针刺足三里和悬钟治疗缺血性脑卒中

目的:观察针刺足三里、悬钟2穴对缺血性脑卒中脑血管功能的影响,分析其可能的作用机制,并对临床疗效做出评价。方法:选择2004-11/2006-05湖北中医药高等专科学校附属古城医院针灸科、荆州市第五人民医院中医康复科、荆州市第三人民医院中医科3单位缺血性脑卒中患者合适病例160例,采用查随机数字表的方法,将其随机分为对照组和针刺组,各80例。对照组采用现代医学常规干预方法进行治疗:卧床,保持呼吸道通畅,预防感染,控制颅内压、血压,维持水电解质平衡。针刺组在此基础上加针刺足三里、悬钟2穴,采用慢速捻转进针法针刺,留针20～30min,每隔5min行针1次。1次/d。两组患者治疗30d。并以经颅多普勒检测观察缺血性脑卒中患者治疗前后脑血管舒缩反应能力、脑血流自动调节功能、大脑半球侧枝循环代偿功能的变化,同时以治疗前后神经功能缺损程度为指标评价其临床疗效。结果:160例病例全部进入结果分析。①针刺组与治疗前相比,脑血管舒缩反应能力明显加强,差异有显著性意义(t=2.97,P<0.05),且优于对照组(t=2.45,P<0.05)。②针刺组与治疗前相比,脑血流自动调节能力明显改善,差异有非常显著性意义(t=8.01,P<0.01),且优于对照组(t=7.67,P<0.05)。③针刺组与治疗前相比,大脑半球侧枝循环代偿功能得到加强,差异有显著性意义(t=3.15,P<0.05),且优于对照组(t=5.16,P<0.05)。④针刺组与治疗前相比,神经功能缺损积分明显降低,差异有非常显著性意义(t=4.83,P<0.01),且优于对照组(t=5.43,P<0.05)。结论:针刺足三里、悬钟2穴对缺血性脑卒中患者脑血管舒缩反应能力、脑血流自动调节功能、大脑半球侧枝循环代偿功能有明显改善作用,并能促进神经功能的恢复。     

长骨干骨折脂肪栓塞综合征患者内固定植入物及其方式的选择：26例随访分析

目的:通过长骨干骨折脂肪栓塞综合征患者内固定植入物及其方式的合理选择,以最大限度减少手术创伤及减少对骨折端的刺激,有效避免脂肪栓塞综合征的复发。方法:①对象:选择1998-02/2006-03唐山市第二医院创伤科收治长骨干骨折行内固定植入的脂肪栓塞综合征患者26例。②方法:采用非扩髓髓内钉固定股骨干、胫骨干中段骨折及多段骨折、微创经皮钢板内固定股骨干远端骨折及胫骨干远近端骨折、钢板固定肱骨干、桡骨骨折;术后早期进行系统的康复治疗;并接受随访。术后定期复查X线片,并观察材料及宿主反应。结果:①术后随访:16例患者术后随访12～24个月,10例患者随访25～108个月。②X线摄片评定骨折愈合结果:长骨干骨折髓内钉固定于术后10～17周临床愈合;微创经皮钢板固定,于术后9～19周临床愈合;钢板固定,于术后13～20周临床愈合。无髓内钉松动及断钉、断板等并发症,肌力5级,未发现脂肪栓塞综合征后遗症。③植入物与组织的生物相容性能评估:术后无切口感染、局部炎症反应、排异反应。结论:对于长骨干骨折的脂肪栓塞综合征患者,非扩髓髓内钉、微创经皮钢板及钢板3种内固定植入物及植入方式均可满足不同部位及类型长骨干骨折的需要,植入物与人体具有良好的生物相容性,不增加脂肪栓塞综合征复发率及后遗症。     

干细胞治疗糖尿病的研究现状及未来

目的:综述干细胞治疗糖尿病的研究现状及未来发展。资料来源:应用计算机检索Pubmed2000-01/2006-11有关干细胞治疗糖尿病方面文献,检索词“diabetes mellitus and stem cell not review”,限定文章语言种类为English。资料选择:对检索到的干细胞治疗糖尿病相关文献进行整理,选取针对性强文章。同一领域文献则选择近期发表或权威杂志文章。资料提炼:共检索到359篇相关文献,有关胚胎干细胞、胰腺干细胞、造血干细胞、神经干细胞、骨髓基质干细胞在糖尿病方面研究文章50篇,其中29篇符合要求。资料综合:干细胞极强的自我更新能力和多向分化潜能为糖尿病的细胞治疗开辟了新途径,按其发育阶段不同可以将干细胞分为胚胎干细胞和胰腺干细胞、造血干细胞、神经干细胞、骨髓基质干细胞等成体干细胞。干细胞移植是治疗糖尿病的一条新途径。干细胞生成胰岛素分泌细胞前需要经过诱导分化、细胞选择和细胞成熟3个阶段。干细胞治疗糖尿病研究已取得一定进展,部分实验已纠正糖尿病动物的高血糖状态。结论:干细胞定向分化为胰岛β细胞研究为糖尿病患者点燃了新希望,其勿庸置疑的成为治疗糖尿病的最佳种子细胞。     

“双重束缚”解析

目的:介绍了Bateson提出双重束缚概念的过程,阐述双重束缚概念的特征,并且论述了这一概念对心理治疗起到的积极作用以及概念本身存在的问题。资料来源:应用计算机在ProQuest数据库、EBSCOhost数据库中搜索1980-01/2006-05相关文章,检索的关键词为“doublebind”,“paradox”;在西南大学图书馆手工查找有关“双重束缚”资料。资料选择:对查找的资料进行筛选,纳入阐述双重束缚提出的历史、概念以及应用的文献。排除:①非实证研究和综述。②管理、文化和道德中双重束缚的研究。③重复性的研究。资料提炼:共收集49篇文章,选择与本文相关的28篇进行综述。另外还参考《理解人性》,《家庭治疗基础》两本书籍。资料综合:“双重束缚”是Bateson结合“再学习”和“Russellian矛盾”两个概念提出的。对“双重束缚”的各种定义均体现了这一概念的如下特征:矛盾性、命令性、不平等性、不可逃避性和长期性。“双重束缚”在心理治疗中有广泛的应用,但是各种对“双重束缚”的研究都存在着不足。结论:“双重束缚”的提出有其特定的历史背景,它对精神分裂、精神错乱的形成有一定的解释力。     

Unusual vertebral artery origins: examples and related pathology.

Anomalies of the vertebral arteries are uncommon, but important to recognize in the diagnosis and catheter based evaluation and treatment of patients suffering cerebrovascular disease. This article illustrates our experience with such anomalies. These include the vertebral artery arising as the fourth and most distal branch of the aortic arch, as a right subclavian artery branch arising distal to the right thyrocervical trunk, as a right common carotid artery branch in a patient with an aberrant right subclavian artery, and a case of left vertebral artery proximal duplication, with both aortic and left subclavian vertebral arteries present in the same patient; the latter join to form a single distal cervical vertebral artery.     

Proven germline mosaicism in a father of two children with CHARGE syndrome

CHARGE syndrome is an autosomal dominant malformation syndrome caused by mutations in the CHD7 gene. The majority of cases are sporadic and only few familial cases have been reported. In these families, mosaicism in one parent, as well as parent- to-child transmission of a CHD7 mutation, has been described. In some further cases, germline mosaicism has been suggested. Here, we report the first case in which germline mosaicism could be demonstrated in a father of two affected children with CHARGE syndrome. The truncating mutation c.7302dupA in exon 34 of the CHD7 gene was found in both affected children but was not detected in parental lymphocytes. However, in DNA extracted from the father's spermatozoa, the c.7302dupA mutation could be identified. Furthermore, mutation analysis of DNA isolated from 59 single spermatozoa revealed that the c.7302dupA mutation occurs in 16 spermatozoa, confirming germline mosaicism in the father of the affected children. This result has a high impact for genetic counselling of the family and for their recurrence risk in further pregnancies.     

Usefulness of echocardiographic left ventricular hypertrophy and silent ischemia in predicting new cardiac events in elderly patients with systemic hypertension or coronary artery disease

The authors performed a prospective study to correlate echocardiographic left ventricular hypertrophy (LVH) and silent ischemia (SI) detected by twenty-four-hour ambulatory electrocardiographic monitoring with new cardiac events in 355 patients, mean age eighty-two +/- eight years, with systemic hypertension or coronary artery disease (CAD). Cardiac events included myocardial infarction, primary ventricular fibrillation, or sudden cardiac death. Mean follow-up was thirty-one +/- seven months (range twelve to forty). Cardiac events occurred in 28 of 147 patients (19%) without LVH or SI (A), in 56 of 113 patients (50%) with LVH and no SI (B), in 16 of 29 patients (55%) with SI and no LVH (C), and in 52 of 66 patients (79%) with LVH and SI (D). Significant p values were p less than 0.001 comparing D with A, D with B, C with A, and B with A; and p less than 0.02 comparing D with C. These data indicate that echocardiographic LVH and SI detected by ambulatory electrocardiographic monitoring are independent risk factors for new cardiac events in elderly patients with systemic hypertension or CAD.     

Endovascular Treatment of a Left Carotid Artery "Bowtie" Pseudoaneurysm with a Covered Wallgraft Stent

The authors present an unusual case of a young male patient with a large left common carotid artery pseudoaneurysm in a shape similar to that of a bowtie treated with a covered Wallgraft. The Wallgraft is a covered stent originally designed to be used in the treatment of tracheobronchial fistula and peripheral arterial applications. The favorable outcome of this case illustrates its endovascular application in nonsurgical traumatic injuries of the carotid artery.     

骨骼肌缺血再灌注损伤的机制

目的:对近年来骨骼肌缺血再灌注损伤的发病机制进行综述。资料来源:应用计算机检索MEDLINE、CBM、CNKI数据库及手工检索1998-01/2006-11期间的相关文献。中文检索词包括"骨骼肌,缺血再灌注损伤,发病机制";英文检索词有"Skeletal muscle","ischemia and reperfusion injury","oxygen freeradical","calcium overload"和"neutrophil"。资料选择:共收集到相关文献300篇,阅读全部文章的文题和大部分文章的摘要。选择文献所述内容与骨骼肌缺血再灌注损伤机制相关的文献。排除重复性研究。资料提炼:共得到符合纳入条件的文献55篇,排除145篇。选择其中30篇进行分析,英文24篇,中文6篇。资料综合:骨骼肌缺血再灌注损伤的机制由于有许多因素的介入而变的十分复杂,目前主要以氧自由基学说,钙超载学说和中性粒细胞学说为主,同时也注意到了一氧化氮和细胞凋亡以及微循环的无复流现象在其中的作用。结论:氧自由基学说,钙超载学说,中性粒细胞学说,一氧化氮,细胞凋亡以及微循环的无复流现象在骨骼肌缺血再灌注损伤中起着重要作用。