心脏围手术期甲状腺激素水平变化的临床研究

为观察心脏围手术期甲状腺激素水平的变化并探讨其临床意义, 对20例心脏手术患者于手术前后各时间点取静脉血标本, 利用放射免疫法测定甲状腺激素水平. 结果发现, 体外循环(cardiopulmonary bypass, CPB)期间以及术后血浆三碘甲状腺原氨酸(T3)、甲状腺素(T4)及游离三碘甲状腺原氨酸(FT3)均明显降低: T3及T4在转流至最低体温时达到最低, 术后5天水平仍明显低于术前; 促甲状腺激素(TSH)及游离甲状腺素(FT4)水平手术前后无明显变化. 结论: 体外循环手术对甲状腺功能有严重影响, 使患者处于低T3综合征状态, 而低T3综合征对术后心功能可能产生不利影响.     

窒息新生儿甲状腺激素测定及临床意义

为观察窒息对新生儿甲状腺功能的影响及其临床意义,本文对21例窒息后新生儿血清促甲状腺激素(TSH)、三碘甲状腺素(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)进行了测定,现报告如下.     

乌鲁木齐健康成年人不同年龄组四项甲状腺激素和TSH测定

本文对8105名乌鲁木齐市健康成年人测定血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺素(TSH).探讨本市不同年龄组血清五项激素的变化规律.     

新生儿呼吸窘迫综合征、新生儿肺炎患儿甲状腺激素水平分析

目的分析新生儿呼吸窘迫综合征、新生儿肺炎患儿甲状腺激素水平。方法 42例新生儿呼吸窘迫综合征者为呼吸窘迫组; 57例新生儿肺炎为肺炎组; 60例健康新生儿为对照组。采用电化学分析法检测患儿血清的甲状腺激素,包括总三碘甲状腺素原氨酸(T3)、总甲状腺素(T4)、游离总三碘甲状腺素原氨酸(FT3)、游离总甲状腺素(FT4)、促甲状腺激素(TSH)。结果呼吸窘迫组患儿血清的T3、T4、FT3、FT4、TSH水平均低于对照组,差异显著(P 0. 05);肺炎组患儿血清的T3、T4、FT4水平均低于对照组,FT3、TSH水平均高于对照组,差异显著(P 0. 05)。结论新生儿呼吸窘迫综合征、新生儿肺炎患儿的甲状腺功能异常,与病情及预后密切相关,及时检测患儿的甲状腺激素水平,评估病情、指导治疗均具有积极作用。     

老年性疾病患者TSH、T3、T4、FT3、FT4测定的临床应用

目的：探讨老年性疾病患者血清TSH、T3、T4、FT3、FT4测定的临床应用。方法：选择30例无老年性疾病和233例患有冠心病（CHD）、慢性阻塞性肺病（COPD）、糖尿病（DM）、脑梗、慢性支气管炎老年性疾病的患者,分别用化学发光免疫法（CLIA）测定血清促甲状腺激素（TSH）、三碘甲腺原氨酸（L）、甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）。结果：常见老年性疾病患者T3、FT3水平明显低于健康对照组水平（P〈0．01）,并与病情程度成相关关系,尤以T3值更为显著降低。TSH根据各病情、年龄的不同较健康对照组有所改变,而各组T4、FT4水平与健康对照组无明显差异（P〉0．05）。结论：常见老年性疾病呈现低T3、FT3,而TSH略有上升易误诊为甲减,其实为低T3综合征,即甲状腺正常的疾病综合征（SES）。同时动态观察血清甲状腺激素的变化,有一定的反映病情状况及观察预后的作用。     

围手术期急性阑尾炎患者甲状腺激素及TSH测定的意义

急性阑尾炎是最常见的急腹症之一,有关本病血清皮质醇、儿茶酚胺、胰岛素等激素水平的变化研究较多[1],但急性阑尾炎围手术期甲状腺激素及TSH水平的变化,国内外报道甚少.为此,作者对52例急性阑尾炎患者进行围手术期血清三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、反T3(rT3)、促甲状腺激素(TSH)测定,以期探讨本病患者血清甲状腺激素及TSH水平的变化规律及其临床意义.     

分化型甲状腺癌术后激素水平变化及对促甲状腺激素抑制治疗的指导

目的探讨分化型甲状腺癌手术治疗后血清三碘甲状腺原氨酸(T3)、甲状腺激素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)和促甲状腺激素(TSH)水平随时间的变化及其对促甲状腺激素抑制治疗的指导价值。方法选取2012年1月至2017年12月于我院接受手术治疗的分化型甲状腺癌患者120例,依据手术方式的不同将患者分为甲状腺全切除组(n=55)和患侧腺叶及峡部切除组(n=65),于术后第1、2、4、6、8、14天检测2组患者T3、T4、FT3、FT4和TSH水平。结果甲状腺全切除组患者术后血清T3和FT3总体呈下降趋势,但术后第6天一过性增高,高于术后第4天水平,术后第14天血清T3和FT3低于正常参考范围。术后至第4天血清T4、FT4呈上升趋势,之后呈下降趋势,于术后第14天低于正常参考范围。血清TSH于术后第2天开始升高,于术后第6天超过正常参考范围,至术后第14天呈上升趋势。患侧腺叶及峡部切除组患者血清T3、FT3水平于术后第6天前呈下降趋势,术后第6天至14天呈上升趋势,第14天时其水平低于正常参考范围;血清T4、FT4于术后第2天达高峰后下降,术后第14天处于正常范围;术后血清TSH于术后4天内呈下降趋势,至术后第8天超过术前水平,术后第14天达正常参考值上限。结论分化型甲状腺癌手术治疗后其甲状腺相关激素呈动态变化规律,临床上应根据其变化规律确定促甲状腺激素抑制治疗时机。     

甲亢患者围手术期T3、T4、FT3、FT4、TSH值的变化探讨

本文对30例甲亢手术病人做前瞻性围手术期血清三碘甲状腺原氨酸(简称T3)，甲状腺案(简称T4)，游离三碘甲状腺原氨酸(简称FT3)，游离甲状腺素(简称FT4)，促甲状腺素(简称TSH)值测定，探讨其变化规律。     

新生儿高胆红素血症甲状腺功能改变及意义

目的探讨新生儿高胆红素血症(简称高胆)对甲状腺功能的影响。方法对162例高胆新生儿采用竞争性放射免疫法进行血清甲状腺功能即三碘甲腺原氨酸(triiodothyronine,T3)、甲状腺素(thyroxine,T4)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(thyroid-stimulating hormone,TSH)测定,对照组参照文献结果。按黄疸程度分为轻度、中度、重度三组比较。结果轻、中度高胆组T4、FT3低于对照组(P<0.01),T3、FT4、TSH与对照组比较差异无显著性(P>0.05);重度组FT3、FT4、TSH低于对照组(P<0.05～0.01),T3、T4与对照组比较差异无统计学意义(P均>0.05)。高胆新生儿甲状腺功能T3、T4、FT3、FT4、TSH与TSB水平无明显相关性(P均>0.05)。结论新生儿高胆可引起甲状腺功能降低,T4和FT3降低可能是高胆新生儿甲状腺损害的敏感指标,FT4降低对预警病情严重有意义。     

垂体腺瘤切除术患者术前术后甲状腺激素测定的意义

目的：探讨垂体腺瘤患者术前、术后血清中甲状腺激素的变化,分析其临床意义。方法：从垂体肿瘤手术病人中,筛选出病理诊断为垂体腺瘤患者纳入分析。50例垂体腺瘤切除术患者均做血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、人血清3,3’,5’-三碘甲腺原氨酸（rT3）的水平测定。结果：垂体腺瘤病人术前FT4、rT3明显低于正常人,FT3、TSH与正常人无显著性差异,和术前比较,垂体腺瘤切除术后FT3明显下降,rT3明显回升,FT4、TSH变化不明显。结论：术前、术后测量甲状腺激素水平有助于监测甲状腺功能恢复情况,以协助判断手术效果。     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

The Beauty of the Network in the Brain and the Origin of the Mind in the Control of Behavior

Behavior is not adequately described as a stimulus-response process. It is initiated by the animal and is generated because of its expected outcome in the future. The outcome can be good or bad for the animal. The brain is in charge of the selection process. This is the basic function of the brain. Taking Drosophila as a study case, this paper discusses initiating activity, several examples of outcome expectations, trying out (the internal search for a suitable behavior), chaining of actions, and the functional roles of chance in action selection. It takes mental processes and states such as goals, intentions, feelings, memories, cognition, and attention as higher levels of behavioral control that have their origin in biological evolution.     

Adequate function of the cell: Interactions between the needs of the cell and the needs of the organism

The continuous maintenance of cell adequate function (cellular stress) is considered to be the main feature which characterizes the activity of a live cell. In accordance with the concept of cellular stress, the transition of the cell to the state of adequate funcitoning represents a dual commitment. The cell must function adequately to respond to the demands of the organism and to provide for its own needs. Thus, it is proposed that two systems exist for the regulation of the adequate function of the cell: one enabling the cell to respond to the demands of the organism, and the other providing for the needs of the cell itself. The hormonal system of the organism represents the first of these mechanisms, and I believe that another system exists for regulation of intracellular needs. Adequate function of the cell is determined by the regulative, controlling and defense mechanisms. The balance between the needs of the cell and of the organism should be a concern of physician, since it provides for the optimal function and health of the organism as a whole.     

On the development of the sympathetic chain and the adrenal medulla in the mouse

Summary The first visible primordia of the sympathetic chain appear in the anterior thoracic region and run caudally through 8 segments in an embryo of 11 gestation days. At 12 gestation days the trunk reaches from the base of the skull into the sacral region. During the following days the trunk develops into ganglia with interganglionic fibers.At 16 gestation days there is a well developed trunk with a cranial ganglion cervicale superior and a ganglion stellatum in the anterior part of the thoracic region. In the remaining sympathetic chain there are segmentally arranged ganglia but in this common pattern large differences are noticed.At the 13th gestation day the first signs of the adrenal medulla and the splanchnic plexus appear in the form of sympathoblasts ventral to the sympathetic chain. The migration of sympathoblasts into the primordia of the adrenal cortex goes on for 3 days while the migration to the splancnic plexus in the mesenchym ventral and lateral to the aorta goes on at least 2 more days.     

指背腱膜滑动与近侧指间关节屈曲关系及临床意义

目的:探讨指背腱膜滑动距离与近侧指间关节(PIP)屈曲关系,为临床修复提供解剖学基础。方法:男性成人新鲜尸体标本10侧30指(示、中、环指各10指),切除手指皮肤,不破坏腱鞘、屈肌支持带、伸肌支持带、内在肌及外在肌,使肌腱保持正常的生理状态,分别测量各指中央束(CS)、侧束(LB)在PIP屈曲45°和90°时的滑动距离。结果:当PIP屈曲45°时,CS滑动距离为(2.7±0.4)mm,LB滑动距离为(2.8±0.6)mm;当PIP屈曲90°时,CS滑动距离为(4.3±0.7)mm,LB滑动距离为(4.8±0.6)mm。结论:指背腱膜滑动距离减少,严重影响手指的屈曲功能。对于指背腱膜的新鲜性损伤应予以精确修复;对于陈旧性损伤的修复应确保指背腱膜的正常滑动范围。     

Anatomical relationship between the morphology of the styloid process of the ulna and the attachment of the radioulnar ligaments

The radioulnar ligaments are the major stabilizers of the distal radioulnar joint under dynamic loading; however, anatomical detail regarding their attachment on the middle and distal thirds of the styloid process of the ulna remains unclear. Because previous anatomical studies included only old cadavers, their anatomical findings might not reflect the morphological features of younger and healthy specimens. This study investigated the anatomical features of the distal ulna, particularly the styloid process, to determine the attachment of the radioulnar ligaments to the styloid process and verified their direction and attachment to the styloid process in younger and healthy donors using magnetic resonance imaging (MRI). We investigated the morphological features of the distal ulna of 12 cadaveric wrists using micro-computed tomography (micro-CT). We also visualized and measured the distribution of the cortical bone thickness. We histologically analyzed three specimens in the axial plane and macroscopically analyzed seven specimens to examine the attachment of the radioulnar ligaments to the styloid process. In addition, we evaluated five wrists from living volunteers using 3.0 Tesla MRI. The distal ulna has a ridge on the dorsoradial aspect of the styloid process that corresponds to the attachment of the radioulnar ligaments. Micro-CT images after data processing revealed that the cortical thickness of the dorsoradial quadrant was thicker than that of the other quadrant at the proximal slice of the styloid process (p < 0.01), and that of the dorsoulnar (p = 0.021) and ulnopalmar (p < 0.01) quadrants at the middle slice. Histological analyses showed that the radioulnar ligaments were attached to the middle and distal thirds of the styloid process via chondral-apophyseal entheses. The direction of the fiber was dorsal in the middle third of the styloid process and changed to palmar in the distal third of the styloid process. The direction and attachment of the radioulnar ligaments on the styloid process were confirmed using MRI for younger and healthy participants. The radioulnar ligaments were attached to the dorsoradial ridge of the styloid process, which was confirmed by cortical bone thickening, histology at the attachment sites, and in vivo MR imaging. The directions of the radioulnar ligaments sterically intersected, which would satisfy both slipping stability and rotational mobility. These anatomical findings may provide the basis for biomechanical consideration of distal radioulnar joint stabilization.     

On the musculature of the gastro-intestinal tract of the guinea-pig

Summary The small intestine, caecum, colon and part of the stomach of guinea-pigs were studied by light microscopy, using semithin sections of plastic embedded specimens. The muscular coat is thicker in the duodenum than in the rest of the small intestine. The ratio between longitudinal and circular muscle is 1:4.6 in the duodenum and it increases regularly along the small intestine, to reach 1:2 in the terminal ileum. In the caecum, shape and sectional area of the muscle tissue were analyzed along the full length of the taeniae. In the caecal circular muscle there is a characteristic change in the arrangement of the muscle bundles from the regions in the centre of the haustrations to the regions of the grooves between haustrations or to those lying beneath a taenia. The functional significance of the taeniae is discussed in terms of an arrangement allowing reduction of the lumen of the organ (which at the level of the grooves between haustrations acquires a triangular outline) more efficiently than if the longitudinal musculature were spread over the entire surface of the organ. Haustrations are present also on one side of the wall of the ascending colon where there is no longitudinal muscle layer. In the descending colon the structure of the wall is examined in different functional states, namely in the regions between fecal pellets (constricted regions) and in the regions around a fecal pellet (moderately distended regions). The musculature increases considerably in thickness in the constricted regions (both muscle layers being actively contracted), while the mucosa and submucosa are thrown into prominent longitudinal folds. These folds produce occlusion of the lumen when the circular muscle has shortened by about 50%.     

On the origin of the corticotectal projections in the cat

Summary Stereotaxic injection of horseradish peroxidase into the superior colliculus produced retrograde labelling of layer V pyramides in the Clare Bishop area and the lateral bank of the suprasylvian sulcus, in area 17,18 and 19. Single labelled cells were also found scattered in the splenial, the suprasplenial, the lateral and the suprasylvian gyri. In the cruciate sulcus no labelled cells were observed. Autoradiographically, the lateral bank of the suprasylvian sulcus was also shown to give rise to fibres to the superior colliculus.