利多卡因治疗重度颅脑外伤的临床研究

目的探讨应用利多卡因经静脉注射对重度颅脑外伤患者的治疗作用.方法重度颅脑外伤患者60例(GCS≤8分),随机分为两组,对照组30例,伤后予常规治疗;治疗组30例,伤后3d内予常规治疗加利多卡因静脉注射治疗14d.治疗前后均作GCS评分、腰穿测定颅内压、头部CT、ECT、TCD检查.结果治疗组利多卡因治疗2～5d即出现出现意识、肢体功能好转、脑血供改善、脑水肿吸收;10d后肢体功能明显恢复,脑血供和颅内血流速度接近正常,脑水肿消退,颅内压接近正常.对照组患者同期治疗后观察头部ECT、TCD、CT未见明显变化,意识、肢体功能、脑血供改善不明显、脑水肿消退缓慢.结论早期应用利多卡因静脉注射能缓解颅脑损伤患者脑血管痉挛,改善脑微循环,减轻脑缺血引起的脑水肿,使颅内压下降,促进脑功能恢复.     

重症颅脑损伤昏迷患者高压氧治疗34例

许多研究认为脑伤后氧的供应与预后密切相关[1]。高压氧(hyperbaric oxyen,HBO)下颈动脉系统血供减少而椎动脑血供反而增加,网状激活系统和脑干血流量增加[2],因此有助于昏迷患者的苏醒。而颅脑外伤是常见的一种外伤,多发生于交通事故,颅脑外伤易发生脑水肿、昏迷、甚至长期昏迷成为植物人,我科自2005年1月至2006年1月共治疗了34例重症颅脑损伤昏迷患者,在行高压氧治疗的同时,给以脱水、激素、改善脑细胞代谢药物,取得比较满意的治疗效果,现将护理体会报告如下。1临床资料本组34例重症颅脑损伤患者中,男21例,女13例,年龄3～65岁,非手术治…     

高压氧治疗重度颅脑损伤后临床、脑电地形图及预后的探讨

目的:探讨高压氧治疗重度颅脑损伤的疗效。方法:重度颅脑损伤患者35例为治疗组,20例为对照组,观察高压的氧治疗前后临床、脑电地形图的变化及预后。结果:治疗组临床(GCS)、脑电地形图及预后经高压氧治疗后均明显改善,而对照组改善不明显。结论:高压氧能够明显改善重度颅脑损伤患者的临床,脑电地形图及预后。     

颅脑外伤后并发低钠血症的危险因素分析

目的探讨颅脑外伤患者并发低钠血症的发生机制及危险因素,以期为其早期预测及预防提供参考。方法回顾性分析2016年6月至2019年6月我院收治的185例中型和重型颅脑外伤患者的临床资料,包括导致低钠血症的不同病因、损伤类型、性别、格拉斯哥昏迷(GCS)评分、手术、脑水肿、颅底骨折和穿透性性损伤等;采用单因素χ^2检验和多因素Logistic回归分析探究颅脑外伤后并发低钠血症的危险因素。结果所有患者中,80例出现低钠血症,其中钠盐摄入不足、利尿剂过量使用47例,抗利尿激素分泌失调综合征19例,脑性耗盐综合征14例。低钠血症更多发生在脑挫裂伤、蛛网膜下腔出血和弥漫性轴索损伤患者中,差异具有统计学意义(P<0.05)。单因素χ^2检验结果显示,GCS评分(P=0.000)、脑水肿(P=0.000)、颅底骨折(P=0.000)、穿透性损伤(P=0.001)是颅脑外伤后并发低钠血症的相关因素。多因素Logistic回归分析结果显示,GCS评分(P=0.006)、脑水肿(P=0.006)、颅底骨折(P=0.000)、穿透性损伤(P=0.015)是颅脑外伤后并发低钠血症的危险因素。结论脑挫裂伤、蛛网膜下腔出血、弥漫性轴索损伤、GCS评分≤8分、脑水肿、颅底骨折和穿透性损伤的颅脑外伤患者更易发生低钠血症,应早期关注患者血清钠水平,明确病因及时纠正,防止病情恶化。     

颅内压监测应用于重型颅脑外伤患者治疗中的临床作用及对死亡率的影响评价

目的：探讨颅内压监测应用于重型颅脑外伤患者治疗中的临床作用及对其死亡率的影响。方法随机选取2013年7月~2014年7月在我院接受治疗的重型颅脑外伤患者106例，并根据患者具体情况分为观察组和对照组各53例，对照组在常规治疗基础上采用一般方式进行监测，观察组在常规治疗基础上采用颅内压监测进行监测，观察并比较两组的治疗效果及患者死亡率。结果观察组患者的死亡率为17.1%，对照组为32.1%，观察组明显低于对照组，P<0.05，有统计学意义。结论对重型颅脑外伤患者进行颅内压监测可及早发现颅内再出血、有效监测继发性脑水肿，为指导和及时调整治疗措施提供有力依据。     

长期亚低温治疗对重型颅脑损伤的疗效

目的通过研究102例长期（5—10d）亚低温脑保护疗法治疗对重型颅脑损伤救治效果及预后的影响，探讨长期亚低温治疗与短期（24～72h）亚低温治疗疗效的差异。方法将102例重型颅脑损伤患者（GCS昏迷≤8分）随机分为长期亚低温治疗和短期亚低温治疗两组。长期组于伤后24h内进行亚低温治疗，共5～10d，短期组于伤后24h内开始亚低温治疗，共24—72h。直肠温度控制在32．5—34％。同时监测病人的生命体征、颅内压（ICP）、血气、血电解质及动脉血氧饱和度。两组病人均于伤后3～6个月时根据COS评估法判定疗效。结果长期组51例患者恢复良好率56．86％（29／51），死亡率9．8％（5／51）；短期组51例患者，恢复良好率41．17％（21／5．1），死亡率17．64％（9／51），两组患者恢复良好率和死亡率均有明显差异（P〈0．05），两组肺部感染、颅内感染、消化道溃疡、肾功能损害、心律失常发生率无明显差异，长期亚低温组死亡率降低，恢复良好率提高，预后显著改善。结论本结果提示，长期亚低温治疗较短期亚低温治疗能显著降低重型颅脑损伤患者的死亡率，改善颅脑损伤患者预后，较短期亚低温治疗未见并发症增高。     

新生儿化脓性脑膜炎合并脑液化(附19例报告)

本组新生儿化脓性脑膜炎合并脑液化，经CT、B超、液化腔穿刺、尸检证实为脑液化。以额、颞、顶叶多见。可能与脑膜血管炎症及梗塞，自由基连锁反应有关、积极控制脑水肿，降低颅内压．改善脑供血，清除自由基对预防脑液化是必要的。     

颅脑外伤后进展性脑出血90例分析

目的 探讨颅脑外伤后进展性脑出血的临床特点和诊治经验.方法 回顾性分析90例PHI患者的临床资料,根据患者入院时患者的性别、年龄、格拉斯哥昏迷评分(GCS)、血压、损伤部位、凝血功能等情况进行分析.结果 男性、40岁以上、低GCS评分、血压控制不良、额颞底挫伤、早期有凝血功能异常者发生进展性脑出血的可能性大.结论 微循环障碍可能是颅脑外伤后进展性脑出血重要的病理生理基础,通过改善微循环治疗和及时的脑CT复查,有利于减少进展性脑出血对机体带来的伤害.     

血糖变化对急性颅脑损伤预后的影响

我 们对 134例急性颅脑外伤患者进行血糖测定 ,为急性颅脑外伤临床治疗提供有价值的实验室指标。1　资料与方法1.1　检测对象1995年 12月至 2 0 0 0年元月共收治中重度颅脑损伤患者 134例 ,男 10 3例 ,女 31例 ,年龄 10岁～ 71岁。受伤原因 :交通事故伤占 70 % ,其它为高处坠落伤 ,重物击伤 ,不慎摔伤 ,头部击打伤等 ,按神经外科GCS计分[1] 中度 ( 9～ 12分 ) 4 3例 ,重度 ( 8分以下 ) 91例。1.2　仪器和试剂日本OLYMPES AU4 0 0型生化自动分析仪。试剂由中外合资上海长征—康仁医学科学有限公司提供。1.3　方法氧化酶法。2　结　果入…     

新生儿化脓必脑膜炎合并脑液化：附19例报告

本组新生儿化脓性脑膜炎合并脑液化，经ＣＴ，Ｂ超，液化脓穿刺，尸检证实为脑液化以额，颞，顶叶多见。可能与脑膜血管炎症及梗塞，自由基链锁反应有关。积极控制脑水肿，降低颅内压，改善脑供血，清除自由对预防脑液化是必要的。     

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.