Invasive techniques for the diagnosis of respiratory infectious diseases

Conclusion Reviewing the history of diagnostic procedures of causative organisms of respiratory infections, invasive techniques such as the protected specimen catheter (PSB) and bronchoalveolar lavage (BAL) have become the preferred choices because they have many advantages. These methods cause the patient relatively little discomfort, and permit an early diagnosis since they can easily be performed at the bedside and the causative organism from the disease site is obtained in cultures. These procedures can be used not only in patients with community-acquired lung infections, but also in immunocompromised hosts, including those with blood diseases or following renal transplantation, in patients in intensive care units and in mechanically-ventilated patients so that the cause can be accurately determined and chemotherapy started quickly, resulting in better therapeutic efficacy. Although these invasive procedures are advantageous for the diagnosis of respiratory infections, they also present various problems which remain to be addressed including minimizing contamination and setting diagnostic threshold values. However, the importance of accurately determining the causative organism in respiratory infections should be recognized as the most important factor, and these methods have shown to date to provide the most accurate information to aid in the timely treatment of respiratory infections in a wide variety of patients.     

肿胀局麻技术的临床应用

目的探讨肿胀技术在体表外科手术中的应用价值。方法随机选择体表肿物与先天性畸形、体表瘢痕、乳房整形、脂肪抽吸、腹壁整形、除皱、隆胸、褥疮、面瘫及颅骨电烧伤等２３０例体表外科手术应用肿胀技术，成人１６４例，完全采用肿胀法局麻技术，儿童６６例，在全麻下应用肿胀技术。并与相应手术非肿胀法下施行进行了比较。结果脂肪抽吸术中利多卡因用量可达３０～６０ｍｇ／ｋｇ体重。肿胀技术具有易于进行解剖间隙的分离、减少术中失血、增强麻醉效果、增加手术安全性和术后恢复快等优点。结论肿胀技术可推广到体表外科手术中广泛应用，对儿童更为适宜，对减少输血造成的疾病具有重要意义。     

改良哈氏棒治疗胸腰段脊柱不稳定骨折

本文报告了作者研制的改良哈氏棒治疗胸腰段脊柱不稳定骨折的临床效果。１９９１年１月～１９９４年１０月，治疗２６例，伤椎椎体前缘高度从４１．９１％，恢复至９５．５７％，椎体后缘高度从８１．０３％恢复至１００％，后凸畸形（Ｃｏｂｂ氏法）从２６°恢复至５°，有５例恢复前凸８°～１０°，神经功能恢复１．８级（Ｆｒａｎｋｅｌ分级）。作者认为回复生理前凸的纵轴上纵向撑开力，更有助于胸腰段脊柱骨折的解剖复位。     

足组织缺损的显微修复

１９８４年～１９９４年共收治各种足部组织创伤缺损２３６例，均采用显微外科技术进行组织移植修复，其中单纯皮瓣移植修复１８７例，复合皮瓣移植修复４９例。吻合血管游离移植修复９７例，带血管蒂移位修复１３９例。４例前足缺损者用带肩胛骨的复合皮瓣移植修复，６例足跟严重缺损者用带血管的腓骨复合皮瓣移植修复。经１～１０年随访，皮瓣、复合皮瓣、移植或再植的骨骨各全部成活，愈合良好，足功能基本得到恢复，可行走、负重，１８６例恢复了原工作。认为，恢复足部结构完整与重建足跟、足底的感觉是获得良好功能的关键     

Study of nerve regeneration in centrocentral anastomosis

Summary Nerve regeneration was studied in a model of centrocentral anastomosis (CCA) performed on the sciatic nerve of the rat. Experimental CCA was made by suturing the proximal end of the peroneal branch on the proximal end of the sural branch, placing between them a peroneal nerve graft (Group I, 20 rats) or a silicone chamber (Group II, 12 rats). Nerve grafts had a length of 5mm and silicone chambers 7 mm. In six silicone chambers an 1 mm nerve graft was placed in the centre of the tube. In group I animals anterograde degeneration was studied by cutting the graft 60 days after surgery. In group II, nerve regeneration was studied 2, 4 and 8 weeks after surgery. Results indicate that in CCA: 1) regenerated axons coming from one nerve end grow into the graft but do not cross the contralateral suture line; 2) regeneration is poorer in silicone chambers than in nerve grafts; and, 3) in silicone chambers regeneration is related to time. The reduction in the regenerative capability in CCA seems to be related to the alteration of nerve sprouts aiming for the peripheral targets.     

A novel technique of ab interno glaucoma surgery: follow-up results after 24 months

Purpose It was the aim of this study to investigate the efficacy, longevity, and safety of a new ab interno intervention for the treatment of primary open-angle glaucoma (POAG). Methods The previously described method of radiofrequency-mediated “sclerothalamotomy ab interno” was applied in 53 eyes of consecutive patients with POAG between April 2002 and July 2002. Average preoperative intraocular pressure (IOP) was 25.6±2.3 mmHg (range 18–48 mmHg). Sclerothalamotomies were carried out with a custom-made high-frequency dissection 19 G probe (tip 0.3×1 mm) applying bipolar current with a frequency of 500 kHz (tip temperature 130°C). Results After a follow-up period of 24 months, the average IOP was 15.0±1.6 mmHg (range 11–20 mmHg) (p<0.005). The average number of topical agents was 2.6±1.0 (range 1–5) preoperatively. Twenty-four months after surgery such agents were used in only five (9.6%) eyes and the average was 0.21±0.53 (range 0–2). Transient IOP elevation was observed in 12 of 53 eyes (22.6%) postoperatively. In all cases elevated IOP could efficiently be controlled with topical medication. In general, IOP dropped continuously over the course of the 6 months following surgery and then remained constant. Conclusions This study indicates that sclerothalamotomy ab interno is a safe and efficient surgical method for the treatment of POAG. Long-term results clearly demonstrate the longevity of IOP reduction.     

Rapid effect of stress concentration corticosterone on glutamate receptor and its subtype NMDA receptor activity in cultured hippocampal neurons

Objective: To study the rapid effect of glucocorticoids (GCs) on NMDA receptor activity in hippocampal neurons in stress and to elucidate its underlying probable membrane mechanisms. Methods: Whole-cell patch-clamp recording was used to assess the effect of stress concentration corticosterone (B) on the responses of cultured hippocampal neurons to glutamate and NMDA (N-methy-D-asparatic acid). To make clear the target of B, intracellular dialysis of B(10μmol/L)through patch pipette and extracellular application of bovine serum albumin-conjugated corticosterone (B-BSA, 10μmol/L)were carried out to observe their influence on peak amplitude of NMDA-evoked current. Results: B had a rapid, reversible and inhibitory effect on peak amplitude of GLU-or NMDA-evoked current in cultured hippoeampal neurons. Furthermore, B-BSA had the inhibitory effect on INMDA as that of B, but intraeeUularly dialyzed B had no significant effect on INMDA. Conclusion: These results suggest that under the condition of stress, GCs may rapidly, negatively regulate excitatory synaptic receptors-glutamate receptors (GluRs), especially NMDA receptor (NMDAR) in central nervous system, which is mediated by rapid membrane mechanisms, but not by classical, genomic mechanisms.     

论现代医院技术创新

创新是医院发展主题,本文采用综合分析、收集资料、对比方法,对技术创新内容、技术创新原则、技术创新趋势进行了较详细的分析研究.     

Optimized and combined T1 and B1 mapping technique for fast and accurate T1 quantification in contrast-enhanced abdominal MRI.

Fast T(1) mapping techniques are a valuable means of quantitatively assessing the distribution and dynamics of intravenously or orally applied paramagnetic contrast agents (CAs) by noninvasive imaging. In this study a fast T(1) mapping technique based on the variable flip angle (VFA) approach was optimized for accurate T(1) quantification in abdominal contrast-enhanced (CE) MRI. Optimization methods were developed to maximize the signal-to-noise ratio (SNR) and ensure effective RF and gradient spoiling, as well as a steady state, for a defined T(1) range of 100-800 ms and a limited acquisition time. We corrected B(1) field inhomogeneities by performing an additional measurement using an optimized fast B(1) mapping technique. High-precision in vitro and abdominal in vivo T(1) maps were successfully generated at a voxel size of 2.8 x 2.8 x 15 mm(3) and a temporal resolution of 2.3 s per T(1) map on 1.5T and 3T MRI systems. The application of the proposed fast T(1) mapping technique in abdominal CE-MRI enables noninvasive quantification of abdominal tissue perfusion and vascular permeability, and offers the possibility of quantitatively assessing dilution, distribution, and mixing processes of labeled solutions or drugs in the gastrointestinal tract.     

介入法制作犬颅内动脉瘤模型

目的运用介入方法建立犬颅内动脉分叉部囊状动脉瘤模型。方法6条犬全麻后，采用血管内介入方法，用冠状动脉球囊导管扩张右颈总动脉近段，再用可脱球囊于扩张段远端将其栓塞，制作成6个分叉部动脉瘤。分别于术后1、2、3d行DSA检查并切除动脉瘤做病理组织学检查。结果6条犬成功获得6个动脉瘤模型。动脉瘤的平均宽度和平均长度在3d内逐渐减少。结论犬动脉瘤模型较好地模拟了人颅内动脉瘤大小、形态及DSA表现，可用于介入治疗新材料、新技术的实验研究。本动脉瘤模型的建立快速、可靠、可重复性强。