Mycoplasma pneumoniae pneumonia in hospitalized children diagnosed at acute stage by paired sera

Background Mycoplasma pneumoniae （M. pneumoniae） is a frequent cause of respiratory tract infections. However,there is deficient knowledge about the clinical manifestations of M. pneumoniae infection. We described the clinical and laboratory findings of M. pneumoniae pneumonia in hospitalized children who were all diagnosed by a ≥ fourfold increase in antibody titer.Methods M. pneumoniae antibodies were routinely detected in children admitted with acute respiratory infection during a one-year period. The medical history was re-collected from children whose M. pneumoniae antibody titer increased≥fourfold at the bedside by a single person, and their frozen paired serum samples were measured again for the M.pneumoniae antibody titer.Results Of the 635 children whose sera were detected for the M. pneumoniae antibody, paired sera were obtained from 82 and 29.3% （24/82） showed a ≥ fourfold increase in antibody titer. There were 24 cases, nine boys and 15 girls, aged from two to 14 years, whose second serum samples were taken on day 9 at the earliest after symptom onset; the shortest interval was three days. All children presented with a high fever （≥38.5℃） and coughing. Twenty-one had no nasal obstruction or a runny nose, and five had mild headaches which all were associated with the high fever. The disease was comparatively severe if the peak temperature was ＞39.5℃. All were diagnosed as having pneumonia through chest X-rays. Four had bilateral or multilobar involvement and their peak temperatures were all ≤ 39.5℃. None of the children had difficulty in breathing and all showed no signs of wheezing.Conclusions The second serum sample could be taken on day 9 at the earliest after symptom onset meant that paired sera could be used for the clinical diagnosis of M. pneumoniae pneumonia in children at the acute stage. M. pneumoniae is a lower respiratory tract pathogen. Extrapulmonary complications were rare and minor in our study. High peak temperature （＞39.5℃） is correlated with the severity of M. pneumoniae pneumonia in children.     

Primary tracheobronchial amyloidosis in China: Analysis of 64 cases and a review of literature

Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease.A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed.The Chinese biological and medical databases from 1970 to 2010 were searched and 75 cases of complete clinical and pathological data were identified.The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time.The results showed that the morbidity associated with primary TBA has increased over recent years.The clinical manifestations were non-specific.Progressive dyspnea, cough and sputum were the most common symptoms.The percentage of patients undergoing computed tomography (CT) scan has increased over the years.The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis.Treatment was reported for a total of 44 cases.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration such as steroids and colchicines were reported to be effective in some patients.It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries.Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s.Chest CT scan provides important clues for the diagnosis of the disease.The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration, such as steroids and colchicines were reported to be effective in some patients.     

Mycoplasma pneumoniae pneumonia in hospitalized children diagnosed at acute stage by paired sera

Background Mycoplasma pneumoniae (M. pneumoniae) is a frequent cause of respiratory tract infections. However,there is deficient knowledge about the clinical manifestations of M. pneumoniae infection. We described the clinical and laboratory findings of M. pneumoniae pneumonia in hospitalized children who were all diagnosed by a ≥ fourfold increase in antibody titer.Methods M. pneumoniae antibodies were routinely detected in children admitted with acute respiratory infection during a one-year period. The medical history was re-collected from children whose M. pneumoniae antibody titer increased≥fourfold at the bedside by a single person, and their frozen paired serum samples were measured again for the M.pneumoniae antibody titer.Results Of the 635 children whose sera were detected for the M. pneumoniae antibody, paired sera were obtained from 82 and 29.3% (24/82) showed a ≥ fourfold increase in antibody titer. There were 24 cases, nine boys and 15 girls, aged from two to 14 years, whose second serum samples were taken on day 9 at the earliest after symptom onset; the shortest interval was three days. All children presented with a high fever (≥38.5℃) and coughing. Twenty-one had no nasal obstruction or a runny nose, and five had mild headaches which all were associated with the high fever. The disease was comparatively severe if the peak temperature was ＞39.5℃. All were diagnosed as having pneumonia through chest X-rays. Four had bilateral or multilobar involvement and their peak temperatures were all ≤ 39.5℃. None of the children had difficulty in breathing and all showed no signs of wheezing.Conclusions The second serum sample could be taken on day 9 at the earliest after symptom onset meant that paired sera could be used for the clinical diagnosis of M. pneumoniae pneumonia in children at the acute stage. M. pneumoniae is a lower respiratory tract pathogen. Extrapulmonary complications were rare and minor in our study. High peak temperature (＞39.5℃) is correlated with the severity of M. pneumoniae pneumonia in children.     

Qingkailing Injection (清开灵注射液) for Treatment of Children Pneumonia Induced by Respiratory Syncytial Virus: A Meta-Analysis of Randomized Controlled Trials

Objective: To evaluate the efficacy and safety of Qingkailing Injection(清开灵注射液, QKL) for treatment of children pneumonia caused by respiratory syncytial virus(RSV). Methods: Randomized clinical trials(RCTs) comparing QKL with ribavirin injection in the treatment of children pneumonia induced by RSV were searched in Pub Med, Science Direct, Cochrane Library, Chinese VIP database, CNKI and Wanfang databases from their inception to March 2014. Meta-analyses were performed using RevMan 5.2 software. The methodological quality of the selected RCTs was evaluated by the Modified Jadad Score. The primary outcome measures were effective rate and the secondary outcomes were relief time of fever and cough. Results: Seven RCTs with 992 cases published from 2008 to 2013 were identified. The meta-analysis results indicated that QKL was more effective in cure rate [risk ratios(RR)=1.32, 95% CI(1.17, 1.50), P0.01], total effective rate [RR=1.07, 95% CI(1.02, 1.13), P=0.009] and less fever clearance time [mean difference=–0.73, 95% CI(–1.22, –0.23), P=0.004], compared with ribavirin injection in the treatment of RSV-induced children pneumonia. No dead case was reported in all trials. There were 3 trials mentioned adverse events, 2 reported no obvious adverse event occurred while 1 reported adverse events described as skin hypersensitivity, elevation of ALT, a mild abnormal of hepatic and renal function in both QKL and ribavirin group. Conclusions: QKL was an effective and relatively safe option for the treatment of RSV-induced children pneumonia. These therapeutic effects were promising but need to be interpreted with caution due to variations in the treatment and methodological weakness in the studies.     

Brain abscess in children, experience Of Mashad University

Objective： Brain abscesses continue to pose a problem in neurosurgery, and it is a serious life-threatening complication for several diseases. The objective of this research was to lock at the clinical profile of children suffering from brain abscess, predisposing conditions, microbiology and outcome of these patients. Methods： Ninety children aged less than 15 years were reviewed. The clinical presentation, predisposing factors, diagnosis, management and outcome were noted. There were 56（ 62.2% ） males and 34 （ 37.7% ） females. The mean age of presentation was 5.7 ± 4.2 years. Results： The mean duration of illness at the time of presentation was 10.6 ± 12.4 days. Typically patients presented with fever, vomiting, headache, neurological deficit, and seizures. The predisposing conditions found were cyanotic congenital heart disease in 18 （20 % ） of children, meningitis in 6 （6.7 % ）, Otitis or mastoiditis in 32 （35.5 % ）, Head trauma in 6 （ 6.7 % ）, previous intraeranial surgery in 8 （8.8 % ） and no underlying cause was found in 22 （24.4 % ） children. The most common microbe in children with cyanotic congenital heart disease was of the Streptococcus group （54 % ）. Computerized tomography confirmed the diagnosis and the most common location of the abscess was the parietal lobe of the cerebral hemisphere. That abscesses were larger than 2 cm in diameter where aspirated surgically. Excision was performed for eight children. Six children expired, two due to intracranial bleeding and the others due to severe cerebral edema and tentorial herniation. Complications were observed in 11 children out of which six had squeal and five had bemiparesis. Conclusion： Attention to hygiene of mouth and teeth in infant and child patients with cyanotic heart disease is very important in prevention of infectious brain diseases. We must also pay attention to ear-nose-throat diseases of children. That is very important the patients be examined again after treatment because of finding and trea     

A retrospective study of 78 patients with severe acute respiratory syndrome

Objective To summarize the clinical features of severe acute respiratory syndrome (SARS) and to discuss diagnosis and management of the disease. Methods A retrospective study was conducted on 78 cases of SARS referred to the Guangzhou Institute of Respiratory Diseases (GIRD) between December 22, 2002 and near the end of March 2003. Items reviewed cover all data concerning clinical manifestations, laboratory investigation and radiology. Results The patients in the study consisted of 42 males and 36 females, aged 20-75 yrs (mean age 37.5±11.6 yrs), including 44 affected health-care professionals. Clinical symptoms seen in the group were fever (100.0%), cough (88.5%), and dyspnea (79.5%). There were 12 cases (15.3%) with WBCs <4.0×10(9)/L, 49 cases (62.8%) ranging between （4.0-10.0）×10(9)/L and 17 cases (21.8%) over 10.0×10(9)/L. The average was（7.58±4.96）×10(9)/L, with 0.75±0.14 (neutrophil) and 0.18±0.11 (lymphocyte). Chest films and CT scanning revealed changes related to pneumonia. The transmission of the disease was likely via close contact with contagious droplets. The prevalences of acute lung injury (ALI, in 37cases) and acute respiratory distress syndrome (ARDS, 21 out of 37 cases) were considerably high among the patients. Seven patients who developed ARDS complicated with multiple organs dysfunction syndrome (MODS) died. Conclusions A history of close contact, fever, sign of pneumonia by X-ray and normal-to-lowered WBC counts are favorable for the diagnosis of SARS. Recognition of ALI as the important index for critical SARS and comprehensive supportive management are of paramount in decreasing the mortality of the disease.     

Autism and mental retardation of young children in China

To understand the prevalence and rehabilitation status of autism and mental retardation in China. Methods Screening test and clinical assessment were conducted for the diagnosis of autism and mental retardation. The assessment included investigation of the histories of medical conditions and development of these two disorders, utilization and needs for the rehabilitation service, and related intellectual and behavioral appraisal. Results Among the 7345 children investigated, the prevalence of autism disorder was 1.10 cases per 1000 children aged 2-6 years （95% CI=0.34 to 2.54）, and the prevalence of mental retardation was 10.76 cases per 1000 children （95% CI=8.40 to 13.12）. All the children suffering from autistic disorder were intellectually disabled, whereas 31.0% of the non-autism mental retardates had other disabilities. The medical conditions prior to birth and perinatal period were important potential factors for autism. Half of the autistic children and 84% of the children with non-autism mental retardation had never received any rehabilitative service. Conclusions The prevalence of autistic disorder in children aged 2-6 years in Tianjin is rather high. It is urgent to improve the status of the autistic and intelligently disabled young children in China. In order to upgrade the level of early diagnostic and improve the intervention to autism and mental retardation, public awareness and training courses should be heightened.     

Clinical and pathological analysis on Traditional Chinese Medicine syndromes in children with immunoglobulin A nephropathy

OBJECTIVE:To evaluate the common Traditional Chinese Medicine(TCM) syndromes and analyze their relationship to clinical and pathological manifestations in children with IgAnephropathy.METHODS:Forty five children diagnosed as having primary IgA nephropathy by renal biopsy for the first time were enrolled in this trial,and their TCM syndromes were evaluated and the distribution of TCM syndromes was observed.All the sick children were growed? according to clinical manifestations and pathological damages,and the differences in TCM syndromes were compared between the groups.RESULTS:The first 5 TCM symptoms were common cold,hyperhidrosis,red dry throat,dark yellow urine and lassitude.In the acute nephritis group,edema and aching pain in loin and knees were significant(P=0.021 and P=0.000).In the severe pathological damage group,edema was obvious(P= 0.004),and 24 h urinary protein was positively correlated with edema(P=0.015) while negatively with common cold(P=0,007).The score of mesangial cell proliferation was correlated with edema,red dry throat and common cold(P=0.006,0.013 and 0.029 respectively).The score of segmental pathological change was positively correlated with edema(P=0.039).CONCLUSION:Common cold,hyperhidrosis,red dry throat,dark yellow urine,lassitude and other symptoms of qi deficiency of the spleen and lung mainly seen in children with IgA nephropathy may bear a close relationship to clinical manifestations and pathological damages.     

Diagnosis and treatment of bacterial pneumonia in liver transplantation recipients: report of 33 cases

Background Bacterial pneumonia in the recipients of liver transplantation (LTX) is a common postoperative complication influencing the prognosis greatly. In this article, the diagnosis and treatment of bacterial pneumonia in 33 LTX recipients are reported. Methods From February 1999 to January 2003, a total of 103 patients underwent allogeneic LTX at our center; afterwards, a retrospective analysis was made on their postoperative clinical manifestations, including symptoms (expectoration, panting and fever), sign (rale), results of laboratory examinations (white blood cell count and sputum culture of tracheal secretions or pleural fluid culture), and chest X-ray films. The following data of the pneumonia and non-pneumonia groups were collected, and the rank sum test (SPSS 11.0, Wilcoxon’s method） was used to analyze the duration of postoperative respirator utilization and the volume of pleural effusion through pleurocentesis or pleural drainage. Results In the 103 patients, 33 experienced 53 episodes of bacterial pneumonia during their hospital stay after transplantation, 14 of them (42.42%) had more than three manifestations of the seven mentioned above. The pathogens causing bacterial pneumonia included Pseudomonas aeruginosa (17.48%), Klebsiella pneumoniae (15.53%), Acinetobacter baumannii (10.68%), and Staphylococcus aureus (7.77%). Amilkacin, tienam, ciprofloxacin, vancomycin, etc. were the antibiotics of choice against those bacteria. Acute rejection occurred during the treatment of bacterial pneumonia in 16 patients, and 5 of them died. Wilcoxon’s rank sum test of the data indicated that the pneumonia group had longer duration of postoperative ventilator treatment and larger volume of pleural effusion than the non-pneumonia group (P<0.05). Conclusions The clinical manifestations of pneumonia after LTX might be atypical,and special attention should be paid to the respiratory symptoms and signs within 2 months after LTX. Whenever the diagnosis of bacterial pneumonia is confirmed, consideration should be given to reasonable use of antibiotics and regulation of immunity in addition to other routine therapies. Chin Med J 2005; 118(22):1879-1885     

Clinical and radiographic predictors in diagnosing sputum smear-negative pulmonary tuberculosis in HIV-negative patients: a cross-sectional study in China

Background In county-level tuberculosis （TB） dispensaries in China,the accurate diagnosis of sputum smear-negative pulmonary tuberculosis （SNPT） needs to be improved by developing and validating clinical and radiographic predictors.Methods The study was conducted simultaneously in three counties per province in Chongqing Municipality and Liaoning Province in China between May 2005 and May 2006.A total of 432 new SNPT patients who are HIV-negative and more than 15 years old diagnosed by expert panels in county-level TB dispensaries were recruited.Their sputum samples were collected for culture before anti-TB treatment,and the treatment outcomes （changes of X-rays） were followed up at the end of the 6th month.Results Of the 432 SNPT patients,sputum culture positive （9.7%） or culture negative with good changes of X-rays at the end of the 6th month （73.6%） was validated as SNPT.Four predictive variables were associated with validated SNPT in the multivariate logistic regression model：age ≤55 years old （odds ratio （OR） 5.66; 95% CI 2.69-11.91）,〉60 days of cough （OR 3.73; 95% CI 1.10-12.65）,≥10% of pulmonary consolidation in the lungs （OR 5.40; 95% CI 2.90-10.06）,and pulmonary consolidation in the upper lobe anterior segment （OR 3.00; 95% CI 1.57-5.72）.The area under the receiver operating characteristic curve of the model was 0.77 （95% CI 0.71-0.83）.Conclusion Four predictors of clinical and radiological characteristics that had a good diagnostic performance of SNPT deserve to be recommended as index indicators of SNPT diagnosis in county-level TB dispensaries in China.     

罗库溴铵联合高频控制通气用于婴幼儿气管异物取出术

目的 研究罗库溴铵联合高频控制通气用于婴幼儿气管异物取出术的麻醉效果.方法 42例ASA I～Ⅱ级行气管异物取出术的患儿,随机分为罗库溴铵组(R组)和对照组(C组),每组21例.R组静脉注射咪唑安定、氯胺酮、罗库溴铵麻醉,消除自主呼吸,插入支气管镜后经侧孔高频控制通气;C组静脉注射咪唑安定、氯胺酮、芬太尼、丙泊酚麻醉,保留自主呼吸,插入支气管镜后经侧孔辅助通气.术中连续监测心电图(ECG)、心率(HR)、呼吸(RR)、脉搏血氧饱和度(SpO2),记录低氧血症、呛咳、气道痉挛等不良反应的发生次数、手术时间、苏醒时间及苏醒期并发症.结果 R组术中不良反应及苏醒期并发症发生率较C组明显降低(P<0.05),手术及苏醒时间较C组明显缩短(P<0.05).结论 在婴幼儿气管异物取出术中,采用罗库溴铵联合高频控制通气较保留自主呼吸更能减少术中缺氧等不良反应的发生,缩短手术时间,苏醒更快且平稳. Abstract： Objective To investigate the efficacy of rocuronium combined with high-frequency ventilation for anaesthesia of airway foreign bodies removal in children.Methods Forty-two ASA Ⅰ-Ⅱ children undergoing airway foreign bodies removal were randomly divided into rocuronium group(R)and control group(C),there were 21 cases in each group. In group R,the children were anesthetized with intravenous midazolam,ketamine,rocuronium and high-frequency mechanically ventilated after bronchoscope intubation. In group C, the children were anesthetized with midazolam,ketamine,fentanyl and assistantly ventilated after bronchoscope intubation. ECG, HR,MAP,RR,SpO2 were continuously monitored. Adverse events(hypoxia, bradycardia,cough,airway convulsion), duration of operation, the time of recovery, postoperative complications (nausea,vomiting,agitated,airway convulsion)were recorded.Results The incidence of adverse events during operation and postoperative complications were significantly lower in group R than that in group C. The duration of operation and the time of recovery were significantly shorter in group R than that in group C.Conclusions Rocuronium combined with high-frequency ventilation can reduce adverse events during operation and result in shorter duration of operation,rapid recovery and fewer postoperative complications.     

帕尼培南/倍他米隆治疗重症获得性肺炎疗效分析

目的 探讨帕尼培南/倍他米隆治疗重症医院获得性肺炎的效果.方法 采用回顾性调查方法,对1例应用帕尼培南/倍他米隆治疗的合并肝硬化的老年重症医院获得性肺炎患者进行分析,记录其治疗后的临床症状变化.结果 对于老年重症医院获得性肺炎患者,经验性使用帕尼培南/倍他米隆治疗能够有效抑制病原菌,并且不良反应少,治疗效果明显.结论 在治疗老年重症医院获得性肺炎患者过程中,早期、正确使用广谱抗生素,能够提高治愈率. Abstract： Objective To study the clinical effect of panipenem/betamipron on severe hospital acquired pneumonia (SHAP). Methods The clinical file of the SHAP patient with hepatocirrhosis, whose temperature and white blood cell counts were obtained as the index of treatment. Results It was proved that panipenem/betamipron was efficacious for severe hospital acquired pneumonia in patient with age over 65 years old and well tolerated with few adverse events for initial empirical therapy. Conclusions Panipenem/betamipron demonstrated good clinical and bacteriological efficacy in elderly patients with SHAP.     

心理护理干预在患儿腰椎穿刺术中的应用

目的 探讨心理干预在儿童腰椎穿刺术中的应用效果.方法 选择3～12岁中枢神经系统感染,需行腰穿患儿168例,随机分成观察组84例和对照组84倒.对照组进行腰椎穿刺常规护理;观察组在常规护理基础上,给予心理干预.对两组腰椎穿刺前、后使用镇静剂、腰椎穿刺的质量、并发症发生情况进行比较.结果 术前,心理干预组患儿只有9.5%的需要使用镇静剂,而对照组46.4%需要使用镇静剂,心理干预组腰椎穿刺成功率明显增加;术后,干预组安静休息时间明显长于对照组,心理干预组并发症发生率只有6%,而对照组为36%,差异均有统计学意义(P<0.05).结论 心理干预在小儿腰椎穿刺中应用效果满意,可减少镇静剂的使用,提高腰椎穿刺质量,减少术后并发症,是一种行之有效的干预方法. Abstract： Objective To study the observation of the effect on children patient of lumbar puncture applied mental intervention. Methods 168 children 3～12 years old of central nervous system infected, which presenting for lumbar puncture.All patients were divided into two groups:the observed group and compared group. Compared group received routine nursing procedures,observation group applying mental intervention besides routine nursing care.The use of ataractic, the quality of puncture and the complication between two groups were compared. Results 9.5% of patients in observed group used ataraetic, but 46.4% of compared group before operation, the success rate of lumbar puncture increased significantly;the rest time of observed group were longer oberversily than the compared group,complication occurred in 6% of the observed group,36% of the compared group.Differences were statistical significance. Conclusions The applying of mental intervention on children patient of lumbar puncture showed that the effect was satisfactory,reducing the use of ataractic and the happening complication,improving the quality of puncture, being an affective method of intervention     

成人社区获得性肺炎患者早期治疗失败的原因

目的 分析成人社区获得性肺炎(CAP)患者早期治疗失败的原因.方法 回顾性分析2002年1月至2008年1月我院呼吸内科收治的成人CAP患者的临床资料,总结早期治疗失败的发生率及其对CAP患者预后的影响.比较老年CAP患者(年龄>65岁)与年轻CAP患者(年龄≤65)导致早期治疗失败原因的异同.结果 成人CAP患者549例,年龄(61±23)岁,年轻患者208例,老年患者421例.住院病死率为10.2%.共计68例(12.4%)患者出现早期治疗失败.根据原因分类,其中诊断错误9例(13.2%),宿主相关因素25例(36.8%),肺炎相关因素27例(39.7%)和不明原因7例(10.3%).相对年轻CAP患者,宿主相关因素导致的早期治疗失败在老年CAP患者中更常见(P＝0.002).而年轻CAP患者中,早期治疗失败主要与肺部相关因素有关(P＝0.005).结论 早期治疗失败会增加CAP患者病死率及延长平均住院时间.在临床工作中及早认识并预防早期治疗失败的出现,对于改善CAP患者预后具有重要意义. Abstract： Objective To determine the incidence and causes associated with early failure in hospital patients with community-acquired pneumonia(CAP). Methods A retrospective cohort analysis was performed for adult patients hospitalized with CAP between Jan.2002 and Jan.2008. The impact of early failure on the prognosis of patients with CAP was evaluated. Differences in causes of early failure between≤65 years and >65 years groups were calculated using χ2 test. Results A total of 549 patients (208 younger and 341 elderly patients) were enrolled with a mean age of (61±23)years. Mean hospital stay was 11 days and in-hospital fatality was 10.2%. As a result, 68 cases (12.4%) presented early failure within 72 h of admission. Most causes of early treatment failure could be attributed to host-related factors (36.8%) and pneumonia-related factors (39.7%). As compared, host-related factors were more important causes for elder patients and pneumonia-related factors were more common in younger patients. Conclusions Early treatment failure is associated with high fatality rate and longer of hospital stay. Its detection and management require careful clinical assessment.     

福州地区儿童微量元素检测结果分析

目的 了解儿童体内铁、钙、锌、铜、镁、铅6种微量元素失衡情况及其年龄分布特点,为早期预防和综合治疗提供依据.方法 使用AA-700型原子吸收光谱仪检测福州地区732例儿童静脉血中铁、钙、锌、铜、镁、铅的含量.结果 732例中,缺钙164例,占22.40%;缺锌158例,占21.04%;缺铁136例,占18.58%;高铅血症272例,占37.16%.缺钙、缺锌、缺铁及高铅血症的发生与年龄及饮食结构有关.结论 福州地区儿童存在一定程度的钙、锌、铁微量元素缺乏,且一定比例儿童血铅水平偏高.建议定期对儿童进行各种血微量元素检测,按照需要调整儿童饮食结构. Abstract： Objective To investigate blood contents of 6 trace elements,including Fe, Ca, Zn, Cu,Mg and Pb,children in Fuzhou area,and understand the level of trace elements as well as the distribution of age, so as to provide basis for prevention and cure at the early stage. Methods Blood contents of Fe, Ca,Zn,Cu,Mg and Pb of 732 cases of children in Fuzhou region were detected by using the AA-700 atomic absorption spectrometer. Results In 732 cases, 164 cases of calcium deficiency,accounting for 22. 40%, 158 cases of zinc deficiency, accounting for 21.04%, 136 cases of iron deficiency,accounting for 18. 58% ,272 cases of high blood lead levels ,accounting for 37. 16%. Calcium deficiency, zinc deficiency, iron deficiency and high blood lead levels are related to age and diet. Conclusions There exist the lack of Ca,Zn and Fe to some degree,and a certain percentage of high blood lead levels of children in Fuzhou. It is recommended to detect various trace elements from blood of children regularly, and adjust the diet of children in accordance with need timely.     

危重症患儿应激性高血糖的监测及预后

目的 探讨危重症患儿血糖水平与病情和预后之间的关系.方法 对106例危重症患儿入院后即采集静脉血,用葡萄糖氧化酶法测血糖并进行动态监测,空腹血糖≥6.9 mmol/L诊断为高血糖.结果 正常对照组、单器官及多器官功能衰竭患儿组的血糖分别为(4.8±1.3)、(8.3±3.1)、(14.2±6.6)mmol/L(P<0.01),血糖浓度与器官功能衰竭个数呈正相关(r=0.461,P<0.01);危重症患儿血糖、血K+较对照组显著升高(P<0.01),血Na+、血Ca2+较对照组显著降低(P<0.05),血糖浓度与血Na+、Ca2+浓度呈负相关(r=-0.343,r=-0.452;P<0.01),与血K+浓度呈正相关(r=0.574,P<0.01);血糖<15 mmol/L组病死率13.06%,≥15 mmol/L组病死率54.54%,血糖值越高,病死率越高.结论 危重患儿血糖浓度与病情危重程度呈正相关,血糖越高,病情越严重,预后越差. Abstract： Objective To investigate the relationship between levels of blood glucose and organ failure,prognosis in children with critical disease. Methods Venous blood glucose of 106 children with critical disease were analyzed with the method of glucose oxydase after admission and continuously monitored that.The index of hyperglycemia was value of fasting blood glucose ≥6.9 mmol/L. Results The level of glucose of the normal control group, haplo-organ failure group and multiple-organ failure group were (4.8±1.3),(8.3±3.1),(14.2±6.6) mmol/L, respectively (P<0.01).The quantity of organ failure was positive correlation with the level of blood glucose (r=0.461,P<0.01). The blood glucose,K+ of children with critical disease were significant increase as to normal control group(P<0.01), but blood Na+ and Ca2+ were lower in contrast. The level of glucose was positive correlation with the level of blood Na+,Ca2+ (r=-0.343,r=-0.452;P<0.01) and negative correlation with blood K+(r=0.574,P<0.01). The mortalities were 13.06% and 54.54% in corresponding blood glucose levels of less than 15 mmol/L and more than 15 mmol/L. The higher the blood glucose value, the higher the death rate. Conclusions The level of blood glucose in children with critical disease is closely associated with organ failure and prognosis,the higher the blood glucose value is, the pathogenetic condition is more severity, the prognosis is more imminent.     

半月板桶柄状撕裂的MRI诊断与关节镜下分类的相关研究

目的 探讨MRI对半月板桶柄状撕裂的诊断与关节镜下分类的比较研究.方法 分析63例患者65个经关节镜检查证实为半月板桶柄状撕裂的术前MRI的特征性表现,并将5种MRI征象(双后交叉韧带征、半月板翻转征、空领结征、碎块内移征和外周残半月板征)与关节镜下Dandy分型进行比较.结果 MRI桶柄状撕裂诊断符合率89.2%.碎块内移征和空领结征阳性率最高,分别为84.6%和81.5%;双后交叉韧带征(双PCL征)、半月板翻转征(双前角征)、外周残半月板征不如上二者普遍(阳性率分别为43%、21.5%、29.3%).未发现外侧半月板双PCL征;内侧半月板交锁Ⅰ型和Ⅱ型及外侧半月板半长全宽型、全长半宽型与MRI碎块内移征和空领结征有相关性;2例为半月板撕裂Ⅲ级信号,5例为假阴性.结论 5种MRI征象中最少2种(碎块内移征和空领结征阳性率最高)以上出现应高度怀疑为桶柄状撕裂. Abstract： Objective To evaluate the arthroscopic findings of meniscal bucket handle tears and to correlate them with the proposed MR imaging signs of meniscal bucket handle tears suggested in the literature. Methods Sixty-three patients who had a diagnosis of bucket handle tear in arthroscopy were included in our study.Meniscal tears were evaluated in arthroscopy according to Dandy's classification.The MRIs were retrospectively analyzed regarding the following findings:absence of bow tie sign,presence of double posterior cruciate ligament(PCL), fragment within the intercondylar region,flipped meniscus sign, abnormal circumferential meniscus sign. Sensitivity were evaluated for the presence of each individual sign. Results Locked types Ⅰand Ⅱfragment of medial meniscus and half-length,whole-width and whole length-half-width fragement of lateral meniscus in arthroscopy were correlated with fragement within the intercondylar notch and absent bow tie signs in MRI.We didn't find the double PCL sign in any of the patients with a lateral meniscal bucket handle tear.The most common signs in MR imagings of meniscal bucket handle tears were the fragement in the notch sign and the absent bow tie sign.They were observed with frequency of 84.6% and 81.5% respectively.The presence of double posterior cruciate ligament, flipped meniscus sign, abnormal circumferential meniscus sign were less common(43%,21.5% and 29.2%,respectively). Conclusions The presence of at least two of the five MRI signs should be regarded as highly suggestive for bucket handle tears of menisci.     

不同药物配方在分娩镇痛中的临床观察

目的 探讨产妇在分娩时镇痛时麻醉药物的选择.方法 选择我院2007年5月至2009年4月期间单胎初产妇150例随机分为三组,分别使用0.75%罗哌卡因20 ml+芬太尼0.2 mg+生理盐水至100 ml;0.75%罗哌卡因20 ml+曲马多200 mg+生理盐水至100 ml;0.75%罗哌卡因20 ml+曲马多200 mg+氟哌利多50 mg+生理盐水至100 ml,观察各组的疼痛评分、镇静评分及副作用.结果 使用芬太尼的患者镇痛、镇静效果明显优于其他的药物配伍,并且不良反应轻.结论 芬太尼在分娩镇痛中具有镇痛、镇静效果好,不良反应少,用药少的优势. Abstract： Objective To explore the choice of narcotic drugs required for analgesia in childbirth in maternal. Methods Random selection in our hospital from May 2007 to April 2009 during the period 150 cases of singleton pregnancies were divided into three groups of primipara.The use of 0.75% ropivacaine 20 ml+fentanyl 0.2 mg+saline to the 100 ml; 0.75% ropivacaine 20 ml+tramadol 200 mg+saline to the 100 ml; 0.75% ropivacaine 20 ml+tramadol 200 mg+droperidol 50 mg+physical salt to 100 ml. Observed in each group the pain score, sedation score and side effects. Results Patients using the fentanyl analgesic, sedative effect is superior to other drug compatibility, and side effects of light. Conclusions Fentanyl labor analgesia with analgesic, sedative effect is good, fewer adverse reactions, medication less advantage.     

雌激素对缺氧/复氧神经元高迁移率族蛋白B1及核因子-κB表达的影响

目的 探讨雌激素对缺氧/复氧诱导新生大鼠皮质神经元损伤的保护作用及其机制.方法 将培养7 d的大鼠皮质神经元随机分为三组,A组为正常对照组,B组采用缺氧/复氧(H/R),C组采用雌激素(17βE2)预处理加H/R处理,各组在H/R后0、1、3、6、12、24 h各时间点,以TUNEL法比较各组凋亡细胞,免疫组化方法比较各组高迁移率族蛋白B1(HMGB1)、核因子-κB(NF-κB)表达.结果 ①B组凋亡神经元明显多于正常对照组(H/R后3～24 h),C组凋亡细胞数目显著少于B组,三组比较差异有统计学意义.②B组HMGB1、NF-κB的表达较正常对照组明显增加,C组HMGB1、NF-κB表达较B组明显减少.结论 雌激素可使H/R后神经元HMGB1、NF-κB表达降低,抑制神经元凋亡,提高其存活率,这可能是其脑保护作用的机制之一. Abstract： Objective To explore the protective effects of estrogen on injured neurons induced by H/R and the mechanisms of that. Methods The cortical neurons cultured for 7 days were randomly divided into group A (normal control group), group B (H/R alone), group C (pretreatment with Estrogen -17βE2 and H/R). Then the apoptotic neurons were count by TUNEL, and the expression of HMGB1,NF- κB was observed by immunocytochemical technique, on each time point after reoxygenation 0,1,3,6,12,24 h of each group. Results ①The number of apoptotic neurons in group B was more than that in control group after H/R 3-24 h, and was less in group C than in group B. ②Compared with group A, the expression of HMGB1 and NF-κB was higher in group B,and was lower in group C than in group B. Conclusions Estrogen could decrease the expression of HMGB1 and NF-κB to inhibit neuronal apoptosis after H/R, which may be one of the mechanisms in which estrogen exerts its neuro-protective effect.     

低浓度5-氟尿嘧啶与糖皮质激素联合激光治疗瘢痕疙瘩的疗效

目的 观察低浓度5-氟尿嘧啶(5-Fu)与糖皮质激素局部注射联合激光治疗瘢痕疙瘩的疗效及安全性.方法 瘢痕疙瘩70例,102处病灶,平均病史8.6年,平均治疗时间为10.29个月.70例瘢痕疙瘩患者108处病灶进行单纯瘢痕内注射,0.6 ml 5-Fu与5 ml曲安奈德、1 ml 2%利多卡因混合后局部注射于瘢痕全层注射,每2～4周1次,瘢痕完全萎缩后逐渐降低药物浓度并延长注射间歇期.另一组70例瘢痕疙瘩患者102处病灶将三联药物局部注射半个月后Nd:YAG激光照射,每2～4周1次.结果 在治疗6个月以上的患者中,5-氟尿嘧啶与糖皮质激素联合激光治疗瘢痕疙瘩的总有效率为97.06%,其中完全缓解者占45.10%,极大缓解者占49.02%,部分缓解者占2.94%,未缓解者为2.94%.结论 低浓度5-氟尿嘧啶与糖皮质激素局部注射联合激光治疗瘢痕疙瘩的疗效显著. Abstract： Objective To monitor the therapeutic action and security of 5-Fu and steroid injected associate with laser to keloid. Methods One hundred and two keloid focuses of 70 patients have the average 8.6 years history and the average therapy period of 10.29 months. Among them,70 patients with total 108 keloid were treated merely with intralesional injection of a mixture of 0.6 ml 5-Fu,5 ml corticosteroid and 1 ml 2% lidocaine once per 2-4 weeks. The other 70 patients with total 102 keloid around sternal area were treated with the mixture once per 2-4 weeks. And they were irradiated with apulsed Nd:YAG laser(wavelength 1064 nm)at 35-140 energy density levels after 15 days. After keloid became flattened,drug concentration was decreased with prolonged intermission of drug injection. Results The total therapy efficacy of 5-Fu associate with steroid to keloid was 97.06%. Of them, the complete remission percentage was 45.10%,the large remission percentage was 49.02%,part remission percentage was 2.94%,and the inefficacy percentage was 2.94%. Conclusions It is more effective that the combination therapy to keloid of low concentration 5-Fu,steroid and Nd:YAG laser.