影像学技术、计算机技术在血管性认知障碍诊断及康复治疗中的应用

目的:综述血管性认知障碍的研究进展,以便预防和治疗血管性认知障碍,提高血管性认知障碍患者的生活质量。资料来源:应用计算检索万方数据库2002-01/2007-01与血管性认知障碍相关的文章,检索词“血管性认知障碍、轻度认知障碍、血管性痴呆、虚拟现实技术、无错性学习、远程康复”,限定语种为中文;同时应用计算机检索Pubmed 1998-01/2007-01的相关文章,检索词为vascular cognitive impairment,virtual reality,errorless learning,telerehabilitation,并限定文章语言种类为English。资料选择:就检索到的100余篇文献进行筛选,选取与血管性认知障碍相关的文章。资料提炼:共收集到相关文章34篇,将筛选到的文献分类,其中认知障碍诊断进展的22篇,康复治疗的12篇。资料综合:血管性认知障碍患者通过磁共振血流灌注加权成像、磁共振波谱成像、弥散加权成像、放射性核素功能显像等影像学检查都会呈现不同程度的异常。神经心理学测验、虚拟现实技术以及计算机辅助技术的应用能够探测到非常细微的认知功能损害,使这部分患者得到早期的诊断,加以治疗,可阻止或延缓痴呆的发生。无错性学习的应用和远程认知康复治疗可使患者的认知功能障碍和功能性活动得到良好的改善。结论:血管性认知障碍对日常生活活动能力影响很大,应对其进行早期的预防、诊断和相应的康复治疗以提高患者的生活质量。     

Intestinal Kaposi''''s sarcoma may mimic gastrointestinal stromal tumor in HIV infection

Diffuse intestinal Kaposi's sarcoma shares macroscopicand histopathologic features with gastrointestinal stromatumors. Correct diagnosis may pose a clinical challengeWe describe the case of a young HIV-1-infected Africanlady without advanced immunodeficiency, who presentedwith a diffuse spindle cell tumor of the gut. Initiadiagnosis was of a gastrointestinal stromal tumor, basedon endoscopy and histopathology. Further evaluationrevealed evidence for human herpesvirus 8 (HHV8) andthe diagnosis had to be changed to diffuse intestinaKaposi's sarcoma. Antiretroviral triple therapy togethewith chemotherapy was commenced, and has led to therapid remission of intestinal lesions. With a backgroundof HIV infection, the presence of HHV8 as the causativeagent of Kaposi's sarcoma should be determined, asdistinct treatment is indicated.     

Measurement of transepidermal water loss in Tanzanian cot-nursed neonates and its relation to postnatal weight loss

In healthy cot-nursed Tanzanian neonates ( n = 92, gestation 26–42 weeks) measurements of transepidermal water loss (TEWL) and weight change were performed during the first 24 h after birth at an average ambient humidity of 70% and an environmental temperature of 32°C. Urine production on day 1 (ml/kg per 24h) was documented for a subgroup of 13 preterm and 8 term infants. In a limited group of preterm infants ( n = 5) TEWL measurements, weight and 24 h urine volume measurements were repeated daily for 7 days. Maximum weight loss was determined in 7 preterm (gestational age 30–36 weeks) and 6 term infants. TEWL was estimated by measuring the evaporation rate at three sites of the body using the water vapour pressure gradient method. On day 1, TEWL was highest in the most preterm infants, whereas TEWL and urine production were higher in large for gestational age infants as compared to appropriate for gestational age (AGA) infants of the same gestational age (31–36 weeks). For the whole group, weight loss on day 1 was correlated with TEWL ( r = 0.49, p <0.05). At follow-up TEWL in preterm infants remained almost constant during the first 4 days and decreased after the fourth day, at which time weight gain commenced. Preterm AGA infants (gestational age 24–37 weeks) showed a mean postnatal weight loss of 4.4% of the birth weight, while in term infants this loss was only 2.6%. A reduced postnatal weight loss as compared to Caucasian infants may be explained by a lower water loss during the first days after birth, through both skin evaporation and urine excretion.     

'Inappropriate' attenders at accident and emergency departments II: health service responses

BACKGROUND: Health services have responded to perceived 'inappropriate' attenders at accident and emergency (A&E) departments in three ways. Firstly, they have responded by attempting to decrease the numbers of patients attending A&E departments. There is little evidence supporting the efficacy of such policies. Secondly, they have responded by referring inappropriate attenders to another site. Research indicates that whilst such referral may be feasible, resultant decreases in departmental workloads have yet to be demonstrated. Patient outcome has also to be determined. Thirdly, by performing triage of attenders they provide care appropriate to their needs. Sessional GPs working in A&E departments manage non-emergency A&E attenders safely and use fewer resources than do usual A&E staff. Long-term effects on health-seeking behaviour and patient perception of the distinction between primary care services have yet to be determined. CONCLUSIONS: Rather than vainly attempting to make the patients appropriate to the service, future initiatives should concentrate on making the A&E service more appropriate to the patient.      

Postdialysis fatigue: lack of effect of a biocompatible membrane

Tumor necrosis factor-alpha (TNF-alpha) has been shown to have somnogenic properties. Plasma levels of this cytokine have been found to increase significantly during dialysis with a bioincompatible (cuprophane) membrane in patients with postdialysis fatigue (PDF). We conducted a crossover study with random assignment to ascertain whether a biocompatible membrane might attenuate the increase of TNF-alpha and severity of PDF. Sixteen patients on maintenance hemodialysis underwent dialysis with either cuprophane (n = 8) or polymethylmethacrylate (PMMA; n = 8) membranes for 1 week and then switched to the opposite membrane during the second week. Predialysis and postdialysis measurements of plasma TNF-alpha levels were performed during the first and last dialysis treatments of each week. A fatigue score was determined from the sum of duration of fatigue and sleep within 6 hours of the completion of dialysis. TNF-alpha levels increased by an average of 18.3% during dialysis with cuprophane membranes but only 2.4% with PMMA membranes (P = 0.04). Despite this, fatigue scores remained unaltered (approximately 4 of 6). Hence, the biocompatible membrane, PMMA, failed to alleviate PDF. This suggests that dialytic stimulation of TNF-alpha plays no substantial role in the pathogenesis of PDF.