Progress in the Treatment of Fungal Infections of the Central Nervous System

HThe incidence of fungal infections of the central nervous system(CNS) has gradually increased in recent years. Intracranial fungal infection can be classified as diffuse and focal infections. The clinical manifestations of these infections include fever and cranial pressure caused by meningitis or meningoencephalitis, and focal neurological defects caused by lesions in the intracranial space. Diagnosing fungal infections of the CNS requires the comprehensive analysis of the patient's medical history, epidemiology, underlying disease, clinical manifestation, imaging manifestations, and various laboratory test results. The identification of fungal bodies or structures in brain tissue or cerebrospinal fluid specimens is the golden standard of diagnosis. The principles for the treatment of the fungal infections of the CNS are the effective control of pathogenic risk factors, use of effective antifungal drugs, and the active implementation of surgical intervention for fungal abscesses and granuloma. In the meantime, new diagnoses and treatments should be actively explored to improve the prognosis of patients.

Effectiveness of Centralized Wastewater Treatment Plant in Removing Emerging Contaminants: A Case Study at Kuching, Malaysia

Before the construction of the Kuching Centralized Wastewater Treatment System Package 1 (KCWTSP1), partially treated blackwater and greywater were discharged directly into natural waterways. The accumulated wastewater had polluted Sarawak river, which is regulated and cannot discharge freely into the South China Sea. The polluted Sarawak river has endangered human health, river water quality, and aquatic ecosystems. Hence, the KCWTSP1 commissioned in 2015 serves the purpose of removing pollutants from wastewater before it is discharged into natural waterways. However, the effectiveness of KCWTPP1 is unknown. This paper is aimed to discuss and review the effectiveness of KCWTPP1 in treating wastewater since its inception in 2015. From 2017 to 2020, KCWTPP1 has treated an average of 4,200,000 m3 of wastewater per year. Generally, most of the discharge effluent met Environmental Quality Act (1974) Standard A criteria, except for the oil and grease parameter. Initially, the plant could not treat suspended solids and total phosphorus, but this was greatly improved in subsequent years. Therefore, some improvements are required to treat oil and grease parameters effectively and efficiently to ensure that only Standard A effluent is discharged into the Sarawak River in the future.

Treatment Strategies for Huge Central Neurocytomas

Central neurocytomas（CNs）, initially asymptomatic, sometimes become huge before detection. We described and analyzed the clinical, radiological, operational and outcome data of 13 cases of huge intraventricular CNs, and discussed the treatment strategies in this study. All huge CNs（n=13） in our study were located in bilateral lateral ventricle with diameter ≥5.0 cm and had a broad-based attachment to at least one side of the ventricle wall. All patients received craniotomy to remove the tumor through transcallosal or transcortical approach and CNs were of typical histologic and immunohistochemical features. Adjuvant therapies including conventional radiation therapy（RT） or gamma knife radiosurgery（GKRS） were also performed postoperatively. Transcallosal and transcortical approaches were used in 8 and 5 patients, respectively. Two patients died within one month after operation and 3 patients with gross total resection（GTR） were additionally given a decompressive craniectomy（DC） and/or ventriculoperitoneal shunt（VPS） as the salvage therapy. Six patients received GTR（＋RT） and 7 patients received subtotal resection（STR）（＋GKRS）. Eight patients suffered serious complications such as hydrocephalus, paralysis and seizure after operation, and patients who underwent GTR showed worse functional outcome [less Karnofsky performance scale（KPS） scores] than those having STR（＋GKRS） during the follow-up period. The clinical outcome of huge CNs seemed not to be favorable as that described in previous reports. Surgical resection for huge CNs should be meticulously considered to guarantee the maximum safety. Better results were achieved in STR（＋GKRS） compared with GTR（＋RT） for huge CNs, suggesting that STR（＋GKRS） may be a better treatment choice. The recurrent or residual tumor can be treated with GKRS effectively.

Effect of intervention treatment from different stages on prognosis in children with central coordination disturbance

BACKGROUND： Central coordination disturbance is regarded as the early-stage symptom of brain injury-induced cerebral palsy. This disease manifests itself as motor disorder, abnormal attitudinal reflex and muscular tension. Early intervention may improve its prognosis. OBJECTIVE： To observe the effects of intervention treatment from different stages on the prognosis of central coordination disturbance following brain injury in children patients. DESIGN： A contrast observation experiment SETTING： Department of Neurology and Rehabilitation, Urumqi Children＇s Hospital PARTICIPANTS ： Totally 151 children who were diagnosed as central coordination disturbance from January 2002 to December 2003 in the Department of Neurology and Rehabilitation of Urumqi Children＇s Hospital were recruited. All the children patients, including 101 male and 50 female, aged from 3 months to 1 year old, met the diagnosis criteria of central coordination disturbance from Vojta. They were divided into slight, moderate and severe abnormity according to Vojta attitudinal reflex. All 151 patients were divided into 2 groups according to their age at diagnosis： 3-6 months old group （n=74）, 62 severe, 10 moderate and 2 slight; 7-12 months old group （n=77）, 66 severe, 7 moderate and 4 slight. All the relatives of children patients were informed of the experiment. METHODS： ① Both groups received physical training （PT） as the main treatment; Hand training was given if necessary. All of the patients received additional hyperbaric oxygen therapy, bioelectric therapy, scalp acupuncture, drug treatment and family training. The importance of integration of hospital and family based rehabilitation was stressed. Those who did not catch up with the normal development or had abnormal reflexes continued to receive treatment. ② Around the age of 2 years old, all children did a final evaluation using Bayley Scales of Infant Development （BSID）. Mental development index （MDI） and physical development index （PDI） were taken as evaluative criteria. Children with scores 80 and above on MDI and PDI were considered to have normal motor and mental development; 79 and below were considered delayers. The Diagnostic Criteria of Cerebral Palsy and Infantecondary School Social Adaptation Scale were used in the final evaluation[scores ≤5 was extremely severe （extremely severe cerebral palsy）, 6 was severe（severe cerebral palsy）, 7 was moderate（moderate cerebral palsy）, 8 was slight（slight cerebral palsy）, 9 was borderline（slight cerebral palsy）, 10 was normal, 11 was above average, 12 was excellent and ≥13 was extremely excellent]. ③ Final evaluative results of 2 groups were compared. And u test was used for the comparison of Bayley development index and Chi-square test for the comparison of normalization rate. MAIN OUTCOME MEASURES： BSID MDI and PDI as well as the normalization rate of motor function and mental behavior of children patients at 2 years old. RESULTS： Totally 151 children patients entered the stage of result analysis. ①Two groups of children patients were given integrated rehabilitation therapy , and evaluated at 2 years old . The 3-6 months old group had higher MDI and PDI than the 7-12 months old group （91.81＋19.99 vs 71.93＋18.98;91.55＋23.61 vs 68.95＋23.51, u=6.265,5.894,P 〈 0.01 ）.②After being given integrated rehabilitation therapy, children patients of 3-6 months old group had significantly higher normalization rate of motor function and mental behavior than 7-12 months old group （73% ,27%,X2=29.723 9,P 〈 0.01 ）. ③Six slight and 17 moderate central coordination disturbance children of 2 groups all completely recovered; After intervention treatment, among 128 severe central coordination disturbance children, 52 recovered and 76 were still abnormal, in which, 43 slight cerebral palsy, 18 moderate cerebral palsy, 5 severe cerebral palsy and 10 extremely severe cerebral palsy. CONCLUSION： To perform integrated intervention treatment before 6 months old can better improve and promote mental and physical development levels of children patients with central coordination disturbance after brain injury than 6 months later.

Treatment of central precocious puberty by GnRH analogs： long-term outcome in men

In boys, central precocious puberty （CPP） is the appearance of secondary sex characteristics driven by pituitary gonadotropin secretion before the age of 9 years. In the last years, relevant improvements in the treatment of CPP have been achieved. Because CPP is rare in boys, the majority of papers on this issue focus on girls and do not address specific features of male patients regarding end results and safety. In the present paper, recent advances of CPP management with GnRH analogs in men are summarized. End results in untreated and treated patients are also reviewed by an analysis of the recently published literature on treatment of CPP in men. The available data indicate that therapy with GnRH analogs can improve final height into the range of target height without significant adverse short-term and long-term effects, but longer follow-up of larger series of patients is still required to draw definitive conclusions.

Utilisation of Non-Conventional Animal Waste as Feeds by Multiple Livestock Species Farmers in Lake Victoria Crescent of Central Uganda

A cross-sectional survey was conducted to establish the utilisation of non-conventional animal waste in multiple livestock species systems. Farmers (150) were selected from four out of ten districts of Central Uganda in Lake Victoria Crescent. A structured questionnaire was used and descriptive analysis showed that over 80% are smallholder farmers on 3.0) years. Household husbands (80%) significantly (P 1.0) as they cause poor livestock health due to pathogens, parasites and toxins which are associated (OD > 1.0) with poor growth, mortality and condemnation of livestock products. The remedy to unsafe non-conventional feeds is to apply effective solar-heating (75%), chemical and ensiling treatment methods. The study showed that there are no significant (P < 0.001) public health risks associated with utilising treated non-conventional feeds instead it improves production and sustainability of multiple livestock species systems.

Surgical Treatment of Central Giant Cell Granuloma with Carnoy’s Solution

A 25-year-old woman presented a unilateral mandibular swelling, after laboratory analysis, radiological studies and aspiration puncture biopsy, the pathological diagnosis of Central Giant Cell Granuloma was made. Radiographically, the multilocular lesion involved the left lower first molar and was 30 mm long by 20 mm high. Dental extraction of the molar involved with forceps and exeresis in toto of the tumor were performed using a Volkmann cutting curette. The tumor made up of 90% vascular tissue produced intra-surgical bleeding that made visibility difficult. The bone bed curettage was aggressive except for its base in direct contact with the inferior dental nerve. Subsequently, to avoid recurrence, the surgical protocol includes a double irrigation with Carnoy’s solution, (fixative composed of 60% ethanol, 30% chloroform and 10% glacial acetic acid 98%) for 5 minutes that produces chemical cauterization. Finally, it was washed with physiological solution and the cavity was filled with iodoformed gauze. The gauze was exchanged and removed gradually over three weeks for second intention healing. This case is presented to demonstrate that inexpensive chemical treatment can be safely used for outpatient surgery under local anesthesia. Because Carnoy’s solution achieved control of intraoperative bleeding, allowed bone healing and prevented recurrence of the lesion in clinical radiographic follow-up for 15 years.

无痛诊疗技术在超声PICC置管患儿中的应用效果研究

目的探讨无痛诊疗技术在超声引导下儿童经外周静脉穿刺中心静脉置管术(peripherally inserted central catheter,PICC)中的应用效果。方法选取笔者医院2021年1月至2023年1月拟行PICC的患儿82例,用随机数字表法将其分为对照组、观察组,每组41例;对照组行常规超声引导下PICC置管术,观察组行无痛诊疗技术超声引导下PICC置管术;对比两组置管成功率、置管完成时间,患儿疼痛程度[儿童疼痛行为量表(children’s pain behavior scale,FLACC)],耐受度[Houpt行为量表(Houpt behavior scale,HBS)],依从性[Frankl量表(Frankl scale,FCS)]及家属满意度。结果观察组置管成功率较对照组高,置管时间较对照组短,差异有统计学意义(P<0.05);观察组FLACC评分较对照组低,HBS评分、FCS评分较对照组高,差异有统计学意义(P<0.05);观察组家属总满意度较对照组高,差异有统计学意义(P<0.05)。结论无痛诊疗技术用于超声引导下儿童PICC置管术可提高置管成功率,缩短置管时间,减轻患儿疼痛程度,增强耐受性、依从性,提升家属满意度。

印染集聚提升园区废水集中处理设施设计与运行

浙江某印染集聚提升园区废水集中处理设施建设规模30000 m^(3)/d,针对园区废水特点,采用主体工艺为“调节池+冷却系统+反应初沉池+厌氧水解池+A/O生化池+二沉池+高效沉淀池”的组合工艺对其进行处理。运行结果表明,该工艺稳定高效,当进水平均COD、BOD5、总锑分别为1370、360、1.17 mg/L时,处理后出水平均COD、BOD5、总锑分别降至88、7.4、0.049 mg/L,对应去除率分别达到94%、98%、96%,出水符合《纺织染整工业水污染物排放标准》(GB 4287—2012)表2间接排放要求。工程采用了混凝药剂强化的初沉工艺,实现了有效的废水碳捕集,间接对外输出能源,有利于减少碳排放,其主要处理单元采用集约化组合及深池型设计,节省占地,可为占地受限型废水处理厂的建设提供参考。

园区污废水排放对周边水环境的影响与污废水集中处理方法研究

文章研究分析园区污废水排放对周边水环境的影响,设计污废水集中处理方法,以维护园区周边的水环境生态质量。首先,建立园区地下水和地表水数值模型,描述污废水渗透和扩散的影响范围,并划分污废水影响边界。然后,根据气象预估地下水位变化,划分污废水造成的污染范围。最后,建立污废水集中处理体系,通过多层级细粒度组合对污废水实施处理,再通过微生物和化学手段完成对园区污废水的集中处理。实验表明,该方法能有效地降低污废水的污染影响。

口腔种植术后疼痛机制及治疗的研究进展

随着口腔种植技术的快速发展,在牙列缺损或牙列缺失患者中,口腔种植修复已逐渐成为一种常规的修复方式。然而,口腔种植术作为“侵入性”治疗,即使经过准确的术前评估和规范的外科手术,患者也可能出现术后疼痛。术后疼痛会影响患者的语言交流、咀嚼及吞咽等,使患者的生活质量降低,甚至可引起医疗事故。随着种植手术的普及,未来可能会有更多的患者遭受种植术后疼痛,尤其是种植术后神经病理性疼痛,其治疗难度仍较大,且治疗药物的疗效往往不确切,并与各种不良反应有关。本文介绍了种植术后疼痛的相关机制,对种植术后疼痛的治疗进行概括,并结合当前研究热点提出未来治疗种植术后神经病理性疼痛的潜在靶点,旨在为开展相关临床工作提供新思路。

污染土壤修复工厂现状及发展研究

污染土壤修复工厂具有缩短修复周期、加快土地流转、降低处置成本等优点,适用于大型退役工业区的土壤修复。本文通过梳理现有政策对修复工厂模式的发展要求,分析了土壤修复工厂建设布置、选址和管理要求;结合国内现有实际案例,总结其发展现状和特性,发现修复工厂多位于经济发达及工业污染严重区域、多采用固化稳定化技术和氧化技术且具有明确的末端处置途径。目前,我国土壤修复工厂模式还存在成熟范例少、转运手续复杂等问题,但其仍具有广阔的发展前景,能够为土壤污染问题提供切实可行的解决方案。

油田联合站碳排放计算及浅析

油田联合站作为油田集输系统的核心单元,涉及油水分离、污水处理、原油含水分析等多个系统的一体化综合性生产过程,同时也消耗了大量的能源,直接或间接地产生了大量碳排放。结合油田联合站的生产运行过程,采用碳排放因子法与物料平衡法对油田联合站的碳排放特性开展了计算分析与讨论,并针对联合站生产过程提出了相应的节能减排措施。通过优化原油处理流程以及耦合光伏发电等可再生能源利用技术,能够减少联合站11.01%的碳排放量,为推动油田行业碳减排发展提供了参考。

1例蜡样芽孢杆菌导致中枢神经系统感染的案例报告并文献复习

本文报告1例颅内肿瘤患者感染蜡样芽孢杆菌(Bacillus cereus)的诊疗过程,收集43例已报道的蜡样芽孢杆菌导致中枢神经系统(CNS)感染的案例,同时复习国内外相关文献,对蜡样芽孢杆菌导致CNS感染的临床表现、治疗方案等进行分析,为临床治疗蜡样芽孢杆菌导致的CNS感染提供借鉴。该类感染在血液恶性肿瘤、早产儿、颅内恶性肿瘤、中心粒细胞减少症的患者中较为多见,应尽早选用万古霉素、美罗培南等敏感且易透过CNS的抗菌药物进行治疗。蜡样芽孢杆菌在临床常被当作污染菌,近年来其导致的感染案例报道越来越多。在易感人群中应高度警惕,尽早开始经验治疗,以改善预后。

基于中医传承计算平台探讨中枢性性早熟中医诊治规律

目的:基于中医传承计算平台(TCMICS)探讨中枢性性早熟(CPP)中医诊治规律,为临床治疗提供参考。方法:计算机检索中国知网、万方数据知识服务平台、维普数据库、中国生物医学文献服务系统等数据库中建库以来至2023年2月所收录的中药内服治疗CPP的临床研究文献,手工检索现代名家医案书籍(出版时间为2004—2021年),提取中药处方,采用Excel软件创建中药治疗CPP处方数据表,借助中医传承计算平台V3.0挖掘诊治规律。结果:纳入现代医案82则,涉及方剂210首,中药216味。82则医案中CPP病位证素以肝为主,涉及脾、胞宫、肾;病性证素以阴虚、热、气滞、痰为多。CPP常见证型为阴虚火旺证、肝郁化火证、痰热内盛证、痰湿内阻证、脾虚痰湿证;频数最高药物依次为知母、黄柏、牡丹皮、生地黄、柴胡等;功效以清热类、补虚类、利水渗湿类、理气类、化痰止咳平喘类为主;四气主要以寒性、平性、温性为主;五味以苦味、甘味、辛味为多;归经频数以肝经为首,肾经、肺经、脾经次之;核心药对有“知母,黄柏”“知母,生地黄”“黄柏,牡丹皮”“知母,牡丹皮”“黄柏,生地黄”;聚类分析得出3个核心组方,组方1为白芍、柴胡、当归、牡丹皮、甘草,组方2为柴胡、浙贝母、白芍、夏枯草、茯苓,组方3为知母、黄柏、牡丹皮、生地黄、夏枯草。结论:CPP的中医药治疗宜补虚泻实,扶正祛邪,肝脾肾同调,尤其要注重调畅肝气。

基于气味厚薄理论探析黄连减轻神经炎症的中医机制

神经炎症几乎发生在所有中枢神经系统疾病的进展过程中,随着临床实践及科学研究的深入,发现黄连及以黄连为主要组成的中药复方对减轻神经炎症、改善疾病预后均有较好效果。基于对“气味厚薄”理论内容的梳理,阐明黄连具有“大苦大寒,味厚气薄”的作用特点,并论述黄连功效与神经炎症中医病机之间的关联,以及黄连通过清心、厚肠、坚肾阴3个方面起到减轻神经炎症的作用机制。

德国肺癌个性化治疗的实施

网络基因组医学(network genomic medicine,NGM)是利用基于二代测序的多重分子诊断来寻找有潜在治疗意义的基因组畸变。德国NGM肺癌项目致力于在常规临床实践中有效地实施个体化的肺癌治疗。该项目不断发展,目前已包括德国约300家转诊机构,并已将多重分子检测纳入了德国主要医疗保险公司的常规报销范围。目前德国每年有超过5000例肺癌患者(约占德国肺癌患者的10%)接受基因分型。NGM的高通量分子诊断方法可对许多患者进行常规检测,使该项目能够有竞争力地参与改变全球临床实践的试验,而且还可以启动多中心临床试验。德国NGM肺癌项目建立了个体化的早期概念验证临床试验平台,包括针对所有可靶向突变的临床试验。德国的国家网络基因组医学(nNGM)肺癌项目于2018年启动。nNGM的理念是将NGM模式扩展到德国全国,从而为晚期肺癌患者提供高度创新的分子诊断和治疗。基于二代测序的分子诊断技术目前已经覆盖了65%的德国晚期肺癌患者。nNGM是目前在复杂和多样化的医疗系统中快速实现创新肿瘤基因组医学的最佳实践范例。本研究介绍了德国NGM肺癌项目的概况,以及nNGM肺癌项目的成功经验,旨在为我国将个性化癌症治疗纳入临床常规提供参考。

雷珠单抗联合不同剂量维替泊芬光动力疗法治疗CSC合并CNV的临床疗效

【目的】探讨雷珠单抗联合不同剂量维替泊芬光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变(CSC)合并脉络膜新生血管(CNV)的临床疗效。【方法】选取2014年2月至2019年12月上海健康医学院附属嘉定区中心医院收治的103例慢性CSC合并CNV患者,根据治疗方法的不同分为常规组[58例58眼,采用雷珠单抗+小剂量(1 mg/m^(2))维替泊芬光动力疗法治疗]和观察组[55例55眼,雷珠单抗+采用半剂量(3 mg/m^(2))维替泊芬光动力疗法治疗]。比较两组患者临床疗效、不良反应发生率及治疗前后视网膜下液隆起最高点高度(HPSF)、最佳矫正视力(BCVA)、视网膜中央静脉血流动力学参数[最大血流速度(V_(max))、最低血流速度(V min)]。【结果】观察组总有效率高于常规组(P<0.05)。治疗前,两组患者HPSF、BVCA比较,差异无统计学意义(P>0.05);治疗后,两组患者HPSF均降低,且观察组低于常规组(P<0.05);治疗后,两组患者BCVA均升高,且观察组高于常规组(P<0.05)。治疗前,两组患者V_(max)、V min比较,差异无统计学意义(P>0.05);治疗后,两组患者V_(max)、V min均降低,且观察组低于常规组(P<0.05)。常规组眼压升高1例,恶心、呕吐2例,不良反应发生率为5.17%;观察组眼压升高2例,恶心、呕吐2例,不良反应发生率为7.27%。两组不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】采用雷珠单抗联合半剂量维替泊芬光动力疗法治疗慢性CSC合并CNV的效果显著,可改善患者视力和视网膜中央静脉血流动力学指标,且安全可靠。

张风梅基于辨病-辨证-辨体诊疗模式治疗慢性CSC

中心性浆液性脉络膜视网膜病变(CSC)是眼科一种常见多发病,具自限性、易复发的特点,多次复发后严重影响患者视功能。王琦院士提出的“辨病-辨证-辨体”三辨诊疗模式,为中医眼科诊疗CSC提供了新的思路与方法。本文整理总结了张风梅运用三辨诊疗模式诊断及治疗慢性CSC的经验,主张临证时先辨病确定病名,再辨证确定证型,结合辨体判定体质与疾病内在联系。治疗上在症候明显的阶段以辨证治疗为主,结合调理体质,临床症状消失后或发病时无全身症状、缺乏明显的证候特点的个体,以辨体论治为主以调体质的偏颇,从而达到改善症状、调理体质而治愈慢性CSC、减少复发的目的。