Multi‐center Retrospective Study of Factors Affecting Perioperative Transfusion of Packed Red Blood Cells for Pelvic Fracture Patients

ObjectiveTo analyze the use of packed red blood cells (PRBCs) for patients with pelvic fracture and evaluate factors associated with PRBC transfusion for patients with pelvic fracture.MethodsThis retrospective cohort study collected 551 patients with pelvic fractures from six hospitals between September 1, 2012, and June 31, 2019. The age span of patients varied from 10 to 95 years old, and they were classified into two groups based on high‐energy pelvic fractures (HE‐PFs) or low‐energy pelvic fractures (LE‐PFs). The study''s outcome was the use of PRBCs, fresh frozen plasma (FFP), and albumin. Demographic data, characteristics, laboratory tests, clinical treatment details, and clinical outcomes were compared between the two groups. Factors that were statistically associated with perioperative PRBCs in univariate analyses were included to conduct an optimal scale regression to determine the independent factors for perioperative PRBCs.ResultsA total of 551 patients were screened from six hospitals, and after inclusion and exclusion, 319 were finally included and finished the follow‐up from admission to discharge, while four patients died during hospitalization. Three hundred and nineteen patients were classified into two groups by their injury mechanisms. A total of 230/319 (72.1%) patients were classified into the HE‐PF group, and 89/319 (27.8%) patients were classified into the LE‐PF group. Patients in the HE‐PF group were transfused with 4.5 (3–8) units of PRBCs, 300 (0–600) ml of FFP, and 0 (0–30) g of albumin, while patients in the LE‐PF group were transfused with 3.5 (2–4.5) units of PRBCs, 0 (0–295) ml of FFP, and 0 (0–0) g of albumin (all P < 0.001). There were higher proportions of male patients and patients under 65 in the HE‐PF group (all P < 0.001). HE‐PF group patients were more severely injured and likely to take external fixation. The optimal scale regression revealed four significant factors associated with perioperative transfused PRBCs, which were patients on admission with hemorrhagic shock (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.148, P = 0.039), and methods of pelvic fixation (importance = 0.008, P = 0.026), ranked by the importance.ConclusionPatients with HE‐PFs had increased transfusions of PRBCs, FFP, and albumin, and hemorrhagic shock on admission, Tile classification, Hb levels, and stabilization methods were found to be associated with perioperative PRBCs.     

基于人工智能的高血压性脑出血医疗文本信息自动识别系统

目的 构建基于人工智能的高血压性脑出血医疗文本信息自动识别系统,快速识别和分析患者临床信息,高效地输出正确的诊疗方案。方法 基于国内外最新高血压性脑出血诊疗指南,经多位高年资神经外科医生和专业人工智能团队共同讨论,构建基于语言表征模型和专家模块的高血压性脑出血医疗文本信息自动识别及决策系统（即H系统）。随后将收集到的高血压性脑出血病例分为训练集、测试集和验证集,以数据库中病例的真实治疗方案为金标准,先总体评价H系统的准确性,再将其与神经外科医生进行对比,分析H系统的判读效率。结果 在测试集中,H系统所输出的治疗方案的准确率为94.0%（91.5%~96.5%）,特异度为91.8%（86.3%~97.3%）,灵敏度为95.5%（89.3%~98.2%）,曲线下面积（area under the curve,AUC）值为0.936（0.922~0.950）（P=0.000）;在验证集中,H系统所输出的治疗方案的准确率为93.3%（89.5%~97.1%）,特异度为 89.9%（83.4%~96.4%）,灵敏度为95.8%（92.3%~99.3%）,AUC值为0.928（0.891~0.966）（P=0.000）。在处理同样的70例病例时,H系统用时（334.60±4.46）s,而神经外科医生用时（12 550.28±95.45）s;在50 min内,H系统处理的病例数为（383±3）例,而神经外科医生处理的病例数为（11±4）例。结论 本研究所构建的H系统能够对高血压性脑出血患者的急诊病例进行自动识别和分析,并快速输出准确的诊疗方案,可协助医生对高血压脑出血进行急诊诊疗。     

李跃华辨治焦虑症发热1例

焦虑抑郁症发病机制至今尚不明确,存在多种假说,其中以脑神经递质与抑郁症的关系研究最为深入。李跃华教授临床辨治1例发热原因不明的患者。患者自发热伊始,原因不明,间断发热,他院给予退热以及激素等治疗,连续应用5月患者病情未改善。患者情绪低落,紧张不安,生活兴趣丧失,李跃华教授以焦虑抑郁症中医辨证诊治,结合清热利湿,并口服西医对症抗焦虑抑郁药物治疗,患者发热好转。     

Oral antipyretic therapy: Evaluation of the N-aryl-anthranilic acid derivatives mefenamic acid,tolfenamic acid and flufenamic acid

Summary The antipyretic activity of three N-aryl-anthranilic acid derivatives, mefenamic acid, tolfenamic acid and flufenamic acid, was compared and their optimal antipyretic dose determined in a trial in 87 children (aged 5 months to 15 years), who suffered from infections and fever exceeding 38.5°C. Tolfenamic acid proved to be the most potent antipyretic agent of the three drugs; it was eight times more powerful than mefenamic acid and three times more powerful than flufenamic acid. The optimal antipyretic doses were: mefenamic acid 4 mg/kg, tolfenamic acid 0.5 mg/kg and flufenamic acid 1.5 mg/kg. It is evident that the antipyretic activity of these anthranilic acid derivatives is even greater than their antirheumatic effect, the difference being most noticeable in the case of tolfenamic acid.     

玉女煎加味治疗遗传性出血性毛细血管扩张症的疗效观察

目的　观察玉女煎加味治疗遗传性出血性毛细血管扩张症（hereditary hemorrhagic telangiectasia,HTT）的临床疗效。方法　收集北京同仁医院变态反应中心1年内就诊HTT患者7例,在鼻科填塞基础上,采用玉女煎随证加减治疗,观察治疗5周后对鼻部症状、鼻出血、生活质量的影响。结果　在治疗后患者的症状明显改善,鼻部视觉模拟评分（4.4±1.3;20.8±1.6）分、鼻出血评分（6.5±2.2;18.7±2.0）分、日常生活质量（9.3±1.6;29.7±5.0）分（P＜0.05）,总有效率达85.7%。此外,HTT鼻部症状与鼻出血具有一定的相关性（R 2=0.8444）,而中药对两者改善程度却无相关性（R 2=0.3905）,对鼻出血的改善程度优于鼻部 症状。结论　中药玉女煎加味明显改善HTT的鼻出血的症状和部分改善特征性毛细血管扩张症。     

清热化瘀法治疗多囊肾发热浅析

认为多囊肾在合并感染或出血情况下的高热不退,其病机特点是邪热与瘀血相结合,可采用温病清热化瘀法进行治疗.运用该法的关键是以准确辨证为前提,并根据病程之久暂、血瘀之轻重灵活变化,施治得法,则可收明显疗效.     

限制性输液复苏法对失血性休克孕兔血流动力学变化的影响

目的 探讨限制性输液复苏法对失血性休克孕兔血流动力学变化及血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)含量变化的影响.方法 将20只妊娠中晚期新西兰大白兔分为2组,分别采用生理盐水传统输液复苏法(PNL组)及限制性输液复苏法(PLH组),每组10只.建立非控制性失血性休克模型,实验设计分为休克期(0～30 min),院前复苏期(30～90 min)及院内复苏期(90～180 min).休克期:两组孕兔均接受颈动脉放血至平均动脉压(MAP)为40～45 mm Hg(1 mm Hg=0.133 kPa).院前复苏期:剪开两组孕兔孕囊血管放血,复制活动性出血模型,然后PNL组和PLH组孕兔分别接受生理盐水及自身血复苏至MAP为80、60 mm Hg.院内复苏期:两组孕兔均接受手术止血及输血、输液治疗.比较两组孕兔各时间点血流动力学、TNF-α及IL-6含量的变化,记录输血、输液量及生存率.结果 (1)120 min时,PLH组孕兔呼吸、心率分别为(66±16)、(235±41)次,PNL组分别为(78±16)、(291±37)次,两组分别比较,差异有统计学意义(P＜0.01);PLH组孕兔MAP和中心静脉压(CVP)分别为(80.4±7.2)mm Hg、(8.0±4.4)cm H2O,PNL组孕兔分别为(72.5±8.2)mm Hg、(5.8±3.1)cm H2O,两组分别比较,差异也有统计学意义(P＜0.01);(2)两组孕兔血清TNF-α、IL-6含量休克后均升高,且在240 min时达高峰,PLH组孕兔血清TNF-α、IL-6含量分别为(105±67)、(118±51)ng/L,PNL组分别为(280±160)、(311±240)ng/L,两组比较,差异有统计学意义(P＜0.01),且PLH组孕兔血清TNF-α、IL-6含量在480 min时已降至正常;(3)PLH组输血、输液量在院前复苏期分别为(16.0±2.2)、(39.0±5.5)ml,在院内复苏期分别为(28.0±6.7)、(90.0±7.1)ml,PNL组在院前复苏期分别为(31.0±8.2)、(85.0±7.9)ml,在院内复苏期分别为(37.5±9.4)、(140.0±24.8)ml,两组比较,差异也有统计学意义(P＜0.05);(4)PLH组孕兔24、72 h的生存率分别为100%、90%;PNL组为80%、60%,两组比较,差异有统计学意义(P＜0.01).结论 限制性输液有利于失血性休克孕兔血流动力学指标的恢复,缓解血清TNF-α、IL-6含量升高的程度,从而提高了动物生存率.     

恙螨体内汉坦病毒核酸的基因芯片检测

目的 建立快速、灵敏、特异的汉坦病毒基因芯片诊断方法。方法 根据发表的汉坦病毒属(HV)76-118株和R22株S基因核苷酸序列，设计引物和探针，制备寡核苷酸芯片。用CV3标记核苷和引物，运用不对称PCR技术制备单链荧光标记核苷酸片段，并与芯片上的寡核苷酸探针杂交，荧光扫描仪检测并分析信号。结果 研究制备的基因芯片能够检测汉坦病毒HTN型和SEO型病毒核酸的特异性荧光信号。结论 HV的基因芯片检测具有特异、灵敏、快速的优点。基因芯片的制备和检测技术的建立，可为肾综合征出血热等传染病的诊断和预防提供理想的方法。     

Acute rheumatic fever in adult patients

Acute rheumatic fever (ARF) is considered as a disorder of children, and attacks in adults are usually a recurrence of disease acquired in the child’s life. Although the incidence of ARF in children has a decreasing trend in developed countries, resurgent and sporadic epidemics still occur in adults. The first attacks of ARF in adult patients without a childhood history can lead to a diagnostic dilemma.A medical record review in adults at least 18 years of age with an arthralgia complaint fulfilling 2015 revised Jones criteria was performed from January 1, 2000 to December 31, 2019.Eleven ARF patients were identified, including 8 with initial attacks (6 females aged 26–42 years, 33.9 ± 5.3) and 3 pre-existing valvular heart disease with recurrent attacks (2 females aged 38–52 years, 45.0 ± 7.0). In addition to febrile pharyngitis and migratory polyarthritis in initial attacks, pericarditis was encountered in 1, valvulitis in 2, prolong PR interval in 3 and skin involvement in 2 patients with erythema marginatum and IgA vasculitis. All responded to antibiotics and nonsteroidal anti-inflammatory drugs therapy with normalized clinical and laboratory abnormalities, no new-onset carditis, and no recurrent disease during a long-term follow-up (3.8–19.8 years, 12.7 ± 5.4).A sporadic occurrence of adult ARF is observed in southern Taiwan. This disease should be considered by physicians for the differential diagnosis of febrile pharyngitis with arthritis and/or carditis in adults, even in areas with a low incidence of ARF.     

安徽省2007～2008年志贺氏菌流行株菌型分布及脉冲场分子分型

目的了解安徽省志贺氏菌的流行菌型,并建立脉冲场凝胶电泳（PFGE）分子分型方法,为菌痢防控提供理论基础。方法对22株志贺氏菌进行血清分型、药物敏感试验和PFGE试验。结果22株志贺氏菌血清分型：B群19株,占总数86.5%;C群1株,占总数的4.5%;D群2株,占总数的9.0%。成功建立了菌痢的PFGE分子分型方法,并将我省22株流行株分为若干带型。试验结果进一步作聚类分析。结论安徽省菌痢流行株以福氏为主;安徽省PFGE分子分型方法和初步带型数据库对提高细菌检测水平有一定意义。