Cutaneous signs of systemic toxicity due to dioxins and related chemicals

The controversy about dioxin effects on human health received a great deal of attention recently when the State of Missouri was declared to have a dioxin crisis. However, dioxin and several related chemicals are widespread throughout the world. Cutaneous signs play an important part in evaluating toxicity of dioxin and similar chemicals. Chloracne is the most sensitive indicator of significant dioxin exposure. Porphyria cutanea tarda and hyperpigmentation are other known cutaneous effects, and malignant fibrous histiocytomas of the skin may possibly be associated, although data are inconclusive on this point. The AMC Council on Scientific Affairs recommended that all physicians become familiar with chloracne and other toxic effects of dioxin. Dermatologists, especially, should be aware of the problem and may discover early cases of previously unsuspected exposure to this group of chemicals.     

蒲公英颗粒联合头孢拉定治疗急性乳腺炎的临床研究

目的探讨蒲公英颗粒联合注射用头孢拉定治疗急性乳腺炎的临床疗效。方法选择2020年2月—2020年9月在河南省中医院治疗的112例急性乳腺炎患者,根据诊治顺序分成对照组(56例)和治疗组(56例)。对照组静脉滴注注射用头孢拉定,1.0 g加入生理盐水100 mL,6 h/次。治疗组在对照组基础上口服蒲公英颗粒,15 g/次,3次/d。两组均治疗1周。观察两组患者临床疗效,比较治疗前后两组患者临床症状改善时间,及血清学指标超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)、细胞间黏附分子-1(ICAM-1)和肿瘤坏死因子-α(TNF-α)水平。结果经治疗,对照组总有效率为85.71%,显著低于治疗组的98.21%(P0.05)。经治疗,治疗组在乳房肿痛消失时间、退热时间、肿块消失时间、通乳时间上均优于对照组(P0.05)。经治疗,两组患者血清hs-CRP、IL-6、PCT、ICAM-1、TNF-α水平均显著降低(P0.05),治疗组下降最明显(P0.05)。结论蒲公英颗粒联合注射用头孢拉定治疗急性乳腺炎可有效改善患者临床症状,降低机体炎症反应,具有一定的临床推广应用价值。     

桂蒲肾清胶囊联合磷霉素氨丁三醇治疗下尿路感染的临床研究

目的探讨桂蒲肾清胶囊联合磷霉素氨丁三醇颗粒治疗下尿路感染的临床疗效。方法选择2018年7月—2020年7月在天津市北辰医院治疗的108例下尿路感染患者,根据使用药物的差别分成对照组和治疗组,每组各54例。对照组口服磷霉素氨丁三醇颗粒,3 g/次,1次/d。治疗组在对照组基础上口服桂蒲肾清胶囊,4粒/次,3次/d。两组患者均治疗5 d。观察两组患者临床疗效,比较治疗前后两组患者尿细菌培养转阴率和症状消失时间,及血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、单核细胞趋化蛋白-1(MCP-1)、血红素氧合酶1(HO-1)和降钙素原(PCT)水平。结果治疗后,治疗组总有效率为96.30%,明显高于对照组的83.33%(P0.05)。治疗后,治疗组患者尿细菌培养转阴率为98.15%,显著高于对照组的81.48%(P0.05)。与对照组相比,治疗组排尿灼急、腰酸痛、小便涩痛、小腹坠胀症状消失时间明显缩短(P0.05)。治疗后,两组患者血清hs-CRP、IL-6、MCP-1、HO-1、PCT水平均显著降低(P0.05),且治疗组降低更显著(P0.05)。结论桂蒲肾清胶囊联合磷霉素氨丁三醇颗粒治疗下尿路感染效果显著,同时在改善患者临床不适症状和炎症因子水平方面也有着积极意义。     

高分子量PCT聚酯的合成及性能表征

以1,4-环己烷二甲醇（CHDM）、对苯二甲酸（PTA）、均苯四甲酸酐（PMDA）和异氰尿酸三缩水甘油酯（TGIC）为原料,通过直接酯化、减压缩聚和熔融扩链的方法制备了一系列分子量可控的芳香族聚酯——聚对苯二甲酸-1,4-环己烷二甲醇酯（PCT）。采用傅里叶红外光谱（FT-IR）、凝胶渗透色谱（GPC）、差示扫描量热（DSC）、热重分析（TG）、广角X-射线衍射（WXRD）、电子万能试验机分别研究了其分子结构、热性能和力学性能。结果表明：当n（CHDM）：n（PTA）=1.2时,用复配催化剂钛酸四丁酯（TBT）、二氧化锗（GeO₂）、三氧化二锑（Sb₂O₃）（用量均为0.1 mg/g）以及醋酸钴（Co（Ac）₂）（用量为0.05 mg/g）,290℃下缩聚3 h得到数均分子量较大的PCT,特性黏数（[η]）为0.560 dL/g。PMDA-TGIC联用扩链可以获得特性黏数为0.680 dL/g的扩链PCT,用其制备的薄膜拉伸强度可达27.6 MPa。     

外周血管阻力指数联合降钙素原对脓毒症早期诊断的价值

目的 分析外周血管阻力指数(SVRI)联合血浆降钙素原(PCT)对脓毒症(sepsis)早期诊断的临床价值,为临床及早对脓毒症病患者开展治疗提供依据,提高脓毒症患者的预后质量.方法 选择2012年1月至2016年1月无锡市第二人民医院收治的符合纳入标准的疑似感染患者284例作为研究对象,在完善各项检查后进行诊断,对患者入组时行SVRI和PCT进行检测,建立ROC曲线,根据ROC曲线设立SVRI和PCT诊断脓毒症的临界值,并根据该临界值对患者做出是否为脓毒症的判断,计算SVRI联合PCT诊断脓毒症的特异度、灵敏度和准确度.结果 一般脓毒症患者[(7.69±0.67)μg/L]、严重脓毒症[(16.47±1.35)μg/L]和脓毒症休克[(23.14±1.84)μg/L]患者的PCT明显高于非脓毒症患者[(0.32±0.10)μg/L],差异均有统计学意义(P<0.05),其中脓毒症休克患者PCT高于一般脓毒症患者和严重脓毒症患者(P<0.05),严重脓毒症患者高于一般脓毒症患者(P<0.05);一般脓毒症患者[(156.75±35.52)kPa·s·L-1·m-2]、严重脓毒症[(124.60±24.76)kPa·s·L-1·m-2]和脓毒症休克[(108.39±15.64)kPa·s·L-1·m-2]患者的SVRI明显低于非脓毒症患者[(192.25±54.33)kPa·s·L-1·m-2],差异均有统计学意义(P<0.05),其中脓毒症休克患者SVRI低于一般脓毒症患者和严重脓毒症患者(P<0.05),严重脓毒症患者SVRI低于一般脓毒症患者(P<0.05).SVRI联合PCT诊断脓毒症的特异度、灵敏度、准确度分别为77.46%、71.83%、74.65%,明显高于单纯采用SVRI(72.87%、63.87%、67.96%)和PCT诊断(48.33%、43.90%、45.77%),差异均有统计学意义.结论 SVRI联合PCT检查对明确感染的患者进行早期脓毒症诊断,灵敏度和特异度均较好,具有较高的临床价值.     

探讨川崎病患儿降钙素原、D-二聚体水平与冠状动脉病变的关系

目的观察并探讨川崎病(KD)患儿血清降钙素原(PCT)、D-二聚体(DD)的水平与冠状动脉病变(CAD)的关系。方法选取2015年1月~2016年12月在本院儿科住院治疗的符合诊断标准的川崎病患儿46例作为观察组,并选取同期住院治疗的符合病毒感染的急性上呼吸道感染患儿46例作为对照组。观察组均行心脏超声心动图检查,分为15例冠状动脉病变组(CAD)和31例非冠状动脉病变组(NCAD)。抽血检查并记录各组儿童血清降钙素原、D-二聚体的水平。结果观察组血清降钙素原、D-二聚体的水平明显高于对照组,两组比较差异有统计学意义(P0.05);CAD组的血清降钙素原水平与NCAD组接近,两组比较差异无统计学意义(P0.05),冠状动脉病变组(CAD组)的D-二聚体水平明显高于非冠状动脉病变组(NCAD组),两组比较差异有统计学意义(P0.05)。结论川崎病患儿的血清降钙素原、D-二聚体水平明显增高,可作为该病诊断的早期临床观察指标,D-二聚体可早期预测冠状动脉病变的发生,有利于病情严重程度的判断和预后评估,血清降钙素原不可预测冠状动脉病变的发生。     

热淋清胶囊联合阿奇霉素治疗尿路感染的临床研究

目的探讨热淋清胶囊联合阿奇霉素注射液治疗尿路感染的临床疗效。方法选取2016年3月—2017年3月在海南省万宁市人民医院进行治疗的尿路感染患者102例作为研究对象,根据用药的差别将入组患者分为对照组和治疗组,每组各51例。对照组静脉滴注阿奇霉素注射液,0.5 g加入到0.5%葡萄糖注射液500 m L中,1次/d。治疗组在对照组基础上口服热淋清胶囊,1.8 g/次,3次/d。两组均治疗7 d。观察两组的疗效,比较两组的尿液细菌清除率、临床症状评分和血清学指标。结果治疗后,对照组和治疗组的总有效率分别为80.39%、96.08%,两组比较差异有统计学意义(P0.05)。治疗后,对照组和治疗组尿液细菌清除率分别为84.31%、98.04%,两组比较差异具有统计学意义(P0.05)。治疗后,两组尿频、尿急、尿痛的临床症状评分均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清血红素加氧酶-1(HO-1)、降钙素(PCT)和白细胞介素-6(IL-6)水平均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论热淋清胶囊联合阿奇霉素注射液治疗尿路感染具有较好的临床疗效,可有效清除尿液细菌,改善临床症状和机体炎症反应,具有一定的临床推广应用价值。     

Role of Procalcitonin in Infectious Gastroenteritis and Inflammatory Bowel Disease

Background and Aim We have evaluated procalcitonin (PCT) as a diagnostic marker for bacterial gastroenteritis (GE) and as a disease activity marker in inflammatory bowel disease (IBD) patients. Methods This was a prospective single-center study performed over a 1-year period. Venous blood samples were drawn from hospitalized patients with acute GE and tested for PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and total white cell count (TWC); stools from the same patients were tested for standard pathogens. Venous blood samples from patients with IBD were tested for PCT, CRP, ESR, and platelet count. The PCT level was measured using an immunofluorescent assay, with normal being defined as <0.5 ng/ml. Results The GE arm of study consisted of 81 patients, 18.5% of whom were diagnosed with bacterial GE. The PCT and CRP levels were good diagnostic markers of bacterial GE, with an area under the curve (AUC) of 0.727 [95% confidence interval (CI) 0.580–0.874] and 0.786 (95% CI 0.627–0.946), respectively. An elevated PCT ≥0.5 ng/ml was associated with a 13-fold increased risk of renal impairment. The IBD arm of study consisted of 72 IBD patients. The PCT levels were not significantly different between active and inactive IBD in this patient cohort. Conclusion Our results indicate that PCT and CRP are comparably good diagnostic markers of bacterial GE but that PCT is not useful as in monitoring disease activity in patients with IBD.     

Kawasaki disease is associated with sensorineural hearing loss: A systematic review

Context

Kawasaki Disease (KD), a systemic vasculitis of unknown etiology, has been associated with the development of sensorineural hearing loss (SNHL). KD is primarily a disease of young children, who are the most susceptible to complications from even minimal hearing loss. If there is a connection between KD and the development of SNHL, a better understanding of this relationship may improve our management of this disease and its complications.

Objective

To perform a systematic review according to a standardized guideline to evaluate the possible association between KD and SNHL.

Data sources

Medline and PubMed online databases were reviewed for appropriate articles.

Study selection

All studies available in English discussing KD and SNHL were included.

Data extraction

Studies were assessed primarily for the incidence of SNHL. Where possible, they were assessed for the degree and laterality of the loss, length of follow up and change in hearing over time.

Results

8 studies meeting the criteria were assessed. 3 were case reports, 1 was a case series and the remaining 4 were prospective control trials. 8 patients have been reported as cases, and 240 assessed in PCT. 36% of patients assessed had some degree of SNHL, and overall 14% had evidence of persistent SNHL at follow up.

Conclusions

This systematic review would suggest there is an association between KD and SNHL. It is important for physicians caring for patients with KD to be aware of this complication and consider screening these patients given possible complications of hearing loss in this age group.