Listeria monocytogenes peritonitis in a patient on continuous ambulatory peritoneal dialysis

We report a case of peritonitis in a patient on continuous ambulatory peritoneal dialysis caused by Listeria monocytogenes. The patient was taking oral corticosteroids for underlying systemic lupus symptoms, and had classic signs and symptoms of peritonitis. There was initial clinical deterioration while in vitro data indicating that the organism was sensitive to vancomycin with a minimum inhibitory concentration of 0.5 micrograms/ml. The patient rapidly responded to intravenous ampicillin. We believe this to be the second reported case of L. monocytogenes peritonitis in a CAPD patient.     

由KLHL3新基因突变所致假性醛固酮减少症Ⅱ型1例报告

患者,女,41岁,因"发现血钾升高18 d"入院.入院前18 d患者在外院住院期间查见血钾升高,予以对症处理,血钾正常后出院,因出院后反复血钾升高来我院就诊.患者有"急性肾炎"及"妊娠高血压"病史;入院半年前发现血压轻度升高未予干预.其父亲有"高血压、糖尿病"病史.入院后实验室检查发现患者具有高钾血症、高氯血症、代谢性...     

以癫痫和坏死性小肠结肠炎为表现的Sotos综合征1例报告及文献复习

目的：收集1例以癫痫和坏死性小肠结肠炎为主要表现的Sotos综合征患儿的临床资料,分析该病明确诊断、抗癫痫治疗和并发症随访的重要性。方法：患儿,男,21个月。临床表现为发育迟缓和抽搐反复发作,查体发现过度生长,面容特殊。既往新生儿期有坏死性小肠结肠炎病史。结合患儿临床和遗传学资料进行诊断,分析诊疗过程,并结合相关文献进行总结。结果：结合本例患儿临床表现、辅助检查和基因检测结果诊断为Sotos综合征和癫痫。予康复治疗1年3个月后发育迟缓有所改善,继续康复随访。予左乙拉西坦单药抗癫痫治疗1月后抽搐完全控制未再发作,复查脑电图正常。患儿新生儿期出现呕吐和血便,结合腹部彩超及X线检查诊断为坏死性小肠结肠炎和结肠穿孔,予非手术保守治疗20余天后症状逐渐改善并痊愈。结论：对于临床疑似Sotos综合征的患儿,建议行基因检测明确诊断并对症治疗,积极进行康复治疗改善患儿发育迟缓,伴癫痫发作者应积极合理使用抗癫痫药物治疗。新生儿期坏死小肠结肠炎为Sotos综合征中首次发现的临床表现,可为该综合征基因型与表型关系的研究提供参考。     

脊髓型颈椎病患者三维有限元模型的构建与生物力学分析

目的：构建颈部三维有限元模型(finite element model,FEM),初步分析脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者与对照者颈部生物力学的差异,为CSM发病机制的研究提供生物力学依据。方法：以1名CSM患者作为力学模拟实验对象进行三维CT扫描,并构建颈部三维FEM依照患者的年龄、性别、身高、体重等参数选取本团队已有的健康颈部三维FEM作为对照,比较患者和对照者在颈椎正常受力情况下椎体、椎间盘、韧带及脊髓的应力差异,以及后仰伸运动后最大应力的差异。结果：成功构建CSM患者及对照者FEM模型,并进行力学分析,CSM患者颈椎椎体受力差异C5~C6节段最明显,对照者和患者的最大应力部位均在椎体前缘,CSM患者椎体前缘的最大应力小于对照者;CSM患者椎间盘应力分布不均匀,最大应力部位集中在椎间盘底部后缘的两侧;CSM患者各韧带的应力分布不均匀,其中后纵韧带应力最大。CSM患者颈椎在后仰伸运动时范围受限。结论：CSM患者相对于对照者可能存在颈部椎体、椎间盘及韧带受力平衡的改变和颈椎运动范围的受限,这可能与CSM力学发病机制相关。     

A calculus within an anal fistula tract in a diabetic patient

A non-insulin dependent diabetic patient with a chronic anal fistula underwent fistulectomy. At operation a calculus was discovered. The patient had an uneventful recovery and healing of the wound in 4 weeks duration. The only case reported previously was in a nondiabetic patient and interestingly from this department.     

经9次核酸检测终确诊的新型冠状病毒肺炎患者1例分析

目前新型冠状病毒肺炎(COVID-19)疫情在全球蔓延,形势严峻,并对全球公共卫生事业构成巨大挑战,快速准确的诊断COVID-19对疫情的防控有重要意义。本文报道1例COVID-19患者的调查和确诊过程,以对COVID-19确诊和疫情防控提供有价值的参考。患者为赴渝务工于2020年1月23日返乡人员,在渝期间,其同工地的一同事确诊为COVID-19,之后该工地接连有另外8位同事被确诊。患者返乡后2月2日被当地疫情防控单位采取医学隔离。患者于隔离后不久出现咳嗽,阵发性,干咳为主,偶可咳出黄色痰液等COVID-19相关临床症状,遂被当地新型冠状病毒肺炎定点医疗单位收治,后经市级新型冠状病毒肺炎诊治专家组远程视频会诊转入四川大学华西医院资阳医院。患者先后经历9次核酸检测,在前8次核酸检测均为阴性的情况下,于第9次核酸检测结果为阳性,2月21日最终确诊为新型冠状病毒肺炎。     

在内分泌科临床教学中引入标准化病人的探索

标准化病人（standard patient，SP）是指经过一定培训的正常人或慢性病病人，同意充当某一疾病的模拟病人，以辅助学生临床学习或训练。标准化病人不仅可以用来训练学生临床实践能力，还可以考核学生的学习效果，从而更有效地训练学生临床实践技能和培养学生解决临床问题的能力。     

碘普罗胺诱发脑病1例报告

患者,男,42岁,因"发作性晕厥10+个月,胸闷20+d,胸痛10+d"入院.诊断为肥厚型心肌病,既往无高血压、糖尿病病史.为了解左室流出道压差及冠脉情况,予以左室心导管检查及冠脉造影术,心导管经右侧桡动脉入路,共使用碘质量浓度为370 mg I/mL的碘普罗胺200 mL,术后患者出现以剧烈头痛、皮质盲、神经精神症状...     

先天性簇绒肠病EpCAM基因复合杂合突变（c.491+1G>A；c.352_353ins CACC）1例报告

患儿男,1月龄,因“反复腹泻20+ d,吐奶4 d”入院。患儿生后第8天开始出现反复顽固性腹泻,伴腹胀、呕吐、脱水、酸中毒、营养不良,家族中多例消化系统恶性肿瘤患者。基因检测发现人上皮黏附因子（epithelial cell adhesion molecule, EpCAM）基因复合杂合突变（c.491+1G>A;c.352_353ins CACC）,确诊为先天性簇绒肠病。予部分肠外营养支持,患儿腹泻好转,但加奶困难,奶量增加即腹胀、呕吐。住院后期出现反复发热,最终家属签字出院。出院后仍有腹泻、吐奶,出院4周患儿体质量下降约1 kg,最终死亡。     

重视医务人员的主体地位 促进医院和谐发展

“以病人为中心”和“以医务人员为主体”的基本理念是“以人为本”。在医患关系建设过程中,贯彻“以病人为中心”是“以人为本”理念的核心,而“以医务人员为主体”,是实现“以病人为中心”的关键。在相关政策和良好的社会氛围支持下,把“以病人为中心”和“以医务人员为主体”相结合,对于我们建立良好的医患关系,促进医疗卫生事业的健康发展具有重要的现实意义。     

1例新型冠状病毒肺炎确诊病例的诊疗经过和调查分析

目的 分析广西田林县人民医院首例新型冠状病毒肺炎(COVID-19)患者肺部CT变化、临床表现特征和流行病学特点,为COVID-19防控提供经验依据。方法 采用描述性流行病学方法对2020年1月30日在田林县人民医院收治的1例COVID-19确诊病例的诊疗经过和流行病史进行分析。结果 患者临床表现为发热、乏力、咳嗽伴少许咳痰,入院以“呼吸道感染”收治,CT显示磨玻璃影,病灶进行性增大,通过对不同日期肺部CT对比高度怀疑新冠疑似病例,进而对患者隔离治疗并取样送检,该患者新冠肺炎病毒核酸检测阳性。患者长期居住田林县定安镇,其本人及家属均无武汉等旅居史;患者发病前同其妻一直经营一家早餐店。经大数据手段对患者潜伏期内到其经营粉店用餐的可疑人员逐一排查发现,2020年1月20日上午来自湖北省黄石市卢某某(卢某某为黄石市确诊病例)在患者经营的粉店用早餐,用餐人员一般情况下均通过递粉小窗口与患者面对面有近距离短暂交流对话。结论 患者临床症状不明显,肺部CT病灶严重程度与临床表现不一致,符合新冠病毒感染肺炎普通型特征。该患者感染途径是通过自疫区的当地短暂旅居者(感染源)发病前(潜伏期后期)近距离空气飞沫途径传播。     

从世界卫生组织第115号警示到北京协和医院病人安全实践

介绍了世界卫生组织第115号警示，结合北京协和医院成立的“以病人为中心”的“病人安全办公室”（Patient Safety Office，PSO），阐释了从病人的角度审视病人安全，注重发现系统缺陷和隐患，提出改进建议，防止相同或相似的医疗差错再次发生。从而建立一个比较安全的卫生体系。     

Comparisons between written and computerised patient histories

Patient histories were obtained from 99 patients in three different ways: by a computerised patient interview (patient record), by the usual written interview (medical record), and by the transcribed record, which was a computerised version of the medical record. Patient complaints, diagnostic hypotheses, observer and record variations, and patients' and doctors' opinions were analysed for each record, and records were compared with the final diagnosis. About 40% of the data in the patient record were not present in the medical record. Two thirds of the patients said that they could express all or most of their complaints in the patient record. The doctors found that the medical record expressed the main complaints better (52%) than the patient record (15%) but that diagnostic hypotheses were more certain in the patient record (38%) than in the medical one (26%). The number of diagnostic hypotheses in the patient record was about 20% higher than that in the medical record. Intraobserver agreement (51%) was better than interobserver agreement (32%), while the inter-record agreement varied from 25% (between the medical and patient records) to 35% (between the transcribed and patient records). One third of final diagnoses were seen in the medical record, with 29% and 22% for the transcribed and patient records, respectively. Interobserver agreement in the final diagnosis was 35%. The results of the study suggest that computerised history taking is suitable for certain patients in addition to, and not as a substitute for, the oral interview with a doctor.     

国内首例植入心脏起搏器后留置导引钢丝患者的救治与围手术期护理

目的 探讨植入心脏起搏器后留置导引钢丝患者的救治与围手术期护理. 方法 2016年10月四川大学华西医院收治1例心脏严重增大的患者,因病情原因,无法使用传统起搏器安置法,现采用植入永久性心脏起搏器后导引钢丝保留体内不撤出,起支架和固定作用,以防电极脱位的创新救治方法,并对其实施个性化的围手术期护理. 结果 患者手术成功,愈后良好,对护理质量满意度高,术后随访期间无不适. 结论 以此该方式完成心脏起搏器植入术尚属国内首创.针对临床特殊患者,采用植入起搏器后保留导丝的创新救治方法具有可行性,围手术期的个性化护理是保证治疗效果的关键.     

标准化病人在血液内科临床教学中的应用

标准化病人（Standard patient,SP）是指经过一定培训的正常人或病人充当某一疾病的模拟病人,以辅助学生临床学习或训练。采用标准化病人对学生进行问诊、体格检查训练,在一定程度上缓解了临床教学资源不足的矛盾,提高了学生的各项临床技能及沟通技巧,促进了医患交流,取得了较好效果。     

辽宁省首次发现米克戴德军团病

1991年2月我们对1例疑似军团病的患者进行了临床观察、病原分离及血清学检测。该患持续高烧,肺部病变发展迅猛,青霉素治疗无效,血液培养分离出一株革兰氏阴性杆菌,经微生物学和血清学鉴定为米克戴德军团菌。该患的血清学结果和临床治疗效果也支持其为米克戴德军团菌感染。这是我省首次发现由米克戴德军团菌引起的现患者,也是国内首次从病人血液中分离出米克戴德军团菌。     

Wheeze in a heart transplant patient with lymphoma.

We report a case of wheeze in a heart transplant patient who was receiving chemotherapy for a transplant-associated lymphoma. The patient was in severe respiratory distress; there were no radiological abnormalities. A diagnosis of invasive bronchopulmonary aspergillosis was made by bronchoscopy and bronchoalveolar lavage. Despite prompt antifungal therapy the patient died. Wheeze in a non-asthmatic immunocompromised patient, even in the absence of radiological abnormalities, is highly suggestive of invasive bronchopulmonary aspergillosis. Diagnosis is best established by bronchoscopy and examination of the fluid obtained by bronchoalveolar lavage; currently the response to treatment is often disappointing.     

Factors Affecting Inpatient Satisfaction: Structural Equation Modeling

Objective: Our study aimed to identify factors affecting patient satisfaction. Data: The study was conducted at a training hospital in Turkey. The final sample consisted of 302 inpatients. In this study, patient satisfaction was examined using a survey questionnaire with 22 questions collected under five dimensions. Method: Factor analysis was used to group 22 questions measuring patients’ satisfaction questions into certain dimensions. Then, structural equation model (SEM) was performed to determine the influence of patient characteristics on patient satisfaction. Results: Our analysis showed the questionnaire has an appropriate reliability and validity. The structural equation model (SEM) was used to determine those factors which could affect patient satisfaction. The results of SEM analysis showed that 15% of the total variance in patients’ satisfaction was explained by the model. The SEM analysis found that variables of education and type of clinic (surgical vs. non-surgical) were significant on patient satisfaction. Persons with a higher level of education were less satisfied when compared to those with a lower level of education. Surgical patients are more satisfied with the care they received when compared to non-surgical patients. Conclusion: The education level of patients and the type of clinics had a significant influence on patient satisfaction.     

非缺失型女性Duchenne型肌营养不良症患者短串联重复序列多态性分析

目的检测1例女性Duchenne型肌营养不良症(DMD)患者Dystrophin基因的突变情况及其短串联重复序列多态性,以探讨其发病机制。方法用多重PCR方法检测1例女性DMD患者的Dystrophin 基因,并用PCR结合基因扫描的方法连锁分析该患者及其家系的5个微卫星DNA位点(STR-44、45、49、40、5' DysⅡ)多态性。结果该患者和其儿子均为非缺失型DMD。短串联重复序列多态单倍型连锁分析发现女性DMD患者STR单倍型有两种情况:(1)和其患病的儿子Ⅳ-1具有一样的单倍型,该单倍型来自其未患病的母亲Ⅱ-1;(2)因该女性DMD患者儿子的第45内含子缺失,该患者的母亲有可能是嵌合体,该女性DMD患者只遗传了父亲的等位基因,则她的单倍型与其母亲及患病的儿子都不同。结论该女性患者由Dystrophin基因突变引起的可能性较小,她和患病的儿子的单倍型可能相同或不相同,说明其发病与短串联重复序列多态性关系不密切。     

背驮式同种原位肝移植的临床研究

对１例原发性肝癌患者作了背驮式原位全肝移植术，历时１１ｈ３０ｍｉｎ，手术获得成功。病肝的切除采用“左右翻转法”，肝静脉重建采用供肝肝上下腔静脉与受者下腔静脉行端侧吻合，其有宜在３０℃～４５℃。术中在无体外静脉转流的情况下，血流动力学保持平稳术后恢复良好。术后第６１天因胸、腹多死于呼吸衰竭。认为背驮式肝移植对全身血流动力学干扰较小，但对罗晚期肝癌就慎