The experiential impact of head injury on adolescents: individual perspectives on long term outcome

Thirty one young people, who were experiencing chronic sequelae of a head injury sustained at least 1 year previously, were interviewed in depth about the impact head injury had had on their lives. Their functioning was also assessed using the Offer Self Image Questionnaire OSIQ R . The main theme raised by subjects was that they had not received adequate explanation of the emotional problems associated with head injury and relevant support in coming to terms with their condition. Head injury had had a devastating effect on their lives, causing limitations in day to day activities, employment, education and relationships, and they scored significantly below norms on the OSIQ R scale of Self Confidence. However, these young people had a predominantly positive attitude towards life, which appeared to be related to their appreciation of how fortunate they had been to survive. They scored significantly above norms on the OSIQ R scale of Social Functioning. Markers of poor functioning were identified and, in clinical practice, could be used as a method of highlighting those head injured young people who potentially are most in need of support. The findings have implications for future research directions, service delivery and planning, in that particular weaknesses of current provision are demonstrated and recommendations made for improvements.     

Olfactory Absorption of Insulin to the Brain

A vast number of potent neuropharmaceuticals, many of which are peptides, are excluded from entry into the brain because of the highly selective blood-brain barrier. The fact that a number of drugs have been shown to be transported directly to the central nervous system following application to the olfactory region of the nose is therefore of major interest. In the present study, the feasibility of delivering peptides to the brain via the olfactory route was assessed using insulin as a model peptide. Systemic hyperinsulinemia induced by subcutaneous injection did not significantly reduce the amount of ¹²⁵I-insulin transported from the nose to the brain in vivo, which suggests that the impact of systemic absorption on drug transport is minimal. A linear relationship was seen between insulin accumulation in the brain and the dose applied, without any relevant saturation. Contrary to what was expected, both systemic and olfactory absorption of insulin was enhanced when the pH of the medium was near the isoelectric point. The amount absorbed to the brain was found to be linearly related to the net charge of the molecule (r = -0.61; n = 20). It was concluded that insulin gains access to the central nervous system from the olfactory region of the nose by a nonspecific pathway. The olfactory route may therefore become an important means to deliver peptides to the brain.     

子宫阔韧带肌瘤的CT诊断

目的　探讨子宫阔韧带肌瘤的CT诊断价值。方法　收集 2 1例子宫阔韧带肌瘤CT资料 ,进行回顾性分析 ,所有病例均经手术病理证实。结果　 2 1例均在盆腔内、子宫外显示肿块 ,CT表现 :实质性肿块 19例 ,边界清楚光整 16例 ,不甚清楚 3例 ,密度均匀 6例 ,平扫时与子宫肌密度相当 ,增强扫描呈明显强化 ,与子宫肌强化基本同步 ,不均匀 13例 ,其强化程度低于子宫肌 (约相差 10～ 2 0HU) ,瘤内变性、坏死或液化区不明显强化或不强化 ;囊实性 2例 ;肿块位置较固定 ,大多在宫旁匍匐生长 ,与子宫位置密切相关 ,其最大径层面与子宫体中心层面基本保持一致 ;形态各异 ,呈条块状、哑铃分叶状及扁圆烧饼状共 15例 ,呈圆形、椭圆形6例。结论　子宫旁呈条块、哑铃分叶状及扁圆烧饼状的实质性或实质性为主的肿块是本病较为可靠的CT征象 ,CT对诊断阔韧带肌瘤有实用价值     

靶向敲减KLF4基因的重组腺相关病毒载体的构建及其在肺动脉高压动物模型中的应用

目的 构建靶向敲减KLF4基因的重组腺相关病毒载体,并应用于肺血管疾病,为后期研究肺血管KLF4基因敲减在肺动脉高压大鼠中的作用及相关分子机制奠定基础。方法 根据大鼠KLF4基因序列,设计针对大鼠特异性的siRNA序列,以pHBAAV-U6-MCS-CMV-EGFP作为空白载体,通过酶切技术构建带有GFP荧光标记的KLF4干扰腺病毒载体pHBAAV-r-KLF4 shRNA-GFP,行测序分析,并进行病毒扩增、纯化及滴度测定。本研究对长时间（3个月）接触香烟烟雾的大鼠进行气道注入AAV1-KLF4-shRNA的干预治疗,观察大鼠右心室收缩压、平均右心室压等血流动力学指标改变。结果 经测序检测显示,大鼠AAV1-KLF4-shRNA腺相关病毒载体构建成功。健康对照组、生理盐水模型组、对照病毒模型组、治疗干预组的右心室收缩压和平均右心室压比较,差异均有统计学意义（P <0.05）。结论 对长时间接触香烟烟雾的肺动脉高压模型大鼠应用AAV1-KLF4-shRNA腺相关病毒载体,能有效改善右心室收缩压和平均右心室压,该载体在相关疾病动物模型中应用有效,为后期顺利开展AAV1-KLF4-s...     

痰涂片阳性肺结核病人传染性控制效果分析

目的采取切实有效的措施,及早发现并治疗传染性结核病病人,遏制结核病的传播和流行。方法对河源市7684例痰涂片阳性有传染性肺结核病人,进行强化期规范治疗。2个月末和3个月末进行痰涂片复查,观察阴转情况。结果2个月末痰菌阴转率为93.92%,3个月末痰菌阴转率为96.45%。新发涂阳病人痰菌阴转率最好,2个月末为96.52%,3个月末为98.56%;其次为复发涂阳病人;效果最差为复治涂阳病人,2个月末仅为80.93%。结论加强归口管治,对新发涂阳病人进行规则治疗,减少耐药菌,是控制肺结核传播和流行的关键。对复发和复治涂阳病人,要及时作药敏试验,最大限度降低排菌肺结核病人,从而有效地控制结核病的传播和流行。     

New evidence from magnetic resonance imaging of brain changes after climbs at extreme altitude

The aim of the present study was to look for anatomical changes in climbers' brains, using magnetic resonance imaging (MRI), after extremely high-altitude climbs and to relate them to possible associated risk factors. Clinical history, neurological examinations and MRI were carried out on a group of nine climbers before and after climbing to over 7500 m without the use of supplementary oxygen. None of the subjects showed any neurological dysfunctions. In five climbers MRI abnormalities (high signal areas, cortical atrophy) were observed before the expedition. After the descent, two of them showed new high intensity signal areas recorded by MRI. Both subjects suffered severe neurological symptoms during the climb. The present study suggested that the brain changes observed by MRI could be related to the severity of clinical events at high altitude. However, we do not know the exact meaning of such MRI findings or the reason for their location, predominantly in posterior regions of the brain. The new evidence that a high percentage of climbers show MRI brain abnormalities, and especially the appearance of changes after the ascent, reinforces the possibility of a potential neurological risk in high-altitude climbing.     

The effect of oral hormone replacement therapy on lipoprotein profile, resistance of LDL to oxidation and LDL particle size

Objectives: To disclose if oral estradiol (E₂), alone or in combination with natural progesterone (P) or medroxyprogesterone acetate (MPA), may modify the oxidizability of low density lipoprotein (LDL), and if the effect is achieved at physiological dosages. LDL oxidizability was assessed by the resistance to oxidation by copper and by the particle size profile, since small particles have increased oxidation susceptibility. Methods: Thirty-three women received two consecutive, two-month length doses of 1 and 2 mg/day of oral E₂. They were then randomly assigned to a fourteen-day treatment of 2 mg/day E₂ plus either 300 mg/day P or 5 mg/day MPA. A parallel group of experiments was performed on a pool of baseline plasma, where hormones were added at the desired concentration. Lipoprotein levels, resistance of LDL to oxidation, and LDL particle diameter, were measured at baseline and after each treatment. Results: Estradiol reduced LDL levels and increased high density lipoprotein (HDL) and triglycerides. P abolished these changes, whereas MPA only reversed the increase of HDL. Estradiol protected LDL from oxidation in a dose-dependent manner, although only at pharmacological concentrations (1 μM or higher). Both P and MPA were inert at either physiological or pharmacological concentrations. The size of the LDL particles remained unaffected except under MPA, in which it was reduced. Conclusions: Estradiol has a protective effect against LDL oxidation, although only at pharmacological dosages. P and MPA did not limit the E₂ action. The size of the LDL particles remained unaltered after each E₂ dose, but MPA, and not P, was associated with a diminution.     

联合应用神经保护剂抑制大鼠局灶性脑缺血后的神经元凋亡

目的探讨联合应用神经保护剂能否较单一用药更好地达到保护脑的作用。方法采用线栓法制作大鼠大脑中动脉闭塞模型(MCAO),分为对照组、1,6-二磷酸果糖(FDP)组、MK-801组、N-乙酰半胱氨酸(NAC)组、联合治疗组和假手术组。应用TUNEL染色检测神经元凋亡,免疫组化及W estern b lot检测caspase-3蛋白表达。结果缺血后6 h和24 h,联合治疗组神经元凋亡和caspase-3蛋白表达均明显少于各单一用药组(P<0.05)。结论联合应用神经保护剂对大鼠局灶性脑缺血的保护作用明显增强。     

非营养性吸吮联合音乐治疗对新生儿疼痛的缓解作用

目的观察非营养性吸吮（NNS）、音乐治疗（MT）及非营养性吸吮联合音乐治疗（NNS＋MT）在缓解新生儿疼痛中的作用。方法收集2008年1～6月在南京医科大学附属南京儿童医院新生儿医学中心普通新生儿病房收治的新生儿作为研究对象,对符合纳入和排除标准的新生儿按照住院号从小到大顺序分为干预组（NNS亚组、MT亚组、NNS＋MT亚组）和空白对照组,干预措施在新生儿足后跟采血前2min开始持续至研究结束,共15min,空白对照组不予干预措施。通过观察新生儿的心率、经皮氧饱和度（SpO2）及新生儿疼痛行为（NIPS）评分,采集采血针刺前1min、针刺时和针刺后13min过程中的每一分种数据,比较各种干预措施缓解新生儿疼痛的临床效果。采用SPSS11.0软件进行多变量方差分析,ANOVA方差检验,同时应用PostHoc进行组间比较。结果纳入住院新生儿80例,男54例,女26例;各亚组和空白对照组各20例。疼痛刺激后各组的心率均显著加快,于刺激后0～2min达峰值,之后逐渐减慢;NNS亚组与空白对照组心率差异无统计学意义,MT、NNS＋MT亚组与空白对照组心率差异均有统计学意义,MT亚组和NNS＋MT亚组心率差异无统计学意义。疼痛刺激后各亚组SpO2均显著降低,于刺激后2～4min降至最低值,之后逐渐升高;NNS亚组与对照组SpO2差异无统计学意义,MT、NNS＋MT亚组与空白对照组SpO2差异均有统计学意义,MT亚组和NNS＋MT亚组SpO2差异无统计学意义。疼痛刺激后各组NIPS评分均显著提高,于0～1min达峰值,之后逐渐降低,各亚组NIPS评分差异均无统计学意义。与空白对照组比较,MT、NNS＋MT干预措施均可缓解疼痛刺激引起的心率、SpO2和NIPS评分变化。结论新生儿临床医护人员可通过使用MT和NNS＋MT可缓解新生儿疼痛。     

急性心脑血管血栓性疾病患者血浆FⅦ：C、FⅧ：C、凝血酶原及纤维蛋白原的变化

目的检测凝血因子Ⅶ、Ⅷ、Ⅱ、Ⅰ的活性,研究其在急性心脑血管血栓性疾病中的变化.方法分别采用凝血活酶时间、部分凝血活酶时间、发色底物法及凝血酶时间法测定了急性心肌梗死(AMI)和急性缺血性脑卒中(AIS)病人血浆FⅦC、FⅧC、凝血酶原及纤维蛋白原相对活性.结果AMI病人血浆FⅦC为98.3%±36.7%,与青年组的104.0%±29.4%和老年组的114.9%±23.6%比较无明显差异(P值均＞0.05),而AIS病人为152.9%±30.3%,较青年组和老年组显著升高(P值均＜0.001).AMI病人血浆FⅧC为234.2%±57.9%,明显高出青年组的101.2%±32.6%和老年组的116.4%±35.7%(P值均＜0.001).但AIS病人FⅧC±为85.5%±32.6%,低于老年组(P＜0.05).AMI和AIS病人血浆凝血酶原活性分别为130.2%±¨.7%和128.0%±29.4%,高于青年组的108.0%±7.7%(P＜0.001和0.01)和老年组的106.1%±19.4%(P值均＜0.001).AMI和AIS病人血浆纤维蛋白原活性分别为207.2%±53.0%和174.3%±28.5%,二者均显著高于正常青年组的103.3%±¨.6%(P值均＜0.001)和老年组的143.8%±16.8%(P＜0.001和0.01).结论AMI病人FⅧC增高,AIS病人FⅧC增高;二者血浆凝血酶原和纤维蛋白原活性均高于正常水平.