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.     

肺结核合并糖尿病80例分析

目的 探讨两种疾病合并存在的相关规律.方法 对2006～2008年来在市结核病防治所完成规则全疗程的肺结核合并糖尿病患者80例相关临床资料进行分析.结果 肺结核病情严重程度治疗效果控制水平有关.结论 肺结核合并糖尿病患者有病变范围广、痰菌涂阳率、空洞率高,其预后通常较差;通过积极控制血糖水平,早期合理抗结核药物治疗,能提高肺结核治愈率.     

2012年EASL慢性乙型肝炎病毒感染临床实践指南解读

最近,EASL官方网站上公布了新一版EASL慢性乙型肝炎临床实践指南(2012版)[1],这是在2008版[2]的基础上经增加新近文献,对部分内容进行的更新.更新版指南仍保留了前几版指南的一贯体例和鲜明特点.(1)在文献综述同时穿插其中逐条列出循证证据和提出临床处理推荐意见;(2)重要循证证据文献和推荐意见后逐一列出循证证据级别和推荐强度.循证证据级别和推荐强度分别按GRADE( Grading of Recommendations Assessment Developmentand Evaluation)系统确定.GRADE系统包括证据级别和推荐强度,前者按高、中、低分A、B、C三级,后者按强弱分1、2两级;(3)由于不如美国、亚太等指南是将推荐意见在文献综述后单独列出而一目了然,因此在阅读时需要费更多时间进行归纳、整理后才能更好读懂和理解;(4)具有鲜明的欧洲患者和国情特点,应当联系我国实际来理解和运用.这次指南更新的内容并不多,但其中仍然包括对一些概念的新诠释,也增加了一些新的推荐意见.笔者在仔细阅读和学习的基础上,结合2008版EASL指南,并对照国内外其他指南进行比读[3-5].现将个人浅显的认识和理解与各位临床医生分享,并对其中部分新修改的推荐意见结合我国实际、对我国临床的参考价值进行了评论.个人见解不一定准确,仅供参考.     

C反应蛋白和临床肺部感染评分在老年社区获得性肺炎预后评估中的作用

目的探讨C反应蛋白(CRP)及临床肺部感染评分(CPIS)的变化对老年社区获得型肺炎(CAP)患者预后的评估作用。方法对98名老年CAP患者进行回顾性分析,以同期入院的30名老年非感染患者为对照组。分别记录和检测肺炎组入院第1天、第7天的CRP、CPIS评分、血白细胞计数(WBC)、中性粒细胞百分比(N)、白蛋白(ALB)和前白蛋白(PA)。根据预后将患者分为生存组和死亡组,通过ROC曲线选取最佳临界点,分别以治疗后CRP下降率<70%和治疗后CPIS下降值<0.5为分组标准,通过统计学处理分析上述不同组别的预后并进行比较。结果入院时CRP在生存组为(77.87±69.97)mg/L,死亡组为(71.10±71.75)mg/L,与对照组(4.30±3.91)mg/L相比显著增高,差异有统计学意义(P<0.01),CRP和CPIS在生存组与死亡组之间差异无统计学意义。治疗7 d后与入院时相比,生存组的CRP(22.44±22.83)和mg/L和CPIS(2.34±2.15)有明显下降,差异有统计学意义(P<0.01),死亡组CRP(61.28±40.37)mg/L和CPIS(6.04±2.23)差异无统计学意义。2者之间相比,死亡组的CRP和CPIS明显高于生存组(P<0.01)。根据ROC曲线计算曲线下面积(AUC),CRP下降率的AUC为0.750,CPIS下降的AUC为0.755。根据ROC曲线计算出最佳临界点,CRP下降率为70.33%,CPIS下降值为0.5。CRP下降率<70%和CPIS下降值<0.52个指标连用对预测死亡的特异性为82.4%、阳性预测值为58.1%,高于单用其中一项指标。对肺炎组的死亡因素进行回归分析得到:Y^=0.551+0.064CPIS2+0.064CPR2-0.205ALB1,该回归方程的决定系数为0.603。结论动态监测CRP和CPIS对于评价老年CAP预后具有重要的临床指导意义。特别是对于临床表现不典型的老年CRP患者,推荐同时监测这2项指标。     

食管癌术后早期营养支持治疗

目的总结我科食管癌术后早期肠内营养支持经验,探讨食管癌术后早期肠内营养支持的可行性、安全性和临床效果。方法将2004至2005年收治的食管癌患者40例,随机分为对照组和早期肠内营养支持组（EN组）,每组20例,对照组术后常规补液,5～7d后管喂普通流质;EN组术后24h内经鼻胃管（或空肠造瘘口）用重力滴注滴入糖盐水500ml,次日改用能全力500ml,以后根据患者的实际情况每日增加500ml直到全量（2000～2500ml）。两组均在术前和术后14d检测患者的各项营养指标：体重（BW）、血清总蛋白（TP）、白蛋白（Alb）、前白蛋白（PA）、外周血淋巴细胞计数（LYM）和住院天数。结果EN组PA术后较术前有明显升高（P〈0．05）,Hb术后较术前有明显降低（P〈0．05）。对照组TP、Alb、Hb术后较术前均有明显降低（P〈0．05）。EN组和对照组各指标在术前均不存在明显差异（P〉0．0S）,但在术后不同的营养支持条件下,BW、TP、Alb、Hb、LYM均表现出明显差异（P〈0．05）。两组患者术后体重均有所下降,对照组下降明显,差异有显著性（P〈0．05）。EN组患者病程较对照组明显缩短（P〈0．05）。结论食管癌术后早期进行肠内营养支持临床效果好且安全可行。     

RFIDs Can Improve the Patient Care Supply Chain

Technologies that increase efficiency, enhance quality, and improve patient safety are essential for all healthcare organizations. Radio frequency identification devices (RFIDs) seem to be right for this challenge. RFIDs can be integrated into all areas of the internal patient supply chain, serving as clearinghouses of information. By providing timely information on patients, processes, and equipment, RFIDs can save time and reduce costs while simultaneously improving quality and patient safety. Healthcare leaders owe it to all constituencies to take a serious look at what RFIDs can offer.     

Comparing diagnostic tests: trials in people with discordant test results

Diagnostic tests are traditionally compared for accuracy against a gold standard but can also be compared prospectively in a trial. A conventional trial comparing two tests would randomize each participant to a testing strategy, but a more efficient alternative is to give both tests to all participants and follow up those with discordant results. Participants could be randomized before or after testing. The statistical analysis of such a trial has not previously been described. We investigated two estimates of the risk difference for a binary outcome: one based on analysing outcomes as if from a conventional trial and one combining estimates of different parameters in the manner of a decision analysis. We show that the trial estimate and decision analysis estimate are both unbiased and derive approximate formulae for their standard errors. By using the decision analysis estimate (but not the trial estimate), the same precision can be achieved by randomizing before testing as by randomizing after. To avoid destroying equipoise, and to allow consenting and randomizing to be carried out at the same visit, we recommend randomizing before testing. Giving both tests to all participants means fewer need to be recruited: in one example from the literature, the proposed design was nearly four times more efficient in this sense than a conventional trial design. Copyright © 2012 John Wiley & Sons, Ltd.     

Narcissistic Vulnerability of the Younger Student

Schools of social work and, of course, BSW programs are increasingly admitting the younger student. While faculties and agency supervisors struggle with this reality, there has been little formal attention to purposeful examination of the demands this creates, especially in field work. The special needs of the younger, frequently narcissistically vulnerable student, are almost often demonstrated in the field practicum. The newer conceptions in narcissistic theory are offered, for possible usage and integration, to form the educational alliance between student and supervisor. Postulated is an increased need or provision of “empathic” non-confrontive supervision.