运动负荷平板系统程序引起的故障

本文详细叙述了美国GP公司TM210运动负荷平板系统由于仪器比较老,而且是在DOS状态下工作,运行程序经常无缘无故出错,经过一段时间的摸索,找到了简单的方法,迅速修复,保证了设备的正常运行。     

Clinical analysis of surgical treatment of portal hypertension

AIM: To review the experience in surgery for 508 patients with portal hypertension and to explore the selection of reasonable operation under different conditions. METHODS: The data of 508 patients with portal hypertension treated surgically in 1991-2001 in our centers were analyzed. Of the 508 patients, 256 were treated with portaazygous devascularization (PAD), 167 with portasystemic shunt (PSS), 62 with selective shunt (SS), 11 with combined portasystemic shunt and portaazygous devascularization (PSS+PAD), 9 with liver transplantation (LT), 3 with union operation for hepatic carcinoma and portal hypertension (HCC+PH). RESULTS: In the 167 patents treated with PSS, free portal pressure (FPP) was significantly higher in the patients with a longer diameter of the anastomotic stoma than in those with a shorter diameter before the operation (P<0.01). After the operation, FPP in the former patients markedly decreased compared to the latter ones (P<0.01). The incidence rate of hemorrhage in patients treated with PAD, PSS, SS, PSS+PAD, and HCC+PH was 21.09% (54/256), 13.77 (23/167), 11.29 (7/62), 36.36% (4/11), and 100% (3/3), respectively. The incidence rate of hepatic encephalopathy was 3.91% (10/256), 9.58% (16/167), 4.84% (3/62), 9.09% (1/11), and 100% (3/3), respectively while the operative mortality was 5.49% (15/256), 4.22% (7/167), 4.84% (3/62), 9.09% (1/11), and 66.67% (2/3) respectively. The operative mortality of liver transplantation was 22.22% (2/9). CONCLUSION: Five kinds of operation in surgical treatment of portal hypertension have their advantages and disadvantages. Therefore, the selection of operation should be based on the actual needs of the patients.     

抑肽酶联合控制性降压在脊柱手术中的应用

目的 探讨抑肽酶联合控制性降压在脊柱手术中应用的血液保护效应.方法 45例择期行脊柱手术患者,随机均分为抑肽酶联合控制性降压组(联合组)、单纯控制性降压组(降压组)和对照组.分别在术前、术毕、术后24 h抽血检测血常规和凝血功能.比较三组患者手术失血量、输血量和凝血功能变化.结果 联合组与降压组手术失血量、输血量、术后24 h切口引流量均较对照组明显下降(P<0.01),联合组上述指标低于降压组(P<0.05).与对照组和降压组比较,联合组术后部分凝血活酶时间(APTT)延长(P<0.01),纤维蛋白原(Fib)值偏高(P<0.05).结论 抑肽酶联合控制性降压可明显减少脊柱手术的失血量和异体血的输入量.     

脊柱云纹照相技术的临床应用

本文从基于云纹图的人体三维图像分析、脊柱健康普查、脊柱矫形手术的设计及保守治疗腰腿痛的疗效评价等方面,就云纹脊柱照相技术的临床应用进行综述,未来有望通过这项技术衡量脊柱的功能,实现中医脊柱"望诊"的客观化.     

突出髓核对神经根挤压作用的临床意义--71例腰椎间盘突出症患者CT(MRI)轴位像分析

目的：观察突出髓核与关节突关节及椎板（黄韧带）的挤压作用对椎管内神经根的影响，并探讨其临床意义。方法：以CT或MRI轴位像为依据，将71例（男45例，女26例；年龄13～59岁，平均37．5岁）腰椎间盘突出症患者按照突出髓核和关节突关节或（和）椎板（黄韧带）间距大小分为3型，测量椎间盘矢状径指数（SI）、患侧直腿抬高角度。观察SI值、间距分组与患侧直腿抬高角度的相关性。结果：患者年龄、性别、SI与患侧直腿抬高角度无关（P〉0．05），间距分组与患侧直腿抬高角度呈负相关（r=-0．8787，P〈0．01）：结论：突出髓核与关节突关节及椎板（黄韧带）等对神经根的挤压作用反映了神经根的受压程度。     

Hypertension in the elderly: insights from recent research

Hypertension is a leading cause of mortality and morbidity around the world and,prevalence of hypertension is increasing with aging.Hypertension in the elderly is associated with increased occurrence rates of sodium sensitivity,isolated systolic hypertension,and ＇white coat effect＇.Arterial stiffness and endothelial dysfunction also increase with age.These factors should be considered in selecting antihypertensive therapy.The prime objective of this therapy is to prevent stroke.The fmdings of controlled trials show that there should be no cut-off age for treatment.A holistic program for controlling cardiovascular risks should be fully discussed with the patient,including evaluation to exclude underlying causes of secondary hypertension,and implementation of lifestyle measures.The choice of antihypertensive drug therapy is influenced by concomitant disease and previous medication history,but will typically include a thiazide diuretic as the first-line agent;to this will be added an angiotensin inhibitor and/or a calcium channel blocker.Beta blockers are not generally recommended,in part because they do not combat the effects of increased arterial stiffness.The hypertension-hypoten-sion syndrome requires case-specific management.Drug-resistant hypertension is important to differentiate from faulty compliance with medication.Patients resistant to the third-line drug therapy may benefit from treatment with extended-release isosorbide mononitrate.A trial of spironolactone may also be worthwhile.     

伽玛刀治疗颞叶内侧癫痫疗效分析(附26例临床分析)

目的探讨伽玛刀治疗颞叶内侧癫痫的方法与疗效。方法2000年9月至2005年1月应用伽玛刀治疗颞叶内侧癫痫患者共26例,病程平均8年（4～42年）。治疗范围包括杏仁核,海马及部分海马旁回,50％等剂量曲线边缘剂量平均19Gy（15～20Gy）。结果随访0．7～5．03年,平均1．13年。26例患者中有10例发作完全消失,发作频率减少在50％以上的患者16例（62％）,在随访时间大于1．5年的9例患者中有6例发作完全消失,发作频率减少在50％以上的患者7例（77．8％）。所有患者中21例复查了核磁共振（MRI）,有14例在术后12个月前后出现局部水肿及血脑屏障破坏。全部病人未见头痛、记忆力下降、视束损伤等并发症。结论初步结果显示伽玛刀治疗颞叶内侧癫痫安全、有效,最终疗效评估仍需大量病例长期随访确定。     

82例睡眠呼吸暂停低通气综合征的诊断与无创正压通气治疗

目的探讨睡眠呼吸暂停综合征(SAHS)的诊断及自动调节持续气道内正压通气(auto-CPAP)对SAHS的治疗价值。方法82例SAHS患者,均行整夜的多导睡眠仪监测,并对18例中重度患者进行auto-CPAP治疗。结果SAHS患者随病情加重Epworth评分、呼吸紊乱程度、最长呼吸暂停时间、鼾声指数、氧减指数等参数明显增加,最低氧饱和度明显降低。Auto-CPAP治疗后呼吸紊乱和低氧血症的程度显著减轻,中枢性呼吸暂停的次数及所占时间没有明显改变。Epworth评分与呼吸紊乱、低氧血症以及打鼾的的时间和次数有明显的相关关系。结论Auto-CPAP可有效的治疗中重度SAHS患者,消除阻塞性及混合性呼吸暂停,减轻低氧血症,明显改善症状,并具有良好的接受性。夜间频繁出现的低氧血症是导致日间过度嗜睡的重要因素。     

脊柱定点旋转复位法治疗游离型腰椎间盘突出症

目的：观察脊枉（定点）旋转复位法治疗游离型腰椎间盘突出症临床疗效并探讨其机制。方法：脊柱（定点）旋转复位法治疗游离型腰椎间盘突出症41例，男27例，女14例；年龄24-57岁，平均38．3岁。按患者主观症状、患侧直腿抬高试验（SLR）、脊柱运动、腰型进行临床评分，比较手法治疗前后评分结果并进行统计学分析。测量观察反映突出髓核大小的MRI椎间盘突出最大层面矢状径指数（SI），比较手法治疗前后SI值并进行统计学分析。结果：手法治疗后患者主观症状、SLR、脊柱运动、腰型积分明显增加（P〈O．05），治疗前后临床综合评分分别为8．4500±2．4385、18．9000±1．8229，治疗后积分显著提高（P〈O．05）。手法治疗前后SI值分别为0．5651±0．1387、0．5292±0．1499，统计学检验无显著性改变（P〉O．05）。41例均获随访，时间3±36个月，平均11个月，无一例复发。结论：游离型腰椎间盘突出症的主要病理改变是单（多）个椎体位移。实施脊柱（定点）旋转复位法恢复患椎的解剖或代偿位置，临床表现可以随之锐减或消失。其机制并非髓核组织的缩小，可能是纠正椎体位移后减轻鞘膜囊（神经根）的形变和张力，恢复了脊柱的稳定性。     

Activity of ciprofloxacin and azithromycin on biofilms produced in vitro by Haemophilus influenzae

Background It is recognized that Haemophilus influenzae isolated from patients with otitis media forms biofilms both in vitro and in vivo, suggesting that biofilm formation in vivo might play an important role in the pathogenesis and chronicity of otitis media, but the effect of antibiotics on biofilm has not been well studied. We investigated the impact of ciprofloxacin and azithromycin on bacterial biofilms formed by Haemophilus influenzae in vitro in this study. Methods Eleven strains of Haemophilus influenzae were isolated from sputum specimens collected from patients with acute exacerbation of chronic obstructive pulmonary diseases. Formation of bacterial biofUm was examined by crystal violet assay and a scanning electron microscope. Alterations of biofilms were measured under varying concentrations of azithromycin and ciprofloxacin. Results Striking differences were observed among strains with regard to the ability to form biofilm. Typical membrane-like structure formed by bacterial cells and extracellular matrix was detected. Initial biofilm synthesis was inhibited by azithromycin and ciprofloxacin at concentrations higher than two-fold minimal inhibitory concentration. Disruption of mature biofilms could be achieved at relatively higher concentration, and ciprofloxacin displayed more powerful activity. Conclusions Haemophilus influenzae is capable of forming biofilm in vitro. Sufficient dosage might control early formation of biofilms. Ciprofloxacin exerts better effects on breakdown of biofilm than azithromycin at conventional concentration in clinics.