以甲状腺肿大为表现的淋巴瘤1例

患者女,69岁,主诉"中上腹部胀痛15d"入院,患者入院15d前无明显诱因出现中上腹部胀痛,呈阵发性,多在进食后出现,空腹时疼痛缓解,疼痛无向别处放射,无返酸、嗳气,无恶心、呕吐,无胸闷、胸痛,无咳嗽、咯痰,无声音嘶哑,无发热,无盗汗,无皮疹,无关节疼痛。既往     

儿童中枢神经系统感染脑脊液主要病原菌的构成及耐药性的监测

目的探讨儿童中枢神经系统感染脑脊液病原菌的构成及耐药性。方法全自动细菌鉴定仪VITEK32进行细菌鉴定和药敏实验并结合K B药敏实验法,根据美国临床和实验室标准协会(CLSI)标准进行结果判读。结果住院患儿中枢神经系统感染脑脊液标本1 990份共分离病原菌181株,检出阳性率9.1%（181/1 990）。细菌检出率95.0%（172/181）,真菌检出率5.0%（9/181）,其中肺炎链球菌19.3%（35/181）,表皮葡萄球菌18.8%（34/181）,大肠埃希菌17.1%（31/181）。3种主要细菌的分离率较高,主要集中分布在1岁以内患儿。大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶（ESBLs）检出率较高,分别为41.9%（13/31）和50.0%（3/6）。主要的革兰阴性细菌大肠埃希菌和肺炎克雷伯菌对厄它培南和亚胺培南耐药率为0,未发现耐万古霉素的革兰阳性细菌。结论对中枢神经系统感染患儿脑脊液进行培养和药敏实验,根据药敏结果合理选用抗生素,对降低细菌的耐药和提高药物的敏感性,临床合理使用抗菌药物有指导作用。     

腹腔镜胆囊阑尾联合切除术的临床应用

本院自2005年7月至2007年7月,行腹腔镜胆囊阑尾联合切除术27例,无一例发生并发症,效果满意。现报告如下。1临床资料1.1一般资料本组27例患者中男12例,女15例;年龄26～73岁,平均46岁。全部患者中有胆囊结石者21例,急性发作15例,胆囊息肉6例。其中,合并糖尿病7例,高血压、冠心病3例。有慢性阑尾炎病史21例,急性单纯阑尾炎5     

婴幼儿重症肺炎支原体肺炎30例临床特点和治疗

目的:探讨婴幼儿重症肺炎支原体肺炎的临床特点,提高其诊治水平.方法:回顾分析了30例婴幼儿重症肺炎支原体肺炎的临床特点.结果:本组患儿起病急,临床症状为发热、刺激性咳嗽,多有气喘,较快出现呼吸困难,均出现程度不同的肺外症状;2例并发肺不张.予大环内酯类抗生素及对症治疗症状缓解.结论:重症婴幼儿肺炎支原体肺炎病情重、变化快,肺外症状明显,2例并发肺不张,应引起儿科医生临床重视.     

慢性胃炎的病理诊断

慢性胃炎的病理诊断参照了新悉尼系统的直观模拟评分法和中国慢性胃炎共识意见（2017,上海）,包括对慢性胃炎的炎症、活动性、萎缩、肠化和幽门螺杆菌进行半定量评价,并给予总结性分类。虽然幽门螺杆菌感染是最常见的原因,但是也不能忽视其他类型的慢性胃炎。病理评估时应尽可能提供病因学依据和线索。慢性胃炎的两个风险评估系统胃炎评价标准(OLGA)和胃黏膜肠化生评价标准(OLGIM)可以有效对胃癌的发生风险进行分层,建议纳入病理评估。完善的慢性胃炎病理诊断系统不仅可以指导临床治疗,也有利于慢性胃炎患者的管理、随访策略的制定以及早癌的筛查。     

高通量血液透析对血清钙、磷和甲状旁腺素的影响

目的:探讨高通量血液透析对血清钙、磷和甲状旁腺素(PTH)的影响。方法:采用双盲随机对照,A组应用高通量透析,B组应用普通透析,分时点检测病人空腹透析前血清总钙、磷和全段PTH的水平。结果:A组病人血清钙各时点均数在正常范围,相互比较无显著变化(P>0.05);血清磷和血清全段PTH在3个月时显著降低并维持犤血磷(1.98±0.08)mmol/L,血清全段PTH(256.16±101.22)pg/L犦,P<0.05。B组病人血清钙在正常范围,血清磷和血清全段PTH水平较高,各时点均数比较,P>0.05。A组血清磷和PTH在3个月时明显低于B组(P<0.05),之后维持;血清钙两组无差异。结论:高通量透析可增加血磷的清除量,有效降低维持性血液透析患者的血磷和PTH。     

HLA-DM基因多态性及其与变应性鼻炎的相关性

目的:对变应性鼻炎患者作HLA-DM分型,探讨HLA-DM基因与变应性鼻炎遗传易感性的可能关系.方法:采用限制性片段长度多态性方法对69例无亲缘关系的变应性鼻炎病人和91例无血缘关系的健康汉族人作HLA-DM分型.结果:汉族变应性鼻炎患者及正常人DMA、DMB均以DMA*0101和DMB*0101为主,变应性鼻炎患者组DMA和DMB各等位基因和基因型与正常对照组差异无显著性(P＞0.05).结论:本组病例未能证实变应性鼻炎与HLA-DM基因有关联性.     

Meta分析在宫颈癌循证医学中的应用

宫颈癌是全球女性中仅次于乳腺癌的最常见的妇科恶性肿瘤之一．在一些发展中国家其发病率居首位。宫颈癌的流行病学研究及合理有效的诊治显得尤为重要。近20年来．循证医学及Meta分析得到了迅速的推广和应用,以其严谨的理念与方法．解决了人们面对眼花缭乱,甚至自相矛盾的医学信息的困惑。本文对近年来宫颈癌流行病学及其诊治相关问题的Meta分析进行回顾．主要综述Meta分析在宫颈癌病因、诊断、治疗的循证医学中应用。[第一段]     

奥美拉唑防治新生儿缺氧缺血性脑病合并上消化道出血80例疗效观察

重症新生儿缺氧缺血性脑病（HIE）患儿,因胃肠功能衰竭而出现上消化道出血的比例很高,导致新生儿失血甚或休克,为此,我科采用质子泵制剂－奥美拉唑胃管内注入预防新生儿消化道出血,取得显著效果,且明显优于甲氰咪胍。     

含多糖中药抗病毒的研究进展

病毒性疾病是危害人类健康的一种重要疾病。与肿瘤、心血管和神经系统的疾病不同,它具有高度的传染性,且是许多其他疾病的病因。病毒为细胞内寄生的微生物,利用宿主细胞的DNA、RNA及蛋白合成系统进行复制,甚至可以将自身的核酸信息整合到宿主细胞的DNA中,与宿主细胞同期复制,并且在不断的复制中产生错误而形成变异。作为抗病     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.