世纪之交的萨满教研究

本文论述了萨满教的两种类型 :传统萨满教和都市萨满教或新萨满教 。

Toxicity of novel anti-hepatitis drug bicyclol: A preclinical study

AIM: To study the toxicity of bicyclol to animals. METHODS: Acute toxicity test was performed in Kunming strain mice that were orally given bicyclol at the doses of 3 and 5 g/kg body weight, respectively. Wistar rats were orally administered bicyclol at a dose of 5 g/kg body weight. Death and clinical symptoms of animals were recorded within 7 d. Sub-acute toxicity test was carried out in rats that were treated with various doses of bicyclol (150, 300, 600 mg/kg) once daily for 14 d. Animal behaviors, blood biochemical markers, blood and urine pictures were examined. Chronic toxicity test was conducted in 80 Wistar rats of both sexes. The animals were orally administered with various doses of bicyclol [150, 300, 600 mg/kg, 100-400 folds corresponding to the proposed therapeutic dose (1.5 mg/(kg·d)) of bicyclol for patients] once daily for 6 mo except for Sunday. The control group was given the same volume of 0.2% sodium carboxyl methylcellulose (Na-CMC). Twenty-one beagle dogs received bicyclol (25, 75, 225 mg/kg, 16.6, 50, 150 folds corresponding to the proposed therapeutic dose of bicyclol for patients) once a day for 6 mo except for Sunday. The body weight, food intake, urine and feces, blood picture, blood biochemical markers, and pathological examination of main organs were determined. Mutagenicity and teratogenicity were determined. Mutagenicity assay included Ames's test, chromosome aberration test in CHL cells and micronucleus test in mice. For the teratogenicity assay, pregnant Wistar rats weighing 200-250 g were treated with 0.2,1.0 g/kg bicyclol once daily from the 7th d of gestation for 10 d. RESULTS: The oral LD50 of bicyclol was over 5 g/kg in mice and rats. No noticeable alterations in subacute and chronic toxicity of rats and dogs were demonstrated. No mutagenicity and teratogenicity of bicyclol were found. CONCLUSION: Bicyclol has no detectable chronic toxicity as well as mutagenicity and teratogenicity in animals.

Predicting various outcomes of post-resuscitation comatose survivors： PRCSs Prognostication Score

Objective To develop a tool capable of early and exactly predicting various outcomes in comatose survivors who restore spontaneous circulation after cardiopulmonary resuscitation （CPR） and validate its performance. Methods Variables that were both readily available and predictive of outcomes were identified by systematically reviewing published literature on resuscitation. A value was assigned to these variables. We used these variables in combination with APACHE II score to devise a multifactorial prediction score system, which we called PRCSs Prognostication Score （PRCSs-PS）. Outcomes in 115 hospitalized comatose survivors after CPR were retrospectively reviewed using PRCSs-PS. Score of patients with different outcomes was compared. The area under the receiver- operating characteristic （ROC） curve was determined to evaluate performance of this tool to identify patients with a poor outcome （CPC4 and 5） and other outcomes （CPC1, 2, and 3）. Results There were differences of PRCSs-PS score among multiple groups with five different outcomes （CPC 1-5）（F=65.91, P=0.000）. Pairwise groups with different CPC were compared： no significant difference was noted between CPC1 and CPC2 （12.41±6.49 vs 17.38±6.91,P=0.092）, but difference between other pairwise CPC groups was statistically significant （CPC2 vs CPC3：17.38±6.91 vs 24.50±5.80, P=0.041, CPC3 vs CPC4：24.50±5.80 vs 32.29±5.24, P=0.006）. The performance of PRCSs-PS to discriminate patients with a poor outcome from patients with other outcomes went as follows： it had 100% sensitivity, 78.6% specificity, and 178.6 diagnostic index at the score cut-off22.5; it had 77.8% sensitivity, 100% specificity and 176.4 diagnostic index at the score cut-off32.5. Score 23 and 33 were two key cut-offpoints. The area under the ROC curve was 0.968, showing excellent discrimination. Conclusions The final outcomes in post-resuscitation comatose survivors can be accurately predicted using PRCSs-PS Score.

Serious response during tilt-table test in elderly and its prophylactic management

Objective: To evaluate the serious response during tilt-table test (TTT) and its prophylactic management. Method: Seventy-six elderly patients were tested at a tilt angle of 70 degrees for a maximum of 45 min and then subjected to isoprotere- nol-provocative tilt testing. ECG and blood pressure were monitored during the test and patients were kept at normal saline con- dition through a peripheral intravenous duct. Results: Fifty-one of 76 patients were defined as positive including 23 having serious response; 6 of the 23 patients had arteriosclerosis involving internal carotid arteries and 7 cases had bradycardia, two of which were associated with II°-I A-V block and the others with chronic atrial fibrillation. The serious response consisted of cardiac arrest for more than 5 s (6 cases), or serious bradycardia for more than 1 min (7 cases) or serious hypotension for more than 1 min (10 cases). Those with serious response were managed by returning to supine position, thus driving up legs and intravenous atropine, CPR (2 cases with cardiac arrest) and needing oxygen supplementation (11 cases). Only 2 hypotension patients recovered gradually by 10 min after emergency management, while others recovered rapidly with no complications. Conclusion: Although non-invasive, TTT may result in serious response, especially in elderly. Therefore proper patient selection, control of isoproterenol infusion and close observation of vital signs are decisive for a safe consequence.

Arousal effect and potential mechanism of dopamine-mediated acupuncture on traumatic brain injury

Traumatic brain injury(TBI)is a brain injury caused by direct external forces,and its prognosis depends on the extent of the damage and the changes in level of consciousness.Timely awakening from a coma is the first thorny problem to be solved in TBI treatment.Therefore,there is a need for the development of safe and effective methods for timely awakening after TBI coma.Dopamine(DA)and its receptors in the nervous system are involved in the regulation of wakefulness.The amount and activity of dopaminergic neurons can affect cellular function and neuroinflammatory response,and are also significant for the awakening process after TBI.The current common awakening therapy for TBI may also be related to the activation of dopaminergic neurons.Acupuncture plays a beneficial role in timely awakening,recovery of conscious level,and functional rehabilitation after TBI.The mechanism may be related to the targeted regulation of DA and its receptors via acupuncture.Among acupuncture first aid therapies,acupuncture at hand 12 Jing-Well points,with its advantages of simple operation and ultra-early intervention,has shown great promise in timely awakening following TBI and triggering a series of subsequent nerve repair effects in the treatment of TBI.We here present a review that provides a new perspective for the timely awakening from TBI-induced coma,with a focus on the role of DA in the regulation of wakefulness and the efficacy and potential mechanism of DA systems in the treatment of TBI by acupuncture.

ANTI-OXIDATIVE MECHANISMS OF PRAVASTATIN PREVENTING AORTIC ATHEROSCLEROSIS IN apoE KNOCKOUT MICE:ROLE OF p38 MAPK PATHWAY

Objective To determine whether pravastatin exerts anti-oxidative effects on preventing aortic＂ atherosclerosis via modulating p38 MAPK pathway. Methods Male 8-week-old apoE^-/- mice fed a diet containing 1.25% cholesterol （wt/wt） were divided into pravastatin group administered with pravastatin （80 mg. kg ^-1· d^-1 ） and atherosclerosis group administered with PBS; and male 8-week-old C57BL/6J mice fed a normal diet were as control group （ n = 12 ）. In thoracoabdominal aortas of mice, levels of Malondialdehyde （ MDA ） and activities of superoxide dismutase （ SOD ） were measured and expression of phosphorylated p38 MAPK （ p-p38 MAPK） and phosphorylated signal transducer and activator of transcr（ption 1 （pSTAT1） were examined by Western blotting. Results After eight weeks, atherosclerosis in aortic root was significantly prevented by pravastatin. In aortic atherosclerosis lesion, the level of MDA was significantly reduced; adversely the activity, of SOD was increased. Expressions of p-p38 MAPK and pSTAT1 were significantly decreased in aortic atherosclerosis lesion. Conclusion Our results suggests that anti-oxidative mechanisms of pravastatin preventing aortic atherosclerosis may partially depend on modulating p38 MAPK signal pathway.

Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury

Objective: To study the effect of hyperbaric oxygen (HBO) treatment of severe brain injury. Methods: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 receiving dehydrating, cortical steroid and antibiotic therapy) to observe the alteration of clinic GCS (Glasgow Coma Scale), brain electric activity mapping (BEAM), prognosis and GOS (Glasgow Outcome Scale) before and after hyperbaric oxygen treatment. Results: In the treatment group GCS,BEAM and GOS were improved obviously after 3 courses of treatment, GCS increased from 5.1 to 14.6 (P< 0.01- 0.001),the BEAM abnormal rate reduced from 94.3% to 38% (P< 0.01- 0.001),the GOS good-mild disability rate was 83.7%, and the middle-severe disability rate was 26.3% compared with the control group. There was a statistic significant difference between the two groups (P< 0.01- 0.001). Conclusions: Hyperbaric oxygen treatment could improve obviously GCS, BEAM and GOS of severe brain injury patients, and effectively reduce the mortality and morbidity. It is an effective method to treat severe brain injury.

Effect of arousal methods for 175 cases of prolonged coma after severe traumatic brain injury and its related factors

Objective: To determine the effect of arousal methods for prolonged coma of 175 patients with severe traumatic brain injury and related factors.Methods: There were 175 cases with persistent coma longer than 1 month after severe traumatic brain injury. Coma lasted 1-12 months. Arousal procedures included hyperbaric oxygen, physical therapy and arousal drugs. Results: In the 175 prolonged coma patients 110 got recovery of consciousness; in 118 cases with coma of 1-3 months, 86 cases recovered consciousness ((72.9)%); in 42 cases with coma of 4-6 months, 20 cases recovered consciousness ((47.6)); and in 15 cases with coma of longer than 6 months, only 4 cases recovered consciousness ((26.7)%). The recovery of consciousness depended on patient’s primary brain stem damage, cerebral hernia, GCS score, and age. Conclusions: Application of appropriate arousal procedures improves recovery of consciousness in patients with prolonged coma.

Evaluation of coma patients after cardiopulmonary resuscitation

Background Coma after cardiopulmonary resuscitation （CPR） is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR . Methods From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score （GCS） , brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography （EEG）, brainstem auditory evoked potential （BAEP）, short latency somatosensory evoked potential （SLSEP）, and transcranial Doppler （TCD） .Results Twenty-four of 35 patients（68.57% ）were in deep coma. The GCS was 3 except for 2 patients;EEG was evaluated not less than grade Ⅳ except for 4 patients, BAEP was evaluated as grade Ⅲ except for 3 patients, and SLSEP was evaluated as grade Ⅲ except for 1 patient. Twenty-four patients died within 1 month and 11 of them （ 45. 83% ） were determined as brain death. Glasgow outcome score （GOS） was evaluated as grade Ⅰ. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as grade Ⅰ in 5 patients, BAEP and SLSEP were evaluated as grade Ⅰ in 3 patients, and GOS was all evaluated as grade Ⅱ among the 11 patients. Two patients（ 18.18% ）regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade Ⅳ and Ⅲ, respectively. Conclusion objectively Combined or continuous evaluation of clinical examinations and laboratory tests can accurately determine brain function after CPR.

Analysis of incidence of traumatic brain injury in blunt trauma patients with Glasgow Coma Scale of 12 or less

Purpose： Early diagnosis of traumatic brain injury （TBI） is important for improving survival and neurologic outcome in trauma victims. The purpose of this study was to assess whether Glasgow Coma Scale （GCS） of 12 or less can predict the presence of TBl and the severity of associated injuries in blunt trauma patients. Methods： A retrospective cohort study including 303,435 blunt trauma patients who were transferred from the scene to hospital from 1998 to 2013. The data was obtained from the records of the National Trauma Registry maintained by Israel＇s National Center for Trauma and Emergency Medicine Research, in the Gertner Institute for Epidemiology and Health Policy Research. All blunt trauma patients with GCS 12 or less were included in this study. Data collected in the registry include age, gender, mechanism of injury, GCS, initial blood pressure, presence of TBI and incidence of associated injuries. Patients younger than 14 years old and trauma victims with GCS 13-15 were excluded from the study. Statistical analysis was performed by using Statistical Analysis Software Version 9.2. Statistical tests performed included Chi-square tests. A p-value less than 0.05 was considered statistically significant. Results： There were 303,435 blunt trauma patients, 8731 （2.9%） of them with GCS of 3-12 that including 6351 （72%） patients with GCS of 3-8 and 2380 （28%） patient with GCS of 9--12. In these 8731 patients with GCS of 3-12, 5372 （61.5%） patients had TBI. There were total 1404 unstable patients in all the blunt trauma patients with GCS of 3-12,1256 （89%） patients with GCS 3-8, 148 （11%） patients with GCS 9-12. In the 5095 stable blunt trauma patients with GCS 3-8, 32.4% of them had no TB1. The rate in the 2232 stable blunt trauma patients with GCS 9-12 was 50.1%. In the unstable patients with GCS 3-8, 60.5% of them had TBI, and in subgroup of patients with GCS 9-12, only 37.2% suffered from TBI. Conclusion： The utility of a GCS 12 and less is limited in prediction of brain injury in multiple trauma patients. Significant proportion of trauma victims with low GCS had no TBI and their impaired neurological status is related to severe extra-cranial injuries. The findings of this study showed that using of GCS in initial triage and decision making processes in blunt trauma patients needs to be re-evaluated.

Changes of evoked potentials and evaluation of mild hypothermia for treatment of severe brain injury

To observe the changes of evoked potentials after severe brain injury and the effect of mild hypothermia on acute severe brain injury. Methods: A total of 44 patients with severe closed head injury (GCS 3 8, admitted within 10 hours from injury) admitted from May 1998 to March 1999 were selected for this study. All patients were admitted into the intensive care unit and divided into 2 groups, Group A (GCS 3 5) and Group B (GCS 6 8). Patients were also randomly assigned to either normothermia or hypothermia subgroups. Patients in the hypothermia group were cooled to 32 34℃. Median nerve short latency somatosensory evoked potentials (SLSEP) and brain stem auditory evoked potentials (BAEP) were recorded before cooling and 4, 24, 48, 72, 96 and 120 hours, respectively after cooling and temperature resuming. SLSEP and BAEP were measured at the same time in the normothermia group (control group). The changes of evoked potentials (EP) were analyzed by statistical methods. Results: In the Group B, N 20 amplitudes in SLSEP and I/V amplitudes in BAEP after mild hypothermia treatment in the hypothermia group differed significantly from those in the control group (P< 0.05 ). However, in the Group A, no significant difference in all parameters was found. Conclusions: These results demonstrate that mild hypothermia treatment (32 34℃) in the Group B has a significant neuroelectrophysiological effect on severe brain injury. Nevertheless, the effect of mild hypothermia in the Group A is not apparent and needs further studying.

Acupuncture plus naloxone hydrochloride in the treatment of coma after surgery for cerebral hemorrhage: a randomized controlled trial

Objective To observe the efficacy of acupuncture combined with naloxone hydrochloride in the treatment of coma after surgery for cerebral hemorrhage and to explore its possible mechanism of action.Methods Seventy-two patients were divided into a control group and an observation group according to the random number table method,with 36 cases in each group.The control group was treated with intravenous naloxone hydrochloride,and the observation group received additional acupuncture treatment.After 1 month of treatment,the awakening rate,Glasgow coma scale(GCS)score,cerebral edema volume,mean velocity(Vm)of the middle cerebral artery,and cerebrospinal fluid Caspase-3,and macrophage migration inhibitory factor(MIF)levels were compared between the two groups.Results During the study,there were 2 cases of shedding in the control group and 34 remaining valid cases;1 case of shedding in the observation group and 35 remaining valid cases.After treatment,the awakening rate was higher in the observation group than in the control group(P<0.05);the GCS score increased in both groups compared with that before treatment(P<0.05),and was higher in the observation group than in the control group(P<0.05);the volume of cerebral edema decreased in both groups(P<0.05),and was smaller in the observation group than in the control group(P<0.05);the middle cerebral artery Vm increased in both groups(P<0.05),and was higher in the observation group than in the control group(P<0.05);the cerebrospinal fluid Caspase-3 and MIF levels decreased significantly in both groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).Conclusion Acupuncture combined with naloxone hydrochloride for the treatment of coma after surgery for cerebral hemorrhage can promote patients’awakening,improve the degree of coma,reduce the volume of cerebral edema,and enhance cerebral blood flow velocity,producing a better effect than naloxone hydrochloride used alone;it may be related to its reduction of cerebrospinal fluid Caspase-3 and MIF levels.

Analysis on care outcome of patients with polytrauma and coma

Objective ： To make further improvement of outcome of patients with polytrauma and coma. Methods： The data of 3 361 patients （2 378 males and 983 females, aged from 5-95 years, 38. 2 years on average） with severe polytrauma and coma admitted to Chongqing Emergency Medical Center （Level I Trauma Center ）, Chongqing, China, from November 1978 to December 2004 were analyzed retrospectively in this study. Results： The overall survival rate and mortality were 93.2%（3 133/3 361 ）and 6.8%（228/3 361 ）, respectively. The mortalities in patients with coma duration 〈 1 hour and combined with neural dysfunction and in patients with coma duration ≥ 1 hour and combined with or without neural dysfunction were signifieantly higher than that of those with coma duration 〈 1 hour but without neural dysfunction [39.5%（136/344）vs 3.0%（92/3 017）, P 〈0.01]. There existed significant differences in GCS, ISS, and revised trauma score （RTS） between the death group and the survival group （P 〈 0. 01 ）. RTS was in good correspondence with patient＇ s pathophysiological status and outcome in patients with multiple trauma and coma for different groups of systolic blood pressure （SBP）. The mortality in patients with SBP 〈90 nun Hg was significantiy higher than that of those with SBP ≥ 90 mm Hg [ 33. 3 % （68/204） vs5.1%（160/3 157）, P 〈0.01]. The mortality in polytranma patients combined with serious head injury （AIS≥3） was8.2%, among which, 76.5% died from lung complications. The morbidity rate of lung complications and mortality rate increased in patients with head injury complicated with chest or abdomen injury （23.9%, 61.1% vs 27.3 %, 50.0 % ）. The mortality reached up to 61.9 % in patients complicated with severe head, chest and abdomen injuries simultaneously. Conclusions： It plays a key role to establish a fast and effective trauma care system and prompt and definite surgical procedures and to strengthen the management of complications for improving the survival rate of patients with severe palytrauma and coma.

Cerebral state index versus Glasgow coma scale as a predictor for in-hospital mortality in brain-injured patients

Objective：To compare the value of Glasgow coma scale （GCS） and cerebral state index （CSI）on predicting hospital discharge status of acute braininjured patients.Methods：In 60 brain-injured patients who did not receive sedatives,GCS and CSI were measured daily during the first 10 days of hospitalization.The outcome of prognostic cut-off points was calculated by GCS and CSI using receiver operating characteristic （ROC） curve regarding the time of admission and third day of hospitalization.Sensitivity,specificity and other predictive values for both indices were calculated.Results：Of the 60 assessed patients,14 patients had mild,13 patients had moderate and 33 patients had severe injuries.During the course of the study,17 patients （28.3％） deteriorated in their situation and died.The mean GCS and CSI in patients who deceased during hospitalization was significantly lower than those who were discharged from the hospital.GCS＜4.5 and CSI＜64.5 at the time of admission was associated with higher mortality risk in traumatic brain injury patients and GCS was more sensitive than CSI to predict in-hospital death in these patients.For the first day of hospitalization,the area under ROC curve was 0.947 for GCS and 0.732 for CSI.Conclusion：GCS score at ICU admission is a good predictor of in-hospital mortality.GCS＜4.5 and CSI＜64.5 at the time of admission is associated with higher mortality risk in traumatic brain injury patients and GCS is more sensitive than CSI in predicting death in these patients.

Therapeutic Effect Observation on Treatment of Craniocerebral Trauma-Related Coma with Acupuncture plus Hyperbaric Oxygen:A Report of 45 Cases

Objective： To investigate the efficacy of treating craniocerebral trauma-related coma with acupuncture plus hyperbaric oxygen. Methods： Coma patients were randomly allocated into observation and control groups. Routine surgery or non-surgical treatment was given according to the condition of injury. The observation group received acupuncture plus hyperbaric oxygen as well as the treatment for the control group. The score was counted by the Glasgow coma scale before and after the treatment. A chi-square test was used. Results： There was a very significant difference in curative effect between the observation and control groups （P〈0.01）. Conclusion： Treatment with acupuncture plus hyperbaric oxygen can promote the patients＇ early revival.