国产外源性肺表面活性物质治疗新生儿重症感染性肺炎多中心前瞻性临床研究

目的 研究国产外源性肺表面活性物质（珂立苏）对新生儿重症感染性肺炎的治疗效果。方法 研究对象为来自中国5家医院的208例重症感染性肺炎新生儿,在入院时根据家长意愿给予常规治疗（对照组,81例）和珂立苏治疗+常规治疗（珂立苏组,127例）,比较两组患儿入院时对氧的依赖程度、治疗前后动脉血气分析结果及肺脏超声表现的变化、机械通气时间、住院时间、住院费用、并发症及预后等。结果 入院时珂立苏组吸入氧浓度明显高于对照组,动脉血氧分压明显低于对照组,二氧化碳分压明显高于对照组,氧合指数明显低于对照组（P < 0.01）。治疗1 h后,两组患儿动脉血气和氧合状态均得到改善,且珂立苏组改善状况显著优于对照组（P < 0.05）。补充珂立苏后4~6 h,患儿肺部实变程度显著减轻。与对照组比较,珂立苏组机械通气时间、住院时间均明显缩短,而两组患儿并发症发生率差异无统计学意义,预后均良好。结论 珂立苏治疗能显著改善新生儿重症感染性肺炎患儿的氧合状态,减轻肺实变程度,缩短患儿机械通气时间和住院时间,值得临床推广应用。     

A Survey on Intelligent Screening for Diabetic Retinopathy

Diabetic retinopathy (DR) is one of the leading causes of vision loss and can be effectively avoided by screening, early diagnosis and treatment. In order to increase the universality and efficiency of DR screening, many efforts have been invested in developing intelligent screening, and there have been great advances. In this paper, we survey DR screening from four perspectives: 1) public color fundus image datasets of DR; 2) DR classification and related lesion-extraction approaches; 3) existing computer-aided systems for DR screening; and 4) existing issues, challenges, and research trends. Our goal is to provide insights for future research directions on DR intelligent screening.     

The disease characteristics of patients both with IgA nephropathy and diabetes mellitus

Objective To sum up and analyze the clinical and pathological characteristics in patients with both IgA nephropathy (IgAN) and diabetes mellitus. Methods A total of 500 patients were recruited, including 25 patients with both IgAN and diabetes mellitus, and 475 patients with IgAN only, who were diagnosed by renal-biopsy during Jan 2015 to Jan 2017 at the First Affiliated Hospital of Zhengzhou University. The clinical and pathological data were collected and analyzed using SPSS 22.0. Propensity Score Matching was used to match and select the patients in the both groups, and thereafter the depth of the basement membrane from the matched patients were compared using electron microscopy. The data of the patients whose follow-up time was ≥3 months were retrospectively collected, and Kaplan-Meier analysis was used to compare the difference of the prognosis. Results Compared to the patients with IgAN only, patients with both IgAN and diabetes mellitus were older [(46.36±13.49) years vs (34.00±13.80) years, P＜0.001], had higher level of serum triglyceride [2.06(1.52, 3.11) mmol/L vs 1.51(1.01, 2.25) mmol/L, P=0.012] and thicker basement membrane [(384.33±61.20) nm vs (346.72±52.65) nm, P=0.044]. The patients with both IgAN and diabetes mellitus were more prone to reach the composite endpoint [4/7(57.14%) vs 25/265(9.33%), P＜0.001] and had worse prognosis (Log-Rank test, P=0.004). Conclusions IgAN patients with diabetes mellitus have different clinical, pathological characteristics and prognosis from patients with IgAN alone. These patients need to be closely monitored and actively treated.     

NDM-1 encoded by a pNDM-HN380-like plasmid pNDM-BJ03 in clinical Enterobacter cloacae

A carbapenemase-producing Enterobacter cloacae hhy03 with a bla_NDM-1 and bla_SHV-12-coharboring plasmid was isolated from a sputum specimen of a patient. This is the third nucleotide sequence report of bla_NDM-1-harboring plasmid from Enterobacter cloacae that have caused lethal infections in China, indicating the spread of NDM-1 by IncX3 plasmid between Enterobacteriaceae.     

Hepatocellular carcinoma after kidney transplantation: analysis of Hong Kong Renal Registry

Kidney transplant recipients have increased risk of cancers when compared with the general population. Hepatocellular carcinoma (HCC) is extremely important in Asia where hepatitis B virus (HBV) infection is endemic. The aim is to study the epidemiological and clinical aspects of all de novo HCC in our kidney transplant recipients. Moreover, various preventive strategies which may help to optimize the outcome will also be discussed. A retrospective review of all patients who developed HCC after kidney transplantation between May 1972 and December 2011 in Hong Kong, based on the data from Hong Kong Renal Registry. After a follow-up period of 40,246 person-years, 20 patients (males 15: females 5) developed HCC. The annual incidence was 49.7/100,000 persons per year. Among them, 16 were HBV carriers, 2 were hepatitis C (HCV) carriers and 2 had HBV and HCV co-infection. Presence of HBV infection was associated with 78-fold higher risk for HCC development. Majority (85%) were asymptomatic when HCC was diagnosed by ultrasound or alpha-fetoprotein surveillance. All patients diagnosed by surveillance received active treatment while 2/3 of symptomatic patients could only receive symptomatic care and died rapidly. In conclusion, HBV infection is the major etiological factor for HCC development in kidney transplant recipients in HBV endemic areas. Regular HCC surveillance appeared to be able to detect early stage cancers which are amenable to treatment and offer the best hope of cure.     

预测子痫前期的生物学标志物研究进展

子痫前期(PE)是围生期母婴发病和死亡的主要原因之一。该病目前尚缺乏有效的治疗手段,终止妊娠是其唯一有效的治疗方法。预测和诊断PE的生物学标志物具有非常重要的临床意义。过去10年对PE发病机制的研究发现,生物学标志物在PE预测、诊断和治疗中发挥了重要作用。笔者总结了目前最新及最有可能用于临床预测和诊断PE的生物学标志物进行综述如下。