综合医院精神科会诊患者失眠的临床研究

目的：探讨综合医院精神科会诊患者失眠的临床特征及与其它精神障碍的关系。方法：对168例精神科会诊患者进行分析。结果：128例(76、2％)会诊患者有失眠．其中61．7％(79／128)为慢性失眠。原发性失眠仅占5．5％(7／128)，85．1％(109／128)是与其它精神障碍有关的失眠。常见的精神障碍诊断为焦虑障碍、心境障碍和谵妄。60．9％的失眠患者在会诊前得到了处理。结论：应对临床医师进行精神卫生教育，提高他们对失眠等常见精神障碍的识别和处理能力。     

The role of bDMARDs in idiopathic inflammatory myopathies: A systematic literature review

Idiopathic inflammatory myopathies (IIM) are a group of different conditions typically affecting striate muscle, lung, joints, skin and gastrointestinal tract. Treatment typically relies on glucocorticoids and synthetic immunosuppressants, but the occurrence of refractory, difficult to treat, manifestations, may require more aggressive treatment, borrowed from other autoimmune diseases, including biologic disease modifying drugs (bDMARDs). In this regard, we conducted a systemic literature review in order to depict the current evidence about the use of bDMARDs in IIM. A total of 78 papers, published during the last 21 years, were retrieved. The majority of patients was treated with TNF-α inhibitors, whose effectiveness was assessed particularly in recalcitrant striate muscle, skin and joints involvement. Rituximab, whose evidence is supported by a large number of real-life studies and trials, seems to be an excellent option in case of ILD and anti-synthetase syndrome, while Tocilizumab, despite not meeting primary and secondary endpoints in a recently published clinical trial, proved its effectiveness in rapidly progressing ILD. Similarly, Abatacept, studied in a phase IIb clinical trial with conflicting evidence, was reported to be effective in some case reports of refractory dermatomyositis. Less data exist for anti-IL1 and anti-IL23 agents, which were employed particularly for inclusion body myositis and severe skin disease, respectively. This study provides an organ-focused assessment of bDMARDs in IIM, which display encouraging results in the treatment of refractory subsets of disease.     

对用消费者权益保护法处理医疗纠纷的不同见解

我们针对社会上要求运用消费者权益保护法保护患者权益的舆论,从３ 个方面阐述了我们的不同见解：①我国卫生事业的性质决定了医院不是提供商品性消费服务的“经营者”;②患者接受对疾病的诊疗过程中的被动地位,及得到的诊疗服务不是等价交换,决定了患者不是接受一般服务的“消费者”;③由于医疗工作的不可完全预见后果的高风险性和医务人员无私奉献,诊疗服务不是一般的“服务”。因此,我们建议尽快专门立法,规范医患关系,处理医患纠纷     

Acute myocardial infarct size reduction by timolol administration

A multicenter, randomized, double-blind study was performed to evaluate the effects of timolol administered early during the evolution of acute myocardial infarction. Of 144 patients entered into the trial, 73 were assigned to timolol and 71 to placebo. The 2 groups were well matched at baseline. The timolol group had reduced myocardial ischemia and infarct size as measured by an accelerated reduction of ST-vector magnitude, a significant reduction of creatine kinase (CK) release and significantly smaller changes in QRS vector variables. The predicted maximal QRS vector change and cumulative CK release for any given initial ST-vector magnitude was significantly reduced in the timolol-treated patients. Furthermore, QRS evolution time and CK release time were significantly reduced after intravenous timolol, as were the need for analgesics and the pain scores. Timolol treatment was well tolerated overall.     

Cerebrospinal fluid beta2-microglobulin: a study in controls and patients with metastatic and non-metastatic neurological diseases

We studied cerebrospinal fluid Beta₂-microglobulin (CSF B₂-m) in 197 patients with a variety of neurological diseases to evaluate the usefulness of B₂-m in the detection of meningeal dissemination of malignancy. In the control group we found a relationship between CSF log B₂-m and age (P < 10⁻⁴). Age standardized reference values were established as 0.65–2.2 mg/l. The results show that CSF B₂-m was elevated in leptomeningeal metastases from solid and haematological tumors. We observed slight elevations of CSF B₂-m in epidural and parenchym metastases from solid tumors. Our study shows that B₂-m in CSF is a sensitive marker for meningeal metastases especially from hemopoietic tumors.     

Giganteaside D induces ROS-mediated apoptosis in human hepatocellular carcinoma cells through the MAPK pathway

Purpose

Every year, almost one million individuals are diagnosed with hepatocellular carcinoma (HCC) worldwide and more than 690,000 patients die of it. At present, most therapeutic anti-HCC agents are not effective, which is due to the appearance of chemo-resistance and/or toxic side effects. Therefore, it is imperative to find novel more effective anti-HCC agents. Here, we evaluated the effect of giganteaside D (GD), an oleanolic acid saponin from P. scabiosaefolia, on the growth and apoptosis of HCC cells.

Methods and results

Using MTT and clonogenic assays, we found that GD exhibited a significant growth inhibitory effect on the HCC-derived cell lines HepG2 and Bel-7402. In addition, we found that GD induced mitochondria-mediated apoptosis in these HCC-derived cells, as indicated by a decreased mitochondrial potential, activation of Caspase-9 and Caspase-3, cleavage of PARP and release of Cytochrome C from the mitochondria. Besides, we found that GD stimulated the generation of reactive oxygen species (ROS) and that blockage of ROS attenuated the GD-induced mitochondria-mediated apoptosis. Additionally, we found that GD treatment led to a decrease in phosphorylated Erk (p-Erk) and triggered the generation of p-JNK, both components of the mitogen-activated protein kinase (MAPK) signaling pathway. Inhibition of Erk or JNK by specific inhibitors or siRNAs augmented or attenuated the cytotoxic and apoptotic effects of GD.

Conclusions

From our results we conclude that GD can induce ROS-mediated apoptosis in HCC-derived cells through the MAPK pathway. This observation may open up avenues to explore the future use of GD as a HCC chemotherapeutic agent.

     

3D打印技术应用于耳鼻咽喉科临床前瞻创新

目的 随着计算机技术不断进步、新型材料大量问世及制作成本下降,3D打印作为当今制造业前沿技术现已广泛应用于各种医疗过程尤其是外科专业,在耳鼻咽喉科领域目前主要应用于假体制造及植入、术前规划、模型重建和技能训练及教学等方面。通过定制个性化植入物及手术器械缩短手术时间、降低手术成本,通过术前规划及模型演练降低手术副损伤。近年来,组织工程学、活体组织器官的复合打印技术作为3D打印的潜在应用也得到了广泛的探索。论文主要讨论3D打印技术在耳鼻咽喉科领域的扩大应用及研究前景。     

单侧特发性声带麻痹神经电刺激治疗后即刻疗效初步观察

目的 探讨单侧特发性声带麻痹喉返神经/喉上神经电刺激治疗后即刻对主观声音改变、声学参数以及动态喉镜观察结果的影响.方法 选取诊断为单侧特发性声带麻痹的患者,回顾性收集其行喉肌电图检查并同期行神经电刺激治疗前后的动态喉镜及嗓音分析检查结果,分析检查及治疗前后主观声音改变,声学参数(jitter、shimmer、DSI、M...     

泪囊炎性肌纤维母细胞瘤一例

11岁女性患儿,因左眼溢泪 2 个月入院,入院诊断为“双泪囊肿瘤”。鼻内镜检查见双侧鼻腔黏膜充血,左侧泪囊处可见膨隆,泪囊处黏膜光滑;鼻窦CT示双侧泪囊占位,有骨质破坏,累及下鼻甲,占位结构界限不清。完善术前准备后,全身麻醉下行内镜下手术治疗,术中见左侧下鼻甲外侧壁有肿瘤浸润,结构不清,质地较硬,行左侧鼻腔外侧壁、泪囊...     

多巴反应性肌张力不全的临床分析（附7例报告）

目的探讨多巴反应性肌张力不全（DRD）的临床特点,以提高对本病的认识,减少误诊、误治。方法对我科诊治的7例患者的,临床资料进行分析。结果7例患者男性3例,女性4例,来自4个家庭,其中一家为三姐弟,一家为双胞胎。发病年龄1—7岁,均表现为最先累及下肢的肌张力不全,行走困难,早晨轻,下午和晚上重,持续较长时间者会出现弓形足。初步诊断后予小剂量多巴制剂试验性治疗,数小时即有明显改善,规律用药后完全恢复正常。结论本病以肌张力不全导致的下肢行动异常为首发症状,病情差异较大,多有晨轻暮重的特点,早期诊断并予小剂量多巴制剂治疗效果显著。