Objective To evaluate the correlation between hyperuricemia (HUA) and benign prostatic hyperplasia (BPH). Methods A total of 666 elderly male patients, who had been admitted to the West China Hospital for routine physical examination in May, 2010, were included in this study. All the following indexes were collected: blood pressure, waistline, medical history, international prostatic symptom score (IPSS), serum uric acid (UA), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG-2), prostate-specific antigen (PSA), and prostate volume (PV) measured by ultrasound. Patients with higher level of UA more than 420 μmol/L were included into the HUA group (n=151) while the other patients with normal UA (NUA) were in the NUA group (n=515). Both the metabolic and prostate related indexes in the two groups were compared, and the correlation between HUA and each indexes were analyzed using logistic regression model. Results HUA was significantly associated with abdominal obesity (OR=1.575, 95%CI 1.059 to 2.340), hypertriglyceridemia (OR=2.78, 95%CI 1.877 to 4.118), metabolic syndrome (CDS2007) (OR=1.912, 95%CI 1.267 to 2.885), BPH (OR=1.464, 95%CI 1.465 to 1.635) and lower urinary tract symptoms (LUTS) rating (OR=1.782, 95%CI 1.173 to 1.522). Conclusion HUA is correlated with BPH, meanwhile it is highly accompanied with other risk factors of cardioascular diseases. Hereby, comprehensive medical screening should be considered when treating such patients.
目的 监测重症医学科（ICU）呼吸机相关性肺炎（VAP）的发病率，探讨实施干预组合措施对VAP发病率的影响。 方法 对2011年6月1日－2012年5月31日ICU使用呼吸机患者478例为监测对象并按时间先后分为两组，对照组按规范方法进行干预，试验组在规范干预基础上再采取组合干预措施，包括：每日评估患者、用一次性呼吸机螺纹管、用床角量角标识抬高床头、床尾设置黄色警示线、调查手卫生依从性等，统计分析两组VAP发病率。 结果 共监测ICU患者5 937个住院日，使用呼吸机1 510个机械通气日，呼吸机使用率25.43%，发生VAP 60例，VAP发病率为39.74例/1 000机械通气日，其中对照组发生VAP 21例，使用呼吸机343个机械通气日，VAP发病率为61.22例/1 000机械通气日；试验组发生VAP 39例，使用呼吸机1 167个机械通气日，VAP发病率为33.42例/1 000机械通气日，两组发病率差异有统计学意义（χ2=12.702，P=0.000）。 结论 实施干预组合措施可使VAP发病率显著下降，但仍高于国内外大型医院，基层医院还需不断努力控制好VAP的发病率。
目的 增加对治疗相关性继发白血病的认识。 方法 报道非霍奇金淋巴瘤治疗后2年继发急性髓细胞白血病M6型1例，结合文献讨论治疗相关性白血病的发病机制、治疗、预后。 结果 1例73岁非霍奇金淋巴瘤患者接受R（Rituxmab，利妥昔单抗）－CHOP环磷酰胺+多柔比星+长春新碱+泼尼松方案规律化学治疗。治疗结束24+个月后，经骨髓涂片及细胞免疫分型诊断为急性髓细胞白血病M6型，染色体检查为：44～48，XY，del（5）（q12q33），-8，-10，der（12）t（4；12）（q11-q12；p13），其一般情况急剧恶化并死亡。 结论 治疗相关性白血病的发生可能与烷化剂等化疗药物使用和免疫受损等有关，利妥昔单抗导致第二肿瘤的发生暂时不能除外。治疗相关性白血病常伴有复杂染色体核型，其病情发展迅速，治疗效果差，生存期明显缩短。Objective To improve the understanding of secondary therapy-related leukemia. Methods The clinical data of one patient with non-Hodgkin lymphoma which transformed into acute myeloid leukemia M6 2 years after chemotherapy were studied. We discussed the pathogenesis, treatment and prognosis of therapy-related leukemia with literature review. Results A 73-year-old patient diagnosed to have non-Hodgkin’s lymphoma accepted R-CHOP chemotherapy.Two years after the treatment, the disease finally developed into acute myeloid leukemia M6 confirmed by cytogenetics, bone marrow morphology and flowcytometry analysis. The chromosome analysis demonstrated complex karyotypes as 44-48, XY, del (5) (q12q33), -8, -10, der (12) t (4; 12) (q11-q12; p13). His general status deteriorated rapidly and soon after the patient died. Conclusions Occurrence of therapy-related leukemia may be due to the administration of alkylating agents, topoisomerase inhibitors and damage of immune function. Therapy-related leukemia often occurs with complex karyotypes and progresses rapidly with poor treatment response.
目的:探讨妊娠相关性宫颈癌的早期诊断、治疗和预后。方法:结合文献回顾分析我院2000年至2007年收治的13例妊娠相关性宫颈癌的诊治经过和预后。结果:妊娠相关性宫颈癌分化程度低，癌灶体积大，早期盆腔淋巴结转移率高，产褥期宫颈癌预后差。结论:宫颈细胞学检查应列为首次产检常规项目；妊娠期宫颈原位癌在密切随诊前提下可暂不予处理，待分娩后6~8周活检确认病变性质后，再采取相应治疗措施；新辅助化疗同样可为晚期别的妊娠相关性宫颈癌争取手术时机。
Objective To analyze the clinical and etiological characteristics and bacterial susceptibility in patients with ventilator-associated pneumonia (VAP) in Guangzhou area.Methods A retrospective study was conducted on VAP patients in four hospital of Guangzhou from Jan 2004 to Oct 2005.Totally 157 patients were enrolled in this study，whose flora was identified and tested by Kirby Bauer disk diffusion susceptibility test.The univariate analysis method was used to analyze the prognostic parameters.Results The average onset time of VAP was 7.7 days after mechanical ventilation with a mortality rate of 38.2%.The proportion of Gram-negative bacilli，Gram-positive cocci and eumycete was 68.0%，23.4% and 8.7% respectively in 184 isolated strains.The most common pathogens were Pseudomonas aeruginosa (18.5%)，Stenotrophomonas maltophilia (14.1％)，Burkholderia cepacia (10.9%)，Staphylococcus aureus (10.3%) and Acinetobacter baumannii (8.7%).Pseudomonas aeruginosa，Stenotrophomonas maltophilia，and Acinetobacter baumannii were resistant to most common antibacterials such as cephalosporin and imipenem.18 strains oxacillin resistant Staphylococcus aureus，7 strains oxacillin resistant Staphylococcus simulans and one vancomycin resistant Staphylococcus aureus were isolated.Expect for vancomycin，teicoplanin and fusidic acid，the resistance of Gram-positive cocci were above 50% to other 9 antibacterials.Conclusions The antibiotic resistance situation of VAP in Guangzhou is very serious with high mortality.It is important to reinforce the prevention and guidance on the proper treatment of VAP.
输血相关性急性肺损伤（TRALI）是发生于输血期间或输血后的罕见并发症，以急性缺氧和非心源性肺水肿为特点，因死亡率高（5%~10%）而越来越受到临床关注[1]，据2004年美国食品药品管理局（FDA）的数据，TRALI为输血相关性死亡的首要因素[2]。根据文献资料，输注血制品、含血浆制品、新鲜冰冻血浆（FFP）和血小板的TRALI发生率分别约为1/5 000[3]，1/2 000[4]，1/7 900[5]和1/432[6]。据报道，所有血制品（除白蛋白外）均可引起TRALI[7]，甚至有作者怀疑大剂量给予白细胞介素-2（IL-2）也可能导致TRALI[8]。目前，我国有关TRALI的报道较少，仅有个别死亡案例报道[9，10]，而相关的研究报道很少，这可能与我们尚未认识到TRALI的危险性，以及对其的诊断率较低有关。
Objective To analyze the risk factors for ventilator-associated pneumonia( VAP) in adult patients undergoing cardiac surgery with cardiopulmonary bypass ( CPB) . Methods A total of 127 consecutive adult patients who received postoperative ventilation for more than 48 hours between January 2002 and June 2008 in the cardiac surgical intensive care unit( CSICU) were included in this study. The patients were assigned into a VAPgroup( n =64) and a control group( n = 63) . Pre-, intra-, and postoperative factors were collected and analyzed between two groups, and the multivariate analysis( logistic regression)were used to identify the risk factors of VAP. Results The overall incidence of VAP was 5.1%. The mortality of VAP was 28. 1% . Compared to the control group, the patients in the VAP group had longer duration of cardiopulmonary bypass time, ventilation time, more blood products usage and the duration of stay in CSICU( P lt; 0. 001) , higher morbidity of low cardiac output syndrome and tracheotomy( P lt; 0. 01) and higher rate of aortic surgery and mortality( P lt; 0. 05) . The preoperative left ventricular ejection fraction ( LVEF) and postoperative oxygenation index( PaO2 /FiO2 ) were lower in the VAP group than those of the control group( P lt; 0. 001) . Five variables were found to be significantly related to the development of VAP by multivariate analysis: CPB time gt; 120 min( OR = 6. 352, P = 0. 000) ; PaO2 /FiO2 lt; 300 mm Hg( OR =3. 642, P = 0. 017) , transfusion of blood products ≥1500 mL( OR = 5. 083, P = 0. 039) , ventilation time≥5 days( OR = 9. 074, P = 0. 047) and tracheotomy( OR = 19. 899, P = 0. 021) . A total of 102 pathogens were obtained by sputum culture in 64 VAP patients. There were 62( 60. 8% ) cases of gram negative bacilli, 19 cases( 18. 6% ) of gram positive cocci and 21( 20. 6% ) cases of eumycetes. Conclusion This study shows that the cardiopulmonary bypass time, ventilation time, hypoxemia, blood products transfusion and tracheotomy are risk factors most likely associated with VAP development.
为预防应激性溃疡和消化道出血, 质子泵抑制剂( PPI) 、组胺H2 受体拮抗剂( H2 RA) 以及硫糖铝在ICU中的应用非常普遍。既往的研究认为以PPI 或H2RA 为代表的抑酸剂( ASD) 可致胃液pH 值增高, 为细菌在胃腔内定植创造了条件, 并进而增加医院获得性肺炎( HAP) , 尤其是呼吸机相关性肺炎( VAP) 发生的风险。我们通过文献复习发现,ASD 与VAP 的关联性迄今仍无明确的证据, 已有的临床研究结论互为矛盾; 另一方面, 既往研究多集中于硫糖铝与H2RA 的比较, 有关PPI 和H2RA 导致VAP 的风险比较研究仍然缺乏, PPI 是否比H2 RA 更易发生VAP 也缺乏研究可资证明。为此我们将有关内容综述如下, 以供同道参考。