平板运动试验诱发宽QRS心动过速的鉴别诊断

目的 了解Vereckei法新四步流程图对宽QRS心动过速(WQRST)的鉴别诊断价值.方法 选择在心电图平板运动试验(ETT)过程中诱发WQRST的受检者27例,应用Vereckei法新四步流程图鉴别诊断WQRST.结果 Vereckei法新四步流程图诊断WQRST的符合率为92.6%,误诊率为7.4%.受检者ETT诱发的WQRST均自行终止,未致严重后果.4例ETT阳性的缺血性室性心动过速(VT)患者和1例ETT阳性的缺血性室上性心动过速(SVT)伴束支传导阻滞者,经积极救治均痊愈出院.结论 Vereckei法新四步流程图对ETT诱发的WQRST有鉴别诊断的价值,有助于及时正确识别VT和SVT,对疾病的治疗和预后有积极的作用.     

天津市某疾控中心工作人员不同进餐地点膳食结构和营养状况

目的研究某疾病预防控制中心（疾控）工作人员不同进餐方式膳食结构和营养状况。方法采用回顾法计算3种进餐方式特定时间内的各种食物摄入量。结果天津市某疾控工作人员每标准人日鱼虾类、畜禽肉、蛋、豆类、坚果、油脂、食盐摄入量以在饭店进餐最高;能量、蛋白质、脂肪、大部分维生素和矿物质摄入量也是饭店进餐方式最高。能量蛋白质、脂肪来源由高到低的进餐地点为饭店、家庭、食堂;能量碳水化合物来源由高到低的进餐地点为食堂、家庭、饭店。结论天津市某疾控工作人员膳食结构和营养状况在不同进餐地点,以家庭就餐较好。3种进餐地点共同存在蔬菜、维生素C摄入偏少,食盐、Na摄入偏多的问题。     

腹膜后腹腔镜保留肾单位手术治疗肾肿瘤的临床体会(附12例报告)

目的:探讨腹膜后腹腔镜保留肾单位手术治疗肾肿瘤的手术方法与临床疗效。方法:回顾分析为12例肾肿瘤患者行腹膜后腹腔镜保留肾单位手术的临床资料,术中用Bulldog夹钳夹肾动脉,冷剪刀剪除肿瘤,连续缝合并用Hem-o-lok收紧缝线,代替打结。观察手术时间、热缺血时间、术中出血量、围手术期并发症及手术疗效。结果:12例手术均获成功,无中转开放手术。手术时间平均(136±28.0)min,热缺血时间平均(27±7.9)min,术中出血量平均(126±83.1)ml。术后病理报告为肾透明细胞癌10例,血管平滑肌脂肪瘤2例。术后1例贫血,白蛋白较低,考虑与患者既往有乙型病毒性肝炎、糖尿病有关,予以对症治疗后恢复正常,余者围手术期未见迟发性出血、尿漏等并发症发生。平均住院(11±3.8)d。术后平均随访(12±9.2)个月,无一例复发。结论:腹膜后腹腔镜保留肾单位手术治疗肾肿瘤疗效确切,手术创伤小,术后康复快,住院时间短,具备熟练腹腔镜操作技术的医师可将其作为首选。     

Visual scenes trigger immediate syntactic reanalysis: evidence from ERPs during situated spoken comprehension

A central topic in sentence comprehension research is the kinds of information and mechanisms involved in resolving temporary ambiguity regarding the syntactic structure of a sentence. Gaze patterns in scenes during spoken sentence comprehension have provided strong evidence that visual scenes trigger rapid syntactic reanalysis. However, they have also been interpreted as reflecting nonlinguistic, visual processes. Furthermore, little is known as to whether similar processes of syntactic revision are triggered by linguistic versus scene cues. To better understand how scenes influence comprehension and its time course, we recorded event-related potentials (ERPs) during the comprehension of spoken sentences that relate to depicted events. Prior electrophysiological research has observed a P600 when structural disambiguation toward a noncanonical structure occurred during reading and in the absence of scenes. We observed an ERP component with a similar latency, polarity, and distribution when depicted events disambiguated toward a noncanonical structure. The distributional similarities further suggest that scenes are on a par with linguistic contexts in triggering syntactic revision. Our findings confirm the interpretation of previous eye movement studies and highlight the benefits of combining ERP and eye-tracking measures to ascertain the neuronal processes enabled by, and the locus of attention in, visual contexts.     

The Influence of Surgical Approach on Quality of Life After Parathyroid Surgery

Background It is well established that quality of life improves after parathyroidectomy. Less well understood is the impact of surgical approach on quality of life during recovery. This study was undertaken to determine whether surgical approach influences quality of life after surgery for hyperparathyroidism. Methods A total of 146 consecutive patients who underwent surgery for hyperparathyroidism were administered the SF-36 Health Survey 1 week before, 1 week after, and 1 year after surgery. Results Ninety-eight patients had minimally invasive parathyroidectomies, while 48 patients had bilateral explorations. All patients were normocalcemic >6 months after surgery. Hospital length of stay was significantly shorter in those undergoing a minimally invasive operation (mean ± SE, .2 ± .0 vs. .9 ± .0 days, P <.001). The rate of complications was not statistically different (3.1% vs. 6.3%, P = .40). Quality of life improved after surgery for hyperparathyroidism, irrespective of surgical approach. The minimally invasive group greatly improved in four scales 1 week after operation, while those with a bilateral exploration improved in two. After 1 year, the minimally invasive group had statistically improved in eight categories, while the bilateral exploration group did so in only four (P <.05 for all). Conclusions With improvements in surgical outcomes and quality of life, these data provide additional evidence that minimally invasive parathyroidectomy is the operation of choice for patients with hyperparathyroidism.     

A composite approach that includes dropout rates when analyzing efficacy data in clinical trials of antipsychotic medications

Background: Often, outcomes in clinical trials of antipsychotic medications are examined using last observation carried forward (LOCF). One limitation of LOCF and other common approaches is that they overlook the meaning underpinning trial completion and noncompletion. Noncompletion often relates to lack of drug tolerability. Because long-term treatment is often indicated, noncompletion is an important outcome. An alternative approach is to test the composite hypothesis of the difference between (a) completion rates and (b) efficacy of complete cases. Studies to date have not applied this relatively new method. Objective: To illustrate the composite approach, we applied it to a systematic review of studies and compared the results with the reported LOCF analysis. Methods: A systematic search of the Schizophrenia Module of the Cochrane Library and Medline was conducted that identified 127 relevant randomized clinical trials of antipsychotic medications conducted since 1995. Extracted from study reports were the P values of a difference in dropout and the P value of a difference in improvement among complete cases. These P values were combined using standard approaches. Results: We identified 11 trials with 5339 participants that provided the necessary information to adequately apply the composite approach. In 2 trials, (18.2%) in which the LOCF results were not significant, the composite results were significant. Conclusions: The composite approach was more sensitive to change than LOCF and conceptually answers a more relevant question. It is likely that applying the composite approach would change how results of many trials are interpreted.     

Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière’s disease: an interdisciplinary review

Summary   Background. Retrosigmoid vestibular neurectomy is suggested to be the most effective and safe procedure to control intractable vertigo associated with Ménière’s disease. The purpose of this study is to report the excellent efficacy of vertigo control, the good preservation of hearing, the rare complications and the simplicity of retrosigmoid vestibular neurectomy performed by an interdisciplinary team of neurosurgery and otorhinolaryngology experts of our teaching hospital. Methods. Seventy-three patients with Ménière’s disease who were refractory to medication or other surgical therapy were consecutively operated on over a period of 7 years. All the patients were referred to the senior author (CSL) for the surgery and were followed-up by the same neurootologist (JTL). The retrosigmoid approach for selective vestibular neurectomy was the only surgical method used in our neurosurgical facility. During surgery the separation line was made just at the cochleo-vestibular cleavage plane on the cochlear nerve to achieve a more complete sectioning of the vestibular fibres. To ensure accurate and complete data collection, patient data was prospectively entered into an electronic database, which was used subsequently for analysis of vertigo control, preservation of hearing, improvement in functional levels, and surgical complications. Results. Long-term excellent and good vertigo control were achieved in 69 (94.5%) and 4 (5.5%) patients respectively. Hearing was preserved to within 10 dB of the pre-operative pure-tone thresholds in 91.8% of patients at 1 month after the surgery. The functional levels improved to level 1 by a reduction of 3–5 points and became stabilised by 2 years of follow-up in all of our patients. No patient was worse post-operatively. Complications were uncommon and included superficial wound infection and transient partial facial paralysis in one patient each. Total hearing loss did not occur post-operatively. The mean operating time was 70 min. Conclusion. Selective vestibular neurectomy via the retrosigmoid approach is an effective and simple neurosurgical procedure for the control of intractable vertigo in Ménière’s disease while preserving hearing. Correspondence: Jen-Tsung Lai, M.D., Otorhinolaryngology Service, Kuang-Tien General Hospital, No. 117, Shatien Road, Shalu, Taichung County 43303, Taiwan.     

Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy

BACKGROUND: The aim of the present study was to highlight the advantages of treatment of bile duct injury (BDI) occurring during cholecystectomy on the basis of a multidisciplinary cooperation of expert surgeons, radiologists, and endoscopists. METHODS: Sixty-six patients had major BDIs or short- or long-term failures of repair. BDI was diagnosed intraoperatively in 27 patients (40.9%) and postoperatively in 39 (59.1%) patients. Among referred patients, 30 had complications from bile leak, 15 from obstructive jaundice, and 20 from recurrent cholangitis. Two patients died from sepsis after delayed referral before repair was attempted. Eleven additional patients had minor BDIs with bile leak both with and without choleperitoneum. RESULTS: Of patients with major BDI, surgical repair was performed in 41 (64.1%). Postsurgical morbidity rate was 15.8%, and there was no mortality. The rate of excellent or good results after surgical repair was 78.0% (32 of 41 patients), and this increased to 87.8% (36 of 41 patients) by continuing treatment with stenting in postsurgical strictures. Biliary stenting alone was performed in 23 patients (35.9%), with excellent or good results in 17 (73.9%). More than 200 endoscopic and percutaneous procedures were performed for initial assessment, treatment of sepsis, nonsurgical repair, contribution to repair, and follow-up. Patients with minor BDIs underwent various combinations of surgical and endoscopic or percutaneous treatments, always with good results. CONCLUSIONS: A multidisciplinary approach was of paramount importance in many phases of treatment of BDI: initial assessment, treatment of secondary complications, resolution of sepsis, percutaneous stenting before surgical repair, dilatation of strictures after repair, final treatment in patients not repaired surgically, and follow-up.