经颅多普勒超声转颈试验在颈性眩晕诊断中的应用价值

目的探讨经颅多普勒超声（transcranial Doppler sonography,TCD）转颈试验在颈性眩晕诊断中的价值。方法选择头晕患者133例,其中颈性眩晕（观察组）67例,其他眩晕（对照组）66例。所有患者均行颈椎X线、MRI和椎动脉磁共振血管造影术以及TCD常规检查和TCD转颈试验。结果 2组患者的颈部外伤病史、骨质增生、颈椎曲度异常、颈椎不稳、椎间盘突出的异常百分比无显著差异,颈痛和磁共振血管造影术椎动脉受压百分比差异有统计学意义（P〈0.05）。2组患者的常规TCD检测结果差异无统计学意义（P〉0.05）。观察组患者TCD转颈试验阳性率为80.60%（54/67）,对照组为4.55%（3/66）,2组间差异有统计学意义（P〈0.01）。结论 TCD转颈试验有助于颈性眩晕的诊断,可作为颈性眩晕诊断的一个客观指标。     

脉冲多普勒超声研究寰椎椎动脉沟环所致的颈性眩晕

本文报告了应用脉冲多普勒超声研究寰椎椎动脉沟环所致颈性眩晕患者的血流动力学改变。结果发现，平卧时寰椎椎动脉沟环患病组血流量与正常组有显著差别。转头试验正常组改变轻微、且有规律，而患病组与正常组对比有高度显著差异。患病组中全环患者改变又较半环患考明显。     

什么是颈性眩晕

颈性眩晕是指椎动脉的颅外段受颈部病变的影响导致血流障碍引起的眩晕综合征,又称椎动脉压迫综合征,椎动脉缺血综合征,颈后交感神经综合征等。颈性眩晕常见于中老年人,其特点是眩晕主要发生于头颈部活动时,如头颈部前后屈伸及左右转动时突发眩晕,一般持续时间较短,随着颈部位置     

推拿对颈性眩晕的椎动脉形态学及血流速的影响

目的：通过观察疗前疗后颈性眩晕患者椎动脉血流速以及椎动脉形态学改变情况,探讨推拿对颈性眩晕的治疗效果。方法：颈性眩晕患者45例,男27例,女18例;年龄25～60岁,平均41．6岁;病程2周-5年。采用TCD检测椎动脉血流速,3D—CTA检查椎动脉形态学作为观察指标。根据其形态学改变不同节段定位,采用三部推拿法观察对椎动脉血流速及形态学的影响。结果：45例推拿前后眩晕主症评分明显改善,差异有统计学意义（P〈0．001）;血流减慢患者及血流增快患者推拿前后Vm比较,差异均有统计学意义（P〈0．01）。部分患者椎动脉形态学有改变。结论：推拿对颈性眩晕椎动脉形态学改变所致的血流速异常有双向调节作用,并能使部分血管形态发生逆转性改变。     

针刺治疗颈性眩晕60例

<正>颈性眩晕系因颈椎退行性改变或外伤使脊椎内外平衡失调,引起颈动脉颅外段即椎基底动脉供血不全,出现以眩晕为主要症状的临床综合征,其特点是头颈部前后屈伸及左右转动时突发眩晕,一般持续时间较短。颈性眩晕在临床十分多见,已引起临床上的普遍重视,针灸治疗颈性眩晕有很好的疗效,笔者采用针刺治疗颈性眩晕60例,现报告如下。     

寰椎椎动脉沟环所致颈性眩晕患者的手术治疗

寰椎椎动脉沟环是引起颈性眩晕的原因之一。作者经治７例沟环所致颈性眩晕患者，经３－６年随访，优良者６例，疗效满意，文内探讨了沟环引起颈性眩晕的机制、诊断、鉴别诊断及手术适应证。作者认为手术切除沟环是治疗该病的有效手段之一     

颈椎冲击器结合头面部推拿治疗颈性眩晕55例疗效观察

目的探讨颈椎冲击整复器结合头面部推拿治疗颈性眩晕的临床疗效和治疗机理。方法将97例颈性眩晕患者随机分为治疗组(颈椎冲击器加推拿组)和对照组(药物颈牵组),观察治疗前后临床近期和远期疗效比较,X摄片和经颅彩色多普勒(TCD)的检查变化。结果治疗组疗效明显优于对照组,经统计学分析差异有显著性意义(P<0.01)。结论颈椎冲击整复器配合头面部推拿治疗颈性眩晕具有安全,快速,有效纠正环枢关节紊乱的作用,能显著改善颈性眩晕的临床症状,增大椎-基底动脉系统的血管舒缩功能,加强血管顺应性,减少脑血管阻力,促进血流速度。     

颈性眩晕的椎动脉形态学改变及其对血流速的影响

目的：观察颈性眩晕患者椎动脉的形态学改变及其对血流速的影响。方法：对84例颈性眩晕患者168支椎动脉进行TCD检测和3D-CTA检查结果进行比较。结果：168支椎动脉中有形态学异常改变的126支，异常率为75％。有形态学改变的126支椎动脉，TCD检测有血流速异常的111支，检出率为88．1％。椎动脉形态改变依次为椎动脉不规则狭窄，椎动脉纤细，骨质增生压迫，椎动脉走行异常，纤维束带牵拉椎动脉移位，骨质畸形压迫，椎动脉闭塞不显示。结论：与TCD检测结果比较显示，椎动脉不规则狭窄，椎动脉纤细，闭塞不显示，TCD检测以低流速表现为主；骨性因素压迫椎动脉，椎动脉走行异常，其血流速呈双相性表现。     

颈部旋转与侧屈活动对椎动脉血供的影响

目的了解颈部旋转和侧屈活动对椎动脉血供的影响,探讨椎动脉血供与颈性眩晕的关系。方法实验组30例颈性眩晕患者均排除耳源性眩晕,且无需要治疗的心、脑血管疾病,男18例,女12例;年龄42～73岁,平均52.13岁;均有不同程度的颈椎退行性改变和颈、肩、背部疼痛史。对照组15例无眩晕症状,无需要治疗的心、脑血管疾病的自愿者,男8例,女7例;年龄38～70岁,平均49.47岁;均有不同程度的颈椎退行性改变。颈椎分别在中立位、左右旋转15°、30°、45°、60°及左右极度侧屈体位,运用经颅多普勒超声(TCD)对两组研究对象进行双侧椎动脉颅内段TCD观察,了解不同颈位对椎动脉血供的影响。结果中立位时,实验组椎动脉血流低于对照组(P<0.01)。与自身中立位时血流作对照,实验组转颈到30°时同侧椎动脉血流开始有较明显下降(P<0.01),对照组转颈到45°时同侧椎动脉血流开始有较明显下降(P<0.01),转颈过程中实验组较对照组血流下降幅度更明显(P<0.01)。侧屈时,实验组有24例、对照组有3例出现同侧椎动脉血流下降(P<0.01)。结论颈性眩晕有静态椎动脉血流下降的基础,即椎动脉血流在中立位时就低于正常,并随着颈椎的活动,出现动态的下降。颈性眩晕的发生可能与转颈过程中椎动脉血流下降幅度或速度超出其代偿能力有关。     

颈性眩晕的发病机理、诊断及治疗进展

颈性眩晕(CSA)系因颈椎退行性改变或外伤使脊椎内外平衡失调，引起颈动脉颅外段即椎一基底动脉供血不全以眩晕为主要症状的临床综合征。为加强对本病的认识，提高其确诊率，现就其发病机理、诊断及治疗进展进行综述。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92