多普勒超声对下肢慢性静脉功能不全症患者中髂静脉压迫的预测价值

目的探讨多普勒超声诊断髂静脉压迫综合征的价值。方法 选取2017 年10 月～2019 年9 月我院治疗的下外周慢性静脉功能不全症患者402 例,行多普勒超声和顺行静脉造影检查,以静脉造影结果为诊断标准,将402 例患者分为髂静脉压迫组和对照组。分析多普勒超声诊断髂静脉压迫综合征的价值。结果 髂静脉压迫综合征患者的多普勒超声诊断总灵敏度为73.6%,特异度为93.7%。比较髂静脉压迫组与对照组的超声数据,结果显示几个指标可帮助诊断髂静脉压迫：左髂静脉最狭窄处与狭窄后血流峰速比值>2.000 的灵敏度为92.13（84.50～96.80）,特异度为95.83（93.0～97.8）;右髂静脉与左髂静脉分叉处血流峰速比值>1.500 的灵敏度为69.32（58.60～78.70）,特异度为80.77（76.00～85.00）;Valsalva 动作后左股总静脉血流峰速变化比值＜2 的灵敏度为92.10%,特异度为84.80%,阳性似然比为6.06,阴性似然比为0.09。结论 多普勒超声是从下肢静脉功能不全患者中筛选髂静脉压迫综合征患者的合理方法。     

Blood total carbon dioxide content and bicarbonate can be used together to predict blood pH correctly in venous blood samples

Blood gas analyses are needed to reveal any kind of acid-base imbalance in some patients. Traditionally, arterial punctures are performed to obtain the blood samples for blood gas analyses. Arterial puncture is not a completely safe procedure. It may cause serious problems including arterial thrombosis, arteriovenous fistula, pseudoaneurysms and hematoma. In this retrospective reviewing, it was aimed to yield novel formulations to predict the blood pH only from CtCO₂ and HCO₃ values which can easily be measured in venous blood samples obtained for other diagnostic and follow-up purposes.     

Relieving pain and distress during venipuncture: Pilot study of the Japan Environment and Children's Study (JECS)

Pain management for needle‐related procedures is poor in Japan. In many countries the use of lidocaine/prilocaine cream for the relief of pain associated with venipuncture has been approved. In children, a psychological approach has also been shown to be effective in reducing pain with venipuncture. We developed a multidisciplinary procedure that combines a cream (2.5% lidocaine and 2.5% prilocaine) and pharmacological approaches such as preparation, education, positioning and distraction. We evaluated the feasibility and acceptability of the procedure for young children. Among 132 pediatric participants, 58.3% did not cry during venipuncture. According to caregiver questionnaire, 71.9% felt that the multidisciplinary procedure eliminated the fear of needle‐related procedures in the children; 90.9% were satisfied with it and 75.8% thought it should be applied to all children undergoing venipuncture. The present results suggest that the multidisciplinary procedure is feasible, acceptable and suitable for use in children undergoing venipuncture.     

舒适护理在门诊经外周静脉穿刺置入中心静脉导管维护病人中的应用

[目的]探讨舒适护理在门诊经外周静脉穿刺置入中心静脉导管(PICC)维护病人中的效果。[方法]采用自身对照的方法,2013年1月25日之前均给予常规护理,并在1月21日-1月25日向病人维护后发放我院设计的“PICC 维护门诊病人满意度调查表”,同时采用舒适度量表评估其满意度和舒适度。1月28日开始采取舒适护理,并在2月25日-3月1日向病人维护后发放满意度调查表和舒适度量表评估其满意度和舒适度。[结果]病人的满意度由常规护理时的81.13分±2.70分上升到舒适护理后的99.80分±0.60分。舒适度评分由常规护理时的3.320分±1.049分下降到舒适护理后0.880分±0.666分。[结论]舒适护理更可提升病人的舒适度和提高病人对护理的满意度。     

Sympathetic nerve fibers sprout into rat odontoblast layer, but not into dentinal tubules, in response to cavity preparation

This study was designed to determine if sympathetic nerve fibers exist in dentinal tubules in rat normal dental pulp, and if they sprout into the dentinal tubules in response to artificial cavity preparation in dentin. Sympathetic nerve fibers in rat molar dental pulp were labeled using an anterograde axonal transport technique involving injection of wheat germ agglutinin-horseradish peroxidase (WGA-HRP) into the superior cervical ganglion (SCG). They were then observed using light and electron microscopes. In normal dental pulp (control), scattered WGA-HRP reaction products were observed in unmyelinated nerve endings in the odontoblast layer and subodontoblastic region. In injured pulp 3 weeks after cavity preparation, reaction products were about 1.8-times more plentiful in the above areas (versus control pulp). However, no labeled nerve fibers were observed in the dentinal tubules in either control or injured dental pulp. These results indicate that although sympathetic nerve fibers do indeed sprout in rat dental pulp in response to cavity preparation, they do not penetrate into the dentinal tubules in which postganglionic nerve endings derived from the SCG were not originally present.     

HSV-1 H129-Derived Anterograde Neural Circuit Tracers: Improvements,Production, and Applications

Anterograde viral tracers are powerful and essential tools for dissecting the output targets of a brain region of interest. They have been developed from herpes simplex virus 1 (HSV-1) strain H129 (H129), and have been successfully applied to map diverse neural circuits. Initially, the anterograde polysynaptic tracer H129-G4 was used by many groups. We then developed the first monosynaptic tracer, H129-dTK-tdT, which was highly successful, yet improvements are needed. Now, by inserting another tdTomato expression cassette into the H129-dTK-tdT genome, we have created H129-dTK-T2, an updated version of H129-dTK-tdT that has improved labeling intensity. To help scientists produce and apply our H129-derived viral tracers, here we provide the protocol describing our detailed and standardized procedures. Commonly-encountered technical problems and their solutions are also discussed in detail. Broadly, the dissemination of this protocol will greatly support scientists to apply these viral tracers on a large scale.     

不同浓度的丁卡因联合用药用于静脉穿刺镇痛的临床应用

静脉穿刺是一种有创护理操作技术,给病人造成了一定的身心痛苦.本课题探讨不同浓度的丁卡因溶液联合不同的皮肤渗透剂甘油、月桂酸氮卓酮在静脉穿刺中的应用,达到镇痛目的,从而推广无痛技术在护理操作中的可行性,最大程度减轻病人的痛苦,现将研究结果报到如下：     

静脉穿刺机械臂穿刺与挑针动作

目的 提出一种新型多关节串联静脉穿刺系统,探究其穿刺过程中进针、挑针动作涉及的以力学、运动学为基础的相关控制问题,验证此系统的可行性。方法 搭建穿刺机械臂实物,结合穿刺力学模型提出进针位移控制算法。利用DH法进行正运动学解算,得到末端针尖坐标,再利用几何法进行逆运动学解算,正逆过程联系紧密。采用运动学正解-逆解-再正解方法比较挑针前后的末端坐标位置误差,最后结合实物进行实验验证与仿真。结果 经过仿真及实验,验证理论模型的准确性。利用该进针算法可以实现一针见血,为机械臂动作的控制提供理论依据。挑针前后末端位置误差可以控制在1 mm以内。机械臂在挑针过程中末端针尖几乎保持固定,故此套挑针方案可行,基本可以验证机械臂挑针动作满足精度与安全要求。结论 该静脉穿刺机械臂真实模拟穿刺过程的进针、挑针动作,能够安全、准确地实现进针穿刺和以针尖为定点的挑针动作,具有一定的临床使用价值。     

Reticulo- and trigemino-hypoglossal connections: A quantitative comparison of ultrastructural substrates

Axon terminals were identified and characterized by electron microscopy after injections of horseradish peroxidase (HRP) into the spinal V nucleus (SPVN) or the medullary reticular formation adjacent to the XIIth nucleus. The synaptic organization and topology of these two different populations of hypoglossal afferents (T-XII and R-XII respectively) were determined by quantitative comparisons. Significant differences were obtained in the ratios of morphological types of terminals, sizes of axonal endings and their location on postsynaptic structures. Axon terminals containing spherical vesicles (S-terminals) and those with flattened/pleomorphic vesicles (F-terminals) were anterogradely labeled with HRP from both injection sites. However, the S/F ratio for R-XII terminals was 1.2:1 compared to 2.6:1 for T-XII afferents. Asymmetrical membrane densities (Gray Type I) were the predominant form of junctional specialization for S-terminal synapses. Asymmetrical densities with subjunctional dense bodies/bars (S-Taxi) were associated with a higher proportion of T-XII synapses than R-XII synapses. Almost all of the F-terminals from both sources had symmetrical densities (Gray Type II). The average diameter of R-XII terminals was greater than that of T-XII terminals. R-XII-F terminals were the largest terminals. The majority of axon terminals from both sources formed axodendritic synapses. However, R-XII terminals had a higher incidence (10% vs. 3%) of axosomatic contacts. The proportion of R-XII-F-terminals decreased from the central toward the distal dendrites, whereas the opposite was found for T-XII-F and T-XII-S-terminals. In contrast to these findings, R-XII-S-terminals were more uniformly distributed on dendrites of all sizes.(ABSTRACT TRUNCATED AT 250 WORDS)