呼吸道变应性炎症

变应性鼻炎和哮喘等呼吸道变应性炎症存在共同的炎症反应机制。本文重点介绍变应性炎症的遗传学基础、免疫病理学、上下呼吸道炎症的相互作用以及治疗的相关性     

经鼻内镜下眼眶肌锥内间隙的解剖入路研究

目的　探索眼眶肌锥内间隙的解剖学关系，并评估经鼻肌锥内间隙手术入路的可行性。方法　采用8个动静脉双灌注的新鲜尸头（共16侧）进行解剖学研究。在标本的一侧采用经筛窦入路，分别进行眼眶内上及内下肌锥内间隙的解剖；在另一侧采用经鼻泪前隐窝入路，分别进行内下及外下肌锥内间隙的解剖。比较两种入路对相应肌锥内 间隙的暴露程度，以及各自的优缺点。结果　经筛窦入路，去除眼眶下内壁的骨嵴，在下直肌与内直肌之间可以暴露眼眶内下肌锥内间隙；向内牵拉内直肌，可暴露内直肌上半部与视神经间的区域。在内直肌与上斜肌之间，可进入眼眶内上肌锥内间隙。经鼻泪前隐窝入路，能在直视下暴露眼眶内下肌锥内间隙，无需牵拉内直肌，且可保留眼眶内下壁骨嵴。向下移位眶下神经，沿着下直肌的外侧缘，可进入眼眶外下肌锥内间隙。结论　经筛窦入路可暴露内上及内下肌锥内间隙，经泪前隐窝入路可显露内下及外下肌锥内间隙。本研究可为经鼻内镜下行眼眶肌锥内间隙内的病变切除提供解剖学参考。     

变应性鼻炎诊疗进展

国际诊疗指南 目前全球在变态反应(过敏)科学领域最具学术水平和影响力的学术团体分别为美国变态反应科学、哮喘和免疫学学会(American Academy of Allergy,Asthma and Immunology,AAAAI)和欧洲变态反应科学和临床免疫学学会(European Academy of Allergy and Clinical Immunology,EAACI).两个学会的官方刊物分别为Journal of Allergy and Clinical Immunology(简称JAC1)和Allergy,这是该专业领域最优秀的两本期刊.     

既往有心脑血管病对严重急性呼吸综合征患者病死率的影响

目的研究心脑血管基础疾病对严重急性呼吸综合征(SARS)患者病死率的影响。方法分析2003年北京市1291例SARS患者(其中121例死亡)的病例资料,比较既往有心脑血管基础疾病和有、无其他基础疾病三组SARS患者病死率的差异及死亡危险因素。结果SARS患者总的病死率为937%。既往有心脑血管疾病、其他基础病和无基础病的SARS患者病死率分别为2864%、1185%和449%(P<00001)。Logistic回归分析表明,调整年龄和职业后既往有心脑血管病的SARS患者死亡的相对危险是无基础病患者的183倍(P<005)。结论既往有心脑血管基础疾病是SARS患者死亡的重要危险因素之一。     

改良悬雍垂腭咽成形术长期疗效的主观评价

目的 评价保留悬雍垂的改良悬雍垂腭咽成形术(Han-uvulopalatopharyngoplasty,H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者术后5年的主观疗效改善程度.方法 回顾性队列研究.电话问卷随访2165例确诊5年及以上的OSAHS患者(呼吸暂停低通气指数≥5次/h),分为未治疗组、...     

微创人工耳蜗植入技术

近几年来微创人工耳蜗植入(minimally invasive cochlear implantation,MICI)在国内、外耳科学界不断被提出。微创手术(minimally invasive surgery)这一治疗理念始于1985年,当时英国泌尿外科医师Payne Wickham在内镜治疗泌尿道结石的报道中首次使用"minimally invasive procedure"一词来描述治疗过程,随后在医学各个学科领域内被广泛使用,微创手术这一理念也被广泛传播。微创手     

89例瞬态声诱发耳声发射筛查未通过婴幼儿听力学特点分析

目的 探讨听力筛查未通过而短声(click)诱发听性脑干反应阈值正常婴幼儿的听力学特点,进一步分析畸变产物耳声发射(DPOAE)不同频率异常与其他客观听力检查异常之间的关系.方法 瞬态声诱发耳声发射(TEOAE)听力筛查未通过而接受包括DPOAE、短声ABR、40 Hz听觉相关电位、226 Hz声导抗、1000 Hz声导抗和声反射等诊断性听力学检查的患儿共695例,以其中诊断性短声诱发ABR阈值正常的新生儿及婴幼儿89例(123耳)作为研究对象,根据DPOAE频率异常的不同分为A组(全频正常)、B组(低频异常)、C组(高频异常)和D组(全频异常).对比各项听力检查结果,分析DPOAE频率异常各组与其他5项客观听力检查(ABR Ⅰ波潜伏期、40 Hz听觉相关电位、226 Hz鼓室声导抗、1000 Hz鼓室声导抗及声反射)之间的相互关系.结果 123耳中所有6项听力检查均正常者7耳(5.7%);6项听力检查中有一项或一项以上异常者116耳(94.3%).男婴的异常率为93.9%(77/82),女婴的异常率为95.1%(39/41),二者差异无统计学意义(P＞0.05);左耳异常率为93.1%(54/58),右耳异常率为95.4%(62/65),二者差异无统计学意义(P＞0.05).各组耳数所占比例由高到低分别是D组48.0%(59/123)、B组27.6%(34/123)、A组16.3%(20/123)和C组8.2%(10/123).A组、B组和D组中异常率最高的检查项目均为声反射,异常率分别为40.0%,55.9%和66.1%;而C组中异常率最高的项目为ABR Ⅰ波潜伏期(50.0%).各组低频听力损失均以轻度为主,在B组中有1耳为中度听力损失,D组中有6耳为中度听力损失,1耳为重度听力损失.结论 听力筛查未通过而短声ABR反应阈值正常的婴幼儿,如果DPOAE全频异常,需要及时进行全面的听力学评估,而DPOAE全频正常、低频异常或高频异常者,需要进行跟踪随访.

Abstract：

Objective The presnt study was to evaluate the audiological characteristics of infants with normal auditory brainstem response thresholds in click and abnormal transiently evoked otoacoustic emissions. Relationships between test results of distortion product otoacoustic emissions(DPOAE) and other hearing testing methods were also evaluated. Methods The participants consisted of eighty-nine infants,with a total of 123 ears. All participants' TEOAE screening results were abnormal but diagnostic click ABR results were normal. The participants were classified into the following goups based on the test results from distortion product otoacoustic emissions: group A (normal all-frequency ), group B (abnormal lowfrequency), group C (abnormal high-frequency ), and group D (abnormal all-frequency ). Results Obtained from these groups were compared to results of other hearing tests including the latency of ABR wave Ⅰ, 40 Hz auditory event related potential (40 Hz AERP), 226 Hz and 1000 Hz tympanometry, and acoustic reflex. Results In six hearing tests in the 123 ears, seven ears (5.7%) were normal, while 116ears (94. 3% ) were abnormal. No significantly differences were detected between boys (93.9%) and girls (95. 1% ), as well as between left (93. 1% ) and right ears (95.4%). The proportion of abnormal test results ranked as follows: 59 ears in group D (48.0%), 34 ears in group B (27.6%), 20 ears in group A (16. 3% ), and 10 ears in group C (8.2%). The highest abnormal rates in groups A, B and D were acoustic reflex, which were 40. 0% for group A, 55.9% for group B and 66. 1% for group D respectively.The highest abnormal rate in group C was the latency of ABR wave Ⅰ ( 50. 0% ). Distribution of lowfrequency hearing loss in each group was mainly mild. However, one ear in group B was moderate hearing loss, six ears in group D were moderate hearing loss, and one ear in group D was severe hearing loss.Conclusions The present study showed that, of which infants with normal thresholds of ABR failed the hearing screening, comprehensively audiology assessment is needed. And of which infants with normal DPOAE in full frequency or abnormal in high frequency region or low frequency region need to be followed up.     

学院型医院建设

学院型医院建设是现阶段我国部分大学附属医院的发展目标。本文介绍了学院型医院的定义、内涵、特征以及建设意义和发展现状;同时提出在学院型医院建设过程中应正确处理好理论研究与实践、附属医院与大学、科研教学与医疗、重点学科与非重点学科之间的关系。