急性肠系膜静脉血栓形成16例临床分析

目的　分析急性肠系膜静脉血栓形成 (ASMVT)的临床特征和诊断方法。方法　对北京友谊医院 1985年 10月至 2 0 0 2年 10月确诊的 16例ASMVT的临床资料进行分析 ,并结合文献 ,总结ASMVT的临床特征和诊断方法。结果 16例ASMVT患者 ,年龄 19～ 6 4岁 (平均 4 5 9岁 )。主要症状有腹痛 ( 16 / 16 )、腹胀 ( 16 / 16 )、呕吐 ( 10 / 16 )、发热 ( 8/ 16 ) ,主要体征有腹部膨隆 ( 16 / 16 )、腹膜刺激征( 16 / 16 )。误诊率 75 % ( 12 / 16 ) ,死亡率 4 4 % ( 7/ 16 )。结论　ASMVT的临床表现有一定的特征 ,早期彩色超声检查、诊断性腹腔穿刺、结合CT或肠系膜上动脉造影异常发现可对ASMVT做出正确的诊断 ,早期手术可以降低死亡率     

经尿道前列腺汽化电切术中电切深度标识的探讨

目的 探讨经尿道前列腺汽化电切术(transurethral electrovaporization of the prostate，TUVP)电切深度标识的可行性。方法 回顾性分析616例前列腺增生症临床资料，其中310例术前彩超提示合并前列腺钙化，156例合并膀胱结石，23例合并膀胱肿瘤。TUVP操作过程中，观察到合并前列腺结石和机械操作“打滑现象”，停止电切。结果 全组手术时间30～120min，平均75min。术中验证术前彩超提示合并前列腺钙化的310例前列腺钙化为结石，同时发现其余306例均存在结石。1例术中膀胱穿孔，无尿道直肠瘘和尿道电切综合征发生。325例随访3～6个月，平均4．5月，最大尿流率由6．5～8．5ml／s提高到18～22ml／s，残余尿由70～150ml降至0～10ml，国际前列腺症状评分由19～24．5分降至0～7分。138例膀胱结石和23例膀胱肿瘤无复发。结论 前列腺结石和机械操作“打滑现象”作为TUVP的电切深度标识是切实可行的。     

Leber遗传性视神经病变24例临床分析

回顾分析了 2 4例 ( 4 8眼 )Leber遗传性视神经病变的临床特征。患者年龄从 1 2岁到 44岁 ,平均 ( 2 0 3± 7 2 )岁 ,男性占 83%。发病典型者多为 1眼无痛性视力下降。视力下降程度从眼前手动到 1 2 ,其中 40眼 ( 83% )≤ 0 1。视野缺损主要为中心暗点或旁中心暗点 ,色觉障碍严重。本组部分病例发病早期有特征性眼底改变 ,包括视盘明显充血 ,视盘周围小血管扩张迂曲 ,神经纤维层水肿。眼底荧光血管造影视盘及盘缘血管无荧光素渗漏。     

浅探溃疡病胃镜征象与中医辨证关系

通过观察１１６例溃疡病人内镜下病变部位的粘膜相，根据四诊资料进行辨证分型，试图从微观角度探讨中医病因、病机、诊断；分析了内镜诊断，胃粘膜相与中医舌象、传统辨证的关系，认为胃粘膜相与舌象改变基本一致。对有血瘀症状而无舌脉改变者，胃镜亦能提示瘀阻胃络的粘膜改变，故可作为中医望诊的延伸运用于临床。将宏观辨证与微观辨证有机结合，可补充传统辨证的不足，有利于对中医证型本质的探讨，为中医辨证论治开辟新的前景。     

Consonant and sign phoneme acquisition in signing children following cochlear implantation

Abstract

Deaf children from signing programs provide new opportunities to investigate changes in sign and speech acquisition following cochlear implantation. We describe the acquisition of sign phonemes (location, movement, and handshapes) and speech phonemes (consonants) in 22 implanted children with diverse demographic backgrounds. New consonants and new sign phonemes emerged in developmentally expected sequences and with statistically significant correlation coefficients between cumulative number of new consonants and new sign phonemes over time. Regression slopes from plotted z scores revealed a burst in consonant and sign growth in early months post-implant, with continuous but plateauing growth over time. These results and documentation of developmental levels of sign and speech phoneme trajectories should be helpful to other researchers and to clinicians working with signing children who have cochlear implants.     

Qualitative research within the Deaf community in Northern Ireland: A multilingual approach

In this methodology article, the authors illustrate how they conducted multilingual qualitative research in an exploration of the barriers that Deaf people in Northern Ireland face when attempting to access the system of justice. The authors’ research practices are informed, to the extent possible, by the principles of community-based participatory research (CBPR). They explore the challenges of conducting research in American Sign Language (ASL), British Sign Language (BSL), and Irish Sign Language (ISL), and spoken English, facilitated by sign language interpreters fluent in BSL and ISL. Centering the research on the lived experiences of Deaf people who navigate the system of justice, the authors implemented CBPR-informed research methods, which ultimately led to sustained discussion and joint action by the authors and members of the Northern Ireland Deaf community aimed at the removal of barriers that Deaf people face when interacting with the justice system. By writing about their methodological approach in Northern Ireland, the authors wish to be transparent about their work in the hope that other researchers can replicate their successes and avoid the limitations of conducting this work in partnership with members of the Deaf community in other countries.     

From Gesture to Sign Language: Conventionalization of Classifier Constructions by Adult Hearing Learners of British Sign Language

There has long been interest in why languages are shaped the way they are, and in the relationship between sign language and gesture. In sign languages, entity classifiers are handshapes that encode how objects move, how they are located relative to one another, and how multiple objects of the same type are distributed in space. Previous studies have shown that hearing adults who are asked to use only manual gestures to describe how objects move in space will use gestures that bear some similarities to classifiers. We investigated how accurately hearing adults, who had been learning British Sign Language (BSL) for 1–3 years, produce and comprehend classifiers in (static) locative and distributive constructions. In a production task, learners of BSL knew that they could use their hands to represent objects, but they had difficulty choosing the same, conventionalized, handshapes as native signers. They were, however, highly accurate at encoding location and orientation information. Learners therefore show the same pattern found in sign-naïve gesturers. In contrast, handshape, orientation, and location were comprehended with equal (high) accuracy, and testing a group of sign-naïve adults showed that they too were able to understand classifiers with higher than chance accuracy. We conclude that adult learners of BSL bring their visuo-spatial knowledge and gestural abilities to the tasks of understanding and producing constructions that contain entity classifiers. We speculate that investigating the time course of adult sign language acquisition might shed light on how gesture became (and, indeed, becomes) conventionalized during the genesis of sign languages.     

Tools for Language: Patterned Iconicity in Sign Language Nouns and Verbs

When naming certain hand-held, man-made tools, American Sign Language (ASL) signers exhibit either of two iconic strategies: a handling strategy, where the hands show holding or grasping an imagined object in action, or an instrument strategy, where the hands represent the shape or a dimension of the object in a typical action. The same strategies are also observed in the gestures of hearing nonsigners identifying pictures of the same set of tools. In this paper, we compare spontaneously created gestures from hearing nonsigning participants to commonly used lexical signs in ASL. Signers and gesturers were asked to respond to pictures of tools and to video vignettes of actions involving the same tools. Nonsigning gesturers overwhelmingly prefer the handling strategy for both the Picture and Video conditions. Nevertheless, they use more instrument forms when identifying tools in pictures, and more handling forms when identifying actions with tools. We found that ASL signers generally favor the instrument strategy when naming tools, but when describing tools being used by an actor, they are significantly more likely to use more handling forms. The finding that both gesturers and signers are more likely to alternate strategies when the stimuli are pictures or video suggests a common cognitive basis for differentiating objects from actions. Furthermore, the presence of a systematic handling/instrument iconic pattern in a sign language demonstrates that a conventionalized sign language exploits the distinction for grammatical purpose, to distinguish nouns and verbs related to tool use.     

“I just answer ‘yes’ to everything they say”: Access to health care for deaf people in Worcester,South Africa and the politics of exclusion

Objective

To explore whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients.

Methods

Qualitative methodology using semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa.

Results

Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, overprotectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services.

Conclusion

These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients.

Practice implications

Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services.     

FLAIR血管高信号征在大脑中动脉供血区急性脑梗死中的临床价值

目的探讨磁共振液体衰减反转恢复(FLAIR)序列高信号血管征(HVS)在评估大脑中动脉供血区急性脑梗死患者病情严重程度及预后中的应用价值。方法回顾性分析大脑中动脉供血区急性脑梗死的患者共52例。根据T2 FLAIR图像上血管高信号征是否存在分为有血管高信号征组和无血管高信号组。比较两组患者弥散序列(DWI)上梗死体积大小、入院时及治疗10天后NIHSS评分、早期神经功能恢复情况及基本临床资料。结果大脑中动脉供血区急性缺血性脑梗死患者52例中无远端HVS组35例(67%)和远端HVS组17例(33%)中,梗死体积大小分别为(89.74±28.82)和(73.15±26.37),入院时NIHSS评分分别为16(6~27)分及10(2~21)分,入院10天NIHSS评分分别为13(6-26)和8(0~19)分,无远端HVS组与远端HVS组差异存在统计学意义(P<0.05)。梗死侧大脑中动脉狭窄程度分为轻度狭窄、明显狭窄、闭塞,HVS组的发生率分别为19例(42%)、11例(73%),16例(89%)。HVS组中大脑中动脉严重狭窄或闭塞者27例,占HVS阳性组77%,血管高信号征阴性组中大脑中动脉严重狭窄或闭塞者5例,占HVS阴性组29%,两组之间存在显著差异(P<0.05)。结论 T2 FLAIR序列HVS是大脑中动脉供血区急性脑缺血性梗死重要的影像学征象。有远端HVS的患者急性梗死灶体积较小,NIHSS评分较低,临床预后较好。责任血管狭窄程度越严重,HVS的出现率越高。大脑中动脉区HVS联合MRA有利于临床评估脑梗死的病变范围、血管病变的大致位置、血管的狭窄程度,可指导临床进行早期干预,改善患者的预后。