COPD住院患者并发白色念珠菌肺炎76例临床分析

目的探讨慢性阻塞性肺疾病（COPD）住院患者并发白色念珠菌肺炎的易感因素及防治对策.方法回顾性分析呼吸内科病房76例COPD并发白色念珠菌肺炎患者和同期76例无院内真菌感染的COPD患者的临床资料.结果 COPD患者并发白色念珠菌肺炎除了与患者的年龄和合并症有关外,还与广谱抗生素和糖皮质激素的应用、长期住院、各种侵入性操作以及全肠外营养的广泛开展等有密切关系.结论合理使用抗生素和糖皮质激素,减少不必要的侵袭性操作,机械通气者尽快脱机,尽可能进行胃肠内营养,改善胃肠道微生态环境,密切监测,及早治疗,可以有效防治COPD患者的真菌感染,改善其预后.     

重复性搬举作业所致背部肌肉疲劳的表面肌电信号分析

目的　应用表面肌电信号 (SEMG)技术对重复性搬举所致的竖脊肌疲劳进行评价。方法　通过对 13名自愿者 10 0次搬举 8kg负荷至腰部高度的EMG波幅分析和搬举前后 2次静态实验EMG信号快速傅立叶转换 (FFT)后的频谱变化分析对竖脊肌疲劳进行评估。结果　 10 0次动态搬举过程中 ,随着时间的延长 ,EMG平均波幅逐渐上升 ,T10右竖脊肌和L3左竖脊肌平均波幅的差异有显著性 (P <0 .0 5、P <0 .0 1) ;而T10左竖脊肌和L3右竖脊肌的差异无显著性 (P >0 .0 5 )。中频截距在T10右竖脊肌、T10左竖脊肌、L3右竖脊肌、L3左竖脊肌均有下降。T10右竖脊肌中频截距下降了2 .0 % ,与搬举前的差异无显著性 (P >0 .0 5 ) ,T10左竖脊肌、L3右竖脊肌和L3左竖脊肌分别下降了10 .9%、2 9.9%、2 7.9% ,与搬举前的差异均有显著性 (P <0 .0 5、P <0 .0 1)。 10 0次搬举后平均功率频率截距在L3左竖脊肌下降了 9% ,与搬举前比较 ,差异有显著性 (P <0 .0 5 ) ,其他部位下降不明显。结论　重复性的搬举可导致竖脊肌疲劳 ,L3部位比T10部位更容易疲劳 ;用中频截距的下降评价肌肉疲劳比用平均功率频率截距下降更敏感。     

Paediatric acid-base disorders: A case-based review of procedures and pitfalls

Acid-base disorders occur frequently in paediatric patients. Despite the perception that their analysis is complex and difficult, a straightforward set of rules is sufficient to interpret even the most complex disorders – provided certain pitfalls are avoided.Using a case-based approach, the present article reviews the fundamental concepts of acid-base analysis and highlights common mistakes and oversights. Specific topics include the proper identification of the primary disorder; distinguishing compensatory changes from additional primary disorders; use of the albumin-corrected anion gap to generate a differential diagnosis for patients with metabolic acidosis; screening for mixed disorders with the delta-delta formula; recognizing the limits of compensation; use of the anion gap to identify ‘hidden’ acidosis; and the importance of using information from the history and physical examination to identify the specific cause of a patient’s acid-base disturbance.     

Differences in knee adduction moment between healthy subjects and patients with osteoarthritis depend on the knee axis definition

ObjectiveThis study, firstly, investigates the effect of using an anatomical versus a functional axis of rotation (FAR) on knee adduction moment (KAM) in healthy subjects and patients with knee osteoarthritis (KOA). Secondly, this study reports KAM for models with FAR calculated using weight-bearing and non-weight-bearing motion.DesignThree musculoskeletal models were created using OpenSim with different knee axis of rotation (AR): transepicondylar axis (TEA); FAR calculated based on SARA algorithm using a weight-bearing motion (wFAR) and a non-weight-bearing motion (nwFAR). KAM were calculated during gait in fifty-nine subjects (n = 20 healthy, n = 16 early OA, n = 23 established OA) for all models and groups.ResultsSignificant differences between the three groups in the first peak KAM were found when TEA was used (p = 0.038). However, these differences were no longer present when using FAR. In subjects with established OA, KAMs were significantly reduced when using nwFAR compared to TEA models but also compared to wFAR models.ConclusionThe presence of excessive KAM in subjects with established KOA showed to be dependent on the definition of the AR: anatomical versus functional. Therefore, caution should be accounted when comparing KAM in different studies on KOA patients. In patients with end-stage knee OA where increased passive knee laxity is likely to exist, the use of weight-bearing motions should be considered to avoid increased variability in the location and orientation of a FAR obtained from activities with only limited joint loading.