输入性恶性疟疾2例流行病学及临床分析

目的探讨输入性恶性疟疾的流行病学和临床特征。方法对2010年10月至2012年7月收治住院的2例输入性恶性疟疾患者的流行病学资料、临床表现、实验室检查、诊治情况进行回顾性分析。结果 1例患者为非洲劳务回国的中年男性,另1例患者是曾去上海世博会旅游的青年男性,均有贫血、脾大、肝功能异常,1例白细胞减少,1例血小板减少。经抗疟治疗后,2例均在短期(1～2周)内治愈出院。结论输入性恶性疟疾患者临床表现复杂,对输入性恶性疟疾患者应及时进行外周血涂片,认真查找疟原虫,明确诊断,抗疟治疗,避免凶险型疟疾的发生。     

成人恶性脑型疟疾2例临床分析并相关文献复习

目的初步探讨成人恶性脑型疟疾的临床特征、诊断及治疗。方法回顾性分析2例确诊成人恶性脑型疟疾患者的流行病学特征、临床表现、实验室检查、治疗经过及其预后,并复习相关文献。结果 2例成人恶性脑型疟疾患者均有非洲工作或生活史,同时均为急性起病,表现为高热、头昏头痛,意识障碍,同时伴有肝功能异常,累及两系以上血象异常,C-反应蛋白明显升高,外周血涂片均找到恶性疟原虫;予以青蒿琥酯等治疗患者痊愈,其中1例出院后因未服用伯安喹而引起复燃,再次治疗有效。结论成人恶性脑型疟疾在我国多为输入性感染,临床易误诊,有必要反复血涂片找疟原虫以便于确诊;该病起病迅速,病情进展快,及时有效抗疟疾治疗病情恢复快,治疗效果好。     

江苏省近二年输入性恶性疟个案分析

目的 通过对江苏省近二年输入性恶性疟的个案分析，研究该病的流行特征。方法 对江苏省近二年38例输入性恶性疟病例的个案资料进行回顾性调查和分类统计。结果 38例输入性恶性疟病例均为从非洲高疟区回归人员，有明确的疫区生活史，全年都可发病，无明显的发病高峰，部分患者临床症状不典型。结论 加强对到非洲高疫区劳务输出人员的疟防自我保护意识，临床医生对从高疟区回归人员不明原因发热应首先考虑恶性疟，要求镜检人员有较高的疟原虫检出能力。     

输血传播恶性疟疾实验室检测和溯源分析——附报告1例

目的通过对有输血史的恶性疟疾感染者进行检测和溯源分析,确定其传染源和传播方式。方法对患者和为其输血的8名献血者血样进行疟疾快速检测、血涂片镜检和Real-time PCR检测,并对阳性血样进行分子溯源和基因分型。结果患者与1名非洲返乡献血者在疟疾快速诊断试剂检测、血涂片镜检和Real-time PCR 3项检测中,均显示为恶性疟阳性。两者血样SSU rRNA基因序列两两比对后同源性为100%,Pf EMP-1基因分型显示受血者和献血者血样均为恶性疟原虫K1型和MD20型混合感染。确定该患者的恶性疟确因输入非洲返乡献血者的血液而感染。讨论由于我国未将疟疾筛查列入献血前检测,因此境外返乡人员在疟疾潜伏期或复发期内参加献血易引起输血传播疟疾。采供血机构需仔细征询既往病史和外出史,并加强宣教,将经血传播的疾病控制在源头。     

疟疾患者骨髓片与血片疟原虫阳性率比较

恶性疟疾是迄今为止全世界最为严重的热带虫媒传染病之一,也是WHO规定的国际间检测传染病之一.我国曾将疟疾发病控制在较低水平[1],近年来随着赴非洲务工人员的增加,本地输入性恶性疟疾亦明显增加.输人性恶性疟疾易误诊,如得不到及时治疗,易转为危重症[2].因此,及时、准确的诊断对有效治疗疟疾及控制其流行具有重要意义[3].检出疟原虫是疟疾明确诊断的最直接证据.目前最常用的是显微镜检查法,现将我院近年收治的疟疾患者骨髓片与血片显微镜检查疟原虫阳性率比较汇报如下.     

北京地区境外输入性恶性疟疾临床分析——附99例报告

目的:探讨北京地区输入性恶性疟疾的临床特点及其诊断与治疗.方法:时99例输入性恶性疟疾患者的临床资料进行数理分析.结果:99例均有疟疾流行区居住史,临床表现复杂多样,其中发热99例(100%)、畏寒90例(90%)、头痛28例、呕吐25例、肌肉疼痛23例、腹泻21例、烦躁不安17例、贫血13例、肝肿大10例、脾肿大43例(43%)、双下肢水肿8例.21例早期误诊,误诊率为21%(21/99).43例给予氯喹治疗,其中16例经治疗无效,加用蒿甲醚治疗;41例应用双氢青蒿素加蒿甲醚治疗;15例应用蒿甲醚加双氢青蒿素哌喹治疗.99例全部治愈,治愈率为100%.3例出现再燃(3%).结论:恶性疟疾早期临床表现复杂,易误诊,临床上遇见有恶性疟疫区居住史的发热患者,应及时行血涂片或骨髓穿刺检查,以免延误诊治.使用青蒿素衍生物治疗恶性疟疾效果好,可作为首选药物.     

2015年全球疟疾防控概况

疟疾是由疟原虫引起的寄生虫病,通过传播媒介雌性按蚊叮咬传播给人类.人类疟疾疟原虫有5种,其中恶性疟原虫和间日疟原虫威胁最大,最难防治.恶性疟原虫在非洲大陆最普遍,而且全球疟疾死亡最多的是恶性疟.间日疟分布比恶性疟广泛,除了非洲,许多热带和亚热带国家都是间日疟占优势.     

2014-2018年山西省疟疾疫情分析

目的为了解2014-2018年山西省输入性疟疾的流行病学特征,评价疟疾监测系统的敏感性,防止疟疾再传播、减少疟疾重症和死亡病例的发生,为制定科学、有效的策略与措施提供依据。方法收集2014-2018年山西省输入性疟疾病例资料,所有病例按血涂片疟原虫形态检查结果分为恶性疟、间日疟、三日疟、卵形疟或混合感染,并对所收集的资料进行统计和分析。结果共报告疟疾75例,均为输入性病例。其中恶性疟53例、间日疟13例、卵形疟5例、三日疟和混合感染各2例。病例以男性为主,占总病例数的94.67%(71/75)。21~50岁年龄组病例数最多,达85.33%(64/75),病例主要职业为工人/农民,占54.67%(41/75)。输入性病例全年均有分布,并且无明显发病高峰。报告病例感染来源以非洲为主,占90.67%。从发病到就诊间隔时间和从就诊到诊断间隔时间中位数分别为3 d和2 d。结论 2014-2018年山西省疟疾病例均为境外输入病例,加强对非洲地区和东南亚地区返乡人员的疟疾监测,及时发现和治疗输入性病例。     

2017-2020年江西省境外输入性恶性疟原虫的抗药性基因多态性研究

目的 了解2017—2020年江西省境外输入性恶性疟原虫的抗药性情况,为临床用药提供技术支撑。方法 收集2017—2020年江西省输入性恶性疟病例的血液样本,采用巢式PCR方法,对样本抗药性基因进行扩增并测序。结果 共收集到输入性恶性疟病例血液样本85份,均为非洲输入。测序分析得出,恶性疟原虫氯喹抗性转运蛋白基因和多药抗性基因1突变比例较低,为16.67%(14/84)和1.18%(1/85),而二氢叶酸还原酶基因突变比例很高,为96.39%(80/83),未发现Kelch螺旋体蛋白基因的突变。结论 近几年江西省境外输入性恶性疟病例均来自非洲,且恶性疟原虫对氯喹的抗药性较低,可以结合临床实验,考虑用氯喹联合其他药物治疗非洲输入恶性疟病例的可能方案;对乙胺嘧啶抗药性较高,未发现青蒿素抗性株,但因为近2年受新型冠状病毒感染疫情影响,样本量少,不能排除江西省无青蒿素抗性株,需继续监测。     

1例输入性恶性疟疾患者的护理

恶性疟疾是由恶性疟原虫感染，经按蚊叮咬传播的寄生虫病，高发于非洲热带地区，常以畏寒、发热、头痛为首发症状，并发症多，若不及时治疗，可危及生命。该病在我国现已罕见，但随着国际交往的日趋频繁，易出现输入性感染。现将本院2007年8月收治的1例恶性疟疾报告如下。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.