高龄患者腹部手术围手术期的血糖监测

目的 总结高龄患者围手术期的血糖监测变化规律.方法 回顾性总结近年来156例腹部外科手术患者术前术后的血糖变化.结果 手术当天及术后第1天血糖水平较术前明显升高.结论 高龄患者腹部手术围手术期的血糖监测非常关键,掌握血糖变化规律,合理正确使用胰岛素.使患者的血糖保持稳定,顺利渡过围手术期.     

赖氨酸、脯氨酸和抗坏血酸钙对去卵巢大鼠骨质疏松的预防作用

目的　探讨赖氨酸、脯氨酸和抗坏血酸钙对去卵巢大鼠骨质疏松的预防作用。　方法　 6～ 9月龄雌性大鼠 90只 ,随机分 9组 :盐酸赖氨酸低剂量组 (LL)和高剂量组 (LH) ,脯氨酸低剂量组 (PL)和高剂量组 (PH) ,抗坏血酸钙低剂量组 (CL)和高剂量组 (CH) ,葡萄糖酸钙阳性对照组 (CG)和骨质疏松模型组 (MOD)及假手术组 (SHAM)。术后 4、8、12周取血测酸性磷酸酶 (ACP)、碱性磷酸酶 (ALP)、钙 (Ca)、磷 (P)。　结果　与SHAM和MOD组比较 ,LL组术后体重增加最多 ;LL和LH组血ACP活性〔(2 2 5 0± 1 2 97)U/L〕和ALP活性〔(30 0 3± 136 9)U/L〕增高 ,P <0 0 1;CL组血ALP活性〔(2 94 0± 12 2 2 )U/L〕增高 ,P <0 0 5 ;CH组血Ca〔(2 6 76± 0 0 73)U/L〕升高 ,与SHAM组比较差异有显著性 (P <0 0 5或P <0 0 1)。　结论　赖氨酸和抗坏血酸钙可能对去卵巢大鼠骨质疏松有一定预防作用。     

Sexual activity in Korean male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury

BACKGROUND: The aim of this study was to assess the sexual function and activity in male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury. METHODS: Eighty-nine patients (mean age 37.6 years with a range of 18-66) were included in the study. We requested all subjects to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). RESULTS: Of 89 patients, 60 (67.4%) reported having attempted no sexual intercourse over the past 6 months and 28 (31.5%) presented with IIEF-5 scores less than or equal to 21 points. When subjects were stratified according to the years since injury, 50.0% (16 of 32) with less than 2 years post-injury had no sexual activity, while 77.2 (44 of 57) with 2 years or more post-injury did (P = 0.027). Patients with sexual activity were 40.4% (23 of 57) and 18.8% (6 of 32) in patients who were able and unable to perform self-catheterization, respectively (P = 0.037). Patients with less than 2 years post-injury had 3.3-fold higher risk (odds ratio 3.33; 95% confidence interval 1.01-10.97; P = 0.048) of no sexual activity than those with 2 years or more post-injury on the multivariate model. The other parameters were not appreciably related to sexual activity. CONCLUSION: Our results demonstrate that sexual activity as well as erectile function is poor in this population. In addition, our findings suggest that years since injury may influence sexual activity of patients with spinal cord injury.     

CT血管成像和CT灌注点征的联合应用在选择中等量脑出血超早期手术方式中的价值

目的 探讨联合应用CT血管成像（CTA）、CT灌注（CTP）点征在基底节中等量脑出血超早期抽吸术或开颅手术的手术方式选择中的应用价值。方法 选择中等量基底节脑出血（出血量30~60ml）且家属同意超早期手术治疗221例，根据入院后患者是否同意行颅脑CTA及CTP检查，分为研究组（同意检查者）105例，对照组（不同意检查者）116例，研究组CTA或CTP点征阳性者，入开颅手术亚组32例，CTA和CTP点征阴性者入抽吸亚组73例。对照组根据患者家属知情同意后选择的手术方式，分为开颅亚组39例，抽吸亚组77例。对比研究组与对照组患者治疗效果的差异，评估联合应用CTA、CTP点征在基底节中等量脑出血超早期手术方式选择中的应用价值。结果 研究组有效率、术后血肿增大率、病死率、颅内感染率分别为77.1%、3.8%、3.8%、2.9%，对照组分别为52.6%、18.1%、15.6%、12.1%，2组比较差异有统计学意义。（P<0.05）。结论 联合应用CTA、CTP点征选择基底节中等量脑出血手术方式，可明显改善患者预后。     

褪黑激素对大鼠缺血/再灌注所致脑损伤的保护机制

目的：研究褪黑激素（melatonin, MT）对大鼠全脑缺血（20 min）再灌注后24 h海马CA1区诱导型一氧化氮合酶（inducible nitric oxide synthase , iNOS）的蛋白质水平和再灌注后48h海马CA1区TUNEL阳性细胞数的影响。方法：于大鼠“四动脉结扎法”全脑缺血（20 min）/再灌注后第0、1、2、6小时4个时间点分别腹腔注射MT2.5和10 mg*kg－1两个剂量,各组大鼠再灌后24 h后用免疫细胞化学法检测海马CA1区iNOS蛋白水平,用末端脱氧核糖核苷酸转移酶介导的dUTP缺口末端标记法（TDT mediated dUTP nick end labling, TUNEL）计算了各组大鼠再灌后48 h海马CA1区TUNEL阳性细胞数。结果：MT2.5 mg*kg－1和10 mg*kg－1两个剂量于大鼠全脑缺血（20 min）/再灌注后第0、1、2、6小时4个时间点分别腹腔注射可降低再灌注24 h大鼠海马CA1区iNOS的蛋白水平,并减少再灌注48 h海马CA1区TUNEL阳性细胞数。结论：降低iNOS的蛋白质水平可能是MT对缺血敏感区神经细胞发挥保护效应的机制之一。     

A gene for autosomal recessive nemaline myopathy assigned to chromosome 2q by linkage analysis

Clinical genetic evidence suggests the existence of an autosomal recessive form of congenital nemaline myopathy in addition to the autosomal dominant one(s). One mutation in an Australian kindred has been identified as causing an autosomal dominant form of the disease. This mutation in the alpha-tropomyosin gene TPM3 has previously been excluded as causing autosomal recessive nemaline myopathy.

We searched systematically for genetic linkage to autosomal recessive nemaline myopathy (NEM2) by studying microsatellite marker alleles in seven multiplex families from Finland, Denmark, Wales, England and The Netherlands. Significant evidence of linkage was found to markers on chromosome 2q, the highest multipoint lod score value being 5.34 for the marker D2S151. Recombinant genotypes in affected individuals demarcate the region in which the NEM2 gene is likely to reside as a 13 cM region between the markers 132S150 and D2Sl42.

These results confirm the existence of at least one distinctive form of autosomal recessive nemaline myopathy and provide a basis for the identification of its gene.     

后路减压植骨融合椎弓根内固定治疗胸腰椎爆裂骨折的临床疗效

目的：研究后路减压植骨融合椎弓根内固定疗法在胸腰椎爆裂骨折治疗中的临床疗效。方法：选择120例胸腰椎爆裂骨折患者,分为前路手术治疗组（27例）与后路手术治疗组（93例）。对比两组的预后情况。结果：后路手术组平均出血量[（350±100）ml]少于前路手术组[（1100±150）ml],差异有高度统计学意义（t=29．853,P〈O．01）。后路手术组平均手术时间[（70±10）min]短于前路手术组[（145±30）min],差异有高度统计学意义（t=31．291,P〈O．01）。术后2年后路手术组植骨融合率（19．2％）低于前路手术组（63．0％）,差异有高度统计学意义（x2：28．61,P〈0．01）。比较后路手术组手术前后ASIA神经功能分级结果提示,后路手术组患者术后2年的脊髓神经功能与术前相比改善1—3级,且无一例患者发生原有神经症状加重,无一例患者发生新的神经症状。结论：后路手术同前路手术相比,具有出血量少、手术操作简单、手术时间短,远期植骨融合率低等优势,疗效基本一致,但需要保持后纵韧带的完整性。在胸腰椎爆裂性骨折治疗中,可根据患者具体情况,优先选择后路手术。     

Effects of terbutaline on peripheral vascular resistance and arterial compliance

In a double blind, randomized placebo-controlled crossover study we characterized how terbutaline affects the mean and short-term fluctuations of peripheral vascular resistance and arterial compliance. The study was carried out in six young and healthy male subjects in the supine and upright positions by recording continuously electrocardiography and finger arterial blood pressure. On average, large intravenous terbutaline doses reduce maximally by 50% the mean systolic-diastolic pressure decay time (windkessel time), by 30% the mean vascular resistance, and by 20% the mean arterial compliance. Terbutaline reduces differently the beat-to-beat variability of peripheral vascular resistance and arterial compliance. The effects can be explained by beta-adrenoceptor activation that mediates smooth muscle relaxation in small resistance arteries and large conduit arteries. Differences between vascular resistance and compliance lowering actions could be explained by differences in the beta-adrenoceptor-mediated vascular relaxation and sympathetically mediated vascular contraction between small and large arteries.