益精注射液对心衰猫心功能及血流动力学影响的实验研究

益精注射液(YJ)是立足于中医基础理论.结合笔者多年临床经验.研制出的中药复方静脉制剂,具有补肾益精气之功效。本实验以静脉注射2％戊巴比妥钠造成猫心衰模型,然后分次静注益精注射液(0.5g/kg、1g/kg),观察其对心衰猫心功能及血流动力学的影响,并与生脉注射液(SM)作了对比观察。实验结果表明:静注YJ后,可增加心衰猫的LVSP(左心室压力峰值)、±dp/dt max(左心室压力上升、下降最大速率);降低TPR(总外周阻力),从而明显增加心衰猫的CO(心输出量)、LVW(左室作功)、CI(心脏指数)、SV(心搏量)。在LVW明显增加同时,心肌耗氧量(MVO_2)增加甚少。对左室舒张功能亦有改善作用,对心率(HR)、血压(BP)无明显影响。其表明YJ能增强心肌的收缩性,降低外周阻力。减轻心脏负荷,尤其是后负荷,提高心脏作功效率,进而明显增强心泵功能而有利于心力衰竭的治疗。YJ与SM的对比观察表明:在增强心泵功能方面YJ略强于SM,但无统计学意义。而在降低心肌耗氧量,提高心脏效率方面YJ优于SM(p<0.05)。YJ1g/kg在降低总外周阻力方面与SM组比较(p<0.05),有显著性差异。     

游戏教学法在学龄前儿童用力肺活量检查中的应用

目的 探讨游戏教学法在学龄前儿童用力肺活量检查中的应用效果.方法 选择2012年1月至2013年12月在我科肺功能室进行肺功能检查的学龄前儿童317例,随机分成两组,对照组118例,其中男82例,女36例;观察组199例,其中男133例,女66例.对照组儿童在做肺功能前由技术操作人员向患儿讲解操作规范、程序、如何用力、如何配合并演示,教导患儿用口深吸气一直到肺总量位置,然后以最快速度吹气,直到能够看见时间容积曲线显示呼气相平台之后,再用最快速度吸气至肺总量位置,然后用一张8cm×21 cm的小纸条让患儿练习直到把纸吹飞.观察组患儿采用游戏教学法,即让患儿先观看电脑画面,操作人员调出游戏软件中的蜡烛画面,一边让患儿看电脑里吹蜡烛的情景,一边做示范用力吹气,重点强调吹气时一定要用最大的力气尽量可能的长时间吹气,就像吹蜡烛一样,只有这样才能把蜡烛全部吹灭,吹灭的蜡烛越多获得的分数就越高,以奖励游戏的形式鼓励患儿进行检查.每一个患儿测定6次,每次间隔2分钟,不成功者休息20分钟再重新测试,2小时以内能完成并达到质控标准的视为成功,2小时内不能达到质控标准的视为不成功,记录患儿肺功能测定的成功率,比较两组患儿进行肺功能检查的成功率.结果 对照组118例中成功完成操作者78例,占66.1％,不成功者40例,占33.9％;观察组199例中成功者160例,占80.4％,不成功者39例,占19.6％.2组结果比较,x2值为8.096,P值为0.004,差异有显著性.结论 在学龄前儿童用力肺活量检查中,游戏教学法可以有效提高检查的成功率.     

Kappa指数在急性阑尾炎腹部体征教学中的应用

目的探讨应用一致性检验在评价外科学临床教学效果中的意义。方法以普外科见习和实习的医学生为研究对象,随机分组进行有针对性教学（n：15）和常规教学（n=21）,统计两组间体检的Kappa指数。结果对于Morris点压痛知识点,接受有针对性教学的学生掌握情况较接受传统教学的学生更优。结论运用Kappa指数,选择某些体检项目在传统教学的基础上加强针对性教学,能达到更好的教学效果。     

Restricted language access during childhood affects adult brain structure in selective language regions

Due to the ubiquitous nature of language in the environment of infants, how it affects the anatomical structure of the brain language system over the lifespan is not well understood. In this study, we investigated the effects of early language experience on the adult brain by examining anatomical features of individuals born deaf with typical or restricted language experience in early childhood. Twenty-two deaf adults whose primary language was American Sign Language and were first immersed in it at ages ranging from birth to 14 y participated. The control group was 21 hearing non-signers. We acquired T1-weighted magnetic resonance images and used FreeSurfer [B. Fischl, Neuroimage 62, 774–781(2012)] to reconstruct the brain surface. Using an a priori regions of interest (ROI) approach, we identified 17 language and 19 somatomotor ROIs in each hemisphere from the Human Connectome Project parcellation map [M. F. Glasser et al., Nature 536, 171–178 (2016)]. Restricted language experience in early childhood was associated with negative changes in adjusted grey matter volume and/or cortical thickness in bilateral fronto-temporal regions. No evidence of anatomical differences was observed in any of these regions when deaf signers with infant sign language experience were compared with hearing speakers with infant spoken language experience, showing that the effects of early language experience on the brain language system are supramodal.

Language is a uniquely human cognitive ability involving a specialized and distributed left-lateralized fronto-temporal brain network (1–3). To date, however, how this highly efficient and complex language network emerges in the brain during early human development is poorly understood. Much of postnatal brain development is experience dependent. A series of neural processes, including synaptogenesis, pruning, and myelination, are shaped by environmental experience and learning (4–6). Language-related regions (including inferior frontal gyrus (IFG), temporal regions, and inferior parietal regions) grow more slowly compared with sensory-motor regions (7–9), suggesting an extended neural plastic period when language from the environment can shape this brain network.Previous studies have found that the variation in the amount of language children experience affects the rate at which they develop language (10–15). Parental vocabulary diversity and syntactic complexity predict advances in children’s language development and the effect increases with age (N = 1,058, r = 0.35) (16). Randomized clinical trials and parent coaching intervention studies have found reliable increases in children’s expressive language skills with increases in parent–child interactions (17–21). Indeed, the more conversational turns 4-to-6-y olds participated in, the greater the BOLD signal changes they showed in brain language areas while performing language tasks. The effects included greater white matter connectivity in the left hemisphere (LH), arcuate and superior longitudinal fasciculi (22, 23) and increased cortical thickness in the LH IFG and supramarginal gyri (24). Five-to-9-year-olds who engaged in more parental conversations showed increased cortical area in the LH perisylvian regions (25).Thus, variation in the amount of language children experience is associated with gray and white matter development in the brain language system. Here we ask whether restricted language in the child’s environment shows effects on measures of cortical structure in the adult brain.Deafness often severely restricts the number of conversations infants and young children can perceive and participate in, because they cannot hear spoken language, and lipreading is too impoverished a language signal to enable spontaneous language acquisition. Although some deaf children successfully acquire spoken language with intensive intervention, many do not. Sign language is visually accessible to children born deaf, and is acquired spontaneously when present in the environment, but it is absent from the environment of most deaf children. Examining the brain developmental outcomes of varying childhood language experience in this population can shed light on the role of early language experience on the emergence of the language network and provide insights on how to better support deaf children’s language and brain development.Behavioral studies have repeatedly found a negative relation between the age-onset of immersion in a sign language environment and the outcome of language learning in the population of deaf signers (26–32) (see ref. 33 for a review). Neurolinguistic studies of the phenomenon have found reduced activation in classic language regions or atypical activation patterns (34–36). In particular, Mayberry et al. (34) found a negative correlation between age of initial sign language immersion (between 0 to 14 y old) and BOLD activation in several left fronto-temporal language regions using sentence processing tasks in American Sign Language (ASL).Few studies have examined the effects of restricted language experience during childhood on the anatomical structure of the brain language system. Here we analyze the dataset from Pénicaud et al. (37) using a surface-based morphometry (SBM) analysis (38) to focus on both language and non-language regions of interest (ROIs) derived from a multi-modal cortical parcellation map (39). The previous whole-brain voxel-based study found that restricted language experience in childhood was negatively correlated with grey matter in occipital areas, with no effects observed in language-relevant regions. Here we reanalyze the data set with SBM to answer three questions. First, can surface-based analysis reveal possible effects of restricted language experience on anatomical structures in the adult brain? If so, we should observe age of exposure effects on the language ROIs but not on non-language ROIs. Second, if structural effects are observed, the question is whether all language-relevant regions are equally affected, or alternatively whether some regions are more affected than others. Third, are the effects of early language experience on the development of the cortical areas of the brain language system altered by the sensory-motor modality of the early language? We answer the last question by comparing surface-based analyses of the participants in the present study, deaf signers who experienced ASL from birth, with hearing non-signing speakers from previous studies at the Montreal Neurological Institute (MNI) matched by handedness and age.     

The importance of inspection in clinical cardiology: Frank's sign

The Frank''s sign (FS) is a diagonal earlobe crease running from the tragus to the edge of the auricle. In this case, we describe a 71 years‐old male patient with FS who presented to the emergency department complaining of epigastric pain. A non‐ST elevation myocardial infarction was diagnosed.     

成人股骨头缺血性坏死比较影像学分析

目的:探讨成人股骨头缺血性坏死的X线、CT、MRI表现和病理基础。方法:搜集经临床证实的30例成人股骨头缺血性坏死的X线、CT及MRI影像资料进行回顾性分析。结果:30例病患共累计47个病变股骨头,X线检查漏诊了16个病变股骨头,CT检查漏诊了5个病变股骨头,MR检查诊断了经X线、CT检查后漏诊的5例病变股骨头。结论:骨髓水肿是成人股骨头缺血性坏死的早期影像学表现,MRI“线样征”是诊断早期缺血坏死的特征性表现,MR是目前诊断早期成人股骨头缺血性坏死最敏感、最有效的影像学检查方法。     

Tenosynovial complications identify TTR cardiac amyloidosis among patients with hypertrophic cardiomyopathy phenotype

Recent evidence suggests that carpal tunnel syndrome (CTS) and brachial biceps tendon rupture (BBTR) represent red flags for ATTR cardiac amyloidosis (ATTR-CA). The prevalence of upper limb tenosynovial complications in conditions entering differential diagnosis with CA, such as HCM or Anderson–Fabry disease (AFD), and hence their predictive accuracy in this setting, still remains unresolved. Objective: To investigate the prevalence of CTS and BBTR in a consecutive cohort of ATTR-CA patients, compared with patients with HCM or AFD and with individuals without cardiac disease history. Participants: Consecutive patients with a diagnosis of ATTR-CA, HCM and AFD were evaluated. A control group of consecutive patients was recruited among subjects hospitalized for noncardiac reasons and no cardiac disease history. The presence of BBTR, CTS or prior surgery related to these conditions was ascertained. Results: 342 patients were prospectively enrolled, including 168 ATTR-CA (141 ATTRwt, 27 ATTRm), 81 with HCM/AFD (N = 72 and 9, respectively) and 93 controls. CTS was present in 75% ATTR-CA patients, compared with 13% and 10% of HCM/AFD and controls (P = 0.0001 for both comparisons). Bilateral CTS was present in 60% of ATTR-CA patients, while it was rare (2%) in the other groups. BBTR was present in 44% of ATTR-CA patients, 8% of controls and 1% in HCM/AFD. Conclusions: CTS and BBTR are fivefold more prevalent in ATTR-CA patients compared with cardiac patients with other hypertrophic phenotypes. Positive predictive accuracy for ATTR-CA is highest when involvement is bilateral. Upper limb assessment of patients with HCM phenotypes is a simple and effective way to raise suspicion of ATTR-CA.     

脑瘫患儿发生癫痫持续状态的急救护理体会

目的对脑瘫患儿发生癫痫持续状态的急救护理方法和效果进行探讨。方法选择2018年4月—2018年9月在医院收治的50例脑瘫发生癫痫持续状态的患儿作为对照组,对其实施常规急救护理,同时选择2018年10月—2019年3月在医院收治的50例脑瘫发生癫痫持续状态的患儿作为观察组,对其实施强化急救护理,对比两组护理满意度、生命体征评分、护理有效率。结果观察组的总体满意率、护理有效率、生命体征评分均优于对照组,两组差异明显,有统计学意义,P<0.05。结论对脑瘫发生癫痫持续状态的患儿实施强化急救护理能够提升治护效果,提高患儿家长满意度,更好的改善患儿生命体征。     

基于“升清-理中-培元”的腹泻型肠易激综合征诊治思路探讨

[目的] 总结储浩然教授对腹泻型肠易激综合征的认识及治疗经验。[方法] 通过临床跟师学习,查阅古籍并结合现代文献研究,总结储师对腹泻型肠易激综合征的认识及治疗思路,明确该疾病基本诊治规律,并举临床医案一则加以佐证。[结果] 储师认为,中焦气机失调是腹泻型肠易激综合征的核心病机,主张以“升清气机-调理中焦-培补元气”为治疗思路,以天枢穴为核心穴位,配以中脘、章门、上巨虚、大肠俞、足三里调理中焦脾胃,配以龙虎交战的针刺手法,助中焦气机畅达。重点选用“百会-内关”调节清气,梳利头脑心神,提升整体气机,此外以“关元-足三里”固本培元,培补先天元气。验案中患者中医辨证为脾胃虚弱证,兼有心神不宁、阳气虚衰之象,储师以升清-理中-培元法治之,补后天以滋先天,并予以安神,收效显著。[结论] 储师临床上根据辨证,增减穴位,通过整合穴位群,使中焦气机升降有利,形成了独具特色的“调中复元”的腹泻型肠易激综合征诊疗体系,为腹泻型肠易激综合征的临床治疗提供了新思路。     

扶正法治疗精神疾病的心悟

慎察精神疾病患者之症象,准确辨证,若系正气虚匮或不足,予相应之扶正方药、针灸等主治或辅治之,收效颇佳.反之,审证不清,"实而误补,固必增邪"(《顾氏医镜》).同时,宜鼓励患者多做活动锻炼,增强体质,提高正气,亦可谓一种较好的扶正辅助疗法.