老年恙虫病合并多器官损害的临床特点

恙虫病是由恙虫病东方体所致的急性自然疫源性疾病,常导致多器官损害.老年人由于自身器官功能的老化和生理功能变化,以及可能存在各种基础疾病,出现器官损害的表现和程度有所不同.现将横县人民医院2009年至2011年住院的74例老年恙虫病合并多器官功能障碍综合征(MODS)的临床情况与同期住院的49例非老年患者进行对比分析,探讨老年人恙虫病合并多器官损害的临床特点,以期提高对老年人恙虫病的诊疗水平.     

热射病的病理生理与救治进展

热射病是热损伤进程中最危险的阶段,其致病原因是机体剧烈运动后或暴露于极端热环境时,体内热量蓄积远超散热而导致的核心体温上升.临床上,热射病以中枢神经系统功能障碍、多器官功能障碍和体温急剧升高为特征.本文拟阐述热射病病理生理学特点和临床救治进展,以期提高热射病临床救治水平.     

心肾综合征的研究现状

广义的心肾综合征是指心脏和肾脏中一个器官对另一个器官的功能损害不能进行代偿时,形成恶性循环,最终导致心脏和肾脏功能的共同损害.狭义的心肾综合征是特指慢性心力衰竭(CHF)患者出现的进行性肾功能损害,并导致肾功能不全.肾功能不全在CHF患者中的发生率很高,且是一个独立预后指标,其预测意义至少与左心室射血分数(LVEF)和纽约心脏病学会(NYHA)心功能分级相等.目前心肾综合征仍是临床治疗的难题.本文综述了心肾综合征的临床特点、发生机制以及防治等研究现状.     

中暑患者22例救治体会

中暑是人体持续处在高温高湿的环境中,下丘脑体温调节功能障碍,汗腺功能衰竭,体液大量丢失,内环境紊乱的临床综合征,严重者导致多器官功能障碍(multiple organ dysfunction syndrome,MODS),依据症状的轻重分为热痉挛、热衰病和热射病,其中热射病最为严重,病死率高达60%[1]。本文报道22例中暑患者的临床诊治体会。临床资料收集2009年6月～2011年10月在我院急诊科诊治的22例(男17,女5)中暑患者的临床资料,年     

Anderson Fabry病的心脏损害及治疗

Anderson Fabry病(AFD)是X性染色体显性遗传疾病,国内未见报道。患者通常有多器官损害,心脏损害尤其常见,可发生进展性肥厚型心肌病、瓣膜病、心律失常,亦可导致冠心病。目前在各种原因所致的肥厚型心肌病中,只有AFD导致的肥厚型心肌病可进行病因治疗。现就AFD患者的心脏病变以及α-galA酶替代疗法作一概述。     

艾塞那肽治疗老年2型糖尿病合并多器官并发症1例

正2型糖尿病是一种遗传和环境因素共同作用而形成的表现为慢性高血糖的多基因遗传性复杂疾病,其特征为胰岛素抵抗或分泌不足、肝糖输出增多,常导致眼、肾、心血管等多器官损害。对存在微血管、大血管并发症的糖尿病患者,临床上常采用胰岛素治疗,但糖化血红蛋白不达标者仍占有很大比例。现将我院以艾塞那肽(exenatide)治疗老年2型糖尿病合并多器官并发症的患者1例报道     

雅博司对多器官功能障碍综合征患者肝功能损害的治疗作用

多器官功能障碍综合征(MODS)是多发伤、休克、大手术后及感染的严重并发症,已成为当今外科ICU患者死亡的首要原因[1,2]。尽管合并单一肝功能损害并不构成创伤后并发MODS患者死亡的主要原因[3],但从临床观察中发现,因肝功能障碍所导致的低蛋白血症、凝血功能紊乱、肝肾综合征及肝性脑病等病理生理改变不可避免地将恶化MODS的进程。因此对于伴有肝损害的MODS患者,采取积极的护肝、治肝措施,将是治疗MODS的重要环节。本研究旨在探讨雅博司对MODS患者肝功能损害的治疗作用,为.ICU可行性应用提供依据。     

特发性嗜酸粒细胞增多综合征一例

特发性嗜酸粒细胞增多综合征(idiopathic hypereosinophilic syndrome,IHES)是一组原因不明的、以嗜酸粒细胞持续增高(>1.5×10~9/L)6个月以上且伴有1个或多个内脏器官浸润及功能损害的综合征.IHES临床表现不典型,合并多器官损害者少见.现报道1例以呼吸道症状发病且合并多器官受损的IHES,以提高对本病的认识.     

重症休克后心功能障碍的发生机制

<正>休克是临床上常见的以组织血液灌流不足为主要特征,出现细胞和重要器官功能代谢障碍、结构损害等严重后果的危重的全身性病理过程。在休克的发展进程中,心功能障碍是引起或加重休克微循环障碍的一个重要环节,也是导致休克进一步发展为多器官功能障碍综合征(MODS)、引起休克难治的重要原因~(〔1〕)。因此,探讨重症休克心功能障碍的机制,并以此为干预靶点决策重症休克的治疗措施,成为休克领域的研究热点之一,但至今仍未完全阐明。近年来,关于线粒体功能障碍、钙     

肠内营养干预对肾综合征出血热患者预后的影响研究

正肾综合征出血热(HFRS)又被称作流行性出血热(EHF),是一种自然疫源性疾病,在我国主要是由黑线姬鼠与褐家鼠所携带的汉坦病毒所致[1]。而我国是HFRS重灾区,由HFRS导致的病死率正在逐年升高[2]。HFRS患者常具有炎症反应、血小板下降、器官损害以及蛋白尿等临床症状,医师根据上述症状发生程度将患者分为轻、中、重、危重和非典型性型,其中重型以及危重型HFRS患者病情进展最快,病死率最     

Regenerative therapies in electrophysiology and pacing

The prevention and treatment of cardiac arrhythmias conferring major morbidity and mortality is far from optimal, and relies heavily on devices and drugs for the partial successes that have been seen. The greatest success has been in the use of electronic pacemakers to drive the hearts of patients having high degree heart block. Recent years have seen the beginnings of attempts to use novel approaches available through gene and cell therapies to treat both brady- and tachyarrhythmias. By far the most successful approaches to date have been seen in the development of biological pacemakers. However, the far more difficult problems posed by atrial fibrillation and ventricular tachycardia are now being addressed. In the following pages we review the approaches now in progress as well as the specific methodologic demands that must be met if these therapies are to be successful.     

The young-adult and normally aged brain. Its blood flow and oxidative metabolism. A review - part I

Blood flow and oxidative metabolism of the mature and healthy young-adult human brain account for about 20% of the cardiac output and about 20 and 25% of the requirements of oxygen and glucose, respectively, for the whole body. Normal cerebral aging is associated with only smaller reductions in the cerebral metabolic rates of oxygen and glucose while cerebral blood flow would seem to be unchanged. The age-dependent reduction in oxidative brain metabolism may be related to a decline in glycolytic flux due to a diminution of enzyme activities also involving acetylcholine synthesis. This metabolic reduction with age may be tentatively accounted for by a physiologically occurring loss of neurons, dendrites and dendritic spines in distinct brain areas. The mechanisms of autoregulation of cerebral blood flow, of CO₂ reactivity of the brain vessels, of arterial hypoxemia on cerebral blood flow and their effects on oxidative and energy metabolism are well documented in young-adult brain. There is, however, no or only minimal information on the responsiveness of the normally aged brain to changes of these important biological parameters controlling and influencing brain blood flow and metabolism.     

TIMP-1和TIMP-2在原发性肝癌生长、浸润及转移中的作用

目的：了解基质金属蛋白酶组织抑制因子-1(tissue inhibitou of metalloproteinase-1，TIMP-1)和基质金属蛋白酶组织抑制因子-2(TIMP-2)mRNA及相关抗原在肝癌组织中的定位和表达状态，探讨TIMP-1和TIMP-2在肝癌组织生长、浸润及转移中所起的作用。方法：以TIMP-1和TIMP-2探针及单克隆抗体（McAb）为试剂，采用原位杂交技术及免疫组织化学法检测原发性肝癌、肝高分化腺癌的肝组织中TIMP-1和TIMP-2mRNA及相关抗原的表达，并与10例正常肝组织做对照。结果：20例原发性肝癌患者的肝组织中TIMP-1和TIMP-1mRNA及相关抗原表达的阳性率为90%;9例肝高分化腺癌的腺癌组织中无TIMP-1和TIMP-2mRNA及相关抗原的表达；10例正常肝组织中TIMP-1和TIMP-2mRNA及相关抗原表达均为阴性；TIMP-1和TIMP-2mRNA及相关抗原阳性信号呈现为棕黄色颗粒状，分布在肝细胞浆内，未见细胞核着色；无论是原发性肝癌癌组织还是癌周组织中,TIMP-1的表达强于TIMP-2的表达，癌周组织中TIMP-1和TIMP-2mRNA和相关抗原的表达与肝组织病理改变相关，即肝硬化者表达强，慢性肝炎者表达弱，正常肝组织无表达。结论：原发性肝癌的癌组织中存在TIMP-1和TIMP-2mRNA及相关抗原的表达，其表达强度可能与原发性肝癌的分型有关，它可能通过抑制MMP的活性使ECM降解减少从而阻止癌细胞通过基底膜移出而抑制肝癌细胞向周围浸润及转移。     

紧贴胃食管壁的贲门周围血管离断术联合涤纶片覆盖治疗食管胃底静脉曲张

目的探讨食管胃底静脉曲张的有效治疗方法.方法将需施行贲门周围血管离断术的食管胃底静脉曲张患者61例随机分成两组.对照组30例,采用传统脾切除术 贲门周围血管离断术;观察组31例,在脾切除术后,紧贴胃食管壁行贲门周围血管离断术,保留自胃冠状静脉→食管旁静脉丛→奇静脉的侧支通畅;创面用生物胶止血,将医用涤纶片覆盖在剥离后的食管下段、胃底.结果术后3、5年,两组食管静脉曲张程度均有明显差异(P＜0.01,P＜0.05);食管胃底静脉曲张再破裂出血率,观察组分别为6.5%(2/31)、9.7%(3/31),对照组分别为30%(9/30)、53.3%(16/30),两组相比均有明显差异(P＜0.05,P＜0.01).术后5年食管胃底静脉曲张再破裂出血致死率,观察组为3.2%(1/31)、对照组为23.3%(7/30),两组相比P＜0.05.结论紧贴胃食管壁的贲门周围血管离断术联合涤纶片覆盖,能有效阻止食管胃底周围新生侧支循环的建立,明显降低贲门周围血管离断术后食管、胃底静脉曲张再破裂出血率.     

Frailty and disability in the elderly: A diagnostic dilemma

Decreased reserves in multiple organ systems identify frailty syndrome in the elderly. However, its clinical diagnostic approach may be hard, particularly in patients with chronic diseases. The purpose of the study was to delineate the role of disability in the frailty syndrome in a group of hospitalized elderly people. A total of 150 consecutive patients (62 males/88 females), aged between 64 and 97 years and 1-2 days before hospital discharge, were submitted to several geriatric scales designed to assess disability and/or morbidity. All the geriatric scales used showed an elevated percentage of abnormal values both in females and in males. Nevertheless, the activities of daily living (ADL), instrumental activities of daily living (IADL), Tinetti balance index (TBI), Barthel index (BI) scores showed significantly better values in men than in women (p = 0.007, =0.02, =0.02 and =0.01, respectively). This preliminary cross-sectional study, underlines the fact that all geriatric tests employed have shown pathological scores, but those of the ADL, IADL, TBI and BI scores exploring disability were significantly better in males than in females. The mismatch between functional and morbidity tests seems to support the hypothesis that a disability state may be independent from morbidity.     

Clinical, radiological and pathological study of 88 cases of typical and complicated scleroma

Background: Scleroma is a chronic specific granulomatous disease. It is considered endemic in Central America, Egypt, tropical Africa, India, and Indonesia. The most common complaint is nasal obstruction, other symptoms include; rhinorrhea, epistaxis, dysphagia, stridor, and dysphonia. Aim: So our objective was to focus on the various clinical and radiological manifestations of scleroma in an endemic area, with some atypical symptoms and signs, and to alert physicians to suspect scleroma or its complications in any case of unexplained nasal lesion. Material and methodology: Our study included 88 cases who were admitted in our otorhinolaryngology department. They presented with various manifestations of Rhino‐pharyngo‐laryngo scleroma, out of these patients 16 cases showed atypical presentations. Our diagnosis was based on clinical and radiological examination, aided by bacteriological and pathological examination. Results: Patients with typical rhinoscleroma (72 patients) presented with various nasal and laryngo‐tracheal symptoms. 16 patients (18%) presented complaining of various nasal symptoms and signs, which were not suspected to be rhinoscleroma, so our workup was directed to diagnose those patients, and their final diagnosis was reached to be rhinoscleroma, we sub classified those patients according to their presentation. Conclusion: Rhinoscleroma can present clinically with atypical features, so in order to avoid misdiagnosis, it is important to keep in mind these atypical manifestations. Please cite this paper as: Fawaz S, Tiba M, Salman M, and Othman H. Clinical, radiological and pathological study of 88 cases of typical and complicated scleroma. Clin Respir J 2011; 5: 112–121.     

Thermal Conductivity and Viscosity: Review and Optimization of Effects of Nanoparticles

This review was focused on expressing the effects of base liquid, temperature, possible surfactant, concentration and characteristics of nanoparticles including size, shape and material on thermal conductivity and viscosity of nanofluids. An increase in nanoparticle concentration can lead to an increase in thermal conductivity and viscosity and an increase in nanoparticle size, can increase or decrease thermal conductivity, while an increase in nanoparticle size decreases the viscosity of the nanofluid. The addition of surfactants at low concentrations can increase thermal conductivity, but at high concentrations, surfactants help to reduce thermal conductivity of the nanofluid. The addition of surfactants can decrease the nanofluid viscosity. Increasing the temperature, increased the thermal conductivity of a nanofluid, while decreasing its viscosity. Additionally, the effects of material of nanoparticles on the thermal conductivity and viscosity of a nanofluid need further investigations. In the case of hybrid nanofluids, it was observed that nanofluids with two different particles have the same trend of behavior as nanofluids with single particles in the regard to changes in temperature and concentration. Additionally, the level of accuracy of existing theoretical models for thermal conductivity and viscosity of nanofluids was examined.     

Processes of care and outcomes for community-acquired pneumonia

Background

Although processes of care are common proxies for health care quality, their associations with medical outcomes remain uncertain.

Methods

For 2076 patients hospitalized with pneumonia from 32 emergency departments, we used multilevel logistic regression modeling to assess independent associations between patient outcomes and the performance of 4 individual processes of care (assessment of oxygenation, blood cultures, and rapid initiation [<4 hours] and appropriate selection of antibiotic therapy) and the cumulative number of processes of care performed.

Results

Overall, 141 patients (6.8%) died. Mortality was 0.3% to 1.7% lower for patients who had each of the individual processes of care performed (P ≥.13 for each comparison); mortality was 7.5% for patients who had 0 to 2 processes of care, 7.2% for those with 3 processes of care, and 5.8% for those with all 4 processes of care performed (P = .39). Mortality was not significantly associated with either individual or cumulative process measures in multivariable models.

Conclusion

Neither the individual processes of care nor the cumulative number performed is associated with short-term mortality for pneumonia.     

Association Between Patient and Physician Sex and Physician-Estimated Stroke and Bleeding Risks in Atrial Fibrillation

Background

Physicians treating nonvalvular atrial fibrillation (AF) assess stroke and bleeding risks when deciding on anticoagulation. The agreement between empirical and physician-estimated risks is unclear. Furthermore, the association between patient and physician sex and anticoagulation decision-making is uncertain.