上颌中切牙阻生的局部因素分析

目的 探讨上颌中切牙阻生的局部因素。方法 回顾分析70例(74颗)上颌阻生中切牙的临床资料,总结分析各种局部因素与中切牙阻生的关系。结果 74颗阻生中切牙的局部因素包括多生牙或牙瘤32颗(43.2%),乳切牙根尖病变12颗(16.2%),乳牙外伤6颗(8.2%),牙胚发育异常(位置、方向、形态)24颗(32.4%)。结论 中切牙阻生的病因较为复杂,及早诊断适时干预是治疗成功的重要因素。     

Score EGSYS para predição de etiologia cardíaca na síncope: tem utilidade no contexto de consulta?

IntroductionThe EGSYS score uses clinical variables to predict which patients may have cardiac (CS) or non‐cardiac syncope (NCS) and has been validated in the emergency department setting. This study aims to determine whether the score has the same applicability in an outpatient setting.MethodsIn this retrospective study of all patients observed in the outpatient setting of a hospital with a syncope unit between January 2015 and December 2016, the EGSYS score was calculated for each patient, and its sensitivity and specificity were determined for the prediction of CS in patients with score ≥3.ResultsA total of 224 patients, mean age 64.3±21.7 years, 116 (51.8%) male, were analyzed. In the 163 (72.7%) patients with confirmed syncope, CS was diagnosed in 27 (16.6%) and NCS in 136 (83.4%). The EGSYS score was ≥3 in 40 (20.0%) patients with NCS and in 13 (48.1%) with CS. A positive score had a sensitivity of 48.2% (95% CI: 28.7‐68.1), a specificity of 77.9% (95% CI: 70.0‐84.6), and a positive and negative predictive value of 30.2% (95% CI: 20.8‐41.8) and 88.3% (95% CI: 83.9‐91.7), respectively.ConclusionThe EGSYS score has limited usefulness in an outpatient setting, where observed patients have already been been medically assessed. Given its high specificity and negative predictive value, it may be useful to reassure low‐risk patients and family members.     

夫妻癌的中医病因病机

夫妻双方生活在一处,形成了一个特殊的人文小社会。夫妻癌,是夫妻双方俱患癌,或同时发病、或先后发病,或患同癌、或患异癌。在异癌方面,或表里隶属,或无牵无联。夫妻癌发病的病因主要是性情相激、摄生相染、处境相仿;病机主要为气滞久矣、邪毒流注、阴阳失和。     

Autoimmunity to specific citrullinated proteins gives the first clues to the etiology of rheumatoid arthritis

Summary: Rheumatoid arthritis (RA) is now clearly a true autoimmune disease with accumulating evidence of pathogenic disease-specific autoimmunity to citrullinated proteins. Citrullination, also termed deimination, is a modification of arginine side chains catalyzed by peptidylarginine deiminase (PAD) enzymes. This post-translational modification has the potential to alter the structure, antigenicity, and function of proteins. In RA, antibodies to cyclic citrullinated peptides are now well established for clinical diagnosis, though we argue that the identification of specific citrullinated antigens, as whole proteins, is necessary for exploring pathogenic mechanisms. Four citrullinated antigens, fibrinogen, vimentin, collagen type II, and α-enolase, are now well established, with others awaiting further characterization. All four proteins are expressed in the joint, and there is evidence that antibodies to citrullinated fibrinogen and collagen type II mediate inflammation by the formation of immune complexes, both in humans and animal models. Antibodies to citrullinated proteins are associated with HLA ‘shared epitope’ alleles, and autoimmunity to at least one antigenic sequence, the CEP-1 peptide from citrullinated α-enolase (KIHAcitEIFDScitGNPTVE), shows a specific association with HLA-DRB1*0401, *0404, 620W PTPN22, and smoking. Periodontitis, in which Porphyromonas gingivalis is a major pathogenic bacterium, has been linked to RA in epidemiological studies and also shares similar gene/environment associations. This is also the only bacterium identified that expresses endogenous citrullinated proteins and its own bacterial PAD enzyme, though the precise molecular mechanisms of bacterial citrullination have yet to be explored. Thus, both smoking and Porphyromonas gingivalis are attractive etiological agents for further investigation into the gene/environment/autoimmunity triad of RA.     

周文泉教授辨治老年病的思路与方法

周文泉教授认为老年人的生理特点是形气衰减,脏腑脆弱,病理特点则是病情隐匿,易于诱发,同时,由于元气不足,患病后不但易于传变,一脏有有病传入他脏引起他脏病变,尚易出现两或两个以上的脏腑同时发病的“合病”,并认为老年人脏气怠钝,患病后多缠绵难愈,老年病的证候特点是临床表现错缩复杂,在治疗上主张调补脾胃以充元气,化痰行瘀以祛邪气,同时在治病的过程中始终贯穿“治未病”的思想,并考虑内外环境特别是精神因素对疾病的影响,做到“三因制宜”,遣方用药上主张复方治病,量小勿大,善于守方,坚持给药。     

诊断不明的胸腔积液的分析和处理

目的探讨诊断不明的胸腔积液的评价和处理.方法回顾性分析一家教学医院5a间诊断不明的胸腔积液15例.结果15例中,男11例,女4例.入院前病程中位数为1个月(7d～5个月),平均住院天数为33.1±4.9d(7～64d).仅通过病史、症状、体征、胸部影像学,血化验和胸液分析来寻求诊断的8例(53.3%).另外7例(46.7%)进行了纤维支气管镜,胸膜活检和胸腔镜等有创检查.除1例外所有患者在出院时接受了抗结核治疗.10例患者接受了1个月至4年6个月(中位数1年4个月)的随访,胸液吸收6例,好转2例,反复2例.结论诊断不明的胸腔积液过多地被考虑为结核病并给予抗结核治疗.需要前瞻性的临床研究来了解我国诊断不明的胸腔积液的转归和预后并确定符合我国情况的处理规范.     

Major affective disorders and schizophrenia: a common molecular signature?

Psychiatric disorders, including affective disorders (AD) and schizophrenia (SZ) are among the most common disabling brain diseases in Western populations and result in high costs in terms of morbidity as well as mortality. Although their etiology and pathophysiology is largely unknown, family-, twin-, and adoption studies argue for a strong genetic determination of these disorders. These studies indicate that there is between 40 and 85% heritability for these disorders but point also to the importance of environmental factors. Therefore, any research strategy aiming at the identification of genes involved in the development of AD and SZ should account for the complex nature (multifactorial) of these disorders. During the last decade, molecular genetic studies have contributed a great deal to the identification of genetic factors involved in complex disorders. Here we provide a comprehensive review of the most promising genes for AD and SZ, and the methods and approaches that were used for their identification. Also, we discuss the current knowledge and hypotheses that have been formulated regarding the effect of variations on protein functioning as well as recent observations that point to common molecular mechanisms.     

强化三叉神经痛对因治疗的临床意义

三叉神经感觉根入髓区血管压迫是三叉神经痛的主要病因,显微血管减压手术是治疗三叉神经痛的有效手段,有效率高,复发率低,针对三叉神经痛的主要病因进行治疗,能够完好保留三叉神经的正常功能。在熟练的显微外科技术的基础上,显微血管减压手术是一种安全的治疗方法。因此,显微血管减压手术是外科治疗三叉神经痛的最佳手段。