NKT cells in the induced sputum of severe asthmatics

To determine whether there was a specific inflammatory process in severe asthmatics, the phenotypic characteristics of induced sputum immune cells were analysed among patients with severe asthma. Twenty-two induced sputa (10 severe asthmatics) were studied. Flow cytometric analysis was performed using immune cells of the sputum and monoclonal antibodies to CD3, CD4, CD8, CD56, CD25, and TCRgammadelta. The number of NKT (CD3(+) CD56(+)) cells was significantly higher in the sputum of severe asthmatics compared with mild asthmatic and healthy control groups (P < .05). CD8(+)CD56(+) cells were the predominant subtype of the increased NKT cells in severe asthmatics. CD3(+)CD56(+)Valpha24(+), TCRgammadelta(+) CD56(+), and CD4(+)CD25(+) T cells were significantly increased in severe asthmatic patients. These results suggest that the immunopathogenesis of severe asthmatics vary between severe and mild asthmatics, and that CD8(+)CD56(+) NKT cells may play an important role in the immunopathogenesis of severe asthma.     

Lung function in adults with stable but severe asthma: air trapping and incomplete reversal of obstruction with bronchodilation.

Five to ten percent of asthma cases are poorly controlled chronically and refractory to treatment, and these severe cases account for disproportionate asthma-associated morbidity, mortality, and health care utilization. While persons with severe asthma tend to have more airway obstruction, it is not known whether they represent the severe tail of a unimodal asthma population, or a severe asthma phenotype. We hypothesized that severe asthma has a characteristic physiology of airway obstruction, and we evaluated spirometry, lung volumes, and reversibility during a stable interval in 287 severe and 382 nonsevere asthma subjects from the National Heart, Lung, and Blood Institute Severe Asthma Research Program. We partitioned airway obstruction into components of air trapping [indicated by forced vital capacity (FVC)] and airflow limitation [indicated by forced expiratory volume in 1 s (FEV(1))/FVC]. Severe asthma had prominent air trapping, evident as reduced FVC over the entire range of FEV(1)/FVC. This pattern was confirmed with measures of residual lung volume/total lung capacity (TLC) in a subgroup. In contrast, nonsevere asthma did not exhibit prominent air trapping, even at FEV(1)/FVC <75% predicted. Air trapping also was associated with increases in TLC and functional reserve capacity. After maximal bronchodilation, FEV(1) reversed similarly from baseline in severe and nonsevere asthma, but the severe asthma classification was an independent predictor of residual reduction in FEV(1) after maximal bronchodilation. An increase in FVC accounted for most of the reversal of FEV(1) when baseline FEV(1) was <60% predicted. We conclude that air trapping is a characteristic feature of the severe asthma population, suggesting that there is a pathological process associated with severe asthma that makes airways more vulnerable to this component.     

Hyper-inflammatory responses in COVID-19 and anti-inflammatory therapeutic approaches

The coronavirus disease 2019 (COVID-19) is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with severe COVID-19 exhibit hyper-inflammatory responses characterized by excessive activation of myeloid cells, including monocytes, macrophages, and neutrophils, and a plethora of pro-inflammatory cytokines and chemokines. Accumulating evidence also indicates that hyper-inflammation is a driving factor for severe progression of the disease, which has prompted the development of anti-inflammatory therapies for the treatment of patients with COVID-19. Corticosteroids, IL-6R inhibitors, and JAK inhibitors have demonstrated promising results in treating patients with severe disease. In addition, diverse forms of exosomes that exert anti-inflammatory functions have been tested experimentally for the treatment of COVID-19. Here, we briefly describe the immunological mechanisms of the hyper-inflammatory responses in patients with severe COVID-19. We also summarize current anti-inflammatory therapies for the treatment of severe COVID-19 and novel exosome-based therapeutics that are in experimental stages.     

谷氨酰胺对重症急性胰腺炎的营养治疗作用

继发感染是急性重症胰腺炎患者死亡的主要原因,细菌易位是导致胰腺感染的主要因素。用谷氨酰胺制剂可以防止细菌易位。加强肠黏膜防御功能,是治疗急性重症胰腺炎的有效制剂。本文综述了谷氨酰胺治疗急性重症胰腺炎的研究进展和作用机制。     

Ventilatory response to moderate and severe hypoxia in adult dogs: role of endorphins

To determine the role of opioids in modulating the ventilatory response to moderate or severe hypoxia, we studied ventilation in six chronically instrumented awake adult dogs during hypoxia before and after naloxone administration. Parenteral naloxone (200 micrograms/kg) significantly increased instantaneous minute ventilation (VT/TT) during severe hypoxia, (inspired O2 fraction = 0.07, arterial PO2 = 28-35 Torr); however, consistent effects during moderate hypoxia (inspired O2 fraction = 0.12, arterial PO2 = 40-47 Torr) could not be demonstrated. Parenteral naloxone increased O2 consumption (VO2) in severe hypoxia as well. Despite significant increases in ventilation post-naloxone during severe hypoxia, arterial blood gas tensions remained the same. Control studies revealed that neither saline nor naloxone produced a respiratory effect during normoxia; also the preservative vehicle of naloxone induced no change in ventilation during severe hypoxia. These data suggest that, in adult dogs, endorphins are released and act to restrain ventilation during severe hypoxia; the relationship between endorphin release and moderate hypoxia is less consistent. The observed increase in ventilation post-naloxone during severe hypoxia is accompanied by an increase in metabolic rate, explaining the isocapnic response.     

重症颅脑损伤合并胸外伤患者的救治和预后研究

目的:探讨重症颅脑损伤合并胸外伤患者的临床救治要点和预后。方法:对2006年1月至2015年12月陕西省森工医院收治的重型颅脑损伤及重型颅脑损伤合并胸外伤患者的临床资料进行回顾性研究,并随访观察其预后情况。结果:我院10年间收治单纯重症颅脑损伤患者137例及重症颅脑损伤合并胸外伤患者86例,单纯重症颅脑损伤患者死亡率为9.5(13/137),主要死亡原因为:脑内出血(36/26.3%)、脑挫裂伤(31/22.6%)、呼吸衰竭(27/19.7%)等;重症颅脑损伤合并胸外伤患者死亡率为17.4(15/86),主要死亡原因为:呼吸衰竭(18/20.9%)、脑挫裂伤(18/20.9%)、脑内出血(15/17.4%)等。单纯重症颅脑损伤患者手术时间为187.6±11.3分钟、术后住院时间为10.9±1.8天、肢体运动障碍12例(8.8%)、植物生存2例(1.5%);重症颅脑损伤合并胸外伤患者手术时间为265.4±18.9分钟、术后住院时间为14.3±2.1天、肢体运动障碍10例(11.6%)、植物生存3例(3.5%)。其中,两组间在手术时间、术后住院时间及肢体运动障碍方面有统计学差异。结论:重症颅脑损伤合并胸外伤较单纯重症颅脑损伤的致死率更高,手术时间长,术后并发症发生率更高,术后住院天数较长。对于重症颅脑损伤合并胸外伤的患者,应尽量保全肢体功能,提高患者存活率和术后生活质量。     

重症肺炎新生儿支气管肺泡灌洗液 病原菌分布及耐药性

目的研究重症肺炎新生儿支气管肺泡灌洗液的病原菌分布和耐药性。方法选择2016年4月至2018年4月在本院呼吸科治疗的新生儿268例,其中符合重症肺炎诊断标准的患儿142例,归为重症肺炎组;不符合重症肺炎诊断标准的患儿126例,归为对照组。检测患儿肺泡灌洗液病原菌分布情况和耐药情况。结果重症肺炎组患儿肺炎克雷伯菌、流感嗜血菌、铜绿假单胞菌、阴沟肠杆菌、大肠埃希菌、金黄葡萄球菌、溶血葡萄球菌、表皮葡萄球菌、肺炎链球菌、草绿链球菌检出率明显高于对照组。肺炎克雷伯菌对亚胺培南,美罗培南的耐药性为0.0%,大肠埃希菌对亚胺培南,美罗培南,阿米卡星的耐药性为0.0%,阴沟肠杆菌对亚胺培南,美罗培南,左氧氟沙星的耐药性为0.0%,肺炎链球菌对万古霉素的耐药性为0.0%,金黄葡萄球菌对万古霉素的耐药性为0.0%。结论新生儿重症肺炎患者病原菌以革兰阴性菌为主,亚胺培南、美罗培南、万古霉素可以用于治疗新生儿重症肺炎,但由于其毒副作用较大,应严格把握适应症。     

Diagnostic significance of "severe dysplasia" in sputum cytology

The diagnostic significance of a cytologic diagnosis of "severe dysplasia" on sputum samples was assessed. In a group of 46 patients with diagnoses of severe dysplasia, follow-up showed no malignancy of the lung in 25 patients (54%) and a malignant process in 21 patients (46%). These groups were compared to 52 patients with correct negative and 202 patients with correct positive sputum diagnoses. Of the patient characteristics investigated, age, previous sputum production, vital capacity and low forced expiratory volume were not significantly related to a sputum cytodiagnosis of severe dysplasia. In contrast, severe dyspnea showed a significantly higher frequency in patients with a sputum cytodiagnosis of severe dysplasia, but without an underlying malignant lung process. Follow-up disclosed a malignant tumor in 10 of 13 patients with disease; the presence of severely dysplastic cells in sputum specimens from such patients should be considered a warning signal for an underlying malignant lung process. Since severe dysplasia should be considered a premalignant epithelial lesion, patients with sputum cytodiagnoses of severe dysplasia should undergo bronchoscopy, with multiple bronchial brushings of all areas showing suspicious mucosal changes, together with segmental bronchial washings. In case a malignant process cannot be located, sputum examinations should be repeated at three-month intervals.     

The Predictive Diagnostic Value of Serial Daily Bedside Ultrasonography for Severe Dengue in Indonesian Adults

Background

Identification of dengue patients at risk for progressing to severe disease is difficult. Significant plasma leakage is a hallmark of severe dengue infection which can suddenly lead to hypovolemic shock around the time of defervescence. We hypothesized that the detection of subclinical plasma leakage may identify those at risk for severe dengue. The aim of the study was to determine the predictive diagnostic value of serial ultrasonography for severe dengue.

Methodology/Principal Findings

Daily bedside ultrasounds were performed with a handheld ultrasound device in a prospective cohort of adult Indonesians with dengue. Timing, localization and relation to dengue severity of the ultrasonography findings were determined, as well as the relation with serial hematocrit and albumin values. The severity of dengue was retrospectively determined by WHO 2009 criteria. A total of 66 patients with proven dengue infection were included in the study of whom 11 developed severe dengue. Presence of subclinical plasma leakage at enrollment had a positive predictive value of 35% and a negative predictive value of 90% for severe dengue. At enrollment, 55% of severe dengue cases already had subclinical plasma leakage, which increased to 91% during the subsequent days. Gallbladder wall edema was more pronounced in severe than in non-severe dengue patients and often preceded ascites/pleural effusion. Serial hematocrit and albumin measurements failed to identify plasma leakage and patients at risk for severe dengue.

Conclusions/Significance

Serial ultrasonography, in contrast to existing markers such as hematocrit, may better identify patients at risk for development of severe dengue. Patients with evidence of subclinical plasma leakage and/or an edematous gallbladder wall by ultrasonography merit intensive monitoring for development of complications.     

The prognostic value of schizontaemia in imported Plasmodium falciparum malaria

ABSTRACT: BACKGROUND: In Plasmodium falciparum infection, peripheral parasite counts do not always correlate well with the sequestered parasite burden. As erythrocytes parasitized with mature trophozoites and schizonts have a high tendency to adhere to the microvascular endothelium, they are often absent in peripheral blood samples. The appearance of schizonts in peripheral blood smears is thought to be a marker of high sequestered parasite burden and severe disease. In the present study, the value of schizontaemia as an early marker for severe disease in nonimmune individuals with imported malaria was evaluated. METHODS: All patients in the Rotterdam Malaria Cohort diagnosed with P. falciparum malaria between 1 January 1999 and 1 January 2012 were included. Thick and thin blood films were examined for the presence of schizontaemia. The occurrence of WHO defined severe malaria was the primary endpoint. The diagnostic performance of schizontaemia was compared with previously evaluated biomarkers C-reactive protein and lactate. RESULTS: Schizonts were present on admission in 49 of 401 (12.2%) patients. Patients with schizontaemia were more likely to present with severe malaria, a more complicated course and had longer duration of admission in hospital. Schizontaemia had a specificity of 0.95, a sensitivity of 0.53, a negative predictive value of 0.92 and a positive predictive value of 0.67 for severe malaria. The presence of schizonts was an independent predictor for severe malaria. CONCLUSION: Absence of schizonts was found to be a specific marker for exclusion of severe malaria. Presence of schizonts on admission was associated with a high positive predictive value for severe malaria. This may be of help to identify patients who are at risk of a more severe course than would be expected when considering peripheral parasitaemia alone.     

重型肝炎低血糖的临床分析及防护对策

目的：探讨重型肝炎患者发生低血糖的临床意义,为针对性的防护提供依据。方法：检测20例健康献血员、44例急性肝炎、51例慢性肝炎及30例重型肝炎患者的空腹血糖水平进行比较,患者在发生低血糖症状时检测其血糖水平。结果：重型肝炎组的空腹血糖水平明显低于正常对照组、急性肝炎组及慢性肝炎组,在病程中低血糖发生率明显高于急性肝炎及慢性肝炎患者组,重型肝炎死亡组在病程中低血糖发生率明显高于存活组。结论：重型肝炎患者常发生低血糖,早期识别低血糖征兆,合理饮食,做好健康宣教是预防的关键;检测空腹血糖对判断重型肝炎危重程度和评估预后有重要意义。     

Host-parasite interaction and morbidity in malaria endemic areas.

Severe morbidity due to Plasmodium falciparum is a major health problem in African children. The patterns of morbidity in endemic areas are modified by the immune response, and vary markedly with transmission intensity. Severe disease falls into three overlapping syndromes: coma, respiratory distress, and severe anaemia. Recently, it has become clear that metabolic acidosis plays a major role in the pathogenesis of severe disease and is particularly important in the overlap between the different clinical syndromes. We propose that the different manifestations of severe malarial morbidity arise from the interaction of a limited number of pathogenic processes: red cell destruction, toxin-mediated activation of cytokine cascades, and infected cell sequestration in tissue microvascular beds. The pattern of severe morbidity varies with age within any one endemic area, with severe anaemia predominating in the youngest children and coma having its highest incidence in older children. Between endemic areas there is a marked variation in mean age of children with severe malaria, and therefore in the importance of different clinical syndromes. The shift in mean age is due to a combination of increased challenge and more rapid development of immunity at higher levels of transmission. Recent comparative studies indicate that at higher levels of transmission the net effect of these shifts may be a paradoxical reduction in total severe malarial morbidity.     

Rates of, and risk factors for, severe infections in patients with systemic autoimmune diseases receiving biological agents off-label

Introduction

The purpose of this observational study was to analyze the rates, characteristics and associated risk factors of severe infections in patients with systemic autoimmune diseases (SAD) who were treated off-label with biological agents in daily practice.

Methods

The BIOGEAS registry is an ongoing Spanish prospective cohort study investigating the long-term safety and efficacy of the off-label use of biological agents in adult patients with severe, refractory SAD. Severe infections were defined according to previous studies as those that required intravenous treatment or that led to hospitalization or death. Patients contributed person-years of follow-up for the period in which they were treated with biological agents.

Results

A total of 344 patients with SAD treated with biological agents off-label were included in the Registry until July 2010. The first biological therapies included rituximab in 264 (77%) patients, infliximab in 37 (11%), etanercept in 21 (6%), adalimumab in 19 (5%), and 'other' agents in 3 (1%). Forty-five severe infections occurred in 37 patients after a mean follow-up of 26.76 months. These infections resulted in four deaths. The crude rate of severe infections was 90.9 events/1000 person-years (112.5 for rituximab, 76.9 for infliximab, 66.9 for adalimumab and 30.5 for etanercept respectively). In patients treated with more than two courses of rituximab, the crude rate of severe infection was 226.4 events/1000 person-years. A pathogen was identified in 24 (53%) severe infections. The most common sites of severe infection were the lower respiratory tract (39%), bacteremia/sepsis (20%) and the urinary tract (16%). There were no significant differences relating to gender, SAD, agent, other previous therapies, number of previous immunosuppressive agents received or other therapies administered concomitantly. Cox regression analysis showed that age (P = 0.015) was independently associated with an increased risk of severe infection. Survival curves showed a lower survival rate in patients with severe infections (log-rank and Breslow tests < 0.001).

Conclusions

The rates of severe infections in SAD patients with severe, refractory disease treated depended on the biological agent used, with the highest rates being observed for rituximab and the lowest for etanercept. The rate of infection was especially high in patients receiving three or more courses of rituximab. In patients with severe infections, survival was significantly reduced. Older age was the only significant predictive factor of severe infection.     

Association of severe noncerebral Plasmodium falciparum malaria in Brazil with expressed PfEMP1 DBL1 alpha sequences lacking cysteine residues

BACKGROUND: Cytoadherence and rosetting contribute to the development of severe Plasmodium falciparum malaria. In Brazil,severe falciparum malaria is mostly associated with renal or pulmonary complications and very rarely with cerebral malaria. The most N-terminal DBL1 alpha domain of PfEMP1, a protein encoded by the var multigene family mediates rosetting. We analyzed parasites of Brazilian patients with severe malaria to determine whether there were particular DBL1 alpha var sequences predominantly expressed in such patients. MATERIALS AND METHODS: DBL1 alpha var sequences were obtained from parasites of Brazilian patients with severe and mild malaria and were analyzed by standard bioinformatic programs. Three hundred twenty var DBL1 alpha sequences obtained from 80 Brazilian patients with mild malaria were spotted in high-density filters and hybridized to probes representing predominantly expressed sequences in parasites from patients with severe malaria. A DBL1 alpha domain was expressed in bacteria and used to demonstrate its binding capacity to erythrocytes by immunofluorescence. RESULTS: Forty-three different and unreported DBL1 alpha amino acid sequences were obtained. Sequences predominantly expressed in patients with severe malaria could be subgrouped due to deletions of 1-2-cysteine residues. These sequences were commonly found in the var gene repertoire of parasites from patients with mild malaria, yet they were rarely expressed in these patients. A recombinant protein representing the most abundantly expressed sequence detected in one patient with severe malaria bound directly to uninfected erythrocytes. CONCLUSIONS: This is the first report showing an association of severe noncerebral malaria from Brazil with particular DBL1 alpha sequences.     

HRR、PLR与中重度颅脑损伤患者短期死亡的关系研究

摘要 目的：探讨血红蛋白/红细胞分布宽度比值（HRR）、血小板/淋巴细胞比值（PLR）与中重度颅脑损伤（TBI）患者短期死亡的关系。方法：回顾性收集2019年9月～2021年9月徐州医科大学附属医院收治的162例中重度TBI患者的病历资料，根据患者入院30d内生存状态分为死亡组和存活组。计算HRR和PLR，采用多因素Logistic回归分析中重度TBI患者短期死亡的影响因素，受试者工作特征（ROC）曲线分析格拉斯哥昏迷量表（GCS）评分联合HRR、PLR对中重度TBI患者短期死亡的预测价值。结果：162例中重度TBI患者入院30 d内死亡率为35.80%（58/162）。与存活组比较，死亡组HRR降低，PLR升高（P＜0.05）。多因素Logistic回归分析显示，GCS评分＜9分、瞳孔散大、脑疝和HRR降低、PLR升高为中重度TBI患者短期死亡的独立危险因素（P＜0.05）。ROC曲线分析显示，HRR、PLR联合GCS评分预测中重度TBI患者短期死亡的曲线下面积最大，为0.924。结论：HRR降低和PLR升高与中重度TBI患者短期死亡相关，可能成为中重度TBI患者短期死亡的辅助预测指标，在GCS评分基础上联合HRR、PLR能提升对中重度TBI患者短期死亡的预测价值。     

2014-2016年南充市儿童手足口病重症流行病学调查及危险因素分析

摘要 目的：了解南充市儿童重症手足口病流行病学特征及其相关危险因素,为降低儿童重症手足口病发病率提供依据。方法：对中国"疾病监测信息报告管理系统"中确诊的南充市（顺庆区、高坪区、嘉陵区、阆中市）2014-2016年儿童手足口病的病例信息进行研究,分析该市儿童手足口病疫情、时间分布、地区分布和人群分布特征,并应用单因素和多因素Logistic回归分析儿童重症手足口病危险因素。结果：2014-2016年顺庆区、高坪区、嘉陵区、阆中市共报告儿童手足口病8068例,其中重症病例426例,占5.28%。全年均有手足口病发生,4~7月为手足口病发病高峰期,2014年峰值明显高于2015年、2016年,重症手足口病时间分布和发病高峰期与以上相同。顺庆区、高坪区、嘉陵区、阆中市均有手足口病发生,阆中市重症病例比例均高于其他辖区,差异有统计学意义（P<0.05）。男性患儿重症病例构成比较高,不同性别患儿重症病例构成比比较差异有统计学意义（P<0.05）;重症病例主要集中在1~3岁儿童,不同年龄段重症病例构成比比较差异有统计学意义（P<0.05）,重症病例主要分布在散居儿童和农村儿童,不同生活方式、不同家庭住址重症病例构成比比较差异有统计学意义（P<0.05）;重症病例主要分布在3~6天时间间隔的就诊患儿,不同就诊时间间隔重症病例构成比比较差异有统计学意义（P<0.05）。多因素Logistic分析显示：年龄为1-3岁、散居、家庭住址为农村是重症手足口病的危险因素（P<0.05）。结论：年龄为1-3岁、散居、家庭住址为农村是重症手足口病的危险因素,应在流动人口集中、生活条件较差的地区开展手足口病的宣传教育,提高人们对手足口病防治的认知,对于1-3岁儿童应作为疾病重点防控对象,提高家长疾病防控意识,以降低重症手足口病的发病率。     

Incidence and predictors of severe obstetric morbidity: case-control study

ObjectiveTo estimate the incidence and predictors of severe obstetric morbidity.DesignDevelopment of definitions of severe obstetric morbidity by literature review. Case-control study from a defined delivery population with four randomly selected pregnant women as controls for every case.SettingAll 19 maternity units within the South East Thames region and six neighbouring hospitals caring for pregnant women from the region between 1 March 1997 and 28 February 1998.Participants48 865 women who delivered during the time frame.ResultsThere were 588 cases of severe obstetric morbidity giving an incidence of 12.0/1000 deliveries (95% confidence interval 11.2 to 13.2). During the study there were five maternal deaths attributed to conditions studied. Disease specific morbidities per 1000 deliveries were 6.7 (6.0 to 7.5) for severe haemorrhage, 3.9 (3.3 to 4.5) for severe pre-eclampsia, 0.2 (0.1 to 0.4) for eclampsia, 0.5 (0.3 to 0.8) for HELLP (Haemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, 0.4 (0.2 to 0.6) for severe sepsis, and 0.2 (0.1 to 0.4) for uterine rupture. Age over 34 years, non-white ethnic group, past or current hypertension, previous postpartum haemorrhage, delivery by emergency caesarean section, antenatal admission to hospital, multiple pregnancy, social exclusion, and taking iron or anti-depressants at antenatal booking were all independently associated with morbidity after adjustment.ConclusionSevere obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone. Most events are related to obstetric haemorrhage and severe pre-eclampsia. Caesarean section quadruples the risk of morbidity. Development and evaluation of ways of predicting and reducing risk are required with particular emphasis paid on the management of haemorrhage and pre-eclampsia.

What is already known on this topic

Maternal mortality is used internationally as a measure of the quality of obstetric intervention, although it is now rare in the developed worldHospital based series estimating the incidence of severe obstetric morbidity have used different definitionsEstimated incidence of severe obstetric morbidity ranges from 0.05 to 1.09

What this study adds

With clear definitions and population based estimates of some severe obstetric morbidities this study estimated the overall incidence of severe obstetric morbidity as 1.2 % of deliveriesTwo thirds of the cases are related to severe haemorrhage, one third to hypertensive disordersRisk factors for severe maternal morbidity include maternal age >34, social exclusion, non-white, hypertension, previous postpartum haemorrhage, induction of labour, and caesarean section     

Severe Neutropenia in Infectious Mononucleosis

Mild neutropenia is a well-known concomitant of infectious mononucleosis caused by the Epstein-Barr virus (EBV) occurring in the first weeks of illness. However, severe neutropenia (less than 200 polymorphonuclear leukocytes per μl) is not generally regarded as a complication of infectious mononucleosis. Three patients were seen with severe neutropenia and EBV infection, and an additional eight cases were found in the literature. In two of the latter cases the neutropenia was fatal.In the 11 cases the severe neutropenia began 14 to 40 days after illness and usually lasted for three to seven days. At the time of severe neutropenia, studies of marrow specimens showed increased proportions of promyelocytes and myelocytes. Our data suggest that EBV infection is the proximate cause of the severe neutropenia in some patients with infectious mononucleosis and that in such cases close observation and early treatment of suspected superinfections is necessary.     

早发型与晚发型重度子痫前期的临床表现及母婴结局的对比分析

目的：探讨早发型与晚发型重度子痫前期的不同临床表现及母婴结局,提高对重度予痫前期的临床认识。方法：回顾性分析重度子痫前期患者76例,按照不同的发病孕周,分为早发型（发病孕周〈32周）和晚发型（发病孕周1〉32周）,比较两组孕妇临床情况、孕妇的并发症及围产儿结局。结果：早发型孕妇与晚发型孕妇在上述方面比较,差异均具有统计学意义（P〈0．05）,早发型孕妇的各项临床表现显著差于晚发型孕妇。结论：对早发型重度子痫前期孕妇,更应加强临床各项监护措施,选择理想的终止妊娠的时机,同时加强预防措施,避免早发型重度子痫前期的发生。     

地塞米松漱口液应用于鼻咽癌放疗的临床观察

目的 观察应用含地塞米松漱口液在减轻鼻咽癌放疗反应中的疗效.方法 将60例鼻咽癌患者随机分为2组,治疗组31例在放疗期间予含有地塞米松的漱口液含漱,对照组29例子不含地塞米松漱口液含漱.结果 治疗组轻度反应18例（58%）,中度反应10例（32）,重度反应3例（10%）;对照组无轻度反应,中度反应12例（41%）.重度反应17例（59%）.结论 治疗组重度反应率占10%,对照组重度反应率占59%,治疗组重度反应明显低于对照组.患者全部能按计划完成全程放疗.