瓦氏动作在脑血流自动调节功能中的应用

CA是指脑血流在动脉血压和脑灌注压发生改变时保持相对稳定的一个复杂的多因素过 程。脑血流自动调节与多种神经系统疾病如脑血管病、帕金森病、头痛、自主神经功能障碍等疾病的 发生、发展及临床预后相关。对脑血流自动调节功能有很多种评估测量方法，监测瓦氏动作所诱导 的血压变化更具有操作性及标准化，适用于各种人群，其安全、简单、准确的特点使其在脑血流自动 调节中运用十分广泛。本文重点对瓦氏动作在脑血流自动调节功能中的应用做一个综述介绍。     

Early Diagnosis of a Pediatric Pancreatic Tumor by Abdominal Physical Examination: A Case Report

BackgroundDetecting a neoplasm in pediatric patients with acute abdominal pain is difficult, especially when there is no palpable mass. Ihara's maneuver, which allows the physician to apply manual pressure directly on the pancreatic body, is a useful palpation method of diagnosing acute pancreatitis in children. We report a case of solid pseudopapillary neoplasm of the pancreas (SPNP) detected by Ihara's maneuver.Case ReportAn otherwise healthy, 15-year-old male visited our emergency department with acute abdominal pain and nausea. His vital signs were appropriate for his age. A physical examination denied peritoneal signs, but Ihara's maneuver induced strong tenderness. His serum amylase and lipase were normal. A contrast-enhanced computed tomography scan revealed a well-defined, 2.2-cm, nonenhanced mass in the pancreatic tail. Laparoscopic distal pancreatectomy was performed, and the diagnosis of SPNP was confirmed. The patient was well postoperatively without any metastasis. SPNP is a rare neoplasm with low malignant potential. Although it typically occurs in young females, it has also been reported in children. The early diagnosis of SPNP is usually challenging because most patients do not have specific symptoms or laboratory findings. In the present case, the SPNP was difficult to detect by palpation because of its size, but Ihara's maneuver induced strong tenderness of the pancreas and led to a diagnosis.Why Should an Emergency Physician Be Aware of This?Ihara's maneuver has the potential to enable early diagnosis not only of pancreatitis but also of pancreatic tumors, such as SPNP.     

The effect of level of injury and physical activity on heart rate variability following spinal cord injury

Objective/Background: To assess frequency domain heart rate variability (HRV) parameters at rest and in response to postural autonomic provocations in individuals with spinal cord injury (SCI) and investigate the autonomic influences on the heart of different physical activities.

Design: Cross-sectional study.

Methods: Ten subjects with complete cervical SCI and fourteen subjects with complete low thoracic SCI were prospectively recruited from the community and further divided in sedentary and physically active groups, the latter defined as regular weekly 4 hour physical activity for the preceding 3 months. Sixteen healthy individuals matched for sex and age were recruited to participate in the control group. The Low Frequency (LF), High Frequency (HF) powers and the LF/HF ratio of HRV were measured from continuous electrocardiogram (ECG) recordings at rest and after sitting using a fast Fourier transformation.

Outcome measures: The LF,HF, and the LF/HF ratio at rest and after sitting.

Results: A significant decrease in all HRV parameters in patients with SCI was found compared to controls. The change in HF, LF and LF/HF following sitting maneuver was significantly greater in controls as compared with the SCI group and greater in subjects with paraplegia as compared to subjects with tetraplegia. Better HRV values and enhanced vagal activity appears to be related to the type of physical activity in active subjects with paraplegia.

Conclusion: In this cohort of subjects spectral parameters of HRV were associated with the level of the injury. Passive standing was associated with higher HRV values in subjects with paraplegia.     

Effect of the Mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia

ObjectiveWe investigated the effect of the Mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia.MethodsWe randomly classified 214 patients with senile vascular dementia and swallowing dysfunction into a control group (CG, n = 106) and observation group (OG, n = 108). Both groups underwent health education, psychological intervention, and training of the oral muscle group. The OG additionally underwent the Mendelsohn maneuver and swallowing training. The Hasegawa Dementia Scale (HDS), China Stroke Scale (CSS), and Neurobehavioral Cognitive Status Examination (NCSE) were used to evaluate dementia, neurological impairment, and cognitive dysfunction, respectively.ResultsThe OG had a higher rate of effective therapy than the CG. After intervention, the OG showed better swallowing function than the CG. At 15 days and 1 month after intervention, the OG had higher video fluoroscopic swallowing exam scores than the CG. The OG had lower serum interleukin (IL)-1, IL-6, and tumor necrosis factor-α levels than the CG. After intervention, the OG had higher HDS and NCSE scores and lower CSS scores than the CG.ConclusionsThe Mendelsohn maneuver and swallowing training can improve swallowing function in patients with senile vascular dementia complicated with dysphagia and help to ameliorate the inflammatory response.     

离心机模拟连续推拉动作训练方法研究

目的建立贴近实战化训练模式的连续推拉动作(PPM)离心机训练方法。方法调研提炼飞行训练中典型的PPM载荷参数,编制离心机模拟连续PPM曲线。16名战斗机飞行员作为志愿者,A组6名,采用-1Gz/3s→+6Gz/10s→2Gz/10s→0Gz/3s→+4.5Gz/10s→2Gz/10s→0.5Gz/3s→+5 Gz/10s连续PPM曲线,B组10名,采用-1Gz/3s→+6Gz/10s→2Gz/10s→0Gz/3s→+4.5Gz/10s→2Gz/10s→-1Gz/3s→+7Gz/5s连续PPM曲线(根据A组建议对曲线进行了改进),进行了HP动作对抗连续PPM离心机训练。志愿者在相对-Gz(小于+1Gz)暴露时采用HP动作的呼吸方式,在向+Gz转换时开始做较用力的HP动作,记录分析+Gz耐力、心率(HR)等指标的变化。结果A组6名志愿者均完成了连续PPM离心机训练,对PPM曲线提出了改进建议。B组9名志愿者采用改进的连续PPM曲线完成离心机训练。两组在相对-Gz时的HR均显著高于安静状态(P<0.05),连续PPM暴露时的HR变化趋势说明心血管调节有持续效应,其适应负荷有滞后。结论建立了高性能战斗机飞行员连续PPM离心机训练方法,模拟连续PPM曲线中不同水平-Gz与+Gz交替作用的模式更能体现实战化训练中长时间反复空战的特点,将应用于后续飞行员离心机训练。     

中俄院校卫勤演习的比较研究

介绍了我校和俄罗斯基洛夫军事医学院的卫勤演习情况,然后针对卫勤演习的构成要素,如演习类型、演习课目、参演对象、演习导调和保障基地等进行了对比分析。在此基础上,从调整参演对象、改变演习时机、改革演习导调、加强基地建设等方面,对我军院校卫勤演习提出了建议。