现代儿科呼吸介入技术在肺部感染性疾病病原学检测方法中的应用进展

肺部感染是5岁以下儿童死亡的主要病因， 肺部感染特别是重症肺部感染 ，诊断和治疗成功的关键是找到病原进行针对性抗微生物治疗。现代儿科呼吸介入技术不仅能获得支气管肺部病灶的液体性标本； 也能获得气管腔内组织标本和肺组织标本， 同时联合导航技术又让这些镜下呼吸介入技术采样更加精准、 安全。加上病原微生物学检测技术的进步， 使得儿科肺部感染病原微生物得到明确诊断率大大提高。因此， 现代儿科介入肺科医生要熟悉和掌握这些儿科呼吸介入技术及其在儿科肺部感染病原学检测的优缺点， 在临床抉择过程中才能做出正确选择。     

Takotsubo Cardiomyopathy in a 22-Year-Old Single-Ventricle Patient

We report a highly unusual case of a 22-year-old woman with single-ventricle anatomy and a history of Fontan palliation who developed takotsubo cardiomyopathy. To our knowledge, takotsubo cardiomyopathy has not previously been described in a patient with single-ventricle anatomy, or more generally in any patient with congenital heart disease. The patient presented at our clinic for urgent examination after a 2-day history of chest pain that had begun upon the death of her dog. Invasive evaluation was refused by the patient; instead, she underwent electrocardiogram-gated coronary computed tomographic angiography, to rule out obstructive coronary disease.A physician who suspects takotsubo cardiomyopathy in a patient should look for new-onset chest pain and dyspnea coupled with these features: immediate onset of segmental akinesia in the midventricular or apical aspects of the heart, elevation of brain natriuretic peptide level 12 to 24 hours after onset of akinesia, elevation of troponin level 24 to 48 hours after onset, and disappearance of the segmental akinesia a few days after onset.     

Causes of Infection after Earthquake, China, 2008

To determine which organisms most commonly cause infection after natural disasters, we cultured specimens from injured earthquake survivors in Wenchuan, China, 2008. Of 123 cultures, 46 (59%) grew only 1 type of pathogenic bacteria. Smear was more effective than culture for early diagnosis of gas gangrene. Early diagnosis and treatment of wounds are crucial.     

主诉为冻结步态的帕金森综合征诊治前瞻性研究

目的 观察以冻结步态为主诉的帕金森综合征（PDS）的诊疗过程，为延缓该症状进展提供线索。方法 本研究为前瞻性研究。选择2010年11月至2016年1月在海军军医大学（第二军医大学）长征医院神经内科帕金森病专病门诊随访、以冻结步态为主诉的PDS患者，跟踪随访2~6年。所有患者均采用阶梯性诊治措施，即初始使用左旋多巴行基础治疗并观察疗效，如无效则先后选用其他抗帕金森病药物、抗抑郁药物、其他治疗方案（包括药物和手术治疗等）。患者初诊时，采用Hoehn-Yahr分级和统一帕金森病评分量表（UPDRS）的第二部分（Ⅱ）、第三部分（Ⅲ）评价运动功能，UPDRS的第一部分（Ⅰ）评价总体精神、行为和情绪情况，简易精神状态检查表（MMSE）评估认知功能，分别采用汉密尔顿抑郁量表（HAMD-17）和汉密尔顿焦虑量表（HAMA）评价抑郁、焦虑状态；初诊和每次随访时均采用起立-行走计时测试（TUGT）评价冻结步态的严重程度。结果 15例冻结步态患者中帕金森病6例，非帕金森病9例（包括2例进行性核上性麻痹、3例原发性进展型冻结步态、1例额颞叶痴呆、1例血管性PDS、1例药物性PDS、1例原因未明PDS）。两组患者年龄、性别，以及初诊时Hoehn-Yahr分级、UPDRS-Ⅰ总分、UPDRS-Ⅱ总分、UPDRS-Ⅲ总分、MMSE总分、HAMD-17总分、HAMA总分和TUGT时间差异均无统计学意义（P均>0.05）。基线时帕金森病组冻结步态病程为（7.50±2.66）年，长于非帕金森病组[（2.56±0.88）年]，差异有统计学意义（P<0.01）。帕金森病组左旋多巴治疗有效率高于非帕金森病组（4/6 vs 0/9，P=0.01）。结论 以冻结步态为主诉的PDS病因具有异质性，冻结步态病程长短有助于诊断原发性帕金森病，冻结步态严重程度对病因提示意义不大。增加左旋多巴剂量对帕金森病中晚期出现的冻结步态有效，对其他原因导致的冻结步态疗效不确定。     

The Role of Child Sexual Abuse in the Etiology of Substance-Related Disorders

ABSTRACT

To elucidate the role of child sexual abuse in the etiology of substance-related disorders, a systematic review of the several articles on the childhood sexual abuse-related risk for developing substance problems in adolescence or adulthood is provided. Seven databases were searched, supplemented with hand-search of reference lists. Six reviews, including 200 studies, were included. Results indicate that child sexual abuse is a statistically significant, although general and nonspecific, risk factor for substance problems. Other biological and psychosocial variables contribute to substance-related disorders, with sexual abuse conferring additional risk, either as a distal, indirect cause or as a proximal, direct cause. Recommendations for future research are provided.     

中药胆胰和胃冲剂对胆道内成石因素的影响和预防术后复发的效果

目的研究中药胆胰和胃冲剂对胆道内环境成石因素的影响,并观察其预防术后胆石形成的临床效果.方法Ⅰ组应用自制中药胆胰和胃冲剂(由柴胡、金钱草、大黄,黄芩等11味中药组成),选择胆道手术后胆道置管引流患者36例,服该冲剂者22例为服药组,不服药14例为对照组. 动态观察服药前后引流胆汁组分的变化,另设15例服药,10例对照,观察胆汁中氧自由基的变化,从多因素研究该冲剂对胆道内环境成石胆汁的影响. Ⅱ组肝胆管结石手术后取净结石患者224例,分2组,服药组130例,不服药对照组114例,随访1a～8a,观察胆石复发情况.结果Ⅰ组:服药组22例,胆汁中胆酸显著增高(mg/L,779±536→957±788),胆红素,粘蛋白显著降低(分别由μmol/L,555±272→376±206;mg/L,160±58→142±41,P＜0.01). 对照组无变化. 服药组胆汁组分胆酸∶胆固醇(服药前779±536∶877±588,后957±790∶850±457);胆酸∶胆红素的比值(服药前779±536∶555±272,后957±790∶372±206),均呈动态升高(P＜0.01). Ⅲ组15例,对照分组10例,检查胆汁中O与SOD,服药分组O低于服药前(8814→3930);SOD显著增高(95→142),两分组均有显著差异(P＜0.01). Ⅲ组肝胆管结石术后服药组130例,胆石复发者5例(3.8%),对照组114例,胆石复发者31例(27.2%,P＜0.01).结论中药胆胰和胃冲剂对调节和改善胆道内环境,逆转成石胆汁有显著影响,对预防胆石形成有良好功效.     

尿道狭窄的原因：损伤还是其他？

先天性尿道狭窄主要发生在青少年的前尿道。血尿是其最主要的症状。获得性尿道狭窄主要在以下几个方面：医源性：多发生于经尿道前列腺电切术、膀胱镜操作、长时间留置尿管、尿道下裂术后及前列腺切除术后等；感染性尿道狭窄包括医院手术后细菌尿引起的尿道狭窄和尖锐湿疣引起的病毒性尿道狭窄；炎症性尿道狭窄主要是硬化性结节病的慢性进展性炎症过程；前尿道的钝性损伤多是会阴部骑跨伤，后尿道损伤多伴有骨盆骨折，枪弹的穿透伤可全尿道损伤。儿童和女性的尿道损伤和狭窄罕见。文章主要对先天性和获得性尿道狭窄的原因进行探讨分析。