慢性阻塞性肺疾病合并侵袭性肺曲霉菌病的临床分析

目的探析慢性阻塞性肺疾病合并侵袭性肺曲霉菌病患者的临床特点。方法对医院2018年2月—2019年12月间收治的慢性阻塞性肺疾病合并侵袭性肺曲霉菌病患者24例相关临床数据进行回顾性分析,归纳此类患者的临床特点,以期为以后收治此类患者在诊疗上提供可参考数据。结果慢性阻塞性肺疾病合并侵袭性肺曲霉菌病患者典型临床症状为肺部罗音、呼吸障碍、胸痛、咳嗽咳痰、发热。影像学检查后典型表现为肺部炎性渗出、空洞、结节、实变。经过积极治疗后有8例患者判定为治疗有效。结论收治慢性阻塞性肺疾病合并侵袭性肺曲霉菌病患者应该做到早期阶段准确诊断,积极治疗,是保障预后的重点。     

“保胆”理念正误

胆囊切除术是公认的胆囊良性疾病的治愈手段，国内外学术界对于手术适应证和手术时机已有明确共识。近年来，“保胆手术”治疗胆囊良性疾病颇受热议，一些医生将“保护胆囊”的学术观点等同于“保留胆囊”的手术技术，这种误解可能导致病人出现差异性的预后。因此，临床医师应明晰“保护胆囊”理念与“保胆手术”的差别，对胆囊良性疾病的诊疗原则有正确的理解和应用。     

Risk of seizures and subclinical epileptiform activity in patients with dementia: A systematic review and meta-analysis

BackgroundSeizures and subclinical epileptiform activity are common yet easily overlooked among demented patients. We aimed to investigate their epidemiological characteristics in patients with dementia from various aspects.MethodsWe retrieved relevant observational studies from PubMed and Embase Library until March 2021. Pooled estimate effects were calculated using random-effects models. This study is registered with PROSPERO, number CRD42020200949.ResultsOf the 19144 identified studies, 27 were eligible for inclusion. The pooled period prevalence rates of seizures were 4.86% (95%CI: 3.43–6.51%), 2.68% (95%CI: 2.13–3.28%), 2.81% (95%CI: 2.02–3.71%）and 7.13% (95%CI: 2.67–13.14%) among patients with Alzheimer’s disease (AD), Dementia of Lewy Body (DLB), Frontotemporal dementia (FTD) and Vascular dementia (VaD), respectively. The pooled incidence rate of seizures was [8.4 (95%CI: 4.2–12.7) per 1000 person-years] in AD patients. And the pooled relative risk of seizures in patients with AD was 3.35 (95%CI: 2.69–4.19). Besides, the pooled cumulative incidence rate and prevalence rate of subclinical epileptiform activity among AD patients were [21.41% (95%CI: 0.001–63.60%)] and 9.73% (95%CI: 0.26–28.38%), respectively.ConclusionsThe accurate rates of seizures and subclinical epileptiform activities in the four major dementia types are high. Besides, patients with AD are likely at a higher risk of seizures.     

刍议清络法论治特发性肺纤维化急性发作＊

本文通过对特发性肺纤维化急性发作病因病机的分析，认为其病因为外邪或内伤引动肺络虚火，从阳化热，病机为“肺热”、“络瘀”；并结合其病因病机，探究归纳《温病条辨》中清络法和中药复方清络饮在论治特发性肺纤维化急性发作时的理论基础，为临床中论治特发性肺纤维化急性发作，改善患者症状提供新方法，为肺络病证治体系构建及应用提供新思路。     

约束隐结构研究冠心病痰湿证的定量化辨证规则＊

目前在中医界已发布的冠心病痰湿证辨证标准是以主症、次症形式定性地给出，存在主观性较强的问题。本文引入约束隐结构分析，该方法将主症、次症的语义作为约束条件加入隐结构分析过程，得到含有主症、次症语义约束的定量化中医证候辨证规则。使用该方法对冠心病痰湿证患者556条无标签数据的分析，得到其约束隐结构模型，最后建立定量化痰湿证辨证规则，舌胖边有齿痕（3.16）、苔腻（3.12）、苔白滑（4.72）、胸闷（1.73）、脉濡或滑（6.04）；次症：肢体困重（0.48）、口黏（0.63）、体胖（0.49）、大便粘滞（1.38）、脘腹痞满（0.97）、面色晦浊（0.79）、嗜睡（1.18）、纳差（1.07）。与经典隐结构模型得到规则和中医界已发布的定性化辨证规则相比，约束隐结构得到的规则客观性强，具有可重复性。在证候类大小、规则的量化合理度上较好地反映了主症、次症的特点，得到的规则切合中医实际，为冠心病痰湿证辨证标准的定量化研究提供帮助和参考。     

Motor dysfunction in mild cognitive impairment as tested by kinematic analysis and transcranial magnetic stimulation

ObjectivePrevious studies have demonstrated voluntary movement alterations as well as motor cortex excitability and plasticity changes in patients with mild cognitive impairment (MCI). To investigate the pathophysiology of movement abnormalities in MCI, we tested possible relationships between movement abnormalities and primary motor cortex alterations in patients.MethodsFourteen amnestic MCI (aMCI) patients and 16 healthy controls were studied. Cognitive assessment was performed using clinical scales. Finger tapping was recorded by a motion analysis system. Transcranial magnetic stimulation was used to test the input/output curve of motor evoked potentials, intracortical inhibition, and short-latency afferent inhibition. Primary motor cortex plasticity was probed by theta burst stimulation. We investigated correlations between movement abnormalities, clinical scores, and cortical neurophysiological parameters.ResultsMCI patients showed less rhythmic movement but no other movement abnormalities. Cortical excitability measures were normal in patients, whereas plasticity was reduced. Movement rhythm abnormalities correlated with frontal dysfunction scores.ConclusionOur study in MCI patients demonstrated abnormal voluntary movement and plasticity changes, with no correlation between the two. Altered rhythm correlated with frontal dysfunction.SignificanceOur results contribute to the understanding of pathophysiological mechanisms of motor impairment in MCI.