甲基强的松龙对脑损伤大鼠血清神经组织蛋白S100和神经元特异性烯醇化酶的影响

目的通过比较血清神经组织蛋白S100(S-100B蛋白)和神经元特异性烯醇化酶(NSE)变化来观察甲基强的松龙对大鼠颅脑损伤的治疗作用。方法将72只SD大鼠随机分为3组,正常组8只,对照组和治疗组大鼠各32只,分为伤后1,6,12,24h4个小组,每小组8只,采用Feenery法造成鼠脑挫裂伤模型后,用酶联免疫检测技术定量检测伤后不同时相点血清S-100B蛋白和NSE水平。结果(1)正常组血清S-100B蛋白为(0.35±0.03)μg/L,NSE水平为(8.35±1.01)μg/L,对照组和治疗组伤后6～24h血清S-100B蛋白和NSE水平均比正常组高(P<0.05);(2)治疗组比对照组血清S-100B蛋白和NSE低(P<0.05)。结论甲基强的松龙对脑损伤有治疗作用。     

高压氧暴露对急性脑梗死患者血清S-100B蛋白含量的影响

目的 探讨高压氧(HBO)暴露对急性脑梗死患者血清S-100B蛋白含量的影响,并评价HBO的治疗作用.方法 应用颅脑MRI/MRA扫描120例急性脑梗死患者,计算脑梗死体积.按照治疗方法分成HBO组(n=56)与对照组(n=64),并采用ELISA法检测2组患者于入院后24、48、72、96h血清S-100B蛋白含量的变化.结果 急性脑梗死患者血清S-1O0B蛋白含量在入院72 h后达到顶峰,S-100B蛋白含量与脑梗死体积呈正相关(P＜0.05),HBO组入院后72 h时血清S-100B蛋白含量[小梗死:(0.71±0.25) μg/L,中梗死:(1.22±0.37) μg/L]较对照组相同时点[小梗死:(1.26±0.36) μg/L,中梗死:(2.02 ±0.72)μg/L]明显下降,差异有统计学意义(P＜0.01或P＜0.05).结论 相同时点中S-100B蛋白含量与急性脑梗死体积密切相关,可能对进展性脑卒中有预测作用;临床早期HBO治疗可以降低S-100B蛋白含量,对提高急性脑梗死患者疗效有一定的作用.     

血清S-100B蛋白、NSE及GST水平与急性脑梗死患者病情、预后的相关性研究

目的：探讨血清S-100B蛋白、神经元特异性烯醇化酶（NSE）及谷胱甘肽-S-转移酶（GST）水平变化与急性脑梗死（ACI）患者病情、预后的相关性。方法采用电化学发光免疫法、ELISA法检测64例ACI患者及60例健康对照组的血清S-100B蛋白、NSE及GST水平,观察并比较ACI患者在不同病情、不同梗死面积时的血清S-100B蛋白、NSE及GST水平变化,采用spearman法对三者进行相关性分析。结果 ACI组患者血清S-100B蛋白、NSE水平均显著高于对照组（P<0.05）,而血清GST水平显著低于对照组（P<0.05）;随着神经功能损伤程度增高和梗死病灶面积的增加,血清S-100B蛋白、NSE表达水平明显升高（P<0.05）,而血清GST表达水平明显降低（P<0.05）;ACI患者血清GST与S-100B蛋白、NSE表达水平呈负相关（P<0.05）,血清S-100B蛋白与NSE表达水平呈正相关（P<0.05）。结论血清S-100B蛋白、NSE、GST可作为ACI患者病情判断、预后评估的敏感性实验室指标。     

S100B蛋白及其脑损伤相关指标与新生儿缺氧缺血性脑病的关系

目的探讨新生儿血浆S100B蛋白及脑损伤相关指标肾上腺髓质素（ADM）、神经元特异性烯醇化酶（NSE）、脑型肌酸激酶同功酶（CK—BB）与缺氧缺血性脑病（HIE）的关系及意义。方法选择54例临床诊断为HIE的新生儿,在出生12h时抽血检测血浆SIOOB、ADM、NSE和CK—BB水平,与47例非HIE窒息新生儿和22名健康新生儿的血浆上述指标水平进行方差分析,两两比较采用成组设计资料t检验,采用Spearman线性相关分析法分析HIE新生儿血浆S100B蛋白与其他各指标间的关系。结果出生12h时HIE患儿血浆S100B为（0．93±0．43）HgZL,ADM为（144．12±18．55）ng／L,NSE为（32．76±18．92）μg／L,CK—BB为（52．89±21．49）U／L,高于窒息组的（0．34±0．16）μg/L,（106．48±20．62）ng／L,（11．22±3．31）μg／L和（20．87±11．55）U／L,也高于对照组的（0．27±0．10）μg/L,（96．51±20．86）ng／L,（9．96±2．41）μg／L和（20．93±11．24）U／L（F〉44．740,P均〈0．01）;相关性分析显示HIE患儿血浆S100B水平与ADM、NSE、CK—BB呈正相关（r=0．429,0．694和0．503,P均〈0．01）。结论HIE患儿出生12h时血浆S100B、ADM、NSE和CK—BB水平能预示HIE患儿的脑部是否有缺血性损伤,且该4项指标关联度高,有助于HIE的早期诊断和预后判断．     

癫痫发作间期脑血流灌注功能与脑组织损伤程度相关性研究

目的探讨癫痫患者抗癫痫药物治疗期间不同疗效状态下,发作间期致痫灶局部血流灌注和脑细胞功能低下与脑组织损伤程度的相关性。方法按随机数字表法随机选择48例癫痫发作间期患者,采用双抗体夹心ELISA法测血清S-10013蛋白的水平,SPECT脑血流显像测定局部脑血流量,并与30例对照者进行比较。采用SPSS11．0软件进行统计学分析,两样本均数之间行t检验,多样本比较采用方差分析,两变量间相关性分析用线性相关分析法进行。结果癫痫发作间期患者血清S-10013蛋白水平（0．572±0．163）μg/L,高于对照组（0．218±0．134）μg/L,差异有统计学意义（t=9．96,P〈0．01）。根据癫痫控制标准,患者中控制20例,显效和有效18例,无效10例;3组s．100t3蛋白水平和局部脑血流（rCBF,％）分别为（0．443±0．083）μg/L和（0．035±0．038）％,（0．585±0．108）μg/L和（0．187±0．075）％,（0．809±0．056）μg/L和（0．337±0．060）％,无效组与其他两组比较,S-10013蛋白水平与rCBF的变化均有统计学意义,其余两组比较差异亦有统计学意义（F=56．740,92．316,P〈0．01）。癫痫患者血清S-100p蛋白水平、rCBF下降百分率呈高度正相关（r=0．887,P〈0．01）。结论SPECT脑血流灌注显像联合检测血清S-100β蛋白水平,可对癫痫致痫灶进行定位,并评价癫痫所致的脑组织损伤。S-100β蛋白水平可作为抗癫痫药物治疗癫痫疗效的监测指标。     

糖原磷酸化酶BB在非ST段抬高急性冠脉综合征诊断和预后中的作用

 目的 探讨血清糖原磷酸化酶BB(GPBB)在非ST段抬高急性冠脉综合征(non-ST-elevation acute coronary syndromes, NSTE ACS)中的诊断和预测价值。方法 检测83例不稳定型心绞痛(unstable angina pectoris, UAP)和72例非ST段抬高急性心肌梗死(non-ST-elevation acute myocardial infarction, NSTE AMI)患者血清GPBB和cTnI水平,应用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)比较两者对NSTE MI的诊断价值;同时随访比较98例NSTE ACS患者3年内发生主要心脏不良事件的情况。结果 NSTE MI组与UAP组GPBB值,胸痛发作6 h内分别为(7.364±5.452)μg/L和(1.118±0.860)μg/L,差异有统计学意义(P<0.01) ;12 h内分别为(8.045±4.934)μg/L和(0.849±0.589)μg/L,差异有统计学意义(P<0.01)。选择GPBB诊断NSTE MI的最佳cutoff值0.92 μg/L,cTnI的最佳cutoff值0.48 μg/L,此时胸痛发作6 h内GPBB曲线下面积0.845,敏感度77.8%,特异度75.9%;cTnI曲线下面积0.816,敏感度63.9%,特异度89.2%。胸痛发作12 h内GPBB曲线下面积0.912,敏感度84.7%,特异度91.6%;cTnI曲线下面积0.936,敏感度90.3%,特异度91.6%。高水平GPBB 的NSTE ACS患者较低水平者3年内更易于发生主要心脏事件。结论 GPBB对 NSTE MI的诊断具有较高敏感度,可辅助cTnI诊断NSTE MI,对NSTE ACS患者具有预后判断价值。     

神经节苷脂对糖尿病脑病患者认知功能的影响研究

目的观察神经节苷脂对糖尿病脑病患者认知功能的影响。方法将我院2008年3月～2010年11月收治的52例糖尿病脑病患者随机分为两组,对照组25例采用常规疗法,观察组27例加用神经节苷脂,以简易精神状态检查量表(MMSE)评分、血清神经元特异性烯醇化酶(NSE)及S-100B蛋白为观察指标比较分析两组患者的认知功能。结果治疗前两组患者的MMSE评分、血清NSE及S-100B情况比较,差异均无统计学意义(P>0.05);治疗后两组患者的MMSE评分、血清NSE及S-100B情况均得到改善,以观察组改善更为明显,组间差异具有统计学意义(P<0.05)。结论神经节苷脂能够有效改善糖尿病脑病患者的认知功能,可能与其神经细胞保护作用有关。     

腰椎脊柱爆裂性骨折伴急性脊髓损伤患者血清NFL、HSP70、NSE表达与神经功能的关系

目的 研究腰椎脊柱爆裂性骨折伴急性脊髓损伤(SCI)患者血清神经丝轻链(NFL)、热休克蛋白70(HSP70)、神经元特异性稀醇化酶(NSE)表达与神经功能的关系.方法 前瞻性选取2018年1月—2020年4月期间空军军医大学第一附属医院骨科收治的113例脊柱爆裂性骨折患者,均为腰椎爆裂性骨折,根据美国脊髓损伤协会(ASIA)神经功能分级法,分为完全SCI组34例,不完全SCI组79例;男性51例,女性62例;年龄45～66岁,平均55.7岁;道路交通伤94例,高处坠落伤19例;糖尿病7例,冠心病4例,高血压7例;饮酒史23例、吸烟史17例.同时纳入同期在笔者医院行身体检查的60例健康志愿者为对照组,比较三组受试者治疗前血清NFL、HSP70和NSE水平.患者均行后路长节段椎弓根螺钉固定术,随访6个月后,根据神经功能恢复情况,将患者分成预后良好组(72例)和预后不良组(41例).单因素分析两组患者基线资料,对差异有统计学意义的单因素进行Logistic多因素回归分析,探究脊柱爆裂性骨折患者预后的独立影响因素,并应用受试者工作特征(ROC)曲线评估血清指标与神经功能的关系.结果 完全SCI组、不完全SCI组和对照组受试者血清NFL[(67.4±6.7)pg/mL vs.(29.3±6.4)pg/mL vs(6.0±1.5)pg/mL,F=58.304,P<0.001]、HSP70[(26.6±4.9)ng/mLvs.(19.2±4.6)ng/mLvs.(13.2±3.4)ng/mL,F=13.633,P<0.001]和NSE[(24.9±3.0)ng/mL vs.(14.7±3.6)ng/mL vs.(10.2±3.0)ng/mL,F=10.431,P<0.001]差异有统计学意义.随访6个月,预后不良组血清NFL[(59.2±7.0)pg/mL vs.(18.3±4.0)pg/mL,t=34.416,P<0.001]、HSP70[(20.3±3.1)ng/mL vs.(15.3±3.3)ng/mL,t=7.937,P<0.001]和NSE[(21.0±4.1)ng/mL vs.(12.8±3.0)ng/mL,t=11.385,P<0.001]表达明显高于预后良好组.Logistic结果表明血清NFL(OR=2.776,95％CI:2.238～3.444)、血清HSP70(OR=2.998,95％CI:1.513～5.942)和血清NSE(OR=1.879,95％CI:1.219～2.898)等指标是爆裂性骨折合并SCI患者预后不良的独立影响因素(P<0.05).根据ROC曲线可得,血清NFL诊断的临界值为40.39pg/mL,其对应的敏感度为73.17％,特异度为73.61％,曲线下面积(AUC)为0.801(95％CI:0.750～0.852);血清HSP70诊断的临界值为17.33ng/mL,其对应的敏感度为70.73％,特异度为69.44％,AUC为0.760(95％CI:0.707～0.812);血清NSE诊断的临界值为16.03ng/mL,其对应的敏感度为58.54％,特异度为58.33％,AUC为0.631(95％CI:0.564～0.698).将回归预测方程作为新变量P,在最佳临界切点时,回归分析的敏感度为80.49％,特异度为79.17％,AUC为0.869(95％CI:0.831～0.907),有一定的预测价值.结论 血清NFL、HSP70和NSE在脊柱爆裂性骨折合并SCI患者异常高表达,且上述诸血清因子是患者神经功能预后不良的独立危险因素.     

胰岛素治疗后糖尿病患者抑郁情绪变化与皮质醇水平的关系

目的观察胰岛素强化治疗前后糖尿病抑郁患者的情绪变化及与血清皮质醇水平的相关性。方法选择340例2型糖尿病(T2DM)患者,其中187例给予胰岛素强化治疗3个月,153例给予口服降糖药治疗,对入选患者治疗前后进行抑郁测定以及血糖、糖化血红蛋白(HbA1c)、血清皮质醇检测,并进行统计学处理。治疗期间空腹血糖控制在4.4～6.1 mmol/L,餐后2h血糖控制在4.4～8.0 mmol/L之间。结果胰岛素治疗前合并抑郁情绪及无抑郁情绪的糖尿病患者皮质醇水平分别为:(276.1±23.4)、(141.1±19.9)μg/L(P<0.01);胰岛素治疗后合并抑郁患者抑郁指数较治疗前明显降低,分别为(0.51±0.13)、(0.68±0.21)(P<0.01),皮质醇水平明显降低为(162.4±17.3)μg/L(P<0.01)。治疗前抑郁指数与皮质醇呈显著正相关(r=0.674,P<0.01);胰岛素组治疗后抑郁指数下降与皮质醇下降呈正相关(r=0.525,P<0.05)。而口服降糖药组治疗前后抑郁指数及皮质醇水平无明显变化。结论胰岛素治疗后T2DM患者抑郁情绪的改善与皮质醇水平相关。     

卒中后发生抑郁的相关因素探讨

 目的 探讨脑卒中后抑郁(post stroke depression, PSD)的相关因素。方法 选取符合条件的脑卒中患者265例, 根据是否有PSD分成对照组(175例)和PSD组(90例)。回顾性观察与分析所有患者的性别、年龄、教育程度(按年计算)、既往史(高血压、糖尿病、冠心病、卒中史、抑郁病史)、入院时斯堪的纳维亚卒中量表(scandinavian stroke scale , SSS)评分、日常生活活动能力 (activities of daily living, ADL)评分、入院时测定的血清同型半胱氨酸水平、卒中部位及侧别和病灶多少, 并对所得数据进行整理和统计学分析。结果 PSD组的教育年限为(4.4±4.7)年, 对照组为(5.7±4.7)年, 两组相比差异有统计学意义(P<0.05)。PSD组既往抑郁发生率 (15.6%)较对照组(5.1%)高, PSD组中额叶损伤占22.2%, 对照组为8.6%, 差异也具有统计学意义(P<0.05)。PSD组SSS评分、ADL评分、血清同型半胱氨酸水平分别为(23.7±5.8)分, (13.72±5.6)分, (24.67±6.24)μmol/L, 对照组分别为(19.5±5.1)分, (26.35±10.2)分, (14.58±5.21)μmol/L, 差异均具有统计学意义(P<0.05)。Logistic回归分析表明额叶损害、SSS评分和ADL评分这三项对PSD的影响最大。结论 教育年限、既往有抑郁史、SSS评分、ADL评分、血清同型半光氨酸水平及额叶损害等因素均和PSD相关。PSD是一个多因素共同影响导致的疾病。     

成批煤气爆燃烧伤的救治体会

报道治疗因煤气泄漏爆炸烧伤病员7例，经应用MEBT技术积极救治，其中6例于伤后17天痊愈出院，另一例特重伤员也于伤后30天康复出院。作者认为：应严格按照MEBT／MEBO要求进行规范治疗，正确处理生命体征、休克、感染、脏器功能和创面的辨证关系。同时，不能忽视外科营养在过程中的重要作用，它是创面修复的物质保证。     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

新疆石河子地区奶牛隐性乳房炎的调查与分析

采用LMT法对新疆石河子地区三个规模化奶牛场泌乳牛群进行了隐性乳房炎检测,共检测994头泌乳牛3976个乳区.结果表明:奶牛隐性乳房炎阳性率为81.9%,乳区阳性率为49.1%.数据分析表明,不同年龄、胎次以及有无卧床奶牛的隐性乳房炎阳性率差异显著(P<0.05),后乳区的隐性乳房炎感染率显著高于前乳区感染率(P<0.05),隐性乳房炎乳区发生数也明显影响当日产奶量(P<0.05).     

Sex differences in neuromuscular fatigability in response to load carriage in the field in British Army recruits

Objectives

Women are resistant to neuromuscular fatigue compared to men in response to a range of exercise tasks. The sex differences in the neuromuscular responses to load carriage have yet to be investigated.

Decrease in eccentric hamstring strength in runners in the Tirol Speed Marathon

Background

The local muscular endurance of knee flexors, during eccentric work in particular, is important in preventing or delaying kinematic changes associated with fatigue during treadmill running. This result, however, may not be transferable to overground running.

Objective

To test the hypothesis that overground running is associated with eccentric hamstring fatigue.

Methods

Thirteen runners (12 male and one female) performed an isokinetic muscle test three to four days before and 18 hours after a marathon. Both legs were tested. The testing protocol consisted of concentric and eccentric quadriceps and hamstring contractions.

Results

There were no significant differences between peak torque before and after the race, except that eccentric peak hamstring torque (both thighs) was reduced.

Conclusion

Overground running (running a marathon) is associated with eccentric hamstring fatigue. Eccentric hamstring fatigue may be a potential risk factor for knee and soft tissue injuries during running. Eccentric hamstring training should therefore be introduced as an integral part of the training programme of runners.     

肺心病慢性呼吸性酸中毒合并代谢性酸碱失衡判断方法探讨(附80例次血气分析)

目的：对42例肺心病慢性呼吸性酸中毒患者的80例次血气测定结果。方法：用不同的酸碱图（卡）及代偿公式进行酸碱类型的初步差别分析。结果：结合临床表现、各种影响因素与治疗反应等作出综合判定。结论：比较二种判定的差异，并提出较为实用、可靠的判断建议，以助于复合型呼吸性酸碱失衡的临床诊断与处理。     

Oxalosis in primary hyperoxaluria in infancy

Primary hyperoxaluria (PH1) is a rare inborn autosomal recessive metabolic disorder due to the deficiency of hepatic alanine-glyoxylate-aminotransferase. This deficiency results in excessive synthesis and urinary excretion of oxalate, inducing renal stone formation and deposition of calcium oxalate in the kidney, bone, myocardium, and vessels (systemic oxalosis, SO) in the most severely affected individuals. We report renal and skeletal changes in a 3-month-old girl with PH1 and SO. Intense cortico-medullary hyperechogenicity and increased homogeneous radiopacity of normal-sized kidneys suggested the diagnosis of SO. Skeletal survey showed osteopenia and characteristic symmetrical metaphyseal transverse bands in long bones, progressively becoming more dense and migrating towards the diaphysis. Multiple pathological and slowly healing fractures of the limbs occurred at the dense band level. A radiopaque rim was then observed in flat bones, epiphyseal nuclei, and vertebral bodies. Inflammatory granulomatous reaction, induced by the presence of oxalate crystals in the marrow spaces, coexisted with progressively evident radiological signs of secondary hyperparathyroidism, with partially overlapping features. The patient was treated by peritoneal dialysis and hemodialysis until combined liver–kidney transplantation. There are no previous reports of infants treated with hemodialysis for more than 2 years.     

Interventional radiology in oncology in private practice

Interventional oncology in private practice requires expert training and can be performed in a stand-alone facility for type 1 procedures in a hospital setting for type 2 and 3 procedures where subspecialized radiologists, state-of-the-art equipment, and postprocedure hospital monitoring are available. A multidisciplinary effort with oncologists, internal medicine physicians and anesthesiologists is necessary. The practice of interventional oncology requires around the clock availability, meticulous and established protocols and procedures and a financial investment. On the other hand, it is professionally gratifying because of constant technical advances and the impact on patients.