Update in the pharmaceutical therapy of the irritable bowel syndrome

The therapeutic management of the irritable bowel syndrome (IBS) is ineffective and not satisfying either patients or practitioners. Research in functions of the enteric nervous system and its interaction with the central nervous system is the basis for the development of emerging pharmaceuticals in therapy of the IBS. These pharmaceuticals include agents such as opioid agonists, psychotropic agents and particularly serotonin receptor modulators. These novel pharmaceuticals aim to provide a more comprehensive approach in the therapy of the IBS and will serve both patients and practitioners. So far, the US Food and Drug Administration has approved two agents specifically for the treatment of the IBS, both belonging to the group of serotonin receptor modulators. However, questions remain whether a single therapy is sufficient in the management of IBS because this disease is influenced by biological and psychological as well as cultural and social factors.     

前路融合钢板内固定治疗不稳定的Hangman骨折

目的探讨前路融合内固定手术治疗Hangman骨折的疗效。方法 2005-12-2009-12我科应用前路融合钢板内固定治疗Hangman骨折13例,男10例,女3例,年龄24～58岁,平均37.4岁。Levine-EdwardsⅡ型7例,Ⅱa型4例,Ⅲ型2例。术前使用Halo-vest架复位固定。患者颈前右侧入路显露C2-3间隙,减压后植入自体髂骨块或椎间融合器并行钢板内固定。结果术后未发现血管神经损伤并发症,X线片显示骨折均达到解剖复位,骨性愈合时间在3～4个月,颈部旋转屈伸功能正常,未发现内固定断裂及松动。结论前路减压植骨内固定治疗不稳定的Hangman骨折,融合固定可靠,无须长期卧床或佩戴Halo氏架,是一种效果确切的治疗方法。     

改良Brook法结合C1-2经关节突螺钉治疗陈旧性齿状突骨折

目的 探讨改良Brook法结合C1-2经关节突螺钉固定治疗陈旧性齿状突骨折的临床疗效. 方法 自2007年1月至2010年6月通过改良Brook法结合C1-2经关节突螺钉内固定技术治疗18例陈旧性齿状突骨折患者,男12例,女6例;年龄21～68岁,平均41 8岁.骨折根据Anderson-D'Alonzo分型:Ⅱ型15例,Ⅲ型3例.其中4例合并颅脑损伤,3例合并胸部损伤.受伤至手术时间41 d至13年,平均18.4个月.结果 本组患者手术时间100 ～ 180 min,平均125 min;术中出血量100～600 mL.,平均250 mL.术中无椎动脉、脊髓损伤发生.所有患者获平均30.2个月(14 ～50个月)随访.术后临床症状评价按照Mayo(McGrory)颈椎创伤后临床评分系统:优7例,良9例,可2例,优良率为88.9％.术后VAS评分(1.4±0.8)分较术前(5.3±1.2)分有明显改善,差异有统计学意义(t=15.853,P=0.000),6例合并神经症状的患者神经症状均有至少1级改善.术后6个月所有患者均获骨性融合.所有患者螺钉位置良好,在随访过程中无松动、移位、断裂等发生.结论 改良Brook法结合C1-2经关节突螺钉固定是一种安全可靠的方法,为陈旧性齿状突骨折的治疗提供了一种术式选择.     

慢性心力衰竭患者下丘脑-垂体-肾上腺轴节律变化与心功能的相关性分析

目的:探讨慢性心力衰竭(CHF)患者下丘脑-垂体-肾上腺轴(hypothalamic-pituitary-adrenal axis,HPA)水平及变化与心功能的关系。方法:连续入选108例CHF患者(非重症CHF组49例,重症CHF组59例),以及同期住院的非CHF患者43例。测定患者血浆总胆红素、白蛋白、肌酐、氨基末端利钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)、C反应蛋白(C-reactive protein,CRP)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(thyroid-stimulating hormone,TSH)水平,计算肾小球滤过率(glomerular filtration rate,GFR)。测定同1天0:00、8:00及16:00的血浆促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)和皮质醇(cortisol,COR)水平,计算患者昼夜COR比值(RCOR8:00/COR0:00)及日间COR比值(RCOR8:00/COR16:00)。比较3组间上述指标的差异。结果:与较非CHF组相比,CHF组0:00血浆ACTH及0:00、16:00血浆COR水平显著升高,RCOR8:00/COR0:00及RCOR8:00/COR16:00均下降(P<0.05)。重症CHF组0:00、8:00血浆ACTH以及0:00、8:00、16:00血浆COR水平均高于非重症CHF组及非CHF组(P<0.05)。重症CHF组RCOR8:00/COR0:00低于非重症CHF组,非重症CHF组低于非CHF组(P<0.05)。结论:CHF患者HPA慢性持续性激活;COR随心功能状态动态变化,可作为反映CHF病情的指标,并对病情评估及预后判断具有较高价值。     

Mitral annular excursion during exercise in endurance athletes

The aim of the present study was to quantify the left ventricular (LV) longitudinal motion during exercise at rest and during upright exercise in 24 healthy male endurance athletes. By using M-mode and two-dimensional echocardiography, the relative mitral annular motion and the absolute LV longitudinal axis was measured at end-diastole and end-systole at rest and during exercise. From rest to peak exercise at a heart rate of 160 beats per minute (bpm) the mitral annular motion increased in the septal and lateral annular borders by 68% and 49% respectively. At rest, mitral annular excursion was significantly (13%) higher in the lateral than in the septal wall but at peak exercise at a heart rate of 160 bpm there was no difference between the septal and lateral annular motion. The total end-diastolic LV axial length did not increase from rest to peak exercise. In conclusion, during upright exercise, mitral annular motion increased significantly with no difference between the septal and lateral annular excursion at peak exercise. The absolute increase in mitral annular motion during exercise was explained by a decrease in axial end-systolic length.     

肠道菌群与孤独症谱系障碍的研究进展

孤独症谱系障碍(ASD)是一种主要症状为社会交往障碍、重复刻板行为及狭隘兴趣为特征的神经发育障碍性疾病。病因极为复杂,目前集中在遗传及环境因素两大方面。由于发病机制不明,尚无有效的治疗方法。随着对ASD研究的深入,发现ASD患儿普遍存在胃肠道疾病及肠道菌群的改变。最近的研究显示,肠道神经系统和中枢神经系统之间存在双向互动,称之为微生物-肠-脑轴。肠道菌群通过神经内分泌、神经免疫和肠道神经系统调控大脑功能,进而影响大脑发育和行为。故肠道菌群的失衡可能与ASD的发生有关。本文将总结至今肠道菌群对ASD的作用和相关治疗进展。     

Temporal control of glucocorticoid neurodynamics and its relevance for brain homeostasis,neuropathology and glucocorticoid-based therapeutics

Glucocorticoids mediate plethora of actions throughout the human body. Within the brain, they modulate aspects of immune system and neuroinflammatory processes, interfere with cellular metabolism and viability, interact with systems of neurotransmission and regulate neural rhythms. The influence of glucocorticoids on memory and emotional behaviour is well known and there is increasing evidence for their involvement in many neuropsychiatric pathologies. These effects, which at times can be in opposing directions, depend not only on the concentration of glucocorticoids but also the duration of their presence, the temporal relationship between their fluctuations, the co-influence of other stimuli, and the overall state of brain activity. Moreover, they are region- and cell type-specific. The molecular basis of such diversity of effects lies on the orchestration of the spatiotemporal interplay between glucocorticoid- and mineralocorticoid receptors, and is achieved through complex dynamics, mainly mediated via the circadian and ultradian pattern of glucocorticoid secretion. More sophisticated methodologies are therefore required to better approach the study of these hormones and improve the effectiveness of glucocorticoid-based therapeutics.     

Proteus mirabilis abscess involving the entire neural axis

Intramedullary spinal cord abscesses are rare and potentially devastating lesions usually associated with other infective processes such as bacterial endocarditis, or pulmonary or urogenital infection. We describe a 2-year-old girl who presented with an infected dermal sinus leading to an intraspinal abscess. This abscess eventually spread and involved the entire neural axis leaving her quadriparetic. Drainage of the abscess resulted in recovery and the child regained normal function of her limbs. To our knowledge this is the first documented case of an intramedullary abscess involving the entire neural axis.