慢性难治性原发性免疫性血小板减少症治疗进展

原发性免疫性血小板减少症(Primary immune thrombocytopenia,ITP)原称特发性血小板减少性紫癜(Idiopathic thrombocytopenic purpura,ITP),是一种自身免疫性疾病,是由于机体免疫系统功能紊乱引起血小板破坏增多致其数目减少引起的出血性疾病,临床表现为皮肤黏膜瘀点、瘀斑,尿血,严重者可引起内脏和颅内出血危及生命,骨髓象表现为巨核细胞发育、成熟障碍。儿童急性ITP大多预后良好,75%~82%急性ITP 6个月内可获得缓解,持续6个月以上的ITP中超过1/4在     

前部缺血性视神经病变的不典型荧光素眼底血管造影表现

目的探讨前部缺血性视神经病变(AION)患者的非典型荧光素眼底血管造影(FFA)表现。方法回顾性分析45例(52只眼)经临床确诊为AION患者的临床检查过程,比较分析其不典型的FFA表现等。结果45例(52只眼)呈典型AION表现者23例(25只眼),不典型表现者22例(27只眼)。不典型AION患者FFA表现为造影早中晚期均呈视乳头持续弱荧光等不典型表现。结论前部缺血性视神经病变有多种FFA表现。     

不同角膜屈光手术对基底膜下神经的影响

目的：观察角膜屈光不同术式后基底膜下神经恢复情况。
　　方法：角膜激光共焦显微镜观察术后1 mo 的 LASEK 12眼、LASIK 12眼、FLEx 12眼、SMILE 12眼,并对部分其它术后时段进行了对比观察。
　　结果：术后1 mo SMILE组基底膜下神经均未见明显破坏,走行规律,完整,切口处被切断神经对合良好;LASEK, LASIK和FLEx基底膜下神经仍现不同程度损害,其它时段眼显示随着时间推移,逐渐形成交通支。
　　结论：SMILE手术对基底膜下神经影响小,相对于其他几种角膜屈光手术,在术后神经恢复方面可能有一定优势。     

208例药品不良反应报告分析

摘 要 目的:分析药品不良反应（ADR）的发生情况、发生特点及相关因素,为临床合理用药提供参考。方法：对2013年收集并上报的208例ADR,分别从性别与年龄、给药途径、因果关系评价、报告人职业分布、涉及的药品种类、累及的器官或系统及临床表现等方面进行统计、分析。结果：208例ADR报告中,40岁以上的中老年患者所占比例最大,占76.92%;女患者构成比略高,占51.44%;静脉滴注引起ADR为144例（69.23％）;涉及的药品中,抗肿瘤药物、抗感染药物、心血管系统用药致ADR构成比高;ADR临床主要表现为皮肤及其附件损害（55例）、全身性损害（50例）、血小板和出血凝血障碍（46例）。结论：抗肿瘤药物、抗感染药物、心血管系统用药是ADR监测的重点药物,医药护要共同努力,加强特殊人群和重点药物的ADR监测,提高合理用药水平,减少药源性疾病的发生。     

西安某高校研究生夜磨牙症现状调查

目的了解高校研究生夜磨牙症的发生情况及相关影响因素。方法选取西安交通大学2014年参加体检的1 944名研究生进行问卷调查和口腔检查,对检查结果进行统计学分析。结果高校研究生夜磨牙症发病率为14.0%;男生发病率为13.9%,女生发病率为14.2%,女生略高于男生,但差异无统计学意义。41.0%的被调查者称有室友患夜磨牙症,其中73.7%的人认为会影响晚上休息。熬夜、精神紧张、父母磨牙、颞颌关节紊乱为夜磨牙症的危险因素(P0.01)。结论高校研究生夜磨牙症发生率较高,对自身健康和同住人员均有影响,但就诊率较低。故学校应加强健康教育,预防和减少学生人群夜磨牙症的发生。     

Sturge–Weber Syndrome Is Associated with Cortical Dysplasia ILAE Type IIIc and Excessive Hypertrophic Pyramidal Neurons in Brain Resections for Intractable Epilepsy

Sturge–Weber syndrome (SWS) is a rare syndrome characterized by capillary‐venous malformations involving skin and brain. Many patients with SWS also suffer from drug‐resistant epilepsy. We retrospectively studied a series of six SWS patients with epilepsy and extensive neurosurgical resections. At time of surgery, the patients' age ranged from 11 to 35 years (with a mean of 20.2 years). All surgical specimens were well preserved, which allowed a systematic microscopical inspection utilizing the 2011 ILAE classification for focal cortical dysplasia (FCD). Neuropathology revealed dysmorphic‐like neurons with hypertrophic cell bodies reminiscent to those described for FCD type IIa in all cases. However, gross architectural abnormalities of neocortical layering typical for FCD type IIa were missing, and we propose to classify this pattern as FCD ILAE type IIIc. In addition, our patients with earliest seizure onset also showed polymicrogyria (PMG; n = 4). The ictal onset zones were identified in all patients by subdural electrodes, and these areas always showed histopathological evidence for FCD type IIIc. Four out of five patients had favorable seizure control after surgery with a mean follow‐up period of 1.7 years. We concluded from our study that FCD type IIIc and PMG are frequently associated findings in SWS. FCD type IIIc may play a major epileptogenic role in SWS and complete resection of the associated FCD should be considered a prognostic key factor to achieve seizure control.     

Trans‐sodium crocetinate provides neuroprotection against cerebral ischemia and reperfusion in obese mice

Trans‐sodium crocetinate (TSC) is a novel synthetic carotenoid compound that improves diffusion of small molecules, including oxygen, in solutions. TSC provides neuroprotection in healthy rats and rabbits. This study seeks to determine whether TSC is neuroprotective in obese mice. Sixteen‐week‐old CD‐1 male mice that had been fed a high‐fat diet for 10 weeks were subjected to a 90‐min middle cerebral arterial occlusion (MCAO). They received TSC by two boluses through a tail vein 10 min after the onset of MCAO and reperfusion, respectively, with doses of 0.14, 0.28, and 0.7 mg/kg or by a bolus–infusion–bolus strategy with a dose of 0.14 mg/kg during MCAO. The neurological outcome was evaluated 72 hr after MCAO. Brain tissues were harvested 24 hr after MCAO to measure nitrotyrosine‐containing proteins, 4‐hydroxy‐2‐nonenal, matrix metalloproteinase (MMP)‐2 and ‐9 activity and expression, and inflammatory cytokines. TSC given in the two‐bolus strategy did not improve the neurological outcome. The bolus–infusion–bolus strategy significantly reduced brain edema, infarct volume, and hemorrhagic transformation and improved neurological functions. TSC reduced nitrotyrosine‐containing proteins, MMP‐9 activity and expression, and inflammatory cytokines in ischemic brain tissues. Our results indicate that TSC delivered by the bolus–infusion–bolus strategy provides neuroprotection in obese mice. This protection may occur through reduction of oxidative stress, MMP‐9 activity, or inflammatory cytokines in the ischemic brain tissues. © 2014 Wiley Periodicals, Inc.     

A fatal case of accidental oral formaldehyde poisoning and its pathomorphological characteristics

International Journal of Legal Medicine - Formaldehyde is a colourless irritating gas at room temperature, which, therefore, is usually stored in liquid form. This compound is often used as an...     

校园网络环境下的病理生理学自主学习模式研究

目的探讨校园网络环境下的病理生理学自主学习模式。方法随机选取学院2012级临床医学6-7班、10-11班分别为对照组(传统教学模式)和教改组。教改组实施以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式,对学生考核成绩进行对比分析和问卷调查。结果教改组学生成绩高于对照组,学生的自主学习能力明显提高(P<0.05)。结论以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式可以实现以学助教,有利于学生的终身发展。     

Gastric metaplasia of the duodenum: in vivo diagnosis by endomicroscopy and its relationship with functional dyspepsia

Background and Aim: Gastric metaplasia (GM) of the duodenum is difficult to assess because of its patchy distribution, and the role of GM in functional dyspepsia (FD) is not clear. The aims of this study were to determine if endomicroscopy could identify GM of the duodenum and whether GM has associations with FD. Methods: A series of 51 patients with FD and 25 asymptomatic controls were enrolled. Confocal laser endomicroscopy was performed to evaluate villi changes in vivo. Targeted biopsy specimens were then compared with histopathological results. Results: The accuracy of the endomicroscopy diagnosis of GM during endoscopy was 92.8%, and the sensitivity, specificity, and positive and negative predictive values were 86.2%, 97.4%, 89.3%, and 96.6%, respectively. The mean κ‐value for interobserver agreement was 0.89. GM in the duodenal bulb was more frequent in patients with FD than in the controls (33.3% vs 12%, P < 0.05), especially in patients with epigastric pain syndrome (47.6% vs 12%, P < 0.01). Conclusions: Endomicroscopy is useful for identifying GM, and GM might be related to FD. These findings could have potential applicability for duodenal screening, and suggest a possible targeting therapy in FD.