非体外循环下再次冠状动脉旁路移植术后早期监护

探讨20例在非体外循环下再次行冠状动脉旁路移植术后患者早期监护的要点.针对手术的致死危险因素如心律失常、左心室射血分数、糖尿病、机械通气时间延长等提出相应的护理措施.     

The Utility of Intraoperative Evaluation of Sentinel Lymph Nodes in Breast Cancer

Background In breast cancer treatment, intraoperative sentinel lymph node (SLN) evaluation is used to identify patients who may potentially benefit from immediate completion of axillary lymph node dissection. Methods Prospectively collected breast cancer registry data identified 516 SLN biopsies between January 2003 and December 2005. Intraoperative evaluation (IE) of the SLNs was performed in 479 axillae. Final pathology by hematoxylin and eosin and, for negative nodes, by immunohistochemical stains was compared with the IE result. The effect of IE and final pathology on surgical treatment was examined. Results The sensitivities for IE of N0(i+) (n = 39), N1mi (n = 41), and N1a–3a (n = 89) metastases were 0%, 5%, and 63%, respectively. The specificity was 99.7%. IE identified 57 (44%) of SLN-positive (N1mi and N1a–3a) axillae, thus resulting in synchronous axillary lymph node dissection for those patients. Reoperation for false-negative IEs (N1mi or N1a–3a with negative IE) occurred in only 27 axillae (39%). Conclusions IE of SLNs has adequate sensitivity and excellent specificity. In addition to allowing patients to benefit from synchronous surgery, IE helped patients to receive care in concordance with recommended practice guidelines. The false-negative IE of SLNs highlights uncertainty with the clinical significance of axillary nodal staging when only small amounts of metastatic disease are identified in the axilla.     

Denial in the first days of acute stroke

Denial is a disorder of self-awareness that is frequent after acute stroke, with potential negative influence in the care of patients. The aim of this study was to describe the presence and correlates of denial in acute stroke. We assessed denial in a sample of 180 consecutive acute stroke patients (≤4 days) and in a control group of 50 acute coronary patients using the Denial of Illness Scale (DIS). 41% (74) acute stroke patients (mean DIS score=4.1, SD=2.2, range 0 to 10) and 24% (12) acute coronary patients (mean DIS score=3.2, SD=1.5, range 0 to 10) presented denial (χ²=4.19, p=.04; U=3405.50, p=.01). Denial was more frequent and severe in patients with lower educational level (χ² = 5.04, p=.04; U=2110.50; p=.01), neglect (χ² = 21.38, p=.00; U=1130.50; p=.00), cognitive impairment (χ² = 6.27, p=.02; U=1181.50; p=.01) and after hemispherical lesions (χ² =4.68, p=.05; U=1982.50; p=.04). In logistic regression low educational level, neglect and cognitive impairment were independent factors predicting denial in stroke patients (R²= 21%). Patients with denial can express depressive symptoms. Patients with denial had a worse outcome at discharge (χ² =4.91, p=.04; U=2918.00; p=.03). Denial is a frequent phenomenon after acute stroke. We propose that there is a multifactorial model for the emergence of denial, lower educational as a predisposing condition, and acute stroke due to hemisphere lesion and causing neglect and cognitive impairment as precipitating events. All these factors limit patients’ assessment of their condition and body functions.     

Upregulation of type I interleukin−1 receptor after traumatic spinal cord injury in adult rats

Post-traumatic inflammation response has been implicated in secondary injury mechanisms after spinal cord injury (SCI). Interleukin-1 (IL-1) is a key inflammatory mediator that is increasingly expressed after SCI. The action of IL-1 is mediated through its functional receptor, type I interleukin-1 receptor (IL-1RI). However, whether this receptor is expressed after SCI remains to be elucidated. In the present study, the temporospatial expression of IL-1RI was detected in rats that received a moderate contusive SCI (a 10 g rod dropped at a height of 12.5 mm) at the ninth to tenth thoracic vertebral level using a widely used New York University impact device. Our study demonstrated that IL-1RI was slightly increased at 4 h post-injury compared to the normal or sham-operated controls, reached the peak at 8 h at mRNA level (4.44-fold, P<0.01) and 1 d at protein level (2.62-fold, P<0.01). IL-1RI remained at its elevated levels for a relatively long duration (4 h–7 days). Spatially, IL-1RI was observed throughout the entire length of a 10 mm-long cord segment containing the injury epicenter. Colocalization of IL-1RI was found in neurons, oligodendrocytes, astrocytes, and activated microglia. Our results suggest that the elevated expression of IL-1RI after SCI may contribute to posttraumatic inflammation responses of IL-1.     

脑片培养在神经科学中的应用

早在1907年Harrison首次通过完善悬滴培养法进行神经系统培养，人们开始通过体外培养对神经领域进行探索。一个世纪以来，国内外学者从改进培养容器，培养条件及培养操作技术方法等多方面进行革新，发展了一系列神经系统体外培养的方法，使细胞或组织能够长期体外生存并保持功能，进一步进行观察、研究和操作。     

焦虑症患者关联性负变

目的 探讨焦虑症患者关联性负变(CNV)的特点.方法 采用光和声成对刺激以及反应时间技术,对24例焦虑症患者和22名正常成人的CNV进行对照研究.结果 焦虑症组波形不规则,CNV-Ⅱ型(延迟型)尤甚.与正常对照组比较,焦虑症患者CNV潜伏期A点延迟(P<0.05),波幅B降低(P<0.05).结论 焦虑症CNV变化诸特点值得进一步随访.     

非小细胞肺癌中CD44v6的表达及与其脑转移的关系

目的:研究非小细胞肺癌中CD44v6的表达及与其分型、颅内转移的关系。方法:应用免疫组化法检测30例非小细胞肺癌组织标本中CD44v6的表达,并分析其临床意义。结果:CD44v6高表达与非小细胞肺癌的淋巴结转移及颅内转移有关(P<0.05),是非小细胞肺癌颅内转移的主要风险因子。结论:检测CD44v6蛋白的表达,有可能为判断非小细胞肺癌淋巴结转移、颅内转移的发展以及评估预后提供依据。     

Expression of tissue inhibitor of metalloproteinase-1 in progression muscular dystrophy

Objective Tissue inhibitor of metalloproteinase-1(TIMP-1) is a multifunctional protein that has the capacity to modify cellular activities and to modulate matrix turnover. This paper revealed the contributive role of TIMP-1 in progressive muscular dystrophy (PMD). Methods We examined the expression and cellular localization of TIMP-1 protein using biopsied frozen muscle from patients with Duchenne muscular dystrophy ( DMD) , Becker muscular dystrophy (BMD) , congenital muscular dystrophy (CMD) by immunohistochemistry, double immunofluorescence and Western blot analysis. Results The results of immunohistochemistry and double immunofluorescence showed that TIMP-1 was positive only in vascular endothelial cells of normal muscles. Immunohistochemistry and Western blot analysis showed that the staining intensity was distinctly increased in some dystrophic muscles of PMD for TIMP-1. Double immunofluorescence revealed that TIMP-1 strongly expressed in the regenerating muscle fibers, macrophages and macrophage infiltrating necrotic fibers. Some activated fibroblasts in endomysium and perimysium of DMD and CMD muscles were also positive for TIMP-1. Conclusion The functional consequence of overexpression of TIMP-1 in the dystrophic muscles is unknown, but the elevated local expression of TIMP-1 in diseased muscles of PMD and their distinct distribution pattern provide evidence that TIMP-1 may participate in the pathogenesis of PMD.     

住院精神分裂症患者主观舒适度的影响因素分析

目的 了解影响精神分裂症患者主观舒适度的相关因素。方法 对200例住院精神分裂症患者测评“抗精神病药物治疗中主观舒适度（SWN）简表”及自制的“相关因素调查表”。结果 住院精神分裂症患者SWN评分异常率为31％,SWN评分异常组与正常组相比,在总病程、住院次数、服药次数、药物剂量、家庭经济水平、服药依从性、社会支持、医患关系、诊断亚型、合并使用抗副作用药、藏药行为等方面差异显著。2项Logistic回归分析显示,精神分裂症患者主观舒适度影响因素依次为：药物剂量、合并使用抗副作用药、服药依从性、藏药行为、家庭经济水平、医患关系。结论 在治疗精神分裂症患者时应注意多因素对主观舒适度的影响,尤其注意发挥人为干预因素作用。     

Anatomic relations of the arachnoidea around the pituitary stalk: relevance for surgical removal of craniopharyngiomas

Purpose  

The growth pattern of craniopharyngiomas (CP) is yet to be understood due to challenges arising from the diversity of morphological features that exist. This in turn has had implications on the development of safe surgical strategies for management of these lesions. The aim of this study is to propose a morphological classification of CP based on their tumor–membrane relationship. It is hoped that this will contribute to better understanding of CP morphology and prediction of the intraoperative classification.