儿童过敏性紫癜253例临床分析

目的 探讨儿童过敏性紫癜（AP）的临床特点及肾损害的相关因素。方法 对253例AP患儿的发病特点、临床表现及肾损害相关因素进行回顾性分析。结果 253例AP患儿年龄〉7岁158例（62、45％），乡村患儿169例（66．80％），春冬季发病168例（66．40％），感染为诱因126例（49．80％）。AP首发症状主要为单纯紫癜164例（64．82％），单纯关节痛30例（11．86％）。肾损害发生率男性（43．97％）高于女性（26．79％），紫癜复发者（56．36％）高于初发者（30．81％）（P〈0．01）。表现单纯紫癜、紫癜加关节症状、紫癜加消化道症状、紫癜加消化道加关节症状者肾损害发生率分别为17.71％、30．56％、59．02％、70．80％。结论 AP发病以学龄儿童、乡村患儿、春冬季较多，感染为第一位诱因。男性和复发患儿肾损害发生率较高；AP早期出现较多肾外症状，尤其是消化道症状者，易发生肾损害。     

173例儿童过敏性紫癜临床分析

目的：分析儿童过敏性紫癜（HSP）的病因及临床特点，提高该病的诊断水平。方法：回顾性分析173例HSP患儿的流行病学资料、病因、临床特征及治疗转归。结果：HSP好发年龄以学龄前儿童居多，年龄（6．7±2．8）岁；冬春季节发病率占全年发病的75．1％（130／173）；感染是HSP的主要诱因，占42．2％（73／173），95例检测过敏原，阳性35例（36．8％），其中食品占71．1％（13／95）；皮疹为临床症状的首位，占83．8％，其次为消化道症状占11．0％，其中伴有消化道出血表现占57．9％（11／19）；85．7％（60／70）患者血液D-二聚体升高；所有患儿都存活。结论：HSP发病以学龄前儿童多见，冬春季节好发，感染为主要诱因，该病临床袁现典型，D-二聚体升高对诊断有一定的意义．预后好。     

儿童过敏性紫癜193例分析

目的：探讨儿童过敏性紫癜的临床特点，方法：对1993年1月1日－2000年12月31日，在本院住院的193例过敏性紫癜患儿的 病特点，临床表现，肾损害相关因素及预后等方面的进行回顾。结果：（1）1993－2003年，每年的患病率依次为1．03％、0．79％、1．19％、1．01％、0．84％、1．34％，1．27％及1．41％。（2）农村患儿136例，占70．47％，（3）诱因：感染121例，占62．69％，寄生虫史29例，占15．03％，进食特殊食物6例，占3．11％，（4）出现肾脏症状54例，发生率为27．98％，29例皮肤紫癜者，3例出现肾脏损害，占10．34％39例皮肤紫癜加关节症状者，6例出现肾脏损害，占15．38％；59例皮肤紫癜加消化道症状者，20例出现肾脏损害，占33．90％，66例皮肤紫癜加关节症状加消化症状者中25例发生肾脏损害，占37．88％（P＜0．05）。（5）预后：180例治愈好转，占93．26％，结论：（1）HSP患病率有升高趋势，但并非呈逐年升高。农村患儿发病较多，发病诱因仍以感染占第一位。（2）HSP早期出现较多肾外症状，特别是消化道症状明显者，易发生肾脏损害。     

腹型过敏性紫癜36例分析

我院1996-08～2006-08收治以消化道症状为首发的过敏性紫癜36例，现分析如下。 1临床资料 1．1一般资料本组男20例，女16例，年龄8～65（平均32）岁。有诱因可查者15例（41．7％），其中发病前有上呼吸道感染史7例，有鱼虾等海产品饮食史3例，青霉索过敏3例，花粉过敏2例。本组均以腹痛等胃肠道症状为首发和突出表现，分别于起病后1～5d就诊，腹痛部位：脐周痛18例，全腹痛11例，下腹痛3例，上腹转为右下腹痛4例。腹痛性质：阵发性绞痛18例，持续性钝痛伴阵发性加重8例。     

成人腹型过敏性紫癜60例临床特征分析

【目的】探讨成人腹型过敏性紫癜的临床特征和误诊情况。【方法】收集本院2000-2008年诊断的过敏性紫癜病人60例,根据有无消化道症状分为腹型组及非腹型组,对两组病人的临床表现、实验室检查等进行比较,分析成人腹型过敏性紫癜的临床特征及误诊情况。【结果】腹型组与非腹型组过敏性紫癜患者在发病年龄、性别、诱发因素、合并肾脏及关节损害、蛋白尿、血尿等方面均无差异,但腹型过敏性紫癜患者白细胞升高及白蛋白降低更为明显。成人腹型过敏性紫癜患者临床表现为皮疹（100％）、腹痛（100％）、消化道出血（72．9％）、呕吐（32．4％）和腹泻（35．1％）等,成人腹型过敏性紫癜误诊率高（51．4％）。【结论】腹型紫癜患者白细胞升高及白蛋白降低较非腹型组更为明显,消化道症状重,而体征轻微,以腹痛为首发表现者极易误诊．     

过敏性紫癜肾脏损害的临床因素分析

目的探讨过敏性紫癜肾脏损害的临床因素。方法回顾性分析72例过敏性紫癜患儿的临床资料，根据尿常规检查，分为尿检正常组和紫癜肾损害组；紫癜肾损害组分为一过性尿异常组及持续性尿异常组。观察相应的临床因素，并行统计学分析。结果紫癜肾损害组年龄，皮疹反复、皮疹持续时间，消化道出血的发生率及严重程度均高于尿检正常组，差异有显著性（P〈0．05）。持续性尿异常组皮疹持续时间、血尿并蛋白尿发生率均高于一过性尿异常组，差异有显著性（P〈0．05）。单纯皮肤紫癜者、紫癜加关节症状者、紫癜加消化道症状者以及同时有紫癜、关节症状和消化道症状者肾损害发生率分别是33．3％、41．7％、54．5％和75．0％，混合型和单纯紫癜者肾损害发生率的差异有显著性（P〈0．01）。结论发病年龄较大，皮疹反复及持续时间长，消化道出血者易发生肾损害；除皮肤紫癜外，合并关节症状和消化道症状者易发生肾损害；皮疹持续时间长、血尿合并蛋白尿与肾脏持续受累有关。     

成人过敏性紫癜内镜表现及临床特点

目的 探讨成人以消化道症状为突出表现的过敏性紫癜患者内镜表现及临床特点.方法 对该院2005年7月～2010年5月住院以消化道症状突出且行胃镜及肠镜检查13例过敏性紫癜患者临床资料进行回顾性分析.结果 腹痛11例(84.6%),呕血、黑便7例(53.8%),其中呕血4例(30.8%),OB(+)11例(84.6%).食...     

以急腹症为主要症状的小儿过敏性紫癜35例临床分析

目的：探讨小儿胃肠型过敏性紫癜的临床表现、诊断和治疗。方法：对35例胃肠型过敏性紫癜进行回顾性分析。结果：临床表现初期多以腹痛症状表现严重而体征相对较轻，腹痛性质为隐痛或阵发性绞痛，有些伴有恶心、呕吐或粘液样血便，查体无固定压痛点，中性粒细胞比例增高者20例，大便潜血阳性20例，占57．1％。腹平片、CT、超声检查等可提示诊断。治疗初期以保守治疗为主，但如有腹膜炎体征时还是以早期手术治疗为宜。结论：胃肠型过敏性紫癜临床表现复杂，容易误诊，应密切观察病情变化，必要时手术治疗。     

以腹痛为首发表现的过敏性紫癜的临床及内镜研究

该文对１２例成人以腹痛为首发表现的过敏性紫癜腹型的临床特点及内镜下表现进行了分析研究，病人均有阵发性腹部绞痛（１００％），腹痛多位于左上腹部（６７％），伴有血样稀便（７５％）。胃镜检查发现十二指肠粘膜有散在的大小不一的出血斑点（９１．７％），病理检查示粘膜肌组织内大量中性白细胞及淋巴细胞浸润。腹痛发生后４￣９ｄ出现双下肢对称性皮肤出血点。此结果显示，对非急腹症病人应尽早检查胃镜观察十二指肠，以期为     

儿童过敏性紫癜150例临床分析

回顾性分析我科2010年1月～2012年1月收治的150例过敏性紫癜患儿的临床资料。（1）过敏性紫癜发病男性多于女性,季节以秋冬季为主,呼吸道感染是最常见诱因;（2）临床表现以皮疹为主,消化道症状55.4%,以消化道症状为首发的过敏性紫癜临床需与急腹症相鉴别,关节症状32.5%,常表现为关节肿痛,部分存在活动受限,紫癜性肾炎发生率为44.1%,临床主要表现为血尿和（或）蛋白尿,病程易迁延。过敏性紫癜是儿童常见病,需重视过敏性紫癜发病诱因的多样性及临床多系统损害。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。