化碳分压(PaCO₂)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1与FVC的比值(FEV1/FVC)、呼吸暂停指数(AHI)、总睡眠时间、最低氧饱和度和Epworth睡眠量表(ESS)评分的改善情况。结果:对照组和观察组患者治疗后的AHI、总睡眠时间、最低氧饱和度及ESS评分均较治疗前有显著改善,差异有统计学意义(t_对照组=21.187,t=6.155,t=7.648,t=29.947;t_观察组=22.380,t=7.931,t=8.168,t=37.593;P<0.05),观察组患者总睡眠时间及ESS评分均显著低于对照组,差异有统计学意义(t=2.315,t=14.232;P<0.05)。对照组和观察组患者治疗后1周和4周与治疗前相比,PaO₂有显著升高,Pa CO₂则有明显降低,差异有统计学意义(F对照组=29.947,F=36.147;F_观察组=27.533,F=34.580;P<0.05),而两组比较差异无统计学意义。对照组和观察组患者治疗后1周和4周的FVC、FEV1及FEV1/FVC通气指标均较治疗前有显著改善(F对照组=16.506,F=40.570,F=59.220;F_观察组=19.680,F=43.962,F=61.728;P<0.05),而两组比较差异无统计学意义。观察组和对照组不良反应发生率分别为19.2%(10/52)和7.3%(3/41),而两组比较差异无统计学意义。结论:对于COPD合并OSAS患者,呼吸机BiPAP模式可显著改善肺功能及肺通气相关指标,莫达非尼能提升睡眠质量,减轻白天的嗜睡症状,且未出现明显不良反应。     

Use of mammalian museum specimens to test hypotheses about the geographic expansion of Lyme disease in the southeastern United States

Lyme disease, caused primarily in North America by the bacterium Borrelia burgdorferi sensu stricto, is the most frequently reported vector-borne disease in North America and its geographic extent is increasing in all directions from foci in the northeastern and north central United States. Several southeastern states, including Virginia and North Carolina, have experienced large increases in Lyme disease incidence in the past two decades, with the biggest changes in incidence occurring in the western portion of each state. We tested the hypothesis that B. burgdorferi s.s. was present in western Virginia and North Carolina Peromyscus leucopus populations prior to the recent emergence of Lyme disease. Specifically, we examined archived P. leucopus museum specimens, sampled between 1900 and 2000, for B. burgdorferi s.s. DNA. After confirming viability of DNA extracted from ear punch biopsies from P. leucopus study skins collected between 1945 and 2000 in 19 Virginia counties and 17 North Carolina counties, we used qPCR of two species-specific loci to test for the presence of B. burgdorferi s.s. DNA. Ten mice, all collected from the Eastern Shore of Virginia in 1989, tested positive for presence of B. burgdorferi; all of the remaining 344 specimens were B. burgdorferi-negative. Our results suggest that B. burgdorferi s.s was not common in western Virginia or North Carolina prior to the emergence of Lyme disease cases in the past two decades. Rather, the emergence of Lyme disease in this region has likely been driven by the relatively recent expansion of B. burgdorferi s.s. in southward-moving ticks and reservoir hosts in the mountainous counties of these two states.     

Comprehensive screening of tick-borne microorganisms indicates that a great variety of pathogens are circulating between hard ticks (Ixodoidea: Ixodidae) and domestic ruminants in natural foci of Anatolia

Grazing domestic ruminants serve as important reservoirs and/or amplificatory hosts in the ecology of tick-borne pathogens (TBPs) and tick vectors in the natural foci; however, many enzootic life cycles including ruminants and ticks are still unknown. This study investigated a wide range of TBPs circulating among ticks and grazing ruminants in the natural foci of Anatolia, Turkey. Tick specimens (n = 1815) were collected from cattle, sheep, and goats in three ecologically distinct areas (wooded, transitional, and semi-arid zones) of Anatolia and identified by species: Dermacentor marginatus, Dermacentor reticulatus, Hyalomma anatolicum, Hyalomma excavatum, Hyalomma marginatum, Hyalomma scupense, Haemaphysalis inermis, Haemaphysalis parva, Haemaphysalis punctata, Haemaphysalis sulcata, Ixodes ricinus, Rhipicephalus bursa, and Rhipicephalus turanicus. PCR-sequencing analyses revealed TBPs of great diversity, with 32 different agents identified in the ticks: six Babesia spp. (Babesia occultans, Babesia crassa, Babesia microti, Babesia rossi, Babesia sp. tavsan1, and Babesia sp. Ucbas); four Theileria spp., including one putative novel species (Theileria annulata, Theileria orientalis, Theileria ovis, and Theileria sp.); one Hepatozoon sp.; four Anaplasma spp., including one novel genotype (Anaplasma phagocytophilum, Anaplasma marginale, Anaplasma ovis, and Anaplasma sp.); six unnamed Ehrlichia spp. genotypes; Neoehrlichia mikurensis; nine spotted fever group rickettsiae, including one putative novel species (Rickettsia aeschlimannii, Rickettsia slovaca, Rickettsia hoogstraalii, Rickettsia monacensis with strain IRS3, Rickettsia mongolitimonae, Rickettsia raoultii, Candidatus Rickettsia goldwasserii, Candidatus Rickettsia barbariae, and Rickettsia sp.); and Borrelia valaisiana. Detailed phylogenetic analyses showed that some of the detected pathogens represent more than one haplotype, potentially relating to the tick species or the host. Additionally, the presence of Neoehrlichia mikurensis, an emerging pathogen for humans, was reported for the first time in Turkey, expanding its geographical distribution. Consequently, this study describes some previously unknown tick-borne protozoan and bacterial species/genotypes and provides informative epidemiological data on TBPs, which are related to animal and human health, serving the one health concept.     

Analysis of the complete mitochondrial genomes of Dermacentor albipictus suggests a species complex

Dermacentor albipictus is a one-host tick broadly distributed across North America. There are two easily recognizable color variants – ornate and inornate/brown – that have been taxonomically synonymized. Based on mt-cox1 and mt-16S data, there is also evidence for two genetic lineages which do not match the color variants. We present for the first time the complete mitochondrial genomes of the two color variants of D. albipictus including representatives of each lineage. The AT-rich genomes are 14,822 bp – 14,865 bp in length and contain 13 protein coding genes, 2 ribosomal RNA genes and 22 transfer RNA genes, arranged in the conserved type 3 metastriate mitochondrial genome order. The overall differences were 10.66% between the mitochondrial genomes of D. albipictus ornate variant lineage 1 and lineage 2, 10.51% between lineage 1 and inornate/brown variant and 5.87% between lineage 2 and inornate/brown variant. The inornate/brown variant did not form a separate lineage and all inornate isolates were found to belong to lineage 2. Ornate variant isolates occurred in both lineage 1 and 2. The high divergence of the mitochondrial genome suggests that D. albipictus may represent a species complex. Other barcoding genes that may help capture the genetic differences between color and lineage variants include nad1, nad2, nad5, cox1 and atp8 loci. The mtDNA data generated in this study are available in GenBank (Accession numbers: OM678457 - OM678459 and ON032564 - ON032573) for future studies on tick taxonomy, phylogenetics and molecular epidemiology.     

基因芯片技术检测方法对耐多药肺结核治疗的指导价值研究

目的探讨基因芯片技术在肺结核耐药检测中的应用及指导临床治疗的价值。方法河北省胸科医院结核科住院的83位复治菌阳肺结核患者为选例对象,根据既往药敏试验结果,择符合条件的56例耐多药肺结核患者作为研究对象,随机分为基因芯片组24例根据基因芯片检测结果制定抗结核化疗方案,常规药敏组32例根据常规药敏试验结果制定抗结核化疗方案,观察评价两组在治疗后痰菌阴转情况及肺部病灶吸收情况。结果痰菌阴转情况基因芯片组58.3%(14/24),常规药敏组53.2%(17/32),基因芯片组略高于常规药敏组,组间相比无显著性差异(P0.05);X线肺部病灶吸收情况基因芯片组45.9%(11/24),常规药敏组43.8%(14/32),组间相比无显著性差异(P0.05)。结论基因芯片技术快速准确,可用于肺结核的耐药检测,指导临床用药。     

微波联合利福平治疗溃疡型淋巴结结核的临床观察

目的观察微波照射联合利福平粉末局部换药治疗溃疡型淋巴结结核的临床效果。方法选取我科溃疡型淋巴结结核患者95例,随机分为治疗组和对照组,两组均给予相同的抗结核方案,即3HRZE/6HR;治疗组应用利福平粉末局部换药,并加用微波局部照射治疗,每次照射15 min,每日1次,治疗4周;对照组无局部用药,无微波照射;分别于治疗1个月、2个月、3个月后比较两组的治疗效果。结果治疗组患者症状改善明显,分泌物减少迅速,溃疡面或窦道愈合较快,肿块减小速度增快,病程缩短。治疗组的治愈率和总显效率明显高于对照组,有统计学意义(P0.05)。结论用利福平粉末局部换药,并加用微波局部照射治疗溃疡型淋巴结结核有效。     

河北省胸科医院护士死亡焦虑现状分析及临床干预

［摘要］ 目的了解河北省胸科医院重症监护室（intensive care unit,ICU）护士对死亡焦虑培训需求情况以及系统培训效果,为今后有目的、有方法地实施系统死亡教育培训提供参考依据。 方法将河北省胸科医院ICU工作的护士作为研究对象,通过《汉化版死亡焦虑量表》及死亡焦虑培训需求百分制度量尺进行调查分析。 结果年龄越大的ICU护士死亡焦虑水平越高（P＜0.01）。年龄越大、学历越高、职称越高、工作年限越长的ICU护士死亡教育需求评分越高（P＜0.01）。死亡焦虑评分与死亡教育需求呈正相关（P＜0.05）。Logistics回归结果显示职称水平是影响死亡教育培训需求的重要因素。培训结束后ICU护士死亡焦虑评分明显低于培训前（P＜0.05）。 结论死亡焦虑评分与死亡教育培训需求呈正相关,职称水平越高对于接受系统死亡教育的培训迫切感越强烈。培训后,ICU护士的死亡焦虑评分明显降低,值得推广死亡教育培训。