Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the introduction of PCV13 in Germany

IntroductionPediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs).MethodsIn a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped.ResultsS. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1–4.3 years] vs. median 5.6 years [IQR 3.8–8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1.ConclusionFollowing the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.     

情景模拟联合案例讨论在急诊护理临床带教中的应用体会

目的探究急诊护理临床带教中采用情景模拟、案例讨论联合教学法效果。方法在本院实习的若干名护生中,选取124名护生分按照教学方法分组,对照组62名实施传统急诊护理带教,观察组62名实施案例讨论、情景模拟联合教学法,对比临床带教效果。结果两组实践与理论成绩相比,观察组成绩更高(P<0.05)。思维、急救及应激能力自我评价相比,观察组的总提高率高于对照组(P<0.05)。实施案例分析结合情景模拟教学模式后,问卷调查中观察组无护生不赞同此模式,非常赞同此教学模式的护生占总人数的90%以上。结论实施案例讨论、情景模拟联合教学模式后,护生急诊护理实践与理论水平均提升,护生我评价较高。     

案例教学法在消化内科见习课的应用效果评价

目的探讨案例教学法在消化内科见习课的教学效果和体会。方法选取2017年10月—2017年12月在消化内科进行见习课的2015级39-40班护理本科学生44例(全部为女生),抓阄分成对照组(22人)和试验组(22人),对照组给予传统的带教方法,试验组给予案例教学法教学,比较两组护生在理论、技能、综合能力和对带教满意度方面有无差异。两组学生在性别、年龄、专业前的课程成绩比较,差异无统计学意义(均P>0.05)。结果观察组在理论考核成绩、操作考核成绩、教学满意度等方面均高于对照组。结论案例教学法能提高护理教学的教学效果,增加学生的理论、操作能力,提高护理临床思维能力,提升学生的学习主动性和积极性。     

The relative risk of noncervical high-risk human papillomavirus-related (pre)malignancies after recurrent cervical intraepithelial neoplasia grade 3: A population-based study

Women with cervical intraepithelial neoplasia grade 3 (CIN3) have a long-lasting increased risk for noncervical high-risk human papillomavirus (hrHPV)-related (pre)malignancies. The aim of our study was to estimate this risk in women with recurrent CIN3 compared to women without a history of CIN3 and women with a single episode of CIN3. Women with a CIN3 diagnosis between 1990 and 2010 were obtained from the Dutch Pathology Registry (PALGA) and matched with a control group of women without CIN3. Analysis has been conducted in a subset of women with recurrent CIN3, defined as reoccurrence minimally 2 years post-treatment. Cases of noncervical hrHPV-related (pre)malignancies of the anus, vulva, vagina and oropharynx were identified until 2015 and incidence rate ratios (IRRs) were estimated. Then, 1,797 women with recurrent CIN3 were included with a median age of 34 years (range 18–76) and 31,594 person-years of follow-up. Women with recurrent CIN3 had an increased risk of developing noncervical hrHPV-related (pre)malignancies compared to women without CIN3 with an IRR of 25.96 (95%CI 6.32–106.58). The IRR was 2.48 (95% CI 1.87–3.30) compared to women with a single episode of CIN3. Studies on posttreatment follow-up and prophylactic hrHPV vaccination are warranted.     

气血同治法治疗胃息肉验案1则

胃息肉在消化道息肉中最常见,疾病早期多无明显症状,即使有临床症状也无特异性,主要表现为上腹疼痛和腹胀等症,极易造成漏治和误治,在很大程度上影响患者的生活质量。于春泉主任总结多年临床经验,在治疗胃息肉方面有独到的见解,以气血同治为治疗法则,通过补气、行气、活血和养血等治法扶正祛邪,恢复脏腑气血阴阳动态平衡,标本兼顾,临床效果可观。     

医用粘胶相关性皮肤损伤的文献计量学分析

目的: 应用文献计量学方法,分析国内外医用粘胶相关性皮肤损伤（Medical adhesive-related skin injuries,MARSI）文献的研究主题和热点。方法: 检索Cochrane Library、PubMed、EMbase、Web of science、sinoMed、CNKI、Wanfang、VIP等数据库MARSI相关文献,检索时限为建库至2019年5月。采用SPSS 22.0 软件进行文献计量分析,利用gCLUTO统计对国内外高频主题词进行聚类分析。结果: 共纳入论文103篇,其中外文文献占总文献量的27.18%,中文文献占总文献量的72.82%。聚类分析将国内外高频主题词聚为4大类,依次为皮肤损伤及损伤类型、相关危险因素、风险评估及风险管理、护理干预措施。结论: MARSI仍是国内外研究的热点,其发病机制研究仍处于探索阶段,目前尚缺乏有效的预防策略,研究领域较局限。在今后的研究中,应加强MARSI预防的研究、注重多学科合作。     

小儿心包积液28例临床分析

目的：探讨小儿心包积液的病因、分类及诊断。方法：病例回顾性分析。结果：28例中，化脓性心包积液4例，结缔组织疾病所致心包积液16例，肾病综合征所致心包答液4例，病毒性、肺吸虫性、幼年型粘液性水肿及肿瘤性心包积液各1例。治愈、好转25例，另3例，分别死于急性心包填塞，风湿性全心炎、心功能不全、呼衰、纵隔肿瘤广泛转移。结论：小儿心包积液，可由多种致病因素引起。其临床特点，对该病的诊治有重要意义。     

婴儿母乳喂养与学龄前肥胖症关系的病例对照研究

①目的　探讨婴儿期母乳喂养行为与学龄前期单纯性肥胖症发生之间的关系。②方法　对 180 0名4～ 5岁儿童的婴儿期母乳喂养情况及其体质指数 (BMI)、发育情况等进行调查 ,分析母乳喂养类型和持续时间与学龄前肥胖症发生之间的关系。③结果　单因素分析发现 ,4个月内只喂母乳、主要喂母乳、母乳与配方奶量基本相同、主要喂配方奶、只喂配方奶者 4～ 5岁时肥胖发生率分别为 12 .6 3% ,13.0 4 % ,16 .98% ,18.18% ,30 .0 0 % ;儿童母乳喂养持续时间 0 ,<1,1～ 3,4～ 6 ,7～ 9,>9个月者 4～ 5岁时肥胖发生率分别为 2 9.4 1% ,30 .0 0 % ,33.33% ,17.2 4 % ,13.92 % ,12 .2 2 % .母乳喂养类型和持续时间不同的儿童学龄前期单纯性肥胖症发生率不同 ,差异有显著性 (χ2 =10 .4 0 7,P <0 .0 5 ;χ2 =2 0 .90 3,P <0 .0 0 1)。多因素Logistic回归分析发现 ,4个月内喂配方奶量越多 ,肥胖发生率越高 (OR =1.12 0 ) ;母乳喂养持续时间越长 ,肥胖发生率越低 (OR =0 .782 )。④结论　婴儿母乳喂养对学龄前期肥胖症的发生有预防作用 ;婴儿期应提倡母乳喂养 ,并尽可能延长母乳喂养时间至 9个月以上。