单纯性下肢静脉曲张中医辨证分型与大隐静脉超声观察指标的相关性研究

目的探讨单纯性下肢静脉曲张中医辨证分型与大隐静脉超声观察指标之间的相关性。方法将132例单纯性下肢静脉曲张患者分为脉络湿邪阻滞证组、脉络湿邪瘀阻证组、脉络湿毒瘀热证组,分别对3组患者进行超声检查,比较3组大隐静脉近心段管径、返流峰值速度、返流时间。结果 3组大隐静脉近心段管径比较差异有统计学意义(P<0.001),3组中每2组管径比较差异均有统计学意义(P<0.05),大隐静脉近心段管径从粗到细的顺序为:脉络湿毒瘀热证组、脉络湿邪瘀阻证组、脉络湿邪阻滞证组。3组返流峰值速度比较差异有统计学意义(P<0.001),3组中每2组返流峰值速度比较差异均有统计学意义(P<0.05),大隐静脉近心段的返流峰值速度从高到低的顺序为:脉络湿毒瘀热证组、脉络湿邪瘀阻证组、脉络湿邪阻滞证组。3组返流时间比较差异有统计学意义(P<0.001),3组中每2组返流时间比较差异均有统计学意义(P<0.05),大隐静脉近心段的返流时间从长到短的顺序为:脉络湿毒瘀热证组、脉络湿邪瘀阻证组、脉络湿邪阻滞证组。结论大隐静脉超声观察指标与单纯性下肢静脉曲张的中医证型具有一定的相关性,可为单纯性下肢静脉曲张辨证分型提供客观依据。     

胃癌根治术后胃瘫综合征的临床诊断

目的探讨胃癌根治切除术后胃轻瘫综合征(postsurgical gastroparesis syndrome,PGS)的病因、诊断及治疗方法。方法回顾性分析作者医院2006/2012年行择期胃癌根治术的612例患者资料,将年龄、性别、手术方式(毕Ⅰ/毕Ⅱ)、体质量指数(body mass index,BMI)、TNM分期、肿瘤大小、伴糖尿病、伴神经系统疾病、围手术期精神药物使用,作为临床相关因素,采用Logistic多因素回归分析确定PGS的分布与临床因素之间的相关性;患者治疗前后采用总症状评分(total symptom score,TSS)比较。结果 612例中有41例出现PGS表现,发生率为6.7%。患者症状主要为恶心,呕吐,腹胀,早饱,腹痛。胃镜检查能顺利通过吻合口,未见机械性梗阻征象。核素标记餐(99 Tcm-DTPA标记混合餐)胃排空显像证实胃排空延迟,性别、伴糖尿病、伴神经系统疾病以及精神药物使用与PGS显著相关。所有患者经保守治疗后均治愈。结论术后胃轻瘫由多因素导致,胃镜检查与胃肠道造影是重要的诊断方法。     

Severe Post-COVID-19 Organizing Pneumonia during Cancer Immunochemotherapy

A 44-year-old man developed coronavirus disease 2019 (COVID-19) pneumonia during immunochemotherapy consisting of carboplatin, paclitaxel, and pembrolizumab for non-small cell lung cancer. Low-grade fever, followed by mild hypoxemia, and febrile neutropenia, were observed, and granulocyte colony-stimulating factor (G-CSF) was administered until the recovery of neutropenia, when he developed a high fever, severe hypoxemia, and hypotension accompanied by consolidation in the bilateral lungs. His conditions promptly improved after treatment including hydrocortisone and the primary and metastatic tumors remained regressed for 10 months without further treatment. Post-COVID-19 organizing pneumonia during cancer immunochemotherapy can be aggravated by immune-checkpoint inhibitors and G-CSF.     

2010年中国艾滋病疫情网络直报现状与分析

  目的  了解2014 — 2018年江苏省南京市新报告HIV阳性男男性行为（MSM）人群婚姻的相关因素及配偶HIV检测情况。  方法  从国家艾滋病综合防治信息系统中筛选出南京市2014 — 2018年新报告的达到法定结婚年龄（≥ 22岁）、通过同性性传播HIV阳性的MSM人群,用SPSS 20.0软件分析其婚姻状况和配偶检测情况。  结果  共2 197例HIV阳性MSM人群纳入分析,其中“有婚姻”组人数为795例,占36.2 %,无婚姻组为1 402人,占63.8 %。logistic回归分析显示30～39岁（aOR = 10.411,95 % CI = 7.700～14.077）、40～49岁（aOR = 41.079,95 % CI = 27.995～60.277）和 ≥ 50岁（aOR = 72.873,95 % CI = 45.405～116.958）有婚姻比例明显高于20～29岁年龄组;学历为高中/中专（aOR = 1.945,95 % CI = 1.426～2.653）和初中及以下（aOR = 2.756,95 % CI = 1.957～3881）有婚姻比例大于大专及以上学历组;职业为工人/农民/渔民（aOR = 1.585,95 % CI = 1.039～2.417）有婚姻比例最高;现住址为外地（aOR = 1.448,95 % CI = 1.099～1.907）的有婚姻的比例明显高于本地;和失访的病例相比,能随访（aOR = 5.963,95 % CI = 1,641～21.664）的病例有婚姻比例较高。有婚姻组的配偶HIV阳性检出率为12.8 %（37/290）。  结论  南京市HIV阳性MSM人群有婚姻比例随着年龄增长不断增加,尽早发现病例,尽快进行配偶告知和检测有利于减少HIV的婚内传播。     

为何美国的新冠肺炎检测如此滞后?

新型冠状病毒（SARS-CoV-2）在全球大流行,给世界各国的医疗环境都带来了严重冲击。目前,其导致的新型冠状病毒肺炎（COVID-19）缺乏特效的治疗方法,早发现、早报告、早隔离、早诊断便成为了遏制疫情传播的有效手段。由于临床表现和体征等方面对COVID-19诊断的灵敏性较差,因此医生需要通过实验室病毒核酸检测等手段以鉴别感染者和非感染者。本文综述了SARS-CoV-2基因组特征以及相关检测原理与细节。在COVID-19的不同阶段,不同检测的效果差异很大。RT-PCR核酸检测在感染早中期阶段较灵敏,血清学检测则可能识别感染后期阶段,可作为核酸检测阴性但疑似感染者的辅助检测手段。为避免出现“假阴性”,造成误诊或漏诊,在病毒检测时应采用多指标联合,以弥补单一方法的不足。     

Sweet综合征6例临床分析

[背景 ]探讨Sweet综合征的临床表现及病因 .[病例报告 ]对 1998年以来的 6例Sweet综合征进行临床分析 ,均有不同的免疫功能低下的诱因和特征性隆起性暗红色疼痛性斑块 ,其边缘有假性水疱 ,伴发热和白细胞增高 ,有血管炎的病理改变 .[讨论 ]Sweet综合征是有特征性皮肤损害的累及多系统的综合征     

后疫情时代的肺移植临床研究发展和未来展望

肺移植技术在全球经历了近半个世纪的发展,在中国也高速发展了二十余年,中国肺移植逐渐融入国际肺移植大家庭。2020年新型冠状病毒肺炎(新冠肺炎)疫情暴发,既是对中国肺移植发展的挑战,也使得全球同行关注中国肺移植发展,加速了国际间的交流与合作。随着对新冠肺炎重症患者肺移植的临床和基础研究逐步深入,移植科医师对于未来中国肺移植在供者的维护、高龄和儿童受者的选择、围手术期管理等方面有了更多的认知和思考。对于肺移植相关学科交叉领域的研究,需要开展设计优良、多方协作的临床试验,不断推进学科理论和实践的创新。     

0.5g/L环孢素A滴眼液对中重度干眼患者眼部症状及体征评分的影响

目的：探讨0.5g/L环孢素A滴眼液对中重度干眼患者眼部症状及体征评分的影响。
　　方法：中重度干眼症患者80例160眼依据随机双盲试验原则将其分为两组：观察组40例80眼,采用10 g/L羧甲基纤维素钠和0.5g/L环孢素A滴眼液治疗,对照组40例80眼,采用10 g/L羧甲基纤维素钠滴眼液治疗,比较两组患者眼部症状和体征评分变化。
　　结果：观察组治疗总有效率95.0%,显著高于对照组(85.0%),差异有统计学意义(P<0.05);观察组和对照组患者未治疗时症状积分分别为36.1±4.4、36.4±4.5分,经治疗后,观察组1、3 lo 时症状积分下降至25.2±3.2、11.09±3.9分,对照组下降至29.4±4.1、22.05±3.1分,治疗前后差异具有统计学意义(P<0.05),但观察组治疗1、3 lo的症状积分显著低于对照组,差异有统计学意义(P<0.05);治疗前,两组患者泪膜破裂时间(BUT)、泪液分泌试验( Slt)、角膜荧光素染色( FL)和生活质量(OSDI)评分之间无统计学差异(P>0.05);经治疗后,观察组四项指标均显著下降(P<0.05),对照组仅 FL 和OSDI评分显著下降,差异有统计学意义( P<0.05);观察组治疗后四项指标均显著高于对照组,差异具有统计学意义(P<0.05);观察组在用药14~28d时3眼出现刺痛感,对照组2眼刺痛感,1眼结膜充血,继续用药时2 d后全部消失。
　　结论：0.5g/L环孢素A滴眼液能够有效缓解中重度干眼患者症状和体征,促进泪液分泌,改善患者眼表环境,治疗效果良好。     

Clustering of and Risk Factors for the Porcine High Fever Disease in a Region of Vietnam

Porcine high fever disease (PHFD) emerged in 2006 in China and spread to Vietnam. Little work has been carried out to investigate PHFD risk factors and space–time dynamics. To fill this gap, we investigated probable cases of PHFD at household level as the outcome. A study area, approximately 100 sq. km, was selected from a province of southern Vietnam that had reported the outbreak of PHFD in 2008. A survey was conducted in the study area to collect information about swine health problems during 2008. The questionnaire included three sections: general information, clinical signs of disease in pigs and production factors believed to be risk factors. Cases were defined at the household level and included interpretation of clinical signs in series. Logistic regression with a random intercept at the hamlet level was used to assess risk factors for PHFD at the household level. Spatial clustering was investigated using the D‐function and a Cuzick–Edward’s test. Spatial clusters were evaluated using a spatial relative risk surface and the spatial scan statistic using a Bernoulli model. Space–time clustering was explored using a space–time K‐function and Knox’s test. Space–time clusters were evaluated using a space–time permutation model in SaTScan. Of 955 households with questionnaire data, 33.4% were classified as cases. The statistical significance of space and space–time clustering differed between methods employed. The risk factors associated with occurrence of cases were higher numbers of sows and finishing pigs (log 2 transformed), receiving pigs from an external source and the interaction between using ‘water green crop’ (WGC) as pig feed and owning ducks with or without direct contact with pigs. The interaction between the presence of ducks and feeding WGC to pigs suggested the involvement of pathogens that might be present in water (environment) and could further replicate in or on ducks.     

Clinical Aspects of Feline Retroviruses: A Review

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are retroviruses with global impact on the health of domestic cats. The two viruses differ in their potential to cause disease. FeLV is more pathogenic, and was long considered to be responsible for more clinical syndromes than any other agent in cats. FeLV can cause tumors (mainly lymphoma), bone marrow suppression syndromes (mainly anemia), and lead to secondary infectious diseases caused by suppressive effects of the virus on bone marrow and the immune system. Today, FeLV is less commonly diagnosed than in the previous 20 years; prevalence has been decreasing in most countries. However, FeLV importance may be underestimated as it has been shown that regressively infected cats (that are negative in routinely used FeLV tests) also can develop clinical signs. FIV can cause an acquired immunodeficiency syndrome that increases the risk of opportunistic infections, neurological diseases, and tumors. In most naturally infected cats, however, FIV itself does not cause severe clinical signs, and FIV-infected cats may live many years without any health problems. This article provides a review of clinical syndromes in progressively and regressively FeLV-infected cats as well as in FIV-infected cats.