脑曼氏迭宫绦虫裂头蚴病的分析

脑裂头蚴病是由于曼氏迭宫绦虫的中绦期-裂头蚴于颅内寄生所致,世界各地均有散在报告,本病多发于青壮年。主要症状有癫痫发作、偏瘫和头痛,易误诊为脑瘤。随着头颅CT、MRI检查技术的普及,脑裂头蚴病的发现有增加趋势。本文通过二例典型病例,综合文献,对脑裂头蚴病的流行病学、临床表现及诊治原则进行介绍。     

15例曼氏裂头蚴病临床分析

目的 分析15例曼氏裂头蚴病患者的临床特征,提高对曼氏裂头蚴病的临床诊治水平。方法 收集 2008—2018年在中南大学湘雅二医院住院治疗的15例确诊为曼氏裂头蚴感染患者资料,回顾性分析患者的流行病学和临床特征。结果 15例患者中,4例喜食烧烤,3例曾食用未熟蛇肉,3例常饮用生水,2例食用生蟹,1例饮生鸡血;白细胞及嗜酸性粒细胞升高患者6例;外周血及脑脊液免疫球蛋白IgG测定高于参考值患者4例;13例裂头蚴抗体阳性;9例颅内曼氏裂头蚴病患者,4例颅内压升高,主要表现为头痛、癫痫,4例脑脊液生化指标异常;治愈9例,好转6例,手术7例。结论 曼氏裂头蚴病临床表现多样,应以流行病资料和临床表现为基础,结合实验室及影像学鉴别诊断。     

脑囊虫病ELISA试验、CT及MRI对比研究

目的:研究ELISA囊虫试验、脑CT及MRI对脑囊虫病的诊断价值。方法:采用回顾性研究,主要对比分析临床确诊的42例脑囊虫病患者的血清及脑脊液ELISA囊虫试验、脑CT及MRI结果。结果:ELISA脑囊虫试验血清抗原、抗体检测阳性率均为54%,脑脊液抗原阳性率为60%,抗体阳性率为15%,抗体假阴性率为85%;血清及脑脊液囊虫抗原阳性一致者46%,抗体阳性一致者35%。42例脑CT/MR检查中,40%患者病灶呈局灶性分布,60%患者病灶呈弥漫性分布;大部分(93%)患者脑CT/MR显示活的囊尾蚴病灶与死的囊尾蚴病灶并存。脑CT及MR两者均进行扫描的患者11例,其中2例CT表现为弥漫性脑水肿,其余病例CT及MR病灶部位基本一致,但MR显示的病灶数目明显多于CT。结论:目前对脑囊虫病的诊断必须依赖综合性措施。     

9例自身免疫性脑炎的临床特征分析

目的:探讨9例自身免疫性脑炎的临床特征。方法:总结天水市第一人民医院2018年1月至2021年4月住院确诊的自身免疫性脑炎患者,对其临床特征进行回顾性分析。结果:9例确诊均自身免疫性脑炎患者中,上呼吸道感染症状者4例,伴发热2例,最高体温38.5℃;精神行为异常3例,最长病程7年,最短1d;抽搐3例,表现为癫痫大发作;认知功能下降1例,右侧肢体活动不灵活1例;血常规白细胞增高3例,中性粒细胞增高5例。腰穿检查颅内压增高1例,脑脊液白细胞计数增高4例,以单个核细胞增高为主,脑脊液糖增高1例,脑脊液蛋白增高1例,氯化物均正常;头颅核磁检查5例患者提示不同程度单侧或双侧海马肿胀,1例右侧岛叶皮层及皮层下异常信号,1例双侧小脑蚓部新鲜病灶,病灶在T2、Flair、DWI均为高信号,T1为低信号。9例患者血液均检测出相应抗神经元自身抗体,3例患者脑脊液检查检测出相应抗神经元自身抗体,结果与血液检查一致。结论:自身免疫性脑炎临床表现以精神行为异常、抽搐发作为主要表现,其特征性影像学表现以海马受累为主,临床上患者出现原发性精神行为异常、抽搐等表现,应尽快行头颅核磁检查、脑脊液检查,进一步结合血液及脑脊液抗神经元自身抗体检查,明确诊断,以提高自身免疫性脑炎的检出率,为尽早诊治患者提供依据。     

脑膜癌病的诊断

探讨脑膜癌病的诊断方法。方法 :总结分析以神经系统症状为首发表现的 2 5例脑膜病患者的临床资料。结果 :影象学检查 8例异常 ,占 3 2 0 0 % ,主要表现为脑组织肿胀、脑沟、脑裂线状强化 ,为脑膜增强表现 ;脑脊液压力增高 2 0例 ( 80 0 0 % ) ,常规、生化检查主要表现为蛋白、细胞数增高 ,糖、氯化物降低酷似结核性脑膜炎的脑脊液表现 ;脑脊液细胞学检查 2 5例均发现癌细胞 ,占 10 0 %。结论 :影象学和脑脊液常规、生化检查对脑膜癌病的诊断有一定帮助作用 ,而脑脊液细胞学检查对脑膜癌病具有确诊价值     

江西省癫患者脑部寄生虫病的流行病学调查

目的探讨江西省癫患者脑部寄生虫病的发病情况。方法1063例癫患者进行脑部寄生虫病流行病学调查,并行头颅MRI或CT检查,进一步行血清学或脑脊液寄生虫抗体结合粪便kato-katz筛查,阳性者在基本排外其他脑部病变后予抗虫治疗,症状、体征、影像学复查好转者为临床确诊病例。结果1063例癫患者中,临床确诊为脑寄生虫病者38例,其中脑血吸虫病8例[脑电图（EEG）异常为25.0%,血清血吸虫抗体阳性率为100.0%,脑脊液血吸虫抗体阳性率为0,血吸虫卵阳性率为37.5%,治愈率为62.5%,好转率为37.5%],脑囊虫病25例（EEG异常为44.0%,血清学囊虫抗体阳性率为72.0%,脑脊液寄生虫抗体阳性率为28.0%,绦虫卵阳性率为4.0%,治愈率为28.0%,好转率为72.0%）,脑裂头蚴病5例（EEG异常为60.0%,血清学寄生虫抗体阳性率为80.0%,脑脊液寄生虫抗体阳性率为0,粪检虫卵率为0;无效5例,其中外科手术4例,未手术1例）。结论癫患者中应考虑筛查寄生虫,且以散发为主,农村高于城市。     

肺曼氏裂头蚴病6例诊治分析

目的 分析6例肺曼氏裂头蚴病的临床特点,以提高临床医师对该病的诊治水平.方法 回顾性分析6例肺曼氏裂头蚴病患者的流行病学特点、临床表现、诊断及治疗情况.结果 有食用蛙肉、蛇肉史3例,外周血嗜酸性粒细胞升高5例,胸水嗜酸性粒细胞显著升高4例.6例患者外周血曼氏裂头蚴抗体检查均呈阳性,肺部CT均表现为片状、斑片状或结节状影,其中5例合并胸腔积液.结论 肺曼氏裂头蚴病临床表现缺乏特异性,为减少误诊并提高对该病的早期诊断率,临床实践中要注意掌握该病流行病学特点,及时行外周血曼氏裂头蚴抗体和肺部CT检查,必要时可进一步作病理活检及虫体鉴定确诊.     

50例脑囊虫病伴发癫痫临床分析

癫痫发作是脑囊虫病最常见的症状之一。笔者收集52例脑囊虫病患者的临床资料，均经头颅CT和／或删检查，血清和／或脑脊液囊虫免疫学，病理学证实，其中伴发癫痫发作38例，现报告如下，并结合文献对其并发癫痫的相关因素进行讨论。     

8种寄生虫病例分析

本文报道并分析8例寄生虫病例,其中包括脑裂头蚴病、眼部裂头蚴病、肺吸虫幼虫移行症、肺吸虫病、钩虫病、肝吸虫病、包虫病和广州管圆线虫病各1例。8例寄生虫病均有不同程度的误诊,其中6例在寄生虫抗体筛查检测阳性后得以确诊。因此,寄生虫病应引起临床医生的重视,抗体筛查有助于发现寄生虫病例。     

经病理或血清学证实的8例脑囊虫病临床分析

目的探讨脑囊虫病的诊断及治疗经验。方法回顾性分析8例脑囊虫病的临床资料。结果脑囊虫病以青壮年多见,流行病学资料及血嗜酸性粒细胞不能提示感染本病。以癫痫为首发症状者占50%,血囊虫循环抗体阳性率高而脑脊液低阳性率低。所有病例均为脑实质病变,脑电图及头颅磁共振检查均有异常表现,后者典型表现呈“靶征”。予吡喹酮或阿苯达唑驱虫,采用小剂量滴定法,合用甘露醇、地塞米松治疗,疗效佳,未发现不良反应。结论脑囊虫病诊断主要依据典型头颅磁共振表现、病理或血清学检查,现行治疗有效而未发现不良反应。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…