伏九贴敷治疗儿童反复咳喘100例临床观察

目的：观察“伏九贴敷”治疗儿童反复咳喘的临床疗效。方法：采用随机对照的方法，将200例反复咳喘患几分成观察组（贴敷组）和对照组（非贴敷组）各100例。观察组给予伏九贴敷治疗，2年为1个疗程。结果：“伏九贴敷”在平喘及消除肺部哮鸣音等方面，显效84例，有效13例，无效3例，总有效率97％，两组有显著性意义。结论：“伏九贴敷”用于治疗咳喘疗效确切，值得临床进一步推广。     

From the Cover: A Middle Eocene lowland humid subtropical “Shangri-La” ecosystem in central Tibet

Tibet’s ancient topography and its role in climatic and biotic evolution remain speculative due to a paucity of quantitative surface-height measurements through time and space, and sparse fossil records. However, newly discovered fossils from a present elevation of ∼4,850 m in central Tibet improve substantially our knowledge of the ancient Tibetan environment. The 70 plant fossil taxa so far recovered include the first occurrences of several modern Asian lineages and represent a Middle Eocene (∼47 Mya) humid subtropical ecosystem. The fossils not only record the diverse composition of the ancient Tibetan biota, but also allow us to constrain the Middle Eocene land surface height in central Tibet to ∼1,500 ± 900 m, and quantify the prevailing thermal and hydrological regime. This “Shangri-La”–like ecosystem experienced monsoon seasonality with a mean annual temperature of ∼19 °C, and frosts were rare. It contained few Gondwanan taxa, yet was compositionally similar to contemporaneous floras in both North America and Europe. Our discovery quantifies a key part of Tibetan Paleogene topography and climate, and highlights the importance of Tibet in regard to the origin of modern Asian plant species and the evolution of global biodiversity.

The Tibetan Plateau, once thought of as entirely the product of the India–Eurasia collision, is known to have had significant complex relief before the arrival of India early in the Paleogene (1–3). This large region, spanning ∼2.5 million km², is an amalgam of tectonic terranes that impacted Asia long before India’s arrival (4, 5), with each accretion contributing orographic heterogeneity that likely impacted climate in complex ways. During the Paleogene, the Tibetan landscape comprised a high (>4 km) Gangdese mountain range along the southern margin of the Lhasa terrane (2), against which the Himalaya would later rise (6), and a Tanghula upland on the more northerly Qiangtang terrane (7). Separating the Lhasa and Qiangtang blocks is the east–west trending Banggong-Nujiang Suture (BNS), which today hosts several sedimentary basins (e.g., Bangor, Nyima, and Lunpola) where >4 km of Cenozoic sediments have accumulated (8). Although these sediments record the climatic and biotic evolution of central Tibet, their remoteness means fossil collections have been hitherto limited. Recently, we discovered a highly diverse fossil assemblage in the Bangor Basin. These fossils characterize a luxuriant seasonally wet and warm Shangri-La forest that once occupied a deep central Tibetan valley along the BNS, and provide a unique opportunity for understanding the evolutionary history of Asian biodiversity, as well as for quantifying the paleoenvironment of central Tibet.^*Details of the topographic evolution of Tibet are still unclear despite decades of investigation (4, 5). Isotopic compositions of carbonates recovered from sediments in some parts of central Tibet have been interpreted in terms of high (>4 km) Paleogene elevations and aridity (9, 10), but those same successions have yielded isolated mammal (11), fish (12), plant (13–18), and biomarker remains (19) more indicative of a low (≤3-km) humid environment, but how low is poorly quantified. Given the complex assembly of Tibet, it is difficult to explain how a plateau might have formed so early and then remained as a surface of low relief during subsequent compression from India (20). Recent evidence from a climate model-mediated interpretation of palm fossils constrains the BNS elevation to below 2.3 km in the Late Paleogene (16), but more precise paleoelevation estimates are required. Further fossil discoveries, especially from earlier in the BNS sedimentary records, would document better the evolution of the Tibetan biota, as well as informing our understanding of the elevation and climate in an area that now occupies the center of the Tibetan Plateau.Our work shows that the BNS hosted a diverse subtropical ecosystem at ∼47 Ma, and this means the area must have been both low and humid. The diversity of the fossil flora allows us to 1) document floristic links to other parts of the Northern Hemisphere, 2) characterize the prevailing paleoclimate, and 3) quantify the elevation at which the vegetation grew. We propose that the “high and dry” central Tibet inferred from some isotope paleoaltimetry (9, 10) reflects a “phantom” elevated paleosurface (20) because fractionation over the bounding mountains allowed only isotopically light moist air to enter the valley, giving a false indication of a high elevation (21).     

Allergy Considerations in Implanted Neuromodulation Devices

ObjectivesAllergic reactions are rare and poorly understood complications of neuromodulation device implantation. There are currently no guidelines for management of allergic reactions to these devices and their components. Here we review the published cases of allergic reactions to implanted neuromodulatory devices and leverage the experiences of other specialties that deal with similar complications to formulate recommendations for prevention and management.Materials and MethodsA review and assessment of the literature.ResultsAllergic reactions to a number of implantable devices have been observed and published. In dentistry and orthopedics, metals such as nickel are the most frequent cause of allergic reactions. In interventional cardiology, where devices closely resemble neuromodulatory devices, titanium, silicone, and polyurethanes are the most common causes of allergic reactions. In neurosurgery, allergic reactions to implantable neuromodulatory devices are rare, and we summarize 13 cases published to date. Such allergic reactions generally present as local dermatitis, erythema, and pruritus, which can be difficult to distinguish from surgical site infection. In one published case, symptoms resolved with corticosteroid treatment, but all other cases required explantation. The successful reimplantation with a modified device was reported in some cases.ConclusionsPatients should be screened for a personal history of contact allergy before implantation procedures. A multidisciplinary approach to suspected cases of postoperative allergic reactions involving collaboration between neurosurgeons and other implanting physicians, dermatologists or allergists, and device manufacturers is recommended. In cases where an allergic reaction is suspected, an infectious etiology should be ruled out first. Clinical suspicion can then be supported with the use of patch testing, interpreted by an experienced dermatologist or allergist. If patch testing supports an allergic etiology, the implanting physician and the device manufacturer can work together to modify the device for safe reimplantation.     

探究不同评分系统评价急诊科危重症预后的应用对比

[目的]探究不同种类评分系统评价急诊科危重症预后的应用效果对比。[方法]将我院收治的184例急诊科危重症病人作为研究对象,采用不同的评分系统评价,分别是简单临床评分量表(SCS)、快速急诊内科评分量表(REMS)及急性生理与慢性健康状况评分Ⅱ量表(APACHEⅡ),对比三种评分系统标准与病人的死亡率情况、三种评分标准与病人的预后情况。[结果]在SCS评分中,>11分及6~11分病人死亡率明显高于0~5分病人死亡率,6~11分病人死亡率明显高于0~5分病人死亡率,差异具有统计学意义(P<0.05)。在REMS评分中,>16分及12~16分病人死亡率明显高于<11分病人死亡率,12~16分病人死亡率明显高于<11分病人死亡率,差异具有统计学意义(P<0.05)。在REMS评分中,>25分及15~24分病人死亡率明显高于<15分病人死亡率,15~24分病人死亡率明显高于<15分病人死亡率,差异具有统计学意义(P<0.05)。使用ROC曲线计算可见,SCS、REMS及APACHEⅡ评分的灵敏度分别为75.23%、76.44%、85.99%,特异度分别为71.23%、71.29%、80.62%,可见APACHEⅡ评分较SCS、REMS评分均具有更高的灵敏度以及特异性,差异具有统计学意义(P<0.05)。SCS、REMS评分相比灵敏度及特异性之间无明显差异(P>0.05)。[结论]SCS、REMS及APACHEⅡ这三种评分系统均能够在一定程度上对急诊科危重症病人的预后进行一定的判断,但结合急诊科危重症病人的实际情况分析,前二者的操作方法更加简便,通过对准确度进行判断可见,SCS评分具有更好的准确度,综合分析可见应用价值更高。     

The effect of summer vacation on bilingual preschoolers' language development

The purpose of the investigation was to examine the developmental trajectories of bilingual preschoolers' comprehension of Spanish and English and to determine whether a lengthy summer vacation impacted children's development during the preschool years. Participants included 83 bilingual children who were followed over a 2‐year period during which time children attended a federally funded preschool programme for children from low‐income homes living in the US. Children were divided into two groups based on whether their scores on receptive language measures increased or decreased during their first year of Head Start. Results revealed that children whose scores increased experienced positive growth in their language comprehension in Spanish and English over the 2‐year period, whereas children whose scores decreased during the first year continued to experience a negative developmental trajectory in their second year. Additionally, it was found that a lengthy summer vacation had a differential effect on children's development. Summer vacation had a negative effect on the developmental trajectories of children who experienced gains in their comprehension of English and Spanish and a positive impact on children whose scores declined during the school year. Clinical implications suggest that children may require differential support during the school year and summer vacation depending upon their developmental trajectories during the first year in preschool.