维生素A辅助治疗反复呼吸道感染、迁延性腹泻疗效观察

维生素A (VA)是人体必需的微量营养素 ,与机体免疫状况密切相关。目前我国儿童临床VA缺乏虽已少见 ,但亚临床VA缺乏 (PVAD)尚存 ,其与感染性疾病的关系日趋受到重视。在呼吸道感染、腹泻患儿PVAD时 ,其反复患病率高、病情重、病程长。采用VA辅助治疗 ,效果满意。提示 :反复呼吸道感染、迁延性腹泻患儿VA水平低于健康儿童 ,处于PVAD状态。     

老年人医院呼吸道感染的研究进展及对策

医院呼吸道感染是最常见的医院感染性疾病,发病率占首位,死亡率达20％～50％,而老年人医院呼吸道感染更为多见。一旦发病病情迅速加重,死亡率极高,故是医院感染监测与控制的重点部分之一。近年来在这方面的研究增多,了解老年人医院呼吸道感染发病情况相关的病原菌种类、发病机制及耐药情况等危险因素,才能预防和控制其医院感染的发生及流行,提高医疗质量,促进老年患者人群的康复。     

补充维生素E能否降低前列腺癌患病风险的荟萃分析

背景:补充维生素E是否能降低前列腺癌的患病风险尚无定论.目的:用荟萃分析的方法定量评价补充维生素E与前列腺癌患病风险之间的关系.方法:计算机检索PubMed、EMBASE、Cochrane Library、CBM、CNKI、VIP数据库,手工检索相关领域的杂志,同时从纳入文献的参考文献中全面搜集有关补充维生素E对前列腺癌影响的随机对照试验,用RevMan5.0软件进行统计分析.结果与结论:纳入5篇随机对照试验共计85 549人,Meta分析结果显示:补充维生素与安慰剂相比对前列腺癌发病率的影响差异均无显著性意义(RR=0.96,95%CI为0.85～1.08),且对前列腺癌病死率的影响差异也无显著性意义(RR=0.84,95%CI为0.57～1.24).表明补充维生素E并不能降低前列腺癌的发病率和病死率,但上述结果仍需高质量大样本的随机对照试验进一步证实.     

胸部物理疗法在小儿肺炎中应用研究进展

肺炎是儿童时期常见的呼吸道感染性疾病,5岁以下儿童肺炎发病率为(0.06～0.27)次/人年,肺炎死亡率为184/10万～1223/10万人口[1]。这主要与小儿呼吸道的生理特点有关,即婴幼儿气管及支气管较成人短且相对狭窄,黏膜柔嫩,缺乏弹力组织,支撑作用差,黏液腺分泌不足致气道干燥,纤毛运动较弱致清除能力差,感染后分泌物不易排出,易发生气道狭窄甚至阻塞[2,3]。胸部物理疗法是采用规范的护理程序、用     

维生素A、D及体液免疫与儿童反复呼吸道感染的相关性研究

目的研究维生素A、D及体液免疫与儿童反复呼吸道感染的相关性,旨在降低儿童反复呼吸道感染率。方法采用随机抽样便利法选取2018年9月至2019年12月该院收治的呼吸道感染儿童418例并调查纳入儿童相关资料,利用多因素Logistic回归模型及多元线性相关分析等方法总结儿童反复呼吸道感染相关因素,并对线性相关分析最显著的因素给予回归法确定最终回归方程,采用决定系数(R2)评定方程回归效果。结果儿童反复呼吸道感染98例,感染率23.44%。反复呼吸道感染患儿在不同年龄、饮食起居、生活环境、抗菌药物使用、维生素A水平、维生素D水平和体液免疫水平构成比的比较,差异有统计学意义(P<0.05)。多因素Logistic回归模型显示年龄、饮食起居、生活环境、抗菌药物使用、维生素A、维生素D和体液免疫均是导致儿童反复呼吸道感染的相关危险因素。线性相关分析显示儿童反复呼吸道感染与年龄、饮食起居、生活环境、抗菌药物使用因素存在一定相关性(r=0.230、0.209、0.218、0.254,P<0.05),与维生素A、维生素D水平和体液免疫相关性更明显(r=0.419、0.445、0.482,P<0.001);相关系数r=0.589,R2=0.347,校正决定系数0.259,回归模型F=3.925,P=0.000,说明儿童反复呼吸道感染与维生素A、D水平和体液免疫存在线性回归关系。结论儿童呼吸道感染危险因素复杂多样,但与维生素A、D水平低下及体液免疫功能下降关系最为密切;在防范常规危险因素基础上,加强对儿童维生素A、D水平及体液免疫的关注尤为重要,必要时补充维生素A、D,提高免疫力,有利于降低儿童反复呼吸道感染发生率。     

维生素A辅助治疗儿童反复呼吸道感染疗效的系统评价

[目的]系统评价维生素A辅助治疗儿童反复呼吸道感染的疗效和安全性。[方法]计算机检索国内主要数据库,纳入与本研究主题相关的随机对照研究。按照拟定的纳入排除标准筛选文献、提取资料并进行质量评价。采用RevMan5.2软件对纳入文献进行Meta分析。[结果]共纳入10个随机对照实验,Meta分析结果显示,维生素A治疗组有效率高于对照组[OR=8.37,95%CI(5.69,12.32),P0.00001],两组患儿均未发生不良反应。[结论]维生素A辅助治疗儿童反复呼吸道感染能有效提高临床疗效,减轻症状。     

维生素A、D、E对0~3岁反复呼吸道感染患儿治疗效果的影响和社区卫生服务干预措施分析

目的探讨维生素A、D、E对0~3岁反复呼吸道感染患儿治疗效果的影响,并分析社区卫生服务对疾病防治的相关干预措施。方法选取2018年2月至2019年2月在该院儿科就诊的125例反复呼吸道感染患儿为观察组;将同期体检身体健康的150例儿童设为对照组。检测所有研究对象血清维生素A、25-羟基维生素D 3[25(OH)D 3]、维生素E水平,比较两组维生素水平是否存在差异。将观察组中接受常规治疗的患儿设为A组,将接受常规联合维生素治疗的患儿设为B组,比较两组治疗效果。总结儿童反复呼吸道感染防治的社区卫生服务干预措施。结果观察组患儿血清维生素A、25(OH)D 3、维生素E水平均低于对照组健康儿童,维生素缺乏率高于对照组,差异均有统计学意义(P<0.05)。经积极抗感染等对症治疗,A组与B组患儿血清免疫球蛋白(IgA、IgG、IgM)水平均有所提高,B组3种免疫球蛋白水平高于A组,差异均有统计学意义(P<0.05);B组患儿发热、咳嗽、扁桃体肿大及肺部啰音症状消失时间均短于A组,不良反应发生率、复发率低于A组,差异有统计学意义(P<0.05)。结论0~3岁低龄患儿反复呼吸道感染发生率较高,维生素A、D、E缺乏是导致患儿发生反复呼吸道感染的重要原因,常规抗感染同时补充维生素可提高治疗效果,社区卫生服务工作需加强低龄儿童营养状况监测,及时补充维生素A、D、E以提高儿童免疫力,预防呼吸道感染的发生。     

急性呼吸道感染儿童流感嗜血杆菌的分离及药敏分析

目的了解急性呼吸道感染儿童流感嗜血杆菌 ( HI)感染状况。方法对急性呼吸道感染儿童 113例及健康儿童 2 19例咽拭标本进行培养鉴定、生物分型及药敏试验。结果急性呼吸道感染儿童 HI分离率 ( 5 1.33% )显著高于健康儿童 ( P<0 .0 1) ,且两者均以生物型 型和 型占优势 ,但急性呼吸道感染儿童 HI生物 型明显高于健康儿童 ( P<0 .0 5 ) ;同时急性呼吸道感染儿童对常用抗生素的耐药率均较健康儿童偏高。结论 HI与呼吸道继发感染关系密切 ,且生物型 型起着重要作用 ;HI感染与其耐药性有一定关系     

感染预防及其经济学影响

感染预防是一门通过多种手段和方法防止病原微生物（或致病微生物）的传播从而避免个体感染的学科。从世界范围来看,感染性疾病是发病率和死亡率最主要的疾病之一。WHO于2008年统计显示,世界范围内最主要的两种死亡原因分别是心血管疾病（约12%）和中风及其他脑血管疾病（约10%）,紧随其后的就是一组感染性疾病,包括呼吸道疾病、腹泻、艾滋病和肺结核。     

肝素稀释盐水冲(封)管预防儿童患者PICC导管堵塞的Meta分析

目的评价使用肝素稀释盐水冲(封)管预防儿童患者PICC导管堵塞的效果。方法计算机检索Cochrane Library、Pubmed/Medline、CINAHL、EMBASE、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)和万方学术论文数据库中符合纳入/排除标准的随机对照研究或临床对照研究,由2名研究者背对文献进行严格质量评价和资料提取,使用Rev Man5. 3软件对符合质量标准的研究结果进行分析和描述。结果共纳入随机对照研究文献3篇,临床对照研究1篇,Meta分析结果显示,与生理盐水比较,肝素稀释盐水对预防PICC导管堵塞的发生差异无统计学意义(OR=0. 53,95%CI:0. 16～1. 69,P=0. 28)。结论尽管分析结果表明,使用肝素稀释盐水与生理盐水儿童患者PICC管进行冲(封)管对预防管道堵塞具有相似效果,但仍需扩大样本量进行更多的随机对照试验进行循证实践。     

Correlation analysis between vitamin A,D, and E status with altitude,seasonal variation,and other factors,among children aged 0–6 years in a Chinese population living in the Tibetan plateau of Ganzi prefecture

ObjectiveWe attempted to understand the status of vitamin (Vit) A, D, and E in children aged 0–6 living in the Tibetan plateau areas of Ganzi prefecture, to provide the basis for relevant government departments to carry out physical examinations of these children and to prevent and cure four key diseases (Infantile diarrhea, nutritional anemia, rickets, and infantile pneumonia).MethodsSerum retinol and tocopherol levels were detected using high‐performance liquid chromatography (HPLC). Serum levels of 25‐(OH)D were detected by high‐performance liquid chromatography–tandem mass spectrometry (LC–MS). The polynomial logistic regression was used to analyze the effects of age, season, altitude, and gender on Vit A, D, and E levels.ResultsVit A and D had the lowest mean serum levels before the age of 1 year and with the most significant deficiency rates. The lowest Vit E levels were seen in the Toddlerhood group. The rates of deficiency and insufficiency were the highest. Vit A, D, and E levels were significantly affected by seasonal changes and were significantly higher in the summer than in any other season. Vit A and D were significantly affected by altitude, and their levels were lowest above 4 km.ConclusionThe overall levels of Vit A, D, and E in children aged 0–6 in the Tibetan plateau areas of Ganzi prefecture were lower than those in the plain''s areas.     

The importance of nutritional care in HIV-infected children in resource-limited settings

Renewed efforts to provide proper nutritional care are essential for appropriate pediatric HIV management. Current studies support the use of vitamin A and macronutrients that increase caloric and protein intake. With additional research on key issues such as the needed composition and timing for nutritional supplementation, we can determine the best strategies to support the growth and development of HIV-infected children in resource-limited settings. Malnutrition among children is common in the resource-limited settings where HIV infection is most prevalent. While malnutrition is associated with higher morbidity and mortality for HIV-infected children, there is only limited evidence to guide the use of nutritional support for HIV-infected children. The best studied is vitamin A, which is associated with improved mortality and clinical outcomes. Zinc and multivitamin supplementation have not consistently been associated with clinical benefits. Limited research suggests macronutrient supplementation, which typically uses enriched formulas or foods, improves key anthropometrics for HIV-infected children, but the optimal composition of nutrients for supplementation has not been determined. More research is needed to understand the most efficient and sustainable ways to ensure adequate nutrition in this vulnerable population.     

The impact of nutrition on physiologic changes in persons who have HIV

HIV affects almost all bodily systems, which can lead to recurrent opportunistic infections, weight loss, distribution of weight changes, and death. Malnutrition and wasting, two symptoms that interfere with nutrient availability, accessibility, and metabolism, are associated with higher morbidity and mortality. Nausea, vomiting, swallowing or chewing difficulties, or the response of the body to opportunistic infections or medications that are considered vital to the treatment of the disease may affect nutritional status. A positive nutritional balance may help to improve the immune and other body systems, and delay the progression of the disease, This article reviews the effect of the nutritional status on the physiologic changes in the person who is infected with HIV.     

Effects of interventions on survival in acute respiratory distress syndrome: an umbrella review of 159 published randomized trials and 29 meta-analyses

Purpose

Multiple interventions have been tested in acute respiratory distress syndrome (ARDS). We examined the entire agenda of published randomized controlled trials (RCTs) in ARDS that reported on mortality and of respective meta-analyses.

Methods

We searched PubMed, the Cochrane Library, and Web of Knowledge until July 2013. We included RCTs in ARDS published in English. We excluded trials of newborns and children; and those on short-term interventions, ARDS prevention, or post-traumatic lung injury. We also reviewed all meta-analyses of RCTs in this field that addressed mortality. Treatment modalities were grouped in five categories: mechanical ventilation strategies and respiratory care, enteral or parenteral therapies, inhaled/intratracheal medications, nutritional support, and hemodynamic monitoring.

Results

We identified 159 published RCTs of which 93 had overall mortality reported (n = 20,671 patients)—44 trials (14,426 patients) reported mortality as a primary outcome. A statistically significant survival benefit was observed in eight trials (seven interventions) and two trials reported an adverse effect on survival. Among RCTs with more than 50 deaths in at least one treatment arm (n = 21), two showed a statistically significant mortality benefit of the intervention (lower tidal volumes and prone positioning), one showed a statistically significant mortality benefit only in adjusted analyses (cisatracurium), and one (high-frequency oscillatory ventilation) showed a significant detrimental effect. Across 29 meta-analyses, the most consistent evidence was seen for low tidal volumes and prone positioning in severe ARDS.

Conclusions

There is limited supportive evidence that specific interventions can decrease mortality in ARDS. While low tidal volumes and prone positioning in severe ARDS seem effective, most sporadic findings of interventions suggesting reduced mortality are not corroborated consistently in large-scale evidence including meta-analyses.     

Effect of thiamine supplementation in critically ill patients: A systematic review and meta-analysis

IntroductionSeveral studies have previously shown the benefit of thiamine supplementation in critically ill patients. In order to fully appraise the available data, we performed a meta-analysis of 18 published studies.MethodsA thorough systematic search was conducted. The studies enrolling critically ill patients receiving thiamine supplementation was compared with the standard of care (SOC) group. Data was analyzed using RevMan 5.4. Clinical outcomes were pooled using Odds Ratio (OR) and mean differences.ResultEighteen studies (8 RCTs and 10 cohort studies) met the criteria for quantitative synthesis. In the analysis of RCTs, thiamine supplementation showed 42% lower odds of developing ICU delirium (OR 0.58, 95% CI, 0.34–0.98). A reduction in mortaliy was observed on performing fixed effect model analysis however, a level of statistical significance could not be reached on performing random effect model analysis (OR, 0.78; 95% CI, 0.59 to 1.04). Further sub-group analysis of 13 studies in patients with sepsis, there was no difference in mortality between the two groups (OR, 0.83; 95% CI, 0.63 to 1.09).ConclusionThiamine supplementation in critically ill patients showed a reduction in the incidence of ICU delirium among RCTs. However, there was no significant benefit in terms of overall mortality, and mortality in patients with sepsis. Further, large scale randomized prospective studies are warranted to investigate the role of thiamine supplementation in critically ill patients.     

2004-2014年浙江省台州市法定传染病疫情分析

目的 了解2004-2014年台州市法定传染病发病特点和流行趋势,掌握当前防控重点。方法 采用描述流行病学分析方法对2004-2014年台州市疾病监测报告管理系统的法定传染病资料进行分析。结果 2004-2014年台州市报告甲乙丙类传染病30种,甲乙类传染病报告发病率呈逐年下降趋势,丙类传染病报告发病率有明显上升;甲乙类传染病按传播途径分类,平均年报告发病率由高到低依次为血源及性传播疾病、呼吸道传染病、肠道传染病、自然疫源及虫媒传染病和新生儿破伤风,2014年与2004年相比,肠道传染病报告发病率下降幅度最大,为95.56%,血源及性传播疾病降幅最小,为39.91%;甲乙类传染病报告发病率和死亡率居前5位的病种位次变化很大,现在梅毒和肺结核发病率居前,艾滋病和肺结核死亡率居前。结论 现阶段台州市传染病防控重点应加强艾滋病、梅毒、肺结核和新发传染病的监测和防控工作力度,重视手足口病防控。     

Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis

ABSTRACT: INTRODUCTION: Critical illness is characterized by oxidative stress, which is a major promoter of systemic inflammation and organ failure due to excessive free radical production, depletion of antioxidant defenses, or both. We hypothesized that exogenous supplementation of trace elements and vitamins could restore antioxidant status, improving clinical outcomes. METHODS: We searched computerized databases, reference lists of pertinent articles and personal files from 1980 to 2011. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated relevant clinical outcomes with antioxidant micronutrients (vitamins and trace elements) supplementation versus placebo. RESULTS: A total of 21 RCTs met inclusion criteria. When the results of these studies were statistically aggregated (n = 20), combined antioxidants were associated with a significant reduction in mortality (risk ratio (RR) = 0.82, 95% confidence interval (CI) 0.72 to 0.93, P = 0.002); a significant reduction in duration of mechanical ventilation (weighed mean difference in days = -0.67, 95% CI -1.22 to -0.13, P = 0.02); a trend towards a reduction in infections (RR= 0.88, 95% CI 0.76 to 1.02, P = 0.08); and no overall effect on ICU or hospital length of stay (LOS). Furthermore, antioxidants were associated with a significant reduction in overall mortality among patients with higher risk of death (>10% mortality in control group) (RR 0.79, 95% CI 0.68 to 0.92, P = 0.003) whereas there was no significant effect observed for trials of patients with a lower mortality in the control group (RR = 1.14, 95% 0.72 to 1.82, P = 0.57). Trials using more than 500 μg per day of selenium showed a trend towards a lower mortality (RR = 0.80, 95% CI 0.63 to 1.02, P = 0.07) whereas trials using doses lower than 500 μg had no effect on mortality (RR 0.94, 95% CI 0.67 to 1.33, P = 0.75). CONCLUSIONS: Supplementation with high dose trace elements and vitamins may improve outcomes of critically ill patients, particularly those at high risk of death.     

Selenium supplementation in critically ill patients: A systematic review and meta-analysis

Purpose

The oxidative stress is recognized as a constant feature in critical illness. Nevertheless, the use of antioxidant therapy remains controversial. We tried to demonstrate that intravenous selenium supplementation could promote antioxidant status and help protect against infection and organ failure, improving outcome in critically ill patients.

Materials and Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the exogenous supplementation of selenium versus standard therapy without any adjuvant in critically ill adults.

Results

Nine RCTs met inclusion criteria. Selenium supplementation was associated with a reduction in 28-day mortality of borderline statistical significance (risk ratio = 0.84, 95% confidence interval 0.71–0.99, P = .04). The analysis of pre-defined subgroups detected no significant effects regarding the supplementation with doses of selenium ≤ 500 μg/d, administration of a load dose with a bolus and duration of treatment. Only 2 studies analyzed 6-month mortality and could not show a difference. No effects could be demonstrated on hospital length of stay, pulmonary infections, or renal failure.

Conclusions

The use of high-dose selenium might be associated with a beneficial effect on 28-day mortality in critically ill patients. Nevertheless, the use of selenium as adjuvant therapy needs further evaluations.     

1989-2016年北京市丰台区甲乙类传染病流行趋势分析

目的 了解1989－2016年北京市丰台区甲乙类传染病流行趋势。方法 采用年估计百分比变化法描述甲乙类传染病发病、死亡的时间变化,采用Pearson相关性分析研究全病种与持续监测病种发病、死亡趋势的相关关系。结果 1989－2016年,丰台区甲乙类传染病发病率由778.43/10万下降到170.91/10万,发病以肠道传染病为主,呼吸道传染病发病构成上升;艾滋病发病率由0.26/10万上升到5.77/10万,梅毒发病率由0.14/10万上升到18.24/10万;肺结核发病顺位由第4位升至第2位,梅毒由第5位升至第3位;全病种与持续监测病种发病、死亡趋势一致（发病:r=0.989,P<0.001;死亡:r=0.924,P<0.001）;死因顺位前3位为病毒性肝炎、肺结核和艾滋病;2004－2016年甲乙类传染病粗死亡率由0.59/10万上升到1.59/10万,标化死亡率由0.75/10万下降到0.54/10万。结论 28年间丰台区甲乙类传染病发病率明显下降,持续监测病种较全病种年均死亡率上升更明显;细菌性痢疾、肺结核、艾滋病与梅毒是丰台区甲乙类传染病中应重点防控的疾病。     

Do the observational studies using propensity score analysis agree with randomized controlled trials in the area of sepsis?

Background and objectives

Sepsis is a leading cause of mortality and morbidity in the intensive care unit, and many studies have been conducted aiming to improve its outcome. Randomized controlled trials (RCTs) and observational studies using propensity score (PS) method are commonly used for this purpose. However, the agreement between these two major methodological designs has never been investigated in this specific area. The present study aimed to compare the effect sizes between RCTs and PS-based studies.

Methods

Electronic databases including Pubmed, Scopus, and EBSCO were searched to obtain PS-based studies in the area of sepsis. The studies were matched to RCTs or systematic reviews and meta-analysis in terms of population, intervention, control, and outcome. When there were multiple PS-based studies or RCTs in one area, the effect sizes were pooled by using random-effects model and inverse variance method. The comparisons were performed by using differences in the effect size.

Results

A total of 8 topics were identified fulfilling the criterion that at least 1 pair of RCT and PS-based study could be matched. The interventions included activated protein C, low-dose steroid, antithrombin III, combination antibiotic therapy, fish oil supplementation, statin, etomidate for intubation, and recombinant human soluble thrombomodulin. The effect sizes were statistically different between RCTs and PS-based studies in most circumstances (6/8). The pooled mean difference in effect sizes was − 0.16 (95% confidence interval, − 0.33 to 0.01), indicating a trend towards larger treatment effect in PS studies than in RCTs. The result remains unaltered by restricting to RCTs and PS studies with the largest sample sizes.

Conclusion

Our study shows that PS studies tend to report larger treatment effect than RCTs in the field of sepsis, indicating the difference between efficacy trials and effectiveness studies.