艾滋病与系统红斑狼疮各125例头发ICP35种元素检验结果比较

笔者分别对125例Aids与正常人、SLE与正常人进行比较基础上。对125例Aids和SLE配对，用ICP法测35种元素，在本文报告31种元素检验结果，经t一检验：平均值的成对二样分析发现：Aids与SLE发检结果比较：Bi、Li、Mn、Ti、A1等5种元素含量为正相关；而Cu、Co、Ge、Mo、Sb、Ce、La、Ga、Th等9种元素含量呈负相关。从而揭示了免疫缺陷病毒感染者与系统性红斑狼疮患者体内元素代谢的差异，为当今世界攻克免疫性疾病指出方向，证明元素平衡医学食疗是解决Aids、SLE、癌症等免疫性疾病必由之路。     

The evolution of today's hospital emergency departments —Current problems and challenges

The announcement of the National Heart Attack Alert Program by the National Heart, Lung and Blood Institute in June of 1991 prompted leaders of the Florida Chapter of the American College of Cardiology to develop a statewide program to reduce the morbidity and mortality from acute myocardial infarctions within Florida. It became apparent that the success of such a program would require the prompt institution of thrombolytic agents or other revascular-ization procedures in appropriate patients. No longer could the decision regarding institution of therapy await discussion by telephone and/or the arrival at the emergency department (ED) of the patient's primary care physician or cardiologist. Efforts to establish appropriate protocols for therapy revealed that many of the 25,000 or more physicians currently staffing the 5,600 or so EDs in this country were moonlighting residents or practitioners from a variety of specialties or subspe-cialties with limited or no formal EM training. Furthermore, it was learned that there were in the entire country only about 800 postgraduate, year-one Council for Graduate Medical Education accredited training positions. There were only 21 such training positions in the entire state of Florida. The reasons for these deficiencies are discussed and a challenge to correct this person power crisis is issued, not principally to the leadership of EM, but to the entire medical profession.     

短暂性脑缺血发作后30天内卒中的危险因素分析

目的通过分析短暂性脑缺血发作后30天内卒中的危险因素,为临床采取相应的预防措施提供依据。方法对2016年8月至2018年8月在开平市中心医院住院的200例TIA患者,通过观察确诊后30天内的情况,使用单因素和多因素Logistic回归分析可能导致卒中的危险因素。结果 200例TIA患者30天共内有40例(20%)进展为脑梗死,其中高血压、7天内反复TIA发作、颈动脉不稳定斑块、颈动脉狭窄是TIA后30天内卒中的独立危险因素,危险程度为:颈动脉狭窄>30天内反复TIA发作>高血压>颈动脉不稳定斑块。结论 TIA患者早期进展为卒中的高危因素有颈动脉狭窄、反复发作的TIA、高血压、不稳定斑块。     

Pandemic A/H1N1 influenza: Transmission of the first cases in Spain

Introduction

Pandemic A/H1N1 influenza emerged in Mexico at the end of March 2009. Since then, it is still important to provide evidences that contributed to the international spread of the virus and to ascertain the attack rate of this new strain of influenza among the first cases in Spain that led to identify the first transmission in Europe.

Methods

Three pandemic A/H1N1 influenza groups related to an overseas flight were studied: 71 student group, 94 remaining passengers, and 68 contacts of confirmed cases. The attack rate with their 95% confidence interval (CI) among the student group and contacts was calculated. On April 26th, when the first cases were notified, strong preventive measures were implemented among the student group and the contacts of the confirmed cases.

Results

On 27th April, the first pandemic A/H1N1 influenza cases confirmed in Spain were three students that came back from Mexico by airplane. A student generated the first native case in Spain and one of the first cases in Europe. Similar attack rates were found between the student group (14.1%; CI: 12.1–16.1) and their contacts (13.2%; CI: 4.4–22.0), but no cases among remaining passengers were detected, suggesting low transmission risk during air travel.

Conclusion

The first cases of pandemic A/H1N1 influenza in Spain were imported by airplane from Mexico. Preventive efforts to reduce the impact of the influenza influenced that primary and secondary rates were lower than first estimations by WHO.     

ABCD2评分对后循环短暂性脑缺血发作患者椎基底动脉狭窄的预测价值:回顾性病例系列研究

目的:探讨ABCD2评分与后循环短暂性脑缺血发作(transient ischemic attack,TIA)患者椎基底动脉主干血管狭窄的相关性.方法 回顾性纳入行脑血管造影的后循环TLA患者,对其ABCD2评分和影像学资料进行分析.结果 共纳入后循环TIA患者108例.不同ABCD2评分的后循环TIA患者椎基底动脉主干血管狭窄程度存在显著性差异(P =0.005),总体狭窄程度随着ABCD2评分的增高而增高(P =0.000).在校正其他血管危险因素后,ABCD2评分对后循环是否存在狭窄[优势比(odds ratio,OR)1.771,95％可信区间(confidence interval,CI)1.234～2.542;P =0.002]及是否存在中至重度狭窄(OR2.083,95％ CI1.336 ～3.176;P =0.001)均具有显著的预测能力,其受试者工作特征曲线下面积分别为0.693(95％ CI0.586～0.800)和0.755(95％ CI0.661～0.849).当ABCD2评分≥3分时,预测后循环狭窄的敏感性为62.6％(95％ CI 53.4％～71.7％),特异性为70.6％(95％ CI62.0％ ～79.1％),预测后循环狭窄程度＞50％的敏感性为78.7％(95％ CI 70.9％～86.4％),特异性为67.5％ (95％ CI 58.7％ ～76.3％).结论 在后循环TIA患者中,椎基底动脉主干血管狭窄程度随着ABCD2评分的增高而增高.ABCD2评分在一定程度上能预测后循环主干血管是否存在狭窄及是否存在中至重度狭窄.     

The hazard of sharp force injuries: Factors influencing outcome

The risk of dying from sharp force injury is difficult to ascertain. To the best of our knowledge, no study has been performed in Norway regarding mortality due to sharp force injury or factors that impact survival. Thus, the objective of the present study was to investigate and assess mortality in subjects with sharp force injury. This retrospective study comprises data on 136 subjects (34 female, 102 male) with suspected severe sharp force injury (self-inflicted or inflicted by others) admitted to Haukeland University Hospital between 2001 and 2010. The majority of subjects were intoxicated, and the injury was most often inflicted by a knife. The incidence of sharp force injury in Western Norway is similar to the incidence in other European countries. Almost half of the subjects with self-inflicted injury died. In cases with injury inflicted by another individual, one in five died. Mortality rates were higher in those with penetrating chest injuries than those with penetrating abdominal injuries and higher in cases with cardiac injury compared to pleural or lung injury. Sharp force injury can be fatal, but the overall mortality rate in this study was 29%. Factors influencing mortality rate were the number of injuries, the topographic regions of the body injured, the anatomical organs/structures inflicted, and emergency measures performed.     

Risk of Wheezing Attacks in Infants With Transient Tachypnea Newborns

Background:

The most common reason of respiratory distress in the newborn is transient tachypnea of the newborn (TTN). There are some reports saying that TTN is associated with increased frequencies of wheezing attacks.

Objectives:

The aims of this study were to determine the risk factors associated with TTN and to determine the association between TTN and the development of wheezing syndromes in early life.

Materials and Methods:

In a historical cohort study, we recorded the characteristics of 70 infants born at the Shohadaye Kargar Hospital in Yazd between March 2005 and March 2009 and who were hospitalized because of TTN in the neonatal intensive-care unit. We called their parents at least four years after the infants were discharged from the hospital and asked about any wheezing attacks. Seventy other infants with no health problems during the newborn period were included in the study as the control group.

Results:

The rate of wheezing attacks in newborns with TTN was more than patients with no TTN diagnosis (P = 0.014). TTN was found to be an independent risk factor for later wheezing attacks (relative risk [RR] = 2.8).

Conclusions:

The most obvious finding of this study was that TTN was an independent risk factor for wheezing attacks. So long-term medical care is suggested for these patients who may be at risk, because TTN may not be as transient as has been previously thought.     

时间差攻击疗法治疗下呼吸道多重耐药铜绿假单胞菌感染疗效观察

目的：探讨时间差疗法治疗下呼吸道多重耐药铜绿假单胞菌感染的疗效。方法：将有多重耐药铜绿假单胞菌感染的病例随机分为实验、对照两组,实验组采用磷霉素与头孢哌酮-舒巴坦时间差攻击疗法,对照组采用磷霉素与头孢哌酮-舒巴坦同时联合疗法。结果：治疗14 d 后,实验组的有效率为85.71%,对照组为65.12%。经χ2检验,有显著性差异（P ＜0.05）。结论：时间差攻击疗法疗效好,为多重耐药铜绿假单胞菌感染提供了一种新的治疗方法。     

吸烟对短暂性脑缺血发作和脑梗死患者血清可溶性细胞间粘附分子1水平的影响

目的研究吸烟健康人群、短暂性脑缺血发作和脑梗死患者血清可溶性细胞间粘附分子1水平的变化,探讨吸烟在脑梗死发生发展中的作用。方法采用双抗体夹心法测定31例脑梗死吸烟者和31例脑梗死不吸烟者、31例短暂性脑缺血发作吸烟者和25例短暂性脑缺血发作不吸烟者以及26例健康吸烟者和28例健康不吸烟者血清可溶性细胞间粘附分子1水平;应用经颅超声多普勒仪测定脑血流速度和吸烟后10min脑血流速度。结果脑梗死吸烟组、短暂性脑缺血发作吸烟组和健康吸烟人群血清可溶性细胞间粘附分子1水平分别高于脑梗死不吸烟组、短暂性脑缺血发作不吸烟组和健康不吸烟人群(P<0.05),血清可溶性细胞间粘附分子1水平升高与吸烟指数呈正相关(r=0.428,P<0.01);吸烟10min后双侧大脑中动脉血流速度较吸烟前明显加快(P<0.05)。结论吸烟使健康人、短暂性脑缺血发作和脑梗死患者血清可溶性细胞间粘附分子1水平升高。可溶性细胞间粘附分子1参与了脑梗死的发生发展过程。     

Quelques nouveaux paradigmes pour l’assistance des victimes d’attentat ?

The particular situation of the attacks in France has had an impact on our expert practice. The expertise has been substantially modified both in form and substance. We find that the expertise of victims of attacks leads us to introduce new aspects in our business and reinforce others. The purpose of this text is to present a reflection on the changes that seem to have been induced by the attacks in our expert practice. We cannot, in the end, do without an existential and philosophical ethical reflection on life and its meaning and practice.