异基因造血干细胞移植后肺烟曲霉菌病合并闭塞性细支气管炎一例附文献复习

背景：异基因造血干细胞移植是多种血液系统恶性疾病和遗传性疾病的有效治疗方法，但移植后易并发全身多脏器的病变，其中尤以肺部并发症多见。肺部并发症绝大部分为感染性疾病，小部分为非感染性疾病，两者亦可并存，但当移植病患同时发生肺部感染性疾病和非感染性疾病时，如何正确诊断和治疗尤为重要。 目的：报道异基因造血干细胞移植1年后发生肺侵袭性烟曲霉菌病合并闭塞性细支气管炎1例，复习相关文献探讨其预防、临床表现和恰当的治疗方法。 方法：患者异基因造血干细胞移植后373 d出现发热伴咳嗽，活动后胸闷，胸部CT提示右肺上叶前段、中叶及下叶背段可见片状阴影，进一步行右肺上叶病灶穿刺活检、培养。 结果与结论：肺穿刺活检病理提示肺泡扩张，肺泡上皮增生，肺间质增厚，间质细胞增生，并见少许散在的异型淋巴样细胞，肺功能中最大通气量明显下降，残气量增加，肺活量减低，基础第1秒用力呼气容积值为59.27%。肺穿刺物培养提示烟曲霉菌生长。细胞免疫组化提示为T淋巴细胞，:CD3(+)、CD45RO(+)，CD20(－)，CD79a(－)，MPO(－)，CD34血管(－)。患者确诊肺侵袭性烟曲霉菌病合并闭塞性细支气管炎，经注射用醋酸卡泊芬净+注射用伏立康唑抗真菌治疗，甲基泼尼松、硫唑嘌呤、阿奇霉素治疗闭塞性细支气管炎，治疗40 d后复查胸部CT病灶完全吸收。     

食管癌介入术后气颅一例

患者 女,64岁.因"反复发热伴头痛1周余"入院.头部CT(图1)示蛛网膜下腔广泛气泡征,患者半年内无头部外伤史,追问病史发现其4个月前因"进行性吞咽困难伴饮水呛咳"在当地医院行食管镜检及活检,提示为"食管中上段鳞癌",行放疗后逐渐出现胸背部烧灼性疼痛,且吞咽困难加重,钡餐检查提示"食管纵膈瘘",遂行"食管支架置入术",术后患者吞咽困难明显好转而出院.查体:神清语利,颈抵抗,余无明显神经系统阳性体征.颈胸部CT(图2)示T1～2椎体骨质破坏,椎间孔、椎管内积气,双肺斑片状渗出,诊断:颅内积气合并肺部感染.给予对症、抗炎治疗,嘱其卧床静养,避免剧烈咳嗽.7d后患者头痛症状明显缓解,体温正常,复查头部CT提示蛛网膜下腔积气明显减少,3d后患者痊愈出院.     

甘露醇合并β-七叶皂甙钠治疗脑出血疗效观察

目的：探讨脑出血患者联合应用β－七叶皂甙钠后的治疗效果。方法：设立治疗组与对照组，治疗组加用β－七叶皂甙钠，一定疗程后头颅CT复查，了解血肿吸收情况。进行分类统计。结果：治疗后血肿吸收情况经统计学处理，有显著意义。结论：合并β－七叶皂甙钠治疗可促进血肿吸收，缩短治疗时间。     

肝移植后真菌感染9例次分析

为了探讨肝移植后真菌感染的诊断和治疗,回顾分析解放军总医院第二附属医院器官移植中心2007-09/2008-12收治的52例肝移植中,8例肝移植受体术后发生真菌感染的诊治情况。52例肝移植患者中,8例患者真菌感染9例次(1例患者发生2次感染),感染率15% (8/52)。感染时间发生在肝移植后2~5个月,感染好发的部位依次为肺(67%,6/9),泌尿系统(22%,2/9),肠道(11%,1/9)。病原菌中白色念珠菌感染占6例次,光滑念珠菌感染占2例次,曲霉菌感染占1例次。在8例患者中6例经抗真菌感染治疗顺利康复,2例患者死亡。可见真菌感染是肝移植术后常见并发症之一,病死率较高,早期诊断和治疗是治愈真菌感染的关键。     

肝移植术后早期深部真菌感染诊治分析

为探索肝移植后早期深部真菌感染的早期诊断和治疗措施,收集了重庆医科大学附属第一医院重庆市器官移植中心2001-10/2008-10的72例肝移植患者移植后并发早期深部真菌感染16例患者的临床资料,分别对其易感因素、病原学特点、诊断方法、治疗方案及预防措施进行回顾性病例分析。16例肝移植患者发生早期深部真菌感染23例次,死亡4例,感染发生率22.2%(16/72),死亡率25.0%(4/16)。肺部感染15例次,肠道感染6例次,胆道感染1例次,颅内感染1例次。白色念珠菌感染占65.22%,非白色念珠菌感染占17.39%,曲霉菌感染占13.04%,隐球菌感染占4.35%。发病时间为移植后5~26 d。可见早期深部真菌感染是影响肝移植患者后生存率的重要原因之一。有效预防、早期诊断和积极治疗是提高深部真菌感染治愈率的关键。     

利奈唑胺治疗肾移植后重症肺部感染30例

为评价利奈唑胺对肾移植患者重症肺部感染的疗效与安全性,对30例肾移植后重症肺部感染患者应用利奈唑胺治疗的临床资料进行回顾性分析。根据临床症状初步判断病原菌,采取经验性降阶梯治疗,联合给予抗细菌、抗病毒和抗真菌治疗,抗生素均采用利奈唑胺300 mg 静滴,2次/d,结合抗杆菌类药物常用的有氨曲南、头孢吡肟、亚胺培南,更昔洛韦抑制巨细胞病毒感染,抗真菌感染应用氟康唑、伊曲康唑、伏立康唑、卡泊芬净、米卡芬净,复方新诺明抗肺孢子虫四联治疗。1例病情严重给予气管插管机械通气辅助呼吸,3 d后死亡外,其余29例患者经积治疗痊愈,其中4例并发急性呼吸窘迫综合征,治愈率达97%,利奈唑胺治疗有效率97%,细菌清除率为91%,未发现与药物相关不良反应导致停止治疗的记录。提示利奈唑胺是治疗肾移植患者重症肺部感染安全有效的药物。     

肺移植后真菌感染1例并文献复习

回顾分析1 例肺移植患者病理过程及诊疗经过,并复习相关文献,总结相关的临床治疗经验。原发性肺动脉高压并三尖瓣关闭不全、充血性心力衰竭女性患者,33岁,2006-04在体外循环下行同种异体原位双肺移植术,术后出现严重的低血容量性休克,伴有严重高钠血症,同时合并严重代谢性碱中毒,pH值最高达7.6,经积极治疗后,血钠水平于术后第14天恢复正常,术后第3天起,从痰培养、气管切开伤口分泌物、血液培养中分离出细菌、真菌共计12种,根据药敏试验给予相应抗生素治疗,真菌培养结果仍持续阳性,于术后第72天死亡。肺移植术后真菌感染是危及生命的严重并发症,对其进行早期诊断、消除各种诱发因素、及时给予足量、联合抗真菌药物治疗是移植后真菌感染防治的关键。     

高原颅内复杂动脉瘤破裂出血合并高原肺水肿一例

患者男,42岁.汉族,因“进藏后胸闷、呼吸困难3d,突发头痛伴意识不清12h”入院.既往体健,初上高原第3天,驻地海拔4900m.查体:血压120/70 mmHg,神志昏迷状态,双侧瞳孔呈圆形,直径3.0mm,对光反射迟钝,病理征(-).按Hunt - Hess分级为Ⅳ级,GCS评分4分.头颅CT示:鞍上池、双外侧裂池、双侧侧脑室、第三脑室及第四脑室高密影,脑室轻中度扩大(图1a);肺部CT提示双肺斑片状高密度影.     

抗磷脂抗体综合征导致反复脑梗死一例

患者,女,60岁,因“交替性两侧肢体瘫痪15个月余,失语1 d”于2004年11月17日入院.患者于2003年8月突发右侧偏瘫,行头颅CT及MRI提示左顶叶脑梗死,粗略计算病灶体积为45 cm^3,外院治疗后能外出旅游爬山,复查CT仅左侧半卵圆中心一大小约为2 cm^3局限条索状软化灶.2004年7月再发左侧偏瘫,行头颅CT示右侧顶叶约60 cm^3低密度灶,恢复后在家能扶物行走,复查CT右顶叶约3 cm^3条片状软化灶.2004年11月16日患者突然出现记忆力丧失,人变糊涂,头颅CT示左颞枕叶片状约30 cm^3低密度灶,边缘清楚,增强未见强化.     

肝移植后肺部感染的因素及防治策略

背景：尽管肝移植已经取得了很大进展，但移植后感染仍是威胁生命的主要问题，其中肺部感染是肝移植患者最常见的感染性并发症，也是导致移植后患者死亡的主要原因之一。 目的：就近年来肝移植后肺部感染的临床研究做一综述，为肝移植后肺部感染的治疗提供临床参考意见。 方法：由第一作者检索1995/2009 SPRINGER数据库 (http://springer.lib.tsinghua.edu.cn/home/main.mpx)及中国期刊全文数据库(http://dlib.cnki.net/kns50/)有关肝移植后肺部感染的易感因素、常见病原体、预防及治疗措施的文献，英文检索词为“liver transplantation，pulmonary infection，treatment”，中文检索词为“肝移植，肺部感染，治疗”。排除重复性研究。 结果与结论：计算机初检得到217 篇文献，最终纳入29篇文献进一步分析。结果提示肝移植后肺部感染的合理预防、早期诊断和及时处理，对于提高肝移植效果至关重要。肝移植临床医生应根据本地区、本单位致病微生物流行病学特点及实际医疗条件结合每个患者的具体情况，及时修正诊断与治疗，制定合理的预防与治疗方案。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Satellite cells and myonuclei in young and elderly women and men

The overall aim of this study was to assess the effects of aging on the satellite cell population. Muscle biopsies were taken from the tibialis anterior muscle of healthy, moderately active young (age range, 20-32 years; n = 31) and elderly (age range, 70-83 years; n = 27) women and men with comparable physical activity pattern. Satellite cells and myonuclei were visualized using a monoclonal antibody against neural cell adhesion molecule and counterstained with Mayer's hematoxylin. An average of 211 (range, 192-241) muscle fibers were examined for each individual. Compared with the young women and men, the elderly subjects had a significantly lower (P < 0.011) number of satellite cells per muscle fiber but a significantly higher (P < 0.004) number of myonuclei per muscle fiber. The number of satellite cells relative to the total number of nuclei [satellite cells/(myonuclei + satellite cells)] was significantly lower in the elderly than in the young women and men. These results imply that a reduction in the satellite cell population occurs as a result of increasing age in healthy men and women.     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.     

Learning and forgetting new names and objects in MCI and AD

We studied how subjects with mild cognitive impairment (MCI), early Alzheimer's disease (AD) and age-matched controls learned and maintained the names of unfamiliar objects that were trained with or without semantic support (object definitions). Naming performance, phonological cueing, incidental learning of the definitions and recognition of the objects were tested during follow-up. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, suggesting that the MCI patients’ preserved semantic memory can compensate for impaired episodic memory. The MCI group performed equally well as the controls in the tasks measuring incidental learning and recognition memory, whereas the AD group showed impairment in this respect. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that word learning is compromised in both MCI and AD, whereas long-term retention of newly learned words is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI.     

Necdin蛋白与神经元的生长分化

在神经系统 ,Necdin只在成熟神经元的细胞核中表达 ,可能与成熟神经元分裂静止状态的保持有关。近年的研究表明 ,Necdin是一种生长抑制蛋白 ,能与多种因子如SV4 0大T抗原 ,腺病毒E1A ,转录因子E2F1以及肿瘤抑制蛋白p5 3等结合 ,在功能上类似于成视网膜瘤蛋白Rb。necdin基因缺陷时 ,会引起脑内 ,特别是下丘脑神经元分化障碍。人类necdin基因位于PWS综合征的基因缺失区 ,可能与PWS的一些症状有关。本文从Necdin蛋白的基本概况 ,生物功能以及Necdin与疾病三个方面进行了综述     

Oxytocin and vasopressin agonists and antagonists as research tools and potential therapeutics

We recently reviewed the status of peptide and nonpeptide agonists and antagonists for the V(1a), V(1b) and V(2) receptors for arginine vasopressin (AVP) and the oxytocin receptor for oxytocin (OT). In the present review, we update the status of peptides and nonpeptides as: (i) research tools and (ii) therapeutic agents. We also present our recent findings on the design of fluorescent ligands for V(1b) receptor localisation and for OT receptor dimerisation. We note the exciting discoveries regarding two novel naturally occurring analogues of OT. Recent reports of a selective VP V(1a) agonist and a selective OT agonist point to the continued therapeutic potential of peptides in this field. To date, only two nonpeptides, the V(2) /V(1a) antagonist, conivaptan and the V(2) antagonist tolvaptan have received Food and Drug Administration approval for clinical use. The development of nonpeptide AVP V(1a), V(1b) and V(2) antagonists and OT agonists and antagonists has recently been abandoned by Merck, Sanofi and Pfizer. A promising OT antagonist, Retosiban, developed at Glaxo SmithKline is currently in a Phase II clinical trial for the prevention of premature labour. A number of the nonpeptide ligands that were not successful in clinical trials are proving to be valuable as research tools. Peptide agonists and antagonists continue to be very widely used as research tools in this field. In this regard, we present receptor data on some of the most widely used peptide and nonpeptide ligands, as a guide for their use, especially with regard to receptor selectivity and species differences.     

Retrospective and prospective design and data

The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder - MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.     

Cortisol levels and depression in men and women using heroin and cocaine

Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are well documented in men using illicit drugs and/or infected with HIV; however, less is known about HPA function, or the health consequence of HPA dysfunction, in their female counterparts. People with depression exhibit hypercortisolemia, and depression is common in people with HIV or substance use problems. The current study investigated cortisol secretion in 209 demographically matched men and women, stratified by their HIV and drug use status. Self-reported depressive symptoms were evaluated using a standardized, validated questionnaire (CES-D). Women reported more depressive symptoms than men (p=.01). Male and female drug users exhibited higher cortisol concentrations (p=.03), and were more likely to report depressive symptoms (p=.04), than non-users. Depression was related to elevated cortisol concentrations for the study population (p=.03), and women with elevated cortisol concentrations were significantly more depressed than all other participants (p=.05). While it is unknown whether high cortisol concentrations precede depressive symptoms or vice versa, these data indicate that higher cortisol concentrations are associated with depressive symptoms in heroin and cocaine users, and that this association is more pronounced in women than men. HIV status did not act in an additive or synergistic way with drug use for either cortisol or CES-D measures in the current study. Unique therapies to treat the endocrine and mental health consequences of illicit drug use in men and women deserve consideration as depressive symptoms, and high cortisol concentrations associated with depressive symptoms, differ by gender.     

Dissociation and Counterdissociation: Nuanced and Binary Perceptions of Good and Evil

Dissociated experiences are often communicated to analysts. Clinicians may absorb patients' dissociation, thereby creating “counterdissociated” states. Counterdissociation contributes to binary thinking in the analyst similar to black- and-white thinking commonly seen in patients' dissociated states. This can have both positive and negative effects: Counterdissociation may help therapists identify with patients' experience, thereby cementing the therapeutic bond. If analysts remain counterdissociated, however, patients may remain dissociated. As analysts identify their counterdissociation, they may gain insight into patients' needs for dissociation. As they overcome counterdissociation, patients may concurrently overcome dissociation. This allows both to have a more nuanced view of inner experience. With two extended case studies of sexually abused men, this article tracks how an analyst deals with counterdissociation created through intimate contact with dissociated positive and negative introjects of victimizers, thus forming identifications or overidentifications with the patients' abused parts.     

Hemodynamic and serum cardiac markers and risk of cognitive impairment and dementia

Introduction

Cardiac function is a key player in maintaining energy homeostasis in the brain. Heart failure is closely related to higher risk of neurocognitive disorders. Recent evidence shows that this relationship might not be limited to patients with advanced heart failure, and even suboptimal cardiac functioning is associated with accelerated brain aging. Hence, hemodynamic and serum cardiac markers may provide valuable information about the risk of dementia.