预防冠状动脉支架术后低血压的护理

目的探讨冠状动脉支架术后患者出现低血压的原因及护理措施。方法对心血管内科2011年2月至2012年7月行冠状动脉支架术后发生低血压患者16例进行原因分析，并采取相应的预防和护理措施。结果16例术后低血压患者经采取积极的抢救护理措施，症状均于0．5～1．5小时内缓解。结论护士加强对术后患者的巡视观察，能及时发现和处理术后低血压的发生，对提高护理质量及提高患者生存质量具有重要意义。     

新昌地区0～5岁儿童急性下呼吸道感染的病原菌及耐药性分析

目的 调查分析新昌地区0～5岁儿童急性下呼吸道感染的病原菌分布及耐药性,为临床抗菌药物使用提供依据.方法 对新昌地区2009年1月-2010年12月0～5岁住院儿童符合急性下呼吸道感染876例患儿进行痰液分离培养,做菌株鉴定和药敏试验.结果 共分离出病原菌303株,其中革兰阳性菌占49.2％,革兰阴性菌占40.2％,真菌占10.6％；革兰阳性菌中以肺炎链球菌和金黄色葡萄球菌为主,对青霉素耐药率均＞75.7％,肺炎链球菌对红霉素耐药率为90.5％；革兰阴性菌以大肠埃希菌、肺炎克雷伯菌及阴沟肠杆菌为主,对氨苄西林、哌拉西林耐药率＞80.0％,而β-内酰胺酶抑制剂复合剂则抗菌活性较好,敏感的抗菌药物为亚胺培南、氟喹诺酮类、氨基糖苷类.结论 由于儿科抗菌药物的广泛使用,使常见病原菌对抗菌药物的耐药性日趋严重,应加强对病原菌及耐药性的监测,促进抗菌药物的合理使用.     

急性胰腺炎早期肠内营养研究进展

急性胰腺炎是临床常见的急危重症,病死率高,恰当的营养支持在机体高代谢及负氮平衡状态下可降低感染率及病死率,是我们一直关注的热点。过去,我们主张通过禁食让胰腺获得休息,从而改善疾病预后。但是,目前越来越多的试验研究表明,相比禁食早期肠内营养让胰腺炎病人获益显著。接下来我将从肠道屏障功能障碍、肠内营养途径、启动时间、营养制剂及营养量的选择等方面就急性胰腺炎早期肠内营养的最新进展作一综述。     

血清可溶性CD44检测对急性髓系白血病的诊断分型价值研究

目的探讨血清可溶性CD44(solCD44)检测对于急性髓系白血病(AML)的临床诊断分型价值。方法选取2014年1月至2016年1月该院血液科收治的AML患者80例,包括初诊31例、复发24例、缓解25例。同期健康体检者40例为对照组。检测比较各组患者的血清solCD44std、solCD44v5、solCD44v6水平变化。结果 AML患者的血清solCD44s、solCD44v5、solCD44v6水平在初诊、复发组中显著高于缓解组及对照组(P0.05),而缓解组与对照组比较差异无统计学意义(P0.05);不同FAB分型(M1+M2)、M3、M4、M5的血清solCD44std、solCD44v5、solCD44v6水平比较差异有统计学意义,且M3型显著高于非M3型(P0.05)。结论血清solCD44尤其是solCD44std水平与AML患者病情活动变化密切相关,可作为AML的诊断分型、预后判断及复发预测的血清学参考指标。     

我国主要少数民族医药防治缺血性心脏病研究概述

我国缺血性心脏病发病率逐年增加，给家庭和社会造成了严重的负担，亟待寻找更好的治疗手段和医疗方案。基于象数思维、整体观等思维方式和临床经验，我国主要少数民族医药逐渐发展出独特的理论体系与治疗特色，在防治缺血性心脏病方面具有极大的应用潜力及研究价值。其中藏族医药（以下简称“藏医药”）、蒙古族医药（以下简称“蒙医药”）、傣族医药（以下简称“傣医药”）均可归属于以自然观与生命观为哲学基础的医学系统，各自发展出“三因”“三根”“四塔五蕴”理论，形成了对缺血性心脏病的独特认识并提出了相应的治法治则，产生了以三味檀香散、八味沉香散、肉蔻五味丸、雅叫哈顿散为代表的经典方剂，并具有以广枣、红景天、血竭为代表的特色民族药资源。笔者拟以藏医药、蒙医药为主，归纳民族医药防治缺血性心脏病的相关研究，并探讨开展该类研究所面临的机遇和挑战，以期为民族药防治缺血性心脏病的临床应用及新药开发研究提供参考。     

The acute effects of waterpipe smoking on lung function and exercise capacity in a pilot study of healthy participants

Abstract

Context: Waterpipe tobacco smoking (WTS) has gained popularity, but its physiologic effects have not been extensively studied: rather, studies have focused on WTS’s chronic effects or have evaluated limited respiratory/cardiac parameters.

Objective: We sought to characterize in a more detailed manner the acute effects of WTS on lung function and exercise capacity.

Method: We recruited 24 healthy WTS males. We used a pilot single-group pre-test (abstained from WTS for ≥48?h) post-test (within 0.5?h of a 45-min WTS session) design. We performed spirometry, diffusing lung capacity and time-limited CPE testing (CPET; cycloergometer; 2-min 20-Watt warm-up and 25-Watt increase every 2-min for 10?min).

Results: Mean age was 20.4 years; Post-WTS, the following significant changes were observed: CO level increased from 3.7?ppm to 24.4; oxygen consumption decreased (from 1.86?L/min to 1.7); baseline respiratory rate increased (from 17.7 breath/min to 19.7); forced expiratory flow over the middle half of the forced vital capacity decreased (from 5.51?L to 5.29); and perceived exertion (measured by Borg scale) at mid and peak exercise increased. Baseline resting systolic blood pressure, pulse pressure, and pulse pressure product increased post-WTS (from 118.9?mmHg to 129.2; from 45.3?mmHg to 55.6; and from 9.9?mmHg/min to 11.1 post-WTS, respectively). During exercise, a decrease in oxygen pulse was observed post-WTS (from 10.89?ml/beat to 9.97), while the heart rate-oxygen consumption relationship increased post-WTS (from 3.52 beats/ml/kg to 3.91).

Conclusion: Acute WTS appears to induce impairment in lung function and exercise capacity. Larger studies are warranted to further characterize the nature and extent of such impairment.     

Influence of cognition and symptoms of schizophrenia on IADL performance

Abstract

People with schizophrenia experience difficulties with instrumental activities of daily living (IADL), which are required for independent living. Yet, factors that influence IADL performance are still poorly understood. Identification of such factors will contribute to the rehabilitation process and recovery. The present study aimed to examine the influence of cognitive abilities, schizophrenia symptoms, and demographic variables on IADL functioning during acute hospital admission. The participants were 81 adults with DSM-IV chronic schizophrenia. They were assessed on the Revised Observed Tasks of Daily Living (OTDL-R), the Positive and Negative Syndrome Scale (PANSS), the Neurobehavioral Cognitive Status Examination (Cognistat), and the Kitchen Task Assessment (KTA) at acute hospitalization. The prediction model of IADL performance at this time consists of executive functioning (explained 21% of variance), memory and abstract thinking (explained 13.5%), negative symptoms (explained 13%), age of illness onset and years of education (explained 8%). The total explained variance is 53.5%. These results provide evidence-based guidelines for the evaluation process in inpatient settings. Such guidelines are important since planning of intervention processes and appropriate community integration programs often occurs during acute hospitalization, while the structured nature of inpatient settings limits natural variability in occupational performance.     

Atypical respiratory complications of dengue fever

In last decade, dengue has emerged as one of the most important vector born disease. With increasing cases, uncommon presentations and complications are now commonly recognized. Here, we report two cases of rare pattern of respiratory involvement in dengue: acute respiratory distress syndrome and bronchiolitis with respiratory failure.     

彩色多普勒用于足月新生儿缺氧缺血性脑病颅内静脉系统检查

目的 观察缺氧缺血新生儿的颅内静脉系统的血流特点,为临床判定缺氧缺血性脑病提供新的参考依据.方法 实验组缺氧缺血新生儿52例,对照组正常足月新生儿52例,通过前囟门应用彩色多普勒观察颅内静脉系统中直窦(SS)、上矢状窦(sss)、双侧横窦(Ts)、双侧室管膜下静脉(SV)及双侧大脑内静脉(ICV)的最大平均血流速度及频谱形态.结果 与对照组相比较,实验组SSS、双侧ICV及双侧SV平均最大血流速度减低.对照组SSS频谱为搏动型,双侧ICV及双侧SV频谱为连续平坦型.实验组SSS的频谱形态可见连续平坦型,SS及双侧TS的频谱形态存在搏动型及连续平坦型.颅内双侧ICV及双侧SV的频谱为连续乎坦型.结论 颅内静脉系统中,SSS、双侧ICV及双侧SV为提示缺氧缺血性脑病的合适观察对象.     

Hyperpolarized 13C magnetic resonance evaluation of renal ischemia reperfusion injury in a murine model

Acute kidney injury (AKI) is a major risk factor for the development of chronic kidney disease (CKD). Persistent oxidative stress and mitochondrial dysfunction are implicated across diverse forms of AKI and in the transition to CKD. In this study, we applied hyperpolarized (HP) ¹³C dehydroascorbate (DHA) and ¹³C pyruvate magnetic resonance spectroscopy (MRS) to investigate the renal redox capacity and mitochondrial pyruvate dehydrogenase (PDH) activity, respectively, in a murine model of AKI at baseline and 7 days after unilateral ischemia reperfusion injury (IRI). Compared with the contralateral sham‐operated kidneys, the kidneys subjected to IRI showed a significant decrease in the HP ¹³C vitamin C/(vitamin C + DHA) ratio, consistent with a decrease in redox capacity. The kidneys subjected to IRI also showed a significant decrease in the HP ¹³C bicarbonate/pyruvate ratio, consistent with impaired PDH activity. The IRI kidneys showed a significantly higher HP ¹³C lactate/pyruvate ratio at day 7 compared with baseline, although the ¹³C lactate/pyruvate ratio was not significantly different between the IRI and contralateral sham‐operated kidneys at day 7. Arterial spin labeling magnetic resonance imaging (MRI) demonstrated significantly reduced perfusion in the IRI kidneys. Renal tissue analysis showed corresponding increased reactive oxygen species (ROS) and reduced PDH activity in the IRI kidneys. Our results show the feasibility of HP ¹³C MRS for the non‐invasive assessment of oxidative stress and mitochondrial PDH activity following renal IRI.