HIV合并肺结核与单纯肺结核的临床特征分析及抗结核治疗效果对比

目的:分析HIV合并肺结核患者的临床特征及抗结核治疗的疗效。方法:将我院收治的HIV感染合并肺结核初治患者53例作为A组,将同期收治的单纯肺结核患者176例作为B组,对两组患者临床资料、实验室检查结果以及治疗效果等进行回顾性分析。结果:A组患者并发症发生率以及肺外结核发生率显著高于B组(P0.05),A组咳嗽发生率低于B组,但发热发生率高于B组(P0.05);A组患者斑点实验、PPD实验、痰查抗酸杆菌阳性率均低于B组(P0.05),A组患者肝功能异常、肾功能异常以及CD4+计数200发生率高于B组(P0.05);A组抗结核治疗的临床疗效低于B组(P0.05);两组患者治疗后CD4+水平均高于治疗前,且B组高于A组(P0.05)。结论:与单纯感染肺结核的患者相比,HIV合并肺结核患者并发症以及肺外结核发生率较高,实验室相关检查敏感性较低,抗结核治疗的效果较差,临床应给予重视。     

肺结核的药物治疗

几千年来,结核病的治疗是一个困扰世人的难题,结核病死亡的人数一直占据了因病死亡的第一位。直到20世纪中叶,人们才真正找到治疗结核病的有效办法。     

肺结核的药物治疗

几千年来,结核病的治疗是一个困扰世人的难题,结核病死亡的人数一直占据了因病死亡的第一位。直到20世纪中叶,人们才真正找到治疗结核病的有效办法。     

肺结核合并肺癌患者的临床分析

目的：探讨肺结核合并肺癌的临床特点,提高临床医师诊断肺结核合并肺癌的警惕性。方法：对2000年1月至2009年12月在我院诊断为肺结核、肺结核合并肺癌、肺癌患者各40例进行回顾性分析。结果：三组之间的临床表现与实验室检查进行相互比较,发现其临床表现并无统计学差异,影像学与支气管镜检查有明显统计学差异外,其他实验室检查无差异。结论：结核合并肺癌与肺结核、肺癌等临床表现、实验室检查近似,易造成漏诊、误诊,临床医师应提高警惕,及时行影像学及支气管镜等检查。     

肺结核合并肺癌患者的临床分析

目的:探讨肺结核合并肺癌的临床特点,提高临床医师诊断肺结核合并肺癌的警惕性.方法:对2000年1月至2009年12月在我院诊断为肺结核、肺结核合并肺癌、肺癌患者各40例进行回顾性分析.结果:三组之间的临床表现与实验室检查进行相互比较,发现其临床表现并无统计学差异,影像学与支气管镜检查有明显统计学差异外,其他实验室检查无差异.结论:结核合并肺癌与肺结核、肺癌等临床表现、实验室检查近似,易造成漏诊、误诊,临床医师应提高警惕,及时行影像学及支气管镜等检查.     

肺结核咯血患者的心理分析

目的：提高肺结核咯血患者的康复成功率。方法：对40例肺结核咳血患者的早期症状、心理特点进行分析．采取相应的护理措施。结果：40例大咯血患者中,无1例发生窒息。结论：通过对40例咯血患者心理特点进行分析,及时进行心理疏导。可以促进患者的早日康复。     

肺结核患者血细胞结果特点分析

目的:为肺结核的诊断及观察预后提出新的思路。方法:对新住院肺结核患者的血常规标本400份及以上患者出院前血常规标本400份,使用MEK-6318K血细胞分析仪检测分析。结果:新住院400例肺结核患者中血小板计数>300×109/L的92例,占23%。92例血小板计数升高的患者中,除9例贫血患者外,83例患者中红细胞计数和血红蛋白量都不低于参考值,但红细胞计数和血红蛋白量呈现不一致性,即针对血红蛋白量而红细胞计数偏高,体现出小红细胞少量增多,这种情况在83例中所占比例为86%。出院前400例肺结核患者血小板计数>300×109/L的5例,占1.2%。结论:由于肺结核患者大多数伴有营养不良,导致造血系统功能障碍,导致小红细胞少量增多,增多的小红细胞被血细胞分析仪计数到血小板计数里,导致血小板计数偏高。这个指标在肺结核诊断中意义很大,为肺结核的诊断探索出新的思路。     

特殊人群甲真菌病的流行病学研究现状

甲真菌病在特殊人群中发病特点各不相同.在年长人群中,发病率随年龄增大而增高.老年人中,指、趾甲同时受累多、TDO型多、混和性真菌感染多;中青年中,常见是DLSO和WSO,WSO随年龄增大而增多,皮肤癣菌感染多见,但年龄越大念珠菌、霉菌感染越多;在穿高跟鞋女性人群中,年穿高跟鞋时间与甲真菌病发病机会、严重程度呈正相关,以DLSO多见,小趾、拇趾多发;在糖尿病人群中,发病率是17%,以Ⅱ型糖尿病为甚,常见类型是DLSO,指甲念珠菌分离率极高,患病时间是严重程度的影响预后因素;在银屑病人群中,甲改变患者培养阳性率是18%,常见类型是TDO,分离真菌最多的是霉菌,以关节病型银屑病真菌感染最多;在肾移植人群中,发病率是12.7%,常见类型是PWSO,分离真菌常见是红色毛癣菌和须癣毛癣菌;HIV人群中,发病率是23.2%,PWSO是HIV感染的早期临床征象,甲真菌病出现概率和CD4细胞计数呈负相关;慢性病毒性肝炎人群的流行特点未有报道.     

肺结核咯血患者的心理分析

目的:提高肺结核咯血患者的康复成功率。方法:对40例肺结核咳血患者的早期症状、心理特点进行分析,采取相应的护理措施。结果:40例大咯血患者中,无1例发生窒息。结论:通过对40例咯血患者心理特点进行分析,及时进行心理疏导,可以促进患者的早日康复。     

肺结核患者食物摄入水平对抗结核治疗效果的影响

目的：探讨肺结核患者的食物摄入水平对抗结核治疗效果的影响,为抗结核治疗患者的营养指导提供科学依据。方法：选取2009—2013年山东省某市县区确诊的肺结核患者作为研究对象,通过问卷调查收集其基本信息,测量患者的身高和体重,计算体质指数（BMI）。应用半定量食物频率表收集调查对象1 w 9类食物的消费情况,采用食物多样化评分（DDS）-9分类法评估膳食多样性,1～3分为膳食多样性不足、4～6分为适中、7～9分为充足。根据中国膳食宝塔将9类食物合并为5类,计算5类食物每日的平均摄入量。追踪随访研究对象的停药原因,使用多因素Logistic回归模型,分析食物摄入水平对抗结核治疗效果的影响。结果：本研究共纳入肺结核患者2 711名,其中未治愈的患者共有147名,占总人数的5.4%。膳食调查结果显示,治愈和未治愈患者的DDS、动物性食物摄入量和蔬菜水果类食物摄入量均呈现显著差异（P均＜0.05）。膳食多样性为不足、适中和充足者的未治愈率分别为11.4%、6.3%和4.3%。与食物多样性不足相比,食物多样性充足可显著降低结核治疗失败的风险,校正混杂因素影响后OR值为0.42（95%CI：0.21~0.81）。采用五分位法计算获得结核病患者平均每日摄入动物性食物量分别为0～250 g、250～300 g、300～400 g、400～550 g、≥550 g,其未治愈率分别为9.7%、3.4%、5.5%、4.6%、3.2%。随着动物性食物摄入增加,结核未治愈率下降（P＜0.01）。与动物性食物摄入量≤250 g/d相比,动物性食物摄入量＞250 g/d可降低抗结核治疗失败的风险。平均每天摄入蔬菜水果类食物量为0～200 g、200～300 g、300～350 g、350～400 g、≥400 g的患者,其未治愈率分别为9.1%、7.2%、4.9%、3.6%、4.4%。随着蔬菜水果类食物摄入增加,结核未治愈率下降（P=0.002）。与蔬菜水果类食物摄入量≤200 g/d相比,蔬菜水果类食物摄入量＞350 g/d可降低抗结核治疗失败的风险。结论：抗结核治疗患者的食物摄入水平可影响抗结核治疗效果,食物多样性、动物性食物和蔬菜水果类食物摄入量的增加,可有效降低抗结核治疗未治愈的风险。     

On treatment of tuberculosis in heterogeneous populations

Global eradication of tuberculosis (TB) is an international agenda. Thus understanding effects of treatment of TB in different settings is crucial. In previous work, we introduced the framework for a mathematical model of epidemic TB in demographically distinct, heterogeneous populations. Simulations showed the importance of genetic susceptibility in determining endemic prevalence levels. In the work presented here, we include treatment and investigate different strategies for treatment of latent and active TB disease in heterogeneous populations. We illustrate how the presence of a genetically susceptible subpopulation dramatically alters effects of treatment in the same way a core population does in the setting of sexually transmitted diseases. In addition, we evaluate treatment strategies that focus specifically on this subpopulation, and our results indicate that genetically susceptible subpopulations should be accounted for when designing treatment strategies to achieve the greatest reduction in disease prevalence.     

2型糖尿病易感候选基因在世界不同人群中的多样性比较分析

近10年来兴起的全基因组关联分析（Genome-wide association study, GWAS）相关研究结果获得了大量与2型糖尿病相关的候选易感基因,了解这些候选基因在正常人群中的遗传多样性程度以及在不同人群间的遗传差异,不但有助于阐明2型糖尿病的遗传机理,而且对于今后在特定人群中进行2型糖尿病发病机制的深入研究具有指导意义。本研究通过对GWAS数据库和相关文献的搜索和整理确定了170个与2型糖尿病相关的基因或基因区域;随后基于千人基因组计划的全基因组测序数据对这些候选基因在世界范围内14个人群间的遗传多样性进行了比较分析;进一步确定了在人群间存在显著差异的易感基因,并分析了这些基因的多样性特征。在所研究的14个世界人群中,2型糖尿病候选易感基因的遗传多样性与基因组范围的平均水平没有显著差异;但其中8个易感基因IL20RA、RNMTL1-NXN、NOTCH2、ADRA2A-BTBD7P2、TBC1D4、RBM38-HMGB1P1、UBE2E2和PPARD在群体间呈现显著差异,其中最明显的是IL20RA基因 (FST=0.152),该易感基因在非洲人群和非非洲人群间存在显著等位基因频率和单倍型频率差异。14个人群中易感基因遗传结构差异的主要原因是由于非洲人群与非非洲人群之间的群体遗传结构的不同所造成的。进一步比较东西方人群间的2型糖尿病候选基因遗传结构差异,发现在东西方人群中同样存在明显的群体遗传结构差别,其中DGKB-AGMO(FST=0.173)和JAZF1(FST=0.182)是差异最显著的易感基因。本研究通过对群体间2型糖尿病易感基因遗传结构进行比较,鉴别出一些差异特别显著的易感基因,对今后2型糖尿病易感基因与不同人群间发病率和易感性差异的相关研究提供重要参考。     

Adverse effects of praziquantel treatment of Schistosoma japonicum infection: involvement of host anaphylactic reactions induced by parasite antigen release

The present study using a murine model heavily infected with Schistosoma japonicum aimed to elucidate the pathogenesis of adverse effects of praziquantel treatment of schistosome-infected subjects. Inbred BALB/c mice were infected with S. japonicum (Yamanashi strain) before being treated with a single dose of praziquantel at 4 or 8 weeks p.i. All the mice treated at 8 weeks p.i. exhibited signs typical of systemic anaphylaxis until half of them died shortly after praziquantel administration. At autopsy, these mice exhibited remarkable intestinal alterations characterised by increased mucosal permeability, mucosal oedema and petechial haemorrhage, which are changes typical of immediate intestinal anaphylaxis. In these mice treated at 8 weeks p.i., degranulation of intestinal mast cells was frequently observed, which was particularly remarkable around S. japonicum eggs hatched as an effect of praziquantel. Furthermore, the plasma histamine concentration just after praziquantel treatment was much higher in mice at 8 weeks p.i. than that in uninfected mice or in S. japonicum-infected mice without drug treatment. In contrast, none of these intestinal changes was observed in untreated or uninfected control mice, or in mice administered praziquantel at 4 weeks p.i., in which worm pairs had just reached sexual maturation and begun egg-laying. The finding by ELISA that serum IgM and IgA levels specific to S. japonicum eggs decreased immediately after praziquantel treatment, together with the results of immunohistochemistry, revealed the sudden release of parasite antigens from the eggs hatched by praziquantel treatment. The results of this study demonstrate that adverse effects of praziquantel treatment of schistosomiasis characterised by abdominal signs depend on anaphylactic reactions due to parasite antigens, especially antigens from eggs hatched as an effect of praziquantel.     

本体OAE对我国上市疫苗相关不良反应表征研究的可行性分析

从广义上来说,疫苗也是一种药物。由于疫苗是接种到成千上万的健康人群用来预防各类传染性疾病,因此对其安全性的要求要比传统药物更高。保证上市疫苗的安全性可以增强广大民众对疫苗的信心,提高疫苗接种的接受度和普及度,进而实现巨大的社会医疗经济效益。当前,我国疫苗年使用量超过世界任何一个国家或地区,但是受制于数据来源匮乏、研究方法缺失等客观因素,我国关于上市疫苗安全性及其相关不良反应的分析研究明显滞后与不足。本文,我们系统地介绍了时下不良反应研究领域热门的数据标准化与整合工具不良反应本体OAE及其在疫苗不良反应研究中的进展情况,并探讨将其引入到我国疫苗相关不良反应报告体系中的可行性,这将为未来我国上市疫苗安全监督体制的完善及后续科研分析带来极大的促进作用。     

Paleopathology in an Iroquoian ossuary, with special reference to tuberculosis

Pathological skeletal remains from the Uxbridge Ossuary (1490 +/- 80 A.D., N = 457) are classified into four broad categories: trauma, congenital disability, tumor, and infection. Traumatic injuries are relatively common (fractures in 5-9.4% of total), considering the date and subsistence pattern of the population. Congenital disabilities and tumors are rare, affecting approximately 2% of the population. Nonspecific periosteitis and osteitis affect 5% of the sample. By far the most common pathological skeletal changes are lytic lesions leading to cavitation of cancellous bone, especially in the lower vertebral and sacro-iliac regions. It is argued that the changes seen and their distribution are most consistent with a diagnosis of tuberculosis. Applying clinical observations regarding bone involvement, it is estimated that a minimum of 26 skeletons were affected. This in turn indicates a very high population tuberculosis incidence. The Uxbridge sample is neither the only nor the earliest Iroquoian ossuary to display apparent tuberculosis (Hartney 1981). The common presence of this disease in some communities and its low incidence in others are discussed in the context of the epidemic wave phenomenon. There is strong evidence for warfare at Uxbridge, and this warfare may have produced crowding, poor hygiene and diet, such that the disease could flourish.     

Approach to equilibrium in age structured populations with an increasing recruitment process

This paper considers a model for the dynamics of an age structured population subject to a density dependent factor which regulates the recruitment. Certain properties of biological interest are obtained and the stability of the equilibrium age distributions is investigated. Finally some applications to known fishery models are considered.Work done under the contract 80.02333.01 of C.N.R.     

Frequency responses of age-structured populations: Pacific salmon as an example

Increasing evidence of the effects of changing climate on physical ocean conditions and long-term changes in fish populations adds to the need to understand the effects of stochastic forcing on marine populations. Cohort resonance is of particular interest because it involves selective sensitivity to specific time scales of environmental variability, including that of mean age of reproduction, and, more importantly, very low frequencies (i.e., trends). We present an age-structured model for two Pacific salmon species with environmental variability in survival rate and in individual growth rate, hence spawning age distribution. We use computed frequency response curves and analysis of the linearized dynamics to obtain two main results. First, the frequency response of the population is affected by the life history stage at which variability affects the population; varying growth rate tends to excite periodic resonance in age structure, while varying survival tends to excite low frequency fluctuation with more effect on total population size. Second, decreasing adult survival strengthens the cohort resonance effect at all frequencies, a finding that addresses the question of how fishing and climate change will interact.     

Monoclonal antibodies: Longitudinal prescribing information analysis of hypersensitivity reactions

Monoclonal antibodies (mAbs) are known to cause hypersensitivity reactions (HSRs). The reactions pose a significant challenge to investigators, regulators, and health providers. Because HSRs cannot be predicted through the pharmacological basis of a therapy, clinical data are often relied upon to detect the reactions. Unfortunately, clinical studies are often unable to adequately characterize HSRs especially in therapies for orphan diseases. HSRs can go undetected until post-marketing safety surveillance when a large number of patients have been exposed to the therapy. The presented data demonstrates how hypersensitivity reaction warnings have changed over time in the prescribing information (PI), i.e., the drug package insert, through August 1, 2011 for 28 US-marketed mAbs. Tracking all PI revisions for each mAb over time revealed that hypersensitivity warning statements were expanded to include more severe manifestations. Over the course of a mAb therapy’s life cycle, the hypersensitivity warning is twice more likely to be upgraded than downgraded in priority. Approximately 85% of hypersensitivity-associated fatality warnings were added in PI revisions as a result of post-marketing experience. Over 60% (20/33) of revisions to hypersensitivity warnings occurred within 3–4 y of product approval. While HSRs are generally recognized and described in the initial PI of mAbs, fatal HSRs are most commonly observed in post-marketing surveillance. Results of this study suggest that initial product labeling information may not describe rare but clinically significant occurrences of severe or fatal HSRs, but subsequent label revisions include rare events observed during post-marketed product use.     

舒芬太尼、瑞芬太尼在急诊脑外伤手术麻醉中的临床应用

目的:探讨急诊脑外伤手术麻醉中舒芬太尼、瑞芬太尼的应用及其不良反应。方法:择取200例脑外伤患者随机分为研究组和对照组,手术前用多功能的监护仪实时监测相关血流动力学指标,麻醉诱导后,气管插管连接麻醉机行呼吸控制,研究组静脉泵注舒芬太尼,对照组静脉泵注瑞芬太尼,待病情稳定后,观察患者治疗后的血流动力学指标、手术情况、苏醒后恢复情况及不良反应。结果:1与对照组比较,治疗后的研究组患者除Sp O_2指标没有明显差异外,SBP、DBP、HR均明显高于对照组(P均0.05);2研究组患者麻醉维持时间明显多于对照组,而自主呼吸时间、、睁眼时间及意识清醒时间明显少于对照组(P均0.05);3研究组患者的手术时间、术后置管的时间、住院时间、住ICU时间、VAS评分均明显低于对照组(P均0.05);4研究组患者不良反应发生率为3%,明显低于对照组(P0.05)。结论:舒芬太尼在急诊脑外伤手术中的麻醉效果及不良反应发生率要明显好于瑞芬太尼,若患者没有禁忌、药物过敏反应,舒芬太尼为急诊脑外伤手术的首选麻醉药物。     

Monoclonal antibodies: Longitudinal prescribing information analysis of hypersensitivity reactions

Monoclonal antibodies (mAbs) are known to cause hypersensitivity reactions (HSRs). The reactions pose a significant challenge to investigators, regulators, and health providers. Because HSRs cannot be predicted through the pharmacological basis of a therapy, clinical data are often relied upon to detect the reactions. Unfortunately, clinical studies are often unable to adequately characterize HSRs especially in therapies for orphan diseases. HSRs can go undetected until post-marketing safety surveillance when a large number of patients have been exposed to the therapy. The presented data demonstrates how hypersensitivity reaction warnings have changed over time in the prescribing information (PI), i.e., the drug package insert, through August 1, 2011 for 28 US-marketed mAbs. Tracking all PI revisions for each mAb over time revealed that hypersensitivity warning statements were expanded to include more severe manifestations. Over the course of a mAb therapy’s life cycle, the hypersensitivity warning is twice more likely to be upgraded than downgraded in priority. Approximately 85% of hypersensitivity-associated fatality warnings were added in PI revisions as a result of post-marketing experience. Over 60% (20/33) of revisions to hypersensitivity warnings occurred within 3–4 y of product approval. While HSRs are generally recognized and described in the initial PI of mAbs, fatal HSRs are most commonly observed in post-marketing surveillance. Results of this study suggest that initial product labeling information may not describe rare but clinically significant occurrences of severe or fatal HSRs, but subsequent label revisions include rare events observed during post-marketed product use.