~我的蓝色生活~科技与体育~

今天的故事其实说到底就是关于免疫的问题，虽然题目是PATERNITY(父子关系)。

棒球运动员的怪异的疾病是由于早期的麻疹病毒躲到大脑里潜伏起来然后在16年后造成了巨大的影响。

说到这里，就不得不说一下House说的那个从母亲带来的持续6个月的免疫能力，这个称为天然被动免疫，指母体抗体经胎盘传给胎儿,或经初乳传给新生儿,使之获得免疫，如新生儿及头 6个月的婴儿对某些传染病(如麻疹、白喉)有免疫力。此种免疫无特异性，维持时间短。所以如果母亲有此类抗体，则婴幼儿可以借此来获得免疫能力。但是这种免疫并不是万能的。在胚胎发育的时候，A，D，E，G，M这么众多类的抗体中仅有抗体G(也就是通常说的IgG，是抗体中的一大类)，能通过母体和胎儿之间的血胎屏障(这就是通常说的胎盘)。所以，有些特定的抗体不能到达胎儿的体内。

再说说疫苗。House用一种正话反说，带着不可置疑的语气，甚至带有点威胁恐吓的方法终于说服了那位认为所谓的跨国公司生产的疫苗只不过是为了赚钱的母亲给孩子打上疫苗。

疫苗是一种好东西，可以给我们的身体带来一段时期(虽然存在个体差异和不同品种的差异，但一般都比较长)对某种疾病的免疫能力。目前我们国家给儿童预防接种的疫苗分为两类。第一类是计划免疫疫苗，第二类是自费疫苗。第一类疫苗由政府出资，包括卡介苗，脊髓灰质炎疫苗，麻疹疫苗，新生儿用乙型肝炎疫苗等。

再讲讲那“万能”的青霉素。为什么在前面的治疗中青霉素直接注射到脑脊液中没有效果呢？这并不是因为青霉素没有达到病灶。而是因为青霉素是属于抗生素类药物，而抗生素类药物最主要的是作用于细菌感染，几乎对病毒没有效果。而这次的病原正是麻疹病毒。而目前存在的迫在眉睫的耐药性也主要是由于抗生素滥用而引起的。众多的耐药菌的出现已经使得抗生素越来越无力面对了。而且面对病菌的时候，也不是越广谱的越好。越有针对性越适当地用药可以使得病菌得到最彻底的消灭。

而House最后对患者的治疗是用了干扰素，这个是目前来说对病毒还是比较有效的方法。它主要作用于DNA复制时期，干扰DNA的正常复制，所以往往对人体也有害，像这种直接注入脑室的方式也是很危险的。像现在治疗乙型肝炎，AIDS的时候都有干扰素的身影存在。

--==截止2007/02/20==--

附EP02的剧情梗概
S1EP02
PATERNITY
Aired 11/23/04
A family arrives for an appointment with House even though it’s a walk-in clinic. They 11:01 2007-2-19claim to have a letter from him about the appointment, which is odd because House doesn’t write letters. It seems that Dr. Cameron wrote the letter and signed House’s name to aid the family.

House agrees to see the patient. Dan is a 16-year old who has the sudden onset of double vision and night terrors. House says that post-traumatic stress and sexual abuse are two common symptoms. Dan, a high school lacrosse player, admits that he was recently struck in the head. House tells the kid to get some glasses to correct the double vision and ride out the concussion that’s causing the night terrors.

As the kid is leaving, House notices Dan’s foot twitch and he asks if he’s tired or about to fall asleep. He isn’t, and House knows the myoclonic jerk is common when a person is falling asleep. The body misinterprets a falling pulse as dying and jolts you awake. House instructs his staff to admit the patient.

House bets Dr. Foreman that the dad isn’t Dan’s biological father. They can’t rule out genetic causes just yet. During the first night, the patient has another night terror, which is recorded on a polysonagraph. But a series of scans and tests show no explanation for the symptoms. House re-examines the MRI and orders another test that shows there is significant blockage. A shunt is inserted to relieve the pressure. After surgery, it turns out what they thought was the issue was only a symptom of something larger. Is it Multiple Sclerosis?

That night, Dan goes missing from his bed. Cameron, Chase and Foreman set off on a search, eventually finding Dan on the roof. Dan thinks he’s on the lacrosse field walking around. The doctors tackle him moments before he wanders off the edge of the roof.

The next morning, House is confused by Foreman’s report from the roof. House is thrilled because this means Dan doesn’t have night terrors -- and thus, is not suffering from MS. Dan must have an infection in his brain, which House thinks is neurosyphillis.

As Cameron and Chase inject penicillin into Dan’s brain, he begins having another attack of voices in his head. The auditory hallucination disproves neurosyphillis. House orders more tests to read Dan’s brain. He notices that the parents have left their lunch behind in the hospital, so House takes a sample to run a DNA test. Cameron finds that neither of them are Dan’s biological parents. He’s adopted. Was his birth mother vaccinated? House thinks infant Dan caught a basic measles virus that mutated and reappeared 16 years later after settling into his brain. He suggests injecting a needle into the boy’s eye to do a biopsy on his retina.

That frightening test reveals the mutated virus which requires a dangerous brain surgery. However, the surgery if effective and Dan will be fine. Turns out Dan already knew he was adopted after doing his own research in the fifth grade.

这是House系列的开篇剧，编者以PILOT为名，可能就想用这个“领导”这个含义来展开接下来的剧目。(我乱猜的)

故事发生在一个幼儿园教师的身上。恩，先说这个教师吧，有没有感觉特别眼熟？对~没错，她就是《越狱(Prison Break)》里的那个女律师，FOX到处拉人跑龙套啊，呵呵。

PS:她的牙齿真的很漂亮。就是在她在做CT检查的时候突然水肿窒息的时候那个镜头从她嘴里探进去的时候看到那晶莹剔透的牙齿，恩，不错不错，不知道是不是后期处理掉的。唉。。。

说到这个CT检查的时候，就不得不说说急救了。里面有一个小细节，澳大利亚帅哥Chase说Hold her neck，这个一般急救时恢复呼吸所要做的。这样抬起脖子之后，会使头自然后仰，这样会有助于会厌打开气管口，加强通气。再说说急救气管切开术(Emergency Tracheotomy，缩写是ET(),ET回地球？呵呵，玩笑玩笑。)。做这个急救手术时，直接从颈部切开皮肤和气管，然后安装上固定器插入导管，再用气囊通气。因为没上临床，所以不知道那个镜头中血涌出来是不是有问题。按照道理，这里没有什么大血管的，切开应该出血也没有像Chase下刀之后出现的那么多的。再补充一点一般野外气管阻塞急救的时候就比这个简单多了，直接拿锐器切开就好。

做CT的时候有个插曲，就是House拒绝答应Cuddy去看门诊，结果作为行政主管的Dr. Cuddy直接切断了House各种使用仪器的权利，按照House的话来说，就是“You want me to treat patients,you aren't letting me treat patients.”。

最后House为了对这个躺在仪器前的女教师进行检查，只能同Cuddy妥协，补完以前所拖欠的门诊时间(据他自己估计需要到2054年才可以偿还清，呵呵)。

到了门诊，首先是一个皮肤变成orange颜色的医院赞助户，结果他仿佛是Holmes，从病人身体变化而其妻子没注意到推断出他的妻子有外遇了，但是走的时候才转到正题，注意点饮食，少吃点胡萝卜和维生素，汗。。。接着还有一个门诊是小儿哮喘的。老实说，用类固醇来治疗哮喘(按照剧中所述，应该是炎性哮喘，用的应该是糖皮质激素类的平喘药)是临床上的一线用药，有强大的抗炎、抗过敏作用，但是其不良反应有免疫抑制，骨质疏松等，感觉不太适用于青少年。(正如妈妈所当心那样——I worry about children taking such strong medicine so frequently.)但是既然是医生经过审慎而开出的药，那自然Your doctor probably was concerned about the strength of the medicine, too。还有一个临床病人，总是怀疑自己有病，House很巧妙地用了安慰剂来治疗其心理。结果最后House还是很狡黠地问Wilson要1美圆的找头去糖果机里。。嘿嘿。。

再回到这女教师身上。Cuddy强烈反对House实验性给类固醇，结果病征竟然奇迹般地好转了。但是好景不长，在晚上Wilson探班的时候，先是出现失明，紧接着就是强烈的角弓反张(也就是大脑对伸肌的抑制作用降低，使背肌强直性痉挛，也就是所谓的去大脑僵直)，这就说明大脑已经受到损伤，调控和抑制作用有障碍。

没办法了，House只好祭出他的最后法宝了，找人到患者家里直接搜索了，这个不像是医生，而有点像警察办案了，呵呵。这或许就是House强硬态度的表现之一，为了寻究出真正的病因而不择手段。更有甚者，因为不知道到底是什么病，只能将病人听之任之，看疾病的恶化速度来判断到底是什么病因。太汗了，这样不会被知道真相的人给打死？

还好，Foreman去患者家里还是有收获的，虽然他自己没有意识到。真正的病因就是没有处理到位的猪肉里的猪肉带绦虫。大家还记得以前吃的糖丸吧？这个就是用来驱逐肠道寄生虫的。虽然这种寄生虫一般只存在于肠道，但是House说的这样的情况也不是不存在，在脑中异位寄生，并引起严重的反应。

现在大家知道了，吃不熟的食物是很危险的，除了各种细菌病毒以外，还可能吃到恶心的“虫子”诶，嘿嘿。

最后故事以奇妙的2片药做出了最终的诊断。从肿瘤(tumor)到血管炎(vasculitis)再到最后的寄生虫病，这说明确诊实在是很重要啊，一不小心就容易出人命了。

对了，再讲下最后治疗寄生虫的药物阿苯达唑(Albendazole)，是继甲苯达唑之后治疗肠道寄生虫，高效低毒的广谱驱虫药。不良反应也正是如Chase所说的那样。只是不知道肠道驱虫药是不是真的能如电视中所说的可以到达脑部并消灭寄生虫。

总的来说，这篇故事很不错，开始就抓住了观众的心理，同时在情节铺开的过程中，将整个故事的人际关系交代了一下，并埋下了伏笔。

如House与Cuddy之间的门诊与否的冲突；House与Foreman之间的“种族歧视”；House和Wilson之间的友情。Foreman进入House的团队竟然是由于他16岁的私闯民宅的“污点”——不过这也方便了House要求手下去患者家里彻底调查，呵呵。
同时House去劝说Rebecca(那个女教师)的时候，讲述了自己为什么会瘸腿的故事，唉，伤心的往事啊。

暂时只能想到了这么多，以后还想到什么继续补充，准备开始看第二集了。

--==截止2007/02/18==--

附EP01的剧情梗概
101: Pilot 
PILOT
Aired 11/16/04
A young woman named Rebecca is teaching her kindergarten class when she begins to have trouble speaking. Soon, she collapses on the floor and begins convulsing. At the hospital, Dr. James Wilson, describes the case to Dr. House. Female, 29, first seizure one month ago, progressive deterioration of mental status. The doctor asks House to take this case and put his team to work on it.

House’s team consists of three young genius doctors: Allison Cameron, Robert Chase and Eric Foreman, all bored stiff by House’s lack of cases. After much persuasion, House agrees to look over the patient. Later, the hospital administrator, Dr. Lisa Cuddy, scolds House about not doing his job. Even though he has tenure, she can still let him go if he avoids his duties of seeing patients.

Cameron and Foreman give Rebecca a CT scan, but she has another seizure inside the machine. The doctors perform an emergency tracheotomy to facilitate breathing. Later, House wonders if Rebecca has vasculitis, or inflamed blood vessels. Allison points out that you can’t diagnose vasculitis without a biopsy. House recommends they give her steroids to treat it and just see what happens.

House suggests to Foreman that he break into Rebecca’s apartment to inspect it. Foreman is reluctant, but does it anyway. Elsewhere, the steroids seem to be having a positive effect on Rebecca. Later that night, Wilson gives Rebecca some basic tests and she proclaims that she can’t see. More convulsions follow.

The next day, Foreman gives Rebecca a basic test which she fails, then passes. House suggests that they let her die, but pay attention post-mortem so that they can finally learn what disease she was suffering from. Foreman and Cameron inspect Rebecca’s apartment. They find nothing. Back at the hospital, Foreman reveals in passing that Rebecca had ham in her fridge. House has an epiphany -- Rebecca must have a tapeworm in her brain. Although this new revelation is diagnosed, Rebecca doesn’t want any more treatments. She just wants to die in peace. House calls her a coward. She wants proof it was a worm since he was wrong on vasculitis. Chase suggests a plain old x-ray to check for worms. House realizes he’s right. If there’s a worm in the brain, there is definitely one in her leg.

Chase shows Rebecca the x-ray. A worm larvae is in her  thigh muscle. She will make a full recovery, and only require a small number of  pills to get rid of the worm.