目的 通过开展入院患者碳青霉烯耐药基因主动筛查,及时采取预防控制措施对降低医院重点科室耐碳青霉烯肺炎克雷伯菌(CRKP)检出率的影响.方法 比较开展入院患者碳青霉烯耐药基因主动筛查前(2021 年 1-5 月)后(2021 年 6-10 月)该院CRKP检出率.结果 开展入院患者碳青霉烯耐药基因主动筛查后重点科室CRKP检出率由 66.67％降至 50.47％,全院CRKP检出率由 60.16％降至 46.39％,差异均有统计学意义(P<0.05).结论 开展入院患者碳青霉烯耐药基因主动筛查可明显降低 CRKP 检出率,为临床医护人员及时提供了预防控制多重耐药菌措施的依据,增加了医院内感染控制措施的时效性.

每个人都希望能够拥有一个幸福的晚年生活,可是您知道吗?根据流行病学调查结果显示,在我国60岁以上人群中,有3 877万老年人患有轻度认知障碍. 轻度认知障碍是什么 轻度认知障碍是介于正常衰老和痴呆之间的一种中间状态,轻度认知障碍到痴呆有个发展过程,即正常状态-轻度认知障碍-痴呆早期-痴呆中期-痴呆晚期,而在轻度认知障碍患者中,每年有10％～15％的人会发展为痴呆;6年后,有80％的人进展为痴呆,其中阿尔茨海默病是最常见的痴呆类型.

目的 研究血清 12 项细胞因子与急性脑梗死预后的相关性.方法 选取 2021 年 7 月至 2021 年 12 月在同济大学附属东方医院神经内科重症病房住院的急性脑梗死患者 99 例,依据 90d改良的 Rankin量表分为预后良好组 45 例和预后不良组 54 例.在发病 48h 检测其血清 12 项细胞因子浓度,包括白细胞介素(IL)-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12P70,IL-17A,α干扰素,γ干扰素,TNF-α,并检测血清白蛋白和球蛋白浓度、白细胞计数和淋巴细胞计数,应用 logistic回归分析明确血清 12 项细胞因子是否为急性脑梗死预后不良的独立预测因素.结果 预后不良组发病 48h 美国国立卫生研究院卒中量表(NIHSS)评分[12.00(8.75,17.25)分 vs 3.00(2.00,6.00)分]、IL-6[39.58(16.35,125.73)ng/L vs 11.61(3.92,29.81)ng/L]、IL-10[3.60(2.50,6.96)ng/L vs 2.50(2.50,2.50)ng/L]、白细胞计数[9.43(7.63,12.31)×109/L vs 7.78(6.10,9.11)×109/L]明显高于预后良好组,淋巴细胞计数[1.21(0.81,1.67)×109/L vs 1.62(1.25,2.02)×109/L]和血清白蛋白[(39.0±5.2)g/L vs(41.9±3.6)g/L]明显低于预后良好组,差异有统计学意义(P<0.01);二元 logistic 回归分析显示,发病 48 h NIHSS评分(OR=1.101,95%CI:1.015～1.195,P=0.020)、外周血白细胞计数(OR=1.257,95%CI:1.002～1.576,P = 0.048)、血清白蛋白(OR=0.875,95%CI:0.770～0.994,P=0.040)是急性脑梗死预后不良的独立预测因素.结论 血清细胞因子不是急性脑梗死预后不良的独立预测因素,发病 48 h NIHSS评分、白细胞计数和血清白蛋白是急性脑梗死预后不良的独立预测因素.

Objective To compare the efficacy and safety about antiplatelet and anticoagulant therapy for the patients with acute cerebral infarction complicated with atrial fibrillation.Mtehods Patients with acute cerebral infarction complicated with atrial fibrillation in the Department of Neurology in East Hospital Affiliated to Tongji University from January 2011 to June 2014 were continuously collected.The patients were divided into antiplatelet or anticoagulant therapy group at random.Patients were given aspirin tablets 100 mg qd through oral or nasal in antiplatelet group.Patients were given low molecular heparin calcium 4 100 AXaIU q12 h through subcutaneous injection in anticoagulant group.Other therapies were dealt in accordance with the adult ischemic stroke early treatment guidelines of American Heart Association ( AHA)/American Stroke Association( ASA) .National Institute of Health Stroke Scal( NIHSS) and modified Rankin Scale( mRS) scores at the time of admission and day 21 in two groups were recorded respectively.At the same time, incidence rates of complications in two groups were compared , such as intracranial hemorrhage,symptomatic intracranial hemorrhage, gastrointestinal bleeding, recurrent infarction, deep vein thrombosis, and the mortality of them.At last, comparisons were taken between the two groups including hospital stay and the total cost of treatment,drug costs and the percentage of drug.Application of χ2 test or Fisher exact probability method for count data.Application of t test for measurement data in accordance with normal distribution;application of rank sum test for measurement data that do not conform to the normal distribution.Results NIHSS scores in two groups were both improved at day 21 compared with admission. [anticoagulant group:3.00(1.00,7.25) vs.4.00(2.00,21.00) (z =-5.882,P ＜0.05);anticoagulant group 4.50(1.00,10.25) sv.8.50(3.00,13.25)(z=-3.298,P＜0.05)].The mRS scores of antiplatelet group were not improved at day 21(P＞0.05).But the mRS scores between the antiplatelet and anticoagulant groups were not statistically significant at day 21 ( P＞0.05 ) .The mortality in anticoagulant group ( 8.7%) was higher than that in antiplatelet group (4.7%) , but the difference was not statistically significant ( P＞0.05).The incidence of all kinds of bleeding,intracranial hemorrhage,symptomatic intracranial hemorrhage and gastrointestinal bleeding was none of significant difference between the two groups(P＞0.05).So were the incidence of cerebral infarction recurrence and deep vein thrombosis ( DVT ) ( P＞0.05 ) .The length of stay,hospital costs,drug costs and the percentage of drug costs were none of significant difference between the two groups either(P＞0.05).Conclusion The efficacy and safety of antiplatelet and anticoagulant therapy for patients with acute cerebral infarction complicated with atrial fibrillation is similar.

目的:探讨血液科住院医师规范化培训临床教学中,CBL教学法的应用效果.方法:选取血液内科规培学员80名,随机分为LBL组和CBL组,比较出科考试成绩及进行教学满意度.结果:CBL组出科考试成绩、学习兴趣的提高、临床思维训练等项指标均明显优于LBL组(P＜0.05).结论:CBL教学法有助于提高血液科规培医师出科考试成绩,提高教学满意度及学习效率.

最新版指南提供了如何对缺血性卒中或短暂性脑缺血发作后存活患者预防未来卒中事件的基于医学证据的全面、及时的建议。指南的受众是所有参与这些患者二级预防的临床医师。基于证据的建议包括控制危险因素，干预血管阻塞，心源性卒中患者的抗凝治疗和非心源性卒中患者的抗血小板治疗。建议还包括各种特殊病因如主动脉弓粥样硬化、主动脉夹层、卵圆孔未闭、高同型半胱氨酸血症、高凝状态、抗心磷脂抗体综合征、镰状细胞病、脑静脉窦血栓形成及妊娠等的卒中二级预防。指南有专门章节阐述颅内出血后的抗血小板和抗凝治疗，以及指南的执行情况。

Objective To explore the risk factors and influence on prognosis of hemorrhagic transformation(HT) after acute cerebral infarction in patients with atrial fibrillation. Methods The clinical data were analyzed retrospectively in 137 acute cerebral infarction patients with atrial fibrillation from January 2011 to June 2013 in department of neurology in shanghai east hospital. The patients were devided in to HT group and non-HT group. Made monofactorial analysis first, screened the related risk factors for HT. According to the results and our expertise, we fitted the multivariate Logistic regression model, adjusted the related confounding factors, found the independent risk factor for HT. NHISS score, mRS score and the recovery rate, case fatality, length of hospital stay and cost of hospitalization were also compared in two groups. Results The prevalence of HT after acute cerebral infarction in patients with atrial fibrillation was 16.8%. Higher NIHSS score(higher than 4 score) was an independent risk factor for HT(OR=4.275, 95%CI:1.368-13.356, P=0.012). The NHISS and mRS score recovery rate in HT group was lower than non-HT group, but there was no statistic signification(0.23±0.52 vs. 0.33±0.44;0.08±0.29 vs. 0.13±0.39, both P>0.05). The case fatality difference had no statistics signification in two groups(4.3%vs. 6.1%,P=1.000). The length of hospital stay was no statistic signification in two group (17 d vs.19 d, P=0.515). The total cost of hospitalization and drug cost were both no statistic signification in two group (23 246 RMB vs. 19 922 RMB;17 617 RMB vs. 17 636 RMB, both P>0.05). Conclusion HT was more common in severe neurofunction defect of acute cerebral infarction patients with atrial fibrillation, but in our study, the HT has no significant influence on prognosis in the near future.

最新版指南提供了如何对缺血性卒中或短暂性脑缺血发作后存活患者预防未来卒中事件的基于医学证据的全面、及时的建议。指南的受众是所有参与这些患者二级预防的临床医师。基于证据的建议包括控制危险因素，干预血管阻塞，心源性卒中患者的抗凝治疗和非心源性卒中患者的抗血小板治疗。建议还包括各种特殊病因如主动脉弓粥样硬化、主动脉夹层、卵圆孔未闭、高同型半胱氨酸血症、高凝状态、抗心磷脂抗体综合征、镰状细胞病、脑静脉窦血栓形成及妊娠等的卒中二级预防。指南有专门章节阐述颅内出血后的抗血小板和抗凝治疗，以及指南的执行情况。

Objective Comparing the efficacy and safety about aspirin and clopidogrel therapy for atrial ifbrillation with cerebral infarction in acute phase.Methods Continuously collected the patients of acute cerebral infarction with atrial fibrillation in the department of neurology in East Hospital affiliated to Tongji University in January 2011 to June 2014. The patients were divided into aspirin or clopidogrel therapy group taking the principle of random. Aspirin group was given aspirin tablets 0.1g through oral or nasal, qd. Clopidogrel group was given clopidogrel tablets 75mg through oral or nasal, qd. Other therapy was dealt in accordance with the American Heart Association (AHA) / (American Stroke Association )ASA adult ischemic stroke early treatment guidelines. Scoring the two groups respectively at the time of admission and after treatment of patients using National Institute of Health Stroke Scale (NIHSS)and modiifed Rankin Scale(mRS) after 21 days. At the same time, incidence rates of these two groups were compared, such as bleeding, intracranial hemorrhage, symptomatic intracranial hemorrhage, gastrointestinal bleeding, recurrent infarction, deep vein thrombosis; comparing the mortality of them; at last, Comparison was taken between the two groups including hospital stay and the total cost of treatment, drug costs and the percentage of drug.Results NIHSS and mRS score of these two groups both improved compared with base line in 21 days , the difference was statistically signiifcant (P<0.05),while the difference of two groups was no statistically signiifcant (P>0.05). The incidence of cerebral infarction recurrence and DVT between two groups was none of signiifcant difference (P> 0.05). Two groups of hospital stay was none of signiifcant difference (P> 0.05);The differences about the total cost of the two groups about hospitalization, drug costs and the percentage of drug was not statistically signiifcant (P> 0.05).Conclusions The efifcacy and safety about aspirin and Clopidogrel therapy for patients of acute cerebral infarction with atrial ifbrillation was similar.

背景与目的本文作者全面回顾了成人急性缺血性卒中的现有证据及各类评估和诊疗建议。本文的目标读者为院前急救人员、内科医师、专职医疗人员和医院内参与卒中发病后最初48 h诊疗的有关人员。这一指南将取代此前的2007版和更新后的2009版指南。方法编写委员会成员由美国心脏协会卒中委员会的科学声明监督委员会指定,各成员来自不同专业领域。共识编写的整个过程严格遵守美国心脏协会的利益冲突政策。小组成员被分配了与自己专业领域相关的主题,重点回顾了前版指南发表之后的卒中文献,并按照美国心脏协会/美国卒中协会的证据分级方案起草建议。结果指南的目的是降低卒中发病率和卒中相关死亡率。本指南既提倡卒中医疗系统的整体概念,又体现卒中医疗的各个细节,从患者的识别到急救医疗服务启动、转运、分诊,包括了整个在急诊室和卒中单元的最初几个小时内的救治过程。本指南讨论了卒中的早期评估和一般性治疗,以及缺血性卒中特殊的干预措施,如再灌注策略以及脑复苏的最优化措施。结论由于很多建议基于有限的资料,急性缺血性卒中的治疗仍亟需进一步研究。

背景与目的本文作者全面回顾了成人急性缺血性卒中的现有证据及各类评估和诊疗建议。本文的目标读者为院前急救人员、内科医师、专职医疗人员和医院内参与卒中发病后最初48 h诊疗的有关人员。这一指南将取代此前的2007版和更新后的2009版指南。方法编写委员会成员由美国心脏协会卒中委员会的科学声明监督委员会指定,各成员来自不同专业领域。共识编写的整个过程严格遵守美国心脏协会的利益冲突政策。小组成员被分配了与自己专业领域相关的主题,重点回顾了前版指南发表之后的卒中文献,并按照美国心脏协会/美国卒中协会的证据分级方案起草建议。结果指南的目的是降低卒中发病率和卒中相关死亡率。本指南既提倡卒中医疗系统的整体概念,又体现卒中医疗的各个细节,从患者的识别到急救医疗服务启动、转运、分诊,包括了整个在急诊室和卒中单元的最初几个小时内的救治过程。本指南讨论了卒中的早期评估和一般性治疗,以及缺血性卒中特殊的干预措施,如再灌注策略以及脑复苏的最优化措施。结论由于很多建议基于有限的资料,急性缺血性卒中的治疗仍亟需进一步研究。

背景与目的 本文作者全面回顾了成人急性缺血性卒中的现有证据及各类评估和诊疗建议。本文的目标读者为院前急救人员、内科医师、专职医疗人员和医院内参与卒中发病后最初48h诊疗的有关人员。这一指南将取代此前的2007版和更新后的2009版指南。方法 编写委员会成员由美国心脏协会卒中委员会的科学声明监督委员会指定,各成员来自不同专业领域。共识编写的整个过程严格遵守美国心脏协会的利益冲突政策。小组成员被分配了与自己专业领域相关的主题,重点回顾了前版指南发表之后的卒中文献,并按照美国心脏协会/美国卒中协会的证据分级方案起草建议。结果 指南的目的是降低卒中发病率和卒中相关死亡率。本指南既提倡卒中医疗系统的整体概念,又体现卒中医疗的各个细节,从患者的识别到急救医疗服务启动、转运、分诊,包括了整个在急诊室和卒中单元的最初几个小时内的救治过程。本指南讨论了卒中的早期评估和一般性治疗,以及缺血性卒中特殊的干预措施,如再灌注策略以及脑复苏的最优化措施。结论 由于很多建议基于有限的资料,急性缺血性卒中的治疗仍亟需进一步研究。

　　背景与目的本文作者全面回顾了成人急性缺血性卒中的现有证据及各类评估和诊疗建议。本文的目标读者为院前急救人员、内科医师、专职医疗人员和医院内参与卒中发病后最初48 h诊疗的有关人员。这一指南将取代此前的2007版和更新后的2009版指南。<br>　　方法编写委员会成员由美国心脏协会卒中委员会的科学声明监督委员会指定，各成员来自不同专业领域。共识编写的整个过程严格遵守美国心脏协会的利益冲突政策。小组成员被分配了与自己专业领域相关的主题，重点回顾了前版指南发表之后的卒中文献，并按照美国心脏协会/美国卒中协会的证据分级方案起草建议。<br>　　结果指南的目的是降低卒中发病率和卒中相关死亡率。本指南既提倡卒中医疗系统的整体概念，又体现卒中医疗的各个细节，从患者的识别到急救医疗服务启动、转运、分诊，包括了整个在急诊室和卒中单元的最初几个小时内的救治过程。本指南讨论了卒中的早期评估和一般性治疗，以及缺血性卒中特殊的干预措施，如再灌注策略以及脑复苏的最优化措施。<br>　　结论由于很多建议基于有限的资料，急性缺血性卒中的治疗仍亟需进一步研究。

背景与目的本文作者全面回顾了成人急性缺血性卒中的现有证据及各类评估和诊疗建议。本文的目标读者为院前急救人员、内科医师、专职医疗人员和医院内参与卒中发病后最初48h诊疗的有关人员。这一指南将取代此前的2007版和更新后的2009版指南。方法编写委员会成员由美国心脏协会卒中委员会的科学声明监督委员会指定,各成员来自不同专业领域。共识编写的整个过程严格遵守美国心脏协会的利益冲突政策。小组成员被分配了与自己专业领域相关的主题,重点回顾了前版指南发表之后的卒中文献,并按照美国心脏协会/美国卒中协会的证据分级方案起草建议。结果指南的目的是降低卒中发病率和卒中相关死亡率。本指南既提倡卒中医疗系统的整体概念,又体现卒中医疗的各个细节,从患者的识别到急救医疗服务启动、转运、分诊,包括了整个在急诊室和卒中单元的最初几个小时内的救治过程。本指南讨论了卒中的早期评估和一般性治疗,以及缺血性卒中特殊的干预措施,如再灌注策略以及脑复苏的最优化措施。结论由于很多建议基于有限的资料,急性缺血性卒中的治疗仍亟需进一步研究。

背景与目的本文作者全面回顾了成人急性缺血性卒中的现有证据及各类评估和诊疗建议。本文的目标读者为院前急救人员、内科医师、专职医疗人员和医院内参与卒中发病后最初48 h诊疗的有关人员。这一指南将取代此前的2007版和更新后的2009版指南。方法编写委员会成员由美国心脏协会卒中委员会的科学声明监督委员会指定,各成员来自不同专业领域。共识编写的整个过程严格遵守美国心脏协会的利益冲突政策。小组成员被分配了与自己专业领域相关的主题,重点回顾了前版指南发表之后的卒中文献,并按照美国心脏协会/美国卒中协会的证据分级方案起草建议。结果指南的目的是降低卒中发病率和卒中相关死亡率。本指南既提倡卒中医疗系统的整体概念,又体现卒中医疗的各个细节,从患者的识别到急救医疗服务启动、转运、分诊,包括了整个在急诊室和卒中单元的最初几个小时内的救治过程。本指南讨论了卒中的早期评估和一般性治疗,以及缺血性卒中特殊的干预措施,如再灌注策略以及脑复苏的最优化措施。结论由于很多建议基于有限的资料,急性缺血性卒中的治疗仍亟需进一步研究。

背景与目的本文作者全面回顾了成人急性缺血性卒中的现有证据及各类评估和诊疗建议。本文的目标读者为院前急救人员、内科医师、专职医疗人员和医院内参与卒中发病后最初48 h诊疗的有关人员。这一指南将取代此前的2007版和更新后的2009版指南。方法编写委员会成员由美国心脏协会卒中委员会的科学声明监督委员会指定,各成员来自不同专业领域。共识编写的整个过程严格遵守美国心脏协会的利益冲突政策。小组成员被分配了与自己专业领域相关的主题,重点回顾了前版指南发表之后的卒中文献,并按照美国心脏协会/美国卒中协会的证据分级方案起草建议。结果指南的目的是降低卒中发病率和卒中相关死亡率。本指南既提倡卒中医疗系统的整体概念,又体现卒中医疗的各个细节,从患者的识别到急救医疗服务启动、转运、分诊,包括了整个在急诊室和卒中单元的最初几个小时内的救治过程。本指南讨论了卒中的早期评估和一般性治疗,以及缺血性卒中特殊的干预措施,如再灌注策略以及脑复苏的最优化措施。结论由于很多建议基于有限的资料,急性缺血性卒中的治疗仍亟需进一步研究。

背景与目的本文作者全面回顾了成人急性缺血性卒中的现有证据及各类评估和诊疗建议。本文的目标读者为院前急救人员、内科医师、专职医疗人员和医院内参与卒中发病后最初48h诊疗的有关人员。这一指南将取代此前的2007版和更新后的2009版指南。方法编写委员会成员由美国心脏协会卒中委员会的科学声明监督委员会指定,各成员来自不同专业领域。共识编写的整个过程严格遵守美国心脏协会的利益冲突政策。小组成员被分配了与自己专业领域相关的主题,重点回顾了前版指南发表之后的卒中文献,并按照美国心脏协会/美国卒中协会的证据分级方案起草建议。结果指南的目的是降低卒中发病率和卒中相关死亡率。本指南既提倡卒中医疗系统的整体概念,又体现卒中医疗的各个细节,从患者的识别到急救医疗服务启动、转运、分诊,包括了整个在急诊室和卒中单元的最初几个小时内的救治过程。本指南讨论了卒中的早期评估和一般性治疗,以及缺血性卒中特殊的干预措施,如再灌注策略以及脑复苏的最优化措施。结论由于很多建议基于有限的资料,急性缺血性卒中的治疗仍亟需进一步研究。

Objective To evaluate the impact of sleep-disordered breathing(SDB)on the quality of life(QOL)in children with SDB and investigate the value of tonsillectomy and adenoidectomy in improving their QOL.Methods Questionnaire of disease-specific quality of life for children with obstructive sleep apnea with 18 items(OSA-18)was used to evaluate QOL in 168 children with SDB within four weeks before and six to 12 months after surgical operation,and correlation between OSA-18 scores to apnea hypopnea index(AHI)and minimum oxygen saturation(MiO2)in 62 of them was evaluated with polysomnography(PSG),with 50 healthy children without snoring as controls.Results Overall scores of OSA-18 in children of SDB group before surgical operation were significantly higher than those in children of control group(t=15.12,P＜0.01).and QOL was seriously affected in 30.4 percent of the children with SDB.Scores of OSA-18 correlated to AHI and MiO2 before surgical operation.QOL was improved significantly in 73.8 percent of children with SDB after tonsillectomy and adenoidectomy.Conclusions SDB has obvious impact on pediatric QOL,which can be improved by tonsillectomy and adenoidectomy.There exists significant correlation between OSA-18 scores and objective indicators of PSG,and the former can be used as clinical diagnosis for SDB in children and as quantitative evaluation for the effectiveness of intervention.

目的 观察大鼠单次全脑照射后脑内少突胶质谱系细胞的变化,以及新型自由基清除剂依达拉奉对少突胶质细胞放射性反应的影响.方法 将雄性SD大鼠120只随机分为假照射组、照射组、依达拉奉组.采用10 Gy单次全脑照射模型,制模后依达拉奉组大鼠分别按剂量0.3、1.0和3.0 mg/kg依达拉奉腹腔注射;构建放射性脑损伤大鼠脑组织芯片,用免疫组织化学法检测皮质A2B5、少突胶质细胞表面标志物4(O4)、2',3'-环磷核苷酸水解酶(CNPase)蛋白表达变化.结果 与假照射组比较,照射后1 d皮质A2B5阳性细胞数目即开始增多,照射后1周最多(P＜0.01),1个月时差异无统计学意义;而O4与CNPase阳性细胞数在照射后1 d时显著减少,以O4阳性细胞数减少为甚(P＜0.01),1周后差异无统计学意义.与照射组比较,依达拉奉干预后A2B5阳性细胞数有不同程度减少,O4、CNPase阳性细胞数有不同程度增加(1.0 mg/kg,P＜0.05;3.0 mg/kg,P＜0.01).结论 大鼠全脑照射后脑皮质少突胶质前体细胞反应性增多,呈时程性变化;一定剂量的依达拉奉对少突胶质细胞放射性反应有保护作用,呈现剂量依赖性。