缺血性卒中治疗中的若干启示

脑卒中具有高发病率、高病死率、高度致残的临床特点。目前对缺血性卒中的治疗已取得了重大进展,但它仍是内科临床工作中最具挑战性的任务之一。哲学反思对科学的发展具有指导作用,本文从哲学的角度对缺血性卒中的治疗策略和措施进行综合分析,以把握其最新的发展趋势。     

Right hemispatial neglect: frequency and characterization following acute left hemisphere stroke

The frequency of various types of unilateral spatial neglect and associated areas of neural dysfunction after left hemisphere stroke are not well characterized. Unilateral spatial neglect (USN) in distinct spatial reference frames have been identified after acute right, but not left hemisphere stroke. We studied 47 consecutive right handed patients within 48h of left hemisphere stroke to determine the frequency and distribution of types of right USN using cognitive testing and MRI imaging. The distribution of USN types was different from the previously reported distribution following acute right hemisphere stroke. In this left hemisphere stroke population, allocentric neglect was more frequent than egocentric neglect.     

Using goal setting, task clarification, and feedback to increase the use of the hands-free technique by hospital operating room staff

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from 32% to 64% and 31% to 70% between baseline and treatment phases in the inpatient and outpatient surgery units, respectively. Five-month follow-up data suggested maintenance of treatment effects. These findings suggest the utility of organizational behavior management strategies in reducing risky behavior in hospital settings.     

抗心肌缺血损伤潜在治疗新靶点——线粒体

缺血预处理可减轻缺血对心肌造成的损伤,提高病人的生存能力。近年来的研究发现,缺血预处理最终通过位于心肌线粒体内膜上的几种蛋白通道发挥作用。因此,研究可调控这些重要通道功能的特异药物,对于预防和治疗缺血性心肌病具有重要的临床意义。线粒体将会成为一个有潜力的重要的治疗缺血性心脏病的新的药物作用靶点。     

盐酸戊乙奎醚对心脏瓣膜置换术患者NF-κB表达的影响

为研究盐酸戊乙奎醚对心脏瓣膜置换术患者心肌NF-κB转录活性的影响,选取择期瓣膜置换术患者60例,随机分为对照组（C）、盐酸戊乙奎醚组1（P1）、盐酸戊乙奎醚组2（P2）,每组20例。结果心肌缺血再灌注后,P1、P2组NF-κB的转录活性明显下降,可见盐酸戊乙奎醚可以抑制心肌NF-κB的激活,在一定程度上具有心肌保护作用。     

糖尿病的免疫抑制治疗

淡化糖尿病的分型为我们提供了一个全新的思维空间。即传统的1型和至少部分2型糖尿病可能都是一种自身免疫性疾病,而目前流行的炎症学说可能是对认可免疫损伤是糖尿病发病理论的一个过渡,我们应该重新审视糖尿病的早期治疗和研究其慢性并发症的发病机理。我们则采用小别量、长时间的治疗理念,早期接受这种免疫治疗的患者出现低血糖的症状,遂减少胰岛素的剂量;再次出现低血糖,我们就继续减少胰岛素的剂量。结果,有部分患者完全摆脱了胰岛素。我们对糖尿病的再认识是建立在对多脏器活检的基础之上。我们的活检结果表明,糖尿病肾病存在着免疫损伤。糖尿病眼底病变是使患者致盲的主要病因,糖尿病患者的眼底病变是一种自身免疫损伤的结果。我们尝试用小剂量的免疫抑制剂环孢菌素A（25mgbid）治疗糖尿病眼底出血,取得了不错的疗效,也证实糖尿病眼底病变是一种血管炎,与自身免疫病变有关。其他的器官还包括垂体、大脑的血管、糖尿病足、冠心病、皮肤的病变和肌肉活检的免疫组化也均有证据表明,免疫损伤是导致多种慢性并发症的罪魁祸首,是一种多器官免疫损伤的结果无论是1型糖尿病,还是2型糖尿病,肌细胞表面或多或少均有免疫复合物沉积。这些免疫复合物的存在势必会影响胰岛素与肌肉细胞表面的胰岛素受体结合,即胰岛素抵抗的存在。为此,我们在临床上广泛采用了免疫抑制治疗的理念治疗糖尿病。应用小剂量胰岛素和小剂量环孢素A治疗早期发现的糖尿病取得了不错的疗效。唯一担心的副作用发生在肝脏,即部分糖尿病患者会出现总胆红素升高,而也有一部分患者总胆红素不升高。     

药物性肝损伤的诊断思维

药物性肝损伤（DILI）是指由于药物或其代谢产物引起的肝脏损害。DILI的诊断尚无金标准,目前国际上比较常用的诊断标准分别从数个不同方面各自进行量化评分,根据得分情况做出诊断。本文归纳DILI的产生机制、诊断标准、临床分型及病理类型,总结推论其临床诊断思维与决策,以供临床医生参考,提高诊断水平。     

USING DIFFERENTIAL REINFORCEMENT TO DECREASE ACADEMIC RESPONSE LATENCIES OF AN ADOLESCENT WITH ACQUIRED BRAIN INJURY

The present study investigated the effects of contingency‐specifying rules and a token economy to decrease the latency to comply with academic instructions by a 16‐year‐old girl with acquired brain injury. Results showed that treatment was successful in reducing academic response latencies. These results replicate previous research in which differential reinforcement was used to decrease slow responding to academic tasks.     

Deficits in executed and imagined aiming performance in brain-injured children

Motor disorders are a frequent consequence of acquired brain injury (ABI) in children and much effort is currently invested in alleviating these deficits. The aim of the present study was to test motor imagery (MI) capabilities in children with ABI (n=25) and an age- and gender-matched control group (n=25). A computerized Virtual Radial Fitts Task (VRFT) was used to investigate the speed-accuracy trade-offs (or Fitts' law) that occur as target size is varied for both executed and imagined performance. In the control group, the speed for accuracy trade-off for both executed and imagined performance conformed to Fitts' law. In the ABI group, only executed movements conformed to Fitts' law. These findings suggest that children with ABI show an inferior ability to imagine the time needed to complete goal-directed movements with differential difficulty levels.     

Introducing the concept of spirit injury in education‐to‐work transitions

This paper introduces the topic of spiritual injury and the possible influences and relationships it might share with education‐to‐work transitions of young adults. Students of both dominant and minority cultural backgrounds were interviewed to gain a detailed understanding of how perceptions of transitions came about. Further, I sought to understand what role spirituality and experiences of spirit injury have in the decision‐making processes.