孟鲁司特钠联合氨溴索对支气管哮喘患儿血清sE-SLT和sICAM-1水平的影响

目的探讨孟鲁司特钠联合氨溴索对支气管哮喘患儿血清可溶性E-选择素(s E-SLT)、可溶性细胞间黏附分子-1(sICAM-1)水平的影响。方法前瞻性研究2014年3月至2017年3月宝鸡市人民医院收治的支气管哮喘患儿100例,按照随机数字表法将患儿分为孟鲁组和常规组,每组各50例,常规组给予常规对症和氨溴索治疗,孟鲁组在此基础上给予孟鲁司特钠治疗,比较两组患儿治疗前后血清sE-SLT、sICAM-1水平,肺功能[一秒钟用力呼气量(FEV1)、用力肺活量(FVC)、FEV1/FVC]和治疗疗效、不良反应情况。结果孟鲁组和常规组治疗后血清sE-SLT(220. 25±24. 19 pg/ml vs. 284. 34±29. 87pg/ml,256. 25±26. 65 pg/ml vs. 282. 77±28. 45 pg/ml)、sICAM-1(223. 54±15. 21 ng/ml vs. 277. 43±27. 67 ng/ml,245. 12±15. 75 ng/ml vs. 274. 45±28. 01 ng/ml)水平明显低于治疗前,孟鲁组治疗后血清sE-SLT、sICAM-1水平明显低于常规组,差异具有统计学意义(P 0. 05);孟鲁组和常规组治疗后FVC(3. 63±0. 51 L vs. 2. 76±0. 32 L,3. 34±0. 43 L vs. 2. 75±0. 42 L)、FEV1(2. 82±0. 42 L vs. 1. 93±0. 26 L,2. 53±0. 27L vs. 1. 94±0. 33 L)、FEV1/FVC(62. 01±7. 66 vs. 46. 67±5. 56,56. 28±6. 67 vs. 46. 32±5. 28)水平明显高于治疗前,孟鲁组治疗后FVCL、FEV、FEV1/FVC水平明显高于常规组,差异具有统计学意义(P 0. 05);孟鲁组治疗有效率为96. 00%,明显高于常规组的78. 00%,差异具有统计学意义(P 0. 05);孟鲁组和常规组的不良反应发生率为10. 00%、14. 00%基本相同,差异无统计学意义(P 0. 05)。结论孟鲁司特钠联合氨溴索治疗可有效改善支气管哮喘患儿血清s E-SLT、sICAM-1水平和肺功能,有利于提高患儿的治疗疗效,且具有良好的安全性,值得临床推广应用。     

4.5~5.5岁聋儿与正常儿童语音清晰度的比较

目的研究同年龄段聋儿与正常儿童的语音发音特征及差异。方法选用《聋儿听力语言康复评估题库》,采用三级人员评估方法,分别对4.5～5.5岁的听障组(20例聋儿)和健听组(20名正常儿童)进行声母和韵母清晰度测试。结果与结论声母清晰度测试显示,聋儿发音清晰度最高的声母为/b.m.d.l.j/,其次为/h.f.r.p.t.n.g.x/,最后为/zh.z.k.c.sh.q.s.ch/;正常儿童发音清晰度最高的声母为/b.p.f.g.m.d.h/,其次为/k.j.x.t.r.l/,最后为/q.zh.ch.sh.n.z.s.c/。韵母清晰度测试显示,两组发音清晰度最高的韵母为单韵母,其次为复韵母,最后为鼻韵母,听障组儿童的三类韵母平均清晰度均明显小于健听组儿童(P<0.01)。     

骨关节炎患者滑膜细胞对于成骨细胞骨向分化的影响及机制研究

目的 探索骨关节炎患者滑膜细胞对成骨细胞骨向分化的影响及其相关机制。方法 取骨关节炎患者滑膜组织及正常滑膜组织,采用酶消化法分离培养滑膜细胞,并传代,取第2代滑膜细胞和成骨细胞进行实验。首先将滑膜细胞与成骨细胞在体外进行共培养,实验分为两组,取P2代骨关节炎患者滑膜细胞与成骨细胞transwell共培养作为实验组(A组),正常滑膜细胞与成骨细胞transwell共培养作为对照组(B组),共培养36 h后,利用CCK-8法检测成骨细胞存活率,实时荧光定量PCR检测成骨细胞miR-21表达。然后,体外培养成骨细胞,构建过表达miR-21的重组慢病毒表达载体并转染入成骨细胞,实验分为两组,转染对照组(C组),miR-21转染组(D组),体外培养7 d后,实时荧光定量PCR检测成骨细胞miR-21表达以及成骨相关基因骨钙素(OCN)、RUNX2及I型胶原(Collagen I) mRNA表达,茜素红S法检测钙离子吸光度,ELISA法检测碱性磷酸酶(ALP)活性,western blot法检测OCN、RUNX2蛋白表达。结果 共培养36 h后,A组与B组成骨细胞存活率无显著差异[(98. 21±1. 07)%vs.(96. 14±0. 93)%,P 0. 05],而A组miR-21表达量明显高于B组(4. 61±0. 47 vs. 0. 32±0. 11,P 0. 05);体外培养7 d后,D组miR-21表达量明显高于C组(11. 02±0. 97 vs. 0. 41±0. 08,P 0. 05),而D组OCN、RUNX2及Collagen I基因表达显著低于C组(0. 33±0. 06 vs. 1. 04±0. 27,0. 27±0. 03 vs. 0. 99±0. 12,0. 73±0. 08 vs. 1. 05±0. 08,P 0. 05),D组钙离子吸光度和ALP活性显著低于C组(P 0. 05),此外,D组OCN、RUNX2蛋白相对表达量均明显低于C组(1. 02±0. 16 vs. 15. 66±1. 37,1. 03±0. 11 vs. 8. 47±0. 94,P 0. 05)。结论 骨关节炎成骨细胞内miR-21水平呈高表达,而成骨细胞存活率却未受明显影响。骨关节炎患者滑膜细胞miR-21可抑制成骨细胞的矿化作用。     

厚朴及6种混乱品种的鉴别

厚朴为木兰科植物厚朴Magnolia officinalis Rehd.et Wils.或凹叶厚朴Magnolia officinalis Rehd.ef Wils.Var.biloba Rehd.et Wils.的干燥干皮、根皮及枝皮.具有燥湿消痰、下气除满功效.用于湿滞伤中,脘痞吐泻,食积气滞,腹胀便秘,痰饮喘咳.     

126例青春期女性盆腔包块的病因及诊治分析

Objective To explore the clinical characteristics,causes,diagnosis and treatment of pelvic mass in adolescents caused by gynecologic diseases. Methods One hundred and twenty-six adolescents with gynecologic diseases presented as pelvic mass were retrospectively reviewed. Results The average age of all patients was 17. 6 years,ranging from 10. 0 to 19. 0 years. Ectopic pregnancy was found in 38 patients(30. 2%) ,the average age of the patients was 18.6 ±0.5 years, ranging from 17.0 to 19.0 years. Ovarian neoplasm was found in 35 patients (27. 8%) ,the average age of the patients was 17. 1 ± 2. 1 years, ranging from 10. 0 to 19. 0 years. Twenty cases (57. l%)had germ cell tumor, eighteen with mature teratomas, one with endodermal sinus tumor and one with immature teratoma. Thirteen cases(37. 2%)had epithelial ovarian tumors;eight with serous cystadenomas,three with mucinous cystadenoma, one with mucinous cystadenoma complicated with serous cystadenoma and one with borderline mucinous cystadenoma. Two cases had simple cyst of the ovary (5. 7%) . Congenital abnormality of reproductive tract was found in 14 patients (11. 1%), the average age was 14. 7 ±2. 2 years, ranging from 13.0 to 19. 0 years. Seven had imperforate hymens, two had rudimentary horn of uterus,four had atresia of vagina,one had atresia of vagina complicated with rudimentary horn of uterus,and one had oblique septum of vagina. Corpus luteum rupture was found in 11 patients (8. 7%) , the average age was 18. 1 ± 1. 9 years, ranging from 13. 0 to 19. 0 years. 116 patients underwent operative treatment and 10 patients underwent conservative therapy. Conclusions According to the stage of adolescents, main causes of pelvic mass in adolescents are different Main causes of pelvic mass in early adolescents are tumorous disease. Congenital abnormalities of reproductive tract are usually in middle adolescents. The gonads develop closely mature in late adolescent period; main causes of pelvic mass are ectopic pregnancy, ovarian neoplasm and physiologic ovarian cyst Surgery is the main therapy of pelvic mass in adolescents.     

《中医药临床杂志》常用参考文献的著录格式

1期刊序号主要责任者.文献题名.刊名,出版年份,卷号（期号）：起止页码2专著序号主要责任者.文献题名.出版地：出版者,出版年.起止页码3论文集序号主要责任者.文献题名.论文集名.出版地：出版者,出版年.起止页码4专利文献序号专利所有者.专利题名.专利国别：专利号,发布日期5国际、国家标准序号标准代号,标准名称.出版地：出版者,出版年6报纸文章序号主要责任者.文献题名.报纸名,出版日期（版次）     

Rhombencephalitis caused by Listeria monocytogenes with hydrocephalus and intracranial hemorrhage:A case report and review of the literature

BACKGROUND Listeria monocytogenes(L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L.monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage,which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few.CASE SUMMARY We herein report a case of rhombencephalitis caused by L. monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance.His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L. monocytogenes. Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus.Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage.Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions.CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes.     

Journal Evidence-Based Medicine 2018年度题录（英文）

Indexed by EMbase (Elsevier),MEDLINE/PubMed (NLM),SCOPUS (Elsevier)Volume 11,issue 1Editorial1:Yao C.Clinical trial in China:The status and challenge of data management and statistical analysis.J Evid Based Med.2018 Feb:1 1(1):3-6.doi:10.1111/jebm.12295.PubMed PMID:29484843.2:Kwong JSW,Li Y,Zhang M.Cochrane in 2017:Opportunities for the research community in China.J Evid Based Med.2018 Feb;11(1):7-11.doi:10.1111/jebm.12292.PubMed PMID:29484845.Aiticles3:Leighton PA,Brealey SD,Dias JJ.Interventions to     

低分子肝素预防性抗凝治疗对晚期非小细胞肺癌预后的影响

目的观察低分子肝素预防性抗凝治疗对晚期非小细胞肺癌生存预后的影响,分析低分子肝素预防性抗凝治疗的优势人群。方法研究入组血栓形成高风险的晚期非小细胞肺癌226例,采用抽签法分为治疗组(113例)与对照组(113例),治疗组予那屈肝素钙注射液4100 u皮下注射1次/日,疗程6个月,并给予标准抗肿瘤治疗,对照组仅予标准抗肿瘤治疗,随访观察治疗组与对照组患者无进展生存期(PFS)与总生存期(OS)。结果治疗组与对照组中位无进展生存时间(mPFS)分别为6. 4月(95%CI:5. 97～6. 83月)与6. 3月(95%CI:5. 98～6. 62月),P=0. 18;治疗组与对照组中位总生存时间(mOS)分别为20. 9月(95%CI:18. 90～22. 90月)与20. 7月(95%CI:17. 70～23. 70月),P=0. 15。表皮生长因子受体(EGFR)突变亚组治疗组与对照组mPFS分别为10. 2月(95%CI:7. 98～12. 42月)与9. 9月(95%CI:9. 17～10. 63月),P=0. 03; EGFR突变亚组治疗组与对照组mOS分别为28. 9月(95%CI:26. 62～31. 18月)与28. 6月(95%CI:28. 08～29. 13月),P=0. 01。表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)治疗亚组治疗组与对照组mPFS为分别11. 9月(95%CI:10. 55～13. 25月)与10. 8月(95%CI:10. 03～11. 57月),P=0. 03; EGFR-TKI治疗亚组治疗组与对照组的中位生存期(mOS)分别为28. 1月(95%CI:27. 29～28. 91月)与27. 8月(95%CI:25. 86～29. 74月),P=0. 02。EGFR突变亚组,治疗组相对于对照组PFS的HR=0. 65,95%CI:0. 43～0. 97,P=0. 03,治疗组相对于对照组OS的HR=0. 53,95%CI:0. 33～0. 84,P=0. 01; EGFR-TKI治疗亚组,治疗组相对于对照组的PFS的HR=0. 59,95%CI:0. 37～0. 95,P=0. 03,治疗组相对于对照组OS的HR=0. 55,95%CI:0. 33～0. 91,P=0. 02。结论低分子肝素那屈肝素钙注射液预防性抗凝治疗对晚期(ⅢB/Ⅳ期)非小细胞肺癌PFS及OS无改善,但能延长EGFR突变及使用EGFR-TKI治疗患者的PFS与OS,降低死亡风险。     

脓毒血症并发急性肾损伤早期诊断标志物的研究

Objective To investigate the accuracy of NGAL in prediction of acute kidney injury (AKI) complicated by sepsis. Methods Blood and urine samples were collected at different time points in 74 sepsis patients, and 17 AKI patients were got from them.Cysteine Cys C levels were detected with Latex enhanced turbidimetric immunoassay (LETIA). Urine NGAL and Scr levels were detected with solid-phase sandwich enzyme-linked immunosorbent assay and creatinine enzymatic assay respectively. At the same time, 57 non-AKI patients were set as controls. Dynamic changes of urine NGAL and Scr were observed in sepsis patients in test and control group. ROC curve was used to evaluate the performance of AKI diagnosis by urinary NGAL.Results The Scr base line was (59. 38 ±16. 72) μmol/L.The median time of diagnose of AKI was 24 (12, 48) h past-sepsis diagnosis, while the Scr was(100. 35± 28. 26) μmol/L. Of the group, 17 cases of sepsis were diagnosed with AKI, accounting for 23% (17/74) prevalence. In sepsis group, base line value[(0. 61 ± 0. 15) mg/L] of serum Cys C was not upregulated at 2, 4 and 6 h, which was (0. 63 ± 0. 14) mg/L, (0. 68 ± 0. 16) mg/L and (0.65±0. 14) mg/L respectively. As to 8 h [(0. 85 ± 0. 22) mg/L], a slight upregulation was found with no significant difference (t = 1.63, P ＞ 0. 05).A trend of gradual increase of serum Cys C levels was found in sepsis AKI group at 12, 18, 24, 36, 48 and 72 h. A significant difference was found compared with base line (t = 2. 81, 2.98, 3.05, 3.11, 3. 38,3. 17,P ＜0.01). NGAL level[(96.21 ±45.32) μg/L] was significantly higher than base line value [(4. 98 ± 1.65) μg/L]. Subsequently, in each time point from the 2 h to 48 h, a trend of gradual increase in urinary NGAL levels was showed. The differences were significant compared with the baseline values (t =2. 74,2. 83,2. 91,3.04,3.15,3.22,3. 31,3.45,3.57 ,P ＜0. 01). Urinary NGAL levels of sepsis AKI group were significantly higher than those in non-AKI group at different time points with significant difference (t =2. 69,2. 73,2. 84,2. 96,3.02,3. 13,3.29,3.43,3.54,3.22,P ＜0. 01). ROC curve was selected to analyze diagnostic performance of urinary NGAL levels in AKI patients 2 h post-sepsis. Area under ROC curve was obtained as 0. 935, 95% confidence interval was 0. 683-0. 971. When cut-off value of urinary NGAL for patients 2 h post-sepsis was 50 μg/L, the sensitivity, specificity and accuracy were 94. 4%, 87. 5% and 96. 8% in AKI diagnosis respectively. Conclusions The occurrence of AKi can be accurately predicted by urinary NGAL levels 2 h post-sepsis , and its AKI diagnosis time is earlier than that of Scr. Urine NGAL can be used as early marker of AKI complicated by sepsis.     

急性期精神分裂症脑影像异常者临床特征分析

目的 分析急性期精神分裂症头部磁共振结构异常者的相关临床特征。方法 回顾性分析首都医科大学附属北京安定医院在2017年1月至2018年12月期间住院的470例急性期精神分裂症患者的头部磁共振影像学资料,依据脑影像有无改变分为研究组204例(头部MRI异常者)、对照组266例(头部MRI正常者),比较两组患者的临床特征差异。结果 急性期精神分裂症脑影像异常者204例,其检出率为43. 4%。与对照组相比,研究组患者的阳性家族史(32. 8%vs. 20. 7%,χ2=8. 89)、围生期异常(18. 6%vs. 8. 3%,χ2=11. 12)、性格内向孤僻(74. 0%vs. 65. 0%,χ2=4. 35)、伴有冲动攻击行为(49. 0%vs. 28. 9%,χ2=19. 81)更常见,差异均具有统计学意义(P 0. 01)。Logistic回归性分析显示,脑影像异常者的危险因素为围生期异常(OR=2. 54,95%CI:1. 42～4. 53),冲动攻击行为(OR=2. 38,95%CI:1. 61～3. 52),阳性家族史(OR=1. 88,95%CI:1. 22～2. 90)(P 0. 01)。结论 急性期精神分裂症脑影像异常检出率高,急性期精神分裂症脑影像异常者存在围生期异常、阳性家族史、冲动攻击行为的风险更高。     

红细胞比容对急性心肌梗死患者预后的影响

Objective To examine the relationship between hematocrit and risk of long term mortality among patients with acute myocardial infarction. Methods A total of 274 patients with acute myocardial infarction were recruited and divided into two groups by death after long term follow-up, the relationship between hematocrit and mortality was evaluated through the methods of independent t-test,chi-square test and multivariate regression analysis. Results The mean age was 69. 79 ± 7.45 years, with 73. 0% of male. The average of followup was 44. 4± 10. 7 months, with mortality of 38.7% . Comparison of baseline data showed that NYHA classification, smoking history, hemoglobin, hematocrit, mean red cell volume, glomerular filtration rate, ejection fraction,left ventricular diastolic diameter and right ventricular diameter was significantly different between the two groups( Ps ＜ 0. 05), Multivariable logistic analysis showed that hematocrit ,glomerular filtration rate, ejection fraction and smoking history were independently predicted factors, with OR of 0. 904 (95% CI: 0. 832 - 0. 982,P =0. 016) ,0. 983 (95% CI: 0. 969 -0. 996,P =0. 014) ,0. 932 (95% CI: 0. 887 -0. 979,P =0. 005) and 3. 230 (95% CI: 1.468 - 7. 106, P = 0. 004), respectively. The power of hematocrit to predict mortality was examined by ROC curves, the area under the curve was 0. 669(P ＜ 0. 001,95% CI: 0. 603 - 0. 736) Conclusion Hematocrit is a significant independent predictor for long term death among patients with acute myocardial infarction.     

围生期心肌病发病相关因素的研究

Objective To explore the risk factors of peripartum cardiomyopathy (PPCM). Methods A total of 82 PPCM and 100 normal delivery females were randomly recruited in the current study. Echocardiographic, cTNI,high sensitive C-reaction protein(hs-CRP) ,NT-proBNP were measured. Fifty-two patients were followed up for a mean of 6 months. Results The PPCM patients (29. 5 ± 6. 4) yrs were older than the controls (25. 2 ± 5. 8) yrs (P<0.01) . Compared to the controls, the PPCM patients showed higher blood pressure (146.9/98. 8 mm Hg v. s. 130. 2/80. 1 mm Hg, P < 0. 01) , higher proportion of cesarean section (65. 9% v. s. 51. 0% , P < 0. 05) and complicated infection(75. 6% v. s. 10. 0% ,P <0. 01). The level of leucocyte(11.0 × 109/L) ,cTNI(0. 17 μg/L), hs-CRP(28. 2 mg/L)and NT-proBNP(650. 1 ng/L) were significantly higher in the PPCM patients compared with control(8. 8 × 109/L,0. 06μg/L,6. 2 mg/L and 110. 5 ng/L,P <0. 01). Hs-CRP was positively related with NT-proBNP(r = 0. 67, P < 0. 01). After average of 6 months of treatment, left ventricular ejection fraction enhanced from 32. 2% to 50. 6%. NT-proBNP significantly declined from 650. 1 ng/L to 225.6 ng/L(P <0. 01). Multiple linear regression analysis showed that diastolic pressure (P < 0. 05), LVED (P < 0. 05) and hs-CRP (P < 0. 05) were the independent predictors for declined NT-proBNP. Conclusions Inflammatory plays an important role in the development of peripartum cardiomyopathy.     

思维导图引导护理干预在肿瘤患者PET-CT检查中的应用效果

目的探讨思维导图引导护理干预应用于肿瘤患者正电子发射断层成像-计算机断层成像(PET-CT)检查中的效果。方法将100例行PET-CT检查的肿瘤患者作为研究对象,按随机数表法分为对照组和观察组,各50例。对照组给予常规护理,观察组给予思维导图引导护理干预。分析并比较2组患者的PET-CT图像质量、检查指导满意度。结果观察组的图像优良率(96. 00%)高于对照组(80. 00%),差异有统计学意义(P 0. 05);观察组的护士指导态度、护士指导及时、护士指导正确评分及总分分别为(4. 72±0. 73)、(4. 92±0. 85)、(4. 79±0. 21)及(12. 89±1. 34)分,高于对照组的(3. 67±0. 78)、(4. 04±0. 59)、(4. 23±0. 62)及(12. 18±1. 28)分,差异有统计学意义(P 0. 05);观察组的躯体症状、心理情况、康复情况评分分别为(89. 62±7. 57)、(92. 35±6. 63)、(88. 82±6. 23)分,高于对照组的(79. 62±8. 92)、(82. 35±6. 64)、(85. 63±5. 86)分,差异有统计学意义(P 0. 05)。结论思维导图引导护理干预可显著改善肿瘤患者PET-CT检查图像质量,提高患者对护士指导的满意度。     

脓毒症早期血清白细胞介素-18和10在疾病严重程度及预后评估中的价值研究

Objective To observe the dynamic changes in levels of serum interleukins (IL-18, IL-10)in the early stage of sepsis, and to appraise their values in the evaluation of severity and prognosis of sepsis.Methods Prospective randomized controlled study was conducted. Thirty-eight patients with sepsis who stayed longer than 72 hours in intensive care unit (ICU) from December 2009 to August 2010 were enrolled as sepsis group. At the same time, 20 patients without sepsis served as control group. The patients were classified as survival (n=12) or death group (n = 26) according to 28-day survival. The clinical laboratory examination data were recorded at 24, 48, 72 hours after admission to the ICU, and venous blood was obtained at the same time. The IL-18, IL-10 levels were determined by enzyme-linked immunosorbent assay (ELISA). Results The vital signs, blood routine, liver function, renal function, coagulation function,arterial blood gas, and electrolyte showed no significant difference between sepsis group and control group 24, 48, 72 hours after admission, the levels of IL-18 were lowered, IL-10 elevated, the IL-18/IL-10 ratio was lowered in the sepsis group, and all of them were higher than control group at each time point. The levels of IL-18, IL-10 in death group of patients with sepsis were all higher than those of survival group at 24, 48, and 72 hours [IL-18 (ng/L): 108. 36± 18. 54 vs. 91. 66±21. 49, 92.13±28. 92 vs. 54.16±31.76,91. 78 ± 17. 33 vs. 76. 04 ±22.09; IL-10 (ng/L): 99. 42 ± 12.10 vs. 77. 20 ±9. 47, 103. 39 ± 17. 24 vs.67.88±18.90, 118. 99 ±11. 20 vs. 99. 20± 12. 46, P＜0. 05 or P＜0. 01]. IL-18/IL-10 ratios were all lowered in both non-survivors and survivors with sepsis at 24, 48, 72 hours, while the differences were not statistically significant (1. 09±0. 19 vs. 1. 20±0. 32, 0. 92±0. 18 vs. 0. 98±0. 29, 0. 78±0.15 vs. 0. 77±0. 23, all P＞0. 05). Conclusion The levels of serum IL-18, IL-10 were all elevated in the early stage of patients with sepsis, and in non-survivors they were higher than those of survivors. With the progress of the illness, IL-18 showed a lowering tendency, while IL-10 showed an elevation. The levels of serum IL-18 and IL-10 may be valuable in evaluating the severity of sepsis and prognosis of patients with sepsis.     

临床罕见巨大胸腔畸胎瘤误诊一例

1 病例资料 男,11岁.因胸闷、气促4月余入院.查体:体温36.8℃,血压90/60 mmHg.消瘦,贫血貌,发育迟缓.全身皮肤、巩膜苍白,无黄染,浅表淋巴结不大.颈软,颈静脉无充盈.胸廓对称,左侧肋间隙凹陷,左肺叩诊清音,右肺第三肋以下叩诊实音.     

16SrRNA基因检测在老年糖尿病烧伤脓毒症诊治中的价值

目的探讨16SrRNA基因检测在老年糖尿病患者烧伤后脓毒症诊断治疗中的作用。方法采用回顾性分析的方法,选取2016年7月至2017年12月锦州市妇婴医院收治的80例老年糖尿病烧伤患者,均为疑似脓毒症,对患者血清标本的细菌培养检测结果与16SrRNA的PCR检测结果进行分析,同时观察PCR检测阳性与阴性、血培养阳性与阴性标本的白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、糖化血红蛋白(Hb A1c)、空腹血糖值(FPG)、餐后2小时血糖值(2 h PG)。结果 16SrRNA的PCR检测阳性率为41. 25%(33/80),明显高于血培养检测的23. 75%(19/80)(P 0. 05)。PCR检测时间平均为(4. 08±1. 14) h,明显少于血培养检测的(26. 72±11. 58) h(P0. 05)。PCR与血培养阳性患者的白细胞计数(WBC)分别为(14. 85±2. 51)×109/L与(13. 84±2. 06)×109/L,明显低于阴性患者的(16. 17±2. 36)×10~9/L与(15. 81±2. 62)×10~9/L(P 0. 05),PCR与血培养阳性患者的IL-6、TNF-α、CRP、FPG、2h PG分别为(23. 48±5. 87) ng/L和(22. 94±5. 63) ng/L、(50. 67±6. 39) ng/L和(51. 47±6. 29) ng/L、(5. 02±1. 33) mg/L和(5. 14±1. 47) mg/L、(9. 14±1. 26) mmol/L和(9. 21±1. 02) mmol/L、(19. 77±2. 21) mmol/L和(19. 37±2. 46) mmol/L,明显高于阴性患者的(6. 84±2. 24) ng/L和(6. 27±2. 37) ng/L、(9. 11±3. 54) ng/L和(9. 37±2. 84) ng/L、(0. 92±0. 34) mg/L和(0. 85±0. 35) mg/L、(8. 44±1. 52) mmol/L和(8. 57±1. 13) mmol/L、(13. 15±2. 62) mmol/L和(12. 74±2. 16) mmol/L(P 0. 05),PCR与血培养阳性患者的Hb A1c分别为(8. 54±2. 16)%和(8. 53±2. 36)%,与阴性患者的(7. 59±2. 28)%和(7. 16±2. 72)%相比,差异无统计学意义(P 0. 05)。结论老年糖尿病患者烧伤后检测血常规以及血清炎性因子指标能够为细菌感染提供预警信息,同时监测血糖水平变化也有一定的作用,对存在脓毒症危险性的患者,可以及时进行16SrRNA基因检测,能够在较短时间内确定是否发生感染,采取有效的治疗措施。     

本体感觉训练治疗膝关节骨性关节炎的疗效及对患者步态特征和平衡能力的影响

目的探讨本体感觉训练治疗膝关节骨性关节炎的临床疗效及其对患者步态特征、平衡能力的影响。方法采用前瞻性研究方法,选取2017年7月至2019年6月内江市第二人民医院收治的80例膝关节骨性关节炎患者作为研究对象,采用随机平行分组法将患者分为观察组与对照组,每组各40例。对照组患者给予消炎、镇痛等常规保守治疗方案,观察组患者在对照组的基础上加用本体感觉训练,每日1次,每次练习25 min,每周训练6 d。两组患者的疗程均为4周。比较两组患者的步态特征、平衡能力指标以及临床疗效。结果治疗前,两组患者各项膝关节平衡指数比较,差异无统计学意义(P 0. 05);治疗后,对照组各项指标与治疗前比较无明显改善(P 0. 05),观察组各项指标与治疗前、同期对照组比较,差异均具有统计学意义(P 0. 05)。治疗前,两组患者各项步态参数比较(49. 68±4. 55 cm vs. 48. 26±3. 65 cm、86. 12±8. 26 cm/s vs. 85. 57±9. 12 cm/s、11. 36%±4. 62%vs. 11. 45%±5. 14%、12. 46±5. 21 cm vs. 12. 62±4. 65 cm),差异无统计学意义(P 0. 05);治疗后,两组患者步长(57. 28±5. 12 cm vs. 54. 31±4. 48 cm)、步速(105. 31±10. 24 cm/s vs. 104. 28±9. 28 cm/s)及双支撑相(8. 24%±3. 59%vs. 8. 37%±3. 62%)均较治疗前明显改善,且观察组步长改善程度明显优于对照组,差异均具有统计学意义(P 0. 05)。观察组愈显率为40. 0%,对照组愈显率为27. 5%,组间比较,观察组明显高于对照组,差异具有统计学意义(P 0. 05)。结论本体感觉训练可有效提高膝关节骨性关节炎的临床疗效、改善患者步态和平衡能力,值得临床推广应用。     

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