远端蒂筋膜皮瓣内浅静脉干定时放血的临床应用

[目的]探讨预防远端蒂筋膜皮瓣静脉危象和提高皮瓣成活质量的方法. [方法]通过于26例大面积下肢皮神经营养血管远端蒂筋膜皮瓣内浅静脉干远心端蒂部结扎,近心端留置静脉留置针外引流,每天6 h定量放血,连续5d,密切观察皮瓣血供及肿胀情况. [结果]26例皮瓣全部成活,无1例出现静脉危象,无明显肿胀期.随访1～2年,皮瓣质地柔软,无明显色素沉着,均恢复保护性感觉. [结论]此方法能预防远端蒂筋膜皮瓣的静脉危象,提高皮瓣的成活质量.     

Performance measurement of the microPET focus 120 scanner.

The microPET Focus 120 scanner is a third-generation animal PET scanner dedicated to rodent imaging. Here, we report the results of scanner performance testing. METHODS: A (68)Ge point source was used to measure energy resolution, which was determined for each crystal and averaged. Spatial resolution was measured using a (22)Na point source with a nominal size of 0.25 mm at the system center and various off-center positions. Absolute sensitivity without attenuation was determined by extrapolating the data measured using an (18)F line source and multiple layers of absorbers. Scatter fraction and counting rate performance were measured using 2 different cylindric phantoms simulating rat and mouse bodies. Sensitivity, scatter fraction, and noise equivalent counting rate (NECR) experiments were repeated under 4 different conditions (energy window, 250 approximately 750 keV or 350 approximately 650 keV; coincidence window, 6 or 10 ns). A performance phantom with hot-rod inserts of various sizes was scanned, and several animal studies were also performed. RESULTS: Energy resolution at a 511-keV photopeak was 18.3% on average. Radial, tangential, and axial resolution of images reconstructed with the Fourier rebinning (FORE) and filtered backprojection (FBP) algorithms were 1.18 (radial), 1.13 (tangential), and 1.45 mm full width at half maximum (FWHM) (axial) at center and 2.35 (radial), 1.66 (tangential), and 2.00 mm FWHM (axial) at a radial offset of 2 cm. Absolute sensitivities at transaxial and axial centers were 7.0% (250 approximately 750 keV, 10 ns), 6.7% (250 approximately 750 keV, 6 ns), 4.0% (350 approximately 650 keV, 10 ns), and 3.8% (350 approximately 650 keV, 6 ns). Scatter fractions were 15.9% (mouse phantom) and 35.0% (rat phantom) for 250 approximately 750 keV and 6 ns. Peak NECR was 869 kcps at 3,242 kBq/mL (mouse phantom) and 228 kcps at 290 kBq/mL (rat phantom) at 250 approximately 750 keV and 6 ns. Hot-rod inserts of 1.6-mm diameter were clearly identified, and animal studies illustrated the feasibility of this system for studies of whole rodents and mid-sized animal brains. CONCLUSION: The results of this independent field test showed the improved physical characteristics of the F120 scanner over the previous microPET series systems. This system will be useful for imaging studies on small rodents and brains of larger animals.     

老年认知功能障碍与脑结构CT测量的相关性研究

目的探讨脑萎缩与老年认知功能障碍之间的相关性。方法对开滦集团公司1063名离退休职工进行健康查体,用简易精神状态量表(MMSE)评定认知功能,按分界值将本次研究对象分为认知功能障碍组和认知功能正常组,同时用CT线性测量脑的相关部位以诊断脑萎缩情况,并对各型脑萎缩与认知功能的相关系数及提示老年认知功能障碍的敏感度、特异度、准确度进行分析。结果1063名观察对象中符合入选标准并资料完整者共计511名,其中108名有认知功能障碍,髓质脑萎缩55名、皮质萎缩5名、混合型萎缩30名;认知功能正常者403名,髓质脑萎缩214名、皮质萎缩13名、混合型萎缩62名。认知功能障碍组脑萎缩的发病率高于认知功能正常组,差异具有统计学意义(P<0.005);2组间颞叶海马钩回间距(26.86mm±3.73mmvs25.95mm±3.80mm)及海马钩回间距/大脑左右径的比值(0.21±0.02vs0.20±0.02)差异具有统计学意义(P<0.05);海马钩回间距、皮质脑萎缩、混合型脑萎缩与认知功能障碍呈负相关(分别为r=-0.094,P=0.034,r=-0.156,P≈0.000,r=-0.147,P≈0.000),以海马钩回间距20mm提示老年认知功能障碍的敏感度最高(98.14%),混合型脑萎缩的特异度(84.86%)、准确度最高(72.80%)。结论CT测量相关脑结构,判断脑萎缩类型可以为老年认知功能障碍的诊断提供有价值的信息。     

年龄小于45岁原发性慢性闭角型青光眼的显微手术治疗

目的探讨原发性慢性闭角型青光眼年轻患者临床治疗的经验和体会。方法对临床收治的41例52眼、年龄〈45岁、临床确诊为进展期或晚期原发性慢性闭角型青光眼的病例进行抗青光眼显微手术处理的病例进行回顾性分析。结果随访时间平均（32．50±5．08）个月；男16例，女25例；进展期28眼，晚期24眼；52眼均行抗青光眼手术-复合式小梁切除手术治疗；眼轴长平均（22．40±1．63）mm，其中〈21mm占17．31％，小眼球占13．46％；前房深度平均（1．90±0．39）mm，其中〈1．9mm占61．46％；超声生物显微镜检查高褶虹膜构型占59．62％，其中睫状突位置靠前者10眼；术前平均眼压（41．73±12．26）mmHg，末次术后平均眼压（12．03±4．57）mmHg，术前后眼压差异有统计学意义（t=3．520，P〈0．001）。术后并发症主要有浅前房，恶性青光眼。恶性青光眼手术处理方式包括玻璃体抽液、前段玻璃体切割以及超声乳化白内障吸除加人工晶状体植入术治疗。4眼因眼压控制不理想，行二次抗青光眼手术治疗。结论年轻原发性慢性闭角型青光眼患者，女性多见，多伴有眼轴短、前房浅等特点，抗青光眼复合式小梁手术治疗要注意防治术后浅前房、恶性青光眼的发生。术前详细检查、手术操作精细以及有效处理术后并发症将有助于提高手术成功率和减少并发症。     

营养素食预防化疗患者便秘的效果观察

目的 观察营养素食预防化疗患者便秘的效果。方法 选择128例化疗患者，随机分为观察组和对照组各61例，对照组常规正常饮食，观察组于化疗开始当天实施营养素食．连续7～10d，比较两组患者便秘发生率及体重、血红蛋白、白蛋白等指标。结果　对照组便秘发生率显著高于观察组（P〈0．01）；两组化疗后营养指标比较，差异无显著性意义（均P〉0．05）。结论　营养素食对化疗患者便秘有较好的预防作用。     

99Tcm-MIBI动力学变化与大鼠缺血-再灌注心肌存活的相关性研究

目的探讨用99Tcm-甲氧基异丁基异腈(MIBI)动力学变化评价心肌存活的价值.方法15只离体Krebs-Henseleit(KH)液灌注的鼠心脏,随机分成3组对照组(5只),有葡萄糖的缺血-再灌注组(IR+G组,5只),无葡萄糖的缺血-再灌注组(IR-G组,5只).用含99Tcm-MIBI(14.8MBq)的KH液灌注,观察40min的摄取和清除.用肌酸激酶(CK)分析、氯化三苯四唑(TTC)染色和透射电镜(TEM)分析研究心肌损伤程度,用放射自显影(ARG)观察99Tcm-MIBI在心肌内的分布.结果99Tcm-MIBI的摄取[每克组织百分注射剂量率(%ID/g)]在IR+G组为(7.09±0.97)%ID/g,IR-G组为(6.64±0.68)%ID/g,对照组为(11.44±1.79)%ID/g,IR-G组与IR+G组相比摄取量差异无显著性(P＞0.05),IR-G组和IR+G组与对照组相比均显著降低(P＜0.05).IR-G组99m-MIBI清除分数为(72.75±9.89)%,远高于对照组[(20.68±1.92)%]和IR+G组[(21.03±3.68)%,P均＜0.05],对照组与IR+G组的差异无显著性.99Tcm-MIBI的40min清除末滞留率在IR-G组[(1.82±0.73)%ID/g]和IR+G组[(5.61±0.89)%ID/g]远小于对照组[(9.09±1.57)%ID/g,P＜0.05],IR-G组也远小于IR+G组(P＜0.001).CK分析、TFC染色和TEM分析证明IR-G组比IR+G组有更多的心肌损伤.通过TTC染色(r=0.84,P＜0.05)和CK分析(r=-0.97,P＜0.05)确定最终99Tcm-MIBI的活度与存活心肌量高度相关,通过ARG证实99Tcm-MIBI分布于鼠心肌细胞及间质内(光镜下).结论99Tcm-MIBI的清除对代谢状态敏感,可用于评价进行性心肌损伤.     

A case of congenital supratentorial tumor: Atypical teratoid/rhabdoid tumor or primitive neuroectodermal tumor?

Two embryonal CNS tumors, atypical teratoid/rabdoid tumor (AT/RT) and primitive neuroectodermal tumor (PNET), may be confused with each other and misdiagnosed. Here we report an infant with a congenital supratentorial tumor, which was detected by fetal MRI at 37 weeks gestation. On routine histological examination, the tumor was composed mainly of small undifferentiated cells, among which many rhabdoid cells and occasional sickle‐shaped embracing cells were observed. No mesenchymal or epithelial areas were evident. Our impression was that the tumor was an atypical example of AT/RT. Immunohistochemically, almost all the tumor cells were strongly positive for vimentin. However, epithelial membrane antigen was notably negative, and most of the tumor cell nuclei were clearly positive for INI1. In addition, many tumor cells were positive for neurofilament protein. There were also occasional small areas containing many tumor cells positive for glial fibrillary acidic protein. Finally, a diagnosis of PNET, with a rhabdoid phenotype and expression of neuronal and glial markers, was made. In the present case, application of INI1 immunostaining was very helpful for distinguishing PNET from AT/RT.     

微创穿刺术治疗基底节区脑出血临床随机对照研究

目的评价比较微创穿刺血肿粉碎清除术与内科保守治疗两种方法治疗基底节区脑出血(25～40m l)的疗效异同。方法采用多中心、随机对照试验的方法,42个参研医院共随机入选465例基底节区脑出血患者,根据纳入与排除标准共排除88例,其中资料不全者16例;不符合入选标准者72例,分别为Glasgow评分≤8分(64例)、术前出血量>40m l(7例)、从发病到达急诊室时间>72h(1例)。评价治疗14d时两组患者神经功能缺损程度和日常生活活动能力、治疗3个月时的日常生活活动能力以及3个月和住院期间病死率。结果最终符合入组标准的病例数为377例,其中微创治疗组195例,对照组182例。微创治疗组患者于治疗14d时,神经功能改善明显优于对照组(χ2=7.931,P=0.02);治疗3个月时达良好功能状态的患者比例明显多于对照组(35.91%vs21.82%;χ2=8.294P=0.004)。微创治疗组病,残率明显低于对照组(40.88%vs63.03%,χ2=16.948,P<0.01);两组病死率间差异无显著性意义(6.67%vs8.79%)。结论与单纯内科保守治疗相比,应用微创穿刺血肿粉碎清除术治疗基底节区小血肿不增加病死率,并可明显提高脑出血患者的日常生活活动能力,降低病残率。