Upper Gastrointestinal Irritation and Arrhythmia

Abstract: The influence of endoscopic examination on the occurrence of arrhythmia was investigated electrocardiographically in 30 patients with cardiovascular disease who underwent transesophageal echocardiography (TEE) (group A) and 38 patients with digestive tract disease who underwent upper gastrointestinal endoscopy (UGIE) (group B). The mode and frequency of arrhythmia during the examination were compared between the two groups. (1) Arrhythmia was more frequently observed in group A (22 of 30, 73.3%) than in group B (9 of 38, 23.7%) patients (p<0.001). The common arrhythmias in both groups were supraventricular premature beat and ventricular premature beat. Serious arrhythmias, such as 2nd degree atrioventricular block and ventricular fibrillation were detected only in group A patients. (2) The region of the esophagus where the tip of the probe or scope was located was classified into three segments: upper (0–15 cm), middle (15–35 cm) and lower (35 cm<). Arrhythmias tended to be frequent when the tip of the probe or scope was located in the middle segment of the esophagus. These data indicate that arrhythmias observed during TEE or UGIE are related to the underlying heart disease. Furthermore, the middle segment of the esophagus appears to be particularly susceptible to the provocation of arrhythmia.     

Endotracheal suctioning causes right upper lobe collapse in intubated children

Objective: Right upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncontrolled negative pressures during endotracheal tube suctioning were significant contributory factors. Methods : The incidence of right upper lobe (RUL) collapse in intubated, ventilated children on a paediatric cardiac intensive care unit was determined over a 3-month period ( n = 102). Graduated suction catheters and suction vacuums of < 165 cm H₂O were then introduced. Another prospective audit was carried out 3 months later ( n = 60). Results : We found that 24% developed RUL collapse and 4 developed an apical pneumothorax. Following the introduction of graduated catheters and controlled vacuums pressures, a significant reduction in the incidence of RUL collapse, to 7%, was observed ( p < 0.05). Conclusions : We conclude that high negative pressure and deep-suctioning causes RUL collapse in children. Any lobar collapse not only prolongs the child's stay in intensive care, but can be associated with further morbidity which may have a serious implication. By improving suctioning technique this morbidity can be significantly reduced.     

The heparin-induced thrombocytopenia and thrombosis syndrome: Treatment with intraarterial urokinase and systemic platelet aggregation inhibitors

We report a case of the heparin-induced thrombocy-topenia and thrombosis syndrome presenting with acute ischemia of a lower limb. The patient was successfully treated by withdrawal of heparin products, intraarterial urokinase, and platelet anti-aggregation therapy consisting of Dextran and aspirin.     

综合矫正训练方案联合中药熏蒸治疗上交叉综合征疗效观察

<正>上交叉综合征(upper crossed syndrome,UCS)是指因上半身长期处于不良姿势,造成相关肌群功能失衡,进而引起颈肩背部疼痛不适、胸闷、睡眠障碍等一系列不良症状的一种亚健康状态^[1]。UCS常见的体态是圆肩、驼背、头前倾^[2]。目前临床上主要通过纠正局部的肌肉失衡来治疗UCS,常用的方法有运动疗法、肌肉能量技术、针灸和推拿等^[3]。     

数值求解人体上肢两刚体系统

目的 简化人体上肢结构，建立两刚体系统动力学模型，并对其进行数值求解。方法 以卡尔登角为广义坐标，运用多刚体动力学理论，建立上肢的动力学方程；运用MATHEMATICA计算软件对方程进行正、反数值求解并进行了比较。结果 得到了上肢的两刚体动力学方程和数值解，对比计算结果表明，将已知运动带入方程求得的主动力作为已知力反求得的卡尔登角与已知运动的卡尔登角基本一致，而且在反解时会出现奇点。结论 运用MATHEMATICA计算软件求解复杂的上肢两刚体系统方程，相当方便，为免奇点出现，应在适当范围内进行求解，在误差允许的范围内，求得的解是可以接受的。     

Central control of upper airway resistance regulating respiratory airflow in mammals

This article reviews recent studies on the importance of glycine receptors for both the spontaneous and the reflex respiratory modulation of the laryngeal abductors and adductors. Our findings show that strychnine blockade of glycine receptors within the brainstem changes the eupneic three-phase respiratory pattern into two phases. This has major implications for glottal control: (i) the inspiratory glottic abduction and early expiratory adduction were both compromised--a finding mimicked by 5% hypoxia; (ii) closure of the glottis during defensive upper airway reflexes became intermittent and the reflex apnoea reversed to sustained inspiratory discharge. Based on these data, we predict that periods of prolonged hypoxia, such as those that occur during sleep apnoeas, will constrain inspiratory glottic abduction thereby impeding inhalation.     

食管入口部的解剖学特点及其临床意义

目的：为全喉切除术后的患者进行发音重建，为制造适合我国人的发音管提供解剖学基础。方法：对４０具正常成人尸体标本食管入口部进行了观察测量，测量食管入口部的内外横径、前后壁厚度，第１、第２气管环之间气管食管共壁的宽度、厚度。结果：发现食管入口部前后壁的厚度相差显著，前壁明显厚于后壁。食管入口部的内横径平均值为１１．９ｍｍ，外横径平均值为１６．６ｍｍ。在第１、第２气管环之间的气管食管共壁宽度的平均值为１２．０ｍｍ；其厚度平均值为６．１ｍｍ等。结论：本研究对进行发音重建、食管镜检查有指导作用，为制造适合我国人的发音管提供数据。     

Fecal microbiota transplantation for Clostridium difficile infection in Taiwan: Establishment and implementation

Clostridium difficile infection (CDI) remains a major public health issue, and fecal microbiota transplantation (FMT) has become one of the standard therapies for recurrent or refractory CDI. When compared to medical therapies, such as metronidazole or vancomycin, FMT has a high rate of treatment response with acceptable safety and efficiency. Following promulgation of the amendments in September 2018 in Taiwan, FMT has been indicated for recurrent or refractory CDI. The Taiwan Microbiota Consortium contributed to the Taiwan FMT Expert Consensus, which established basic norms and stipulated essential principles, including the indications for transplantation, eligible locations and personnel, donor screening policies, fecal sample handling, and post-FMT follow-up. However, establishing an eligible FMT team in a qualified hospital remains a clinical challenge, and the requirement for facilities and well-screened donors impedes the implementation of FMT. In this review, we aim to provide domestic FMT teams with explicit instructions to facilitate realization and increase the practice of FMT. Based on the Taiwan FMT Expert Consensus and current regulations, we performed a literature review and integrated the experiences of Taiwanese multidisciplinary experts into this article. The content intends to offer clinicians up-to-date evidence and highlight the essential points of FMT.     

上消化道出血患者检测血清前白蛋白的临床意义

目的:探讨血清前白蛋白在上消化道出血中的意义。方法:对32例肝硬化并发上消化道出血患者及30例胃十二指肠疾病并发上消化道出血患者进行血清前白蛋白(PA)测定,并与34例正常对照相比较。结果:肝硬化并发上消化道出血患者血清PA低于胃十二指肠疾病并发上消化道出血者及正常对照组,且肝硬化组PA分布与后两者无重迭;Child分级间PA有显著差异。结论:上消化道出血患者检测血清PA有助于肝硬化并发出血的诊断,并可帮助判断病情及估计预后。     

Development of allergy in children. I. Association with virus infections.

Children born into allergic families, with two allergic parents, are at high risk of developing allergy within the first 5 years of life. In order to observe possible external factors in the sensitization process, a prospective study of 13 such children was done, in which serial clinical and immunologic observations were made at 3- to 6-month intervals over a period of 1 to 4 yr. Eleven of these children are now clinically allergic; 5 have asthma. Immunologic evidence for allergic sensitization was observed in these 11 children by RAST, antigen-induced leukocyte histamine release, lymphoblastogenesis, and rise in serum IgE. Upper respiratory infections (URI) occurred in these 11 allergic children 1 to 2 months prior to the onset of allergic sensitization. In 10 of these 11 URI children, complement-fixing antibodies to viruses (parainfluenza, RSV, CMV) increased in the same blood samples in which immunologic allergic sensitization was first evidenced. This coincidence suggests that certain viruses may contribute to the allergic sensitization process.