下肢静脉高压症顺行性静脉造影的诊断意义

本文对临床上有下肢静脉高压症的56例病人,共76条下肢,进行了顺行性静脉造影的X线研究。其中对12条下肢做了经皮腘静脉造影检查。作者认为:(1)下肢静脉高压除因下肢静脉血栓形成外,下肢深静脉瓣膜功能不全是其另一个主要原因。(2)经皮腘静脉造影是检测下肢深静脉瓣膜功能的有效、准确的方法。(3)下肢静脉造影的联合应用,在检查下肢静脉高压中具有科学性和准确性。     

慢性肾功能不全时测定左心室收缩时间间期的意义

本文报道了36例慢性肾功能不全患者的左心室收缩时间间期测定结果,并探讨其临床意义。作者认为,该项检查在慢性肾功能不全患者中有实际应用的价值;有关PEP/LVET比值和多种病理因素的相关分析表明,尿毒症晚期心肌病变确非单一因素引起。     

主动脉内球囊反搏在小儿中的应用

主动脉内球囊反搏(intraaortic balloon pump，IABP)已广泛应用于成年人心源性休克和围手术期低心排血量综合征的治疗，并取得良好的治疗效果，但在小儿中的应用仍较局限。现就有关IABP在小儿中的应用进行综述，着重分析IABP的适应证和影响在小儿中应用的技术困难和其他因素，介绍小儿IABP应用的技术要点，可能的并发症和治疗效果。在无体外膜式氧合器(ECMO)和左心辅助设备的情况下，小儿心脏直视手术后如不能脱离体外循环机或发生严重低心排血量综合征等，应用IABP治疗可收到较好的效果。     

Suppression of hippocampal synaptic plasticity during slow-wave sleep

The influence of behavioral state on the induction of long-term enhancement (LTE) of hippocampal synapses was studied in chronically prepared animals. Perforant path evoked field potentials and EEG were recorded from fascia dentata during slow-wave sleep (SWS) and waking. LTE was strongly suppressed during SWS, suggesting that hippocampal information storage may be inactivated at certain phases of the sleep cycle. Normal LTE was observed in the same animals while awake.     

小儿急性肾功能不全临床与病理分析

回顾性分析２７例急性肾功能不全患儿临床与肾脏病理变化。临床分析表明，小婴儿以药物性肾损害多见，预后差和病死率高；年长儿以肾小球疾病多见，其中急性肾炎预后好，肾病和紫癜性肾炎预后差，易发展至慢性肾功能不全。病理学研究显示肾小球大量硬化的患儿易发生慢性肾功能不全。     

阻塞性睡眠呼吸暂停为高胰岛素血症及糖代谢异常的独立危险因子

目的：探讨阻塞性睡眠呼吸暂停（ＯＳＡ）与肥胖、高血压、高血脂及糖代谢异常之间的关系。方法：１６３例患者均行整夜多导睡眠仪及口服糖耐量（ＯＧＴＴ）检查；以ＯＧＴＴ时胰岛素反应曲线下面积（ＡＵＣｉｎｓｕｌｉｎ）作为胰岛素抵抗的指标，应用多元逐步回归分析ＯＳＡ患者呼吸暂停指数（ＡＩ）与胰岛素抵抗、高胰岛素血症及糖代谢异常之间的关系。结果：①直线相关分析表明，ＡＵＣｇｌｕｃｏｓｅ（血糖反应曲线下面积）及ＡＵＣｉｎｓｕｌｉｎ均与ＡＩ呈显著相关；②分别以ＡＵＣｇｌｕｃｏｓｅ及ＡＵＣｉｎｓｕｌｉｎ为依存因子建立的多元回归方程中均包括ＡＩ；尤其在后一方程中，ＡＩ对ＡＵＣｉｎｓｕｌｉｎ的贡献率仅次于身高体重指数。结论：ＯＳＡ为高胰岛素血症及糖代谢异常的重要危险因子，且其作用独立于肥胖、糖尿病家族史及年龄等混淆因素     

Is monoamine oxidase inhibitor induced myoclonus serotoninergically mediated?

Summary In the present study a single case observation of myoclonus during sleep-wave transition was monitored in a depressed patient treated with the monoamine oxidase inhibitor, phenelzine. The myoclonus had a rhythm of 1 c/second and lasted for two years, the duration of phenelzine treatment. Myoclonus appeared neither during wakefulness nor during sleep, but at wake-sleep-wake transitions. This switch myoclonus was associated with phasic muscle hyperactivity during REM sleep.Methysergide a 5-HT suppressor, decreased the switch myoclonus frequency and the REM muscle hyperactivity, indicating serotoninergic involvement in the mechanism of phenelzine induced myoclonus.     

Work at sea: a study of sleep,and of circadian rhythms in physiological and psychological functions,in watchkeepers on merchant vessels

Summary Sleep length and sleep quality scores were collected on board ships over periods of up to two weeks from 38 watchkeepers working a 4-on/8-off routine and 29 dayworkers. All watchkeepers exhibited fragmented sleeping patterns, which indicated a lack of adaptation of the sleep/wakefulness cycle to the hours of work. There were only slight differences in total sleep length between watchkeepers and dayworkers, however, both groups did not obtain an adequate amount of sleep. Within the watchkeeping crews the 3rd Officers had by far the shortest sleep length. Concerning sleep quality, daytime sleep was generally given the lowest ratings, whereas sleep starting before midnight was on average evaluated as the best, both by watchkeepers and dayworkers. Watchkeeping personnel do not normally have any days off during a voyage so that missed sleep might even amount to a sleep deficit. A solution for this problem could perhaps be a new, stabilized system that allows a single uninterrupted sleep, which is required for full recuperation, to be taken each day.Dedicated to Professor J. Aschoff on the occasion of his 75th birthdayPartly supported by a grant from the Ministry for Technology and Research, Federal Republic of Germany, Project Schiff der Zukunft, Part ET83b     

基于慢性肾脏病管理的精准分级诊疗应用实践

分级诊疗制度是优化基本医疗卫生制度的重要步骤,但落地实施时遇到阻碍,因存在转诊标准不一、空间不连贯和时间滞后等问题,医联体模式推进存在难度。上海市浦东新区人民医院联合7家社区卫生服务中心,构建了一套以信息化为支撑的川沙医联体慢性肾脏病（CKD）专病精准分级诊疗管理方案。以CKD病种为例,基于指南梳理CKD患者的疾病管理规律,建立医疗信息联通共享、转诊规则标准的CKD专病分级诊疗知识库,设计区域CKD专病分级诊疗系统,构建了基于医院-社区联动管理的专病分级诊疗一体化管理模型。且实证应用评价显示,基于CKD知识库的专病分级诊疗模式,可以精准定位易发和高危人群,及时筛查评估CKD早期患者,提升CKD患者的健康管理和诊疗效率。     

全科医学与睡眠医学如何协同发展

全科医学和睡眠医学作为国内目前新兴的两个临床学科,两者在学科建设过程中存在着诸多交集,互补性强,在学科发展和人才培养上存在一定的交叉融合。中国专科医师培训认证制度在人才培养方面为全科医师从事睡眠医学工作开辟了道路,使其有良好的协同发展的基础及必要性。本文分析了目前中国全科医学与睡眠医学两者学科协同发展的基础及学科协同共建的必要性,介绍了南京医科大学附属无锡人民医院在全科医学与睡眠医学学科共建方面取得的经验,并邀请相关专家就目前存在的问题进行讨论。