Mycoplasma pneumoniae infection and neurological disease

The cases are reported of 13 children seen over a 22 month period who presented with a variety of acute neurological illnesses associated with Mycoplasma pneumoniae infection. Although presentation with a decreased level of consciousness or seizures was common, psychosis, hemiparesis, cranial nerve palsies, and Guillain-Barré syndrome were also seen. In contrast with published reports, only one child had an associated chest infection. Although some children have been left with residual disability, most have made a complete recovery. In this recent experience, M pneumoniae is a not rare cause of neurological illness in childhood and may present in unusual ways.     

Hormonal treatment of cryptorchidism—hCG or GnRH—a multicentre study

In a modified, double-blind controlled study, 163 prepubertal boys (aged 1.8-13.0 years) with bilateral and 94 (aged 1.5-13.1 years) with unilateral cryptorchidism were allocated to treatment with either human chorionic gonadotrophin (im), gonadotrophin releasing hormone (intranasally) or placebo (intranasally). In individuals with the bilateral condition treatment with human chorionic gonadotrophin resulted in complete descent of both testes in 23% of patients. Treatment with human chorionic gonadotrophin in unilateral cryptorchidism resulted in complete descent in 19% of patients; all results were significantly better than those obtained with gonadotrophin releasing hormone or placebo. Linear and logistic regression analysis of the results obtained by treatment of bilateral disease showed that all treatments were more successful the younger the age of the boys. The data indicated that bilateral and unilateral cryptorchidism respond differently to hormonal treatment. We suggest that human chorionic gonadotrophin should be the first choice of treatment for prepubertal boys older than one year.     

Dexamethasone and bacterial meningitis in Pakistan

The objective of this study was to assess, in a developing country setting, the effect of dexamethasone therapy on bacterial meningitis outcomes. A prospective double blind placebo controlled trial was conducted in 89 children aged from 2 months to 12 years suffering from bacterial meningitis. Neurological, developmental, and hearing assessments were conducted at one, four, and 12 months after discharge. Forty eight patients received dexamethasone and 41 placebo. Initial antimicrobial drugs used were ampicillin and chloramphenicol. For all patients at the time of admission the mean duration of illness was 5.7 days; 47% had had seizures and 56% had impaired consciousness. Seventeen of 89 (19%) patients died. The mortality for the dexamethasone group was 25% as compared with 12% in the group receiving placebo. Presentation to the hospital after four days of symptoms and with impaired conscious state were independent predictors of death. Of the dexamethasone group survivors, 26.5% had neurological sequelae and 42.3% had hearing impairment, whereas in the placebo group it was 24% and 30% respectively. Altered state of consciousness was a predictor of neurological sequelae. The presence of neurological sequelae and high cerebrospinal fluid protein independently predicted hearing loss. No beneficial effect of dexamethasone was observed on morbidity or mortality of this group of patients with bacterial meningitis. Dexamethasone is therefore not useful in developing countries as adjunctive treatment in patients seriously ill with bacterial meningitis, who present late for treatment and have been partially treated.     

癌症基因组图集数据库及其应用

癌症多是由DNA变异引起的细胞恶性增生,在基因组水平上研究这些变异及变异间相互作用引起的癌变分子机制,将有助于提高我们对癌症的预防、诊断及治疗能力。基于此,美国国家癌症研究所（NCI）和国家人类基因组研究所（NHGRI）联合发起了癌症基因组图集计划（TCGA）,获得了海量数据。这些数据加速了人们对癌变分子机制的认识,为精准治疗和个性化治疗奠定了坚实的基础。此计划完成后国内鲜有对其详实的介绍,本文将对该基因组数据的产生、数据的类型、数据的获取与应用等进行描述,促进这些数据运用于癌症的预防、早期诊断和治疗中。     

99Tcm-MIBI显像联合血清甲状旁腺素测定对原发性甲状旁腺机能亢进症的诊断价值

目的：对临床怀疑原发性甲状旁腺功能亢进症（PHPT）患者行⁹⁹Tcm-MIBI显
像及血清甲状旁腺素(PTH)测定,阐明99Tcm-MIBI显像联合PTH测定对PHPT的诊断
价值。 方法：回顾性分析43例怀疑PHPT患者⁹⁹Tcm-MIBI显像及血清PTH测定结果,以术后病理为
金标准,对⁹⁹Tcm-MIBI显像、血清PTH测定及⁹⁹Tcm-MIBI显像联合血清PTH测定3种诊断方法的灵敏度、特
异度、阳性预测值、阴性预测值、阳性似然比及阴性似然比、准确度进行比较和评价。结果：以术后病理证实, ⁹⁹Tcm-MIBI显像、血清PTH测定及99Tcm-MIBI显像联合血清PTH测定3种诊断方法比较,灵敏度分别为93.75%、84.38%及100.00%,特异度分别为45.50%、54.55%及36.36%,阳性预测值
分别为83.33%、84.38%及88.89%,阴性预测值分别为71.43%、54.55%、100.00%,阳性似然比分别为1.72、1.85及1.57,阴性似然比分别为0.14、0.29及0,准确度分别为81.40%、76.74%及83.72%。结论：99Tcm-MIBI显像联合血清PTH测定可以提高PHPT的诊断准确性,降低漏诊率。
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儿童复杂性尿道狭窄的治疗

目的 探讨儿童复杂性尿道狭窄手术方法的选择及成功的关键。方法 25例复杂性尿道狭窄采用不同的手术方法治疗30次，其中采用口腔粘膜管状重建尿道3例。口腔粘膜补片尿道成形3例；经耻骨径路尿道端端吻合11例，膀胱壁瓣尿道成形2例；经会阴径路尿道端端吻合8例；双阴唇带蒂皮瓣Ⅰ期尿道成形2例；带蒂包皮内板Ⅰ期尿道成形1例。结果 术后随访2-36个月。平均18.5个月。一次手术后排尿通畅20例。术后效果不佳5例。经再次手术后排尿通畅4例。结论 儿童尿道狭窄手术方法的选择应根据尿道狭窄段的长短，位置选择合适的术式；口腔粘膜具有取材方便。创伤小，有较强的抗感染力的优点，是一种较好的尿道替代物。     

精神紧张致咬合紊乱1例

<正>1临床资料患者,女性,16岁,高中二年级学生,特长画画。头痛不适3 d,晚餐后突然头向左侧倾斜后仰,下颌向左侧偏斜,头颈部活动及开闭口受限,颞下颌关节处持续性疼痛半小时来我院就诊。查体:神智清晰,营养中等,查体合作,心、肺、腹未见异常。专科检查:头向左侧倾斜后仰,下颌向左偏,颈部及下颌侧向运动障碍,触之左侧颈前区僵硬并有     

Trends in cardiovascular risk factor levels in Finnish children and young adults from the 1970s: The Cardiovascular Risk in Young Finns Study

OBJECTIVES: The Cardiovascular Risk in Young Finns Study is an ongoing multicentre study of atherosclerosis precursors in Finnish children and young adults. The aim of the present report is to describe the secular trends in cardiovascular risk factors between 1980 and 2001 in children and young adults. METHODS: Data on cardiovascular risk factors were collected in a cohort of subjects (original n=3596) that were followed with serial cross-sectional studies from childhood to adulthood. The study was initiated in 1980, and the latest follow-up (after 21 years) was performed in 2001 (with n=2285 participants). To assess secular trends up to the year 2001, selected risk variables were analyzed (ie, total cholesterol, low density lipoprotein [LDL] cholesterol, high density lipoprotein [HDL] cholesterol, triglycerides, apolipoproteins A1 and B, blood pressure, body mass index [BMI] and daily intake of energy and quality of fat) in subjects with complete data for the years 1980, 1986 and 2001 (n=1758). RESULTS: From 1980 to 1986, LDL-cholesterol concentrations decreased 0.32 mmol/L (P<0.0001) in subjects aged 15 to 18 years. From 1986 to 2001, LDL concentrations did not change in 24-year-old subjects (delta=-0.12 mmol/L, P>0.05). HDL-cholesterol concentrations decreased 0.28 mmol/L (P<0.0001) from 1986 to 2001. Triglyceride concentrations increased 0.21 mmol/L (P<0.0001) from 1980 to 1986 and 0.26 mmol/L (P<0.0001) from 1986 to 2001. In female subjects, BMI increased both from 1980 to 1986 (delta=0.5 kg/m(2), P=0.03) and from 1986 to 2001 (delta=1.7 kg/m(2), P=0.0002). Systolic blood pressure levels decreased 3.7 mmHg (P<0.0001) from 1980 to 1986 and 7.0 mmHg (P<0.0001) from 1986 to 2001 in all subjects. CONCLUSION: The authors conclude that between 1986 and 2001, the decreases in LDL-cholesterol concentrations among young adults in Finland stopped. During the same time, HDL-cholesterol concentrations started to decrease, and triglyceride concentrations continued to decrease, and in female subjects, BMI continued to increase. However, also during this time, blood pressure levels continued to decrease in all subjects.     

胸腺肽与干扰素联合治疗慢性乙型肝炎58例观察

目的 :观察胸腺肽与干扰素联合应用与单用干扰素治疗慢性乙肝的疗效对比。方法 :选择慢性乙肝 5 8例 ,胸腺肽与干扰素联合组 32例 ,干扰素组 2 6例 ,根据用药时间观察各化验指标。结果 :血清HBeAg/抗HBe转换率至治疗第 6个月 ,联合组达 5 0 % ,干扰素组达 30 .7% ,联合组疗效显著高于干扰素组(P <0 0 5 )。两组治疗中 ,联合组HBVDNA阴转率高于干扰素组 (P <0 .0 5 )。结论 :胸腺肽与干扰素联用具有协同作用 ,治疗慢性乙肝优于干扰素组。     

Hyaluronic acid: a unique topical vehicle for the localized delivery of drugs to the skin

Hyaluronic acid (HA) is a naturally occurring polyanionic, polysaccharide that consists of N-acetyl-D-glucosamine and beta-glucoronic acid. It is present in the intercellular matrix of most vertebrate connective tissues especially skin where it has a protective, structure stabilizing and shock-absorbing role. The unique viscoelastic nature of HA along with its biocompatibility and non-immunogenicity has led to its use in a number of clinical applications, which include: the supplementation of joint fluid in arthritis; as a surgical aid in eye surgery; and to facilitate the healing and regeneration of surgical wounds. More recently, HA has been investigated as a drug delivery agent for various routes of administration, including ophthalmic, nasal, pulmonary, parenteral and topical. In fact, regulatory approval in the USA, Canada and Europe was granted recently for 3% diclofenac in 2.5% HA gel, Solaraze, for the topical treatment of actinic keratoses, which is the third most common skin complaint in the USA. The gel is well tolerated, safe and efficacious and provides an attractive, cost-effective alternative to cryoablation, curettage or dermabrasion, or treatment with 5-fluorouracil. The purpose of this review is to describe briefly the physical, chemical and biological properties of HA together with some details of its medical and pharmaceutical uses with emphasis on this more recent topical application.