炎症性肠病患者饮食管理软件应用评价

目的 评价国内外炎症性肠病患者饮食管理软件,探究其基本功能设置及性能。方法 在Android、IOS应用商店中搜索截至2020年3月发布的与炎症性肠病患者饮食管理相关软件,下载并安装后对软件基本功能设置及性能进行评价。结果 共纳入18个炎症性肠病患者饮食管理相关软件,Android系统2个,IOS系统14个,IOS及Android兼容系统2个;版本1.X 7个,2.X 6个,3.X及以上4个,1个版本不详;纳入的均为英文软件。功能数2~15（6.8±3.9）个,软件功能主要涉及饮食记录（14/18）个,食谱参考(4/18)个,饮食咨询（3/18）个,饮食查询（5/18）个,饮食不良反应记录反馈（4/18）个,食物消化情况（2/18）个,个性化饮食管理设置（7/18）个,饮食教育（8/18）个。另有其他辅助功能如症状管理、情绪管理、药物管理、厕所定位、信息发送等。在纳入的软件中,50%有使用指导,33.3%提供了参考资料来源,44.4%有专业医护人员参与软件开发。结论 市面上正在运营的炎症性肠病患者饮食管理软件均来自国外且质量良莠不齐,多数软件功能不全面,如缺少炎症性肠病患者营养摄入需求的评估模块,缺乏对患者饮食不良反应的关注,饮食推荐不符合我国人群饮食习惯等软件对患者实验室检查结果的关注度较低,难以判断饮食管理效果。另外,大部分软件的信息设计未循证相关指南,缺乏专业医疗人员参与,科学性较差,建议改良或开发适合我国国情的炎症性肠病患者饮食管理软件。     

An Objective Assessment of the Value of Exercise Training to Patients with Chronic Obstructive Airways Disease

The value of a programme of graded exercise training was assessedin ten subjects with chronic obstructive airways disease. Assessmentswere made at two-weekly intervals during three twelve-week periods:before, during and after a period of training. During the trainingthe subjects were able to walk significantly further in a 12minute walking test. There was also a small but significantincrease in the forced expiratory volume in one second and thedifference between the values of total lung capacity estimatedby body plethysmography and those estimated by helium dilutionwas significantly smaller. The transfer factor for carbon monoxideincreased and was significantly greater in the period afterstopping the training. The difference between alveolar and arterialoxygen tensions at rest was smaller during the training period.The changes in the results of the 12 minute walking test, transferfactor and the oxygen tension difference were maintained inthe period after stopping the training. Despite the improvementsin some of the indices of respiratory function there were noimprovements in any of the indices of cardiorespiratory fitnesswhich may be because the subjects were incapable of undertakingsufficiently intense training. It is concluded that trainingis of some benefit to patients with chronic obstructive airwaysdisease but that the benefit may be greater in patients whoare less incapaciated and who are able to undertake a more strenuoustraining programme.     

4例Castleman病临床观察及文献分析

目的:分析Castleman病的诊断和治疗方法。方法:分析4例Castleman病因的临床资料并复习相关文献。结果:本组男性2例,女性2例,年龄19～45岁。临床分型:局灶型3例,多中心型1例。病理学分型:透明血管型4例。局灶型经手术均治愈。多中心型经干扰素及联合化疗治疗后病情稳定。结论:该病诊断主要依靠病理学确定。手术、化疗可控制本病发展。     

Ultrasound-Based Shear Wave Elastography in the Assessment of Patients with Diabetic Kidney Disease

In previous studies of acoustic radiation force impulse (ARFI) elastography, using Virtual Touch tissue quantification (VTQ) (Siemens Acuson S2000), it was reported that the measurement of renal shear wave speed in patients with chronic kidney disease (CKD) is not influenced exclusively by renal fibrosis. The purpose of the present study was to analyze the role of VTQ in patients with diabetic kidney disease, considered the main cause of CKD. The study group included 164 patients: 80 patients with diabetic kidney disease (DKD) and 84 without renal disease or diabetes mellitus. In each subject in lateral decubitus, five valid VTQ measurements were performed in each kidney and a median value was calculated, the result being expressed in meters/second. The following means of the median values were obtained In DKD patients, the means of the median values were for VTQ right kidney, 2.21 ± 0.71 m/s, and for VTQ left kidney, 2.13 ± 0.72 m/s, whereas in the normal controls statistically significant higher values were obtained: 2.58 ± 0.78 m/s for VTQ right kidney (p = 0.0017) and 2.46 ± 0.81 m/s for VTQ left kidney (p = 0.006). Patients with an estimated glomerular filtration rate (eGFR) >60 mL/min (DKD stages 1 and 2 together with normal controls) had a significantly higher kidney shear wave speed compared with patients with an eGFR <60 mL/min (2.53 m/s vs. 2.09 m/s, p < 0.05). In the DKD group, there was a significant correlation between eGFR and VTQ levels for the right kidney (r = 0.28, p = 0.04). There was no correlation of VTQ values with proteinuria level, stage of diabetic retinopathy or glycated hemoglobin. Our study indicates that shear wave speed values in patients with diabetic kidney disease and eGFRs <60 mL/min are significantly lower compared with those of patients with eGFRs >60 mL/min (either normal controls or diabetic patients with DKD stages 1 and 2), and values decrease with the decrease in eGFR. However, proteinuria, diabetic retinopathy and glycated hemoglobin have no influence on VTQ.     

生长抑素在直肠癌开腹手术后腹胀治疗中的应用

目的探讨生长抑素在直肠癌开腹手术术后腹胀治疗中的应用价值。方法选取收治的36例行直肠癌开腹手术术后腹胀的患者作为研究对象,随机分为两组,每组各18例。试验组给予常规治疗加生长抑素治疗,对照组给予常规治疗。观察两组的治疗效果。结果试验组总有效率为94.4%,对照组为83.3%,差异有统计学意义(χ2=5.9148,P=0.0150)。结论生长抑素治疗直肠癌开腹手术术后腹胀疗效确切,值得临床广泛应用。     

Tei指数评价川崎病患者心功能的研究

目的 应用Tei指数评价急性期川崎病患者左心功能变化。 方法 急性期川崎病患者83例，正常对照组40例，以M-型超声获得左室射血分数（LVEF），在心尖五腔观，应用脉冲多普勒（PW）同时获得二尖瓣口和主动脉瓣口血流频谱，在同一心动周期内测量所需数据并计算出Tei指数、E／A比值。比较两组间参数。 结果 川崎病组与正常组LVEF差别无显著性意义（P〉0．05）；川崎病组E／A比值低于正常对照组（P〈0．05），而Tei指数明显高于正常对照组（P〈0．01），差别具有显著性意义。 结论 Tei指数可以很好地评价川崎病患者急性期左心整体功能的损害，较之射血分数（EF）值更为敏感、准确。     

彩色脉冲多普勒超声对类风湿关节炎活动期的评估

目的应用彩色脉冲多普勒超声,对类风湿关节炎（RA）患者的手、腕、掌指关节和尺桡面的关节滑膜囊内血液供应情况和血流频谱进行检测评估。方法对30例类风湿患者,分成活动期和非活动期两组的300个掌指关节（MCP）60个尺桡面（URS）进行检测,并测量所有血流的阻力指数（RI）和搏动指数（PI）。结果16例患者有62个MCP检测到血流信号,20例患者中有29个URS探测到血流信号。应用彩色脉冲多普勒超声评估RA活动期的敏感性,特异性,阳性预测值和阴性预测值分别为94%,64%,81%和88%。且血流信号数目与RI间存在负相关,血流信号数目越多,RI值越低。结论应用彩色脉冲多普勒评估RA是否为活动期,是一种安全、可靠、敏感度高的检测方法。     

新型冠状病毒肺炎患者医院营养管理专家意见(2020)

为更好地防控新型冠状病毒肺炎疫情、加强患者营养管理,北京市临床营养治疗质量控制和改进中心组织相关专家制订了《新型冠状病毒肺炎患者医院营养管理专家意见(2020)》.意见明确提出,应将营养管理、食品安全和食品卫生纳入新型冠状病毒肺炎防控、诊疗和患者康复的全过程,建立包括营养风险筛查、营养不良诊断、营养支持治疗和营养监测在...     

Autologous Mixed Lymphocyte Reaction in Patients with Hodgkin's Disease: EVIDENCE FOR A T CELL DEFECT

The proliferative response of T lymphocytes cultured with autologous non-T lymphocytes is known as the autologous mixed lymphocyte reaction (MLR). This reaction can be demonstrated reproducibly in healthy individuals and has been shown to generate specific cytotoxic T cells, as well as T cells that regulate antibody synthesis and cell-mediated immunity. In this study, we demonstrate that the autologous MLR is impaired or absent in most patients with Hodgkin's disease regardless of age, sex, pathologic stage, or histologic classification. In 64 patients, the mean autologous MLR was 3,084±1,878 cpm compared to 16,552±6,532 in 29 healthy donors. A defect in autologous MLR was observed in newly diagnosed patients before the initiation of therapy, but was also found in patients without evidence of recurrent disease up to 15 yr after treatment.     

新型冠状病毒肺炎患者医院营养管理专家意见(2020)

为更好地防控新型冠状病毒肺炎疫情、加强患者营养管理,北京市临床营养治疗质量控制和改进中心组织相关专家制订了《新型冠状病毒肺炎患者医院营养管理专家意见(2020)》。意见明确提出,应将营养管理、食品安全和食品卫生纳入新型冠状病毒肺炎防控、诊疗和患者康复的全过程,建立包括营养风险筛查、营养不良诊断、营养支持治疗和营养监测在内的合理规范的营养管理路径,以改善新型冠状病毒肺炎患者的免疫状况、生活质量和临床结局。     

Esophagomediastinal Fistula in Hodgkin's Disease

A 31 year old woman with a rare esophagomediastinal fistula associated with Hodgkin's disease was successfully managed without surgical intervention. Intravenous nitrogen mustard relieved progressive dyspnea and improved symptoms of a superior vena cava syndrome. The syndrome and fistula completely disappeared after irradiation with cobalt 60.     

克罗恩病患者英夫利西治疗期间的自我管理

目的探讨应用英夫利西（infliximab）治疗克罗恩病期间患者的自我管理。方法制定英夫利西治疗克罗恩病患者的自我管理内容并制作成表格,治疗前让患者熟悉表格中要填写的内容,教会患者自我评价并填写表格。开始治疗前及治疗后每天自我记录腹痛程度、大便情况、体温情况及自我感觉,在治疗的同时进行统计分析,比较治疗前后的变化。结果13例患者共输注英夫利西65次,输注后腹痛程度、大便情况、体温情况及自我感觉得到有效的改善。结论英夫利西能够有效地改善患者的症状、体征,教会患者进行规范自我管理,避免患者长期住院或频繁就诊,且有利于医生准确掌握治疗的效果。     

酒精性肝病患者焦虑及抑郁情绪评估分析

目的探讨酒精性肝病患者焦虑及抑郁情绪情况。方法以健康志愿者为对照,观察比较酒精性肝病患者焦虑及抑郁情绪的状况,采用焦虑自评量表(SAS)与抑郁自评量表(SDS)分别对其焦虑、抑郁状况评估。结果酒精性肝病各组患者SAS评分高于对照组(P<0.05),酒精性肝硬化患者SDS评分高于对照组(P<0.05)。结论酒精性肝病患者存在不同程度的焦虑及抑郁的情绪障碍,应引起足够重视。