无骨折、脱位的颈脊髓损伤

通过对176例外伤性颈脊髓损伤中24例无骨折、脱位病例的回顾分析,认为MRI对不伴骨折或脱位的颈髓损伤的诊断是目前较可靠手段。提出这些病例可分为脊髓压迫型和无脊髓压迫型。治疗上前者以前路减压为佳,而脊髓内外联合减压术对阻止后者神经损害的进展有帮助。早期诊断,尽早制动,牵引乃至手术十分必要。     

Nimodipine prevents the in vivo decrease in hippocampal extracellular acetylcholine produced by hypobaric hypoxia

Hypoxia decreases acetylcholine (ACh) synthesis and release in vitro, and ACh synthhesis in vivo; however, its effect on extracellular concentration of ACh in vivo is not known. The calcium channel blocker nimodipine is a cerebrovascular dilator which also increases extracellular ACh in vivo. Therefore, it may provide protection from the effects of hypobaric hypoxia on the cholinergic system either via its effects on vascular function or by direct action on the nervous system. This study examined the effect of hypobaric hypoxia on extracellular ACh and choline levels, as measured by microdialysis, as well as the effects of nimodipine under hypoxia. Microdialysis guide cannulae were implanted into the hippocampal region of male Fischer rats so that probes would sample from the CA1 and DG regions. Animals were then exposed for eight hours to a simulated altitude of 5,500 m (18,000 ft) or tested at sea level for an equivalent duration. HPLC with electrochemical detection was used for analysis of the dialysates. At 5,500 m extracellular ACh levels in the placebo-treated group were significantly lower than the sea level group values. This decrement was reversed by nimodipine administered i.p. immediately preceding altitude ascent (10 mg/kg) and 250 min post-altitude ascent (10 mg/kg). These data suggest that nimodipine may provide protection from the detrimental effects of hypoxia on hippocampal cholinergic function.     

快速减压对家兔脊髓组织学的影响

目的探讨快速减压对家兔脊髓组织学和超微结构的影响。方法将18只实验兔随机分为对照组、减压病3h组和减压病3d组。5min内用压缩空气加压至0．6MPa，停留60min，然后于3～5min内减至常压。以上3组分别于进舱前、出舱后3h和3d，取脊髓进行光镜和透射电镜检查。结果（1）光镜显示脊髓灰白质散在出血灶，软脊膜及脊髓白质毛细血管内可见气泡；（2）电镜下显示脊髓白质毛细血管周围水肿，神经纤维变性、胶质细胞坏死。结论脊髓软脊膜及白质毛细血管内气泡，灰白质出血、水肿，神经纤维变性和胶质细胞坏死是减压病脊髓损伤发病的病理学基础。     

Bipolar disorder and neurophysiologic mechanisms

Recent studies have suggested that some variants of bipolar disorder (BD) may be due to hyperconnectivity between orbitofrontal (OFC) and temporal pole (TP) structures in the dominant hemisphere. Some initial MRI studies noticed that there were corpus callosum abnormalities within specific regional areas and it was hypothesized that developmentally this could result in functional or effective connectivity changes within the orbitofrontal-basal ganglia-thalamocortical circuits. Recent diffusion tensor imaging (DTI) white matter fiber tractography studies may well be superior to region of interest (ROI) DTI in understanding BD. A “ventral semantic stream” has been discovered connecting the TP and OFC through the uncinate and inferior longitudinal fasciculi and the elusive TP is known to be involved in theory of mind and complex narrative understanding tasks. The OFC is involved in abstract valuation in goal and sub-goal structures and the TP may be critical in binding semantic memory with person–emotion linkages associated with narrative. BD patients have relative attenuation of performance on visuoconstructional praxis consistent with an atypical localization of cognitive functions. Multiple lines of evidence suggest that some BD alleles are being selected for which could explain the enhanced creativity in higher-ability probands. Associations between ROI’s that are not normally connected could explain the higher incidence of artistic aptitude, writing ability, and scientific achievements among some mood disorder subjects.     

Chewing function impacts oral health-related quality of life among institutionalized and community-dwelling Korean elders

Abstract – Objective The aim of this study was to assess the association of chewing ability to oral health‐related quality of life (OHRQoL) measured by the Oral Health Impact Profile‐14 (OHIP‐14) controlling for clinical oral health status, self‐reported health status, demographic factors, and socioeconomic conditions among community‐dwelling and institutionalized Korean elders. Methods This cross‐sectional study comprised a sample of 307 community‐dwelling and 102 institutionalized people over the age of 60, using a cluster sampling procedure. A questionnaire was implemented and a clinical oral examination was completed for each subject. The outcome variable of interest was the OHIP‐14 score, and its associations with chewing ability, objective oral health status, self‐reported health status, demographic factors, and socioeconomic conditions were assessed. Because of highly‐skewed distribution of the OHIP‐14 scores, nonparametric analytic methods were used. The final model was developed using a multivariable two‐level logistic regression model for a dichotomized OHIP‐14 score to account for the cluster sampling method applied to this study. Results The mean age of the participants was 75.4 years, with 67.7% being women. The median OHIP‐14 score was 7. Negative oral health impacts were experienced fairly often or very often by a total of 36.4% of elderly. In the final model, elders who could chew none to three and four to six foods among seven indicator foods were 3.4 (P = 0.010) and 2.0 (P = 0.040) times more likely, respectively, to have worse OHRQoL compared with elders who could chew all seven food types. Also significant associations with worse OHRQoL were shown for being concerned about oral health [Odds Ratio (OR) = 4.9, P = 0.002], fair or better self‐reported oral health (OR = 0.12, P = 0.002), very good/good self‐reported general health (OR = 0.38, P = 0.008), being married (OR = 2.0, P = 0.054), and having a favourable economic status (OR = 0.43, P = 0.042). Conclusions This study showed highly significant association between chewing ability and OHRQoL measured by the OHIP‐14 score after controlling for related factors. Amelioration of chewing ability might independently contribute to improving the OHRQoL of elders.     

特高海拔现场高压氧治疗对肺水肿病人肺动脉压的影响

目的　观察特高海拔地区现场高压氧 (HBO)治疗对高原肺水肿 (HAPE)病人肺动脉压的影响 ;评价HBO对HAPE的疗效 ;探讨肺动脉高压 (PH)与HAPE的关系 ;强调现场就地治疗的重要性。方法　在 4636米特高海拔 (气压 5 7.41kPa,氧分压 1 2 .OkPa)现场治疗来自海拔 4636～ 5 1 30米 (气压5 7.41～ 5 3.2 8kPa/431 .6～ 40 0 .6mmHg,氧分压 1 2 .0～ 1 1 .6kPa/90 .0～ 87.0mmHg)的HAPE 32例。治疗前后对其临床症状、X光胸片、血氧饱和度 (SaO2 )、平均肺动脉压 (MPAP)进行自身对照。结果　治疗前后 32例HAPE临床症状、体征及MPAP等各项观测指标显著改善 ,P <0 .0 0 1。结论　特高海拔现场HBO救治HAPE效果肯定 ,它能使显著增高的肺动脉压降低 ,全部病例病情迅速改善 ,其中 1 1例 ( 34.3% )基本治愈。为下送进一步治疗创造了条件。HAPE患者均有PH ,而PH者未必一定发生HAPE ;PH是机体适应缺氧环境的正常代偿 ,PH失代偿的阈值确有必要探讨     

急性股部筋膜间室综合征的诊断与治疗

目的：分析讨论急性股部筋膜间室综合征的诊断与治疗。方法：经测压确诊8例股部筋膜间室综合征病例，行股部内、外侧切口进行股部外、内及后部筋膜间室切开减压。结果：2例术后第3d及第4d死亡，6例存活，患肢均遗有严重的感觉及运动障碍，丧失工作能力。结论：急性股部筋膜间室综合征是一严重创伤性疾病，病死及病残率高，愈后差。正确的股部切开减压及预防多脏器功能衰竭是抢救成功的关键。     

局部脑血流显像对硬膜外血肿快速减压后脑损伤机理的实验研究

目的探讨局部脑血流(rCBF)断层显像在硬膜外血肿快速减压后脑损伤的应用价值。方法利用rCBF显像分别对新西兰大白兔硬膜外血肿动物模型压迫前、压迫时及解压后的不同时段进行显像。对不同时相点数据进行三维重建,利用感兴趣区(ROI)技术,生成脑顶叶时间放射性曲线。同时分别测定局部脑游离[Ca2 ]浓度与脑含水量的动态变化。结果硬膜外血肿急性减压后,rCBF显像示脑皮质首先表现为严重的低灌注,快速减压后则表现为急性的超过正常的过度灌注。[Ca2 ]于压迫后明显升高;减压后短暂降低,继之缓慢增加,24h达到高峰。减压后[Ca2 ]与脑组织含水量呈显著正相关关系(r=0469,P<001)。结论rCBF显像对判断硬膜外血肿急性减压后脑组织的再灌注损伤有价值。