Analysis of sleep quality,disease uncertainty,and psychological tolerance in patients undergoing chemotherapy for digestive tract malignancies

BACKGROUND Colorectal cancer is the second leading cause of cancer-related deaths among digestive tract malignancies,following gastric cancer.Sleep is of great significance for maintaining human health.The incidence of sleep disorders in patients with cancer is approximately twice that observed in the general population.Lack of sleep can prolong hospital stays,increase the likelihood of infection,and increase mortality rates.Therefore,studying the factors related to sleep quality is significant for improving the quality of life of patients with malignant tumors of the digestive tract.AIM To investigate the relationships among sleep quality,disease uncertainty,and psychological resilience in patients undergoing chemotherapy for digestive tract malignancies.METHODS A total of 131 patients with malignant digestive tract tumors who were treated at Hefei BOE Hospital between April 2021 and September 2022 were selected as research participants.Based on their Pittsburgh Sleep Quality Index(PSQI)scores,participants were divided into either the sleep disorder group(PSQI score>7)or the normal sleep group(PSQI score≤7).The clinical data—together with the Mishel Uncertainty in Illness Scale for Adults(MUIS-A)and Connor-Davidson Resilience Scale(CD-RISC)scores—were compared.RESULTS In this study,78(59.54%)patients with digestive tract malignancies developed sleep disorders after chemotherapy.Sleep disorder incidence was higher in patients with colorectal cancer than in those with gastric and esophageal cancers(P<0.05).The total MUIS-A score and those for each item in the sleep disorder group were higher than those in the normal sleep group.The total CD-RISC score and those for each item in the sleep disorder group were lower than those in the normal sleep group(P<0.05).The PSQI scores of patients with malignant digestive tract tumors were positively correlated with the scores for lack of disease information,disease uncertainty,and unpredictability in the MUIS-A and negatively correlated with the scores for tenacity,self-improvement,and optimism in the CD-RISC(P<0.05).CONCLUSION Patients undergoing chemotherapy for digestive tract malignancies are prone to sleep problems related to disease uncertainty and psychological resilience.Therefore,interventions can be implemented to improve their sleep quality.

Applications of gastric peroral endoscopic myotomy in the treatment of upper gastrointestinal tract disease

Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy,prov-iding a new direction for the treatment of gastroparesis.With the recent and rapid development of G-POME therapy technology,progress has been made in the treatment of gastroparesis and other upper digestive tract diseases,such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture,with G-POME.This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.

Intestinal Microecology in Children with Pneumonia: The Relationship Between Digestive Health and Disease Recovery

This paper explores the association between intestinal microecology and digestive health and disease recovery in children with pneumonia.Intestinal microecological imbalance is common in children with pneumonia,which is closely associated with digestive health and disease recovery.Intestinal microecological imbalance may affect digestive enzyme activity,intestinal mucosal barrier function,and nutrient absorption,which in turn affects digestive health.In addition,intestinal microecological imbalances may be associated with immune regulation,inflammatory responses,and pathogen suppression,affecting disease recovery.Strategies to regulate intestinal microecology include probiotic supplementation,dietary modification,and pharmacological treatment.Currently,the study of intestinal microecology in children with pneumonia faces challenges,and there is a need for improved research methods,individualized treatment strategies,and the development of novel probiotics.In conclusion,the intestinal microecology of children with pneumonia is closely related to digestive health and disease recovery,and the regulation of intestinal microecology is of great significance to the treatment of children with pneumonia.Furthermore,future research should further explore the application of the microecology of the intestinal microecology in the treatment of children with pneumonia.

Characterics of upper digestive tract diseasesin fishermen of the Bohai Bay

AIM To study the characteristics of upper digestive tract diseases (UDTDs) in the fishermen of the Bohai Bay. METHODS An investigation was carried out in 1488 fishermen with symptoms of UDTDs except liver, biliary and pancreatic diseases during the period from December 1991 to February 1995, which included medical history inquiry, physical, gastroscopic and pathological examinations, detection of Helicobacter pylori ( H. pylori) infection, and nitrate content in their drinking water. RESULTS Among the 1488 subjects investigated, 1467 suffered from one or more diseases among 14 kinds of UDTDs, most of which were chronic atrophic gastritis (CAG, 1103 cases), peptic ulcer (268 cases), and cancer of the upper digestive tract (25 cases). CONCLUSION Incidence rate of UDTDs tends to be high among the fishermen, especially CAG, peptic ulcer and upper digestive tract cancer, and complicated state of illness due to their special life habits, and high nitrate content in their drinking water, etc, and UDTDs in fishermen is significantly different from that in inland residents in clinical manifestations.

Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion

AIM: To study the palliative treatment of malignant obstruction of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs. METHODS: A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus, stomach, duodenum and jejunum), per anal (colon and rectum) and percutaneous transhepatic (biliary) installation of metallic stent. Among them, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger's technique. RESULTS: Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8-43 weeks among those with intra-arterial drug infusion, which was later than 4-26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3-105) weeks, which was significantly longer than 13 (3-24) weeks of the latter group. CONCLUSION: Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.

Upper gastrointestinal microbiota and digestive diseases

Metagenomics which combines the power of genomics,bioinformatics,and systems biology,provide new access to the microbial world.Metagenomics permit the genetic analysis of complex microbial populations without requiring prior cultivation.Through the conceptual innovations in metagenomics and the improvements in DNA high-throughput sequencing and bioinformatics analysis technology,gastrointestinal microbiology has entered the metagenomics era and become a hot topic worldwide.Human microbiome research is underway,however,most studies in this area have focused on the composition and function of the intestinal microbiota and the relationship between intestinal microbiota and metabolic diseases(obesity,diabetes,metabolic syndrome,etc.) and intestinal disorders [inflammatory bowel disease,colorectal cancer,irritable bowel syndrome(IBS),etc.].Few investigations on microbiota have been conducted within the upper gastrointestinal tract(esophagus,stomach and duodenum).The upper gastrointestinal microbiota is essential for several gastrointestinal illnesses,including esophagitis,Barrett's esophagus,and esophageal carcinoma,gastritis and gastric cancer,small intestinal bacterial overgrowth,IBS and celiac disease.However,the constitution and diversity of the microbiota in different sections of the upper gastrointestinal tract under health and various disease states,as well as the function of microbiota in the pathogenesis of various digestive diseases are still undefined.The current article provides an overview of the recent findings regarding the relationship between upper gastrointestinal microbiota and gastrointestinal diseases;and discusses the study limitations and future directions of upper gastrointestinal microbiota research.

New endoscopic ultrasound techniques for digestive tract diseases: A comprehensive review

Endoscopic ultrasound(EUS) is one of the most important modalities for the diagnosis of digestive tract diseases.EUS has been evolving ever since it was introduced.New techniques such as elastography and contrast enhancement have emerged, increasing the accuracy, sensitivity and specificity of EUS for the diagnosis of digestive tract diseases including pancreatic masses and lymphadenopathy.EUS-elastography evaluates tissue elasticity and therefore, can be used to differentiate various lesions.Contrast-enhanced EUS can distinguish benign from malignant pancreatic lesions and lymphadenopathy using the intravenous injection of contrast agents.This review discusses the principles and types of these new techniques, as well as their clinical applications and limitations.

Burden of RSV among inpatients with lower respiratory tract infection under 5 years of age: A 10-year retrospective study in Southwest China from 2009 to 2019

Objectives:Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infection(LRTI).However,few comprehensive descriptions of the disease burden,medical resource utilization(MRU),and costs of RSV are available for China.This study aimed to provide the basis for the development of RSV prevention strategies by analyzing the burden of RSV among inpatients with lower respiratory tract infection under 5 years of age.Methods:We conducted a retrospective hospital-based study from June 2009 to May 2019 in Chongqing.Inpatients with LRTI were tested for eight viruses.We analyzed the RSV disease burden,MRU,and direct hospitalization costs by using non-parametric Mann‒Whitney U test,Chi-squared test or Fisher’s exact test and logistic regression.Results:A total of 6991 children under 5 years of age with LRTI were included in this study.The overall RSVpositive rate was 34.5%(2410/6991).Prior to admission,81.9%(1973/2410)of these RSV-positive cases were otherwise healthy.Compared with children aged 24–59 months,the odds ratio(OR)and 95%confidence interval(CI)for RSV infection were 2.509(2.139–2.945),1.882(1.549–2.222),and 1.479(1.240–1.765)for those aged 1–5 months,6–11 months,and 12–23 months,respectively.The proportions of patients treated with invasive ventilation and continuous positive airway pressure(CPAP)were significantly higher among RSV-positive cases(1.1%[27/2410]and 3.9%[93/2410])than RSV-negative cases(0.9%[43/4581]and 2.7%[124/4581])(P=0.023).Compared with RSV-negative cases,RSV-positive cases had significantly longer hospital length of stay(6[5,8]days vs.6[5,8]days,P<0.001)and higher hospitalization costs(963.0[757.9,1298.5]USD vs.935.6[719.7,1296.3]USD,P=0.022).Conclusions:Most RSV infections occurred during early childhood and among individuals in the otherwise healthy group.Younger age was associated with a higher RSV-positive rate.Effective prevention measures are needed in the earliest stages to reduce the RSV burden.

Epidemiological investigation of Barrett's esophagus in patients with gastroesophageal reflux disease in Northwest China

Objective： To investigate the prevalence and possible risk factors of Barrett＇s esophagus （BE） in patients with gastroesophageal reflux disease （GERD） in Northwest China. Methods： Patients older than 18 years who underwent regular health check-up or had upper gastrointestinal symptoms in the endoscopy centers of four major teaching hospitals located in four different provinces of Northwest China from September 2008 to February 2009 were included in the study. A face-to-face reflux diagnostic questionnaire including risk factors were taken and scale scores （So） were accumulated. Diagnostic criterion of GERD was Sc≥12 points. None of these subjects received anti-acid medication prior to their endoscopy done. Barrett＇s esophagus was diagnosed when specialized intestinal metaplasia was detected histologically. Results： A total of 528 patients met the criteria of GERD, among which 32 patients （20 male and 12 female） were diagnosed with BE. BE was present in 6.06% with a mean age of 51.2±11.6 years, which was significantly older than patients with GERD without BE （46.6±13.3 years） （P〈0.05）. There weresignificant differences between BE and GERD patients regarding gender, age, hiatus hernia, smoking and alcohol consumption （P〈0.05）, while no significant difference regarding symptoms of GERD. There was significant difference between short segment Barrett＇s esophagus and long segment （65.6% vs 34.4%, P〈0.05）. Conclusion： The prevalence of BE was 6.06% in patients with GERD in northwest China and was dominated by SSBE. The potential risk factors of Barrett＇s esophagus were older age, male, esophageal hiatal hernia, smoking and alcohol consumption.

Narrow band imaging evaluation of duodenal villi in patients with and without celiac disease:A prospective study

BACKGROUND Duodenal biopsies are commonly obtained during esophagogastroduodenoscopy(EGD) but are very often histopathologically normal. Therefore, a more strategic method for evaluating the duodenal mucosa and avoiding unnecessary biopsies is needed.AIM To examine the clinical utility of narrow band imaging(NBI) for evaluating duodenal villous morphology.METHODS We performed a prospective cohort study of adult patients at Mayo Clinic Rochester from 2013-2014 who were referred for EGD with duodenal biopsies. A staff endoscopist scored, in real-time, the NBI-based appearance of duodenal villi into one of three categories(normal, partial villous atrophy, or complete villous atrophy), captured ≥ 2 representative duodenal NBI images, and obtained mucosal biopsies therein. Images were then scored by an advanced endoscopist and gastroenterology fellow, and biopsies(gold standard) by a pathologist, in a masked fashion using the same three-category classification. Performing endoscopist, advanced endoscopist, and fellow NBI scores were compared to histopathology to calculate performance characteristics [sensitivity, specificity,positive and negative, negative predictive value(NPV), and accuracy]. Inter-rater agreement was assessed with Cohen's kappa.RESULTS112 patients were included. The most common referring indications were dyspepsia(47%), nausea(23%), and suspected celiac disease(14%). Duodenal histopathology scores were: 84% normal, 11% partial atrophy, and 5% complete atrophy. Performing endoscopist NBI scores were 79% normal, 14% partial atrophy, and 6% complete atrophy compared to 91%, 5%, and 4% and 70%, 24%,and 6% for advanced endoscopist and fellow, respectively. NBI performed favorably for all raters, with a notably high(92%-100%) NPV. NBI score agreement was best between performing endoscopist and fellow(κ = 0.65).CONCLUSION NBI facilitates accurate, non-invasive evaluation of duodenal villi. Its high NPV renders it especially useful for foregoing biopsies of histopathologically normal duodenal mucosa.

Hidden in the hands-the special inner Bagua acupoints for pediatric massage

Pediatric massage is one of the external treatment methods that can improve children'sconstitution and immunity by regulating the viscera (the basic organs in traditonal Chinesemedicine theory), dredging the meridians, regulating Qi and blood, and balancing Yin and Yang.As one of the specific acupoints of pediatric massage, inner Bagua acupoint (one of the clinicallyused acupoints in children's massage that locate in the palm of the hand and the periphery ofthe palm) play a key role. Inner Bagua acupoints are the commonly used acupoints in pediatricmassage, which have the function of regulating Qi and eliminating phlegm (a kind pathologicfluid in TCM theory) and improving digestion. Inner Bagua acupoints have a unique curativeeffect on many diseases of digestive and respiratory system in children. Therefore, this articleattempts to elaborate and summarize the origin, location, operation and clinical application ofthe inner Bagua acupoints. This article hopes to provide a basis information for advocating anddisseminating pediatric massage, which is favorable for wide-range popularization anddevelopment.

家兔奇异变形杆菌的分离鉴定及致病性分析

为探究河南省某规模化兔场暴发的以精神萎靡、腹泻为主要症状的疾病病原,本实验随机选取6只病死兔剖检并观察其各组织剖检病变后,通过四区划线法分离纯化并增菌培养后,分别于普通琼脂培养基、血琼脂培养基和麦康凯琼脂培养基培养,并对分离菌进行疑似病原菌的PCR鉴定、球虫检测、生化鉴定、16S r RNA基因的PCR扩增、测序和序列分析,构建分离菌16S r RNA基因的进化树,进一步确定病原菌。剖检观察可见病死兔肾脏呈土黄色、肝脏肿大有出血点、胸腺出血、脾脏萎缩呈深褐色、肺脏发白且有散在出血点等。疑似病原菌的鉴定结果显示,大肠杆菌、肺炎克雷伯氏菌、魏氏梭菌、沙门氏菌、波氏杆菌及球虫均呈阴性,且通过细菌的分离培养、16S r RNA基因的PCR扩增、测序并构建系统进化树,进一步确定引起该兔场发病的病原菌为奇异变形杆菌,并将其命名为HN001株。通过PCR检测该菌携带的毒力基因,并采集病死兔肝、肾、肠等病变组织制作病理切片,观察其病理变化。将HN001株以1011cfu/mL感染家兔,一周后剖杀,观察各组兔的剖检病变,并再次从兔的内脏分离并鉴定病原菌。毒力基因的PCR检测结果显示,HN001菌株中鞭毛基因FliL和菌毛结构亚单位基因Mrp A均为阳性,溶血素基因Hpm A、金属蛋白酶结构亚单位基因ZapA和“雾蔓”菌毛迁移能力的调控基因Rsb A均为阴性。组织病理学结果显示,病死兔肾、肝、胸腺、脾、肺脏和空肠组织均损伤严重,主要表现为炎性细胞浸润、散在分布部分红细胞等病理变化。家兔致病性试验结果显示,该病原菌感染兔后出现与自然感染兔类似的症状和脏器的剖检症状,但病变程度与自然感染兔相比较轻。且从病兔体内再次分离到与感染菌相同的菌株,表明奇异变形杆菌为该兔场暴发疾病的病原菌。本研究为兔奇异变形杆菌病的防控提供参考依据。

动物消化道黏液屏障与肠道微生物的关系研究进展

黏液屏障主要由水、黏蛋白、脂质、盐、抗菌肽、肠上皮细胞分泌的其他蛋白质和细胞碎片组成,覆盖在胃肠道等表面。不同消化道部位的黏液结构不同,在胃和大肠中,黏液为2层;而在小肠中,黏液只有单层。黏液屏障在宿主的生命活动中承担着免疫调节和维持肠道稳态等作用。肠道中存在的大量微生物与黏液屏障之间存在相互作用,可保障体内的正常生命过程及机体健康。本文阐述了黏液屏障与微生物的关系及它们对健康产生的影响,为进一步探究动物消化道复杂变化、消化道疾病的预防和治疗提供新思路。

振动胶囊:一种慢性便秘的创新型非药物治疗方法

慢性便秘是一种临床常见的消化道疾病,其病理生理机制较为复杂,且在国内外均有较高患病率。目前的治疗手段主要包括药物、手术和生物反馈疗法以及饮食和生活方式等,但治疗结果往往不理想,在临床实践中极具挑战性。振动胶囊是一种新型的具有振动功能的胶囊,其可通过对肠壁的刺激促进肠道蠕动,从而缓解或治疗慢性便秘。该胶囊相对于药物治疗具有更高的安全性,且不良反应更小。但目前国内外对其研究时间较短,仍需在制造技术和临床试验上进行更深入的探索和研究。本文针对慢性便秘的流行病学、分类及发病机制、振动胶囊的研究历程及疗效作一综述。

香砂平胃颗粒治疗消化道疾病疗效和安全性的系统评价和Meta分析

目的对香砂平胃颗粒治疗消化道疾病的疗效及安全性进行系统评价。方法根据相关关键词,检索知网、万方、维普、PubMed、Embase数据库文献。采用Review Manager 5.0软件进行数据分析,计算合并的比值比(OR)或均数差(MD)及其95%置信区间(95%CI),检验异质性,评估发表偏倚。结果最终纳入14篇文献,研究质量较好,偏倚风险较低。Meta分析结果显示,香砂平胃颗粒联合西药治疗消化道疾病的总有效率高于西药单独治疗[95%CI=(3.69,9.28),P<0.001],各研究间无异质性(I2=0.0%,P=0.55)。在临床症状积分上,香砂平胃颗粒联合西药可显著改善餐后饱胀、早饱、上腹痛和上腹灼烧感(P<0.05);在胃肠激素水平上,显著改善胃动素、胃泌素和血浆P物质水平(P<0.001)。另外,香砂平胃颗粒可有效清除幽门螺杆菌(Hp),且不增加不良反应。结论与常规西药相比,香砂平胃颗粒联合西药可显著提高临床总有效率,明显改善临床症状积分、胃肠激素水平,有效清除Hp,不良反应少,安全性好。

小儿肺炎支原体肺炎并发消化道系统损害的相关影响因素分析

目的:探讨小儿肺炎支原体肺炎并发消化道系统损害的相关影响因素。方法:回顾性分析2020年1月—2023年3月南通大学附属南通妇幼保健院收治的132例小儿肺炎支原体肺炎患儿临床资料,根据是否并发消化道系统损害分为消化道系统损害组(n=35)、非消化道系统损害组(n=97)。收集患儿一般资料,包括性别、年龄、体重、发热病程、病程、大环内酯类药物开始使用时间、糖皮质激素开始使用时间、红细胞沉降率(ESR)、C反应蛋白(CRP)水平、白细胞(WBC)水平、中性粒细胞百分比。对一般资料进行单因素分析,再对有统计学差异因素的进行多因素logistic回归分析。结果:132例小儿肺炎支原体感染患儿发生35例消化道系统损害,发生率26.52%(35/132)。单因素分析显示,两组性别、体重、病程、糖皮质激素开始使用时间、ESR、WBC、中性粒细胞百分比对比,差异均无统计学意义(P>0.05)。两组年龄、发热病程、大环内酯类药物开始使用时间、CRP水平比较,差异均有统计学意义(P<0.05)。logistic回归分析显示,年龄≤3岁、发热病程≥7 d、大环内酯类药物使用时间<3 d、CRP≥10 mg/L是小儿肺炎支原体感染并发消化道系统损害的独立危险因素(OR>1且P<0.05)。结论:小儿肺炎支原体肺炎患儿并发消化道系统损害与年龄≤3岁、发热病程≥7 d、大环内酯类药物使用时间<3 d、CRP≥10 mg/L有关。

1例小儿食入122颗“泡大球”诊治及经验总结

目的探讨小儿消化道异物吸水球的病例特点,总结其诊断及治疗要点。方法报道了1例本院近期收治的小儿食入122颗吸水球的病例;回顾性分析本院2015—2023年收治的25例相关患儿的临床资料,并对其诊断及治疗经验进行总结。结果所有患儿中男孩多于女孩(17︰8),其中3岁以上患儿数量与3岁以下患儿数量比较,差异无统计学意义(P>0.05)。约20%的患儿会出现肠梗阻并发症,并发症组的平均年龄(1.2±0.4)岁,明显低于非并发症组的平均年龄(3.15±1.6)岁。食入异物后的中位数就诊时间并发症组为48(20,120)h,无并发症组为6(4.75,8.25)h,其差异具有统计学意义(P<0.05)。结论吸水球作为一种较少见的小儿消化道异物,大多数可以保守治疗为主,但部分患儿会出现进行性肠梗阻需要积极手术干预,出现肠梗阻的几率与患者年龄及食入异物后的就诊时间等因素有关,临床需要予以重视。

SAA联合外周血细胞形态学对小儿病毒性呼吸道感染病情诊断的价值

目的 探讨血清淀粉样蛋白A (SAA)联合外周血细胞形态学对小儿病毒性呼吸道感染病情诊断的特异性及敏感性。方法 按照1∶1比例选取2022年8月至2023年8月平顶山市妇幼保健院收治的122例血常规正常小儿病毒性呼吸道感染患儿(病毒组)及122例健康儿童(对照组)进行前瞻性研究,检测并比较两组儿童外周血细胞形态学(核左移、反应性淋巴细胞比例)改变及SAA水平。统计外周血细胞形态学(核左移、反应性淋巴细胞比例)改变及SAA检出血常规正常小儿病毒性呼吸道感染情况,以病原学诊断结果为金标准,分析外周血细胞形态学改变、SAA及联合检测对小儿病毒性呼吸道感染病情诊断的特异性及敏感性。比较不同病情程度患儿外周血细胞形态学改变及SAA水平,应用Spearman分析外周血细胞形态学改变及SAA水平与病情程度相关性。结果 病毒组儿童的核左移数量、反应性淋巴细胞比例及血清SAA分别为(9.54±3.15)个、(5.94±1.87)%、(29.60±9.53) mg/L,明显高于对照组的(2.27±0.66)个、(0.32±0.20)%、(3.60±0.92) mg/L,差异均有统计学意义(P<0.05);以病原学诊断结果为金标准,外周血细胞形态学改变联合SAA诊断小儿病毒性呼吸道感染的敏感度(98.36%)、特异度(99.18%)、准确率(98.77%)最高,漏诊率(1.64%)最低(P<0.05);重症肺炎儿童的核左移数量、反应性淋巴细胞比例、血清SAA分别为(15.87±5.02)个、(14.26±3.78)%、(47.25±11.33) mg/L,明显高于普通肺炎儿童的(10.61±2.30)个、(5.13±1.54)%、(30.29±8.57) mg/L和上呼吸道感染儿童的(6.09±1.54)个、(6.09±1.54)%、(22.32±4.40) mg/L,而普通肺炎儿童的核左移数量、反应性淋巴细胞比例、血清SAA明显高于上呼吸道感染儿童,差异均有统计学意义(P<0.05);经Spearman分析结果显示,核左移数量、反应性淋巴细胞比例、SAA水平与病情程度均呈正相关(r=0.725、0.801、0.820,P<0.05)。结论 小儿病毒性呼吸道感染反应性淋巴细胞比例及血清SAA增高,核左移明显,在血常规检测不能反映临床表现的情况下,联合外周血细胞形态学改变、SAA可为临床诊断提供可靠的感染证据及病原学信息,从而指导临床做出正确的治疗决策方案。

冠心病合并消化道肿瘤患者行经皮冠状动脉介入治疗后出血与缺血的风险分析

目的分析冠心病(CHD)合并消化道肿瘤患者行经皮冠状动脉介入(PCI)治疗后出血与缺血的风险。方法选取行PCI治疗的CHD合并消化道肿瘤患者90例,按照术后是否发生出血与缺血分为发生组(n=27)和未发生组(n=63),采用自制调查问卷收集2组患者年龄、性别、体质量指数(BMI)、吸烟史、外周血管病变、手术支架个数等临床资料,分析CHD合并消化道肿瘤患者行PCI术后出血与缺血的影响因素。结果单因素分析显示,年龄、吸烟史、外周血管病史、鞘管型号、球囊扩张次数是CHD合并消化道肿瘤患者行PCI术后出血与缺血的影响因素(P<0.05);logistic回归分析显示,年龄>65岁、有吸烟史、有外周血管病变史、>6F鞘管、球囊扩张次数>3次是CHD合并消化道肿瘤患者行PCI术后发生出血与缺血的危险因素(P<0.05)。结论影响CHD合并消化道肿瘤患者行PCI术后出血与缺血的因素较多,临床应密切观察伴有危险因素患者的临床指标,并及时采取预防措施,降低术后出血与缺血的发生率。

《儿童反复呼吸道感染治未病干预指南》解读

《儿童反复呼吸道感染治未病干预指南》是以中医经典及中西医最新研究进展为理论基础,遵循循证性临床诊疗指南的制定方法,并结合中西医临床实际情况,提出了预防反复呼吸道感染的原则及具体方法,从3个方面进行推荐。未病先防方面,该指南以科学养育方式作为基础预防,从膳食模式、睡眠时间、体育活动、环境卫生、疫苗接种等方面进行调整,并根据中医儿童体质推荐相应喂养方式及中医食养。既病防变方面,要祛除病因,积极治疗原发病,在未病先防的基础上加入小儿推拿、穴位贴敷、药物香佩等中医外治法,必要时还可加用内服药物进行干预。瘥后防复方面,需参照未病先防内容进行防护,在痊愈之初可加入既病防变中的外治法。有别于既往指南对于药物治疗的描述,治未病指南更强调生活习惯及养育方式的合理性,在健康生活方式的大前提下结合个体中医体质特点,进行针对性更强的辨体调理,将疾病预防广泛运用于生活实际。