神经型布氏杆菌病四例报告并文献复习

目的总结神经型布氏杆菌病的临床特点。方法收集2017年9月至2019年5月首都医科大学宣武医院诊治的4例神经型布氏杆菌病患者的临床资料,分析其流行病学、临床表现、辅助检查结果、诊疗经过及预后,总结临床特点。结果 3例有较明确的流行病学接触史。2例表现为脑膜炎,1例表现为脊髓炎,1例表现为坐骨神经根炎。所有患者血清布氏杆菌虎红平板凝集试验(rose bengal plate agglutination test, RBPT)结果阳性。3例脑脊液检查示颅内压增高,蛋白增高、糖降低,2例白细胞数增多,3例IgG寡克隆区带(oligoclonal band, OB)阳性。1例头颅MRI示脑积水伴脑膜强化,1例示白质脱髓鞘病变。3例接受抗菌药物联合治疗,临床症状改善。结论神经型布氏杆菌病临床表现多样,缺乏特异性,主要根据神经精神症状、脑脊液及血清学结果的综合分析诊断,早期诊断和治疗对预防神经型布氏杆菌病并发症具有重要意义。     

5例神经型布氏杆菌病患者的调查分析

目的提高对神经型布氏杆菌病的认识。方法对5例神经型布氏杆菌病患者的流行病学资料、临床表现、实验室检查等进行回顾性分析。结果男4例、女1例,年龄30~60岁之间,5例患者中有4例病前有与羊的密切接触史,1例有经常进食涮羊肉史。5例患者均有不同程度的发热、头疼、关节疼痛,2例恶心、呕吐伴脑膜刺激征,2例手足麻木,1例双下肢无力。5例患者确诊后除一般治疗及对症治疗外,均应用米诺环素、利福平及头孢曲松3种药物联合治疗,预后良好。结论神经型布氏杆菌病传播途径复杂,临床表现多样,影像学又无特异性改变,故易漏诊、误诊。当遇到患者出现不明原因的神经症状时,应特别注意有无布氏杆菌流行病学史。患者脑脊液布氏杆菌抗体及血清凝集试验检测应作为常规检查,做到早诊断、早治疗,改善预后。     

神经型布氏杆菌感染脑膜炎的研究进展

神经型布氏杆菌病(NB)是布氏杆菌累及中枢神经系统后出现的罕见且严重并发症，其临床表现复杂多样。脑膜炎是神经型布氏杆菌病最常见的临床表现，在疾病早期即可出现。神经型布氏杆菌病所致脑膜炎的研究尚处于初级阶段，致病机制及代谢通路尚不明确，为提高临床工作者对神经型布氏杆菌感染脑膜炎的认识，本文将对神经型布氏杆菌病患者常见临床表现脑膜炎进行讨论，现将其发病机制、临床特点、辅助检查、诊断及治疗综述，希望通过利用代谢组学、宏基因二代测序等技术明确诊断，在疾病早期进行治疗干预，改善患者病情及预后，提高患者生活质量。     

6例神经型布氏杆菌病临床特点与分析

目的:分析探讨神经型布氏杆菌病的临床特点.方法:回顾性分析本院自2009年1月～2012年1月收治的6例神经型布氏杆菌病病例.结果:经临床对症治疗,4例治愈,2例好转.结论:神经型布氏杆菌病传播途径复杂,临床表现多样,易导致误诊;治疗需早期、联合用药、足够疗程治疗方可改善预后.     

布氏杆菌病合并脑膜炎27例临床分析

目的 探讨布氏杆菌病合并脑膜炎的临床表现、诊断及治疗、预后情况.方法 采用回顾性随机抽样的方法,描述、总结、分析了我院2007-2011年收治的27例布氏杆菌病合并脑膜炎病人的临床资料.结论 布氏杆菌病病人临床表现多种多样,诊断主要依据流行病学史、临床表现及实验室检查.经过规范化治疗后,预后良好.     

神经型布氏杆菌病1例报告及相关文献资料复习

目的报告1例神经型布氏杆菌病病例,复习相关资料,以提高对其认识.方法通过对病例的回顾,分析其发病机制,总结神经型布氏杆菌病的多种临床表现.结果神经型布氏杆菌病临床表现多种多样,极易误诊.结论神经型布氏杆菌病临床少见,遇到反复波动性发热,合并有神经系统症状、体征者,要详细询问牧区居住史以及牛羊制品食用史,并进行必要的血清学、病原学检查,以排除或确诊神经型布氏杆菌病.     

神经型布氏杆菌病1例报告及相关文献资料复习

目的：报告1例神经型布氏杆菌病病例，复习相关资料，以提高对其认识。方法：通过对病例的回顾，分析其发病机制，总结神经型布氏杆菌病的多种临床表现。结果：神经型布氏杆菌病临床表现多种多样，极易误诊。结论：神经型布氏杆菌病临床少见，遇到反复波动性发热，合并有神经系统症状、体征者，要详细询问牧区居住史以及牛羊制品食用史，并进行必要的血清学、病原学检查，以排除或确诊神经型布氏杆菌病。     

不典型布氏杆菌病诊疗体会

目的 总结不典型布氏杆菌病临床症状及治疗效果,提高布氏杆菌病的诊治水平.方法 回顾性分析33例布氏杆菌病患者的临床资料,并对其临床表现及治疗方法和效果进行分析.结果 典型临床表现者为76％,初诊确诊者72.7％,复诊确诊者24.2％,多次复诊确诊者3％.33例患者全部治愈出院,6个月内复查无复发.结论 布氏杆菌病临床表现复杂,临床医生要熟悉其发病机理、临床表现及实验室检查,早诊断,早治疗.     

广州地区布氏杆菌病的临床分析

目的 探讨广州市布氏杆菌病的流行情况、诊断及治疗.方法 对2例布氏杆菌病的流行病学、临床资料、治疗经过行系统分析.结果 2例布氏杆菌病患者均为广州市人,本地发病,以不规则低热为主要表现,因血培养阳性确诊,利福平、强力霉素治疗效果佳.结论 布氏杆菌病广州市多年已未发现,且可因临床表现不典型,极易误诊,临床医生应提高警惕,对抗生素治疗效果欠佳的低热患者,血培养为简单、易行的方法.     

以脊髓压迫症起病的布氏杆菌病1例报道并文献复习

<正>当今神经系统感染性疾病发病呈现散发趋势,但神经型布氏杆菌病有增多趋势。其表现多样,以脑膜炎、脑膜脑炎、脊髓炎和脊髓病多见,而以脊髓压迫症发病的还未见报道。回顾性分析保定市第一医院2013年3日诊断明确的1例神经布氏杆菌病的临床表现、辅助检查结果以及诊断与治疗经过,并结合文献分析其发病特点。1临床资料患者,男性,39岁,主因发热20 d伴颈部疼痛向双上肢放射15 d入院。既往体健,否认结核等传染病     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.