The Mini-Cog as a screen for dementia: validation in a population-based sample

OBJECTIVES: To test the Mini-Cog, a brief cognitive screening test, in an epidemiological study of dementia in older Americans. DESIGN: A population-based post hoc examination of the sensitivity and specificity of the Mini-Cog for detecting dementia in an existing data set. SETTING: The Monongahela Valley in Western Pennsylvania. PARTICIPANTS: A random sample of 1,119 older adults enrolled in the Monongahela Valley Independent Elders Survey (MoVIES). MEASUREMENTS: The effectiveness of the Mini-Cog in detecting independently diagnosed dementia was compared with that of the Mini-Mental State Examination (MMSE) and a standardized neuropsychological battery. RESULTS: The Mini-Cog, scored by an algorithm as "possibly impaired" or "probably normal," and the MMSE, at a cutpoint of 25, had similar sensitivity (76% vs 79%) and specificity (89% vs 88%) for dementia, comparable with that achieved using a conventional neuropsychological battery (75% sensitivity, 90% specificity). CONCLUSION: When applied post hoc to an existing population, the Mini-Cog was as effective in detecting dementia as longer screening and assessment instruments. Its brevity is a distinct advantage when the goal is to improve identification of older adults in a population who may be cognitively impaired. Prior evidence of good performance in a multiethnic community-based sample further supports its validity in the ethnolinguistically diverse populations of the United States in which widely used cognitive screens often fail.     

自由基对海马神经元的损害及人参皂甙保护作用的免疫组化研究

目的：探讨自由基对海马神经元胆囊收缩素（ Ｃ Ｃ Ｋ）的损害及人参皂甙的抗损害作用。方法：对１８ ｄ Ｗｉｓｔａｒ 大鼠胚胎海马神经元进行培养。培养第４ 天随机分为正常组、自由基组和人参皂甙组。采用免疫组化结合图像分析检测其灰度值,进行统计学分析及处理。结果：自由基作用２４ ｈ,自由基组 Ｃ Ｃ Ｋ８ 含量明显低于正常组（ Ｐ ＜００１）,而人参皂甙组 Ｃ Ｃ Ｋ８ 含量接近正常组（ Ｐ＜ ００５）。结论：自由基可降低海马神经元 Ｃ Ｃ Ｋ 含量,人参皂甙可增加 Ｃ Ｃ Ｋ 含量。说明自由基具有影响 Ｃ Ｃ Ｋ 等多肽合成,人参皂甙具有较强的抗氧化作用。     

多层螺旋CT门静脉容积显示技术三维成像

目的：探讨多层螺旋CT肝脏门静脉容积显示技术三维成像方法。材料和方法：14例正常者及32例肝胰疾病患者行多层螺旋CT门静脉成像。方法为容积显示技术三维重建，对正常和异常的门静脉图像进行分析。结果：通过选择合适的窗宽、窗位、亮度及不透明度，均可获得良好的门静脉VR图像。VR图像可清晰显示正常和病变组的门静脉系血管情况，具有较强的立体感。结论：多层螺旋CT门静脉容积显示技术三维成像是快捷而有效的无创性血管造影术，可为临床提供更优质的图像和更多的信息。     

CT导引下电化学治疗肝癌

目的：评价CT导引下电化学治疗肝癌的临床效果。方法：在CT导引下利用电化学对67例肝癌患者进行治疗。铂金电极针精确地插入肿瘤内，阳极位于肿块中央区，阴极分布四周，针间距2．0－3．0cm。按照1cm直径肿瘤80－100C电量的治疗标准，取电压6－10V，电流60－100mA。根据肿瘤直径的大小，将67例分为3组，A组：直径≤3cm（24例）；B组，直径3-8cm(31例）；C组：直径≥8cm（12例）。分别观察3组的1、2、3年生存率。结果：肿瘤体积与疗效呈负相关。A组1、2、3年生存率分别为91．67％、87．50％、70．83％；B组分别为70．97％、48．39％、29．03％；C组分别为50．00％、25．00％、8．33％。结论：在CT导引下利用电化学治疗中，小肝癌效果显著，是1种简便、安全、有效的方法。对那些不能耐受手术又对化疗不敏感的大肝癌患者，电化学疗法仍可作为1种选择的治疗方法。     

非体外循环冠状动脉搭桥手术对老年患者甲状腺功能的影响

目的:探讨80岁以上非体外循环冠状动脉搭桥手术患者甲状腺功能的变化。方法:50例患者分别于术前1d,返回监护室即刻和术后第1、2、5天检测甲状腺功能。根据欧洲心脏手术风险评估系统将患者分为高风险组和中低风险组,分析2组患者甲状腺激素水平及围术期临床资料的差异。结果:2组主动脉内气囊反搏(IABP)使用、术后24h正性肌力药物评分、呼吸机辅助时间和ICU监护时间差异有统计学意义(P<0.01)。高风险组术后总三碘甲状腺原氨酸、游离三碘甲状腺原氨酸和促甲状腺激素明显低于中低风险组(P<0.05或P<0.01)。其甲状腺功能低谷时段恰好是该组患者术后血流动力学不稳定期。结论:非体外循环冠状动脉搭桥手术不能防止正常甲状腺功能病态综合征的发生,甲状腺激素是评估心功能障碍患者转归的重要指标。     

自体脂肪颗粒移植在颜面部年轻化美容手术中的应用

目的探讨自体脂肪颗粒注射移植在颜面部年轻化美容中的效果。方法根据几何计算方法预先测定颜面部脂肪颗粒移植的组织量,利用一次性注射器抽取自体皮下脂肪颗粒,注射移植在颜面部需要填充的部位。结果 72例（136个部位）中61例接受1次脂肪颗粒注射,11例接受2次脂肪颗粒注射,每次注射量为2～60mL;经6个月以上的随访,效果较满意,仅2例形态欠满意。结论自体脂肪颗粒是较理想的软组织填充材料,注射移植在面部美容中是一种易操作、损伤小、简便安全及有效的方法 。     

Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein

BACKGROUND/AIMS: To evaluate the benefits of the tumor thrombus types system on determining treatments and prognosis of hepatocellular carcinoma patients (HCC) with tumor thrombi in the portal vein. METHODOLOGY: According to anatomic features of the portal vein in the liver and tumor thrombus of HCC developing modes, a uniform tumor thrombus types system (types I-IV) was first recommended. 84 HCC patients with portal vein tumor thrombi, which from January 2000 to January 2003 in the Eastern Hepatobiliary Surgery Hospital, were divided into I-IV groups according to types I-IV of the tumor thrombus system. The median survival periods and effectiveness of surgical resection or non-resection for I-IV groups were retrospectively observed. RESULTS: The median survival periods for patients of group I (n=17), II (n=26), III (n=35) and group IV (n=6) were 10.1, 7.2, 5.7 and 3.0 months, respectively (p = 0.0001). From tumor thrombus type I to type III, the patients received surgical resection were better than that of non-resection (P = 0.0006). Among the patients receiving resection treatment, resection of tumor thrombus type I had the best effects, while for patients with tumor thrombus type IV, the results were not good. In case of non-resection treatments, the survival periods of patients with tumor thrombi type I, II and III were similar, which supposed that TACE may be of little effects on tumor thrombi. CONCLUSIONS: Types of tumor thrombus system suggested may be helpful to determine the treatments and prognosis of HCC patients with tumor thrombi in the portal vein.     

新型人工半骨盆的研制与临床应用的初步报告

目的：研制新一代的人工半骨盆并临床应用。方法：应用计算机三维重建、个体化设计及数控制造技术研制新一代的人工半骨盆,应用椎弓根螺钉固定假体,将新型人工半骨盆置换入人体。结果：临床应用1例髂骨软骨肉瘤术后复发患者,手术顺利,随访3个月,患者恢复良好,X线检查未见异常。患侧髋关节活动及下肢感觉、运动等正常,可持拐下地。结论：计算机三维重建、个体化设计及制造技术研制人工半骨盆,增加了假体固定后的可靠性和稳定性,有较好临床应用前景。人工半骨盆的外形和功能“仿生”及生物力学上的稳定性,仍是人工半骨盆研究的重点。     

实时荧光定量检测人血浆中RASSF1A基因启动子甲基化

目的 建立检测人血浆DNA中RASSF1A基因甲基化的方法.方法 以肺癌细胞株NCI-H460作为RAssF1A基因启动子区甲基化阳性样本,传统酚/氯仿法提取细胞DNA,经紫外分光光度计定量后以10倍稀释的浓度梯度依次投入到200 μl健康人血浆中,制备得到模拟肺癌患者血浆.用磁珠法从模拟血浆样本和15例早期肺癌患者血浆中提取总DNA.对血浆DNA模板进行亚硫酸氢盐化学修饰,并以TaqMan技术的实时荧光定量甲基化特异性PCR(MSP)进行检测.以模拟血浆样品作为标准品,用外标准曲线法对肺癌患者血浆中的甲基化RASSF1A进行定量.结果 实时荧光定量MSP对模拟肺癌患者血浆的检测最低限为150拷贝(甲基化的肿瘤DNA)/ml(血浆).15例肺癌患者5例RASSF1A甲基化阳性(33.3%).5例肺癌患者血浆中甲基化的RASSF1A基因的浓度分别为2.56×103,8.20×104,1.45×104,3.31×104和4.24×104拷贝/ml.结论 实时荧光定量MSP法检测肺癌患者血浆DNA中RASSF1A基因甲基化,灵敏度高,特异性强.     

肾移植后供者细胞的迁移和嵌合

采用聚合酶链反应（ＰＣＲ）技术对１９８７年７月～１９９６年６月接受男性供肾的５７例女性受者的嵌合状态进行研究。发现嵌合总发生率为５４．４％（３１／５７）；生存期３年以上的受者嵌合发生率为６６．７％（１８／２７），而三年以内嵌合发生率为４３．３％（１３／３０），两者差异有显著性（Ｐ＜０．０５）；肾移植后２个月内，嵌合的形成尚不稳定。结果表明：随着肾移植受者生存期的延长，嵌合的发生率相应增高；嵌合反映了供者器官与受者免疫系统之间双向作用的关系，并与免疫耐受存在某种联系。