颅内破裂动脉瘤手术时机的探讨(附237例分析)

目的探讨颅内破裂动脉瘤手术时机与临床预后的关系。方法回顾性分析2005年我院收治的237例颅内破裂动脉瘤，其中196例行手术治疗。按入院时Hunt—Hess分级将手术病人分为A组（Ⅰ～Ⅲ级）162例，B组（Ⅳ、Ⅴ级）34例；根据手术时间分为早期手术组（SAH3d内手术）19例，延期手术组（SAH4～10d手术）82例，晚期手术组（SAH11d之后手术）95例。比较不同手术期别动脉瘤术中破裂率、术后1个月GOS评分及术后主要并发症（脑血管痉挛、脑积水）发生率，并进行统计学分析。结果24例（10．1％）因再出血丧失治疗机会。术中动脉瘤破裂早期手术组3例（15，8％），延期手术组8例（9．8％），晚期手术组6例（613％）。术后脑血管痉挛发生率早期手术组为15，8％，延期手术组为19，5％，晚期手术组为17，9％。脑积水发生率以晚期手术组最高（14，7％）。对术后1个月GOS评分Ridit分析结果显示：A、B两组中均以早期手术组治疗效果最佳．延期手术次之．晚期手术最差。结论早期手术可规避颅内破裂动脉瘤再出血的风险，降低主要并发症发生率。对于各个级别（包括Ⅳ、Ⅴ级）的SAH病人，均应根据治疗者的手术经验与技巧和所在医院的条件，及早诊断，尽早手术。     

Panfacial fractures: analysis of 33 cases treated late.

PURPOSE: The aim of this retrospective study was to analyze the characteristics of delayed panfacial fractures and evaluate treatment results. PATIENTS AND METHODS: Thirty-three patients with delayed panfacial fractures were treated in the Maxillofacial Trauma Center of Peking University, School and Hospital of Stomatology between 1998 and 2004. Each patient was examined by computed tomography (CT) scans before operation. For those who had no severe opening restriction, dental impressions were taken to fabricate dental casts. For those with severely comminuted fractures, 3-dimensional (3D) models of the facial skeleton were used. Re-establishing the continuity of the mandible was the first step and then used as a platform to reconstruct the maxillary fractures via maxillomandibular fixation after Le Fort I osteotomy. The third step was to restore the mid- and upper-facial width and projection by coronal approach to expose the zygomatic complex and frontal bone/sinus and/or naso-orbito-ethmoid (NOE) fractures. RESULTS: There were 3 types of mandibular fractures that affected the treatment plan: 1) type I, mandibular body/symphysis fracture(s) (17/33, 51.52%); 2) type II, mandibular angle and/or condylar fracture(s) (6/33, 18.18%); and 3) type III, both mandibular body/symphysis and angle/condylar fractures (10/33, 30.30%). Fourteen cases were associated with NOE fractures (42.42%) and 3 cases had frontal sinus fractures (9.1%). Twelve cases had enophthalmos (36.36%) and 3 lost 1 eyeball. The order of treatment was dependent on the mandibular fracture type. For type I fractures, reconstructing the mandibular arch was the first step. For type II fractures, repairing the angle, ascending rami, and condylar areas was the first step. For type III fractures, when both mandibular height and arch were disrupted, freeing the malunited angle or condyle was the first step before restoring the mandibular arch form. Reconstruction of the mandibular height and projection was then carried out. For all 3 types, the second step was to restore the mid- and upper facial width and projection by reducing the zygomatic complex and frontal bone/sinus or NOE fractures. Maxillary fixation across the Le Fort I level was the last step. Le Fort I osteotomy was used for all 33 cases. Bone grafts and soft tissue suspension also were used. Twenty-one cases (63.64%) had good results, 7 (21.21%) cases were acceptable, and 5 (15.15%) were not good. There were 7 cases (21.21%) that still had soft tissue problems that needed secondary operations. CONCLUSIONS: Reconstruction of the mandible first with Le Fort I osteotomy is a good way to treat delayed panfacial fractures. Computed tomography and 3D CT, model surgery, and occasionally 3D models are necessary aids for diagnosis and treatment. Soft tissue problems, including lacerations and asymmetries, were often the factors that caused an unfavorable outcome.     

玻璃体视网膜手术后早期低眼压和睫状体脱离的临床观察

目的 观察玻璃体视网膜手术后早期睫状体脱离的发生率及其自然病程，并分析其与手术后早期低眼压的关系。方法 利用超声生物显微镜检查(UBM)连续观察行玻璃体视网膜手术治疗的患者46例46只眼。按玻璃体视网膜手术后不同填充内容分组：气体填充组11例11只眼，硅油填充组8例8只眼，平衡盐溶液（BSS）填充组27例27只眼。按手术后眼压分组：眼压<10 mm Hg（1 mm Hg=0.133 kPa)组25例25只眼，≥10 mm Hg组21例21只眼。玻璃体视网膜手术后第3天行UBM确定有无睫状体脱离，手术后每天用非接触眼压计监测眼压，有睫状体脱离者每隔7 d复查1次，直至睫状体脱离复位，所有患者均随访观察14～35 d。结果 手术后睫状体脱离20例，占本组患者的43.5％。无睫状体脱离者26例，占本组患者的56.5%。玻璃体视网膜手术后气体填充组睫状体脱离发生率 27.3％，硅油填充组25.0％，而BSS填充组为55.6％。睫状体脱离者手术后平均眼压(6.47±4.49) mm Hg （1 mm Hg=0.133 kPa），无睫状体脱离者平均眼压(15.61±7.72) mm Hg，两者差异有统计学意义（t=8.031,P＜0.001）。手术后眼压<10 mm Hg组患者睫状体脱离发生率为68.0％，眼压≥10 mm Hg组患者睫状体脱离发生率为14.3％，两组差异有统计学意义(χ2＝15.60, P＜0.001)。玻璃体视网膜手术后早期睫状体脱离患者除1例因低眼压引起视盘水肿而需行气体填充外，其余患者均在手术后30 d内自行复位。结论 手术后早期睫状体脱离是玻璃体视网膜手术的常见并发症。玻璃体视网膜手术后行BSS填充患者手术后睫状体脱离的发生率高。绝大多数患者睫状体脱离能够在玻璃体视网膜手术后30 d内自行复位。     

Directed differentiation of Balb/C mouse embryonic stem cells into pancreatic islet-like cell clusters in vitro: observation by atomic force microscope]

OBJECTIVE: To observe the morphological changes of Balb/C mouse embryonic stem cells following directed differentiation into pancreatic islet-like cell clusters (PICC) in vitro using atomic force microscope (AFM). METHODS: Balb/C mouse embryonic stem cells were first cultured into embryonic bodies (EBs) and allowed to differentiate spontaneously for 4 days. The cells were then transferred to gelatin-coated dishes for the EBs to attach and spread on the tissue culture plates, in the course of which a series of cell growth factors such as basic fibroblast growth factor (bFGF), insulin-like growth factor 1 (IGF-1) and nicotinamide were added into the culture medium at specific time points to induce directed differentiation of the stem cells into PICC. Immunocytochemistry was employed to detect the cells positive for insulin and glucagon, which were observed with AFM. RESULTS: The embryonic stem cells developed into cell clusters of different sizes, in which the cells were tightly arranged. Islet B cells were numerous in the center of clusters and darkly stained, but fewer in the peripherals with lighter stains. Islet A cells expressing glucagon were relatively fewer in the cell clusters, found mainly in the peripherals. Scanning of the insulin-positive clusters by AFM revealed large quantity of tissue fibers resembling nerve fibers that formed a reticular structure in disorderly arrangement. Numerous round granules were observed in the cytoplasm of almost identical sizes ranging from 0.5 to 1.0 mum in diameter. CONCLUSION: The cell clusters obtained by directed differentiation are mature in both morphology and function with also well organized structures.     

小剂量异丙酚加喉上神经阻滞用于纤支镜检查

目的：观察异丙酚加喉上神经阻滞用于纤支镜检查期间，患对操作刺激反应、耐受程度以及对心血管反应和遗忘程度。方法：选40例拟诊肺癌患行ASAⅡ～Ⅲ纤支镜检查，喉上神经阻滞成功后推注0．5～1mg／kg异丙酚，患意识消失后，进行纤支镜操作。结果：所有病人都能耐受检查。术中收缩压、舒张压、心率、血氧饱和度等无明显影响，无恶心、呕吐等并发症，大大减轻了检查对病人带来的痛苦。结论：异丙酚加喉上神经阻滞用于纤支镜检查，对呼吸、循环影响小，能减轻病人痛苦，术后具有遗忘作用，值得推广。     

老年认知功能障碍与脑结构CT测量的相关性研究

目的探讨脑萎缩与老年认知功能障碍之间的相关性。方法对开滦集团公司1063名离退休职工进行健康查体,用简易精神状态量表(MMSE)评定认知功能,按分界值将本次研究对象分为认知功能障碍组和认知功能正常组,同时用CT线性测量脑的相关部位以诊断脑萎缩情况,并对各型脑萎缩与认知功能的相关系数及提示老年认知功能障碍的敏感度、特异度、准确度进行分析。结果1063名观察对象中符合入选标准并资料完整者共计511名,其中108名有认知功能障碍,髓质脑萎缩55名、皮质萎缩5名、混合型萎缩30名;认知功能正常者403名,髓质脑萎缩214名、皮质萎缩13名、混合型萎缩62名。认知功能障碍组脑萎缩的发病率高于认知功能正常组,差异具有统计学意义(P<0.005);2组间颞叶海马钩回间距(26.86mm±3.73mmvs25.95mm±3.80mm)及海马钩回间距/大脑左右径的比值(0.21±0.02vs0.20±0.02)差异具有统计学意义(P<0.05);海马钩回间距、皮质脑萎缩、混合型脑萎缩与认知功能障碍呈负相关(分别为r=-0.094,P=0.034,r=-0.156,P≈0.000,r=-0.147,P≈0.000),以海马钩回间距20mm提示老年认知功能障碍的敏感度最高(98.14%),混合型脑萎缩的特异度(84.86%)、准确度最高(72.80%)。结论CT测量相关脑结构,判断脑萎缩类型可以为老年认知功能障碍的诊断提供有价值的信息。     

经肝动脉灌注三氧化二砷对肝移植瘤血管的作用

目的 :探讨经肝动脉灌注As2 O3 对肝移植瘤血管的作用 .方法 :采用新西兰大白兔建立 5 0只肝脏Vx 2移植瘤动物模型 ,随机平均分成 5组 .移植瘤术后 2wk ,经肝动脉插管灌注不同浓度As2 O3 ,并以顺铂和生理盐水作对照 ,连续 7d ,6wk末切取肝肿瘤组织 ,观察肿瘤组织微血管有无改变 ,检测移植瘤组织血管内皮生长因子 (VEGF)的表达 .结果 :实验组肿瘤组织毛细血管内皮细胞肿胀、细胞核碎裂、细胞坏死及微血栓形成 ,阴性对照组和阳性对照组无类似改变 .实验组VEGF表达低于对照组 ,差异有显著性 (P <0 .0 1 ) ,而实验组间VEGF表达无差异性 (P =1 .0 0 ) .结论 :经肝动脉灌注As2 O3可减少肿瘤组织的血管生成 ;选择性破坏肝移植瘤组织血管 ,并存在一定剂量效应相关性     

Changing health status and health expectancies among older adults in China: Gender differences from 1992 to 2002

Numerous studies document improvements in health status and health expectancies among older adults over time. However, most evidence is from developed nations and gender differences in health trends are often inconsistent. It remains unknown whether changes in health in developing countries resemble Western trends or whether patterns of health improvement are unique to the country's epidemiologic transition and gender norms. Using two nationally representative samples of non-institutionalized adults in China aged 65 years and older, this study investigates gender differences in the improvements in disability, chronic disease prevalence, and self-rated health from 1992 to 2002. Results from multivariate logistic regression models show that all three indicators of health improved over the 10-year period, with the largest improvement in self-rated health. With the exception of disability, the health of women improved more than men. Using Sullivan's decomposition methods, we also show that active life expectancy, disease-free life expectancy, and healthy life expectancy increased over this decade and were patterned differently according to gender. Overall, the findings demonstrate that China experienced broad health improvements during its early stages of the epidemiologic transition and that these changes were not uniform by gender. We discuss the public health implications of the findings in the context of China's rapidly aging population.     

Characteristics of teenage mothers and predictors of breastfeeding initiation in the Michigan WIC Program in 1995. Women, Infants, and Children.

Although breast milk is recommended as the optimal source of infant nutrition, breastfeeding initiation is below recommended levels, especially among teenage mothers. Breastfeeding initiation rates among Michigan (US) teenage mothers (12-19 y) were compared by demographics and health behaviors. Multivariate analyses determined which factors were significant independent predictors of breastfeeding initiation among teenage mothers enrolled prenatally in the Michigan Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in 1995. Significant predictors independently associated with breastfeeding initiation were race/ethnicity, education, marital status, postpartum anemia status, parity, prenatal trimester of WIC enrollment, and smoking. The strongest predictor of breastfeeding initiation differed for white mothers (positive predictor: education beyond high school [OR = 3.13]) and black mothers (negative predictor: multiparous [OR = 0.25]). Initiation rates for this population of teenage mothers fall below the national average for mothers of all ages and the US Healthy People 2010 goals. Research is needed concerning how breastfeeding support and education can be improved to reach the US national health goals.     

单甲氧聚乙二醇化学修饰药物酶的研究进展

用单甲氧基聚乙二醉(1)化学修饰药物酶是生化药物研究开发的重要手段之一。本文综述了1化学修饰药物酶的一般方法及修饰后酶在生物和理化性质方面的变化，同时对1研究前景进行展望，并指出了尚待解决的问题。