缺血性脑卒中急性期神经保护治疗的研究进展

0 引言 缺血性脑卒中是脑卒中的主要类型,约占脑卒中总发病率的70%～80%.其早期治疗主要有两种途径:血管再通和神经保护治疗.溶栓治疗受限于其过窄的时间窗和对出血等并发症的担心,尚不能广泛应用.     

Peroneal tendon injuries: CT analysis

Computed tomographic (CT) evaluation of the peroneal tendons was obtained in 25 normal ankles and 30 abnormal ankles studied for trauma. The tendons and associated soft-tissue and bony structures, such as the calcaneofibular ligament, superior and inferior peroneal retinacula, fibular groove, and peroneal tubercle, which have heretofore evaded documentation on routine radiographs, are illustrated and discussed. Special attention is given to normal variations such as convex fibular tip and enlarged peroneal tubercle, which predispose the peroneal tendons to abnormal mechanical stresses. Examples of CT-established peroneal tendon abnormalities in the 30 cases examined are also demonstrated. These abnormalities include subluxation, dislocation, entrapment, and tenosynovitis of the peroneal tendons. The authors believe CT has proved to be an extremely useful and relatively noninvasive imaging tool for the evaluation of peroneal tendon injuries.     

Thyroid radiation absorbed dose from diagnostic procedures in U.S. population

According to a 1981 survey of thyroid imaging methods in the United States, radionuclide thyroid scans and uptake studies increased 250%-300% between 1966 and 1981, while the U.S. population increased only 17%. Collective absorbed dose decreased from 18 X 10(6) rad (18 X 10(4) Gy) in 1966 to 13.9 X 10(6) rad (13.9 X 10(4) Gy) in 1981. The decrease was due to the use of iodine 123 and technetium 99m pertechnetate rather than iodine 131 (I-131 was used for 100% of scans and uptake studies in 1966 and 10% and 54%, respectively, in 1981) and also to fewer free-standing thyroid uptake studies (150,000 in 1966 and 33,000 in 1981). Even with reduced usage, I-131 still accounted for 93% of the collective absorbed dose in 1981. If I-131 were eliminated from diagnostic procedures, the annual absorbed dose would decrease to 1.4 X 10(6) rad (1.4 X 10(4) Gy). The number of radiation-induced cancer cases would also be reduced.     

Integration of vitamin A supplementation with the Expanded Programme on Immunization: lack of impact on morbidity or infant growth

Vitamin A deficiency is associated with increased morbidity and mortality from diarrheal disease, measles, and malaria. It has been proposed that vitamin A supplementation could be linked with childhood immunization programs to improve child health. We conducted a randomized, doubleblind, placebo-controlled clinical trial to evaluate the impact of linking vitamin A supplementation with the Expanded Programme on Immunization on morbidity and child growth. In West Java, Indonesia, 467 six-week-old infants were randomized to receive 7.5 mg retinol equivalent (RE), 15 mg RE, or placebo with childhood immunization contacts at 6, 10, and 14 wks and 9 mo of age. Child growth was assessed through anthropometry, and morbidity histories were obtained. Vitamin A supplementation had no apparent impact upon linear or ponderal growth or infectious disease morbidity in the first 15 mo of age when integrated with the Expanded Programme on Immunization.

Conclusion : Although improving vitamin A nutriture is of general importance in reducing diarrheal and measles morbidity and mortality in developing countries, this clinical trial showed no apparent benefit of vitamin A capsules for infant health when given through childhood immunization programs.     

Water: An Essential But Overlooked Nutrient

Water is an essential nutrient required for life. To be well hydrated, the average sedentary adult man must consume at least 2,900 mL (12 c) fluid per day, and the average sedentary adult woman at least 2,200 mL (9 c) fluid per day, in the form of noncaffeinated, nonalcoholic beverages, soups, and foods. Solid foods contribute approximately 1,000 mL (4 c) water, with an additional 250 mL (1 c) coming from the water of oxidation. The Nationwide Food Consumption Surveys indicate that a portion of the population may be chronically mildly dehydrated. Several factors may increase the likelihood of chronic, mild dehydration, including a poor thirst mechanism, dissatisfaction with the taste of water, common consumption of the natural diuretics caffeine and alcohol, participation in exercise, and environmental conditions. Dehydration of as little as 2% loss of body weight results in impaired physiological and performance responses. New research indicates that fluid consumption in general and water consumption in particular can have an effect on the risk of urinary stone disease; cancers of the breast, colon, and urinary tract; childhood and adolescent obesity; mitral valve prolapse; salivary gland function; and overall health in the elderly. Dietitians should be encouraged to promote and monitor fluid and water intake among all of their clients and patients through education and to help them design a fluid intake plan. The influence of chrpnic mild dehydration on health and disease merits further research. J Am Diet Assoc. 1999;99:200–206.     

Body Composition, Dietary Intake, and Energy Expenditure in Nonobese, Prepubertal Children of Obese and Nonobese Biological Mothers

Objective To determine differences in dietary intake, resting energy expenditure, activity level, fat-free mass, and percentage body and abdominal fat in nonobese children of obese mothers compared with nonobese children of nonobese mothers.Design Cross-sectional comparison study. Children's food diaries were analyzed to determine average energy and nutrient content. Resting energy expenditure of children was measured by means of indirect calorimetry. Children's activity levels were estimated through questionnaires administered during interviews. Dual-energy x-ray absorptiometry was used to estimate body composition of children.Subjects Mothers of subjects responded to advertisements and were recruited as nonobese (body mass INDEX=20 to 25) or obese (body mass index ≥30). Offspring included in the study were prepubertal and nonobese (10th to 90th percentile of weight for height by gender). Twelve pairs of children could be matched for weight, gender, and age.Statistical analysis performed Wilcoxon signed rank tests were used to determine differences between the 2 groups of children.Results Percentage abdominal fat was greater (median DIFFERENCE=3.15, P=.001) and fat-free mass was lower (median DIFFERENCE=1.19, P=.04) in children of obese mothers compared with children of nonobese mothers. No statistically significant differences between the 2 groups of children were found for dietary intake, resting energy expenditure, activity level, or percentage body fat.Applications/conclusions The significantly higher percentage of abdominal fat and lower fat-free mass in children of obese mothers may contribute to obesity onset. Use of dual-energy x-ray absorptiometry as a screening tool for nonobese, prepubertal children with an obese parent will help to identify those at risk. Education and lifestyle changes can then be implemented to help prevent the onset of obesity. J Am Diet Assoc. 1999;99:58-65.