国内高压氧联合药物治疗突发性耳聋临床疗效的Meta分析

目的评价近几年来国内高压氧联合药物综合疗法治疗突发性耳聋的临床疗效。方法检索2008²012年近五年来中国学术期刊、中国数字图书馆、维普信息资源系统、超星数字图书馆、中国生物医学文献数据库、万方数据库中关于高压氧联合药物综合治疗突发性耳聋的随机对照研究,对符合纳入标准的文献进行方法学的评价,并用RevMan5.1软件对符合质量标准的随机对照研究进行Meta分析。结果纳入了20个随机对照研究,患者总数为2554例,其中有1347例接受高压氧联合药物治疗,即治疗组,另外1207例接受药物单纯疗法,即对照组。通过Meta分析表明治疗组比对照组的临床疗效显著(P<0.00001),而且早期使用高压氧治疗比晚期使用的临床疗效显著(P<0.00001)。结论在突发性耳聋的治疗过程中,应用高压氧联合药物综合疗法比药物单纯疗法的效果要显著,而且引入高压氧治疗的时间越早效果越好。     

药理学课程引入小专论的教学实践探讨

文中介绍了将撰写小专论引入八年制医学生的药理学教学实践，井分析撰写小专论对转变教学观念、提高学生的学习兴趣、自主学习能力以及综合素质培养的作用。我系将小专论作为考核的一种重要形式纳入到整个教学过程，药理学课程总成绩中，期中和期末闭卷考试成绩占70％，小专论撰写成绩占30％，此考试形式的改革，提高了学生的成绩，学生反映这种综合成绩的评定更为客观、全面和均衡。     

姜黄素对慢性应激大鼠不同脑区促肾上腺皮质激素释放因子表达的影响

目的为探讨姜黄素可能的抗抑郁作用机制,观察姜黄素对慢性应激大鼠不同脑区促肾上腺皮质激素释放因子(CRF)表达的影响。方法采用不同应激方式交替、持续应激20d,制成大鼠慢性应激损伤模型,用开野实验、逆转录聚合酶链反应测定大鼠给姜黄素(2.5,5和10mg·kg-1,po,每日1次,共21d)前后行为的改变以及下丘脑、海马及额叶皮质中CRFmRNA的表达。结果慢性应激模型组大鼠在开野实验中5min内穿越格数、探究次数均显著减少;给予姜黄素后,应激大鼠穿越格数、探究次数均较应激对照组不同程度的增加。慢性应激模型组大鼠下丘脑、海马和额叶皮质中CRFmRNA表达均较正常对照组明显升高;姜黄素可以明显逆转上述脑区CRFmRNA表达的改变。结论姜黄素对慢性应激大鼠的活动性有明显的改善作用,这一作用很可能与逆转慢性应激大鼠不同脑区的CRFmRNA的异常表达有关。     

Acute scrotal swelling: A sign of neonatal adrenal haemorrhage

Two neonates presented with acute scrotal swelling suggestive of testicular torsion. Surgical exploration in one patient revealed an infected haematoma. Subsequent investigations including ultrasonography and urinary catecholamine determination disclosed adrenal haemorrhage as the cause of the scrotal haematoma. A second patient in whom a purplish discolouration of the right hemiscrotum was noted was also investigated with ultrasonography, which revealed a normal right testis and a right adrenal haematoma. Both cases of adrenal haemorrhage resolved spontaneously on conservative treatment. Adrenal haemorrhage should be considered as a possible cause of acute scrotal swelling in neonates. Ultrasonography assessment should be performed in such cases to examine the intra-abdominal organs especially the adrenal glands.     

食管癌742例的内镜检查及病理分析

目的:探讨食管癌近年来的发病情况、病理特点及诊断方法.方法:回顾性分析近5年来742例食管癌的内窥镜检查(简称内镜)及病理资料.结果:742例食管癌中,男545例,女197例,男女之比为2.77:1.上段癌98例,中段癌478例,下段癌166例.病理类型:鳞癌725例,腺癌15例,小细胞癌2例.结论:近年来食管癌的发病人数增加,男性发病比女性多.病理仍以鳞癌为主.加强对高危人群的普查和内镜检查.可提高对食管癌的早期诊断.     

Serial immunoreactive erythropoietin levels in autologous blood donors

The variations in plasma erythropoietin (EPO) concentration during preoperative deposit of autologous blood were studied in 12 patients (8 men, 4 women). Four donations were scheduled at weekly intervals. A predonation hemoglobin concentration of 11 g per dL (110 g/L) was required. Hemoglobin concentration decreased from 14.3 +/- 1.1 g per dL (143 +/- 11 g/L) (mean +/- SD) before the first donation to 11.7 +/- 0.7 g per dL (117 +/- 7 g/L) on Day 22 (p less than or equal to 0.0001). Reticulocyte counts increased from a median of 31,800 (range, 4900-95,000) per microL (median, 32 x 10(9)/L [range, 5-95 x 10(9)/L]) to 93,800 (16,800-194,900) per microL (median, 94 x 10(9)/L [range, 17-195 x 10(9)/L]) on Day 28 (p less than or equal to 0.01). Plasma EPO concentration was 17.8 +/- 5.1 mU per mL prior to the first donation and displayed a small and transient peak after each donation. A sustained elevation followed each peak. Although plasma EPO concentration differed significantly from the baseline value after the first donation, only the peak concentrations after the second (35.5 +/- 15.5 mU/mL), third (38.0 +/- 14.5 mU/mL), and fourth (36.1 +/- 11.0 mU/mL) donations exceeded the normal range. The moderate, biphasic increase in plasma EPO concentration and the moderate increase in erythropoiesis suggest two strategies in autologous blood donation that should be investigated with respect to efficiency and safety: 1) more aggressive donation schemes, which reduce donation intervals and/or the minimum hemoglobin concentration and 2) the administration of recombinant human EPO.     

基于TBLT培养中医学专业学生中西融合临床思维方法

院校式中医医学教育取得了巨大成就,但依然存在一些不足,中医医学生临床基本功和临床实践能力不足,没有建立正确临床思维方法,中医疗效没有保障,成为中医医师更加晚熟的原因之一。本文基于任务型教学法(Task based language teaching,TBLT)的基本原理,从病例开始,逐步引导中医医学生完成疾病诊断与鉴别诊断、证侯诊断、病情评估、预后判断、治疗方案设计,培养中西融合的临床思维方法。     

Altered cardiovascular autonomic regulation after salmeterol treatment in asthmatic children

The effects of therapeutic 4 weeks' inhaled salmeterol treatment on the cardiovascular and respiratory autonomic nervous regulation was studied in 11 asthmatic children using inhaled corticosteroid medication. The study followed a randomized, double-blind, placebo-controlled cross-over design. The salmeterol dose was 50 μg twice daily. The 4-week salmeterol treatment increased baseline heart rate, low-frequency/high-frequency (LF/HF) variability ratio of R–R intervals, LF variability of systolic arterial pressure (SAP) and maximum tidal volume during the deep breathing test, as well as morning and evening peak expiratory flow (PEF) values. The 4-week salmeterol treatment decreased baseline HF variability of R–R intervals. As a response to the acute 600 μg of salbutamol, the changes in heart rate, HF variability of R–R intervals and diastolic blood pressure were significantly smaller after 4 weeks' salmeterol treatment. In conclusion, 4 weeks' therapeutic salmeterol treatment decreases basal cardiovagal reactivity, increases sympathetic dominance in the cardiovascular autonomic balance and improves pulmonary function. A tolerance develops in the cardiovascular response but not in the bronchodilatory response.     

Extubation criteria after weaning from intermittent mandatory ventilation and continuous positive airway pressure

The "traditional" weaning criteria, arterial blood gases, and a number of other physiologic variables were measured in 47 patients to evaluate to what extent reduced ventilatory reserves or extrapulmonary organ dysfunction affect successful extubation. All patients had been weaned from continuous positive airway pressure (CPAP) and from mechanical ventilation according to the intermittent mandatory ventilation (IMV) method; at the time of study, all patients had compromised arterial oxygenation relieved by supplemental inspired oxygen. No significant difference between patients successfully extubated and those who required reintubation was found using the traditional weaning criteria or blood gases. On the other hand, patients who required reintubation had significantly lower urine volume (p less than 0.01), lower respiratory quotient values (p less than 0.05), and a higher incidence of positive blood culture (p less than 0.05). These 3 variables also correlated best to the patients' outcome after extubation.