窒息新生儿早期肾损伤与神经损伤程度的相关性分析

目的探讨窒息新生儿早期肾损伤与神经损伤程度的相关性及临床意义。方法抽取86例窒息新生儿为研究对象,患儿生后6h的血液检测其血尿素氮及血清肌酐等肾功能指标,并在生后7d行NBNA评分,患儿病后诊断新生儿缺氧缺血性脑病程度,并以此分成4组,即HIE0、HIE1、HIE2、HIE3组。结果 4组生后6h内血BUN、Scr与7dNBNA评分比较,4组间血BUN、sCR、NBNA评分等指标均存在显著性差异(F_B=4.682,P_B=0.005;F_C=3.221,P_C=0.027;FN=80.568,PN=0.000),患儿生后6h内BUN、sCR与生后7d NBNA评分值呈显著相关(r_B=-0.306,P=0.004;r_C=-0.255,P=0.018)。结论窒息新生儿早期肾损伤与患儿神经损伤程度存在相关性,临床可作为指导进行早期治疗,改善预后。     

Efficacy of novel recombinant fowlpox vaccine against recent Mexican H7N3 highly pathogenic avian influenza virus

Since 2012, H7N3 highly pathogenic avian influenza (HPAI) has produced negative economic and animal welfare impacts on poultry in central Mexico. In the present study, chickens were vaccinated with two different recombinant fowlpox virus vaccines (rFPV-H7/3002 with 2015 H7 hemagglutinin [HA] gene insert, and rFPV-H7/2155 with 2002 H7 HA gene insert), and were then challenged three weeks later with H7N3 HPAI virus (A/chicken/Jalisco/CPA-37905/2015). The rFPV-H7/3002 vaccine conferred 100% protection against mortality and morbidity, and significantly reduced virus shed titers from the respiratory and gastrointestinal tracts. In contrast, 100% of sham and rFPV-H7/2155 vaccinated birds shed virus at higher titers and died within 4?days. Pre- (15/20) and post- (20/20) challenge serum of birds vaccinated with rFPV-H7/3002 had antibodies detectable by hemagglutination inhibition (HI) assay using challenge virus antigen. However, only a few birds (3/20) in the rFPV-H7/2155 vaccinated group had antibodies that reacted against the challenge strain but all birds had antibodies that reacted against the homologous vaccine antigen (A/turkey/Virginia/SEP-66/2002) (20/20). One possible explanation for differences in vaccines efficacy is the antigenic drift between circulating viruses and vaccines. Molecular analysis demonstrated that the Mexican H7N3 strains have continued to rapidly evolve since 2012. In addition, we identified in silico three potential new N-glycosylation sites on the globular head of the H7 HA of A/chicken/Jalisco/CPA-37905/2015 challenge virus, which were absent in 2012 H7N3 outbreak virus. Our results suggested that mutations in the HA antigenic sites including increased glycosylation sites, accumulated in the new circulating Mexican H7 HPAIV strains, altered the recognition of neutralizing antibodies from the older vaccine strain rFPV-H7/2155. Therefore, the protective efficacy of novel rFPV-H7/3002 against recent outbreak Mexican H7N3 HPAIV confirms the importance of frequent updating of vaccines seed strains for long-term effective control of H7 HPAI virus.     

间歇蓝光照射联合静脉滴注白蛋白治疗新生儿病理性黄疸患儿的临床疗效

目的探讨不同蓝光照射方式联合静脉滴注白蛋白治疗新生儿病理性黄疸的临床疗效及其安全性。 方法选取2015年2月至2017年10月,东营市东营区人民医院收治的82例新生儿病理性黄疸患儿为研究对象。采用掷硬币随机方法进行分组,将其分为实验组(n＝41,接受间歇蓝光照射＋静脉滴注白蛋白)和对照组(n＝41,接受连续蓝光照射＋静脉滴注白蛋白)。采用成组t检验,对2组患儿的新生儿出生体重、胎龄,以及血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、超敏C反应蛋白(HS-CRP)、总胆汁酸(TBA)、游离脂肪酸(FFA)、碱性磷酸酶(AKP)及γ-谷氨酰转肽酶(γ-GT)水平等进行统计学比较。采用χ²检验,对2组患儿的性别构成比、治疗总有效率及不良反应率进行统计学分析。本研究遵循的程序符合东营市东营区人民医院伦理委员会所制定的伦理学标准,得到该委员会批准(批准文号：20150103),所有受试儿监护人均签署临床研究知情同意书。 结果①2组患儿的性别构成比、新生儿出生体重和胎龄分别比较,差异均无统计学意义(P>0.05)。②实验组患儿治疗后第7天血清TBIL、DBIL与IBIL水平分别为(153.9±9.6)μmol/L、(8.2±2.4)μmol/L和(139.6±8.9)μmol/L,均显著低于治疗前的(208.2±11.2)μmol/L、(20.9±2.8)μmol/L和(191.3±8.1)μmol/L,组内分别比较,差异均有统计学意义(t＝23.549、23.055、27.429,P<0.001)。对照组患儿治疗后第7天血清TBIL、DBIL与IBIL水平分别为(157.4±7.9)μmol/L、(8.9±1.5)μmol/L、(142.0±7.2)μmol/L,亦显著低于治疗前的(210.8±10.9)μmol/L、(21.3±3.1)μmol/L、(192.9±8.9)μmol/L,并且差异均有统计学意义(t＝25.400、22.154、28.470,P<0.001)。此外,2组患儿治疗前与治疗后第7天的血清TBIL、DBIL与IBIL水平分别组间比较,差异均无统计学意义(P>0.05)。③实验组患儿治疗后第7天的HS-CRP、TBA、FFA、AKP和γ-GT水平分别为(1.3±0.3)mg/L、(12.3±3.4)μmol/L、(2 493.0±199.7)μmol/L、(126.2±10.2)μmol/L、(60.5±10.3)μmol/L,均显著低于治疗前的(3.4±0.4)mg/L、(32.6±5.9)μmol/L、(4 049.8±132.8)μmol/L、(238.7±11.4)μmol/L、(151.7±11.3)μmol/L,并且差异均有统计学意义(t＝26.091、19.138、41.560、47.061、38.174,P<0.001)。对照组患儿治疗后第7天的HS-CRP、TBA、FFA、AKP和γ-GT水平分别为(1.3±0.1)mg/L、(14.6±2.1)μmol/L、(2 546.4±224.1)μmol/L、(129.0±9.4)μmol/L、(63.0±9.2)μmol/L,均显著低于治疗前的(3.3±0.5)mg/L、(33.4±6.3)μmol/L、(4 009.5±121.5)μmol/L、(242.4±10.6)μmol/L、(154.2±10.6)μmol/L,并且差异均有统计学意义(t＝23.781、18.119、36.750、51.306、41.420,P<0.001)。此外,2组患儿治疗前与治疗后第7天的HS-CRP、TBA、FFA、AKP和γ-GT水平分别组间比较,差异均无统计学意义(P>0.05)。④实验组患儿治疗总有效率为95.1%(39/41),与对照组的92.7%(38/41)比较,差异无统计学意义(χ²＝0.210,P＝0.644)。⑤实验组患儿腹泻、脱水、体温升高、奶量减少、哭闹与烦躁发生率,均低于对照组,2组分别比较,差异均有统计学意义(χ²＝4.491、6.252、5.623、7.291、5.143, P＝0.032、0.013、0.024、0.012、0.022)。 结论间歇蓝光照射结合静脉滴注白蛋白对新生儿病理性黄疸的疗效较好,并且能明显降低患儿不良反应发生率。     

Determinants of postoperative morbidity and mortality in children managed for typhoid intestinal perforation in Kano Nigeria

Background

Intestinal perforation is a serious but poorly understood complication of typhoid fever. This study aims to determine the patient factors associated with postoperative morbidity and mortality.

Alkaline haematin D-575, a new tool for the determination of haemoglobin as an alternative to the cyanhaemiglobin method. I. Description of the method

A new method for the rapid and accurate measurement of haemoglobin has been developed as an alternative to the conventional cyanhaemiglobin method. This method is based on the conversion of all haeme, haemoglobin, and haemiglobin species into a stable end product by an alkaline solution of a non-ionic detergent ('AHD reagent'). The reaction product, designated as alkaline haematin D-575, is extremely stable and shows a characteristic absorption peak at 575 nm. As compared to the cyanhaemiglobin method, the determination of haemoglobin by alkaline haematin D-575 offers several advantages such as (1) extreme stability of the AHD reagent and the conversion product, (2) decreased conversion time of all haemoglobin species into the end product, (3) decreased amounts of plasma and cell errors, and errors caused by delayed conversion of carboxy- and fetal haemoglobins, and (4) standardisation by a primary standard (purified crystalline chlorohaemin).     

高通量血液透析对长期透析患者血清β2-MG浓度的影响及其临床意义

目的探讨高通量血液透析对长期血液透析患者血清β2-微球蛋白(β2-MG)浓度的影响及临床意义.方法选择26例长期血液透析患者(高通量组14例,低通量组12例),高通量和低通量透析器均选用聚砜膜,表面积均为1.3m2,分别测定两组患者研究开始第一次透析治疗前、后治疗2周和6个月时透析前血清β2-MG浓度,同时观察关节痛程度的变化.结果高通量透析能有效清除血液透析患者体内的β2-MG,单次高通量透析后患者血清β2-MG的下降率达45.2%;高通量组患者血清β2-MG浓度在治疗开始、2周及6个月时分别为:66.3 mg/L、51.2 mg/L和47.6 mg/L,同时关节痛症状改善,而低通量组均无明显变化.结论高通量透析能够缓解长期血液透析患者的关节痛症状,这与高通量透析有效清除并持续降低血液透析患者血清β2-MG浓度有关,透析膜的通量是影响清除血液透析患者血清β2-MG的主要因素.     

右归饮对体外成骨细胞增殖和分化影响的实验研究

目的在右归饮治疗激素性股骨头坏死的临床研究和动物实验研究基础上,进一步观察对体外成骨细胞增殖和分化的影响.方法采用血清药理学方法,对体外培养的大鼠成骨细胞作MTT法细胞增殖测定、PNPP法ALP活性测定、以及茜素红染色矿化结节计数.结果培养48、72h,10%和15%右归饮血清组的细胞增殖速度较对照组快(p＜0.05);培养72h,10%和15%右归饮血清组的ALP活性较对照组增加(p＜0.05);培养2w,矿化结节计数显示15%右归饮血清组多于对照组(p＜0.01).结论右归饮对体外大鼠成骨细胞的增殖和分化具有促进作用.     

大量输血后血清电解质及酸碱平衡的变化

目的探讨大量输血后血清电解质及酸碱平衡的变化。方法应用全自动化生化分析仪及血气分析仪检测大量输血患者在输血前、中、后血清中电解质及酸碱平衡的变化。结果大量输血后的患者血清钾离子及pH明显减低。结论大量输血后的患者易出低钾血症与不同程度的代谢性酸中毒。     

高效液相色谱法测定家兔离体血液中头孢哌酮衰除速度的实验研究

目的比较家兔体内与体外头孢哌酮衰除速度的差异,了解离体血液中头孢哌酮对受血者的影响。方法健康家兔20只,体重(3±0.3)kg,随机分为实验组(离体组)和(在体组)各10只,2组均从兔耳缘静脉注射头孢哌酮150mg/kg,实验组于给药45min后从耳缘静脉取血(8—10)ml/只,置于(4±2)℃冰箱保存,用高效液相色谱法测定0、6、12、24、48、72、120和168h血药浓度;对照组分别于给药后1、2、3、4、5h从耳缘静脉取血1ml/只(次),用高效液相色谱法测定血药浓度;分别计算兔离体和在体血液中头孢哌酮的半衰期。结果实验组血液中头孢哌酮的消除半衰期为(146.08±9.56)h,对照组则为(1.55±0.048)h。离体血液中头孢哌酮的半衰期较在体血液中头孢哌酮的半衰期显著延长(P<0.01)。结论离体血液中头孢哌酮代谢较慢,不能在血液储存期内衰除到安全浓度水平以下,输血时可能引起受血者产生药物不良反应。     

血清铁蛋白水平与冠状动脉病变程度的相关性探讨

目的 现察血清铁、铁蛋白及转铁蛋白与冠状动脉狭窄的关系.探寻冠心痛的发病原因.方法 对315例冠心病患者行冠状动脉造影和血清铁、铁蛋白及转铁蛋白的测定,采用Gensini评分系统衡量冠状动脉造影结果 .按照Gensini评分的三分位间距将观察时象分为3组,应用方差分析研究铁代谢指标在3组中的分布情况,应用多因素回归分析研究Gensini评分与铁代谢指标的关系.结果 单因素方差分析显示.血清铁、血清铁蛋白及血清转铁蛋白/血清铁蛋白比值与Gensini评分肴相关性(相关系数分别为6.162、7.191和4.380,均P<0.05);多因素逐步线性回归分析显示,血清铁蛋白与冠状动脉狭窄程度的评分独立相关(其偏相关系数为0.240,P<0.01).结论 血清铁蛋白与冠状动脉狭窄独立相关.