分泌性中耳炎（SOM）的临床特征表现为听力下降和中耳积液,与中耳化脓性炎症常伴随耳部急性感染不同,SOM常伴随耳部闷胀、轻微耳痛等,致使听力出现障碍。SOM发病机制较为复杂,可能与感染、免疫、咽鼓管功能障碍等多种因素相关,治疗方法也因此呈现出多样化的特点。本文就SOM的病因病机及其治疗方式展开综述,以期为临床及早诊断和治疗SOM提供理论依据。

The clinical characteristics of secretory otitis media（SOM）are hearing loss and effusion in the middle ear．Different from acute ear infection of suppurative inflammation in the middle ear,SOM is often accompanied by ear tightness and mild earache,resulting in hearing impairment．The pathogenesis of SOM is complex,which may be related to infection,immunity,eustachian tube dysfunction and other factors．Therefore,the treatment methods are diversified．This paper reviews the etiology,pathogenesis and treatment of SOM,in order to provide theoretical basis for clinical early diagnosis and treatment of SOM.

目的 探讨无症状感染者在新冠肺炎家庭聚集性疫情中的传播风险,分析家庭聚集性疫情中所有患者的住院治疗情况,为防控策略和治疗方案制定提供依据。方法 通过现场流行病学调查获得旅居史和暴露危险因素,并收集临床治疗资料,利用统计软件进行作图和分析。结果 指示病例的潜伏期为15天,其余4名家庭成员的潜伏期为1～15天,其中指示病例作为无症状感染者,在感染后第4～6天内具有传染性相继导致4名成员感染;指示病例携带病毒8天以上,其余4人从2天到31天不等; 症状持续时间5~20天,住院期间共进行CT检查次数为4～10次,肺部炎症最快在住院第三天好转。发病初期只有1个病例出现白细胞、淋巴细胞降低。发病到就诊和住院的时间间隔为1～10天,平均住院时间为23.4天。结论 无症状感染者在家庭聚集性疫情传播中具有关键作用,难以及时发现,存在较大传播风险,为新冠肺炎疫情防控带来较大难度。

Objective To study the transmission risk of asymptomatic patient in a family-clustered outbreak of new coronavirus pneumonia, analyze the hospitalization,and provide a basis for prevention strategies and treatment plan. Methods We collected the information about residence history and exposure risks by onsite epidemiological investigation, and collected clinical treatment-related data, used statistical software for mapping and analysis. Results The incubation period of the indicated case was 15 days, and the incubation period of the remaining four family members were 1-15 days. The indicated case as an asymptomatic patient had infectious succession within 4-6 days after infection,and four family members were infected one after another. The indicated case carried the virus for more than 8 days, and the remaining 4 patients ranged from 2 to 31 days. The duration of symptoms was 5-20 days of all 5 patients, and the number of CT examinations during hospitalization was 4-10 times. The pulmonary inflammation was improved on the third day of hospitalization at best. In the early stage of the disease, only one patient had leukopenia and lymphopenia decreased. The interval between onset and hospitalization was 1-10 days for five family members, with an average hospitalization time of 23.4 days. Conclusion The asymptomatic infected patient of COVID-19 plays a key role in the family convergence epidemic transmission. The symptoms are inapparent, so it is difficult to find in time. It will cause the risk of infection and increase the difficulty of COVID-19 prevention and control.

目的 总结一种新的技术在心脏术后纵隔感染的应用经验。方法 回顾性分析2017年2月—2019年6月15日心脏术后发生纵膈感染成人患者,共有5例(1.2%),其中男性4例,女性1例,平均年龄(49±19)岁,平均体质量(70±15)kg,2例为急性A型主动脉夹层,2例为冠心病,1例为感染性心内膜炎合并白塞氏病,患者确诊后出现创面感染重、分泌物多,行VSD(负压封闭引流)进行过渡治疗,待创面清洁、肉芽新鲜后入手术室行清创术,术中4例采用SternaLock胸骨固定系统进行固定,1例因未累及至胸骨后,仅在胸骨前方行清创缝合。结果 4例完全治愈并顺利出院,1例因出现多器官功能衰竭死亡,但伤口愈合良好。结论 通过VSD引流增加了胸骨血流,加速肉芽组织形成,防止感染进一步加重,稳定胸骨,为进一步清创创造了良好的基础,同时运用SternaLock^®胸骨固定系统(8孔型钛板及2.4 mm自钻锁螺钉)进行固定,明显增加了胸骨的稳定性,进一步改善患者预后。

Objective To summarize the application experience of a new technique in mediastinal infection after cardiac operation. Methods A retrospective analysis of adult patients with mediastinal infection after cardiac surgery from February 2017 to June 15, 2019 were taken including a total of 5 cases (1.2%), of which 4 were male and 1 was female, with an average age (49±19) years old, average weight (70±15) kg;2 cases had acute type A aortic dissection, 2 cases had coronary heart disease, 1 case had infective endocarditis with Behcet's disease. After diagnosed, the patients developed severe wound infection and excessive secretion. VSD (vacuum sealing drainage) was performed for transitional treatment. After the wounds were cleaned and the granulation were still fresh, the wounds were for debridement in the operating room. During the operation, 4 cases were fixed with the SternaLock^® plating system, and 1 case was only treated with debridement and suture in front of the sternum because it did not involve the sternum. Results Four cases were cured and discharged smoothly, and 1 case died due to multiple organ failure, but the wound healed well. Conclusion The VSD increased sternum blood flow, which accelerated the granulation tissue formation, further to prevent infection and stable sternum, create a good foundation for further debridement, meanwhile the SternaLock ^® plating system(consists of eight pass since the titanium plate and 2.4 mm drill lock screw) was used for fixation, which significantly increased the stability of the sternum, further improved the prognosis of patients.

目的 分析难治性痛风的治疗效果及经验总结。方法 收集30例难治性痛风性关节炎患者分长病程及短病程组,对比各组基线指标及治疗后的血尿酸水平,肾功能情况及受累部位关节超声变化,及患者VAS评分比较,最后统计分析组间差异及探讨难治性痛风预后与降尿酸控制水平、炎症指标、血肌酐变化的相关性。结果 30例痛风患者治疗前后对比,短病程组患者VAS评分从5.6±3.3下降至3.2±1.1,血沉从59.3±12.4下降至20.6±6.9,受累关节滑膜厚度从（3.57±0.63）mm下降至（1.96±0.65）mm,血尿酸从（589.3±146.2）μmol/L下降至（403.8±96.4）μmol/L,P<0.05;短病程组及并发症少的患者改善更明显,血尿酸控制更低的患者相关指标下降更明显,P<0.01;患者的血尿酸下降趋势跟关节滑膜厚度与炎症指标（ESR）、血肌酐的变化趋势符合,通过回归分析有相关性意义,P<0.05。结论 难治性痛风的处理核心还是有效的控制尿酸,但需要对影响预后的因素,包括感染、肾功能不全、消化性溃疡等并发症进行风险管理,降低相关风险及合并症治疗对难治性痛风的有效治疗管理非常重要。

目的 分析献血者献血后血肿(瘀斑)应用不同治疗方法的效果。方法 随机选取147例在广州血液中心献血后出现血肿(瘀斑)的献血者,根据其采用处理方式的差异分为甲组(n=66)、乙组(n=48)、丙组(n=33),为甲组献血者实施冷热敷法,为乙组献血者实施马铃薯片贴敷法,为丙组献血者实施喜辽妥(多磺酸粘多糖)软膏外敷法。结果 乙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=4.63,P＜0.05),丙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=13.99,P＜0.05),丙组献血者临床总有效率高于乙组献血者,2组差异有统计学意义(χ²=3.99,P＜0.05)。结论 献血者献血后血肿应用喜疗妥软膏外敷法疗效确切,可使其身心健康得到改善。

Objective To analyze the effects of different treatment methods on blood donors with haematoma(or bruise) after blood donation. Methods 147 blood donors with haematoma(or bruise) after blood donation in our blood station were randomly selected. According to the difference of treatment methods, they were divided into group A (n=66), group B (n=48) and group C (n=33), for the group A of blood donors to carry out cold and hot compress method, for the group B blood donors to implement the potato slice application method, for the group C blood donors to implement the hi-treatment ointment external application method. Results The total effective rate of group B blood donors was higher than that of group A blood donors. The difference was statistically significant (χ²=4.63,P＜0.05). The total clinical effective rate of group C blood donors was higher than that of group A blood donors. There is statistical significance (χ²=13.99,P＜0.05). The total effective rate of donors in group C was higher than that in group B. The difference between the two groups was statistically significant (χ²=3.99,P＜0.05). Conclusion The effect of external application of Hirudoid(Mucopolysaccharide Polysulfate Cream) on blood donors after blood donation is effective, which may improve their physical and mental health.

       结直肠癌（CRC）是全球第三大最常见的癌症，也是癌症相关死亡的第二大常见原因。结直肠癌肝转移（CRLM）是导致CRC患者死亡的主要原因，根治性肝切除术是目前有望治愈CRLM的唯一途径，但大部分患者不能进行根治性肝切除术。通过早期发现并进行针对性干预，能够改善患者的治疗效果及预后。文章通过综述CRLM的发病机制、诊疗现状及最新纳米诊疗方法，为深入探索高效诊疗方法提供思路。

      Colorectal cancer（CRC）is the third most common cancer and the second most common cause of cancer-related death worldwide．Colorectal cancer liver metastases（CRLM）are the leading cause of death in patients with CRC．Radical hepatectomy is the only way to cure CRLM so far，while most patients cannot undergo radical hepatectomy．CRLM treatment efficacy and prognosis can be improved by early diagnosis and specialized intervention．This paper reviews the pathogenesis，diagnosis，and treatment status of CRLM and the latest nano-diagnosis and treatment methods so as to provide ideas for in-depth exploration of efficient diagnosis and treatment methods．