犯罪青少年家庭教养方式的特征

目的:分析犯罪青少年家庭教养方式与正常青少年群体父母教养方式的差异,以及犯罪青少年父母教养方式的一致性问题。方法:于2004-11/2005-02以某省少年教养管理所在册的少教学员86名作为观察组,同期随机抽取初中和高中在校学生86名作为对照组。采用父母教养方式评价量表和自编一般家庭情况问卷对两组被试评分进行比较。父母教养方式量表包括父亲和母亲两个量表。父亲教养方式包括6个因子:情感温暖、理解,惩罚、严厉,过分干涉,偏爱被试,拒绝、否认,过度保护。母亲教养方式包括5个因子:情感温暖、理解,过分干涉、过度保护,拒绝、否认,惩罚、严厉,偏爱被试。测试包括从不、偶尔、经常、总是4个等级(分数越高表明父母教养方式各方面越突出)。结果:共发放问卷200份,回收有效问卷172份。①观察组父亲教养方式中情感温暖与理解、过分干涉评分低于对照组[(44.86±9.61),(51.41±8.25)分;(22.21±6.97),(33.30±3.49)分,P均<0.01],惩罚严厉、偏爱被试等评分高于对照组[(21.48±7.64),(14.21±4.74)分;(11.74±3.87),(8.56±4.29)分,P均<0.01];观察组母亲教养方式中情感温暖与理解评分低于对照组[(42.98±11.84),(52.97±9.05)分,P<0.01],拒绝否认、过分干涉与保护、惩罚严厉等评分高于对照组[(14.41±5.10),(9.02±2.84)分;(37.40±8.91),(33.97±5.90)分;(14.48±4.80),(12.94±3.45)分,P<0.01,P<0.05]。②观察组父母教养方式在偏爱被试、过度干涉保护、惩罚严厉以及拒绝否认贬低等方面存在严重分歧[(12.03±3.99),(9.50±3.68)分;(21.85±6.82),(37.78±8.3)分;(21.12±7.59),(14.44±5.03)分;(9.68±2.87),(14.26±4.91)分,P均<0.01]。对照组父母在情感温暖理解、过度干涉保护、惩罚严厉等方面存在分歧[(52.00±8.31),(53.08±9.18)分;(33.27±3.41),(34.77±6.12)分;(14.21±5.03),(13.22±3.82)分,P<0.05,P<0.01]。结论:犯罪青少年的父母教养方式存在3个明显不足,即缺少情感温暖、沟通和理解;极端化;父母教养方式严重分歧。母亲的过分干涉保护可能是青少年犯罪的一个重要相关因素。     

经皮电神经刺激在脑卒中康复中的应用：时尚与事实

经皮电神经刺激（TENS）对疼痛的治疗 经皮电神经刺激（transcutaneouselectricalnervestimulation，TENS）是一种外周神经刺激，自1967年开始成功地用于缓解疼痛的治疗，至今已有40年.其理论基础源于1965年Melza-ck等提出的著名的闸门控制学说。基于当时的实验基础，研究者们认为脊髓背侧角的胶质细胞是通过闸门控制系统工作，这些细胞在传人纤维终止于脊髓背侧角的第一级传入神经元之前起着调节作用。一级传入神经元通过前外侧系统调节大脑对疼痛的辨别和感受。触摸、挤压和振动刺激粗的有髓鞘纤维（如A-α、A-β纤维），后者作用于小的伤害性传人纤维，增强了背侧角神经元细胞终止前的突触前抑制，以减少传入神经元对大脑的刺激，从而达到减轻疼痛的目的。相反，小直径纤维，包括有髓鞘和无髓鞘（如A-γ和C纤维）则会在以上水平上减弱突触前抑制，从而加重疼痛。     

自体骨髓干细胞移植治疗急性心肌梗死围手术期并发症分析

目的：分析自体骨髓干细胞经冠脉移植治疗急性心肌梗死患者围手术期并发症情况。方法：抽取2004—09／2006—12唐山工人医院收治的急性心肌梗死患者40例，均行经皮冠状动脉介入治疗＋标准药物治疗＋经冠脉注入自体骨髓单个核细胞治疗，实验方案经医院伦理委员会批准，并获得患者知情同意，术前及术后根据临床需要给予标准药物治疗。于患者双侧髂后上棘穿刺，抽取骨髓，滤筛去除脂肪颗粒及骨渣，共采集100-120mL，经密度梯度离心获得骨髓单个核细胞悬液12～15mL，室温下保存少于4h。两侧冠脉造影，左前降支植入支架后，将导丝放置于原病变远端，沿导丝将over the wire球囊置入支架内，将分离的骨髓单个核细胞悬液经over the wire球囊导管中心腔内注入梗死相关动脉血管远端，每次注射4．0～5．0mL，抽空球囊间歇2min后再次同法注射，反复共3次。结果：40例行骨髓单个核细胞冠脉移植的心肌梗死患者均进入结果分析。围手术期各种并发症共34例次，其中血管并发症发生率20％，胸痛17．5％，心律失常15％，低血压12．5％，心功能障碍10％，迷走神经反射7．5％，低血糖反应2．5％。结论：随着冠状动脉介入治疗技术的开展和操作的规范，手术成功率逐步提高，但仍然会在围手术期出现各种并发症及突发事件。提示应严密观察病情，有针对性地采取预防措施和正确的应急处置，从而减少干细胞移植手术的风险。     

颈椎类风湿性关节炎患者的影像学分期及其功能评估

目的:探讨临床和影像学分期及评估对指导颈椎类风湿性关节炎患者治疗的意义。方法:选择1995-01/2004-07解放军第98医院住院治疗累及颈椎的类风湿性关节炎患者21例,平均病程8.0年。①所有患者常规摄颈椎或颅颈部正侧位、屈/伸侧位片及开口位片和枕颈部CT平扫,疑神经损伤者行MRI检查。②临床和影像学分期显示Ⅱ期(中度进展期)5例和Ⅲ期(重度进展期)16例;神经系统评估按Ranawat等标准(级别越高,神经损害越重)示Ⅰ级4例,Ⅱ级11例、ⅢA级4例、ⅢB级2例。③21例患者行甲氨蝶呤 其他DMARDs的联合治疗,Ranawa分级Ⅰ级4例行颈围外固定,11例Ⅱ级患者行枕颌吊带牵引,Ⅲ级6例手术行后路寰枢或枕颈融合治疗。④出院和随访时行临床疗效评估。结果:21例均进入结果分析。①影像学结果显示前向寰枢椎半脱位最常见,有16例,与侵蚀性骨破坏累及寰枢、寰齿、寰枢关节有关。②平均随访5.6年,21例中缓解2例,显效12例,有效4例,无效3例。③6例手术患者的齿突周围血管翳在随访中较术前明显减小。结论:对颈椎类风湿性关节炎患者可成功行临床和和影像学分期及评估,根据评估结果指导临床治疗效果满意。提示为防止枕颈部脊髓压迫,宜对此类患者行常规、定期的临床和影像学随访。     

Malnutrition,Critical Illness Survivors,and Postdischarge Outcomes: A Cohort Study

Background: We hypothesized that preexisting malnutrition in patients who survived critical care would be associated with adverse outcomes following hospital discharge. Methods: We performed an observational cohort study in 1 academic medical center in Boston. We studied 23,575 patients, aged ≥18 years, who received critical care between 2004 and 2011 and survived hospitalization. Results: The exposure of interest was malnutrition determined at intensive care unit (ICU) admission by a registered dietitian using clinical judgment and on data related to unintentional weight loss, inadequate nutrient intake, and wasting of muscle mass and/or subcutaneous fat. The primary outcome was 90‐day postdischarge mortality. Secondary outcome was unplanned 30‐day hospital readmission. Adjusted odds ratios were estimated by logistic regression models adjusted for age, race, sex, Deyo‐Charlson Index, surgical ICU, sepsis, and acute organ failure. In the cohort, the absolute risk of 90‐day postdischarge mortality was 5.9%, 11.7%, 15.8%, and 21.9% in patients without malnutrition, those at risk of malnutrition, nonspecific malnutrition, and protein‐energy malnutrition, respectively. The odds of 90‐day postdischarge mortality in patients at risk of malnutrition, nonspecific malnutrition, and protein‐energy malnutrition fully adjusted were 1.77 (95% confidence interval [CI], 1.23–2.54), 2.51 (95% CI, 1.36–4.62), and 3.72 (95% CI, 2.16–6.39), respectively, relative to patients without malnutrition. Furthermore, the presence of malnutrition is a significant predictor of the odds of unplanned 30‐day hospital readmission. Conclusions: In patients treated with critical care who survive hospitalization, preexisting malnutrition is a robust predictor of subsequent mortality and unplanned hospital readmission.     

重组pEGFP-N1-IGF-1体内转基因预处理对脊髓损伤后一氧化氮合酶活性的影响

目的:观察阳离子脂质体介导的重组pEGFP-N1-IGF-1体内转基因预处理对脊髓损伤后血清一氧化氮合酶及脊髓组织诱导型一氧化氮合酶影响,进一步探讨转基因治疗脊髓损伤的机制。方法:实验于2005-07/11在解放军第二军医大学动物实验中心完成。取54只雄性SD大鼠单纯随机分为3组:①生理盐水组(24只):采用脊髓内直接注射法,将2μL生理盐水 6μLTransfectamreagent共8μL注入T8～T10脊髓内,无下肢功能障碍者1周后按改良Nystr"m’s压迫法制作大鼠脊髓不完全损伤模型(压迫总质量35g,压迫时间5min)。②pEGFP-N1-IGF-1转基因组(24只):给药方法、部位、剂量以及造模方法与生理盐水组相同,但脊髓内注入6μLTransfectamreagent 2μg质粒pEGFP-N1-IGF-1。③正常组(6只):不损伤脊髓,不给药,作为正常对照。前2组损伤后1,4,8,24h、1,2周,取尾静脉血和损伤区域脊髓,测定血清一氧化氮合酶活性及局部脊髓组织诱导型一氧化氮合酶活性变化。结果:经补充后54只大鼠进入结果分析。①血清一氧化氮合酶活性:正常组为(305.4±52.0)μkat/L,其他2组在损伤后1～8h迅速升高,并于伤后24h达到高峰[pEGFP-N1-IGF-1转基因组:(522.6±60.3)μkat/L;生理盐水组:(757.0±83.7)μkat/L],其后逐渐降低,术后一两周仍维持在较高水平。pEGFP-N1-IGF-1转基因组各个时间点均低于生理盐水组(P<0.05,0.01)。②脊髓组织诱导型一氧化氮合酶活性:正常组为(72.5±17.3)μkat/g,其他2组在损伤后1～8h迅速升高,并于伤后24h达到高峰[pEGFP-N1-IGF-1转基因组:(140.2±24.2)μkat/g;生理盐水组:(207.2±36.8)μkat/g],其后逐渐降低,术后一两周仍维持在较高水平。pEGFP-N1-IGF-1转基因组各个时间点均低于生理盐水组(P<0.05,0.01)。结论:阳离子脂质体介导胰岛素样生长因子1基因转染预处理能够有效地下调大鼠一氧化氮合酶活性,特别是其可有效抑制诱导型一氧化氮合酶,从而减轻继发性损伤所致的神经组织的损害,侧面证明了胰岛素样生长因子1转基因治疗的可行性。     

The Effect of External Pituitary Irradiation on Elevated Serum Prolactin Levels in Patients with Pituitary Macroadenomas

The response of serum prolactin to external radiotherapy wasstudied in 58 patients (32 women) with pituitary tumours, agedbetween 16 and 75 years. Forty-four patients underwent pituitarysurgery before radiotherapy. Six Patients were irradiated witha regimen of 20 Gy in eight fractions over 10–11 daysand the remainder received 35–42.5 Gy in 15 fractionsover 20–22 days. Following radiotherapy, 44 patients receivedadditional treatment with dopaminergic agonists. Prolactin levelsranged from 1078 to 491000 mU/I (median 11750 mU/I) before radiotherapyand all but three patients showed a fall in serum prolactin(measured 4 weeks after stopping bromocriptine in those on dopamineagonist therapy) during observation over periods of up to 154months. All patients had evidence of pituitary fossa erosionor expansion at presentation and large tumours (Hardy-VezinaGrade 3–4) were more common in male patients (²=10.08,p<0.01). The rate of fall of serum prolaetin levels was greaterin patients with true prolactin-secreting tumours when comparedwith those who had stalk or hypothalamic damage (p< 0.005).The rate of decline of serum prolactin was also significantlyrelated to the pre-radiotherapy value (p=0.519, p<0.01).A serum prolactin level. <500 mU/I was achieved in 31 outof 44 patients treated with radiotherapy and dopaminergic agonistbut only nine remained normoprolactinaemic when medication wasdiscontinued for 4 weeks or more. The serum prolactin levelfell permanently to <500 mU/I in two of 14 patients treatedwith radiotherapy only. Actuarial analysis of data from allpatients indicated a 50 per cent probability that prolactinwould be reduced to <500 mU/I by 10 years; this increasedto 58 per cent for patients with smaller tumours (Hardy-Vezinagrade 2). Fourteen of 19 women of premenopausal age were amenorrhoeicbefore radiotherapy, but despite bromocriptine, menstruationwas restored in only five. A separate group of nine patientswith primary suprasellar, non-prolactin-secreting tumours andelevated prolactin levels was also studied. Prolactin concentrationsranged between 1016 and >4600 mU/I intially and were reducedby radiotherapy at a rate indistinguishable from that of patientswith pituitary adenomas associated with disconnection hyperprolactinaemia.None achieved permanent reduction of serum prolactin to <500mU/I. External radiotherapy is effective in reducing serum prolactinlevels in patients with pituitary macroadenomas, particularlywhere the hyperprolactinaemia is due to true tumour hypersecretion,but normal levels may take over 10 years to achieve. Radiation-inducedhypothalamic damage probably contributes to the hyperprolactinaemiapersisting after therapy and together with tumour-associatedor radiation-induced hypopituitarism accounts for the poor prospectsfor fertility in female patients.     

Structural evidence for distinct IgG subclass-specific Fc receptors on mouse peritoneal macrophages

Membrane proteins which selectively bind to the Fc portion of IgG were identified in the Nonidet P-40 extracts of radiolabeled thioglycollate- elicited mouse peritoneal macrophages. Affinity columns of various IgG preparations coupled to Sepharose 4B were used to absorb the Fc-binding proteins. Analysis of the acetic acid or sodium dodecyl sulfate (SDS) eluates from aggregated human IgG or antigen-complexed rabbit IgG columns revealed two Fc(gamma)/-specific proteins with apparent 67,000 and 52,000 mol wt. These proteins were not detected in acid or SDS eluates from F(ab’)(2) columns or in eluates from IgG column, over which were passed lysates of Fc receptor-negative cells. With the use of affinity columns that contained aggregated mouse myeloma proteins of different IgG subclasses, we found that the 67,000-dahon protein selectively binds to IgG2a, whereas the 52,000-dalton protein binds to IgG1 and IgG2b. Neither protein was found in SDS eluates from IgG3 columns. Trypsin treatment of the macrophages before detergent lysis removed the 67,000-dalton protein, although it leaves intact the 52,000-dalton protein. These results provide structural confirmation for the existence of separate Fc receptors on mouse macrophages and indicate that the two Fc-binding proteins identified in this study represent all or part of the trypsin- sensitive Fc receptor which binds IgG2a and the trypsin-resistant Fc receptor which binds IgG2b and IgG1.     

肝损伤Balb—c小鼠用于细胞移植治疗的有效亚致死放疗剂量

目的:探索肝损伤Balb-c小鼠适合的亚致死性放疗剂量,为细胞移植治疗用于肝病动物模型提供预处理方案。方法:实验于2004-10/2005-06在中山大学附属第一医院神经科实验室和中山大学实验动物中心完成。供体鼠为48只雄性Balb-c小鼠,受体鼠为24只雌性Balb-c小鼠。24只雌性受体鼠以2-乙酰氨基芴法建立肝损伤模型,根据γ射线照射剂量按随机数字表法分为4组,即γ射线8Gy,7Gy,6Gy和5Gy照射组,每组6只。放疗后当天接受带有CM-Dil荧光标记的供体雄性小鼠骨髓干细胞移植,每只受体小鼠移植骨髓干细胞1.0×107个。移植后追踪12周,观察受体鼠的一般情况及移植物抗宿主病反应,检测干细胞示踪剂CM-DiI(积分吸光度值)和供体雄性Sry基因(Sry与β-actin扩增产物积分吸光度比值)在受体鼠肝脏中的表达,以明确供体细胞在受体鼠肝脏存活情况。结果:放疗后γ射线8Gy照射组小鼠在放疗后4～10d内全部死亡,γ射线7Gy照射组死亡4只,共14只小鼠进入结果分析。①移植后受体鼠的移植物抗宿主病情况比较:γ射线7Gy照射组移植后第1周时移植物抗宿主病症状明显,4周后完全消失;γ射线5,6Gy照射组移植物抗宿主病症状轻微,持续3周消失。②各组受体小鼠肝脏中的CM-DiI分布情况比较:γ射线5,6,7Gy照射组CM-DiI积分吸光度值分别为2.86±0.72,2.65±0.55,2.53±0.42,3组相比差异无显著性意义(P>0.05)。③各组受体小鼠肝脏中雄性Sry基因的表达情况比较:γ射线7,6和5Gy照射组Sry与β-actin扩增产物积分吸光度比值分别为0.194±0.015,0.213±0.031,0.208±0.027,各组间差异无显著性意义(P>0.05)。结论:鉴于外周血细胞被供体细胞取代量随着放疗剂量增加而增加的理论,肝损伤Balb-c小鼠模型用于细胞移植研究的适合亚致死性放疗剂量是6Gy。