游泳治疗新生儿毒性红斑效果观察

[目的]探讨游泳对新生儿毒性红斑的治疗作用.[方法]将192例发生毒性红斑的新生儿随机分为观察组和对照组,各96例.两组新生儿每日常规用38℃～40℃温水沐浴1次,洗浴后用干净毛巾擦干,用75%乙醇消毒脐部,适当包裹.观察纽除此之外从发生毒性红斑第1天起由具有水疗资格的护士帮助新生儿游泳,严格控制室温在26℃～28℃,水温在37℃～38℃,在喂奶1h后进行,每天2次,每次10 min～15 rain.[结果]观察组新生儿毒性红斑消退明显早于对照组,脓疱疮发生率低于对照组.[结论]游泳可促进新生儿毒性红斑的消退.     

Complex liver retransplantation to treat graft loss due to long-term biliary tract complication after liver transplantation: A case report

BACKGROUND Loss of graft function after liver transplantation(LT) inevitably requires liver retransplant. Retransplantation of the liver(Re LT) remains controversial because of inferior outcomes compared with the primary orthotopic LT(OLT).Meanwhile, if accompanied by vascular complications such as arterial and portal vein(PV) stenosis or thrombosis, it will increase difficulties of surgery. We hereby introduce our center’s experience in Re LT through a complicated case of ReLT.CASE SUMMARY We report a patient who suffered from hepatitis B-associated cirrhosis and underwent LT in December 2012. Early postoperative recovery was uneventful.Four months after LT, the patient’s bilirubin increased significantly and he was diagnosed with an ischemic-type biliary lesion caused by hepatic artery occlusion. The patient underwent percutaneous transhepatic cholangial drainage and repeatedly replaced intrahepatic biliary drainage tube regularly for 5 years.The patient developed progressive deterioration of liver function and underwent liver re-transplant in January 2019. The operation was performed in a classic OLT manner without venous bypass. Both the hepatic artery and PV were occluded and could not be used for anastomosis. The donor PV was anastomosed with the recipient’s left renal vein. The donor hepatic artery was connected to the recipient’s abdominal aorta. The bile duct reconstruction was performed in an end-to-end manner. The postoperative process was very uneventful and the patient was discharged 1 mo after retransplantation.CONCLUSION With the development of surgical techniques, portal thrombosis and arterial occlusion are no longer contraindications for ReLT.     

Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic

The current corona virus disease 2019 outbreak caused by severe acute respiratory syndrome coronavirus 2 started in Wuhan,China in December 2019 and has put the world on alert.To safeguard Chinese citizens and to strengthen global health security,China has made great efforts to control the epidemic.Many in the global community have joined China to limit the epidemic.However,discrimination and prejudice driven by fear or misinformation have been flowing globally,superseding evidence and jeopardizing the anti-severe acute respiratory syndrome coronavirus 2 efforts.We analyze this phenomenon and its underlying causes and suggest practical solutions.     

Chidamide based combination regimen for treatment of monomorphic epitheliotropic intestinal T cell lymphoma following radical operation:Two case reports

BACKGROUND Monomorphic epitheliotropic intestinal T cell lymphoma(MEITL)is a rare extranodal T-cell lymphoma that has uniformly aggressive features with a poor prognosis.No standardized treatment protocols have been established.Previous experience has demonstrated favorable outcomes with combination chemotherapy followed by autologous hematopoietic stem cell transplant.However,many patients are unable to tolerate the toxicities.Chidamide is a new histone deacetylase inhibitor that has shown preferential efficacy in mature T-cell lymphoma.CASE SUMMARY We herein present two cases of MEITL who were both intermediate risk according to enteropathy-associated T cell lymphoma prognostic index.Case one was a 61-year-old man.He complained of upper abdominal pain and intermittent black stool for 2 mo.Imaging examination revealed that the intestinal wall was thickened.He received a partial excision of the small intestine.A chidamidebased combination regimen was given postoperatively.Eleven months later,he presented with recurrence in the bilateral lungs.He passed away 15 mo after his diagnosis.Case two was a 35-year-old woman who complained of abdominal distention for 1 mo.Positron emission tomography/computed tomography demonstrated wall thickening of the small intestine and upper sigmoid colon.Colon perforation and septic shock occurred on the fourth day of her admission.She was treated by sigmoid colostomy.Chidamide-based combination therapy was then provided.She was recurrence-free for 6 mo until lesions were found in the bilateral brain and lived for 17 mo since her diagnosis.Compared to historical data,chidamide seems to improve the prognosis of MEITL slightly.CONCLUSION MEITL is a type of aggressive lymphoma.Chidamide is a new promising approach for the treatment of MEITL.     

Optimal use of fielder XT guidewire enhances the success rate of chronic total occlusion percutaneous coronary intervention

BACKGROUND Chronic total occlusion(CTO) is found in 18-31% of patients who undergo coronary angiography. Successful recanalization of CTOs is associated with reduced recurrent angina pectoris rates and increased long-term survival.Although the success rate of CTO percutaneous coronary intervention(CTO-PCI)has improved, CTO-PCI remains technically challenging. The Fielder XT guidewire was designed for CTO lesions. To validate whether the use of the guidewire increases the success rate, we compared the results of CTO-PCI with or without the guidewire. We hypothesized that the use of Fielder XT guidewire can increase the success rate of CTO-PCI.AIM To investigate whether the use of Fielder XT guidewire increases the final procedural success of CTO-PCI via the anterograde approach.METHODS Between January 2013 and December 2015, a retrospective study was conducted on 1230 consecutive patients with CTO who received PCI via the anterograde approach at the General Hospital of Northern Theater Command. The patients were divided into an XT Group(n = 686) and a no-XT Group(n = 544) depending on whether Fielder XT guidewire was used. Both groups were compared for clinical parameters, lesion-related characteristics, procedural outcomes and inhospital complications. The data were statistically analyzed using Pearson's χ~2 test for categorical variables, and Students' t test was used to compare the quantitative data. Significant independent factors and a risk ratio with 95%confidence interval(CI) were assessed by multivariate logistic regression analysis.RESULTS In total, 1230 patients were recruited; 75.4% of the patients were male, and 55.8%of the patients were in the XT group. The overall success rate was 83.9%, with87.8% in the XT group. Based on multivariate logistic regression analysis, factors positively associated with procedural success were the use of Fielder XT guidewire(P = 0.005, 95%CI: 1.172-2.380) and systolic blood pressure(P = 0.011,95%CI: 1.003-1.022), while factors negatively associated with procedural success were blunt stump(P = 0.013, 95%CI: 1.341-11.862), male sex(P = 0.016, 95%CI:0.363-0.902), New York Heart Association(NYHA) class(P = 0.035, 95%CI: 0.553-0.979), contrast amount(P = 0.018, 95%CI: 0.983-0.998) and occlusion time(P =0.009, 95%CI: 0.994-0.999). No significant differences were found between the XT group and the no-XT group with respect to clinical parameters, lesion-related characteristics, coronary artery rupture [3(0.4%) vs 8(1.5%), P = 0.056], inhospital death [2(0.3%) vs 6(1.1%), P = 0.079] or in-hospital target lesion revascularization [3(0.4%) vs 7(1.3%), P < 0.099]. However, there were significant differences between the groups with respect to success rate [602(87.8%) vs 430(79.0%), P < 0.001], procedure time [(74 ± 23) vs(83 ± 21), P < 0.001], stent length[(32.0 ± 15.8) vs(37.3 ± 17.6), P < 0.001], contrast amount [(148 ± 46) vs(166 ± 43),P < 0.001], post-PCI myocardial infarction [43(6.3%) vs 59(10.8%), P = 0.004],major adverse cardiovascular event [44(6.4%) vs 57(10.7%), P = 0.007], side branch loss [31(4.5%) vs 44(8.1%), P = 0.009], contrast-induced nephropathy [29(4.2%) vs 40(7.4%), P = 0.018] and no reflow [8(1.2%) vs 14(2.9%), P = 0.034].CONCLUSION The use of Fielder XT guidewire shortens the Procedure and increases the success rate of CTO-PCI, and is also associated with reduced complication rates.     

聚肌胞结合中药治疗扁平疣60例临床观察

扁平疣,中医称扁瘊。为临床常见的良性病毒性皮肤病。皮损为米粒至绿豆大小的扁平坚实丘疹,略高出皮面,表面平滑,境界清楚,圆形、椭圆形,呈正常皮色或灰褐色,数量不等,好发于面部、手背等部位[1-2],不仅影响美观且具有传染     

1例妊娠合并尿路结石的护理

泌尿系统结石是由尿液中所含晶体和胶体形成的.一般先以血块、纤维蛋白、细胞碎屑、管型、细菌等各种异物为核心,然后尿液中的晶体和胶体围绕这一核心沉积,逐渐增多而形成结石[1].     

大剂量服用维生素A不安全

维生素A又称视黄醇,是一个具有酯环的不饱和一元醇,包括维生素A1、A2 两种.维生素A可由植物来源的β-胡萝卜素合成,故β-胡萝卜素也称为维生素A原.维生素A是构成视觉细胞中感受弱光的视紫红质的组成成分.维生素A只存在于动物性食物中,A1存在于哺乳动物及咸水鱼的肝脏中,而A2存在于淡水鱼的肝脏中,植物组织中尚未发现维生素A.维生素A具有多种生理功能,对视力、生长、上皮组织及骨骼的发育、精子的生成和胎儿的生长发育都是必需的.人体缺乏维生素A,会影响暗适应能力,导致儿童发育不良、皮肤干燥、干眼病、夜盲症等.     

Significant benefits of osimertinib in treating acquired resistance to first-generation EGFR-TKIs in lung squamous cell cancer: A case report

BACKGROUND Lung squamous cell cancer(LSCC)rarely harbors epidermal growth factor receptor(EGFR)mutations,even much rarer for acquired T790M mutation.Although clinical trials of AURA series illustrated that non-small cell lung cancer(NSCLC)with EGFR T790M mutation can benefit from osimertinib,only five LSCC patients were enrolled in total;moreover,the efficacy for LSCC was not shown in the results.Therefore,the response of LSCC to osimertinib is still unclear to date.CASE SUMMARY We report an LSCC case with T790M-related acquired resistance after treatments with first-generation EGFR-tyrosine kinase inhibitors(EGFR-TKIs)and benefited from osimertinib significantly.A 63-year-old Chinese man was diagnosed with stage IV(cT2N2M1b)LSCC harboring an EGFR exon 19-deletion mutation.Following disease progression after gefitinib and multi-line chemotherapy,rebiopsy was conducted.Molecular testing of EGFR by amplification refractory mutation system-polymerase chain reaction detected the exon 19-deletion without T790M mutation.Therefore,the patient was given erlotinib,but progression developed only 3 mo later.Then the frozen re-biopsy tissue was tested by next-generation sequencing(NGS),which detected an EGFR T790M mutation.However,he was very weak with symptoms of dysphagia and cachexia.Fortunately,osimertinib was started,leading to alleviation from the symptoms.Four months later,normal deglutition was restored and partial response was achieved.Finally,the patient achieved an overall survival time period of 29 mo.CONCLUSION Our findings highlight that EGFR T790M mutation may also be an important acquired drug resistance mechanism for LSCC and offer direct evidence of the efficacy of osimertinib in LSCC with T790M mutation.NGS and better preservation conditions may contribute to higher sensitivity of EGFR T790M detection.     

对男护士现状的分析

就近几年学校和社会中男护士的状况及出现的一些相关问题进行分析,以帮助他们正确看待自己的专业,解决一些疑惑,从而以良好的状态成功地走向工作岗位.     

不同舞姿老年交谊舞练习者自然行走时震荡吸收能力的生物力学分析

背景:人体行走时产生不同的撞击地面的方式往往影响着人体的震荡吸收,而震荡吸收能力与人体日常步行中的许多损伤有关.目的:比较不同舞姿的老年交谊舞练习者在正常步行中的撞击震荡吸收能力.设计:对比观察.单位:广西师范大学体育学院,北京体育大学运动人体科学学院.对象:选择北京体育大学家属区中老年交谊舞练习者14名,其中7名由专业社交舞教师评价为跳舞平稳的受试者作为平稳组,另7名明显不平稳者作为不平稳组.两组年龄、身高、体质量有可比性.方法:将丹麦生产BK4393 uni-gain微型加速计固定在胫骨结节下 3 cm及额骨中线上,测试受试者正常步行时的冲击加速度,并计算胫骨和头部间的振荡吸收.同步进行常速摄像机定点拍摄,得到步态相关的运动学参数.主要观察指标:正常行走时相关肢体步态运动学参数,以及胫骨、头部加速度峰值和振荡缓冲能力.结果:①运动学参数:正常行走时不平稳组受试者膝最大屈曲角、踝最大背屈角、踝背屈角大于平稳组(P ＜ 0.05).②振荡吸收结果:起步相时,两组胫骨冲击加速度比较差异不明显(P ＞ 0.05),平稳组头部冲击加速度低于不平稳组(P ＜ 0.05),平稳组胫骨和头部间的振荡吸收明显多于不平稳组(P =0.007)结论:采用合理的平稳型舞姿将有利于提高交谊舞练习者的整体震荡吸收能力和改善踝关节背屈控制能力和全身协调能力.     

对大学生突发伤害处理能力的调查

[目的]了解大学生突发伤害的应对处理能力.[方法]对200名在校大学生进行问卷调查.[结果]学生在伤害的处理中,对自身疾病能完全处理的居前三位的是腹痛、发热、鼻出血,分别占61.0%,72.0%,78.5%;对一般伤害如烫伤、外伤、骨折等也基本能在他人帮助下处理;意外伤害如火灾、溺水、车祸等,大多数学生表示能在他人帮助下处理或不能完全处理.[结论]大学生对伤害的处理能力一般.     

北京市院前院内急救人员对院前院内衔接认识的比较研究

目的 了解北京市院前、院内急救人员对院前院内衔接的认识和实际衔接过程中存在的问题.方法采用自行设计的调查问卷对670名院前急救人员、715名院内急救人员展开了调查,采用Epi3.0进行问卷调查结果录入,运用SPSS11.5进行数据分析.结果院前、院内医护人员都认为院前院内衔接很重要,两者之间的认识差异无统计学意义(P＞0.05).院前急救人员对于目前衔接状况的整体感觉满意度低于院内急救人员(P＜0.05).院前医护人员认为院内急诊科在院前院内衔接方面存在的不足主要表现在:院内医务人员接诊不及时;院内急诊科没有救护车专用通道;借故推诿患者等方面.院内医护人员认为院前急救单位在院前院内衔接方面存在的不足主要表现在:院前没有交接记录单,只是口头交接;与院内交接病情叙述不够详细;遇到危重患者很少提前打电话通知院内等方面.结论北京市院前、院内急救人员对于衔接重要性的认识程度比较高,目前院前院内衔接缺乏统一的交接制度,并存在急救人员衔接工作不到位以及急救衔接所需的设施不配套等问题,有待进一步改善.     

Thomas Hodgkin生平

英国病理学家Thomas Hodgkin1798年8月17日出生于英国Middlesex,Pentonville,St.James教区的一个虔诚的贵格教派(Quaker)家庭.父亲John Hodgkin和母亲Elizabeth Riekmen都属于贵格教"朋友协会"(The Society of Friends)的成员.在当过短时期的药剂师之后,他选择了医学,并于21岁时(1819)在伦敦的Guy医院注册就学.     

Clinical characteristics and 28-d outcomes of bacterial infections in patients with hepatitis B virus-related acute-on-chronic liver failure

BACKGROUND Acute-on-chronic liver failure(ACLF),which includes hepatic and multiple extrahepatic organ failure,is a severe emergency condition that has high mortality.ACLF can rapidly progress and requires an urgent assessment of condition and referral for liver transplantation.Bacterial infections(BIs)trigger ACLF and play pivotal roles in the deterioration of clinical course.AIM To investigate the clinical characteristics and 28-d outcomes of first BIs either at admission or during hospitalization in patients with hepatitis B virus(HBV)-ACLF as defined by the Chinese Group on the Study of Severe Hepatitis B(COSSH).METHODS A total of 159 patients with HBV-ACLF and 40 patients with acute decompensation of HBV-related chronic liver disease combined with first BIs were selected for a retrospective analysis between October 2014 and March 2016.The characteristics of BIs,the 28-d transplant-free survival rates,and the independent predictors of the 28-d outcomes were evaluated.RESULTS A total of 194 episodes of BIs occurred in 159 patients with HBV-ACLF.Among the episodes,13.4%were community-acquired,46.4%were healthcare-associated,and 40.2%belonged to nosocomial BIs.Pneumonia(40.7%),spontaneous bacterial peritonitis(SBP)(34.5%),and bloodstream infection(BSI)(13.4%)were the most prevalent.As the ACLF grade increased,the incidence of SBP showed a downward trend(P=0.021).Sixty-one strains of bacteria,including 83.6%Gramnegative bacteria and 29.5%multidrug-resistant organisms,were cultivated from 50 patients with ACLF.Escherichia coli(44.3%)and Klebsiella pneumoniae(23.0%)were the most common bacteria.As the ACLF grade increased,the 28-d transplant-free survival rates showed a downward trend(ACLF-1,55.7%;ACLF-2,29.3%;ACLF-3,5.4%;P<0.001).The independent predictors of the 28-d outcomes of patients with HBV-ACLF were COSSH-ACLF score(hazard ratio[HR]=1.371),acute kidney injury(HR=2.187),BSI(HR=2.339),prothrombin activity(HR=0.967),and invasive catheterization(HR=2.173).CONCLUSION For patients with HBV-ACLF combined with first BIs,pneumonia is the most common form,and the incidence of SBP decreases with increasing ACLF grade.COSSH-ACLF score,acute kidney injury,BSI,prothrombin activity,and invasive catheterization are the independent predictors of 28-d outcomes.     

中西药湿敷防治输液所致静脉炎效果比较

临床上输液导致静脉炎与长期、大量和反复输液有关,为常见输液并发症,不仅给病人造成痛苦,也给继续输液带来困难.我们应用中药当归、红花、丹参、牛膝、玄参和西药硫酸镁,分别湿敷防治输液所致静脉炎并进行比较观察,结果中药组明显优于西药组.现将结果报告如下.     

医疗机构就医环境评价探讨

目前,中国的医疗保障覆盖率还很小,据"第三次国家卫生服务调查主要结果"反映,2003城市医疗保障覆盖的人口仅为43.0%,农村社会保障的覆盖率则只有3.1%[1].虽然近年来医疗保障的覆盖率有所提高,但总体水平还是非常低.由于医疗保障的覆盖率低,社区医疗服务体系还没有完全建立,三级医院转诊制度还无法全面实施,导致生病时就医还得主要靠自己决策.这对于普通老百姓来说,确实是一个具体的问题.     

慢性乙型肝炎病毒变异及其中医辨证论治研究进展

乙型肝炎病毒（HBV）的复制是以其RNA为中间体，通过反转录酶的作用而进行的，可能由于缺乏校读的功能，因此，与大多数DNA病毒相比，HBV具有较高的突变率，故了解其变化特点十分重要。现就HBV不同的基因型与病毒变异及临床的关系，不同基因位点变异的临床意义以及中医辨证论治研究概况介绍如下。     

不同有氧运动锻炼对老年人血脂的影响

目的：观察不同有氧运动锻炼对老年人血脂的影响。方法：135例老年人根据参加运动情况分轻、中、大运动量3组（分别为A、B、C组）各45例,与年龄和例数同等的不参加运动锻炼组（D组）的老年人进行血脂比较。分别检测甘油三脂（TG）、胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）等。结果：A与D组血脂各项指标比较差异无显著性意义,与B、C组比较,TG、TC、LDL-C均明显升高,HDL-C降低（P〈0.05,0.01）;B组与C组比较则血脂各项指标差异无显著性意义。结论：长期有氧运动锻炼对增强老年人体质,降低血脂,预防肥胖及心血管疾病,减缓衰老具有重要作用。     

Stability and infectivity of coronaviruses in inanimate environments

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is a highly contagious virus that can transmit through respiratory droplets,aerosols,or contacts.Frequent touching of contaminated surfaces in public areas is therefore a potential route of SARS-CoV-2 transmission.The inanimate surfaces have often been described as a source of nosocomial infections.However,summaries on the transmissibility of coronaviruses from contaminated surfaces to induce the coronavirus disease 2019 are rare at present.This review aims to summarize data on the persistence of different coronaviruses on inanimate surfaces.The literature was systematically searched on Medline without language restrictions.All reports with experimental evidence on the duration persistence of coronaviruses on any type of surface were included.Most viruses from the respiratory tract,such as coronaviruses,influenza,SARS-CoV,or rhinovirus,can persist on surfaces for a few days.Persistence time on inanimate surfaces varied from minutes to up to one month,depending on the environmental conditions.SARSCoV-2 can be sustained in air in closed unventilated buses for at least 30 min without losing infectivity.The most common coronaviruses may well survive or persist on surfaces for up to one month.Viruses in respiratory or fecal specimens can maintain infectivity for quite a long time at room temperature.Absorbent materials like cotton are safer than unabsorbent materials for protection from virus infection.The risk of transmission via touching contaminated paper is low.Preventive strategies such as washing hands and wearing masks are critical to the control of coronavirus disease 2019.