儿童急性肾盂肾炎临床及预后分析

目的分析儿童急性肾盂肾炎的临床特点及预后转归。方法选择2009年1月-2010年12月在温州医学院附属第二医院育英儿童医院。肾内科诊断为急性肾盂肾炎的患儿共230例,分析其临床特征、病原学、细菌耐药情况及预后,并采用Logistic回归分析儿童急性肾盂肾炎后肾疤痕形成的危险凶素。结果230例急性肾盂肾炎患儿中,男性93例,女性137例,男女比1：1．47,其中〈1岁99例,男女比为1．30：1;1～5岁75例,男女比为1：2．75;〉5岁56例,男女比为1：2．29。在230例APN患儿中,共检出病原菌106株,其中革兰阴性菌91株,革兰阳性菌13株,真菌2株;居前3位病原菌分别为大肠埃希菌65株（61．32％）,肺炎克雷伯杆菌13株（12．6％）和屎肠球菌9株（8．49％）。65株大肠埃希菌产ESBLs有44株,均对氨苄西林耐药,对头孢菌素及复方磺胺甲嗯唑、氨曲南等中等耐药,而对阿米卡星、阿莫西林／克拉维酸、呋喃妥因、亚胺培南等敏感。52例患儿于出院后6—12月进行双肾发射单光子计算机断层（ECT）复查,其中31例有肾疤痕形成（59．62％）,21例好转（40．38％）。泌尿系统畸彤或膀胱输尿管返流是儿童急性肾盂肾炎肾疤痕形成的独立危险因素（OR值6．89,P〈0．05）。结论儿童急性肾盂肾炎的发病率随年龄的增加而逐渐下降,≤1岁以男性患儿为主,而〉1岁则好发于女性。大肠埃希菌仍是主要的致病菌,且存在着多重耐药。伴有泌尿系统畸形或膀胱输尿管返流的急性肾盂肾炎患儿更易有肾疤痕形成。     

阴道镜检查2280例临床分析

目的：探讨阴道镜在诊断宫颈病变方面的作用。方法：采用深圳金科威实业有限公司生产的SLC-2000B系列电子阴道镜数字成像系统,对2280例宫颈疾患女性检查并以改良Reid评分,其中有1886例同时接受病理检查。结果：病理确诊宫颈不典型增生（CINⅠ-Ⅲ）161例,其中CINⅠ～Ⅱ级156例（占6．84％）;CINⅢ级5例（占0．22％）;宫颈原位癌3例（占0．13％）。与阴道镜检查结果对照,3例原位癌在镜下诊断癌疑,161例CIN的改良评分为1～5分。结论：阴道镜检查对早期发现宫颈癌以及癌前病变有重要价值。     

宫颈环形电切术诊治宫颈病变187例临床分析

目的：探讨宫颈环形电切术（LEEP）在宫颈病变（各种慢性宫颈炎、宫颈上皮内瘤变）诊治中的临床应用价值。方法：对妇科检查、细胞学及阴道镜下活检诊断为各种宫颈病变187例,采用环形电刀行宫颈环切术。结果：LEEP治疗宫颈疾病的成功率为100％,平均手术时间为5min,出血量10ml,无继发性出血及感染发生,手术标本病理诊断,其与阴道镜下宫颈活检病理诊断符合率为96％。结论：LEEP治疗宫颈病变安全有效、并发症少、复发率低,值得临床推广使用。     

Clinical features and prognostic factors for patients with bone metastases from prostate cancer

To identify the clinical features and independent predictors of survival in patients with bone metastases from prostate cancer (PCa). We retrospectively analysed 115 PCa patients with bone metastases between 1997 and 2009. The overall survival rate after bone metastases was calculated using the Kaplan–Meier method. The prognostic factors were identified by univariate analysis using a log-rank test and by multivariate analysis using Cox proportional hazards regression models. The follow-up rate was 100%, the follow-up cases during 1, 3 and 5 years were 103, 79 and 55, respectively. The 1-, 3- and 5-year survival rates were 89.1%, 60.9% and 49.8%, respectively, with a median survival time of 48.5 months for patients with bone metastases from PCa. In univariate analysis, age, Gleason score, clinical stage, the number of bone lesions, alkaline phosphatase (ALP) level, invasion of neighbouring organs and non-regional lymph node metastases were correlated with prognosis. By multivariate analysis using Cox regression, ALP level, Gleason score and non-regional lymph node metastases were independent prognostic factors. These prognostic factors will help us to determine the appropriate dose and fraction of radiotherapy for these patients.     

扶正泄浊保肾汤对CRF大鼠血浆ET-1、Scr、BUN及肾组织病理的影响

目的：观察扶正泄浊保肾汤对慢性肾衰竭（CRF）大鼠血浆内皮素-1（ET-1）、血肌酐（Scr）、尿素氮（BUN）及肾组织病理的影响,探讨其作用机制.方法：采用5/6肾切除的方法制造CRF模型.将60只雄性SD大鼠随机分为6组：假手术组、模型组、尿毒清组及扶正泄浊保肾汤大、中、小剂量组;分别按一定比例予大、中、小剂量组大鼠灌胃,假手术组及模型组同时间予等体积的生理盐水灌胃.所得数据均采用（±s）表示,组间比较用t检验,采用SPSS 18.0进行统计学处理.结果：各治疗组与模型组间比较,血浆ET-1及Scr、BUN水平显著下降,差异有统计学意义（P＜0.05）,且肾脏病理改变较轻;大、中剂量组与小剂量、尿毒清组间差异有统计学意义（P＜0.05）;大、中剂量组间差异无统计学意义（P＞0.05）;小剂量组与尿毒清组间差异无统计学意义（P＞0.05）.结论：扶正泄浊保肾汤具有降低大鼠血清ET-1、Scr、BUN水平,减轻肾脏病理表现的作用.     

Ventricular Arrhythmia Factors in Mitral Valve Prolapse

To assess tbe prevalence of ventricular arrhythmias and late potentials (LPs) in mitral valve prolapse (MVP) and to identify clinical, ECG, and echocardiographic markers of spontaneous ventricular arrhythmias, we studied 58 consecutive patients (mean age 46.6 ± 17.8 years; 29 males, 29 females) with MVP diagnosed by echocardiography. Patients underwent ambulatory ECG recording (n = 58), exercise stress test (n = 56), signal-averaged ECG (n = 58), and programmed ventricular stimulation (n = 52). Ten patients (17.2%) had spontaneous nonsustained ventricular tachycardia (NSVT), 26 patients (44.8%) had premature ventricular contractions (PVGs), Lown grade ≥ 3 during 24-hour EGG, and 19 had Lown grade ≥ 3 PVCs during exercise stress test; 13 patients had LPs (22.4%). We provoked sustained VT in one case and NSVT in ten cases. Patients with complex ventricular arrhythmias during 24-hour EGG and exercise stress test were older and more often had mitral regurgitation. There was a statistical correlation between the presence of LPs and spontaneous VT (46.1 % vs 8.9%; P < 0.005) and induced ventricular arrhythmias (50% vs 12.8%; P < 0.005). No correlation was found between spontaneous ventricular arrhythmias and thickness or posterior displacement of the mitral valve. In conclusion, complex ventricular arrhythmia (especially VT) and LPs are frequent in MVP. Patient age and mitral regurgitation seem to be determinant factors of complex ventricular arrhythmias in MVP. On signal-averaged EGG, absence of LPs seems to be a good additional marker to identify MVP patients without spontaneous VT. On the other hand, programmed ventricular stimulation does not appear valuable in determining a MVP subgroup with a high risk of ventricular arrhythmias.     

狼疮性肾炎肾活检病理与临床对照分析

目的探讨狼疮性肾炎(LN)不同病理类型与临床表现特点的关系。方法采用肾穿刺活检、免疫荧光、组织化学以及临床检验(尿检,SCr,ANA,dsDNA,C3)等方法对75例LN病人临床与病理改变进行对照分析和观察。结果 75例LN中,急性肾炎综合征(AG)占48例(64%),Ⅲ型LN占26例(34.67%),二者为LN最多见的临床和病理类型;Ⅳ型LN各项临床检测指标异常(尿改变、ds-DNA阳性以及补体C3降低等)明显高于其他类型LN。结论 AG和Ⅲ型LN分别为发病率最高的临床和病理类型;Ⅳ型LN的临床检查指标异常提示,LN免疫机制异常与病变程度关系密切。     

肺郎格汉斯细胞组织细胞增生症的临床、X线、CT表现(2例报告并文献复习)

目的探讨肺郎格汉斯细胞组织细胞增生症(PLCH)的临床、X线及CT表现,以提高对该病的影像学认识。方法回顾性分析2例病理证实的PLCH患者的临床、X线和CT资料。2例患者均行胸部螺旋CT、高分辨CT(HRCT)扫描及X线胸部平片摄影,1例行头颅CT扫描。结果 2例患者CT及HRCT均为双中上肺野广泛分布的高密度小结节状影、纤维条索影及囊状和蜂窝状影。1例头颅CT示右枕骨局限性骨质破坏;胸部平片示双肺野透光度减低,双肺纹理模糊;另1例胸部平片示双肺纹理紊乱,右肺中野可见多个小囊状低密度区;纵隔影明显增宽。结论 PLCH的X线、CT及HRCT表现有一定的特征性,尤其是HRCT显示病变更加清晰,结合临床资料可提高对此病的诊断,确诊仍需病理学诊断。     

When should we test for voltage-gated potassium channel complex antibodies? A retrospective case control study

Patients with voltage-gated potassium channel (VGKC)-complex antibodies are increasingly recognized as having central, peripheral or combined phenotypes. With increasing awareness, more patients are tested and the clinical spectrum is expanding. Consequently, clinicians may be uncertain as to which patients should or should not be tested. Previous studies have identified common clinical features, but none has looked at the usefulness of these in predicting seropositive disease. We conducted a case-control study of patients tested for VGKC-complex antibodies over 10 years at a regional tertiary neurology centre determining which clinical/biochemical features were associated with antibody-positive disease. We found a marked increase in the numbers tested, although the percentage positive remained low. Antibody titre was highest in central disease (p < 0.001). Time from presentation to testing was shorter in those with VGKC-disease (p = 0.01). Seizures were present in 11 (69%) of those with VGKC-disease versus three (18%) without (odds ratio [OR] 10.3, 95% confidence interval [CI]: 2.0–52.7, p = 0.005). There was an inverse correlation between the antibody titre and serum sodium. A multivariate model selected seizures and hyponatraemia as predictive of VGKC disease (sensitivity 75% and specificity 82%); faciobrachial dystonic movements were specific but insensitive. Interestingly serum alkaline phosphatase was higher in those with VGKC-disease (p = 0.016) and highest in those with peripheral disease (p = 0.015). An ALP > 70 u/L was strongly associated with antibody positivity (OR 4.11 95% CI: 1.43–11.8, p = 0.007) with a sensitivity of 74.2%. The presence of seizures, faciobrachial movements, and hyponatraemia should raise suspicion of VGKC-disease; alkaline phosphatase may represent a novel biomarker, particularly in those with peripheral disease.     

精神分裂症患者语音信号的临床分析

背景：语音参数是精神分裂症生物学指标研究的一个全新领域,其中一些已被证明与情感反应相关,情感反应是精神分裂症患者显著受限制的一个特点,特别是对那些具有突出阴性症状的患者。
　　目标：评估慢性精神分裂症患者的选择性语音参数与临床症状严重程度之间的关系,并比较患者与所匹配的健康对照者的这些特征。
　　方法：对26例住院慢性精神分裂症患者（入组时和一周后）和30名健康对照者（仅在入组时）通过电话采集的15分钟语音样本,对该样本进行10项语音测量参数的评估,包括6个语音韵律参数、共振峰带宽和振幅、以及2个频谱特征。采用阳性与阴性症状量表(Posiitve and Negaitve Syndrome Scale)、阴性症状评估量表(Scale for the Assessment of Negaitve Symptoms)、临床总体印象量表-精神分裂症分量表(the Clinical Global Impression-Schizophrenia scale)分别在基线和1周后进行患者临床特征的评估。
　　结果：患者组症状在1周的时间间隔中保持稳定,并且10项语音参数的前后一周重测信度良好（内部相关系数[intraclass correlation coefficient, ICC]介于0.55到0.88之间）。语音参数中6项韵律参数、共振峰带宽和振幅参数在患者组和对照组之间没有显著差异,但2项光谱参数在组间有差异：患者组美尔频率倒谱系数(the Mel-frequency cepstral coefficient, MFCC)评分显著低于对照组,并且患者组的线性预测系数(linear prediction coding, LPC)评分显著高于对照组。在患者组中,在10个本研究所考虑的语音参数和17个所考虑的临床参数之间构成的170个相关性中,有10个达到了p<0.05的统计学显着性水平（相关系数>0.40)。结论：这项研究支持了语音参数具有作为精神分裂症阴性症状严重程度指标（即,生物指标）的潜在价值,但在这些语音参数的潜在效用获充分评估前,我们需要对更多样化的患者进行更大样本量、更详细的随访研究。