小儿肺炎病原学检测分析

目的了解小儿肺炎感染病原学情况.方法用免疫荧光法(IFA)检测113例小儿肺炎患儿血清中的副流感病毒Ⅰ(PIV Ⅰ)、副流感病毒Ⅱ(PIVⅡ)、副流感病毒Ⅲ(PIVⅢ)、呼吸道合胞病毒(RSV)、柯萨奇B1病毒(CB1V)、嗜血流感杆菌(HI)、肺炎支原体(MP)和肺炎克雷伯杆菌(KP)8种病原体的特异性IgM抗体.结果113例肺炎病例血清特异性IgM阳性76例,阳性率67.3%,其中RSV 45例,阳性率39.8%,CB1V 32例,阳性率28.3%,PIVⅡ28例,阳性率24.8%,PIVⅢ26例,阳性率23.0%,HI9例,阳性率8.0%,MP 4例,阳性率3.5%,KP 2例,阳性率1.8%,PIV Ⅰ 0例.单纯病毒病原感染61例,感染率54.0%,两种及两种以上病原体混合感染41例,占36.3%.结论病毒仍是小儿肺炎的主要致病病原,其中以RSV阳性率最高,CBV逐渐成为小儿肺炎的主要致病病毒之一.     

儿童哮喘并发病毒性肺炎的病原分析

目的观察儿童哮喘并发病毒性肺炎的病毒学特征及对哮喘急性发作严重度的影响.方法112例患儿均采用直接免疫荧光标记法检测呼吸道合胞病毒(RSV)、腺病毒(ADV)、流感病毒A型(IVA)、B型(IVB),副流感病毒Ⅰ型(PIVⅠ)、Ⅱ型(PIVⅡ)、Ⅲ型(PIVⅢ)呼吸道七项病毒抗原.结果共检出病毒72例,其中RSV54例,PIVⅢ4例,PIVⅡ3例,PIVI 2例,ADV 5例,IVA 2例、IVB 2例;病毒检测阳性率为64.3%(72/112),RSV检测阳性率为48.2%(54/112);RSV占病毒检出总数的75%(54/72);哮喘中重度发作与RSV感染无关(χ22=0.188,P＞0.05).结论儿童哮喘并发病毒性肺炎以RSV感染为主,但哮喘中重度发作与RSV感染无关.     

南京地区9种呼吸道病原体感染的流行病学分析

目的 了解南京地区呼吸道感染人群的病原学流行现状,分析其趋势与特点.方法 使用9项呼吸道感染病原体IgM抗体检测试剂盒对2013年5月至2015年4月就诊于南京医科大学附属南京医院、南京医科大学附属儿童医院、南京军区南京总医院的25 057例呼吸道感染患者的血清进行IgM抗体检测.结果 共检出病原体阳性8 575例(34.22％),其中肺炎支原体(MP)抗体阳性率最高,为23.77％;其次为呼吸道合胞病毒(RSV)5.19％、腺病毒(ADV)4.56％、副流感病毒1、2和3型(PIVS) 4.02％、乙型流感病毒(INFB) 2.28％.RSV、ADV感染季节性分布明显,在冬、春季节(12月至4月)高发,夏季较低.婴幼儿到学龄前患者阳性例数最多(5 274例);MP抗体阳性率随着患者年龄增长逐渐下降.结论 南京地区呼吸道感染病原体主要为MP,病原体感染与年龄组有相关性且有季节流行趋势.     

909例儿童急性呼吸道感染病原体RNA检测结果分析

目的分析我院急性呼吸道患儿病原体感染的检测情况,为临床诊疗及防治提供依据。方法采集佛山市第一人民医院2016年8月至2017年9月儿科收治的909例急性呼吸道感染住院患儿咽拭子标本,采用双扩增技术(DAT)技术进行呼吸道合胞病毒(RSV)、副流感病毒(PIV)、腺病毒(ADV)、肺炎支原体(MP)和肺炎衣原体(CP)五种病原体RNA检测。结果 909例标本总阳性率为38.28%,病原体检出率依次为RSV 16.61%、MP 11.11%、PIV 8.69%、ADV 3.96%和CP 0.99%,其中混合感染率为2.64%;冬季病原体阳性率最高48.94%,四季间病原体阳性率比较差异有统计学意义(P<0.05);肺炎患儿病原体阳性率最高(43.00%),其次支气管炎(37.40%),不同疾病间阳性率比较差异有统计学意义(P<0.05);不同性别及不同年龄段病原体阳性率比较差异无统计学意义(P>0.05),但RSV和PIV感染率随患儿年龄增长而下降,MP检出率随患儿年龄增长显著升高。结论本院儿童急性呼吸道感染病原体以RSV为主,MP和PIV次之,存在混合感染,呈现季节性,...     

住院儿童急性呼吸道感染多病原联合检测结果分析

目的对住院儿童急性呼吸道感染多病原联合检测情况进行分析。方法选择629例患儿进行呼吸道病原检测。结果流感病毒B型（IVB）感染多见于秋冬季节;流感病毒A型（IVA）、MP感染多见于冬春季节;HI感染多见于夏秋季节。呼吸道合胞病毒（RSV）、腺病毒3（AV3）、副流感病毒（PIV）及肺炎原体（cP）、嗜肺军团菌-1（LPSl）、肺炎克雷伯杆菌（KP）和季节的关联度不确定;夏季病原体总检出率比其他三季要低。IVB感染以3—12岁为高;MP、IVB感染则以6～12岁为高;HI、IVB感染以3～12岁为高;RSV、AV3、IVA、PIV及CP、LPSl、KP与年龄关系无法确定。结论IIT对儿童急性呼吸道感染病原诊断有一定的应用价值。     

淮安市儿童急性呼吸道感染病原学分析

目的探讨急性呼吸道感染（ARI）患儿呼吸道病原体的感染情况及季节流行特点,为临床实施行之有效地预防和诊治提供依据。方法应用间接免疫荧光法（IFA）检测该院2015 年1 月-2015 年12 月3 461 例0～12 岁ARI患儿血清中呼吸道合胞病毒（RSV）、腺病毒（ADV）、甲型流感病毒（FluA）、乙型流感病毒（FluB）、副流感病毒（PIV）、肺炎支原体（MP）、肺炎衣原体（CP）、嗜肺军团菌（LP）IgM抗体。结果3 461 份血清中呼吸道感染病原体IgM 抗体阳性检出率为69.17%,最常检测到的病原体是FluB（51.1%）、FluA（36.38%）、MP（25.14%）和RSV（9.04%）。FluA、FluB和MP 感染无明显季节性,检出率整年均较高;RSV 呈现流行高峰在冬、春季;ADV和CP 为春、夏季多发;PIV和LP发病率终年较低。随年龄增长RSV发病率下降,而其他病原体则相反。病原体混合感染检出1 627 例,占47.01%;混合感染最常见病原体为FluA+FluB和FluA+FluB+MP。结论淮安地区2015 年8 种呼吸道病原体阳性率达69.17%,以FluB检出率最高;呼吸道病原体感染的流行季节各有不同;伴随年龄的增长RSV 阳性率降低,而其他病原体阳性率则逐步增长;以FluA 和FluB 的混合感染为最多见;早期检测呼吸道病原体,将有助于儿科医生诊治和控制呼吸道感染。     

263例急性呼吸道感染住院患儿的病毒病原学分析

目的:探讨无锡地区儿童急性呼吸道感染的病毒病原学特点.方法:采集2006年12月～2007年3月因急性呼吸道感染而住院治疗患儿的鼻咽分泌物,用直接荧光法检测呼吸道合胞病毒(RSV)、腺病毒(ADV)、流感病毒A、B型(IFVA、B)、副流感病毒Ⅰ、Ⅱ、Ⅲ型(PIV Ⅰ、Ⅱ、Ⅲ)共7种病毒抗原.结果:263例患儿鼻咽分泌物中病毒抗原检测阳性共107例,阳性率40.6%;所检病毒依次为呼吸道合胞病毒、流感病毒A型、副流感病毒Ⅲ型、流感病毒B型、副流感病毒I型和腺病毒.呼吸道合孢病毒占所检出抗原阳性病毒的76.6%,喘息性疾病患儿阳性率明显高于支气管肺炎及急性支气管炎患儿(P＜O.01),3岁以下患婴检出阳性率明显高于3岁以上患儿(P＜0.05).结论:本地区急性呼吸道感染住院患儿病毒病原体以RSV为主,喘息性疾病和小年龄组感染率较高.     

儿童急性下呼吸道感染非典型病原体的流行情况分析

目的了解急性下呼吸道感染患儿非典型病原体感染情况,为诊断、治疗和预防提供依据。方法急性下呼吸道感染患儿1640例,分为婴儿组302例、幼儿组545例和儿童组793例,检测嗜肺军团菌Ⅰ型(LP1)、肺炎支原体(MP)、Q热立克次体(COX)、肺炎衣原体(CP)、腺病毒(ADV)、呼吸道合胞病毒(RSV)、甲型流感病毒(INFA)、乙型流感病毒(INFB)和副流感病毒(PIV)的Ig M抗体。结果 MP阳性率55.8%,其感染主要在幼儿组和儿童组。INFB阳性率29.7%,INFA阳性率18.8%,感染主要在婴儿组和幼儿组,年龄增大,阳性检出率呈下降趋势。PIV阳性率18.7%,感染主要在婴儿组和幼儿组。ADV、RSV感染主要在婴儿组。结论检测儿童呼吸道非典型病原体感染情况,可为诊断提供依据,预防抗生素滥用,提高疗效。     

间接免疫荧光法对多种呼吸道病毒快速检测方法

目的：建立一种新的快速诊断呼吸道病原微生物感染检测方法。方法：采用德国欧蒙公司间接免疫荧光技术对578例患者进行流感病毒A（FluA）、流感病毒B（FluB）、副流感病毒1（PIV1）、副流感病毒2（PIV2）、副流感病毒3（PIV3）、腺病毒3（ADV3）以及合胞病毒（RSV）、肺炎支原体（MP）、肺炎衣原体（CP）、克雷白（KLB）、军团菌（LPS）、嗜血流感（HI）等12种病原微生物进行检测。结果：下呼吸道感染在儿童组阳性率为46．1％（140／304）,以合胞病毒感染最为多见;在成人组感染阳性率为42．0％（115／274）,以腺病毒感染最为常见。结论：间接免疫荧光方法检测呼吸道病毒具有高灵敏度和特异性,而且操作简捷,适合临床实验室病毒检测的要求。     

新生儿喘息性肺炎120例病毒检测

目的 探讨新生儿肺炎喘息发作与呼吸道病毒感染的相关性.方法 采集2007年10月至2008年3月新生儿肺炎喘息发作的120例住院新生儿鼻咽分泌物,用直接免疫莹光法(DFA)检测呼吸道合孢病毒(RSV)、腺病毒(ADV)、流感病毒A、B型(IVA、B)、副流感病毒(PIVⅠ、Ⅱ、Ⅲ)共7种病毒抗原.结果 120例喘息发作的新生儿病毒抗原检出共62例,占51.67%;其中RSV 48例(40%),PIVⅡ5例(4.17%),PIVⅠ3例(2.5%),ADV及PIVⅢ各2例(1.67%),IVA、IVB各1例(0.83%),两种以上病毒抗原同时阳性患儿4例.RSV占所检出抗原阳性患儿的77.4%.结论 新生儿肺炎喘息的病毒病原体以RSV为主.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.