别让你的孩子变成“孤雁”

2010年夏天,门诊来了一位8岁男孩阳阳。自进入诊室后,阳阳一直低头端坐、寡言少语,家长在一旁代述病情,语气里透着深深的焦虑。经过问诊,医生了解到,阳阳自幼经常打喷嚏、流鼻涕,但家长一直未加以关注。近两年,阳阳同时出现咳嗽、喘憋症状,虽然在外院按过敏性鼻炎和过敏性哮喘进行过正规的药物治疗,但效果却并不稳定。在家长的坚持下,学校允许阳阳不用上体育     

过敏原特异性IgE合理应用临床案例解读

过敏原特异性IgE（specific IgE,sIgE）检测是明确患者过敏原的重要途径之一。但随着过敏患者的病情变化,sIgE也常处于动态变化过程中,临床上甚至会出现sIgE检出结果与患者病史不相符的情况。本文通过对3例典型病例sIgE结果的案例解读,分别阐述了sIgE动态变化、sIgE假阴性检出及假阳性检出的原因及临床意义,为过敏原特异性IgE合理应用提供了实践依据。     

儿童胸闷变异性哮喘肺功能改变的特征

目的探讨胸闷变异性哮喘患儿肺功能改变的特点,为临床诊断和管理提供依据。方法选取2018年8月至2019年5月确诊为胸闷变异性哮喘的44例患儿为研究对象,选取同期初诊的非急性发作期的典型哮喘患儿62例及健康体检儿童46例为对照组。所有入组儿童在初诊或体检时进行呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)和肺通气功能的检测,胸闷变异性哮喘组和典型哮喘组行支气管激发试验。分析对比不同组患儿的FeNO水平、肺通气功能改变及气道高反应性严重程度。结果胸闷变异性哮喘组FeNO中位数值为14.0(8.0,24.0)ppb,其水平明显低于典型哮喘组[31.0(12.0,51.0)ppb,P<0.05],高于健康儿童组[9.0(7.0,18.5)ppb,P<0.05];胸闷变异型哮喘儿童肺通气功能参数中FEV1/FVC[0.998(0.967~1.079)]、PEF[(94.41±12.91)]、FEF50[79.15(64.78~93.75)]、FEF75[66.50(53.10~95.90)]均显著低于健康儿童组[1.080(1.039~1.103),P<0.01]、[(106.38±14.14),P<0.01]、[86.17(79.05~97.67),P<0.05]、[72.29(66.14~81.90),P<0.05],但与典型哮喘组无明显差异(P>0.05);胸闷变异性哮喘组第1秒用力呼气容积(FEV1)下降20%时吸入的乙酰甲胆碱累积剂量(PD20-FEV1)均值为(0.855±0.691)mg,显著高于典型哮喘组[(0.321±0.213)mg,P<0.01]。结论胸闷变异性哮喘患儿FeNO水平高于健康儿童,通气功能FEV1/FVC、PEF及小气道功能指标均低于健康儿童;胸闷变异性哮喘患儿肺通气功能与非急性发作期的典型哮喘患儿接近,但其FeNO水平及气道高反应性的程度均显著低于后者。     

《食物蛋白诱导性小肠结肠炎综合征诊断和治疗国际共识指南》解读

食物蛋白诱导性小肠结肠炎综合征（FPIES）是一种重要的非IgE介导的食物过敏反应,常见于婴幼儿,急性发作时严重者会出现脱水、休克,慢性病程者可能出现生长发育迟缓。2017年,美国变态反应、哮喘和免疫学会下属的食物不良反应委员会联合国际FPIES协会制定并发布了迄今为止唯一一部FPIES诊治指南——《食物蛋白诱导性小肠结肠炎综合征诊断和治疗国际共识指南》。该指南基于文献回顾和临床证据提出了30条意见,为FPIES的临床诊治提供了参考依据。目前,国内医护人员对FPIES的知晓率较低,相关研究很少。该文围绕FPIES的临床表现、诊断、辅助检查、治疗以及预后等方面对该指南进行了详细解读,以加深国内医护人员对FPIES的认识,提高其诊治能力。     

髂后痛对椎间盘源性腰痛的临床诊断价值研究

腰痛是人类最常见的疾病之一,由于能够引起腰痛的解剖部位多且复杂,如何判断腰痛的来源,进行定性及定位诊断一直是临床实践中的难点.在众多的可能产生腰痛的病因中,近年来椎间盘源性腰痛受到更多的重视,并被认为是腰痛最常见的病因[1,2].     

维生素D对儿童哮喘发病机制的影响及辅助治疗方案选择

维生素D作为一种类固醇激素,不仅在骨骼和肌肉健康中而且在骨骼外组织代谢中起着重要的作用,它具有重要的生理功能,包括调节细胞分化、增殖和免疫调节。研究表明,儿童血清维生素D水平低与哮喘风险增加、症状恶化和肺功能下降有关。维生素D已成为预防哮喘复发、症状加重或改善肺功能、增强糖皮质激素抗炎作用的重要免疫调节剂。越来越多的实验研究,随机、对照干预研究阐明了维生素D对哮喘发病机制的潜在影响。在哮喘标准治疗的基础上补充维生素D辅助治疗可获得临床益处,但也有不同结论。将研究成果转化为临床治疗措施面临着选择何时补充维生素D、补充剂量、用药途径、疗程时间、血浆25(OH)D目标水平等问题,以及这些不同治疗方案选择对疗效的影响。     

表皮生长因子对雨蛙肽联合应激诱导的大鼠急性出血性胰腺炎的保护作用

表皮生长因子(EGF)是参与细胞增殖、成熟和再生的主要因子。目前已证实其对胃肠道黏膜具有保护作用,能促进溃疡愈合,但是罕见关于EGF在急性出血性胰腺炎中作用的报道。目的:观察外源性EGF对雨蛙肽联合应激诱导的大鼠急性出血性胰腺炎的保护作用。方法:予雄性Sprague鄄Dawley大鼠腹腔内注射雨蛙肽(40μg/kg,两次注射间隔1h)联合水浸束缚应激(第一次注射雨蛙肽后开始,持续5h)诱导急性出血性胰腺炎。EGF治疗组第一次注射雨蛙肽之前0.5h和之后2.5h,分别皮下注射EGF1、10或30μg/kg。观察各组动物胰腺炎生化、病理学等指标的变化。结果:制模开始后12h,对照组的胰腺湿重为4.24g/kg±0.68g/kg,血清淀粉酶含量为4325U/L±822U/L,胰腺组织DNA和淀粉酶含量分别为1577μg/g±433μg/g和21.39U/mg蛋白±6.83U/mg蛋白,各病理学指标评分均为0。胰腺炎组的胰腺湿重(10.49g/kg±1.87g/kg)和血清淀粉酶含量(24433U/L±16751U/L)较对照组显著增高(P<0.01),胰腺组织DNA(561μg/g±278μg/g)和淀粉酶含量(16.95U/mg蛋白±5.01U/mg蛋白)则降低,病理学评分显著增高(P<0.01)。10μg/kgEGF能显著降低胰腺湿重(6.47g/kg±2.64g/kg,P<0.01)和血清淀粉酶含量(9010U/L±3983U/L,P<0.05),提高胰腺组织淀粉酶含量(23.92U/mg蛋白±8.58U     

腰椎后路椎间融合(PLIF)固定矫形治疗症状性退变性腰椎侧凸

目的总结腰椎后路减压、椎间植骨融合(PLIF)手术治疗退变性腰椎侧凸的疗效及安全性。方法通过总结我科近五年治疗31例退变性脊柱侧凸患者,年龄56～77岁,平均63.7岁,其中男性14例,女性17例,随访12～24个月,平均15个月。术前评估包括详细体格检查,腰、腿痛VAS评分,ODI评分;影像学检查包括站立位腰椎正侧位片、腰椎MRI;所有患者均行腰椎后路减压,退变间隙椎间撑开、植骨、椎弓根螺钉内固定术,术后1、3、6、12个月随访,复查VAS、ODI及X线平片。结果术前腰、腿部VAS评分分别为6.5分和4.7分;ODI术前评分为57.7%;术前腰椎侧凸Cobb角平均为22.8°,腰椎生理前凸角为20.7°。末次随访腰、腿部VAS评分为3.3分和2.4分;ODI评分为30.3%;腰椎侧凸Cobb角平均为9.8°,腰椎生理前凸角为32.1°;以上差异均有统计学意义。未发生椎弓根螺钉断裂及松动,有7例相邻上位间隙进一步发生退变,但患者功能提高,未再手术;无神经瘫痪、深部感染及死亡等严重并发症。结论腰椎退变性侧凸经腰椎后路减压椎间融合矫形椎弓根螺钉内固定既可以矫正不对称性退变,又可以去除疼痛源,恢复腰椎生理前凸,具有手术相对安全、椎弓根螺钉固定牢固等优点,是提高患者功能的有效治疗方法。     

Differentiation of adipose-derived stem cells towards nucleus pulposus-like cells induced by hypoxia and three-dimensional chitosan-alginate gel scaffold in vitro

Background Injectable three-dimensional (3D) scaffolds have the advantages of fluidity and moldability to fill irregular-shaped defects, simple incorporation of bioactive factors, and limited surgical invasiveness. Adipose-derived stem cells (ADSCs) are multipotent and can be differentiated towards nucleus pulposus (NP)-like cells. A hypoxic environment may be important for differentiation to NP-like cells because the intervertebral disc is an avascular tissue. Hence, we investigated the induction effects of hypoxia and an injectable 3D chitosan-alginate (C/A) gel scaffold on ADSCs. Methods The C/A gel scaffold consisted of medical-grade chitosan and alginate. Gel porosity was calculated by the liquid displacement method. The pore microstructure was analyzed by light and scanning electron microscopy. ADSCs were isolated and cultured by conventional methods. Passage 2 BrdU-labeled ADSCs were co-cultured with the C/A gel. ADSCs were divided into three groups (control, normoxia-induced, and hypoxia-induced groups). In the control group, cells were cultured in 10% FBS/DMEM. Hypoxia-induced and normoxia-induced groups were induced by adding TGF-β1, dexamethasone, vitamin C, sodium pyruvate, proline, bone morphogenetic protein-7, and 1% ITS-plus to the culture medium and maintained in 2% or 20% O2, respectively. Histological and morphological changes were observed by light and electron microscopy. ADSCs were characterized by flow cytometry. Cell viability was investigated by BrdU incorporation. Proteoglycan and type II collagen were measured by safranin O staining and the Sircol method, respectively. mRNA expression of hypoxia inducing factor-1α (HIF-1α), aggrecan, and type II collagen was determined by RT-PCR. Results C/A gels had porous exterior surfaces with 80.57% porosity and 50–200 μm pore sizes. Flow cytometric analysis of passage 2 rabbit ADSCs showed high CD90 expression, while CD45 expression was very low. The morphology of induced ADSCs resembled that of NP cells. BrdU immunofluorescence showed that most ADSCs survived and proliferated in the C/A gel scaffold. Scanning electron microscopy showed that ADSCs grew well in the C/A gel scaffold. ADSCs in the C/A gel scaffold were positive for safranin O staining. Hypoxia-induced and normoxia-induced groups produced more proteoglycan and type II collagen than that in the control group (P <0.05). Proteoglycan and type II collagen levels in the hypoxia-induced group were higher than those in the normoxia-induced group (P <0.05). Compared with the control group, higher mRNA expression of HIF-1α, aggrecan, and type II collagen was detected in hypoxia-induced and normoxia-induced groups (P <0.05). Expression of these genes in the hypoxia-induced group was significantly higher than that in the normoxia-induced group (P <0.05). Conclusions ADSCs grow well in C/A gel scaffolds and differentiate towards NP-like cells that produce the same extracellular matrix as that of NP cells under certain induction conditions, which is promoted in a hypoxic state.     

Dynesys内固定系统治疗单节段与双节段腰椎退变性疾病的短期疗效对比

目的 比较单节段与双节段Dynesys系统内固定治疗腰椎退变性疾病的短期临床疗效.方法 2008-10-2011-08,我院采用Dynesys内固定系统治疗37例腰椎退变性疾病患者,其中单节段固定29例,双节段固定共8例(皆为L4-5及L5-S1两节段),对29例单节段固定患者中的16例进行随访(其中L4-5及L5-S1各8例),双节段固定患者均获得随访,随访时间6～18个月,平均12.3个月.疗效评价指标包括VAS、ODI、椎间隙高度及椎间活动度(ROM).结果 24例患者均获得随访,单节段与双节段相比,术后及各个随访时间段VAS及ODI差异无统计学意义(P＞0.05),但均较术前明显改善(P＜0.05);术后1周及术后3个月椎间隙高度与椎间活动度相比无明显差异(P＞0.05);术后6个月及末次随访双节段与单节段相比,椎间隙高度减小(P＜0.05),椎间活动度增大(P＜0.05).结论 Dynesys对于治疗腰椎退变性疾病的短期临床疗效是肯定的,双节段固定和单节段Dynesys系统固定短期临床疗效无明显差异,但是双节段Dynesys固定效果可能较单节段固定差.