改良超滤与零平衡超滤结合应用于婴幼儿体外循环手术59例的体会

目的总结改良超滤与零平衡超滤在59例婴幼儿体外循环手术中结合应用的经验、方法及临床效果。方法 59例婴幼儿,其中男40例,女19例,年龄4月～3岁之间,体重5～14kg,体外循环手术中均采用在体外循环过程中根据灌注压、红细胞压积给予零平衡超滤,停机后给予改良超滤。结果 59例患儿均顺利停机,无1例死亡,未出现超滤并发症,转中血球压积18～30(22.5±2)%,停机改良超滤后血球压积上升至32～38(35.8±1.4)%,在CCU住院时间为2～6d,皆顺利出院。结论在婴幼儿体外循环中将零平衡超滤与改良超滤的结合应用,零平衡超滤利于炎性介质的滤出,改良超滤可在CPB结束后快速排出多余的水分,提高红细胞压积,改善心肺功能,适用于低体重血液稀释度大的婴幼儿及体外循环时间长者。     

A serial echocardiographic study of myocardial abscess in a patient surviving staphylococcal septicemia

2D echocardiography was performed on a 4-year-old child suffering from right thigh abscess due to MRSA infection following diagnosis of pericardial effusion by USG abdomen. It revealed myocardial abscess and pericardial effusion. This child underwent series of 2D echocardiographic studies which showed image appearance of myocardial abscess with its time course of healing.     

A simulator for percutaneous hepatic microwave thermal ablation under ultrasound guidance

The purpose of this study was to provide a simulation therapy environment for microwave thermal ablation (MWA) under the guidance of ultrasound, and to present an inexpensive and portable simulator built on real patient-based pre-operative computed tomography (CT) data. We established an experimental simulation system for teaching MWA and present the results of a preliminary evaluation of the simulator’s realism and utility for training. The system comprises physical elements of an electromagnetic tracking device and an abdominal phantom, and software elements providing three-dimensional (3D) image processing tools, real-time navigation functions and objective evaluation function module. Details of the novel aspects of this system are presented, including a portable electromagnetic tracking device, adoption of real patient-based pre-operative CT data of liver, operation simulation of MWA, and recording and playback of the operation simulation. Patients with liver cancer were selected for evaluation of the clinical application value of the experimental simulation system. A total of 50 consultant interventional radiologists and 20 specialist registrars in radiology rated the simulator’s hardware reality and overall ergonomics. Results show that the simulator system we describe can be used as a training tool for MWA. It enables training with real patient cases prior to surgery, and it can provide a realistic simulation of the actual procedure.     

Effects of laparoscopic Roux-en-Y gastric bypass on bone mineral density and markers of bone turnover

BackgroundDespite multiple beneficial effects of weight loss after laparoscopic Roux-en-Y gastric bypass (LRYGB), the influence on bone mineral density (BMD) remains largely unknown. Our objective was to evaluate the changes in BMD and serum/urine bone markers after LRYGB.MethodsThirty-four women undergoing LRYGB were prospectively enrolled and underwent bone densitometry and serum/urine analysis preoperatively and 1 year postoperative. Changes≥.025 g/cm² in hip, femoral neck, and spine BMD and decreases>2% in total BMD were considered significant. Statistical analysis included paired t tests and McNemar’s test.ResultsMean age was 44.6 years. Body mass index at the preoperative and 1-year postoperative intervals were 46.7 and 29.6 kg/m², respectively. Mean hip, femoral neck, and spine (L1–L4) BMD was 1.191 versus 1.087 g/cm² (P< .001), 1.105 versus 1.032 g/cm² (P< .001), and 1.323 versus 1.277 g/cm² (P< .001) at the preoperative and 1 year postoperative intervals, respectively. Mean total BMD decreased from 1.328 preoperatively to 1.251 g/cm² at 1 year postoperative (P<.001). The decreases in BMD were 5.8%, 6.5%, 3.5%, and 8.8% for hip, femoral neck, spine (L1–L4) and total BMD from preoperative to 1 year postoperative. The proportion of patients with low vitamin D levels decreased from 55% preoperatively to 21% at 1 year postoperative (P = .004). Elevated osteocalcin and bone alkaline phosphatase was observed in 4% and 63% (P<.001), and 14% and 41% (P = .011) of patients preoperatively and at 1 year postoperative, respectively.ConclusionBMD and bone markers changed significantly after LRYGB. Current recommendations for supplementation in post-LRYGB women may need to be reevaluated.     

桌面虚拟现实技术在医学多媒体课件中的设计与应用

介绍了桌面虚拟现实技术在课件制作中的设计思路及实现方法。指出将虚拟现实技术与课件教学内容的知识点相整合,可强化课件的学习自主性和知识交互性,从而提高学习效率和教学质量。     

婴儿组织胞浆菌病1例并文献复习

目的提高对婴儿组织胞浆菌病(histoplasmosis,HP)的认识。方法报告1例婴儿组织胞浆菌病,并结合文献对该病病原学、流行病学、临床表现、诊断和治疗等方面进行分析。结果婴儿HP以不规则发热、咳嗽、腹泻、肝脾肿大为主要临床表现,骨髓穿刺检查找到组织胞浆菌确诊。结论 HP是由荚膜组织胞浆菌感染所致的一种以侵犯网状内皮系统或肺部为主的深部真菌病。婴儿HP临床表现多样,以播散型为主,病情进展迅速,在短期内即可造成多器官功能衰竭而导致救治失败。确诊有赖病原学的检查。     

Effects of combination of zinc and vitamin A supplementation on serum fasting blood sugar,insulin, apoprotein B and apoprotein A-I in patients with type I diabetes

Background and aim There is accumulating evidence that shows the metabolism of zinc and vitamin A are altered in diabetes mellitus type I (DMTI), thus the present study was conducted to evaluate the effects of combination of zinc and vitamin A supplementation on serum fasting blood sugar (FBS), insulin, apoprotein B and apoprotein A-I in patients with DMTI.

Design Forty-eight, 7-year-old to 20-year-old patients with at least 2 years of DMTI history, without any metabolic condition or medicine intake with insulin treatment, participated in a randomized double-blind clinical trial for 12 weeks. They were divided into zinc and vitamin A (VAZ)-supplemented (10 mg elemental zinc per day and one-half of a 25,000 IU vitamin A tablet every other day) and/or placebo groups after matching for sex, age and DMTI duration. Nutrient intake was estimated using 24 h recall and was analyzed by food processor program. Serum apoproteins B and A-I, FBS and insulin levels were determined at the beginning and end of the trial.

Results There was significant increase in apoprotein A-I (P <?0.0001) and a significant decrease in apoprotein B (P <?0.0001) and apoprotein B/apoprotein A-I ratio (P <?0.0001) at the end of the study compared with baseline values in the VAZ group but apoprotein A-I had a significant increase (P <?0.0001) and the apoprotein B/apoprotein A-I ratio had a significant decrease (P = 0.02) at the end of study in the VAZ group compared with the control group

Conclusion It seems that combined zinc and vitamin A supplementation can improve serum apoprotein A-I, apoprotein B and the apoprotein B/apoprotein A-I ratio in patients with DMTI.     

Management of osteoporosis in the elderly

ABSTRACT

Background: Osteoporosis is predominantly a condition of the elderly, and the median age for hip fracture in women is approximately 83 years. Osteoporotic fracture risk is multifactorial, and often involves the balance between bone strength and propensity for falling.

Objective: To present an overview of the available evidence, located primarily by Medline searches up to April, 2009, for the different management strategies aimed at reducing the risk of falls and osteoporotic fractures in the elderly.

Results: Frailty is an independent predictor of falls, hip fractures, hospitalisation, disability and death in the elderly that is receiving increasing attention. Non-pharmacological strategies to reduce fall risk can prevent osteoporotic fractures. Exercise programmes, especially those involving high doses of exercise and incorporating balance training, have been shown to be effective. Many older people, especially the very elderly and those living in care institutions, have vitamin D inadequacy. In appropriate patients and given in sufficient doses, vitamin D and calcium supplementation is effective in reducing both falls and osteoporotic fractures, including hip fractures. Specific anti-osteoporosis drugs are underused, even in those most at risk of osteoporotic fracture. The evidence base for the efficacy of most such drugs in the elderly is incomplete, particularly with regard to nonvertebral and hip fractures. The evidence base is perhaps most complete for the relatively recently introduced drug, strontium ranelate. Non-adherence to treatment is a substantial problem, and may be exacerbated by the requirements for safe oral administration of bisphosphonates.

Conclusion: Evidence-based strategies are available for reducing osteoporotic fracture risk in the elderly, and include exercise training, vitamin D and calcium supplementation, and use of evidence-based anti-osteoporotic drugs. A positive and determined approach to optimising the use of such strategies could reduce the burden of osteoporotic fractures in this high-risk group.