Acute upper extremity flaccid paralysis in a 5 year old child secondary to enterovirus infection

The incidence of acute flaccid paralysis has been on a declining trend with the global efforts on eradication of polio virus. A few scattered clusters of acute flaccid paralysis associated with pathogens like enterovirus other than polio virus and flaviviruses have recently come to limelight. This is a case of acute onset flaccid paralysis of left upper extremity in a fully immunized 5 year old child in New York.     

真武汤加味治疗老年冠心病心力衰竭42例

目的:观察真武汤加味治疗老年冠心病心力衰竭的临床疗效。方法:将84例老年冠心病合并心力衰竭患者随机分为治疗组与对照组各42例,对照组给予常规西医治疗,治疗组给予真武汤加味治疗,连续治疗14d为1个疗程,比较两组患者临床疗效及SOD、GSH-PX水平变化。结果:治疗组与对照组有效率分别为97.7%、88.1%,治疗组有效率明显高于对照组(χ2=8.265,P=0.034);两组患者治疗后SOD及GSH-PX水平均较治疗前明显增高(P0.05),但同期组间比较治疗组较对照组增高明显(P0.05)。结论:真武汤加味治疗老年冠心病心力衰竭疗效显著,其机制可能与增强血清抗氧化酶活性有关。     

真武汤加味方治疗扩张型心肌病临床研究

目的观察真武汤加味方治疗扩张型心肌病（DCM）的疗效。方法66例DCM患者随机分为两组。对照组33例给予强心、利尿、扩血管等西医常规治疗,治疗组33例在对照组治疗基础上加用真武汤加味方,两组疗程均为3个月。观察临床症状及血清TNF-α、IL-6、hs-CRP水平治疗前后变化。结果治疗组治疗后气促、心悸、水肿、乏力等主要症状改善优于对照组（P〈0.05）;治疗组治疗后TNF-α、IL-6、hs-CRP水平明显低于对照组（P〈0.05,P〈0.01）。结论真武汤加味方能有效改善扩张型心肌病症状,可能与其抑制炎症反应有关。     

WebBioBank: A new platform for integrating clinical forms and shared neurosignal analyses to support multi-centre studies in Parkinson’s Disease

BackgroundThe web-based systems available for multi-centre clinical trials do not combine clinical data collection (Electronic Health Records, EHRs) with signal processing storage and analysis tools. However, in pathophysiological research, the correlation between clinical data and signals is crucial for uncovering the underlying neurophysiological mechanisms. A specific example is the investigation of the mechanisms of action for Deep Brain Stimulation (DBS) used for Parkinson’s Disease (PD); the neurosignals recorded from the DBS target structure and clinical data must be investigated.ObjectiveThe aim of this study is the development and testing of a new system dedicated to a multi-centre study of Parkinson’s Disease that integrates biosignal analysis tools and data collection in a shared and secure environment.MethodsWe designed a web-based platform (WebBioBank) for managing the clinical data and biosignals of PD patients treated with DBS in different clinical research centres. Homogeneous data collection was ensured in the different centres (Operative Units, OUs). The anonymity of the data was preserved using unique identifiers associated with patients (ID BAC). The patients’ personal details and their equivalent ID BACs were archived inside the corresponding OU and were not uploaded on the web-based platform; data sharing occurred using the ID BACs. The system allowed researchers to upload different signal processing functions (in a .dll extension) onto the web-based platform and to combine them to define dedicated algorithms.ResultsFour clinical research centres used WebBioBank for 1 year. The clinical data from 58 patients treated using DBS were managed, and 186 biosignals were uploaded and classified into 4 categories based on the treatment (pharmacological and/or electrical). The user’s satisfaction mean score exceeded the satisfaction threshold.ConclusionsWebBioBank enabled anonymous data sharing for a clinical study conducted at multiple centres and demonstrated the capabilities of the signal processing chain configuration as well as its effectiveness and efficiency for integrating the neurophysiological results with clinical data in multi-centre studies, which will allow the future collection of homogeneous data in large cohorts of patients.     

绝经后妇女宫内节育器取出方法探讨

目的:探讨绝经后妇女取器的有效方法.方法:将收集绝经后妇女取器100例相关资料分为2组,A组手术前1周每晚阴道给欧维婷软膏0.5g(含雌三醇0.5mg),术前2小时阴道后穹窿置米索前列醇400ug,术中吸入氧化亚氮;B组于术前2小时阴道后穹窿置米索前列醇400ug.结果:A组宫颈软化程度、手术时间及出血与B组比较均有统计学意义(P＜0.05).结论:术前应用欧维婷、米索前醇、术中吸入氧化亚氮,可以提高手术成功率,减轻受术者痛苦.     

Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections

The prevalence of skin and soft tissue infections (SSTIs) has been increasing in the United States. These infections are associated with an increase in hospital admissions. Hospitalists play an increasingly important role in the management of these infections and need to use hospital resources efficiently and effectively. When available, observation units are useful for treating low-risk patients who do not require hospital admission. Imaging tools may help to exclude abscesses and necrotizing soft tissue infections; however, surgical exploration remains the principal means of diagnosing necrotizing soft tissue infections. The most common pathogens that cause SSTIs are streptococci and Staphylococcus aureus. Methicillin-resistant S aureus (MRSA) is a prevalent pathogen, and concerns are increasing regarding the unclear distinctions between community-acquired and hospital-acquired MRSA. Other less frequent pathogens that cause SSTIs include Enterococcus species, Escherichia coli, Klebsiella species, Enterobacter species, and Pseudomonas aeruginosa. Cephalexin and clindamycin are suitable options for infections caused by streptococcal species and methicillin-susceptible S aureus. The increasing resistance of S aureus and Streptococcus pyogenes to erythromycin limits its use in these infections, and better alternatives are available. Parenteral cefazolin, nafcillin, or oxacillin can be used in hospitalized patients with nonpurulent cellulitis caused by streptococci and methicillin-susceptible S aureus. When oral MRSA therapy is indicated, clindamycin, doxycycline, trimethoprim-sulfamethoxazole, or linezolid is appropriate. Vancomycin, linezolid, daptomycin, tigecycline, telavancin, and ceftaroline fosamil are intravenous options that should be used in MRSA infections that require patient hospitalization. In the treatment of patients with SSTIs, hospitalists are at the forefront of providing proper patient care that reduces hospital costs, duration of therapy, and therapeutic failures. This review updates guidelines on the management of SSTIs with a focus on infections caused by S aureus, particularly MRSA, and outlines the role of the hospitalist in the effective management of SSTIs.     

A theoretical framework for the site-specific and frequency-dependent neuronal effects of deep brain stimulation

BackgroundDeep brain stimulation is an established therapy for several neurological disorders; however, its effects on neuronal activity vary across brain regions and depend on stimulation settings. Understanding these variable responses can aid in the development of physiologically-informed stimulation paradigms in existing or prospective indications.ObjectiveProvide experimental and computational insights into the brain-region-specific and frequency-dependent effects of extracellular stimulation on neuronal activity.MethodsIn patients with movement disorders, single-neuron recordings were acquired from the subthalamic nucleus, substantia nigra pars reticulata, ventral intermediate nucleus, or reticular thalamus during microstimulation across various frequencies (1–100 Hz) to assess single-pulse and frequency-response functions. Moreover, a biophysically-realistic computational framework was developed which generated postsynaptic responses under the assumption that electrical stimuli simultaneously activated all convergent presynaptic inputs to stimulation target neurons. The framework took into consideration the relative distributions of excitatory/inhibitory afferent inputs to model site-specific responses, which were in turn embedded within a model of short-term synaptic plasticity to account for stimulation frequency-dependence.ResultsWe demonstrated microstimulation-evoked excitatory neuronal responses in thalamic structures (which have predominantly excitatory inputs) and inhibitory responses in basal ganglia structures (predominantly inhibitory inputs); however, higher stimulation frequencies led to a loss of site-specificity and convergence towards neuronal suppression. The model confirmed that site-specific responses could be simulated by accounting for local neuroanatomical/microcircuit properties, while suppression of neuronal activity during high-frequency stimulation was mediated by short-term synaptic depression.ConclusionsBrain-region-specific and frequency-dependant neuronal responses could be simulated by considering neuroanatomical (local microcircuitry) and neurophysiological (short-term plasticity) properties.     

真武汤合苓桂术甘汤治疗扩张性心肌病24例

扩张性心肌病起病缓慢，主要表现为胸闷气短、心悸、乏力、呼吸困难、腹胀、水肿等。该病可发生在任何年龄，尤其以30-50岁为多见。近年来，我们运用中药治疗扩张性心肌病，取得了较好的疗效，现总结如下。     

真武汤眼科治验举隅

真武汤一方出自<伤寒论>,方由茯苓、芍药、白术、生姜、附子组成,具有温阳利水功效,主治脾肾阳虚、水气内停及太阳病.笔者将此方用于治疗因脾肾阳虚、水气内停所致的目疾,均获良效,现报道如下.     

5471例儿科留观病例分析暨儿科急诊观察室功能评价

目的 评估儿科急诊观察室的功能.方法 回顾性分析2006年1月至12月温州医学院附属第二医院儿科急诊观察室的病历记录和儿内科住院患者的出院诊断.用率的95%置信区间表示疾病在观察室的使用及从观察室转病区的需要.用优势比(odds ratios,OR)及95%置信区间表示某些疾病对观察室利用的优势.结果 观察室床位45张,收住患者5471人次,病区床位348张,收住患者12 881人次,观察室收住患者数足病区的42.5%,平均每床1年收住患者122人,是病区的3倍.观察室出院3879人次(70.9%),转病区住院1592人次(29.1%).观察室患者年龄中位数7岁,≤2岁占65.6%.住院时间中佗数95.7 h.呼吸和消化系统疾患是留住观察窜患者最常见的疾病,分别占患者总数的40.3%和17.5%.观察室利用率高的疾病分别为:喉炎73/75(97.3%);中毒277/285(97.2%);哮喘128/133(%.2%);高热惊厥251/271(92.6%);肠炎伴脱水618/726(85.1%);无热惊厥274/365(75.I%);上呼吸道感染486/624(77.9%).上述疾病对观察窒利用的优势与对病区利用的优势比较:中毒OR 43.2(26.1,71.6),P<0.01;喉炎OR 15.7(8.3,29.7),P<0.01;哮喘OR 10.5(7.0,15.8),P<0.01;高热惊厥OR 8.5(6.5,11.1),P<0.01;无热惊厥OR 2.6(2.2,3.i),P<0.001;上呼吸道感染OR 1.0(0.9,1.1),P=0.591,肠炎伴脱水OR 1.0(0.9,1.1),P=0.919,两者对观察室和病区的利用优势无明显区别.结论 儿科急诊观察室在儿科、尤其婴幼儿患者常见疾病的观察、治疗和住院周转等方面具有容量大、周转快、每床利用率高的特点,并为儿科某些特定疾病的治疗提供了一个新的选择空间.在门急诊容量很大的儿童医院扩建观察室是对医院资源更有效的利用.