FDG PET脑显像在癫痫定位诊断中的应用—与SPECT、MRI、CT检查对比分析

目的：探讨功能性显像技术在癫痫灶定位中的价值。方法：我们对６０例癫痫分别进行脑正电子发射计算机断层（ＰＥＴ）、单光子发射计算机断层（ＳＰＥＣＴ）、ＭＲＩ和ＣＴ检查，对癫痫灶进行定位。５９例为ＰＥＴ发作间期显像，１例进行了发作间期和发作期显像，并与其ＣＴ和ＭＲＩ结果进行比较，结果分析采用目测法。结果：发作间期阳性率ＰＥＴ为８６７％（５２／６０），ＳＰＥＣＴ为６０％（３６／６０）。ＰＥＴ与ＳＰＥＣＴ定位完全符合者占８０６％（２９／３６）。ＰＥＴ定位癫痫灶的灵敏度明显优于ＳＰＥＣＴ、ＣＴ、ＭＲＩ。结论：我们认为ＰＥＴ功能显像通过观察脑葡萄糖代谢进行癫痫灶定位是目前较好的无创性的检查方法。结合解剖结构图像可为治疗提供更多的信息     

经食管超声心动图的一种新用途：TEE对38例食管肿瘤诊断作用的研究

采用经食管超声心动图（ＴＥＥ）对３２例食管癌和６例食管平滑肌瘤进行检查并与纤维胃镜、ＣＴ及手术后病理结果对照。结果显示：ＴＥＥ术前检查对食管癌进行病理分期（Ｔ分期）准确率为８０．６％，高于ＣＴ的准确率４２．９％；ＴＥＥ测定食管癌长度值为５．２６９±１．９１６ｃｍ，与病理检查测值５．３４５±１．９０１ｃｍ比较无显著差异（Ｐ＞０．０５）。而胃镜检查测值４．０５２４±１．８０６ｃｍ与病理检查测值有显著差异（Ｐ＜０．０５）。ＴＥＥ结合胃镜对６例食管平滑肌瘤进行定性诊断，结果与病理检查完全符合。而ＣＴ对４例食管平滑肌瘤进行诊断，仅２例与病理检查结果符合。ＴＥＥ术前检查发现食管周围淋巴结４４枚，术中切除６６枚，总显示率为６６．７％。总之，ＴＥＥ在食管肿瘤诊断方面有独特价值，应进一步研究应用     

自身脾片移植治疗ITP的临床研究

为保持脾切患者机体的免疫功能，自１９９０年１０月，对３１例肾上腺糖皮质激素治疗无效的原发性血小板减少性紫癜（ＩＴＰ）脾切除患者，进行了脾切除后自身脾片移植的研究，结果：显效２４例，占７７．５％，良效３例，占９．７％，进步２例，占６．５％，无效２例，占６．５％，术后１，３个月复查，仅ＰＡＩｇＧ下降，而其它各项细胞，体液免疫指标均恢复正常，Ｔ４／Ｔ８，ＩｇＧＩｇＡＩｇＭ较对照组明显为高（Ｐ〈０．０５）     

广西瑶族与汉族葡萄糖—6—磷酸脱氢酶基因三种常见突变型？…

目的 研究广西瑶族葡萄糖－６－磷酸脱氢酶（Ｇ６ＰＤ）基因突变特点，并与汉族作比较。方法 用突变特异性扩增系统（ＡＲＭＳ）法对广西瑶族３４例和汉族３７例Ｇ６ＰＤ缺乏进行中国常见的三种Ｇ６ＰＤ基因突变型筛查。结果 广西３４例瑶族Ｇ６ＰＤ缺乏的基因型分别为Ｇ１３７６Ｔ １４例（４１．２％），Ｇ１３８８Ａ９例（２６．５％），Ａ９５Ｇ５例（１４．７％），Ｃ１３１１Ｔ１例（２．９％）。     

血清过氧化氢酶活性测定的临床应用

应用比色测定法检测了１１５６例不同疾病患者的血清ＣＡＴ活性。与正常对照组比较，有３５８例不同疾病患者的血清ＣＡＴ活性增高，占疾病总数的３１．０％（Ｐ＜０．０１）。其中胰腺炎组为７６．５％（１３／１７）；胆囊炎组为４６．２％（６／１３）；肝癌组为５９．３％（１６／２７）；心衰组为５４．６％（６／１１）；非癌性肝病组为６４．６％（４２／６５）；精神分裂症组为５９．６％（５３／８９）。正常不同妊期妇血清ＣＡＴ活性在晚孕组校对照组明显增高，Ｐ＜０．０１。顺产与难产妇女血清ＣＡＴ活性和顺产与难产新生儿脐血清ＣＡＴ比较，结果均有差异（Ｐ＜０．０５）。     

老年人血清过氧化氢酶活性测定探讨

本文采用分光光度比色法，检测了１０８例健康老年人的血清ＣＡＴ活性（男５８名，女５０名）．男性组的血清ＣＡＴ活性水平是５８．５±１９．７ＫＵ／Ｌ（２５．８～１１９．８），女性组为５６．８±１１７；４ＫＵ／Ｌ（１８．５～１０２．２），二者平均值是５７；８±１７．５ＫＵ／Ｌ（１８．５～１１９．８）。对２７３例不同疾病组的老年患者的血清ＣＡＴ活性检测表明，与正常对照组比较，有６６例血清ＣＡＴ结果增高明显，占２４．２％（Ｐ＜０．０１）；其中胰腺炎组的阳性符合率为７５．０％，肝癌组为５５．６％，心衰组为５０．０％，肝炎组为４０．０％。     

G6PD缺乏红细胞膜磷脂含量及其不对称性改变的研究

目的：通过测定葡萄糖－６－磷酸脱氢酶（Ｇ６ＰＤ）缺乏红细胞膜磷脂的含量及其不对称性的变化，研究Ｇ６ＰＤ缺乏对红细胞膜结构的影响。方法：不对称性实验采用磷脂酶Ａ２处理完整红细胞，磷脂的测定采用高效液相色谱法。结果：正常红细胞膜磷脂酰乙醇胺（ＰＥ）、磷脂酰丝氨酸（ＰＳ）、磷脂酰胆碱（ＰＣ）含量分别为５．５９±１．１６，２．９２±０．５０，６．６４±０．９２ｍｇ／ｍｇ膜蛋白；Ｇ６ＰＤ缺乏红细胞膜ＰＥ、ＰＳ、ＰＣ分别为５．１８±１．８６，１．５１±０．５８，５．７０±１．９１ｍｇ／ｍｇ膜蛋白，两组中ＰＳ有显著性差异（Ｐ＜０．００１），说明Ｇ６ＰＤ缺乏红细胞膜ＰＳ含量降低。在正常人红细胞膜中有１７．６％±２．５％ＰＥ，５７．９％±４．７％ＰＣ在外层，外层未发现ＰＳ，在Ｇ６ＰＤ缺乏红细胞膜中有３０．２％±５．７％ＰＥ，５３．８％±７．４％ＰＣ，２７．２％±５．８％ＰＳ在外层，两组中ＰＥ和ＰＳ有显著性差异（Ｐ＜０．０１和Ｐ＜０．００１），外层的ＰＣ无明显变化，说明ＰＥ、ＰＳ均向外层移动。结论：由于Ｇ６ＰＤ缺乏，红细胞膜磷脂结构发生改变，是红细胞溶血的重要机制之一。     

TIPSS与TIPSS并用SEEV治疗肝硬变门静脉高压的临床观察（附84例报告）

本文报告了采用经颈静脉肝内门腔静脉内支架分流术（ＴＩＰＳＳ）和ＴＩＰＳＳ并用食管胃底静脉硬化栓塞术ＳＥＥＶ或称门静脉断流术两种方法，治疗８４例门静脉高压症的临床结果。８２例获得成功（成功率９７．６％）。其中，３４例仅采用ＴＩＰＳＳ方法；４８例采用ＴＩＰＳＳ并用ＳＥＥＶ方法。７１例为择期治疗，另１１例为急诊ＴＩＰＳＳ。肝内分流通道直径分别为８～１０ｍｍ（６９例）和１２ｍｍ（１３例）；术后门静脉压力平均下降１３．０±５．４ｃｍＨ２Ｏ。术后平均随访时间为９．５个月（１～３０个月）。术后７例有再出血发生（８．５％），其中，ＴＩＰＳＳ组６例（２４％）；ＴＩＰＳＳ并用ＳＥＥＶ组且例（２．６％）；１１例出现肝性脑病（１３．４％），其余病例均良好。     

依那普利治疗轻中度原发性高血压的临床疗效观察

本文将８３例轻中度原发性高血压患者进行单盲分组对照试验。治疗组益压利４２例，对照组怡那林４１例。益压利组５～２０ｍｇ／次，每日１次。６周后坐位ＢＰ由２３．２±２．０／１３．１±０．８降至１９．８±１．２／１１．６±０．７ｋＰａ，立位ＢＰ由２３．０±１．９／１３．０±０．８降至１９．４±１．０／ｌｌ．５±０．７ｋＰａ，其降压临床显效率４７．６％，总有效率９０．５％。怡那林组５～２０ｍｇ／次，每日１次，６周后坐位ＢＰ由２３．３±２．０／１３．１±０，８降至２０．８±１．２／１２．３±０．７ｋＰａ，立位ＢＰ由２３．０±２．０／１３．１±０．８降至２０．６±１．０／１２．２±０．７ｋＰａ，其显效率３４．１％，总有效率８２．９％。结果表明两组均有明显降压效果，但两组间临床总有效率无显著性差异（Ｐ＞０．０５）。而２４小时ＡＢＰ谷：峰（Ｔ／Ｐ）比值显示，益压利组ＳＢＰ为８１．７％，ＤＢＰ为７６．０％，优于怡那林组的５０．８％及４４．１％。     

院内产后子痫32例分析

１临床资料１．１一般资料１９２例中院内发生产后子痫３２例,（１６．０９％）,外院转入１０例。１７～２８岁,平均２２．６岁。２例经产;其余为初产妇。２５例作过产前检查（７８．１２％）。１．２发病情况９～１２月２４例（７５％）,３～７月７例（９２１．５８％）,８月１例。发病前有头晕、眼花、视物模糊、恶心、呕吐等５例（１５．６２％）,无任何症状２７例（８４．３４％）。发病前完全无症状１９例（２８．１３％）,轻度妊高征１９例（５９．３２％）中度妊高征３例（６．２５）,重度妊高征１例（３．１３％）。剖宫产…     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.