高热惊厥脑干听觉诱发电位的分析

本文报道了30例高热惊厥患儿的脑干听觉诱发电位检测结果。结果提示,高热惊厥患儿脑干听觉诱发电位异常率较高,以Ⅰ—Ⅴ波峰间期延长为主,同时Ⅰ、Ⅲ、Ⅴ波耳间差值增大。文中讨论了这一结果与高热惊厥发病年龄特征的关系。     

Clinical study on the pattern of lymphnode metastasis in carcinoma of esophagus (an analysis of 200 cases)

Objective: To study the pattern of lymphnode metastasis in carcinoma of esophagus. Methods: 200 cases of resected esophageal cancer specimens were carefully examined pathologically. Lymphnode metastasis, its pathway and extent in relation to pathological changes were analyzed. Results: Lymphnode metastasis was mainly regional and extended vertically in both directions. Leaping-over metastasis was another feature. The deeper invasion by the tumor, the higher frequencies of metastasis development, and vice versa. However, leaping-over metastasis was more likely to occur where tumor invasion was less severe. Conclusion: Owing to the high frequency of lymphnode metastasis in the superior mediastinum and the widely spanned leaping-over metastasis, an operative approach by three incisions through right thoracotomy with excision of the whole segment of esophagus and anastomosis at cervical region was recommended, in order to dissect lymphnodes in the cervical, thoracic and abdominal regions and to leave less or no metastatic lymphnodes behind.     

Neurohumoral interactions in the posttraumatic period and possibilities of their correction

Changes of neuromediators and their correction in the posttraumatic period after acute blood loss were studied experimentally in mongrel dogs. Survival of white rats was examined after heavy combined trauma during therapeutic use of exogenous cholinesterase and serotonin. Their use was studied clinically in patients with heavy combined trauma. The use of exogenous cholinesterase and serotonin in a complex of resuscitation measures permits stabilization of the functional state of the adrenal cortex and the cholinergic, adrenergic and serotoninergic systems.     

生长抑素及其类似物联合质子泵抑制剂应用于急性非静脉曲张性上消化道出血的循证分析

目的 系统评价生长抑素及其类似物联合质子泵抑制剂（proton pump inhibitor，PPI）治疗急性非静脉曲张性上消化道出血（acute non-variceal upper gastrointestinal bleeding，ANVUGIB）的有效性和安全性，并分析其用药经济性。方法 采用循证医学方法搜集生长抑素及其类似物联合PPI治疗ANVUGIB的RCT、队列研究进行meta分析，得到相应的有效性及安全性分析结果，并进行成本-效果分析。结果 最终纳入6个RCT均未接受内镜治疗，共610例受试者。Meta分析结果显示，生长抑素及其类似物联合高、中、低剂量PPI治疗在以下方面均优于单用高、中、低剂量PPI治疗，差异有统计学意义，总有效率[OR=3.34，95%CI（2.03，5.47），P<0.000 01]、止血时间[MD=-9.04，95%CI（-11.69，-6.38），P<0.000 01]、输血量[MD=-1.10，95%CI（-1.46，-0.74），P<0.000 01]；在不良反应发生率方面，2组差异无统计学意义[OR=0.49，95%CI（0.11，2.12），P=0.34]。ANVUGIB患者予生长抑素联合高、中、低剂量奥美拉唑与单用高、中、低剂量奥美拉唑进行成本-效果分析，增量成本效果比分别为172.28，217.26，330.37，敏感性分析后显示结果稳定。而接受内镜治疗后应用生长抑素及其类似物联合PPI治疗仅1个队列研究，研究结果显示内镜治疗成功后联合治疗并不优于PPI单药治疗。结论 现有证据表明，生长抑素及其类似物联合PPI治疗未经内镜治疗的ANVUGIB患者为较有效的方案，两者安全性相当、耐受性较好，从药品直接成本考虑，高剂量PPI组联合治疗较中、低剂量PPI组联合治疗更具有成本效果性。而对于经内镜下止血治疗的患者两者疗效相当，可考虑单用PPI。     

The effects of bright light therapy on depression and sleep disturbances in patients with Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials

BackgroundDepression and sleep disturbance are well-recognized non-motor features in patients with Parkinson's disease (PD). This meta-analysis aimed to explore the potential role of bright light therapy (BLT) in depression and sleep disturbances in Parkinson's Disease (PD).MethodsFour databases were independently searched by two reviewers: PubMed, Cochrane, Web of Science and Embase until February 2021. We evaluated the following depression related scales: Beck's Depression Inventory (BDI); the Geriatric Depression Rating Scale, 30-item (GDS-30); the Hamilton Depression Rating Scale (HDRS); the Hospital Anxiety and Depression Scale (HADS); the Epworth sleepiness scale (ESS); the Fatigue Severity Scale (FSS); the Pittsburgh sleep quality index (PSQI); the Parkinson's disease sleep scale (PDSS); Scales for Outcomes in Parkinson's disease Sleep Scale (SCOPA) and the Insomnia severity index (ISI) to access the effects of bright light therapy on depression and sleep disturbances in patients with PD. Effect size (standardized mean deviation [SMD] and 95% confidence interval [CI]) were used to analyze the continuous results data of intervention group and control light group. Data from five randomized, controlled trials totaling 173 patients with PD was included.ResultsBLT significantly improved depression symptoms (BDI, GDS-30, HDRS and HADS) of PD patients (0.34, 95% CI = 0.06–0.61). Insomnia symptoms (SCOPA and ISI) for patients with PD were significantly improved by BLT as well (1.15, 95% CI = 0.71–1.60). Whereas, no difference was observed in the control light group in improving the depression or insomnia symptoms of PD patients.ConclusionBLT is an effective intervention for improving depressive symptoms and sleep disturbances in patients with PD.     

寰椎侧块螺钉钉道与颈内动脉位置关系的三维CT血管成像分析

背景：植入寰椎侧块的双皮质螺钉存在损伤位于寰椎侧块前方的颈内动脉的风险。目的：通过对颈部三维CT血管成像多平面重建测量,研究寰椎侧块螺钉钉道与颈内动脉的位置关系,以避免寰椎侧块螺钉植入造成颈内动脉的损伤。方法：从2012年9月至2012年11月行头颈CT血管造影扫描的患者中选取寰枢椎及头颈部血管无明确病变者126例,利用其图像数据进行三维多平面重建成像,在寰椎侧块螺钉进钉平面上测量颈内动脉与寰椎前皮质的最短距离,寰椎侧块的宽度,颈内动脉内侧缘分别至寰椎正中线、过横突孔内侧缘的矢状线、过进钉点的矢状线的距离,并测量进钉点与颈内动脉内侧缘切线的外偏角,同时在进钉平面上根据寰椎侧块进行区域划分,根据颈内动脉内侧缘所在区域分析颈内动脉与寰椎侧块的位置关系。结果：在寰椎侧块螺钉进钉平面上,颈内动脉与寰椎前皮质的最短距离为（3．32±1．07）mm,有35侧（13．9％）小于2mm,最小值为1．49mm;颈内动脉内侧缘至寰椎正中线的距离为（22．99±2．86）mm;颈内动脉内侧缘与过横突孔内侧缘的矢状线距离为（1．08±1．50）mm,其中182侧（72．2％）颈内动脉内侧缘位于横突孔内侧;颈内动脉内侧缘与过进钉点的矢状线距离为（3．99±1．84）mm;进钉点与颈内动脉内侧缘切线的外偏角为（9．90±5．57）°,最小值为-4．6°,其中有17侧（6．7％）小于0°。各项测量指标左、右侧差异均无统计学意义（P〉0．05）。颈内动脉内侧缘位于侧块外侧有95侧（37．7％）,位于侧块前方有157侧（62．3％）,其中位于侧块前方区域外1／3有136侧（54．O％）,位于侧块前方区域中1／3有21侧（8．3％）,未发现有位于侧块前方内1／3及侧块内侧者。结论：颈内动脉位于寰椎侧块的前外侧方,采用5°的内偏钉道有利于避免寰椎双皮质侧块螺钉对颈内动脉的损伤,术前通过颈部三维CT血管成像可以清楚地显示两者的解剖位置关系,为寰椎侧块螺钉的安全植入提供帮助。     

急性缺血性脑卒中不同品种数辅助药物治疗方案的成本-效果分析

目的观察急性缺血性脑卒中患者应用不同品种数辅助药物治疗方案的成本与效果差异,从中筛选出最为经济、合理的治疗方案,为制定报销政策及实行临床路径和按病种收费提供参考。方法抽取某医院2012-2013年满足条件的急性缺血性脑卒中患者病历,统计辅助药物用药情况;按同时使用辅助药物品种数将治疗方案分为3组,考察其成本、效果,进行药物经济学评价及敏感性分析。结果 3组方案的成本分别为9263.99元、11046.06元和12807.18元,治疗有效率分别为56.0%、81.8%、86.7%。在单药治疗的基础上,每再获得一个单位效果,二联治疗、三联治疗方案所须追加的成本分别为69.07元、115.41元。敏感性分析不影响结果。结论二联治疗为较理想的辅助药物治疗方案。     

1,2,3,4,6-O-五没食子酰基葡萄糖对MPP+诱导PC12细胞凋亡的保护作用

目的 考察1,2,3,4,6-O-五没食子酰基葡萄糖(1,2,3,4,6-penta-O-galloyl-β-D-glucose,β-PGG)对MPP⁺诱导的帕金森病细胞模型中PC12细胞凋亡的保护作用及其机制研究。方法 PC12细胞孵育于高糖DMEM培养基中,在药物处理前1周,将神经生长因子(NGF)加入培养基中,使培养基中NGF的终质量浓度为50 ng/mL。将细胞分为对照组、MPP⁺组以及50 μmol/L β-PGG预处理7、12、20、30 h组,观察预处理不同时间对MPP⁺中PC12细胞存活影响。采用台盼蓝染色法检测细胞死亡情况,MTT法检测细胞活力,免疫印迹法检测Bcl-2、Bax、Fas、FasL、procaspase-3、procaspase-8、procaspase-9蛋白表达情况,并检测caspase-3、caspase-8、caspase-9活力。结果 对照组PC12细胞死亡率最低,MPP⁺组PC12细胞死亡率最高,从β-PGG预处理12 h起PC12细胞死亡率较MPP⁺组均明显降低(P< 0.01)。MPP⁺组PC12细胞活力最低,50 μmol/L β-PGG预处理12 h时PC12细胞活力进一步增高,预处理20 h时细胞活力最高。β-PGG预处理5 h后即可见Bcl-2、procaspase-3、procaspase-8、procaspase-9蛋白含量增加,至15 h时增加达到高峰;与之相反的是,β-PGG预处理5 h后即可见Bax、Fas、FasL蛋白含量减少,至30 h时达最少。50 μmol/L β-PGG预处理PC12细胞15 h后caspase-3、caspase-8、caspase-9的活力分别为MPP⁺组的36.5%、40.2%、42.2%。结论 β-PGG对MPP⁺诱导PC12细胞凋亡具有保护作用,其机制是通过增强Bcl-2的表达、抑制Bax、Fas、FasL的表达以及降低caspase-3、caspase-8、caspase-9的活力实现了抑制MPP⁺引起的PC12细胞凋亡,促进PC12细胞的存活。     

Iron phosphide nanoparticles as a pH-responsive T1 contrast agent for magnetic resonance tumor imaging

In this work, the potential of FeP nanoparticles as a pH-responsive T₁ contrast agent was investigated. The FeP nanoparticles have good biocompatibility and can significantly amplify T₁ magnetic resonance signals in response to the acidic microenvironment of solid tumors, holding great promise in serving as an acid-activatable T₁ contrast agent for tumor imaging.

In this work, the potential of FeP nanoparticles as a pH-responsive T₁ contrast agent was investigated.

Magnetic resonance imaging (MRI) is currently one of the most powerful medical imaging techniques due to its noninvasive character, deep tissue penetration, and ability to provide images with excellent anatomical details.^1–3 MRI contrast agents are a group of contrast media that can improve the accuracy and specificity of MRI.^4–6 In general, MRI contrast agents can be divided into T₁ positive contrast agents and T₂ negative contrast agents according to the relaxation processes. T₁ contrast agents shorten the longitudinal relaxation time of water protons, resulting in a brighter signal, while T₂ contrast agents reduce the transverse relaxation time, leading to a darker signal.^7,8 Nanomaterials containing paramagnetic metal ions (e.g., Gd³⁺, Mn²⁺, and Fe³⁺) have been widely used as T₁ MRI contrast agents.^9–14 On the other hand, magnetic nanoparticles with high saturation magnetization are the most commonly used as T₂ contrast agents because they can generate a local magnetic field in the presence of the external magnetic field to accelerate the dephasing of surrounding water protons.^15–17The exploitation of highly specific and sensitive imaging contrast agents is of great importance for precise disease diagnosis.¹⁸ Activatable imaging contrast agents that can respond to biological stimulis (e.g., pH, redox potential, and enzyme) to produce contrast signals, have emerged as the next generation of molecular imaging probes.^19–22 They can minimize the signal from nontarget background, therefore greatly improve the target-to-background ratio. Conventional T₁ contrast agents such as Gd₂O₃ nanoparticles and MnO nanoparticles have been demonstrated that can afford effective T₁ shortening effect to improve the visibility. However, these contrast agents continuously emit signals are “always on”, which fail to response to pathological parameters and hence lack in specificity and sensitivity. Activatable MRI contrast agents that only generate signals in response to a certain stimuli (e.g., physiological difference in pH in tumor microenvironment) thus are highly desirable, because they not only greatly enhance the specificity and sensitivity of disease diagnosis, but also potentially allow MRI to monitor biological processes.^23–25 Herein, we report a novel pH-activatable T₁ contrast agent based on FeP nanoparticles. We found that the as-synthesized FeP nanoparticles can respond to the acidic microenvironment of solid tumor to produce significant T₁ contrast enhancement by releasing paramagnetic Fe ions. Furthermore, both in vitro and in vivo investigations indicate that the FeP nanoparticles have good biocompatibility that show no obvious cytotoxicity and harmful effects. Therefore, the FeP nanoparticles can potentially serve as an acid-responsive T₁ MRI contrast agent for tumor imaging.