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EV71病毒疫苗研究进展
肠道病毒71型(Enterovirus 71,EV71)为二十面立体对称的球型结构,直径为24-30 nm.病毒衣壳由60个亚单位构成,每个亚单位由4种衣壳蛋白(VP1-VP4)组成[1].根据病毒衣壳蛋白VP1核苷酸序列的差异,可将EV71分为A、B、C 3个基因群和11个基因类型(A,B1-B5和C1-C5)[2].EV71引起的手足口病(Hand foot and mouth disease,HFMD)和疱疹性咽峡炎,在世界各地均有暴发流行,是一种在儿童中常见的自限性疾病.
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手足口病114例护理体会
手足口病(Hand,foot and mouth disease,HFMD)是由肠道病毒引起的传染病,多发生于婴幼儿,可引起手、足、口腔等部位的疱疹,个别患者可引起心肌炎、肺水肿、无菌性脑膜脑炎等并发症.引发手足口病的肠道病毒有20多种(型),柯萨奇病毒A组的16、4、5、9、10型,B组的2、5型,以及肠道病毒71型均为手足口病较常见的病原体,其中以柯萨奇病毒A16型(Cox A16)和肠道病毒71型(EV 71)为常见.
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儿童手足口病的预防研究进展
手足口病(Hand,foot and mouth disease , HFMD)是全球范围内流行性传染疾病.近年来,手足口病发病在我国呈上升趋势,2009年全国累计报告手足口病例115 618例,死亡50例.报告病例中以婴幼儿为主,5岁以下占94.8%,3岁以下占77.6%.本文对手足口病的预防及早期治疗综述如下:
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Objective To realize the characteristics of“zheng”differentiation-treatment for hand, foot and mouth disease (HFMD), a new methodology of syndrome differentiation for different stages of HFMD has been explored.
Methods Total of 2 325 cases with HFMD were recorded by distributing them into exterior syndrome stage, interior syndrome stage, severe syndrome stage and recovered syndrome stage, respectively, and the main symptoms and subsidiary symptoms of different stages of HFMD have been observed. The major and minor pathogenesis of HFMD in different stages were obtained, and compared with the “2010 Guideline for the Diagnosis and Treatment of HFMD”.
Results It was found that the major pathogenesis of exterior stage was deifned as“the invation of the wen-evil to the defender of the body with the collaterals got involved”, and the minor as“qi deifciency”;in interior stage,“the fury of Gan-Yang”was the main pathogenesis, and“qi in chaos and qi deifciency”was the minor;in severe syndrome stage,“the damage of heart, liver and lung”was the main pathogenesis, and“qi in chaos”was the minor;and the pathogenesis of recovered stage was“qi-yin deficiency”. Compared with the“2010 Guideline for the Diagnosis and Treatment of HFMD”, it showed that“the obstruction of the fei-pi qi by the mixture of shi-re evil”and“the mixture of shi-re”in vivo was quite dififcult to be explained in completely different context in the general situation; in the severe stage, the TCM clinical characteristics of syndrome differentiation might lose;in the early acute severe cases, the phenomenon that xin-yang and fei-qi almost ran out was dififcult to be observed, then, the line between the severe and the acute severe became vague.
Conclusions The theory of syndrome differentiation by stages of HFMD was reasonable in the actual situation of clinical description on HFMD which was expected to be further tested and widely applied in the“zheng”differentiation-treatment of HFMD in the future. -
Objective To analyze the clinical and laboratory features of patients with mild and severe HFMD to identify early predictive or diagnostic markers for severe cases. Methods Samples of feces, nasopharyngeal-swab specimens, peripheral blood, serum and cerebral spinal lfuid were collected. Postmortem pathological examination was conducted on 2 dead patients with complication due to neurogenic pulmonary edema. Reverse transcription-polymerase chain-reaction (RT-PCR), culture and isolation of enterovirus 71 (EV71) were performed to detect EV71 infection. Both univariate and multivariate logistic analysis were used to identify factors associated with severe cases. Results EV71 was mainly responsible for HFMD. In this study, 5 isolated EV71 strains belonged to C4 gene subtype. Compared with mild patients, EV71-RNA detection rate was higher and CoxA16 detection rate was lower among severe patients (P < 0.01). Inlfammatory cell inifltration in the lung, cardiac and liver tissues were mild by postmortem pathological examination. It was found that body temperature, vomitting, limb tremor, neutrophil, blood glucose and EV71 infection were significantly related to the severe cases by univariate logisticanalysis. However, after multivariate logistic regression analysis, only vomiting (OR 16.1, CI 2.3-110.5,P < 0.01) and limb tremor (OR 117.6, CI 13.8-1004.5,P < 0.01) were signiifcantly and independently correlated with the severe cases. Conclusions EV71 was mainly responsible for HFMD, particularly for severe cases. Vomiting and limb tremor were predictive markers for severe cases.
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Objective To evaluate the efifcacy and safety of traditional Chinese medicine (TCM) combined with Western medicine in the treatment of patients with common hand, foot and mouth disease (HFMD) by conducting a prospective, controlled, and randomized trial.
Methods A total of 452 patients with common HFMD were randomly assigned to receive Western medicine alone (n=220) or combined with TCM (Reduning or Xiyanping injections) (n=232). The primary outcome was the incidence rate of rash/herpes disappearance within 5 days, while secondary outcomes included the incidence rate for fever, cough, lethargy, agitation, and vomiting clearance within 5 days.
Results The rash/herpes disappearance rate was 45.5% (100/220) in Western medicine therapy group, and 67.2% (156/232) in TCM and Western medicine combined therapy group, with significant difference (P<0.001). Moreover, TCM remarkably increased the incidence rate of secondary disappearance, which was 56.4%in Western medicine therapy group and 71.4%in TCM and Western medicine combined therapy group (P=0.001). No drug-related adverse events were observed.
Conclusions It’s suggested that the integrative TCM and Western medicine therapy achieved a better therapeutic efficacy. TCM may become an important complementary therapy on relieving the symptoms of HFMD. -
手助腹腔镜结直肠癌根治术42例报告
随着腹腔镜技术的发展,尤其是蓝碟的发明问世,手助腹腔镜技术(hand assisted laparoscopic surgery,HALS)在普通外科疾病诊治中发挥越来越大的作用.我科2010年10月至2011年4月期间对42例结直肠癌患者采用手助式腹腔镜实施结直肠癌根治术,近期疗效满意,现报道如下.
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肠道病毒71型手足口病致神经系统发病机制的新进展
肠道病毒71型(Enterovirus 71,EV71)是导致手足口病(hand foot and mouth disease,HFMD)的主要病原体之一,作为一种嗜神经组织性病毒与引起HFMD婴幼儿严重的神经系统并发症密切相关.目前研究发现,EV71感染后引发机体一系列改变,包括机体的免疫反应变化、细胞因子级联活化、神经细胞凋亡等.本文就EV71 HFMD患者机体发生神经系统病变机制的新研究进展做简要介绍.
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肠道病毒71相关性手足口病新进展
肠道病毒71型(Enterovirus 71,EV 71)是引起手足口病(Hand foot and mouth disease,HFMD)的常见病因,因近年来EV 71相关性HFMD在全球多个国家和地区暴发流行,且与神经系统严重并发症的发生密切相关,对EV 71的研究成为了热点.
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手足口病的研究进展
手足口病(hand foot and mouth disease,HFMD)是由肠道病毒感染导致的临床症候群,患病人群以婴幼儿为主,大多数临床症状轻微,主要表现出发热和手、足、口腔等部位皮疹或疱疹等症状,预后良好.个别重症HFMD患儿病情进展快,死亡率高.
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用SIRS/sepsis理论指导重症病毒感染性疾病诊治——从手足口病谈起
感染/炎症和免疫问题是生命科学和临床医学永恒的主题.近几十年来,我国相继发生传染性非典型肺炎、禽流感、肠道病毒71型(EV71)、甲型H1N1流感等病毒感染性疾病流行.院内感染,如ICU、新生儿病房等院内抗药性耐甲氧西林金黄色葡萄球菌(MRSA)等耐药菌株交叉感染事件时有发生.
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门急诊儿童手足口病286例分析
2008年3月至5月,安徽省阜阳市爆发流行儿童手足口病(hand,foot and mouth disease,HFMD),一度引起国人的关注.我们采用回顾性研究,将我院2008年3月至7月儿科门急诊收治的286例儿童手足口病的流行特征与临床分析总结如下.
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中外手外科学术比较与任务
◆中外手外科领域主要任务的差别·研究领域的差别2004年5月20~24日在上海召开了第九届全国手外科学术会议,随后于6月13~17日在匈牙利首都布达佩斯召开了第九届国际手外科学术会议.国内会议共收到论文756篇,其中创面修复论文多,达150篇,占总数的20%,其次为断肢(指)再植与再造130篇,占17.2%,及周围神经损伤(包括臂丛损伤)120篇,占15.9%.三类论文共占53%.由此可见手部急性创伤的修复与重建是我国手外科领域的主要任务.国际会议共收到论文943篇,其中骨关节损伤论文多达418篇,占总数的44%,其次为周围神经损伤158篇,占17%,此二类论文共占61%,详见表1.从上述论文数据即可了解骨关节病变的诊治已成为国际手外科领域的主要研究内容,而我国则仍然以手部急性创伤的诊治为主要任务.这也是发达国家手外科与发展中国家手外科的主要差别.
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医务人员两种洗手方法效果的比较研究
在日常医院感染管理工作中,医务人员的手作为一种感染传播媒介,其卫生学意义相当重要.ICU病人多来自医院其他科室,病情危重,院内感染发生率相对较高.有研究指出,医务人员的手是散播微生物的重要传播媒介,经医务人员的手传播细菌而造成的医院感染约占30%[1].肥皂洗手是目前降低医务人员手细菌数普遍的方法.2009年6月我们做了使用肥皂液洗手和皮肤消毒剂擦手前、后手带菌数、洗手合格率的比较,现报道如下.
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Mouse Hand Pain“鼠标手”离你还远吗
在科技不断发展的今天,社会已进入信息时代,生活中处处都离不开电脑,因此,它成为了人们工作、生活以及学习中不可缺少的电子科技工具.但是,虽然它对我们有益,但仍会有些负面的影响.比如有些人长期用电脑,就会导致这样或那样的疾病.我们常常听说的"鼠标手"就是其中之一."鼠标手"知多少"鼠标手"主要是"重复性压力伤害"所致.一般来说,正常人的手腕活动不会妨碍正中神经.但是在我们操作电脑时,由于键盘和鼠标有一定的高度,人的手腕必须背屈一定角度,这时腕部就处于强迫体位,从而不能自然伸展."鼠标手"通俗而狭义的讲就是"腕管综合症",这类症状主要是人体的正中神经以及进入手部的血管在腕管处受到压迫所产生的,主要会导致食指和中指僵硬疼痛、麻木与拇指肌肉无力感.
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手足口病的症状及个人预防措施
手足口病(hand,foot and mouth disease,HFMD)是由肠道病毒引起的传染病,多发生于婴幼儿,可引起手、足、口腔等部位的疱疹,个别患者可引起心肌炎、肺水肿、无菌性脑膜脑炎等并发症.手足口病起病一般较急,患儿常有发热,体温38~40℃,热程多为4 d~7 d,7 d以上者少见.
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手背静脉穿刺致尺神经损伤1例
静脉穿刺是临床护理工作中常见的技术操作,也是临床治疗抢救危重病人的重要给药途径,由于病人的病情、体质不同,护理人员对穿刺部位解剖结构的不熟悉,也会导致很多并发症的发生,现将临床1例尺神经损伤的病例报告如下.
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46例重症手足口病患儿的急救与护理
手足口病(hand,foot and mouth disease,HFMD)是由多种肠道病毒引起的急性传染病,常见柯萨奇病毒A16型和肠道病毒71型(EV71)[1,2].多数患儿表现为手、足、口腔等部位的皮疹、疱疹,大多预后良好,但少数患儿可表现为严重的中枢神经系统损害,引起神经源性肺水肿、无菌性脑膜炎、急性迟缓性麻痹,病情进展迅速.病死率高[3,4].
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负压封闭引流治疗手足毁损伤病人的护理
手足毁损伤是骨科常见病之一.2008年9月-2009年1月我科应用负压封闭引流技术配合内固定手术治疗手足毁损伤,缩短了创面愈合时间,降低了治疗费用,取得了满意疗效.现将护理体会报道如下.