丘脑卒中患者认知功能损害及其临床判别

目的:探讨丘脑卒中后认知损害的特点,尝试应用回归函数方程推测和判别这种损害程度。方法:①选择2004-04/12大连市第二人民医院和大连市海港医院收治,并经CT确诊的丘脑卒中患者21例为丘脑卒中组;按1∶3匹配原则,将63例年龄与性别与丘脑卒中组匹配的非脑部疾病者入选为对照组。②丘脑卒中组住院后进行影像学和生理、生化学指标检查,对所有入组人员进行神经心理学测查其认知功能,内容包括4个纬度(智能纬度、执行功能纬度、注意机能纬度和记忆纬度)13个认知因子,以韦氏成人智力量表、韦氏记忆量表和威斯康星卡片分类实验等为测查工具。③将对照组每项认知因子均数根据其在认知中的作用不同,加或减1.64标准差为界值,以判断丘脑卒中组认知损害程度,并建立回归方程和认知损害程度表达式。结果:84例均进入结果分析。①丘脑卒中组在13个认知指标中有9个指标与对照组相比差异显著(P<0.05),4个纬度均有涉及。②建立丘脑组认知损害程度函数表达式,计算出每例认知损害程度函数值(F0)。以丘脑组每例认知损害程度函数值为应变量,以临床影响因子为自变量建立了回归方程Y=43.679-2.304*β。以Y值推测F0值。当Y<0.98,可考虑为轻度认知损害,当Y=0.98～8.15时可考虑为中度认知损害,当Y>8.15时可考虑为重度认知损害。结论:①丘脑卒中可引起广泛的认知损害。②临床可以根据影响因素建立回归方程,计算出Y值,以Y值推测F0值。     

经胸超声心动图指导下应用国产Amplatzer封堵器介入治疗先天性心脏病及其术后随访评估

目的:经胸超声心动图指导下应用国产Amplatzer封堵器介入治疗先天性心脏病,分析其应用价值。方法:选择2005-05/2007-03在成都市第三人民医院应用国产Amplatzer封堵器进行介入治疗的先天性心脏病患者59例,其中膜周型室间隔缺损30例,继发房间隔缺损15例,动脉导管未闭14例,所有患者均知情同意。①所有Amplatzer封堵器均由北京形状记忆合金材料有限公司提供。仪器采用Sequoia256及Sequoia512型彩色多普勒诊断仪,探头频率为2.5～5.0MHz。②在经胸超声心动图及X射线的引导下采用国产封堵器行先天性心脏病介入封堵术,术后1d,7d、1个月、3个月、1年随访,观察封堵器的位置,有无残余分流。结果:59例患者均封堵成功,全部进入结果分析,无脱落。2例膜周型室间隔缺损患者微量残余分流在术后3个月完全消失;其余患者均未见封堵器脱落、移位,无溶血、房室传导阻滞、瓣膜反流、心脏穿孔等严重并发症。结论:经胸超声心动图可用于引导先天性心脏病的封堵器介入治疗,同时也可用于术后随访,观察封堵器封堵后的移位、脱落等物理学变化。     

Seroconversion to human immunodeficiency virus (HIV) in hemophiliacs. Relation to lymphadenopathy

The authors studied the natural history of human immunodeficiency virus (HIV) exposure in 187 hemophiliacs followed for an average of 45 months. Overall, 55 percent developed antibody specific for HIV and 21 percent developed persistent generalized lymphadenopathy. Most patients seroconverted sometime between early 1982 and the end of 1984. Four patients developed acquired immune deficiency syndrome (AIDS) and four seropositive patients developed idiopathic thrombocytopenia (ITP). One of the four patients who developed AIDS and three of the four with ITP had preexisting lymphadenopathy. None of the 10 patients with lymphadenopathy or the 20 asymptomatic patients was seropositive for human T-lymphotropic virus, type I. Although seropositivity and lymphadenopathy have been found in many of the authors' patients, few have developed clinical disease that can be related to HIV infection.     

瘢痕疙瘩家系Fas基因的突变：2个家系10份标本分析

目的:观察瘢痕疙瘩家系样本中Fas基因有无突变,探讨Fas基因突变在瘢痕疙瘩形成中的意义。方法:实验于2005-01/05在上海基康公司完成。①标本来自南方医科大学南方医院整形外科2005年收集的A和B两个瘢痕疙瘩家系,所有参与观察的家系成员均签署知情同意书。②采用聚合酶链反应及基因测序技术,分别以A家系两例患者的瘢痕疙瘩组织为观察对象,以其周围正常皮肤及外周静脉血作为自身对照;其配偶的外周静脉血作为正常对照。并以B家系中两例患者的外周静脉血作为不同家系间的对照。共取10份样本,4份组织样本,6份静脉血标本。检测10份样本中Fas基因外显子1～9的基因序列。结果:①基因测序发现所检测的10个瘢痕疙瘩家系标本Fas基因的1～8外显子均未发现突变。②2份瘢痕疙瘩组织标本在第9外显子编码区的11bp,53bp两个位点上存在单个碱基的基因突变或多态性改变。结论:瘢痕疙瘩Fas基因外显子9区段的基因结构异常极有可能造成Fas蛋白的功能改变,从而导致身体局部瘢痕疙瘩的形成。     

Potential role of reactive metabolites of addictive drugs at the receptor: a novel hypothesis

The central nervous system (CNS) stimulants to CNS depressants such as morphine, cocaine, methamphetamine and nicotine each have the capacity for inducing chemical dependence with an enormous impact on human behavior. Because of the difficulties in isolation, the role of the reactive metabolites as a modulating factor in the receptor activation and related addiction of these drugs is not studied. The chemical transformations of these compounds to their metabolites at the receptors have been proposed. There is the distinct possibility that irreversible binding of N-hydroxy, N-formyl or related metabolites of morphine, cocaine, methamphetamine, or nicotine with the respective receptors can occur. This unique role of highly reactive molecular species is postulated. In this way, the synaptic glutaminergic and or dopaminergic transmission can be compromised. On repeated exposure of the drug, the receptor reserve may decrease. More drug is needed to activate the residual receptor to maintain the reward in addiction.     

Calcium carbonate gallstones in children

Background

In the United States, cholesterol stones account for 70% to 95% of adult gallstones and black pigment stones for most of the remainder. Calcium carbonate stones are exceptionally rare. A previous analysis of a small number of pediatric gallstones from the north of England showed a remarkably high prevalence of calcium carbonate stones. The aims of this study were to analyze a much larger series of pediatric gallstones from our region and to compare their chemical composition with a series of adult gallstones from the same geographic area.

Methods

A consecutive series of gallbladder stones from 63 children and 50 adults from the north of England were analyzed in detail using Fourier transform infrared microspectroscopy. Demographic and clinical data were collected on all patients. The relative proportions of each major stone component were assessed: cholesterol, protein and calcium salts of bilirubin, fatty acids, calcium carbonate, and hydroxyapatite.

Results

Thirty-nine (78%) adults had typical cholesterol stones, 7 (14%) had black pigment bilirubinate stones, and only 2 (4%) had calcium carbonate stones. In contrast, 30 (48%) children had black pigment stones, 13 (21%) had cholesterol stones, 15 (24%) had calcium carbonate stones, 3 (5%) had protein dominant stones, and 2 (3%) had brown pigment stones. In children, cholesterol stones were more likely in overweight adolescent girls with a family history of gallstones, whereas black pigment stones were equally common in boys and girls and associated with hemolysis, parenteral nutrition, and neonatal abdominal surgery. Calcium carbonate stones were more common in boys, and almost half had undergone neonatal abdominal surgery and/or required neonatal intensive care.

Conclusion

The composition of pediatric gallstones differs significantly from that found in adults. In particular, one quarter of the children in this series had calcium carbonate stones, previously considered rare. Geographic differences are not the major reason for the high prevalence of calcium carbonate gallstones in children.     

Successful treatment of chronic hepatitis C with pegylated interferon in combination with ribavirin in a methadone maintenance treatment program

Injection drug users constitute 60% of the more than 4 million people in the United States with hepatitis C virus (HCV), including many methadone maintenance patients. Few data exist describing clinical outcomes for patients receiving HCV treatment on-site in methadone maintenance settings. In this retrospective study, we describe clinical outcomes for 73 patients receiving HCV treatment on-site in a methadone maintenance treatment program. Fifty-five percent of patients achieved end-of-treatment response, and 45% achieved sustained viral response. These treatment response rates are nearly equivalent to previously published HCV treatment response rates, despite high prevalences of ongoing drug use (49%), psychiatric comorbidity (67%), and HIV coinfection (32%). These data show that on-site HCV treatment with pegylated interferon and ribavirin is effective in methadone-maintained patients, many of whom are active drug users, psychiatrically ill, or HIV coinfected, and that methadone maintenance treatment programs represent an opportunity to safely treat chronic hepatitis C.