韦素芬诊所指伤寒、副伤寒以外的各种沙门菌所引起的急性传染病,临床表现复杂,可分为胃肠炎型、类伤寒型、败血症型、局部化脓感染型,亦可表现为无症状感染,除伤寒、副伤寒以外的沙门菌导致感染,胃肠,对症处理,针对病原体治疗,可以进行补液治疗,糖皮质激素治疗,抗菌药物治疗等,胃肠炎型沙门氏菌感染应与急性细菌性痢疾、急性出血坏死性小肠炎、葡萄球菌性食物中毒、变形杆菌食物中毒、嗜盐杆菌食物中毒等相鉴别;类伤寒型、败血症型应与伤寒、副伤寒和其它细菌引起的败血症相鉴别;沙门氏菌引起的局部化脓感染型与其它细菌所致者,临床上很难区别,须通过局部病灶脓液培养来鉴别,动物性食物如肉类及其制品均应煮熟煮透,血常规,病原学检查,血清学检查,分离病原菌检测,。
鸡蛋是人们在日常生活中最为常见的食物之一,也是营养价值极高的一种食物。鸡蛋中不但富含优质蛋白、卵磷脂、维生素、矿物质等多种营养元素,而且消化、吸收率极高,几乎是人们每天必吃的食物。但是,鸡蛋虽好且是人们日常必备的食材之一,却并不是每种鸡蛋都能吃,尤其在遇到以下几种鸡蛋时,更是应少吃或者不吃。
溏心蛋
所谓的溏心蛋,即使没有蛋黄没有熟透的鸡蛋,尤其是蛋心部分呈粘稠的粥状。溏心蛋的蛋黄在口感上不像熟透的鸡蛋那样松散、干燥,也因此受到了很多人的喜欢。虽然溏心蛋看起来好看、吃起来好吃,但却也无法避免的存在一定的健康风险,溏心蛋没能被加热彻底,其中所含的沙门氏菌也就不会被完全杀死,人在吃了以后极容易引起细菌性食物中毒。据相关统计显示,世界各国的细菌性食物中毒事件中,沙门氏菌引起的食物中毒常列榜首。
炸鸡蛋
所谓的炸鸡蛋,顾名思义,就是从热锅热油中走过的鸡蛋,这种鸡蛋因为富含油脂,让人吃起来也会感到格外的香。但需要注意的是,鸡蛋是极易吸收油脂的食物,而过多的油脂不但可以引发肥胖,还是引发血脂异常乃至高血脂症、高胆固醇血症、高血压、冠心病等多种疾病的重要危险因素。炸鸡蛋虽然好吃却不宜多吃,最为健康的吃鸡蛋的方式就是水煮蛋。
散黄蛋
所谓的散黄蛋,指的是鸡蛋的外壳虽然是完好无损的,但是鸡蛋的内部的蛋黄却不再是完整的一个,而是呈松散状,这其实是鸡蛋开始变质的表现。绝大多数的散黄蛋都是由于放置的时间过常,导致鸡蛋内部的蛋白质结构遭到破坏而导致的,尤其是当散黄蛋的蛋液浑浊、且存在异味时,更是说明该鸡蛋已经彻底变质。吃了这样的散黄蛋,不但会口感差、会损伤人的胃肠道,还可能会引发呕吐、腹痛等症状。
死胎蛋
死胎蛋,也较毛蛋、毛鸡蛋,是指鸡蛋在孵化过程中因受到细菌或寄生虫污染,或者由于温度、湿度条件不适宜等原因,从而导致胚胎停止发育的蛋。适时,蛋壳里边已经并非是蛋清和蛋黄,而是没有发育完全却已经有了头、翅膀、爪等的痕迹,虽然很多人都喜欢吃毛蛋,但事实上这种蛋因为其中的蛋白质已经被分解,其他营养成分也已发生了变化,很可能会产生一些有毒物质,严重的还可能会导致人体中毒,不宜进食。
加热过度的鸡蛋
鸡蛋在加热时间过长、或经过反复加热的情况下,其蛋黄的最外面会抱有一层呈深绿色的物质,这种物质叫半胱氨酸,是因为鸡蛋加热到很长时间的某个阶段时所产生的。半胱氨酸本身无毒,但是继续在加热的条件下,却会发生硫化反应进而产生硫化氢,硫化氢跟鸡蛋中含的铁发生反应又会产生硫化铁。硫化铁属于低毒物质,会刺激人的胃肠道,并会增加膀胱癌的发病率。白煮蛋不宜加热时间过长,卤蛋和茶蛋也应尽量少吃。
鸡蛋如今家家户户都能吃的起,尤其是春节过后,鸡蛋的价格也呈现下降的趋势,平均一个鸡蛋也就是五毛钱。鸡蛋中含有的蛋白质是非常适合我们身体的优质蛋白,能够促进儿童的生长发育。鸡蛋的吃法很多,但是这3种吃法却让鸡蛋失去了食用的价值。
不吃蛋黄
蛋黄吃起来有点噎人,喜欢吃的人是特别喜欢,不喜欢吃的人直接就把蛋糕扔掉。上学的时候非常要好的同桌就不喜欢吃蛋糕,只要是我吃蛋黄,同学吃蛋清。其实鸡蛋主要的营养价值就在蛋黄上。虽然蛋黄中含有的胆固醇比较高,但是蛋黄中含有卵磷脂是一种非常好的物质,有利于降低血清胆固醇同时还能促进智力发育。蛋黄中还含有B族维生素,B族维生素作为辅酶参与能量代谢,也是身体不可或缺的营养素。
溏心蛋
鸡蛋煮的时间长了蛋黄就有点变颜色,吃起来有点噎人。溏心蛋的蛋黄颜色特别好看,有的朋友就是喜欢吃这种蛋黄没有完全凝固的鸡蛋。溏心蛋因为没有完全煮熟,可能会存在沙门氏菌感染的问题,因此不建议您吃溏心蛋。
煎鸡蛋
早上起来煎个鸡蛋夹在面包片中来食用,这是很多人早餐的选择之一。煎鸡蛋的时候如果您是用一般的炒锅就需要加点食用油,要不然鸡蛋会粘锅。鸡蛋的吸油率其实是非常高的,一个50克的鸡蛋就能吸收50克的油。中国营养学会建议每天食用油不要超过25克,过量油脂的摄入量会增加肥胖、高脂血症等疾病的发生。如果您想吃煎鸡蛋,建议您选择不粘锅减少食用油的添加量。
鸡蛋最好的吃法无疑是煮鸡蛋或者是蒸鸡蛋糕,这是吸收率最好的吃法。在煮鸡蛋的时候时间不宜太短或太长,水开后再煮五分钟关火可以。
鸡蛋,是老百姓最为常见的食物,从小时候开始添加辅食的时候,我们就开始食用鸡蛋的历程。即使是长大以后,很多人依然保留着每天食用一个鸡蛋的习惯。吃不过在吃鸡蛋的时候,也有一些注意事项,吃不对身体也会出问题。
鸡蛋中的蛋白质是优质蛋白,也被称为完全蛋白,利用率比较高。而且鸡蛋中所含有的维生素种类也比较多,比如维生素A、维生素D、B族维生素等等。鸡蛋中的卵磷脂,对于大脑发育有着重要的作用,同时还会抑制胆固醇在身体中的吸收。鸡蛋的食用方法很重要,这些饮食禁忌要提前知晓。
不吃溏心蛋
溏心蛋,很多人喜欢吃。拨开鸡蛋的蛋壳,蛋黄还没有完全凝固,蛋黄液还能够流出一些。这样的鸡蛋看起来更嫩,颜色也更为新鲜。只不过溏心蛋并没有完全煮熟,没有煮熟的鸡蛋可能会存在沙门氏菌感染的情况。食用溏心蛋,可能会引起腹泻。
吃鸡蛋不吃蛋黄
鸡蛋的蛋黄,有些人是一点也不爱吃。吃鸡蛋的时候,就把蛋黄扔掉。其实,这样的做法不仅仅是浪费的问题。鸡蛋所含有的营养物质主要集中在蛋黄上,比如维生素A、B族维生素、卵磷脂等等。吃鸡蛋,蛋黄必须吃,这样才能获得鸡蛋的营养物质。
鸡蛋炒着吃
西红柿炒鸡蛋、西葫芦炒鸡蛋、黄瓜炒鸡蛋,这些菜肴中都会加上鸡蛋。炒鸡蛋也是鸡蛋的主要食用方式之一,很多人认为这样吃更有滋味。其实,在炒鸡蛋的时候,我们往往会先在锅里放油。鸡蛋的吸油率比较高,1个50克的鸡蛋就可以吸收50克的食用油。炒鸡蛋虽然好吃,却会增加油的摄入量。食用油摄入量超标,身体健康也会出现更多问题。
鸡蛋直接喝
上火的时候,有些人为了能够败火而把生鸡蛋直接喝下去。虽然直接喝生鸡蛋,口感并不好,但是为了能够败火,很多人也是拼了。其实,鸡蛋的这种吃法根本起不到败火的作用,反而因为这种不健康的吃法给身体带来健康隐患。鸡蛋中含有的胰蛋白酶抑制剂会抑制蛋白质的吸收,同时生鸡蛋还可能会存在沙门氏菌感染的情况。这些不利因素叠加在一起,鸡蛋也就成了不健康的食品。
其实,鸡蛋最为健康的吃法就是白水煮鸡蛋。煮鸡蛋,可以保留鸡蛋更多的营养物质,鸡蛋中所含有的营养物质,人体吸收率也更高。在煮鸡蛋的时候,也要注意时间,煮鸡蛋时间太长会影响鸡蛋的口感,时间太短也难以煮熟鸡蛋。
煮鸡蛋的时候要把握好,五分钟鸡蛋是刚刚好。五分钟鸡蛋是指蒸锅冒出蒸汽后再煮上五分钟后关火,这样煮出来的鸡蛋也就被叫做五分钟鸡蛋。每天要坚持吃上一个鸡蛋,一个鸡蛋就可以。
以下内容来源于新英格兰医学杂志。
以下内容来源于新英格兰医学杂志。
Presentation of Case
Dr. Christine M. Parsons (Medicine): A 75-year-old woman was evaluated at this hospital because of arthritis, abdominal pain, edema, malaise, and fever.
Three weeks before the current admission, the patient noticed waxing and waning “throbbing” pain in the right upper abdomen, which she rated at 9 (on a scale of 0 to 10, with 10 indicating the most severe pain) at its maximal intensity. The pain was associated with nausea and fever with a temperature of up to 39.0°C. Pain worsened after food consumption and was relieved with acetaminophen. During the 3 weeks before the current admission, edema developed in both legs; it had started at the ankles and gradually progressed upward to the hips. When the edema began to affect her ambulation, she presented to the emergency department of this hospital.
A review of systems that was obtained from the patient and her family was notable for intermittent fever, abdominal bloating, anorexia, and fatigue that had progressed during the previous 3 weeks. The patient reported new orthopnea and nonproductive cough. Approximately 4 weeks earlier, she had had diarrhea for several days. During the 6 weeks before the current admission, the patient had lost 9 kg unintentionally; she also had had pain in the wrists and hands, 3 days of burning and dryness of the eyes, and diffuse myalgias. She had not had night sweats, dry mouth, jaw claudication, vision changes, urinary symptoms, or oral, nasal, or genital ulcers.
The patient’s medical history was notable for multiple myeloma (for which treatment with thalidomide and melphalan had been initiated 2 years earlier and was stopped approximately 1 year before the current admission); hypothyroidism; chikungunya virus infection (diagnosed 7 years earlier); seropositive erosive rheumatoid arthritis affecting the hands, wrists, elbows, and shoulders (diagnosed 3 years earlier); vitiligo; and osteoarthritis of the right hip, for which she had undergone arthroplasty. Evidence of gastritis was reportedly seen on endoscopy that had been performed 6 months earlier. Medications included daily treatment with levothyroxine and acetaminophen and pipazethate hydrochloride as needed for cough. The patient consumed chamomile and horsetail herbal teas. She had no known allergies to medications, but she had been advised not to take nonsteroidal antiinflammatory drugs after her diagnosis of multiple myeloma.
Approximately 5 months before the current admission, the patient had emigrated from Central America. She lived with her daughter and grandchildren in an urban area of New England. She had previously worked in health care. She had no history of alcohol, tobacco, or other substance use. There was no family history of cancer or autoimmune, renal, gastrointestinal, pulmonary, or cardiac disease.
On examination, the temporal temperature was 37.1°C, the heart rate 106 beats per minute, the blood pressure 152/67 mm Hg, and the oxygen saturation 100% while the patient was breathing ambient air. She had a frail appearance and bitemporal cachexia. The weight was 41 kg and the body-mass index (the weight in kilograms divided by the square of the height in meters) 15.2. Her dentition was poor; most of the teeth were missing, caries were present in the remaining teeth, and the mucous membranes were dry. She had abdominal tenderness on the right side and mild abdominal distention, without organomegaly or guarding. Bilateral axillary lymphadenopathy was palpable. Infrequent inspiratory wheezing was noted.
The patient had swan-neck deformity, boutonnière deformity, ulnar deviation, and distal hyperextensibility of the thumbs (Fig. 1). Subcutaneous nodules were observed on the proximal interphalangeal joints of the second and third fingers of the right hand and on the proximal interphalangeal joint of the fourth finger of the left hand. Synovial thickening of the metacarpophalangeal joints of the second fingers was noted. There was mild swelling and tenderness of the wrists. She had pain with flexion of the shoulders and right hip, and there was subtle swelling of the shoulders and right knee. Pitting edema (3+) and vitiligo were noted on the legs. No sclerodactyly, digital pitting, telangiectasias, appreciable calcinosis, nodules, nail changes (including pitting), or tophi were present. The remainder of the examination was normal.
The blood levels of glucose, alanine aminotransferase, aspartate aminotransferase, bilirubin, globulin, lactate, lipase, magnesium, and phosphorus were normal, as were the prothrombin time and international normalized ratio; other laboratory test results are shown in Table 1. Urinalysis showed 3+ protein and 3+ blood, and microscopic examination of the sediment revealed 5 to 10 red cells per high-power field and granular casts. Urine and blood were obtained for culture. An electrocardiogram met (at a borderline level) the voltage criteria for left ventricular hypertrophy.
Dr. Rene Balza Romero: Computed tomography (CT) of the chest, abdomen, and pelvis, performed after the intravenous administration of contrast material, revealed scattered subcentimeter pulmonary nodules (including clusters in the right middle lobe and patchy and ground-glass opacities in the left upper lobe), trace pleural effusion in the left lung, coronary and valvular calcifications, and trace pericardial effusion, ascites, and anasarca. The scans also showed slight enlargement of the axillary lymph nodes (up to 11 mm in the short axis) bilaterally and a chronic-appearing compression fracture involving the T12 vertebral body.
Dr. Parsons: Morphine and lactated Ringer’s solution were administered intravenously. On the second day in the emergency department (also referred to as hospital day 2), the blood levels of haptoglobin, folate, and vitamin B12 were normal; other laboratory test results are shown in Table 1. A rapid antigen test for malaria was positive. Wright–Giemsa staining of thick and thin peripheral-blood smears was negative for parasites; the smears also showed Döhle bodies and basophilic stippling. Antigliadin antibodies and anti–tissue transglutaminase antibodies were not detected. Tests for hepatitis A IgG and hepatitis C antibodies were positive. Tests for hepatitis B core and surface antibodies were negative. A test for human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) was negative.
Findings on abdominal ultrasound imaging performed on the second day (Fig. 2A and 2B) were notable for a small volume of ascites and kidneys with echogenic parenchyma. Ultrasonography of the legs showed no deep venous thrombosis. An echocardiogram showed normal ventricular size and function, aortic sclerosis with mild aortic insufficiency, moderate tricuspid regurgitation, a right ventricular systolic pressure of 39 mm Hg, and a small circumferential pericardial effusion. Intravenous hydromorphone was administered, and the patient was admitted to the hospital.
On the third day (also referred to as hospital day 3), nucleic acid testing for cytomegalovirus, Epstein–Barr virus, and hepatitis C virus was negative, and a stool antigen test for Helicobacter pylori was negative. An interferon-γ release assay for Mycobacterium tuberculosis was also negative. Oral acetaminophen and ivermectin and intravenous hydromorphone and furosemide were administered.
Dr. Balza Romero: Radiographs of the hands (Fig. 2C through 2F) showed joint-space narrowing of both radiocarpal joints and proximal interphalangeal erosions involving both hands. Radiographs of the shoulders showed arthritis of the glenohumeral joint and alignment suggestive of a tear of the right rotator cuff. A radiograph of the pelvis showed diffuse joint-space narrowing of the left hip, without osteophytosis, and an intact right hip prosthesis.
Dr. Parsons: Diagnostic tests were performed, and management decisions were made.
Final Diagnosis
Overlap syndrome of rheumatoid arthritis and systemic lupus erythematosus complicated by proliferative lupus nephritis, superimposed on amyloid A amyloidosis.
以下内容来源于PubMed。
Abstract
Sacituzumab govitecan (SG) significantly improved progression-free survival (PFS) and overall survival (OS) versus chemotherapy in hormone receptor-positive human epidermal growth factor receptor 2-negative (HR+HER2-) metastatic breast cancer (mBC) in the global TROPiCS-02 study. TROPiCS-02 enrolled few Asian patients. Here we report results of SG in Asian patients with HR+HER2- mBC from the EVER-132-002 study. Patients were randomized to SG (n = 166) or chemotherapy (n = 165). The primary endpoint was met: PFS was improved with SG versus chemotherapy (hazard ratio of 0.67, 95% confidence interval 0.52-0.87; P = 0.0028; median 4.3 versus 4.2 months). OS also improved with SG versus chemotherapy (hazard ratio of 0.64, 95% confidence interval 0.47-0.88; P = 0.0061; median 21.0 versus 15.3 months). The most common grade ≥3 treatment-emergent adverse events were neutropenia, leukopenia and anemia. SG demonstrated significant and clinically meaningful improvement in PFS and OS versus chemotherapy, with a manageable safety profile consistent with prior studies. SG represents a promising treatment option for Asian patients with HR+HER2- mBC (ClinicalTrials.gov identifier no. NCT04639986 ).
以下内容来源于PubMed。
Abstract
Irritable bowel syndrome with diarrhea (IBS-D) is a common and chronic gastrointestinal disorder that is characterized by abdominal discomfort and occasional diarrhea. The pathogenesis of IBS-D is thought to be related to a combination of factors, including psychological stress, abnormal muscle contractions, and inflammation and disorder of the gut microbiome. However, there is still a lack of comprehensive analysis of the logical regulatory correlation among these factors. In this study, we found that stress induced hyperproduction of xanthine and altered the abundance and metabolic characteristics of Lactobacillus murinus in the gut. Lactobacillus murinus-derived spermidine suppressed the basal expression of type I interferon (IFN)-α in plasmacytoid dendritic cells by inhibiting the K63-linked polyubiquitination of TRAF3. The reduction in IFN-α unrestricted the contractile function of colonic smooth muscle cells, resulting in an increase in bowel movement. Our findings provided a theoretical basis for the pathological mechanism of, and new drug targets for, stress-exposed IBS-D.
Keywords: AdorA2B; Lactobacillus murinus; irritable bowel syndrome with diarrhea; spermidine; stress; type I interferon; xanthine.
Abstract
The severe bronchiolitis endotype characterized by a high abundance of H. influenzae, high proportion of RV-A and RV-C infections, and high asthma genetic risk had a significantly higher risk for developing asthma.
Background: Infants with bronchiolitis are at increased risk for developing asthma. Growing evidence suggests bronchiolitis is a heterogeneous condition. However, little is known about its biologically distinct subgroups based on the integrated metagenome and asthma genetic risk signature and their longitudinal relationships with asthma development.
Methods: In a multi-center prospective cohort study of infants with severe bronchiolitis (i.e., bronchiolitis requiring hospitalization), we profiled nasopharyngeal airway metagenome and virus at hospitalization, and calculated the polygenic risk score of asthma. Using similarity network fusion clustering approach, we identified integrated metagenome-asthma genetic risk endotypes. We also examined their longitudinal association with the risk of developing asthma by age six years.
Results: Of 450 infants with bronchiolitis (median age, 3 months), we identified five distinct endotypes-characterized by their nasopharyngeal metagenome, virus, and asthma genetic risk profiles. Compared with endotype A infants (who clinically resembled "classic" bronchiolitis), endotype E infants (characterized by a high abundance of H. influenzae, high proportion of RV-A and RV-C infections, and high asthma genetic risk) had a significantly higher risk for developing asthma (35.9% versus 16.7%; ORadj, 2.24; 95%CI, 1.02-4.97; p=0.046). The pathway analysis showed that endotype E had enriched microbial pathways (e.g., glycolysis, L-lysine, arginine metabolism) and host pathways (e.g., IFNs, IL-6/JAK/STAT3, fatty acids, MHC, and immunoglobin-related) (FDR<0.05). Additionally, endotype E had a significantly higher proportion of neutrophils (FDR<0.05).
Conclusion: In this multi-center prospective cohort study of infant bronchiolitis, the clustering analysis of integrated-omics data identified biologically distinct endotypes with differential risks for developing asthma.
Summary
Interpretation