Objective To investigate the clinical characteristics of patients with cryptococcal meningoencephalitis with unstable gait as the initial symptom. Methods The clinical datas of a cryptococcal meningoencephalitis patient with unstable gait as the initial symptom were analyzed.Results A 45-year-old male presented with unstable gait two years ago, and the symptoms worsened progressively, complicated with decreased memory and delayed response. Brain MR scans showed dilation of the ventricular system, and cerebrospinal fluid examination revealed cryptococcal infection. After treatment with amphotericin B and fluorocytosine, the clinical symptoms improved. Conclusion Cryptococcal meningoencephalitis usually has an insidious onset, and unstable gait may be the initial symptom, which should be paid attention in clinical practice.

目的 系统评价银杏内酯注射液联合阿替普酶治疗急性缺血性卒中(AIS)的疗效与安全性.方法 采用Cochrane系统评价方法,检索中国期刊全文数据库、万方数据库、维普中文科技期刊全文数据库、中国生物医学文献数据库、中国硕士和博士论文全文数据库、Clinical Trials.gov、PubMed、Embase、The Cochrane Library和Web of Science等数据库,截止日期为2020年7月.筛选关于银杏内酯注射液联合阿替普酶治疗AIS的随机对照试验(RCT)文献.由两名评价员对所有纳入临床研究独立进行数据分析提取及质量评价,采用revman5.3软件进行Meta分析.结果 共纳入9项RCT、765例AIS患者,全部为中文文献.Meta分析结果显示,与阿替普酶治疗比较,银杏内酯类注射液联合阿替普酶治疗显著改善AIS患者神经功能缺损(MD=-3.08,95％CI:-3.74～-2.43,P<0.00001),临床有效率显著提高(OR=3.93,95％CI:2.37～6.52,P<0.00001),患者生活质量(MD=7.06,95％CI:3.71～10.40,P<0.0001)及Barthel指数显著改善(MD=8.96,95％CI:6.00～11.92,P<0.00001),而不良反应发生率比较差异无统计学意义(OR=0.76,95％CI:0.42～1.40,P=0.38).结论 银杏内酯注射液联合阿替普酶治疗AIS患者可显著改善神经功能缺损,提高临床疗效和患者生活质量,但仍需要更多大样本、多中心、高质量研究证实.

Duchenne型肌营养不良症(Duchenne muscular dystrophy,DMD)是一种X连锁致死性遗传性肌病,由Dystrophin基因突变导致抗肌萎缩蛋白缺失所致.DMD尚缺乏有效的治疗方法,但随着对该病发病机制和病理变化过程的认识不断深入,其治疗选择越来越多.这些治疗方法旨在恢复Dystrophin蛋白表达或弥补Dystrophin蛋白缺失.

目的 分析螨过敏类变应性鼻炎(AR)患儿行粉尘螨滴剂舌下含服不同疗程的疗效情况.方法 回顾性分析2013年以来就诊于华中科技大学协和深圳医院(南山医院)耳鼻喉科的螨过敏AR患儿共120例,随访资料齐全且已完成4年疗程舌下含服免疫方法(SILT),治疗前、治疗期间间隔3个月开展随访就结束治疗后分别评估鼻炎症状评分(TNSS)、鼻炎用药评分(TRMS)、视觉模拟量表(VAS)及鼻结膜炎生活质量量表(RQLQ)评分以及不良反应情况.结果 与治疗前相比,SLIT治疗1年结束时TNSS、TRMS、VAS评分、RQLQ评分均有显著改善(P<0.05);与SLIT 1年疗程相比,SLIT治疗2年结束时TNSS、TRMS、VAS、RQLQ评分均有显著改善(P<0.05).与SLIT 2年疗程相比,SLIT治疗3年结束时VAS、RQLQ评分均有显著性改善(P<0.05).与SLIT 3年疗程相比,SLIT治疗4年结束时TNSS、TRMS、VAS、RQLQ评分差异均无统计学意义(P>0.05).治疗1、2、3年及4年结束时,患儿的不良反应发生率对比差异无统计学意义(P>0.05),所有患儿均未出现严重不良反应.结论 螨过敏AR患儿开展超过2年粉尘螨滴剂舌下含服疗效较1年更佳,3年疗程VAS及RQLQ评分改善较2年更明显,因此患儿至少需坚持2年治疗,3年是最佳疗程.

喉部不典型类癌作为喉部神经内分泌癌其中1个亚型，在临床上较为罕见。本文报道了1例珠海市人民医院耳鼻咽喉科收治的69岁男性患者，主诉为咽部异物感2月余，加重伴咳嗽、咽痛2周，完善检查并行病理活检后诊断为喉不典型类癌，舌根部乳头状瘤。全麻下行舌根肿物切除术+全喉切除术＋区域性双颈部淋巴清扫术＋气管造瘘术，术后行放射治疗，随访1年，患者恢复良好无复发。本文总结其病例特点并通过文献复习，介绍神经内分泌癌的好发部位、临床特点、病理分型及治疗方法。

Objective:To explore the effect of individualized multi-compound sound therapy on chronic subjective tinnitus and the relationship between tinnitus frequency," notch " hearing loss and the treatment effect of sound therapy.Method: Seventy-eight cases of chronic subjective tinnitus with the pure tone test threshold (PTA)in normal range (≤25 dB HL)were enrolled in this study. Their hearing threshold were re-evaluated using the precise pure-tone audiogram (P-PTA).Tinnitus was evaluated on pitch and loudness matching, and the effectiveness of tinnitus was measured using Tinnitus Handicap Inventory (THI) before they received the individualized customized multi-compound sound therapy for 3 months. THI were re-evaluated on the 30th day and 90th day after treatment.Result: ①The averaged THI score of these patients before the sound treatment was 24.62±15.65 (n=78). The score dropped significantly to 15.82±13.02 and 13.62 ±10.98 on the 30th day and 90th day after treatment, respectively (P<0.01). ②Patient' s gender, age, and the side of tinnitus has no effect on the sound treatment of tinnitus. ③Of these 78 tinnitus patients, 31 patients who showed "notch " hearing loss and 47 patients without "notch " hearing loss in the P-PTA. The averaged THI score between the patients with and without "notch " showed no statistical difference after the treatment (P>0.05).These data suggested that "notch " hearing loss in P-PTA has no effect on the sound therapy.④Of 31 tinnitus patients with "notch " hearing loss, the tinnitus frequency of 22 cases was at the "notch " hearing loss and that of 9 cases was not at the "notch " hearing loss. Sound treatment showed significant between the former and the latter(P<0.05). After 30 days of treatment, tinnitus frequency of four patients whose tinnitus was not at the notch hearing loss drifted to the "notch " hearing loss frequency. Conclusion: Customized multi-compound sound therapy can reduce the THI score of chronic subjective tinnitus patients.The treatment reduced patient's anxiety and improved their quality of life.Sound treatment showed a better improvement in the patients whose tinnitus frequency was located at their notch hearing loss.

目的 探讨传统纯音测听正常的主观性耳鸣患者精细化听力学检测的临床特征和应用价值.方法 对2017年2月～12月我院眩晕耳鸣门诊106例传统纯音测听(pure-tone audiogram,PTA)正常(气导125Hz～8KHz,1个倍频程间隔,阈值均≤25 dB HL)的主观性单侧耳鸣患者进行传统的耳鸣听力学测试和精细化检测.其中传统的耳鸣听力学测试包括传统的PTA、耳鸣频率和响度匹配、残余抑制试验;耳鸣精细化检测包括:1/24倍频精细化纯音测听(precise pure-tone audiogram,P-PTA)、精细化耳鸣匹配、残余抑制试验.41例年龄匹配听力正常的无耳鸣人群为对照组.结果 1、106例耳鸣患者中,P-PTA有频率"切迹"的54耳,无频率"切迹"的62耳.41例正常听力无耳鸣组(82耳)中,P-PTA有频率"切迹"的8耳,无"切迹"的74耳.两组之间的差异有统计学意义(P<0.0001).2、耳鸣匹配:根据传统纯音测听结果进行耳鸣匹配,106例耳鸣患者中匹配阳性的52例(50.9％),阴性的54例;而根据精细化纯音测听结果进行耳鸣匹配,阳性的89例(84.0％),阴性的17例.精细化测试耳鸣匹配的成功率明显高于传统方法(P<0.001),而耳鸣的响度≤5 dB SL的比例从25.9％提高到55.1％(P<0.01).3、残余抑制:根据精细化耳鸣匹配测试结果进行残余抑制试验,阳性率从37.0％提高到53.9％(P<0.05).结论 部分耳鸣患者在基于倍频程的传统听力检测中表现正常听力,而采用1/24倍频的精细化检测,由于增加刺激频率更容易发现隐藏的听力损伤("损伤切迹"),找到精确的耳鸣位点,提高残余抑制试验的阳性率,为耳鸣患者的听觉评估和干预提供更精确的信息和依据.

目的 探讨鼻中隔成形术后单侧与双侧鼻腔Merocel填塞的临床效果.方法 将204例鼻中隔偏曲患者按入院的先后顺序分为研究组和对照组,每组102例.2组均采用鼻中隔成形术.研究组术后采用单侧鼻腔Mer-ocel填塞,对照组术后采用双侧鼻腔Merocel填塞.观察2组术后填塞期间头痛程度、抽取填塞物的难易程度、抽取填塞物时患者舒适度的比例.结果 研究组填塞期间头痛为轻度疼痛、抽取填塞物为容易、抽取填塞物时患者轻度不适所占比例均明显高于对照组,填塞期间头痛为重度疼痛、抽取填塞物为较难及难、抽取填塞物时患者重度不适所占比例均明显低于对照组(均P<0.05).结论 对鼻中隔偏曲患者行鼻中隔成形术后采用单侧鼻腔Mero-cel填塞具有较好的效果.

OBJECTIVE:To evaluate the effect and safety analysis of Allergovit standardized dust mite subcutaneous immunotherapy in patients with allergic rhinitis.METHOD:From Jan 2006 to Jan 2009,425 patients with persistent were treated with Allergovit standardized dust mite allergen in 3 years, which data were retrospectively analyzed. The scores of the rhinoconjunctivitis quality of life were collected per-treatment and three years treatment. VAS (visual analogue scale) of all nasal symptoms and drug use scores were evaluated before treatment and every 6 weeks. The frequency of local and systemic reactions were recorded in the duration of dose escalation and maintenance.RESULT:The Overall QOL were significantly improved after 3 years treatment [pre-treatment: 3.8 (2.9; 4.5); post-treatment: 1.1 (1.0; 2.0), P < 0.01]. VAS of all nasal symptoms and drug used scores decreased dramatically after escalation period [pro-treatment: 23. 7 (20.5; 27.8), 3.9 (3.2; 4.7); post-treatment: 2.1 (1.6; 2.2), 0(0;0), P < 0.01]. Local reaction's rate was 3.15%, the frequency systemic reaction's rate was 0.90%.CONCLUSION:The standardized specific allergen immunotherapy for allergic rhinitis is safe and effective.

<正>资料患者女性,21岁。因左鼻腔反复鼻塞、流脓涕、涕中带血2周余于2011年12月5日入院。体格检查:一般情况良好,血压正常,浅表淋巴结均未触及。专科检查:外鼻无畸形,左侧中鼻甲明显肿大,表面黏膜呈暗红色、光滑,触之不易出血,对麻黄碱无收缩反应;中鼻道无法显露;下鼻道见少量脓性分泌物;鼻咽部未见新生物。鼻窦增强CT扫描提示:①左鼻腔、鼻窦占位性病变;②左侧上颌窦、筛窦炎;③泡性中鼻甲(图1)。入院后全身应用抗生素,做好术前准备。在全身麻醉下行鼻内镜手术。术中剪开中鼻甲黏膜,有大量咖啡色液体溢出。中鼻甲呈囊壁样改变,其内为一大的空腔。充分去除残壁,切除部分中鼻甲,中鼻道及筛窦可见灰白色新生物。切除

Objective To investigate the repairing effect on nasal cartilage defect with associated graft of perichondrium and allogenic demineralized bone matrix (DBM). Methods Eighteen New Zealand rabbits were randomly divided into 3 groups (in each group,n=6). Nasal alar cartilage and perichondrium were ablated in each rabbit. Autogenic auricular perichondrium wrapped by allogenic DBM was grafted into the defect in group A,autogenic auricular cartilage in group B and autogenic auricular perichondrium in group C. At the 10th week after repair,the effect was evaluated by gross inspection,histopathology,immunohistochemical detection of Soluble protein-100 (S100) and transforming growth factor-β1 (TGF-β1) antibodies of the cartilage from the defect. Results The cartilage cell and matrix from group A and B were similar to those of the normal cartilage with no obvious differences between group A and group B. Being compared with the cartilage cells from group A and group B,the cell number,cytoplasm,and positive S100 and TGF-β1 cells were significantly reduced in group C (P 0.01). Conclusion The repairing effect on nasal cartilage defect with associated graft of perichondrium and allogenic DBM is coincide with autogenic cartilage and surpass the autogenic perichondrium.

Objective To investigate the correlation between seven kinds of serum food-specific IgG anti-bodies and allergic rhinitis.Method Seven kinds of serum food-specific IgG antibodies were detected from 1280 patients with allergic rhinitis by ELISA.Results Total positive rate of serum food-specific IgG antibody was 81.14% in 1280 patients.Of seven kinds of food-specific IgG antibodies,egg was the highest rate(62.27%),followed by fish(58.20%) and milk(47.27 %).Food allergy showed specificity in different age groups.Conclu-sion Specific IgG antibodies are related to allergic rhinitis and food intolerance,the detections of them can be conducive to the clinical diagnosis and treatment.