小儿中枢神经系统肿瘤71例病理分析

本文分析了1962年至1986年间的71例小儿中枢神经系统肿瘤的病理资料,该病占同期中枢神经系统肿瘤的16.6％。71例中,颅内肿瘤67例,椎管内肿瘤4例。颅内肿瘤中幕上38例,以星形细胞瘤多见,其次为先天性肿瘤。幕下29例以髓母细胞瘤多见,其次为星形细胞瘤。小儿中枢神经系统肿瘤以恶性居多,预后不佳。脑中线是肿瘤的好发区。     

彩色多普勒超声对高度近视眼后巩膜改变相关因素的评价

目的:探讨高度近视眼后巩膜形态改变与眼轴长度、近视程度及血流动力学变化之间的关系。方法:应用ATL超9型APOOGE-800型彩色多普勒超声诊断仪,探头频率5.0~10.0MHz。对26例正常眼,36例轻中度近视眼,51例高度近视眼后巩膜进行观察。并对26例正常眼,17例轻中度近视眼,26例高度近视眼的眼动脉(OA)、视网膜中央动脉(CRA)、睫状后动脉(PCA)进行检测。结果:轻中度近视组、高度近视组的眼轴长度与近视程度呈正相关性。两者之间的直线回归方程Y=-3510.3 1668.1X,R=0.9432,P<0.0001。后巩膜形态改变与正常对照组比较差异有显著性意义(P<0.001)。高度近视眼组、轻中度近视组与正常对照组比较,OA血流参数差异无显著性意义(P>0.05),而高度近视组的CRA、PCA的收缩期(PSV)、舒张期(EDV)、平均血流速度(AV)均减低,CRA的阻力指数(RI)升高(P<0.05)。轻中度组与对照组比较差异无显著性意义(P>0.05)。结论:视网膜血管、睫状血管系统血供不足与后巩膜形态变化的类型、眼轴长度、近视的程度及血流动力学改变密切相关,是引起高度近视眼病理性眼底改变发生和发展的重要因素。     

Chrome congestive heart failure: Non-invasive measurement of cardiac output by a carbon dioxide rebreathing method at rest and during exercise

Cardiac output was measured in 11 patients undergoing routinecardiac catheterization using a carbon dioxide rebreathing techniqueand compared with cardiac output measured by direct Fick andthermodilution. The carbon dioxide rebreathing technique gaveconsistently lower values for cardiac output than the othertwo methods (mean difference –0·73, 95% CI –0·95to–0·511. min^–1 with the direct Fick and–0·72. 95% CI –1·19 to –0·261.min^–1 with thermodilution). The direct Fick and thermodilutionmethods gave similar results (mean dtfference –0·08,95% CI –0·32 to 0·16a. min^–1). Cardiacoutput was also measured in 10 healthy subjects at rest andduring two steady-state levels of exercise using the carbondioxide rebreathing technique. Measurements were made in triplicateon 3 separate days. The technique gave reproducible resultsbetween replicates at rest (coefficient of variation 91%) andbecame more reproducible on exercise (coefficients of variation56% and 54% respectively at each exercise level). There wasa good correlation between cardiac output and oxygen consumption(r=0·98 The carbon dioxide rebreathing technique is afeasible non-invasive way of measuring cardiac output. It tendsto underestimate cardiac output at rest but is reproducibleand becomes more so on exercise which is where it should beof most value.     

猕猴实验性脑动脉硬化扫描电镜观察

本实验表明,猕猴高脂造型22—28个月,其大脑中动脉(Middle Cerebral Artery:MCA)内皮发生水肿、细胞间隙变宽,局部破裂等改变,中膜平滑肌细胞增生、迁移。老年高脂组病损程度较重,且中央支也表现出类似改变。结果提示,高血脂可以引起脑动脉硬化性改变,且病损程度与年龄因素密切相关。     

Post-prandial cardiovascular responses in man after ingestion of carbohydrate,protein or fat

Changes in cardiac output and in superior mesenteric arterial flow were followed with Doppler ultrasound techniques in five young, healthy persons for 2 h after ingestion of medium-sized (4 MJ), fluid meals containing either carbohydrate, protein, fat or water only. Measurements were carried out before meals and at regular post-meal intervals, during which mean arterial blood pressure was also followed. All energy-containing meals caused marked and gradually developing post-prandial increases in cardiac output as well as in superior mesenteric arterial flow. The maximum flow levels were reached in the course of 30–60 min and maintained until the observations ended after 2 h. The intake of water caused no such flow increases. There were considerable interpersonal variations in the size and in the speed of development of the flow increases after the three types of energy-containing meals. The flow-increasing effects of the three meal types were not significantly different, even if the most marked increases (median values about 1 1 min^-1 for both cardiac output and superior mesenteric arterial flow) occurred after carbohydrate meals. The marked effects on circulation of the three food components were also revealed in the calculated, integrated amounts of ‘extra’ cardiac output and superior mesenteric arterial flow observed in the course of the 2 h following the meal. Values of more than 100 1 for such ‘extra’ flows were seen after carbohydrate meals. The marked ingestion-released increase in blood flow to the splanchnic organs is apparently partly met by an increase in cardiac output, and partly by some redistribution of flow, which benefits the digestive system.     

壳聚糖作为中枢神经系统支架材料的可行性研究

目的探索壳聚糖作为中枢神经系统组织工程支架材料的可行性。方法选择孕14～16dWistar大鼠剖宫取胎鼠脑进行分离、培养,经巢蛋白、胶原纤维酸性蛋白、特异性烯醇化酶和半乳糖脑苷酯免疫细胞化学染色鉴定获得神经干细胞,种植于壳聚糖膜和明胶膜表面培养,然后行巢蛋白免疫细胞化学染色,观察神经干细胞在壳聚糖膜和明胶膜表面的贴附、生长和分化状态,以及壳聚糖、明胶的降解速度。结果从胎鼠大脑分离获得的神经干细胞,巢蛋白染色呈阳性反应,可分化形成神经元和胶质细胞,分化细胞分别呈胶原纤维酸性蛋白、特异性烯醇化酶和半乳糖脑苷酯染色阳性反应。神经干细胞接种后12h即贴附于壳聚糖膜表面,24h壳聚糖膜和明胶膜均贴附牢固;48h明胶膜表面神经球周围首先出现带突起的分化细胞,壳聚糖膜迟至生长第3天才出现。神经干细胞接种生长后第3天,壳聚糖膜部分降解,明胶膜完全降解;第4天膜表面长满分化细胞;第5、6天壳聚糖膜大部分降解,分化细胞部分死亡。结论壳聚糖与神经干细胞生物相容,具有促细胞贴附和分化作用,由于机械性能差,不宜作为中枢神经组织工程的结构性生物支架材料,但可以单独或者联合促贴附物明胶作为促神经干细胞贴附和分化的支架表面修饰剂。     

3D kinematic analysis of the acromioclavicular joint during arm abduction using vertically open MRI.

Many researchers have evaluated the motions of the shoulder girdle, especially scapular and humeral motion. However, few reports exist that describe motions of the acromioclavicular joint. The purpose of the present study was to analyze the 3D kinematics of the acromioclavicular joint during arm abduction using 3D MR images obtained by a vertically open MRI. Fourteen shoulders of seven volunteers were examined in seven static positions from 0 degrees to the maximum abduction in a seated position. 3D surface models of the clavicle and scapula were created, and the movements of the acromioclavicular joint from 0 degrees to each position were calculated using the volume-based registration technique. From these calculations, the translations were evaluated and the rotational motions were analyzed using the concept of the screw axis. In the anteroposterior direction, the clavicle translated most posteriorly (-1.9 +/- 1.3 mm) at 90 degrees of abduction and most anteriorly (1.6 +/- 2.7 mm) at maximum abduction. In the superoinferior direction, the clavicle translated slightly superiorly (0.9 +/- 1.9 mm). When analyzing relative motion of the scapula with respect to the clavicle, the scapula generally rotated about a specific screw axis passing through the insertions of both the acromioclavicular and the coracoclavicular ligaments on the coracoid process. The average rotation was 34.9 +/- 8.4 degrees.     

Effects of metyrapone on hypothalamic-pituitary-adrenal axis and sleep in women with post-traumatic stress disorder.

BACKGROUND: Metyrapone blocks cortisol synthesis which results in removal of negative feedback, a stimulation of hypothalamic corticotropin releasing factor (CRF) and a reduction in delta sleep. We previously reported a diminished delta sleep and hypothalamic-pituitary-adrenal (HPA) response to metyrapone in men with post-traumatic stress disorder (PTSD). In this study, we aimed to extend these findings to women. METHODS: Three nights of polysomnography were obtained in 17 women with PTSD and 16 controls. On day 3, metyrapone was administered throughout the day up until bedtime. Plasma adrenocorticotropic hormone (ACTH), cortisol, and 11-deoxycortisol were obtained the morning following sleep recordings the day before and after metyrapone administration. RESULTS: There were no significant between-group differences in hormone concentration and delta sleep at baseline. Relative to controls, women with PTSD had decreased ACTH and delta sleep responses to metyrapone. Decline in delta sleep was associated with the magnitude of increase in ACTH across groups. CONCLUSIONS: Similar to our previous findings in men, the ACTH and sleep electroencephalogram response to metyrapone is attenuated in women with PTSD. These results are consistent with a model of downregulation of CRF receptors in an environment of chronically increased CRF activity or with enhanced negative feedback regulation in PTSD.     

No difference in symptoms of irritable bowel syndrome between healthy subjects and patients with recurrent depression in remission

There is bidirectional comorbidity between anxiety/depression and irritable bowel syndrome (IBS). To investigate the prevalence of IBS symptoms, and factors associated with gastrointestinal symptoms in patients with recurrent depressive disorder. Patients (n = 95) with recurrent type of major depression according to DSM-IV criteria and sex- and age-matched controls (n = 190) were sent questionnaires investigating symptoms of IBS [Gastrointestinal Symptom Rating Scale (GSRS)-IBS] and symptoms of anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]. Medical records were checked over a 10-year period for chronic somatic symptoms or diseases. Seventy-three patients with unipolar disorder (mean age 63.6 years SD 13.8; range 23-86 years) and 156 controls (mean age 59.2 years SD 11.6, range 21-85 years) responded. Patients with recurrent depression had higher GSRS-IBS scores and showed a strong correlation between symptoms of IBS and anxiety-depression (r(s) = 0.54; P < 0.001). IBS symptoms were also associated with multiple pain symptoms, higher health-seeking behaviour and selective-serotonin-reuptake inhibitor intake. However, patients with recurrent depression (n = 46) in remission (HADS-Depression score <8) did not have more symptoms of IBS than controls (GSRS-IBS median score 6.0 vs 6.5; P = 0.46). There is a strong association between symptoms of IBS and symptoms of anxiety and depression, whereas depressive patients in remission do not have more IBS symptoms than controls.     

枕颈融合联合鼻内镜治疗枢椎肿瘤

目的探讨枕颈融合联合鼻内镜技术行颈椎重建和肿瘤切除治疗枢椎肿瘤的疗效及其预后。方法2005年7月以来,共收治5例枢椎肿瘤,采取后路枕颈融合联合前路鼻内镜肿瘤切除术治疗。结果5例患者术后颈椎稳定性均得到满意重建,肿瘤切除充分。其中2例瘫痪患者术后JOA评分较术前明显增加。结论枕颈融合联合鼻内镜技术治疗枢椎肿瘤,肿瘤切除率高,并发症低,为高颈段肿瘤的治疗提供了新的临床思路。