血液肿瘤患儿医院获得性血流感染的临床特点

目的 了解血液肿瘤患儿医院获得性血流感染（nosocomialblood streaminfection,NBSI）的临床特点及病原体分布和耐药性,为临床上预防NBSI 及早期合理应用抗菌药物提供依据。方法 回顾2011年1月至2013 年12 月血液肿瘤住院治疗并发生NBSI患儿的临床资料和血培养结果,分析患儿的临床表现特点,病原菌分布及耐药性、治疗方法及转归。结果 发热及C反应蛋白（CRP）增高是NBSI患儿共有的表现,细胞因子中IL-6 和IL-10 增高发生率在50%以上。1 500例次住院患儿发生NBSI161例次,发生率10.73%（161/1 500）,其中血培养阳性70 例,阳性率为43.48%（70/161）;70 例血培养阳性患儿共检出病原菌79 株,革兰阳性菌55.70%,革兰阴性菌43.04%,真菌1.27%;排在前3 位的病原菌依次为表皮葡萄球菌、大肠埃希菌、肺炎克雷伯菌,分别占20.25%、15.19%、15.19%;葡萄球菌对万古霉素、利奈唑胺敏感,大肠埃希菌、肺炎克雷伯菌对头孢哌酮/舒巴坦、亚胺培南、美罗培南敏感。结论 血液肿瘤患儿发生NBSI缺乏特异症状体征,CRP 及IL-6和IL-10可能有助于NBSI 的诊断。NBSI病原学以革兰阳性菌为主,早期联合用药是成功治疗血液肿瘤患者NBSI 的关键。     

儿童过敏性紫癜的临床特点及血淋巴细胞亚群的变化

目的探讨过敏性紫癜（HSP）患儿的临床特点及发病机制。方法对76例HSP患儿急性期的临床表现进行分析总结；并采用流式细胞仪分析技术及免疫比浊法对外周血淋巴细胞亚群（CD3、CD4、CD8、CD19、NK细胞）及血清补体C3进行检测，与30例健康儿童进行对照比较。结果76例患儿中发病同时或发病前2周内有呼吸道感染62例（81.6%）。76例患儿均先后出现紫癜，以双下肢皮肤紫癜最多见，合并消化道症状56例（73.7%），其中以消化道症状为首发症状21例（27.6%）；合并肾损害36例（47.3%），其以微量蛋白尿型、血尿和蛋白尿型为多见，肾病综合征型少见。HSP组急性期外周血CD4及NK细胞数量降低、CD19显著升高，与对照组比较，差异均有统计学意义（均P＜0.01）；血清补体C3增高，与对照组比较，差异有统计学意义（P＜0.05）；血CD8增高，但与对照组比较，差异无统计学意义（P＞0.05）。结论 HSP患儿发病与呼吸道感染有密切关系，胃肠道症状为首发症状的比例较高，合并肾损害也较多，但以微量蛋白尿型、血尿和蛋白尿型为多见，预后良好。儿童HSP的发病与T、B淋巴细胞及NK细胞的功能紊乱有关，且补体系统也参与HSP的发病。     

院内获得性肺炎呼吸道病毒病原分析

目的了解当前小儿院内获得性肺炎（HAP）病毒病原学的状况。方法收集251例HAP的患儿资料,对其中做痰液病毒分离,获得合胞病毒（RSV）、流感病毒、副流感病毒病原学检测阳性结果的病例进行分析。结果251例HAP患儿中141例做了痰液病毒检测,其中阳性67例,病毒检出率为47.52%（67/141）,其中以RSV肺炎最为多见。67例病毒性HAP均以喘息为主要临床表现,多数不发热或低热,少部分可以表现为高热,血常规、CRP基本正常。67例中22例有明确的诱因,其中以使用激素最为多见。67例患儿均治疗有效。结论251例住院患儿中HAP病毒检出以呼吸道合胞病毒为主,预后均良好。     

英夫利西单抗治疗幼年特发性关节炎不良反应的观察与护理

幼年特发性关节炎（JIA）是儿童时期一种常见的类风湿性疾病,临床上以长期发热、皮疹、关节痛及多脏器受损为特征,因缺乏特异的诊断及治疗方法,常为青少年致残的主要疾病之一[1]。JIA的治疗药物包括非甾体抗炎药、抗风湿药及糖皮质激素等[2]。英夫利西单抗（即类克）作为一种新的生物制剂,它是人-鼠嵌合性单克隆抗体,是一种肿瘤坏死因子（TNF-α）抑制剂,是第一个被美国和欧洲批准用于治疗类风湿关节炎的抗TNF-α抗体。据国外临床观察报道,英夫利西单抗除具有肯定疗效外,还具有良好的耐受性和安全性[3]。但在治疗的过程中仍发现诸多不良反应,主要有药物过敏反应、肝功能损害及结核感染等,发生率依次为3.5%、0.4%、0.4%[2]。近年来,我科对JIA患儿进行了23例次英夫利西单抗治疗,建立针对性的输注护理流程,现将不良反应的临床表现及护理体会报道如下。     

低渗温热腹腔灌注化疗治疗恶性腹腔积液的临床研究

目的 评价低渗温热腹腔灌注化疗治疗恶性腹腔积液的疗效及不良反应。方法 行腹腔穿刺置单腔中心静脉导管,外接引流袋,记录腹水引流量,当日排放腹水1 500ml 后,予加热至43~45℃注射用双蒸馏水1 000ml 行腹腔灌注,次日重复放液1 500ml,再予加热至43~45℃注射用双蒸馏水1 000ml 行腹腔灌注,并于灌注后腹腔注入顺铂60mg、氟尿嘧啶500mg 并封管,治疗期间常规给予简单水化、对症止吐等治疗。结果 31 例恶性腹腔积液患者共完成低渗温热腹腔灌注化疗42 周期,完全缓解7例,部分缓解15,稳定5 例,进展4 例,完全缓解+ 部分缓解占70.97%。中位进展时间（TTP）3.6个月（2～9 个月）, 中位生存期（MST）5.6 个月。毒副反应以消化道反应为主。结论 低渗温热腹腔灌注化疗治疗恶性腹腔积,在延长患者的生存期、提高生活质量方面效果较好,临床上可推荐应用。     

Seizure warning algorithm based on optimization and nonlinear dynamics

There is growing evidence that temporal lobe seizures are preceded by a preictal transition, characterized by a gradual dynamical change from asymptomatic interictal state to seizure. We herein report the first prospective analysis of the online automated algorithm for detecting the preictal transition in ongoing EEG signals. Such, the algorithm constitutes a seizure warning system. The algorithm estimates STL_max, a measure of the order or disorder of the signal, of EEG signals recorded from individual electrode sites. The optimization techniques were employed to select critical brain electrode sites that exhibit the preictal transition for the warning of epileptic seizures. Specifically, a quadratically constrained quadratic 0-1 programming problem is formulated to identify critical electrode sites. The automated seizure warning algorithm was tested in continuous, long-term EEG recordings obtained from 5 patients with temporal lobe epilepsy. For individual patient, we use the first half of seizures to train the parameter settings, which is evaluated by ROC (Receiver Operating Characteristic) curve analysis. With the best parameter setting, the algorithm applied to all cases predicted an average of 91.7% of seizures with an average false prediction rate of 0.196 per hour. These results indicate that it may be possible to develop automated seizure warning devices for diagnostic and therapeutic purposes.Mathematics Subject Classification (1991):20E28, 20G40, 20C20     

Multifractal detrended cross-correlation analysis for epileptic patient in seizure and seizure free status

This paper reports a study of EEG data of epileptic patients in terms of multifractal detrended cross-correlation analysis (MF-DXA). The EEG clinical data were obtained from the EEG Database available with the Clinic of Epileptology of the University Hospital of Bonn, Germany. The data sets (C, D, and E) were taken from five epileptic patients undergoing presurgical evaluations. The data sets consist of intracranial EEG recordings during seizure-free intervals (interictal periods) from within the epileptogenic zone (D) and from the hippocampal formation of the opposite hemisphere of the epileptic patients’ brain, respectively (C). The data set (E) was recorded during seizure activity (ictal periods). MF-DXA is a very rigorous and robust tool for assessment of cross-correlation among two nonlinear time series. The study reveals the degree of cross-correlation is more among seizure and seizure free interval in epileptogenic zone. These data are very significant for diagnosis, onset and prognosis of epileptic patients.     

Electroencephalogram (EEG) time series classification: Applications in epilepsy

Epilepsy is among the most common brain disorders. Approximately 25–30% of epilepsy patients remain unresponsive to anti-epileptic drug treatment, which is the standard therapy for epilepsy. In this study, we apply optimization-based data mining techniques to classify the brain's normal and epilepsy activity using intracranial electroencephalogram (EEG), which is a tool for evaluating the physiological state of the brain. A statistical cross validation and support vector machines were implemented to classify the brain's normal and abnormal activities. The results of this study indicate that it may be possible to design and develop efficient seizure warning algorithms for diagnostic and therapeutic purposes. Research was partially supported by the Rutgers Research Council grant-202018, the NSF grants DBI-980821, CCF-0546574, IIS-0611998, and NIH grant R01-NS-39687-01A1.     

Investigation of mental fatigue through EEG signal processing based on nonlinear analysis: Symbolic dynamics

To investigate nonlinear analysis of attention physiological indices this study used a simple repetitive attentive task in four consecutive trials that resulted in mental fatigue. Traditional performance indices, such as reaction time, error responses, and EEG signals, were simultaneously recorded to evaluate differences between the trials. Performance indices analysis demonstrated that a selected task leads to mental fatigue. In addition, the study aimed to find a method to determine mental fatigue based on nonlinear analysis of EEG signals. Symbolic dynamics was selected as a qualitative method used to extract some quantitative qualifiers such as entropy. This method was executed on the reaction time of responses, and EEG signals to distinguish mental states. The results revealed that nonlinear analysis of reaction time, and EEG signals of the frontal and central lobes of the brain could differentiate between attention, and occurrence of mental fatigue in trials. In addition, the trend of entropy variation displayed a reduction in the complexity of mental activity as fatigue occurred.     

神经内镜下单鼻孔经蝶窦入路垂体瘤切除手术的临床体会

目的 探讨神经内镜下单鼻孔经蝶窦入路垂体瘤切除的手术方法及疗效。方法 2011 年3 月至2013年6 月收治 的垂体瘤患者共53 例,均行神经内镜下单鼻孔经蝶窦入路垂体瘤切除手术,对患者的手术效果、术后并发症、住院天数等指标进行回顾性分析。结果 神经内镜下单鼻孔经蝶窦入路垂体瘤完全切除49 例（92.4%）,次全切除4 例（7.6%）,术后平均住院天数6.2d,无手术死亡病例。术后出现并发症5 例（9.4%）,1 例患者术后出现鞍内出血及额叶血肿,1 例患者麻醉清醒后视力下降,2例出现一过性尿崩,1例出现脑脊液漏。结论 神经内镜下单鼻孔经蝶窦入路垂体瘤手术具有创伤小、术后并发症少及恢复快等优点,是治疗垂体瘤较为有效的术式。     

常规肺通气功能检测在儿童支气管哮喘规范化管理中的应用

目的 通过对比支气管哮喘患儿规范化治疗前后肺功能指标的变化,为本地区儿童哮喘规范化管理提供依据。方法 采用肺功能测定系统对33 例哮喘儿童在急性发作期、缓解期3、6 个月及1 年分别进行常规肺通气功能测定,比较各期实测值,以及异常比例的差异。结果 哮喘患儿急性发作期用力肺活量（FVC）、1 秒用力呼气量（FEV1）、最大呼气流量（PEF）及75%、50%、25%肺活量时用力呼气流速（FEF25~75）等实测值与预计值比较均下降,规范化治疗后3个月开始相关指标逐渐恢复,6个月后反映大气道功能相关指标（FVC、FEV1等）基本恢复。1年时反映小气道功能相关指标FEF25~75 恢复。结论 通过对支气管哮喘儿童肺功能的监测,可以动态观察患儿气道功能恢复情况,为儿童支气管哮喘规范化管理提供客观依据。     

Arithmetical thinking in children attending special schools for the intellectually disabled

This article focuses on spontaneous and progressive knowledge building in “the arithmetic of the child.” The aim is to investigate variations in the behavior patterns of eight pupils attending a school for the intellectually disabled. The study is based on the epistemology of radical constructivism and the methodology of multiple clinical interviews. Theoretical models elucidate behavior patterns and the corresponding mental structures underlying them. The individual interviews of the pupils were video recorded. The results show that the activated behavior patterns, which are responses to well-adapted contexts presented by the researcher, are compatible with findings in Swedish compulsory schools. Six of the pupils’ mental structures in the study are numerical. A substantial implication for special education is the harmonization of the content in teaching with the children's own ways of operating, which implies a triadic teaching process.     

A multi-phase DES modelling framework for patient-centred care

We provide a framework for simulating the entire patient journey across different phases (such as diagnosis, treatment, rehabilitation and long-term care) and different sectors (such as GP, hospital, social and community services), with the aim of providing better understanding of such processes and facilitating evaluation of alternative clinical and care strategies. A phase-type modelling approach is used to promote better modelling and management of the specific elements of a patient pathway, using performance measures such as clinical outcomes, patient quality of life, and cost. The approach is illustrated using stroke disease. Approximately 5% of the United Kingdom National Health Service budget is spent treating stroke disease each year. There is an urgent need to assess whether existing services are cost-effective or new interventions could increase efficiency. This assessment can be made using models across primary and secondary care; in particular we evaluate the cost-effectiveness of thrombolysis (clot busting therapy), using discrete event simulation. Using our model, patient quality of life and the costs of thrombolysis are compared under different regimes. In addition, our simulation framework is used to illustrate the impact of internal discharge queues, which can develop while patients are awaiting placement. Probabilistic Sensitivity Analysis of the value parameters is also carried out.     

声速匹配组织量化技术对非酒精性脂肪性肝炎定量评价的初步应用研究

目的探讨声速匹配组织量化（SVQ）技术定量评价非酒精性脂肪性肝炎（NASH）的可行性和临床应用价值。方法选取经肝穿刺或临床资料证实的非酒精性单纯性脂肪肝（NAFL）及NASH患者各20例,并选取健康体检者20例作为对照组,分别采集3组受试者临床相关资料,进行SVQ检测,采集声速匹配值（ZSI）和组织声速（SV）。结果3组受试者在年龄、身高、体重方面均无统计学差异（均P＞0.05）,BMI、ZSI和SV均存在统计学差异（均P＜0.01）。SVQ技术诊断NASH的AUC为0.801。以SV=1527m/s作为临界点,判断NASH的灵敏度、特异度分别为95.20%、70.60%。结论SVQ技术定量评价NASH是可行的,具有很好的临床应用价值。