高压氧联合糖皮质激素治疗难治性突发性聋疗效观察

目的 观察高压氧(hyperbaric oxygen,HBO)联合糖皮质激素(glucocorticoid,GC)对难治性突发性聋临床疗效.方法 经患者知情同意,并经医院伦理委员会批准,根据患者是否使用GC治疗,将有完整临床资料的79例突发性聋患者分为HBO联合GC治疗组44例,单纯HBO组35例.另外,在我院同期耳鼻喉科收治的复诊就医的突发聋患者中,选取使用GC治疗但未进行HBO治疗患者32例,作为单纯GC组.通过分析治疗有效率、治愈率和听力改善率,对比联合治疗与单纯HBO治疗及单纯GC药物治疗的疗效差异.结果 HBO联合GC组患者的治疗有效率(59.52％)和听力改善率[(61.3±14.7)％]明显高于单纯HBO组[28.13％,(43.6±5.5)％]和单纯GC组[31.25％,(56.4±4.1)％].结论 对难治性突发性聋HBO联合GC较单纯HBO治疗或GC治疗效果更好.     

甲钻胺对64例突发性耳聋患者耳鸣症状的疗效观察

目的观察甲钴胺对改善突发性耳聋患者耳鸣症状的疗效。方法运用前瞻分组对照研究的方法,取发病7d内就诊且伴有耳鸣的突发性耳聋患者64例,按就诊先后顺序分为治疗组及对照组,两组均应用东菱克栓酶（DF-521）、丹参、地塞米松、辅酶A等常规药物治疗,治疗组加用甲钴胺注射液500μg肌注1次／d;对照组加用生理盐水注射液10ml肌注1次／d。10d为1个疗程,治疗2个疗程。疗程结束1个月后观察患耳耳鸣恢复情况。结果治疗组耳呜恢复有效率为52．9％;对照组有效率为26．7％,差异有统计学意义（P＜0．05）。结论甲钴胺对改善突发性耳聋患者的耳鸣症状有明显效果。     

龙胆泻肝汤合高压氧治疗突发性耳聋临床观察

目的探讨龙胆泻肝汤合高压氧治疗突发性耳聋的疗效。方法 110例突发性耳聋患者,随机分为两组,治疗组65例,对照组45例,对照组采用高压氧治疗,治疗组采用龙胆泻肝汤合高压氧治疗,两组均以10 d为1个疗程,共观察2个疗程,每个疗程结束时复查一次电测听和安全性检测。观察两组临床疗效和不良反应。结果治疗组65例（70耳）治疗后治愈19耳,显效27耳,有效21耳,无效3耳,总有效率为95.7%;对照组45例（48耳）治疗后治愈4耳,显效13耳,有效18,无效13耳,总有效率为72.9%,两组比较差异有统计学意义（P〈0.05）,治疗组较对照组疗效好,两组患者治疗后均未出现不良反应。结论龙胆泻肝汤合高压氧治疗突发性耳聋较单用高压氧疗效好,安全性高,值得临床推广。     

Effects of histidine and imidazolelactic acid on various parameters of the oxidative stress in cerebral cortex of young rats

Histidinemia is an inherited metabolic disorder caused by deficiency of histidase activity, which leads to tissue accumulation of histidine and its derivatives. Affected patients usually present with speech delay and mental retardation, although asymptomatic patients have been reported. Considering that the pathophysiology of the neurological dysfunction of histidinemia is not yet understood and since histidine has been considered a pro-oxidant agent, in the present study we investigated the effect of histidine and one of its derivatives, l-beta-imidazolelactic acid, at concentrations ranging from 0.1 to 10 mM, on various parameters of oxidative stress in cerebral cortex of 30-day-old Wistar rats. Chemiluminescence, total radical-trapping antioxidant potential (TRAP), thiobarbituric acid reactive substances (TBA-RS), and the activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) were measured in tissue homogenates in the presence of l-histidine or l-beta-imidazolelactic acid. We observed that l-histidine provoked an increase of chemiluminescence and a reduction of TRAP at concentrations of 2.5 mM and higher, while TBA-RS measurement, GSH-Px, CAT and SOD activities were not affected. Furthermore, l-beta-imidazolelactic acid provoked antioxidant effects at high concentrations (5-10 mM) as observed by the reduction of chemiluminescence, although this compound enhanced chemiluminescence at low concentrations (0.5-1 mM). These results suggest that in vitro oxidative stress is elicited by histidine but only at supraphysiological concentrations.     

The Pathological Evaluation of Autophagy-Related Protein (LC3B) and Its Association with the Infiltration of Immune Cells in Glioma

Background: Tumor cell autophagy can influence cellular immunity by participation in the recognition and modification of tumor-related antigens. Objectives: The objective of this study was to evaluate the immunohistochemical expression of the autophagy-related marker; light chain 3B (LC3B) in tumor cells and the assessment of T lymphocytes by a cluster of differentiation 3 (CD3) in gliomas, and to correlate them with the available clinic-pathological variables in glioma patients. Materials and methods: Immunohistochemical staining for LC3B and CD3 was performed on 60 paraffin-embedded glioma tissue. LC3B immunoreactivity score of 0-6 was designated negative, and those scoring 7-12 were considered positive. The median level of CD3 positive T lymphocytes was calculated for both high and low-grade gliomas. In low-grade gliomas, the CD3 expressing T lymphocytes equal to or more than 2.6, were considered positive while in high-grade gliomas, those equal to or more than 16 were considered positive. Results: LC3B expression in tumor cells was detected in 24/60 (40%) of gliomas. Expression of LC3B was significantly more frequent in high-grade gliomas (23/33, 69.7%) compared to low grade ones (1/27, 5%), (p value= 0.000). LC3B expression was correlated with the patients age (P value= 0.047) & histological variants (P value= 0.000). CD3 positive T lymphocytes were significantly more prominent in high-grade gliomas (25/33 , 41.7%)  than low-grade ones (2/27, 3.3%), (P value= 0.001). A significant association was noted between CD3 expression and the patients age (P value= 0.003), sex (P value: 0.035) and histological variants (P value= 0.001). LC3B expression in tumor cells was significantly correlated with CD3 positive T lymphocytes (P value: 0.000). Conclusion: Autophagic activity of tumor cells and T lymphocyte infiltrates were reported more in high-grade gliomas compared to low-grade ones, giving high-grade gliomas the chance in autophagy target therapy & immunotherapy.     

《中国成年患者营养治疗通路指南》 解 读:外科空肠造口

早期肠内营养对手术患者尤其是上消化道手术患者具有十分重要的意义。 早期外科空肠造口是肠内营养的一种 方式,消化道手术患者可在术中接受置管,术后即可早期进行肠内营养。 可以通过开放式手术包括隧道式空肠造口术(Witzel 空肠造口术)、Roux-en-Y 空肠造口术、穿刺针导管空肠造口术(NCJ)等术式以及开放胃进行空肠造口术和腹腔镜下外科空 肠造口技术实现。 食管切除手术患者,由于肠外营养的并发症较多以及不利于术后消化功能恢复,建议术中空肠造口建立肠 内营养治疗途径给予营养治疗。 同样的,腹部手术患者也可以在术中接受空肠造口置管。 而对于胰十二指肠切除患者,相比 于外科空肠造口,鼻肠管更适用。 对于术前已存在严重营养不良,或术后需要放化疗的患者,可通过空肠造口进行家庭肠内 营养,提高患者生活质量。 本文主要从外科空肠造口技术、适应证等方面介绍目前的最新进展。     

白癜风伴矮小、耳聋、视力下降一例

报道1例白癜风伴矮小、耳聋、视力下降。患者,男,6岁,出生时即出现黄疸,1岁时发现发育延迟,4岁时出现听力减退,5岁时诊断为矮小,同年发生右上臂白斑。全外显子测序发现PTPRQ基因突变。皮肤科检查：右上臂屈侧多片色素减退斑。诊断：白癜风合并矮小、耳聋、视力下降。     

Auditory cortical stimulability in non habilitated individuals – An evidence from CAEPs

ObjectiveThe effect of long term auditory deprivation on Cortical Auditory Evoked Potentials (CAEPs) especially in human models is not well explored. Hence, the current study was aimed to investigate the effects of long-term auditory deprivation and stimulability of auditory cortex in non habilitated congenitally deaf adolescents and adults using CAEPs.Methods and ResultsA total of 27 non-habilitated congenitally deaf adolescents/adults with age and gender matched normal hearing adolescents/adults participated in the study. The congenitally deaf group was fitted with high gain hearing aids (first fit). Further, the CAEPs were recorded. The obtained CAEP components were assessed for group effect, source and topographical differences. The between group analysis for CAEP responses showed a significant difference only for P2 latency and amplitude. The source analysis revealed that, in the normal hearing group for CAEPs, the sources were within the temporal regions. However, in the congenitally deaf group, along with the temporal cortex, the bilateral prefrontal cortex also was activated.ConclusionThe findings revealed that it is possible to stimulate and evoke a matured CAEP response from a long deprived auditory system with adequate acoustic stimulation. The presence of CAEP responses is indicative of the functionality of the innate auditory pathway and the crossmodal plasticity in long auditory deprived individuals.     

辨证施护辅助治疗儿童突发性耳聋的效果观察

〔摘 要〕 目的：观察中医辨证施护辅助药物治疗对突发性耳聋患儿治疗依从性及临床效果的影响。方法：选取南 阳市中心医院 2018 年 3 月至 2020 年 10 月期间收治的 68 例突发性耳聋患儿,随机分为对照组和观察组,各 34 例。 对照组采用前列地尔静滴＋甲钴胺口服＋基础护理,观察组在对照组基础上给予苇管灸、鸣天鼓、耳穴压豆、鼓膜按 摩及生活、饮食、情志中医证候施护。比较干预前后两组患儿纯音听阀值及受损频率听阈值改善情况、临床疗效及患 儿治疗依从性。结果：经药物治疗和辨证施护 14 d 后,观察组患儿的治疗总有效率为 94.12 %,高于对照组的 70.59 %, 差异有统计学意义（P ＜ 0.05）。干预后观察组患儿的纯音听阀值和受损频率听阈值均低于对照组,差异具有统计学 意义（P ＜ 0.05）。观察组患儿的治疗依从性为 97.06 %,明显高于对照组的 76.47 %,差异具有统计学意义（P ＜ 0.05）。 结论：中医辨证施护辅助药物治疗能有效提高突发性耳聋患儿治疗依从性,提升疗效,促进听力恢复。