食管癌术后经鼻肠管注入中药促进胃肠功能恢复研究

目的 促进食管癌术后患者胃肠功能的恢复.方法 将60例食管癌术后患者随机分为观察组和对照组各30例,对照组经鼻肠管内注入肠内营养液后注入100 ml生理盐水;观察组经鼻肠管内注入肠内营养液后注入150 ml自制中药,1次/d,连续3 d后评价效果.结果 观察组术后首次肛门排气、排便及肠鸣音恢复时间显著早于对照组,血浆胃...     

视频喉镜引导困难气管插管的护理配合

对69例气管插管困难患者在视频喉镜引导下气管插管成功,无一例因护理配合不当出现并发症。提出术前做好用物准备,对患者气管插管困难进行预测及判断患者有无寰椎关节运动受限或张口异常,针对性做好应对措施;术中熟练操作步骤,密切配合,加强生命体征观察,可提高气管插管成功率、减少损伤、增加安全性。     

机械通气高龄患者应用鼻肠管行肠内营养支持的临床意义

目的观察鼻肠管在使用机械通气的高龄病人行肠内营养支持中的应用效果。方法将52例使用机械通气的高龄病人随机分为观察组和对照组,每组26例,对照组采用鼻胃管进行肠内营养支持,观察组采用鼻肠管进行肠内营养支持。置管后1个月内分别观察并记录两组病人行肠内营养支持时不良反应的发生情况。结果观察组各种不良反应发生率均低于对照组(P<0.05)。结论高龄机械通气病人应用鼻肠管行肠内营养支持可有效减少不良反应的发生,优于常规应用鼻胃管。     

Effect of low tube kV on radiation dose and image quality in retrospective ECG-gated coronary CT angiography

IntroductionCoronary computed tomography angiography (CCTA) has emerged as a useful diagnostic imaging modality in the assessment of coronary artery disease. However, the potential risks due to exposure to ionizing radiation associated with CCTA have raised concerns.ObjectivesCCTA can be done with low dose technique to reduce radiation exposure, without compromise of image quality or diagnostic capabilities.Material and methodsForty patients referred for CCTA were examined with low kV (100 kV for patients ?85–61 kg and 80 kV for patients ?60 kg). The dose length product (DLP) were compared with other group (40 patients) with comparable body weight, scan length and acquisition parameters. The second group was selected from PACS database, for which CCTA was done with standard 120 kV.ResultsThere was considerable reduction of radiation dose about 40% with 100 kV and 60% with 80 kV compared to standard 120 kV CCTA protocols with preserved image quality.ConclusionThe use of lower tube voltage leads to significant reduction in radiation exposure in CCTA. Image quality in non-obese patients is not negatively influenced.     

激光泪道成形联合硅胶管植入术治疗上泪道阻塞的临床观察

目的:观察激光泪道成形联合硅胶管植入术治疗上泪道阻塞的临床效果。方法:上泪道阻塞患者128例148眼,全部有流泪病史,均经泪道冲洗检查确诊,行激光泪道成形联合硅胶管植入术,保留硅胶管1a,拔管后随访24mo,定期冲洗泪道,观察泪道通畅情况。结果:拔管后治愈120眼(81.08%),无流泪,泪道保持通畅;好转18眼(12.16%),流泪减轻,泪道通而不畅;无效10眼(6.76%),仍流泪,泪道冲洗不通。总有效率达93.24%。结论:激光泪道成形联合硅胶管植入术是治疗上泪道阻塞的有效方法。     

Effect of percutaneous endoscopic gastrostomy on gastro-esophageal reflux in mechanically-ventilated patients

AIM:To investigate the effect of percutaneousendoscopic gastrostomy (PEG) on gastroesophagealreflux (GER) in mechanically-ventilated patients.METHODS :In a prospective,randomized,controlledstudy 36 patients with recurrent or persistent ventilator-associated pneumonia (VAP) and GER>6% were dividedinto PEG group (n=16) or non-PEG group (n=20).Another 11 ventilated patients without reflux (GER<3%) served as control group.Esophageal pH-metry wasperformed by the"pull through"method at baseline,2and 7 d after PEG.Patients were strictly followed up forsemi-recumbent position and control of gastric nutrientresidue.RESULTS:A significant decrease of median (range) re-flux was observed in PEG group from 7.8 (6.2-15.6) atbaseline to 2.7 (0-10.4) on d 7 post-gastrostomy (P<0.01),while the reflux increased from 9 (6.2-22) to 10.8(6.3-36.6) (P<0.01) in non-PEG group.A significantcorrelation between GER (%) and the stay of nasogastrictube was detected (r=0.56,P<0.01).CONCLUSION:Gastrostomy when combined with semi-recumbent position and absence of nutrient gastric resi-due reduces the gastroesophageal reflux in ventilatedpatients.     

波形蛋白与层粘连蛋白在人胚早期神经管中的表达

目的观察层粘连蛋白（LN）和波形蛋白（Vim）在人胚早期神经管发育中的表达变化,探讨人胚神经管发育早期细胞微环境的特点。方法收集早期人胚23天和45天标本8例,分别用LN和Vim抗体对人胚标本的组织切片行免疫组织化学ABC法染色。图像分析不同观测指标阳性细胞的积分光密度值,结果用t检验进行统计分析。结果人胚发育早期,LN和Vim在神经管的神经上皮层、中间层和边缘层的神经细胞胞中表达。在神经管发育到23天时,LN的积分光密度值（1258．17±635）比Vim的积分光密度值（2611．34±502）低（P〈0．05）。结论在人胚早期,神经管的细胞基质成分以Vim为主,LN为辅,可能对神经干细胞的发育有重要作用。     

Metformin therapy to reduce weight gain and visceral adiposity in children and adolescents with neurogenic or myogenic motor deficit

Casteels K, Fieuws S, van Helvoirt M, Verpoorten C, Goemans N, Coudyzer W, Loeckx D, de Zegher F. Metformin therapy to reduce weight gain and visceral adiposity in children and adolescents with neurogenic or myogenic motor deficit.
The aim of this randomized, placebo-controlled study was to explore the effect of metformin in children with a neurogenic or myogenic motor deficit, who are therefore prone to develop overweight, adiposity, and insulin resistance.
Study participants (n = 42) had a mean age of 15.5 yr, a short stature (height −2.4 SD), a relatively high BMI (+1.7 SD), and a high body fat fraction (41.9% or +2.8 SD). Abdominal CT confirmed the high fat mass and disclosed a high fraction of visceral fat. As expected, insulin resistance was increased.
As compared to placebo, metformin intake for 6 months exerted an insulin sensitizing effect and lowered weight (mean difference of 2 kg within 6 months, p = 0.007) and BMI (p = 0.016). Weight loss appeared to be primarily due to loss of visceral fat (∼20% vs. placebo; p < 0.0001). Results were similar across diagnostic subgroups.
In conclusion, metformin treatment for 6 months was associated with a rise in insulin sensitivity and with a reduction of visceral adiposity in children and adolescents with a primary muscle disorder or with a neural tube defect. These findings suggest that insulin resistance underpins, at least partly, the overweight and visceral adiposity of these patients, who are not necessarily obese.     

Gender-dependent differences in the incidence of ochratoxin A-induced neural tube defects in the Pdn/Pdn mouse

Genetic polydactyly/arhinencephaly mouse embryo, Pdn/Pdn , exhibits suppression of Gli3 gene expression. Ochratoxin A (OTA) is a teratogen that causes neural tube defects (NTD) in mice. We investigated gender-dependent differences in the incidence of NTD induced by OTA in the Pdn/Pdn mouse. After administering 2 mg/kg OTA to Pdn /+ female mice, mated with Pdn /+ males, on day 7.5 of gestation, we examined the genotypes, sex and NTD of fetuses on day 18. Non-treated Pdn / Pdn had a 15.8% risk of NTD, and all NTD fetuses were female. When Pdn / Pdn embryos were exposed to OTA, the incidence of NTD increased to 16 (51.6%) of 31 Pdn / Pdn fetuses, and 10 (71.4%) of 14 male Pdn / Pdn fetuses exhibited NTD. From these results, it was speculated that NTD in OTA-treated male Pdn / Pdn were due to the synergistic effect between depressed Gli3 and altered sex-correlated gene expression from OTA treatment. After treatment with OTA, the embryos were recovered on day 9 and gene expressions, which were correlated with Gli3 , telencephalic morphogenesis, formation of gonadal anlage, and gender-dependent differentiation were investigated. From real-time polymerase chain reaction analysis results, it was suggested that the manifestation of NTD in the male OTA-treated Pdn/Pdn might be due to the complicated altered gene expressions among Gli3, Wnt7b, Wnt8b , Fez1 , Barx1, Lim1, Dmrt1, Igf1 , Fog2, Dax1 and Sox9, and in particular, upregulation and gender-dependent difference in Barx1 and gender-dependent difference in Sox9 gene expressions might be noteworthy findings.