Altered chromatin landscape in circulating T follicular helper and regulatory cells following grass pollen subcutaneous and sublingual immunotherapy

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机械通气气管插管吸痰方法探讨

目的探讨不同的吸痰方法,从而有效地清除气管插管患者的呼吸道分泌物。方法对47例气管插管病人均采用常规法和呛咳法两种方法吸痰,呛咳法要求:吸痰管带负压进入气管插管,随吸痰管插入深度调节负压,适时安全吸痰,适度气道湿化。常规法按临床一般方法进行吸痰。将两种方法吸出的痰量,痰液性状及吸痰前后20min血氧饱和度(SpO2)进行比较。结果两种方法在吸出的痰量,痰液性状和SpO2方面存在着显著差异(P<0.05,P<0.01),呛咳法吸出的痰多且粘稠。吸痰后SpO2明显高于吸痰前和常规法。结论呛咳法吸痰能充分吸出气道深部的痰液,可以有效防止气道阻塞,改善通气功能。     

人体心脏舒张最大吸力的模拟实验研究

目的:模拟研究人体心脏舒张早期潜存的心室最大负压.材料与方法:先在血液循环体外模拟装置上模拟正常生理情况下的左、右心室心动周期压力曲线,然后近似阻断房室瓣,分别测定左、右心室压力.结果:模拟实验得到的左、右心室心动周期压力曲线和正常生理情况下的左、右心室心动周期压力曲线非常接近.近似阻断房室瓣时,左、右心室舒张的负压平均值分别是-93.25 mmHg(-12.43 kPa)和-10.28 mmHg(-1.37 kPa).结论:(1)模拟得到的实验结果可以定性地说人体心脏舒张和静脉血液回流心生物动力学关系;(2)心脏舒张时心室压力的减低(负压)是形成静脉-心房-心室压力梯度的根本原因,心脏舒张所产生的舒张吸力是静脉血液回流心室的主要动力,即静脉血液回流心脏是心脏舒张吸力作用的结果;(3)心脏前负荷产生的机理应该是心脏舒张抽吸静脉血液回流心脏所需的吸力;(4)静脉血液在被抽吸回流心室腔的过程中对心室肌没有伸展作用,即Starling心定律没有心脏舒张动力学基础.     

伴和不伴类风湿性关节炎患者腰椎管狭窄后路减压融合过程中隐性失血的对比

背景:腰椎管狭窄症后路手术除术中出血和术后引流外,还存在大量的"隐性失血"。合并类风湿性关节炎患者可能会影响围术期出血尤其是隐性失血,此前并无报道。目的:针对合并类风湿性关节炎的腰椎管狭窄患者与非类风湿性关节炎行腰椎后路手术时术中出血量、术后引流量以及隐性失血情况进行对比,并探讨类风湿性关节炎患者隐性失血的危险因素。方法:回顾性纳入了65例合并类风湿性关节炎的腰椎管狭窄患者(类风湿性关节炎组),筛选87例未合并类风湿性关节炎的腰椎管狭窄患者(非类风湿性关节炎组),所有患者均采取椎弓根螺钉+钛棒+椎间融合器内固定系统进行腰椎后路减压融合和后外侧融合治疗,术中行自体骨后外侧植骨。提取信息包括人口统计学信息、类风湿性关节炎信息(如类风湿性关节炎病史、Steinbrocker分级、抗类风湿性关节炎药物)、手术信息以及出血量相关指标。以术中出血量、术后引流量和隐性失血作为主要指标;以手术时间、术前术后红细胞压积和血红蛋白及其变化值、手术前后贫血数量、术后新发贫血数量、自体血和异体血输注量等作为次要指标。结果与结论:①类风湿性关节炎组腰椎管狭窄患者平均年龄为(65.97±8.02)岁,平均体质量指数为(25.76±3.68)kg/m^2,非类风湿性关节炎组中患者在性别比例、年龄和手术节段数上均与之匹配;②类风湿性关节炎组中患者平均病程为(16.78±12.73)年,其中单药或联合口服改变病情抗风湿药者最常见,2组在椎弓根螺钉数和椎间融合器置入数量上差异均无显著性意义,围术期并发症发生率2组差异亦无显著性意义;③主要结果对比显示2组在总失血量、术中出血量和术后引流量方面差异无显著性意义,而隐性失血以及隐性失血所占总失血量比例在非类风湿性关节炎组中更低(P<0.001,0.012);根据手术节段数进行分层分析,长节段(≥3节段)手术中非类风湿性关节炎组中隐性失血和隐性失血所占总失血量比例均优于类风湿性关节炎组;④次要指标对比红细胞压积改变值(P=0.021)在非类风湿性关节炎组小于类风湿性关节炎组但血红蛋白减小值2组差异无显著性意义;术后2组新发贫血以及贫血加重情况相比差异无显著性意义,异体血输注和手术时间相比差异也无显著性意义;⑤对类风湿性关节炎组患者隐性失血进行多元线性回归分析显示,类风湿性关节炎的Steinbrocker级别高、未服用改变病情抗风湿药、血红蛋白变化和输注异体血为隐性失血的独立危险因素;⑥提示类风湿性关节炎组和非类风湿性关节炎组在总失血量、术中出血、术后引流和手术时间上无差异,而隐性失血以及隐性失血所占总失血量比例类风湿性关节炎组高于非类风湿性关节炎组,尤其是长节段手术;类风湿性关节炎组的Steinbrocker分级高、未服用改变病情抗风湿药、血红蛋白改变较多以及输注异体血为隐性失血的独立危险因素。     

甲状腺的淋巴流向

在５０例新鲜童尸上，用普鲁士兰氯仿溶液向甲状腺实质内注射后，观察该器官的淋巴液向，甲状腺的淋巴管从器官内器官表面形成淋巴管网。自淋巴管网发出的淋巴管向外侧、向上、向下走行，注入颈内静脉淋巴结，喉前淋巴结，气管旁淋巴结和气管前淋巴结。     

A randomized, double blind, placebo-controlled study to investigate the use of conscious sedation in conjunction with paracervical block for reducing pain in termination of first trimester pregnancy by suction evacuation

BACKGROUND: This study evaluated the role of conscious sedation in pain relief during termination of first trimester pregnancy by suction evacuation (SE) under local anaesthesia. METHODS: A hundred women undergoing SE before 12 weeks gestation were randomized by computer using the sealed envelope method to receive placebo (saline) or conscious sedation (2 mg midazolam and 25 microg fentanyl) i.v. 5 min before cervical dilatation. Paracervical block was given to all patients, 2 min later. Pain scores during and after SE, post-operative side-effects and satisfaction level were compared. RESULTS: No statistically significant differences in pain scores were found between the two groups. Post-operative side-effects such as dizziness (P = 0.015) and drowsiness (P < 0.001) were significantly more severe in the conscious sedation group. However, patients in the conscious sedation group reported better satisfaction levels than the control group (P = 0.003). CONCLUSION: The use of conscious sedation significantly improved patient satisfaction during termination of first trimester pregnancy by SE under local anaesthesia, despite a lack of improvement in pain relief and the presence of increased severe dizziness/drowsiness in the post-operative period.     

Low resting potentials in single isolated heart cells due to membrane damage by the recording microelectrode

Single myocytes from adult rat hearts were prepared following the method of Powell and co-workers (9, 10, 11). Low resting potentials (E_m) could be improved by three techniques. (i) Elevation of Ca_o to 7.2 mM which, however, mostly resulted in spontaneity and irreversible contracture. (ii) Pre-incubation in a KB medium (6). (iii) Use of suction pipettes instead of tapered microelectrodes for intracellular recordings (2). It is concluded that low E_m measured previously (11) were due to membrane damage upon microelectrode impalement accopanied by insfufficient healing of the membrane around the electrode insertion.     

全膝关节置换后不放置引流的相关管理策略

背景:近年来,随着全膝关节置换技术提升、手术时间缩短、术中及术后止血药的应用,其总失血量不断减少,术后引流量也逐渐减少,术后快速康复理论应运而生,引流管放置也再次成为骨科医生所热议的问题,越来越多的医生认为可以常规取消放置引流,引流似乎已可有可无。目的:旨在复习既往文献,对全膝关节置换后引流放置的相关问题归纳总结,提供围术期引流管理的相关经验。方法:检索中国知网、万方、维普、中国生物医学文献数据库等中文数据库,以及PubMed、The Cochrane Library、WebofScience、EMBASE、OVID等外文数据库,以"引流,膝关节置换术"及"totalknee arthroplasty,drainage"为检索词,检索自建库始至2020年2月为止所有与主题相关的文献,总结归纳全膝关节置换后不放置引流管围术期各方面需综合考虑的要素。结果与结论:①引流管的放置问题关乎全膝关节置换手术的最终结果,与术后出血、血肿、血栓、感染等并发症的发生关系密切;②目前全膝关节置换术后不推荐常规放置引流,但不意味着不需要管理,其实际上对临床医护在围术期各方面的管理提出更高的要求,包括但不限于术前适应证选择、手术操作、止血带使用、术中及术后药物使用、物理疗法的使用等。     

Perivascular Drainage of Amyloid-β Peptides from the Brain and Its Failure in Cerebral Amyloid Angiopathy and Alzheimer's Disease

Alzheimer's disease is the commonest dementia. One major characteristic of its pathology is accumulation of amyloid-β (Aβ) as insoluble deposits in brain parenchyma and in blood vessel walls [cerebral amyloid angiopathy (CAA)]. The distribution of Aβ deposits in the basement membranes of cerebral capillaries and arteries corresponds to the perivascular drainage pathways by which interstitial fluid (ISF) and solutes are eliminated from the brain—effectively the lymphatic drainage of the brain. Theoretical models suggest that vessel pulsations supply the motive force for perivascular drainage of ISF and solutes. As arteries stiffen with age, the amplitude of pulsations is reduced and insoluble Aβ is deposited in ISF drainage pathways as CAA, thus, further impeding the drainage of soluble Aβ. Failure of perivascular drainage of Aβ and deposition of Aβ in the walls of arteries has two major consequences: (i) intracerebral hemorrhage associated with rupture of Aβ-laden arteries in CAA; and (ii) Alzheimer's disease in which failure of elimination of ISF, Aβ and other soluble metabolites from the brain alters homeostasis and the neuronal environment resulting in cognitive decline and dementia. Therapeutic strategies that improve elimination of Aβ and other soluble metabolites from the brain may prevent cognitive decline in Alzheimer's disease.     

闭合性脑外伤脑电图变化与脑电地形图结果比较

目的:探讨脑电学检查在闭合性脑外伤中的应用.方法:对123例闭合性脑外伤患者进行EEG和BEAM检查.结果:EEG异常率为56.9%,表现为弥漫性或局部性慢波增多,BEAM异常率为70.7%,表现为θ或δ频带功率呈弥漫性或局限性增高.结论:闭合性脑外伤的损伤程度与EEG的变化有良好的正相关性;闭合性脑外伤EEG和BEAM,两者有显著性差异;多次重复脑电学检查,有重要临床价值.