Head injuries coexistent with pelvic or lower extremity fractures-early or delayed osteosynthesis

Summary The authors compared the results of a retrospective analysis of two groups of head-injured patients who had coexistent pelvic or lower extremit fractures. One group was treated with early osteosynthesis within the first 12 hours after trauma, simultaneously with neurosurgical treatment, while the second group was treated neurosurgically and osteosynthesis was postponed for 4 to 10 days. The second group revealed a higher mortality, which was due to fat embolism. We conclude that early osteosynthesis is the treatment of choice in patients with coexistent head injury and lower extremity fractures.     

颅内破裂动脉瘤手术时机的选择

目的探讨颅内破裂动脉瘤不同手术时机与临床预后的关系.方法回顾性分析121例前循环动脉瘤,其中延期手术夹闭97例,早期24例,采用不同的统计方法分析不同手术时机对预后的影响.结果早期手术夹闭24例中除1例V级患者于术后3d死亡和1例Ⅲ级患者于术后2月因颅内感染死亡外,余22例均获得优或良疗效;平均住院18.2d,无1例再出血,延期手术的97例平均住院时间是前者的2倍,14例发生再出血.结论早期显微外科治疗颅内破裂动脉瘤,尤其对Hunt&HessI～Ⅲ级患者,有利于缩短住院时间,降低保守治疗期间再出血的危险性,而对于Ⅳ～V级脑肿胀患者,早期手术的困难程度相应增加.     

大鼠脑挫伤DNA含量变化与损伤时间的关系

目的观察大鼠脑挫伤后DNA含量的时序变化规律。方法建立自由落体打击大鼠脑挫伤动物模型，采用Feulgen’s DNA染色方法，结合图像分析技术。结果损伤侧大脑皮质浅层和海马区平均积分光密度（IOD）变化呈：24h内迅速下降，24—96h有缓慢上升趋势；伤后24h内上述两区域平均积分光密度均与损伤时间呈线性关系，R^2分别为0．668和0．615。可导出直线回归方程。结论采用Feulgen’s DNA染色法结合图像分析技术观察伤后DNA含量变化，可以应用于脑损伤时间推断的研究，探索推断脑损伤时间的新方法。     

慢性泪囊炎泪道引流管置入术后导管留置最佳时机探讨

目的：探讨慢性泪囊炎行泪道引流管置入术后导管留置的最佳时机。

方法：回顾性选取2011-04/2016-10于我院行泪道引流管置入术的慢性泪囊炎患者143例143眼,根据术后导管留置时间进行分组,其中A组患者50例50眼术后导管留置6wk,B组患者57例57眼术后导管留置9wk,C组患者36例36眼术后导管留置12wk。比较三组患者术后临床疗效、视力、溢泪和复发情况及并发症发生情况。

结果：拔管当天,A组和B组患者临床疗效总有效率(94%和93%)优于C组(39%)(均P<0.0167),但拔管后3mo,三组患者临床疗效总有效率(56%、51%、36%)、视力、溢泪发生率(46%、53%、56%)均无明显差异。拔管后随访6mo,三组患者术后复发率(4%、7%、19%)无明显差异(P=0.056),但C组患者术后并发症发生率(25%)明显高于A组(4%)和B组(7%)(均P<0.0167)。

结论：慢性泪囊炎行泪道引流管置入术后导管留置6wk或9wk临床获益优于12wk,更具临床应用价值。     

血浆瓜氨酸对重症患者肠内营养时机选择的价值研究

目的 探讨针对重症患者实施血浆瓜氨酸水平测定对其肠内营养时机选择的价值。方法 本院于2018年9月至2020年9月纳入240例ICU重症患者开展研究。根据急性胃肠损伤(AGI)诊断标准观察患者AGI发生情况并开展AGI分级(其中AGIⅠ～Ⅳ级患者各60例),随后对所有患者进行血浆瓜氨酸水平测定,比较不同AGI分级患者一般资料、病情严重程度、预后情况及各阶段(入组时、肠内营养开始实施时、出现胃肠道相关并发症时)血浆瓜氨酸水平;再根据血浆瓜氨酸检测水平分组,其中浓度≥12μmol/L的137例患者纳入试验组,将血浆瓜氨酸浓度12μmol/L的103例患者纳入对照组;探讨肠内营养时机的选择。结果 AGIⅣ级患者APACHEⅡ评分、SOFA评分及28 d病死率显著高于AGIⅠ、Ⅱ、Ⅲ级,其ICU治疗时间明显长于其他三级,而AGIⅣ级患者血浆瓜氨酸水平显著低于AGIⅠ、Ⅱ、Ⅲ级;试验组患者肠内营养24 h喂养量明显多于对照组,其喂养目标达标时间显著短于对照组;试验组喂养不耐受、胃潴留、腹泻及腹胀、胃肠道出血、腹腔高压等胃肠道相关并发症发生率及28 d病死率均低于对照组,差异有统计学意义(P0.05)。结论 重症患者血浆瓜氨酸水平与其病情严重程度及AGI分级呈反比,通过测定血浆瓜氨酸含量可预测患者发生胃肠道并发症的风险,从而明确肠内营养开展时机(血浆瓜氨酸浓度≥12μmol/L)。     

Channel Interaction and Current Level Affect Across-Electrode Integration of Interaural Time Differences in Bilateral Cochlear-Implant Listeners

Sensitivity to interaural time differences (ITDs) is important for sound localization. Normal-hearing listeners benefit from across-frequency processing, as seen with improved ITD thresholds when consistent ITD cues are presented over a range of frequency channels compared with when ITD information is only presented in a single frequency channel. This study aimed to clarify whether cochlear-implant (CI) listeners can make use of similar processing when being stimulated with multiple interaural electrode pairs transmitting consistent ITD information. ITD thresholds for unmodulated, 100-pulse-per-second pulse trains were measured in seven bilateral CI listeners using research interfaces. Consistent ITDs were presented at either one or two electrode pairs at different current levels, allowing for comparisons at either constant level per component electrode or equal overall loudness. Different tonotopic distances between the pairs were tested in order to clarify the potential influence of channel interaction. Comparison of ITD thresholds between double pairs and the respective single pairs revealed systematic effects of tonotopic separation and current level. At constant levels, performance with double-pair stimulation improved compared with single-pair stimulation but only for large tonotopic separation. Comparisons at equal overall loudness revealed no benefit from presenting ITD information at two electrode pairs for any tonotopic spacing. Irrespective of electrode-pair configuration, ITD sensitivity improved with increasing current level. Hence, the improved ITD sensitivity for double pairs found for a large tonotopic separation and constant current levels seems to be due to increased loudness. The overall data suggest that CI listeners can benefit from combining consistent ITD information across multiple electrodes, provided sufficient stimulus levels and that stimulating electrode pairs are widely spaced.