烧伤科成人院内获得性肺炎危险因素的研究

目的了解烧伤科成人院内获得性肺炎的危险因素,为临床治疗提供参考资料。方法对2001年1月～2010年12月于本院烧伤科患者中诊断为院内获得性肺炎者运用统计学方法进行回顾性分析。结果老年患者比年轻患者院内获得性肺炎感染率高,差异有统计学意义(χ2=28.3,P<0.05);重度及特重烧伤患者较轻中度烧伤患者院内获得性肺炎感染率高,差异有统计学意义(χ2=123.1,P<0.05);有吸入性损伤者较无吸入性损伤者院内获得性肺炎感染率高,差异有统计学意义(χ2=116.6,P<0.05);气管切开及机械通气者较未行气管切开者院内获得性肺炎感染率高,差异有统计学意义(χ2=51.2,P<0.05);女性较男性院内获得性肺炎感染率低,但差异无统计学意义(χ2=0.43,P>0.05)。痰培养显示,院内获得性肺炎主要有2种或2种以上细菌混合感染引起,革兰阴性杆菌是主要的致病菌。创面细菌迁移和胃肠-肺感染途径是院内获得性肺炎的重要感染途径。结论烧伤科感染院内获得性肺炎危险因素有年龄、烧伤程度、吸入性损伤、气管切开,与性别无关。对胃肠道反流和创面处理上需要引起足够的重视,并尽量避免交叉感染。     

64排螺旋CT造影对肺栓塞表现和严重性判断的临床价值

目的探讨64排螺旋CT造影对肺栓塞表现和严重性判断的临床价值。方法选择30例确诊的肺栓塞患者并与30例拟诊但后来经临床排除肺栓塞的患者比较,CT显示支气管动脉扩张和中央肺动脉受累情况,计算栓塞指数判断CT造影在肺动脉栓塞中的诊断价值。结果肺动脉栓塞组CT造影显示支气管动脉扩张和中央肺动脉受累的比例显著高于非肺动脉栓塞组,差异有统计学意义(P<0.05),而合并有基础心肺疾病的比例亦显著高于非肺动脉栓塞组,差异有统计学意义(P<0.05),肺动脉栓塞组的栓塞指数显著高于非肺动脉栓塞组,差异有统计学意义(P<0.05)。结论 64排螺旋CT肺血管造影对于肺栓塞患者的检查,具有无创、快捷、可重复等特点,且其敏感性高,是一种初诊急性肺动脉栓塞的首选方法。     

Stability of immunophenotypic markers in fixed peripheral blood for extended analysis using flow cytometry

The analysis of whole blood samples by flow cytometry for pharmacodynamic and biomarker assessments in clinical studies has been limited by the necessity to test these samples within a short time frame after blood collection. In most clinical studies, blood specimens are shipped to a centralized testing facility; it is critical to demonstrate specimen stability over a period of time which will encompass the time elapsed between specimen collection and testing. A possible solution to overcome this limitation is the use of a fixative to preserve the cell surface antigen stability in whole blood. We examined the stability of markers for T lymphocytes (CD3, CD4, CD8, CD45RA, and CD45RO), B lymphocytes (CD19), NK cells (CD16 + CD56), activation (CD25 and HLA-DR), chemokine receptors (CCR5 and CXCR3) and skin homing (CLA) in fixed blood over 7 days and used this information to select the markers for global clinical studies. These assays with selected markers were further validated using fit-for-purpose approach (Lee et al., 2006) and to set the sample acceptability criteria for use in clinical sample testing. Most of the markers examined were stable when collected in Cyto-Chex® BCT for one week with the exception of the activation markers on T cells.     

Battlefield extremity injuries in Operation Iraqi Freedom

Objective

Extremity injuries account for the majority of wounds incurred during US armed conflicts. Information regarding the severity and short-term outcomes of patients with extremity wounds, however, is limited. The aim of the present study was to describe patients with battlefield extremity injuries in Operation Iraqi Freedom (OIF) and to compare characteristics of extremity injury patients with other combat wounded.

Patients and methods

Data were obtained from the United States Navy-Marine Corps Combat Trauma Registry (CTR) for patients who received treatment for combat wounds at Navy-Marine Corps facilities in Iraq between September 2004 and February 2005. Battlefield extremity injuries were classified according to type, location, and severity; patient demographic, injury-specific, and short-term outcome data were analysed. Upper and lower extremity injuries were also compared.

Results

A total of 935 combat wounded patients were identified; 665 (71%) sustained extremity injury. Overall, multiple wounding was common (an average of 3 wounds per patient), though more prevalent amongst patients with extremity injury than those with other injury (75% vs. 56%, P < .001). Amongst the 665 extremity injury patients, 261 (39%) sustained injury to the upper extremities, 223 (34%) to the lower extremities, and 181 (27%) to both the upper and lower extremities. Though the total number of patients with upper extremity injury was higher than lower extremity injury, the total number of extremity wounds (n = 1654) was evenly distributed amongst the upper and lower extremities (827 and 827 wounds, respectively). Further, lower extremity injuries were more likely than the upper extremity injuries to be coded as serious to fatal (AIS > 2, P < .001).

Conclusions

Extremity injuries continue to account for the majority of combat wounds. Compared with other conflicts, OIF has seen increased prevalence of patients with upper extremity injuries. Wounds to the lower extremities, however, are more serious. Further research on the risks and outcomes associated with extremity injury is necessary to enhance the planning and delivery of combat casualty medical care.     

Venous glucose and arterial lactate as biochemical predictors of mortality in clinically severely injured trauma patients—A comparison with ISS and TRISS

Background

Early assessment of injury severity is important in trauma. Trauma scores are calculated after the fact and are useful for audit and research, but not in the emergency clinical setting. Glucose metabolism is altered in trauma, and we hypothesised that alterations in glucose and lactate levels would be an early predictor of mortality.

Methods

Review of trauma registry data identified 1197 patients between May 2000 and September 2006 who had a trauma-team call out. Data collected included trauma scores, venous glucose (gluc), and arterial lactate (lact) on arrival. The predictive value of these variables was compared by ROC curves.

Results

The mortality rate for patients with gluc >11.0 mmol/L was 13.4% compared to 1.8% in those with gluc ≤11.0 mmol/L (p < 0.0001). Gluc had a specificity of 93.2% and a sensitivity of 37.9% for death. 13.0% of patients with lact >2.0 mmol/L died, versus 2.7% with lact ≤2.0 mmol/L, (p 0.0003, specificity 56.8% and sensitivity 81.0%). Glucose was the better biochemical predictor of mortality compared to lactate (ROC area 0.845 and 0.716, respectively). The TRISS (trauma and injury severity score) was a very accurate predictor (ROC 0.963), whereas the ISS (injury severity score) significantly less so (ROC 0.854). There was a significant correlation between gluc, ISS, and TRISS (p 0.01), as well as lactate and ISS (p 0.01).

Conclusion

Glucose and lactate can predict mortality in severe trauma. The predictive value of glucose is comparable to that of ISS, and can be more easily employed in the clinical setting.     

Standardizing ADOS Scores for a Measure of Severity in Autism Spectrum Disorders

The aim of this study is to standardize Autism Diagnostic Observation Schedule (ADOS) scores within a large sample to approximate an autism severity metric. Using a dataset of 1,415 individuals aged 2–16 years with autism spectrum disorders (ASD) or nonspectrum diagnoses, a subset of 1,807 assessments from 1,118 individuals with ASD were divided into narrow age and language cells. Within each cell, severity scores were based on percentiles of raw totals corresponding to each ADOS diagnostic classification. Calibrated severity scores had more uniform distributions across developmental groups and were less influenced by participant demographics than raw totals. This metric should be useful in comparing assessments across modules and time, and identifying trajectories of autism severity for clinical, genetic, and neurobiological research.     

Brief Report: Pragmatic Language in Autism Spectrum Disorder: Relationships to Measures of Ability and Disability

Pragmatic language skill is regarded as an area of universal deficit in Autism Spectrum Disorder (ASD), but little is known about factors related to its development and how it in turn might contribute to skills needed to function in everyday contexts or to the expression of ASD-related symptoms. This study investigated these relationships in 37 high-functioning children with ASD. Multiple regression analyses revealed that structural language skills significantly predicted pragmatic language performance, but also that a significant portion of variance in pragmatic scores could not be accounted for by structural language or nonverbal cognition. Pragmatic language scores, in turn, accounted for significant variance in ADOS Communication and Socialization performance, but did not uniquely predict level of communicative or social adaptive functioning on the Vineland. These findings support the notion of pragmatic language impairment as integral to ASD but also highlight the need to measure pragmatic skills in everyday situations, to target adaptive skills in intervention and to intervene in functional, community-based contexts.     

An open-label study of quetiapine in the treatment of fibromyalgia

The aim of this exploratory study was to systematically assess the potential effectiveness and tolerability of quetiapine, an atypical antipsychotic, for the treatment of patients with fibromyalgia. This was a unicentre, open-label study conducted in thirty-five outpatients, 18 years or older, who met the ACR criteria for fibromyalgia and who had not satisfactorily responded to their previous fibromyalgia treatment. Quetiapine, flexibly dosed (25-100 mg/day), was added to their original treatment regimen for 12 weeks. The primary outcome measure was the mean change from baseline to endpoint in the Fibromyalgia Impact Questionnaire (FIQ) total score. Secondary efficacy measures included mean changes from baseline to endpoint in the scores of the Clinical Global Impression (CGI) of Severity scale, Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), 12-Item Short Form Health Survey (SF-12), and individual items of the FIQ. Thirty (85.7%) patients (mean age 47+/-7.9, 93.3% females) had a postbaseline evaluation and constituted the intent-to-treat efficacy sample. Mean FIQ total score decreased significantly by 10.2 points from a baseline of 63.2 to 53.0 at study endpoint (p<0.001). A statistically significant reduction was observed in FIQ stiffness and FIQ fatigue subscores but not in FIQ pain subscore. Large effect sizes were observed for the FIQ total (1.04), CGI-severity (1.00) and PSQI (1.07), while moderate effect sizes (i.e.> or =0.50) were encountered in the FIQ fatigue, FIQ stiffness and SF-12 mental component summary. Quetiapine was safely administered and well tolerated. Despite the lack of effect on pain, the significant and relevant improvement in overall efficacy measures and quality of life suggests that quetiapine may be a valuable drug for treatment of patients with fibromyalgia that should be further tested in double-blind, placebo-controlled trials.     

Alcoholism effects on social migration and neighborhood effects on alcoholism over the course of 12 years

BACKGROUND: Although a short-term effect of neighborhood characteristics on individual alcohol abuse has been demonstrated by a quasi-experimental residential mobility study, the obversed effect of alcohol problem involvement on place of residence and residential character has not been studied. We test the alcoholism effect on place of residence, and we also attempt to replicate the neighborhood-to-alcoholism effect. METHODS: A sample of 206 Caucasian men (average age was 33) who were systematically recruited for alcoholism through a court record search of drunk driving offenses and door-to-door canvassing, in a 4-county-wide area were followed up at 3-year intervals in a prospective study of the course and outcomes of alcoholism. Participants' alcoholism diagnoses were made by semistructured diagnostic interviews. Residential addresses at baseline and at 12-year follow-up were geocoded. Corresponding census tract variables were used as indicators of neighborhood residential character. RESULTS: The regression analysis shows that, the more alcohol problems a man has, the more likely he is going to remain in, or migrate into, a disadvantaged neighborhood. This effect is only evident when a number of relevant confounding variables, including initial level of socioeconomic status, age, antisocial symptomatology, and spousal alcohol-use disorder status at baseline are controlled. Alcoholics in remission tended to live in neighborhoods whose residential characteristics were not distinguishable from those of nonalcoholics. Unremitted alcoholics, however, tended to stay in or migrate into more disadvantaged neighborhoods. CONCLUSION: Alcoholic involvement has long-term negative effects on place of residence; involving an elevated likelihood of moving into or remaining in a disadvantaged neighborhood. Recovery from alcoholism is protective against downward social drift on the one hand, and is favorable to improvement in social conditions on the other.     

帕金森病患者轻度认知功能损害

目的 探讨帕金森病(PD)患者伴轻度认知功能损害(MCI)即PD-MCI的特征及其相关因素.方法 采用多种量表[MMSE、Hoehn-Yahr分期、Webster评分、PD统一评分量表-运动(UPDRS-motor)及剑桥老年认知检查量表中文版(CAMCOG-C)]评估PD患者的病情严重程度、运动和认知功能;应用Petersen改良标准诊断PD-MCI.结果 89例PD患者中,认知正常(PDCOGNL)56例(63%),PD-MCI 20例(22%),PD痴呆(PDD)13例(15%).PD-MCI组较PDCOGNL组在定向、语言、记忆、注意、执行、思维、知觉等方面均存在明显损害,两组年龄和起病年龄差异无统计学意义,受教育程度差异有统计学意义(PD-MCI:4.4±4.3,PDCOGNL:7.1±4.9;q=3.270,P<0.05);PD-MCI组的年龄、起病年龄及受教育程度较PDD组差异均无统计学意义;而PDD组较PDCOGNL组在年龄、起病年龄、受教育程度等方面差异均有统计学意义(q=-4.913、-4.997、4.740,均P<0.01);3组间病程差异无统计学意义.Hoehn-Yahr分期、Webster评分及UPDRS-motor评分与PD认知功能均存在负相关.结论 PD-MCI是PD认知正常与PDD之间的过渡状态,存在多个区域的认知损害;高龄、起病年龄迟、受教育程度低可能是PD认知损害的危险因素;疾病严重程度及运动功能与PD认知功能存在着负相关.