成人自身免疫性脑炎临床特征分析

目的分析成人自身免疫性脑炎(AE)的临床特点。方法收集2015年4月—2020年9月天津市环湖医院确诊的16例AE患者临床资料,分析患者一般资料、临床表现、血液及脑脊液化验、神经电生理、头颅影像学、治疗以及预后等临床特点。结果 16例患者中男性11例,女性5例。抗NMDAR抗体(6/16)、抗LGI1抗体(3/16)、抗GABABR抗体(2/16)、抗AMPAR抗体(2/16),抗体阳性比例较高。常见临床表现为癫痫发作(13/16),认知功能障碍(9/16),言语障碍(9/16)。肿瘤标志物中神经元特异性烯醇化酶阳性8例(8/16)。15例患者给予一线免疫治疗,1例症状轻微拒绝免疫治疗。6例患者病情明显缓解。结论随着AE研究的逐渐深入,越来越多的抗神经元抗体被发现,这为AE的诊断及治疗提供了重要参考依据。早期的免疫治疗对AE患者的预后具有明显疗效,因而一旦患者临床表现符合AE诊断,应积极尽早干预及治疗。     

儿童抗富亮氨酸胶质瘤失活1蛋白抗体相关脑炎2例并文献复习

目的探讨儿童抗富亮氨酸胶质瘤失活1蛋白(LGI1)抗体相关脑炎的临床特征,并进行文献复习。 方法选择2016年3月至11月,于首都儿科研究所附属儿童医院及北京天坛医院神经内科住院的2例抗LGI1抗体相关脑炎患儿(患儿1、患儿2)为研究对象,进行病例资料分析并总结其临床特征。设定检索策略：以"富亮氨酸胶质瘤失活1蛋白"免疫性脑炎"LGI1"leucine-rich glioma-inactivated 1 protein"及"autoimmune diseases of the nervous system"为关键词,对万方数据知识服务平台、医知网、PubMed文献数据库、美国国家生物技术信息中心建库至2017年10月,收录的关于抗LGI1抗体相关脑炎的文献进行检索,并总结该病患儿的临床特征。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》。 结果①患儿1,男性,8岁,为目前报道年龄最小的儿童抗LGI1抗体相关脑炎患儿。主诉"夜间睡眠减少50 d",临床主要表现为夜间睡眠减少伴兴奋,家族史及生长发育史未见异常,神经系统体格检查未见异常。头颅MRI提示左侧海马病变。脑脊液及血清抗LGI1抗体检测结果呈阳性。该例患儿接受静脉注射用人免疫球蛋白(IVIG)及泼尼松治疗后,夜间睡眠减少伴兴奋及头颅MRI较前明显好转。②患儿2,男性,15岁,主诉"发作性抽搐7 d",临床主要表现为抽搐,形式为复杂部分性发作和部分性发作继发强直-阵挛,不伴记忆力下降及认知、精神、睡眠及运动障碍,血清抗LGI1-IgG抗体检测结果呈阳性(1∶100),该例患儿接受IVIG及左乙拉西坦片治疗后,随访1^＋年的结果显示无神经、精神症状,学习成绩良好。③设定检索策略进行相关文献检索的结果显示,仅检索到3篇国外文献报道涉及3例年龄<18岁抗LGI1抗体相关脑炎患儿(14、15、17岁)。其中,14岁患儿的症状为近期记忆力障碍、精神行为异常,为目前公开报道的最小年龄抗LGI1抗体相关脑炎患儿。 结论本研究8岁患儿为目前国内外报道的年龄最小抗LGI1抗体相关脑炎患儿。儿童抗LGI1抗体相关脑炎可单纯以睡眠障碍或癫痫发作起病,头颅MRI表现具有典型特征,采取IVIG和糖皮质激素治疗疗效良好。     

10例不伴肿瘤的自身免疫性脑炎的临床特点

目的:探讨不伴肿瘤的自身免疫性脑炎的临床特点,提高临床对该疾病的认识.方法:收集安徽省立医院神经内科临床诊断为自身免疫性脑炎患者的临床资料,共10例,分析其类型及临床特点.结果:10例患者,其中6例为抗NMDA受体脑炎;3例为抗GABABR脑炎;1例LGI1蛋白抗体脑炎.主要表现为精神行为异常7例;癫痫发作9例;不自主运动4例;自主神经功能障碍3例.脑脊液抗体均阳性.MRI异常4例.脑电图异常4例.免疫治疗有效10例,完全恢复4例,好转6例,无死亡患者.结论:不伴肿瘤的自身免疫性脑炎与其他报道的伴发肿瘤的自身免疫性脑炎临床特点相似,表现为精神行为异常、癫痫发作、不自主运动等,头颅MRI均有边缘系统损害,免疫治疗预后均较好.     

抗NMDA受体脑炎12例临床脑电图分析及文献回顾

目的探讨抗N-甲基-D-天冬氨酸(NMDA)受体脑炎临床、脑电图特征。方法回顾性分析12例西安市儿童医院收治的抗NMDA受体脑炎患者临床特点、脑电图特征并回顾文献资料。结果本研究12例患者中,1起病方式:精神行为异常8例,步态异常1例,惊厥3例;2临床表现:精神行为异常和性格改变12例,意识障碍9例,惊厥5例,不自主运动和肌张力障碍5例;3脑电图:脑电图正常3例,发作间期脑电图异常9例,9例均有背景活动减慢,其中弥漫性或局限于前后头部的δ波4例,多灶性放电4例,无一例见到δ刷;4预后:大多数患儿预后良好,有2例患儿存在语言减少、注意力不集中等轻微症状。结论抗NMDA受体脑炎在儿童不是一种少见疾病,临床表现多样,但肿瘤少见,脑电图表现多为非特异性慢波,少数可有多灶性放电或正常,早期诊断和积极免疫治疗可获得较好的预后。     

儿童病毒性脑炎68例临床分析

目的分析儿童病毒性脑炎的临床特点及治疗方案。方法对某院儿科收治的68例病毒性脑炎患儿临床症状、体征,脑脊液常规和生化检查,脑电图与CT结果进行综合分析。结果68例患儿中有60例(88.24%)病前有其他部位感染;其临床表现:均有发热,呕吐48例(70.59%),头痛41例(60.29%),头痛伴腹痛20例(29.41%),惊厥23例(33.82%),抽搐持续状态5例(7.35%),昏迷3例(4.41%),精神症状40例(58.82%),意识障碍19例(27.94%),合并脑膜刺激征和病理征32例(47.06%),肢体瘫痪3例(4.41%),失语1例(1.47%);脑脊液检查异常48例(70.59%),脑电图异常50例(73.53%),36例头颅CT平扫异常8例。采用止惊、退热、降低颅高压等综合治疗加抗病毒治疗,临床治愈53例,好转11例,放弃治疗3例,病死1例。结论小儿病毒性脑炎临床表现呈多样化,早期诊断、及时治疗是治疗成功的关键。     

髓鞘碱性蛋白、神经元特异性烯醇化酶在支原体肺炎并发脑炎患儿中的临床研究

目的 测定脑脊液中髓鞘碱性蛋白(MBP)及神经元特异性烯醇化酶(NSE)的含量,探讨其在支原体肺炎并发脑炎患儿中的临床价值。方法 2016年4月-2017年10月选取68例支原体肺炎合并脑炎的患儿为实验组(包括非惊厥组36例,惊厥组32例),30例支原体肺炎患儿为对照组;采用ELISA方法检测脑脊液MBP、NSE的含量。结果 惊厥组、非惊厥组患儿脑脊液MBP、NSE水平均显著高于对照组(P<0.05),且惊厥组均明显高于非惊厥组(P<0.05)。结论 脑脊液MBP、NSE含量可作为评估支原体肺炎并发脑炎患儿中枢神经系统损伤及损伤程度的指标,这有助于临床医生及早判断病情和合理诊治。     

2例抗NMDAR脑炎护理体会

抗NMDAR脑炎是一种新型自身免疫性脑炎,临床表现多样,无特异性,主要为发热、记忆障碍、癫痫发作、意识障碍、自主神经功能紊乱,伴或不伴畸胎瘤,对免疫治疗有效.本病进展较快,精神症状较重,具有潜在致死性,诊断不明确,尤其是要排除病毒性脑炎和其他自身免疫性疾病给治疗和护理带来了难度[1].     

小儿病毒性脑炎96例临床分析

[目的]探讨小儿病毒性脑炎的临床特点. [方法]对某院2008年1月-2009年12月收治的96例病毒性脑炎患儿的临床资料进行回顾性分析. [结果]96例患儿治愈出院76例,遗留后遗症17例(智力障碍10例,运动障碍5例,继发性癫痫2例),死亡3例(多脏器功能衰竭2例,脑疝1例).脑电图异常率为91.7%(88/96),明显高于脑脊液、头颅CI和MRI,差异有统计学意义(P(0.05). [结论]小儿病毒性脑炎早期临床表现无特异性,发病无明显季节性,起病前上呼吸道感染为最常见症状,脑电图对早期诊断和预后评估具有重要参考价值,应结合临床表现、脑脊液和MRI综合诊断分析.     

病毒性脑炎患儿脑脊液病毒核酸检测及临床分析

目的了解合肥地区儿童病毒性脑炎的病原构成及不同年龄组患儿临床表现差异。方法将53例病毒性脑炎患儿根据年龄分为A组（〈3岁）、B组（3岁～6岁）及C组（〉6岁）3组。（1）采用PCR法检测脑脊液常见病毒核酸,包括肠道病毒（EV）、单纯疱疹病毒（HSV）、水痘-带状疱疹病毒（VZV）和人巨细胞病毒（HCMV）。（2）分析不同年龄组临床表现特点。结果（1）32例核酸检测阳性（60.38%）,其中EV 23例（43.40%）,HSV 8例（15.09%）,HCMV 1例（1.89%）,未检出VZV。（2）A、B两组中有惊厥者明显多于C组（P〈0.01）,C组以头痛为早期症状者23例（85.19%）,而A、B两组分别只有1例和4例（P〈0.01）。HSV脑炎惊厥发生明显多于其他病毒性脑炎。结论证实合肥地区儿童病毒性脑炎病原以EV和HSV为主,HSV脑炎临床症状较严重,提示临床应加强病毒性脑炎病原检测工作,而PCFR检测患儿脑脊液中特异性病毒核酸片段符合临床快速、特异诊断要求。     

儿童患者超剂量应用抗生素致抗生素脑病误诊为病毒性脑炎临床分析

目的 探讨儿童患者超剂量应用抗生素致抗生素脑病的临床特点及病毒性脑炎临床鉴别。 方法 用HIS系统检索和查阅病历资料,回顾2009年1月20日-2011年6月20日某医院临床诊断为病毒性脑炎患儿504例,记录患儿临床用药史,疾病发生与演变过程,临床治疗与检查结果,分析儿童抗生素脑病临床特点及儿童病毒性脑炎的鉴别。结果 儿童抗生素脑病与超剂量应用抗生素直接相关,临床表现为呕吐、意识障碍、抽搐、腹泻、脑膜刺激征,实验室检查、病原学检查和脑影像学检查阴性,脑脊液压力、白细胞数(>200)、降钙素原(procalcitonin,PCT)较病毒性脑炎低,两组患儿统计数据差异有统计学意义(P＜0.05)。 结论儿童超剂量应用抗生素是抗生素脑病的直接因素,严格掌握抗生素的使用指征、种类、用法用量是预防的关键;充分了解患儿抗生素应用情况结合实验室检查、病原学检查和脑组织影像学检查是鉴别病毒性脑炎的可靠依据。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.