5项炎性指标在血流感染性疾病中的表达及其与血培养的相关性

目的探讨降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)和中性粒细胞(NEUT)、单核细胞(MONO)在一些血流感染性疾病中的表达,以及其与血培养的相关性。方法将88例血培养阳性患者按病种分为布鲁菌病(以下简称布病)、菌血症、败血症和脓毒血症4组,并且检测PCT、hs-CRP、NEUT、MONO和WBC水平,并进行比较。结果 PCT和hs-CRP水平在4组均升高,布病组的升高程度低于其他3组,差异有统计学意义(P0.05)。PCT阳性率在4组均为100.0%,hs-CRP阳性率在布病组和脓毒血症组为100.0%。WBC和NEUT水平及阳性率在其他3组明显高于布病组(P0.05),MONO水平和阳性率在布病组明显高于其他3组(P0.05)。4组PCT和hs-CRP与血培养均有高度相关(P0.05),布病组WBC和NEUT与血培养无显著相关,MONO与血培养有高度相关(P0.05),WBC和NEUT在其他3组与血培养有较好的相关性(P0.05)。结论 PCT、hs-CRP及WBC检测可作为血流感染性疾病早期的拟诊指标,可为此类疾病的早期治疗与合理使用抗菌药物提供依据。     

糖尿病合并重症肺炎患者血常规、HbA1c、PCT、hs-CRP水平变化及与预后的相关性

目的分析糖尿病合并重症肺炎患者血常规、糖化血红蛋白(HbA1c)、降钙素原(PCT)、高敏C反应蛋白(hs-CRP)水平变化及与预后的相关性。方法选取2017年4月至2019年2月该院收治的92例糖尿病合并肺炎患者,其中非重症肺炎30例(非重症组),重症肺炎62例(重症组),比较两组患者及重症组中存活者、病死者的血常规[血红蛋白(Hb)、白细胞计数(WBC)、中性粒细胞百分比(NEUT)、血小板计数(PLT)、淋巴细胞绝对值(LYM#)、嗜酸性粒细胞百分比(EO)]、HbA1c、PCT、hs-CRP水平,采用多因素Logistic回归分析影响患者预后的因素,应用受试者工作特征(ROC)曲线分析各指标对预后的预测价值。结果 (1)重症组WBC、NEUT、HbA1c、PCT、hs-CRP水平高于非重症组,LYM#低于非重症组(P0.05)。(2)治疗前病死者NEUT、HbA1c、PCT、hs-CRP水平高于存活者,LYM#低于存活者(P0.05);与治疗前比较,存活者治疗1、3d后WBC、NEUT、HbA1c、PCT、hs-CRP水平均降低(P0.05);病死者治疗前,治疗1、3d后WBC、NEUT、HbA1c、PCT、hs-CRP水平比较,差异无统计学意义(P0.05)。(3)NEUT、HbA1c、PCT、hs-CRP是影响预后的独立危险因素(P0.05)。(4)在预测价值方面,治疗1d后PCT的ROC曲线下面积(AUC)最大,其次是hs-CRP、HbA1c、NEUT,治疗3d后的AUC由大到小依次为hs-CRP、HbA1c、PCT、NEUT。结论糖尿病合并重症肺炎患者WBC、NEUT、HbA1c、PCT、hs-CRP存在明显异常,NEUT、HbA1c、PCT、hs-CRP水平与预后相关。     

脑脊液中性粒细胞与淋巴细胞比值（NLR）对神经外科开颅术后颅内感染的诊断价值

目的　探讨脑脊液中性粒细胞与淋巴细胞比值（neutrophil and lymphocyte ratio,NLR）对神经外科开颅术后导致颅内感染患者的诊断价值。方法　选取在东部战区医院神经外科经过开颅术后,确诊颅内感染的患者 53 例,无颅内感染的患者 23 例,分别检测脑脊液和血液中白细胞计数 (WBC)、中性粒细胞百分比 (percentage of neutrophil,NEUT)、淋巴细胞百分比（percentage of lymphocyte,LYMPH）以及超敏 C 反应蛋白 (hs-CRP) 水平,比较两组患者的差异,并采用受试者工作特性曲线 (receiver operating curve, ROC) 比较各参数的诊断性能。结果　与非感染组相比较,感染组血液指标 WBC 和 NEUT 结果差异无统计学意义 (Z=-1.076,-1.629,均 P>0.05),LYMPH,NLR 以及 hs-CRP 结果差异有统计学意义 (Z=-2.054,-1.978,-2.370,均 P<0.05);而感染组脑脊液中 WBC, NEUT, LYMPH 以及 NRL 的差异均有统计学意义 (Z=-4.342,-2.882,-2.882,-2.882,P<0.05)。ROC 曲线显示,除 LYMPH 外,其它项目的 AUC 均大于70.0%,敏感度以 NEUT 最高,为 72.0%,特异度以 WBC 最高,为 92.9%。结论　脑脊液中 NLR 水平对开颅术后患者颅内感染的发生具有较好的临床诊断价值。     

4项炎性指标在感染性和非感染性疾病中的表达及其与血培养的相关分析

目的探讨降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、中性粒细胞(NEUT)等炎性指标在一些感染性和非感染性疾病中的表达及与血培养的相关性。方法 244例患者中感染组184例,其中肺部感染亚组105例和其他感染亚组79例,非感染组60例。检测患者的PCT、hs-CRP、WBC及NEUT,然后将检测结果在各组进行对比。结果肺部感染亚组和其他感染亚组PCT水平和阳性率明显高于非感染组(P0.05),而肺部感染亚组又明显高于其他感染亚组(P0.05)。肺部感染亚组和其他感染亚组hs-CRP阳性率均大于90%,WBC及NEUT水平和阳性率明显高于非感染组(P0.05)。血培养阳性率在肺部感染亚组为49.5%,与hs-CRP、WBC和NEUT有较好的相关性(P0.05);其他感染亚组为51.9%,与WBC和NEUT有很好的相关性(P0.05);在非感染组为16.7%,与PCT、WBC和NEUT有较好的相关性(P0.05)。结论 PCT、hsCRP及WBC检测可作为多种疾病的辅助诊断指标,可为这些疾病的早期治疗及合理使用抗菌药物提供依据。     

PCT、hs-CRP及WBC检测在肺部细菌感染中的诊断价值分析

分析降钙素原(PCT)、超敏C反应蛋白(hs-CRP)及白细胞(WBC)检测在肺部细菌感染中的诊断价值。选取我院50例肺部细菌感染者为观察组,另选取同时期肺部非细菌感染者49例为对照组,检测对比两组PCT、hs-CRP及WBC水平及各指标对肺部细菌感染诊断准确率、灵敏度、特异度、阳性预测值及阴性预测值。观察组PCT、hs-CRP及WBC水平均高于对照组,差异具有统计学意义(P0.05);PCT、hs-CRP及WBC检测对肺部细菌感染均具有较高检测准确率,且灵敏度、特异度、阳性预测值及阴性预测值均较高,联合检测检测准确率高于单一检测,联合检测特异度、阳性预测值高于WBC、hs-CRP单一检测,差异具有统计学意义(P0.05)。降钙素原、超敏C反应蛋白及白细胞联合检测在肺部细菌感染中具有较高诊断价值。     

3项指标联合检测在儿科感染性疾病中的临床应用

目的探讨降钙素原(PCT)、超敏C反应蛋白(hs-CRP)和白细胞计数(WBC)联合检测在儿科感染性疾病诊断中的应用。方法研究对象来源于该院收治的儿童,其中细菌性感染组226例,非感染性疾病组155例和健康对照组192例,检测血清中PCT、hs-CRP、WBC水平,并对结果进行统计分析。结果细菌性感染组PCT、hs-CRP和WBC水平明显升高,高于非感染性疾病组和健康对照组(P0.05);细菌性感染组PCT、hs-CRP和WBC检测的阳性率明显高于非感染性疾病组和健康对照组,差异有统计学意义(P0.05)。结论联合检测PCT、hs-CRP、WBC对鉴别细菌性感染和非感染性疾病具有重要参考价值,有助于诊断儿科感染性疾病的严重程度,指导早期治疗。     

组合检测指标在手足口病早期诊断中的价值

目的 探讨组合检测指标在早期诊断手足口病(HFMD)中的临床价值及其有效性.方法 选取手足口病患者100例,其中重症组、轻症组各50例,另设对照组30例,检测白细胞(WBC)、中性粒细胞计数及百分比(NEUT#、NEUT％)、高敏C反应蛋白(hs-CRP)、降钙素原(PCT)、白细胞介素6(IL-6)、血糖(GLU)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、病毒核酸类型等指标,观察上述指标在重症组、轻症组、对照组的变化.结果 重症组、轻症组IL-6、PCT、WBC、NEUT#、ALT、AST均显著高于对照组(P＜0.05),但重症组与轻症组之间比较,差异无统计学意义(P＞0.05);轻症组hs-CRP显著高于重症组和对照组(P＜0.01),而重症组与对照组之间差异无统计学意义(P＞0.05);重症组、轻症组、对照组之间NEUT％、GLU均差异无统计学意义(P＞0.05);肠道病毒71型(EV71)在重症组中占58.0％,轻症组占4.0％,其他通用型肠道病毒(包括CoxA16)在重、轻症组分别占42.0％、96.0％,并且差异有统计学意义(P ＜0.01).结论 HFMD重症组、轻症组在上述组合检测指标中大多与对照组有明显差异,但与病情无明显关系;病情重反而hs-CRP水平较低;EV71仍是重症HFMD的主要病毒类型.     

PCT、SAA、hs-CRP、Neu%和WBC检测对感染性疾病的临床诊断价值分析

目的探究血清降钙素原(PCT)、淀粉样蛋白A(SAA)、超敏C反应蛋白(hs-CRP)、中性粒细胞百分比(Neu%)和白细胞计数(WBC)对感染性疾病的早期诊断价值。方法选取2019年1-6月在同济大学附属同济医院门、急诊就诊的141例感染性疾病患者作为研究对象,将其分为非细菌性感染组(87例)和细菌性感染组(54例)。另选取同期该院体检科50例健康体检者作为对照组。检测3组血清PCT、SAA、hs-CRP、Neu%和WBC水平,并应用受试者工作曲线(ROC曲线)评价临床诊断价值。结果细菌性感染组PCT、SAA、hs-CRP、Neu%和WBC水平均高于非细菌感染组和对照组,差异均有统计学意义(P0.05);非细菌性感染组PCT、SAA、hs-CRP和Neu%水平均高于对照组,但低于细菌性感染组,差异均有统计学意义(P 0.05)。PCT、SAA、hs-CRP、Neu%和WBC用于诊断细菌性感染疾病的ROC曲线下面积分别为0.911、0.922、0.861、0.895、0.921。PCT、SAA、hs-CRP、Neu%和WBC用于诊断非细菌性感染疾病的ROC曲线下面积分别为0.870、0.830、0.751、0.736、0.537。PCT、SAA、hs-CRP、Neu%和WBC用于鉴别诊断细菌性和非细菌性感染的ROC曲线下面积分别为0.625、0.632、0.693、0.728、0.915。结论 PCT、SAA、hs-CRP、Neu%和WBC检测对感染性疾病有相应的早期诊断价值,同时可用于感染性疾病的鉴别诊断,从而指导临床合理用药。     

评价 PC T 、CRP、WBC计数、N EU T％在急、慢性感染性疾病中的对比应用

目的：评价联合检测降钙素原（PCT）、C反应蛋白（CRP）、白细胞（WBC）、中性粒细胞百分比（NEUT％）在急、慢性感染性疾病中的诊断价值。方法选取2014年1～5月收治的糖尿病患者（除外急性感染）152例（糖尿病组）,外科急性感染患者（包括烫伤感染、急腹症患者）62例（外科急性感染组）,以及体检健康者110例（健康对照组）,采用散射比浊法检测各组CRP水平,双抗体夹心免疫层析法检测PCT水平,全自动血细胞分析仪检测WBC计数及NEUT％。结果糖尿病组患者与健康对照组PCT和CRP水平、WBC计数及 NEUT％比较差异均无统计学意义（P＞0．05）。与健康对照组比较,外科急性感染组患者PCT和CRP水平、WBC计数及NEUT％均增高,比较差异均有统计学意义（P＜0．05）。结论急性感染性疾病患者 PCT 和CRP水平、WBC计数及NEUT％升高更明显,更有诊断价值。     

NLR、PLR联合CRP检测对手足口病患儿的临床价值

目的探讨外周血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)联合C反应蛋白(CRP)检测对手足口病(HFMD)患儿的临床诊断。方法将2016年5月至2017年9月该院住院的HFMD患儿112例作为病例组,并按病情分为普通组、重症组、危重症组及病死组,另以该院健康体检儿童42例作为对照组。检测2组研究对象的血常规和生化结果,收集白细胞(WBC)、中性粒细胞(NEUT)、淋巴细胞(LYMPH)、血小板(PLT)、CRP检查结果数据,并计算NLR、PLR值。结果随疾病加重,WBC、NEUT、LYMPH、NLR、PLR、CRP等免疫炎性指标水平呈升高趋势。2组WBC、CRP水平比较,差异均有统计学意义(P0.01);NEUT、NLR水平在危重组、重症组、普通组之间比较,差异有统计学意义(P0.05);重症组和普通组LYMPH高于对照组(P0.05);各组PLT、PLR水平均高于普通组和对照组(P0.05),其余各组间比较,差异无统计学意义(P0.05)。且NLR与WBC(R~2=0.34)、CRP(R~2=0.39)及PLR与WBC(R~2=0.21)、CRP(R~2=0.41)呈正相关(P0.05)。结论 NLR、PLR联合CRP检测与HFMD的发生、发展密切相关,可作为一种经济、简便的炎性指标,用于HFMD的诊疗及预后判断。     

Doing more with less and less with more

The "devil is in the details" of any policy response. What forms such changes may take, and what research informs them, are critical to the profession as a whole and to practitioners on a daily basis. Research partnerships between home care agencies and university professors may provide rigorous, systematic, and validated findings necessary for meaningful solutions (Plotkin & Roche, 2000). The evidence of a dialogue between nursing researchers, home healthcare practitioners, and policymakers anticipating impacts on practice of changing fiscal and information-gathering requirements is scant. Such issues are in need a priority discussion by agencies, and collaborative investigative efforts between all involved.     

Communicating with clients and colleagues with hearing loss

Abstract:

Aside from elderly relatives, some of us may have never had any direct personal experience with a person who is deaf or hard of hearing, and so may be unfamiliar with how to effectively communicate with these people. This can make for a very awkward, frustrating and possibly embarrassing experience for both parties. This author is a wearer of hearing aids herself, and would like to share some information on hearing loss and tips on effective communication with a person with hearing loss.     

Mindfulness and Coping with Dysphoric Mood: Contrasts with Rumination and Distraction

Past research has shown that rumination exacerbates dysphoric mood whereas distraction attenuates it. This research examined whether the practice of mindfulness meditation could reduce dysphoric mood even more effectively than distraction. A dysphoric mood was induced in 139 female and 38 male participants who were then randomly assigned to a rumination, distraction, or meditation condition. As predicted, participants instructed to meditate reported significantly lower levels of negative mood than those in either of the two other conditions. Distraction was associated with a lessening of dysphoric mood when compared to rumination but was not as effective as mindfulness meditation. The implications of these findings are discussed.     

Special problems with children and adolescents with diabetes.

Treatment of children and adolescents with insulin-dependent diabetes mellitus (type 1) is different in many ways than it is for adults. Physical, cognitive, and emotional development changes affect therapeutic goals and modalities. Neonatal, early childhood, school-age, and adolescent patients all have unique needs. Further, diabetes can affect psychosocial maturation and the likelihood of difficulties with mood.     

Interaction of peptidoglycans with anti-IgGs and with complement.

This report describes the interaction of peptidoglycan (Streptococcus group A, Staphylococcus epidermidis and Micrococcus lysodeikticus) with 2 serum mediator systems, namely with the anti-IgG system and with complement. The observation that the majority of rabbits hyperimmunized with A-variant streptococcal vaccine produced anti-group carbohydrate antisera containing anti-IgGs and antibodies directed to peptidoglycan suggested that the production of these 2 latter antibodies was related. This view was supported by the finding of a monoclonal 7S anti-IgG with antibody specificity for the pentapeptide of peptidoglycan as evidenced by inhibition of the coprecipitation of 7S anti-IgG with antigen-antibody complexes by the pentapeptide. Inhibition of the anti-idiotype reaction by the pentapeptide provided further evidence for the antibody specificity of 7S anti-IgG for peptidoglycan. When added to normal human sera all peptidoglycan preparations inhibited the hemolytic activity of the sera. Consumption of C3 in C2 deficient serum and consumption of C2 in normal serum indicated the activation of both known complement pathways. Activation of the classical pathway of complement was more efficient since 50 mug of peptidoglycan consumed approximately 70% of C2 per ml normal serum whereas more than 2 mg of the same preparations was required to inactivate 17-24% of C3 in C2 deficient sera. Each of the different peptidoglycan preparations consumed similar amounts of complement in all 20 sera tested. This finding suggested that activation of the classical complement pathway by peptidoglycan was not mediated by anti-peptidoglycan antibodies present in only 20-40% of normal human sera.     

Expanded timed up and go test with subjects with stroke: reliability and comparisons with matched healthy controls

Faria CD, Teixeira-Salmela LF, Silva EB, Nadeau S. Expanded Timed Up and Go test with subjects with stroke: reliability and comparisons with matched healthy controls.ObjectivesTo investigate the intra- and interrater reliabilities of the Expanded Timed Up and Go (ETUG) test with subjects with stroke and to compare the ETUG scores between subjects with stroke and healthy control subjects.DesignCross-sectional.SettingResearch laboratory.ParticipantsStroke participants (n=48; mean age ± SD, 59.29±15.84y) and healthy controls (n=48), matched by age, sex, and levels of physical activity.InterventionsNot applicable.Main Outcome MeasuresThe time spent to complete the ETUG in absolute (s) and ratio values regarding the percentages of the total time. Intraclass correlation coefficients (ICCs), Student t tests, and 95% confidence intervals were employed to investigate the reliability and differences between the groups (α<.05).ResultsBoth intra- and interrater reliabilities showed significant and excellent results for both groups for the absolute values (0.86≤ICC≤1.00; P<.001) and ratio values (0.55≤ICC≤0.99; P<.001). The mean time, in seconds, for all of the ETUG activities was higher for the subjects with stroke than for the control subjects (3.15≤t≤5.78; P<.001). However, when the comparisons considered the ratio values, no significant differences between the groups were found (0.45≤t≤1.15; 0.25≤P≤0.65). These results were confirmed by the 95% confidence interval.ConclusionsSubjects with stroke spent more time in all of the ETUG activities when compared with control subjects. All of the activities appeared to contribute similarly to the poorer performances observed in subjects with stroke, because the ratio values were similar between the groups. Considering the positive intra- and interrater reliability results, the ETUG could be applied to assess the functional mobility of both groups.     

Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm. Received: 25 January 2000/Accepted: 21 February 2001