用秩和比法对我院的10个公示病种医疗质量进行综合评价

目的对我院2005年度公示的10个病种进行医疗质量综合评价。方法采用秩和比法(RSR)进行统计分析。结果我院的10个公示病种被划分成4个医疗质量等级:老年性白内障、小儿支气管肺炎2个病种质量为优,急性阑尾炎、腹股沟疝(单侧)、子宫平滑肌瘤、剖宫产4个病种质量为良,胃大切、脑梗塞、急性心肌梗塞3个病种质量为中,脑出血1个病种质量为差。结论通过对综合指数秩和比(RSR)的计算并根据其值分级归档,反映出所研究病种之间存在着医疗质量高低的差异。控制和降低本院临床常见病种的医药费用,进行医疗全程连续性控制,为患者提供经济有效的医疗服务。     

Techniques for difficult cases of laparoscopic cholecystectomy

Our basic techniques for the management of difficult cases of laparoscopic cholecystectomy (LC) are presented in this article. If access to Calot's triangle cannot be gained safely, dissection should be started at the fundus or body of the gallbladder (GB), rather than the neck (fundus-first method). In cases with a short and wide cystic duct, a transfixing suture should be applied for ligation instead of clipping. EndoGIA is useful for ligating and transecting this case to avoid a subsequent stricture caused by normal method of ligation. Intraoperative cholangiography should be performed near the neck of the GB in cases in which orientation is lost during dissection. More dissection should be performed in the direction of the junction of the bile ducts after orientation is regained. In cases with GB filled with stones accompanied by severe fibrosis, part of the GB is incised to remove the stones and expose the lumen of the GB. Confluence stones can be removed by placing an incision on the GB side of the junction of the duct. The incised part is closed with suture. A cystic tube (C-tube) is placed in the common bile duct through the cystic duct for decompression. In more difficult cases in which dissection cannot be started safely at any location, the body and the fundus of the GB are excised, and a drain is placed at the neck of the GB. Dissection can be carried out from the main surgeon's or the assistant's side depending on the situation, and cooperation between the two surgeons is mandatory to achieve safe LC in difficult cases. When performing the LC, one must have a low threshold for converting to open surgery if injuries cannot be managed safely.     

Access编制数据库在白内障病例管理中的应用

目的 应用微机对白内障病例进行管理，实现病例管理自动化。方法 根据患者姓名、晶状体等各项临床信息，在Windows98及以上版本的操作平台上，应用Access2000建立患者信息病例库。结果 建立Access病例库管理白内障病例，病例存储量大，查询方便快捷，数据处理方便。结论 Access2000编写的数据库在临床病例的管理中值得广泛应用及推广。     

四川省绵阳市2019—2021年流行性感冒流行病学特征分析

目的 了解绵阳市2019—2021年流行性感冒流行病学特征,为绵阳市流感防控工作提供重要依据。方法 收集绵阳市2019—2021年流感监测相关数据,采用描述性流行病学方法进行统计学分析。结果 绵阳市2019—2021年流感共报告发病55 970例,年均报告发病率388.08/10万。报告流感样病例（influenza-like illness cases, ILI） 103 723例,年平均ILI%为3.58%。2019年流感报告发病率、ILI%、阳性检出率均远超过历年同期水平。人群分类构成以15岁以下学生为主。报告发病数居前三位的地区分别为涪城区20 118例（占35.94%）、游仙区6 394例（占11.42%）、江油市5 800例（占10.36%）。2019—2021年共收到并检测ILI标本10 126份,阳性率19.53%;标本阳性检出率以15岁以下学生为主。历年流感病毒优势毒株呈现出交替流行的趋势,2019年以A（H3）型为主,2020年受新冠疫情影响,全年阳性检出率均较低,2021年除检出2份A（H9）型外,其余均为BV型。2019—2021年共报告ILI暴发疫情43起,发生时间主要集中在冬季,场所以小学居多。结论 2019—2021年绵阳市流感病例、ILI、病原学监测、暴发疫情的特征基本一致,15岁以下的学生及学校仍为重点关注人群及场所。而新型冠状病毒肺炎疫情大流行下,流感的低发水平进一步印证非药物干预措施对流感防控工作的重要性。     

小儿重症哮喘多因素回归分析

应用电脑对111例儿童哮喘50项指标进行多因素逐步回归分析,把发作时喘憋严重,平时也有不同程度的喘息症状患儿列入小儿重症哮喘,与非重症哮喘比较,结果显示夜间喘、急性发作持续天数、非特异性刺激诱发、间歇期症状、发绀、呼吸困难、入院后激素治疗、中性粒细胞、IgA、pH、哮喘持续状态等11个因素入选重症哮喘回归方程,表明这些因素与小儿重症哮喘相关,提出儿童哮喘危险信号的临床指标。     

Imported paracoccidioidomycosis : A public health problem in non-endemic areas

Diagnosis of paracoccidioidomycosis in an immigrant who had returned to Italy following a long sojourn in Venezuela prompted a review of imported cases of this Latin American disease in nonendemic countries. Forty-two such instances of well documented paracoccidioidomycosis were compiled. Among these, eleven individuals had arrived in nonendemic countries with active symptomatic infections, fifteen others were first suspected of having tuberculosis, and four each were considered to have blastomycosis caused by Blastomyces dermatidis and carcinomas. Three, individuals were considered to have Wegner's granulomatosis or blastomycosis. Two other patients were treated for syphilis before being diagnosed as having paracocidioidomycosis. A striking feature of most of these cases was the long asymptomatic period following initial infection. The dormant periods ranged form four months to 60 years with an average duration of 14 years. The need to question patients about travel to or residency in foreign countries is emphasized, along with the necessity to include the mycoses in differential diagnoses. Three reported cases, all from Africa with no history of travel to the endemic areas of the New World, were considered to be doubtful. In one of these, Russell bodies apparently had been mistaken for the tissue-form cells of Paracoccidioides brasiliensis. A Japanese case, upon restudy of available histologic slides, revealed that the fungal cells present in various organs were those of Cryptococcus neoformans and not of P. brasiliensis.Corresponding author     

2015—2019年四川省流感哨点监测结果分析

目的 描述四川省2015—2019年流感病毒流行特征,为疫情防控提供依据。方法 对流感监测系统上报的流感样病例数据开展回顾性流行病学分析。结果 2015—2019年间,四川省共监测流感样病例标本131 477份,其中阳性标本23 844份,流感阳性率为18.14%。2015—2019年四川省优势流感亚型主要为甲型H1N1,季节性H3N2和B(Victoria)系流感。流感阳性率随月份、季节而改变,四川省流感阳性率高峰主要出现在冬季,其次为秋季。甲型流感主要在秋冬季流行,乙型流感主要在冬春季流行。流感病毒阳性检出率在5～14岁组年龄段最高。结论 四川省流感有明显的冬季流行高峰,各型别呈交替流行。秋冬季应加强流感防控工作;甲型和乙型流感好发于5～14岁群体,应继续加强对儿童学生流感的防控。     

关思友治疗疑难病的临床辨证思路撷菁

关思友先生治疗疑难病时,在辨证论治的基础上,借鉴前医经验,注重逆向思维,取得良好的临床疗效。临证时,不囿表面所见,把细究病因放在重要地位,并提倡“治病不可因循守旧,固守古训,要圆机活法,因人、因地、因时治宜,有是证用是药。”     

Clinical presentation,viral kinetics,and management of human monkeypox cases from New Delhi,India 2022

We describe the clinical and demographic characteristics, virological follow-up, and management of five confirmed monkeypox cases from New Delhi, India without any international travel history. The viral load kinetics and viral clearance were estimated in oropharyngeal swabs (OPS), nasopharyngeal swabs (NPS), EDTA blood, serum, urine, and various lesion specimens on every fourth day of follow-up ranging from 5 to 24 post onset day (POD) of illness. All five cases presented with mild to moderate-grade intermittent fever, myalgia, and lesions on the genitals, groins, lower limb, trunk, and upper limb. Four cases had non-tender firm lymphadenopathy. No secondary complications or sexually transmitted infections were recorded in these cases except for the presence of viral hepatitis B infection marker hepatitis B virus surface antigen (HBsAg) in one case. All the cases were mild and had a good recovery. A higher viral load was detected in lesion fluid (POD 9), followed by lesion roof (POD 9), urine (POD 5), lesion base (POD 5), and OPS/NPS (POD 5). The monkeypox virus (MPXV) DNA was detected in clinical samples from 5th to 24th POD. These monkeypox cases without international travel history suggest the underdiagnosed monkeypox infection in the community. This emphasizes the need for active surveillance of MPXV in the high-risk population such as men having sex with men and female sex workers.