我院管辖社区老年人脑卒中主要危险因素分析

目的探讨深圳市龙华人民医院管辖社区老年人发生脑卒中的主要危险因素。方法选取2010年5月至2012年5月深圳市龙华人民医院管辖社区老年人群(≥60岁)脑卒中的患者340例,并同期选取该社区健康老年人160例作为对照组,对引起患者发生脑卒中的相关性因素进行分析、总结。结果观察组脑卒中的危险因素的检出率较对照组老年人群高,比较差异有统计学意义(P<0.05),吸烟、饮酒、慢性阻塞性肺病、高血压、糖尿病、心脏病以及糖尿病等因素均是引起老年脑卒中的主要危险因素。两组的血细胞比容、三酰甘油比较差异有统计学意义(P<0.05)。结论老年人脑卒中主要危险因素检出率较高,且大部分人群处于脑卒中发病的低危阶段,早期加强脑卒中的防治工作,可以显著改善患者的生活质量。     

论大面积烧伤感染期的诊治特点

目的：总结皮肤原位再生医疗技术在大面积特重度烧伤患者感染期的救治特点，提高烧伤皮肤原位再生医疗技术在大面积烧伤中的救治水平。方法：作者9年来分别在全国23个省市会诊抢救烧伤面积在90％以上的烧伤患者62例，均采用烧伤皮肤再生疗法救治，抢救成功最大烧伤面积100％＋口腔黏膜、食道黏膜烫伤。结果：62例严重烧伤患者，治愈60例，死亡2例，其中1例死于入院48h内暴发脓毒性休克，1例死于重度吸入性损伤继发肺部感染。结论：总结皮肤原位再生医疗技术在严重烧伤感染期的救治特点，包括感染期观察的三个“3”阶段规律和四项观测指标，强调了预防烧伤感染的原则是早期应用抗生素，在确诊感染后应及时、高效、足量的联合应用敏感抗生素，同时加强清除创面液化物等皮肤原位再生医疗技术的规范化创面处理。     

Activation of leukocyte immunoglobulin-like receptor B2 signaling pathway in cortical lesions of pediatric patients with focal cortical dysplasia type IIb and tuberous sclerosis complex

BackgroundsFocal cortical dysplasia type IIb (FCD IIb) and tuberous sclerosis complex (TSC) are very frequently associated with epilepsy in pediatric patients. Human leukocyte immunoglobulin-like receptor B2 (LILRB2) participates in the process of neurite growth, synaptic plasticity, and inflammatory reaction, suggesting a potential role of LILRB2 in epilepsy. However, little is known about the distribution and expression of LILRB2 in cortical lesions of FCD IIb and cortical tubers of TSC.MethodsIn this study, we have described the distribution and expression of LILRB2 signaling pathway in cortical lesions of pediatric patients with FCD IIb (n = 15) and TSC (n = 12) relative to age-matched autopsy control samples (CTX, n = 10), respectively. The protein levels of LILRB2 pathway molecules were assessed by western blotting and immunohistochemistry. The expression pattern was investigated by immunohistochemistry and double labeling experiment. Spearman correlation analysis to explore the correlation between LILRB2 protein level and seizure frequency.ResultsThe protein levels of LILRB2 and its downstream molecules POSH, SHROOM3, ROCK1, ROCK2 were increased in cortices of patients compared to CTX. Protein levels of LILRB2 negatively correlated with the frequency of seizures in FCD IIb and TSC patients, respectively. Moreover, all LILRB2 pathway molecules were strongly expressed in dysmorphic neurons, balloon cells, and giant cells, LILRB2 co-localized with neuron marker and astrocyte marker.ConclusionTaken together, the special expression patterns of LILRB2 signaling pathway in cortical lesions of FCD IIb and TSC implies that it may be involved in the process of epilepsy.     

Endoscopic ultrasound elastography for small solid pancreatic lesions with or without main pancreatic duct dilatation

Background/Objectives: Endoscopic ultrasound elastography (EUS-EG) is useful for diagnosis of small solid pancreatic lesions (SPLs), particularly in excluding pancreatic cancer (PC), but its dependence on main pancreatic duct dilatation (MPDD) has not been examined. We aimed to investigate EUS-EG for diagnosis of small SPLs with and without MPDD.MethodsPatients with pathologically diagnosed SPLs of ≤20 mm were included and retrospectively analyzed. Using the blue:green ratio, an EUS-EG image was classified as blue-dominant, equivalent, or green-dominant. Using multiple EUS-EG images per patient, a lesion with a greater number of blue-dominant than green-dominant images was classified as stiff, and the others as soft. EUS-EG images in random order were judged by three raters. Considering stiff SPLs as PC, diagnostic performance of EUS-EG was examined for SPLs with and without MPDD.ResultsOf 126 cases analyzed, 65 (52%) were diagnosed as PC, and 63 (50%) had MPDD. A total of 1077 EUS-EG images were examined (kappa coefficient = 0.783). Lesions were classified as stiff in 91 cases and soft in 35 (kappa coefficient = 0.932). The ratio of stiff to soft lesions was significantly higher in PC than in non-PC (62:3 vs. 29:32, P < 0.001). The sensitivity, specificity, and negative predictive value of a stiff lesion with vs. without MPDD for diagnosis of PC were 94%, 23%, and 50% vs. 100%, 60%, and 100%, respectively.ConclusionsUsing the EUS-EG stiffness classification for small SPLs, PC can be excluded with high confidence and concordance for a soft lesion without MPDD.     

Myometrial electrophysiologic activity and gap junctions in the pregnant rabbit

Electromyographic activity of the myometrium, intrauterine pressure, and myometrial gap junctions were examined in rabbits at various stages of pregnancy and during parturition. Electromyographic activity occurred throughout pregnancy and was characterized by electromyographic bursts lasting up to 5 minutes at a frequency of one to four per hour. The gap junction area of plasma membrane showed a significant increase at delivery at a time when electromyographic activity changed to rhythmic bursts of short duration at a frequency of about one per minute. This study shows that the rabbit uterus is active throughout pregnancy; furthermore, the development of large numbers of gap junctions between myometrial cells occurs at a time when uterine activity changes to the expulsive activity required for labor.     

Outcome in infants 501 to 1000 gm birth weight delivered to residents of the McMaster Health Region

The mortality and morbidity for all 255 live births of infants with birth weight 501 to 1000 gm and delivered to residents of a geographically defined region between 1977 and 1980 are reported. In all, 117 (46%) infants were discharged alive; there were four postdischarge deaths, and three infants were lost to follow-up. The mean birth weight and gestational age of the survivors was 850 +/- 118 gm and 27.1 +/- 2 weeks, respectively. Neurosensory handicaps were detected in 26 (24%) of 110 survivors followed for a minimum of 2 years corrected age. In addition, 29 (26%) infants had nonneurologic problems and 55 (50%) were considered apparently normal. Within 100 gm birth weight groups, survival improved significantly with increasing birth weight, but the handicap rate among survivors remained relatively constant. These figures are proposed for use in describing the current prognosis at birth for liveborn tiny infants from comparable unselected populations.     

干预性早产89例分析

目的探讨降低早产儿的病死率。方法回顾性分析89例干预性早产的原因，比较不同治疗措施对围生儿结局的影响。结果重度妊高症、前置胎盘和胎儿窘迫是引起干预性早产的最常见病因，有规律的产前检查、应用促胎肺成熟药物可降低早产儿的并发症和围生儿的死亡率。结论不可避免的干预性早产，规律的产前检查、适当的宫内治疗可提高早产儿成活率。     

Clinical experiences with fetal heart rate monitoring of one thousand patients in labor

A series of 1,000 labor patients has been monitored electronically, and their records reviewed. Monitoring provides accurate objective evidence that fetal condition is good and that tolerance for labor is normal. With a normal record, the likelihood is strong that a normal baby will be delivered. Electronic fetal heart rate monitoring is unreliable in the prediction of babies born in poor condition. It does, however, provide an excellent screening test for selection of patients for scalp pH determinations. Electronic monitoring of fetal heart rate provides early evidence of fetal anoxia. It should be carried out in all patients receiving oxytocin during labor to avoid episodes of fetal anoxia. External monitoring methods currently available permit routine monitoring of all patients in labor. Whether monitoring all normal patients will improve fetal health and survival is still an unanswered question.     

Sacrifice of the unsatisfactory hand.

A hand which compares unfavorably with a prosthesis in function, comfort, and appearance may be better amputated. This decision must be made conjointly by the surgeon and the patient. Contributory factors are severe tissue loss, pain, appearance, infection, functional requirements, sexual reasons, psychological makeup of the patient, economics, safety, the time elapsed since injury, the patient's body image and his desires, and the surgeon's opinion. Fifteen patients elected hand amputation for various combinations of these factors. Eleven were fitted with a prosthesis at the time of operation and three within 3 weeks. All patients expressed satisfaction with their decision and 12 were successful users of the prosthesis.     

Ultrasonic identification and examination of fetal heart structures

Ultrasonic studies were performed on normal fetuses ranging from 36 to 40 weeks gestational age in an attempt to visualize anatomical details of the fetal heart. We were able to visualize cardiac structures hitherto thought to be unidentifiable. Two-dimensional B-scan exposures of sections showed transverse and longitudinal sections of the fetal heart, including the cardiac septa and inlet and outlet sites of the large vessels. To attempt to elucidate the dynamics of the fetal heart, the motility patterns of the cardiac structures were examined by time-motion mode scanning and the patterns obtained were compared to those observed in the postnatal heart. The reliability of the theories advanced and the further prospects are discussed.