巨细胞病毒感染与早产儿支气管肺发育不良的关系探讨

目的:探讨巨细胞病毒(CMV)感染与早产儿支气管肺发育不良(BPD)的关系。方法:选择BPD的早产儿36例(观察组)、非BPD的早产儿40例(对照组),采用ELISA法检测所有受试对象血清CMV-IgM、IgG抗体,辅助检查包括:肝功能、血常规、心肌酶测定及胸部X线摄片,比较两组间CMV感染率以及CMV感染临床症状分类。结果:两组CMV感染率分别为88.89%和67.50%,两组CMV感染率相比有显著性差异(P<0.05)。CMV感染能显著增加支气管肺发育不良的危险3.852倍(95%CI:1.123～13.206)。相对在于无症状性感染,CMV症状性感染能显著增BPD的危险3.194倍(95%CI:1.083～9.423)。结论:巨细胞病毒症状性感染是早产儿支气管肺发育不良的危险因素。     

非动脉炎性前部缺血性视神经病变的血流动力学分析

目的：探讨血流动力学因素在非动脉炎性前部缺血性视神经病变（nonarteritic anterior ischemic optic neuropathy,NAION)发生中的作用。方法对NAION患者48例50只眼和非ANION患者50例50只眼的肱动脉压、眼动压和眼压进行比较,结果NAION组的肱动脉、眼动脉收缩压和舒张压均显著低于非NAION组（P＜0．05）,而眼压显著高于非NAION组（P＜0．05）。眼动脉收缩压和舒张压与眼之差均显著低于非NAION组（P＜0．01）。结论相对的低血压,高压眼和眼动脉压与眼压的不平衡是引起NAION的重要因素。     

从藏象学说再论湿疹病因病机简

湿疹是多种因素引起的一种具有明显渗出倾向的皮肤炎症性疾病,是皮肤科常见病,其病因复杂,皮损的表现也多种多样,容易反复。随着社会的工业化进程,人们生活方式的改变,及环境污染等因素的影响,湿疹的发病呈逐年上升的趋势。中医治疗湿疹有数千年的历史,针对湿疹的不同病期,采用中药内服、外用治疗疗效好,复发率低。对于湿疹的病因、病机各医家进行了论述,对其病因主要围绕着风、湿、热邪进行论述,对湿疹发病过程中涉及的脏腑,有从心论述的,有从脾论述的,也有从心、脾、肺、肝等方面论述的,认识不一。为进一步了解湿疹的病因、病机,该文从中医藏象学说的角度,分析五脏与湿疹发病的关系,更好的从病因、病机方面认识、治疗湿疹。     

The Picture of Health for Midlife and Older Women in America

This report overviews the major health problems of middle aged and older women and health care access issues. The relationship of labor force involvement to health status and insurance benefits is considered. Other payment sources such as Medicaid and Medicare are critiqued for their failure to finance needed prevention and other services.     

Transition in the Cause of Fever from Malaria to Dengue,Northwestern Ecuador, 1990–2011

In tropical areas, the predominant cause of fever has historically been malaria. However by 2011, among febrile patients in northwestern Ecuador, dengue was identified in 42% and malaria in none. This finding suggests a transition in the cause of fever from malaria to other illnesses, such as dengue.     

小儿血液系统疾病人细小病毒B_(19)感染的研究

目的:探讨我国西北地区血液系统疾病患儿人细小病毒B19(HPV B19)感染情况及两者的相关性。方法:对特发性血小板减少性紫癜、再生障碍性贫血和白血病患儿的外周血分别采用PCR方法检测HPV B19-DNA和ELISA方法检测HPV B19-IgG。结果:特发性血小板减少性紫癜患儿HPV B19-IgG阳性率为43.08%(28/65),白血病患儿HPV B19-IgG阳性率为41.07%(46/112),病例组较对照组比较有极显著性差异(P<0.01);再生障碍性贫血患儿HPV B19-IgG阳性率为21.43%(6/28),病例组较对照组比较有显著性差异(P<0.05)。65例特发性血小板减少性紫癜患儿HPV B19-DNA阳性率为40.00%(26/65);28例再生障碍性贫血患儿HPV B19-DNA阳性率为21.43%(6/28);112例白血病患儿HPV B19-DNA阳性率为27.68%(31/112);对照组HPV B19-DNA检测均为阴性。结论:HPV B19感染与我国西北地区部分血液系统疾病患儿发病相关。     

福建省闽西地区维持性血液透析患者病因及贫血状况的多中心调查

目的 了解福建省闽西地区终末期肾病(ESRD)患者的病因构成及其贫血状况。 方法 回顾性分析闽西地区11家医院2014年1-12月因ESRD行维持性血液透析的858例患者的临床资料,比较患者的血红蛋白水平与铁缺乏、营养状况、甲状旁腺激素、透析充分性、促红细胞生成素(EPO)治疗之间的关系。 结果 ESRD的病因中,前3位分别为慢性肾小球肾炎(458例,52.79%)、糖尿病肾病(143例,16.67%)和高血压肾病(128例,14.92%)。使用EPO治疗775例,治疗率90.33%,贫血治疗达标率42.87%。血红蛋白越低,EPO治疗的比例越高,用量也越大。与贫血治疗达标患者比较,贫血治疗不达标患者血清铁蛋白、转铁蛋白饱和度、血清白蛋白水平明显低下(均为P<0.05),血甲状旁腺素、肌酐、尿素氮水平明显升高(均为P<0.05),每周3次透析的患者所占比例明显下降(P<0.05)。 结论 闽西地区ESRD的病因主要是原发性肾小球肾炎、糖尿病肾病和高血压肾损害; 维持性血液透析患者贫血治疗率高,但达标率仍偏低,主要影响因素是铁缺乏、营养不良、继发性甲状旁腺功能亢进和透析不充分。     

代偿性酸中毒、炎性反应和病因是影响急性肾损伤预后的重要因素

目的分析影响急性贤损伤(AKI)预后的因素,评判不同病因对预后的影响。方法回顾性分析507例AKI病例,分为预后良好组和预后不良组,收集临床资料,根据治疗前后SCr变化,分析AKI预后的危险因素和病因对预后的影响。结果预后良好组253例(49.9%),预后不良组254例(50.1%)。预后不良组年龄较大(P0.001),SCr基线值较高(P0.01),贫血和低白蛋白血症的发生率较高(P0.01和P0.001),炎性指标更高(P0.001)。通过Logistic回归分析建立预后模型,分析结果显示,即使代谢性酸中毒处于HCO3-降低而p H值正常的阶段,仍是影响预后的危险因素(P0.05),MODS(P0.001)、炎性因子(P0.01)和少尿(P0.01)也是影响预后的危险因素;血白蛋白(P0.01)和血红蛋白(P0.05)是预后的保护性因素。本研究中,AKIN 1、2期中最常见病因为重症感染导致的AKI,AKIN 3期中最常见小管间质损害,不同分期对预后的影响无显著差别。结论 1)代偿性酸中毒、MODS、炎性反应和少尿是AKI预后的危险因素;2)需重视病因对AKI临床结局的影响。     

Chronic Idiopathic Cough: A Discrete Clinical Entity?

STUDY OBJECTIVES: Despite the success of specialist cough clinics, there is increasing recognition of a subgroup of chronic coughers in whom a diagnosis cannot be made even after thorough, systematic investigation. We call this condition chronic idiopathic cough (CIC). The aim of this study is to compare the clinical characteristics of CIC patients with those of coughers in whom a diagnosis has been established (non-CIC) to see if there is a recognizable clinical pattern that distinguishes CIC from non-CIC. DESIGN: Retrospective analysis of the medical records of chronic cough patients. SETTING: The Royal Brompton Hospital Chronic Cough Clinic, London. PATIENTS: One hundred patients with chronic cough referred to the Royal Brompton Hospital Cough Clinic between October 2000 and February 2004. RESULTS: Seventy-one percent of all patients were female. Median age was 57 years (range, 19 to 81 years), with a median duration of symptoms of 48 months (range, 2 to 384 months). The primary diagnoses were CIC (42%), postnasal drip syndromes (22%), gastroesophageal reflux disease (16%), asthma (7%), and others (13%). In CIC patients, the median age at referral, age at onset of cough, and proportion of females did not differ significantly from non-CIC patients. CIC patients had a longer median duration of cough (72 months vs 24 months, p = 0.002), were more likely to report an upper respiratory tract infection (URTI) as the initial trigger of their cough (48% vs 24%, p = 0.0014), and had a significantly lower cough threshold in response to capsaicin (log concentration of capsaicin required to induce five or more coughs, - 0.009 vs 0.592, p = 0.032) than non-CIC patients. CONCLUSIONS: Patients with CIC commonly describe a URTI that initiates their cough, which then lasts for many years, and they demonstrate an exquisitely sensitive cough reflex. We believe that CIC may be a distinct clinical entity with an as-yet unidentified underlying pathology.     

Exchange transfusion for neonatal hyperbilirubinemia: an 8-year single center experience at a tertiary neonatal intensive care unit in Turkey

Objective: The aim of present study was to evaluate the indications and the complications associated with neonatal exchange transfusion (ET) performed for hyperbilirubinemia.

Methods: This study included overall 306 neonates who underwent ET between 2005 and 2012. The demographic characteristics of patients, causes of jaundice and adverse events occurred during or within 1 week after ET were recorded from their medical files. Those newborns that underwent ET were classified as either “otherwise healthy” or “sick” group.

Results: Of the 306 patients who underwent ET, 244 were otherwise healthy and had no medical problems other than jaundice. The remaining 62 patients were classified as sick that had medical problems other than jaundice ranging from mild to severe. The mean gestational age was 37.6?±?2.5 weeks and the mean peak total bilirubin levels was 25.8?±?6.6?mg/dl. The mean age at presentation was 5.4?±?3.8?d for all infants. The most common cause of hyperbilirubinemia was ABO isoimmunization (27.8%). None of newborns died secondary to ET. Three infants had had necrotizing enterocolitis, and also three infants had had acute renal failure. The most common encountered complications of ET procedure were hyperglycemia (56.5%), hypocalcaemia (22.5%) and thrombocytopenia (16%).

Conclusions: Our data showed that ABO isoimmunization was the most common cause of hyperbilirubinemia. Even mortality was not seen, very rare but major gastrointestinal and renal complications were associated with ET. The majority of adverse events associated with ET were laboratory abnormalities mainly hyperglycemia, hypocalcaemia and thrombocytopenia which were asymptomatic and treatable.