以腹胀为主要表现的睾丸非精原细胞瘤1例

患者男,汉族,39岁,自诉近4个多月以来无明显诱因出现腹胀,呈持续性发作,喝酒后明显,严重时伴有嗳气,嗳气排放后腹胀町缓解,同时伴有消瘦、体重进行性减轻,无发热、恶心、呕吐、腹痛、腹泻、呕血、胸闷、心悸、黑便等症状,并在院外规律治疗,症状无明显缓解,到我院就诊,以"腹胀原因待查"收住院,无发热、恶心、呕吐、腹痛、腹泻、呕血、胸闷、心悸、气促等不适,进食稍差,大小便次数减少,体重减轻15 kg.     

席汉氏综合征致精神障碍1例

1 病例资料 患者,女,42岁,8年前因产后大出血出现闭经、怕冷、少汗、淡漠、疲倦、反应迟钝、被动、少语、厌食,腋毛、阴毛显著脱落,眉毛稀少,体质虚弱、机体抵抗力差.1月前,无明显诱因出现被害、关系妄想,情绪低落、发愁、心烦,爱发脾气来我院治疗.入院检查:意识清晰、接触被动、皮肤干燥、毛发脱落、心肺无异常;定向力存在,有关系、被害妄想,情绪低落,自知力部分存在.辅助检查:心电图、脑电图、头颅CT、血常规、尿常规、肝功能、肾功能均无异常.诊断:席汉氏综合征致精神障碍.经肾上腺皮质激素、甲状腺素、性激素及抗精神病、抗抑郁等药物治疗,好转出院.     

中药加针刺对脑卒中患者肢体运动功能的影响

１资料与方法急性脑卒中患者９０例 ,均经临床、ＣＴ或ＭＲＩ确诊 ,男５４例 ,女３６例 ,年龄４０～７８岁 ,平均年龄５６岁。其中脑出血２７例 ,脑梗塞６３例。随机分为２组。治疗组６０例 ,内服中药治疗 ,方剂为 :赤芍、川芎各１５ｇ,黄芪、黄精各３０ｇ,三七、蒲黄、全蝎各１０ｇ,蜈蚣３条 ,地龙、丹参、首乌各２０ｇ ,每付煎３００ｍｌ,每次服１００ｍｌ ,２次／ｄ ,１月为１疗程。针刺取穴 :上肢 :肩、曲池、手三里、外关、合谷、劳宫。下肢 :环跳、阳陵泉、太冲、足三里、申脉、委中、昆仑 ,针刺后用补法 ,行针３０～４０ｍｉｎ ,起…     

消灭越冬蚊

夏秋季气温较高,是蚊子大量繁殖、猖狂活动的季节。到了冬季,蚊子大多数冻死了,只有少数吸过血的雌蚊寻找温暖潮湿,避风、阴暗、不受惊动的地方,如地下室、防空洞、空屋、仓库、柴草间、储藏室、地窖、枯井、牛栏、猪圈、床下,楼梯底下躲藏起来过冬。这时蚊子不仅数量少,不繁殖,栖息集中,而且不食、不飞、不动,是蚊子一生中最脆弱的时期,因此,是我们消灭它的最好季节。冬天消灭一只蚊子,     

消瘦、呕吐、吞咽、构音障碍、黄疸

1　病历摘要患者女 ,68岁。因厌食、消瘦、呕吐 2个月 ,加重伴构音障碍、吞咽困难 1 5天 ,于 2 0 0 0年 7月 2 2日入院。患者 2个月前因与家人争吵后开始出现情绪低落 ,寡言少语 ,食欲下降 ,恶心、频繁呕吐 ,进食即吐 ,吐出胃内容物 ,伴腹胀、乏力 ,体重减轻约 1 0ｋｇ ,无腹痛、腹泻 ,无发热、头痛 ,无胸痛、咳嗽、咳痰、胸闷、心悸、气急 ,无盗汗、午后潮热 ,无多饮、多尿症状。多次在当地医院就诊 ,诊断为“胃病、抑郁症、神经性厌食” ,用吗丁啉、法莫替丁、多塞平等治疗无效。 1 5日前突然出现讲话困难、进食呛咳 ,开始尚能进食稀饭 ,…     

二维斑点追踪成像技术评价完全性左束支传导阻滞患者的左心室功能及同步性

目的应用二维斑点追踪成像技术（2D-STI）探讨不同应变模式对完全性左束支传导阻滞（CLBBB）患者左心室收缩功能及同步性的影响。 方法选取2016年4月至2018年4月在中国医科大学附属第一医院接受检查的CLBBB患者90例,根据二维纵向应变特征分为经典型（CPD）组及非CPD型（n-CPD）组,再进一步选取其中左心室射血分数（LVEF）>50%的患者,同上分为CPD组及n-CPD组;另选30名健康人作为健康对照组。对各组均行常规超声心动图及2D-STI检查,测量常规超声心动图参数：左心室舒张末期内径（LVEDD）、左心室舒张末期容积（LVEDV）及LVEF等;测量并计算左心室整体纵向峰值应变（GLS）、左心室流出道与右心室流出道射血前期时间差（IVMD）、基底段和中间段左心室侧壁与室间隔的应变达峰时间延迟（b-Ssl,m-Ssl）以及左心室18节段心肌纵向应变达峰时间的标准差（SDt）。 结果与健康对照组比较,CPD组及n-CPD组LAD、RVBD、E/e′增高,E/A、EDT减低,差异均有统计学意义（t=5.12、3.67、7.29、5.69、5.89、3.15、2.05、5.89、5.22、3.83,P均<0.01）;与n-CPD组比较,CPD组LAD、E/e′增高,E/A减低,差异均有统计学意义（t=8.12、3.24、3.94,P均<0.01）。与健康对照组比较,CPD组QRS、LVEDD、LVESD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高,LVEF、左心室间隔、侧壁及总体纵向应变减低,差异均有统计学意义（t=20.38、7.17、7.35、6.50、5.86、10.24、7.15、6.35、11.24、10.99、5.92、6.12,P均<0.001）;与健康对照组比较,n-CPD组QRS、LVEDD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高,LVEF、左心室间隔、侧壁及总体纵向应变减低,差异均有统计学意义（t=16.54、1.99、2.12、2.07、5.87、2.53、2.10、5.06、2.68、3.66、2.06、3.62,P均<0.05）;与n-CPD组比较,CPD组QRS、LVEDD、LVESD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高,LVEF、左心室间隔、侧壁及总体纵向应变减低,差异均有统计学意义（t=4.68、5.96、6.63、5.32、5.01、5.10、5.28、4.86、7.16、4.74、7.20、3.78、3.57,P均<0.001）。进一步选择LVEF>50%的患者进行比较,组间LVEF比较,差异无统计学意义（P>0.05）,与健康对照组比较,CPD组QRS、LVEDD、LVESD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高,左心室间隔、侧壁及总体纵向应变减低,差异均有统计学意义（t=19.44、4.01、5.21、5.61、4.73、9.19、5.27、3.16、3.25、8.02、4.15、5.42,P均<0.001）;与健康对照组比较,n-CPD组QRS、LVEDD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高,左心室间隔及总体纵向应变减低,差异均有统计学意义（t=20.68、2.46、3.15、3.10、6.95、3.00、4.59、6.53、3.84、4.05,P均<0.05）;与n-CPD组比较,CPD组QRS、LVEDD、LVESD、LVEDV、LVESV、IVMD、b-Ssl、SDt增高,左心室间隔、侧壁及总体纵向应变减低,差异均有统计学意义（t=2.73、2.13、3.88、3.06、2.19、3.94、3.00、3.25、4.38、2.90、2.30,P均<0.05）。 结论常规超声心动图结合2D-STI技术可早期发现CLBBB患者左心室收缩功能及收缩同步性减低,且CPD型CLBBB较n-CPD型CLBBB进一步减低的现象,可提示临床需密切关注CPD型CLBBB患者,及时进行治疗干预。     

湖南南洋专修学院招生及新版书信息

湖南南洋专修学院是经省教委批准的一所综合性大学 ,以培养高级和中级实用人才为办学宗旨 ,每年的春秋季面向社会招收全日制住读生及业务函授生 ,层次分为本科、大专及中专。专业设置 :临床医学、中医、口腔学、护理学、药学、医学影像、医学检验、经济管理、计算机应用、法律、英语、公关文秘、市场营销、会计、旅游管理、工艺美术、工民建、服装、电子、国际贸易、金融、行政管理等。本校环境幽雅 ,设施齐全 ,学习结束考试合格 ,发国家承认学历的毕业证书 ,可解决农转非户口 ,安置就业。欲报名者请来信 ,并随信夹寄 3元资料费 ,索取彩印招…     

浅析《伤寒论》误治之变

溯及《伤寒论》原文,临证不明表里、虚实、寒热、病位、病邪、病势等,治失其法,导致火邪炽盛,伤津耗液,或误治伤正,阳气亏虚,或正虚邪陷,虚实夹杂等,酿成动血、谵语、烦躁、惊狂、发黄、奔豚、心悸、中虚、痞满、结胸、不寐、下利、便难、发喘之变。该篇从条文出发,探析误治的原因和条件及误治对疾病传变和人体正气的影响,究极误治之病因病机,强调不论何种变证,辨证论治贯穿治疗始末。     

新鲜土三七外敷治疗局部软组织水肿的疗效观察及护理

土三七又称养心草,别名毛田七、景天三七、八仙草、活血丹、血山草,又名见肿消、见血散、菊叶三七,属景天科类植物,是民间常用中草药,食用可强身健体,全草或根均可入药。该药性平、味甘、微酸、无毒性,有凉血止血、散瘀、消炎、安神、镇痛等作     

内镜下治疗上消化道异物67例

从1995年4月～1998年7月,本院经内镜下治疗上消化道异物67例,现报道如下。1临床资料1．1一般资料67例中,男38例,女29例,年龄3～83岁,平均34岁。病程最短半小时,最长7天。误服35例,自残13例,胃内源性异物19例。1．2异物的种类与部位金属类异物21例,共23件,包括铁钉、铁丝、缝衣针、锁匙、折叠剪刀、硬币、金戒指、金耳坠、耳环、发夹、手表（女式）,刀片、拉链手柄等。非金属类27例,共29件,有包装材料用铂、瓶盖、牙刷、钮扣、义齿、鸡骨、排骨、鱼刺、鱼骨、龙虾壳、食物团、枣核等。内源性异物19例,术后缝线残留10例,蛔虫7…     

Discovery of the causative organism of Weil's disease: historical view

On January 20, 1915, Inada and Ido announced the discovery of the causative agent of Weil's disease. Subsequently, on February 13, 1915, they published the first paper on the discovery of the causative organism (a new species of Spirochaeta) of Weil's disease. Besides discovering the causative organsim of the disease, Inada and colleagues clarified the pure culture in medium, and determined the source and route of the infection, its pathology and morbid anatomy; the distribution of the organism in various organs and tissues; the excretion of the spirochete, and its division, filterability, and morphological characteristics; and the clinical picture, laboratory findings, diagnosis, prophylaxis, and treatment of the disease. These studies were conducted by Inada, Ido, Kaneko, Hoki, and Ito, in the years 1914 to 1915. In the early investigation of leptospirosis, Inada and colleagues played a prominent part. We would like to remember these remarkably complete and definitive original achievements on leptospirosis made by Inada and colleagues. Received: August 21, 2000 / Accepted: December 12, 2000     

Comparison of the postantibiotic and postantibiotic sub-MIC effects of levofloxacin and ciprofloxacin on Staphylococcus aureus and Streptococcus pneumoniae.

The postantibiotic subminimum inhibitory concentration effect (PA SME) may simulate in vivo drug exposure more accurately than the postantibiotic effect (PAE) since subinhibitory concentrations of drug persist between antibiotic dosings. In this study, we compared the PAEs and PA SMEs of levofloxacin and ciprofloxacin for clinical isolates of fluoroquinolone-susceptible Staphylococcus aureus and Streptococcus pneumoniae. At two times the MIC, PAEs of levofloxacin were an average of 0.6 h longer than the PAEs obtained for ciprofloxacin for methicillin-susceptible and methicillin-resistant S. aureus strains. The PAEs of levofloxacin and ciprofloxacin ranged from 1.8 to 3.1 and 1.1 to 2.4 h, respectively. Continued exposure of the methicillin-resistant strain to 1/16, 1/8, and 1/4 the MIC resulted in PA SMEs of 6.5, 15.3, and >22.3 h, respectively, for levofloxacin and 3.8, 8.0, and 12.3 h, respectively, for ciprofloxacin. For isolates of S. pneumoniae, at two times the MIC of both fluoroquinolones, the average PAEs of levofloxacin and ciprofloxacin were equivalent: 1.3 h for the penicillin-susceptible isolate and 0.6 h for the penicillin-resistant isolate. Continued exposure of the penicillin-susceptible S. pneumoniae strain to 1/16, 1/8, and 1/4 the MIC resulted in average PA SMEs of 1.0, 1.4, and 2.8 h, respectively, for levofloxacin and 1.8, 2.0, and 2.5 h, respectively, for ciprofloxacin. Continued exposure of penicillin-resistant S. pneumoniae to 1/16, 1/8, and 1/4 the MIC of the same fluoroquinolones resulted in average PA SMEs of 0.6, 1.1, and 2.9 h, respectively, for levofloxacin and 0.6, 1.1, and 1.5 h, respectively, for ciprofloxacin. The PA SMEs observed demonstrate the superior activity of levofloxacin against methicillin-susceptible or methicillin-resistant S. aureus. Although PAEs were similar for the penicillin-susceptible and penicillin-resistant S. pneumoniae strains, the PA SME of levofloxacin at one-fourth the MIC was longer for penicillin-resistant S. pneumoniae.     

应用“以药测机”理论研究2型糖尿病3期不同病机

目的:应用“以药测机”理论分析2型糖尿病3期的不同病机。方法:通过检索近10年分别治疗2型糖尿病前期、糖尿病期及糖尿病并发症期的文献,经过统计分析治疗疾病3期的不同药物分类、功效主治、性味归经的频次与频率,再通过药物的性质反推出疾病的病机。结果:糖尿病前期共检出中药369频次:以补虚药(105频次)与清热药(69频次)为主;功效以补虚、清热、利水渗湿、解表为主,频率为62.6%;药性以寒凉为主,频率为43.75%;五味以甘、苦、辛为主,频率为81.5%。归经以肝、脾、肾、肺、胃为主,频率为79.7%。糖尿病期共检出中药262频次:以补虚药(97频次)与清热药(78频次)为主;功效以补虚、清热、利水渗湿、活血化瘀为主,频率为80.5%;药性以寒凉为主,频率为67.06%;五味以甘、苦、辛为主,频率为87.5%;归经以肝、肺、脾、胃、肾为主,频率为79.1%。糖尿病并发症期共检出中药380频次:以补虚药(121频次)与活血化瘀药(87频次)为主;功效以补虚、活血化瘀、清热、解表为主,频率为73.9%;药性以温热为主,频率为58.2%;五味以甘、苦、辛为主,频率为83.2%;归经以肝、脾、肺、肾、胃为主,频率为80.8%。结论:糖尿病前期及糖尿病期治以清热益气养阴为主,且解表与利水渗湿并举。糖尿病并发症期治以益气补血、活血化瘀为主,且息风止痉与祛风寒湿并举。总体上以调理肝脾、补益肺肾治其本,重用清热、利水、行气、凉血、活血类药物治其标。从病机上看,糖尿病前期及糖尿病期的病机主要是气阴两虚、肺脾失调。随着疾病进展,“瘀”逐渐加重。当疾病发展成为并发症期时,其病机主要为气血两虚,痰瘀互结,肝肾失调。     

胡金辉运用体质辨证、内外合治三步法分期治疗肉芽肿性乳腺炎经验

目的:肉芽肿性小叶性乳腺炎是一种慢性炎症性疾病,其特征是以乳腺小叶为中心的非干酪样坏死、肉芽肿的形成,病程较长,易反复发作。为缩短病程,降低复发率,减轻患者身心痛苦。方法:胡金辉根据患者的体质辨证,从痰邪致病的理论出发,依证施治,分期论治,内外并重,以"消、托、补"为总治则。在肿块期间,治疗以疏肝解郁、化痰散结为主,外用箍围透药法,使肿块消于无形;在脓肿期间,治疗以清热解毒,理气化痰、消淤散结,外治以提脓祛腐;溃后期内治以益气健脾,托毒生肌,外治以生肌收口。辅以疏肝解郁、活血化瘀,外治则防止创口过早粘连而闭门留寇。结果:经过体质辨证、内外合治后能最大程度的维持乳房外观,治愈率高,复发率低,能大大缩短病程。结论:中医药治疗本病不仅在疗效及复发率不劣于西医,同时具有更好的乳房外观,具有临床指导意义,可作为一种选择的方式。     

正确掌握老年病人的合理用药

老年人随着年龄的不断增长，各器官功能的逐渐减退，对药物的吸收、分布、代谢、排泄及其作用与青年人相比都有很大差异，又由于体弱多病，用药种类较多，药物的不良反应也随之增加。老年病人用药必须严格遵照药物的体内过程及药物代谢动力学理论，结合患者的生理、病理条件，合理使用药物，以取得最佳的疗效。正确掌握合理有效的用药，要结合老年人年高、体弱、多病的特点，选择最佳剂量、时间，合理的配伍和用药方法。既要考虑药物有效性、合理性和安全性，又要权衡药物疗效、配伍禁忌。临床医师必需要以对病人健康极端负责的精神，精通业务，通晓药理及有关知识，慎重、准确地使用药物，尽量避免药物不良反应的产生。确保老年病人的用药安全和疗效。     

In vitro selection of ramR and soxR mutants overexpressing efflux systems by fluoroquinolones as well as cefoxitin in Klebsiella pneumoniae

The relationship between efflux system overexpression and cross-resistance to cefoxitin, quinolones, and chloramphenicol has recently been reported in Klebsiella pneumoniae. In 3 previously published clinical isolates and 17 in vitro mutants selected with cefoxitin or fluoroquinolones, mutations in the potential regulator genes of the AcrAB efflux pump (acrR, ramR, ramA, marR, marA, soxR, soxS, and rob) were searched, and their impacts on efflux-related antibiotic cross-resistance were assessed. All mutants but 1, and 2 clinical isolates, overexpressed acrB. No mutation was detected in the regulator genes studied among the clinical isolates and 8 of the mutants. For the 9 remaining mutants, a mutation was found in the ramR gene in 8 of them and in the soxR gene in the last one, resulting in overexpression of ramA and soxS, respectively. Transformation of the ramR mutants and the soxR mutant with the wild-type ramR and soxR genes, respectively, abolished overexpression of acrB and ramA in the ramR mutants and of soxS in the soxR mutant, as well as antibiotic cross-resistance. Resistance due to efflux system overexpression was demonstrated for 4 new antibiotics: cefuroxime, cefotaxime, ceftazidime, and ertapenem. This study shows that the ramR and soxR genes control the expression of efflux systems in K. pneumoniae and suggests the existence of efflux pumps other than AcrAB and of other loci involved in the regulation of AcrAB expression.     

NEWS AND INNOVATIONS

Representative Frank R. Wolf, Chairman of the U.S. House of Representatives Subcommittee on Commerce, Justice, State, and the Judiciary, Committee on Appropriations; and Representative James C. Greenwood, Chairman of the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, requested that the U.S. Government Accounting Office (GAO) investigate OxyContin Abuse and Diversion. The GAO is the audit, evaluation and investigative arm of Congress. On December 23, 2003, the GAO submitted a 57 page report to the Representatives describing the outcomes of the investigation.

The full report includes appendices that describe the scope and methodology of the investigation, summaries of FDA changes to the original approved OxyContin label, databases used to monitor abuse and diversion of OxyContin and oxycodone, and comments from the FDA and DEA. This special report is an abstract of the GAO report and includes the conclusions and recommendations for action form the full report.     

Changes in the screening efficacy of lower calf circumference,SARC-F score, and SARC-CalF score following update from AWGS 2014 to 2019 sarcopenia diagnostic criteria in community-dwelling older adults

[Purpose] To identify changes in the efficacy of the Asia Working Group for Sarcopenia (AWGS) screening tools and the differences between the different screening tools following the updates from the AWGS 2014 to 2019 criteria for community-dwelling older adults. [Participants and Methods] We included 139 community-dwelling older adults aged ≥65 years. We assessed the lower calf circumference, SARC-F score, SARC-CalF score, skeletal muscle mass, grip strength, and gait speed. Moreover, we investigated the sensitivity, specificity, likelihood ratios, and area under the ROC curve of the lower calf circumference, SARC-F score, and SARC-CalF score using the AWGS 2014 and 2019 criteria for sarcopenia diagnosis. [Results] The prevalences of sarcopenia were 10.8% and 12.9%, and 5.0% using the AWGS 2014 and 2019, and 2019 severe sarcopenia diagnostic criteria, respectively. Using AWGS 2014 criteria, the sensitivity and specificity of lower calf circumference, SARC-F score, and SARC-CalF score, were 86.7% and 62.1%, 13.3% and 91.9%, and 66.7% and 80.6%, respectively. Using AWGS 2019 criteria, the sensitivity and specificity of lower calf circumference, SARC-F score, and SARC-CalF score were 83.3% and 62.8%, 11.1% and 91.7%, and 66.7% and 81.8%, respectively. Using AWGS 2019 severe sarcopenia criteria, the sensitivity and specificity of lower calf circumference, SARC-F score, and SARC-CalF score were 100% and 59.8%, 14.3% and 91.7%, and 71.4% and 78.0%, respectively. [Conclusion] All screening tools used in AWGS 2014 and 2019 were similar in terms of efficacy; however, the AWGS 2019 severe sarcopenia criteria had different characteristics.Key words: Sarcopenia, Screening, Community-dwelling older adults     

近五年神经病理性疼痛相关研究的可视化分析

目的:探索过去5年来神经病理性疼痛研究中的学科热点和合作网络，对这些研究进行定性和定量的分析，以明确未来的研究方向，促进进一步的研究。方法:有关神经病理性疼痛的研究文献来源于Web of Science数据库。通过CiteSpace 5.8.R3软件分别从年发文量、被引频次、国家、机构、基金、作者、关键词、参考文献等方面进行可视化分析。结果:共纳入3187篇文献，分析结果显示：该领域年均发文量在600篇以上，年发文量总体呈上升趋势，发文量最多的作者为元祥涛，作者Finnerup NB和Chaplan SR为主要影响人物，美国约翰斯·霍普金斯大学为领先机构，基于中枢敏化、氧化应激、神经炎症、小胶质细胞激活探讨的发病机制，以及重复经颅磁刺激、经皮神经电刺激、和非阿片类药物开发的治疗措施，是该领域的研究热点。预测以免疫机制为基础，探讨免疫系统和神经病理性疼痛之间的相互作用，评估免疫调节剂在疼痛中的疗效，探究有效的神经病理性疼痛的防治措施，可能成为前沿趋势。结论:本研究通过可视化分析总结了神经病理性疼痛领域的研究趋势和发展，并预测潜在的研究前沿和热点方向。     

Effects of cadence on energy generation and absorption at lower extremity joints during gait

BACKGROUND: Information regarding kinetic changes associated with walking speed is important for identifying alterations in locomotor disorders caused by pathological processes, as opposed to those arising solely from altered speeds. METHODS: Fourteen healthy subjects were assessed walking at both natural and imposed cadences of 60, 80, and 120 steps/min. A 3D motion analysis system, force platforms, and related software were used to obtain kinematic and kinetic data. Net joint powers were calculated across cycles and the area under the positive and negative phases of the power curves provided the mechanical work generated and absorbed at the hip, knee, and ankle. The relative contributions to the total positive and negative work across the four cadences were calculated for each joint. ANOVAs followed by planned contrasts were used to assess the effects of laterality, joint, and cadence. FINDINGS: Power and mechanical work, as well as the contributions of individual joints to the total energy generated and absorbed, were shown to be influenced by walking cadence, independent of laterality. The ankle, knee, and hip contributions to the total limb generation and absorption at the lowest cadence were 53%, 21%, and 26%, and at the highest cadence, the corresponding values were 34%, 33%, and 33%, respectively. INTERPRETATION: Power and mechanical work, as well as the contributions of individual joints to the total energy generated and absorbed, were shown to be influenced by the walking cadence, independent of laterality. These findings will be helpful for identifying walking strategies and adaptations in populations with gait disorders.