双歧三联活菌联合重组人干扰素α1b对轮状病毒性肠炎患儿肠道菌群和心肌酶谱的影响

目的分析双歧三联活菌联合重组人干扰素α1b对轮状病毒性肠炎患儿肠道菌群和心肌酶谱的影响。方法选择2017年1月-2018年6月接诊的100例轮状病毒性肠炎患儿,采用随机数字表分为两组,每组50例。对照组采用双歧三联活菌治疗,观察组采用双歧三联活菌联合重组人干扰素α1b治疗。比较治疗1周后疗效、退热时间、止泻时间、纠正脱水时间、住院时间、治疗前后肠道菌群数量和心肌酶谱、治疗期间不良反应。结果观察组患儿总有效率显著高于对照组(P0.05)。观察组患儿退热时间、止泻时间、纠正脱水时间、住院时间均显著短于对照组(均P0.05)。治疗前,两组患儿肠道菌群数量、心肌酶谱比较差异均无统计学意义(均P0.05);治疗后,两组患儿肠道菌群数量、心肌酶谱比较差异均有统计学意义(均P0.05)。与治疗前比较,两组患儿治疗后肠道双歧杆菌、乳杆菌数量均显著升高(均P0.05),大肠埃希菌数量显著降低(P0.05),肌酸激酶、乳酸脱氢酶、肌酸激酶同工酶均显著降低(均P0.05)。两组患儿不良反应发生率比较差异无统计学意义(P0.05)。结论双歧三联活菌联合重组人干扰素α1b治疗小儿轮状病毒性肠炎疗效确切,可改善患儿肠道菌群数量,减轻心肌损伤,安全性高,值得临床推广使用。     

双歧三联活菌在小儿湿疹中的临床应用价值分析

目的 探讨双歧三联活菌在小儿湿疹患儿中的临床应用价值.方法 分析2016年1至12月在西北妇女儿童医院接受诊治的306例小儿湿疹患儿的临床资料.将入选者随机分成观察组(双歧三联活菌+盐酸西替利嗪滴剂)和对照组(单纯盐酸西替利嗪滴剂),每组153例.比较两组患儿的一般资料、治疗前后的肠道菌群、T淋巴细胞亚群水平、治疗后的临床疗效及复发率.结果 两组患儿的一般资料均无明显统计学差异(均P>0.05).治疗前两组患儿的肠道菌群及T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)水平均无明显统计学差异(均P>0.05);治疗后,观察组患儿的乳酸杆菌与双歧杆菌含量、CD4+及CD4+/CD8+水平明显高于对照组,CD8+水平均明显低于对照组(t值分别为13.81、19.76、13.93、11.80和24.67,均P<0.05);观察组患儿治疗后的乳酸杆菌与双歧杆菌含量均明显较治疗前增加(t值分别为14.73、21.38,均P<0.05);两组患儿治疗后的CD4+及CD4+/CD8+水平明显较治疗前升高,CD8+水平均明显较治疗前降低(观察组t值分别为27.07、27.87、78.20,对照组t值分别为14.64、11.60、76.34,均P<0.05).观察组患儿治疗后的总有效率(90.8%)明显高于对照组(80.4%),χ2=6.795,P=0.01.观察组患儿的复发率(9.8%,15/153)明显低于对照组(25.5%,39/153),χ2=12.95,P<0.01.结论 小儿湿疹采用双歧三联活菌辅助治疗的临床疗效突出,治疗后患儿免疫功能及T淋巴细胞亚群均得以改善,且疾病复发风险较小,值得推广.     

布拉酵母菌辅助治疗小儿轮状病毒性肠炎的疗效及对患儿肠道菌群的影响

目的研究布拉酵母菌辅助治疗小儿轮状病毒性肠炎对肠道菌群的影响,旨在为该病临床治疗提供相关参考。方法纳入2016年9月-2019年10月浙江萧山医院收治的90例轮状病毒性肠炎患儿随机分为观察组和对照组各45例,其中对照组患儿接受常规基础治疗,观察组患儿在对照组治疗基础上加用布拉酵母菌治疗。对比两组治疗效果,分析两组治疗前、后菌群变化(包括大肠埃希菌、乳酸杆菌、双歧杆菌及大肠杆菌),比较两组治疗前、后炎症因子及免疫指标CD4~+、CD8~+、白细胞介素-2 (IL-2)、IL-10变化情况,并对比两组不良反应发生率。结果观察组患儿治疗总有效率91.11%显著高于对照组患儿的73.33%,差异有统计学意义(P0.05)。两组治疗后大肠埃希菌、乳酸杆菌、双歧杆菌数量均显著高于治疗前,差异有统计学意义(P0.05),大肠杆菌与治疗前比较差异无统计学意义(P0.05);观察组治疗后大肠埃希菌、乳酸杆菌、双歧杆菌数量均显著高于对照组,差异有统计学意义(P0.05),而大肠杆菌数量与对照组比较差异无统计学意义(P0.05)。两组患儿治疗后CD4~+及IL-2水平显著高于治疗前,IL-10显著低于治疗前,差异有统计学意义(P0.05),CD8~+与治疗前比较差异无统计学意义(P0.05);观察组治疗后CD4~+及IL-2水平显著高于对照组,IL-10水平显著低于对照组,差异有统计学意义(P0.05),CD8~+水平与对照组比较差异无统计学意义(P0.05)。观察组不良反应发生率为8.89%,对照组不良反应发生率为11.11%,两组比较差异无统计学意义(P0.05)。结论布拉酵母菌用于辅助治疗小儿轮状病毒性肠炎对调节肠道菌群平衡、增强免疫具有重要临床价值,且安全性良好值得临床推广。     

布拉酵母菌散联合双歧杆菌四联活菌片治疗小儿轮状病毒性胃肠炎效果分析

目的探讨布拉酵母菌散联合双歧杆菌四联活菌片治疗小儿轮状病毒性胃肠炎的临床疗效和应用价值。方法以本院2014年12月—2015年12月进行治疗的98例小儿轮状病毒性胃肠炎患儿作为研究对象,随机均分为两组各49例,对照组给予常规治疗,观察组给予布拉酵母菌散联合双歧杆菌四联活菌片联合治疗,比较临床疗效。计量资料比较采用t检验,计数资料比较采用χ2检验,P0.05为差异有统计学意义。结果观察组患儿总有效率为93.88%;对照组为79.59%,两组患儿总有效率比较,差异有统计学意义(χ2=4.346,P0.05)。观察组患儿治疗后白细胞介素-6、肿瘤坏死因子-α[(9.31±2.03)、(8.78±1.79)pg/ml]优于对照组[(17.37±4.13)、(16.84±4.09)pg/ml],差异均有统计学意义(均P0.05)。治疗前后两组患儿的白细胞介素-6、肿瘤坏死因子-α比较,差异均有统计学意义(t=19.639、10.190、23.586、12.494,均P0.05)。与对照组比较[(40.01±3.12)、(27.69±1.03)%、(1.46±0.24)],观察组患儿治疗后CD4~+、CD8~+、CD4~+/CD8~+[(44.82±4.58)、(24.11±0.44)%、(1.68±0.37)]显著变化,差异均有统计学意义(均P0.05);治疗前后两组患儿CD4~+、CD8~+、CD4~+/CD8~+比较,差异均有统计学意义(t=13.720、9.446、24.669、10.857、9.249、7.950,均P0.05)。结论布拉酵母菌散联合双歧杆菌四联活菌片治疗小儿轮状病毒性胃肠炎的效果可靠,可有效减轻炎症反应,提升患儿免疫功能。     

消旋卡多曲(颗粒)双歧杆菌(三联胶囊)联合治疗小儿轮状病毒性肠炎疗效观察

目的:研究小儿轮状病毒性肠炎应用消旋卡多曲颗粒联合双歧杆菌三联胶囊治疗的临床疗效.方法:将在我院诊治的轮状病毒性肠炎患儿99例作为研究对象,并将其分为甲(常规治疗)、乙(常规治疗+双歧杆菌三联胶囊)、丙(常规治疗+消旋卡多曲颗粒+双歧杆菌三联胶囊)三组,对比分析每组患儿临床疗效与患儿腹泻改善时间.结果:乙组、丙组患者的大便次数、大便性状恢复时间以及呕吐停止时间均显著短于甲组,三组组间差异明显(p<0.05),在临床疗效方面乙组与丙组显著高于甲组,三组组间差异明显(p<0.05).结论:消旋卡多曲联合双歧杆菌联合治疗小儿轮状病毒性肠炎,能在短时间改善患者症状,缩短患者腹泻时间,疗效显著.     

罗伊氏乳杆菌对轮状病毒感染肠炎患儿免疫功能与肠道菌群及临床疗效的影响

目的探究罗伊氏乳杆菌DSM 17938在治疗轮状病毒感染肠炎患儿中的疗效及对免疫功能、肠道菌群的影响。方法收集于2018年2月-2019年2月在阳光融和医院进行诊治的轮状病毒感染肠炎患儿126例,随机分为试验组(63例)和对照组(63例)。对照组给予常规补液治疗及蒙脱石散和枯草杆菌二联活菌口服治疗,试验组采用常规补液治疗及蒙脱石散和罗伊氏乳杆菌DSM 17938辅助治疗。观察两组患儿的腹泻改善情况,并分析对免疫功能(IgG、IgA、CD4^+/CD8^+水平)及肠道菌群失调的影响。结果在治疗72 h后,试验组患儿的治疗总有效率为92.06%,高于对照组的74.60%(P=0.009);且治疗后两组患儿的IgG、IgA、CD4^+/CD8^+水平均较治疗前有升高(P<0.05),且试验组水平高于对照组(P<0.05)。对患儿肠道菌群进行分析,在治疗1周后,试验组患儿肠道菌群失调程度低于对照组,且试验组的肠道菌群正常比例高于对照组(P<0.05)。结论罗伊氏乳杆菌DSM 17938对于辅助治疗轮状病毒感染肠炎患儿具有良好的疗效,能够提高患儿免疫力,改善肠道菌群失调,减轻患儿腹泻症状,具有一定的临床应用价值。     

布拉氏酵母菌对小儿腹泻总病程的影响及可能的机制研究

目的研究布拉氏酵母菌对小儿腹泻总病程的影响及其可能的机制。方法纳入2013年1月-2017年1月该院90例小儿腹泻患儿作为研究对象,随机抽签分为两组,每组各45例。观察组行布拉氏酵母菌干预,对照组常规治疗。观察两组临床治愈时间及复发率,分别采用酶联免疫吸附法(ELISA)和免疫荧光标记法检测血清白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及白介素-10(IL-10)和CD3~+、CD4~+、CD8~+及CD4~+/CD8~+水平,比较两组患儿治疗前后肠道菌群变化情况。结果观察组患儿临床治愈时间显著短于对照组(P=0.000)。观察组患儿出院半年复发2例,对照组5例,两组复发率比较差异无统计学意义(P0.05)。两组治疗后IL-8、TNF-α及IL-10水平较治疗前均显著降低(P0.05),观察组治疗后IL-8、TNF-α及IL-10水平显著低于对照组(P0.05)。观察组治疗后CD3~+、CD4~+及CD4~+/CD8~+显著高于治疗前和对照组(P0.05),CD8~+显著低于治疗前和对照组(P0.05),对照组治疗前后CD3~+、CD4~+、CD8~+及CD4~+/CD8~+差异无统计学意义(P0.05)。观察组治疗后肠杆菌显著低于治疗前和对照组(P0.05),肠球菌、双歧杆菌及乳杆菌均显著高于治疗前和对照组(P0.05),对照组治疗前后差异无统计学意义(P0.05)。结论布拉氏酵母菌用于小儿腹泻能显著缩短患儿病程,这可能与布拉氏酵母菌能抑制炎症反应、改善免疫功能,恢复肠道菌群平衡有关。     

双歧杆菌四联活菌片对轮状病毒性肠炎患儿血清IL-6、TNF-α表达的影响

目的探讨双歧杆菌四联活菌片对轮状病毒性肠炎儿童血清白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)表达的影响。方法选取2015年5月-2017年5月温岭市第一人民医院收治的124例轮状病毒性肠炎患儿为研究对象,按照随机数字表法将患者分为两组,每组各62例,观察组患儿接受常规补液、抗病毒、纠正酸碱失衡、水电解质紊乱、饮食指导等治疗方案;观察组在此基础上加用双歧杆菌四联活菌片。比较两组患儿症状缓解、病毒转阴时间、血清IL-6、TNF-α水平、心肌酶指标及临床疗效。结果对照组患儿临床治愈10例,显效17例,有效16例,无效19例,总有效率69.35%;观察组治愈26例,显效18例,有效12例,无效6例,总有效率仅为90.32%,观察组总有效率明显高于对照组(χ~2=14.471,P=0.000);观察组患儿粪便轮状病毒转阴时间、退热时间、大便性状及次数恢复正常的时间明显少于对照组(均P0.05);治疗前两组患儿血清IL-6、TNF-α的比较,差异无统计学意义(均P0.05);治疗3 d、7 d后,观察组患儿的血清IL-6、TNF-α水平均低于对照组(均P0.05);治疗前两组患儿的心肌酶指标CK-MB、LDH、HBDH的比较,差异无统计学意义(均P0.05);治疗后观察组患儿的血清CK-MB、LDH、HBDH水平均低于对照组(均P0.05)。结论联合应用双歧杆菌四联活菌片,能较快地缓解轮状病毒性肠炎患儿的临床症状,降低血清IL-6、TNF-α及心肌酶水平,最终提高临床疗效。     

消旋卡多曲颗粒联合双歧杆菌三联胶囊治疗小儿轮状病毒性肠炎疗效观察

目的观察消旋卡多曲颗粒联合双歧杆菌三联胶囊治疗小儿轮状病毒性腹泻的临床疗效。方法选取定西市临洮县人民医院门诊收治的轮状病毒感染的急性腹泻患儿99例,随机分为三组:对照组(A组);双歧杆菌组(B组)在常规对症治疗的基础上给予双歧杆菌三联胶囊治疗;联合治疗组(C组)除给予双歧杆菌三联胶囊外,再给予消旋卡多曲颗粒。每组各33例。观察各组患儿腹泻症状改善时间及临床疗效。结果 B组和C组患儿呕吐停止时间、大便性状恢复正常时间和大便次数恢复正常时间、病毒转阴时间均短于A组(P0.01),且B组与C组比较差异有统计学意义(P0.05);三组患儿治疗后第3天、第5天、第7天病毒转阴率经比较差异有统计学意义(P0.01);A组、B组和C组治疗有效率分别为78.8%、90.9%、100.0%,三组比较差异有统计学意义(χ~2=1.33,P0.01)。结论通过常规对症治疗相比,消旋卡多曲颗粒联合双歧杆菌三连胶囊治疗婴幼儿轮状病毒性腹泻,能明显改善症状,缩短腹泻总病程。     

西沙必利对小儿便秘合并肺部感染患儿炎症因子及免疫水平的影响

目的探讨西沙比利对小儿便秘合并肺部感染患儿炎症因子和免疫水平的影响。方法选择2015年5月-2017年3月医院儿科收治的小儿便秘合并肺部感染患儿120例,随机数字法分为对照组和研究组,每组60例。对照组采用双歧杆菌三联活菌胶囊治疗,研究组在对照组基础上联合西沙比利治疗,采用酶联免疫吸附试验测定两组患儿治疗前后白介素-8(IL-8)、白介素-10(IL-10)及单核细胞核因子(NF-kB)水平;采用流式细胞计数仪测定外周血T淋巴细胞亚群水平,观察两组患儿治疗效果。结果研究组患儿疗效率为95.00%,高于对照组的81.67%,两组比较差异有统计学意义(χ2=5.175,P=0.023);治疗后两组炎症因子水平均降低(P<0.05);且研究组治疗后降低幅度均优于对照组(P<0.05);研究组与对照组治疗后免疫水平均高于治疗前(P<0.05),且研究组治疗后CD4+、CD8+、CD4+/CD8+比值升高幅度均优于对照组(P<0.05)。结论西沙比利用于小儿便秘合并肺部感染患儿中优于双歧杆菌三联活菌胶囊,有助于提高临床疗效,降低炎症因子,改善机体免疫水平,值得推广应用。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.