血必净治疗高原多器官功能障碍综合征猪模型的疗效及治疗前后肺组织中 NF －κB mRNA 的表达变化

目的：观察血必净治疗巴马小香猪高原多器官功能障碍综合征（ H－MODS）模型的疗效及治疗前后肺组织中NF－κB mRNA的表达,进一步揭示血必净对H－MODS的防治作用。方法24只巴马小香猪麻醉后随机抽取8只作为空白对照组（ A组）,其余16只采用内毒素（ LPS）制作H－MODS模型后,随机分为模型组（ B组）、血必净治疗组（ C组）,每组8只。血必净治疗组给予血必净注射液3 mL／kg,2次／d;对照组及模型组给予等体积生理盐水,2次／d;共治疗3 d。于不同时间段观察巴马小香猪血白细胞的变化趋势。采用RT－PCR法测定肺组织NF－κB mRNA表达量变化。结果①模型组、血必净治疗组动物死亡率分别为33．3％、16．6％。②与对照组比较,24 h模型组肺泡腔内可见弥散性瘀血,巨噬细胞增多,且有大量红细胞渗出及少量中性粒细胞浸润,肺泡间隔增宽,毛细血管扩张充血,24 h血必净治疗组肺泡腔内出血较少,肺泡壁模糊,有少量红细胞渗出,肺泡间隔仍有增厚。③模型组及血必净治疗组血白细胞（ WBC）呈“勺型”变化。模型组48 h WBC变化幅度较治疗组更明显（ P＜0．05）。④与对照组比较,模型组、治疗组24 h NF－κB mRNA表达量均显著上升（P＜0．01）;与模型组比较,治疗组24 h NF－κB mRNA表达量升高幅度较低（ P＜0．05）;模型组、治疗组72 h NF－κB mRNA表达量仍高于对照组,以模型组升高最明显（ P＜0．05）。结论血必净可明显减轻内毒素所诱导的H－MODS模型动物死亡率,减轻内毒素所致的炎症反应,下调肺组织NF－κB mRNA的表达量,提高H－MODS的救治成功率。     

青稞红曲的质量标准研究

目的：建立青稞红曲的质量标准。方法：采用显微、薄层色谱法建立定性鉴别;参考2010年版《中国药典》（一部）相关方法测定其水分、总灰分、酸不溶性灰分和浸出物的含量;采用高效液相色谱法测定酸式洛伐他汀和内酯型洛伐他汀的含量。结果：青稞红曲的显微、薄层色谱鉴别特征明显,专属性强;青稞红曲中水分6.04%-8.78%,总灰分2.15%-2.92%,酸不溶性灰分0.23%-0.29%,水浸出物27.99%-30.17%,醇浸出物14.12%-18.51%。青稞红曲中酸式洛伐他汀含有量在0.11%-0.29%范围内,内酯型洛伐他汀在0.02%-0.08%范围内。结论：本文建立的方法操作简单、准确可靠、重复性良好,可用于控制青稞红曲质量。     

Syphilis and vision loss: A role for point-of-care ultrasound

Vision loss in young adults is relatively rare. In patients with suspected HIV or syphilis, the risk of developing vision loss is increased, and should alert the emergency physician of specific retinal pathologies. We present a case of a 33-year-old man with recently identified syphilis and HIV, who was diagnosed with bilateral retinal detachments (RDs) with the help of point-of-care ultrasound (POCUS) in the setting of panuveitis (preventing visualization with direct fundoscopy).     

Infections caused by aterial catheters used for hemodynamic monitoring

Utilizing a semiquantitative technique for culturing vascular catheters, we prospectively studied the risk and profile of infection caused by arterial catheters used for hemodynamic monitoring in 95 patients with a high risk of nosocomial infection. Of 130 catheters, 23 (18 per cent) produced local infection (larger than or equal to 15 colonies on semi-quantitative culture) and five septicemia (4 per cent). Sixteen of the 23 local infections and all septicemias occurred with catheter placements exceeding four days (p less than 0.001). Other factors associated with an increased risk of infection included insertion by surgical cut-down rather than percutaneously (ninefold increased rate of bacteremia, p = 0.008) and the presence of local inflammation (12-fold increase, p = 0.009). Systemic antimicrobial therapy (given to 80 per cent of the entire group and to four of the five with septicemia) did not protect against catheter-related infection but may account for the predominance of enterococci, Candida and gram-negative bacilli in these infections. Twelve per cent of all nosocomial bacteremias occurring in this critical care unit population originated from an arterial catheter. Indwelling arterial catheters pose a significant risk of bacteremic infection to ctirically ill patients. The percutaneous mode of placement is preferred; when prolonged arterial cannulation is required, the site should be rotated every four days. Local pain or inflammation, or clinical signs of sepsis without an obvious source should prompt removal and culture of the catheter.     

海拔5000m以上驻防官兵卫生保健认知调查分析

目的调查海拔5 000 m以上驻防官兵高原卫生保健认知情况,为加强官兵自我保健提供参考。方法采用问卷对高原驻防官兵进行调查,内容主要包括健康自我评价、特需药品使用状况及官兵吸氧现状。结果官兵的健康自我评价优良以上人数比例为60.8%,保健认知评价优良以上人数比例仅为29.0%,坚持每天吸氧人数比例为14.8%;能罗列出3种以上高原特需药品的人数比例仅占34.1%。结论海拔5 000 m以上驻防官兵的高原卫生保健认知一般,应该采取多种措施,提高官兵主动保健意识及健康水平。     

高原不同人群血液流变学指标改变及血液粘度的调节

目的 :观察高原不同人群血液流变性特点 ,探讨低氧环境下人体血液粘度调节机制。方法 :对高原红细胞增多症 (简称高红症 )患者及不同居住时间和不同种族人群进行血液流变学相关指标检测和分析。结果 :高红症患者、汉族久居高原人群和藏族世居人群反映红细胞聚集性和变形性的相关指标较对照组明显下降 ,组织供氧指数、红细胞压积和平均红细胞体积均显著高于对照组。结论 :高原低氧环境下 ,人体通过改变红细胞功能和形态等方式 ,代偿性调节因红细胞压积增高引起的血液粘度的过度升高 ,有助于维持组织的正常供氧     

Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis

Objective

We evaluated images of patients undergoing a thoracic endovascular aortic repair procedure using two reference points as a means for differentiating stent graft migration from aortic elongation. Conventional standards define migration of a stent graft as an absolute change in the distance from the distal graft ring to a distal landmark ≥10 mm compared with a baseline measurement. Aortic elongation occurs over time in both healthy individuals and patients with aortic disease. Aortic elongation in patients with stent grafts may result in increased distal thoracic aortic lengths over time. False-positive stent graft migration would be defined when these patients meet the standard definition for migration, even if the stent has not moved in relation to the elongating aorta.

复方红景天参芪花粉制剂防治高原大鼠严重烧伤后早期肝损害的实验研究

目的：观察大鼠高原烧伤后，复方红景天参芪花粉制剂（RACC）对早期肝损害的防治作用，方法：在3480m高原成功复制大鼠30％Ⅲ度烧伤模型，104只大鼠随机分为试验组，对照组和正常组，实验组伤后采用RACC灌胃，对照组则用生理盐水灌胃，在伤后不同时相点测定血清GPT，GOT和总胆红素变化。结果：伤后3h，试验组，对照组血清GPT，GOT及总胆红素水平均显著高于正常组（P＜0．01），伤后48h和72h上述指标均接近正常，但试验组较对照组各项指标明显偏低，结论：RCC可对烧伤后肝功能损害成功一定的保护作用，具有一定的临床意义。     

高原旅客列车客运乘务员职业健康状况评价

目的评价高原旅客列车客运乘务员频繁往返高原17个月后的职业健康状况。方法对248名乘务员的3次体检结果资料进行分析评价,主要评价指标包括收缩压、舒张压、血氧饱和度、右心室流出道、右心室内径（左右径）、右肺下动脉干横径、动脉干横径与气管径比值、肺活量、实测值,预期值、红细胞、血红蛋白、红细胞压积等。结果与高原心脏病、高原红细胞增多症等相关的主要生理指标发生了一定的代偿性变化。岗前和第2次岗间体检各项指标比较中,血压、血氧饱和度、右心室流出道、右肺下动脉干横径、右肺下动脉干横径与气管横径比值、室间隔厚度、肺活量、实测值,预期值、血红蛋白指标比较差异有统计学意义;血氧饱和度、心电图、肺活量、实测值,预期值、红细胞压积在第2次体检中的异常发生率分别为4．84％、3．23％、14．92％、8．87％和20．97％,均高于第1次岗间体检。结论在目前的交路和高原工作强度下,高原值乘17个月后,乘务员的健康状况基本良好。