臂丛神经根性损伤膈神经移位术对青壮年患者早期呼吸功能的影响

目的研究臂丛神经损伤膈神经移位术对青壮年患者早期呼吸功能的影响.方法对16例接受膈神经移位治疗的患者,在术前、术后（10 d）进行肺功能指标的比较,同时定期进行门诊随访,观察呼吸系统自觉症状程度.结果13例术后出现了不同程度的供氧不足症状,16例全部出现一侧膈肌抬高,术后第10天肺活量（VC）、肺活量预计值百分数（VC%）分别比术前减少37.98%和26.88%,两者差异有统计学意义（tvc=11.532、tvc%=0,P＜0.01）.其它项目如残气量（RV）较术前轻度下降,肺总量（TLC）下降值达到术前肺总量的36.49%,残气量/肺总量比值（RV/TLC%）较术前上升了4.75%,上述各指标的差值均有统计学意义.1 s用力呼气量/用力肺活量比值（FEV1/FVC）和术前比基本无改变,但其差值有统计学意义.膈神经移位右侧（10例）与左侧（6例）术前、术后肺活量比较差异有统计学意义.术后随访8个月～2年,所有患者均无明显呼吸困难和胸闷等症状.结论膈神经移位术后对青壮年患者肺容量有较大的丧失,肺通气功能减弱和小气道阻力增加,但其丧失程度在机体自身代偿耐受范围内,不会导致急剧发生的严重呼吸功能障碍.建议对右侧臂丛神经根性损伤的患者,术前进行严格的肺、心功能检查,避免发生较为严重的并发症.     

Autoimmune progesterone dermatitis: absence of contact sensitivity to glucocorticoids, oestrogen and 17-α-OH-progesterone

Autoimmune progesterone dermatitis is a rare condition, characterized by recurrent premenstrual exacerbations of a dermatosis, in which sensitivity to progesterone can be demonstrated. The sensitizing mechanism is unknown. The aim of this study was to test the hypothesis that cross-sensitivity between steroid groups could induce allergy to endogenous progesterone in these patients. 5 patients with autoimmune progesterone dermatitis and 1 with oestrogen-sensitive dermatitis have been patch tested with a corticosteroid series, conjugated oestrogen 1% in petrolatum (pet.), and 17-α-OH-progesterone 2% pet. There were no immediate or delayed reactions at 2 and 4 days to any steroid group. We have therefore been unable to demonstrate steroid cross-sensitivity, or a use for 17-α-OH-progesterone in the investigation of oestrogen - and progesterone-sensitive dermatoses.     

A Series of Serological Tests for the Detection of Antigens and Specific Antibodies in Deep-Seated Candidosis: Experimental Aspects/Eine Gruppe von Antigen- und Antikörpertests zur Serodiagnose von tieflokalisierten Candida-Mykosen: Experimentelle Aspekte

Summary: We describe a series of six serological tests for the diagnosis of deep-seated candidosis. The array comprises two commercial tests (antigen test, Ramco Inc., and antibody test, Roche), as well as four enzyme immunoassays which have been developed in this laboratory: an antigen test for detection of Candida-proteinase, the corresponding assays for monitoring of anti-proteinase antibodies, and two assays for monitoring of IgG and IgM against heterogenous metabolic antigens of C. albicans. The highly sensitive and specific proteinase antigen-test tolerates samples with high concentration of serum proteins. Proteinase antigen was detected in 10 out of 11 normal mice after intravenous infection with C. albicans blastospores. The proteinase antigen peaked between the second and fourth day after infection. A rise in corresponding antibodies was observed in all animals. No proteinase antigen was detected in sera of healthy human individuals; anti-proteinase antibody titers in these sera amounted up to 1:8000. In related ELISAs, using metabolic fungal antigens, titer values of specific IgG and IgM amounted to 5120 and 1280, respectively. The six tests were carried out in an comparative study under diagnostic conditions, the results of which are the subject of a forthcoming communication. Zusammenfassung: Ein Satz von sechs serologischen Tests für die Diagnostik der tiefen Candida-Mykosen wird vorgestellt. Die Gruppe schließt zwei kommerziell vertriebene Testbestecke ein (Latex-Agglutinationstest zum Antigennachweis, Ramco Inc., und Hämagglutinationstest zum Antikörpernachweis, Roche). Vier weitere Enzymimmuntests wurden von uns entwickelt: Ein Antigentest zum Nachweis von sekretorischer Candida-Protease, ein entsprechender Test zum Nachweis von Antikörpem gegen Candida-Protease, und zwei Assays zum Nachweis von IgG-bzw. IgM-Antikörpem gegen heterogene metabolische Antigene von C. albicans. Der empfindliche spezifische Protease-Antigentest toleriert hohe Konzentrationen unspezifischer Serumproteine und kann deshalb auf Serumproben in geringer Verdünnung (z. B. 1:20) angewandt werden. Protease-Antigen war in 200 fach verdünnten Seren von 10 aus 11 intravenös infizierten NWNI-Mäusen nachweisbar. Die höchste Antigen-Konzentration trat zwischen dem 2. und 4. Tag nach Infektion auf; die Serum-Halbwertszeit von gereinigter Protease in der Maus betrug etwa 60 nun. Ein Anstieg korrespondierender Antikörper war in alien infizierten Tieren zu beobachten. Auch im Serum gesunder Probanden waren Antiprotease-Antikörper bis zu einem Titer von 1:8000 nachweisbar; der Protease-Antigentest fiel hingegen immer negativ aus. Die Titer von Antikörpern gegen metabolische Candida-Antigene erreichten in derselben Gruppe von Seren Werte von 1:5120 bzw. 1:1280. Die sechs Tests wurden unter diagnostischen Bedingungen verglichen; Ergebnisse dieser Studie sind Gegenstand einer weiteren Mitteilung.     

Psychological Assessment of the Headache Patient

Most clinicians agree that psychological factors are important considerations in the evaluation and treatment of headache patients. There has been a lack of systematic research, however, that has examined the relationship between these variables. Attention to such factors may become a greater concern as the frequency of a patient's headaches increases, there is increased disability secondary to headaches, and/or there is an inadequate response to usually effective treatment. In addition, there is no consensus as to the proper method to assess psychopathology in headache patients.     

A longitudinal study of age-associated memory impairment

An 8-year longitudinal study of elderly people has provided data concerning age-associated impairment (AAMI). In 1985 a random sample of 146 persons aged 65 years or more, living in their own homes, were assessed using the Guild Memory Test the Mini–Mental State Examination (MMSE) and other ratings. After excluding 21% of the sample because they scored less than 24 on the MMSE, and another 34% who fulfilled other exclusion criteria, some 48% of the remainder (22% of the total sample) clearly fulfilled NIMH criteria for AAMI and a further 36% (16% of the total sample) were recorded as forgetful. The NIMH criteria are appropriate for certain research purposes but not in assessing prevalence of memory disorders. Follow–up interviews were conducted after 2, 4, 6 and 8 years. The mortality rate and development of dementia among those fulfilling criteria for AAMI appeared similar to the other non-demented groups of subjects; the mortality rate of those with MMSE scores below 24 was significantly higher. Guild test results at 2-yearly intervals showed considerable changes; half of those scoring least well who were retested showed improvement.     

2002年广州地区淋球菌对4种抗生素耐药性结果分析

目的了解广州地区2002年淋球菌对抗生素的耐药性及产青霉素酶淋球菌(PPNG)和高水平耐四环素淋球菌(TRNG)的流行状况。方法用琼脂稀释法测定四环素、壮观霉素、头孢三嗪和环丙沙星4种抗生素对100株淋球菌的最低抑菌浓度(MIC)及用纸片碘量法检测β-内酰胺酶。结果100株淋球菌检出PPNG 15株(15%)、TRNG 28株(28%),环丙沙星耐药率高达98%,高度耐药株(MIC≥16 mg/L)32株(32%),未发现对头孢三嗪、壮观霉素的耐药菌株,但头孢三嗪的敏感性有所下降。结论目前广州地区流行的淋球菌菌珠耐药状况仍然严重,尤以环丙沙星为甚,但对壮观霉素和头孢三嗪仍较敏感。此外,有必要持续监测球菌的耐药性。     

Repeatability of the C‐100 colour vision test

Background: The C‐100 colour vision test has been shown to have a high validity for diagnosing the type of red‐green colour vision defect, however, there is little information on the repeatability of the test. This study examines the repeatability of the C‐100 in classifying the colour vision defect as either protan or deutan. Methods: The C‐100 was administered on two occasions to 58 subjects with congenital red‐green colour vision defects: The sessions were separated by a minimum period of 10 days. Results: The repeatability of the C‐100 was high with a kappa coefficient of agreement for diagnosis of 0.96. The few discrepancies were misclassifying protans as deutans. Conclusion: The C‐100 is a highly repeatable test in terms of separating protans from deutans. However, if a discrepancy occurs, it is more likely to be a protan misclassified as a deutan rather than vice versa.     

A recycling framework for the construction of Bonferroni‐based multiple tests

In this paper we describe Bonferroni‐based multiple testing procedures (MTPs) as strategies to split and recycle test mass. Here, ‘test mass’ refers to (parts of) the nominal level α at which the family‐wise error rate is controlled. Briefly, test mass is split between different null hypotheses, and whenever a null hypothesis is rejected, the part of α allocated to it may be recycled to the testing of other hypotheses. These recycling MTPs are closed testing procedures based on raw p‐values associated with testing the individual null hypotheses, and the class of such MTPs includes, for example, serial and parallel gatekeeping, fallback and Holm procedures. Graphical displays and a concise algebraic notation are provided for such MTPs. This recycling approach has pedagogical advantages and may facilitate the tailoring of MTPs for different purposes. Copyright © 2009 John Wiley & Sons, Ltd.     

头低位模拟失重状态对前庭功能的影响

为研究头低位模拟失重对运动病症状、垂直视动眼震（ＶＯＫＮ）及体液重新分配的影响，在头低位－１０°的模拟失重状态下，采用大视野的垂直视动刺激，观察１８名正常人的运动病症状、ＶＯＫＮ、激素（ＡＶＰ、ＶＩＰ、ＣＯＲＴ、ＡＬＤＯ）的反应特点。结果表明，头低位－１０°状态下的大视野垂直视动刺激可以诱发出明显的运动病症状，头低位－１０°的垂直视动刺激比坐位更容易诱发运动病。坐位状态ＶＯＫＮ慢相速度有明显的方向性不对称，敏感组ＶＯＫＮ方向性不对称有显著差异（Ｐ＜０．０５）。头低位－１０°时ＶＯＫＮ的不对称现象不明显，向下方向运动的ＶＯＫＮ慢相速度显著增加。分析指出，头低位－１０°状态下垂直视动刺激比坐位和秋千刺激的贡献率大。尿中ＣＯＲＴ（皮质醇）在秋千和头低位的垂直视动刺激前后有显著性增加。提示：大视野的垂直视动刺激与头低位－１０°两种刺激的结合可能成为预测空间运动病的方法之一．     

A prospective evaluation of changes in neuropsychological and liver function tests following transjugular intrahepatic portosystemic stent-shunt

Background/Aims: This study was designed to assess changes in: (a) neuropsychological tests, measures of memory, quality of life and scores for anxiety and depression; (b) liver function tests; and (c) the relationship between these following transjugular intrahepatic portosystemic stent-shunt.Methods: Twenty-nine patients undergoing transjugular intrahepatic portosystemic stent-shunt for recurrent variceal haemorrhage, 12 matched patients with cirrhosis and variceal haemorrhage manage with variceal band ligation and 16 normal controls were studied. Patients in any of the groups who were clinically encephalopathic were excluded from the study. Serial changes in the conventional liver function tests and Indocyanine green clearance, and psychometric function (Hospital Anxiety Depression Scale, Rivermead Behavioral Memory Test, Quality of Life and the memory and reaction sub-tests of the Cambridge Automated Neuropsychological Test Assessment Battery) were measured prior to and 1, 3, 9 and 15 months following transjugular intrahepatic portosystemic stent-shunt.Results: Over a mean follow up of 9.1 months in the transjugular intrahepatic portosystemic stent-shunt group (range 3–28), one patient (3%) developed clinically detectable encephalopathy. Sixty-seven percent of patients with cirrhosis showed evidence of subclinical encephalopathy as compared with the control population. Significant deterioration occurred in the reaction sub-tests of the Cambridge Automated neuropsychological Test Assessment Battery in patients, both in the transjugular intrahepatic portosystemic stent-shunt group and the controls with cirrhosis, during follow up. Transjugular intrahepatic portosystemic stent-shunt was followed by significant deterioration in levels of anxiety and psychological component of the quality of life. The Rivermead Behavioural Memory Test and the memory sub-test of the Cambridge Automated Neurpsychological Test Assessment Battery did, however, improve significantly at 1 and 15 months after transjugular intrahepatic portosystemic stent-shunt, respectively. Serum alanine aminotransferase, bilirubin and indocyanine green clearance deteriorated significantly following transjugular intrahepatic portosystemic stent-shunt (p<0.001, p<0.001 and p<0.0001, respectively). Significant correlation was observed between changes in the indocyanine green clearance and changes in the complex and simple reaction time subtests of the Cambridge Automated Neuropsychological Test Assessment Battery (r=0.6 and r=0.66, respectively).Conclusions: The results of this study showed that about 67% of patients with cirrhosis were subclinically encephalopathic and that temporary deterioration occurred in the Cambridge Automated Neuropsychological Test Assessment Battery during follow up, both in patients having transjugular intrahepatic portosystemic stent-shunt and in the controls with cirrhosis. These parallel the changes in the liver function tests and indocyanine green clearance. Temporary deterioration was also observed in the Quality of Life and Hospital Anxiety Depression Scale in the transjugular intrahepatic portosystemic stent-shunt group, although the measures of memory improved. Further studies should address the biochemical mechanisms of these changes and the role of prophylactic measures.