异基因造血干细胞移植后肺烟曲霉菌病合并闭塞性细支气管炎一例附文献复习

背景：异基因造血干细胞移植是多种血液系统恶性疾病和遗传性疾病的有效治疗方法，但移植后易并发全身多脏器的病变，其中尤以肺部并发症多见。肺部并发症绝大部分为感染性疾病，小部分为非感染性疾病，两者亦可并存，但当移植病患同时发生肺部感染性疾病和非感染性疾病时，如何正确诊断和治疗尤为重要。 目的：报道异基因造血干细胞移植1年后发生肺侵袭性烟曲霉菌病合并闭塞性细支气管炎1例，复习相关文献探讨其预防、临床表现和恰当的治疗方法。 方法：患者异基因造血干细胞移植后373 d出现发热伴咳嗽，活动后胸闷，胸部CT提示右肺上叶前段、中叶及下叶背段可见片状阴影，进一步行右肺上叶病灶穿刺活检、培养。 结果与结论：肺穿刺活检病理提示肺泡扩张，肺泡上皮增生，肺间质增厚，间质细胞增生，并见少许散在的异型淋巴样细胞，肺功能中最大通气量明显下降，残气量增加，肺活量减低，基础第1秒用力呼气容积值为59.27%。肺穿刺物培养提示烟曲霉菌生长。细胞免疫组化提示为T淋巴细胞，:CD3(+)、CD45RO(+)，CD20(－)，CD79a(－)，MPO(－)，CD34血管(－)。患者确诊肺侵袭性烟曲霉菌病合并闭塞性细支气管炎，经注射用醋酸卡泊芬净+注射用伏立康唑抗真菌治疗，甲基泼尼松、硫唑嘌呤、阿奇霉素治疗闭塞性细支气管炎，治疗40 d后复查胸部CT病灶完全吸收。     

食管癌介入术后气颅一例

患者 女,64岁.因"反复发热伴头痛1周余"入院.头部CT(图1)示蛛网膜下腔广泛气泡征,患者半年内无头部外伤史,追问病史发现其4个月前因"进行性吞咽困难伴饮水呛咳"在当地医院行食管镜检及活检,提示为"食管中上段鳞癌",行放疗后逐渐出现胸背部烧灼性疼痛,且吞咽困难加重,钡餐检查提示"食管纵膈瘘",遂行"食管支架置入术",术后患者吞咽困难明显好转而出院.查体:神清语利,颈抵抗,余无明显神经系统阳性体征.颈胸部CT(图2)示T1～2椎体骨质破坏,椎间孔、椎管内积气,双肺斑片状渗出,诊断:颅内积气合并肺部感染.给予对症、抗炎治疗,嘱其卧床静养,避免剧烈咳嗽.7d后患者头痛症状明显缓解,体温正常,复查头部CT提示蛛网膜下腔积气明显减少,3d后患者痊愈出院.     

甘露醇合并β-七叶皂甙钠治疗脑出血疗效观察

目的：探讨脑出血患者联合应用β－七叶皂甙钠后的治疗效果。方法：设立治疗组与对照组，治疗组加用β－七叶皂甙钠，一定疗程后头颅CT复查，了解血肿吸收情况。进行分类统计。结果：治疗后血肿吸收情况经统计学处理，有显著意义。结论：合并β－七叶皂甙钠治疗可促进血肿吸收，缩短治疗时间。     

肝移植后真菌感染9例次分析

为了探讨肝移植后真菌感染的诊断和治疗,回顾分析解放军总医院第二附属医院器官移植中心2007-09/2008-12收治的52例肝移植中,8例肝移植受体术后发生真菌感染的诊治情况。52例肝移植患者中,8例患者真菌感染9例次(1例患者发生2次感染),感染率15% (8/52)。感染时间发生在肝移植后2~5个月,感染好发的部位依次为肺(67%,6/9),泌尿系统(22%,2/9),肠道(11%,1/9)。病原菌中白色念珠菌感染占6例次,光滑念珠菌感染占2例次,曲霉菌感染占1例次。在8例患者中6例经抗真菌感染治疗顺利康复,2例患者死亡。可见真菌感染是肝移植术后常见并发症之一,病死率较高,早期诊断和治疗是治愈真菌感染的关键。     

外伤后脑脂肪栓塞2例

例1，男，24岁，因车祸伤1h入院。查体：神志清楚，头面部多处裂伤，左胸锁关节肿胀，骨擦感（＋），左大腿中段肿胀畸形。骨擦感（＋）。头CT未见明显异常。计算机摄影（com—puted radiography，CR）示左股骨干骨折、左锁骨骨折。伤后3h在人手术室准备行骨折复位术途中突发意识不清。复查头CT示左侧迟发性硬膜外血肿．量约15ml，双额叶脑挫裂伤。暂保守观察治疗。伤后6h神志清楚。伤后15h复查头CT示双侧小脑出现低密度梗塞灶，提示外伤后小脑脂肪栓塞。给予激素和改善微循环治疗10d后行骨折复位术。入院31d复查头CT示双侧小脑低密度梗塞灶明显缩小。3月后痊愈出院。     

高原颅内复杂动脉瘤破裂出血合并高原肺水肿一例

患者男,42岁.汉族,因“进藏后胸闷、呼吸困难3d,突发头痛伴意识不清12h”入院.既往体健,初上高原第3天,驻地海拔4900m.查体:血压120/70 mmHg,神志昏迷状态,双侧瞳孔呈圆形,直径3.0mm,对光反射迟钝,病理征(-).按Hunt - Hess分级为Ⅳ级,GCS评分4分.头颅CT示:鞍上池、双外侧裂池、双侧侧脑室、第三脑室及第四脑室高密影,脑室轻中度扩大(图1a);肺部CT提示双肺斑片状高密度影.     

利奈唑胺治疗肾移植后重症肺部感染30例

为评价利奈唑胺对肾移植患者重症肺部感染的疗效与安全性,对30例肾移植后重症肺部感染患者应用利奈唑胺治疗的临床资料进行回顾性分析。根据临床症状初步判断病原菌,采取经验性降阶梯治疗,联合给予抗细菌、抗病毒和抗真菌治疗,抗生素均采用利奈唑胺300 mg 静滴,2次/d,结合抗杆菌类药物常用的有氨曲南、头孢吡肟、亚胺培南,更昔洛韦抑制巨细胞病毒感染,抗真菌感染应用氟康唑、伊曲康唑、伏立康唑、卡泊芬净、米卡芬净,复方新诺明抗肺孢子虫四联治疗。1例病情严重给予气管插管机械通气辅助呼吸,3 d后死亡外,其余29例患者经积治疗痊愈,其中4例并发急性呼吸窘迫综合征,治愈率达97%,利奈唑胺治疗有效率97%,细菌清除率为91%,未发现与药物相关不良反应导致停止治疗的记录。提示利奈唑胺是治疗肾移植患者重症肺部感染安全有效的药物。     

肺移植后真菌感染1例并文献复习

回顾分析1 例肺移植患者病理过程及诊疗经过,并复习相关文献,总结相关的临床治疗经验。原发性肺动脉高压并三尖瓣关闭不全、充血性心力衰竭女性患者,33岁,2006-04在体外循环下行同种异体原位双肺移植术,术后出现严重的低血容量性休克,伴有严重高钠血症,同时合并严重代谢性碱中毒,pH值最高达7.6,经积极治疗后,血钠水平于术后第14天恢复正常,术后第3天起,从痰培养、气管切开伤口分泌物、血液培养中分离出细菌、真菌共计12种,根据药敏试验给予相应抗生素治疗,真菌培养结果仍持续阳性,于术后第72天死亡。肺移植术后真菌感染是危及生命的严重并发症,对其进行早期诊断、消除各种诱发因素、及时给予足量、联合抗真菌药物治疗是移植后真菌感染防治的关键。     

肾移植术后重症肺部感染的诊治

摘要 目的：探讨肾移植术后重症肺部感染的诊治及病原体分布。方法：对14例肾移植术后重症肺部感染的患者资料进行回顾性分析。结果：细菌感染5例,真菌感染4例,多重细菌感染1例,细菌加真菌2例,2例未检出病原菌;5例死亡,9例治愈。结论：肾移植术后合并重症肺部感染者病情危重,死亡率较高;早期联合抗感染治疗、免疫抑制剂的适当调整、早期的病原学诊断、呼吸支持治疗、免疫调节剂的应用和营养补充等综合治疗可提高其治愈率。     

肝移植术后早期深部真菌感染诊治分析

为探索肝移植后早期深部真菌感染的早期诊断和治疗措施,收集了重庆医科大学附属第一医院重庆市器官移植中心2001-10/2008-10的72例肝移植患者移植后并发早期深部真菌感染16例患者的临床资料,分别对其易感因素、病原学特点、诊断方法、治疗方案及预防措施进行回顾性病例分析。16例肝移植患者发生早期深部真菌感染23例次,死亡4例,感染发生率22.2%(16/72),死亡率25.0%(4/16)。肺部感染15例次,肠道感染6例次,胆道感染1例次,颅内感染1例次。白色念珠菌感染占65.22%,非白色念珠菌感染占17.39%,曲霉菌感染占13.04%,隐球菌感染占4.35%。发病时间为移植后5~26 d。可见早期深部真菌感染是影响肝移植患者后生存率的重要原因之一。有效预防、早期诊断和积极治疗是提高深部真菌感染治愈率的关键。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.     

Learning and forgetting new names and objects in MCI and AD

We studied how subjects with mild cognitive impairment (MCI), early Alzheimer's disease (AD) and age-matched controls learned and maintained the names of unfamiliar objects that were trained with or without semantic support (object definitions). Naming performance, phonological cueing, incidental learning of the definitions and recognition of the objects were tested during follow-up. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, suggesting that the MCI patients’ preserved semantic memory can compensate for impaired episodic memory. The MCI group performed equally well as the controls in the tasks measuring incidental learning and recognition memory, whereas the AD group showed impairment in this respect. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that word learning is compromised in both MCI and AD, whereas long-term retention of newly learned words is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI.     

Necdin蛋白与神经元的生长分化

在神经系统 ,Necdin只在成熟神经元的细胞核中表达 ,可能与成熟神经元分裂静止状态的保持有关。近年的研究表明 ,Necdin是一种生长抑制蛋白 ,能与多种因子如SV4 0大T抗原 ,腺病毒E1A ,转录因子E2F1以及肿瘤抑制蛋白p5 3等结合 ,在功能上类似于成视网膜瘤蛋白Rb。necdin基因缺陷时 ,会引起脑内 ,特别是下丘脑神经元分化障碍。人类necdin基因位于PWS综合征的基因缺失区 ,可能与PWS的一些症状有关。本文从Necdin蛋白的基本概况 ,生物功能以及Necdin与疾病三个方面进行了综述     

Satellite cells and myonuclei in young and elderly women and men

The overall aim of this study was to assess the effects of aging on the satellite cell population. Muscle biopsies were taken from the tibialis anterior muscle of healthy, moderately active young (age range, 20-32 years; n = 31) and elderly (age range, 70-83 years; n = 27) women and men with comparable physical activity pattern. Satellite cells and myonuclei were visualized using a monoclonal antibody against neural cell adhesion molecule and counterstained with Mayer's hematoxylin. An average of 211 (range, 192-241) muscle fibers were examined for each individual. Compared with the young women and men, the elderly subjects had a significantly lower (P < 0.011) number of satellite cells per muscle fiber but a significantly higher (P < 0.004) number of myonuclei per muscle fiber. The number of satellite cells relative to the total number of nuclei [satellite cells/(myonuclei + satellite cells)] was significantly lower in the elderly than in the young women and men. These results imply that a reduction in the satellite cell population occurs as a result of increasing age in healthy men and women.     

Necdin蛋白与神经元的生长分化

在神经系统,Necdin只在成熟神经元的细胞核中表达,可能与成熟神经元分裂静止状态的保持有关.近年的研究表明,Necdin是一种生长抑制蛋白,能与多种因子如SV40大T抗原,腺病毒E1A,转录因子E2F1以及肿瘤抑制蛋白p53等结合,在功能上类似于成视网膜瘤蛋白Rb.necdin基因缺陷时,会引起脑内,特别是下丘脑神经元分化障碍.人类necdin基因位于PWS综合征的基因缺失区,可能与PWS的一些症状有关.本文从Necdin蛋白的基本概况,生物功能以及Necdin与疾病三个方面进行了综述.     

Retrospective and prospective design and data

The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder - MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.     

Cortisol levels and depression in men and women using heroin and cocaine

Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are well documented in men using illicit drugs and/or infected with HIV; however, less is known about HPA function, or the health consequence of HPA dysfunction, in their female counterparts. People with depression exhibit hypercortisolemia, and depression is common in people with HIV or substance use problems. The current study investigated cortisol secretion in 209 demographically matched men and women, stratified by their HIV and drug use status. Self-reported depressive symptoms were evaluated using a standardized, validated questionnaire (CES-D). Women reported more depressive symptoms than men (p=.01). Male and female drug users exhibited higher cortisol concentrations (p=.03), and were more likely to report depressive symptoms (p=.04), than non-users. Depression was related to elevated cortisol concentrations for the study population (p=.03), and women with elevated cortisol concentrations were significantly more depressed than all other participants (p=.05). While it is unknown whether high cortisol concentrations precede depressive symptoms or vice versa, these data indicate that higher cortisol concentrations are associated with depressive symptoms in heroin and cocaine users, and that this association is more pronounced in women than men. HIV status did not act in an additive or synergistic way with drug use for either cortisol or CES-D measures in the current study. Unique therapies to treat the endocrine and mental health consequences of illicit drug use in men and women deserve consideration as depressive symptoms, and high cortisol concentrations associated with depressive symptoms, differ by gender.     

相关性和一致性：这对相仿概念和测量方法的回顾与阐明

概述：一致性(agreement)和相关性(correlation)是两个广泛使用的概念,用来评估变量之间的关联。虽然二者相似且相关,但是它们代表关联完全不同的概念。评估变量之间的一致性假设变量测量的是相同的结构,而在变量测量完全不同的结构时也可以评估它们之间的相关性。这种概念上的差异就要求使用不同的统计方法,并且当评估一致性或相关性时,统计方法根据数据的分布和研究者的兴趣可能会有所不同。例如, Pearson相关性,作为评估连续变量之间相关性的一种普遍测量方法,只有用于符合线性关系的变量时才能提供有用的信息;当用于不符合线性关系的变量时就无法提供准确信息甚至会产生误导。同样地,内部相关性,作为一种评估连续变量之间一致性的常用方法,如果一致性不好的实质正好是研究兴趣所在,那么该测量就不能为研究者提供充分的信息。本报告回顾了一致性和相关性的概念,并讨论了几种常用方法在应用中的差异。