新生儿败血症156例临床分析

目的分析新生儿败血症的临床特性及病原菌情况,指导诊断治疗及预防.方法对156例3个医院的新生儿败血症临床及病原菌进行回顾性分析总结.结果发病男多于女,男:女是2.06:1,临床表现多无特异性,多表现为病理性黄疸,不吃少吃,反应差,体温异常等.感染途径以皮肤粘膜损伤为主要感染途径,其次为呼吸道感染(包括窒息后吸入),再其次为脐部感染.病原菌以葡萄球菌为主占77.1%,其中表皮葡萄球菌占28.4%,整个菌株中机会菌占85.7%.结论新生儿败血症临床特征缺少特异性,病原菌以葡萄球菌为主,并以毒性较低的机会菌为主.     

新生儿败血症87例临床分析

目的 比较新生儿败血症的感染途径、临床表现,争取早期诊断.方法 对87例新生儿败血症的临床表现、实验室检查进行分析.结果 ①生后感染比产前、产时感染高,以皮肤、脐部、呼吸道为主要感染途径;②以发热或体温不升、少吃、少哭、少动、皮肤黄疸症及腹胀为主的临床表现;③血培养阳性率低.结论 ①新生儿败血症表现不典型;②对疑诊病例要高度重视;③采用综合治疗,根据药敏试验结果调整抗生素;④注意新生儿皮肤、脐部护理及呼吸道感染,降低该病发病率.     

新生儿败血症45例临床分析

目的 :探讨比较新生儿败血症感染途径、临床表现及病原病变化特点。方法:比较80年代组与90年代组新生儿败血症异同点。结果:(1)两组相比脐部皮肤呼吸道感染始终是主要感染途径。(2)体温异常,喂养困难,精神差及黄疸均是两组常见的临床表现。(3)在两组中表皮葡萄球菌、金黄色葡萄球菌是最常见的细菌。(4)耐甲氧西林金黄色葡萄球菌(MRSE)80年代感染率为0,90年代则上升为主要致病菌。结论:注意新生儿脐部皮肤护理及呼吸道感染减少新生儿败血症发病,加强医护人员手的消毒和清洁以减少院内感染的机会     

新生儿败血症的病原学及血清C反应蛋白对其早诊的价值(附83例分析)

８３例新生儿败血症的血培养以葡萄球菌为主，其中以表皮葡萄球菌最多。产后感染占６６％，多为脐部、呼吸道、皮肤粘膜感染。早期做ＣＲＰ检查，对败血症的早期诊断，指导治疗及判断预后都有一定价值。讨论新生儿败血症的病原学、感染途径、早期检测是防治新生儿败血症的重要措施。     

新生儿败血症的病原学及血清C反应蛋白对其早诊的价值

８３例新生儿败血症的血培养以葡萄球菌为主，其中以表皮葡萄球菌最多。产后感染占６６％，多为脐部，呼吸道，皮肤粘膜感染。早期做ＣＲＰ检查，对败血症的早期诊断，指导治疗及判断预后都有一定价值。讨论新生儿败血症的病原学，感染途径，早期检测是防治新生儿败血症的重要措施。     

新生儿败血症76例临床分析

目的探讨比较新生儿败血症的临床表现、病原学特点及感染途径，以指导治疗。方法对1998年1月-2007年12月住我院儿科76例新生儿败血症的临床资料、实验室检查、药敏试验、治疗及转归进行回顾性分析。结果临床表现为反应差、少哭少吃少动（47．4％），体温异常（65．8％），皮肤黄症（76．3％）；感染途径为皮肤、脐带、呼吸道感染；葡萄球茼为主要致病菌，且对氨苄青霉索、青霉素等耐药率迭75％-80％以上。结论新生儿败血症临床表现不典型、症状缺乏特异性，血培养仍是诊断本病的金标准，治疗采用综合疗法并根据血培养药敏结果选择抗菌素，可降低病死率，注意预防皮肤、脐带及呼吸道感染可减少发病率。     

新生儿败血症106例临床分析

目的:探讨近10年新生儿败血症病原学的变化特点.方法:比较80年代组与90年代组新生儿败血症的临床表现、血培养结果、药敏结果的异同点.结果:80年代组以院外感染为主(占81.67%),90年代组院内感染增加达65.30%;皮肤、脐部及呼吸道感染始终是主要的感染途径.体温异常、喂养困难、精神差及黄疸、脐部炎症是两组均常见的临床表现.表皮葡萄球菌、金黄色葡萄球菌是主要的致病菌,90年代组耐甲氧西林金黄色葡萄球菌感染率明显上升.青霉素、红霉素及氨苄青霉素敏感率较低;β内酰胺酶抑制剂的抗生素,(优力新,头孢二、三代)敏感性较高.结论:防治医院内获得性感染,是减少新生儿败血症发生的主要措施;随着致病菌的变化,含β内酰胺酶抑制剂的抗生素敏感性较高.     

新生儿败血症121例临床分析

目的了解新生儿感染血培养的分布及对抗生素敏感和耐药情况，以指导临床合理用药。方法对1998年1月-2002年12月住院的121例新生儿败血症。按发病日龄分为早发性与晚发性两组．对其临床资料进行回顾性分析。结果两组临床症状均以少吃、反应差、皮肤黄疸、脓疱疹、脐炎、肺部罗音为主要表现，皮肤、脐部及肺部感染为主要感染途径。金黄色葡萄球菌、表皮葡萄球菌是两组主要的致病菌．对青霉素、红霉素、苯唑青霉素敏感性低，对头孢哌酮、头孢三嗪、头孢唑啉、头孢唑肟高度敏感。结论防治皮肤、脐部及呼吸道感染是减少新生儿败血症发生的主要措施。致病菌对头孢菌素类抗生素敏感性较高。     

新生儿金黄色葡萄球菌败血症167例临床分析

本科１９９２年３月至１９９３年２月收治新生儿金黄色葡萄球菌败血症１６７例，占同期新生儿败血症（血培养阳性）之首位。感染途径为呼吸道（３７．１％）、脐部（３５．２％）及皮肤（８．３％）。新生儿金黄色葡萄球菌败血症特点：（１）感染中毒症状可以不重；（２）约半数合并肺炎（大多为轻型），脓胸、脓气胸、肺脓肿等少见；（３）猩红热样皮疹、多形性皮疹少见；（４）外周血白细胞计数以增高为主，Ｉ／Ｔ增高不多见，血小板减少多见。     

新生儿败血症115例防治体会

报道新生儿败血症１１５例，占同期新生儿疾病的１６．８％，发病＜３天３０例，＞８天，农村１０２例，人工喂养７７例，脐部，皮肤粘膜感染占６９．６％，血培养以表皮葡萄球菌和金黄色葡萄球菌为主，治愈１０４例，自动出院６例，死亡５例，文中分析了新生儿败血症的感染途径，病原菌，临床表现及喂养的关系，并提出了一些防治措施。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.