支气管灌洗液SCC、CEA、CYFRA21-1、NSE、CA50检测对肺癌的诊断价值

目的：探讨支气管灌洗液（BLF）鳞状细胞癌抗体（SCC）、癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21－1）、神经元特异性烯醇化酶（NSN）、糖抗原50（CA50）检测对肺癌的诊断价值。方法：SCC、CEA、CYFRA21－1、NSE、CA50测定采用放射免疫（ELISA）方法，标本取自48例肺癌病人和35例非肺癌病人的支气管灌洗液。结果：肺癌患者BLF中测定SCC、CEA、CYRA21－1、NSE的阳性率分别为95．8％、56．3％、83．3％、64．6％，肺癌组SCC、CEA、CYFRA21－1、NSE水平明显高于非肺癌组（P＜0．01）。两组间CA50则无明显差异（P＞0．05）。结论：BLF中SCC、CEA、CYFRA21－1、NSE检测对肺癌的诊断有重要的意义。     

Effects of Maxingloushi decoction on immune inflammation and programmed death markers in mice with chronic obstructive pulmonary disease

BACKGROUND: To investigate effects of Maxingloushi decoction on lung inflammation and programmed death markers(programmed death-1 [PD-1], programmed death-ligand 1 [PD-L1]) in the lung tissue, peripheral blood, and bronchoalveolar lavage fl uid(BLF) in a mouse model of chronic obstructive pulmonary disease(COPD).METHODS: Thirty-six mature male BALB/C mice were randomly divided into normal group(group A, n=6), COPD model group(group B, n=10), Maxingloushi decoction + COPD group(group C, n=10), and PD-1 inhibitor + COPD group(group D, n=10). The COPD model was established by smoke inhalation combined with lipopolysaccharide(LPS). Levels of PD-1 and PD-L1 in plasma and BLF were measured by enzyme-linked immunosorbent assay(ELISA). Histopathological techniques were used to semi-quantitatively analyze the immuno-fluorescence optical density(IOD) value of the lung tissue. RESULTS: In plasma and BLF, the expression of PD-1 in the group B was higher than that in the group A, and the expression of PD-L1 was lower than that in the group A. The expression of PD-1 and PD-L1 in the lung tissue was normalized in the group C in comparison with the group B(P<0.05) and the group D(P<0.05), and infl ammatory cell infiltration in the lung tissue was also improved.CONCLUSIONS: These findings reveal that COPD causes an immune imbalance in the peripheral blood and lung tissue, and that both Maxingloushi decoction and PD-1 inhibitor treatment can mitigate lung inflammation in COPD by reducing PD-1 expression and increasing PD-L1 expression. The treatment effect of Maxingloushi decoction may be superior to that of PD-1 inhibitor.     

Comparison of cell profiles of bronchial and bronchoalveolar lavage fluids between normal subjects and patients with idiopathic pulmonary fibrosis

The cell profiles of bronchial and bronchoalveolar lavage fluids (BLF and BALF) of patients with idiopathic pulmonary fibrosis (IPF) were compared with those of normal volunteers (NV) and age-matched control patients (CP), to characterize the cell profiles of the bronchoalveolar region in normals and patients with IPF. In BALF of nonsmokers from both control groups (NV and CP), alveolar macrophages (AM) were predominant and the percentage of neutrophil leukocytes and that of eosinophil leukocytes below 1% of the total cells. The percentage of neutrophils and that of bronchial epithelial cells were higher in BLF than in BALF of both control groups. Of the immune and inflammatory cells in BLF, the mean percentage of neutrophils was 12% in NV group and 42% in CP group. The percentage of neutrophils and that of eosinophils in BALF were higher in IPF group than in CP group, but the percentage of neutrophils in BLF of IPF group was comparable to that of CP group. In the IPF group, the percentage of neutrophils in BALF was lower than that in BLF. These results indicated that even in healthy subjects, a considerable number of neutrophils are present in the bronchial region and that the cell profile of the lavage fluid of the bronchoalveolar tree changes depending on the method of lavage. Presumably the higher percentage of neutrophils in BALF of patients with IPF is partly due to derangements of the alveolar structure, because the amount of saline infused into this region is limited.     

支气管灌洗液肿瘤标志物联合检测对肺癌诊断价值探讨

目的　探讨支气管灌洗液 (BLF)中癌胚抗原 (CEA)、恶性肿瘤生长因子 (TSGF)及细胞角蛋白 19片段(CYFRA2 1 1)联合检测对肺癌的诊断价值。方法　标本取自 5 1例肺癌患者和 30例非肺癌患者的支气管灌洗液 ,CEA和CYFRA2 1 1测定采用放射免疫法 ,TSGF采用分光光度比色法检测。结果　肺癌组上述 3项指标均高于非肺癌组 (P <0 .0 0 1) ;肺癌组BLF中CEA、CYFRA2 1 1及TSGF的阳性率分别为 37.2 %、78.4 %及 88.2 % ,特异性分别为 83.3%、76 .4 %及 76 .4 % ,3项指标联合检测则特异性达 96 .7%。结论　BLF中CEA、CYFRA2 1 1及TSGF检测对肺癌的诊断有一定价值 ,3者联合检测有明显的互补性 ,可提高肺癌诊断的特异性及准确性     

Anaphylaxis: assessing patients with allergies

Adam's assessment identified the presence of the most severe symptoms of anaphylaxis, respiratory difficulty and shock. The actions of the ambulance crew ensured that on arrival at the ED, Adam's condition was improving. However, it was found that despite the interventions already undertaken, Adam was suffering significant respiratory difficulty due to the cascade of events that occur in anaphylaxis. Adam was seen on arrival and the ALSG's (2005) assessment method proved to be the most effective to ensure that Adam was assessed and treated rapidly. The most beneficial aspect of this assignment is that the author can return to practice with this knowledge and will be more confident when faced with other patients with anaphylaxis. Understanding the underlying processes and symptoms has decreased the fear of 'not knowing' and will aid accurate assessment. It will also provide a good basis for educating parents of affected children and members of nursing teams.     

三伏贴治疗小儿支气管哮喘稳定期的临床护理

目的 观察三伏贴对小儿支气管哮喘稳定期的治疗效果。 方法 选取2015年7月-2016年7月就诊于儿科门诊的支气管哮喘稳定期患儿共240例,采用本院的三伏贴贴敷,每年贴3伏,连续1~2年,随访至2017年7月,根据贴敷时间,将患者儿分为1年组和2年组,比较2组治疗效果及平均住院次数。 结果 2年组患儿治疗效果好于1年组(Z=-2.020,P=0.043),住院次数少于1年组(t=41.917,P<0.001)。 结论 三伏贴治疗可改善小儿支气管哮喘病情,减少急性发作次数及年住院次数,治疗效果肯定,且贴敷时间越长效果越明显。     

Cellular composition and T-lymphocyte subpopulations in the bronchoalveolar lavage fluid in patients with fibrosing alveolitis and pulmonary granulomatosis

Cytological and immunological investigations of bronchoalveolar lavage fluid (BLF) have been performed in 87, 27, 32 and 94 patients with fibrosing alveolitis (FA), exogenous allergic alveolitis (EAA), histiocytosis and pulmonary sarcoidosis (PS), respectively. The diseases appeared to demonstrate significant differences in BLF cell composition and relations between T-lymphocyte theophyllin-resistent and theophyllin-sensitive subpopulations. The findings can be applied in differential diagnosis of disseminated processes in the lungs. The number of neutrophils and the subpopulations correlation in FA and EAA may serve criteria of the disease activity and adequacy of the treatment administered.     

Infective, chronic carriers of Hepatitis C virus among blood donors with no history of clinical hepatitis

Summary. We investigated the infectivity of three hepatitis C virus antibody (anti-HCV) positive blood donors with either hepatitis B core antibodies (anti-HBc) (Nos 1 and 2) or raised alanine aminotransferase (ALT) (No. 3). The 57 recipients of blood products from these donors during the period 1971–1990 were identified and the living 23 were tested for anti-HCV. Among these, 11 out of 14 (78%) recipients from Nos 1 and 2, and 1 out of 9 (11 %) recipients from No. 3 were anti-HCV positive. The former donors had high titres of anti-C 100-3 and high rating scores in the HCV recombinant immunoblot assay (RIBA). They were evidently infective, chronic carriers of HCV but had no clinical signs or medical history of hepatitis. The latter donor had low titres of anti-C100-3 and a low RIBA rating score. She had clinical signs of chronic hepatitis and persistently elevated ALT, but only one of her recipients was anti-HCV positive.     

Takotsubo Syndrome Associated with a New Onset Manic Episode: A case report

Takotsubo syndrome is a condition that mimics acute coronary syndrome. The exact pathogenesis of the condition is unclear but it tends to occur more frequently in elderly women and a large proportion of cases have acute, former, or chronic neurologic or psychiatric disorders. Here we describe a 55-year-old female patient, who was brought to the emergency department presenting with a new-onset manic episode characterized by grandiosity, distractibility, decreased need for sleep, and increased goal-directed behaviours. She experienced chest pain approximately two days later, and non-ST elevation myocardial infarction was observed. The emergent coronary angiogram showed patent coronary arteries, and a diagnosis of Takotsubo syndrome was made. We suggest clinical multidisciplinary vigilance for somatic complaints, especially cardiac ones, in people with psychiatric disorders in order to make timely therapeutic interventions.     

A 2 1/2-year-old girl with reflex sympathetic dystrophy syndrome (CRPS type I): case report

An unusual case of a 2 1/2-year-old girl with reflex sympathetic dystrophy (RSD) of the left arm is described. She is the youngest RSD case ever presented in the literature. Upper extremity involvement is also rare in childhood RSD. She had both physical and psychological trauma in an earthquake preceding the disease. The association of RSD with a psychological disorder is stressed and awareness of the condition to the general paediatrician is recommended for early diagnosis and successful treatment.     

KAP健康教育模式在学龄儿童功能性便秘治疗中的作用

目的探讨KAP健康教育模式在学龄儿童功能性便秘治疗中的作用。方法将132例便秘学龄儿童随机分为一般治疗组与健康教育组,一般治疗组予以药物治疗及行为干预告知与生物反馈训练,健康教育组在一般治疗组基础上辅以KAP模式健康教育。健康教育方式为对患儿及家长进行一对一面谈教育,内容包括排便的生理过程、便秘症状发生的机制及治疗的原理、方向、目的和步骤,指导改进、调整膳食结构和建立正确排便习惯的方法,强调行为干预和生物反馈疗法在治疗中的重要性等。结果健康教育组的服药依从性评分及行为依从性评分明显高于一般治疗组(P<0.01);一般治疗组与健康教育组的治疗前症状评分比较差异无统计学意义(P>0.05),治疗后健康教育组的症状评分明显低于一般治疗组(P<0.01);两组治疗后症状评分与服药依从性评分、行为干预依从性评分均存在显著负相关(Pearson相关系数分别为-0.605、-0.579),服药依从性评分、行为依从性评分之间存在显著正相关(r=0.609)。结论在儿童功能性便秘的治疗过程中实施KAP模式健康教育,可有效增强服药和行为依从性,从而提高临床疗效。     

Hepatic Artery Pseudoaneurysm Rupture: A Case Report and Review of the Literature

Background

Ruptured hepatic artery pseudoaneurysm, a type of visceral artery aneurysm, is a rare condition that is life threatening if not diagnosed and treated rapidly in the emergency department (ED). Patients presenting with this condition require aggressive resuscitation. Endovascular embolization is the first-line treatment option.

Objectives

We present a case of spontaneously ruptured hepatic artery pseudoaneurysm and provide a review of the current literature on this topic, focusing on appropriate ED management.

Case Report

A 41-year-old woman with a history of systemic lupus erythematosus and multiple hepatic bilomas presented to the ED in critical condition with sudden onset of severe abdominal pain and hemodynamic instability. She was found to have a ruptured hepatic artery pseudoaneurysm with marked hemoperitoneum on computed tomography angiography. She was aggressively resuscitated and successfully managed via endovascular embolization.

Conclusion

Ruptured hepatic artery pseudoaneurysm is a life-threatening condition that must be rapidly diagnosed and managed in the ED. Visceral artery aneurysm rupture is a diagnosis that should be considered in any patient presenting to the ED with hemodynamic instability and abdominal pain. Definitive management is with endovascular embolization.     

Chronic paroxysmal hemicrania: A case report

In a 38-year-old woman who had had CPH since the middle 1960s and had been successfully treated with indomethacin (dosage usually within the limits of 50-175 mg/day) for approximately 10 years, the requirement for indomethacin was gradually reduced to nought in the spring of 1985. She was then pain-free without indomethacin for almost 1 1/2 years. In the late fall of 1986 she had a 3-week exacerbation. In recent months, she again seems to have a slowly increasing, although clearly fluctuating, indomethacin requirement. Long-lasting remissions may thus appear even in the chronic stage. The remission could be a spontaneous one or it could in some way be related to the protracted indomethacin treatment; the authors favour the former possibility. The recurrence of symptoms after a while shows that the attack-generating potential has not been permanently extinguished by indomethacin.     

急性冠脉综合征患者早期风险识别与管理策略应用研究

目的 探讨急性冠脉综合征(acute coronary syndrome,ACS)患者早期风险识别与管理策略应用效果。方法 选取2018年8月-2019年5月入住笔者所在医院心血管内科ACS患者60例。将2018年8-12月收治的30例患者设为对照组,采取常规的护理方案;2019年1-5月收治的30例患者设为观察组,采取基于国家早期预警评分(national early warning score,NEWS)联合使用欧洲五维健康量表(Euro qol five-dimensional questionnaire,EQ-5D)进行早期风险识别,并实施管理策略。结果 干预后,观察组总住院日缩短(t=-2.288,P=0.026);医生对护士病房巡视、报告病情、医护沟通满意率明显增高(P<0.05),观察组患者对护士主动观察病情、关注患者不适的满意率均高于对照组(P＜0.05)。结论 基于NEWS评分联合使用EQ-5D量表对ACS患者进行评估,利于护士在判断病情严重度基础上更好地实施护理策略,能改善疾病相关指标,提高医生和患者对护理服务的满意度。     

Geriatric problems and their management. The nursing perspective

Geriatric problems and its Nursing care is not like any other speciality which deals with one group of diseases. Older adults suffer from various disabilities and diseases. Geriatric group will lose memory power, bearing, eyesight, etc. The Nurse who deals with geriatric patients is expected to be well versed in all the aspects. She approaches the patients through Nursing process. She plans and directs the day-to-day Nursing care according to the situation that arises. Because of the scientific knowledge and modern techniques acquired by the Nurses and health care workers they are able to give a fairly comfortable life to the elderly people.     

Inflammatory infrarenal abdominal aortic aneurysm in a young woman

Inflammatory abdominal aortic aneurysm is a rare cause of abdominal pain in young adults that may be difficult to diagnose in the Emergency Department. This case highlights the significance of this condition as a possible diagnosis in young patients presenting with abdominal symptoms. A 32-year old woman presented with lower abdominal and back pain. She had four previous visits to the Emergency Department and one hospital admission with similar symptoms and had been discharged without a definite diagnosis. Her vascular risk factors included hypercholesterolemia and smoking. A computed tomography (CT) scan showed a non-leaking infrarenal saccular abdominal aortic aneurysm and para-aortic lymphadenopathy. A transthoracic echocardiogram excluded endocarditis. There was no evidence of bacterial, viral, or fungal infection on blood and serum assays, and her autoimmune screen was negative. She underwent urgent open repair using a synthetic graft. The aneurysmal wall and para-aortic lymph node histology confirmed the diagnosis of inflammatory aneurysm with periaortitis. She remained asymptomatic at 8 months after surgery with no evidence of additional aneurysmal disease. Inflammatory abdominal aortic aneurysm is an unusual cause of abdominal pain in young adults. It is more likely in patients with persistent or recurrent abdominal symptoms.     

Demographic and clinical characteristics of patients with episodic migraine versus chronic daily headache

We compared data from 243 patients with episodic migraine (EM) and 132 patients with chronic daily headache (CDH). We divided the matter group into those with tension-type headache only (CDH Type 1) and those with headaches having migrainous features (CDH Types 2+3) and compared each with the EM group and all three groups with one another. CDH Type l patients differed from those in the other groups by virtue of gender (more often male) and mean age at headache onset (older). The CDH Types 2+3 and EM groups differed only in that the former were more likely to have undergone a brain-imaging study. These data suggest that CDH Type 1 may represent a distinct headache syndrome, while CDH Types 2+3 closely resemble episodic migraine.     

脑卒中偏瘫恢复期患者健康教育路径研究设计

目的 提高脑卒中偏瘫恢复期患者的健康教育效果和最大程度地促进患者康复。方法 借鉴国外应用临床护理路径的经验，将临床护理路径用于脑卒中偏瘫恢复期患者的健康教育。56例脑卒中偏瘫恢复期患者分为实验组和对照组，实验组实施规范化康复护理，应用健康教育路径．对照组实施传统护理，传统健康教育方法。入选时、干预1、2个月后进行Barthel指数、简化Fugl—Meyer运动功能评分量表、脑卒中后抑郁多模式方法诊断、焦虑自评量表、并发症发生率评定。结果 2组患者Barthel指数、简化Fugl-Meyer运动功能评分均较前一阶段提高（P〈0．01）；1月后．实验组提高分高于对照组．但无显著性差异，2月后．实验组提高分高于对照组．有显著性差异（P〈0．01）。2组脑卒中后抑郁多模式方法诊断、焦虑自评分均较前一阶段显著性降低（P〈0．01）；焦虑自评分：1，2月后实验组降低分均显著大于对照组（P〈0．01），脑卒中后抑郁多模式方法诊断评分：1月后，实验组降低分大于对照组（P〈0．05）．2月后．试验组降低分显著大于对照组（P〈0．01）。实验组的并发症发生率低于对照组（P〈0．05）。结论 健康教育路径可提高健康教育质量，有助于患者整体康复。