重型颅脑损伤的手术治疗

目的探讨重型颅脑损伤梯度减压的手术方法对预防术中脑膨出、降低死亡率及致残率的效果。方法对100例重型颅脑损伤患者采用分次减压手术方式及去骨瓣后，硬膜与颞肌筋膜瓣减张缝闭硬膜切口方法。结果40例脑肿胀患者术中脑嘭出6例占15．0％，死亡19例占47．5％；60例脑内血肿病人未发生脑膨出，死亡12例占20％。结论脑外伤后脑血管调节麻痹及血肿压迫继发脑水肿易造成脑膨出.术中分次减压降低了骨窗部位脑组织的顺应性，从而降低了局部的压力梯度，避免脑血管急性扩张，能有效防止脑膨出，降低死亡率及致残率。     

高压氧综合治疗持续植物状态30例疗效分析

目的评估高压氧综合治疗持续植物状态的疗效和探讨最佳治疗方案。方法回顾性分析了1999年—2005年应用高压氧治疗的30例持续植物状态病例,主要分析了原发病因、高压氧治疗次数以及高压氧治疗时机与疗效的关系。结果脑外伤组显效率和好转率明显高于非脑外伤组(P<0.05),开始治疗时间≤30d组及31～60d组好转率明显高于≥61d组(P<0.05)。结论高压氧综合治疗对脑外伤所致持续植物状态患者60d以内开始行高压氧治疗的患者疗效较好。     

Cerebral autoregulation is preserved in multiple system atrophy: A transcranial Doppler study.

Patients with multiple system atrophy (MSA) present large changes in blood pressure (BP) due to autonomic disturbances. We analyzed how this change may influence dynamic cerebral autoregulation (DCA). Simultaneous recordings of arterial BP (Finapres) and middle cerebral artery (MCA) blood flow velocity (BFV) (transcranial Doppler) were performed in 10 patients with MSA (61 +/- 12 yr of age) and 12 healthy volunteers (61 +/- 11 yr of age): cerebral BFV response to oscillations in mean BP was studied in the supine position by cross-spectral analysis of mean BP and mean MCA BFV. The DCA was also studied during the decrease in BP the first seconds when standing up from a sitting position by the assessment of the cerebrovascular resistance index (CR; mean BP/mean MCA BFV ratio). The MCA BFV/BP cross-spectral analysis showed a phase for the mid-frequency band (0.07-0.2 Hz) significantly larger in MSA, suggesting more active autoregulation in response to larger changes in BP. Changes in CR reflecting the rate of autoregulation, when standing did not differ between the two groups. These data suggest that dynamic cerebral autoregulation is preserved in MSA.     

肾损伤的治疗进展

轻度、中度的肾损伤可行保守治疗。严重的肾损伤出血应首选超选择性肾动脉栓塞术,因该技术定位准确,止血迅速,创伤小,恢复快,并发症少,能最大限度地保护肾脏功能,是一种安全可靠治疗肾损伤出血的有效方法。     

44例老年重症哮喘的院前急救体会

目的探讨老年重症哮喘急性发作的院前急救措施。方法在常规平喘治疗基础上,治疗组用甲基泼尼松龙80mg加入5%葡萄糖溶液(0.9%氯化钠溶液)40ml中静脉注射,对照组用地塞米松10mg加入5%葡萄糖溶液(0.9%氯化钠溶液)20ml中静脉注射,观察治疗前、后两组患者临床疗效评分变化。结果治疗组比对照组起效快,疗效好,两组疗效间差异有显著性意义(P<0.01)。结论甲基泼尼松龙是老年重症哮喘院前急救的首选方法,尽早使用,有利于提高抢救成功率。     

Periodontal mechano-sensory responses following trauma to permanent incisor teeth in children

Abstract –  The aim of this study was to investigate mechano-sensory responses of injured and uninjured incisor teeth. Twenty-five children who had experienced dental trauma, together with age- and gender-matched controls, were studied prospectively. Touch thresholds of incisor teeth from both groups were determined using calibrated sets of von Frey hairs (force range 0.5–10.0 g in 0.5 g increments) using a forced choice staircase method. Forces were applied perpendicular to the buccal enamel surfaces along the midline, 2 mm from the incisal edge. Touch threshold was defined as the lowest force detected in three out of the five occasions. Following statistical analysis, P  < 0.05 was considered significant. At initial examination, the touch threshold values of 25 traumatised teeth were significantly greater than the untraumatised controls ( P  < 0.001), and these values approached those of the control teeth over 3–12 months ( P  > 0.05). Dental trauma was associated with increased touch thresholds in permanent incisor teeth, with recovery toward healthy control values usually occurring between 3–12 months.     

Freezing of gait in postmortem-confirmed atypical parkinsonism.

The frequency and pathophysiology of freezing of gait (FoG) in atypical parkinsonism is unknown. We analysed the frequency of FoG in postmortem-confirmed atypical parkinsonian disorders (APD) comprising corticobasal degeneration (CBD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). Sixty-six patients with pathologically confirmed APD (CBD, n = 13; DLB, n = 14; MSA, n = 15; PSP, n = 24) formed the basis for a multicenter clinicopathological study. Clinical features at first and last clinical visit were abstracted from patient records on standardized forms following strict instructions. At the first visit (median 36 months after symptom onset), 24% of APD had FoG (CBD, 8%; DLB, 21%; PSP, 25%; MSA, 40%). Logistic regression analysis showed a significant association of FoG and urinary incontinence (P = 0.04) at first visit. At last visit, 47% of APD had FoG (CBD, 25%; PSP, 53%; DLB, 54%; MSA, 54%). Clinicopathological correlation based on routine postmortem examination failed to identify a consistent neuropathological substrate of FoG. This study demonstrates that (1) FoG is common in APD, and (2) urinary incontinence is significantly associated with FoG in these disorders. Whether FoG and urinary incontinence share similar neuropathological substrates remains to be determined by future studies.     

Health-related quality of life assessed before and during chemotherapy predicts for survival in multiple myeloma

Measurement of health-related quality of life was integrated into a randomized trial (NMSG 4/90) comparing melphalan/prednisone to melphalan/prednisone + interferon α-2b in newly diagnosed multiple myeloma. One of the aims of the study was to assess the prognostic significance of quality-of-life scores, using the EORTC QLQ-C30 questionnaire. Univariate analysis showed a highly significant association with survival from the start of therapy for physical functioning as well as role and cognitive functioning, global quality of life, fatigue and pain. In multivariate analysis, physical functioning and W.H.O. performance status were independent prognostic factors ( P values=0.001 for both) when analysed in a Cox regression model with the somatic variables β-2 microglobulin, skeletal disease and age. The best prediction for survival from the start of therapy was obtained by combining the β-2 microglobulin and physical functioning scores in a variable consisting of three risk factor levels with an estimated median survival of 17, 29 and 49 months, respectively. At a 12 months landmark analysis, the relative risk for patients with physical functioning score 0–20 v 80–100 was 5.63 (99% CI 2.76–11.49), whereas the relative risk for patients without an objective response to chemotherapy compared to those with at least a minor response was 2.32 (99% CI 1.44–3.74). Quality-of-life assessment may be an independent and valuable addition to the known prognostic factors in multiple myeloma.     

Multiple regression analysis of twin data obtained from selected samples

The multiple regression analysis of twin data in which a cotwin's score is predicted from that of a proband (the member of a twin pair selected because of a deviant score) and the coefficient of relationship provides a powerful test of genetic etiology (DeFries and Fulker: Behav Genet 15:467-473, 1985). Moreover, when an augmented model containing an interaction term is fitted to the same data set, direct estimates of heritability (h2) and the proportion of variance owing to shared environmental influences (c2) are also obtained. In the present paper, the expected partial regression coefficients estimated from these models are derived, and the flexibility of the general approach is illustrated. An extended model is formulated for the analysis of data from combined samples of affected and control twin pairs that yields tests for differential h2 and c2 in the two groups as well as pooled estimates of these parameters. The application of these models is illustrated by an analysis of data from reading-disabled and control twin pairs. Because of the ease, flexibility, and utility of the multiple regression analysis of twin data, it is an appealing alternative to more traditional model-fitting approaches.