导道滑脱风险跟踪评估监控流程的设计及应用

目的规范预防导管滑脱管理,降低非计划拔管发生率。方法制定导管滑脱风险评估监控表和导管滑脱风险跟踪评估监控流程,将导管滑脱风险评估监控表和跟踪评估监控流程应用于临床并进行动态管理。结果实施后高危拔管患者非计划拔管发生率显著低于实施前(P0.05)。结论实施导管滑脱风险跟踪评估监控流程,能降低非计划拔管发生率。     

Single drug therapy for intractable epilepsy

Summary Single drug therapy with either phenytoin or primidone resulted in complete seizure control in 11 of 35 patients (31%) referred to an epilepsy clinic for treatment of uncontrolled chronic epilepsy with complex-partial seizures. Complete seizure control was associated with an increase in the mean plasma concentrations from 14 g/ml to 23 g/ml phenytoin and from 34 g/ml to 40 g/ml phenobarbitone with no change in the antiepileptic drug. Insufficiently low plasma concentrations of less than 11 g/ml phenytoin or phenobarbitone were measured at the first visit in 14 patients (40%). Non-compliance was admitted by eight patients (23%). Optimum single drug therapy is of considerable clinical value in intractable epilepsy with complex-partial seizures.

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Zusammenfassung Eine Monotherapie mit Phenytoin oder Primidon führte zur Anfallsfreiheit bei 11 von 35 Patienten (31%), die wegen schwerbehandelbarer psychomotorischer Anfälle eine Epilepsieambulanz aufsuchten. Anfallsfreiheit trat auf bei einem Anstieg der mittleren Plasmakonzentration von 14 g/ml auf 23 g/ml Phenytoin und von 34 g/ml auf 40 g/ml Phenobarbital. Ein Wechsel der Medikamente war nicht notwendig. Während der ersten Untersuchung wurden bei 14 Patienten (40%) zu niedrige Plasmakonzentrationen von weniger als 11 g/ml Phenytoin oder Phenobarbital gefunden. 8 Patienten (23%) gaben eine unregelmäßige Einnahme der Medikamente (non-compliance) zu. Eine konsequente Monotherapie ist von klinischem Wert für die Behandlung von schwerbehandelbaren Epilepsien mit psychomotorischen Anfällen.

     

Partial Seizures in West Syndrome

Summary: Purpose: To study the occurrence of partial seizures (PS) and elucidate the characteristics of patients with West syndrome (WS) with PS.
Methods: We investigated the electroclinical and radiologic features in 92 children with WS who were older than 3 years at follow-up.
Results: Thirty-six (39.1%) children had PS at some time during the course of the disease. They had a significantly high incidence of asymmetric spasms, hemiparesis, and asymmetric hypsarrhythmia. Their seizure prognosis was significantly less favorable. PS appeared only before spasms (group A, six children), concomitant with spasms (group B, 18 children), and only after spasms ceased (group C, 12 children). Five children in group B had PS after spasms stopped. PS in group A and during the period of active spasms in group B showed high seizure frequency and variability of both seizures and EEG manifestations. The PS and EEG epileptiform discharges were mainly in parietal-posterior temporal-occipital, and central regions. Late PSs in group B and PSs in group C were characterized by stereotyped manifestations and relatively low seizure frequency. These PSs originated mostly from frontal regions.
Conclusions: In some children with WS, cortical lesions can induce both PS and spasms in series, whereas in others, both types of seizures occur with abnormally increased excitability throughout the cortex rather than as the result of a single cortical lesion. These findings suggest caution in interpreting focal discharges, which may fluctuate and are not necessarily indicative of a surgically accessible lesion. When the discharges are stable and correlate with an equally stable clinical pattern, the likelihood of an underlying cortical lesion is greater.     

神经电生理监测下听神经瘤显微手术中面神经的保护

目的总结分析术中神经电生理监测结合显微手术操作技巧在听神经瘤手术中预防面神经损伤的作用。方法选取我科2011～2012年施行乙状窦后入路显微手术的大型及中型听神经瘤（肿瘤直径≥2.4 cm）患者62例,术中应用神经电生理监测技术对手术进行综合监护,同时密切留意骨性解剖、蛛网膜解剖、神经与血管解剖关系。术后随访6个月,评估肿瘤切除程度并根据House-Brack-mann面神经功能分级对患者面神经功能进行评估。结果肿瘤全切除58例（93.5%）,次全切除4例（6.5%）;无围手术期死亡患者。面神经功能评定：Ⅰ级57例（91.9%）,Ⅱ级5例（8.1%）。结论对于大型和中型听神经瘤患者,术中进行综合电生理监护,同时操作时注意典型的解剖位置与熟练的显微手术技术,可达到较高的肿瘤全切除率,并尽可能地保全面神经功能。     

Current challenges in detecting food allergens by shotgun and targeted proteomic approaches: a case study on traces of peanut allergens in baked cookies

There is a need for selective and sensitive methods to detect the presence of food allergens at trace levels in highly processed food products. In this work, a combination of non-targeted and targeted proteomics approaches are used to illustrate the difficulties encountered in the detection of the major peanut allergens Ara h 1, Ara h 2 and Ara h 3 from a representative processed food matrix. Shotgun proteomics was employed for selection of the proteotypic peptides for targeted approaches via selective reaction monitoring. Peanut presence through detection of the proteotypic Ara h 3/4 peptides AHVQVVDSNGNR (m/z 432.5, 3+) and SPDIYNPQAGSLK (m/z 695.4, 2+) was confirmed and the developed method was able to detect peanut presence at trace levels (≥10 μg peanut g(-1) matrix) in baked cookies.     

妊娠期高血糖患者血糖波动特点及其与妊娠结局的关系

妊娠期高血糖包括糖尿病合并妊娠与妊娠期间首次发现的高血糖.妊娠期高血糖患者整体血糖水平升高及血糖波动增加与围产期母婴不良结局密切相关.动态血糖监测(CGM)有助于全面了解血糖波动的变化特点,在妊娠期高血糖患者血糖管理、改善母婴预后等方面具有重要作用.利用CGM可以分析妊娠期高血糖患者的血糖波动特点,分析血糖波动与胰岛细胞功能的关系、对母婴结局的影响.     

Sevoflurane anaesthesia in children after induction of anaesthesia with midazolam and thiopental does not cause epileptiform EEG

Background. Sevoflurane is a methyl ether anaesthetic commonlyused for induction and maintenance of general anaesthesia inchildren. Sevoflurane is a non-irritant and acts quickly soinduction is usually calm. However, inhalation induction withhigh concentrations of sevoflurane can cause convulsion-likemovements and seizure-like changes in the electroencephalogram(EEG). Little is known about the EEG during maintenance of anaesthesiawith sevoflurane, so we planned a prospective trial of sevofluranemaintenance after i.v. induction with benzodiazepine and barbiturate,which is another common induction technique in children. Methods. EEG recordings were made before premedication withmidazolam (0.1 mg kg^–1 i.v.), during induction ofanaesthesia with thiopental (5 mg kg^–1), and duringmaintenance with sevoflurane (2% end-tidal concentration inair/oxygen without nitrous oxide) in 30 generally healthy, 3-to 8-year-old children having adenoids removed. Noise-free EEGdata of good quality were successfully recorded from all 30children. Results. Two independent neurophysiologists did not detect epileptiformdischarges in any of the recordings. Conclusion. Premedication with midazolam, i.v. induction withthiopental and maintenance of anaesthesia with 2% sevofluranein air does not cause epileptiform EEG patterns in children. Br J Anaesth 2002; 89: 853–6     

Monitoring and evaluation of refractive error and presbyopia for Vision 2020

Purpose: To develop output and outcome indicators for the correction of refractive error and presbyopia to a level comparable with those advocated by Vision 2020 for cataract. Methods: World Health Organization, Vision 2020 and published eye care intervention literature were searched to find evidence of best practice. This information was used to construct a suite of indicators for monitoring the correction of refractive error and presbyopia. Results: Indicators for the monitoring and evaluation of refractive error and presbyopia correction were proposed, addressing refraction and spectacle dispensing outputs and rates, and refractive error correction and presbyopia correction coverage. Conclusion: Using data collection that should be occurring in everyday clinical practice, the proposed indicators would provide more comprehensive information than those currently suggested by Vision 2020. As such, they would be more useful in the monitoring and evaluation of the correction of refractive error and presbyopia in the context of Vision 2020.     

胜利油田地区德国小蠊抗药性监测结果分析

目的了解山东省胜利油田地区德国小蠊抗药性现状,为有效杀灭德国小蠊提供科学策略。方法采用药膜法监测胜利油田不同地区德国小蠊对常用化学杀虫剂的抗药性;应用酶试剂盒测定谷胱甘肽S-转移酶(GSTs)、乙酰胆碱酯酶(AChE)和超氧化物歧化酶(SOD)的活性。结果胜利油田地区东营、河口、孤岛、仙河4个地区德国小蠊对溴氰菊酯的抗性倍数最高,分别为25.76、16.68、15.77、14.21;其次是氯氰菊酯,抗性倍数分别为23.72、8.34、8.05、7.81;不同地区野外品系德国小蠊分别与敏感品系酶活力比较,东营、孤岛、仙河野外品系德国小蠊的GSTs酶活力分别为(75.97±4.16)、(58.87±2.88)、(59.51±2.73)U/mgprot,均高于敏感品系的(53.16±2.25)U/mgprot,东营、河口、孤岛、仙河野外品系德国小蠊的AChE酶活力分别为(1.22±0.07)、(1.01±0.06)、(0.97±0.11)、(0.77±0.04)U/mgprot,均高于敏感品系的(0.39±0.01)U/mgprot,东营野外品系德国小蠊的SOD酶活力为(33.24±1.53),高于敏感品系的(29.18±1.25)U/mgprot,差异均有统计学意义(均P<0.05)。结论胜利油田地区野外品系德国小蠊对溴氰菊酯和氯氰菊酯的抗药性较高, GSTs和AChE相对活性可作为德国小蠊抗药性的监测指标。