肝功能损害对非胆源性重症急性胰腺炎预后的影响

目的 探讨肝脏功能状态与重症急性胰腺炎(severe acute pancreatitis,SAP)患者病情严重程度及预后的关系,为临床早期对SAP患者严重度做出预测,并对肝脏功能损害进行治疗,减少SAP患者局部和全身并发症,降低死亡率提供临床依据.方法 分析非胆源性SAP患者发生多器官功能衰竭(multiple organ dysfunction syndrome,MODS)的相关关系或趋势,以MODS作为SAP患者预后指标进行统计,进行回顾性病例对照研究,应用单因素及多因素Logistic回归分析其预后与肝功能损害各项实验室指标的关系.结果 单因素Logistic回归分析结果显示,AST、ALT、ALB与SAP患者MODS的发生之间作用有统计学意义,多因素Logistic回归分析结果显示,变量AST、ALT、ALB与SAP患者MODS的发生之间的关系有统计学意义.结论 非胆源性SAP患者肝功能检查中的AST、ALT浓度升高和ALB浓度降低,提示SAP患者预后不良.     

选择性支气管动脉栓塞治疗大咯血的临床应用

目的 探讨选择性支气管动脉栓塞（SBAE）治疗大咯血的疗效。方法 采用股动脉穿刺放入导管,对42例大咯血或长期反复咯血患者行DSA确定出血血管,然后对病变血管进行栓塞。共栓塞病变血管55支。结果 栓塞治疗24h内,42例中的40例（95．24％）被成功止血。随访6～72个月,仪3例肺癌与2例肺结核患者偶有痰中带血。所有病例未发生严重的栓塞相关并发症。结论S BAE治疗大咯血是一种高效、安全、操作简便的治疗方法,值得进一步推广。     

重症肺炎抗生素降阶梯疗法的疗效观察

目的评价重症肺炎采用抗生素降阶梯疗法的疗效。方法60例重症肺炎患者随机分为治疗组及对照组,治疗组30例采用抗生素降阶梯疗法,与对照组比较疗效。结果两组死亡率、ICU住院时间、机械通气时间、总住院时间均具有显著性差异（P〈0．05,P〈0．01）。结论抗生素降阶梯疗法对重症肺炎具有良好疗效。     

支气管肺泡灌洗抢救重症肺炎并呼吸衰竭的临床研究

目的探讨支气管肺泡灌洗抢救重症肺炎并呼吸衰竭的临床价值。方法将37例患者随机分为灌洗组和非灌洗组,灌洗组18例在常规治疗基础上加支气管肺泡灌洗,非灌洗组19例采用常规治疗,观察两组病例的治疗效果。结果治疗48 h、72 h后灌洗组的PaO2和氧合指数（PaO2/F iO2）明显高于非灌洗组（P〈0.01）,PaCO2明显低于非灌洗组（P〈0.01）;灌洗组总有效率为88.8%,非灌洗组为47.4%。两组比较有显著性差异（P〈0.01）。结论支气管肺泡灌洗抢救重症并呼吸衰竭,可减少使用有创机械通气,疗效确切,有较高的临床价值。     

血浆置换对重型乙型病毒性肝炎HBV DNA含量的影响及与预后的关系

探讨经血浆置换（PE）治疗重型乙型病毒性肝炎后,患者血清中HBV DNA含量的变化对预后的影响。随机选取60例乙型肝炎病毒标志物阳性患者,20例为对照组,40例在内科治疗的基础上加PE治疗。观察治疗前后血清HBV DNA含量变化。40例经PE治疗的患者血清HBV DNA含量下降,PE治疗有效组比PE治疗无效组和对照组降低更明显,且肝功能指标改善也更明显。PE治疗可以有效的去除重型肝炎患者血清HBV DNA,改善肝功能及预后,提高患者的存活率。     

The Effect of Severe Shot Peening on Fatigue Life of Laser Powder Bed Fusion Manufactured 316L Stainless Steel

Severe shot peening (SSP) was used on additive manufactured 316L by laser powder bed fusion. The effect of the post processing on the surface features of the material was analyzed through residual stress measurements, tensile testing, hardness-depth profiles, and fatigue testing by flexural bending. The results showed that SSP can be utilized to form residual stresses up to −400 MPa 200 μm below the surface. At the same time, a clear improvement on the surface hardness was achieved from 275 HV to near 650 HV. These together resulted in a clear improvement on material strength which was recorded at 10% improvement in ultimate tensile strength. Most significantly, the fatigue limit of the material was tripled from 200 MPa to over 600 MPa and the overall fatigue strength raised similarly from a low to high cycle regime.     

皮质醇水平轨迹分析识别脓毒症新亚型

目的 采用纵向血浆皮质醇水平轨迹识别脓毒症患者的新亚型。方法 回顾性选择2019年3月至2021年8月于复旦大学附属中山医院重症医学科住院治疗的成人脓毒症患者96例,在入组后第1～3个晨8时和第1、2个下午4时采集患者血液,分析皮质醇浓度变化轨迹。根据轨迹潜在类别分析结果将患者分组,比较不同组基础情况、疾病严重程度、实验室检查及临床结局(如住院时间、死亡率)等。结果 96例脓毒症患者中位年龄68岁,以男性患者为主(68.8%)。诱发脓毒症的原发病以腹部感染为主(83.3%),而合并症以肿瘤居多(61.5%),特别是肠道肿瘤。根据皮质醇水平轨迹,将患者分为皮质醇水平由较高浓度逐渐回落组(回落组,n=33)和在正常范围且波动较为稳定组(稳定组,n=63)。回落组入组时病情更重,序贯器官衰竭评分（SOFA）分值[8(6, 11)分vs 6(4,8)分]及APACHEⅡ评分[20(15,23)分vs 15(11,18)分]高于稳定组（P<0.01）。回落组28 d死亡率(42.4%vs 17.4%)和90 d死亡率(45.5%vs 22.2%)明显高于稳定组（P<0.05）。结论 ...     

重症肺心病患者应用低分子肝素钠治疗的疗效、凝血功能及GMP-140分析

目的:探讨重症肺心病患者应用低分子肝素钠治疗的疗效、凝血功能及GMP-140分析.方法:将2017年5月30日～2019年5月30日在某院心血管科就诊的120例患有重症肺心病患者作为本次临床试验的研究对象,对120例重症肺心病患者应用随机数字分配法进行随机分为试验组和对照组各60例,对照组主要采用重症肺心病的常规治疗方...     

Risk Factors for SARS-CoV-2 Infection and Illness in Cats and Dogs

We tested swab specimens from pets in households in Ontario, Canada, with human COVID-19 cases by quantitative PCR for SARS-CoV-2 and surveyed pet owners for risk factors associated with infection and seropositivity. We tested serum samples for spike protein IgG and IgM in household pets and also in animals from shelters and low-cost neuter clinics. Among household pets, 2% (1/49) of swab specimens from dogs and 7.7% (5/65) from cats were PCR positive, but 41% of dog serum samples and 52% of cat serum samples were positive for SARS-CoV-2 IgG or IgM. The likelihood of SARS-CoV-2 seropositivity in pet samples was higher for cats but not dogs that slept on owners’ beds and for dogs and cats that contracted a new illness. Seropositivity in neuter-clinic samples was 16% (35/221); in shelter samples, 9.3% (7/75). Our findings indicate a high likelihood for pets in households of humans with COVID-19 to seroconvert and become ill.     

Burkholderia pseudomallei in Environment of Adolescent Siblings with Melioidosis,Kerala, India, 2019

In 2019, Burkholderia pseudomallei was isolated from the backyard of 2 siblings with melioidosis in Kerala, India. This finding highlights the value of healthcare providers being aware of risk for melioidosis in febrile patients, of residents taking precautions when outside, and of increasing environmental surveillance for B. pseudomallei in this region.