心脑血管疾病高危因素对脑铁沉积影响的磁共振影像学研究

目的: 采用MRI方法研究常见心脑血管疾病高危因素与脑铁沉积的关系。方法: 纳入84名无神经系统疾病和脑外伤的社区中老年人,全面评估其心脑血管疾病高危因素,行MRI检查获取高清T1加权图像及T2^*加权三维梯度回波序列（ESWAN）图像,ESWAN图像后处理得R2^*图,采用计算机分割技术对高清T1加权图像进行组织分割,配准至ESWAN图像后,提取各脑区的R2^*值。采用多元线性回归分析揭示中老年人性别、年龄、心脑血管疾病高危因素对各脑区R2^*值的影响。结果: 海马、脑白质、脑皮质R2^*值升高与吸烟有关（β值分别为0.244、0.317、0.277,P < 0.05或P < 0.01）;壳核R2^*值升高与高血压有关（β值为0.241,P < 0.05）;丘脑R2^*值升高与高血糖有关（β值为0.234,P < 0.05）;男性丘脑R2^*值高于女性（β值为0.320,P < 0.05）;丘脑、尾状核、苍白球、脑白质、脑皮质等R2^*值与年龄相关（β值分别为-0.218、-0.254、0.216、-0.280和-0.238,P < 0.05或P < 0.01）。结论: 常见心脑血管疾病高危因素可能导致脑铁沉积,且不同因素引起的铁沉积模式不同。     

“4＋4”模式八年制临床医学专业神经病学临床实习带教探讨

浙江大学医学院的八年制临床医学专业实行“4+4”模式（4年非医专业本科+4年医学专业培养）;在医学专业教育阶段开展了整合式医学课程模块化教学,旨在培养基础扎实、思维宽广的医学生。在神经、精神与运动模块整合背景下,神经病学临床实习带教中,教学者根据学生特点和自身带教经验,提出重视经典“三基”教育、推广多样化教学、利用云模型尝试新评价方法等措施,以利于医学高级人才培养。     

Subciliary incision and lateral cantholysis in rigid internal fixation of zygomatic complex fractures

Objective: To introduce the technique of subciliary incision and lateral cantholysis with tri-dimension reduction and rigid internal fixation to treat zygomatic complex fractures. Methods：The subciliary incision and lateral cantholysis combined with tri-dimension reduction and rigid internal fixation of zygomatic complex fractures with titanium microplates were applied in 56 patients with zygomatic complex fractures. Another lateral eyebrow incision or sublabial incision was used to simplify the operation. Results: The postoperative follow-up period ranged from 6 months to 5 years. During the follow-up period, all the patients had satisfying postoperative results. All clinical symptoms disappeared except the numbness in the infraorbital region in 2 patients. In 94.6% patients no complications such as obvious scar, ectropion, entropion or blepharoedema were found, only 5.4% of the patients had slight ectropion 6 months after operation. Conclusions: The subciliary incision and lateral cantholysis have many advantages such as invisible scar,sufficient exposure, minimal injury, and few complications and combined with rigid internal fixation with titanium microplates this technique could be used as one of the routine operation methods to treat zygomatic complex fractures.     

肝脏恶性肿瘤682例手术治疗分析

目的　探讨影响肝脏恶性肿瘤患者手术治疗后长期生存的因素。方法　回顾性分析1989年 1月至 2 0 0 3年 1月施行外科手术治疗的 6 82例肝脏恶性肿瘤患者的临床资料。结果　小肝癌 (直径 <5cm ,n =2 96 )患者术后 3年、5年生存率分别为 (6 1 2 5± 4 4 1) %和 (5 3 84± 5 6 8) % ,巨大肝癌 (直径 >10cm ,n =14 5 )患者术后 3年、5年生存率分别为 (45 90± 6 98) %和 (30 2 1±10 2 3) % ;肿瘤单发患者 (n =4 0 3)术后 3年、5年生存率分别为 (6 1 86± 3 6 9) %和 (5 5 4 0±4 91) % ,肿瘤多发 (2个或 2个以上 )患者 (n =2 4 6 )术后 3年、5年生存率分别为 (38 31± 4 97) %和(2 8 0 1± 6 31) % ;术前肝功能Child分期为Ⅰ期的患者 (n =397)术后 3年、5年生存率分别为 (6 0 6 8± 3 6 8) %和 (5 0 99± 5 10 ) % ,Ⅱ期或Ⅱ期以上的患者 (n =2 85 )术后 3年、5年生存率则为 (43 0 1±5 33) %和 (36 39± 7 5 8) % ;行局部或一段切除的患者 (n =2 98)术后 3年、5年生存率分别为 (6 8 6 5± 4 95 ) %和 (6 5 38± 5 6 9) % ,行两段或两段以上及半肝切除的患者 (n =32 4 )术后 3年、5年生存率分别为 (49 88± 4 13) %和 (37 98± 5 70 ) %。结论　小肝癌     

Index-finger pointing in generalized tonic–clonic seizures

ObjectiveMost patients with localization-related epilepsy (LRE) and genetic generalized epilepsy (GGE) are classified based on semiology and video-EEG, but both features occasionally fail to provide a definitive diagnosis. Several reliable lateralizing signs have been described, although hand and finger posturing has received little attention. We sought to investigate the frequency of index-finger pointing (IFP) during generalized motor convulsions as a lateralizing semiology in LRE.MethodsWe retrospectively analyzed 98 videos of generalized convulsions in 64 consecutive patients who were admitted for diagnostic video-EEG (vEEG). Demographics were recorded, and IFP ipsilateral, contralateral, and bilateral to vEEG ictal correlate was compared between LRE, GGE, and nonepileptic attacks (NEAs). The angle of IFP was measured to quantify the mean degree of IFP in “pointers” versus “nonpointers”. Statistical analysis was completed using JMP 9.0.ResultsIndex-finger pointing was more common in epileptic GTC seizures than in convulsive NEAs (83.6% vs 12.0%; p < 0.001) and was more common in LRE compared with GGE (96% vs 56.6%; p ≤ 0.001). The frequency of contralateral, ipsilateral, or bilateral IFP did not differ between LRE and GGE. The average angle at the MCP joint in “pointers” was 35.8° (SD 22.0°) and in “nonpointers” 3.0° (SD 7.2°).SignificanceThis is the first study to examine hand and finger postures as a clinical sign to help classify epilepsy type. The presence of IFP was more common in patients with LRE than in patients with GGE and very rarely occurred in NEA. Index-finger pointing and other hand semiologies are potentially quantifiable localizing signs to aid in the characterization of patients with GTC seizures.     

胸部爆炸伤紧急救治临床指南（2022年）

胸部爆炸伤是现代战伤和恐怖袭击中最常见的损伤类型之一,也是爆炸伤中致死率最高的伤类之一,大部分严重胸部爆炸伤患者死于受伤早期和院前转运途中,故对其紧急救治特别重要。目前普遍存在治疗不规范、疗效差异大等问题,且临床上缺乏胸部爆炸伤救治规范。中华医学会创伤学分会遵循科学性、实用性和先进性的原则,针对胸部爆炸伤的分型、院前急...     

Chronic fluoxetine enhances extinction therapy for PTSD by evaluating brain glucose metabolism in rats: an [18F]FDG PET study

Annals of Nuclear Medicine - Recent studies suggest that selective serotonin reuptake inhibitors (SSRIs) and exposure therapies have been used to reduced footshock-induced posttraumatic stress...     

Evaluation of 5-aminolevulinic acid-mediated photodynamic therapy in postmenopausal women with persistent HPV infection with or without cervical and vaginal low-grade squamous intraepithelial lesions (CIN1/VaIN1)

ObjectiveTo analyze the efficacy and safety of photodynamic therapy (PDT) on postmenopausal women with persistent human papillomavirus (HPV) infection with or without low-grade cervical and vaginal intraepithelial neoplasia (CIN1 and VaIN1).Materials and methodsThe clinicopathological and follow-up data of 86 postmenopausal women with HPV infection (35 cases with chronic cervicitis and 51 cases with CIN1/VaIN1) were collected. All the women in this group met these criteria: menopausal time ≥ 1 year, HPV infection time ≥ 2 years, colposcopy and pathological diagnosis of biopsy ≤ CIN1/VaIN1 before PDT treatment, and 5-aminolaevulinic acid (5-ALA) as photosensitizer treating for 6 times with a week interval. The above patients were followed up 6 months and 12 months after PDT treatment, and the follow-up contents included HPV typing, cytology, colposcopy and pathological examinations. HPV negative conversion rate and lesion remission rate are the evaluation indicators of treatment efficacy. In addition, we also assessed the safety of PDT treatment.ResultsAt 12-month follow-up, the overall HPV clearance rate was 60% (45/75), of which the negative conversion rate of 16/18 HPV was 41.38% (12/29), and non-16/18 HPV was 71.74% (33/46) (p = 0.009). In patients without lesions, the HPV clearance rate was 51.72% (15/29), while in patients with CIN1/VaIN1 (n = 46), the HPV complete remission rate and lesion regression rate were 65.22% (30/46) and 89.13% (41/46), respectively. In addition, the clearance rate of HPV in lesion regression group was significantly higher than that in lesion persistence/progression group (0.00% vs. 73.17%, p = 0.003). The adverse reactions after PDT treatment were mild, mainly manifested as increased vaginal secretions or burning/tingling.ConclusionsPhotodynamic therapy can significantly enhance the elimination rate of persistent HPV infection in postmenopausal women and reduce the progression of CIN1/VaIN1. It could be an effective conservative treatment for persistent HPV infection and CIN1/VaIN1 in postmenopausal women.     

股骨近端上移重建骨盆肿瘤切除后的骨缺损

 目的 总结以股骨近端上移重建骨盆肿瘤切除后骨缺损的手术技术要点,探讨其手术适应证。方法 自2006年10月至2011年5月,对5例骨盆恶性肿瘤患者采用同侧股骨近端截骨上移重建骨盆环连续性、肿瘤型人工关节假体重建髋关节,男3例,女2例;年龄19~55岁,平均30.6岁。软骨肉瘤3例、原始神经外胚层瘤2例。3例肿瘤累及骨盆Ⅰ+Ⅱ区,2例累及Ⅱ+Ⅲ区。所有患者均获得随访,统计并发症发生情况,采用国际骨肿瘤协会(Musculoskeletal Tumor Society, MSTS)功能评分评价患肢功能,评价肿瘤学预后。结果 至末次随访时5例患者中1例死亡,1例带瘤生存,其余3例无瘤生存。主要并发症包括肿瘤局部复发、假体松动、植骨不愈合、浅表感染、坐骨神经麻痹。1例患者术后15个月发生植骨不愈合,内固定松动,可扶拐行走。1例患者因假体松动,术后26个月行翻修手术。1例患者术后6个月肿瘤局部复发改行截肢手术;1例术后18个月局部复发,未进一步处理带瘤生存。MSTS评分为11~25分,平均19.2分。结论 同侧股骨近端上移重建骨盆肿瘤切除后的骨缺损是一种有效重建骨盆连续性的方法,既适用于骨盆Ⅱ+Ⅲ区缺损,也适用于骨盆Ⅰ+Ⅱ区缺损。但此术式仍具有较高的并发症发生率,其近期效果与骨盆假体类似,远期疗效有待于进一步观察。     

膝关节骨关节炎内侧间室软骨病损的MRI表现与关节镜术后疗效的相关性研究

目的探讨膝关节骨关节炎（OA）内侧间室软骨病损的MRI表现和关节镜手术后疗效的相关性及膝关节OA的关节镜手术适应证。方法对92例关节镜手术病例,其中男54例,女38例;年龄43～69岁,平均58.5岁。对患者膝关节股骨内髁和胫骨内侧平台软骨的MRI表现按ICRSMR分级标准进行分级,对所有患者均进行了术后12～30个月的随访,随访时进行Lysholm评分。结果 92例92个膝关节,核磁共振显示关节软骨损伤Ⅳ级10例;Ⅲ级16例;Ⅱ级20例;Ⅰ级25例;0级21例,分级的均数为（1.66±1.303）;术后Lysholm评分最高100分;最低64分,评分的均数（95.42±7.398）。术后Lysholm评分与ICRSMR分级相关系数r=-0.672,P〈0.05,统计学处理呈负相关。结论认为术前膝关节内侧间室软骨的MRI（1.5T）分级对膝关节OA关节镜手术指征的判断有重要的参考价值。