综合降低血氨浓度治疗乙肝肝硬化引起的肝性脑病

目的通过综合降低血氨浓度,观察治疗乙肝肝硬化引起的肝性脑病的临床疗效。方法将56例乙肝肝硬化出现肝性脑病患者随机分为综合降低血氨治疗组（包括口服乳果糖、醋酸灌肠、乙酰谷酰胺静脉注射,n=30）和乙酰谷酰胺治疗组（n=28）,1周治疗后观察临床疗效。结果综合治疗组显效21例（70．0％）,有效9例（30．0％）,无效0例,无死亡,总有效率100％;而乙酰谷酰胺治疗组显效8例（28．6％）,有效8例（28．6％）,无效7例（25．0％）,死亡5例（17．8％）,总有效率为57．1％,2组总有效率比较差异有统计学意义（P〈0．001）。综合治疗组死亡率和血氨浓度也显著降低（P〈0．05）。结论综合降低血氨浓度是控制乙肝肝硬化患者肝性脑病的有效方法,可显著降低肝性脑病的发生,降低患者死亡。     

门冬氨酸和鸟氨酸联合治疗肝性脑病的疗效观察

目的观察联合使用门冬氨酸和鸟氨酸治疗各种肝硬化引起肝性脑病患者的临床疗效，探讨其对生化指标的影响。方法收集2004-08-2007-08乙肝、丙肝和酒精性肝硬化住院患者84例，住院期间均出现不同程度的肝性脑病，分为门冬氨酸和鸟氨酸治疗组与乙酰谷酰胺治疗组（各42例），治疗5～7d观察2组患者的临床表现，记录临床症状、体征的变化．检测治疗前后患者血氨和肝功能，判断临床疗效变化。结果2组患者均经过5～7d治疗后，门冬氨酸和鸟氨酸治疗组患者显效22例（52．4％）．有效16例（38．1％），无效4例（9．5％），无死亡病例，总有效率为90．5％；乙酰谷酰胺治疗组患者显效16例（38．1％），有效14例（33．3％），无效8例（19．1％），死亡4例（9．5％），总有效率为71．4％。2组总有效率比较，差异有统计学意义（P〈0．05）。另外，发现门冬氨酸和鸟氨酸治疗组患者的血氨水平比乙酰谷酰胺治疗组显著下降（P〈0．05），而2组之间的血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酰转肽酶、胆红素和凝血酶原时间均无明显变化（P〉0．05）。结论降低血氨是治疗肝性脑病的重要步骤，门冬氨酸联合鸟氨酸是控制肝性脑病发生的有效药物。     

乙肝肝硬化患者并发肝性脑病的临床分析

目的 分析乙肝肝硬化患者并发肝性脑病时临床治疗方法及疗效.方法 收集2005-08～2006-12 因乙肝肝硬化出现的肝性脑病患者60例,随机分为乙酰谷酰胺治疗组(n=30)和门冬氨酸、鸟氨酸对照组(n=30),治疗1周后观察临床疗效,分析患者的肝功能变化情况.结果 乙酰谷酰胺组显效7例(23.3%),有效12例(40.0%),无效8例(26.7%),死亡3例(10.0%),总有效率为63.30%;而门冬氨酸和鸟氨酸治疗组显效15例(50.0%),有效12例(40.0%),无效3例(10.0%),无死亡,总有效率为90.0%;2组之间总有效率比较有明显差异(P＜ 0.01).另外,检测2组患者的肝功能,包括血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酰转肽酶、胆红素和凝血酶原时间,发现均有不同程度的恢复,但2组间无明显差异(P ＞ 0.05).结论 联合门冬氨酸和鸟氨酸是治疗乙肝肝硬化并发肝性脑病的有效药物.     

门冬氨酸和鸟氨酸联合治疗肝性脑病的疗效观察

目的观察联合使用门冬氨酸和鸟氨酸治疗各种肝硬化引起肝性脑病患者的临床疗效,探讨其对生化指标的影响。方法收集2004-08～2007-08乙肝、丙肝和酒精性肝硬化住院患者84例,住院期间均出现不同程度的肝性脑病,分为门冬氨酸和鸟氨酸治疗组与乙酰谷酰胺治疗组(各42例),治疗5～7d观察2组患者的临床表现,记录临床症状、体征的变化,检测治疗前后患者血氨和肝功能,判断临床疗效变化。结果2组患者均经过5～7d治疗后,门冬氨酸和鸟氨酸治疗组患者显效22例(52.4%),有效16例(38.1%),无效4例(9.5%),无死亡病例,总有效率为90.5%;乙酰谷酰胺治疗组患者显效16例(38.1%),有效14例(33.3%),无效8例(19.1%),死亡4例(9.5%),总有效率为71.4%。2组总有效率比较,差异有统计学意义(P<0.05)。另外,发现门冬氨酸和鸟氨酸治疗组患者的血氨水平比乙酰谷酰胺治疗组显著下降(P<0.05),而2组之间的血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酰转肽酶、胆红素和凝血酶原时间均无明显变化(P>0.05)。结论降低血氨是治疗肝性脑病的重要步骤,门冬氨酸联合鸟氨酸是控制肝性脑病发生的有效药物。     

肝性脑病患者临床分析

目的 对各种严重肝脏疾病出现肝性脑病患者进行药物治疗,对比研究临床疗效.方法 收集乙肝或丙肝肝硬化、原发性肝癌、药物性肝炎、布-卡综合征合并不同程度的肝性脑病患者48例.随机分为门冬氨酸和鸟氨酸治疗组(n=26)和乙酰谷酰胺治疗组(n=22),治疗7d后分析临床疗效,观察肝功能、血氨水平变化.结果 经过7d治疗,发现门冬氨酸和鸟氨酸治疗组显效14例(53.8%),有效10例(38.5%),无效2例(7.7%),无死亡,总有效率为92.3%;而乙酰谷酰胺组显效6例(27.3%),有效9例(40.9%),无效5例(22.7%),死亡2例(9.1%),总有效率为68.2%;2组间总有效率差异有统计学意义(P《0.05).2组患者肝功能(血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酰转肽酶、胆红素和凝血酶原时间)均有不同程度的恢复,但差异无统计学意义(P》0.05);而2组患者的血氨水平均有明显降低(P《0.05).结论 门冬氨酸和鸟氨酸是治疗肝性脑病的有效药物,可显著改善患者的临床症状.     

乙酰谷酰胺治疗肝硬化合并肝性脑病的疗效观察

目的观察乙酰谷酰胺治疗肝硬化合并肝性脑病的临床疗效。方法选取2013-03—2014-12于本院进行诊治的38例肝硬化合并肝性脑病患者为研究对象,按随机分配的原则分为对照组(门冬氨酸鸟氨酸治疗组)19例和观察组(门冬氨酸鸟氨酸加乙酰谷酰胺治疗组)19例,比较2组不同分期及病因患者的治疗总有效率及清醒时间。结果观察组中不同分期及病因患者的治疗总有效率均高于对照组,清醒时间构成也均好于对照组,P均0.05。结论乙酰谷酰胺治疗肝硬化合并肝性脑病的临床疗效较好,显效较快,临床应用价值较高。     

门冬氨酸鸟氨酸联合乙酰谷酰胺治疗肝性脑病疗效观察

目的 观察门冬氨酸鸟氨酸与乙酰谷酰胺联合治疗肝性脑病患者的临床疗效.方法 选择2010-12-2012-12在我院住院的肝性脑病患者88例,按随机数字表法随机分为治疗组和对照组.治疗组48例患者在口服乳果糖及支链氨基酸基础上,采取门冬氨酸鸟氨酸10 g加入250 mL 5%葡萄糖注射液中静滴,2次/d;乙酰谷酰胺0.6 g加入250 mL 5%葡萄糖注射液中静滴,1次/d.对照组40例患者在常规治疗的基础上应用乙酰谷酰胺0.6 g加入250 mL 5%葡萄糖注射液中静滴,1次/d.2组均连续治疗7 d.观察2组患者治疗前后血氨水平、谷丙转氨酶水平、血清总胆红素水平、清醒时间等情况,并进行对比分析.结果治疗7 d后,治疗组总有效43例（89.6%）,死亡2例（4.2%）;对照组总有效25例（62.5%）,无效15例中12例（30.0%）死亡.与治疗前比较,2组患者治疗后血氨水平、谷丙转氨酶水平、血清总胆红素水平均降低,清醒时间均延长,差异均有统计学意义（P＜0.05）.治疗组患者治疗后血氨水平、谷丙转氨酶水平、血清总胆红素水平低于对照组,清醒时间短于对照组,差异均有统计学意义（P＜0.05）.结论 门冬氨酸鸟氨酸联合乙酰谷酰胺治疗肝性脑病确切疗效,优于采取乙酰谷酰胺的单一疗法.     

乙肝肝硬化肝性脑病临床诊治分析

目的探讨乙肝肝硬化肝性脑病患者的临床治疗及疗效。方法 2010-06—2012-06期间,我院诊治的60例乙肝肝硬化肝性脑病患者,随机将其分为对照组(门冬氨酸、鸟氨酸治疗)和观察组(乙酰谷酰胺联合门冬氨酸、鸟氨酸治疗),每组各30例,治疗一周后,对其临床疗效及治疗前后血氨浓度变化情况,进行观察和比较。结果与对照组相比(70.0%),观察组总有效率明显升高(96.7%),P<0.05。与治疗前相比,治疗后2组的血氨浓度均有明显下降;与对照组相比,治疗后观察组血氨浓度明显下降,P<0.05。结论乙酰谷酰胺联合门冬氨酸鸟氨酸治疗乙肝肝硬化肝性脑病的疗效显著,明显改善患者的肝功能,值得临床推广。     

杜密克治疗肝硬化引起的肝性脑病的疗效观察

目的 观察杜密克治疗肝硬化引起的肝性脑病的临床疗效.方法 将56例由乙肝或丙肝致肝硬化而出现肝性脑病患者随机分为治疗组(n=32)和对照组(n=24).治疗组接受杜密克口服液,对照组接受常规护肝治疗,经治疗2周后,观察临床疗效、肝功能、血氨、脑电图等变化.结果 杜密克组显效9例(28.1%),有效14例(43.8%),无效9例(28.1%),死亡2例(6.3%),总有效率为71.9%;而对照组显效2例(8.3%),有效3例(12.5%),无效19例(79.2%),死亡5例(20.8%),总有效率为20.8%.两组总有效率比较差异有显著性(P＜0.001).杜密克组血氨浓度显著降低(P＜0.01).结论 杜密克是预防和治疗肝炎肝硬化患者肝性脑病的有效药物,可改善临床症状.     

乳果糖和白醋灌肠联合治疗肝性脑病临床疗效分析

目的分析联合乳果糖和白醋灌肠治疗各种严重肝病引起的肝性脑病(HE)患者的疗效。方法采集2004-12～2008-02因乙肝肝硬化、丙肝肝硬化和酒精性肝硬化引起的HE患者42例,随机分为治疗组(n=22)和对照组(n=20)。治疗组接受乳果糖和白醋保留灌肠,对照组仅用白醋保留灌肠治疗,1周后视察临床疗效、肝功能、血氨、脑电图等变化。结果治疗组患者显效7例(31.8%),有效9例(41.0%),无效5例(22.7%),死亡1例(4.5%),总有效率为72.7%;对照组患者显效3例(15.0%).有效5例(25.0%),无效10例(50.0%),死亡2例(10.0%),总有效率为40.0%。2组总有效率比较差异有显著性(P<0.05)。治疗组血氨浓度亦比对照组降低明显(P<0.05)。结论联合乳果糖和白醋保留灌肠是预防和治疗各种肝病患者出现HE的有效方法,可显著改善患者临床症状。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Release of endogenous catecholamines from slices of hypothalamus of rats

The release of endogenous catecholamines from superfused slices of rat hypothalamus was studied under basal conditions and during release evoked by 40 mM K⁺. Catecholamines in superfusates, and in extracts of the tissue after stimulation, were isolated by column chromatography and quantitated by liquid chromatography with electrochemical detection. Norepinephrine (NE) was not consistently demonstrable in superfusate collected under basal conditions, but 40 mM K⁺ caused the release of from 2 to 4 ng/g of tissue per min. The addition of cocaine to the superfusate caused increases in basal and evoked release of NE. Epinephrine (E) could be measured in superfusates of slices from male but not female rats and then only when cocaine was added to the superfusate. Accordingly, the concentration of E in hypothalamus was greater in male rats than in female rats. Dopamine (DA) was not consistently measurable in the spontaneous overflow from slices either in the presence or absence of cocaine. K⁺-evoked release of DA could be demonstrated in slices from female rats. The addition of cocaine increased the evoked release of DA from slices from both sexes. Corticosterone, added to cocaine, had no effects on the efflux of any of the catecholamines. The experiments suggest that neuronal reuptake of all catecholamines is very efficient in the hypothalamus both under basal conditions and during evoked release.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。