Churg-Strauss syndrome associated with HIV infection

A 28-year-old woman with a history of asthma and recent deep venous thrombosis presented with fever, chest pain, and peripheral eosinophilia. The patient was subsequently diagnosed with Churg-Strauss syndrome and HIV infection, representing to our knowledge only the second case of this association. Rheumatologic manifestations of HIV may precede clinical signs of infection. This is significant because steroidal and cytotoxic therapy may potentially worsen HIV infection. As the prevalence of HIV infection rises, there may be atypical presentations of various rheumatologic syndromes. The following case demonstrates a patient whose initial presentation for HIV infection was Churg-Strauss syndrome.     

妊娠合并骨髓异常增生综合征1例

骨髓增生异常综合征（ MDS）是起源于造血干细胞的一组异质性髓系克隆性疾病,病理学表现为髓系细胞分化及发育异常,临床表现为无效造血、难治性血细胞减少、造血功能衰竭,高风险向急性髓系白血病（ AML）转化。 MDS治疗主要集中于两类问题：骨髓衰竭及并发症、AML转化。对于不同的患者而言,MDS患者自然病程和预后的差异性很大,治疗宜个体化。     

A boy with Churg-Strauss syndrome and thrombosis associated with eosinophilia

A 13-year-old boy, recently diagnosed as having Churg-Strauss syndrome, presented with a thrombus at the level of the aortic bifurcation. Echocardiography revealed a left-ventricular thrombus as well. He was treated by means of surgical thrombectomy, corticosteroids, heparinisation and a coumarine derivative. Eosinophilia (an increase in the number of eosinophilic granulocytes in the circulation or tissues) occurs in various diseases, such as allergic diseases, parasitic infestations, haematologic diseases and autoimmune diseases like the rare Churg-Strauss syndrome. It appears likely that eosinophilia played an important role in the development of both thrombi in the described patient. Eosinophils produce cationic proteins that may inhibit the effect of natural anticoagulants. Infiltration of eosinophils may also cause endocardial damage with the subsequent formation of intracardial thrombi.     

急性冠脉综合症患者介入术后护理体会

目的通过对急性冠脉综合症介入术后有效护理,观察护理疗效。方法回顾我院2011年1月-12月间收治急性冠脉综合症患者84例,随机分为观察组和对照组,运用不同护理方法观察护理效果。结果通过两组不同护理后,两组各并发症对比,差异不大,P>0.05,对照组出现18例并发症患者,占对照组42.86%,观察组只出现5例并发症患者,占观察组总人数11.90%。结论合理有效预防护理,可以有效降低并发症发生几率、促使尽早出院,还可以减轻患者经济负担、减轻患者的心理痛苦、保证手术成功率,也可以有效提高患者家属满意度,值得临床进一步推广     

心电图与冠状动脉造影诊断急性冠状动脉综合征相关病变血管的对比研究

目的观察急性冠状动脉综合征(ACS)患者心电图(ECG)与冠状动脉造影(CAG)结果的关系。方法对107例由急诊科收入院的ACS患者的ECG及CAG结果进行分析。结果(1)不稳定型心绞痛及非ST段抬高的急性心肌梗死患者血管病变情况复杂,单支、2支、3支病变均占一定比例;急性前壁心肌梗死单支病变以左前降支病变为主,2支以上病变均包含左前降支病变;急性下壁心肌梗死单支病变以右冠状动脉病变为主,2支以上病变均包含右冠状动脉病变。(2)ST段抬高的急性心肌梗死与非ST段抬高的急性心肌梗死单支病变发病率差异无统计学意义(36%vs28%,P>0.05),2支以上病变发病率差异也无统计学意义(64%vs63%,P>0.05)。(3)<65岁组单支病变发病率明显高于≥65岁组(46%vs18%,P<0.01),<65岁组2支以上病变发病率明显低于≥65岁组(48%vs78%,P<0.01)。(4)ECG诊断ACS相关病变血管的特异度为100.0%,敏感度为33.3%。结论ST段抬高的急性心肌梗死患者ECG能基本确定相关病变血管,而非ST段抬高的急性心肌梗死及不稳定型心绞痛患者ECG不易确定相关病变血管,应尽早行CAG检查明确诊断;年龄越大,患者冠状动脉病变情况越复杂,亦应尽早行CAG检查。     

代谢综合征相关因素对子痫前期预测价值探讨

目的研究代谢综合征的相关因素与子痫前期的关系,建立合理的评分系统对妊娠不同阶段进行评估预测,降低子痫前期的发生和发展。方法将2012年1至6月在甘肃省妇幼保健院定期产检并分娩的单活胎妊娠孕妇221例,分为子痫前期组85例,正常妊娠对照组136例,分别在孕14～20周、分娩前1周内两个时间段空腹测定血糖、甘油三脂、高密度脂蛋白。结果与对照组相比,子痫前期组中患者身体质量指数（t＝5．211,P＝0．000）增加,空腹血糖（t＝4．003,P＝0．000）、血清甘油三脂水平（t＝2．995,P＝0．001）升高、高密度脂蛋白（t＝3．005,P＝0．001）下降。子痫前期组和对照组中身体质量指数＞31kg/m2者分别占68．2％和26．5％,甘油三脂＞3．42mmol/L分别占72．9％和32．4％,空腹血糖＞5mmol/L分别占35．3％和18．4％,高密度脂蛋白＜1．24mmol/L分别占37．6％和21．3％;代谢性指标评分≥2分的比例分别为65．9％和19．1％,两组比较差异均有统计学意义（均P＝0．000）。结论通过识别代谢指标紊乱可以早期识别子痫前期高危人群,对于代谢性指标评分≥2分者应给予预防建议,有望降低子痫前期的发病率。     

多ADP-核糖聚合酶Val762Ala多态性与急性冠状动脉综合征的关系

目的探讨多ADP-核糖聚合酶[poly(ADP-ribose)polymerase,PARP]单核苷酸多态性位点Val762Ala基因多态性与急性冠状动脉综合征(acute coronary syndrome,ACS)的关系。方法选择2007年7月—2008年4月经冠状动脉造影确诊的ACS患者84例为病例组和非ACS患者87例为对照组,检测两组PARP的表达,并采用Se-quenom公司MassARRAY时间飞行质谱生物芯片系统单核苷酸多态性基因型分析技术对其进行PARP基因单核苷酸位点Val762Ala基因分型。比较两组间Val762Ala的基因型分布。结果定量分析可见病例组血浆PARP水平明显高于对照组(P0.05)。Val762Ala位点成功分型率为98.5%,病例组与对照组TC+CC基因型频率分别为86.9%和20.7%,两组差异有统计学意义(P0.05)。结论 PARP水平与冠状动脉粥样斑块稳定性有相关性,可能是致冠状动脉斑块破裂的重要原因之一。Val762Ala多态性与粥样硬化斑块破裂可能存在相关性。     

儿童噬血细胞综合征发病机制研究进展

噬血细胞综合征,又称噬血细胞性淋巴组织细胞增生症,是由多种病因引起的自身免疫系统功能发生紊乱而导致的一组临床征候群,主要与细胞毒T淋巴细胞(CTL)和自然杀伤细胞(NK细胞)的细胞毒效应显著降低,不能及时有效清除病毒等抗原,进而导致CTL和巨噬细胞异常持续活化和增生异常有关.其病理生理机制是由于免疫功能缺陷和/或免疫调节功能异常,使自身淋巴细胞和组织细胞过度活化,发生快速、严重的炎性反应,以高热、肝脾肿大、全血细胞减少、肝功能和凝血功能障碍为临床特征.噬血细胞综合征的发病机制尚未完全明确,其起病急骤,进展迅猛,病死率高,临床表现往往相对复杂.临床上噬血细胞综合征的发病人群多以儿童为主,易被误诊或延误治疗时机,极易导致患儿死亡.该文对儿童噬血细胞综合征近年的发病机制进展做一综述.     

Potential factors associated with fruit and vegetable intake after premature acute coronary syndrome: a prospective cohort study

Abstract

Studies on dietary changes and their associated factors are limited, particularly with respect to younger cardiovascular patients. Our objective was to evaluate the factors associated with fruit and vegetable intake among adults with premature acute coronary syndrome (ACS) 1 year after the event. We used data from GENESIS-PRAXY, a multicentre prospective study of adults aged 18–55 years, hospitalised for ACS. Participants were 704 adults from 24 centres in Canada, 1 in USA and 1 in Switzerland. Data were collected through questionnaires and chart reviews at baseline and 1 year post-ACS. Fruit and vegetable intake was low among adults with premature ACS, and remained suboptimal at 1 year post-ACS, with only 21% meeting the minimum recommendations of at least 5 daily servings. The findings suggest that patient lifestyle characteristics, such as the number of hours spent at work and baseline intake are factors that may be associated with the intake of fruits and vegetables. More research is needed to assess effective strategies to increase fruit and vegetable intake among patients with premature ACS so that they meet dietary recommendations.     

DuoPAP联合InSurE治疗早产儿呼吸窘迫综合征的临床分析

目的 探讨经鼻双水平正压通气(DuoPAP)联合气管插管-肺表面活性物质-拔管(InSurE)技术治疗早产儿呼吸窘迫综合征(RDS)的疗效.方法 选取2015年1至12月泰安市妇幼保健院新生儿科收住的确诊为新生儿呼吸窘迫综合征(NRDS),且出生6h内需要无创呼吸支持的79例早产儿作为研究对象.DuoPAP组(39例)应用InSurE策略后给予DuoPAP治疗;NCPAP组(40例)应用InSurE策略后给予NCPAP治疗.记录所有患儿治疗后的血气变化及氧合指数(OI),以及患儿72h内再次插管机械通气率、无创呼吸支持时间、住院天数、住院费用、并发症等的发生情况,并对结果进行分析.结果 DuoPAP组的动脉氧分压(PaO2)、氧合指数(OI)、pH在2h(t值分别为5.721、6.175、2.188)、12h(t值分别为3.370、2.010、2.090)均高于NCPAP组(均P<0.05).DuoPAP组二氧化碳分压(PaCO2)在2h(t=-3.092)、12h(t=-2.868)、24h(t=-4.427)均低于NCPAP组(均P<0.05),在48h和72h差异均无统计学意义(均P>0.05).DuoPAP组总无创呼吸支持时间(t=8.437)、72h内再次插管有创呼吸支持率(χ2=5.785)、重复使用肺表面活性物质(PS)的比率(χ2=5.785)、总住院时间(t=2.258)、总住院费用(t=5.507)均低于NCPAP组(均P<0.05).DuoPAP组与NCPAP组的并发症及死亡率差异均无统计学意义(均P>0.05).DuoPAP组与NCPAP组在恢复出生体重时间、全肠道喂养时间、体重增长率方面差异均无统计学意义(均P>0.05).结论 DuoPAP联合InSurE技术治疗早产儿RDS能更好地改善气体交换,在最大程度上避免了有创通气,从而减少了住院时间及上机时间,缩短了住院天数,降低了医疗费用.DuoPAP与InSurE技术联合应用能更大限度地发挥PS的作用,减少患儿对额外PS的需求.     

老年急性冠脉综合征23例临床分析

目的 提高急性冠脉综合征(ACS)抢救成功率。方法 将某部队2001年师以上离退休干部年龄在60岁以上患急性冠脉综合征23例门诊急诊就医及转归情况进行分析。结果不稳定心绞痛(UAP)20例，急性心肌梗死(AMI)3例，其中再梗死1例。经皮腔内冠脉成形术(PTCA) 支架植入术3例，支架植入术后冠状动脉搭桥术1例，冠状动脉搭桥术4例。结论 认识缺血性胸痛，及时诊断，早期处理是提高ACS抢救成功率的关键。     

Early predictors of chronic work disability associated with carpal tunnel syndrome: a longitudinal workers' compensation cohort study

BACKGROUND: The study objectives were to identify early predictors of chronic work disability associated with carpal tunnel syndrome (CTS) and to test the hypothesis that variables from each of several domains (sociodemographic, clinical, work-related, and psychosocial) would add unique predictive information. METHODS: Washington State workers were interviewed 18 days (median) after submitting a new workers' compensation claim for CTS. Baseline predictors of chronic work disability (> or =180 days of work disability compensation in the year after claim submission) were examined for workers who had at least 1 day of disability compensation (N = 899). RESULTS: Baseline demographic variables, symptom severity, functional limitations, lack of job accommodation, job physical demands, job psychosocial conditions, and worker psychosocial characteristics predicted chronic disability bivariately. Each domain of variables added significantly to the prediction of chronic disability. The final multivariable model had fair ability to discriminate individuals with versus without chronic disability (cross-validated area under the ROC curve = 0.76). CONCLUSIONS: Sociodemographic, clinical, work-related, and worker psychosocial factors early in a claim contribute unique information to the prediction of subsequent work disability associated with CTS.     

香烟烟雾溶液对人淋巴细胞的损伤及修复

目的　了解香烟烟雾溶液作用于人淋巴细胞后DNA的损伤及修复状况。方法　以 8× 10 - 3 支 /ml香烟烟雾溶液作用于正常人淋巴细胞 ,用彗星试验检测 0 ,0 5,1,2 ,3 ,4,5,6h时点细胞的DNA损伤状况。结果　与 0h组相比 ,2h至 6h组彗星尾长均显著增长 (P <0 0 0 1) ,3h达到最长 ,之后逐渐降低 ,但到 6h未恢复至正常水平。结论　香烟烟雾溶液能直接引起人淋巴细胞的DNA损伤 ,且细胞能在一定程度上修复这种损伤     

急性冠状动脉综合征合并低T3综合征的临床特点分析

目的 探讨急性冠状动脉综合征(ACS)合并低T3综合征的临床特点及其与预后的相关性.方法 选择ACS合并低游离三碘甲腺原氨酸(FT3)水平的住院患者87例(低FT3组),另外选择64例FT3水平正常的ACS患者作为对照组,均行冠状动脉造影检查.抽取患者空腹静脉血检测FT3、N-末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白Ⅰ(cTnI)、超敏C反应蛋白(hs-CRP)水平;记录两组单支病变、2支病变与多支病变的患者数量.结果 与对照组比较,低FT3组NT-proBNP、cTnI及hs-CRP均显著升高[(1242.14±226.32) ng/L比(1126.36±195.55) ng/L,(0.92±0.23) ng/L比(0.84±0.19) ng/L,(6.46±2.25) mg/L 比(5.71±1.78) mg/L](P＜ 0.01或＜0.05).两组FT3水平均与NT-proBNP、cTnI及hs-CRP呈显著负相关(P＜0.05).两组冠状动脉病变数量比较差异无统计学意义(x2=4.512,P=0.105).结论 ACS患者血清FT3水平与病情的严重程度有良好相关性,与冠状动脉病变数量无明显相关性,对预后有一定预测价值.     

机械通气治疗新生儿呼吸窘迫综合征75例

目的:探讨机械通气治疗新生儿呼吸窘迫综合征(NRDS)的有效性及临床价值。方法:对75例NRDS患儿进行机械通气治疗。结果:75例NRDS患儿中治愈50例(66.7%),死亡18例(24.0%),放弃治疗7例。较用头罩吸氧治疗NRDS有显著性差异。2000～2003年NRDS治愈率(77.8%)较1996～1999年NRDS治愈率(50.0%)明显升高;2000～2003年机械通气并发症较前4年亦明显降低。结论:以机械通气为主的综合治疗是提高NRDS抢救成功率的重要措施。     

Exclusive adult lesbianism associated with Turner's syndrome mosaicism

A case of exclusive adult lesbianism and manic-depressive illness associated with Turner's syndrome mosaicism is reported. Turner's syndrome women are described as hyperfeminine without problems in gender identity, gender role, or arousal pattern. Adult lesbianism has never previously been reported in these women. The significance of lesbianism in association with Turner's syndrome mosaicism is discussed.     

香港社区SARS流行因素的研究

目的评价流行病学相关因素对香港社区SARS流行的影响。方法采用构筑式多元逐步回归法和Logistic回归法评估各种因素对香港社区SARS流行的影响。这些因素包括气象、时间（流行天数）、各类SARS病例、干预措施和医院感染等。2003年3月11日至2003年5月22日香港暴发SARS期间每日各类病例资料来源于香港卫生署和香港大学医学院数据库，每日气象数据由香港天文台提供。结果在消除其他因素的可能影响后，日平均气温每上升1℃，香港社区居民SARS每日病例可能下降约1．6例。ICU的SARS病例数占全部累计SARS病例数的比例每增加10％。社区居民的SARS病例约增加7．6例。ICU的SARS病例数与每日确诊的医护人员病例数的相乘作用每增加200，社区SARS病例增加1例。流行日每增加1d，社区的sARS病例可能减少0．27例。日平均气温≤24．6℃时，社区SARS暴发的危险性为气温〉24．6℃的12．82倍。结论日平均气温、ICU的SARS病例数占全部累计SARS病例数的比例、流行时间及ICU的SARS病例数与每日医护人员病例数的相乘作用都可能对香港社区SARS的流行构成影响。