FDG PET脑显像在癫痫定位诊断中的应用—与SPECT、MRI、CT检查对比分析

目的：探讨功能性显像技术在癫痫灶定位中的价值。方法：我们对６０例癫痫分别进行脑正电子发射计算机断层（ＰＥＴ）、单光子发射计算机断层（ＳＰＥＣＴ）、ＭＲＩ和ＣＴ检查，对癫痫灶进行定位。５９例为ＰＥＴ发作间期显像，１例进行了发作间期和发作期显像，并与其ＣＴ和ＭＲＩ结果进行比较，结果分析采用目测法。结果：发作间期阳性率ＰＥＴ为８６７％（５２／６０），ＳＰＥＣＴ为６０％（３６／６０）。ＰＥＴ与ＳＰＥＣＴ定位完全符合者占８０６％（２９／３６）。ＰＥＴ定位癫痫灶的灵敏度明显优于ＳＰＥＣＴ、ＣＴ、ＭＲＩ。结论：我们认为ＰＥＴ功能显像通过观察脑葡萄糖代谢进行癫痫灶定位是目前较好的无创性的检查方法。结合解剖结构图像可为治疗提供更多的信息     

经食管超声心动图的一种新用途：TEE对38例食管肿瘤诊断作用的研究

采用经食管超声心动图（ＴＥＥ）对３２例食管癌和６例食管平滑肌瘤进行检查并与纤维胃镜、ＣＴ及手术后病理结果对照。结果显示：ＴＥＥ术前检查对食管癌进行病理分期（Ｔ分期）准确率为８０．６％，高于ＣＴ的准确率４２．９％；ＴＥＥ测定食管癌长度值为５．２６９±１．９１６ｃｍ，与病理检查测值５．３４５±１．９０１ｃｍ比较无显著差异（Ｐ＞０．０５）。而胃镜检查测值４．０５２４±１．８０６ｃｍ与病理检查测值有显著差异（Ｐ＜０．０５）。ＴＥＥ结合胃镜对６例食管平滑肌瘤进行定性诊断，结果与病理检查完全符合。而ＣＴ对４例食管平滑肌瘤进行诊断，仅２例与病理检查结果符合。ＴＥＥ术前检查发现食管周围淋巴结４４枚，术中切除６６枚，总显示率为６６．７％。总之，ＴＥＥ在食管肿瘤诊断方面有独特价值，应进一步研究应用     

自身脾片移植治疗ITP的临床研究

为保持脾切患者机体的免疫功能，自１９９０年１０月，对３１例肾上腺糖皮质激素治疗无效的原发性血小板减少性紫癜（ＩＴＰ）脾切除患者，进行了脾切除后自身脾片移植的研究，结果：显效２４例，占７７．５％，良效３例，占９．７％，进步２例，占６．５％，无效２例，占６．５％，术后１，３个月复查，仅ＰＡＩｇＧ下降，而其它各项细胞，体液免疫指标均恢复正常，Ｔ４／Ｔ８，ＩｇＧＩｇＡＩｇＭ较对照组明显为高（Ｐ〈０．０５）     

血清过氧化氢酶活性测定的临床应用

应用比色测定法检测了１１５６例不同疾病患者的血清ＣＡＴ活性。与正常对照组比较，有３５８例不同疾病患者的血清ＣＡＴ活性增高，占疾病总数的３１．０％（Ｐ＜０．０１）。其中胰腺炎组为７６．５％（１３／１７）；胆囊炎组为４６．２％（６／１３）；肝癌组为５９．３％（１６／２７）；心衰组为５４．６％（６／１１）；非癌性肝病组为６４．６％（４２／６５）；精神分裂症组为５９．６％（５３／８９）。正常不同妊期妇血清ＣＡＴ活性在晚孕组校对照组明显增高，Ｐ＜０．０１。顺产与难产妇女血清ＣＡＴ活性和顺产与难产新生儿脐血清ＣＡＴ比较，结果均有差异（Ｐ＜０．０５）。     

广西瑶族与汉族葡萄糖—6—磷酸脱氢酶基因三种常见突变型？…

目的 研究广西瑶族葡萄糖－６－磷酸脱氢酶（Ｇ６ＰＤ）基因突变特点，并与汉族作比较。方法 用突变特异性扩增系统（ＡＲＭＳ）法对广西瑶族３４例和汉族３７例Ｇ６ＰＤ缺乏进行中国常见的三种Ｇ６ＰＤ基因突变型筛查。结果 广西３４例瑶族Ｇ６ＰＤ缺乏的基因型分别为Ｇ１３７６Ｔ １４例（４１．２％），Ｇ１３８８Ａ９例（２６．５％），Ａ９５Ｇ５例（１４．７％），Ｃ１３１１Ｔ１例（２．９％）。     

老年人血清过氧化氢酶活性测定探讨

本文采用分光光度比色法，检测了１０８例健康老年人的血清ＣＡＴ活性（男５８名，女５０名）．男性组的血清ＣＡＴ活性水平是５８．５±１９．７ＫＵ／Ｌ（２５．８～１１９．８），女性组为５６．８±１１７；４ＫＵ／Ｌ（１８．５～１０２．２），二者平均值是５７；８±１７．５ＫＵ／Ｌ（１８．５～１１９．８）。对２７３例不同疾病组的老年患者的血清ＣＡＴ活性检测表明，与正常对照组比较，有６６例血清ＣＡＴ结果增高明显，占２４．２％（Ｐ＜０．０１）；其中胰腺炎组的阳性符合率为７５．０％，肝癌组为５５．６％，心衰组为５０．０％，肝炎组为４０．０％。     

G6PD缺乏红细胞膜磷脂含量及其不对称性改变的研究

目的：通过测定葡萄糖－６－磷酸脱氢酶（Ｇ６ＰＤ）缺乏红细胞膜磷脂的含量及其不对称性的变化，研究Ｇ６ＰＤ缺乏对红细胞膜结构的影响。方法：不对称性实验采用磷脂酶Ａ２处理完整红细胞，磷脂的测定采用高效液相色谱法。结果：正常红细胞膜磷脂酰乙醇胺（ＰＥ）、磷脂酰丝氨酸（ＰＳ）、磷脂酰胆碱（ＰＣ）含量分别为５．５９±１．１６，２．９２±０．５０，６．６４±０．９２ｍｇ／ｍｇ膜蛋白；Ｇ６ＰＤ缺乏红细胞膜ＰＥ、ＰＳ、ＰＣ分别为５．１８±１．８６，１．５１±０．５８，５．７０±１．９１ｍｇ／ｍｇ膜蛋白，两组中ＰＳ有显著性差异（Ｐ＜０．００１），说明Ｇ６ＰＤ缺乏红细胞膜ＰＳ含量降低。在正常人红细胞膜中有１７．６％±２．５％ＰＥ，５７．９％±４．７％ＰＣ在外层，外层未发现ＰＳ，在Ｇ６ＰＤ缺乏红细胞膜中有３０．２％±５．７％ＰＥ，５３．８％±７．４％ＰＣ，２７．２％±５．８％ＰＳ在外层，两组中ＰＥ和ＰＳ有显著性差异（Ｐ＜０．０１和Ｐ＜０．００１），外层的ＰＣ无明显变化，说明ＰＥ、ＰＳ均向外层移动。结论：由于Ｇ６ＰＤ缺乏，红细胞膜磷脂结构发生改变，是红细胞溶血的重要机制之一。     

依那普利治疗轻中度原发性高血压的临床疗效观察

本文将８３例轻中度原发性高血压患者进行单盲分组对照试验。治疗组益压利４２例，对照组怡那林４１例。益压利组５～２０ｍｇ／次，每日１次。６周后坐位ＢＰ由２３．２±２．０／１３．１±０．８降至１９．８±１．２／１１．６±０．７ｋＰａ，立位ＢＰ由２３．０±１．９／１３．０±０．８降至１９．４±１．０／ｌｌ．５±０．７ｋＰａ，其降压临床显效率４７．６％，总有效率９０．５％。怡那林组５～２０ｍｇ／次，每日１次，６周后坐位ＢＰ由２３．３±２．０／１３．１±０，８降至２０．８±１．２／１２．３±０．７ｋＰａ，立位ＢＰ由２３．０±２．０／１３．１±０．８降至２０．６±１．０／１２．２±０．７ｋＰａ，其显效率３４．１％，总有效率８２．９％。结果表明两组均有明显降压效果，但两组间临床总有效率无显著性差异（Ｐ＞０．０５）。而２４小时ＡＢＰ谷：峰（Ｔ／Ｐ）比值显示，益压利组ＳＢＰ为８１．７％，ＤＢＰ为７６．０％，优于怡那林组的５０．８％及４４．１％。     

院内产后子痫32例分析

１临床资料１．１一般资料１９２例中院内发生产后子痫３２例,（１６．０９％）,外院转入１０例。１７～２８岁,平均２２．６岁。２例经产;其余为初产妇。２５例作过产前检查（７８．１２％）。１．２发病情况９～１２月２４例（７５％）,３～７月７例（９２１．５８％）,８月１例。发病前有头晕、眼花、视物模糊、恶心、呕吐等５例（１５．６２％）,无任何症状２７例（８４．３４％）。发病前完全无症状１９例（２８．１３％）,轻度妊高征１９例（５９．３２％）中度妊高征３例（６．２５）,重度妊高征１例（３．１３％）。剖宫产…     

TIPSS与TIPSS并用SEEV治疗肝硬变门静脉高压的临床观察（附84例报告）

本文报告了采用经颈静脉肝内门腔静脉内支架分流术（ＴＩＰＳＳ）和ＴＩＰＳＳ并用食管胃底静脉硬化栓塞术ＳＥＥＶ或称门静脉断流术两种方法，治疗８４例门静脉高压症的临床结果。８２例获得成功（成功率９７．６％）。其中，３４例仅采用ＴＩＰＳＳ方法；４８例采用ＴＩＰＳＳ并用ＳＥＥＶ方法。７１例为择期治疗，另１１例为急诊ＴＩＰＳＳ。肝内分流通道直径分别为８～１０ｍｍ（６９例）和１２ｍｍ（１３例）；术后门静脉压力平均下降１３．０±５．４ｃｍＨ２Ｏ。术后平均随访时间为９．５个月（１～３０个月）。术后７例有再出血发生（８．５％），其中，ＴＩＰＳＳ组６例（２４％）；ＴＩＰＳＳ并用ＳＥＥＶ组且例（２．６％）；１１例出现肝性脑病（１３．４％），其余病例均良好。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."