高血压病心尖搏动图的改变

50例高血压病人ACG和 FDACG 检测的结果显示:高血压病不论舒张压高低或有无心脏增大,均有舒张功能改变,表现为A/EO 比值增高,A_2-dA/dt-min 和A_2O延长。此三项指标的异常出现率分别为40％、30％及14％,三项联合检测其中任何一项异常的出现率为54％。收缩功能无明显改变。治疗显效后,A/EO降低,A_2-dA/dt-min 缩短,说明心功能明显改善。     

Ambulatory 24-hour esophageal pH monitoring

If 24-hour esophageal pH monitoring is to be a useful diagnostic tool, it must reliably discriminate gastroesophageal reflux patients despite daily variations in distal esophageal acid exposure. To address this issue, we studied 53 subjects (14 healthy normals, 14 esophagitis patients, and 25 patients with atypical symptoms) with two ambulatory pH tests performed within 10 days of each other. Intrasubject reproducibility of 12 pH parameters to discriminate the presence of abnormal acid reflux was determined. As a group, the parameters of percent time with pH<4 (total, upright, recumbent) were most reproducible (80%). Therefore, a subject was defined as having gastroesophageal reflux disease if at least one of these three values were abnormal. Intrasubject reproducibility for the diagnosis of reflux disease was 89% for the entire sample. Among subsets, the reproducibility was 93% for the normals and esophagitis patients and 84% for the atypical symptom patients. Total percent time with pH<4 was the single most discriminate pH parameter (85%) and nearly equaled that of the three combined parameters (89%). The intrasubject variability of this parameter was determined by the mean ±2sd of the relative differences between the two test results for all 53 subjects. Total percent time with pH<4 may vary between tests by a factor of 3.2-fold or less (218% higher to 69% lower). We conclude: (1) ambulatory 24-hr esophageal monitoring is a reproducible test for the diagnosis of gastroesophageal reflux disease; and (2) the large intrastudy variability in 24-hr total acid exposure may limit this test's usefulness as a measurement of therapeutic improvement.Supported, in part, by Public Health Services Grant AM 34200-01A1 from NIADDIK.     

对社区老人认知功能干预的近期效果

目的:探索对社区老人认知功能干预的近期效果。方法:对某社区65岁以上自愿参加的老人进行为期12周(共24次)的认知功能干预;采用老年成套神经心理测验(NTBE),比较干预组(44名自愿参加的老人)和对照组(51名完成基线和随防评估的老人)认知功能差异。结果:在干预前后两组NTBE的自身比较中:干预组在视觉匹配和推理等项目得分的差异有统计学意义,对照组在运动测验、前摄抑制和学习效应指数等得分的差异有统计学意义。通过Logistic回归分析,认知干预和NTBE相关的项目如下:听觉词汇学习4正确、听觉词汇学习4重复、分类测验、小标记测验、视觉匹配和推理、听觉词汇8插入和连线测验1顺序提示数共7项,均呈正相关。结论:综合认知训练干预在短期内能改善或延缓部分认知功能的衰退,逻辑推理能力是社区老人认知干预的易感领域。     

细胞毒性蛋白检测在移植肝急性排斥反应诊断中的意义

目的检测移植肝组织中穿孔素、颗粒酶B及细胞毒颗粒相关蛋白（TIA-1）的表达情况，评价其在肝移植术后急性排斥反应诊断及鉴别诊断中的意义。方法应用免疫组织化学方法检测肝移植术后急性排斥组和非排斥组患者移植肝组织中穿孔素、颗粒酶B及TIA-1的表达情况；结合组织形态学观察，分析肝组织中不同区域的阳性细胞数量。结果肝移植术后共行移植肝组织活检108例次，其中排斥组62例次，非排斥组46例次。两组移植肝汇管区及小叶内表达穿孔素、颗粒酶B及TIA-1的阳性细胞数比较，差异均有统计学意义（P〈0．05）；两组移植肝胆管或血管中表达阳性的细胞浸润率比较，差异也有统计学意义（P〈0．05）。表达穿孔素和颗粒酶B的阳性细胞数与排斥反应组织学分级及肝功能生化指标（天冬氨酸转氨酶和γ-谷酰转肽酶）升高成正相关。结论检测移植肝组织中穿孔素、颗粒酶B及TIA-1的表达对急性排斥反应的诊断及分级具有重要意义。     

Conditions to optimise the reversal action of neostigmine upon a vecuronium-induced neuromuscular block

Background: Since neostigmine was introduced for reversal of neuromuscular block, there has been controversy about the optimum dose for antagonizing neuromuscular block. The purpose of this study was to characterise recovery of neuromuscular transmission following a vecuronium-induced block 15 min after neostigmine administration using different stimulation patterns, and to determine the effects of different doses of neostigmine given at various pre-reversal twitch heights. Methods: Adductor pollicis (AP) mechanical activity in response to low (0.1 and 2 Hz) and high (50 and 100 Hz) frequency stimulation, was recorded 15 min after 20, 40 and 80 μg/kg neostigmine, given to reverse a vecuronium-induced block at 10, 25 and 50% pre-reversal twitch height (TH). Fifty four ASA class I and II anaesthetised (methohexital, fentanyl, N₂O/O₂) young adult patients were studied and randomly allocated into 9 groups of 6 patients each. Results: In contrast to twitch height (TH) and residual force after 50 Hz, 5 s tetanic stimulation (RF50_Hz), the greater sensitivity of train-of-four (TOF) ratio and residual force after 100 Hz, 5 s tetanic stimulation (RF100_Hz) points out the best reversal conditions (prereversal TH and the optimal neostigmine dose) (P<0.001, two-way analysis of variance). The highest reversal scores (about 0.9 TOF ratio and RF100_Hz) were obtained when 40 μg/ kg of neostigmine was given at 25 and 50% TH. A 0.9 TOF ratio was also observed when 40 μg/kg of neostigmine was given at 10% TH, but, under these conditions, RF100_Hz was only 0.6 (P<0.05, Duncan test). Conclusion: To optimise the reversal action of neostigmine in order to obtain the highest neuromuscular transmission recovery (0.9 TOF ratio and RF100_Hz) during a vecuronium-induced neuromuscular block, the 40 μg/kg dose has to be given at 25 to 50% recovery of TH.     

对CT所见腰椎间盘突出的重新鉴别与治疗观察

目的：因临床发现有些经ＣＴ检查有腰椎间盘突出的患者，其症状体征与ＣＴ结果不符。对１１２ＣＴ阳性者根据症状体征进行重新鉴别。方法：将ＣＴ阳性者根据“三种试验”分为阳性、阴性两组，再选压痛点作注射治疗。结果：两组治疗结果阴性组优良率较高。结论：ＣＴ结果可供参考，但不能作临床考虑的主要依据。对腰椎间盘突出症的诊断与治疗要以症状体征为主     

左氧氟沙星治疗细菌性感染70例

目的：观察左氧氟沙星治疗细菌感染的疗效和安全性。方法：以左氧氟沙星治疗细菌性感染７０例（男性３５例，女性３５例，年龄５４±ｓ１５ａ），其中下呼吸道感染４０例，尿路感染３０例，剂量一般为０．２ｇ，ｐｏ，ｂｉｄ，疗程７～１４ｄ；单纯性下尿路感染为０．２ｇ，ｐｏ，ｑｄ，疗程５～７ｄ。结果：总有效率９３％，细菌清除率８８％，不良反应轻微，呈一过性，发生率为６％。结论：左氧氟沙星治疗细菌性感染有效而安全。     

Effectiveness and cost-effectiveness of colorectal cancer screening: Selecting the ideal strategy

Abstract Colorectal cancer is the second most common cancer killer of Americans. Recently developed and tested methods of screening and surveillance can effectively diagnose and treat the disease in most patients before symptoms develop when the chance of cure is high. It is also possible to prevent colorectal cancer by detecting and resecting premalignant adenomatous polyps. Evidence-based guidelines recommend that the average-risk population greater than age 50 be screened with annual faecal occult blood tests plus periodic flexible sigmoidoscopy. This approach is feasible, efficacious, affordable and cost-effective in a high-risk country such as the US. Widespread compliance with these recommendations could reduce the mortality from this malignancy by more than 50%.     

Five different tests of reaction time evaluated in HIV seropositive men

In an attempt to develop a short neuropsychological test battery five different tests of reaction time were assessed according to their ability to discriminate between HIV seropositive men and healthy controls. In all tests a patient group with clinical symptoms was slower than the control group. In the complex reaction time test, which has a large cognitive aspect, even a clinically "asymptomatic" group was slower than the control group. The movement test, a new test with a large motor component, identified most slow responders, defining approximately half of the patients with clinical symptoms and one third of the "asymptomatic" patients as such. A test battery consisting of three tests is suggested for serial assessment and screening.