经颅彩色双功超声在脑血管疾病中的临床应用和进展

经颅彩色双功超声是一种新型、无创的超声诊断仪,高空间分辨率显示颅内血管和脑实质的结构,笔者查阅了近年来相关文献,主要综述经颅彩色多普勒血流显像在颅脑血管疾病中的诊断价值,同时讨论二维经颅超声的应用及新的实验性显像技术。     

Laparoscopic Local Resection Based on Sentinel Node Evaluation for Early Gastric Cancer: A Preliminary Report

We previously reported that lymphatic mapping using isosulfan blue can be used to identify sentinel nodes (SNs). This study was undertaken to evaluate the feasibility of using the SN technique in treating early gastric cancer and to explore its usefulness for minimal invasive surgery. Twenty-three patients with early gastric cancer who underwent SN biopsy were retrospectively evaluated. Based on SN evaluation, individualized surgery was performed in five patients with T1N0M0 gastric cancer. When pathological examination of frozen sections revealed metastasis in SNs, we performed a standard D2 gastrectomy. Laparoscopic local resection was applied when the SN biopsy was negative. Our results showed that the success rate with SN biopsy in early gastric cancer was 100%, as were the accuracy, sensitivity, and specificity. All five patients with early gastric cancer had SNs negative for metastases both by frozen section and by postoperative pathology. Thus, all these patients underwent laparoscopic local resection without extended lymphadenectomy. We conclude that SN biopsy is a useful tool to individualize the operative procedure, and laparoscopic local resection can be safely performed using SN guidance in selected patients with early gastric cancer.     

重症胆管炎23例临床治疗分析

目的：探讨急性重症胆管炎患者的手术时机和死亡原因。方法：回顾性分析23例急性重症胆管炎患者的治疗及预后情况。结果：死亡2例（手术死亡及传统治疗死亡各1例）。早期大剂量短期应用糖皮质激素患者休克得到纠正率85％，明显高于未用糖皮质激素患者休克纠正率50％。结论：急性重症胆管炎患者应在出现休克和（或）精神症状之前手术，对已出现休克的患者，应先给予充分的保守治疗，待病情稳定后再手术。贻误手术时机，严重合并症如多器官功能衰竭及高龄是死亡的主要原因。     

心血管疾病并发焦虑抑郁症状2050例心理干预治疗分析

目的:了解心血管疾病并发焦虑抑郁症状的情况并探讨心理干预等对焦虑抑郁症状的影响。方法:对住院的2050例心血管疾病并发焦虑抑郁症状的患者进行回顾性分析。结果:心血管疾病患者中并发有焦虑抑郁症状者占56%;其常表现为类似心绞痛、左心衰竭症状,可并发有心律失常;高血压病并发有焦虑抑郁患者对血压升高的耐受性差,动态血压检查以非勺型改变者居多;单纯使用心血管药物治疗效果欠佳,心理干预,焦虑抑郁症状严重者结合抗焦虑抑郁药物疗效显著。结论:心血管疾病患者常并发焦虑抑郁症状,心理干预治疗等可有效改善患者的症状。     

内脏器官激光多谱勒血流灌注图象的显示

目的显示内脏器官血流灌注和分布的图象,探讨激光多谱勒血流成像技术在内脏微循环检测中的价值。方法应用激光多谱勒血流灌注成像仪(LDPI),对大鼠和家兔腹部脏器(肝、脾、肾、膀胱、胃、大小肠和肠系膜等)的血流灌注进行扫描和血流图显示。结果在体内脏器官显像清晰,肝、肾、脾、膀胱等微循环血流的整体分布较均匀;而胃、肠系膜、回盲肠等激光多谱勒血流图上大血流线状显示极其显著;大鼠与家兔两种动物之间相同脏器血流图上的差异并不明显。结论LDPI能将内脏器官的微循环状态以图象的形式显示,该新技术方法在检测内脏血流方面将有一定的应用价值。     

Central metabotropic glutamate receptors differentially participate in interleukin-1beta-induced mechanical allodynia in the orofacial area of conscious rats.

The present study investigated the role of central metabotropic glutamate receptors (mGluRs) in interleukin-1beta (IL-1beta)-induced mechanical allodynia and mirror-image mechanical allodynia in the orofacial area. Experiments were carried out on male Sprague-Dawley rats weighing 230 to 280 g. After administration of 0.01, 0.1, 1, or 10 pg of IL-1beta into a subcutaneous area of the vibrissa pad, we examined the withdrawal behavioral responses produced by 10 successive trials of an air-puff ramp pressure applied ipsilaterally or contralaterally to the IL-1beta injection site. Subcutaneous injection of IL-1beta produced mechanical allodynia and mirror-image mechanical allodynia in the orofacial area. Intracisternal administration of CPCCOEt, a mGluR1 antagonist, or MPEP, a mGluR5 antagonist, reduced IL-1beta-induced mechanical allodynia and mirror-image mechanical allodynia. Intracisternal administration of APDC, a group II mGluR agonist, or L-AP4, a group III mGluR agonist, reduced both IL-1beta-induced mechanical allodynia and mirror-image mechanical allodynia. The antiallodynic effect, induced by APDC or L-AP4, was blocked by intracisternal pretreatment with LY341495, a group II mGluR antagonist, or CPPG, a group III mGluR antagonist. These results suggest that groups I, II, and III mGluRs differentially modulated IL-1beta-induced mechanical allodynia, as well as mirror-image mechanical allodynia, in the orofacial area. PERSPECTIVE: Central group I mGluR antagonists and groups II and III mGluR agonists modulate IL-1beta-induced mechanical allodynia and mirror-image mechanical allodynia in the orofacial area. Therefore, the central application of group I mGluR antagonists or groups II and III mGluR agonists might be of therapeutic value in treating pain disorder.     

医院信息系统设计中的安全分析与建模

本文深入到当前的医院信息系统内部,揭示出这些系统中令人不安的却又极其重要的安全问题.通过比较与分析现实中的两个案例,我们逐步构建起有自身特色的可信赖的安全模型并演示了非常具体的实现过程,从而使医院信息系统可以在当今复杂的网络环境中得以生存.     

后循环缺血与眩晕

后循环又称椎基底动脉系统，由椎动脉、基底动脉和大脑后动脉（posterior cerebral artery，PCA）组成，主要向脑干、小脑、丘脑、枕叶、部分颞叶等结构供血。后循环缺血（posterior circulation ischemia,PCI）是常见的缺血性脑血管病。与前循环缺血一样，PCI也可按缺血程度和持续时间的不同分为短暂性脑缺血发作（transient ischemic attack,TIA）和脑梗死。其同义词包括椎基底动脉系统缺血、后循环TIA和脑梗死、椎基底动脉疾病、椎基底动脉血栓栓塞性疾病。     

Nonspecific mitochondrial disease with epilepsy in children: diagnostic approaches and epileptic phenotypes

OBJECTIVES: This study sought to characterize epileptic phenotypes in children with nonspecific mitochondrial disease (MD) and to evaluate MD diagnostic approaches. METHODS: A retrospective analysis of the medical, electroencephalogram, and laboratory records of 142 patients with epilepsy was performed. The patients were evaluated for MD, and 124 patients were included in the final cohort. The MD criteria used included an oral glucose lactate stimulation test (OGLST) and urine organic acid/plasma amino acid (UOA/PAA) assays as metabolic indicators of modified Walker criteria, as suggested by Bernier et al. (Neurology 59:1406-1411, 2002). RESULTS: Twenty-two patients were classified as having definite MD (9), probable MD (5), possible MD (6), or pyruvate dehydrogenase (PDH) deficiency (3), including one patient which showed a respiratory chain (RC) defect and PDH deficiency. Seven out of eight patients in whom significant RC defects were observed showed complex I defects. In 14 patients, epileptic seizures start at infantile ages. Of 17 patients who substantially presented generalized seizures, 4 patients started with partial seizures. Five patients consistently presented only partial seizures. The OGLST and UOA/PAA assays were useful for a more precise diagnosis of MD, although low positive predictive value of the OGLST was regrettable. No patient was classified as definite MD by Walker's original criteria, but the use of our revised MD criteria resulted in the classification of nine additional patients as definite MD. CONCLUSIONS: MD manifested considerable diverse epileptic phenotypes and should be considered in the differential diagnosis of epilepsy in children with unexplained encephalomyopathy and progressive and fluctuating clinical courses.     

Performance and comparison of the Cockcroft-Gault and simplified Modification of Diet in Renal Disease formulae in estimating glomerular filtration rate in a Chinese Type 2 diabetic population.

AIMS: Our aim was to assess performances of the Cockcroft-Gault and simplified Modification of Diet in Renal Disease (MDRD) formulae in estimating glomerular filtration rate (GFR) in Chinese diabetic populations and their association with vascular risks. METHODS: A total of 1009 patients with Type 2 diabetes were categorized into low estimated GFR groups (GFR < 60 ml/min/1.73 m(2)) and control groups by the two equations. The performances of these formulae were assessed at different stages of kidney function. Carotid artery intima-media thickness (IMT) and the prevalence of diabetic retinopathy or albuminuria were compared among the groups. The ability of these formulae to identify established vascular risk markers using sensitivity, specificity, positive and negative predictive values were also compared. RESULTS: The prevalence of low estimated GFR was 32.7% with the Cockcroft-Gault formula and 5.2% with the MDRD formula, respectively. In low estimated GFR subjects by the MDRD formula, IMT was significantly thicker than those by the Cockcroft-Gault formula (1.2 mm vs. 1.0 mm; P < 0.05), with a higher prevalence of albuminuria (78.4 vs. 52.8%, P < 0.05) and diabetic retinopathy (46.5 vs. 30.5%; P < 0.05). The Cockcroft-Gault formula gave a specificity of 71.7% and a sensitivity of 37.0%, and the MDRD formula gave a specificity of 96.6% and a sensitivity of 7.9% in estimating low GFR relevant for established vascular risks. CONCLUSIONS: These formulae performed differently in Chinese diabetic populations. The simplified MDRD formula is minimally superior to the Cockcroft-Gault formula for its high specificity and positive predictive values in estimating low GFR relevant for vascular risks.