听性稳态反应和听性脑干反应检测对老年噪声性耳聋患者的意义

目的探析噪声聋患者的客观听阈评估工作中听性稳态反应(ASSR)与听性脑干反应(ABR)的临床意义。方法 31例老年噪声聋患者为观察组,18例正常听力者(共40只耳)为对照组。两组基线资料差异无统计学意义(P0.05)。结果观察组纯音听阈在3 000、4 000及6 000 Hz的频率与ABR反应阈差异无统计学意义(P0.05),而在250、500、1 000及2 000 Hz差异有统计学意义。对照组各频率的纯音阈值与ABR反应阈差异有统计学意义(P0.05)。对照组中250、500 Hz的纯音听阈与ASSR反应阈值差异无统计学意义(P0.05);其他频率的纯音听阈与ASSR反应阈值差异有统计学意义(P0.01)。观察组2 000 Hz频率处的纯音听阈与ASSR反应阈值差异有统计学意义(P0.05),其他频率差异无统计学意义(P0.05)。结论 ASSR频率特异性较好,在噪声性聋的客观评估及伪聋的鉴定方面有着重要的应用价值。     

高频、低频rTMS作用健侧半球吞咽皮质代表区对老年脑卒中后吞咽障碍的影响对比

目的 探究与分析高频、低频重复经颅磁刺激(rTMS)作用健侧半球吞咽皮质代表区对老年脑卒中后吞咽障碍的影响。方法 选取2018年1月至2021年2月收治的162例老年急性缺血性脑卒中后吞咽障碍患者，采取随机数字表法分为3组，分别为高频组、低频组及假刺激组，每组各54例，3组均给予常规内科药物治疗及吞咽康复训练，吞咽康复训练30 min/次，1次/d,每周治疗5 d,连续治疗2 w。高频组实施rTMS时在健侧半球舌骨上肌群吞咽皮质代表区给予刺激，每次给予250脉冲，5 Hz, 1次/d, 10 min/次，每周治疗5 d,连续治疗2 w;低频组实施rTMS时在患者健侧半球舌骨上肌群吞咽皮质代表区给予刺激，每次给予250脉冲，1 Hz, 30 min/次，1次/d,每周治疗5 d;假刺激组给予假rTMAS刺激治疗，线圈90°倾斜，采取与高频组同等的刺激频率。对比3组临床疗效、治疗前后基于吞咽造影检查(VFSS)的定量指标、洼田饮水试验评分及经口摄食功能量表(FOIS)评分，同时采用表面肌电(sEMG)测定舌骨上肌群均方根值(RMS)评估控制吞咽功能的肌肉活动功能，观察治疗期间不良反应。结果...     

埋藏式起搏器与胸壁刺激脉冲间同步现象2例

<正> 例1 男性,57岁。因Ⅲ度房室传导阻滞(A-VB)于1986年8月8日埋藏AXB-3型VVI起搏器。埋入前经起搏分析仪测试,各项指标均符合要求。术后3小时,起搏频率稳定于71次/分。3个月后,为了解起搏器的感知功能,进行胸壁刺激试验。采用FD-I型刺激仪,脉宽10ms,电压15V,当刺激频率为80次/分时,埋藏起搏器的频率也加快至80次/分,两种脉冲重迭,保持1∶1同步。停止胸壁刺激后,起搏器脉冲频率恢复到刺激前情况。再次用80次/分刺激,重复出现上述结果。将刺激频率提高到90次/分时,则起搏器不发放脉冲,同步现象消失。例2 男性,58岁。因Ⅲ度A-VB于1988年10月30日埋藏AXB-3型VVI起搏器,术前测试频率为     

成人分泌性中耳炎的听力评价及相关分析

目的 分析成人分泌性中耳炎的临床听力学特征,探讨年龄、病程与听力改变的相关性.方法 选37例(47耳)成人分泌性中耳炎为观察组,选25例(50耳)正常成人为对照组,分别进行纯音测听和声导抗测试检查,并分析比较两组的0.125～8 KHz频率气导听阈、0.25～4 KHz频率骨导听阈、纯音气导听阈均值、纯音骨导听阈均值、气骨导差均值等纯音测听结果 ,以探讨患者年龄、病程与听阈变化产生的相关性.结果 分泌性中耳炎组(观察组)78.72%(37/47耳)为传导性耳聋,21.28%(10/47耳)为混合性耳聋,其各频率气导听阈、0.5～4 KHz各频率骨导听阈、纯音气导听阈均值、纯音骨导听阈均值、气骨导差均值均高于对照组(P<0.01);分泌性中耳炎组年龄与纯音气导听阈均值、纯音骨导听阈均值及气骨导差均值呈正相关(P<0.01),病程与纯音气导听阈均值呈正相关(P<0.05),病程与纯音骨导听阈均值、气骨导差无明显相关(P＞0.05).结论 成人分泌性中耳炎除影响中耳传音机能外,对内耳也存在损害,患者年龄是影响分泌性中耳炎的听力状况的重要因素,病程也有一定影响.     

腹水超滤浓缩回输治疗顽固性腹水疗效观察

目的探讨腹水超滤浓缩回输治疗顽固性腹水的疗效。方法选择15例顽固性腹水患者,采用德国Fresenius 4008B血液透析机及其配套血液管路,按无菌操作规范将患者的腹水引入透析器超滤浓缩后回输至腹腔或静脉,共治疗46次。结果15例患者腹胀、呼吸困难症状消失,食欲增加;4例患者尿量增加;2例术中出现头昏、心慌、血压下降;发热1例、腹痛3例,2例行1～2次治疗后出现血性腹水而停止治疗。结论腹水超滤浓缩回输治疗顽固性腹水是一种有效的方法,但疗效不巩固。     

不同强度的中频脉冲电疗对脑梗死偏瘫患者肢体功能康复的疗效观察

目的观察不同强度的中频脉冲电疗对脑梗死偏瘫患者肢体功能康复的效果,探讨中频脉冲电疗的最佳刺激强度。方法选择急性脑梗死偏瘫患者66例,分为低频率组、中频率组、高频率组各22例。在常规治疗及康复治疗基础上,对各组均使用YKL-B型电脑中频治疗仪进行中频脉冲电疗,低频率组给予中频脉冲电刺激20~30 Hz,中频率组给予31~40 Hz,高频率组给予41~50 Hz。各组共治疗2周。治疗前及治疗后,采用美国国立卫生研究院卒中量表(NIHSS)、Brunnstrom分期评估神经功能缺损,采用简化Fugl-Meyer运动功能量表(FMA)评估运动能力,采用改良Barthel指数(MBI)评分评估日常生活能力。比较三组患者治疗前后神经功能、日常生活能力评分及其变化值(⊿NIHSS、⊿Brunnstrom、⊿FMA、⊿MBI)。结果总体患者治疗后的Brunstrom分期、FMA评分、MBI评分均高于治疗前,NIHSS均低于治疗前(P均<0.05)。治疗后,中频率组Brunstrom分期、FMA评分、MBI评分均高于低频率组和高频率组,NIHSS均低于低频率组和高频率组(P均<0.05)。结论中频脉冲电疗对脑梗死偏瘫患者的肢体功能康复有明显疗效,且31~40 Hz的脉冲电强度效果最好。     

语频听力正常耳鸣患者高频测听与耳声发射的检测及意义

对56例语频听力正常的耳鸣患者做高频听阈测试和耳声发射检测,以46例相同年龄段听力正常无耳鸣者作正常对照。结果显示,随着测试频率的增高,听阈逐渐提高,听阈检出率逐渐下降,相同频率耳鸣患者与对照组听阈的差异有统计学意义（P〈0．01）,12～20kHz范围内两组听阈检出率差异有统计学意义（P〈0．01）,耳鸣组和对照组耳声发射检出率差异有统计学意义（P〈0．01）。表明耳鸣患者高频听阈明显高于对照组,而耳声发射检出率则明显低于对照组,高频测听能够在早期为耳鸣患者提供听力损失的参考依据。     

经咽鼓管鼓室注入地塞米松治疗难治性突发性聋的临床观察

目的 观察经咽鼓管鼓室内注入地塞米松对难治性突发性聋的治疗效果.方法 对36例(36耳)常规治疗无效的突发性聋患者用电子喉镜经咽鼓管口逆向鼓室内注入地塞米松约5 mg,1次/2d,共5次.在治疗开始前1 d和治疗结束后3 d,分别测试受治疗耳的纯音听阈,比较受损频率纯音听阈均值(PTA),下降15 dB HL以上为有效.结果 36例经治患者20例有效,16例无效,有效率为55.56%.治疗前PTA为(71.63±10.60)dB HL,治疗后为(43.07±12.33)dB HL,治疗后比治疗前明显降低(P<0.05).结论 经咽鼓管逆行鼓室内注入地塞米松可作为常规治疗无效的突发性聋患者的再次挽救治疗的有效手段,也可以作为对激素治疗有禁忌证的突发性聋患者的治疗方法.     

慢性化脓性中耳炎老年患者的听力损害

目的慢性化脓性中耳炎和老化均可导致听力损害,本文探讨了慢性化脓性中耳炎老年患者的听力学损害特征。方法回顾性研究了2007年4月至2010年5月,上海交通大学附属第六人民医院耳鼻咽喉科手术治疗的单侧慢性化脓性中耳炎老年患者39例（≥60岁）和中青年患者30例（30至40岁）,分析两组患者在术前言语频率和4kHz纯音听阈以及疾病所致并发症、术后病理和治疗费用等方面的差异。结果老年组患耳言语频率气导、骨导纯音听阈,4kHz气导、骨导纯音听闽均高于中青年组,差异具有统计学意义（均P〈0．01）。分别以相对健侧耳为自身对照,计算了两组患者的耳间听阈差值,以排除组间年龄因素对听力的影响,发现两组间的耳间言语频率气导听闽差值差异无统计学意义（P=0．160）,撕老年组的耳间言语频率骨导听阈差值高于中青年组（P=0．014）。老年组患者的并发症发生率及治疗费用均高于中青年组（P〈0．05）。结论慢性化脓性中耳炎对老年患者的内耳感音功能损害更为严重,疾病所致并发症的发生率和所需治疗费用较高。本研究提示了慢性化脓性中耳炎早期诊治的必要性。     

低频重复经颅磁刺激联合高压氧治疗老年患者神经性耳鸣的疗效

目的观察低频重复经颅磁刺激(rTMS)联合高压氧治疗对老年神经性耳鸣患者相关症状的治疗效果。方法选取老年神经性耳鸣患者58例,随机分为两组,均进行常规药物治疗,治疗组29例,给予低频rTMS联合高压氧治疗,对照组29例,给予高压氧治疗,低频rTMS患者行耳鸣同侧颞顶叶皮质1 Hz rTMS磁刺激,每天40次×40次,共20 d。两组患者均于治疗前、治疗20 d后,采用耳鸣致残(THI)量表、阿森斯失眠(AIS)量表及目测类比法(VAS)进行评估。对治疗前后两组患者的THI评分、AIS评分和VAS评分进行比较。结果治疗前,两组THI评分、AIS评分和VAS评分比较差异无统计学意义(P0.05)。治疗20 d后,治疗组的THI、AIS评分和VAS评分显著低于治疗前和对照组(P0.05)。治疗20 d后,治疗组中有19例患者THI评分降幅≥20分,有效达65.5%;对照组有12例患者THI评分降幅≥20分,有效率为41.4%,组间比较,差异有统计学意义(P0.05)。结论 rTMS联合高压氧治疗可以显著改善老年神经性耳鸣患者临床症状。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。