低温等离子腺样体切除联合双侧扁桃体方案治疗儿童鼾症的疗效及其影响因素研究

目的 探讨低温等离子腺样体切除联合双侧扁桃体方案治疗儿童鼾症的疗效及其影响因素研究。 方法 选取鼾症患儿110例作为研究对象，按照随机数字表法分为对照组与观察组，各55例。观察治愈率及总有效率，对比术前、术后1个月、6个月的免疫球蛋白A(immunoglobulin A，IgA)、免疫球蛋白G(immunoglobulin G，IgG)、免疫球蛋白M(immunoglobulin M，IgM)。评估术前、术后7 d的呼吸暂停低通气指数（apnea hypopnea index，AHI）、夜间最低氧饱和度［minimum blood oxygen saturation，LSa(O2）］及儿童睡眠问卷(pediatric sleep questionnaire,PSQ)评分。 结果 观察组的总有效率高于对照组，且治愈率高于对照组（P＜0.05）。观察组手术时间、术中出血量、术后疼痛时间及症状缓解时间均低于对照组（P＜0.05）。2组IgA、IgG、IgM均随着时间增加，术后1个月、6个月，观察组的IgA、IgG、IgM高于对照组（P＜0.05）。2组IgA、IgG、IgM在组间，时点间，组间时点间交互作用比较差异有统计学意义（P＜0.05）。简单效应LSD-t成对比较显示，术前2组IgA、IgG、IgM、AHI、LSa(O2）及PSQ评分比较，差异无统计学意义（P＞0.05）；术后1个月、6个月，观察组的IgA、IgG、IgM高于对照组（P＜0.05）。术后7 d，观察组的AHI低于对照组，而LSa(O2）、PSQ评分高于对照组（P＜0.05）。治愈/显效组与有效/无效组在性别、年龄、病程、体重、术前IgA、术前IgG、术前IgM、术前AHI、术前LSa(O2）、术前PSQ评分比较中，差异无统计学意义（P＞0.05）；而在手术方法比较中差异有统计学意义（P＜0.05）。logistic回归分析显示，动力切割系统切除腺样体联合常规剥离双侧扁桃体手术是影响儿童鼾症治疗效果的独立危险因素（P＜0.05）。 结论 低温等离子腺样体切除联合双侧扁桃体切除治疗小儿鼾症效果显著，不仅对免疫功能影响小，并且能改善患者通气功能。     

Murine typhus complicated by sHLH mimicking adult-onset Still's disease

IntroductionAdult-onset Still's disease (AOSD) is a rare multisystemic disorder and a diagnostic challenge for physicians because of the wide range of differential diagnoses. Common features of AOSD and secondary hemophagocytic lymphohistiocytosis (sHLH) could favour diagnostic uncertainty, in particular in case of infection-related sHLH.ObservationA 61-year-old man was admitted to our internal medicine department for suspected AOSD. He reported a 2-week history of sudden onset fever, headaches, myalgia, sore throat, diarrhoea, and an erythematous macular rash of the trunk as well as petechial purpuric lesions on both legs on return from Reunion Island. Laboratory tests found cytopenia, hepatic cytolysis, hypertriglyceridaemia, and hyperferritinaemia. Hemophagocytosis was diagnosed on bone marrow aspiration in favour of the diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH). Subcutaneous anakinra (100 mg) was initiated to treat sHLH with favourable course. Oral doxycycline was added 3 days later because of atypical features for AOSD diagnosis such as diarrhoea, hypergammaglobulinaemia, and doubtful serologies for Rickettsia and Coxiella. Three weeks later, Rickettsia typhi serology was checked again and revealed an increase in IgG titer > 4 times that confirmed the diagnosis of murine typhus. A diagnosis of murine typhus complicated by sHLH was retained, successfully treated by anakinra and doxycycline.ConclusionOur observation shows that AOSD diagnosis has to be stringent due to the many differential diagnoses, particularly infection complicated by sHLH, which may be rare. It is important to consider murine typhus in patients returning from endemic areas, such as La Reunion or other tropical areas, when they present fever of unknown origin with non-specific clinical features. Moreover, this case illustrates the effectiveness of IL-1 blockers as a treatment for symptomatic sHLH without severity criteria, regardless of the aetiology.     

发热伴血小板减少综合征研究热点的可视化分析

[摘要]　目的　对发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome, SFTS）的相关文献进行文献计量学和可视化分析，探寻近年来的研究现状、热点及趋势，为临床治疗和基础研究提供参考。方法?以Web of Science（WOS）核心合集和中国知网（China national knowledge infrastructure, CNKI）数据库为文献来源，检索2011年1月1日—2021年12月31日有关SFTS的文献，导入CiteSpace.5.7.R2软件，以国家、作者、文献共被引、关键词为节点进行可视化分析，并绘制相关图谱。结果?在WOS核心合集共检索到797篇文献，在CNKI数据库共检索到714篇文献。相关领域发文量总体呈上升趋势，中国发文量居首位，美国和日本之间机构合作密切。研究热点集中在发病机制、抗体、特异性治疗等领域。非结构蛋白、临床预后、血小板减少、SFTS感染的靶细胞等将是未来的研究重点。结论?国内外关于SFTS的研究逐渐成熟，新型布尼亚病毒、免疫功能、预后是研究重点，但是对SFTS发病机制和病毒受体尚不清楚，仍须进一步探索。     

Medicinal nicotine in COVID-19 acute respiratory distress syndrome,the new corticosteroid

The cholinergic anti-inflammatory pathway (CAP) refers to the anti-inflammatory effects mediated by the parasympathetic nervous system. Existence of this pathway was first demonstrated when acetylcholinesterase inhibitors showed benefits in animal models of sepsis. CAP functions via the vagus nerve. The systemic anti-inflammatory effects of CAP converges on the α7 nicotinic acetylcholine receptor on splenic macrophages, leading to suppression of pro-inflammatory cytokines and simultaneous stimulation of anti-inflammatory cytokines, including interleukin 10. CAP offers a novel mechanism to mitigate inflammation. Electrical vagal nerve stimulation has shown benefits in patients suffering from rheumatoid arthritis. Direct agonists like nicotine and GTS-1 have also demonstrated anti-inflammatory properties in models of sepsis and acute respiratory distress syndrome, as have acetylcholinesterase inhibitors like Galantamine and Physostigmine. Experience with coronavirus disease 2019 (COVID-19) induced acute respiratory distress syndrome indicates that immunomodulators have a protective role in patient outcomes. Dexamethasone is the only medication currently in use that has shown to improve clinical outcomes. This is likely due to the suppression of what is referred to as a cytokine storm, which is implicated in the lethality of viral pneumonia. Nicotine transdermal patch activates CAP and harvests its anti-inflammatory potential by means of an easily administered depot delivery mechanism. It could prove to be a promising, safe and inexpensive additional tool in the currently limited armamentarium at our disposal for management of COVID-19 induced acute hypoxic respiratory failure.     

Examining Acute Coronary Syndrome Across Ethnicity,Sex, and Age

Acute coronary syndrome (ACS) remains one of the leading causes of death in the United States. With its heightened prevalence, considerable variabilities in the disease process exist across ethnicities, sex, and age. This creates substantial disparities in the recognition and management of ACS, which consequently contributes to poor outcomes. It is of utmost importance that nurse practitioners remain vigilant, cognizant, and maintain a high index of suspicion to accurately identify ACS presentations and thus efficaciously intervene to successfully manage the disease process.