Noninvasive Ventilation Interfaces in the Treatment of Acute Respiratory Insufficiency: A Critical Review

Background: Noninvasive ventilation (NIV) is an important therapeutic modality for the treatment of acute respiratory failure (ARF). In this review, we critically analyze randomized controlled trials on the most used NIV interfaces in the treatments of ARF. Methods: The searches were conducted in the Medline, Lilacs, PubMed, Cochrane, and Pedro databases from June to November 2021. The inclusion criteria were Randomized clinical trials (RCTs) published from 2016 to 2021 in Portuguese, Spanish, or English and involving adults (aged ≥ 18 years). The eligibility criteria for article selection were based on the PICO strategy: Population—Adults with ARF;Intervention—NIV Therapy;Comparison—Conventional oxygen therapy, high-flow nasal cannula (HFNC) oxygen therapy, or NIV;Outcome—improvement in ARF. The search for articles and the implementation of the inclusion criteria were independently conducted by two researchers. Results: Seven scientific articles involving 574 adults with ARF due to various causes, such as chest trauma, decompensated heart failure, coronavirus disease 2019 (COVID-19), and postoperative period, among others, were included. The interfaces cited in the studies included an oronasal mask, nasal mask, full-face mask, and helmet. In addition, some favorable outcomes related to NIV were reported in the studies, such as a reduction in the rate of orotracheal intubation and shorter length of stay in the ICU. Conclusions: The most cited interfaces in the treatment of ARF were the oronasal mask and the helmet.

Viral and Bacterial Etiology of Acute Febrile Respiratory Syndrome among Patients in Qinghai, China

Objective This study was conducted to investigate the viral and bacterial etiology and epidemiology of patients with acute febrile respiratory syndrome(AFRS) in Qinghai using a commercial routine multiplex-ligation-nucleic acid amplification test(NAT)-based assay. Methods A total of 445 nasopharyngeal swabs specimens from patients with AFRS were analyzed using the RespiFinderSmart22 kit(PathoFinder BV, Netherlands) and the LightCycler 480 real-time PCR system. Results Among the 225(225/445, 51%) positive specimens, 329 positive pathogens were detected, including 298(90.58%) viruses and 31(9%) bacteria. The most commonly detected pathogens were influenza virus(IFV;37.39%;123/329), adenovirus(AdV;17.02%;56/329), human coronaviruses(HCoVs;10.94%;36/329), rhinovirus/enterovirus(RV/EV;10.03%;33/329), parainfluenza viruses(PIVs;8.51%;28/329), and Mycoplasma pneumoniae(M. pneu;8.51%;28/329), respectively. Among the co-infected cases(17.53%;78/445), IFV/AdV and IFV/M. pneu were the most common co-infections. Most of the respiratory viruses were detected in summer and fall. Conclusion In our study, IFV-A was the most common respiratory pathogen among 22 detected pathogens, followed by AdV, HCoV, RV/EV, PIV, and M. pneu. Bacteria appeared less frequently than viruses, and co-infection was the most common phenomenon among viral pathogens. Pathogens were distributed among different age groups and respiratory viruses were generally active in July, September, and November. Enhanced surveillance and early detection can be useful in the diagnosis, treatment, and prevention of AFRS, as well as for guiding the development of appropriate public health strategies.

Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency

BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed.The data of 321 patients with no acute respiratory insufficiency as controls were also collected.Clinical variables of the first 24 hours after admission to intensive care unit were collected,including age,sex,comorbid disease,type of surgery,admission type,presence of shock,presence of acute kidney injury,presence of acute lung injury/acute respiratory distress syndrome,acute physiologic and chronic health evaluation(APACHE Ⅱ) score,sepsis-related organ failure assessment(SOFA),and PaO_2/FiO_2 ratio.Duration of mechanical ventilation,length of intensive care unit stay,intensive care unit death,length of hospitalization,hospital death and one-year survival were calculated.RESULTS:The incidence of acute respiratory insufficiency was 37.2%(190/321).Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases(P=0.001),surgeryrelated infection(P=0.004),hypo-volemic shock(P<0.001),and emergency surgery(P=0.018),were independent risk factors of postoperative acute respiratory insufficiency.Compared with the patients without acute respiratory insufficiency,the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay(P<0.001),a prolonged length of hospitalization(P=0.006),increased intensive care unit mortality(P=0.001),and hospital mortality(P<0.001).Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency(P=0.029,RR:8.522,95%CI:1.243-58.437,B=2.143,SE=0.982,Wald=4.758).Compared with the patients without acute respiratory insufficiency,those with acute respiratory insufficiency had a shortened one-year survival rate(78.7%vs.97.1%,P<0.001).CONCLUSION:A history of chronic obstructive pulmonary diseases,surgery-related infection,hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency.Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency.Compared with patients without acute respiratory insufficiency,those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.

Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency

BACKGROUND: The present study aimed to determine the short-term and long-term outcomes of critically ill patients with acute respiratory insuffi ciency who had received sedation or no sedation.METHODS: The data of 91 patients who had received mechanical ventilation in the first 24 hours between November 2008 and October 2009 were retrospectively analyzed. These patients were divided into two groups: a sedation group(n=28) and a non-sedation group(n=63). The patients were also grouped in two groups: deep sedation group and daily interruption and /or light sedation group.RESULTS: Overall, the 91 patients who had received ventilation ≥48 hours were analyzed. Multivariate analysis demonstrated two independent risk factors for in-hospital death: sequential organ failure assessment score(P=0.019, RR 1.355, 95%CI 1.051–1.747, B=0.304, SE=0.130, Wald=50483) and sedation(P=0.041, RR 5.015, 95%CI 1.072–23.459, B=1.612, SE=0.787, Wald=4.195). Compared with the patients who had received no sedation, those who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and hospital, and an increased in-hospital mortality rate. The Kaplan-Meier method showed that patients who had received sedation had a lower 60-month survival rate than those who had received no sedation(76.7% vs. 88.9%, Log-rank test=3.630, P=0.057). Compared with the patients who had received deep sedation, those who had received daily interruption or light sedation showed a decreased in-hospital mortality rate(57.1% vs. 9.5%, P=0.008). The 60-month survival of the patients who had received deep sedation was signifi cantly lower than that of those who had daily interruption or light sedation(38.1% vs. 90.5%, Log-rank test=6.783, P=0.009).CONCLUSIONS: Sedation was associated with in-hospital death. The patients who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and in hospital, and an increased in-hospital mortality rate compared with the patients who did not receive sedation. Compared with daily interruption or light sedation, deep sedation increased the in-hospital mortality and decreased the 60-month survival for patients who had received sedation.

100 Cases of Clinical and Etiological Aspects of Cardiac Insufficiency in N’Djamena, Chad

Introduction: Cardiac Insufficiency is progressively taking over as the leading cause of morbidity and mortality in the world and a major public health problem in Chad. Our study was to contribute and provide a deeper understanding of the clinical and etiological aspects concerning the etiology and management of Cardiac Insufficiency in N’Djamena, Chad. Due to having no published data to distinctly understand this pathology in this part of the world, we represent here a summary of available data which could be used to describe the clinical and etiological aspects of Cardiac Insufficiency and to help in changing practices for an optimal management as a baseline for comparison in future studies. Patients and Methods: This was a prospective, descriptive study conducted from November 30th 2011 to May 30th 2013 at the Good Samaritan Hospital of N’Djamena. Results: 100 hospitalized patients were included consecutively. The sex ratio was 1.08 with an average age of 40.21 ± 21.30 years. The main cardiovascular risk factors were high blood pressure (15%), obesity (12%) and diabetes (11%). Clinically, exertional dyspnea was found in 95% of cases, and signs of congestive heart failure in 61% of cases. The etiologies were 50% of Rheumatic valvulopathy, 22% of Dilated cardiomyopathy, 13% of Hypertensive cardiomyopathy and 12% of Congenital heart disease. Conclusion: The most common etiologies were Rheumatic valvulopathy, Congenital heart disease, Dilated cardiomyopathy and Hypertensive cardiomyopathy.

Etiological and Radiological Profile of Acute Lower Respiratory Infections during the Pre-COVID Period in the Paediatric Ward of the Teaching Hospital of Mali and in the Community Health Centre of Yirimadio in Bamako

Introduction: Every year, nearly 4 million people pass away from acute respiratory infections. 98% of such deaths are due to lower respiratory tract infections. Even though studies have been carried on lower respiratory infections x-ray aspects in Mali, very few studies have been done to reveal bacteriological and virological evidence of this disease. Materials and methods: It is about a descriptive prospective study carried out from January to December 2018 having involved patients of all ages, coming for medical consultation at the Yirimadio Community-based health center as well as children from 6 months to 15 years old coming at the pediatric department of UHC Hôpital du Mali for a lower respiratory infection. They had all undergone chest X-ray and a PCR. The purpose: of this work is to study etiological and x-ray aspects of acute lower respiratory infections at the Yirimadio Community-based Health Center and at the UHC pediatric department of Hôpital du Mali. Findings: From January to December 2018, we recorded a frequency of 1.19%. The age group 0 - 5 years was the most represented (64.5%) with a sex ratio of 0.97 for women. Cough was the most common clinical sign (98.7%) followed by fever (58.9%). Standard frontal chest X-ray was pathological in 70% of our patients. It was bronchitis in 75.4% of cases, pneumonia (13.5%), and bronchopneumonia (12.3%). PCR positive was in 83.9% of patients. It revealed a co-infection in more than half of the patients (52.5%), bacterial infection (16.1%) and viral infection (15.2%). Pathogens isolated ranked by frequency were Streptococcus pneumoniaa (87.6%) followed by Staphylococcus aureus (24.9%) and human rhinovirus (17%). The most common viral causes were human rhinovirus (17%), followed by influenza A and B virus (7%) and human parainfluenza virus (7%). Conclusion: It stemed from the study that lower respiratory infections were mainly due to Streptococcus pneumonea and human rhinovirus during pre-COVID at the Yirimadio Community-based health center and UHC Hôpital du Mali.

Advances in the genetic etiology of premature ovarian insufficiency

Premature ovarian insufficiency(POI),defined as the loss of ovarian function in women before the age of 40 years,is a challenging reproductive issue that affects hundreds of millions of people globally with compromised fertility and a higher risk of cardiovascular disease.POI is highly heterogeneous in etiology,including genetic,infectious,metabolic,environmental,iatrogenic,and immunological factors.

Surgical resection of a giant thymolipoma causing respiratory failure: A case report

BACKGROUND Thymolipoma is a rare benign tumor arising from the anterior mediastinal thymus and is composed of mature fatty tissue and interspersed nonneoplastic thymic tissue. This tumor accounts for only a small percentage of mediastinal masses, and the majority of them are asymptomatic and found incidentally. To date, fewer than 200 cases have been published in the world literature, of which most excised tumors weighed less than 0.5 kg and the largest weighed 6 kg.CASE SUMMARY A 23-year-old man presented with a complaint of progressive breathlessness for 6mo. His forced vital capacity was only 23.6% of the predicted capacity, and his arterial partial pressure of oxygen and carbon dioxide were 51 and 60 mmHg,respectively, without oxygen inhalation. Chest computed tomography revealed a large fat-containing mass in the anterior mediastinum that measured 26 cm × 20cm × 30 cm in size and occupied most of the thoracic cavity. Percutaneous mass biopsy revealed only thymic tissue without signs of malignancy. A right posterolateral thoracotomy was successfully performed to remove the tumor along with the capsule, and the excised tumor weighed 7.5 kg, which to our knowledge, was the largest surgically removed tumor of thymic origin. Postoperatively, the patient’s shortness of breath was resolved, and the histopathological diagnosis was thymolipoma. No signs of recurrence were observed at the 6-mo follow-up.CONCLUSION Giant thymolipoma causing respiratory failure is rare and dangerous. Despite the high risks, surgical resection is feasible and effective.

合肥市某三甲医院2021至2023年发热儿童临床体征及呼吸道病原抗体监测分析

目的:分析发热儿童呼吸道病原体分布及临床体征,探讨呼吸道病原体检出影响因素。方法:收集发热儿童人口特征学资料、临床表现和体征、实验室检查等资料,统计其流行病学特征、临床体征和病原抗体分布,分析不同因素对病原抗体阳性率的影响。结果:发热儿童2月、3月、6月住院比例较高,分别占同期儿科住院病例的6.50%、5.23%、4.85%;临床症状前五位分别是咽部充血、抽搐、呼吸音粗、扁桃体肿大、咳嗽;52.84%的发热儿童呼吸道病原体抗体阳性,联合感染占31.40%,肺炎支原体、副流感、甲流、乙流感染分别占48.91%、17.03%、1.75%、1.75%,各病原体阳性率之间差异有统计学意义(P<0.001);不同的年份、月份、症状、白细胞值、SAA值其病原体阳性率不同,且差异均有统计学意义(P=0.011、0.017、0.019、0.001、0.044)。结论:发热儿童首要症状为咽部充血,感染病原体主要为肺炎支原体。发热儿童呼吸道感染性疾病监测时建议关注2月、3月、11月,咽部充血、扁桃体肿大,白细胞异常、SAA异常的患儿。

新冠疫情前后重症肺炎合并急性呼吸衰竭患儿的临床特点与病原学分析

目的探讨苏州地区新冠疫情前后急性重症肺炎合并呼吸衰竭(sever pneumonia complicated with acute respiratory failure,SP-ARF)患儿的临床特点与病原学分析结果。方法本研究回顾性分析2018年1月至2021年12月所有入住苏州大学附属儿童医院SP-ARF患儿病历资料,根据疫情发生时间分为疫情前组(2018年1月至2019年12月)与疫情后组(2020年1月至2021年12月)2组,比较2组临床资料及病原学结果等。结果疫情前组141例,疫情后组127例,疫情后组月龄较大(P<0.05),合并基础疾病比例更高(P<0.05),疫情前后每年10-12月均是SP-ARF高发时段。疫情前病原学总检出116例,阳性率为82.27%,检出前4位依次为革兰阴性菌(36.88%)、革兰阳性菌(26.95%)、病毒(26.95%),肺炎支原体(9.22%);疫情后病原学总检出109例,阳性率为85.83%,检出前4位依次革兰阴性菌(37.80%)、病毒(28.35%)、革兰阳性菌(22.83%),肺炎支原体(9.45%)。结论疫情后无基础疾病的儿童进展为SP-ARF发生比例减少,无论疫情前后,每年10-12月均是SP-ARF高发时段,且两组患儿的病原体均以细菌为主,革兰阴性菌占比最高。

一种改良式氧气呼吸器在Ⅰ型呼吸衰竭患者中的应用效果

目的探讨一种改良式氧气呼吸器在Ⅰ型呼吸衰竭患者中的应用效果。方法选取2022年10月至2023年11月在入住山西医科大学第二医院Ⅰ型呼吸衰竭患者的临床资料,按照吸氧面罩的不同种类分为对照组和观察组共88例,对照组48例使用抗生素+普通面罩吸氧治疗,观察组40例使用抗生素+改良式氧气呼吸器治疗。比较2组患者脉搏血氧饱和度(SpO_(2))下降发生率、饮水呛咳发生率、腹胀发生率、患者满意度得分情况。结果2组患者SpO_(2)下降发生率和饮水呛咳发生率分别为21%、15%,差异均有统计学意义;与对照组相比,观察组患者满意度得分有所提升,为2.9分,差异有统计学意义;腹胀发生率降低了4%,差异无统计学意义。结论Ⅰ型呼吸衰竭患者应用改良式氧气呼吸器可降低因暂停吸氧造成的SpO_(2)下降发生率、饮水呛咳发生率,有助于提高患者满意度,患者获益大,可在临床广泛应用。

陈华教授从“阴虚瘀热”论治小儿反复呼吸道感染经验总结

[目的]总结陈华教授从“阴虚瘀热”论治小儿反复呼吸道感染的经验。[方法]通过随师临证,总结整理病案资料,阐释陈师治疗小儿反复呼吸道感染的临床经验及方药特色,并通过临床验案加以佐证。[结果]陈师认为,小儿反复呼吸道感染病因为风、痰、瘀、虚,病机为肺脾两虚,痰瘀阻络,迁延不愈,瘀热互结,创新性地提出从“阴虚瘀热”辨治小儿反复呼吸道感染,总结出重视风邪,祛风解表;三因制宜,滋阴清瘀;详辨虚实,巧用和法;顾护中焦,健运脾胃的诊治经验。验案为反复呼吸道感染患儿,辨为阴虚感冒,兼痰瘀阻滞证,陈师分期论治,滋阴清瘀治法贯穿疾病治疗的中后期,迁延期养阴退热、化痰祛瘀,恢复期养阴退热、健脾益气,疗效显著。[结论]陈师继承浙派中医儿科特色,从“阴虚瘀热”辨治小儿反复呼吸道感染,疗效显著,对指导临床有较高实用价值。

粤东地区2019~2022年儿童呼吸道感染病原学分析

目的分析粤东地区2019~2022年儿童呼吸道感染病原学分布情况,为临床诊疗提供参考依据。方法收集2019年5月~2022年10月期间咽拭子标本(来源均为急性呼吸道感染至汕头市中心医院就诊患儿)3052份,提取病原体核酸,应用逆转录-聚合酶链式反应(RT-PCR)、多重聚合酶链式反应(PCR)技术进行扩增后,进行15种(型)常见呼吸道病原体的筛查,将其分为单纯DNA病毒组、单纯RNA病毒组、单纯细菌组、单纯肺炎支原体组、混合DNA和RNA病毒组、混合病毒和细菌组、混合肺炎支原体和病毒或细菌组。分析儿童呼吸道感染病原学检测结果、各组的性别构成情况,比较各年龄段儿童呼吸道病原体检测阳性情况、月份分布情况。结果呼吸道感染患儿的咽拭子标本3052份,其中阳性2714份,阴性338份,呼吸道感染阳性患儿的性别比例、年龄分布、疾病类型、月份分布和就诊时体温与呼吸道感染阴性患儿有统计学差异(P<0.05)。2714例呼吸道感染阳性患儿中,检出率最高的为巨细胞病毒759例,检出率为28.0%。2714例呼吸道感染患儿中,男性1643例(60.5%),女性1071例(39.5%)。同一病原体的男性发病率明显高于女性。单纯肺炎支原体感染发病率随年龄增长逐渐增加;单纯DNA病毒、单纯RNA病毒、单纯细菌、混合DNA和RNA病毒、混合病毒和细菌发病率随年龄增长逐渐降低。单纯DNA病毒组、单纯RNA病毒组、单纯肺炎支原体组、混合DNA和RNA病毒组、混合肺炎支原体和病毒或细菌组7~9月发病率最高,分别为45.3%、40.7%、46.9%、43.9%、47.4%,单纯细菌组、混合病毒和细菌组4~6月发病率最高,分别为29.3%、29.3%。结论粤东地区儿童急性呼吸道感染以巨细胞病毒为主;发病率男性均比女性高;单纯肺炎支原体感染发病率随年龄增长逐渐增加,单纯DNA病毒、单纯RNA病毒、单纯细菌、混合DNA和RNA病毒、混合病毒和细菌发病率随年龄增长逐渐降低;7~9月呼吸道感染首先应警惕病毒和肺炎支原体感染,如果7~9月呼吸道感染考虑存在细菌感染,应警惕混合病毒或肺炎支原体感染可能。

卵巢功能不全病因病机及动物模型构建研究进展

卵巢功能不全(premature ovarian insufficiency,POI)又称“卵巢功能低下”,其发病率高达1%~5%,近年来还呈现不断上升的趋势,已经严重影响女性的身心健康及生活质量。目前,关于POI的发病原因及机制尚不明确,模型构建方法与应用也较混乱,且绝大多数模型在针对性、稳定性等方面存在一定不足,这也极大的限制了POI的相关研究及其临床诊断和治疗。因此本文对POI的病因病机与POI动物模型的构建进行综述和讨论,以期为POI的病因病机研究及模型的选择和构建提供更多参考。

高甘油三酯血症性急性胰腺炎并发急性呼吸衰竭危险因素及预测模型的建立

目的分析高甘油三酯血症性急性胰腺炎(HTG-AP)患者并发急性呼吸衰竭(ARF)的危险因素,并构建风险预测模型。方法222例HTG-AP患者根据ARF诊断指南分为非ARF组176例和ARF组46例,比较2组临床资料并筛选预测因子,将筛选的因子纳入多因素Logistic回归分析并建立回归模型,绘制受试者工作特征(ROC)曲线、校准图及决策曲线分析(DCA)分别评估模型的预测能力、准确性及临床实用性。结果与非ARF组相比,ARF组高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白蛋白(ALB)水平降低(P<0.05),而肌酐(Cr)、尿素氮(BUN)、天冬氨酸转氨酶(AST)、C-反应蛋白(CRP)水平及胸水、腹水发生率升高(P<0.05)。多因素Logistic回归分析结果显示,较高水平的Cr、AST,较低水平的ALB、HDL-C及有腹水为HTG-AP并发ARF的独立危险因素(P<0.05)。基于该结果建立HTG-AP并发ARF的列线图预测模型ROC曲线下面积为0.952(95%CI:0.923~0.981),约登指数0.808,敏感度、特异度分别为93.33%、87.43%。校准曲线显示,模型预测HTG-AP并发ARF概率与实际发生概率具有较好一致性。DCA曲线显示,模型具有一定的临床实用价值。结论构建的列线图预测模型可为临床预防HTG-AP并发ARF提供方案。

不同支持模式下体外膜肺氧合期间患者血小板变化的回顾性队列研究

背景体外膜肺氧合(ECMO)已被广泛应用于治疗各类急危重症的心脏及呼吸功能衰竭疾病,但治疗过程中血小板计数(PLT)会显著下降,导致患者出血风险增加,从而影响患者预后。因此,研究ECMO治疗期间PLT的变化规律,有助于预防血小板下降所导致的出血相关风险,从而改善患者预后。目的回顾性分析不同支持模式下成人ECMO支持期间PLT的变化规律。方法纳入高州市人民医院心脏中心2019年1月—2021年10月进行静脉-静脉ECMO(V-V ECMO)或静脉-动脉ECMO(V-A ECMO)支持治疗的40例成年患者为研究对象。根据患者是否行心脏手术分为手术组(n=23)与非手术组(n=17),根据患者ECMO干预后是否死亡分为死亡组(n=22)和存活组(n=18)。收集患者基线资料,同时收集患者基线、ECMO前、干预期间PLT及血小板输注情况。结果患者平均年龄(49.0±17.8)岁,平均ECMO支持时间(6.0±3.2)d。手术组与非手术组患者ECMO干预原因比例比较,差异有统计学意义(P<0.05)。ECMO干预前患者血小板减少发生率为18%(7/40),其中3例采用V-V ECMO,均患有重症肺炎,4例采用V-A ECMO;ECMO支持1 d后血小板减少发生率为56.0%(18/32),其中4例采用V-V ECMO,14例采用V-A ECMO;非手术组有9例患者输注血小板治疗,手术组患者有13例输注血小板治疗,患者首次血小板输注有效率为59.1%(13/22)。手术组ECMO前血小板减少比例高于非手术组(P<0.05)。非手术组ECMO支持第4天PLT最低,手术组ECMO支持第5天PLT最低。死亡组患者年龄高于存活组,ECMO支持时间、脱机率、ECMO支持第7天PLT低于存活组(P<0.05)。结论ECMO支持下的PLT于第3~4天达到最低值,患者预后与PLT存在相关性。患者首次输注异体血小板可以提升PLT,提示临床上可以根据PLT变化规律做好相应的干预准备,减少PLT过低引发出血等并发症,改善接受ECMO患者的预后。

新生儿重度窒息并发急性肾损伤的危险因素及近期预后分析

背景新生儿急性肾损伤(AKI)早期诊断困难,病死率高,而目前关于重度窒息并发新生儿AKI的相关研究相对缺乏。目的探讨新生儿重度窒息并发AKI的危险因素及近期预后情况,并分析相关因素的预测价值,以采取措施减少AKI的发生,并提高此类患儿的抢救成功率。方法纳入2016年1月—2023年1月于蚌埠医学院第一附属医院新生儿重症监护病房住院治疗的172例重度窒息新生儿为研究对象,根据患儿是否并发AKI,分为AKI组(n=43)和非AKI组(n=129)。收集患儿临床资料和实验室检查结果,并记录AKI患儿的近期预后情况(住院期间存活或死亡)。采用多因素Logistic回归分析探究新生儿重度窒息并发AKI的影响因素,采用受试者工作特征(ROC)曲线探究相关指标对新生儿重度窒息并发AKI的预测价值。结果AKI组患儿胎龄、出生体质量、5 min Apgar评分、血小板计数低于非AKI组,昏迷状态比例、有创机械通气比例、合并呼吸衰竭比例、血胱抑素C(Cys C)高于非AKI组(P<0.05)。多因素Logistic回归分析结果显示,5 min Apgar评分(OR=1.553,95%CI=1.193~2.021,P=0.001)、有创机械通气(OR=2.965,95%CI=1.021~8.611,P=0.046)、血Cys C值(OR=0.231,95%CI=0.109~0.487,P<0.001)是新生儿重度窒息并发AKI的影响因素。ROC曲线分析结果显示血Cys C预测AKI的ROC曲线下面积(AUC)为0.777(95%CI=0.701~0.854,P<0.05),5 min Apgar评分预测AKI的AUC为0.792(95%CI=0.715~0.869,P<0.05)。AKI组患儿住院病死率为51.2%(22/43),非AKI组患儿住院病死率为21.7%(28/129),AKI组患儿病死率高于非AKI组(χ^(2)=13.572,P<0.001)。结论低5 min Apgar评分、有创机械通气、出生后高血Cys C会增加重度窒息新生儿发生AKI的风险。5 min Apgar评分、出生后血Cys C是预测新生儿重度窒息并发AKI的可靠指标。

早发性卵巢功能不全遗传因素中相关基因改变的研究进展

早发性卵巢功能不全(POI)是指女性在40岁之前出现月经及激素水平异常等现象。近年来,POI的发病率出现逐年提高的趋势,引起国内外学者的强烈关注。随着全外显子测序、全基因组测序等技术的发展,不同的POI候选基因及致病基因被发现,越来越多的研究证实基因突变参与POI的病理生理过程,大大增加了人们对其遗传学病因的认识。本文从DNA损伤修复和同源重组相关基因、转录因子相关基因及卵巢功能相关基因三个方面综述了POI相关基因改变及其分子机制的最新进展,以期进一步明确其发病机制的多样性,为POI的遗传学筛查和治疗提供新的思路。

下肢慢性静脉功能不全严重程度与超声结果的关系

目的:探讨下肢静脉功能不全的患者临床严重程度与超声检查结果的关系。方法:选取2022年1月至2023年6月在我院住院就诊的下肢静脉功能不全的285例患者,对所有患者的超声检查进行回顾,并依据临床、病因、解剖-病理(CEAP)分级、静脉临床严重程度评分(VCSS)和HASTI评分来评估患者的临床严重程度。结果:通过回顾性分析285例患者(463条患肢),研究发现重度静脉功能不全的风险与年龄、体质量指数(BMI)和糖尿病相关。超过60%的患肢有大隐静脉反流,有54.86%的患肢有穿支静脉反流,大隐静脉反流和穿支静脉反流与静脉功能不全的严重程度显著相关,重度静脉功能不全的患肢大隐静脉、小隐静脉、穿支静脉直径均显著高于轻中度,重度静脉功能不全的患肢大隐静脉反流时间、穿支静脉反流时间、股静脉反流时间显著大于轻中度。大隐静脉直径、穿支静脉直径和反流时间与VCSS和HASTI评分成正相关。结论:重度慢性静脉功能不全的超声阳性检出率更高,结果可作为静脉功能不全严重程度的客观评价指标。

2559例儿童呼吸道感染病原体分布及流行病学特征调查

目的:研究儿童呼吸道感染病原体分布及流行病学特征。方法:选取2023年于河南中医药大学第一附属医院因呼吸道感染住院治疗的患儿2559例,检测病原体类型,分析其分布情况、流行病学特征情况。结果:共收集标本2559例,男性多于女性,年龄0~14(5.74±3.57)岁,阳性检出率为96.83%。共检出病原体5639株,革兰阳性菌958株(16.99%);革兰阴性菌1308株(23.20%);病毒1998株(35.43%);真菌114株(2.02%);支原体、衣原体、立克次体1182株(20.96%),最常见的病原体为肺炎支原体(MP)、流感嗜血杆菌(Hi)、肺炎链球菌(SP)、鼻病毒(RV)、呼吸道合胞病毒(RSV)。2559份标本中检出MP 1182株,不同性别儿童MP检出率比较差异无统计学意义,6~14岁儿童MP检出率最高(P<0.05),在10-12月期间检出率最高(P<0.05)。MP基因23S rRNA区域耐药突变位点主要为A2063G,耐药率达89.85%。结论:儿童呼吸道感染病原体以MP、Hi、SP、RV、RSV为主,不同性别、年龄、发病月份有特异性分布,其中MP耐药基因突变率达到89.85%。呼吸道感染在临床上须尽早诊断,早明确,合理用药,以便控制病情、改善预后。