爱维治治疗前部缺血性视神经病变的疗效观察

目的 观察爱维治治疗前部缺血性视神经病变（AION）的疗效。 方法 临床确诊的AION患者58例60只眼，其中29例30只眼接受爱维治1200 mg/d静脉滴注治疗（治疗组）；另外29例30只眼接受1～2种溶栓抗凝剂或血管扩张剂1次/d静脉滴注治疗（对照组）。均以15 d为1个疗程。对照组中20只眼还同时进行眼局部药物注射，包括糖皮质激素、654-2球后或球旁注射，1次/d或1次/2 d，用药3～5次。两组患者用药后每天观察视力、眼底变化，治疗前有视野检查者复查视野。 结果 治疗组视力提高程度明显好于对照组，两组间差异有统计学意义(t=2.74, P<0.01); 用药第3天，两组视力提高程度差异无统计学意义(t=1.34, P＞0.05); 第5、10、15天，治疗组视力提高程度明显好于对照组，其差异有统计学意义（t=2.01, P<0.05; t=2.07, P<0.05; t=2.74, P<0.01）；治疗组有视野检查的15只眼中，13只眼治疗后视野好转，占87.00%；2只眼无变化，占13.00%。对照组有视野检查的13只眼中，4只眼治疗后视野好转，占31.00%；9只眼无变化，占69.00%。两组视野变化的差异比较有统计学意义（χ2=9.66,P<0.01）。 结论 爱维治治疗AION有效。 (中华眼底病杂志, 2006, 22: 97-99)     

畸变产物耳声发射在唇腭裂婴幼儿听力检查中的应用

目的探讨唇腭裂婴幼儿畸变产物耳声发射（distortion product otoacoustic emission,DPOAE）的特点,并将其与听性脑干反应（auditory brainstem response,ABR）阂值检查的结果加以对照,以探讨DPOAE在这类患儿听力检查中的应用价值。方法DPOAE检查63例（126耳）,年龄2个月-42个月,平均11.83个月。其中单纯腭裂组（以下简称腭裂组）23例（46耳）,腭裂并发唇裂及牙槽裂组（以下简称唇腭裂组）30例（60耳）,单纯唇裂组（以下简称唇裂组）10例（20耳）,每耳均检查8个频率,若2-5kHz4个频点有≥3个频点通过即为该耳通过。在上述患儿中,ABR阈值检查腭裂组17例（34耳）,唇腭裂组10例（20耳）,唇裂组6例（12耳）,以能重复引出V波的最小刺激强度为ABR阈值。结果DPOAE检查：腭裂组通过7耳,未通过39耳,通过率为15.22％;唇腭裂组通过6耳,未通过54耳,通过率为10.00％;唇裂组通过18耳,未通过2耳,通过率为90％。统计分析腭裂组与唇腭裂组无显著差异,而腭裂组与唇裂组,唇腭裂组与唇裂组均有显著差异。ABR阈值检查统计分析结果与DPOAE一致。将各组DPOAE通过率与ABR正常率进行比较,腭裂组及唇腭裂组中二者无差异（P〉0.05）,虽然唇裂组中二者有差异（P〈0.05）,但唇裂组ABR阈值反应的听力下降较轻（均≤50dB nHL）。从总体趋势上说,DPOAE与ABR阈值检查在检测的结果上是一致的。结论唇腭裂患儿DPOAE和ABR检测结果一致,与ABR相比,DPOAE具有快速、简便、易实施等特点,因此DPOAE可以作为唇腭裂婴幼儿听力检查的手段,但仍需进一步结合ABR及其他相关的听力检查,以明确听力损害的程度和类型。     

Body Fat Moderates the Association of Olfactory Dysfunction with Dietary Intake in U.S. Middle-Aged and Older Adults: A Cross-Sectional Analysis of NHANES 2013–2014

Background: Obesity relates to impaired olfactory function. Abnormal olfactory function is also associated with poor diet; however, whether obesity-related markers shape this relationship is unknown. Methods: Cross-sectional analysis (n = 1415, age > 40 years) of NHANES 2013–2014 examined body fat percent (BF%) and waist circumference (WC) as moderators of the relationship between olfactory function and diet. The olfactory function test identified adults with olfactory dysfunction (OD) or normal olfaction (NO). Validated 24 h recall captured nutrient intake and Healthy Eating Index-2010 scores. BF% and WC were measured. We tested adjusted linear regression models, with an interaction term between olfactory function and BF%/WC, for each nutrient or HEI score, and reported coefficients (β), standard errors (SE), and p-values for significant interaction terms. Results: In OD (9.5%; mean age 50.9 years, 95% CI 49.6, 52.2) compared with NO (mean age 49.3 years, 95% CI 48.8, 49.9), higher BF% was associated with higher intake of saturated fat (β (SE): 0.2 (0.1) g; p = 0.06) and percent of total calories from total fat (0.2 (0.1); p = 0.07), saturated (0.1 (0.004); p = 0.02), and monounsaturated fat (0.1 (0.1); p = 0.08); lower percent of total calories from carbohydrates (−0.2 (0.1); p = 0.09) and mg of sodium (−17.8 (09.6); p = 0.08); and a higher (healthier) refined grain score (0.1 (0.1); p = 0.04). Higher WC was associated with higher refined grain scores (0.01 (0.02); p = 0.01) in OD. Conclusion: BF% may shape dietary intake and quality in OD. Longitudinal studies are needed to elucidate the directionality of these relationships and develop strategies to improve dietary intake among OD.     

头颈部遗传性肿瘤概述

头颈部遗传性肿瘤主要包括家族性头颈部副神经节瘤、多发性内分泌腺瘤病1型、多发性内分泌腺瘤病2型、家族性甲状旁腺功能亢进、家族性甲状腺乳头状癌、神经纤维瘤病I型、神经纤维瘤病II型、家族性鼻咽癌及家族性鳞状细胞癌。本文从头颈部遗传性肿瘤的分类、临床特征、遗传学和治疗等方面做一综述。     

Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging,alloimmune thrombocytopaenia and monochorionic twins

Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Recognised causes of haemorrhagic fetal stroke include alloimmune and autoimmune thrombocytopaenia, maternal and fetal clotting disorders and trauma but these are relatively rare. It is likely that a significant proportion of periventricular and intraventricular haemorrhages are of venous origin. Recent evidence highlights the importance of arterial endothelial dysfunction, rather than thrombocytopaenia, in the intraparenchymal haemorrhage of alloimmune thrombocytopaenia. In the context of placental anastomoses, monochorionic diamniotic twins are at risk of twin twin transfusion syndrome (TTTS), or partial forms including Twin Oligohydramnios Polyhydramnios Sequence (TOPS), differences in estimated weight (selective Intrauterine growth Retardation; sIUGR), or in fetal haemoglobin (Twin Anaemia Polycythaemia Sequence; TAPS). There is a very wide range of ischaemic and haemorrhagic injury in a focal as well as a global distribution. Acute twin twin transfusion may account for intraventricular haemorrhage in recipients and periventricular leukomalacia in donors but there are additional risk factors for focal embolism and cerebrovascular disease. The recipient has circulatory overload, with effects on systemic and pulmonary circulations which probably lead to systemic and pulmonary hypertension and even right ventricular outflow tract obstruction as well as the polycythaemia which is a risk factor for thrombosis and vasculopathy. The donor is hypovolaemic and has a reticulocytosis in response to the anaemia while maternal hypertension and diabetes may influence stroke risk. Understanding of the mechanisms, including the role of vasculopathy, in well studied conditions such as alloimmune thrombocytopaenia and monochorionic diamniotic twinning may lead to reduction of the burden of antenatally sustained cerebral palsy.     

黄褐毛忍冬总皂苷对卵清蛋白致敏小鼠肠道炎症因子和抗炎因子的影响

目的 观察黄褐毛忍冬总皂苷(Ful)对卵清蛋白(OVA)致敏小鼠肠道炎症因子和抗炎因子的影响.方法 24只雌性BALB/c小鼠随机取16只,采用卵清蛋白致敏和激发构建食物过敏模型,均分为2组,即食物过敏组(FA组)和Ful干预组(Ful组).Ful组小鼠自造模第20天起每日皮下注射Ful 200 mg/kg,共22 d.另8只小鼠作为正常对照组(NS组).采用逆转录-聚合酶链反应(RT-PCR)法检测小鼠空肠组织中转化生长因子β1(TGF-β1)、白细胞介素6(IL-6)、白细胞介素17A(IL-17A)、叉头蛋白3-T细胞转录因子(Foxp3)mRNA表达;免疫组织化学法检测小鼠空肠组织中TGF-β1、IL-6、IL-17A蛋白表达;检测空肠中髓过氧化物酶(MPO)活性代表中性粒细胞活化水平.结果 FA组小鼠空肠组织中TGF-β1、IL-6、IL-17A的mRNA[(0.370±0.013)、(0.475±0.015)]和TGF-β1、IL-6、IL-17A蛋白表达水平[(53 075.70±20 727.06)、(256 881.66±36 561.79)、(435 064.25±69 911.48)]均增高,Foxp3 mRNA(0.231±0.014).经黄褐毛忍冬总皂苷干预后,小鼠空肠组织TGF-β1表达未下降,但IL-6、IL-17A的mRNA[(0.196±0.005)、(0.204±0.008)]和蛋白表达水平[(114 040.30±20 295.25)、(218 200.74±30 077.69)]均明显降低,而Foxp3 mRNA(0.578±0.021)表达明显增高.空肠组织中MPO水平各组间比较差异无统计学意义(P＞0.05)..结论 食物过敏发生时肠道内存在以IL-6、IL-17A表达增高为主的炎症反应.Ful可有效降低OVA致敏小鼠肠道炎症因子IL-6、IL-17A的过度表达,显著增强调节性T细胞特异性转录因子Foxp3的表达,从改善OVA诱导的肠道炎症.     

中药治疗药物流产后阴道流血的效果观察

目的:观察中药汤剂对药物流产后阴道出血情况的影响。方法:选择2006年1月至2007年12月自愿要求药物流产的早孕妇女随机分为治疗组100例,对照组100例,服药方法为2d服用米非司酮总量150mg,d3晨6点服米索前列醇600μg,应用米索前列醇后6h观察排出物并记录出血量。孕囊排出后,观察组开始服中药汤剂,每天1剂,煎好后分3次服,连服5d,对照组每次服益母草膏15g,3次/d,连服5d。结果:阴道出血量及出血持续时间,治疗组优于对照组(P<0.05)。结论:中药汤剂可减少药物流产后阴道出血量,缩短出血时间,值得临床推广应用。     

以学科教学知识能力促进中医院校教师专业发展

从学科教学知识能力（Pedagogical content knowledge,PCK）的基本概念出发,以开展PCK提升的外部环境、促进教师自主发展和教学观念转变、教师发展价值取向改变等维度阐述PCK对中医院校教师专业发展的重要性,并从高等中医药教育的教师专业发展实际需求出发提出相应的对策。     

发作性睡病病因的中西医学研究进展

发作性睡病是一种慢性睡眠障碍,是一种白天过度嗜睡的重要原因,往往伴有猝倒发作、睡眠瘫痪、睡眠幻觉等其他症状,合称为发作性睡病四联症。该文综述近年来中西医在发作性睡病病因方面的研究进展,为本病发病机制的研究提供进一步的方向。目前,西医主要认为发作性睡病的发病机制与食欲素和HLA-DQB1基因?0602亚型密切相关,此外,近年来西欧某些国家(英国、芬兰、瑞典)研究还发现, H1 N1流感疫苗的使用导致了发作性睡病发病率明显上升。中医主要认为,阴阳偏盛和营卫运行失常易引起睡眠障碍,同时儿童发作性睡病的病因与脏腑的关系也相当密切。     

Theatre of paediatric surgery

In the 50 years since the first edition of this journal, operative paediatric surgery has undergone radical change. Many of the most common instruments are unchanged, both as a testament to their utility and in recognition of past surgeons remembered eponymously. Surrounding that basic core of instruments, theatre has changed radically as new tools and techniques have arisen. Surgeons have come down from their pedestals, recognising surgery as a team sport rather than a solo performance. More than half of the current paediatric surgical trainees are women, a higher proportion than in any other craft group of the Royal Australasian College of Surgeons. The appearance, and rapid development, of laparoscopy is to many observers the most notable change in surgery over the last 50 years. Placed in its context though, it is simply the most prominent example of a frameshift in surgical thinking. The patient as a whole is now the focus, rather than just the disease. Recent developments are as much about minimising harm to normal tissues as they are about extirpating pathology. As a surgical maxim, ‘Primum non nocere’ is even more in evidence in 2015 than it was in 1965.