功能性卵巢高雄患者雌激素合成影响因素分析

目的探讨功能性卵巢高雄（FOH）患者雌激素合成的影响因素。方法18例FOH，患者分为2组：双侧小卵泡（Ф2～8mm）数量为8～11的为FOHⅠ组（9例）。数量为12-24的为FOHⅡ组（9例）。8名正常妇女作为对照组。用人绝经期促性腺激素（150U）和绒毛膜促性腺激素（5000U）进行卵巢兴奋试验，试验后3，8，12，18，24h时检测血清睾酮（T）和雌二醇（E2）水平，计算芳香化酶功能状态和活性。结果3h时点FOHⅠ组E2水平显著高于对照组。而8，12，18，24h时点FOHⅡ组E2水平则显著高于FOHⅠ组，但芳香化酶功能状态和活性在各时点差异均无统计学意义。结论雄激素水平和卵泡数量均可影响卵巢兴奋试验后E2的合成，且具有协同作用，卵泡数量较多的患者对卵巢兴奋试验更加敏感。     

功能性孕激素撤退与分娩发动

人类对分娩发动机制尚不清楚,因对分娩机制缺乏了解而无法主动选择合适时机计划分娩以降低母儿死亡率.目前,关于分娩发动机制有几种假说,其中功能性孕激素撤退学说因孕激素在妊娠中的重要作用而倍受关注,即人类分娩发动时局部组织孕激素的功能下调,而不是孕激素水平下降.孕激素受体-A/孕激素受体-B值升高是功能性孕激素撤退的基础,孕激素受体-B可上调孕激素激活基因的表达,而孕激素受体-A则下调孕激素的反应活性,即孕激素受体-A/孕激素受体-B值升高削弱孕激素对雌激素的调节性抑制作用,使得雌激素受体的表达增加,进而上调雌激素的功能及促收缩基因的表达,从而使子宫失去静止状态而诱发分娩.     

Primary total hip arthroplasty for displaced intracapsular fracture of the femoral neck: Medium-term functional and radiographic outcomes

The number of complications after primary total hip arthroplasty for displaced intracapsular fractures of the femoral neck is higher than that after operations for osteoarthritis. The aim of this study is to evaluate the number of complications and mid-term functional and radiological findings of patients after primary THA for displaced intracapsular fractures of the femoral neck. Between 1995 and 1998, we operated on a total of 89 patients for acute displaced intracapsular fractures of the femoral neck, i.e. Garden Type 3 and 4. In all the patients we evaluated intraoperative and early postoperative complications. We reviewed clinical and radiological results in 65 patients. The only intraoperative complication was abruption of the greater trochanter. Early postoperative complications occurred in 13 patients (15%). The specific complications, THA dislocation, occurred in 3 patients. Non-specific complications were recorded in 10 patients. No delayed healing of the surgical wound, neural lesion or early, delayed or late infection was recorded. Of 65 patients followed-up for an average of 78 months (range, 62–109 months), 8 patients underwent revision surgery. Of 57 patients with primary THA, very good and good clinical results according to the Harris Hip Score were recorded in 48 patients (84%) and poor results in only 2 patients (4%). Nine of 57 followed-up patients showed radiological signs of loosening (16%). The radiolucent line could be seen in 3 patients in the region of the cup, in 1 patient in the region of the femoral component and in 5 patients in both components. Clinical complaints that would result in indication for reimplantation were recorded in none of the mentioned patients. Number of complications, functional results and resumption of full self-reliance by patients after THA for an intracapsular fracture of the femoral neck are so positive that we consider the indication of THA for a displaced femoral neck fracture fully justified.     

Visual neglect as a predictor of functional outcome one year after stroke

OBJECTIVE: The aim was to study the role of visual neglect in acute right hemisphere brain infarct as a predictor of poor functional outcome during the first year after stroke. In particular, we were interested in the additional value of neglect measures besides hemiparesis, hemianopia, cognitive deficits and age. PATIENTS AND METHODS: A consecutive series of 57 patients with a neuroradiologically verified right hemisphere infarct was examined within 10 days of the stroke. Fifty patients were followed up for 1 year. Neglect was measured with the Conventional and the Behavioural subtests of the Behavioural Inattention Test (BITC and BITB, respectively). The predictors were determined at the 10-day examination. Functional outcome was assessed 3, 6 and 12 months after the onset with the Frenchay Activities Index. RESULTS: Neglect in BITB was the best single predictor, which together with high age formed the best combination of predictors for poor functional outcome at each follow-up. Hemiparesis was also included in this prediction model at the 3-month follow-up, but hemianopia, BITC, or visuoconstructional and memory deficits showed no additional predictive value. However, neglect usually recovered soon. When neurological and cognitive deficits were assessed at the same time as the outcome, hemiparesis rather than neglect was the strongest correlate of poor outcome. CONCLUSION: Neglect in acute stroke is an important predictor of poor functional recovery. Residual neglect, which could be compensated in the follow-up tests, may nevertheless restrict patients' real-life activities and hobbies.     

浅论体质辨析的临床意义

讨论了体质辨析的内涵、临床操作及临床意义。指出体质辨析的内涵有辨析形体结构、辨析机能代谢和辨析心理特征3方面;临床上体质辨析的对象是健康人、亚健康状态人和患者。健康人体质特征的确定对其预防疾病、延年益寿具有重要意义;亚健康状态人的体质辨析对其通过合理的调适以恢复健康状态具有重要作用;患者的体质辨析对认识疾病的病因病机及提高诊治水平具有决定意义。     

Ultrastructure of Amelanotic Melanocytes from Human Hair Follicles

To investigate the ultra structure of amelanotic melanocytes （AMMC）. Methods： The hair follicles obtained from normal human scalp by 0.50% collagenase type V treatment were washed with 0.1 mol/L phosphate buffer salt （PBS）. Hair-follicle cell suspensions were prepared by trypsin treatment and cultured in melanocyte medium. Remaining keratinocytes were removed by differential trypsinization. 100μg/ml geneticin was used to eliminate the contaminating fibroblasts. At third passage, the cells were trypsinized, and then washed in phosphate-buffered saline and processed for transmission electron microscopy. Results： Under transmission electron microscope, the cultured cells showed round or oval shape, with single large nuclear and the karyotheca were double deck. There were obvious euchromosome within the nucleus, and sparse heterochromosome. There were various organelles in the cytoplasm, including plentiful melanosomes with nearly similar size, mitochondria, rough endoplasmic reticule （RER） and ribosome. The electron density granules in most of the melanosomes disposed along concentric circularities. Golgi apparatus in the cells was inconspicuous. Conclusion： The ultra structure of AMMC from human hair follicles is different from that of epidermal melanocytes, and these characteristics determine the functional immature of AMMC.     

加味红白皂龙汤合养精胶囊治疗功能性不射精

[目的]探讨功能性不射精的治疗方法及其可能机制.[方法]以中药"红白皂龙汤"为主方,加大理气活血通络之品,并且联合养精胶囊口服.[结果]2例患者分别于用药后78d、10d成功射精,其中1例2月后配偶怀孕.[结论]中药加味红白皂龙汤联合养精胶囊治疗功能性不射精有较好的临床疗效,其可能机制为其独特的一"通"一"冲"之功.     

急性脊髓损伤后脑脊液中兴奋性氨基酸含量在脊髓功能恢复中的临床意义

目的 探讨急性脊髓损伤后脑脊液中兴奋性氨基酸含量变化与脊髓功能恢复的关系及其对预后的影响。方法 采用氨基酸自动分析仪检测32例急性脊髓损伤患者脑脊液（CSF）中天门冬氨基酸（Asp）和谷氨酸（Glu）在损伤后不同时段的含量变化。结果 天门冬氨基酸（Asp）和谷氨酸（Glu）在损伤后16h达到高峰，24h后开始逐渐下降；兴奋性氨基酸在损伤后高峰越早，升高得越多，脊髓损伤越严重；CSF中兴奋性氨基酸含量升高越高、持续的时间越长，脊髓功能恢复越差。结论 CSF中兴奋性氨基酸含量是脊髓损伤的敏感指标，可以作为早期预测脊髓损伤程度和判断其预后的指标之一。     

Conceptualization and measurement of quality of life as an outcome variable for health care intervention and research

If health care providers are to be able to document effective outcomes resulting from their interventions, they must first develop clear conceptual definitions for the outcomes, and then select measures that represent these concepts. No consensus exists in the health care disciplines about what quality of life is or how it should be measured. This paper presents historical and conceptual arguments in favour of a particular definition of quality of life, and distinguishes between quality of life and concepts often confused with it in the literature: symptoms, mood, functional status, and general health status. Whether quality of life is actually amenable to change as a result of health care interventions, and whether we ought to be trying to influence clients' quality of life is also discussed. We conclude that quality of life is an important outcome of health care intervention. However, traditional approaches to influencing quality of life may be misdirected, and the relative importance of our interventions to clients--whose opinions matter the most--ought to be put into perspective.     

Evolution of pediatric epilepsy surgery program over 2000–2017: Improvement of care?

PurposeWe assessed trends in spectrum of candidates, diagnostic algorithm, therapeutic approach and outcome of a pediatric epilepsy surgery program between 2000 and 2017.MethodsAll pediatric patients who underwent curative epilepsy surgery in Motol Epilepsy Center during selected period (n = 233) were included in the study and divided into two groups according to time of the surgery (developing program 2000–2010: n = 86, established program 2011–2017: n = 147). Differences in presurgical, surgical and outcome variables between the groups were statistically analyzed.ResultsA total of 264 resections or hemispheric disconnections were performed (including 31 reoperations). In the later epoch median age of candidates decreased. Median duration of disease shortened in patients with temporal lobe epilepsy. Number of patients with non-localizing MRI findings (subtle or multiple lesions) rose, as well as those with epileptogenic zone adjacent to eloquent cortex. There was a trend towards one-step procedures guided by multimodal neuroimaging and intraoperative electrophysiology; long-term invasive EEG was performed in fewer patients. Subdural electrodes for long-term invasive monitoring were almost completely replaced by stereo-EEG. The number of focal resections and hemispherotomies rose over time. Surgeries were more often regarded complete. Histopathological findings of resected tissue documented developing spectrum of candidates. 82.0% of all children were seizure-free two years after surgery; major complications occurred in 4.6% procedures; both groups did not significantly differ in these parameters.ConclusionIn the established pediatric epilepsy surgery program, our patients underwent epilepsy surgery at younger age and suffered from more complex structural pathology. Outcomes and including complication rate remained stable.