Infections in patients with systemic lupus erythematosus

Infection is a major contributor to morbidity and mortality in patients with systemic lupus erythematosus (SLE). In most clinical series, infection ranks first or second as the most common cause of death in SLE patients worldwide, including Hong Kong. In this article, the spectrum of infections and their protean manifestations in lupus patients will be reviewed with emphasis on clinical data from Hong Kong and other Asian countries. A high index of suspicion and dedicated work‐up to identify the causative pathogens is pivotal to the early diagnosis and effective management of infective complications in patients with SLE.     

Validation study of a portable monitoring device for identifying OSA in a symptomatic patient population

Background and objective: Obstructive sleep apnoea syndrome (OSAS) is a common disorder associated with early atherosclerosis, diabetes mellitus, ischaemic heart disease and cerebrovascular disease. The gold standard for confirming OSAS is based on an attended overnight polysomnography (PSG) in a sleep laboratory; however lack of health‐care resources creates long waiting times for patient access to this diagnostic test. This study evaluated the ability of a portable sleep‐monitoring device to identify patients in Hong Kong with suspected OSAS. Methods: Patients with symptoms of OSAS were invited to use the ARES (apnoea risk evaluation system) concurrently with an attended inpatient PSG. Several sets of AHI were generated by the ARES provider based on different oxygen desaturation criteria and surrogate parameters of arousal. The results were compared against PSG to determine the optimal sensitivity and specificity. Results: There were 141 patients who completed the study successfully. Results of AHI from the ARES study were presented in the order of different scoring criteria––4% oxygen desaturation alone, obstructive events with 3% oxygen desaturation and obstructive events with 1% desaturation plus surrogate arousal criteria. The sensitivity was 0.84 (95% confidence interval (CI): 0.77–0.90), 0.89 (95% CI: 0.89–0.94) and 0.97 (95% CI: 0.94–0.99), respectively. The specificity was 1, 1 and 0.63 (95% CI: 0.55–0.71), respectively. The receiver operating curve had an area of 0.96, 0.97 and 0.98, respectively. The kappa coefficient varied from 0.24 to 0.55 for agreement of severity between PSG and ARES. The likelihood ratio positive and the likelihood ratio negative were 2.61, infinity, infinity and 0.16, 0.11, 0.05, respectively, in the order of oxygen desaturation described earlier. Conclusions: The ARES device has reasonable sensitivity and specificity for diagnosing severe OSAS in symptomatic Chinese patients. There is moderate agreement between ARES and PSG in the diagnosis of severe disease, but less agreement in patients with mild/moderate disease.     

成人严重骨性Ⅲ类错(牙合)畸形手术前后的正畸治疗

目的：研究成人严重骨性Ⅲ类错耠畸形在正颌外科治疗的术前与术后正畸的特点及难点。方法：成人严重骨性Ⅲ类错胎病例35例，对该类畸形的临床特点、正颌手术前后正畸治疗方法和注意事项进行分析研究。结果：术前正畸治疗必须完成个别牙齿错位的调整，纠正牙弓形态与宽度的不调和牙齿代偿的去除：术后正畸的主要目的是牙弓内残留间隙的关闭和咬合关系的进一步精细调整。结论：只有完善的术前、术后正畸治疗与正颌外科手术相互配合，才能较好地完成成人严重骨性Ⅲ类错胎的临床治疗。     

高压灭菌器对口腔医疗器械灭菌效果的实验研究

目的：评价高压灭菌器对口腔诊室常用医疗器械的消毒效果。方法：随机选取患者使用过的高速手机、洁牙手柄各20件，使用Tuttnauer-2540MK高压灭菌器对高速手机、洁牙手柄进行消毒，然后进行细菌采样，观察48d小时细菌计数。采用ELISA法对HB-sAg阳性血清处理过的器械进行消毒后检测，判断标准：S／N≥12．1为阳性．反之为阴性。结果：Tuttnauer-2540MK高压灭菌器对细菌及HBsAg的消杀效果良好，经消毒15分钟后，高速手机组有9份样本细菌杀灭率为100％，1份为99．84％。洁牙手柄组有8份标本细菌杀灭率为100％，1份为99．89％。20件被HBsAg阳性血清污染的器械，消毒后S／N值均小于2．1，全部阴性。结论：Tuttnauer-2540MK高压灭菌器灭菌所需时间短较，可使各种结构复杂的口腔医疗器机均达到并灭活HBsAg的要求。     

踝臂指数评价肾功能不全患者下肢外周动脉病的研究

目的通过测量踝臂指数（ankle—brachial index，ABI）评价我国肾功能不全患者下肢外周动脉病（Pe—ripher alarterial disease．PAD）的发病情况，并对肾功能不全和PAD的共同危险因素进行评价。方法按照肌酐清除率．将2005年1月至2006年6月于北京、上海、石家庄、青岛等十几家医院住院及门诊就诊期间的6108例患者为研究对象分为两组，以肌酐清除率〈60ml·min^-1·1．73m^-2作为肾功能不全组，以肌酐清除率〉60ml·min^-1·1．73m^-2作为肾功能正常组，分别进行踝臂指数测量，以ABI≤0．9作为PAD的诊断标准，并进行资料收集和统计学处理。结果与非PAD组相比，PAD组患者肌酐清除率较低、年龄较大、男性发病率较高、糖尿病、冠心病、高血压、有吸烟史者的发病率较高，总胆固醇值较高，而在身高、体重、体重指数、收缩压、舒张压等方面无统计学意义。结论在肾功能不全患者中，PAD有非常高的发病率；ABI与肌酐清除率呈负相关，即随着肌酐清除率的下降，PAD的发病率逐渐增加。     

持续救护模式在危重新生儿救治中的应用

目的探讨持续救护模式在危重新生儿救治中的应用及成效。方法对NICU收冶的1207例危重新生儿实施持续救护模式，包括院前转运采用STABLE模式．住院期问运用新生儿个体化发育支持性护理模式（NIDCAP）和出院后给予定期随访、早期干预模式。结果采用持续救护模式后．危重新生儿转运成功率为100％，治愈率为96．5％，病死率3．5％。体重〈1000g早产儿的救治存活率为88．5%。出院随访130例，早期发现脑瘫2例。神经发育迟缓4例,者通过积极干预后，明显好转。结论持续救护模式对危重新生儿的救护安全、有效。     

含抗生素骨水泥假体在人工关节术后感染中的应用

目的回顾分析含抗生素骨水泥假体(PROSTALAC)治疗人工关节置换术后感染的疗效.方法对16例髋和膝关节置换术后感染的病例采用PROSTALAC方法,进行二期翻修治疗并进行随访.结果16例髋和膝关节置换术后感染中,有14例于治疗后接受二期全髋或全膝关节翻修术,经平均46月的随访,感染无复发,成功率达87.5%.术后Harris髋关节评分平均达82.9分,膝关节评分平均达90.5分.结论在PROSTALAC基础上进行的二期全髋和全膝关节翻修手术能成功地治疗人工关节术后感染,并且保持术后关节的功能.     

脊柱颈胸交界段的MRI测量及其临床意义

目的:探讨有利于术前选择脊柱颈胸交界段手术入路的颈胸段MRI测量方法。方法:随机抽取95例颈椎MRI片,测量胸骨上切迹向后水平延长至相应椎体前缘的距离(AO)和对应的椎体或椎间隙,同时测量胸骨上切迹向后上方至C7/T1椎间隙前缘中点的距离(BO),测量AB间的距离及两线之夹角(称为颈胸手术角)。结果:AO距离平均为50.40mm,BO距离平均50.97mm,AB距离平均为41.41mm,夹角平均为47.64°。胸骨上切迹相对应的椎体最常见的为T3椎体的上1/3,其次为T2/3椎间隙。结论:颈胸段手术入路的选择可结合患者脊柱颈胸段的MRI表现,判断颈胸结合部与胸骨上切迹以及胸骨角水平面的关系,估计常规的下颈椎低位前方入路或经仅劈胸骨柄的手术入路能否到达颈胸结合部的病灶,从而便于选择损伤最小、手术时间最短、手术并发症较少、利于患者康复的手术入路。     

The clinical efficacy of intensive chemoradiation for inoperable squamous esophageal cancer: case‐controlled study

Aims: We evaluated the role of intensive chemoradiation regimen for patients with inoperable T4 or cervical nodal metastatic squamous esophageal cancer. Methods: From 1996 to 2003, patients with histologically proven, inoperable, squamous cell esophageal carcinoma who received intensive chemoradiation therapy of two 3‐weekly cycles of continuous infusion of 5‐fluorouracil, day 1 and 22 cisplatin and concurrent radiotherapy 50–60 Gy were recruited for analysis. Efficacy of treatment was analysed by endoscopy, biopsy, computerized axial tomography before and 8 weeks after completion of treatment. Median survival and the need palliative esophageal stenting were compared with the matched control group during the same period that decline chemoradiation therapy. Both groups were comparable in demographic characteristics, pretreatment dysphagia score, comorbidity, tumour differentiation, location, staging and size. Results: Thirty‐six consecutive patients (33 male, mean age 63.2, S.D.9.5) with either T4 (81%) and/or cervical nodal metastatic (50%) tumour had received chemoradiotherapy. Treatment was completed in 32 patients (89%). Grade II neutropenia occurred in 8 patients (22%) and the incidence of febrile neutropenia was 11%. There was no therapy‐related mortality. Tumor volume as measured by CT scan was significantly reduced after treatment with a major clinical response (>*Τ*50% reduction in tumour volume) observed in 18 patients (50%). Four patients (11%) received salvage esophagectomy for local recurrence 1–3 years after initial complete response. As compared to the matched controlled patients, chemoradiation therapy had significantly improved the 5‐year survival (0 vs 19%, P=0.01), median survival (4.0 months vs 9.5 months, P < 0.005) and the need of palliative stenting (100 vs 22%, P=0.005). Conclusions: Although prognosis of patients with inoperable and cervical nodal metastatic esophageal cancer is extremely poor, this study confirms the efficacy and good tolerance of radiochemotherapy in these patients which can both improve their overall survival and reduce the need of esophageal stenting.