Video EEG diagnosis of repetitive behavior in early childhood and its relationship to seizures

Differentiating seizures from pseudoseizures frequently is challenging in very young children manifesting repetitive, stereotypic behavior. Using video electroencephalographic recording, we evaluated 60 patients, younger than 10 years of age, with episodic signs and symptoms believed to be seizures despite repeatedly normal routine electroencephalograms. Nine patients (15%) had simple partial and atypical absence seizures. Twenty-four patients (40%) had pseudoseizures presenting as rhythmic movements or staring. Pseudoseizure frequency was greater than the frequency of true seizures; brief staring episodes were common. Motor pseudoseizures usually were of longer duration than true seizures and could be brought on with verbal encouragement. Furthermore, the stereotypic motor presentations were quite different from those of true motor seizures but were difficult to recognize from historic, clinical, and routine electroencephalographic data. Symptomatic patients can be clinically diagnosed by analyzing confirmed episodes with video electroencephalography.     

血管重塑对大鼠血管成形术后再狭窄的影响

目的：建立大鼠颈动脉再狭窄模型，原位灌注固定取材。评价PTA后血管重塑（VR）的动态变化规律，定量分析血管重塑在血管再狭窄过程中的变化及作用。方法：制作70只SD雄性大鼠颈总动脉再狭窄模型，分原位灌注实验组、对照组，于术后1h、3、7、14、28和42天原位灌注固定取材，行HE染色、Masson染色，观察标本血管狭窄情况。结果：①血管重塑指数（VRI）在PTA后即刻最大，3天组明显降低，7天组稍有增大，其后不断减小，剩余血管腔面积百分比同VRI的变化曲线基本一致。②FFA后，血管腔面积总体呈逐渐缩小趋势，内弹力板围绕面积（IELA）1h组较对照组明显增大，3天组较1h组明显缩小，14、28、42天组较对照组明显缩小。外弹力板围绕面积（EELA）逐渐缩小。EELA、IELA的变化与血管腔面积变化呈正相关。③VRI与血管腔面积的变化呈正相关，新生内膜面积与剩余狭窄率、血管腔面积无直线相关。结论：再狭窄过程中存在扩张性重塑和收缩性重塑现象，管腔的狭窄与否取决于血管重塑指数的变化，而不是新生内膜的变化，新生内膜的形成是血管重塑过程中的一部分。IELA和EELA可作为判断管腔狭窄及评价血管重塑的指标。     

Can burst fractures be predicted from plain radiographs?

Plain radiographs of 67 acute spinal compression fractures in 49 patients were analysed by subjective and objective criteria, using CT scans as the diagnostic standard for the diagnosis of burst fracture. Discriminant analysis correctly predicted the type of fracture in 88% of cases. Burst fractures, however, were almost as frequently misdiagnosed as being wedge compression fractures using this technique, compared with the reading of 25 films from patients without previous information. A quarter of the injuries would have been misdiagnosed had reliance been placed solely on the plain radiographs. CT scans of all patients with acute spinal compression fractures should be considered to decrease this potentially serious diagnostic error.     

小儿维生素D中毒三例误诊分析

近年来,随着人们对维生素D缺乏病的重视,临床已很难看到典型的维生素D缺乏的患儿,相反,因过量或错误使用维生素D而导致中毒的病例时有发生[1]。现将我院5年来误诊的3例维生素D中毒报告如下。1病例资料【例1】女,2岁。因夜尿、遗尿1周就诊。无发热、尿急、尿痛等不适。查体:心肺听诊未闻及异常,腹软,外生殖器无异常。尿常规正常。疑诊为尿路感染,服诺氟沙星治疗3天,症状无改善。再次追问病史,得知因急性结膜炎患儿奶奶给其服用鱼肝油治疗,至发病时已服1个月,总量约60万单位。考虑维生素D中毒,急查血钙3·2 mmol/L(正常参考值2·10~2·55 m…     

Ultrasonography of the urinary bladder

Summary Ultrasonography of the urinary bladder has evolved with improvements in ultrasound instrumentation. The bladder may be visualized transabdominally, transurethrally, and transrectally. Bladder tumors may be accurately staged. Postvoiding residual urine may be measured accurately and noninvasively. As newer indications are evaluated, including ultrasound imaging of the bladder during urodynamic studies, ultrasound of the bladder will be performed more readily by urologists.     

人PD-L2基因克隆及其在大肠杆菌中的表达

目的 克隆人PD-L2基因并构建PD-L2胞外区的原核表达载体，在大肠杆菌中进行表达。方法 以RT-PCR方法从活化的人外周血单个核细胞总RNA中克隆PD-L2基因的cDNA，构建PD-L2胞外区的原核表达载体，在大肠杆菌BL21(ED3)中进行表达并鉴定。结果 克隆到PD-L2基因cDNA编码区全长序列，经DNA测序证明其与已报道的序列一致。进而构建了PD-L2胞外区的原核表达载体，并在大肠杆菌表达，免疫印迹分析表明在IPTG诱导后表达PD-L2胞外区蛋白，相对分子质量Mr为22000，与理论值大小相符。结论 成功克隆PD-L2基因，其胞外区蛋白在大肠杆菌中获得表达，为进一步研究PD-L2功能提供了条件。     

UVB对角质形成细胞产生细胞因子的影响

角质形成细胞可产生多种细胞因子，这些细胞因子除介导炎症和免疫反应外，还参与组织细胞的生长和分化。UVB照射影响了角质形成细胞合成、分泌细胞因子，并影响细胞因子对角质形成细胞的作用及细胞因子之间的相互作用。概述角质形成细胞产生各种细胞因子的生物学效应。     

全膝关节置换翻修术的Meta分析

目的 通过对已报道的全膝关节置换翻修术文献进行总结分析,讨探膝关节置换翻修术前后的膝关节功能、翻修的主要原因、主要并发症及不同假体的术后疗效.方法 按照以下标准收集和分析有关全膝关节置换翻修术的文献:①1990年至2002年间发表,②报告患者数大于10例,③采用通用的膝关节评分标准.一名骨科专科医生独立收集数据,一名医学统计学专家独立采用Meta统计方法分析数据.结果 共有33 篇符合条件的文献被收集.患者共1356 例,其中男429例,女611例(部分文献性别分类数据缺失),平均年龄67岁(45～49岁),加权平均随访时间57个月( 6～108 个月),加权平均术前膝关节功能总评分为49 分(15～94分),术后为84分( 58～109分),全膝关节置换翻修术前后的总评分、功能评分、活动范围等有显著性提高,差异有统计学意义(总评分t=12.507,P<0.01, 功能评分t=4.704,P<0.01,活动范围:t=5.346,P< 0.01).全膝关节置换翻修术的原因主要是假体松动(55%),其它包括聚乙烯磨损(11%)、假体不稳(10%)、感染(7%).翻修术后的主要并发症仍然为假体松动(18%),其它包括假体不稳(16% )、感染(16% )、髌骨问题( 15% )及不明原因的膝关节疼痛(13%).髌骨问题包括髌骨脱位、半脱位、髌韧带撕裂、髌股关节疼痛等.结论 可以认为膝关节置换后翻修术是一种安全有效的手术.假体松动是膝关节置换翻新的主要原因和并发症.     

转移瘤致股骨近端病理骨折的治疗

目的　探讨转移瘤致股骨近端病理骨折的治疗方法。方法　分析 1995年 5月至 2 0 0 2年 5月手术治疗的 16例的临床资料。结果　无手术并发症 ,术后疼痛明显缓解 ,伤口除 1例浅层感染外 ,余愈合良好。所有病例均存活在 3个月以上 ,14例术后继续原发肿瘤治疗。结论　股骨近端转移瘤所致的病理骨折应积极行手术治疗 ,内固定以带锁髓内钉加骨水泥为好。