复发性多软骨炎6例诊治分析

目的：探讨复发性多软骨炎的临床特征及诊治方法,提高其诊疗水平。方法：回顾性分析总结6例复发性多软骨炎的临床资料,复习相关文献并做综合分析。结果：6例患者经用皮质类固醇激素治疗随访1～6a后均得到控制。结论：复发性多软骨炎是一种较为少见的综合征,激素是治疗本病最有效的药物。     

复发性多软骨炎的临床特征

目的探讨复发性多软骨炎（RP）的临床特征及诊治方法，提高诊治水平。方法对8例RP患者做回顾性分析，并复习相关文献。结果RP是一种全身多器官软骨结构及结缔反复发作性炎症为特征的自身免疫性疾病，目前以糖皮质激素、氨苯砜为主药物治疗。结论对有特征性临床表现的病例应尽早确诊并药物治疗。     

复发性多软骨炎1例误诊分析

目的提高对复发性多软骨炎的认识,减少误诊。方法报道广西龙潭医院1例诊断复发性多软骨炎患者的临床资料,并进行分析。结果患者曾被误诊为肺部感染及支气管哮喘,经回顾性分析更正诊断为复发性多软骨炎。结论以呼吸道症状为首发表现的复发性多软骨炎需正确诊断,应用糖皮质激素治疗能显著改善症状及预后。     

以哮喘为首发表现的复发性多软骨炎1例并文献复习

复发性多软骨炎(relapsing polyclaondritis,RP)是一种原因不明、少见的、累及全身系统的自身免疫性疾病,具有反复发作及进展性炎性破坏性病变等特点,可累及软骨和其他全身结缔组织[1].本院收治1例以哮喘为首发表现的RP患者,结合文献复习并分析其临床资料,旨在提高对本病的认识及早期诊治水平.     

全身骨显像在复发性多软骨炎诊断中的应用2例

复发性多软骨炎（relapsing polychondritis）是一种较少见的炎症破坏性疾病，以反复发生的软骨组织及结缔组织炎症为特征，主要累及耳廓、鼻、气管、支气管、外周关节、眼、内耳、心脏等器官，其病因不明，目前诊断主要按照McAdam提出的诊断标准及Damiani的修订标准。1988年荷兰学者ter Borg曾报道了核素全身骨显像在复发性多软骨炎诊断中的应用日，而迄今国内有关复发性多软骨炎患者核素全身骨显像应用方面的资料仍较少，现报道两例复发性多软骨炎及全身骨显像表现如下。     

复发性多软骨炎误诊分析

复发性多软骨炎曾被命名为全身性软骨软化、弥漫性多软骨周围炎 ,是一种侵犯全身广泛软骨组织器官的炎性疾病。由于早期症状隐匿 ,表现复杂 ,临床易误诊。近年来我们遇到 3例 ,报告如下。1　临床资料1 1　一般资料　 3例均为男性 ,年龄 39～ 4 2岁。 3例均有低热或间歇热 ,急性     

一例以呼吸困难为主的复发性多软骨炎患者的护理

一例以呼吸困难为主的复发性多软骨炎患者的护理中国人民解放军南京部队总医院专修科欣翠玲复发性多软骨炎（ＲｅｌａｐｓｉｎｇＰｏｌｙｃｈｏｎｄｒｉｔｉｓ，ＲＰ）是一种原因未明的严重的全身性疾病。主要累及全身软骨组织、心血管系统和特殊感觉器官（耳和眼）。在现...     

复发性多软骨炎5例诊治体会

复发性多软骨炎是一种少见的风湿病,主要累及耳、鼻、气管支气管等富含软骨部位和内耳、眼等特殊感官器官,部分病人因气管塌陷致窒息或感染致死亡。本科自1992年以来诊治5例复发性多软骨炎病人,现将该5例病人的临床表现和诊治体会总结如下。     

复发性多软骨炎合并强直性脊柱炎一例

复发性多软骨炎是一种累及多系统、反复发作的自身免疫性疾病,临床表现多种多样,缺乏特异性诊断指标,易误诊或漏诊。治疗上以NSAID、糖皮质激素和免疫抑制剂为主,生物制剂也有一定的疗效。该文报道1例复发性多软骨炎合并强直性脊柱炎患者,使用生物制剂、糖皮质激素和免疫抑制剂联合治疗,随访2年病情稳定。该例提示,应提高对复发性多软骨炎合并强直性脊柱炎的认识,提高诊治能力,治疗中应密切监测疗效和不良反应。     

复发性多软骨炎二例

目的:提高对复发性多软骨炎的认识,避免误诊误治.方法:对收治的2例复发性多软骨炎的临床资料进行回顾性分析.结果:本组例1因间断发热9个月,双耳肿痛4个月,多关节肿痛3个月入院.1个月前鼻软骨出现局限性塌陷,在当地医院行双耳软骨清理术,术后病理诊断为软骨梗死性坏死.查双侧外耳廓呈菜花样畸形,鼻呈鞍鼻畸形,双手掌指关节、近端指间关节、双膝关节、双踝关节、双足跖趾关节肿胀、触痛,双膝浮髌征(+);血白细胞18.3×109/L,中性粒细胞0.92,红细胞沉降率150 mm/h;r-氨基转肽酶150 U/L,碱性磷酸酶556 U/L,明确诊断为复发性多软骨炎.例2因双耳廓肿胀伴面神经炎4个月,发作性癫痫2个月入院.查双耳廓肿胀,皮色略红,触痛(+);血白细胞13.3×109/L,中性粒细胞0.86,红细胞沉降率50 mm/h,经协和及北京中日友好医院风湿科专家会诊诊断为复发性多软骨炎.结论:复发性多软骨炎是较为罕见的自身免疫性风湿病,激素及免疫抑制剂治疗有效,临床应注意鉴别诊断.     

Oxidative parameters and mortality in sepsis induced by cecal ligation and perforation

OBJECTIVE: This study assessed parameters of free radical damage to biomolecules, mitochondrial superoxide production, superoxide dismutase, and catalase activities and their relationship to sepsis mortality. DESIGN AND SETTING: Prospective animal study in a university laboratory for experimental. SUBJECTS: 140 male Wistar rats. INTERVENTIONS: The animals were randomly divided into three groups: sham-operated (n=20), cecal ligation and perforation resuscitated with normal saline (n=40), and cecal ligation and perforation with normal saline plus antibiotics (n=40). MEASUREMENTS AND RESULTS: Blood samples were collected from all animals 3, 12, and 24 h after CLP through a jugular catheter inserted before CLP. Rats were evaluated during 5 days after the intervention. Nonsurvivor animals were grouped according to the duration between sepsis induction and death, and oxidative parameters were compared to survivors and sham-operated. Lipid peroxidation, protein carbonyls, and superoxide dismutase were significantly increased in nonsurvivor septic rats and were predictive of mortality. We demonstrated that there is a different modulation of superoxide dismutase and catalase in nonsurvivors during the course of septic response. There was a marked increase in superoxide dismutase activity without a proportional increase in catalase activity in nonsurvivors. CONCLUSIONS: This is the first report of plasma superoxide dismutase as an earlier marker of mortality. Ours results might help to clarify an important aspect of oxidative response to sepsis, i.e., an increase in superoxide dismutase activity without a proportional increase in catalase activity     

Gabapentin and pregabalin in the treatment of fibromyalgia: a systematic review and a meta-analysis

WHAT IS KNOWN AND OBJECTIVES: Fibromyalgia (FBM) is a common chronic pain disorder affecting up to 2% of the general population. Current treatment options are mostly symptom-based and limited both in efficacy and number. Two promising alternatives are gabapentin (GP) and pregabalin (PB). We aimed to estimate the efficacy and safety/tolerability of the two compounds in FBM through a systematic review and a meta-analysis of relevant randomized double-blind placebo-controlled (RCT) were performed. DATA SOURCES, EXTRACTION AND ANALYSIS: A literature search was conducted through MEDLINE, EMBASE, Cochrane CENTRAL and the reference lists of relevant studies. Responders to treatment (>30% reduction in mean pain score) and dropouts due to lack of efficacy were used as primary outcome measures. Dropout rates and incidence of common adverse outcomes were also investigated. Four RCTs, reporting data on 2040 patients, were reviewed and three of them using PG were included in the meta-analysis. RESULTS: Pregabalin at a dose of 600, 450 and 300 mg per day is effective in FBM compared to placebo (NNT: 7, upper 95% CI: 12, 450 mg). A number of adverse events (AE), such as dizziness, somnolence, dry mouth, weight gain, peripheral oedema, is consistently associated with treatment at any dose and could lead one out of four patients to quit treatment (NNH: 6, lower 95% CI: 4, 600 mg). Indirect comparison meta-analysis suggests that PB at a dose of 450 mg per day could result in more responders than at 300 mg, but this result needs to be interpreted with caution as there were no significant differences between 600 and 300 mg or between 600 and 450 mg. Data on GP is limited. WHAT IS NEW AND CONCLUSIONS: The analysis indicates that PB at a dose of 450 mg per day is most likely effective in treating FBM, although AE are not negligible. Further evidence is necessary for more conclusive inferences.     

Irish nurses' and midwives' understanding and experiences of empowerment

AIM: This study explored conceptualizations of empowerment among Irish nurses and midwives. BACKGROUND: Current literature on the meaning of empowerment lacks consensus. As a result there is a likelihood that empowerment will be conceptualized differently between managers and subordinates. METHOD: In order to get a sense of how Irish practitioners viewed empowerment, 10 focus groups were held in locations throughout Ireland (n = 93). A national distribution of participants was obtained. RESULTS: Twenty-one different responses emerged representing what nurses and midwives understood by the term empowerment. In relation to experiences of empowerment, six themes were found to impact on empowerment experiences. Three themes emerged as central to empowerment. One theme (education for practice) was identified as an antecedent to empowerment. CONCLUSION: Empowerment is a complex concept and its meaning is contextually determined. Managers play a key role in impacting on the empowerment perceptions of Irish nurses and midwives.     

鸣禽发声学习记忆与即刻早期基因

背景鸣禽受到声音信号的刺激或自身表现出发声行为时,脑内即刻早期基因(immediate early gene,IEG)能迅速被激活而表达.其中zenk,c-fos和c-jun表达的脑区及水平与鸟在鸣唱时神经元的活动区域及活动程度相一致,暗示即刻早期基因在鸣禽发声学习记忆中起重要作用.目的探讨鸣禽发声学习与即刻早期基因之间的关系,有助于对人类语言及中枢调控机制的理解.资料来源应用计算机检索Medline数据库1990-01/2001-11的相关文章,检索词为"songbird"和"vocal learning,memory,zenk,c-fos,c-jun",分别组合进行检索,限定文章语言种类为英文.同时计算机检索中国期刊全文数据库、万方数据库1990-01/2001-11期间的相关文章,检索词"鸣禽,发声,学习记忆,即刻早期基因",限定文章语言种类为中文.资料选择对资料进行初审,选取包括鸣禽学习记忆与即刻早期基因相关内容的文献,然后筛除非随机对照实验,对剩余的文献开始查找全文. 资料提炼共收集到17篇关于鸣禽学习记忆及即刻早期基因的文章,其中11个试验符合纳入标准,排除6篇为综述.资料综合①zenk基因与发声行为Zenk在鸟脑内的表达可能通过调节特定蛋白质的合成,来影响学习记忆.在鸣啭过程中,一些半衰期较短的蛋白质被消耗,而Zenk的高效表达可能通过某种途径补充这些蛋白质的消耗.②c-fos对不同鸣曲的反应鸟脑内局部神经元对亲鸟鸣声的活动性反应取决于鸣啭学习时鸣曲因素的数目.③c-jun与c-fos的协同作用Zenk,fos和jun的表达为保持长期记忆所必需,这可能是通过信号转导、诱导突触重建、合成及传递所需蛋白质等途径来发挥作用.结论鸣禽受到声音信号的刺激或自身表现出发声行为时,脑内即刻早期基因能迅速被激活而表达.其中zenk,c-fos和c-jun表达的脑区及水平与鸟在鸣唱时神经元的活动区域及活动程度相一致,暗示即刻早期基因在鸣禽发声学习记忆中起重要作用.     

彩色多普勒超声对假性动脉瘤的诊断和治疗

目的：本文旨在总结假性动脉瘤的彩色多普勒超声表现，并介绍彩色多普勒超声引导下的压迫治疗方法。方法：对１９９５～１９９８年我院经彩色多普勒超声诊断的１３例假性动脉瘤进行分析。在彩色多普勒超声引导下压迫治疗２例假性动脉瘤。结果：１３例假性动脉瘤病人中１１例经手术证实。另２例压迫治疗成功。结论：彩色多普勒超声对假性动脉瘤诊断准确率较高。彩色多普勒超声引导下压迫治疗假性动脉瘤是一种安全、有效的非介入性方法     

Vertebral arteries and cervical rotation: modeling and magnetic resonance angiography studies

OBJECTIVE: To determine whether lumen narrowing in vertebral arteries during atlanto-axial rotation is due to stretch or localized compression. DESIGN AND SETTING: Experiments with models were made in a private chiropractic clinic, whereas studies of cadaveric specimens were performed in an anatomy laboratory. Doppler ultrasound and magnetic resonance angiography (MRA) studies were carried out in the radiology department of a public hospital. PATIENTS: Eight patients had their vertebral arteries examined by use of a Doppler velocimeter and MRA. Main Outcome Measure: Stenosis of the vertebral arteries caused by stretch, localized compression, or kinking. RESULTS: All 16 vertebral arteries from the 8 patients displayed no changes in their lumen dimensions with full cervical rotation, although curves in each of the arteries did change. The model and cadaveric vertebral arteries demonstrated localized compression or kinking of the vessel wall with atlanto-axial rotation contralaterally but revealed no evidence of major contribution of stretching to stenosis. CONCLUSION: The lumen of vertebral arteries is usually unaffected by atlanto-axial rotation. In cases where there is stenosis, this is mainly due to localized compression or kinking. These findings are relevant to premanipulative screening of vertebral arteries with Doppler ultrasound scanning.     

Age and gender as risk factors for hyponatremia and hypernatremia

BACKGROUND: This study assesses gender and age as independent risk factors for hypo- and hypernatremia and describes the prevalence of hypo- and hypernatremia in different population groups. METHODS: Details of all serum Na results with accompanying patient demographics for 2 years were downloaded from the laboratory database into Microsoft Access for multiple logistic regression analysis using SPSS. Female gender and age <30 years were the reference groups. RESULTS: Data from 303577 samples on 120137 patients were available for analysis. Prevalence at initial presentation to a health care provider of Na<136, <116, >145, and >165 mmol/l were for acute hospital care patients: 28.2%, 0.49%, 1.43%, and 0.06%; ambulatory hospital care: 21%, 0.17%, 0.53%, and 0.01%; community care: 7.2%, 0.03%, 0.72%, and <0.01%. Age odds ratios rose with increasing age to 1.89 and 8.70 (Na<136 and <116 mmol/l) and 7.09 and 24.39 (Na>145 and >165 mmol/l, respectively) for age >81 years. Male gender was a mild risk factor for Na<136 mmol/l and was otherwise unimportant. CONCLUSIONS: Hyponatremia is a common but generally mild condition while hypernatremia is uncommon. Increasing age is a strong independent risk factor for both hypo- and hypernatremia. Gender is not an important risk factor for disturbances of serum Na concentration.     

Combined UV and IR laser ablation of dentine

OBJECTIVE: The aim of this study was to increase the rate of removal of dentine tissue by a 213-nm laser through the introduction of an Er:YAG assisting laser. BACKGROUND DATA: The rate of dentine removal is increased by using a CO2 laser to assist a XeCl excimer laser. METHODS: Extracted human teeth were sliced parallel to the crown and exposed to 213-nm laser and Er:YAG laser beams that were spatially and temporally aligned. The 213-nm laser radiation was generated using a Q-switched Nd:YAG (5 nsec, 10 Hz) and three nonlinear crystals. The Er:YAG laser was free running with a pulse duration of 100 microsec and a pulse repetition rate of 10 Hz. A fluence range of 5-18.6 J/cm2 (213 nm) and 0.6-1.3 J/cm2 (Er:YAG) was used. Axial ablation rates were measured for different pulse energies and pulse overlaps. RESULTS: The ablation rate of dentine increased in most cases by a factor of two. The highest ablation rate achieved was 18.3 microm/pulse +/- 2.51, which is more than twice the highest ablation rate previously published using a 213-nm laser. Changes in the pulse superpositions that were investigated did not present a significant change in the ablation rate. CONCLUSIONS: The Er:YAG laser can be used to increase the removal rate of dentine by a short-pulse ultraviolet (UV) laser.