银杏达莫注射液治疗急性脑梗死的疗效观察

目的 :观察银杏达莫注射液治疗急性脑梗死的疗效及治疗前后的血液流变学的变化。方法 :选择发病 72h内的急性脑梗死患者 80例 ,随机分为治疗组和对照组各 4 0例 ,分别用药 14d。两组治疗前后评价神经功能缺损评分并检测血液流变学指标。结果 :治疗组基本痊愈率 30 % ,显著进步率 35 % ,进步率 2 0 % ,总有效率 85 % ;对照组基本痊愈率 17.5 % ,显著进步率2 2 .5 % ,进步率 35 %。总有效率 75 %。两组比较有显著差异。治疗组用药后血液流变学较用药前也有显著改善 (P <0 .0 5 )。结论 :银杏达莫治疗急性脑梗死疗效显著未发现不良反应。     

麻醉前使用右美托咪定或咪达唑仑临床效果的比较

目的探讨右美托咪定与咪达唑仑作为麻醉前用药的镇静效果及对患者记忆功能的影响。方法选择择期手术患者40例,年龄20～60岁,ASAⅠ或Ⅱ级,随机均分为右美托咪定组(A组)和咪达唑仑组(B组)。麻醉前20minA组静脉泵注右美托咪定0.7μg/kg,持续10min;B组静注咪达唑仑0.07mg/kg,所有患者在用药前、用药后10min均观看了内容不同的两张水果图片。记录用药前5min、用药后10min患者OAA/S评分,焦虑视觉模拟/焦虑状态问卷(AVA/SAI)评分和BIS,记录MAP、HR和SpO2,术后24h随访患者对用药前后水果图片的记忆情况。结果用药后10min两组MAP明显低于、HR明显慢于用药前5min(P<0.05或P<0.01),A组HR明显慢于B组(P<0.05)。用药后10min两组OAA/S、AVA/SAI评分和BIS明显低于用药前5min(P<0.05),A组OAA/S评分明显低于B组(P<0.05)。术后24h随访,两组患者对给药前图片西瓜记忆率均为100%,A组对给药后图片香蕉记忆率为95%,明显高于B组的0%(P<0.01)。两组患者未出现寒战和躁动。结论作为麻醉前用药,右美托咪定和咪达唑仑具有良好的镇静作用。右美托咪定对记忆功能几乎无影响,但对HR的干扰更明显。     

Liposomal nystatin in patients with invasive aspergillosis refractory to or intolerant of amphotericin B

We assessed the activity and safety of liposomal nystatin, a broad-spectrum antifungal agent, for invasive aspergillosis in patients refractory to or intolerant of amphotericin B. Thirty-three patients were enrolled, received at least one dose of the study drug, and were evaluable for safety. Twenty-six patients had confirmed probable or definite aspergillosis and were fully eligible. Most patients had a hematological malignancy (53.8%) or hematopoietic stem cell transplantation (23.0%), were neutropenic (61.5%), and were refractory to previous amphotericin B (92.3%). The median duration of previous amphotericin B treatment was 16.5 days (range, 5 to 64 days). Aspergillosis was definite in 3 cases and probable in 23 cases. Liposomal nystatin was initiated at a dose of 4 mg/kg of body weight/day. Twenty-five patients were evaluable for response: a complete response was achieved for one patient, and a partial response was achieved for six. Thus, the overall response rate is 7 of 25 (28%; 95% confidence interval, 12 to 49%). Seventeen (68.0%) of the 25 evaluable patients died during therapy or within 1 month after the end of therapy. The primary cause of death was invasive aspergillosis for nine patients and underlying malignancy for eight patients. The most frequent side effects included chills, shivering, and fever, leading to discontinuation of therapy for two patients. Grade 1 decline in renal function was seen for 10 (30.3%) patients, and hypokalemia was seen for 13 (39.4%). We conclude that liposomal nystatin can be effective for salvage therapy of invasive aspergillosis. Infusion-related adverse events have been observed frequently.     

GSK650394对慢性应激抑郁症模型大鼠行为及海马神经营养的调节作用

目的探讨血清和糖皮质激素调节蛋白激酶1(SGK1)抑制剂GSK650394对抑郁症模型大鼠抑郁样行为及海马神经营养的调节作用。方法将SD大鼠随机分为对照组、抑郁模型(慢性温和不可预见性应激加孤养)组、GSK650394(2.8 g/L,按1 mL/kg腹腔注射)干预组;采用强迫游泳、糖水消耗、Morris水迷宫实验观察模型动物的情绪行为变化;用ELISA检测大鼠海马血浆和血清中皮质酮(CORT)、5-羟色胺(5-HT)、去甲肾上腺素(NE)含量;用Western blot检测海马中脑源性神经营养因子(BDNF)、神经营养素3(NT-3)、神经生长因子(NGF)的表达。结果与对照组比较,模型组大鼠蔗糖水偏食度显著降低、游泳不动时间增加(P<0.01)、逃避潜伏期(EL)、目标象限的潜伏时间(Lat.T)均显著延长(P<0.05或P<0.01);血浆CORT显著升高(P<0.01)、血清5-HT、NE和海马NT-3、BDNF、NGF表达显著降低(P<0.05或P<0.01)。与模型组比较,GSK650394可显著增加蔗糖水偏食度、降低游泳不动时间(P&l...     

Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinuses: A Meta-Analysis

Objectives To identify independent predictors of outcome in patients with adenoid cystic carcinoma (ACC) of the paranasal sinuses and skull base.Design Meta-analysis of the literature and data from the International ACC Study Group.Setting University-affiliated medical center.Participants The study group consisted of 520 patients, 99 of them from the international cohort. The median follow-up period was 60 months (range, 32 to 100 months).Main Outcome Measures Overall survival (OS) and disease-specific survival (DSS).Results The 5-year OS and DSS of the entire cohort were 62% and 67%, respectively. The local recurrence rate was 36.6%, and the regional recurrence rate was 7%. Distant metastasis, most commonly present in the lung, was recorded in 106 patients (29.1%). In the international cohort, positive margins and ACC of the sphenoid or ethmoidal sinuses were significant predictors of outcome (p < 0.001). Perineural invasion and adjuvant treatment (radiotherapy or chemoradiation) were not associated with prognosis.Conclusion Tumor margin status and tumor site are associated with prognosis in ACC of the paranasal sinuses, whereas perineural invasion is not. Adjuvant treatment apparently has no impact on outcome.     

Predictors of delay in presentation to the ED in patients with suspected acute coronary syndromes

Delays in seeking medical attention for patients with acute coronary syndromes (ACS) preclude early application of life-saving treatment and diminish efficacy. Previous studies suggest 3-hour delays between onset of symptoms and ED arrival in patients with typical presentations of acute myocardial infarction (AMI). A prospective observational study was conducted in an urban ED measuring lag time (LT) among adults presenting within 48 hours of onset of symptoms suggestive of ACS. Univariate and multiple regression analyses were performed on 5 predictors: age, sex, symptoms at presentation, and 2 different outcomes (AMI and ACS). Three hundred seventy-four patients were enrolled. Mean age was 63 years with 38% 70 years or older. Seventy-three percent of all patients with suspected ACS presented with chest pain, 27% with atypical symptoms. Overall mean LT was 8.7 hours (standard deviation 11). In subgroup analysis, patients aged >/=70 years were more likely to have LTs >12 hours (29% vs. 19% P =.043) and patients without chest pain had longer mean LTs (11.6 vs. 7.6 hours, P =.01). Delay in ED presentation is group specific. Advanced age and patients with atypical symptoms are predictive of longer LTs. Contrary to previously published data, patients with symptoms suspicious for ACS can delay an average of 9 hours, which might alter current thinking in the prevention and care of these patients.     

Constitutive nitric oxide synthase inhibition combined with histamine and serotonin receptor blockade improves the initial ovalbumin-induced arterial hypotension but decreases the survival time in brown norway rats anaphylactic shock

Anaphylactic shock accidents after allergen exposure are frequent. After immunization with ovalbumin (OVA), a common dietary constituent, we evaluated the efficacy of pretreatment with histamine-receptor or serotonin-receptor blockers administered alone or in combination with a nitric oxide synthase inhibitor (L-NAME) on OVA-induced anaphylactic shock in Brown Norway rats. Animals were allocated to the following groups (n = 6 each): control (0.9% saline); diphenydramine (15 mg kg(-1)); cimetidine (20 mg kg(-1)); diphenydramine + cimetidine; dihydroergotamine (50 microg kg(-1)); diphenydramine + cimetidine + dihydroergotamine; L-NAME (100 mg/kg) alone or associated with diphenydramine, cimetidine, diphenydramine + cimetidine, dihydroergotamine, or diphenydramine + cimetidine + dihydroergotamine. Mean arterial blood pressure (MABP), heart rate (HR), and survival time were monitored for 60 min following treatment. The shock was initiated with i.v. OVA. The MABP drop after i.v. OVA was worsened by diphenydramine and was modestly attenuated by cimetidine, dihydroergotamine, or both together. L-NAME potentiated slightly the effects of cimetidine and dihydroergotamine by lessening the initial MABP decrease, but this transient effect was not sufficient to prevent the final collapse or to improve survival time. Decreased vasodilatory (prostaglandins E2), increased vasoconstrictory (thromboxane B2) prostaglandins, and unchanged leukotriene C4 concentrations were contributory to the overall hemodynamic changes. Thus, the combined blockade of vasodilator mediators (histamine, serotonin, and nitric oxide) slowed the MABP drop in anaphylactic shock, but did not improve survival. More studies are needed to understand these discordant effects.     

Pulse high-volume haemofiltration for treatment of severe sepsis: effects on hemodynamics and survival

Introduction

Severe sepsis is the leading cause of mortality in critically ill patients. Abnormal concentrations of inflammatory mediators appear to be involved in the pathogenesis of sepsis. Based on the humoral theory of sepsis, a potential therapeutic approach involves high-volume haemofiltration (HVHF), which has exhibited beneficial effects in severe sepsis, improving haemodynamics and unselectively removing proinflammatory and anti-inflammatory mediators. However, concerns have been expressed about the feasibility and costs of continuous HVHF. Here we evaluate a new modality, namely pulse HVHF (PHVHF; 24-hour schedule: HVHF 85 ml/kg per hour for 6–8 hours followed by continuous venovenous haemofiltration 35 ml/kg per hour for 16–18 hours).

Method

Fifteen critically ill patients (seven male; mean Acute Physiology and Chronic Health Evaluation [APACHE] II score 31.2, mean Simplified Acute Physiology Score [SAPS] II 62, and mean Sequential Organ Failure Assessment 14.2) with severe sepsis underwent daily PHVHF. We measured changes in haemodynamic variables and evaluated the dose of noradrenaline required to maintain mean arterial pressure above 70 mmHg during and after pulse therapy at 6 and 12 hours. PHVHF was performed with 250 ml/min blood flow rate. The bicarbonate-based replacement fluid was used at a 1:1 ratio in simultaneous pre-dilution and post-dilution.

Results

No treatment was prematurely discontinued. Haemodynamics were improved by PHVHF, allowing a significant reduction in noradrenaline dose during and at the end of the PHVHF session; this reduction was maintained at 6 and 12 hours after pulse treatment (P = 0.001). There was also an improvement in systolic blood pressure (P = 0.04). There were no changes in temperature, cardiac index, oxygenation, arterial pH or urine output during the period of observation. The mean daily Kt/V was 1.92. Predicted mortality rates were 72% (based on APACHE II score) and 68% (based on SAPS II score), and the observed 28-day mortality was 47%.

Conclusion

PHVHF is a feasible modality and improves haemodynamics both during and after therapy. It may be a beneficial adjuvant treatment for severe sepsis/septic shock in terms of patient survival, and it represents a compromise between continuous renal replacement therapy and HVHF.     

后颅窝扩大重建术促进Chiari畸形合并脊髓空洞症患者上下肢运动及感觉功能恢复

目的观察后颅窝扩大重建术后Chiari畸形合并脊髓空洞症患者上下肢运动及感觉功能的恢复情况,探讨此术式对Chiari畸形合并脊髓空洞症脊髓功能恢复的作用。方法所有患者被分为两组:后颅窝扩大重建术组(posteriorfossareconstruction,PFR组)共56例患者;后颅窝减压术组(posteriorfossadecompression,PFD组)共62例患者。定期随访。按NCSS(NeurosurgicalCervicalSpineScale)定量分析上下肢运动及感觉障碍恢复情况,其结果作统计学分析。结果PFR组的上、下肢和感觉功能的有效率分别为76%,71%,70%;PFD组的上、下肢和感觉功能的有效率分别为58%,60%,66%。两组上下肢及感觉障碍的有效率经χ2检验差异无统计学意义。结论PFR能明显促进Chiari畸形合并脊髓空洞症患者上下肢运动及感觉障碍的功能恢复。