胆囊切除术后胆总管扩张及未扩张患者胆汁动力学特征比较

目的:运用放射性核素肝胆动态显像研究胆囊切除术后胆总管扩张和未扩张患者胆汁动力学特征。方法:回顾性分析南方医科大学顺德医院(佛山市顺德区第一人民医院)34例胆囊切除术后接受肝胆动态检查患者的临床资料,其中22例术后有胆总管扩张,为扩张组;12例术后未发生扩张,为无扩张组。另纳入12例体检健康未行胆囊切除者为对照组。术后采用肝胆动态核素显像技术记录3组研究对象胆汁动力学指标。比较胆总管扩张不同严重程度患者胆汁动力学指标水平。结果:3组研究对象肝脏高峰显影时间和半排时间比较,差异无统计学意义(P0.05)。扩张组患者胆总管显影高峰所需时间和胆总管半排时间分别为(43.87±12.46)min和(29.32±5.66)min,显著长于无扩张组和对照组,差异有统计学意义(P0.05)。扩张组患者十二指肠开始显影时间和肝门至十二指肠通过的时间显著长于无扩张组和对照组,差异有统计学意义(P0.05)。胆总管扩张不同严重程度患者总管显影高峰所需时间、胆总管半排时间、十二指肠开始显影时间和肝门至十二指肠通过的时间比较,差异有统计学意义(P0.05)。结论:胆囊切除术后胆总管扩张程度与胆汁动力学关系密切,监测胆汁动力学有助于判断胆总管扩张严重程度,指导临床。     

99mTc-EHIDA闪烁显像研究胆汁反流性胃炎胆汁排泌途径异常

目的探讨动态多时相99m Tc-EHIDA显像技术分析生理状态下胆汁反流性胃炎的胆汁排泌功能途径的变化。方法正常对照组12例,其中男性7例,女性5例;年龄38~68岁,平均年龄53.2岁。胆囊结石组12例,其中男性6例,女性6例;年龄33~67岁,平均年龄51.7岁。胆汁反流性胃炎组23例,其中男性14例,女性9例;年龄23~56岁,平均年龄42.0岁。应用动态多时相99m Tc-EHIDA闪烁显像技术,分析胆汁排泌途经。结果胆汁反流性胃炎组排胆分数(GBEF)、排胆率(GBER)与正常对照组差异无统计学意义,但高于胆囊结石组。胆汁反流性胃炎组中,与6例反流阴性和13例轻度反流患者相比,4例呈重度反流患者显像剂在肠道的放射性浓集程度明显减低,且十二指肠开始显影的时间均在35 min后。结论动态多时相99m Tc-EHIDA闪烁显像能生理(非侵入)状态下检测胆汁排泌的途径异常,其临床诊断价值肯定。     

干燥综合征唾液腺核素动态显像的临床价值

目的 探讨干燥综合征(SS)唾液腺核素动态显像的影像特点及临床价值.方法 32例SS患者,其中男性2例,女性30例,年龄23～65岁;12例健康对照者,其中男性1例,女性11例,年龄20～57岁.对所有患者静脉注射99TcmO4-370MBq(10mCi),行唾液腺动态显像,连续采集40min.于30min时,受检者含服维生素C(VitC)0.2g,刺激唾液腺分泌.根据时间-放射性曲线,计算相关功能参数并进行定量分析,将SS组和对照组的指标进行比较分析.结果 对照组双侧唾液腺核素动态显像结果及时间-放射性曲线正常.SS患者腮腺和颌下腺的摄取比值(UR)分别为3.1±1.0和1.4±0.6,正常对照组为6.0±1.3和3.4±1.0,两组比较差异有统计学意义(P<0.05);SS组最大浓聚率(MAR)、最大排泌率(MSR)等参数均低于对照组,差异有统计学意义(P<0.05);SS患者Vit C刺激后,腮腺及颌下腺放射性由最高峰降至最低的时间(Tmin)分别为(4.5±1.9)min和(4.7±1.6)min,正常对照组为(2.0±1.3)min和(2.3±1.0)min,两组比较差异有统计学意义(P<0.01);SS组唾液腺放射性计数达到最高值的时间(Tmax)与对照组比较差异无统计学意义(P>0.05).结论 UR、Tmin、MAR、MSR等参数是判断SS患者唾液腺功能重要的灵敏指标,而测定Tmax临床意义不大.唾液腺核素动态显像定量分析是一种诊断SS的最有价值的方法,能方便、无创、经济、客观地评价唾液腺功能.     

膝关节软骨负荷运动前后磁共振T_2时间与容积变化研究

目的通过比较分析负荷运动前后膝关节软骨磁共振T2时间和软骨容积变化,探讨利用T2时间和容积变化反映负荷作用下软骨形态变化的可行性。方法选择20例健康志愿者,其中男性16例,女性4例;年龄为20.1~30.4岁,平均年龄25.7岁。在同等运动负荷前后进行软骨T2mapping序列成像,测量股骨内外侧髁、胫骨平台和髌软骨T2时间;以三维脂肪抑制快速扰相梯度回波(3D-FS-SPGR)序列扫描并采用最大信号强度投影法(MIP)重建后测量髌软骨及股骨髁软骨容积。比较负荷前后软骨T2时间变化、软骨容积差异,并分析软骨容积与T2时间变化间的相关性。结果运动前与运动后髌软骨T2时间最长,胫骨外侧平台最短;运动后不同部位软骨T2时间均降低(P=0.000),股骨内侧髁软骨下降幅度最大(t=-27.96,P=0.000);运动后膝关节软骨容积减小(P=0.000),股骨髁软骨容积变化程度(t=-86.71,P=0.000)大于髌软骨(t=-9.42,P=0.000);软骨容积与T2时间变化间无线性相关性(P0.05)。结论运动后膝关节软骨各部位T2时间和局部软骨容积均减少,但软骨容积与T2时间变化间无相关性;软骨T2mapping和软骨容积变化磁共振成像技术对评价负荷作用下软骨形态变化有一定的意义。     

迷走神经背核对消化间期小肠肌电活动的影响

目的:研究迷走神经背核(the dorsal motor nucleus of vagus,DMV)对大鼠小肠消化间期肌电活动的影响,探讨DMV对胃肠道功能活动的调控。方法:建立大鼠DMV电刺激模型,采用双极法测定大鼠空肠的消化间期复合肌电(IMC)。分析刺激后慢波频率和振幅的变化、活动期的总持续时间及活动期与周期比值(A/T比值)的变化,刺激即时慢波与动作电位出现概率的变化。结果:电刺激DMV后大鼠空肠慢波的平均频率和平均振幅均增加(P0.05),活动期总持续时间延长(P0.01),A/T比值增大(P0.05)。刺激即时,慢波的平均频率降低、平均振幅增加(P0.01),快波出现概率增加(P0.001)。结论:电刺激致DMV兴奋,可导致大鼠小肠肌电的活动异常,这可能是DMV机能损伤引发胃肠道功能紊乱的途径之一。     

丙泊酚镇静下瑞芬太尼抑制喉罩置管和气管插管心血管反应的半数有效浓度比较

目的 测定抑制喉罩通气道LMA-Fastrach、LMA-Proseal置管和气管插管心血管反应的瑞芬太尼半数有效浓度以及比较置管期间相应脑电双频谱指数(BIS)的变化.方法 择期全麻下行胆囊切除术患者63例,美国麻醉医师协会(ASA)I～II级,按置管类型的不同随机均分为T、F、P 3组,每组21例.4 mg/L启动并调整丙泊酚靶控,使得BIS稳定于45～55,之后按Minto药代模式设置并启动瑞芬太尼效应室靶控,5 min后给0.6 mg/kg罗库溴铵,2 min后置管:T组气管插管,F组LMA-Fastrach置管,P组放置LMA-Proseal.比较患者麻醉诱导前、诱导后平均动脉压(MAP)、心率(HR)值及置管前后的BIS变化.记录置管前1、2min及置管后5min内的MAP、HR值以判定患者有无心血管反应.应用Dixon-Mood序贯法计算抑制3种置管心血管反应的瑞芬太尼的半数有效浓度(EC50).结果 与麻醉诱导前相比,3组麻醉诱导后MAP、HR均明显下降[MAP:T、F、P组麻醉诱导前后分别为(87.9+10.5)mmHg比(71.6+9.0)mm Hg,(91.8+8.8)mm Hg比(73.5±9.9)mm Hg,(87.2±10.2)mm Hg比(70.9+8.6)am Hg,HR:T、F、P组麻醉诱导前后分别为(78.8±11.6)次/min比(68.7+8.5)次/min,(74.8±10.3)次/min比(64.1±6.7)次/min,(76.7±8.2)次/min比(67.3±8.3)次/min,1 mm Hg=0.133 kPa,P<0.05],而置管前后的BIS值则无变化(P>0.05).瑞芬太尼抑制3组置管心血管反应的半数有效浓度依次为T组4.47 μg/L、F组4.78 μg/L、P组2.05 μg/L.结论 Minto模式靶控测得瑞芬太尼抑制3种置管心血管反应的EC50 LMA-Fastrach置管略高于气管插管,LMA-Proseal置管则最低.     

糖尿病足手术中行超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞的临床应用价值

目的 探讨糖尿病足（DF）手术中行超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞的临床应用价值。方法 选择2016年6月至2019年4月于东部战区空军医院行DF手术的糖尿病（DM）患者100例,其中男性58例,女性42例;年龄55～85岁,平均年龄56.78岁。依据随机数字表法将患者分为坐骨神经及股神经阻滞组（观察组）和单次蛛网膜下腔阻滞组（对照组）,每组50例。记录2组患者麻醉前（Tb）、麻醉后5 min(T5)、麻醉后10 min(T10)、麻醉后15 min(T15)、麻醉后30 min(T30)的收缩压（SBP）、舒张压（DBP）和心率（HR）;记录麻醉操作时间（OT）、手术等待时间（SWT）、首次镇痛时间（FAT）、首次自主排尿时间（FUT）;记录2组患者术后6、12、18、24 h时视觉模拟量表（VAS）评分;记录术后麻醉并发症及不良反应发生情况。结果 在T5、T10、T15、T30时,对照组SBP均明显低于观察组[（138.85±17.16） mmHg vs (147.66±13.52) mmHg、（132.96±15.93） mmHg vs (145.29±18.1...     

电刺激穴位按摩对局部运动疲劳后姿势控制能力恢复的影响

目的从关节力矩、肌电信号、平衡能力以及足底压力分布等指标入手,对踝关节局部运动疲劳后电刺激穴位按摩对姿势控制能力恢复的效果进行评价。方法总共6人(12人次)在踝关节运动疲劳后正常休息或电刺激穴位按摩两种情况下,进行等速、肌电、足底压力测试。结果经过电刺激穴位按摩后,①足底受力中心(COF)的前后移走显著降低,足底第1、第2和第4、5趾区的接触面积显著增加到(11.64±2.12)、(6.57±0.97)、(3.72±1.33)cm2。②踝关节90°/s等速运动时,跖屈、背屈总功显著提高到(56.71±13.26)和(19.75±3.79)J。③单脚站立时,胫骨前肌和腓肠肌外侧的肌群均方根(RMS)值下降具有显著性;踝关节90°/s等速运动时,腓肠肌内外侧的RMS值由(48.95±13.50)和(33.67±6.41)μV显著上升到(59.87±11.46)和(43.73±4.65)μV。结论电刺激穴位按摩能够优化踝关节的发力模式,提高踝关节的稳定性,进而提高姿势控制能力,促进运动能力的恢复及避免运动损伤。     

HT型胶囊式内窥镜在门诊体检者中的应用价值

目的探讨门诊体检中应用口服胶囊式内窥镜检查系统的安全性和临床诊断价值。方法回顾性分析2011年1月至2011年12月解放军第二炮兵总医院普通外科应用HT型胶囊式内窥镜检查的成人受检者50例,男31例,女19例,年龄19～70岁,平均年龄46.94岁。受检者均为自愿接受胶囊内窥镜体检的健康者,于检查前均已告知检查风险并签知情同意书。结果受检者均顺利完成检查,吞服的胶囊通过幽门管进入十二指肠时间平均为72.66min(29～219min),小肠滞留时间平均为354.32min(210～510min),胶囊工作时间平均为499.02min(468～542min),48例完成全小肠检查,胶囊自吞服到排出体外平均用时69.26h(29～117h)。拍摄图像大部分清晰,检出4种病变共6例,阳性率12%。结论胶囊内窥镜安全性高,在门诊体检中对胃肠道疾病诊断具有临床应用价值。     

高频电刺激指导肾动脉射频消融的实验研究

目的:用电刺激的方法指导肾脏去神经术(renal denervation,RDN)中射频消融靶点的选择,同时比较电刺激与射频消融时血压变化的异同。方法:成年健康昆明犬6只,行肾动脉造影排除肾动脉畸形后,每侧肾动脉从远段开始,由远及近选择数个位点进行电刺激并消融。连续记录术中血压的变化,术后通过软件分析血压的变化情况。采用常规HE和Masson染色观察肾动脉壁结构及其周围组织;采用酪氨酸羟化酶(tyrosine hydroxylase,TH)免疫组化染色观察消融后肾动脉去神经效果。结果:本实验中刺激/消融位点共计50个,其中对电刺激有反应的位点占34%,无反应位点占66%。对有反应位点进行120 s电刺激时,其收缩压按每20 s分段与基线血压相比分别变化(0.34±3.38)、(0.41±3.04)、(10.47±5.73)、(13.27±3.63)、(10.17±1.87)和(0.78±1.87)mm Hg;将120 s连续消融时的收缩压数据同样按每20 s与基线血压相比,变化分别为(0.88±3.44)、(-1.64±3.47)、(13.17±3.12)、(12.82±3.21)、(9.50±2.68)和(-6.09±2.21)mm Hg。无反应位点进行电刺激和射频消融时均无明显血压升高。组织病理学检查显示,有反应位点肾动脉神经面积为(0.51±0.28)mm~2,无反应位点处为(0.09±0.06)mm~2,差异有统计学显著性(P0.01);免疫组化染色表明消融部位神经TH的表达显著低于未消融部位(P0.01)。结论:高频电刺激可以标测肾交感神经,且电刺激指导下的射频消融能对肾动脉交感神经造成有效损伤。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.