Issues in selecting outcome measures to assess functional recovery after stroke

Most patients who survive a stroke experience some degree of physical recovery. Selecting the appropriate outcome measure to assess physical recovery is a difficult task, given the heterogeneity of stroke etiology, symptoms, severity, and even recovery itself. Despite these complexities, a number of strategies can facilitate the selection of functional outcome measures in stroke clinical trial research and practice. Clinical relevance in stroke outcome measures can be optimized by incorporating a framework of health and disability, such as the International Classification of Functioning, Disability, and Health (ICF). The ICF provides the conceptual basis for measurement and policy formulations for disability and health assessment. All outcome measures selected should also have sound psychometric properties. The essential psychometric properties are reliability, validity, responsiveness, sensibility, and established minimal clinically important difference. It is also important to establish the purpose of the measurement (discriminative, predictive, or evaluative) and to determine whether the purpose of the study is to evaluate the efficacy or effectiveness of an intervention. In addition, when selecting outcome measures and time of assessment, the natural history of stroke and stroke severity must be regarded. Finally, methods for acquiring data must also be considered. We present a comprehensive overview of the issues in selecting stroke outcome measures and characterize existing measures relative to these issues.     

ApoMT对CdMT肾毒性保护作用研究

本文研究了去除金属离子的金属硫蛋白（ApoMT）对镉金属硫蛋白（CdMT）肾毒性作用的影响。结果发现，与单独给予CdMT比较，ApoMT能降低尿蛋白量和尿碱性磷酸酶（AKP）活性，并能促进尿Cd的排泄。肾组织形态学结果显示肾近曲小管损伤程度明显减轻。提示ApoMT对CdMT肾小管损伤具有保护作用。     

全肺切除术治疗肺癌的临床分析

目的 :探讨全肺切除术和经心包内处理血管的全肺切除术治疗肺癌的效果。方法 :对 74例Ⅱb～Ⅲb期肺癌患者行全肺切除术 ,其中 32例在肺癌的全肺切除术中进行了心包内处理血管 ,其余 4 2例行标准全肺切除术。结果 :心包内处理血管组与标准切除组术后各有 1例并发脓胸 ,其中心包内处理血管组的并发脓胸者死亡。术后两组分别随访 2 2例和 31例 ,5年生存率分别为 18.1%和 16 .1%。经心包内处理血管的全肺切除与标准全肺切除术患者 5年生存率和术后并发症发生率差异均无显著性 (P =1.0 0 0和P >0 .0 5 )。结论 :全肺切除术中力争达到根治 ,经心包内处理血管技术的应用 ,对于提高患者的生存率、改善晚期肺癌的生活质量是有价值的     

超声诊断不典型胃穿孔1例

<正> 患者男性,52岁,突发上腹痛6 h来诊。疼痛呈持续性,无放射痛,无呕吐、腹泻、黄疸。既往有胃溃疡病史。查体:神清,T37.8℃,痛苦面容,平卧位,巩膜皮肤无黄染,心肺(-),上腹部压痛,轻度肌卫,无反跳痛,肝浊音界存在,移动性浊音(-),肠鸣音减弱。化验:WBC12.0×10~9/L、中性0.87。腹     

大肠埃希氏菌和肺炎克雷伯菌AmpC酶及ESBLs酶的检测及耐药性分析

目的：了解我院大肠埃希菌和肺炎克雷伯菌产AmpC酶和产ESBLs的情况及耐药性分析，为临床合理用药提供依据。方法：分别采用改良三维试验和CLSI／NCCLS推荐的纸片扩散法确证试验，检测大肠埃希菌和肺炎克雷伯菌产AmpC酶和产ESBLs菌株。结果：大肠埃希菌和肺炎克雷伯菌单产AmpC酶菌株检出率分别为9．3％和4％，单产ESBLs检出率分别为28％和12％，同时产AmpC酶及ESBLs检出率分别为14．7％和0。两种菌单产AmpC酶和单产ESBLs的菌株以及同时产两种酶的菌株对亚胺培南保持较低耐药率，均低于15％，而对其它类抗菌素大于50％，耐药率均较高。两种菌产酶株与不产酶菌株耐药率相比，均有显著性差异（P〈0．01）。结论：产酶株耐药情况严重，应慎重选择用药，减缓耐药菌株的进一步发生发展。     

q-Space diffusion of myelin-deficient spinal cords.

The apparent water diffusion anisotropy in white matter (WM) of excised spinal cords of myelin-deficient (md) rats and their age-matched controls was studied by high-b-value q-space diffusion MRS and MRI at different diffusion times. Non-monoexponential signal decay was observed at long diffusion times. The mean displacements in the md spinal cords were found to be higher than those of the controls. The apparent anisotropy (AA) of the fast-diffusing component was found to decrease more dramatically with the increase in diffusion time for the md spinal cords as compared with controls, whereas the AA of the slow-diffusing component in the controls was found to increase with the increase in diffusion time while that of the md cords decreased with the increase in diffusion time. When diffusion MRI was performed, similar diffusion anisotropy was extracted for the md and control spinal cords at diffusion times of 22 and 50 ms. Only at a diffusion time of about 200 ms was a significant difference obtained in the AA of the two groups. This originates from the much smaller increase in the mean displacement perpendicular to the fiber direction in the control group vs. the md group when the diffusion time was increased.     

年龄小于45岁原发性慢性闭角型青光眼的显微手术治疗

目的探讨原发性慢性闭角型青光眼年轻患者临床治疗的经验和体会。方法对临床收治的41例52眼、年龄〈45岁、临床确诊为进展期或晚期原发性慢性闭角型青光眼的病例进行抗青光眼显微手术处理的病例进行回顾性分析。结果随访时间平均（32．50±5．08）个月；男16例，女25例；进展期28眼，晚期24眼；52眼均行抗青光眼手术-复合式小梁切除手术治疗；眼轴长平均（22．40±1．63）mm，其中〈21mm占17．31％，小眼球占13．46％；前房深度平均（1．90±0．39）mm，其中〈1．9mm占61．46％；超声生物显微镜检查高褶虹膜构型占59．62％，其中睫状突位置靠前者10眼；术前平均眼压（41．73±12．26）mmHg，末次术后平均眼压（12．03±4．57）mmHg，术前后眼压差异有统计学意义（t=3．520，P〈0．001）。术后并发症主要有浅前房，恶性青光眼。恶性青光眼手术处理方式包括玻璃体抽液、前段玻璃体切割以及超声乳化白内障吸除加人工晶状体植入术治疗。4眼因眼压控制不理想，行二次抗青光眼手术治疗。结论年轻原发性慢性闭角型青光眼患者，女性多见，多伴有眼轴短、前房浅等特点，抗青光眼复合式小梁手术治疗要注意防治术后浅前房、恶性青光眼的发生。术前详细检查、手术操作精细以及有效处理术后并发症将有助于提高手术成功率和减少并发症。     

阴茎包埋对海绵体内一氧化氮合酶的影响

目的:探讨阴茎包埋对海绵体内一氧化氮合酶(NOS)活性的影响。方法:通过建立大鼠隐匿阴茎模型获得实验标本,分2个月组、4个月组和6个月组进行观测,每组80只大鼠。各阶段中包括包埋组(n=50)、假手术组(n=15)和正常组(n=15)。称量大鼠体重和海绵体重量后,采用化学比色法检测海绵体内NOS活性。结果:各阶段包埋组阴茎海绵体重量、体重及两者的比值与正常组和假手术组比较均无显著性差异(P>0.05);包埋降低大鼠阴茎海绵体组织的NOS活性(2个月组P>0.05,4个月组P<0.05,6个月组P<0.01)。结论:阴茎包埋可影响海绵体内NOS活性,且与包埋时间呈正相关,但对海绵体外观和重量无明显影响。     

肌病肾病代谢综合征治疗进展

肌病肾病代谢综合征是急性动脉阻塞致骨骼肌溶解的严重并发症。积极治疗原发病，及早补液扩容、碱化尿液、早期血液净化治疗是降低截肢率、病死率的关键。本文就肌病肾病代谢综合征治疗进展作一综述。