Correlates of lithium response in psychotic-affective syndromes

We examined clinical and biochemical predictors of lithium response in 17 schizoaffective patients as well as the effect of lithium treatment upon several aminergic systems in this group. Ten patients were rated improved by the addition of lithium to the treatment regimen. No clinical predictors reached significance although DSM-III diagnosis and family history showed trends. Pretreatment plasma GABA was higher in the responders to lithium as compared to the nonresponders. Lithium tended to increase CSF HVA, CSF GABA, and plasma cAMP and to decrease plasma GABA. Lithium had little effect upon CSF 5HIAA, CSF cAMP, or plasma HVA.     

胸腔镜手术与开胸手术治疗先天性支气管囊肿的对比分析

目的总结传统开胸手术与胸腔镜手术治疗先天性支气管囊肿的经验,分析两种手术的可行性及优劣。方法回顾性分析本院自2013年1月至2叭5年11月收治的先天性支气管囊肿患儿临床资料。患儿均经产前超声检查获得初步诊断,经产前评估及出生后增强CT检查明确诊断,最后经手术确诊。手术方式分为传统开胸手术及胸腔镜手术,比较两组手术时间、术中出血量、住院时间及胸腔引流管留置情况,探讨小儿胸腔镜手术治疗支气管囊肿的可行性及风险。结果共13例确诊,12例手术,1例家属决定暂不手术。手术病例中,女性6例,男性6例,男:女=1:1。左右侧比为1:1,其中6例手术诊断为支气管囊肿,3例合并肺囊腺瘤,3例合并肺隔离症。5例术前准确诊断为支气管囊肿,7例诊断为肺囊腺瘤或肺隔离症。手术年龄最小5 d,最大1岁,平均手术年龄4.8个月。5例采取传统开胸手术;7例采取胸腔镜手术,其中1例2月龄患儿因术中须行肺叶切除而增加辅助切口。所有手术病例均治愈。结论先天性支气管囊肿属于少见疾病,由于存在感染以及占位的风险,建议早期手术。胸腔镜下操作,对于婴幼儿病例,不会增加手术风险,是一种可行的手术方式。     

伸膝装置远端联合软组织手术治疗儿童先天性髌骨脱位的探讨

目的探讨伸膝装置远端联合软组织手术治疗儿童先天性髌骨脱位的方法及其效果评价。方法自2011年6月至2015年1月,我们采用伸膝装置远端联合软组织手术治疗儿童先天性髌骨脱位8例14膝,其中6例双侧,2例单侧;男性6例,女性2例,年龄7个月至12岁,平均6岁。比较手术前后疼痛或僵硬、髌下捻发感、膝关节活动度、关节功能、影像学检查主客观指标。结果 8例手术后均恢复良好,并获得随访,平均随访时间26.9个月。截止随访日,除1例10月龄合并多关节挛缩病例以外,其余均独立行走,步态正常,未诉疼痛,膝关节屈伸活动良好,下肢力线正常。1例1膝出现一过性再脱位,其余无再脱位。优良率达78.3%。术后Q角由20.5°±6.4°改善至16.7°±3.4°(t=4.128,P0.05),股骨髁间角由150.8°±3.4°改善至140.7°±3.8°(t=6.347,P0.05)。结论先天性髌骨脱位久之易致严重膝关节功能障碍,宜早诊断早治疗。伸膝装置远端联合软组织手术是一种治疗儿童先天性髌骨脱位安全有效的治疗方式。     

婴儿先天性肌性斜颈保守综合治疗1142例

目的分析和评估婴儿先天性肌性斜颈(congential muscular torticollis,CMT)综合治疗疗效和影响疗效的相关因素。方法对确诊为先天性肌性斜颈婴儿采取手法牵拉、按摩包块、超声短波理疗相结合的治疗方法,并根据患儿的恢复情况辅以局部注射糖皮质激素,按改良Cheng~([1])评估治疗的疗效,分析影响疗效的相关因素。结果 1 142例患儿中,男性684例,女性458例,最短随访时间1年,最长9年,平均为3.14年。有103例(占9.03%)最终行手术治疗,有效率90.97%。影响最终疗效的相关因素是有无肿块(P=0.049)、是否拉断(P0.001)、初诊年龄(P0.001)、旋转受限度数(尸0.001)和性别(P=0.038);物理治疗中发生拉断(Give-way)患儿与初诊年龄(P0.001)、是否难产(P=0.011)有关联;根据有肿块(P=0.044)、是否拉断(P=0.005)、初诊年龄(P0.001)和旋转受限程度(P0.001)分组后各组的手术率差异有统计学意义。结论手法牵拉、按摩包块、超声短波理疗三种相结合的方法治疗CMT,并根据患儿恢复情况辅以局部注射糖皮质激素的综合疗法,对于CMT患儿是一种安全、有效的方法。     

Asir-V联合“双低”扫描技术在儿童先天性心脏病诊断中的应用

目的：阐述 Revolution CT 低剂量扫描技术在儿童先天性心脏病（congenital heart diseas, CHD）中的应用价值。方法选择 CHD 患儿34例,随机分为两组,A 组17例,Asir— V：50％,B 组：17例,Asir—V：80％,两组扫描条件均为70 Kv,300 mAs,探测器宽度120～160 mm,扫描时间0.3 s,造影剂：碘海醇350 mgI ／mL,用量1 mL／kg,记录升主动脉、降主动脉、肺动脉主干、左心室的 CT 值及同层面背部软组织 CT 值,根据标准差 SD 计算各兴趣区信噪比（signal-to-noise ratio,SNR）及对比信噪比（contrast-to-noise ratio,CNR）,记录每个病例的剂量长度乘积（dose-length product,DLP）,并根据公式换算有效剂量（effective doses,ED）,由两位工作10年以上的副主任医师独立读片诊断并对图像质量进行评分。结果A 组各兴趣区 SNR 及 CNR 小于 B 组,差异有统计学意义（P ＞0.01）,A 组 DLP 及 ED 与 B 组比较,差异无统计学意义（P ＜0.01）,两位医师读片显示病例图像质量良好,读片结果一致性良好（K ＝0.621、0.683）;结论CTA 是小儿先天性心脏病的重要诊断手段,“双低”技术保证图像质量的前提下有效减少了 CT 辐射剂量,Asir—V：80％会获得更高的图像信噪比。     

Contributions of pathologic margins and Dukes' stage to local recurrence in colorectal carcinoma

Two hundred fourteen patients with colorectal carcinoma who underwent curative resection for biopsy-proved or autopsy-proved local recurrences with a minimum of 2 years follow-up were evaluated. The only predictive variables for anastomotic recurrence were Dukes' stage and tumor margins. There were 49 Dukes' A lesions with no observed recurrences. There were also 83 Dukes' B lesions and 84 Dukes' C lesions with a total of 18 local recurrences in 214 cases or 8.4 percent (of Duke's B lesions or 6 percent and 14 of Dukes' C lesions or 17 percent). When proximal or distal margins were less than 5 cm there were seven total recurrences (three Dukes' B lesions and four Dukes' C lesions). However, when margins were greater than 5 cm, 11 local recurrences were observed (1 Dukes' B and 10 Dukes' C lesions). It appears that margins are not as important in preventing local recurrences of Dukes' A lesions as they are of both Dukes' B and C lesions. Although the numbers are small in this study, it appears that Dukes' B lesions can be satisfactorily resected with a very low incidence of local recurrence if their margins are 5 cm or greater, whereas if the resected margins are less than 5 cm, the incidence of local recurrences increases from 9 percent (1 of 11 lesions) to 43 percent (3 of 7 lesions), or almost a fivefold increase. Therefore, it appears that good surgical technique and adequate margins of greater than 5 cm are very important in reducing local recurrences of Dukes' B lesions. However, when margins are greater than 5 cm, this does not guarantee freedom from local recurrence of Dukes' C lesions. This may merely reflect the difference in the biologic characteristics among Dukes' A, B, and C lesions and the fact that limited resection, particularly in the rectosigmoid region, cannot possibly remove all intralymphatic disease, which is the presumed culprit in locally recurrent Dukes' C lesions.     

What is so special about thinking; after all,we all do it!

Understanding the adaptive immune system can be simplified by treating it as three linked modules, the generation of the recognitive repertoire, the sorting of the repertoire by purging anti-self, and the coupling of the repertoire to appropriate effector mechanisms. Each of these modules has a unique database and a logic that is determined by evolutionary considerations founded on value versus harm. Selection cannot operate to perfection, only to adequacy, meaning not limiting to the procreation of the species. Consequently, this system has limits in that it fails, by human standards, to adequately protect against a variety of pathogens and, even when protecting successfully against others, all too often initiates autoimmunity and innocent bystander pathology. What evolution trivializes defines the subject called clinical immunology. If we wish to deal with the pathology that evolution views to be of an acceptable frequency, then we had best first understand what it did give us as a sufficiently functional system, namely the decision pathways of the three modules and in what ways their protective outputs are limited.     

Pharmacokinetic study of salvianolic acid A in beagle dog after oral administration by a liquid chromatography–mass spectrometry method: A study on bioavailability and dose proportionality

Ethnopharmacological relevance

Salvianolic acid A (SAA) is one of the main water-soluble components isolated from Salvia miltiorrhiza Bunge. Pharmacological researches revealed that it had various curative activities after oral and intravenous administration, including beneficial effects on diabetes and its complications, cardioprotective effect, anti-platelet aggregation, and so on. However, there is no report regarding the pharmacokinetics of SAA in beagle dogs after oral administration up to now.

Aim of the study

To study the pharmacokinetics of different doses of SAA in beagle dogs and figure out the absolute bioavailability and dose proportionality of SAA after oral administration.

Materials and methods

Male and female beagle dogs were orally administered SAA 5, 10 and 20 mg/kg randomly. The plasma drug concentration was detected by a rapid, sensitive and reproducible liquid chromatography–mass spectrometry (LC–MS) method. The pharmacokinetic parameters were calculated from plasma concentration–time data using the DAS pharmacokinetic software Data Analysis System Version 3.0 program.

Results

After single-dose oral administration of SAA, the mean peak plasma concentration (C_max) values for groups treated with 5, 10 and 20 mg/kg doses ranged from 14.38 to 38.18 µg/L, and the mean area under the concentration–time curve (AUC_(0–t)) values ranged from 38.77 to 130.33 (µg/L⋅ h). SAA showed lack of dose proportionality over the dose range 5–20 mg/kg, based on the power model. However, the increase in systemic exposure with dose appeared linear. The absolute bioavailability was calculated to range from 1.47% to 1.84%.

Conclusion

The pharmacokinetic properties of SAA in beagle dogs after oral administration were characterized as rapid oral absorption, quick clearance, and poor absolute bioavailability. Systemic exposure exhibited lack of dose proportionality over the dose range 5–20 mg/kg. Furthermore, a readily preparative LC–MS method was demonstrated in this study for the research of traditional Chinese medicine.     

腔镜手术治疗新生儿及婴幼儿膈肌发育缺陷

目的探讨腔镜手术治疗新生儿及婴幼JLN肌发育缺陷的可行性和优越性。方法38例膈肌发育缺陷患儿,其中膈疝4例,膈膨升5例,食管裂孔疝29例。术前均经上消化道造影及胸腹CT检查确诊;腹腔镜下探查膈肌病变类型及有无合并病变;膈疝患儿行膈肌修补缝合术,食管裂孔疝行食管裂孔修补Nissen胃底折叠术,膈膨升患儿行膈肌折叠术。结果38例中3例中转开放手术,其余35例采用腹腔镜技术完成手术。平均手术时间147min（75—210min）;手术中出血量平均5mL（1—10mL）。患儿术后平均24h饮水,5d恢复饮食;术后平均住院时间6．7d。随访1个月至5年,原有症状消失,体重增加,生长发育正常,无明显并发症发生。2例食管裂孔疝术后3个月及1年复发,经再次腔镜手术后治愈。2例食管裂孔旁疝分别复发2次,1例现第3次腔镜手术后1年余无复发;另1例术后4个月食管裂孔疝复发、胃小弯侧靠近幽门处穿孔,行膈肌修补、胃穿孔修补;第二次手术后3个月再次复发,行生物补片修补,随访至今4个月无异常。结论腔镜手术治疗新生儿及婴幼儿膈肌发育缺陷疗效确切,安全可行。