2010--2013年上海市闸北区非职业性一氧化碳中毒病例分析

目的了解2010--2013年上海市闸北区非职业性一氧化碳中毒病例报告特征,分析其发生原因,研究可行的预防和干预措施。方法回顾性调查2010--2013年闸北区各级医疗机构报告的非职业性一氧化碳中毒病例。结果2010--2013年共发生病例84例,病例主要集中青年（69．05％）;中毒原因主要为人工煤气泄漏（60．71％）;每年3和11月为发病高峰期,其余时间段发病人数较少;主要为轻度中毒（73．8l％）,绝大多数病例均存活（96．43％）,居住在老式公房病例（57．14％）在所有病例中构成比最高。结论非职业性一氧化碳中毒病例人群、中毒时间、中毒地点存在一定的规律性、需要予以重视与采取有针对性的措施来降低发病率。     

鲁甘湘三省2007年水痘住院病例经济负担调查

目的了解中国住院水痘病例的疾病负担。方法在山东、湖南、甘肃省,按照经济水平在市、县、乡分层抽样,抽取≤14岁住院临床诊断水痘185例,进行入户调查。结果≤14岁住院临床诊断水痘平均费用是4025.86元（直接费用2952.60元,间接费用为1073.26元）。全国水痘住院病例的疾病负担总计1.03亿元（按照住院病例占总病例的0.54%测算）。结论中国目前水痘的经济负担较重。     

天水市2005～2008年度流行性感冒监测分析

目的观察天水市流行性感冒（流感）流行状况及流感病毒类型,分析流行趋势,为流感预防控制提供依据。方法2005年11月-2008年10月,采集流感监测点医院和辖区内流感样病例爆发疫情典型病例咽拭子标本,送甘肃省疾病预防控制中心（CDC）,采用鸡胚和狗肾传代细胞分离流感病毒,并用血凝和血凝抑制试验对病毒进行鉴定,分离的毒株送中国CDC病毒病预防控制所国家流感中心进行复核鉴定。结果共采集流感样病例咽拭子标本1819份,分离出流感病毒247株,分离率为13．58％。其中甲,型36株,占14．57％;甲,型75株,占30．36％;乙型136株,占55．06％[维多利亚（Victoria）系121株、山形（Yamagata）系15株]。结论天水市存在甲,型、甲3型和乙型流感病毒活动,在不同年度以不同强度同时或交替活动,爆发疫情均发生在农村中小学校,以乙型为主。     

奥曲肽与垂体后叶素治疗肝硬化上消化道出血的 效果评价

摘要:目的　研究奥曲肽与垂体后叶素合用在治疗肝硬化上消化道出血中的作用。方法　以某院消化内科2011年3月-2013年12月收治的80例肝硬化上消化道出血患者作为研究对象,根据是否联合使用奥曲肽和垂体后叶素将患者分为实验组和对照组,每组各40例;在一般对症支持治疗的基础上,实验组患者采用奥曲肽与垂体后叶素联合治疗,对照组仅采取奥曲肽治疗,比较2组患者治疗有效率、止血时间、不良反应等指标。结果　实验组40例患者中,38例有效,有效率为95.0%,对照组40例患者中,28例有效,有效率为70.0%,两者差异有统计学意义。实验组平均止血时间为（36.2±10.7）h,对照组平均止血时间为（48.3±11.6）h,两者差异有统计学意义（P＜0.05）。2组患者不良反应发生率差异无统计学意义（P＞0.05）。结论　奥曲肽与垂体后叶素联合使用治疗肝硬化上消化道出血在治疗有效率、止血时间上效果显著,不良反应发生率与单用奥曲肽相比也无明显差异,此方案值得在临床上进一步推广。     

叶天士《临证指南医案》论治厥证经验

叶天士以《黄帝内经》理论为指导,师法仲景,在《临证指南医案》中灵活运用脏腑辨证、奇经辨证及卫气营血辨证理论论治厥证。在脏腑辨证中重视厥阴风木,在奇经辨证中重视冲脉之气为病,在卫气营血辨证中重视火热邪气的传变,并提出"肝为刚脏"的理论,根据肝"体阴用阳"的生理特点及脏腑生化关系提出"柔肝通络""缓肝息风""潜阳益乙癸""补胃凝肝""补金柔制""益胃阴伏冲气""通补阳明"等治法,以血肉介类味厚之药填补下焦,通补奇经,选用奇经引经药入冲任脉镇冲逆之气,并重视阴液,拓宽后世论治厥证思路。     

郑重光运用当归四逆汤辨治厥阴病

郑重光临证治病尤为尊崇仲景六经辨证,在医案中反复强调治病宗经之论.其认为,当归四逆汤证中脉象虽细而欲绝,但是必重按有力,遵从仲景的理论,认为阳证阴脉,法当难治,并提出了阳证阴脉,舍证从脉的辨证方法,即阳证阴脉,以脉为准,强调了脉诊在临证中的重要性.运用当归四逆汤辨治厥阴痢疾、厥阴疟疾、虾蟆瘟等,临床用药特点有:擅用姜附...     

Kikuchi-Fujimoto disease manifesting as recurrent thrombocytopenia and Mobitz type II atrioventricular block in a 7-year-old girl: a case report and analysis of 138 Chinese childhood Kikuchi-Fujimoto cases with 10 years of follow-up in 97 patients

BACKGROUND: The diagnosis of Kikuchi-Fujimoto disease (KFD) is challenging for a paediatrician. Recognizing unusual clinical presentations and features of KFD is essential for doctors to obtain a thorough understanding of this clinical entity. METHOD: We reported a case recently diagnosed in our ward with manifestation of recurrent thrombocytopenia and Mobitz type II atrioventricular block, which is very unusual in childhood KFD. We also used three powerful Chinese Journal Search Engines (Cqvip.com, Wanfang.data and ScienceChina) to search the cases reported in China from 1989 to 2006. RESULTS: One hundred seventy-three patients younger than 16 years old with pathologic proof of KFD were identified. Among them, 138 cases with detailed clinical records from eight different provinces and cities were analyzed, and of which 97 patients were followed-up for average of 10 years and the outcomes are discussed. CONCLUSIONS: KFD is characterized by a spectrum of distinctive features, but also a variety of systemic manifestations. A hyperimmune reaction to unidentified agents as well as an autoimmune component may play an important role in this disease. Early corticosteroid therapy may improve the long-term prognosis of KFD in children.     

Analysis of a COVID-19 Prescreening Process in an Outpatient Clinic at a University Hospital during the COVID-19 Pandemic

BackgroundTo minimize nosocomial infection against coronavirus disease 2019 (COVID-19), most hospitals conduct a prescreening process to evaluate the patient or guardian of any symptoms suggestive of COVID-19 or exposure to a COVID-19 patient at entrances of hospital buildings. In our hospital, we have implemented a two-level prescreening process in the outpatient clinic: an initial prescreening process at the entrance of the outpatient clinic (PPEO) and a second prescreening process is repeated in each department. If any symptoms or epidemiological history are identified at the second level, an emergency code is announced through the hospital''s address system. The patient is then guided outside through a designated aisle. In this study, we analyze the cases missed in the PPEO that caused the emergency code to be applied.MethodsAll cases reported from March 2020 to April 2021 were analyzed retrospectively. We calculated the incidence of cases missed by the PPEO per 1,000 outpatients and compared the incidence between first-time hospital visitors and those visiting for the second time or more; morning and afternoon office hours; and days of the week.ResultsDuring the study period, the emergency code was applied to 449 cases missed by the PPEO. Among those cases, 20.7% were reported in otorhinolaryngology, followed by 11.6% in gastroenterology, 5.8% in urology, and 5.8% in dermatology. Fever was the most common symptom (59.9%), followed by cough (19.8%). The incidence of cases per 1,000 outpatients was significantly higher among first-time visitors than among those visiting for the second time or more (1.77 [confidence interval (CI), 1.44–2.10] vs. 0.59 [CI, 0.52–0.65], respectively) (P < 0.001).ConclusionFever was the most common symptom missed by the PPEO, and otorhinolaryngology and gastroenterology most frequently reported missed cases. Cases missed by the PPEO were more likely to occur among first-time visitors than returning visitors. The results obtained from this study can provide insights or recommendations to other healthcare facilities in operating prescreening processes during the COVID-19 pandemic.     

清代《武强县新志》“附急救方”评介

清代道光十年（1830）纂修的《武强县新志》卷10《杂稽志》下《附急救方》中,用大量篇幅收录了中医急救方法,共计13000余字,分列14个条目。在每个条目下,先抄录宋代《洗冤集录》中的急救内容,接着补充了很多具体急救方法。这些方法总结了宋代以来的中医急救技术和经验,集清代中国北方地区急救疗法之大成,代表了当时中医急救医学的真实水平。在一部县志中全篇收录中医急救方法实属罕见,对《洗冤集录》的版本沿革研究也具有重要价值。