消渴肾安胶囊联合西药治疗糖尿病肾病的临床观察

目的观察消渴肾安胶囊治疗糖尿病肾病的疗效。方法将90例患者随机分为两组,分别用西医常规治疗(30例)和消渴肾安胶囊联合西药治疗(60例),疗程8周,并对治疗前后的有关指标进行观察。结果总有效率治疗组为85．0％,对照组为73．3％,治疗组优于对照组(P<0．05)。空腹血糖、血压、24h尿蛋白定量、尿白蛋白排泄率、肾功能、血脂、血液流变学等治疗组治疗前后比较差异有显著性(P<0．05或P<0．01),且有些指标优于对照组(P<0．05或P<0．01)。结论消渴肾安胶囊联合西药能有效治疗糖尿病肾病。     

金黄色葡萄球菌生物被膜耐药机制研究进展

金黄色葡萄球菌是常见的引起医院感染和社区感染的致病菌之一。近年来, 临床上金黄色葡萄球菌抗感染治疗失败的病例越来越多, 生物被膜的形成被认为是导致抗菌药物治疗失败的主要原因。然而, 金黄色葡萄球菌生物被膜的耐药机制并未完全阐明。证据表明, 金黄色葡萄球菌生物被膜感染难以治愈且容易反复, 感染后反复治疗将大大增加患者的痛苦和经济负担。本文对金黄色葡萄球菌生物被膜耐药机制的研究进展进行综述, 以期为开发新的抗菌药物提供参考依据。     

不同类型慢性乙型肝炎血清HBV DNA基因含量与临床的关系

探讨不同类型慢性乙型肝炎 (慢乙肝 )患者病毒复制水平与肝损害程度的关系。 180例慢乙肝患者血清HBVDNA基因含量采用荧光定量PCR方法检测。血清HBeAg阳性组HBVDNA含量 (10 6 3 5± 1 84)显著高于HBeAg阴性组 (10 4 73± 1 88) (P <0 0 1) ,不同类型慢乙肝组血清HBVDNA含量相比较无显著性差异 (P >0 0 5 )。研究证实 ,血清HBeAg的存在影响HBVDNA的水平变化 ,不同类型慢性乙型肝炎肝损害程度与血清HBVDNA基因含量无明显关系     

Accuracy of cardiac CT in evaluating severity of left atrial appendage spontaneous echo contrast: comparison with transesophageal echocardiography

To investigate the capacity of biphasic cardiac CT (CCT) for qualitative and quantitative evaluation of different grades of left atrial appendage spontaneous echo contrast (LAASEC). The study included 267 inpatients with confirmed atrial fibrillation who underwent both CCT and transesophageal echocardiography (TEE). CT numbers for LAA, ascending aorta (AA), and left atrium (LA) were identified, and ROC curves for LAA, LAA/AA, and LAA/LA were plotted. With TEE as the standard, the sensitivity, specificity, PPV, NPV, and accuracy of CCT for LAASEC grade?≥?1 were 60.3, 92.9, 92.4, 64.8, and 75.7%; and for grade?≥?2 were 100.0, 84.4, 71.4, 100.0, and 88.8% respectively. The values of LAA, LAA/AA, and LAA/LA were significantly larger in LAASEC grade 0 versus 1 and in grade 1 versus 2, but were similar in grades 2 and 3 or in grades 3 and 4. The values of LAA/AA were larger in grade 2 versus 4. When the cutoff value for LAA/AA?=?0.897, sensitivity, specificity, PPV, NPV, and accuracy of CCT for LAASEC grade?≥?1 was 89.6, 83.2, 87.9, 85.5, and 86.9% and with a cutoff for LAA/AA of 0.524, the sensitivity, specificity, PPV, NPV, and accuracy for LAASEC grade?≥?2 was 98.7, 92.7, 84.1, 99.4, and 94.4%. Although CCT showed limited diagnostic accuracy for grade 1 LAASEC, grade?≥?2 LAASEC could be excluded when there was no LAA filling defect on first-phase CCT, and TEE can be avoided. CCT has an excellent accuracy in diagnosing LAASEC, and quantitative analysis (in particular LAA/AA) is superior.     

扶他林治疗心脏电除颤所致电灼伤的疗效观察

目的观察扶他林对心脏电除颤所致电灼伤的治疗效果及安全性。方法 2011年1月至2014年12月在我院就诊的因电除颤引起的皮肤电灼伤患者66例,按照不同的治疗方法随机分为硫酸镁湿敷组、扶他林治疗组,每组33例。硫酸镁组采用50%硫酸镁湿敷,3次/d,连续5~7 d;扶他林组在局部皮肤发红处涂抹薄层扶他林,3次/d,连续5~7 d。比较两组的治疗效果及安全性。结果硫酸镁湿敷组显效13例(39.4%),有效15例(45.6%),无效5例(15.0%);扶他林治疗组显效25例(75.8%),有效8例(24.2%),无效0例。扶他林治疗组疗效优于硫酸镁湿敷组,两组比较差异具有统计学意义(P<0.05)。两组均无药物不良反应发生。结论扶他林治疗心脏电除颤所致电灼伤的效果好于硫酸镁湿敷,且无明显的药物不良反应,是治疗心脏电除颤所致电灼伤的一种非常有效且安全的药物。     

Schistosomiasis in a migrating population in the lake region of China and its potential impact on control operation

Coverage of migrating people in schistosomiasis control program is a growing concern in China. Schistosomiasis caused by Schistosoma japonicum is still one of the major infectious diseases of public health importance in China though tremendous efforts have been made to control the transmission over the past decades. Along with the rapid social-economic development, migrant population has been remarkably increasing across the country. The infected migrants may introduce a new souse of infection to endemic areas or the areas where the transmission had been controlled or interrupted but the intermediate host Oncomelania snail is still present. Preliminary studies for surveillance on schistosomiasis prevalence in migrants were reported, but there is little basic information provided. We carried out an investigation on the prevalence in immigrants, emigrants and permanent residents in three villages of Hunan province located in the main endemic area of lake region, and analyzed the potential impact of migration on control practice. In the study villages, the migrant population accounts for 53.6% of the total. Schistosoma infection was detected by modified Kato-Katz method and miracidium hatching test. Questionnaire survey was conducted comprising knowledge of disease and its transmission, water contact, personal protective measures, and whether examined and treated after water contact. The survey indicated that the migrants and permanent residents had similar life style, and the majority of them experienced water contact in agricultural work or routine life activities. However, the infection rate in immigrants was significantly higher than that in permanent residents. It was also found that the migrants had significantly less knowledge about the disease than the permanent residents, and took no personal protective measures. This is due to that the control program could not cover the migrants when they were absent at the time the program being implemented. The present study suggested that the surveillance and intervention for migrants, immigrants in particular, should be included and strengthened in schistosomiasis control program and a feasible scheme be developed.     

从人体阴阳本体结构谈扶阳派唐农教授治疗血管性痴呆的经验

唐农教授精于扶阳,崇尚经典。揭示了人体内阳外阴的本体结构,运用《周易》的泰否二卦加以描述,在理论推导与经验事实上都给出了很好的证明。指出《伤寒论》三阴病的本质是虚寒,致使阴阳本体结构被破坏出现了阴阳各离本位的否象。治则关键在于温化三阴经的阴寒,使阴阳和,恢复人体内阳外阴的本体结构。认为血管性痴呆属于三阴病,因三阴经的虚寒而致肾收藏不利,影响到信息的储存,表现为血管性痴呆记忆力减退。而肾之藏是与肺之收为前提的,因此提出从肺论治血管性痴呆。并举一则医案加以说明。     

一起诺如病毒感染性腹泻暴发的流行病学调查

目的分析马山县白山镇一起水源性诺如病毒感染性腹泻暴发的流行病学特征,为防制诺如病毒感染性腹泻提供科学依据。方法确定病例定义进行病例搜索和流行病学调查,采集病人肛拭子标本和水源水、学校二次供水和银峰屯饮用水等水样进行逆转录-聚合酶链(RT-PRT)反应法检测诺如病毒抗原,食物中毒常规致病菌检测。结果本次疫情历时4 d时间,共发病108例,其中学生和老师92例、学校外围人员16例。采集34例病例肛拭子标本,实验室检测诺如病毒抗原阳性24例,阳性率70.59%。采集生活饮用水3份,诺如病毒抗原阳性3份,阳性率100.00%。结论本次疫情为诺如病毒感染引起的感染性腹泻暴发流行,被诺如病毒污染的水源是疫情的主要传播途经。应加强饮用水的消毒和管理,开展健康教育是控制疫情的关键。     

心尖肥厚型心肌病患者的冠状动脉病变特点及其预后分析

目的总结心尖肥厚型心肌病（AHCM）患者的冠状动脉病变特点,并对心尖肥厚型心肌病预后的影响因素进行分析。方法连续人选自2005年1月至2012年8月经超声心动图和（或）心脏磁共振成像确诊为心尖肥厚型心肌病并进行了冠状动脉造影或多排螺旋CT（MDCT）检查的患者共240例,总结其冠状动脉病变特点,并分析冠状动脉病变对AHCM预后的影响。结果74例（30．83％）患者合并冠心病,其中单支病变32例,双支病变25例,三支病变17例;33例经皮行冠状动脉介入治疗（PCI）,2例行冠状动脉旁路移植术（CABG）,余39例采取单纯药物治疗。23例（9．58％）患者合并冠状动脉肌桥,受累血管均为前降支单支病变;其中1例经皮行冠状动脉介入治疗（PCI）,1例行冠状动脉旁路移植术（CABG）,余21例采取单纯药物治疗。合并冠心病组（74例）与非冠心病组（143例）比较,前者平均年龄、平均糖化血红蛋白水平及高血压病史的比例均高于后者（P〈0．05）;合并冠心病组预后较冠脉正常组差,Cox比例风险回归模型多因素分析发现,左室射血分数（HazardRatio==0．826,95％C10．746—0．915,P=0．001）和左房前后径大小（HazardRatio--1．423,95％CI：1．142-1．773,P=0．002）是影响AHcM合并冠心病预后的独立危险因素。结论应当对高龄、以胸痛主诉、合并高血压病及平均糖化血红蛋白水平均较高的AHCM患者常规进行冠状动脉检查;合并冠心病对AHCM预后有不良影响;LVEF和左房前后径大小是AHCM合并冠心病预后的独立危险因素。