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593例社区获得性肺炎住院患儿病毒和非典型细菌病原学分析

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593例社区获得性肺炎住院患儿病毒和非典型细菌病原学分析

作者：王思菱（Alice cynthia Dewi）中山大学

学位级别：硕士

研究背景社区获得性肺炎(community acquired pneumonia, CAp)是儿童期最常见的感染性疾病，发病率高，危害严重，列于我国儿童死亡的五大疾病之首。我国每年约有2110万5岁以下小儿罹患肺炎(0.22次/人年)，发病率明显高于发达国家(0.02... 详细信息

研究背景社区获得性肺炎(community acquired pneumonia, CAp)是儿童期最常见的感染性疾病，发病率高，危害严重，列于我国儿童死亡的五大疾病之首。我国每年约有2110万5岁以下小儿罹患肺炎(0.22次/人年)，发病率明显高于发达国家(0.026次/人年)。儿童CAp的病因通常难以判定，约有40％至60％的肺炎患儿无法找到明确病因。许多研究人员根据患儿的病史、临床表现、体征、实验室及影像学检查资料来判断社区获得性肺炎的病因，但尚未发现足够可靠的证据进行鉴别。关于社区获得性肺炎住院患儿管理的大量报道显示，大约80％的社区获得性肺炎患儿采用了经验性治疗。当患儿被诊断为CAp后，是否使用抗生素进行治疗以及如何选择与病因相关的适当抗生素仍是个很大的问题。一项关于住院儿童社区获得性肺炎的研究表明，绝大多数儿童肺炎是病毒感染所致，故须对不必要的抗生素治疗加以制止。另外，肺炎衣原体和支原体亦日益成为导致儿童获得性肺炎的重要致病因素。这些非典型细菌需要特定的抗生素，而针对典型病原体使用的常规抗生素无效。肺炎病因研究不足及抗生素治疗不当最终可导致社区获得性肺炎病原体的抗生素耐药性，这种抗生素耐药又将成为另一个全球健康问题。基于这些原因，深入了解CAp在日常临床中病原流行病学，不同病原肺炎的临床特点助于提高诊断，采取适当的管理和预防措施，进而减少由于过度治疗和不适当的抗生素治疗所致的经济负担，同时降低社区获得性肺炎相关疾病的死亡率。目的 1、阐明儿童社区获得性肺炎的常见呼吸道病毒病原谱分布;2、确定病毒和非典型细菌病原体的年龄和季节分布;3、分析特定病原体的临床特点。方法 1.研究对象本研究在2010年1月至2011年12月期间收集593例住院病区中确诊的社区获得性肺炎病例。患儿年龄范围为1个月至14岁之间，其中：婴儿组(1-12个月)286例(48.2％)，学龄前儿童组(>12个月至5岁)259例(43.7％)，学龄儿童组(5岁以上至14岁)48例(8.1％)。 2.病例收集、病例评估、数据分析所有患儿在入院24小时内均采集2毫升的外周血，用于血常规，肝、心脏、肾功生化和各项炎症指标的血液化验，并采集口咽拭子标本。将咽拭子标本采用实时定量pCR检测方法对病毒和非典型病原体进行同时检测。一个患儿样本中检测出任何一种病原体，则作为一个阳性病例。如一个患儿样本中只发现一种病原体，则该患儿则被认为只有一项感染，即单一感染。如发现了多个病原体，则被认为是混合感染。入院时收集的信息包括填写日期、个人信息、前驱症状、临床表现。在住院期间，患儿每日的病情变化均详细记录，包括呼吸系统的体格检查、临床症状的变化、实验室数据、并发症、治疗措施等。出院日期也被记录在内，以计算患者的住院时间。评估病情严重程度根据临床评分(呼吸频率、三凹征、呼吸音改变、精神状态、肤色)。结果 1、患儿年龄于1个月至14岁之间，中位年龄为14个月。男性占67％，女性占33％。男女之比为2:1。男女中位年龄之间比较差异无统计学意义(U=35112，p>0.05)。中位发病时间7天(于1-160天)，中位住院时间7天(于2-36天)。 2、593例标本中，阳性标本共367例，总检出率为61.9％。单一病原体感染289例(48.7％)，混合病原体感染78例(13.2％)。病原体以RSV最常见，共133例(22.4％);其它依次为Inf A56例(9.4％)，EV52例(8.8％)，ADV40例(6.7％)，Mpp39例(6.6％)，hCoV32例(5.4％)，hBoV31例(5.2％)，pIV29例(4.9％)， hMpV25例(4.2％)，Inf B24例(4％)，及Cp7例(1.2％)。病原体不明确的标本226例(38.1％)。593例患儿中，病毒感染(包括单一或混合病毒感染)共318例(53.6％)。单一的非典型细菌感染(包括Mpp或Cp)共31例(5.2％)，病毒/非典型细菌混合感染共18例(3％)。 3、289例单一病原体感染标本中，RSV为91例(15.3％)占首位，其次为InfA32例(5.4％)，ADV30例(5.1％)，Mpp28例(4.7％)。78例混合病原体感染标本中，以2种病原体混合感染为主(57例，9.6％)，3种病原体混合感染为次(20例，3.4％)，且有1例是五种病原体混合感染。最常见混合感染为RSV合并其他病毒，其中RSV+EV15例，RSV+Inf A9例，RSV+hCoV5例。 4、CAp患儿年龄及病原体分布情况：在婴儿组，RSV阳性检出率最高占33.6％。Inf A、Inf B、hBoV、 hCoV、hMpV常见于学龄前儿童组，而pIV在婴儿组多发。学龄儿童组当中，最常见的病原体是ADV和Mpp，各占16.7％。EV感染可

关键词：社区获得性肺炎病毒病原学儿童

Diabetes Mellitus and Colorectal Neoplasia

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Journal of Cancer Therapy 2012年第6期3卷 859-865页

作者： Alejandro Acevedo Yaritza Diaz cynthia M. perez Maria Garau John Baron Marcia Cruz-Correa Department of Biostatistics and Epidemiology Graduate School of Public Health Medical Sciences Campus University of Puerto Rico San Juan Puerto Rico Department of Medicine Community and Family Medicine Dartmouth Medical School Dartmouth US Department of Medicine Community and Family Medicine Dartmouth Medical School Hanover USA Department of Medicine School of Medicine University of Puerto Rico San Juan Puerto Rico University of puerto Rico Comprehensive Cancer Center San Juan Puerto Rico

Background: Many studies have provided evidence for an association between obesity, physical inactivity, and western diet as risk factors for colorectal cancer (CRC). Few studies directly address the association between type 2 Diabetes Mellitus (DM) and the risk of colorectal lesions at specific anatomic locations. Methods: 2663 subjects with a previous history of adenoma (s) and removal of all current adenomas at study entry were followed for a mean time of three years across three different chemoprevention clinical trials. The primary endpoint was colorectal adenoma recurrence and number of lesions during the treatment phase;the secondary endpoints were presence of advanced colorectal neoplasia (CRN) and location of CRN. Using log linear regression, the effect of DM status on the relative risk (RR) of CRN recurrence, advanced CRN, and location of CRN was assessed. Results: DM status was not significantly associated with incidence of colorectal adenomas, incidence of advanced colorectal lesions, or left-sided colorectal neoplastic lesions. Subjects with DM had a marginally increased risk of right-sided (p = 0.06) colorectal adenomas and a significant increased risk of multiple right-sided adenomas (p = 0.03) in the unadjusted model;this association was not significant after adjusting for age and other potential confounders (RR = 1.22, 95% CI: 0.85 - 1.76). Conclusion: We did not observe a statistically significant increased risk in CRN recurrence for overall neoplasia, advanced neoplasia or location of neoplasia in individuals with DM compared to non-DM individuals. However, given the patterns observed in this investigation, future studies with longer follow-up time and longer DM exposure, incorporating objective measurements of type 2 DM might help elucidate the risk of CRN among individuals with DM.

关键词： Diabetes Mellitus Colorectal Neoplasia Colorectal Adenomas Chemoprevention

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《中国失语症语言评估量表》的设计原理

中国听力语言康复科学杂志 2017年第5期15卷 336-341页

作者：廖敏 cynthia K.Thompson 美国西北大学失语症神经语言学中心埃文斯顿60208 对外经济贸易大学密云分校北京101500

《中国失语症语言评估量表(标准版)》是参考西北命名成套测验(northwestern naming battery,NNB)和西北动词语句成套测验(northwestern assessment of verbs and sentences,NAVS),在词汇加工认知神经心理模型和语句两阶段加工模型的理... 详细信息

《中国失语症语言评估量表(标准版)》是参考西北命名成套测验(northwestern naming battery,NNB)和西北动词语句成套测验(northwestern assessment of verbs and sentences,NAVS),在词汇加工认知神经心理模型和语句两阶段加工模型的理论基础上,结合现代汉语语音、词汇、句法和语义特点,参照中国人的认知心理,由北京语言大学和美国西北大学联合研发的适用于汉语失语症患者语言能力综合评价的成套测验。该测验是国内第一个基于语言认知理论设计的汉语失语症语言能力评估工具。本文在介绍失语症语言障碍的基础上,对该评估量表的命名分量表和动词语句分量表的设计原理进行了详细介绍。

关键词：失语症语言评估命名动词语句

Telemonitoring and hemodynamic monitoring to reduce hospitalization rates in heart failure： a systematic review and meta-analysis of randomized controlled trials and real-world studies

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Journal of Geriatric Cardiology 2018年第4期15卷 298-309页

作者： Gary Tse cynthia Chan Mengqi Gong Lei MENG Jian ZHANG Xiao-Ling SU Sadeq Ali-Hasan-Al-Saegh Abhishek C Sawant George Bazoukis Yun-Long XIA Ji-Chao Zhao Alex pui Wai Lee Leonardo Roever Martin CS Wong Adrian Baranchuk Tong Liu Department of Medicine and Therapeutics Faculty of Medicine Chinese University of Hong Kong Hong Kong China Li Ka Shing Institute of Health Sciences Faculty of Medicine Chinese University of Hong Kong Hong Kong China Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of Cardiology Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University Tianjin China State Key Laboratory of Cardiovascular Disease Heart Failure Center Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Peking Union Medical College Beijing China Department of Cardiology Qinghai Provincial People's Hospital Xining China Cardiovascular Research Center Shahid Sadoughi University of Medical Sciences Yazd Iran Division of Cardiology State University of New York at Buffalo Buffalo NY USA The Second Department of Cardiology Laboratory of Cardiac Electrophystology Evangehsmos General Hospital of Athens Athens Greece Department of Cardiovascular Medicine the First Affiliated Hospital of Dalian Medical University Dalian China Auckland Bioengineering Institute the University of Auckland Auckland New Zealand Department of Clinical Research Federal University of Uberlandia Uberlandia MG Brazil JC School of public Health and primary Care Faculty of Medicine the Chinese University of Hong Kong Hong Kong China Division of Cardiology Kingston General Hospital Queen 's University Kingston Ontario Canada

Background Heart failure is a significant problem leading to repeated hospitalizations. Telemonitoring and hemodynamic monitoring have demonstrated success in reducing hospitalization rates, but not all studies reported significant effects. The aim of this systematic review and meta-analysis is to examine the effectiveness of telemonitoring and wireless hemodynamic monitoring devices in reducing hospitalizations in heart failure. Methods ＆ Results pubMed and Cochrane Library were searched up to 1st May 2017 for articles that investigated the effects of telemonitoring or hemodynamic monitoring on hospitalization rates in heart failure. In 31,501 patients （mean age： 68 ± 12 years; 61% male; follow-up 11 ± 8 months）, telemonitoring reduced hospitalization rates with a HR of 0.73 （95% CI： 0.65-0.83; p 〈 0.0001） with significant heterogeneity （I2 = 94%）. These effects were observed in the short-term （≤ 6 months： HR = 0.77, 95% CI： 0.65-0.89; p 〈 0.01） and long-term （≥ 12 months： HR = 0.73, 95% CI： 0.62-0.87; p 〈 0.0001）. In 4831 patients （mean age 66 ± 18 years; 66% male; follow-up 13 ± 4 months）, wireless hemodynamic monitoring also reduced hospitalization rates with a HR of 0.60 （95% CI： 0.53-0.69; p 〈 0.001） with significant heterogeneity （I2 = 64%）.This reduction was observed both in the short-term （HR = 0.55, 95% CI： 0.45-0.68; p 〈 0.001; I2 = 72%） and long-term （HR = 0.64, 95% CI： 0.57-0.72; p 〈 0.001; I2 = 55%）. Conclusions Telemonitoring and hemodynamic monitoring reduce hospitalization in both short- and long-term in heart failure patients

关键词： Heart failure Hemodynamic monitoring Hospitalization Telemedicine Telemonitoring

Motor adaptation and internal model formation in a robot-mediated forcefield

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psychoradiology 2021年第2期1卷 73-87页

作者： Myriam Taga Annacarmen Curci Sara pizzamigglio Irene Lacal Duncan L.Turner cynthia H.Y.Fu 无 School of Health Sports and BioscienceUniversity of East LondonLondonUK Department of Computer Science School of ArchitectureComputing and EngineeringUniversity of East LondonLondonUK Department of physiology and pharmacology Sapienza UniversityRomeItaly School of psychology University of East LondonLondonUK Centre for Affective Disorders Institute of PsychiatryPsychology and NeuroscienceKing’s College LondonLondonUK

Background:Motor adaptation relies on error-based learning for accurate movements in changing ***,the neurophysiological mechanisms driving individual differences in performance are *** magnetic stimulation(TMS)-evoked potential can provide a direct measure of cortical ***:To investigate cortical excitability as a predictor of motor learning and motor adaptation in a robot-mediated ***:A group of 15 right-handed healthy participants(mean age 23 years)performed a robot-mediated forcefield perturbation *** were two conditions:unperturbed non-adaptation and perturbed *** was applied in the resting state at baseline and following motor adaptation over the contralateral primary motor cortex(left M1).Electroencephalographic(EEG)activity was continuously recorded,and cortical excitability was measured by TMS-evoked potential(TEp).Motor learning was quantified by the motor learning ***:Larger error-related negativity(ERN)in fronto-central regions was associated with improved motor per-formance as measured by a reduction in trajectory *** TEp N100 peak amplitude predicted motor learning(p=0.005),which was significantly attenuated relative to baseline(p=0.0018)following motor ***:ERN reflected the formation of a predictive internal model adapted to the forcefield *** in TEp N100 amplitude reflected an increase in cortical excitability with motor adaptation reflecting neuroplastic changes in the sensorimotor *** N100 is a potential biomarker for predicting the outcome in robot-mediated therapy and a mechanism to investigate psychomotor abnormalities in depression.

关键词： EEG TMS motor adaptation robot-mediated forcefield N100 ERN

Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans

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Military Medical Research 2018年第1期5卷 19-32页

作者： Rebecca A.Johnson David L.Albright James R.Marzolf Jessica L.Bibbo Hayley D.Yaglom Sandra M.Crowder Gretchen K.Carlisle Amy Willard cynthia L.Russell Karen Grindler Steven Osterlind Marita Wassman Nathan Harms Research Center for Human Animal interaction College of Veterinary Medicine University of Missouri Columbia MO 65211 USA. ResearchService Harry S. Truman Memorial Veterans' Hospital ColumbiaMO 65211 USA. School of Social Work University of AlabamaTuscaloosa AL 35487 USA. Occupational Health Services Harry S. Truman Memorial Veterans' Hospital Columbia MO 65211 USA. Center for the Human-Animal Bond College of Veterinary MedicinePurdue University West Lafayette IN 47907 USA. School of Health professions University of Missouri Columbia MO 65211 USA. TREE House of Greater St. Louis Wentzville MO 63385 USA. School of Nursing and Health Studies University of Missouri-Kansas CityKansas City MO 64108 USA. Cedar Creek Therapeutic Riding Center Columbia MO 65201 USA. College of Education School and Counseling Psychology University of Missouri Columbia MO 65211USA. Ride-On St. Louis Kimmswick MO 63053 USA.

Background:Large numbers of post-deployment *** are diagnosed with post-traumatic stress disorder(pTSD)and/or traumatic brain injury(TBI),leading to an urgent need for effective interventions to reduce symptoms and increase veterans’*** includes anxiety,flashbacks,and emotional *** symptoms increase health care costs for stress-related illnesses and can make veterans’civilian life ***:We used a randomized wait-list controlled design with repeated measures of *** veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding(THR)program for decreasing pTSD symptoms and increasing coping self-efficacy,emotion regulation,social and emotional *** participants were recruited and 29 enrolled in the randomized *** were randomly assigned to either the horse riding group(n=15)or a wait-list control group(n=14).The wait-list control group experienced a 6-week waiting period,while the horse riding group began *** wait-list control group began riding after 6 weeks of participating in the control *** and health history information was obtained from all the *** symptoms were measured using the standardized pTSD Checklist-Military Version(pCL-M).The pCL-M as well as other instruments including,The Coping Self Efficacy Scale(CSES),The Difficulties in Emotion Regulation Scale(DERS)and The Social and Emotional Loneliness Scale for Adults-short version(SELSA)were used to access different aspects of individual well-being and the pTSD ***:participants had a statistically significant decrease in pTSD scores after 3 weeks of THR(p≤0.01)as well as a statistically and clinically significant decrease after 6 weeks of THR(p≤0.01).Logistic regression showed that participants had a 66.7%likelihood of having lower pTSD scores at 3 weeks and 87.5%likelihood at 6 *** the generalized linear model(GLM),our ANOVA findings for the coping self

关键词： Animal-assisted intervention Coping self-efficacy Emotion regulation Military veterans post-traumatic stress disorder Social engagement Therapeutic horseback riding Traumatic brain injury

Individuals with and without normal tension glaucoma exhibit comparable performance on tests of cognitive function

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International Journal of Ophthalmology(English edition) 2021年第11期14卷 1721-1728页

作者： Qi N.Cui David Green Mohit Jethi Todd Driver Travis C.porco Jane Kuo Shan C.Lin Robert L.Stamper Ying Han cynthia S.Chiu Saras Ramanathan Michael E.Ward Katherine possin Yvonne Ou Department of Ophthalmology University of California San Francisco University of pennsylvania Francis I.proctor Foundation University of California San Francisco Glaucoma Center of San Francisco Department of Neurology University of California San Francisco Neurogenetics Branch National Institute of Neurological Disorders and StrokeNational Institutes of Health

AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension ***:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Department of *** data and glaucoma parameters were extracted from electronic medical records for both *** of executive function[Executive Abilities:Measures and Instruments for Neurobehavioral Evaluation and Research(EXAMINER)]and learning and memory[California Verbal Learning Test–Second Edition(CVLT-II)]were administered to both NTG and ***,handedness,best-corrected visual acuity,maximum intraocular pressure,optic nerve cup-todisc ratio,visual field and optic nerve optical coherence tomography parameters,and a measure of general health(Charlson Comorbidity Index)were compared between NTG and controls as well as within NTG *** linear regression was used to compare group performances on the EXAMINER battery and CVLT-II while controlling for age,sex,and years of ***:NTG and controls were comparable with respect to age,sex,race,education,handedness,and the Charlson Comorbidity Index(p>0.05 for all).performance on the EXAMINER composite score and the CVLT-II did not differ between NTG and controls(p>0.05 for both).CONCLUSION:This is the first prospective study in which the cognitive function of subject with NTG were evaluated using a comprehensive,computerized neurocognitive *** with NTG do not perform worse than unaffected controls on tests of executive function,learning,and memor *** do not suppor t the hypothesis that individuals with NTG are at higher risk for cognitive dysfunction and/or dementia.

关键词： low tension glaucoma dementia mild cognitive impairment neurodegeneration memory and executive function

重度肥胖患者胃肠分流术后低氧血症机制的分析

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广东医学 2001年第5期22卷 385-386页

作者：李靖 George SMCowan cynthia K Buffington 广东省广州呼吸疾病研究所 510120 美国田纳西州大学医学院外科美国38163

目的　研究重度肥胖对胃肠分流术后动脉血氧分压的影响。方法　对 6 1例进行胃肠分流术的重度肥胖患者及 5 5例择期腹部手术的正常体重患者进行术前肺功能、术前及术后 1～ 5d的血气分析检测。结果　肥胖组术后1～ 5d、对照组术后 1～ 2... 详细信息

目的　研究重度肥胖对胃肠分流术后动脉血氧分压的影响。方法　对 6 1例进行胃肠分流术的重度肥胖患者及 5 5例择期腹部手术的正常体重患者进行术前肺功能、术前及术后 1～ 5d的血气分析检测。结果　肥胖组术后1～ 5d、对照组术后 1～ 2d的动脉血氧分压较术前显著下降 (p p <0 .0 0 0 1)。结论　重度肥胖者较正常体重患者在腹部手术后发生低氧血症的程度较严重且持续时间长。

关键词：重度肥胖胃肠分流术低氧血症手术后并发症

Impact of Insurance Status on the prognosis of Acute Lower Limb Ischemia

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World Journal of Cardiovascular Diseases 2016年第7期6卷 218-223页

作者： Shyamal premaratne J. David Neel cynthia X. Zhao Linda D. Doucet Tze-Woei Tan Wayne W. Zhang Hunter Holmes McGuire Veterans Administration Medical Center Richmond Virginia USA Department of Surgery Louisiana State University Health Sciences Center Shreveport Louisiana USA Department of pathology Louisiana State University Health Sciences Center Shreveport Louisiana USA

The objective of this study was to investigate if the insurance status of patients impacted the treatment options and prognosis in acute limb ischemia (ALI). A retrospective chart review was performed at a single university tertiary care center using ICD-9 codes for the diagnosis and procedure for ALI from January 2000 to January 2011. A total of 96 patients were diagnosed with ALI, comprising of 66 males and 30 females with a mean age of 56 years (range was 19 - 80 years). Time to presentation and prognosis (rate and level of amputation) were analyzed using insurance status as the independent variable. patients covered under commercial insurance were compared to patients with Medicare and Medicaid and to patients without any insurance coverage. Statistical analysis was performed using the proportion z test to evaluate differences among the groups investigated. A “p” value of ≤0.05 was considered significant. In this study, ALI occurred more commonly in African Americans (p = 0.0029) and in patients without insurance coverage regardless of race (p = 0.0034). Chronic obstructive pulmonary disease (COpD), hypertension (HTN), and acute renal failure (ARF) were significantly higher in the uninsured group, compared to the insured group (p = 0.0005, 0.0055, and 0.0034, respectively). The time to hospital admission was significantly longer in uninsured patients compared to the insured group (p = 0.0449). The rates of major amputation above the ankle were 46% in patients with commercial insurance, 62% in the government insurance (Medicare and Medicaid) group, and 51% in the uninsured group. There was no significant difference in major versus minor amputation in patients with commercial insurances. However, the rates of major amputation were significantly higher than the rates of minor amputation in both Medicare and Medicaid and uninsured patients (p = 0.005, and pectively). With respect to acute lower limb ischemia, African Americans presented more frequently a

关键词： Ischemia Lower Extremity Amputation Insurance