发热原因待查208例临床分析

目的:分析总结208例发热原因待查(fever of unknown origin,FUO)患者的临床特点,指导临床FOU诊断。方法:回顾性分析208例FUO患者的临床表现、相关辅助检查、诊断经过、诊断性治疗等情况。结果:208例FUO患者最后确诊182例,确诊率为87.5%。182例确诊病例中感染性发热98例(53.8%),其中普通细菌感染51例(52.0%),结核感染36例(36.7%);非感染性发热84例(46.2%),其中风湿病57例(67.9%),恶性肿瘤17例(20.2%)。结论:感染性发热仍是临床上发热最常见的原因。结核感染、结缔组织病及造血系统恶性肿瘤所致的发热是FUO常见的原因:一些疑似的结核病可积极进行诊断性治疗,并积极病理组织活检以明确诊断。发热原因待查患者中结缔组织病的比例较前有明显提升,结缔组织病合并感染也可引起高热,需引起足够重视,以免误诊。     

小儿结核病患病因素调查分析

目的:了解小儿结核病患者的患病因素,为预防小儿结核病的发生提供临床参考。方法:抽取河南省胸科医院2011年1月~2011年12月门诊小儿结核病患者46例,从患者的有无接触结核病患者史、结核家族史、有无接种卡介苗、起居环境、体弱多病、不明原因等方面进行分析小儿肺结核的患病因素。结果:有结核家族史的15例(32.61%),接触结核患者史的有10例(21.74%),未接种卡介苗的7例(15.22%),起居环境潮湿不经常通风的5例(10.87%),接种卡介苗4例(8.70%),体弱多病的3例(6.52%),不明原因2例(4.34%)。结论:预防小儿结核,让小儿远离传染源、积极接种卡介苗、起居环境通风干燥、对体弱多病的小儿增强营养、适当的体育锻炼以增强免疫力,可减少感染结核的机会。     

67例艾滋病合并新生隐球菌性脑膜脑炎临床分析

目的探讨艾滋病合并新生隐球菌性脑膜脑炎的临床特点及预后。方法回顾性收集2010年1月1日～2016年12月31日于北京佑安医院住院治疗的艾滋病合并新生隐球菌性脑膜脑炎患者,分析临床表现、实验室特点、治疗方案及转归。结果共67例患者确诊为艾滋病合并新生隐球菌性脑膜脑炎(男60例,女7例)。主要临床表现为头痛(74.6%),发热(47.8%)和恶心呕吐(40.3%),为最常见的3个症状。最常见的辅助检查异常是颅内压升高(78.9%),平均216.6 (±100.3 mmH_2O)。实验室检查CD4~+T细胞计数为53.7(±79.9)个/mm~3。本组患者病死率29.9%%(20/67)。结论新生隐球菌性脑膜脑炎是艾滋病患者的严重并发症,降低隐球菌性脑膜脑炎病死率的关键是早期诊断及充分、规范的治疗,以减少隐球菌对脑实质的损伤,挽救患者生命。     

泌尿系结核行肾切除术76例临床分析

目的:总结泌尿系结核行肾切除术患者的临床特点,探讨诊治对策。方法:回顾分析2002年1月至2009年1月在我院施行肾切除术的泌尿系结核患者的临床资料。结果:入组76例,常见主诉为:尿路刺激症状(72.4%),血尿(46.1%),肾区疼痛(40.8%)等。常用检查手段:尿常规异常率为82.9%,B超诊断率为21.1%,静脉肾盂造影诊断率为51.6%,CT诊断率为75.0%。所有患者均经抗结核药物治疗。肾切除治疗效果满意。结论:降低泌尿系结核患者肾切除率的关键在于早期诊断,规范抗结核治疗。应加强对该病的认识,仔细分析病史,熟悉该病临床表现,各检查结果特点。     

40例艾滋病合并肺结核患者的临床研究

目的总结艾滋病合并肺结核患者的临床特点及诊治方法。方法对2014年1~10月我院收治的艾滋病合并肺结核患者40例的临床资料进行回顾性分析,总结其症状体征、影像学特点、感染途径、治疗方法和效果等。结果本组患者以青壮年居多,人类免疫缺陷病毒(HIV)感染途径主要是血液接触、性接触、静脉注射毒品;主要症状为持续发热(82.5%),明显消瘦(92.5%),纳差、乏力、全身酸痛(100%),咳嗽、咳痰(72.5%)。肺结核经X线检查均有结核影像学表现,无典型病变部位;痰培养或痰涂片检查,19例阳性;结核菌素(PPD)实验,16例呈阳性。结论艾滋病合并肺结核无典型的临床表现,临床上应提高认识,加强检测,避免二者相互作用。治疗上尽可能同时进行抗结核与抗HIV治疗,以降低死亡率,延长患者的生存期。     

慢性肺曲霉菌病55例临床分析

目的分析慢性肺曲霉菌病(CPA)临床特点,为诊断和治疗提供依据。方法回顾性分析55例临床诊断CPA患者的临床资料、影像学特征及实验室检查。结果在诊断为CPA55例患者中,34例诊断为慢性空洞性肺曲霉病,15例亚急性侵袭性肺曲霉菌病,4例单纯性肺曲霉菌球,2例曲霉菌结节。在CPA患者中合并慢性阻塞性肺疾病29例(52.7%),恶性肿瘤6例(10.9%)、肺结核5例(9.1%)、哮喘4例(7.3%)、支气管扩张4例(7.3%)、间质性肺疾病1例(1.8%)。CPA患者最常见症状是咳嗽(94.5%)、咳痰(81.8%)、咯血(54.5%)和发热(36.4%)。最常见胸部CT扫描异常是空腔(96.4%)、结节(63.6%)、渗出或实变(7.3%)和胸膜增厚(5.5%)。结论 CPA患者多合并慢性阻塞性肺疾病、恶性肿瘤、肺结核、哮喘、支气管扩张、间质性肺疾病,慢性空洞性肺曲霉病是CPA患者最常见的类型。积极寻找病原学和影像学证据,必要时行肺穿刺及肺切除手术,尽早开始抗真菌治疗,改善CPA患者的预后。     

32例噬血细胞综合征实验室检查及临床分析

目的分析继发性噬血细胞综合征(HPS)患者的实验室指标及临床特点,以提高对该病的认识。方法对2005年6月~2015年6月在广西肿瘤防治研究所治疗的32例继发性HPS患者的病因、临床表现、实验室特征、治疗及预后等进行分析。结果 32例患者中,血液系统肿瘤17例,单纯感染13例,自身免疫性疾病2例。临床上以发热(100%)、肝脾(87.5%)及淋巴结(43.8%)肿大为主要表现。实验室检查以血细胞减少(100%)、铁蛋白升高(96.9%)、自然杀伤细胞活性降低或缺失(96.9%)为主,纤维蛋白原降低(68.8%),甘油三酯升高(56.3%),81.3%的患者骨髓涂片检查可见噬血细胞现象。结论继发性HPS可由多种病因引起,临床表现多样,对可疑患者及时进行相关实验室检查有助于早期明确诊断;合并多脏器衰竭、DIC的患者预后不良。     

抗结核药致药物性肝损伤相关因素研究

目的分析抗结核药物引发药物性肝损伤的影响因素。方法回顾性分析2016年6月~2017年7月在我院就诊的500例结核病患者的临床资料,以评估其药物性肝损伤的发生情况及相关危险因素。结果抗结核治疗的500例患者中出现药物性肝损伤50例(10.0%),药物性肝损伤的发生与吸烟、饮酒、结核类型、年龄等因素密切相关(P0.05)。结论抗结核治疗出现药物性肝损伤与吸烟、饮酒、脂肪肝、血吸虫病史、结核类型、年龄等因素密切相关。     

老年难愈性创面患者临床特征及创面细菌学分析

目的分析老年难愈性创面患者的临床特征、创面细菌学及疗效,为临床治疗提供参考依据。方法回顾性分析我科2012年1月至2017年12月收治的114例老年难愈性创面患者的临床资料。对患者合并内科基础疾病、生理机能状况、创面病因和部位、创面分泌物细菌和多重耐药菌分布、创面治疗效果等进行分析。结果患者常见内科基础疾病有高血压(63例)、糖尿病(42例)、脑血管疾病(38例)和心脏病(31例),常见生理指标异常为白蛋白降低(89例)和贫血(70例)。本组共有186处创面(37例患者有1个以上创面),常见病因为烧伤(44.62%)、压迫(35.48%),常见病变部位为下肢(67.74%)。创面分离出病原菌113株,革兰阴性菌占71.68%。常见菌为铜绿假单胞菌(35.40%)、金黄色葡萄球菌(25.66%)、大肠埃希菌(12.39%)。多重耐药菌检出率为71.68%(81/113)。本组创面的治疗效果为:治愈94处、好转64处、未愈28处。38.17%创面进行了手术治疗。手术治疗的疗效为治愈58处、好转10处、未愈3处,明显优于非手术治疗(Z=-6.478,P=0.000)。结论老年难愈性创面患者合并内科基础病多、生理机能状况差,创面细菌以革兰阴性球菌为主、多重耐药菌比例高,创面治疗效果偏差,手术比例低,但手术治疗取得了较好疗效。     

西藏64例结核性脑膜炎临床分析

目的:总结西藏地区结核性脑膜脑炎的临床特点.方法:回顾分析2009年1月至2012年1月在西藏军区总医院感染结核科住院治疗的结核性脑膜脑炎患者64例,总结分析其临床特点及实验室、影像学检查结果.结果:临床表现中发热、头痛病例较高,神经系统症状并发症占总病例数比例高达53.1％(34/64).脑脊液改变:蛋白(0.16-7.5)g/L,平均(2.13± 1.61)g/L;糖定量(0.2-4.0)mmol/L,平均(1.49± 0.96)mmol/L;氯化物(92.3-124.7) mmol/L,平均(106.8± 7.51) mmol/L.头颅影像异常29例(45.3％),其中脑积水25例(39.1％),脑梗死2例(3.1％),脑膜增厚2例(3.1％).64例患者经治疗后,好转46例(72％),在院死亡8例(12.5％),自动出院10例(15.6％).结论:西藏地区结核性脑膜炎患者以成人为主,在临床特点及实验室、影像学检查结果方面有自身地域和民族特点,及时诊治预后较好.     

Recent advances in the study of Kaposi's sarcoma-associated herpesvirus replication and pathogenesis

It has now been over twenty years since a novel herpesviral genome was identified in Kaposi's sarcoma biopsies. Since then, the cumulative research effort by molecular biologists, virologists, clinicians, and epidemiologists alike has led to the extensive characterization of this tumor virus, Kaposi's sarcoma-associated herpesvirus(KSHV; also known as human herpesvirus 8(HHV-8)), and its associated diseases. Here we review the current knowledge of KSHV biology and pathogenesis, with a particular emphasis on new and exciting advances in the field of epigenetics. We also discuss the development and practicality of various cell culture and animal model systems to study KSHV replication and pathogenesis.     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

The structure, reproduction and taxonomy of Vidalia and Osmundaria (Rhodophyta, Rhodomelaceae)

Comprises species occurring mostly in subtidal habitats in tropical, subtropical and warm-temperate areas of the world. An analysis of the type species, V. spiralis (Sonder) Lamouroux ex J. Agardh, a species from Australia, establishes basic characters for distinguishing species in the genus. These characters are (1) branching patterns of thalli, (2) flat blades that may be spiralled on their axis, (3) width of the blade, (4) primary or secondary derivation of sterile and fertile branchlets and (5) position of sterile and fertile branchlets on the thalli. Application of the latter two characters provides an important basic method for separation of species into three major groups. Osmundaria , a genus known only in southern Australia, was studied in relation to Vidalia , and its separation from the Vidalia assemblage is not accepted. Species of Vidalia therefore are transferred to the older genus name, Osmundaria. Two new species, Osmundaria papenfussii and Osmundaria oliveae are described from Natal. Confusion in the usage of the epithet, Vidalia fimbriala Brown ex Turner has been clarified, and Vidalia gregaria Falkenberg, described as an epiphyte on Osmundaria pro/ifera Lamouroux, is revealed to be young branches of the host, Osmundaria prolifera.     

New or rare chromosome counts in Artemisia L. (Asteraceae, Anthemideae) and related genera from Kazakhstan

Fifteen chromosome counts of six Artemisia taxa and one species of each of the genera Brachanthemum, Hippolytia, Kaschgaria, Lepidolopsis and Turaniphytum are reported from Kazakhstan. Three of them are new reports, two are not consistent with previous counts and the remainder are confirmations of very scarce (one to four) earlier records. All the populations studied have the same basic chromosome number, x = 9, with ploidy levels ranging from 2x to 6x. Some correlations between ploidy level, morphological characters and distribution are noted.