热毒宁注射液联合蒙脱石散与喜炎平联合消旋卡多曲颗粒治疗小儿病毒性肠炎临床疗效比较研究

目的 比较热毒宁注射液联合蒙脱石散与喜炎平联合消旋卡多曲颗粒治疗小儿病毒性肠炎临床疗效.方法 将我院2012年1月-2013年1月收治的90例病毒性肠炎患儿随机分为观察组与对照组,每组45例,观察组患儿接受热毒宁注射液联合蒙脱石散治疗,对照组接受喜炎平联合消旋卡多曲颗粒治疗,比较两组治疗效果及患儿腹泻、发热、呕吐消失及住院时间,记录并比较两组患儿治疗费用.结果 两组患儿治疗效果、发热消失时间比较差异无统计学意义(P＞0.05),观察组患儿腹泻、呕吐及住院时间显著低于对照组(P＜0.05),两组患儿临床治疗费用比较(P＞0.05)差异无统计学意义.结论 热毒宁注射液联合蒙脱石散治疗小儿病毒性肠炎临床疗效显著,能有效缓解患儿临床症状、缩短患儿病程,减少患儿住院时间.     

消旋卡多曲辅助治疗小儿轮状病毒性肠炎的临床可行性研究

目的:探讨消旋卡多曲辅助治疗小儿轮状病毒性肠炎的临床可行性.方法:2016年3月至2021年3月在本院治疗的的137例轮状病毒性肠炎患儿分为对照组72例(蒙脱石散治疗),观察组65例(蒙脱石散+消旋卡多曲辅助治疗).比较两组患儿治疗5d后临床疗效及临床症状改善情况,并比较两组实验室指标,观察用药安全性.结果:治疗后,观察组总有效率95.38％高于对照组80.56％(P<0.05);观察组大便次数及大便性质恢复时间、止泻时间、住院时间均短于对照组(P<0.05);观察组人轮状病毒抗原、酸碱度值正常率、剩余碱正常率、尿酮体阴性率均显著高于对照组(P<0.05);两组患儿治疗过程中无严重不良反应出现.结论:消旋卡多曲辅助蒙脱石散治疗小儿轮状病毒性肠炎疗效高,是一种安全的治疗方案.     

消旋卡多曲颗粒联合蒙脱石散治疗婴幼儿轮状病毒肠炎疗效观察

目的 探讨消旋卡多曲颗粒联合蒙脱石散治疗婴幼儿轮状病毒肠炎的疗效.方法 将临床确诊为婴幼儿轮状病毒肠炎患儿78例随机分为治疗组和对照组各39例.对照组予蒙脱石散、金双歧、保护胃肠黏膜、补液等综合治疗,治疗组在对照组综合治疗的基础上加用消旋卡多曲颗粒治疗,治疗72h后观察疗效.结果 两组主要临床表现消失时间(大便次数正常时间和大便性状正常时间)治疗组分别为(2.71±0.16)d、(2.91±0.23)d,对照组分别为(3.08±0.29)d、(3.24±0.38)d,两组比较差异均有统计学意义(P<0.01).治疗组总有效率为94.86%,对照组总有效率为76.91%,两组比较差异均有统计学意义(χ2=5.19,P<0.05).治疗组平均住院时间(2.61±0.83)d、对照组平均住院时间(5.29±0.24)d,两组比较差异均有统计学意义(t=19.37,P<0.01).结论 消旋卡多曲颗粒联合蒙脱石散治疗婴幼儿轮状病毒肠炎疗效好,能明显缩短病程,迅速改善临床症状,且未发现与药物有关的不良反应,安全性好,值得临床广.     

消旋卡多曲联合双歧杆菌四联活菌及蒙脱石散对急性腹泻患儿的治疗效果分析

目的:研究消旋卡多曲联合双歧杆菌四联活菌及蒙脱石散对急性腹泻患儿炎性因子、临床症状及安全性.方法:选取2021年10月至2022年9月本院收治急性腹泻患儿101例,根据治疗方案不同分为对照组(双歧杆菌四联活菌+蒙脱石散,n=49)和观察组(消旋卡多曲+双歧杆菌四联活菌+蒙脱石散,n=52).治疗7 d后采用酶联免疫吸附法检验白介素-10(Interleukin-10,IL-10)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、C反应蛋白(C-reactive protein,CRP)水平;并根据《腹泻病疗效判定标准的补充建议》分析临床症状量化积分及安全性.结果:观察组IL-10水平高于对照组,TNF-α、CRP水平均显著低于对照组(P<0.05);观察组大便性状及次数、呕吐、腹痛腹涨、口渴、食欲不振及尿短黄的临床症状分级量化积分均低于对照组(P<0.05);两组不良反应发生率比较无差异(P>0.05).结论:急性腹泻患儿应用消旋卡多曲联合双歧杆菌四联活菌及蒙脱石散可有效改善炎性因子水平、临床症状,且具有一定安全性,值得临床适当应用.     

小儿轮状病毒性肠炎应用药物治疗的安全性分析

目的 分析小儿轮状病毒性肠炎应用炎琥宁及蒙脱石散治疗的临床疗效及安全性.方法 将80例小儿轮状病毒肠炎患者随机分为两组,每组患者40例,分别给予蒙脱石散治疗(对照组)及联合炎琥宁治疗(观察组),观察两组经治疗后的临床治疗效果及药物不良反应发生率.结果 两组经治疗后退热时间、止泻时间、脱水纠正时间、抗原转阴时间及住院时间均存在显著差异,观察组以上观察指标改善时间均明显短于对照组(t=5.3957,P=0.0000;t 17.5852,P=0.0000;t=10.5886,P=0.0000;=6.3800,P=0.0000;t=6.9887,P=0.0000).观察组患者在接受治疗3天后的治疗总有效率同样明显优于对照组(x2=10.3127,P =0.0013).此外两组在住院治疗期间药物不良反应发生率比较未见统计学差异(x2 =0.7207,P=0.3959),两组治疗前后肝肾功改变比较未见统计学差异(t=0.5678,P=0.2858;t=1.3600,P=0.0888;t =0.4065,P=0.3427;t-0.3257,P=0.3727).结论 炎琥宁、蒙脱石散联合应用可显著提高小儿轮状病毒性肠炎的治疗效果,并且安全可靠.     

双岐四联活菌片联合蒙脱石散治疗小儿腹泻临床疗效观察

目的 探讨双岐四联活菌片联合蒙脱石散治疗小儿腹泻临床疗效。方法 选取2017年1月~2018年1月我院收治的小儿腹泻患儿100例,随机分为观察组和对照组,每组50例。对照组采用蒙脱石散治疗,观察组在对照组基础上加用双岐四联活菌片治疗。比较两组患者的临床疗效、用药前后腹泻积分、小儿营养情况（ALB、HGB、TP）、止泻的平均天数、腹痛持续时间、体温正常时间、呕吐消失时间以及不良反应情况。结果 观察组总有效率为98.00%,高于对照组的78.00%,差异具有统计学意义（P＜0.05）。用药后观察组腹泻积分为（0.25±0.05）分,低于对照组的（1.14±0.11）分,差异具有统计学意义（P＜0.05）;观察组ALB、HGB、TP水平均高于对照组,差异具有统计学意义（P＜0.05）。观察组止泻平均天数、腹痛持续时间、体温正常时间、呕吐消失时间均短于对照组,差异具有统计学意义（P＜0.05）。两组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论 蒙脱石散联合双岐四联活菌片治疗小儿腹泻,临床疗效显著,可加速病情康复,改善营养情况,安全性好。     

西咪替丁对小儿轮状病毒肠炎的临床疗效分析

目的 探讨西咪替丁对小儿轮状病毒肠炎的临床疗效分析.方法 选择2012年1月-2015年12月收治的150例轮状病毒感染的肠炎患儿,根据随机数字表法,将所有患儿分为观察组与对照组.两组均给予常规治疗,对照组在常规治疗基础上给予利巴韦林用药,观察组在常规治疗基础上给予西咪替丁用药,观察两组患儿平均退热时间、平均止泻时间、平均止吐时间、疗效及不良反应.观察两组治疗前后的IL-2、IL-6及TNF-α水平.结果 观察组的平均退热时间、平均止泻时间、平均止吐时间明显低于对照组,观察组的总有效率明显高于对照组,治疗后两组患儿的IL-6、TNF-α均显著降低,组内对比差异明显,组间对比发现观察组明显低于对照组(P＜0.05);治疗后两组的IL-2均明显升高,组内对比差异明显,组间对比观察组明显高于对照组(P＜0.05).观察组的不良反应率低于对照组,但组间对比无统计学差异(P＞0.05).结论 西咪替丁可通过调节轮状病毒引起的炎症反应,提高治疗总有效率,加快患儿临床症状的恢复,治疗小儿轮状病毒肠炎安全有效,值得临床推广应用.     

光量子疗法在小儿病毒性肠炎中的应用

目的通过光量子治疗小儿轮状病毒性肠炎,进行疗效观察.方法采用随机分组方法进行对照治疗.结果对照组平均退热时间1.96±0.84天,平均止泻时间3.16±0.88天,治疗组平均退热时间1.12±0.46天,平均止泻时间2.28±0.94天(p<0.05).结论光量子组在退热及止泻时间上优于对照组光量子对小儿轮状病毒性肠炎有良好的疗效,无毒副作用.     

氨溴索治疗小儿支气管肺炎的临床效果分析

目的:探讨氨溴索联合头孢呋辛钠治疗小儿支气管肺炎的临床效果.方法:选择 2020 年 10 月至 2022 年 6月医院接收的小儿支气管肺炎患儿 96 例,采用随机数字表法分为对照组和观察组(n=48).对照组采用头孢呋辛钠治疗,观察组采用氨溴索联合头孢呋辛钠治疗,治疗 7 d后记录患者发热、咳嗽等症状消失时间,并采用血液分析仪、免疫扩散法测定白细胞技术和C-反应蛋白(C-reactive protein,CRP),对比两组患者总有效率.结果:观察组发热、咳嗽、肺部湿啰音等临床症状消失时间均显著短于对照组(P＜0.05).治疗前,两组的白细胞计数、CRP水平均无显著差异(P＞0.05).治疗 7 d后两组白细胞计数、CRP水平均低于治疗前,且观察组低于对照组(P＜0.05).观察组治疗总有效率为显著高于对照组(P＜0.05).结论:氨溴索联合头孢呋辛钠治疗能促进小儿支气管肺炎患儿的临床症状消失,降低小儿支气管肺炎患儿机体炎症反应.     

干扰素治疗轮状病毒肠炎的疗效观察

目的 观察干扰素治疗轮状病毒肠炎的疗效.方法将我院196例轮状病毒肠炎,随机分为治疗组及对照组,对照组给予利巴韦林、思密达及肠道益生菌,治疗组在对照组的基础上加用重组人α- 1b干扰素注射液.结果 经过治疗组痊愈时间平均为3.6d,显著少于对照组的平均6.8d,差异有统计学意义(P＜0.05).结论 干扰素治疗轮状病毒肠炎安全可靠、可明显缩短患儿发热、腹泻时间、减少并发症的发生,疗效显著、且副作用少,值得临床推广应用.     

Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma

Background: Racemic albuterol is an equal mixture of (R)-albuterol (levalbuterol), which is responsible for the bronchodilator effect, and (S)-albuterol, which provides no benefit and may be detrimental. Objective: We sought to compare 2 doses of a single enantiomer, levalbuterol (0.63 mg and 1.25 mg), and equivalent amounts of levalbuterol administered as racemic albuterol with placebo in patients with moderate-to-severe asthma. Methods: This was a randomized, double-blind, parallel-group trial. Three hundred sixty-two patients 12 years of age or older were treated with study drug administered by means of nebulization 3 times daily for 28 days. The primary endpoint was peak change in FEV₁ after 4 weeks. Results: The change in peak FEV₁ response to the first dose in the combined levalbuterol group was significantly greater compared with the combined racemic albuterol group (0.92 and 0.82 L, respectively; P = .03), with similar but nonsignificant results after 4 weeks (0.84 and 0.74 L, respectively). Improvement in FEV₁ was similar for levalbuterol 0.63 mg and racemic albuterol 2.5 mg and greatest for levalbuterol 1.25 mg. Racemic albuterol 1.25 mg demonstrated the weakest bronchodilator effect, particularly after chronic dosing. The greatest increase in FEV₁ was seen after levalbuterol 1.25 mg, especially in subjects with severe asthma. All active treatments were well tolerated, and β-adrenergic side effects after administration of levalbuterol 0.63 mg were reduced relative to levalbuterol 1.25 mg or racemic albuterol 2.5 mg. At week 4, the predose FEV₁ value was greatest in patients who received levalbuterol or placebo when compared with those who received racemic albuterol. The difference was more evident and was statistically significant in patients who were not receiving inhaled corticosteroids. Conclusion: Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function. (J Allergy Clin Immunol 1998;102:943-52.)     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Establishing Safety with Patients with Dissociative Identity Disorder

Abstract

The incidence of self-mutilation and suicidality among patients with dissociative disorders is quite high. It is necessary for clinicians working with this population to be adept at dealing with safety problems. This article presents a sequence of basic steps that can be used when helping dissociative patients establish safety, a discussion of the functions of self-destructiveness, and an overview of specific experiences and thinking patterns that contribute to self-destructiveness among dissociative patients.     

VACTERL with hydrocephalus: Family with X-linked VACTERL-H

We describe in a five generation family four affected males with hydrocephalus (4 offspring/4 examined) due to aqueductal stenosis (3/3), symmetrical radial ray abnormalities (4/4), renal anomalies (2/3), anal atresia (3/4), hypoplastic penis/abnormal testes (2/3), and cardiac abnormalities (1/3). X-linked inheritance seems certain in this family. These abnormalities are characteristic of the rare X-linked VACTERL-H syndrome. In addition, one maternal female cousin had a severe tracheo-esophageal fistula. This may represent partial manifestation in a female carrier. Chromosomes were apparently normal (46XY) with no spontaneous or excess induced breakages in one of the affected offspring and his mother. In the absence of a genetic marker, diagnostic ultrasonography is the investigation of choice for early in utero detection of this syndrome. A confident ultrasonographic diagnosis was possible by 20 weeks in the 2 cases examined. Am. J. Med. Genet. 76:74–78, 1998. © 1998 Wiley-Liss, Inc.     

拉米夫定与泛昔洛韦联合治疗乙型肝炎病毒慢性感染的临床研究

目的 观察拉米夫定与泛昔洛韦联合治疗乙型肝炎病毒(HBV)慢性感染的临床疗效。方法 慢性乙型肝炎患者90例。设联合治疗组28例，单用拉米夫定组30例，单用泛昔洛韦组32例。联合治疗组给予口服拉米夫定0．1g／d(PO)，泛昔洛韦1．5g／d(PO)，24周。拉米夫定、泛昔洛韦单用组剂量及疗程分别同联合治疗组。结果 3组均无明显副反应，丙氨酸转氨酶(ALT)复常率无差异。3组HBV DNA阴转率分别为89．3％、66．7％、40．6％，差异有显著性。乙型肝炎表面抗原(HBeAg)阴转率分别为28．6％、23．3％、21．9％，差异无显著性。结论 拉米夫定与泛昔洛韦联合用药安全、耐受性好，临床显示联合治疗对HBV DNA的抑制作用显著优于单用药。     

Intervention with epinephrine in hypotension associated with mastocytosis

The occurrence of the episodes of vasodilatory hypotension can be a life-threatening manifestation of systemic mastocytosis. This article describes the reversal by epinephrine of episodes of severe hypotension in two hospitalized patients with mastocytosis. Recognition of the efficacy of epinephrine in hypotension associated with mastocytosis can be important when other methods fail to restore hemodynamic stability.