头痛、昏迷、抽搐、失明

头痛、昏迷、抽搐、失明关键词朊病毒病，尸检，鉴别诊断中国图书分类号Ｒ５ｌ２．３吉林化学工业公司职工医院病理科、神经内科白求恩医科大学第一临床医院神经内科１病历摘要患者女性，３４岁，工人。４ｄ前出现右颞部持续跳痛，阵发性加剧伴行为轻度异常，无发热、呕吐...     

反复牙龈出血、便血、经期延长、腹腔出血

1病历摘要患者女,47岁,因“反复牙龈出血、便血伴经期延长近40年,腹腔出血2年”入院。1.1病史患者1968年无诱因出现睡眠时牙龈出血,量多,止血药物治疗后出血停止。症状反复出现,未诊治。1970年无诱因出现便血,鲜红色,量多,曾一过性晕厥,外院予输血、止血治疗后好转。其后反复便中带鲜血,每月1~2次,量约10mL,自服止血药及中药可好转。1972年月经初潮,第二次月经持续约6周,量大,曾晕厥,外院查血Hb4g/L,诊为“功能性子宫出血”,予雌激素及止血治疗后,月经量稍有减少,输全血后月经量逐渐减少至停止。此后长期服用止血中药及雌激素,每月月经持…     

乏力、反应迟钝、肌肉疼痛、呼吸困难

１　病史摘要患者男性,６２岁,因乏力、阵发性手足抽搐半年,症状加重伴反应迟钝、吞咽困难、肌肉疼痛１个月,于１９９８年６月２９日入院。半年前无明显诱因出现乏力、阵发性手足抽搐,继而出现指端麻木、苍白,双膝关节僵硬,活动不灵。曾在某医院住院诊断为甲状腺功能减退,给予甲状腺片每日４０毫克口服,症状略好转出院。近１个月来上述症状加重,并出现反应迟钝,抬头无力,食欲减退,张口及吞咽困难,四肢肌肉疼痛,以下肢为重,同时伴有心悸、气短,门诊拟心包积液收住院。既往无肺结核、糖尿病、关节炎病史,无烟酒嗜好。体检：…     

孕早、中、晚期正常孕妇Zn、Ca、Mg、Fe分析

目的了解南京孕妇在不同孕期微量元素的变化规律。方法按孕周将547名孕妇分为早孕(小于16周)、中孕(16～28周)、晚孕(大于28周)3个实验组,130名正常体检妇女为对照组,采用原子吸收分光光度法检测孕妇及对照组妇女微量元素的含量,比较实验组及对照组微量元素值。结果随着孕周的增加,缺乏铁和镁的孕妇比例升高,钙元素早孕组缺乏的比例最高,中孕组孕妇缺锌比例最高。结论孕妇早孕期应注意钙元素的补充,中孕期应加强锌、镁、铁元素的补充,饮食上应注意膳食平衡,保证足够的微量元素铁供应。     

浮肿、发热、截瘫

患者女,34岁,因"浮肿1年余,发热3个月,双下肢瘫痪6天"入院.1病例摘要(第1部分)1.1病史患者于1年余前无明显诱因出现颜面及双下肢浮肿,伴脱发.查血常规WBC 3.2×109/L,Hb1O1 g/L,PLT 89 ×109/L,尿常规:蛋白5.0 g/L,24h尿蛋白定量4.03g,血A1b 25g/L,Cr正常,ANA、抗dsDNA(+),肾穿病理:狼疮性肾炎Ⅳ-S(A) +V型.诊断系统性红斑狼疮(SLE)给予泼尼松龙55 mg qd→每月减5mg,25 mg qd之后每月减2.5mg,来氟米特50 mg/d×3 d→20 mg qd维持.尿蛋白逐渐减少,浮肿、脱发逐渐减轻.1年前泼尼松龙减至40 mgqd时出现发热,多于上午出现,Tmax 39℃,下午自行降至正常,伴盗汗,中药治疗数日后体温正常.8个月前再次发热,性状同前,中药治疗约20d后体温正常.3个月前泼尼松龙减至15 mg qd时第3次发热,Tmax40℃,上午及夜间达峰值,可自行降至正常,伴盗汗、畏寒,偶有寒战,无咳嗽、咳痰.胸部CT提示"双肺结节,肺间质改变".考虑SLE病情活动合并肺间质病变,泼尼松龙加至30 mg qd,并加用左氧氟沙星,3d后体温正常.停抗生素后再次发热,将泼尼松龙改为早20 mg,晚10 nmg,至今未再发热.1个月前感乏力,行走无力,8d前双下肢无力明显加重,无法行走,伴感觉减退,大小便失禁,6d前双下肢完全瘫痪.否认结核接触史.既往史、个人史、月经婚育史、家族史:无殊.     

紫癜、发热、肉眼血尿、左侧偏瘫

1病历摘要 患者,女,27岁.因鼻衄、紫癜6年,发热、腰痛、肉眼血尿4个月,突发左侧肢体无力6天入院.     

头昏、四肢无力、食呛、谈漠、语言不清

头昏、四肢无力、食呛、谈漠、语言不清安徽省铜陵市人民医院病理科皖南医学院病理学教研室１病史摘要患者，男，２０岁。因头昏、四肢无力，渐加重４０余日，食呛、语言不清、淡漠１０余日。发病前无明显诱因，病程中无发热。ＥＥＧ示中度异常双额区段慢波。拟诊“脑干脑...     

腹水、肾损害、心肌病变、免疫球蛋白减少

1病例摘要 患者女性,59岁,因“腹胀、乏力半年,加重1个月”于2011-05-23收入北京协和医院消化科.患者2010年10月无明显诱因出现腹胀、乏力,伴食欲减退、体重减轻.外院查血常规WBC 8×109/L,Hb104 g/L,PLT 5×109/L(磕碰后有皮肤出血点).肝功:ALT 59 U/L,AST 74 U/L,ALP 278 U/L,G,GT394 U/L,余(-);肾功:Cr 95 μmol/L(2010年11月),259 μmol/L( 2011年4月).免疫球蛋白IgG3.7 g/L,IgA 0.55 g/L,IgM 0.54 g/L.     

皮疹、腹痛、腹泻、发热、球麻痹

患者,男,51岁.因"皮疹2年,脐周胀痛、腹泻半年余,加重伴高热5 d"入院. 1病历摘要 1.1病史 患者2005年7月无诱因出现左手腕部淡红色皮疹,直径约0.5 cm,凸出皮面,脱屑,轻度瘙痒,无疼痛.外用药(具体不详)治疗后皮疹渐消褪至褐色色素沉着.     

发热、咳嗽、腹胀、腹泻

1　病历摘要男婴 ,80天。因不规则发热 1个月余伴咳嗽 1周 ,腹胀、腹泻 4天入院。患儿于 1个月前无明显诱因下出现不规则发热 ,体温 38℃左右 ,最高时达 39℃ ,在当地医院给予“头孢唑啉、苯唑青霉素、头孢噻肟、头孢哌胴”等治疗 ,体温仍维持 38℃左右。 1周前出现咳嗽 ,为阵发性呛咳 ,4～ 5天前出现腹胀、腹泻 ,大便 4～ 5次 /天 ,为稀粘液便 ,以“败血症、肺炎”转入我院。患儿为Ｇ3 Ｐ2 ,足月顺产 ,生下即哭 ,人工 (牛乳 )喂养。按时预防接种 ,无肝炎、结核等传染病接触史。父母无肝炎、结核等病史。当地医院胸片报告未见结核病灶。体检…     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.