外伤性急性硬膜下血肿选择性非手术治疗体会

目的探讨急性硬膜下血肿选择性非手术治疗的适应证。方法回顾性分析近5年来保守治疗74例外伤性急性硬膜下血肿患者的临床资料。所有患者入院后即行持续颅内压监护,并根据颅内压的变化随时调整治疗方案。结果62例保守治疗,6例急诊开颅清除血肿,4例亚急性期血肿钻孔冲洗引流,2例慢性硬膜下血肿钻孔引流。结论除急诊手术外,部分急性硬膜下血肿患者在严密监护下,尤其在持续颅内压监护下,保守治疗或延期手术取得良好的效果。     

颅内压监测对重型颅脑创伤患者预后与疾病负担影响的队列研究

目的 了解颅内压(ICP)监测在重型颅脑创伤(TBI)患者中的应用情况及其对预后和经济负担的影响.方法 抽取上海市5家二级以上综合性医院在2009年1月至2011年1月间收治的重型TBI住院患者535例,按是否行ICP监测分为两组(ICP组和非ICP组),对比两组患者的病死率,急性期总住院费用,住院天数,寿命年费用及质量调整寿命年费用.结果 重型TBI患者行ICP监测的比例为28.0％.ICP组患者的住院病死率为16.7％,显著低于非ICP组患者的住院病死率32.2％(P＜0.001).多元Logistic回归分析显示行ICP监测的患者死亡风险仅为非ICP监测患者的0.32倍(95％ CI,0.19,0.54).重型颅脑创伤患者行ICP监测可使病死率下降15.5％,但平均多耗费住院费用69 620元(P＜0.001);行ICP监测的寿命年费用中位数为5 995元,显著高于未行ICP监测的寿命年费用中位数2 236元(P＜0.001);行ICP监测的质量调整寿命年费用中位数为11 558元,显著高于未行ICP监测的寿命年费用中位数3 938元(P＜0.001).结论 我国重型TBI行ICP监测的比例仍较低,重型TBI患者行ICP监测可能会增加经济负担,但却大大降低患者病死率.     

Quantitative evaluation of extracellular glutamate concentration in postischemic glutamate re-uptake, dependent on brain temperature, in the rat following severe global brain ischemia

Changes in brain temperature are known to modulate the marked neuronal damage caused by an approximately 10-min intra-ischemic period. Numerous studies have suggested that the extracellular glutamate concentration ([Glu](e)) in the intra-ischemic period and the initial postischemia period is strongly implicated in such damage. In this study, the effects of intra-ischemic brain temperature (32, 37, 39 degrees C) on [Glu](e) were investigated utilizing a dialysis electrode combined with ferrocene bovine serum albumin (BSA), which allows oxygen-independent real-time measurement of [Glu](e). This system allowed separate quantitative evaluation of intra-ischemic biphasic glutamate release from the neurotransmitter and metabolic pools, and of postischemic glutamate re-uptake in ischemia-reperfusion models. The biphasic [Glu](e) elevation in the intra-ischemic period did not differ markedly among intra-ischemic brain temperatures ranging from 32 to 39 degrees C. Intra-ischemic normothermia (37 degrees C) and mild hyperthermia (39 degrees C) markedly inhibited [Glu](e) re-uptake during the postischemic period, although the intra-ischemic [Glu](e) elevation did not differ from that during intra-ischemic hypothermia (32 degrees C). It was assumed that normothermia or mild hyperthermia in the intra-ischemic period influences intracellular functional abnormalities other than the intra-ischemic [Glu](e) elevation, thereby inhibiting glutamate re-uptake after reperfusion rather than directly modulating intra-ischemic [Glu](e) dynamics.     

裸鼠原位和异位脑肿瘤生物发光信号成像实验研究

目的应用生物发光成像技术,非侵入性地连续检测活体裸鼠原位和异位脑肿瘤发展演进过程。方法用SMPU-R-MND-luc载体转染人脑肿瘤U87MG细胞系,形成具有高荧光素酶活性的细胞克隆。在裸鼠脑内和胁腰部皮下植入持续表达荧光素酶的肿瘤细胞,建立原位和异位脑肿瘤模型,用影像学资料显示肿瘤部位。用光子发射定量分析动态监测肿瘤生长情况。结果成功地建立了表达荧光素酶活性的原位和异位脑肿瘤动物模型。采集反映肿瘤生长的生物发光信号,肿瘤细胞植入后不同时间点的发光信号值呈显著正相关,而且原位和异位脑肿瘤间存在明显差异。但生物发光脑肿瘤生物发光信号值在第4 d和第14 d时无显著差异。结论体内生物发光成像可以非侵入性地动态检测活体内脑肿瘤演进过程,为研究肿瘤发展机制及最佳治疗策略的选择提供了新的手段和工具。     

Differential Diagnosis in Pseudoepileptic Seizures

Summary: With increasing use of intensive video-EEG monitoring, publications concerning pseudoepileptic seizures have burgeoned, but without clarification concerning differing psychopathologic mechanisms and without distinction of different syndromic varieties. The frequent concurrence of pseudoepileptic and epileptic seizures has not been sufficiently recognized, and an undue reliance on clinical experience on the one hand and individual tests such as EEG on the other has proven equally misleading in this group of cases.     

应用动态血糖监测系统评价甘精胰岛素作为基础胰岛素治疗的优越性

采用动态血糖监测系统比较磺脲类药物治疗效果不佳的2型糖尿病患者睡前联合甘精胰岛素或中性鱼精蛋白锌胰岛素（NPH）治疗12周后血糖谱的变化。结果显示，联合甘精胰岛素治疗，在空腹血糖达到同样较好控制的同时，夜间低血糖发生率低，全天血糖曲线波动小。     

老年高血压病人血压变异性分析

目的：探讨老年高血压病患血压变异性与靶器官损害及年龄的关系。方法：对478例老年高血压病人及229例非高血压进行了24小时动态血压监测，以测得的血压标准差作为血压变异性指标。结果：高血压病患的24小时血压变异性大于非高血压（P＜0．05），高血压病人中靶器官损害的24小时血压变异性大于无损害的（P＜0．05）；各年龄组间的血压变异性无明显差别。结论：老年高血压病人24小时血压变异性增加，靶器官损害的24小时变异性更高。     

胸部肿瘤手术麻醉期间心律失常原因及处理

目的通过观察分析2485例胸科手术患者麻醉期间心律失常的发生情况,探讨胸科手术麻醉期间心律失常的发生原因及处理原则。方法麻醉期间采用胸前Ⅰ导联或标准Ⅱ导联连续监测ECG。记录心律失常的发生时间、类型、治疗措施及效果。结果麻醉中共发生各类心律失常2386例（96．02％）,严重心律失常827例（33．28％）,经及时处理,绝大多数均很快纠正。结果显示胸科手术麻醉期间易发生心律失常,主要原因包括全麻气管插管和拔管反应、手术过程中操作刺激、单肺通气时间过长、术前合并心肺疾病、术前心电图异常、高龄等,麻醉期间应予重视。结论胸科肿瘤手术麻醉期间心律失常发生率高,术前要进行充分准备,术中要严密监测,以降低围术期并发症和死亡率。     

我国农村土壤蛔虫卵污染状况监测及SWOT分析

目的 目的 了解土源性线虫病国家级监测点土壤中蛔虫卵污染情况, 为制定防治对策及评价防治效果提供科学依据。方法 方法 根据 《全国土源性线虫病监测方案 （试行）》 要求, 在22个土源性线虫病国家级监测点中, 每年每监测点随机抽取10户居民, 分别采集菜园、 厕所周边、 庭院及厨房的土样, 采用改良饱和硝酸钠漂浮检查法分离土壤蛔虫卵, 并鉴别受精和未受精蛔虫卵, 鉴定受精蛔虫卵的死活。另外, 对土源性线虫病国家级监测点土壤中蛔虫卵监测工作进行SWOT分析。结果 结果 2006-2010年, 22个土源性线虫病监测点共监测1 090户, 土壤中蛔虫卵总检出率为30.73%, 未受精蛔虫卵、 受精蛔虫卵和活受精蛔虫卵的总检出率分别为13.21%、 26.42 %和20.28%, 菜园、 厕所周边、 庭院和厨房土壤蛔虫卵的总检出率分别为16.51%、 13.49%、 14.22%和10.73%。SWOT分析表明, 监测点土壤蛔虫卵监测工作存在优势和劣势, 同时面临机会与挑战。结论 结论 部分土源性线虫病国家级监测点土壤蛔虫卵污染情况仍十分严重, 应加强粪便无害化处理、 改水改厕、 改造环境等措施, 以保护人群免受感染。     

Ambulatory Blood Pressure Variability Is Increased in Diabetic Hypertensives

The purpose of this study was to examine the possible difference in the 24-hr BP profile—including short-term BP variability, assessed as the standard deviation—between diabetic and non-diabetic hypertensives. We measured 24-hr ambulatory BP in 11 diabetic hypertensives (diabetic HT) and 10 non-diabetic hypertensives (non-diabetic HT) who were hospitalized for the educational program in our hospital and were under stable salt intake. Renal function and sleep apnea were also estimated. There were no significant differences in 24-hr systolic BP (141 mmHg vs. 135 mmHg, ns), daytime systolic BP (143 mmHg vs. 138 mmHg, ns), and nighttime systolic BP (135 mmHg vs. 130 mmHg, ns) between diabetic HT and non-diabetic HT. The values of 24‐hr HR (69.7 beats/min vs. 65.2 beats/min, ns) and 24-hr HR variability (9.9 beats/min vs. 10.1 beats/min, ns) were also similar between the groups. Interestingly, diabetic HT had a significantly greater 24-hr systolic and diastolic BP variability than non-diabetic HT (18.2 mmHg vs. 14.5 mmHg, p < 0.05; 11.5 mmHg vs. 9.6 mmHg, p < 0.05, respectively). The values for creatinine clearance, urinary protein excretion, and apnea-hypopnea index were similar between the groups. Bivariate linear regression analysis demonstrated that fasting blood glucose was the primary determinant of 24-hr diastolic BP variability (r = 0.661, p < 0.01). Multiple stepwise regression analysis revealed that fasting blood glucose was a significant and independent contributor to 24-hr systolic BP variability (r = 0.501, p < 0.05). Taken together, these results demonstrate that BP variability is increased in diabetic hypertensives. Furthermore, it is possible that an elevation of fasting blood glucose may contribute to the enhanced BP variability in hypertensives.