喉罩通气技术在急诊院前急救心肺复苏中的应用

目的 探讨喉罩通气技术在急诊科院前急救心肺复苏中的应用效果。方法 选取中铁二局集团中心医院2015年1月~2017年6月院前急救的呼吸心跳骤停患者90例为研究对象,按照所接受的不同呼吸支持方式将其分为观察组和对照组,每组45例,观察组给予喉罩人工呼吸支持,对照组采取气管插管呼吸支持,比较两组心腹复苏效果及患者抢救情况。结果 观察组气道建立时间、自主循环恢复时间明显短于对照组,心肺复苏2 min、5 min时,观察组的PetCO2水平高于对照组 ,差异有统计学意义(P<0.05);观察组一次插管成功率100.0%,心肺复苏成功率73.30%,对照组分别为68.90%和48.90%,组间差异有统计学意义（P<0.05）;观察组并发症发生率、复苏后综合征发生率及死亡率分别为8.90%、8.90%和4.40%,均低于对照组的28.90%、33.30%和28.90%,差异有统计学意义（P<0.05）。结论 喉罩通气应用于院前急救心肺复苏中,可快速建立人工气道、促进患者恢复自主循环,心肺复苏成功率高、并发症少,可显著降低患者的死亡率,有较高的应用价值。     

复苏早期应用氨茶碱对腺苷及血管活性因子的影响

目的： 观察心搏骤停大鼠复苏早期应用氨茶碱对复苏成功率、血浆去甲肾上腺素(NE)、腺苷、一氧化氮(NO)水平及心肌组织内皮素-1(ET-1)、腺苷水平的影响。方法: 选60只SD大鼠，随机分为3组：手术对照组、肾上腺素治疗组和肾上腺素+氨茶碱治疗组各20只。分别测定治疗组自主循环恢复30 min后及手术对照组的血浆NE、腺苷、NO及心肌组织ET-1、腺苷的水平。结果: 肾上腺素+氨茶碱治疗组自主循环恢复时间明显少于肾上腺素治疗组(P＜0.05)。肾上腺素+氨茶碱治疗组自主循环恢复率为75%，30 min存活率为70%，肾上腺素治疗组分别为60%和55% (P>0.05)。2个治疗组自主循环恢复大鼠的血浆腺苷、NE水平及心肌组织ET-1、腺苷水平均明显高于手术对照组(P<0.05)，肾上腺素治疗组血浆NO水平也显著高于手术对照组(P＜0.01)，肾上腺素+氨茶碱治疗组血浆NO及心肌组织ET-1水平低于肾上腺素治疗组(P＜0.05)。结论: 在复苏早期应用腺苷受体拮抗剂氨茶碱不仅可提高复苏成功率，并且降低血浆NO和心肌组织ET-1水平，有利于减轻复苏后综合征。     

心肺复苏90例肾上腺素用量研究

肾上腺素是心肺复苏(CPR)首选药物,但在用量上仍有分歧.本文总结90例CPR中肾上腺素用量对存活率的影响及其相关因素进行分析研究.1 临床资料90例中男50例,女40例,年龄19～92岁,平均68±17.31岁,院外心跳停止者10例,院内心跳停止者80例,开始复苏时的心电类型有:停搏14例,电机械分离25例,室颤51例.全部病例行标准CPR,2分钟内使用肾上腺素或电击除颤,肾上腺素上肢静脉给药88例,气管内给药2例,全部首剂1mg,无效3～5分钟重复,最大剂量至5mg,用药至恢复自主循环或持续复苏时间达60分钟,或家属要求放弃.病因包括:心血管疾病45例,脑血管意外22例,肺疾患13例,窒息8例,中毒2例2 结果     

心肺复苏后的动态脑电图观察分析

心跳呼吸骤停时，人体各脏器组织对缺氧耐受最差的是大脑。因此，脑复苏就成了心肺复苏抢救成功的关键。脑电图在当前仍是检测脑功能的重要手段。对脑复苏病人脑功能的恢复的预后脑电图可以作出一定的评估。现将我院3例因心脏疾患导致心跳呼吸骤停复苏后的动态脑电图(AEEG)检查结果报道分析如下：     

萨勃机在心肺复苏抢救过程中的应用

目的探讨改进的心肺复苏术（CPR）对猝死患者初期复苏的作用。方法本组共189例呼吸、心跳骤停猝死患者，90例作为对照组，使用传统CPR；99例作为试验组，使用“一医三护配合法”和“萨勃机”的改进CPR进行急诊复苏。记录血压、自主呼吸、自主心律的恢复情况作为评估指标。结果试验组中的血压、自主呼吸、自主心律的恢复率情况分别为32．3％、19．2％、54．5％，均高于对照组的18．9％、8．9％、38．9％，两组比较差异具有统计学意义，P〈0．05。结论改进的CPR较传统CPR更具有分工明确、配合默契、科学合理等优点，为CPR抢救赢得了宝贵时间，提高了复苏的成功率。     

复苏后心功能不全犬模型心肌凋亡的变化

目的观察犬心跳骤停复苏后心肌细胞凋亡的变化.方法体外电击诱发犬室颤,3min后复苏,12只犬随机分为2组,CPR组,空白对照组,每组6只,采用Swan-Ganz漂浮导管监测复苏前和后6h的CO和PAWP, 6h后取心肌组织,TUNEL法检测心肌组织凋亡的形态学改变.结果两组各血流动力学指标在心跳骤停前无统计学差异,CPR组的MAP在复苏成功即时高于空白对照组,随后开始下降,在复苏后4、6h低于空白对照组.CPR组的PAWP从心跳骤停前的(5.00±1.26)mmHg一直上升,到复苏后达高峰(28.83±4.79)mmHg,各观察点均高于空白对照组,CO在复苏成功后随时间延长而下降,6h降至最低,复苏后各观察点均低于空白对照组.CPR组心肌细胞凋亡指数高于空白对照组.结论电击诱发室颤犬复苏成功后存在着心功能不全和心肌细胞凋亡增加.     

复苏后心功能不全犬模型心肌凋亡的变化

目的观察犬心跳骤停复苏后心肌细胞凋亡的变化.方法体外电击诱发犬室颤,3min后复苏,12只犬随机分为2组,CPR组,空白对照组,每组6只,采用Swan-Ganz漂浮导管监测复苏前和后6h的CO和PAWP,6h后取心肌组织,TUNEL法检测心肌组织凋亡的形态学改变.结果两组各血流动力学指标在心跳骤停前无统计学差异,CPR组的MAP在复苏成功即时高于空白对照组,随后开始下降,在复苏后4、6h低于空白对照组.CPR组的PAWP从心跳骤停前的(5.00±1.26)mmHg一直上升,到复苏后达高峰(28.83±4.79)mmHg,各观察点均高于空白对照组,CO在复苏成功后随时间延长而下降,6h降至最低,复苏后各观察点均低于空白对照组.CPR组心肌细胞凋亡指数高于空白对照组.结论电击诱发室颤犬复苏成功后存在着心功能不全和心肌细胞凋亡增加.     

心肺复苏术后患者的脑电图分析

目前,心肺复苏技术不断完善,及时准确的心肺复苏能成功挽救病人的生命,但有效的脑复苏仍是当前比较棘手的问题,尤其是心跳呼吸停止时间较长的患者。本文报告我院10例心肺复苏术后患者脑电图结果,探讨脑电图(EEG)对脑复苏患者的预后判断价值。     

心肺复苏128例患者的急救分析

目的探究心肺复苏（CpR）成功救治的关键因素。方法回顾分析本院128例呼吸心跳骤停患者实行心肺复苏救治的过程和结果。结果统计数据显示cPR开始时间、基本生命支持、强化生命支持和一定范围内肾上腺素荆量的大小与心肺复苏成功率相关（P〈0．01）。结论影响心肺复苏成功救治的因素主要为CPK开始时间、基本生命支持和强化生命支持的措施及运用肾上腺素的剂量。加强院前急救生命支持的措施和能力,及适时恰当的加大肾上腺激素运用的剂量可在一定程度上提高心肺复苏救治的成功率。     

在心肺脑复苏抢救中应用盐酸纳洛酮20例分析

目的:探讨心跳呼吸骤停患者在心肺脑复苏抢救过程中应用纳洛酮治疗的体会,以提高复苏成功率。方法:将各种心跳呼吸骤停患者随机分为纳洛酮组及常规组各20例。常规组给予胸外心脏按压、气管插管、机械通气、电击除颤、静脉用药(肾上腺素、阿托品、利多卡因等)及支持对症治疗。纳洛酮组除上述治疗措施外,同时给予盐酸纳洛酮2.0mg加入5%葡萄糖或0.9%氯化钠液250ml中静脉滴注,观察2组心肺脑复苏情况。结果:纳洛酮组20例复苏成功11例,成功率55.0%;常规组20例,复苏4例,成功率20%。纳洛酮组复苏成功率明显高于常规组(P<0.05)。结论:在常规复苏基础上加纳洛酮能显著提高心肺脑复苏的抢救成功率。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The case for allele‐specific recognition by the TCR

There is a sharp difference in how one views TCR structure–function–behaviour dependent on whether its recognition of major histocompatibility complex‐encoded restriction elements (R) is germline selected or somatically generated. The generally accepted or Standard model is built on the assumption that recognition of R is by the V regions of the αβ TCR, which is not driven by allele specificity, whereas the competing model posits that recognition of R is allele‐specific. The establishing of allele‐specific recognition of R by the TCR would rule out the Standard model and clear the road to a consideration of a competing construct, the Tritope model. Here, the case for allele‐specific recognition (germline selected) is detailed making it obvious that the Standard model is untenable.