发热伴血小板减少综合征并发脑室出血及侵袭性肺曲霉菌病一例临床分析

目的提高对发热伴血小板减少综合征并发自发性脑室出血、侵袭性肺部曲霉菌病的临床特点的认知。方法结合1例发热伴血小板减少综合征并发脑室出血及侵袭性肺部曲霉菌感染者的临床资料及文献复习,对本病的临床表现、实验室指标、影像学特征、诊断及治疗加以分析。结果发热伴血小板减少综合征以白细胞及血小板减少为主要特点,以发热、乏力、咳嗽、咯痰为主要临床表现,可引起心、肝、肾、凝血等多脏器损害,重者病死率高;脑室出血可因凝血功能异常导致,及时恰当的救治预后较好;侵袭性肺曲霉菌病在难以取得活检组织病理结果的情况下,应结合宿主因素、肺部感染的临床特征、生物学指标及时做出临床诊断,尽早治疗可降低病死率。结论发热伴血小板减少综合征合并脑室出血及侵袭性肺曲霉菌感染的病例临床罕见,其发生可能与白细胞及血小板减少、免疫力低下、凝血异常有关。     

10例新型布尼亚病毒致发热伴血小板减少综合征患者的临床分析

近年来,我国山东、河南以及安徽等多个省份发现多例发热伴血小板减少为主要临床表现的患者,其中少数重症患者因发生多脏器损害救治无效而死亡。早些年研究曾经认为,是嗜吞噬细胞无形体所致人粒细胞无形体病导致发热伴血小板减少,后根据中国疾病预防控制中心的研究结果,新型布尼亚病毒可能是发热伴血小板减少综合征的主要致病原。2013年6至10月本院共收治10例新型布尼亚病毒导致的发热伴血小板减少综合征患者,现将其临床资料报道如下。     

构巢曲霉致肺曲霉病患者二例临床特征和病原学分析

目的探讨构巢曲霉致肺曲霉病的临床及病原学特点。 方法收集首都医科大学宣武医院2017年1月2例住院慢性阻塞性肺疾病患者的病例信息,分析患者的临床资料和实验室对病原菌的分离鉴定并复习相关文献。 结果两例患者均有慢性阻塞性肺部疾病史及多种基础疾病,临床表现为发热、咳嗽、喘息等,胸部影像学显示肺部斑片状高密度影;实验室检测G试验和GM试验均为阳性;痰液直接涂片镜检可见隔菌丝,分支45°角,分离菌经质谱和测序分析确定为构巢曲霉。临床根据病原学结果改用伏立康唑治疗后患者症状及体征好转出院。 结论构巢曲霉致肺曲霉病相对少见,病原学诊断对临床早期有效治疗肺曲霉病很重要。     

重症慢性阻塞性肺疾病合并侵袭性支气管肺曲霉病确诊病例的临床特点

目的探讨重症慢性阻塞性肺疾病（COPD）合并侵袭性支气管肺曲霉病（IBPA）确诊病例的临床特点。方法回顾性分析北京朝阳医院呼吸重症监护室（RICU）2006年4月至2012年8月收治的7例COPD合并IBPA确诊病例的病史、实验室检查、气管镜及影像学资料。结果7例COPD合并IBPA确诊患者入RICU前多有大剂量糖皮质激素（6／7）和多种广谱抗菌药物（7／7）应用史。临床最常见的表现为对大剂量糖皮质激素及广谱抗菌药物治疗无效的发热、持续气道痉挛所致呼吸困难和双肺广泛哮鸣音。7例患者中,5例为曲霉性气管支气管炎（ATB）合并侵袭性肺曲霉病（IPA）,患者支气管镜下主要表现为气道黏膜严重充血、水肿、糜烂及气道痉挛,并伴有气道内伪膜形成,胸部影像学提示由最初大致正常迅速进展为渗出影或实变影,在临床上均发生呼吸衰竭并迅速进展为多脏器功能衰竭而死亡。存活的2例患者仅存在气道病变,且均在出现胸部渗出影前开始抗真菌治疗,病情好转。结论 重症COPD合并IBPA病情进展迅速,如不能及时诊断并尽早治疗,患者单纯ATB迅速进展为肺实质受累的IPA而死亡。早期支气管镜检查及气道黏膜活检有助于建立诊断和指导治疗。     

发热伴血小板减少综合征患者的护理

目的探讨发热伴血小板减少综合征患者的护理与防治措施。方法对53例发热伴血小板减少综合征患者进行积极对症支持治疗,做好高热、营养支持、皮肤、口腔、预防出血等综合护理干预,切实做好隔离与防护措施。结果 53例中48例病情均得到有效控制,症状缓解,5例放弃治疗出院,治疗过程中无一例医务人员、陪护家属及其他住院患者发生感染。结论加强对发热伴血小板减少综合征患者的早期诊疗和隔离管理,实施及时的综合护理干预,可有效减少并发症的发生,缩短病程,提高治疗成功率。     

新型布尼亚病毒感染六例临床分析

近年来,我国多个省份相继报道了一些以发热伴血小板减少为主要临床表现的感染性疾病病例,其中少数重症患者因多脏器损害而救治无效死亡。早些年曾经认为是嗜吞噬细胞无形体所致人粒细胞无形体病,后在一些疑似人粒细胞无形体病病例的样本中发现了一种新型布尼亚病毒,所致疾病现称为发热伴血小板减少综合征。我院近年来收治了6例确诊为新型布尼亚病毒感染所致发热伴血小板减少综合征患者,为提高对该疾病临床特征的认识,现将其临床特征总结如下。     

造血干细胞移植后植入综合征研究进展

植入综合征是造血干细胞移植后中性粒细胞恢复初期发生的一种临床综合征,其临床上可以表现为发热、皮疹和毛细血管渗漏综合征,进而发展为肺实质浸润及体质量增加,甚至出现多器官功能衰竭。因其与急性移植物抗宿主病的表现接近,在其诊断及鉴别诊断方面有一定困难。本文就植入综合征发生情况、危险因素及其发病机制、诊断标准、治疗以及预后等方面进行综述。     

浙江省首例蜱叮咬感染新布尼亚病毒诊治分析

近几年,河南、安徽等地相继出现以发热伴血小板减少为主要表现的感染性病例,被命名为发热伴血小板减少综合征(sfts),其中少数重症患者因多脏器功能衰竭死亡[1-2].部分sfts病例为人粒细胞无形体病[3],但大多数却检测不到其核酸和特异性抗体.2010年5月中国疾病预防控制中心(cdc)在河南、湖北等6省从发热伴血小板减少为主要表现的患者血液中分离到病毒,并确定为布尼亚病毒科白蛉热病毒属的一种新病毒,命名为发热伴血小板减少综合征布尼亚病毒(severe fever with throbocytopenia syndrome bunyavirus, sftsv)[4].     

发热伴血小板减少综合征临床观察——附22例病例分析

发热伴血小板综合征是一类新发的重要人兽共患自然疫源性疾病,2007年河南省首发病例在光山县,2010年5月中国疾病控制中心检测出新型布尼亚病毒,卫生部于9月10日发布<发热伴血小板减少综合征防治指南(2010版)>,强调对症支持治疗,目前尚无推荐特异性治疗方案.本院自2010年5月至2010年11月收治符合诊断发热伴血小板综合征患者共22例,经过积极探索临床治疗路径,取得了显著疗效,现总结报道如下.     

发热伴血小板减少综合征患者的血液及免疫系统损伤

发热伴血小板减少综合征（SFTS）是以发热伴血小板减少为主要特征的新发传染病。临床表现常累及多个器官,其中以血液和免疫系统损伤较为常见。血液系统方面,患者血小板及白细胞数量明显减少,淋巴细胞及中性粒细胞等也出现不同程度减少,多项凝血指标异常提示凝血功能存在损伤;免疫系统方面,T淋巴细胞亚群、NK细胞及B细胞等多项细胞免疫指标异常,同时骨髓穿刺发现SFTS患者可能存在骨髓抑制及噬血细胞综合征。作为新发传染病,SFTS发病机制和早期诊断等尚存在争议,本文对SFTS患者血液和免疫系统在该疾病发展过程中的动态变化特点进行综述,为探讨SFTS病理机制和及时防治提供思路。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。