机体不同状态下高压氧暴露后对脑微血流动力作用的差异性

目的 :探讨正常及急性脑缺血损伤动物高压氧暴露后大脑微循环血流动力作用的变化。方法 :成年沙土鼠 61只 ,随机分为 0 .1MPa、0 .2MPa、0 .2 5MPa高压氧暴露组 ,脑缺血损伤组和对照组。实验时动物用urethane麻醉 ,在颅骨顶开窗 ,暴露软脑膜。用阻断双侧颈总动脉造成脑缺血损伤。用LMB 1检测软脑膜细动静脉管径和流速 ,用LDF 3检测脑皮质局部血流量。动物在小型氧舱进行了实验暴露。结果 :动物在 0 .2MPa氧暴露后软脑膜细动脉比暴露前收缩 10 .1% ,细动脉血流速度比高压氧暴露前减慢 0 .58mm/s ,细静脉流速比高压氧暴露前减慢 0 .2 9mm/s ,大脑皮质血流量减少 3 4 % ,有非常显著差异 (P <0 .0 1)。而脑缺血损伤动物暴露于 0 .2 5MPa高压氧 60min ,细动脉可在颈动脉再灌流后血流速度得到一定改善的基础上净增 0 .85mm/s ,细静脉血流速度增加 0 .3 1mm /s ,脑皮质血流量在高压氧暴露后可恢复到或接近脑损伤前水平。单纯脑缺血组在实验观测期间软脑膜细动静脉血液速度和脑皮质血流量均明显减少 (P <0 .0 1)。结论 :机体不同状态 (脑缺血性损伤与正常机体 )高压氧暴露后脑血流动力作用出现的差异 ,可能与机体在不同状态下对氧的反应与需求有关。     

Robot-assisted neurosurgery versus conventional treatment for intracerebral hemorrhage: A systematic review and meta-analysis

The aim of this review is to determine the efficacy and safety of robotic surgery for intracranial hemorrhage (ICH). PICO question was formulated as: whether robot-assisted neurosurgery is more effective and safer than conventional treatment for ICH with respect to drainage time, complications, operation time, extent of evacuation and neurological function improvement. We searched PubMed, Web of Science, Wiley Online, OVID, Embase, Cochrane Library, Clinical Trails, Current Controlled Trials, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), OpenGrey and references of related papers. Key words included robot, robotic, hematoma, hemorrhage and neurosurgery. Then we used Microsoft Excel to collect data. Except from qualitative analysis, we did meta-analysis using Review Manager 5.3. 9 papers were included in qualitative synthesis, 6 in meta-analysis for rebleeding rate and 4 in analysis for operative and drainage time. Qualitative synthesis showed shorter operative time and drainage time, a larger extent of evacuation, better neurological function improvement and less complications in robotic group, while meta-analysis suggested that robot-assisted surgery reduced rebleeding rate compared to other surgical procedures, but whether it is superior to conservative treatment in preventing rebleeding still needs more proof. Meta-analysis for operative and drainage time should be explained cautiously because a significant heterogeneity existed and we supposed that differences in baseline characteristics might influence the results. Finally, we drew a conclusion that robotic neurosurgery is a safe and effective approach which is better than conventional surgery or conservative treatment with respect to rebleeding rate, intracranial infection rate and neurological function improvement.     

Endovascular treatment of symptomatic intracranial atherosclerotic stenosis with low profile visualized intraluminal support stent

ObjectiveSevere intracranial atherosclerotic stenosis has become one of the main causes resulting transient ischemic attack and stroke. This study aimed to evaluate the efficacy and safety of low profile visualized intraluminal support (LVIS) stent in treating symptomatic intracranial atherosclerotic stenosis.MethodsData of 31 patients with at least 70% stenosis treated with LVIS stent in our center were retrospectively collected between July 2017 and November 2020. Further evaluation of lesion characteristics, technical success rate, preoperative complication, clinical and angiographic follow-up outcome, delayed in-stent stenosis were conducted.ResultsStent delivery and deployment were successfully achieved in all 31 patients (100%). 22 cases (71%) were located in anterior circulation and 9 cases (29%) were located in posterior circulation. The mean degree of stenosis lesion before stent deployment was 85.6 ± 9.4%, while after stenting was 11.2 ± 11.8%. One patient suffered from ischemic complication in stenting procedure, and timely delivery of rt-PA successfully recanalized the artery. Clinical follow-up was available in all 31patients (100%) with mean follow-up time 15.0 ± 12.1(3–45) months. No patients experienced the recurrence of stroke or TIA or death after discharge. Angiographic follow-up was available in 21patients (67.7%) with mean follow-up time 11.43 ± 6.8 (6–36) months. 19 patients (90.5%) were stable while 2 patients (9.5%) developed ISR in their last angiographic follow-up. The 2 patients received balloon angioplasty and reached satisfactory results after retreatment.ConclusionThis preliminary study suggests that LVIS stent deployment was a feasible approach in treating intracranial atherosclerotic stenosis with satisfactory procedure success rate, low complication rate and favorable long-term outcome.     

Retrospective analysis of a TMJ ankylosis protocol with a 9 year follow up

ObjectiveTemporomandibular joint ankylosis (TMJa) is a debilitating condition that causes difficulty in mastication, speech and mouth opening. Its treatment poses surgical and rehabilitative challenges along with a high incidence of reankylosis. This study was designed to assess the long-term outcomes with a new two phase physiotherapy protocol following conservative resection of the ankylotic mass.Materials and methods143 patients who were treated for TMJa were initially recruited, among whom 98 were inducted into the study and retrospectively evaluated using clinical records and 3-dimensional computed tomography. All the patients underwent a minimal pre auricular incision and conservative interpositional gap arthroplasty with collagen membrane. This was followed by the new two phase physiotherapy protocol with the use of a bite block. The primary outcome measures were the maximum interincisal distance, vertical ramus height and complications. The patients were followed up at monthly intervals during the first year, quarterly intervals during the second year, and at intervals of 6 months during subsequent follow-up years. The mean follow up period was 6.38 ± 2.36 years after ankylotic release. Paired student t test was used for statistical analysis.ResultsThe mean scores for mouth opening at T1, T2 and T3 were statistically significantly different at all intervals (p < 0.0005). The mean scores for ramal length were statistically significantly different at T1 and T2 interval (p < 0.0005) and insignificant at T2 and T3 interval. No reankylosis was observed in patients who followed the physiotherapy protocol.ConclusionsIn the management of TMJa, the success of the conservative surgical technique with interpositional arthroplasty is less dependent on the longevity and rigidity of the interpositional material but more indebted to the patient compliance in following the proposed physiotherapy protocol.     

Fire/flames mortality in Australian children 1968–2016, trends and prevention

IntroductionMortality attributed to fire and flame for children (0?14 years) over a fifty-year period has not been previously analyzed in Australia. The literature has focused on these deaths over a shorter time period or disaggregated with other causes of burns or deaths in one burns center. However, mortality associated with fire/flames affects this age group the greatest. The aims of this study are to: (1) develop a trends analysis of fire and flames mortality between1968 to 2016, using the Australian Bureau of Statistics (ABS) mortality database and, (2) determine the association of interventions with fire and flames mortality using the Haddon's categorical intervention framework.MethodsInternational Classification of Disease (ICD) codes were extracted and code equivalencies between ICD 8, 9, 10 and the Australian Bureau of Statistics for fire/flames data between 1968-–2016 were assessed. To determine whether population changes affected the risks of mortality, the frequency and, rates per 100,000 were used. A literature review was conducted that summarized the current knowledge of interventions associated with the major decreases in the fire and flames mortality rate.ResultsIn Australia, we found was a downward trend for the period although with significant variation from year to year when compared to external cause mortality. Additionally, there were multiple successful interventions associated with a sustained decrease in mortality. After 2016, child fire-related mortality remains a problem particularly in low socioeconomic groups and indigenous peoples. A combination of research, public awareness, engineering, legal enforcement, advancements in burns care and, evidence-based policy development all have a role to play in future injury prevention initiatives. Although direct causation to an individual is not possible, associations can be drawn from interventions on a population level to decreases in mortality.ConclusionWe found was a steady decline in both rates and frequency of childhood fire and flames mortality from 1968 to 2016 associated with multiple interventions.     

Protein intake and physical function in older adults: A systematic review and meta-analysis

BackgroundThe present study explored cross-sectional and longitudinal associations between protein intake and physical function in older adults.MethodsWe conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated the association between protein intake and measures of physical function in older adults. Cross-sectional, case-control, and longitudinal cohort studies that investigated the association between protein intake and physical function as a primary or secondary outcome in people aged 60 + years were included. Studies published in languages other than English, Italian, Portuguese, or Spanish were excluded. Studies were retrieved from MEDLINE, SCOPUS, EMBASE, CINAHL, AgeLine, and Food Science Source databases through January 31, 2022. A pooled effect size was calculated based on standard mean differences (SMD), MD, log odds ratio (OR) and Z-score..ResultsTwenty-two cross-sectional studies examined a total of 11,332 community-dwellers, hospitalized older adults, and elite senior athletes with a mean age of approximately 75 years. The pooled analysis indicated that a protein intake higher than the recommended dietary allowance (RDA) was significantly associated with higher Short Physical Performance Battery (SPPB) scores (SMD: 0.63, 95% CI: 0.27, 0.99, P-value: 0.0006), faster walking speed, greater lower-limb (SMD: 0.22, 95% CI: 0.04, 0.40, P-value: 0.02) and isometric handgrip strength (Z-score: 0.087, 95% CI: 0.046–0.128, P-value: 0.0001), and better balance (SMD: 0.33, 95% CI: 0.05, 0.62, P-value: 0.02). Nine longitudinal studies investigated 12,424 community-dwelling and native older adults with a mean age of approximately 85 years. A protein intake higher than the current RDA was not associated with lower decline in either isometric handgrip strength (logOR: 0.99, 95% CI: 0.97–1.02, P-value= 0.67) or walking speed (logOR: 0.92, 95% CI: 0.77–1.10, P-value= 0.35).ConclusionsA protein intake higher than the RDA is cross-sectionally associated with better physical performance and greater muscle strength in older adults. However, a high consumption of proteins does not seem to prevent physical function decline over time.     

氯仿、氯苯和多氯联苯对染毒家兔红细胞脂质过氧化和膜流动性的影响

比较了氯仿、氯苯和多氯联苯三种氯代化合物对染毒家兔红细胞脂质过氧化和膜流动性的影响。结果发现，每天给家兔腹腔注射含有上述毒物的花生油溶液，对红细胞脂质过氧化具有程度不等的４酶促进作用，但对膜脂流动性的影响并不一致，氯仿有促流效应，多氯联苯的作用相反，说明毒物分子的结构特性也对膜流动性具有影响。此外发现，膜流动性可能与细胞形态的维持有关。     

长航对舰员心理健康状况的影响分析

目的 探讨长航对舰员心理健康状况的影响,为制定相应应对措施提供依据.方法 以整群抽样的方法选取某批次护航编队的全体舰员为测试对象,采用症状自评量表、应对方式问卷等调查表对参加长航的舰员进行集体测试,并分析心理健康与应对方式及个人因素的关系.结果 长航初期(航行15d)躯体化、强迫、焦虑、症状总分等指标与后面3个阶段(航行50、90、140d)存在显著差异(P＜0.05),而后3个阶段之间差异不明显.长航初期抑郁、敌对指标与长航后期及返航期存在显著差异(P＜0.05).舰员心理健康状况随着长航时间的推移有变差的趋势,心理健康状况与消极应对方式密切相关,长航后期的心理健康状况未恢复至正常水平.不同学历、婚姻状况、职务人员的心理健康因子无显著差异(F=2.241,p=0.123; F=1.152,P=0.284:F=1.172.P=0.311).自我效能感等指标是心理健康水平的重要预测指标.结论 长航对舰员心理健康状况有影响.长航时须关注消极应对方式多、自我效能感弱的人员.长航结束后须对长航人员进行必要的心理干预以帮助解决其心理健康问题.