地震造成大规模人群的复杂创伤,病情进一步发展,常导致多脏器功能障碍(MODS)。本文总结了地震伤后MODS的发病机制、预防、早期诊断以及治疗措施。

BACKGROUND: At present, there are many drugs and therapeutic methods for dementia at home and abroad. Both xingding and piracetam are the kind of improver for circulatory obstruction and protector for nerve cells and can slow down the functional decline of brain tissue and provide improvement for cognitive deficit.OBJECTIVE: To observe the improvement of allied application of xingding and piracetam on cognitive function in treatment of vascular dementia.DESIGNS: Case-controlled study based on patients.SETTING: Neurological Department in Affiliated Hospital of Henan University. PARTICIPANTS: Totally 91 cases of vascular dementia hospitalized in Neurological Department of First Affiliated Hospital of Henan University from October 2000 to March 2002, which were randomized into treatment group of 48 cases and the control of 43 cases.INTERVENTIONS: In treatment group, xingding injection of 20 mL and piracetam of 8 g were administrated and 50 g/L glucose injection 250 mL was added respectively for intravenous injection, once daily and 14 days made one session. In the control, piracetam of 8 g was prescribed with 50 g/L glucose injection 250 mL added for intravenous injection, once daily and 14 days made one session. There was no any difference in other medication treatment. One month later after treatment of two groups, he patients were re-examined with mini-mental state examination(MMSE) and Hasegawa dementia scale(HDS) was used to assess the cogitative improvement and neurological defect scale(NDF) was used to analysis the improvement of neurological functional symptoms.MAIN OUTCOME MEASURES: ① Scores of MMSE, HDS and NDF in two groups. ② Analysis on therapeutic effects.RESULTS: Totally 91 cases entered the analysis on the results. There was no significant difference in MMSE and HDS before treatment in two groups. In treatment group, after treatment, MMSE and HDS scores were (23.26±5.12) and(2.78±3.46) respectively, indicating significant difference(t=4.79, 15.44, P＜0.01) compared with the control(19.14 ±3.21)and(15.21±2.29) . NDF score was 13.68±7.83 after treatment and the significant difference was presented compared with the control(17.33 ±8.81) . The total effective rate(total remarkable rate + progression) was 92% in the treatment group and was 56% in the control. By the comparison between two groups, the difference was significant(χ2= 15.48, P＜0.01).CONCLUSION: After treatment, MMSE score in treatment group was higher than that in the control and HDS score was lower than that in the control, explaining that xingding allied piracetam significantly improves cogitative function in the treatment of vascular dementia.

Objective To investigate the diagnostic value of anti-cyclic citrullinated peptides ( CCP ) antibodies combined rheumatoid factors (RF) on elderly patients with rheumatoid arthritis.Methods From January 2012 to December 2014, 29 cases of elder patients in our hospital with rheumatoid arthritis (elder RA group, age >60 year), 47 cases of elderly health control group (elder RA group, age≥60), and 48 cases of elder patients without rheumatoid arthritis (non-elder RA group, age<60 year) were selected.The anti-CCP antibodies and rheumatoid factor (RF) levels of three groups were detected, and the significance of anti-CCP antibody combined RF on the diagnosis of elderly rheumatoid arthritis was analyzed.Results Diagnostic positive rate of anti-CCP antibodies +RF was significantly higher than that of anti-CCP antibodies, and the difference was significant (χ2 =7.632, P =0.006).Diagnostic positive rate of anti-CCP antibodies +RF was higher than that of RF, but the difference was not statistically significant (χ2 =3.107, P=0.078).The diagnostic positive rate of anti-CCP antibodies, RF, and anti-CCP antibodies +RF for diagnosis of elderly rheumatoid arthritis had no statistically difference with that of non-elderly RA group.The sensitivity and negative predictive value of anti-CCP antibodies +RF was higher than that of only anti-CCP antibodies and RF.The area under the ROC curve of detecting anti-CCP +RF was 0.786, which was higher than that of anti-CCP antibodies (0.699) and RF (0.663), indicated that the reliability of anti-CCP antibodies +RF was higher than that of anti-CCP antibodies and RF.Conclusion The anti-CCP antibodies and RF can diagnose elderly rheumatoid arthritis, and anti-CCP antibodies combined RF has more clinical significance.

Objective To optimize the injection protocol of spiral CT portography(SCTP) and to evaluate its diagnostic value.Methods 48 normal individuals were randomly divided into three groups with different injection rates of contrast material:4 ml/s,3 ml/s and 2 ml/s.Single-level dynamic CT was performed through the trunk of portal vein.In each scan,time-attenuation curves of the portal vein,liver and P-L(the difference between portal vein and liver)were obtained.And SCTP was prospectively performed in 30 cases.The SCTP findings in a variety of disease were analyzed and the quality of SCTP images was assessed.Results ①The groups of 4 ml/s and 3 ml/s had greater peak enhancement of the portal vein and P-L than the group of 2 ml/s(?

Objective To study the value of contact heat evoked potentials (CHEPs) for the early diagnosis of diabetic peripheral polyneuropathy. Methods Seventy-five diabetic patients were examined by conventional nerve conduction velocity studies and then divided into 2 groups: diabetics with normal nerve conduction and diabetics with abnormal nerve conduction. Thirty-three normal subjects were used as controls. Toronto Clinical Neuropathy Sco-ring System was used to evaluate the patients. CHEPs were recorded using different stimulation intensities at different temperatures. Results The peak latencies of 45℃ , 50℃, 53℃ in diabetics with normal nerve conduction group were longer than those in normal control group, with a significant difference between the 2 groups(P<0.05). The peak latencies of diabetics were positively related to Toronto scores. Conclusion CHEPs could detect the impair-ment of diabetic peripheral nerve and reveal the impairment earlier than conventional nerve conduction velocity exami-nation, The prolongation of peak latency in diabetics group was significantly and positively related to clinical condi-tion.

Objective To explore the pathogenesis of femoral head ischemic necrosis(FHIN),and to observe the clinical therapeutic effects of extracorporeal shock waves therapy(ESWT) for FHIN in soldiers.Methods With exclusion of the femoral head necrosis sAbsequent to femoral neck fracture,108 cases of FHIN in ARCO stage Ⅰ-Ⅲ period,induding 86 males and 22 females,with aged ranged from 17 to 25 years,were involved in the present study,and the treatment modality was chosen by patients voluntarily.In 50 patients,ESWT combined with drilling decompression procedure(ESWT group) was chosen,and 9-12kV(0.16-0.22mJ/mm2) of extracorporeal shock wave was applied on the second day after drilling decompression.X-ray and MRI of bilateral hip joints were taken and Harris hip score(HHS) was estimated at 6 and 12 months after treatment.58 patients chose the treatment of simple drilling decompression served as controls.The results of the two groups were analyzed by Student's paired t test.Results No aggravation of FHIN occurred in the two groups.The average ratio of necrosis zone in ESWT group was diminished by 22.9%,32.8% and 34.3%,respectively,in the stages of ARCO Ⅰ,Ⅱ and Ⅲ,and the improvement was better in ARCO Ⅱ and Ⅲ stages than that in control group(P

Objective To study the effect of extracorporeal shock wave therapy with percutaneous autogenous bone marrow grafting in the mannagement of long bone nonunion.Methods After success in marrow aspiration from patients' iliac crest,19 cases of patients accepted the treatment of bone marrow grafting and ESWT.Then,it's therapeutic effect was compared with 23 cases of single ESWT group,such as average rate of bone union and average healing time during follow-up period.The data of this study was analyzed by independent-samples t test,and a P value of

Objective To evaluate the technique and clinical effect of retroperitoneoscopic adrenalectomy for pheochromocytoma.Methods A total of 78 patients received roperitoneoscopic adrenalectomy for pheochromocytoma from March 2006 to June 2008.Retroperitoneal space was enlarged routinely with patient in lateral decubitus position.After adequate retroperitoneal space was created,three relatively bloodless planes were orderly entered for exposure and separation of the adrenal gland and tumor.The first dissection plane was between the psoas and posterior Gerota's fascia.The subsequent dissections were proceeded in the plane between anterior Gerota's fascia and perirenal fat.The third dissection plane was between the adrenal gland and upper pole of kidney.The tumor and parts of adrenal glands were then excised.Results A1l operations were successful.The mean operative time and estimated blood loss were 145?53min and 100?49 ml,with no blood transfusion,and no conversion to open surgery.The mean postoperative analgesic(pethidine) consumption was 57?38mg.Time for oral intake of food and ambulation after operation were 1.6?0.5d and 1.5?0.3d,respectively.The mean postoperative hospital stay was 5.8?1.9d.No major intraoperative complications occurred.Conspicuous fluctuation of blood pressure(≥50mmHg) was observed in 49 patients during operation.56 patients were followed up,and no recurrence or metastasis of the tumor was found during a follow-up period of 12.3?8.7 months in average(range from 2 to 26 months).Conclusions With adequate preparations,retroperitoneoscopic adrenalectomy for pheochromocytoma(≤6cm) is a safe and effective procedure in the hand of an exparienced surgeon since it gives a clear operative field,adequate space for manipulation,distinct anatomic landmark and minimal agitation.

Objective To explore the optimal low-dose protocol of volumetric high-resolution CT (VHRCT) of the lung and evaluate its diagnostic value.Methods Catphan phantom were scanned using GE Lightspeed VCT with different parmeters from 120 kV,10 mAs to 120 kV,250 mAs in 10 mAs increments.Other parameters included 0.969 pitch,20 mm scan coverage,0.625 mm collimation and 30 cm display field of view and bone recon kernel.The spatial and density resolution,noise and radiation dose of each scanning were measured to determine the low-dose VHRCT protocol.In clinical study,105 patients with diffuse lung diseases underwent standard-dose VHRCT with 120 kV,250 mA according to the clinical needs.Low-dose VHRCT was performed with 120 kV,120 mAs in follow-up.Two radiologists who were unaware of the CT technique reviewed randomized images for the detail of diffuse lung diseases,including linear or reticular opacities,micro-nodules or tree-in-bud patterns,bronchiolectasis,ground-glass opacities and emphysema using a 4-point scale.Results In phantom study,the spatial-resolution maintained at 9 LP/cm from 250 mAs to 120 mAs.Below 120 mAs,the spatial-resolution and density-resolution decreased and noise increased with the decrease of tube-current.In clinical study,there were no statistical differences between standard-dose and low-dose VHRCT in demonstrating the detail of diffuse lung diseases(P ＞0.05).The CTDIvol was 23.44 mGy at 250 mAs and 11.25 mGy at 120 mAs,with 52％dose reduction by low-dose VHRCT.Conclusions Low-dose VHRCT at 120 kV,120 mAs offers maximum dose reduction without compromising spatial resolution and diagnostic value.

Objective To investigate the difference of colon length between patients with intractable constipation and normal peo-ple.Methods 40 patients with intractable constipation and 35 cases of normal control group received air enema CT scan,post-pro-cessing techniques-curved planar reformation and volume rendering were used to measure the length of colon.Results Colon length of normal people and constipation patients were (1 230±33)mm and (1 605±47)mm,respectively.There was significant difference between normal people and constipation patients (t=163,P=0.015).Conclusion CT air enema technique can be used to measure the length of colon obj ectively for diagnosing and treating redundant colon.