脓毒症患者PtcO2PtcCO2的监测意义及对预后的评估作用研究

目的:探讨脓毒症患者无创经皮组织氧分压(tcpO_2)和二氧化碳分压(tcpCO_2)的监测意义及用于患者预后评估的价值。方法:选择2016年1月至2018年12月我院接诊的80例脓毒症患者进行研究,根据监测方式的不同分为观察组(n=50)和对照组(n=30)。对照组患者采用常规监测动脉血气,观察组患者采用经皮氧分压/二氧化碳分压连续监测,并根据相关数据指导液体复苏,提高氧输送,并追踪患者预后。分析和比较两组的tcpO_2、tcpCO_2、氧偏移度及急性生理与慢性健康评分Ⅱ(APACHEⅡ)在脓毒症的变化及诊断价值。结果:观察组患者tcpO_2、tcpCO_2、氧偏移度及APACHEⅡ均明显高于对照组(P0.05);两组死亡组患者tcpO_2、氧偏移度及APACHEⅡ均显著高于存活组、而tcpCO_2低于存活组(P0.05);logistic回归分析显示tcpO_2、tcpCO_2均与氧偏移度及APACHEⅡ呈显著正相关(P0.05);tcpO_2诊断脓毒症的AUC为0.806,95%CI为0.710～0.902;tcpCO_2诊断脓毒症的AUC为0.723,95%CI为0.608～0.839;氧偏移度诊断脓毒症的AUC为0.970,95%CI为0.938～1.000;APACHEⅡ诊断脓毒症的AUC为0.932,95%CI为0.879～0.985;联合检测诊断脓毒症的AUC为0.997,95%CI为0.989～1.000,联合检测的特异度、准确度分别为93.74%、95.68%,显著高于各指标单独检测(P0.05)。结论:经皮氧/二氧化碳分压监测装置早期监测有助于早期评估脓毒症的严重程度与预后。     

持续脑电双频指数监测在脓毒症相关性脑病患者中的应用价值

目的:探讨持续脑电双频指数监测(Bispectral Index,BIS)用于脓毒症相关性脑病患者诊断及病情评估的临床应用价值。方法:选择2015年1月-2018年6月我院重症加强治疗病房(Intensive Care Unit,ICU)收治的脓毒症患者90例,其中38例患者出现脓毒症相关性脑病(脑病组),其余52例患者为非脓毒症相关性脑病(非脑病组)。所有患者在入住ICU后进行BIS持续监测24 h,并比较两组患者的血清降钙素原(procalcitonin,PCT)、S100β水平,并分析BIS与格拉斯哥昏迷评分(glasgow coma scale,GCS)、APACHE-Ⅱ的相关性。结果:脑病组患者的血清PCT、S100β水平及急性生理健康与慢性疾病评分(Acute Physiology and Chronic Health EvaluationⅡscore,APACHE-II)均明显高于非脑病组(P0.05),而BIS值、GCS评分均明显低于非脑病组(P0.05)。脓毒症相关性脑病患者BIS值与GCS评分呈正显著相关性(r=0.487,P=0.013),与APACHE-II评分呈明显负相关性(r=-0.682,P=0.027)。结论:采用BIS监测脓毒症患者利于相关性脑病的及早诊断,结合检测血清PCT、S100β水平变化可能有助于判断患者的病情严重程度。     

动态监测血清降钙素原对多发伤患者并发脓毒症的诊断价值

目的:探讨动态监测血清降钙素原(PCT)对多发伤合并脓毒症的诊断价值。方法:选取我院重症监护室并发脓毒症的多发伤患者21例(Sepsis组)、无并发脓毒症的多发伤患者20例(非Sepsis组),连续检测患者入院第1、3、5、7 d血清中的PCT含量,并测定C反应蛋白和白细胞计数。结果:Sepsis组血清PCT浓度明显高于非Sepsis组(P<0.01);不同程度脓毒症患者间PCT水平有显著差异,随严重程度升高而升高(P<0.01)。结论:血清PCT对多发伤患者合并脓毒症的诊断具有重要价值,且血清PCT水平与脓毒症的严重程度有关,监测其动态变化有助于预后判断。     

microRNA参与脓毒症免疫调控机制研究进展

脓毒症是重症监护病房(ICU)患者死亡的重要原因之一,因其高患病率、高死亡率、高治疗费用的特点,以及缺乏有效的救治策略,使它成为人类健康的巨大威胁。免疫炎症反应失衡与脓毒症的发生发展密切相关,但其关键调控机制尚不清楚。微小RNA(micro RNA,mi RNA)在固有免疫反应和适应性免疫反应中起着重要作用。mi RNA通过调控炎症信号通路中关键分子的表达,从而影响脓毒症相关炎症因子的表达。因此,mi RNA可能成为在基因转录后水平诊断和治疗脓毒症的新靶点。     

联合检测PCT、hs-CRP在新生儿脓毒症诊疗中的应用价值

目的探讨联合检测血浆降钙素原(PCT)及超敏C反应蛋白(hs-CRP)在新生儿脓毒症诊疗中的应用价值。方法选取2015年2月至2016年2月大连市妇幼保健院新生儿科88例住院感染患儿作为感染组,同期出生的21例正常足月产儿作为对照组,采用免疫荧光干式定量法进行血浆PCT及hs-CRP的检测。结果感染组患儿PCT、hs-CRP水平均明显高于对照组,差异有统计学意义(P0.01);2组患儿WBC水平差异无统计学意义(P0.05)。轻度脓毒症组、中度脓毒症组、重度脓毒症组各患儿治疗前血浆PCT、hs-CRP水平依次升高,各组间比较差异有统计学意义(P0.01);而各组患儿全血WBC水平比较差异无统计学意义(P0.05)。轻度脓毒症组、中度脓毒症组、重度脓毒症组各患儿治疗后血浆PCT、hs-CRP水平较治疗前显著降低(P0.01);而各组患儿全血WBC治疗前后水平比较差异无统计学意义(P0.05)。结论 PCT及hs-CRP能反映脓毒症的病情严重程度,联合检测PCT及hsCRP、并对其动态监测对新生儿脓毒症的早期诊断、疗效评价和预后判断具有重要的应用价值。     

一氧化氮合酶与脓毒症的研究进展

脓毒症在外科临床工作中较常见,治疗相当困难;本文主要概述了一氧化氮合酶的基因定位、结构特点以及一氧化氮合酶与脓毒症的关系,进一步说明由一氧化氮合酶介导的一氧化氮生成与脓毒症关系密切,而选择性一氧化氮合酶抑制剂在脓毒症各阶段恰当的应用可能是有效治疗脓毒症、降低病死率的一个重要途径,也将成为今后研究的热点。     

我国学者提出骨骼肌“有氧糖酵解”新概念

由 30 4医院全军烧伤研究所副所长柴家科教授、著名烧伤专家盛志勇院士和长海医院全军烧伤中心夏照帆教授等共同完成的“烧伤后全身炎症反应和脓毒症的基础与临床研究”,获 2 0 0 2年度国家科技进步一等奖。该研究系统阐述了烧伤后机体促炎 /抗炎反应失衡的发病规律及信号转导机制 ,提出了烧伤脓毒症骨骼肌“有氧糖酵解”的全新概念 ,创建了符合烧伤实际的烧伤脓毒症新的诊断标准和临床综合防治方案 ,使我国严重烧伤临床治疗水平跃居国际领先地位 ,治疗效果达98.97% ,远远高于美国 2 8个烧伤中心 81.0 0 %的治疗水平摘自《科学时报》2 0 0 3…     

一氧化氮合酶与脓毒症的研究进展

脓毒症在外科临床工作中较常见,治疗相当困难;本文主要概述了一氧化氮合酶的基因定位、结构特点以及一氧化氮合酶与脓毒症的关系,进一步说明由一氧化氮合酶介导的一氧化氮生成与脓毒症关系密切,而选择性一氧化氮合酶抑制剂在脓毒症各阶段恰当的应用可能是有效治疗脓毒症、降低病死率的一个重要途径,也将成为今后研究的热点。     

脓毒症患儿血清SAA、PCT、CRP水平与预后的关系及其诊断价值分析

摘要 目的：探讨脓毒症患儿血清淀粉样蛋白A（SAA）、降钙素原（PCT）、C反应蛋白（CRP）与预后的关系,并分析三者对脓毒症的诊断价值。方法：纳入我院于2016年8月～2020年6月期间收治的脓毒症患儿60例开展回顾性研究,作为脓毒症组,选取同期于我院进行体检的健康儿童40例作为对照组,比较两组血清SAA、PCT、CRP水平。根据脓毒症患儿1个月内的生存、死亡情况,分成生存组（n=42）、死亡组（n=18）,比较两组临床资料及血清SAA、PCT、CRP水平,经COX回归模型分析脓毒症患儿死亡的危险因素。绘制受试者工作特征（ROC）曲线分析血清SAA、PCT、CRP对脓毒症的诊断价值。结果：脓毒症组血清SAA、PCT、CRP水平显著高于对照组（P＜0.05）。死亡组器官障碍数量＞2个、脓毒性休克患儿占比分别为55.56%、44.44%,显著高于生存组的19.05%、9.52%（P＜0.05）;死亡组入院后1 h内使用抗菌治疗患儿占比为38.89%,显著低于生存组的69.05%（P＜0.05）;死亡组血清SAA、PCT、CRP水平高于生存组（P＜0.05）。COX多因素分析结果显示,器官障碍数量＞2、脓毒性休克及血清SAA、PCT、CRP水平升高是脓毒症患儿死亡的危险因素（P＜0.05）,而入院后1 h内使用抗菌治疗是脓毒症患儿死亡风险的保护性因素（P＜0.05）。血清SAA、PCT、CRP单独及三者联合诊断脓毒症的曲线下面积（AUC）分别为0.808、0.780、0.761、0.912。结论：脓毒症患儿血清SAA、PCT、CRP明显升高,三者升高均为脓毒症患儿死亡的危险因素,且对脓毒症具有一定诊断价值。     

肠道菌群调控黏膜免疫与脓毒症的发病机制

脓毒症和脓毒症休克是临床重症监护室患者的主要死亡原因之一。肠道菌群作为脓毒症过程中重要参与者,其紊乱能激活肠道黏膜免疫,进而影响全身免疫系统,诱发和加剧脓毒症。此外,肠道微生物还能通过"肠道-器官"轴参与脓毒症发生发展过程,针对肠道微生物的靶向治疗能防治脓毒症。本文深入探讨了肠道微生物、肠道黏膜免疫与脓毒症之间的相互作用,以期为临床开发新的疗法提供理论基础。     

Intestinal Parasite Infections in Symptomatic Children Attending Hospital in Siem Reap,Cambodia

BackgroundInfections with helminths and other intestinal parasites are an important but neglected problem in children in developing countries. Accurate surveys of intestinal parasites in children inform empirical treatment regimens and can assess the impact of school based drug treatment programmes. There is limited information on this topic in Cambodia.MethodsIn a prospective study of intestinal parasites in symptomatic children attending Angkor Hospital for Children, Siem Reap, Cambodia, April-June 2012, samples were examined by microscopy of a direct and concentrated fecal sample. Two culture methods for hookworm and Strongyloides stercoralis were employed when sufficient sample was received. Demographic, clinical and epidemiological data were collected.Conclusions/SignificanceThis study confirms the importance of intestinal parasitic infections in symptomatic Cambodian children and the need for adequate facilities for laboratory diagnosis together with education to improve personal hygiene and sanitation.     

视频脑电图和影像学检查对继发性癫痫患儿的诊断价值研究

目的:研究视频脑电图(V-EEG)和影像学检查对继发性癫痫患儿的诊断价值。方法:选取从2014年3月到2017年4月在我院接受诊治的癫痫患儿168例纳入本次研究。分别对所有患儿实施V-EEG和核磁共振成像(MRI)诊断,比较两种方式的诊断价值。结果:168例患儿中,V-EEG监测到154例有异常的脑电信号,其中120例有痫样放电,V-EEG显示痫样放电分布在左侧和右侧导联的比例较双侧导联明显更高(P0.05),MRI检测结果显示,140例患儿有颅内有关结构的病变亦或是发育异常,28例未发现异常。168例患儿中,发作类型为单纯部分型者72例,占比最高,为42.86%;主要病因中,颅内感染的发作类型以全身型为主,占11.31%。脑梗塞的发作类型以单纯部分型为主,占8.33%。颅内软化灶的发作类型以复杂部分型为主,占6.55%。颅内肿瘤的发作类型以单纯部分型为主,占6.55%。MRI定位主要在单侧,其中左侧占38.10%,右侧占29.76%;而经V-EEG监测显示异常放电154例,占91.67%,其中颅内感染和脑梗塞以及颅内肿瘤和颅内软化灶的阳性检出比例最高,分别为24.40%,13.10%,11.90%和10.71%。V-EEG诊断灵敏度和特异度均明显高于MRI(P0.05)。结论:V-EEG较MRI对继发性癫痫患儿的诊断价值更高,能够更加准确地提供诊断结果数据,值得在临床诊治过程中给予推广和应用。     

Recurrent Neutropenia Due to Dopamine Agonists in a Patient with Microprolactinoma

ObjectiveThe objective of our case report is to increase the awareness of neutropenia as a rare but potentially serious adverse outcome of commonly used dopamine agonists for the treatment of prolactinomas.MethodsThis report reviews the clinical history, diagnosis, investigations, and drug treatment of our patient.ResultsNeutropenia was recurrent after changing to various different dopamine agonists necessitating surgical treatment of a prolactinoma.ConclusionThis case serves a reminder of this adverse drug reaction. Considering the significant impact and potentially a life threatening outcome, we advocate routine monitoring of full blood count prior to and during the treatment with dopamine agonists. (Endocr. Pract. 2013;19:e122-e123)     

Detection of circulating tumor-derived material in peripheral blood of pediatric sarcoma patients: A systematic review

BackgroundDetection of circulating tumor-derived material (cTM) in the peripheral blood (PB) of cancer patients has been shown to be useful in early diagnosis, prediction of prognosis, and disease monitoring. However, it has not yet been thoroughly evaluated for pediatric sarcoma patients.MethodsWe searched the PubMed and EMBASE databases for studies reporting the detection of circulating tumor cells, circulating tumor DNA, and circulating RNA in PB of pediatric sarcoma patients. Data on performance in identifying cTM and its applicability in diagnosis, and evaluation of tumor characteristics, prognostic factors, and treatment response was extracted from publications.ResultsA total of 79 studies were assigned for the present systematic review, including detection of circulating tumor cells (116 patients), circulating tumor DNA (716 patients), and circulating RNA (2887 patients). Circulating tumor cells were detected in 76% of patients. Circulating DNA was detected in 63% by targeted NGS, 66% by shallow WGS, and 79% by digital droplet PCR. Circulating RNA was detected in 37% of patients.ConclusionOf the cTM from Ewing's sarcoma and rhabdomyosarcoma ctDNA proved to be the best target for clinical application including diagnosis, tumor characterization, prognosis, and monitoring of disease progression and treatment response. For osteosarcoma the most promising targets are copy number alterations or patient specific micro RNAs, however, further investigations are needed to obtain consensus on clinical utility.     

Can We Predict Oral Antibiotic Treatment Failure in Children with Fast-Breathing Pneumonia Managed at the Community Level? A Prospective Cohort Study in Malawi

BackgroundPneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia. This study aimed to develop a prognostic model for fast-breathing pneumonia treatment failure in sub-Saharan Africa.MethodWe prospectively followed a cohort of children (2–59 months), diagnosed by community health workers with fast-breathing pneumonia using World Health Organisation (WHO) integrated community case management guidelines. Cases were followed at days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the prognostic model using eight pre-defined parameters, using multivariable logistic regression, validated through bootstrapping.ResultsWe assessed 1,542 cases of which 769 were included (32% ineligible; 19% defaulted). The treatment failure rate was 15% at day 5 and relapse was 4% at day 14. Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26) were associated with treatment failure. The model demonstrated poor calibration and discrimination (c-statistic: 0.56).ConclusionThis study suggests that it may be difficult to create a pragmatic community-level prognostic child pneumonia tool based solely on clinical markers and pulse oximetry in an HIV and malaria endemic setting. Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.     

儿童社区获得性支原体肺炎病原学与影像学特征分析

目的:回顾性分析我院儿童社区获得性肺炎(Community-acquired pneumonia,CAP)患儿病原学检测结果,为本地区CAP患儿的临床治疗提供参考依据。方法:选取2014年5月-2018年5月812例符合中华医学会儿科学分会制定的儿童社区获得性肺炎(2013修订)诊断标准的CAP患儿,分析患儿的临床特征及影像学检查结果,并进行分析。结果:非重症CAP患儿812例,CAP占10.2%;感染病原体例数481例,阳性检出率为59.2%;1月-1岁龄组与1-5岁龄组比较差异无统计学意义(P0.05);5-14岁龄组发热发生率明显高于前两组,差异均有统计学意义(P0.05)。咳嗽、喘息、固定湿啰音发生率集中在1月-1岁龄组与1-5岁龄组,且高于5-14岁龄组发生率(P0.0);肺部影像学改变的患儿共657例,占80.9%。三个年龄组;肺部影像学改变差异有统计学意义(P0.05)。结论:不同年龄段CAP患儿病原体检出率不同;不同年龄和不同病原学感染的儿童CAP的影像学表现各有特点,对于临床医生早发现、早诊断、早治疗具有一点的指导性意义。     

鼓膜置管术对分泌性中耳炎患儿术后生活质量的影响

目的:探讨鼓膜置管术对分泌性中耳炎(SOM)患儿术后生活质量的影响,为临床治疗SOM患儿提供理论参考。方法:采用中文版本《慢性耳病调查量表》(CCES)、中耳炎儿童生活质量调查问卷(OM-6)评分和儿童行为量表(CBCL)对我院2016年1月到2019年8月收治的300例SOM患儿行鼓膜置管术前术后进行评分,比较分析鼓膜置管术对患者生活质量的影响。结果:治疗后,患儿CCES各项目分值较治疗前均明显升高(P0.05),患者OM-6调查问卷评分在听力丧失、情感障碍、身体疼痛、活动限制及家长担忧五个方面分值均明显降低,差异均有统计学意义(P0.05)。治疗后,男患儿CBCL调查在抑郁、社交退缩、多动、攻击性、分裂样及强迫性六个方面评分明显低于治疗前,差异均有统计学意义(P0.05);女患儿CBCL调查在抑郁、社交退缩、多动、攻击性及分裂强迫五个方面评分明显低于治疗前,差异均有统计学意义(P0.05)。结论:SOM患儿鼓膜置管术后临床症状和生活质量改善明显,鼓膜置管术是分泌性中耳炎患儿患儿有效的治疗措施。     

Qualitative interview study of communication between parents and children about maternal breast cancer

ObjectiveTo examine parents'' communication with their children about the diagnosis and initial treatment of breast cancer in the mother.DesignQualitative interview study within cross sectional cohort.SettingTwo breast cancer treatment centres.Participants32 women with stage I or stage II breast cancer with a total of 56 school aged children.ResultsWomen were most likely to begin talking to their children after their diagnosis had been confirmed by biopsy, but a minority waited until after surgery or said nothing at all. Family discussion did not necessarily include mention of cancer. There was considerable consistency in the reasons given for either discussing or not discussing the diagnosis. The most common reason for not communicating was avoidance of children''s questions and particularly those about death. While most mothers experienced helpful discussion with a doctor concerning their illness, few were offered help with talking to children; many would have liked help, particularly the opportunity for both parents to talk to a health professional with experience in understanding and talking to children.ConclusionsParents diagnosed with cancer or other serious illnesses should be offered help to think about whether, what, and how to tell their children and about what children can understand, especially as they may well be struggling themselves to come to terms with their illness.     

Pituitary Adenoma: A Clinician’S Perspective

ObjectiveTo review the underlying causes of pituitary lesions, a rational approach to their diagnosis, and therapeutic options.MethodsThe types of pituitary lesions and their clinical manifestations are reviewed, and treatment strategies and long-term follow-up are discussed.ResultsA pituitary adenoma is quite common and poses a challenge to the clinician to determine the clinical significance, the appropriate diagnosis, the need for treatment, and the appropriate therapy or therapies. The treatment of a pituitary adenoma depends on the type of tumor; a prolactinoma is treated medically with a dopamine agonist drug, and other lesions are usually treated by transsphenoidal surgical removal. Replacement of a deficient hormone or hormones is necessary for optimal functioning. Some patients require more than one treatment, including surgical intervention, replacement of a hormone or hormones, medications to lower hormone hypersecretion to normal (for prolactinoma, acromegaly, or Cushing disease), pituitary radiation therapy (optimally with focused irradiation such as the Gamma Knife or LINEAC), and, in the situation of persistent Cushing disease, bilateral adrenalectomy as a last resort. Lifelong monitoring is necessary for all these patients.ConclusionThe goal is to decrease the mass effect of the adenoma, to restore normal pituitary function, and to suppress hormone hypersecretion. Achievement of this goal necessitates the cooperation and interdisciplinary efforts of several medical specialties. (Endocr Pract. 2008;14:757-763)     

Paracoccidioidomicosis en pediatría: descripción de 4 casos

BackgroundParacoccidioidomycosis is the most frequent systemic mycosis in Latin America, caused by the dimorphic fungus Paracoccidioides. Paracoccidioidomycosis in children is uncommon. Our aim is to describe clinical features of patients who had a confirmed diagnosis of paracoccidioidomycosis in our hospital in the last 10 years.Case reportsWe describe 4 cases of paracoccidioidomycosis in previously healthy children from the north of our country. Diagnoses were made by biopsy or culture.ConclusionsThe diagnosis of paracoccidioidomycosis should be considered in a patient coming from regions where Paracoccidioides is endemic, and presenting with a lymphoproliferative syndrome, anemia, eosinophilia and hypergammaglobulinemia.