血清降钙素原及血清淀粉样蛋白A在早期新生儿败血症诊断中的价值

目的探讨降钙素原(PCT)及血清淀粉样蛋白A(SAA)在诊断早期新生儿败血症的应用价值。方法选取38例新生儿败血症患儿为观察组,另外选择38例同期同病区的非感染性新生儿为对照组。2组患儿均检测PCT、SAA、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)及红细胞沉降率(ESR),并比对结果。结果观察组PCT、SAA、hs-CRP与对照组比较差异有统计学意义(P0.05);WBC及ESR与对照组比较差异无统计学意义(P0.05)。PCT、SAA、hs-CRP对新生儿败血症的诊断灵敏度分别为78.9%、63.2%、52.6%,特异度分别为86.8%、73.7%、68.4%。结论 PCT在诊断早期新生儿败血症具有较高的临床诊断价值。     

ROC曲线评价多参数对新生儿感染的诊断价值

目的探讨多个实验室指标对于新生儿感染的早期诊断价值。方法选取确诊感染入院的新生儿30例,检测其血降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)和白细胞计数(WBC),并以未感染的新生儿作为对照组,比较两组受试者上述指标的水平,用ROC曲线评价这些指标对于新生儿感染诊断的临床应用价值。结果新生儿感染组各参数均高于对照组,差异有统计学意义(P0.05);由ROC曲线可知,PCT和hs-CRP敏感度和特异性达100.0%,TNF-α敏感度为96.7%,特异性为99.3%;IL-6和IL-8敏感度均为93.3%,但特异性分别为73.3%和80.0%,WBC则为70.0%和80.0%。结论各参数均可以用于新生儿感染诊断,但灵敏度与特异性均较高的是PCT和hs-CRP,其次为TNF-α;IL-6和IL-8敏感性虽高,但其特异性不甚满意;WBC诊断价值虽最小,但却是临床必不可少的常规观察指标。     

PCT和hs-CRP检测早期诊断新生儿感染性疾病中的价值

收治的78例细菌感染性疾病患儿作为观察组,取同时期78例健康儿童为对照组。检测两组PCT、hs-CRP含量及观察观察组在入院时和治疗后PCT、hs-CRP水平的变化情况。观察组PCT、hs-CRP水平明显高于对照组(t PCT=34.474,P=0.000;ths-CRP=31.595,P=0.000);观察组PCT阳性率、hs-CRP阳性率明显高于对照组(X2PCT=57.308,P=0.000;X2hs-CRP=39.000,P=0.000);与入院时对比,经过治疗后观察组的PCT、hs-CRP水平显著降低(t PCT=33.522,P=0.000;ths-CRP=24.499,P=0.000),均恢复到正常范围内。血清PCT、hs-CRP在新生儿感染性疾病诊断中具有重要意义,值得推广。     

新生儿肺炎患者血清载脂蛋白E的表达变化及意义探讨

目的测定血清ApoE在新生儿肺炎中的表达变化及探讨其临床意义。方法选取85例新生儿肺炎患儿作为观察组,85例健康新生儿作为对照组,比较两组新生儿血清载脂蛋白E(ApoE)、超敏C-反应蛋白(hs-CRP)和降钙素原(PCT)水平的差异,比较观察组新生儿血清ApoE、hs-CRP和PCT水平与疾病严重程度的关系,绘制ROC曲线分析血清ApoE、hsCRP和PCT对新生儿肺炎的诊断价值,采用Spearman进行新生儿肺炎患儿血清ApoE、hs-CRP和PCT间的相关性分析。结果观察组患儿血清ApoE、hs-CRP和PCT水平较对照组显著升高,重度肺炎组患儿血清ApoE、hs-CRP和PCT水平较轻症肺炎组患儿显著升高,比较具有统计学意义(P0.05)。绘制ROC曲线分析得出ApoE、hs-CRP和PCT对新生儿肺炎的诊断AUC分别为:0.903、0.874、0.956,敏感性分别为:80%、82.4%、83.5%,特异性分别为:92.9%、81.2%、97.6%。进行Spearman相关性分析得出新生儿肺炎患儿血清ApoE与hs-CRP之间呈不存在相关性(r=0.108,P=0.324),血清ApoE与PCT之间存在正相关性(r=0.379,P0.01),血清hs-CRP与PCT之间存在正相关性(r=0.325,P0.01)。结论新生儿肺炎患儿的血清ApoE水平显著升高,且与肺炎严重程度密切相关,可用于新生儿肺炎的诊断和病情监测。     

鞘内注射抗生素在颅脑损伤后颅内感染患者中的应用价值

目的探讨鞘内注射抗生素对颅脑损伤后颅内感染的预防作用。方法将260例颅脑损伤后颅内感染患者随机分为对照组和观察组。对照组鞘内给予生理盐水6 m L置换脑脊液;观察组鞘内给予头孢他啶0.08 g,溶于6 m L生理盐水中置换脑脊液。比较2组临床转归及治疗前后脑脊液、血液中疾病相关因子水平。结果观察组颅内感染发生率为9.23%,显著低于对照组的31.54%(P0.05)。治疗后1、3 d,观察组患者脑脊液中PCT水平、WBC计数显著低于对照组,而氯化物和葡萄糖水平则显著高于对照组(P0.05);观察组患者血清中PCT、TNF-α、IL-1β、IL-6和hs-CRP水平显著低于对照组(P0.05)。结论鞘内注射抗生素能有效抑制颅脑损伤患者的炎症状态,降低颅内感染的发生率。     

痰热清注射液治疗老年重症肺炎的临床疗效及对血清超敏C反应蛋白、降钙素原的影响

目的探讨痰热清注射液治疗老年重症肺炎的临床疗效及对血清超敏C反应蛋白(hs-CRP)、降钙素原(PCT)的影响。方法将76例老年重症肺炎患者按随机数字表法分为对照组和观察组,每组38例。对照组进行内科常规治疗,观察组在常规治疗基础上加用痰热清注射液治疗,疗程均为15d,观察两组临床疗效及治疗前后血清hs-CRP、PCT的变化。结果对照组和观察组总有效率分别为63.2%、89.5%,两组差异有统计学意义(P0.05)。治疗前两组血清hs-CRP、PCT水平差异无统计学意义(P0.05),治疗15d后观察组hs-CRP、PCT水平较治疗前明显下降(P0.05),且明显优于对照组(P0.01)。两组均未见明显不良反应。结论痰热清注射液可显著降低老年重症肺炎患者血清hs-CRP、PCT水平,从而明显提高临床疗效,并且安全性好。     

PCT和hs-CRP水平联合检测在新生儿细菌性脑膜炎中的诊断价值

目的探究血清降钙素原(PCT)和超敏C反应蛋白(hs-CRP)水平联合检测在新生儿细菌性脑膜炎诊断中的价值。方法选取经临床确诊的细菌性脑膜炎新生儿60例为观察组,选择同期临床确诊的病毒性脑膜炎新生儿56例为对照组。对照组行常规抗病毒治疗,观察组行常规抗感染治疗。比较两组治疗前后血清PCT和hs-CRP水平变化情况,两指标单独检测及联合检测对新生儿细菌性脑膜炎的诊断价值。结果治疗前,观察组血清PCT和hs-CRP水平均显著高于对照组(P0.05);治疗后,观察组血清PCT和hs-CRP水平均明显低于治疗前(P0.05);治疗后两组血清PCT和hs-CRP水平比较无明显差异(P0.05)。血清PCT和hs-CRP水平联合检测的灵敏度、特异度和准确度分别为96.67%、94.64%和95.69%,均明显高于单独检测任一项指标(P0.05)。结论血清PCT和hs-CRP检测在新生儿细菌性脑膜炎诊断中具有重要的价值,两者联合检测可提高诊断灵敏度、特异度和准确度。     

加用布地奈德对新生儿肺炎治疗效果的研究

目的探讨布地奈德应用于新生儿肺炎的治疗,以及对白细胞介素-6(IL-6)、血清降钙素原(PCT)及细胞免疫指标的影响。方法将该院96例新生儿肺炎患儿随机分为观察组(48例)和对照组(48例)。对照组患儿采用常规基础对症治疗,观察组在对照组治疗的基础上加用布地奈德气雾剂雾化吸入治疗,1毫升/次,2次/天。2组患儿1个疗程为7d,均连续用药7d。比较2组临床症状及住院时间、临床疗效,治疗前后检测IL-6、PCT、可溶性髓系细胞触发受体-1(sTREM-1)、超敏-C反应蛋白(hs-CRP)、CD4~+、CD8~+水平,计算CD4~+/CD8~+,并记录2组患儿不良反应发生情况。结果观察组气促消失时间、鼻阻消失时间、肺部湿罗音消失时间、住院时间明显低于对照组(P0.05);观察组总有效率(91.7%)显著高于对照组(75.0%)(P0.05);治疗后观察组IL-6、PCT、sTREM-1、hs-CRP、CD8~+水平明显低于对照组,CD4~+、CD4~+/CD8~+明显高于对照组(P0.05);2组患儿治疗过程中均发生哭声嘶哑、鹅口疮等不良反应,但差异无统计学意义(P0.05)。结论布地奈德治疗新生儿肺炎能提高临床疗效,改善临床症状,显著降低IL-6、PCT水平,提高细胞免疫功能,安全性好,值得临床推广应用。     

射干麻黄汤对慢性支气管炎急性发作老年患者血清IL-6、PCT、hs-CRP的影响

目的:观察射干麻黄汤对慢性支气管炎急性发作老年患者的疗效及血清IL-6(白细胞介素6,interleukin 6,IL-6)、PCT(降钙素原,procalcitonin)、hs-CRP(超敏C反应蛋白,hypersensitive C-reactive protein,hs-CRP)的影响。方法:70例老年慢性支气管炎急性发作患者,随机分为2组,各35例。对照组采用常规西药治疗,研究组在对照组治疗的基础上给予射干麻黄汤进行治疗。治疗10d后,对两组患者的治疗效果以及血清IL-6、hs-CRP、PCT水平进行分析比较。结果:治疗后,研究组治疗总有效率(97.14%)明显高于对照组(77.14%),差异有统计学意义(P<0.05)。研究组血清IL-6、hs-CRP、PCT水平明显低于对照组,差异有统计学意义(P<0.05)。研究组治疗后的不良反应发生率(5.71%)高于对照组(8.56%),两组比较无统计学差异(P>0.05)。结论:射干麻黄汤治疗慢性支气管炎急性发作患者,能够有效提高疗效,降低血清IL-6、hs-CRP、PCT水平。     

左氧氟沙星联合比阿培南治疗多重耐药菌致医院获得性肺炎的效果

目的 探讨左氧氟沙星联合比阿培南治疗多重耐药菌致医院获得性肺炎的效果。方法 选取郑州市第三人民医院2016年10月至2018年5月收治的多重耐药菌致医院获得性肺炎患者200例,采用随机数字表法分为对照组和观察组,每组100例。对照组给予比阿培南治疗,观察组给予左氧氟沙星联合比阿培南联合治疗,比较两组的治疗效果、治疗前后白细胞计数(WBC)、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)以及淀粉样蛋白A(SAA)水平、症状恢复用时以及不良反应发生情况。结果 治疗后,对照组治疗总有效率(76. 00%,76/100)低于观察组(89. 00%,89/100),差异有统计学意义(χ2=5. 853,P 0. 05);两组患者的WBC、hs-CRP、PCT以及SAA水平较治疗前均明显降低,且观察组降低幅度较对照组更高(P 0. 05);经治疗,观察组患者的体温、肺部体征恢复、胸片异常阴影、WBC、hs-CRP恢复用时均显著短于对照组(P 0. 05);治疗期间,对照组有11例患者出现恶心呕吐、皮疹等不良反应,发生率为11. 00%;观察组有9例患者出现不良反应,发生率为9. 00%,经治疗后症状均有缓解,两组的不良反应发生情况比较差异未见统计学意义(χ2=0. 222,P=0. 637 0. 05)。结论 左氧氟沙星联合比阿培南治疗多重耐药菌致医院获得性肺炎患者,临床效果较好,可改善炎症因子水平,缩短治疗时间,安全可靠。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.