重型颅脑损伤死亡原因分析及预防

目的 探讨重型颅脑损伤的死亡因素和防治对策。方法 回顾我院1998-11～2003-11收治116例重型颅脑损伤病人的临床资料。结果 116例重型颅脑损伤病人中GCS6～8分73例，死亡12例，死亡率16．44％：3～5分43例，死亡21例，死亡率48．84％；GCS3～8分116例，死亡33例，死亡率28．45％。结论 重型颅脑损伤应尽早确立主要临床诊断、及早解除脑受压、积极防治并发症，是降低死亡率的关键。     

重型、特重型颅脑损伤合并易漏诊部位损伤的早期诊断和治疗

目的探讨重型、特重型颅脑损伤合并易漏诊部位损伤的早期诊断和治疗。方法对2000年1月至2007年8月收治的432例重型、特重型颅脑损伤合并其他部位损伤患者的临床资料进行回顾性分析。所有病例均符合重型、特重型颅脑损伤合并其他部位损伤患者的诊断标准,并按损伤严重评分（ISS）和GCS评分对伤情进行评估。同时对漏诊组（50例）和非漏诊组（382例）患者进行分析比较。结果432例患者中有50例漏诊,漏诊率为11．57％。与非漏诊组比较,漏诊组患者ISS评分,GCS≤8的病例所占比例及死亡率均较非漏诊组患者高（P〈0．05）。视神经、空腔脏器及脊髓损伤漏诊率较高,这些易漏诊部位损伤的致残率和死亡率也较高。结论对重型、特重型颅脑损伤应重视其视神经、脊髓等合并伤的诊断,规范其诊疗流程,降低漏诊率。     

重型颅脑损伤死亡原因分析及预防

目的 探讨重型颅脑损伤的死亡因素和防治对策。方法 回顾我院1998-11-2003-11收治116例重型颅脑损伤病人的临床资料。结果 116例重型颅脑损伤病人中GCS 6-8分73例,死亡12例,死亡率16.44％;3-5分43例,死亡21例,死亡率48.84％;GCS 3-8分116例,死亡33例,死亡率28.45％。结论 重型颅脑损伤应尽早确立主要临床诊断、及早解除脑受压、 积极防治并发症,是降低死亡率的关键。     

脑室内颅内压监测在老年颅脑损伤中的意义

目的探讨脑室内置管监测颅内压在老年颅脑损伤救治中的意义。方法对57例老年颅脑损伤患者（重型52例，中型4例，轻型1例）采用脑室内置管监测颅内压，根据监测结果控制颅内压，指导脱水药物应用和开颅手术。结果57例中死亡19例，GCS评分3～5分29例中，死亡13例，死亡率45％；GCS评分6。8分23例，死亡6例，死亡率26％。出院后6个月GOS评分：1分19例，2分1例，3分2例，4分14例，5分21例。结论老年颅脑损伤患者持续有创进行颅内压监测，有助于及时了解颅内压的变化，有利于早期诊断及调整治疗方案，并对判断预后有着重要意义。     

386例重型颅脑损伤病人的救治

目的总结386例重型颅脑损伤病人的救治经验。方法对386例GCS≤8分重型颅脑损伤病人进行回顾性分析。结果出院时按COS评定386例病人中恢复良好168例(43．5％)，中残62例(16．1％)，重残25例(6．5％)，植物生存10例(2、6％)，死亡121例(31．3％)。结论重型颅脑损伤病人早期有效治疗是降低死亡率。提高生存质量的关键。     

重型颅脑损伤90例死亡原因分析

目的探讨重型颅脑损伤死亡原因和救治经验。方法2007年1月至2011年1月收治的重型颅脑损伤病人761例,死亡10例,对90例死亡患者的临床资料进行回顾性分析。结果重型颅脑损伤病人761例,死亡90例,死亡率11．8％。其中GCS3—5分死亡65例,GCS6~8分死亡25例。伤后1～3d内死亡24例,4～6d死亡19例,7~9d死亡26例,10～30d死亡21例。结论早期诊断,综合救治,积极预防并发症是救治重型颅脑损伤的关键。     

缺血修饰白蛋白对重型颅脑损伤患者早期心肌损伤的评估价值

目的探讨缺血修饰白蛋白（IMA）对重型颅脑损伤继发心肌损伤的早期诊断价值及其与患者预后的关系。方法检测52例重型颅脑损伤患者（实验组）血清IMA、心肌肌钙蛋白（cTnI）、肌酸激酶同工酶（CK～MB）、肌红蛋白（MYO）,并检测同期46例健康体检者血清IMA。结果实验组血清IMA水平显著高于对照组（P〈0．01）。实验组血清IMA、cTnI、MYO、CK-MB阳性率分别为78．84％、53．85％、32．69％、30．77％,IMA的阳性率显著高于cTnI、MYO、CK—MB的阳性率（P〈0．01）。GCS6-8分组、4-5分组、3分组的ACB值分别为（67.21±5．96）U／ml、（52．85±5．13）U／ml、（40．78±4．85）U／ml,三组间ACB值有统计学差异（P〈0．05）。预后差（GOS评分4～5分）患者血清IMA水平显著低于预后好患者（GOS评分1～3分,P〈0．01）。结论IMA对重型颅脑损伤继发心肌损伤的早期诊断有重要价值,并且检测IMA有助于评估重型颅脑损伤患者的病情严重程度及预后。     

重型颅脑损伤合并严重多发伤的临床救治

目的评估重型颅脑损伤合并严重多发伤的临床救治结果。方法对22例重型颅脑损伤合并严重多发伤进行回顾性总结。结果预后按GOS评分,良好者8例（36．4％）,轻残4例（18．2％）,重残2例（9％）,植物生存3例（13．6％）。死亡5例（22．7％）。结论早诊断、早治疗、积极抗休克治疗、合理的救治顺序是提高重型颅脑损伤合并严重多发伤的治疗效果,减少致残率及降低死亡率的有效措施。     

早期肠内营养对重型颅脑损伤患者血清C反应蛋白含量变化的影响

目的观察早期肠内营养（EEN）对重型颅脑损伤患者血清C反应蛋白（CRP）的影响，探讨EEN对保护肠道黏膜、减轻全身炎症反应的作用。方法30例重型颅脑损伤患者中，GCS6～8分者23例，GCS3-5分者7例。随机分为EEN组（15例）和早期胃肠外营养（PN）组（15例）。入院48h内给予不同方法的营养支持。测定入院时及伤后1、4、7和14d血浆中CRP的含量。结果随着伤后时间推移两组患者血清CRP浓度均呈下降趋势，但EEN组下降幅度更明显，伤后第4、7及14天EEN组血清CRP含量明显低于PN组（P〈0．05或P〈0．01）。EEN组伤后14d GCS评分明显高于PN组（P〈0．05）。结论EEN可保护重型颅脑损伤患者的胃肠道黏膜，减轻其全身炎症反应，改善其意识状态。如果重型颅脑损伤患者胃肠道功能允许，应尽早给予EEN。     

重型颅脑损伤并多器官功能衰竭45例临床分析

目的 探讨重型颅脑损伤并发多系统器官衰竭(MSOF)的主要临床特征和预防、治疗对策。方法 对586例重型颅脑损伤患者中并发MSOF的45例患者进行原发病的治疗及各种指标的监测。结果 重型颅脑损伤后MSOF的发生率7．68％；既往有疾病的器官发生MSOF机率较高，达69％；颅脑损伤越重，MSOF发生率越高，GCS 6～8分者MSOF发生率为3．4％，3～5分者发生率为8．1％，脑疝者发生率为10．4％；死亡31例，病死率68％。结论 早期开颅手术，解除颅内高压，控制肺部感染，密切监测各器官功能，加强对器官功能的支持，可降低MSOF的发生率。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -     

Summary of legislation of 1941 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -     

Asymmetry of on- and off-pathways of blue-sensitive cones of the retina of macaques

Macaque retinal ganglion cells whose receptive-field center recieves input from blue-sensitive cones show an overt asymmetry of the frequency of ON-center and OFF-center varieties, an asymmetry not present in ganglion cells whose center receives input from the other two cone types. A similar asymmetry of ON/OFF responses is found in the local electrotetinogram (d-wave) mediated by signals from blue-sensitive cones. ‘Blue-ON-center’ ganglion cells have larger receptive-field centers and shorter conduction latencies than other opponent-color varieties, suggesting an appreciable degree of receptor convergence and presumably large cell bodies. Intracellular stainings of these neurons with Procion Yellow show that they correspond to diffuse stratified (Parasol) ganglion cells whose flat-topped dendritic arborization stratifies in the sclerad half of the inner plexiform layer. In view of the known characteristics of macaque bipolar cells and of the ON/OFF asymmetry, it is proposed that these ganglion cells are postsynaptic to cone-specific flat bipolars possibly mediating sign-inverting synaptic contacts. The results also indicate a reversal, for the blue-cone pathway, of the ON/OFF lamination of the inner plexiform layer that has recently been described in other species.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.