ECT治疗抗精神病药物的严重副反应

作综述性地报告了临时性休克（ECT）对抗精神病药物副反应的治疗效果及进展。两种主要的副反应是迟发性运动障碍（TD）和恶性症侯群（NMS），这也是我们临床见到的在处理方法上较为困难的副反应，本讨论了ECT治疗TD和NMS的可能性机制。     

迟发性运动障碍的药物治疗进展

就维生素E、氯硝西泮、苯妥英、氯氮平等10种药物对迟发性运动障碍（TD）的治疗情况作了简要概述。这10种药物对TD的治疗情况虽仍不尽人意，但目前在未发现新的特异性抗TD药物之前，选择这些药物可能对TD的治疗有所帮助。另外，本文还就每种药物对TD的治疗机制进行了讨论。     

伴迟发性运动障碍的精神分裂症患者糖耐量观察

目的观察伴有迟发性运动障碍（TD）的精神分裂症患者糖耐量的情况。方法按照AIMS量表评定有无TD，使用WHO诊断标准来判断有无糖耐量异常及2型糖尿病。结果与非TD组相比，TD组有更多的糖耐量异常（x^2=4．45，df=1，P〈0．05）。结论对伴有TD者要经常监测血糖，如血糖过高，要给予相应的医疗干预措施。     

促发迟发性运动障碍的有关因素

迟发性运动障碍（TD）的发生，不但与年龄、性别有关，而且与所用药物种类，疗程有关，近年来，又发现与所患疾病、吸烟、饮酒有关。本结合献进行了综述。     

迟发性运动障碍的糖耐量研究

目的研究伴有迟发性运动障碍（TD）的精神分裂症患者糖耐量的情况。方法按照AIMS量表评定有无TD，使用WHO诊断标准来判断有无糖耐量异常及2型糖尿病。结果与非TD组相比，TD组有更多的糖耐量异常（c2=4．45，df=1，P〈0．05）。结论对伴有TD者要经常监测血糖，如血糖过高，要给予相应的医疗干预措施。     

迟发性运动障碍的影响因素

概述了迟发性运动障碍（TD）的影响因素，如年龄、累积药量与用药期限、性别、精神病严重度、药物种类、锥外副反应及吸烟等，并简述其流行病学及一般防治措施。     

脑内迟发性血肿的CT诊断价值

目的及早发现、及时诊断脑内迟发性血肿，最大限度的提高颅脑外伤患者的诊治生存率，降低残病率。方法收集45例外伤性迟发性脑内血肿，主要对迟发性出血的时间、部位、大小等进行了分析。结果迟发性脑内血肿的出现时间一般为外伤24h之后，额叶最多。对冲部位多于直接受力部位。结论2次及以上CT复查对颅内迟发性血肿检出率较首次CT检查高，应引起临床医生的足够重视。     

98例外伤性迟发性颅内血肿的临床分析

目的分析导致外伤性迟发性颅内血肿的因素。方法回顾性分析98例外伤性迟发性颅内血肿的临床资料，用Ch i-Square统计方法分析导致外伤性迟发性颅内血肿相关因素。结果导致外伤性迟发性颅内血肿与凝血异常、存在脑挫伤或SAH、颅内压变化及首次CT检查有关。结论了解导致外伤性迟发性颅内血肿的相关因素对改善患者预后有重要意义。     

异丙嗪治疗抗精神病药所致迟发性运动障碍对照研究

目的 探讨异丙嗪对抗精神病药所致迟发性运动障碍（TD）的疗效。方法 采用异丙嗪与安定随机双盲对照治疗60例TD。以不自主运动评定量表AMIS、CGI评定症状和疗效。结果 异丙嗪对TD的显效率为66．7％，安定为26．7％，两组有显性差异（P＜0．01）。治疗后两组AIMS的减分率有显性差异（P＜0．01），疗效与年龄、病程之间呈显的反比关系。结论 异丙嗪治疗TD的疗效优于安定。     

伴迟发性运动障碍的精神分裂症患者糖耐量观察

目的观察伴有迟发性运动障碍(TD)的精神分裂症患者糖耐量的情况。方法按照AIMS量表评定有无TD,使用WHO诊断标准来判断有无糖耐量异常及2型糖尿病。结果与非TD组相比,TD组有更多的糖耐量异常(χ2=4.45,df=1,P<0.05)。结论对伴有TD者要经常监测血糖,如血糖过高,要给予相应的医疗干预措施。     

Traveller's diarrhea among Austrian tourists to warm climate countries: II. Clinical features

The syndrome Traveller's Diarrhea (TD) is important for tourists travelling to warm-climate countries. In this study a worldwide survey on the clinical features of enteritis among 1,455 Austrian tourists is reported. The clinical parameters of TD show that this disease exhibits a very uniform clinical course which is not influenced by different regions with considerable differences in aetiology or by travel-associated parameters such as accomodation, travel style and individual dietary hygiene: TD starts mainly at the end of first week of the stay and the average duration of illness is 3.6+/–2.7 days. Watery and mucous stools were reported by 99% of patients with a frequency of 4 bowel movements per day, while bloody diarrhea occurred very rarely. However, 57.2% of patients suffered from abdominal cramps, less than one third of patients reported nausea and/or vomiting and fever accompanied the acute disease in 13%. Symptoms indicate that TD should not be considered a severe disease. The diarrheal illness will show the characteristics of an enteroinvasive disease only in rare cases. Treatment of TD is discussed: symptomatic or other nonantibiotic agents are preferable as antibiotics will only occasionally be necessary for treatment of an illness with a self-limiting character. For prophylaxis of TD, the preferable way to resolve the problem of TD in international travel, very few effective preparations are currently available, emphasizing the need for extensive research in this field.     

旅行者腹泻的风险分析和健康干预

旅行者腹泻是国际旅行者最常见的疾病,了解其风险因素及干预措施对于保障国际旅行者的健康尤为重要。笔者对旅行者腹泻的风险因素从致病因素、传播途径、临床特点、易感人群、季节性、地理分布及危害性7个方面进行详细分析,并从事前干预和事后应对2方面提出了针对性的干预措施。本文为国际旅行者提供了有关旅行者腹泻的安全有效的旅行卫生保健服务。     

共患和不共患ADHD的抽动障碍患儿临床特征调查分析

目的 分析共患和不共患注意力缺陷多动障碍(ADHD)的抽动障碍(TD)患儿临床特征,为临床治疗提供思路。方法 病例随机选自2018年6月-2019年11月就诊于中国中医科学院广安门医院儿科6～12岁符合研究标准的单纯TD患儿及TD共患ADHD(TD+ADHD)患儿共计408例(单纯TD患儿296例,TD+ADHD患儿112例),调查两组患儿抽动障碍病程、亚型分布、抽动障碍始发年龄等发病情况以及疾病严重程度方面的差异;分析TD+ADHD组患儿注意缺陷多动障碍病情分布情况。结果 在耶鲁综合抽动严重程度量表(YGTSS)总分及损害率方面,TD+ADHD组明显高于单纯TD患儿(t=-23.24、-19.17,P＜0.001),但其分值高低却不受ADHD亚型的影响;在TD+ADHD患儿组中,注意缺陷子量表分值高于多动/冲动子量表(t=2.96,P＜0.05);与TD共患注意缺陷为主型ADHD(TD+ADHD-I)患儿相比,TD共患多动/冲动为主型ADHD(TD+ADHD-HI)与TD共患混合型ADHD(TD+ADHD-C)的就诊年龄较偏小(F=7.93,P=0.019)。结论 TD+ADHD的患儿抽动障碍病情更为严重,但其严重程度却不受ADHD亚型的影响;TD+ADHD-HI与TD+ADHD-C患儿的早期行为问题更加突出且易被发现,因此更早地选择去医院就诊,但TD+ADHD-I患儿在就诊时其注意缺陷问题已经非常严重。     

抽动障碍240例临床分析

目的 分析各类型抽动症在小儿中的分布特点,探讨治疗方法.方法 对廊坊市医院2002年2月至2006年2月240例抽动症患儿进行了回顾性分析,描述抽动障碍类型分布、年龄分布及氟哌啶醇对发声与多种运动联合抽动障碍综合征的治疗效果.结果 抽动障碍发病水平为性别上男孩明显高于女孩,其中男184例、女56例.发病类别以短暂性抽动障碍最为多见,为131例,占54%(P=0.039);心理治疗对短暂性抽动障碍及发声抽动障碍有效;氟哌啶醇(haloperidol)对发声与多种运动联合抽动障碍综合征类型效果明显,有效率94%(P=0.013).结论 短暂性抽动障碍及慢运动性抽动或发声抽动障碍心理治疗有效,发声与多种运动联合抽动障碍综合征需药物治疗,该病总体预后良好.     

Thiamine deficiency in children with congenital heart disease before and after corrective surgery

BACKGROUND: Malnutrition is common in children with congenital heart disease, while thiamine deficiency (TD) is common in malnutrition, in critically ill children, and in adults with congestive heart failure treated with loop diuretics. Our goal was to determine whether children with congenital heart disease had TD and whether treatment with loop diuretics is related to TD in these patients. METHODS: Twelve children with ventricular septal defect (VSD) treated with furosemide, and 10 children with tetralogy of Fallot (TOF) referred for corrective surgery were consecutively enrolled into a prospective study. Data were collected 24 hours before surgery and 5 days after surgery for nutrition evaluation, medications used, anthropometric measurements, and laboratory markers of malnutrition. Thiamine and pyridoxine deficiencies were evaluated using activated enzyme assays. RESULTS: Seven children (32% of patients) did not meet the recommended daily allowance (RDA) for calories and 18% of patients did not meet the RDA for thiamine intake. Anthropometric measurements were low in both groups, more so in those with VSD, although the difference did not reach statistical significance. Overall, 18% (1/12 with VSD and 3/10 with TOF) of children with congenital heart disease had thiamine deficiency before surgery. Three of the four children with TD had adequate intake of thiamine. Six children (27%) had TD 5 days postsurgery (3 children with VSD and 3 children with TOF). CONCLUSIONS: TD is common in children with congenital heart disease (CHD) referred for corrective surgery both before and after surgery. Our results suggest that neither diuretic treatment nor malnutrition can fully explain the development of TD in these children.     

河北太行山某恙虫病疫源地传播媒介与宿主调查

目的：了解河北省恙虫病疫源地的传播媒介与宿主。方法：１９９８年８月至１９９９年１月,对太行山区某恙虫病流行村定期捕鼠和分离恙螨,采集老鼠的肝脾和恙螨传代昆明种小鼠,取传代鼠肝脾涂片进行姬姆萨染色和切片进行免疫荧光法检测Ｒｔ,对采集鼠和传代鼠采血检测血清恙虫病抗体。结果：褐家鼠和黑线姬鼠为当地的优势鼠种,无论采集鼠和传代鼠的血清中均查到恙虫病抗体,传代鼠的肝脾涂片和切片均查到恙虫病立克次体。传播媒介     

儿童抽动障碍176例临床分析

目的 了解儿童抽动障碍的病因、临床特征及发病特点,以便早期诊断、早期治疗.方法 以西安市儿童医院儿保门诊1997年1月至2002年1月已确诊抽动障碍的176例儿童作为研究对象,进行辅助视频脑电图、血清微量元素、注意力测试等相关辅助检查.结果 男性发病多于女性;各年龄组临床特征不同;血微量元素缺乏37例,占21%;抽动障碍伴多动18例,占10.2%;测脑电图者41例,其中正常者占78.1%,轻度异常占21.9%,但无特异性改变.结论 儿童抽动障碍发病与性别、年龄有关;部分儿童补铁治疗有效.抽动伴多动者,优先治疗抽动后多动症状可缓解,采取综合治疗,早期进行干预,预后良好.     

Platelet Activating Factor levels and metabolism in Tangier Disease: a case study

ABSTRACT: BACKGROUND: Tangier disease (TD) is a phenotypic expression of rare familial syndrome with mutations in the ABCA1 transporter. The risk of coronary artery disease in patients with TD is variable. On the other hand the pivotal role of Platelet-Activating Factor (PAF) mediator in atheromatosis was found. Plasma lipoproteins are transporters of the PAF acetylhydrolase (PAF-AH) in cells and known as lipoprotein-phospholipase A2 (Lp-PLA2) in plasma and regulators of PAF levels in blood. In addition, PAF can be biosynthesized from the remodeling and the de novo pathways in which Lyso-platelet activating factor-acetyltransferase (Lyso-PAF-AT) and platelet activating factor-cholinephosphotransferase (PAF-CPT) are the regulatory enzymes. The aim of this study is to investigate in a TD patient with a unique mutation (C2033A), the concentration of PAF in blood, the Equivalent Concentration for 50% aggregation (EC50) values of platelet rich plasma (PRP) toward PAF, adenosine diphosphate (ADP) and thrombin, and the activities of PAF metabolic enzymes Lp-PLA2, PAF-AH, Lyso-PAF-AT and PAF-CPT. METHODS: The EC50 value of PRP was measured by an aggregometer. The determination of the specific activity of PAF-CPT and Lyso-PAF-AT was made after in vitro enzymatic assay, chromatographic separation and measurement of the produced PAF in a biological assay with washed rabbit platelets. The determination of PAF-AH and Lp-PLA2 was made after an in vitro enzymatic assay from the decay of radioactive PAF. RESULTS: The TD patient had lower bound-PAF values in blood, decreased specific activity of PAF-CPT and Lyso-PAF-AT, increased specific activity of PAF-AH in platelets and leukocytes and Lp-PLA2 in plasma compared to healthy women. The EC50 of PAF and Thrombin were higher compared to healthy women. CONCLUSION: The increased LpPLA2 activity, as well as, the decreased activities of PAF-CPT and Lyso-PAF-AT, explain the decreased bound-PAF level in TD patient and the EC50 of PAF. However, total PAF is in a normal range and this probably can explain one of the reasons this TD patient has no CAD.     

Exact transmission-disequilibrium tests with multiallelic markers

The transmission-disequilibrium (TD) test is a powerful method for detecting linkage between marker and disease loci in the presence of linkage disequilibrium. For multiallelic markers, we propose the use of exact tests, which are implemented using both an exact algorithm and Markov chain Monte Carlo simulation. Simulation studies show that exact tests improve both the small sample validity and the power of the TD method. We also compared the usual single-affected-offspring sampling scheme to one in which pairs of affected siblings are sampled. Affected-sib-pair sampling greatly increases the power of the TD method and will be most useful when a sample of affected sib pairs is available from prior linkage studies. Genet. Epidemiol. 14:337–347,1997. © 1997 Wiley-Liss, Inc.     

我国出境旅行者腹泻流行特征及其经济损失研究

〔目的〕揭示我国当前出境旅行者腹泻(TD)的流行特征、规律及其对经济造成损失的情况,科学地指导我国国际旅行卫生保健工作。〔方法〕对2004年经广州机场口岸入境的中国籍回国旅行团进行整群抽样的问卷调查。利用计算机Excel软件对资料进行整理、归类和计算,运用SPSS统计软件对计算结果进行统计分析。〔结果〕根据对988名回国旅行者的问卷调查,共发现115例TD病人,总发病率为11.64%。去东南亚国家旅行组的TD发病率为15.31%,明显高于去其他国家旅行组(5.26%);探亲和文化科技交流活动组的TD发病率为20.23%,显著高于观光和商务旅行组(9.82%)。运用非条件logistic回归分析法建立的中国出境TD发病的回归模型,同时反映了旅行目的地、旅行目的、职业等8个因素与TD发病的相关程度,其中旅行目的地与TD发病的相关程度最大。旅行总消费费用中位数为人民币7800元的115例TD病例,每例TD的直接经济损失中位数为340元,占病例旅行总消费费用中位数的4.36%;每例TD因耽误旅行行程时间所造成的间接经济损失中位数为2642元,占病例旅行总消费费用中位数的33.87%。[结论]面对当前较高的出境TD发病率及其巨额的经济损失,建议我国旅游行政管理部门、旅行社、口岸卫生检疫部门、航空公司等单位重点加强对去东南亚国家旅行的重点人群的健康教育和宣传,同时采取其他行之有效措施来预防和控制TD。