Ruptured distal anterior choroidal artery aneurysm.

Ruptured aneurysms of the distal anterior choroidal artery (AchA) are extremely rare and management is dictated by clinical presentation. This report describes a rare patient with a distal AchA aneurysm and subarachnoid and intraventricular haemorrhage. A 60-year-old woman presented with a sudden onset of severe headache and vomiting. No aneurysms could be found on initial angiograms. A repeat angiogram performed 10 days after admission demonstrated an aneurysm in a branch of the cisternal segment of the left AchA without a definite neck. Surrounding vessels showed multifocal stricture and dilatation. Microsurgical clipping was not performed because the patient died suddenly due to pulmonary failure. The aetiology of the aneurysm in this case and surgical strategy are discussed.     

危重症患者的APACHEⅡ评分与中医辨证相关性研究

目的：通过比较不同中医证型的ICU危重症患者的APACHEⅡ评分，同时对比两组死亡率，评价中医辨证在预后判断中的临床意义。方法：对纳入研究的85例ICU危重症患者于入ICU及出ICU时分别进行中医辨证，分为阳类证和阴类证两型，对所有病人进行APACHEⅡ评分，比较两型病人在进入ICU及出ICU时的APACHEⅡ分值，并与死亡率比较。结果：初始为阴类证的患者在入ICU及出ICU时的APACHEⅡ评分显著高于初始为阳类证的患者（P=0．0001及F〈0．05），死亡率亦显著高于阳类证患者（P=0．0369）：治疗后由阳类证转为阴类证患者APACHEⅡ评分较维持阳类证者增高（P=0．0161），而阴类证转为阳类证的患者APACHEⅡ分值较维持阴类证者减低（P=0．0424）。结论：中医证型对危重症的病情程度及预后判断有较好的预测价值，阴类证患者的预后较阳类证患者差，证型转换可能引起预后改变。     

Cause-specific and total mortality in the Canterbury (New Zealand) insulin-treated Diabetic Registry population: a 15-year follow-up study.

AIMS: To establish all-cause and cause-specific death rates, and risk factors for mortality in insulin-treated diabetic individuals living in the province of Canterbury, New Zealand. METHODS: Insulin-treated diabetic subjects (n = 995) on the Canterbury Diabetes Registry were followed up over 15 years and vital status determined. Death rates were standardized and hazard regression was used to model the effects of demographic covariates on relative survival time. RESULTS: There were 419 deaths in 11 226.3 person-years of follow-up with a standardized mortality ratio (SMR) of 2.0 (95% confidence interval (CI) 1.8-2.2). Relative mortality was greatest for the group aged 0-29 years (SMR 3.0 (95% CI 2.4-3.7)). After controlling for diabetes duration and gender, a 10-year increment in age of onset was associated with a 33% decrease in relative hazard (95% CI 29-36%), indicating that excess mortality due to diabetes declines with rising age of onset. After controlling for age of onset and gender, each 10-year increment in duration of diabetes is associated with a 26% decrease in relative hazard (95% CI 24-29%), indicating that with longer survival the mortality hazard approaches the general population hazard. Relative mortalities were increased for cardiovascular, renal and respiratory disease, but not malignancy. Relative mortality from acute metabolic complications was increased in the subgroup with age of onset of diabetes < 30 years and requiring insulin within 1 year of diagnosis. CONCLUSIONS: Mortality rates are high for insulin-treated diabetic individuals relative to the general population.     

体外诱导条件下大鼠骨髓基质细胞骨钙素和Ⅰ型胶原mRNA的表达

目的　研究体外培养大鼠骨髓基质细胞诱导条件下 ,成骨分化标志骨钙素和 型胶原 m RNA水平的表达。方法　采用成骨诱导剂 (含地塞米松 10 - 8mol/ L、β甘油磷酸钠 10 mm ol/ L和抗坏血酸 AA 5 0μg/ml)对培养状态下的不同代大鼠骨髓基质细胞进行成骨诱导 ,提取 RNA,采用 RT- PCR方法 ,以β-肌动蛋白 c DNA为内参照 ,检测骨钙素和 型胶原 m RNA的表达。结果　与对照组相比 ,接受成骨诱导剂作用的大鼠骨髓基质细胞随诱导时间的延长骨钙素和 型胶原 m RNA出现高表达 ,且维生素 D为诱导骨钙素 m RNA表达的必需成分。结论　体外培养的大鼠骨髓基质细胞保持成骨未分化状态 ,无骨钙素和 型胶原 m RNA的表达 ,诱导后可向成骨分化 ,骨钙素和 型胶原 m RNA表达升高     

发育期大鼠高热惊厥前后海马γ-氨基丁酸B受体亚基表达的变化

目的：研究高热惊厥(febrile seizures，FS)对发育期大鼠脑内γ-氨基丁酸(γ-aminobutyric acid，GABA)B受体亚基GABABR1与GABARR2蛋白表达的影响。方法：采用热水浴诱导大鼠高热惊厥模型。隔日诱导惊厥1次，共诱导10次，末次惊厥后24h处死大鼠。发育期大鼠随机分为3组：对照组(n＝24)，1次高热处理组(n＝28)，10次高热处理组(n＝40)。高热处理组根据是否出现惊厥再分为1次高热惊厥组(FS1，n＝16)与1次高热未惊厥组(F1，n＝12)，10次高热惊厥组(FS10，n＝15)与10次高热未惊厥组(F10，n＝13)。采用免疫组化方法观察不同次数高热惊厥大鼠脑内GABABR1与GABABR2蛋白表达的变化。结果：FS10大鼠海马齿状回、CAl-CA3区GABABRl和GABABR2蛋白表达明显低于F10、F1、FSl和对照组；F10大鼠上述脑区GABABRl和GABABR2蛋白表达低于F1、FS1和对照组；F1及FS1大鼠与对照组相比差异无显著性；海马各区GABABR1与GABABR2表达的改变大部分平行，但10次高热惊厥后GABABR2在CA1—CA3区下降更明显，而GABABR1在齿状回下降更明显。结论：反复高热惊厥及反复高热均可使发育期大鼠脑内GABABR亚基蛋白表达降低，高热惊厥的影响较单纯高热更为明显，提示GABABR亚单位与发育期大鼠高热惊厥及其脑损伤密切相关。GABABR1与GABABR2改变的不平行可能与受体亚单位组合的可塑性改变有关，这种改变可能导致抑制功能的改变。     

脾脏钝伤的CT诊断

本文回顾性分析了３２例脾脏钝伤ＣＴ平扫的表现；对脾损伤进行ＣＴ分类；指出腹腔积血和脾周血块（“哨兵血块征”）在诊断脾损伤方面的作用。ＣＴ平扫诊断钝性脾脏损伤是一种敏感、可靠的方法，可帮助外科医生制订治疗方案。ＣＴ平扫诊断钝性脾损伤的灵敏度为９４％，诊断正确率为９１％     

Clinical Study on Long-Term Treatment of Ankylosing Spondylitis with Integrative Medicine

Ａｎｋｙｌｏｓｉｎｇｓｐｏｎｄｙｌｉｔｉｓ（ＡＳ）ｉｓａｒｈｅｕｍａｔｉｃｄｉｓｅａｓｅｗｉｔｈｈｉｇｈｉｎｃｉｄｅｎｃｅ，ｉｎｄｕｃ ｉｎｇｄｉｓａｂｉｌｉｔｙａｎｄｉｎｖａｄｉｎｇｔｈｅｓｐｉｎａｌａｘｉａｌｊｏｉｎｔａｓｉｔｓｃｈｉｅｆｃｈａｒａｃｔ     

青年人群血清流感抗体水平纵向监测

通过对北京４０５例青年１９９２～１９９４年流感抗体的纵向监测结果表明，３年中Ｂ型流感表现很活跃，抗体分别在１９９３年和１９９４年春出现高峰。Ａ型流感抗体在１９９３年春出现高峰。其中２１８例个体连续３年６次抗体检测，据抗体波动提示：３年中流感３个亚型总的感染频率为４４０％，每个体每年平均为１．４次，其中Ａ１型感染频率最高，每个体３年内平均１．８次；Ａ３型次之为１．５２；Ｂ型为１．０６。流感３个亚型抗体在机体内有６７％～７３％高水平抗体个体可在０．５～１年内下降至≤２０的低水平。２１８例个体中Ａ１型抗体３年内长期低水平者有３％，Ａ３有９％，Ｂ有３８％。     

布一加综合征的诊断和治疗(附48例报告)

目的：探讨布一加综合征的诊治经验。方法：回顾分析本院自1993年－2002年，采用超声介入及手术方法治疗48例布加综合征的疗法结果。超声引导下支架术治疗布一加综合征38例，其中内支架术联脾肾分流术治疗5例，支架术联合肠腔分流术治疗8例；腔房人工血管转流术治疗4例，肠腔转流术治疗2例，肠颈转流术治疗2例，经右心房联合破膜2例。结果：随访1个月－9年，平均4．68年，37例获显疗效，2例改善，6例行二次手术治疗，3例死亡。结论：应重视早期诊断和治疗。腔内超声介入方法治疗布一加综合征，简便、准确、安全、疗效肯定；联合分流术解除肝静脉梗阻，可获得满意疗效。