伊曲康唑治疗隐球酵母菌性脑膜炎临床疗效观察

目的 观察研究伊曲康唑治疗隐球酵母菌性脑膜炎疗效及安全性.方法 选择2000年1月-2009年1月收住院的隐球酵母菌性脑膜炎患者临床资料,进行回顾性统计分析;依据治疗用药的方案分为3组,A组:应用两性霉素B(AmB)、5-氟胞嘧啶(5-FC)联合治疗;B组:应用伊曲康唑与AmB、5-FC联合治疗;C组:应用AmB联合5-FC治疗后,伊曲康唑口服序贯治疗;随访观察治愈、好转、死亡率、复发以及不良反应等,进行组间统计比较.结果 共纳入108例患者,所有患者均经病原学确诊;纳入A组45例、B组21例、C组42例;A组治愈16例占36.0％、好转11例占27.0％、死亡9例占20.0％;B组治愈9例占41.5％、好转7例占33.3％、死亡5例占23.8％;C组治愈24例占56.3％、好转13例占31.0％、、死亡2例占4.8％;3组患者均随访1～3年,A组复发6例占10.3％,B组未出现复发,C组3例复发占7.1％;3组患者的不良反应差异无统计学意义.结论 伊曲康唑应用于治疗隐球酵母菌性脑膜炎临床疗效好,安全可靠,可减少复发率和不良反应.     

中国艾滋病患者隐球菌脑膜炎患病率Meta分析

目的 了解中国艾滋病隐球菌性脑膜炎(CM)患病率及不同地区的疾病负担。 方法 系统检索PubMed、Web of Science、中国知网和万方数据知识服务平台截至2022年10月10日发表的相关文献,使用Stata 17.0软件进行Meta分析。 结果 随机效应模型显示,中国艾滋病CM总体患病率为2.8%(95%CI：1.9%~3.8%),南方地区患病率(3.3%)高于北方地区(1.8%);西南地区患病率最高(3.5%),华北地区最低(2.0%);广泛抗逆转录治疗(ART)时期艾滋病CM患病率(2.7%)较有限ART时期(2.9%)有所下降。 结论 中国艾滋病患者CM疾病负担较重,且患病率呈南高北低态势,ART广泛开展后艾滋病CM总体患病率有所下降。     

影响骨肉瘤患者预后的多因素分析

目的 探讨影响骨肉瘤患者预后的因素.方法 回顾性分析32例骨肉瘤患者的临床资料,对患者性别、年龄、病程、血清碱性磷酸酶(AKP)水平、肿瘤大小、肿瘤生长部位、Enneking外科分期、手术方式及远处转移9个因素进行统计学分析.结果 32例患者均获得随访,随访时间6～ 52(40.28±5.58)个月;随访期间死亡12例,3年生存率为62.5％(20/32).单因素分析结果显示肿瘤生长部位、Enneking外科分期、手术方式及远处转移与患者预后明显相关(P＜0.05).多因素分析结果显示Enneking外科分期、手术方式及远处转移是影响患者预后的独立危险因素(OR值分别为2.420、0.318、2.166,P值分别为0.008、0.006、0004).结论 Enneking外科分期、手术方式及远处转移是影响骨肉瘤患者预后的独立危险因素,早期诊断及充分切除肿瘤可改善患者预后.     

小儿病毒性脑膜炎主要影响因素分析及临床预测模型构建

目的 探究小儿病毒性脑膜炎主要影响因素,并建立个体化预测毒性脑膜炎患病风险的列线图模型。方法 以1[DK]∶1比例分别选取1000例病例组与对照组,采用logistic回归分析可能影响病毒性脑膜炎的因素;应用R软件建立预测毒性脑膜炎患病风险的列线图模型,采用ROC曲线和Hosmer-Lemeshow拟合优度检验评价模型。结果 男性（OR=1.254）、饭前便后不洗手（OR=2.752）、家庭卫生状况一般和差（OR=2.016;OR=2.847）、邻居或亲戚有疑似患者（OR=7.793）是小儿病毒性脑膜炎的危险因素,中性粒细胞/淋巴细胞比值（OR=0.322）是保护因素。拟合优度结果显示模型拟合良好,（P=0.259）;ROC曲线下面积为0.843（95%CI:0.826~0.860）,模型区分度良好。结论 本研究基于小儿病毒性脑膜炎影响因素,建立具有良好区分度与准确度的风险预测模型,对早期识别小儿病毒性脑膜炎高风险人群,制定针对诊疗具有指导意义。     

AIDS合并结核性脑膜炎患者的死亡风险因素分析

目的　探讨AIDS合并结核性脑膜炎患者死亡的风险因素,以帮助临床医生尽快制定预防及干预策略,从而降低死亡率。方法　回顾性分析2009年 1月—2017年12月北京地坛医院125例AIDS合并结核性脑膜炎入院治疗患者的临床资料。结果　125例患者中有50例（40.00％）于12个月随访期内死亡。低蛋白血症、中枢神经系统病变诊断不明、非AIDS指征性疾病是AIDS合并结核性脑膜炎患者随访期生存率明显下降、死亡风险增加的影响因素。结论　低蛋白血症、中枢神经系统病变诊断不明、非AIDS指征性疾病是导致AIDS合并结核性脑膜炎患者死亡的风险因素。因此,具备这些风险因素的患者,在入院早期应当给予重视及积极的重症监护治疗。     

应用因子分析探讨影响流行性脑脊髓膜炎流行的因素

应用因子分析理论，结合随州市８年来的流脑监测资料，对影响流脑流行的１２个因素进行了研究。结果表明，影响流脑流行的前六位因素是：人群流脑菌Ｂ群、Ａ群带菌率、一月份相对湿度、一月份发病率、流行前期流脑接种率和人群抗体平均滴度。尽管当前流脑发病以散发为主，但影响流脑流行的因素并未完全消失，继续广泛使用流脑Ａ群多糖菌苗，加强对流动人口及重点地区人群的监测工作仍具有重要意义     

Comparison of prognostic and socio-economic factors in screen-detected and symptomatic cases of breast cancer

Background: The relationship between breast cancer and socioeconomic deprivation is complex. Although women from more deprived areas are less likely to get breast cancer, in general they experience poorer survival. A number of reasons have been proposed, including differences in tumour stage and tumour biology, but recent studies suggest that treatment factors or host response are the most important. The introduction of a national health service breast screening programme (NHSBSP) means that an additional factor now has to be taken into account. As deprived women are less likely to attend for screening we set out to determine the nature of the relationship between prognostic factors evident at diagnosis, screening status and socio-economic deprivation, in order to assess the implications for the NHSBSP.Methods: The NHSBSP computer systems and the Thames Cancer Registry (TCR) database were used to examine breast cancers diagnosed in women aged 50–64 y during the period 1988–1992. Cases had previously been classified into screen-detected, interval cancers, eligible but not yet invited, non-attenders and those not registered with the programme. A prognostic score was assigned to each case using TCR data on the morphology and extent of the disease. Socio-economic comparisons were made from the women's postcodes and census details using the Carstairs method.Results: Screen-detected cases had a significantly better prognosis at diagnosis than those presenting with symptoms, and were less deprived than those who did not comply with the screening programme (by either failure to attend or not being registered). When the relationship between presentation status, deprivation and prognosis was assessed together, screen-detected cases had a better prognosis at diagnosis irrespective of deprivation level.Conclusion: The poor survival rate of deprived women with breast cancer due to host or treatment factors is likely to be compounded by poor attendance for screening. Unless the NHSBSP increases its efforts to target these women, the socio-economic gradient in breast cancer survival is likely to increase.     

Sex therapy for erectile dysfunction: Characteristics of couples,treatment outcome,and prognostic factors

Outcome and prognostic factors were studied in 36 couples who entered sex therapy because of the male partners' erectile dysfunction. Treatment was completed by two thirds. Noncompletion was associated with lower socioeconomic status, the female partner having a history of psychiatric treatment, pretreatment poorer motivation of the male partner, poor communication in the general relationship, and less sexual pleasure experienced by the female. A positive treatment outcome occurred in 69.4%, and was associated with better pretreatment communication and general sexual adjustment, especially the female partner's interest and enjoyment of sex, absence of a positive psychiatric history in the female partner, and a couple's early engagement in homework assignments. Results highlight important aspects of the initial assessment, indicate couples for whom the initial phase of treatment should be prolonged and modified or an alternative approach considered, and have implications for assignment of couples to treatment groups in evaluative studies of therapy.     

肝硬化并发肝衰竭患者发生血流感染的预后因素分析

目的　回顾性研究影响肝硬化并发肝衰竭患者发生血流感染的预后因素,为诊治该类患者提供循证医学证据,以期降低病死率。方法　采取回顾性研究方法,以原解放军第三〇二医院收治的肝硬化并发肝衰竭发生血流感染的124例患者为研究对象,根据随访至血流感染发生后30 d的生存情况,分为死亡组、存活组,对纳入指标进行单因素分析,将2组间差异显著的指标纳入Logistic回归分析,筛选出影响患者预后的因素。结果　入组124例患者,死亡55例。与生存组相比,死亡组女性及年龄为46～65岁患者的比例更高（P均＜0.05）,且多数患者发生血流感染前终末期肝病模型（model for end-stage liver disease, MELD）评分＞25分。2组感染时血中性粒细胞比例,合并肝细胞癌、肝性脑病、急性肾功能不全、肺炎、自发性细菌性腹膜炎、脓毒性休克、12 h内应用抗生素患者的比例相比,差异均有统计学意义（P均＜0.05）。Logistic回归分析显示,46～65岁（OR=3.450,95%CI：1.042～11.420）,感染前MELD评分＞25分（OR=6.949,95%CI：2.080～23.209）,感染发生后＞12 h应用抗生素治疗（OR=3.142,95%CI：1.013～9.747）,感染后发生脓毒性休克（OR=5.260,95%CI：1.681～16.459）的患者病死率更高（P均＜0.05）。结论　肝硬化并发肝衰竭患者一旦发生血流感染,如果年龄在46～65岁、感染前MELD评分＞25分,感染发生后＞12 h应用抗生素治疗以及感染后发生脓毒性休克,预后差。     

Transsexualism—General outcome and prognostic factors: A five-year follow-up study of nineteen transsexuals in the process of changing sex

Ninetten transsexuals, approved for sex reassignment, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behavior), and DMT (Defense Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n=13) had improved in at least two areas of functioning. In 3 cases (16%) outcome were judged as unsatisfactory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socioeconomic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome. Supported by Swedish Medical Research Council Grant 3-21X-10411-01A, and a grant from the Joint Committee of Northern Health Regions.     

隐球菌抗原-胶体金免疫层析法在隐球菌性脑膜炎和隐球菌性肺炎诊断中的应用价值

目的探讨胶体金检测隐球菌荚膜多糖抗原对隐球菌性脑膜炎和隐球菌性肺炎的诊断价值。方法选取2017年1月-12月南昌大学第一附属医院548例疑似隐球菌性肺炎患者与414例疑似隐球菌性脑膜炎患者为研究对象,分析应用胶体金免疫层析法检测患者隐球菌荚膜多糖抗原对隐球菌性脑膜炎和隐球菌性肺炎诊断的敏感性、特异性、阳性预测值和阴性预测值。结果 962例患者经病理活检或培养阳性或墨汁染色确诊为隐球菌性肺炎36例,隐球菌性脑膜炎38例;胶体金免疫层析法诊断隐球菌性肺炎的敏感性和特异性分别为91.67%和99.61%,阳性预测值和阴性预测值分别为94.29%和99.42%;诊断隐球菌性脑膜炎的敏感性和特异性分别为97.37%和99.73%,阳性预测值和阴性预测值分别为97.37%和99.73%。结论胶体金免疫层析法具有准确率高、快速简便的特点,可作为隐球菌性脑膜炎和隐球菌性肺炎的辅助诊断,具有一定的临床应用价值。     

社区获得性肺炎合并哮喘住院患者临床特征和预后因素分析

目的 探讨合并哮喘对社区获得性肺炎（CAP）住院患者疾病特征和预后的影响。方法 回顾性收集2013年1月1日—2015年12月31日北京、山东、云南4所医院住院的所有CAP患者病例资料,比较合并哮喘（AS-CAP）和不合并哮喘（非AS-CAP）患者人口学、临床和影像学特征、病原学和临床结局,单因素分析影响AS-CAP住院患者30天病死率的独立危险因素。结果 3 901例CAP患者纳入分析,AS-CAP占5.9%（231/3 901）。相比于非AS-CAP患者,AS-CAP患者多为女性,年龄较轻,吸入因素、一年内CAP病史和使用吸入糖皮质激素史多见,发生胸腔积液少见,但PSI分级/CURB-65评分、病原学分布、入住ICU比例和30天病死率以及住院时间两组相似。AS-CAP住院患者30天病死率为2.2%（5/231）。与生存组相比,死亡组男性、脑血管病、慢性肝病、吸入因素和影像学空洞比例更高,PSI分级更高,差异均有统计学意义（均P<0.05）。结论 AS-CAP和非AS-CAP患者临床特征和结局相似,合并AS不增加CAP患者病情严重性和30天病死率。除PSI分级外,临床医生还应该重视吸入因素等。     

Prevalence of meningococcal meningitis in China from 2005 to 2010

BackgroundWe aimed to estimate the prevalence and epidemiologic characteristics of meningococcal meningitis (MM) in mainland China (excluding Taiwan, Hong Kong, and Macau) and to provide reference data for controlling the outbreak and prevalence of MM.MethodsData from the National Notifiable Diseases Registry System and the MM case information reporting system from 2005 to 2010 as well as data from the MM Surveillance System were used.ResultsThe morbidity of MM for the whole country was, on average, 0.09 cases per 100,000 (range 0.02 [2010]–0.18 [2005] cases per 100,000) from 2005 to 2010, the incidence rate was highest in the Xinjiang autonomous region (average 0.56 cases per 100,000), and the majority of cases came from Anhui province (average 0.32 cases per 100,000). Morbidity was highest in children under 1 year old (average 0.60 cases per 100,000). The proportion of laboratory-confirmed cases of serogroups A, B, and C were 37.2, 11.5 and 42.7, respectively, from 2005 to 2010.ConclusionsThe incidence level declined year-to-year in mainland China. Children and students are the most at risk groups. The proportion of serogroup C cases has increased year-to-year, and new cases of serogroup W135 have been found. Controlling the epidemic of serogroup C and preventing outbreaks of serogroup B and W135 represent major future challenges.     

Japanese encephalitis virus in meningitis patients, Japan

Cerebrospinal fluid specimens from 57 patients diagnosed with meningitis were tested for Japanese encephalitis virus. Total RNA was extracted from the specimens and amplified. Two products had highest homology with Nakayama strain and 2 with Ishikawa strain. Results suggest that Japanese encephalitis virus causes some aseptic meningitis in Japan.     

职业性白细胞减少症患者的临床疗效及预后分析

本文对130例职业性白细胞减少症患者的临床资料进行了回顾分析,并对患者的近、远期疗效及影响疗效的多种因素应用Cox模型进行统计计算。结果发现,现有常用升白药近、远期疗效都很差,在现有治疗方案中,以长时间复合用药效果最佳。治疗方法、疾病种类、住院次数对近期疗效有明显影响,远期疗效则主要取决于出院时白细胞的多少,单纯休息及不规律间断用药对血象影响不大。本文将Cox模型用于职业病临床疗效分析,荻得初步成功。     

无菌性脑膜炎患者肠道病毒感染鉴定方法

目的建立一种快速、准确的鉴定无菌性脑膜炎患者肠道病毒感染的方法。并与传统的细胞培养及血清分型相比较。方法对78例无菌性脑膜炎患儿脑脊液中肠道病毒,用人宫颈癌细胞(HeLa)、横纹肌细胞(RD)和人喉癌细胞(Hep-2)细胞进行分离培养血清分型,同时用根据肠道病毒5’UTR区基因序列设计引物,用PCRT-R法扩增病毒的基因。结果该方法可检测的灵敏度的组织培养感染量(TCID50)为0.1;78例脑脊液(CSF)中46例肠道病毒培养为阳性,而用RT-PCR法检测52例阳性。结论该方法与细胞培养及肠道病毒血清分型法相比较具有较高的灵敏度和特异性,可快速、灵敏地检测脑脊液中的肠道病毒。     

细菌性脑膜炎患者脂氧化酶和脂氧素A4水平的变化及临床意义

目的 探讨白细胞15-脂氧化酶、白细胞5-脂氧化酶、血液脂氧素A4(lipoxin A4,LXA4)和CRP水平在细菌性脑膜炎患者外周血的变化及其临床意义.方法 根据脑膜炎诊断标准及分度标准选取脑膜炎患者104例作为病例组,其中轻、中、重度脑膜炎患者分别为35、42、27例;选取健康体检者40名作为对照组.采用RT-PCR方法测定血白细胞15-脂氧化酶和5-脂氧化酶的mRNA表达,应用ELISA方法测定血液LXA4含量,采用免疫透射比浊法测定血液CRP浓度.结果 轻、中、重度细菌性脑膜炎患者血白细胞15-脂氧化酶相对表达量分别为(1.73±0.54)、(1.25±0.19)和(0.53±0.22),血液LXA4浓度分别为(5.12±1.89)、(1.75±0.70)和(0.79±0.34) μg/L,均逐渐降低,但仍分别高于对照组的(0.23±0.11)和(0.03±0.02) μg/L (P均＜0.01).而轻、中、重度细菌性脑膜炎患者白细胞5-脂氧化酶相对表达量分别为(0.24±0.16)、(0.71±0.32)和(1.19±0.49),血液CRP浓度分别为(15.07±0.74)、(53.71±27.91)和(117.91±40.62) mmol/L,均随病情严重而逐渐升高,均高于对照组的(0.11±0.04)和(3.04±1.25) mmol/L(P均＜0.01).结论 细菌性脑膜炎患者随着病情加重,体内15-脂氧化酶及其产物LXA4逐渐下降,5-脂氧化酶及CRP水平逐渐升高,上述指标变化可客观反应炎症严重程度、评估治疗效果.     

Pattern of bacterial meningitis in Italy, 1994

During 1994, 603 cases of bacterial meningitis were reported in Italy. Seventy-five percent of cases with determined etiology was due to three agents: Neisseria meningitidis (33.4%), Streptococcus pneumoniae (23.4%) and Haemophilus influenzae (18.6%). The majority of cases due to N. meningitidis and H. influenzae occurred in subjects below five years of age (35.7% and 84.8%, respectively) while S. pneumoniae accounted for 52.8% of meningitis cases in subjects older than 44 year of age. The estimated incidence of N. meningitidis on the national population in 1994 was 0.27 per 100,000. Serogroup B accounted for 62.5% of the serotyped isolates, group C for 23.1%, group A for 7.2%, group W135 for 3.6%, group Y for 1.8%. All tested meningococcal strains were susceptible to penicillin as well as to rifampin. Incidence of meningococcal meningitis in 1994 has been low suggesting that its relative importance compared to other bacteria causing meningitis is likely to change in the future. Therefore, extended surveillance on bacterial meningitis by other etiological agents has to be maintained and implemented in order to undertake the appropriate control measures and evaluate their effect.