恙虫病的特殊临床类型

恙虫病是一种全身多脏器受累的疾病,肝、心、肺、肾等器官均可累及,临床有多种特殊类型。本文总结了恙虫病的8种特殊临床类型,分别为呼吸系统损害型、消化系统损害型、泌尿系统损害型、循环系统损害型、神经系统损害型、血液系统损害型、内分泌系统损害型及生殖系统损害型,以使临床医生对该病早期特点能够充分认识,避免误诊、漏诊。     

应用O型管组作腹膜透析的初步报告

本文比较了三种腹膜透折系统(瓶装透析、国产袋装透析、O型管组透析)腹膜炎的发生率,发现瓶装组((?)=71)腹膜炎发生率为1次/11.4病人月,国产袋装组(n=30)为1次/4.5病人月,而O型管组(n=54)腹膜炎发生率显著低于其它两组,为1次/219.9病人月(P<0.05).本文结果提示行O型管组腹膜透析可显著降低腹膜炎的发生率.     

肝门胆管癌不同临床分期及分型对手术根治性切除及预后的评估价值

肝门胆管癌(HCCA)是一种胆管黏膜上皮癌,累及肝总管、左右肝管及其汇合部。其起病隐匿,当出现黄疸时大多已进入晚期,被公认为外科领域的治疗难题。根治性切除是治疗HCCA的最佳方法,是影响肿瘤复发率和患者生存期的重要因素。因此,术前评估肿瘤的可切除性是治疗HCCA的重要一步。目前,HCCA的分型和分期方法主要有8种: Bismuth-Corlette分型、改良T分期、TNM分期、JSBS分期、Gazzaniga分期、国际胆管癌协会分期系统、梅奥分期、Blechacz分期。在临床实践中,不同分期和分型均存有各自的优缺点。主要对HCCA的分期和分型方法作一系统综述,重点评述各分期和分型在术前评估根治性切除和预后方面的临床价值。     

CoaguChek XS国标标准化比值检测仪的临床应用

目的 探讨CoaguChek XS国际标准化比值(international normalized ratio,INR)检测仪在临床上的应用.方法 应用CoaguChek XS INR检测仪与ACL TOP凝血分析仪分别检测166例口服抗凝药患者的INR.比较CoaguChek XS INR检测仪与ACL TOP凝血分析仪检测口服抗凝药患者INR的相关性,偏倚及一致性.结果 CoaguChek XS与ACLTOP检测患者的INR的相关性良好(r=0.9539,y=1.0748X-0.1452).两种方法 总体均值偏倚差值为-0.06,CoaguChek XS比ACL TOP检测值略高.在INR>3.51时,CoaguChek XS比ACLTOP检测结果 明显偏高,两种方法 的检测结果 比较,差异有统计学意义(P<0.05).在INR<3.50时两种方法 的检测结果 比较,差异无统计学意义(P>0.05).结论 CoaguChek XS INR检测仪能够满足口服抗凝药患者的INR监测.     

Pseudo-elevation of conduction system pacing threshold through parallel connection of an intracardiac electrogram recording system

Parallel connection of an electrophysiology recording system (EP system) to equipment for conduction system pacing (CSP) has been widely used for fine monitoring of intracardiac electrograms and pacing evaluation. We experienced a case showing unexpected pacing threshold exacerbation under specific conditions when the EP system was connected in parallel. We evaluated the underlying mechanism using an ex vivo model. An ex vivo pacing and intracardiac electrogram monitoring model was generated using an oscilloscope, pacing system analyzer (PSA), EP system, and simulated heart. The discrepancy between expected output at the PSA and the actual measured output value at the simulated heart was measured under various conditions and using various combinations of pacing equipment. Parallel connection of the EP system was associated with reduced electrical output from the PSA as recorded at the simulated heart. The unexpected adverse effects were particularly noticeable when using an RMC-5000 EP system with the pacing function on. The trouble is completely resolved by simply turning off the pacing function of the system. There is a possibility that the EP system might increase the pacing threshold in CSP when the PSA and EP system is are deployed in parallel. The issue may provoke pseudo failure of CSP due to the high pacing threshold. When the RMC-5000 is used for conduction system pacing in parallel with a PSA for the pacing test, the pacing function of RMC-5000 should be turned off.     

肿瘤专科医院护士分层考核信息系统建设与实践

目的构建肿瘤专科医院护士分层理论考核信息系统，并应用于护士分层考核中。 方法利用医院信息系统，构建护士理论考核信息系统。考题包括基础知识和肿瘤专科知识两大部分，遵循依护士层级升高，考题难度递增的原则，形成不同层级护士理论考核电子试卷，应用于护士分层考核中。 结果考核系统应用简单便利，应用考核信息系统后，考试前准备时间、试卷统计、批阅时间、考试支出费用及护理人员对考试形式的满意度均明显优于使用考核信息系统前，差异有统计学意义（P<0.05）。 结论肿瘤专科医院护士分层理论考核系统实现了考核的信息化，使考核更加科学和规范，同时节省了人力资源，降低了管理成本。     

An accurate exercise lead system for bicycle ergometer tests

In order to minimize muscle noise in the exercise electrocardiogram,Mason and Likar proposed a new lead system where the limb electrodesare instead placed on the trunk. The Mason-Likar system is widelyused for both the resting ECG before exercise and recordingsduring exercise. Several studies have, however, reported greatdifferences between this lead system and the standard lead system.This study shows greater R wave amplitudes in leads II, aVFand III, smaller R wave amplitudes in leads aVL and I and thusa vertical shift of the frontal plane QRS axis for the Mason-Likarsystem compared with the standard system. For many years anotherlead system for exercise tests with the bicycle ergometer hasbeen used in our laboratory. The limb electrodes are placedat the proximal part of the arms and the left iliac crest. Thislead system yields ECG signals with a low level of muscle noise.The differences between this lead system and the standard ECGare much less pronounced than the differences between the Mason-LikarECG and standard ECG. We propose our lead system for exercisetests with the bicycle ergometer.     

Clinical evaluation of different fluid-filled systems for oesophageal manometry.

In a clinical study of oesophageal manometry with fluid-filled catheters, both a non-perfused system and a perfused system with a syringe pump have been compared to a system with a low-compliance perfusion pump, which served as a reference. Significantly lower values of motility amplitudes, motility derivatives, and partly of LES pressures, and a time delay of up to 0.5 sec of the amplitude maximum were obtained with the non-perfused system and the system with a syringe pump in comparison to the low-compliance system. Since the oesophageal function can be erroneously evaluated by use of a non-perfused system or a perfused system with a syringe pump, such systems cannot be recommended for clinical use.     

血吸虫毛蚴动态自动识别系统（装置）效果评价

目的　研发血吸虫毛蚴动态自动识别系统（装置）,实现其自动化检测,以提高其检测效率和检出率。方法　血吸虫毛蚴动态自动识别系统（装置）由光学体视镜、数字摄像机、动态自跟踪识别软件和计算机组成。在不同条件下,对比系统检测与5名专业人员人工检测的效率、准确率等。结果　血吸虫毛蚴动态自动识别系统（装置）的基本功能为毛蚴动态识别、标记、提醒,并可以自动保存视频和生成登记表、检验单等。室内实验该系统可自动识别毛蚴,无漏检率。人工检测无水虫组总符合率为74.67%,有水虫组为66.67%,系统检测总符合率则分别为100.00%和96.67%,差异有统计学意义（[χ2] = 9.634、11.081,P 均< 0.01）,系统检测效果优于人工。结论 血吸虫毛蚴动态自动识别系统（装置）可以替代人工观察,该系统可以用于血吸虫病的现场查病及相关基础研究。     

The plasma contact system 2.0

The contact system is a protease cascade that is initiated by factor XII activation on cardiovascular cells. The system starts procoagulant and proinflammatory reactions, via the intrinsic pathway of coagulation and the kallikrein-kinin system, respectively. The biochemistry of the contact system in vitro is well understood. However, activators of the system in vivo and their contributions to disease states have remained enigmatic. Recent experimental and clinical data have identified misfolded proteins, collagens, and polyphosphates as the long-sought activators of the contact system in vivo. Here we present an overview about contact system activators and their contributions to health and pathology.     

同步蓝牙心电诊断系统的临床应用研究

目的研究同步蓝牙心电诊断系统记录心电信号的准确性,同时评价其安全性和有效性。方法入选30例患者。每例应用同步蓝牙心电诊断系统以及美国GE公司生产的MAC-5000RestingECGSystem12导联同步心电图机,按照标准心电图导联的位置记录并打印二份心电图,分为蓝牙组与MAC组。对二组心电图进行波形与心电图临床诊断的比较,同时二组进行时间和幅度参数的比较。结果二组波形与心电图诊断完全一致。二组之间P波、QRS时限;PR和QT间期之间无显著性差异。二组之间除了Ⅱ导联R波幅度以及V5导联P波和S波幅度具有显著性差异之外,其余各导联的其它各波幅度均无显著性差异;Ⅱ导联R波幅度差值百分比为2.91%(0.026mV),小于心电图机国际及国家标准允许误差的范围;V5导联P波幅度差值百分比为11.8%,但绝对差值仅为0.009mV,无明显临床意义。蓝牙心电诊断系统传输数据安全正确。结论蓝牙心电诊断系统能准确提供12导联同步心电图记录。     

砷的神经系统损伤作用研究进展

砷能够通过血脑屏障到达中枢神经系统,发挥毒作用,不仅引起机体外周神经病变,还可导致人或实验动物行为异常和智力障碍。本文综述砷在中枢神经系统中可能的代谢途径与对外周神经系统、中枢神经系统和子代神经发育的损伤作用,并归纳砷致神经系统损伤的毒作用机制。目前,有关砷对神经系统损伤作用的研究日益增多,尤其对损伤机制的研究正逐步深入,但仍有许多问题有待进一步研究解决。     

Performance parameters of the diagnostic scoring systems for autoimmune hepatitis

The diagnostic criteria for autoimmune hepatitis (AIH) have been codified by an international panel, and a revision of the original scoring system based on 12 clinical components has been promulgated. A simplified scoring system has been proposed recently that is based on four clinical components. The goals of this study were to compare the performance parameters of the revised original and the simplified scoring systems and to determine the prowess of each as a diagnostic instrument. Diagnostic scores were determined using each scoring system in 435 patients with diverse chronic liver diseases, including 153 individuals with AIH by codified clinical criteria. The sensitivity, specificity, and predictability of each scoring system for the pretreatment diagnosis of AIH were determined. The revised original scoring system had greater sensitivity for the diagnosis than the simplified scoring system (100% versus 95%), and seven patients diagnosed as AIH using the revised original system were nondiagnostic by the simplified system (5%). The revised original scoring system also ascribed a diagnosis of AIH to 20 of 21 patients with cryptogenic chronic hepatitis, whereas only five patients were similarly classified by the simplified system (95% versus 24%). The simplified system had greater specificity (90% versus 73%) and predictability (92% versus 82%) for AIH than the revised original system, and it more commonly excluded the diagnosis in other diseases with concurrent immune features (83% versus 64%). CONCLUSION: The revised original scoring system performs better in patients with few or atypical features of AIH, and the simplified system is better at excluding the diagnosis in diseases with concurrent immune manifestations. Each system has attributes that can be exploited.     

延髓闩部肿瘤与其他部位脑肿瘤心电图改变的对比研究

目的 :比较延髓心血管调节中枢受累和其他部位脑肿瘤的心电图改变 ,探讨不同部位脑肿瘤与心电图改变之间的关系及其发生机制。方法 :15 2例脑肿瘤患者分成延髓组、边缘系统组、非边缘系统组 ,分别对其术前心电图进行观察、测量、统计学处理。结果 :48%的患者有心电图异常。延髓组边缘系统组与非边缘系统组比较心电图异常率、校正后的QT间期 (QTc间期 )异常、QTc间期均值、ST段异常、T波异常及窦性心动过速发生均有显著性差异 (P <0 0 5 )。心率延髓组较边缘系统组和非边缘系统组增快 ,有显著性差异 (P <0 0 5 )。结论 :延髓闩部心血管调节中枢受累 ,可以使副交感神经受到抑制 ,交感神经系统兴奋性异常增高 ,产生心率增快、复极障碍为主的心电图改变 ,心电图异常率明显增高。边缘系统损害产生与延髓受累相似的心电图改变 ,非边缘系统组心电图改变与延髓组有显著差异 ,表明脑损害部位与心电图改变之间存在相关性。     

Distribution of Subsidized Insecticide-treated Bed Nets through a Community Health Committee in Boboye Health District,Niger

In Niger, insecticide-treated bed nets (ITNs) have been distributed to the target group of households with young children and/or pregnant women at healthcare facilities in the course of antenatal/immunization clinics. With the aim of universal coverage, ITNs were additionally distributed to households through strengthened community health committees in 2009. This study assessed the impact of the community-based net distribution strategy involving community health committees in the ITN coverage in Boboye Health District, Niger. A cross-sectional survey was carried out on 1,034 households drawn from the intervention area (the co-existence of the community-based system together with the facility-based system) and the control area (the facility-based system alone). In the intervention area, 55.8% of households owned ITNs delivered through the community-based system, and 29.6% of households exclusively owned ITNs obtained through the community-based system. The community-based system not only reached households within the target group (54.6% ownership) but also those without (59.1% ownership). Overall, household ITN ownership was significantly higher in the intervention area than in the control area (82.5% vs. 60.7%). In combination, the community-based system and the facility-based system achieved a high ITN coverage. The community-based system contributed to reducing leakage in the facility-based system.     

系统性红斑狼疮血液系统损害与疾病预后分析

目的 分析系统性红斑狼疮(SLE)血液系统损害与疾病活动情况、免疫学指标的异常及疾病预后相关性.方法 总结江苏省1999-2009年间首次住院SLE患者的临床及实验室资料,观察血液系统损害情况,并分析了血液系统损害与SLE疾病活动情况、免疫学指标及SLE患者病死率间的关系.统计学处理采用X2检验.结果 1958例SLE患者纳入研究范围,其中女性患者1836例,男性患者122 例.所有SLE患者中,1549例(79.1%)患者合并血液系统损害,其中贫血占62.3%,白细胞减少占45.5%,血小板减少占29.4%;轻、中、重度活动组患者血液学损害率均高于基本无活动组(P=0.01和P＜0.01);血液系统损害发生率在红细胞沉降率、补体C3、抗双链DNA(dsDNA)抗体阳性组高于阴性组(P＜0.01);有166例患者在随访中死亡,其中因重症感染死亡占38.6%,因肾功能衰竭死亡占22.9%,因神经系统损害死亡占15.1%,心血管疾病占10.2%,其他死因占13.3%.死亡病例中存在血液系统损害占91.6%,无血液系统损害占8.4%,血液系统损害率在死亡患者中明显增高(p＜0.01).结论 血液系统是SLE最常受累的系统之一,其中以贫血最为常见,血液系统损害与狼疮病情活动密切相关;免疫性指标异常的患者容易继发血液系统的损害;重症感染是SLE患者死亡的主要原因,存在血液系统损害的SLE患者病死率高于非血液系统损害的SLE患者.

Abstract：

Objective To explore the relationship between the impairment of hematological system and disease activity,immunological parameters,and the prognosis of systemic lupus erythematosus (SLE).Methods The clinical and laboratory data of in-patients with SLE in Jiangsu Province were investigated and all patients were hospitalized between 1999-2009.The impairment of hematological system was assessed and the relationship between hematological system damage and disease activity,immunological parameters,mortality rate of patients with SLE were analyzed.Statistic method used was X2 test.Results One thousand nine hundred and fifty eight cases of SLE were included in the study,in which,1836 were female and 122 were male.One thousand five hundred and forty nine (79.1%) patients complicated with hematological system damage,62.3% were anemia,45.5% with leucopenia and 29.4% with thrombocytopenia.There were significant differences in hematological system damage rate among patients with mild activity group,moderate activity group,severe activity group and almost no activity group,compared respectively with almost no activity group.The P values were P=0.01 and P＜0.01 respectively.The incidence of hematological system damage in elevated ESR,low complement C3 level,anti-dsDNA antibody group was higher than that in patients who had normal ESR,complement C3 level and anti-dsDNA group.(P＜0.01).During follow-up,166 patients died,of which the mortality rate(91.6%) in patients had hematological system damage,was obviously higher than those without hematological damage(8.4%)(P＜0.01 ).Among the 166 deceased patients,38.6% died of severe infection,22.9% died ofrenal failure,15.1% died ofnervous system damage,10.2% died of cadiovascular damage and 13.3% died from other causes.Conclusion Hematological system is one of the most commonly involved system in patients with SLE,of which anemia is the most common,and the incidence of leukopenia follows.The impairment of hematological system is closely related to lupus activity.Patients with abnormal immune parameters tend to have secondary hematological system damage.Severe infection is the main cause of death in patients with lupus,followed by nervous system damage and kidney damage.The mortality rate in patients with lupus that complicated hematological system damage is higher than patients who have no hematological system damage.     

免疫评分系统在结直肠癌中应用的研究进展

结直肠癌是常见的消化系统恶性肿瘤,发病率和死亡率呈逐年上升趋势。TNM分期系统是目前国际上最为通用的肿瘤分期系统,但其分期标准仅基于肿瘤细胞本身特征,未能纳入患者整体免疫情况,在对患者预后的指导中逐渐显露不足。因此,在量化分析肿瘤微环境中免疫细胞的基础上,提出了免疫评分系统。近年多项研究证实,免疫评分系统能够更精准地评估结直肠癌患者的临床预后,且效果优于TNM分期。此外,免疫评分系统在辅助放化疗、评估免疫治疗疗效等方面也发挥重要作用,可进一步优化TNM分期系统及风险分层,有利于制定肿瘤患者的个体化治疗方案。本文就免疫评分系统在结直肠癌患者预后及疗效评估方面的研究进展进行综述。     

江西省晚期血吸虫病人治疗救助信息管理系统开发与应用

目的开发江西省晚期血吸虫病人治疗救助信息管理系统。方法采用Access 2003数据库,利用Visual Basic 6.0程序设计语言编写应用程序,采用Setup Factory 8.0打包发布。结果系统具有输入、输出、查询、统计和分析晚期血吸虫病人治疗救助数据的功能。系统操作简单,易于使用,维护成本低,数据查询和调用方便。结论成功开发了江西省晚期血吸虫病人治疗救助信息管理系统。     

绦虫病/囊尾蚴病现场问卷调查管理系统的设计与应用

本研究开发了针对绦虫病/囊尾蚴病的现场信息采集系统,旨在实现对绦虫病/囊尾蚴病流行情况的动态监测,提高疾病信息管理的智能水平。该系统包括应用层、核心层和数据层3层架构,采用Browser/Server整体架构进行数据传输和远程通信。该系统能够使疾病数据采集工作变得更加精准,标准化的数据可为后续数据分析工作提供更多便利。