目的观察旋转振动扫痰仪预防长期卧床老年患者坠积性肺炎的临床效果。方法将182例老年脑卒中偏瘫患者(年龄56～91岁)分为治疗组(117例)和对照组(65例)。治疗组采用旋转振动扫痰仪治疗,每次10min,1～2次/d;对照组采用传统护理方法预防坠积性肺炎。结果对照组发生坠积性肺炎5例,治疗组无1例发生,治疗组治疗效果优于对照组(P<0.05)。结论旋转振动扫痰仪对预防长期卧床老年患者坠积性肺炎有良好效果。

Objective To observe the effects of vaporized perfluorocarbon (PFC) combined with exogenous pulmonary surfactant (PS) inhalation on rabbit models of acute lung injury (ALI).Methods Thirty-two New Zealand rabbits were randomly divided into four groups: ALI group, combination treatment group, PFC group, and PS group (each groupn = 8 rabbits). The rabbit model of ALI was induced by the whole lung normal saline lavage. After modeling, in the combined group, 3 mL/kg vaporized perfluorooctyl bromide/dipalmitoylphosphatidylcholine (PFOB/DPPC) emulsion was inhaled, the rabbits in PFC and PS groups were treated with vaporized PFOB emulsion and vaporized DPPC emulsion 3 mL/kg inhalation respectively, and in the ALI group was given the same amount of vaporized normal saline inhalation. In each group, before modeling for 30 minutes (basic value), after modeling for 1 hour and after treatment at 0 minute, 30 minutes, 2 hours, 4 hours, the respiratory rate (RR), oxygenation index (OI), dynamic lung compliance (Cdyn) were observed, and the lung coefficient (LI) and lung permeability index (LPI) were calculated; the levels of serum tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA); the lung tissue was collected and the lung pathological changes were observed under macroscopic and microscopic observation.Results Aftermodeling, the levels of OI, Cdyn were quickly lowered, RR became significantly elevated, and there were obvious edema, hemorrhage and exudation in lung tissue of ALI group. The levels of OI were significantly increased in combined group and PFC group compared with the level in ALI group after treatment at 0 minute initially [mmHg (1 mmHg = 0.133 kPa): 231.0±16.7, 221.4±19.0 vs. 189.5±21.0, both P < 0.05], while the level of OI in PS group was increased significantly until 4 hours after treatment, being higher than that in ALI group (mmHg: 297.0±20.7 vs. 243.3±36.7,P < 0.05); RR was decreased significantly in combined treatment group at 30 minutes after treatment compared with that in ALI group (bpm: 151.1±13.3 vs. 178.5±32.0,P < 0.05), while the RR in PFC group and PS group were not increased significantly until 4 hours after treatment being higher than that in ALI group (bpm: 129.3±14.3, 133.1±13.9 vs. 157.5±32.5, bothP < 0.05). Compared to ALI group, the three treatment groups resulted in significant improvement in Cdyn right at 0 minute (mL/cmH2O: 1.64±0.10, 1.45±0.10, 1.43±0.09 vs. 0.57±0.05, allP < 0.05), their LPI, LI and inflammatory cytokines were significantly decreased [LPI (×10-5): 4.21±0.42, 4.76±0.55, 4.87±0.49 vs. 5.56±0.52, LI: 8.04±0.58, 8.90±0.88, 9.22±0.71 vs. 10.85±0.73, TNF-α (ng/L): 50.05±4.91, 56.18±5.54, 63.60±5.96 vs. 73.60±5.27, IL-1β (ng/L): 34.27±4.55, 40.29±5.03, 48.13±6.38 vs. 54.71±4.26, allP<0.05], and pulmonary edema, congestion and inflammatory cell infiltration were obviously ameliorated (pathological scores: 3.74±0.58, 4.50±0.75, 5.29±0.72 vs. 6.13±0.72, P < 0.05). Cdyn levels were increased significantly in combined treatment group at 0 minute, 30 minutes, 4 hours after treatment compared with thosein PFC and PS group, but there were no significant differences between PFC and PS group. Levels of LI, LPI, inflammatory factors and pathological scores were decreased significantly in combined treatment group compared with those in PFC and PS group, the degrees of improvement of inflammatory factors and pathological scores in PFC group were more obvious than those in PS group (allP < 0.05).Conclusions PFOB combined with DPPC inhalation can provide greater oxygen delivery, reduce the pro-inflammatory cytokines, supplement PS and influence its distribution on the surface of lung, which might lead to a marked and sustained improvement in oxygenation, pulmonary function and amelioration of lung edema and inflammatory reaction in saline lavage induced lung injury of rabbits.

BACKGROUNDTo study etiology of clinically diagnosed non A-E hepatitis.

METHODSHBV, TTV, human parvovirus B19, SENV DNA were detected by nested polymerase chain reactions (nPCR), while HGV, HCV RNA were tested by reverse transcription nested polymerase chain reactions (RT-nPCR).

RESULTSOf 60 patients with clinically diagnosed non A-E hepatitis, 30 (50.0%) were HBV DNA positive alone, 10 (16.7%) HBV and TTV DNA positive, 6 (10.0%) HBV and B19 DNA positive; 1 (1.7%) HBV, SENV DNA and HCV RNA positive, 1 (1.7%) HCV RNA positive alone, 1 (1.7%) HCV RNA and B19 DNA positive, 2 (3.3%) B19 DNA positive alone, 1 (1.7%) TTV DNA positive alone, and the remaining 8 (13.3%) negative for all viruses. All the 60 patients were HGV RNA negative. There were no differences in serum biochemical markers of hepatitis B patients with or without TTV or B19 virus infection.

CONCLUSIONSHBV is a major etiologic agent for the clinically diagnosed non A-E hepatitis. HGV, TTV, B19 and SEBV may not be associated with nonA-E hepatitis.

Adult ; Aged ; DNA, Viral ; blood ; Female ; Hepacivirus ; genetics ; isolation & purification ; Hepatitis B ; diagnosis ; Hepatitis B virus ; genetics ; isolation & purification ; Hepatitis, Viral, Human ; diagnosis ; virology ; Humans ; Male ; Middle Aged ; RNA, Viral ; blood ; Sequence Analysis, DNA

Objective:To master the diagnostic status of brucellosis in Yunnan Province.Methods:The basic information and clinical diagnosis data of all brucellosis cases reported in Yunnan Province from January 2006 to December 2022 in the China Disease Prevention and Control Information System were retrospectively collected. The diagnostic status of cases with different characteristics and clinical stages (acute, subacute, chronic) were analyzed.Results:A total of 3 892 cases of brucellosis were reported in Yunnan Province from 2006 to 2022, of which the acute phase accounted for 92.09% (3 584/3 892), the subacute phase accounted for 4.91% (191/3 892), and the chronic phase accounted for 3.01% (117/3 892). The median time interval between onset and diagnosis was 13 days. Males accounted for 69.63% (2 710/3 892), while females accounted for 30.37% (1 182/3 892). The age of the patients was mainly concentrated in the age group of 40 - 59 years, accounting for 53.13% (2 068/3 892). The median time interval between onset and diagnosis was the longest in the age group of 30 - 39 years (15 days), followed by the age group of 0 - 9 years (14 days), and 13 days in other age groups. In terms of occupational distribution, farmers and herdsmen together accounted for 85.25% (3 318/3 892) of the total reported cases; 84.88% (3 042/3 584), 90.05% (172/191) and 88.89% (104/117) of the total cases were in the acute, subacute and chronic phases, respectively. The distribution of medical treatment areas showed that there were 2 120 cases seeking medical treatment in this county (district), with a local treatment rate of 54.47% (2 120/3 892), including 1 930 cases (91.04%) in the acute phase, 115 cases (5.42%) in the subacute phase, and 75 cases (3.54%) in the chronic phase. There were 1 772 cases seeking medical treatment in different locations, with a referral rate of 45.53% (1 772/3 892), including 1 654 cases (93.34%) in the acute phase, 76 cases (4.29%) in the subacute phase, and 42 cases (2.37%) in the chronic phase. The distribution of visiting departments showed that 67.58% (542/802) of the cases were diagnosed and treated in the infectious disease department, and 32.42% (260/802) of the cases were diagnosed and treated in the non-infectious disease department.Conclusions:From 2006 to 2022, brucellosis in Yunnan Province is mainly in the acute stage, with a short time interval between onset and diagnosis. The main population is middle-aged and elderly male farmers and herdsmen.

Objective To analyze the epidemiological characteristics of school varicella and varicella public health emergency event (PHEE) in Yunnan Province, and to provide a scientific basis for the prevention and control of varicella in schools. Methods The descriptive epidemiological method was used to analyze the reported PHEE of varicella in students and varicella in schools in Yunnan Province from 2018 to 2020. Results From 2018 to 2020, a total of 69,391 cases of varicella were reported in students in Yunnan Province, accounting for 71.48% (69 391 / 97 080) of the total cases in the province, and the annual average reported incidence rate was 255.56/100 000 (69 391/27.1522 million). The time distribution of the incidence showed double peaks, which were from May to July (26.48%) and October to January of the following year (53.88%). The incidence rates of different schools from high to low were 301.74/100 000 for primary schools (34 816/11.538 3 million), 250.43/100 000 for kindergarten (11 526/4.6024 million), 202.74/100 000 for middle school (16 779/8.276 1 million), and 119.07/100 000 for others (3 257/2.735 4 million). The age distribution was mainly concentrated in 5-9 years old, accounting for 39.81% (27 625/69 391). Varicella PHEE accounted for 25.64% (180/702）of the province's PHEE in the same period, school varicella PHEE accounted for 100% of varicella PHEE, and the attack rate was 3.38% (6 566/194 260). The sources of reported varicella PHEE were hospitals 45.40% (58/123), epidemic analysis 36.78% (44/123), schools 13.22% (15/123), and others 4.60% (6/123). Conclusion The incidence of varicella in schools in Yunnan Province is high, which is harmful to students. PHEE reported in rural schools are relatively lagging behind. On the basis of doing two doses of varicella vaccination, emergency prevention should be focused on epidemic seasons, lower grade schools and rural schools. The source of infection shall be controlled and managed in time to prevent the outbreak of the epidemic. It is recommended that varicella should be included in the management of Class C infectious diseases.