儿童急性淋巴细胞白血病化疗后感染的临床特征及危险因素分析

目的 探讨儿童急性淋巴细胞白血病化疗后感染的临床特征及危险因素。方法 选取2016年6月— 2019年6月天津市儿童医院住院治疗的急性淋巴细胞白血病化疗患儿714例。收集患儿年龄、性别、住院时间、住院季节、感染部位、病原微生物物培养结果、实验室检查指标等资料,分析感染的临床特征及危险因素。结果 化疗后感染发生率为51.12%,主要感染部位为肺部（26.58%）,其次为上呼吸道（15.89%）;获取83株病原菌包括革兰阴性菌（48.19%）、革兰阳性菌（32.53%）、病毒（9.64%）、真菌（6.02%）、肺炎支原体（3.61%）;急性淋巴细胞白血病患儿化疗后,糖皮质激素治疗、预防性抗菌药物、是否诱导缓解期、住院时间、最低中性粒细胞计数、中性粒细胞缺乏持续时间、最低血红蛋白、化疗次数及不同住院季节的感染率比较,差异有统计学意义（P?<0.05）;性别、年龄及最低血小板计数的感染率比较,差异无统计学意义（P?>0.05）;诱导缓解期、住院时间>14?d、最低中性粒细胞计数<0.5×109/L、中性粒细胞缺乏持续时间>7?d及化疗次数>3次 是化疗后感染的独立危险因素（P?<0.05）。结论 临床应针对急性淋巴细胞白血病患儿化疗后感染的危险因素采取有效措施加以控制,降低化疗后感染率,减少对患儿病情的影响。     

血液疾病患者发生感染的相关危险因素分析

目的探讨血液疾病患者发生感染的危险因素。方法选取2005年1月-2011年12月在我院住院血液系统疾病患者963例患者,对其临床资料进行回顾性分析,找出患者发生感染的不同的危险因素。结果全部患者中有237例患者发生感染,占24.61%。急性白血病感染率最高,慢性白血病出现最低,差异有统计学意义（P〈0.05）。研究发现年龄〉55岁、住院时间〉45d、安置导管、进行侵入性治疗者或使用化疗药物感染率比较高,差异有统计学意义（P〈0.05）。结论血液疾病患者急性白血病感染发生率高,同时住院时间、老龄、安置导管、进行侵入性治疗或使用化疗药物也是感染的危险因素,临床需要治疗。     

成人急性白血病医院感染及其危险因素分析

目的了解成人急性白血病患者发生院感情况,并对其发生院感的危险因素进行分析。方法选取我院2012年6月至2017年6月住院治疗的符合纳入标准的成人急性白血病351例,详细记录医院感染部位、病原微生物培养结果。采用单因素和多因素Logistic回归分析。结果医院感染发病率为45.58%,例次发病率为78.8%。感染部位以上呼吸道、下呼吸道和血液为主,分别占25%、23.75%、10%;病原学分析显示,以G-菌感染为主,占52.7%,G+菌占31.6%,真菌占15.7%。预防性使用抗生素、糖皮质激素、化疗疗程、住院季节因素是导致急性白血病患者发生医院感染的主要危险因素(P0.05)。结论急性白血病患者医院感染率高,临床上应当针对患者抗菌药物预防性应用、糖皮质激素和化疗后免疫治疗等相关危险因素采取积极的防治对策,减少医院感染的发生。     

急性髓系白血病患者化疗后引起医院感染的相关因素分析

目的分析急性髓系白血病(AML)患者化疗后住院期间引起感染的相关因素,并探讨其预防措施。方法 166例AML患者接受化疗554例次,回顾性分析所有患者的病历资料,对其年龄、中性粒细胞绝对值、粒细胞缺乏持续时间与医院感染发生率的关系进行分析。结果年龄60岁者医院感染发生率明显高于年龄60岁者(75.6%vs.32.9%,P0.05)。ANC最低值0.5×109/L者医院感染发生率明显高于ANC最低值0.5×109/L者(89.0%vs.53.0%,P0.05)。粒细胞缺乏持续时间7d者医院感染发生率明显高于粒细胞缺乏持续时间≤7d者(95.7%vs.79.2%,P0.05)。结论年龄、中性粒细胞缺乏及持续时间是导致AML患者化疗后医院感染的危险因素,针对这些危险因素采取有效预防措施对降低AML患者化疗后医院感染率十分必要。     

老年急性白血病医院感染的临床分析

目的：探讨老年急性白血病患者医院感染的临床特点,发生原因及防治措施。方法：回顾分析６８例老年急性白血病患者医院感染的发生率、感染部位、危险因素及治疗情况等,并与同期非老年患者进行比较。结果 老年组院内感染率５６％,双重感染率２４％,感染病死率４７％,均高于同期非老年组,其中医院感染率及感染病死率两组相比差异有显著性（Ｐ〈０．０５）。感染部位以口腔及呼吸道多见,白细胞减少,化疗,高龄是增加感染的危险     

浙江嵊州地区急性心肌梗死患者医院感染的危险因素分析及预防对策

目的 分析浙江嵊州地区急性心肌梗死患者医院感染的危险因素,并制定预防策略,以降低医院感染率.方法 回顾性分析本地区于2006年1月～2012年5月治疗的578例急性心肌梗死患者的临床资料,对医院感染的各项危险因素进行单因素及多因素分析.结果 共发生医院感染92例,感染率15.9%;感染部位以呼吸系统感染率最高（56.7%）.单因素分析显示,医院感染的危险因素包括高龄（＞60岁）、有严重合并症、入住ICU、长期使用免疫抑制剂及广谱抗生素（≥20 d）、住院时间长（＞30 d）、侵入性操作,而多因素分析进一步显示长期使用广谱抗生素危险性最大（OR = 9.247）,其余依次为严重合并症（OR = 8.973）、住院时间长（OR = 8.047）、入住ICU（OR = 7.165）、高龄（OR = 5.428）、侵入性操作（OR = 4.177）、长期使用免疫抑制剂（OR = 3.809）.结论 浙江嵊州地区急性心肌梗死患者医院感染的危险因素较多,临床上应采取针对性预防对策,从而有效控制感染率.     

老年急性白血病化疗后合并医院感染79例临床分析

目的探讨老年急性白血病患者医院感染的危险因素。方法回顾分析79例老年白血病化疗后医院感染的发生率、病原菌、感染部位、危险因素。结果老年白血病化疗后医院感染率为70.5%,同期非老年白血病院内感染率为50.8%,组间差异有统计学意义。结论老年白血病患者医院感染发病率高、感染部位以肺部最多见,病原菌以G-菌为主,危险因素与中性粒细胞缺乏等有关     

导致肿瘤内科患者合并医院感染的相关因素及预防

目的：探讨导致肿瘤内科患者合并医院感染相关因素及预防措施。方法：40例肿瘤内科合并医院感染患者作为观察组,按照1∶1病例选择同期40例肿瘤内科无医院感染的患者作为对照组,比较观察组与对照组相关因素上的差异。结果：观察组平均年龄为（60.34±11.34）岁、合并其他疾病55.00%、实施化疗（2.53±1.77）次、实进行侵袭性操作37.50%、应用含激素化疗方案30.00%、预防应用抗菌药物35.00%、住院时间（22.14±4.32）d均高于对照组（P〈0.05）,为引起医院感染危险因素。结论 ：肿瘤内科患者合并医院感染与多种因素有关,应该采用相应的措施减少或避免医院感染的发生。     

儿童急性白血病化疗后医院感染临床特点及分析

目的:探讨儿童急性白血病化疗后医院感染临床特点、高危因素及预后。方法:回顾性分析儿科急性白血病患者医院感染患儿临床资料。结果:485例次急性白血病化疗患者中发生医院感染108例次,医院感染率22.3%。呼吸道感染43例,占39.8%,其次为败血症、口腔感染、不明部位感染等,分别占15.7%、14.8%、12.0%。108例次医院感染患者中检出21株致病菌,其中15株为革兰阳性球菌,占71.4%。住院时间延长、粒细胞减少为医院感染危险因素。结论:儿童急性白血病化疗后出现医院感染概率相对较高,为避免医院感染的发生,针对存在的高危因素进行医院感染防控,如根据治疗要求尽量缩短住院时间,针对骨髓抑制程度采取有效措施等,从而降低医院感染发生率,尽可能有效改善预后。     

神经内科医院感染调查分析

目的探讨神经内科医院感染的调查情况。方法回顾性分析254例神经内科医院感染患者的临床资料。结果从神经内科医院感染患者的感染部位分析,发生在呼吸系统部位的患者占160例（63.0%）,发生在泌尿系统部位的患者占45例（17.7%）,发生在消化系统部位的患者占21例（8.3%）,发生在皮肤软组织部位的患者占4例（1.6%）,其他部位感染患者占22例（8.7%）;住院时间在8d以上的患者医院感染率明显比住院时间在7d以内的高（P〈0.05）;住院患者中年龄在60岁以上感染率明显高于年龄低于60岁的患者（P〈0.05）。结论神经内科患者医院感染率较高,主要和患者的年龄、住院时间有关,应该给予重点监控。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.