干扰素联合炎琥宁治疗小儿手足口病的临床效果评价

目的 探究干扰素联合炎琥宁治疗小儿手足口病的效果观察.方法 选取2016年4月—2019年3月医院收治的手足口病患儿104例,依随机数字表分为参照组和干预组,各52例.参照组患儿应用干扰素治疗,干预组患儿加用炎琥宁治疗.观察两组患儿的治疗效果、临床症状消退时间、黏附分子表达量和心肌酶水平.结果 干预组患儿治疗总有效率为90.38%,明显高于参照组患儿的75%;干预组患儿发热、口腔溃疡和手足皮疹的消退时间均明显短于参照组患儿(P<0.05);两组患儿治疗后的CD44、ICAM-1、VCAM-1、CK、LDH和CK-MB水平均明显低于治疗前水平(P<0.05),且干预组患儿治疗后的CD44、ICAM-1、VCAM-1、CK、LDH和CK-MB水平均明显低于参照组患儿治疗后水平(P<0.05).结论 干扰素联合炎琥宁治疗小儿手足口病的效果显著.     

糖尿病患者饥饿感中医病机浅识

糖尿病患者饥饿感病机有胃火炽盛、胃强脾弱、脾胃虚弱、瘀热消谷、痰热消谷等。糖尿病初期,痰热、火热之证常见,患者出现多食易饥表现,应考虑痰热消谷、火热消谷,选用白虎汤、玉女煎、消渴方等加减治疗;病程日久,火热伤阴,壮火食气,出现气阴两虚等表现,此时出现多食易饥症状,则需考虑胃强脾弱、脾胃虚弱等病机,采用半夏泻心汤、附子理中丸、参苓白术散等治疗;瘀血贯穿糖尿病始终,故在使用以上方法治疗糖尿病患者消谷易饥效果欠佳时,可考虑瘀热消谷的因素,采用桃核承气汤、白虎汤合桂枝茯苓丸治疗。糖尿病与痰湿关系密切,针对该病机引起的饥饿感,在清热的同时,还应化痰除湿。糖尿病病程日久患者,饥饿感病机复杂,宜"观其脉证,知犯何逆,随证治之"。     

Influence of Orientation and Radiative Heat Transfer on Aluminum Foams in Buoyancy-Induced Convection

Two differently-produced open-cell aluminum foams were compared to a commercially available finned heat sink. Further, an aluminum plate and block were tested as a reference. All heat sinks have the same base plate dimensions of four by six inches. The first foam was made by investment casting of a polyurethane preform and has a porosity of 0.946 and a pore density of 10 pores per linear inch. The second foam is manufactured by casting over a solvable core and has a porosity of 0.85 and a pore density of 2.5 pores per linear inch. The effects of orientation and radiative heat transfer are experimentally investigated. The heat sinks are tested in a vertical and horizontal orientation. The effect of radiative heat transfer is investigated by comparing a painted/anodized heat sink with an untreated one. The heat flux through the heat sink for a certain temperature difference between the environment and the heat sink’s base plate is used as the performance indicator. For temperature differences larger than 30 ^°C, the finned heat sink outperforms the in-house-made aluminum foam heat sink on average by 17%. Furthermore, the in-house-made aluminum foam dissipates on average 12% less heat than the other aluminum foam for a temperature difference larger than 40 ^°C. By painting/anodizing the heat sinks, the heat transfer rate increased on average by 10% to 50%. Finally, the thermal performance of the horizontal in-house-made aluminum foam heat sink is up to 18% larger than the one of the vertical aluminum foam heat sink.     

椎体成形术并补肾壮骨汤治疗骨质疏松性椎体压缩骨折

目的 观察经皮椎体成形术 (PVP)配合补肾壮骨汤治疗骨质疏松性椎体压缩骨折的疗效.方法 42例(共60个椎体)骨质疏松性椎体压缩性骨折患者,随机分成治疗组 21例和对照组 21例,治疗组采用 PVP加补肾壮骨汤治疗,对照组只采用PVP治疗.分别在术前、术后 8个月对患者的骨密度、疼痛、有无相邻椎体新发骨折进行分析.结果 手术均顺利完成,并无严重并发症发生.随访 12~20个月,平均15个月,治疗组疗效明显优于对照组,两组差异有统计学意义 (P<0.05);治疗组治疗后椎骨密度增加显著 (P<0.01),治疗后两组间椎骨密度比较,差异有统计学意义 (P<0.01).结论 经皮椎体成形术后配合补肾壮骨汤,对患者的骨量增加、预防再新发骨折等方面,有较好效果.     

Mechanical support of the heart

Mechanical support of the heart can be offered to patients who are refractory to pharmacological treatment, therapy for coronary or valvular disease or resynchronization therapy. Ventricular assist devices enable end-organ perfusion in the setting of heart failure. This can be temporary (as a bridge to recovery or transplantation) or permanent (destination therapy). Devices can be extracorporeal or implanted, and generated flows can be pulsatile or non-pulsatile. Implantation usually requires sternotomy with or without cardiopulmonary bypass, but percutaneous devices exist. Cardiostable anaesthesia with inotropic support is vital. Problems include bleeding versus thrombosis, high pulmonary vascular resistance, right heart failure and late infections. Transoesophageal echocardiography can be used to detect potential right-to-left atrial shunts, aortic regurgitation and cannula malposition, and to monitor filling and right ventricular function after implantation. In the future, total implantability of the devices, including the power source, is likely to occur. Eventually, they are likely to become a widespread alternative to transplantation.     

眶内异物强力磁铁在眼眶深部磁性异物取出术中的应用

目的:探讨眼眶深部磁性异物摘出术中眶内异物磁铁应用的手术方法和治疗效果.方法:回顾性分析河北省眼科医院2014-06/2017-05眼眶深部磁性异物住院患者23例23眼的临床资料,其中肌锥外眶内异物14眼,眼球后肌锥内异物9眼.应用眶内异物强力磁铁摘出眶内深部磁性异物,观察异物摘出成功率和术后并发症情况.结果:肌锥内异物9眼均顺利摘出,成功率100%;14眼肌锥外眶内异物者中摘出异物12眼,成功率86%.术后轻度眶内出血2眼,未发生视力下降、眶内大量出血、眼球运动受限等并发症.结论:眼眶深部磁性异物应用眶内异物强力磁铁进行手术,手术创伤小、成功率高、时间短、并发症少.     

Rapid and Efficient Enrichment of Snake Venoms from Human Plasma Using a Strong Cation Exchange Tip Column to Improve Snakebite Diagnosis

Snake envenomation is a serious public health issue in many tropical and subtropical countries. Accurate diagnosis and immediate antivenom treatment are critical for effective management. However, the venom concentration in the victims’ plasma is usually low, representing one of the bottlenecks in developing clinically applicable assays for venom detection and snakebite diagnosis. In this study, we attempted to develop a simple method for rapid enrichment of venom proteins from human plasma to facilitate detection. Our experiments showed that several major protein components of both Naja atra (N. atra) and Bungarus multicinctus (B. multicinctus) venoms have higher isoelectric point (pI) values relative to high-abundance human plasma proteins and could be separated via strong cation exchange–high-performance liquid chromatography (SCX-HPLC). Based on this principle, we developed an SCX tip column-based protocol for rapid enrichment of N. atra and B. multicinctus venom proteins from human plasma. Application of liquid chromatography-tandem mass spectrometry (LC-MS/MS) led to the identification of cytotoxin and beta-bungarotoxin as the major proteins enriched by the SCX tip column in each venom sample. The entire process of venom enrichment could be completed within 10–15 min. Combination of this method with our previously developed lateral flow strip assays (rapid test) significantly enhanced the sensitivity of the rapid test, mainly via depletion of the plasma protein background, as well as increase in venom protein concentration. Notably, the SCX tip column-based enrichment method has the potential to efficiently enrich other Elapidae snake venoms containing proteins with higher pI values, thereby facilitating venom detection with other assays. This simple and rapid sample preparation method should aid in improving the clinical utility of diagnostic assays for snakebite.     

强离子隙在特发性肺纤维化患者中的水平改变及临床意义

目的探讨强离子隙(strong ion gap,SIG)水平在特发性肺纤维化(Idiopathic pulmonary fibrosis,IPF)患者血清中的改变及其与呼吸功能的相关性。方法 2012年1月至2013年6月我院55例IPF患者,根据是否使用家庭呼吸机氧疗分为康复组(35例)和观察组(20例),两组患者随访定期复查肺功能,在测定血气、电解质等的基础上,应用Stewart-Figge方程式计算SIG。综合比较两组患者各项指标和存活率情况。结果 FCV方面,观察组患者FVC水平表现持续下降趋势,由入选时的(2.89±0.43)L,逐渐下降至随访24月时的(2.35±0.55)L(P0.05),下降程度明显高于康复组,尤其是第18个月(P0.05)。DLco方面,观察组表现出持续下降趋势,由入选时的(14.2±3.1)ml/(min×mm Hg),逐渐下降至随访24月时的(9.5±1.6)ml/(min×mm Hg)(P0.05)。在6分钟步行试验,观察组DLco水平表现出持续下降趋势,由入选时的(369.3±69.2)m,至随访24月时的(243.5±61.98)m(P0.05),而康复组可见第6个月(375.3±29.1)m和第12个月(383.6±35.1)m的短暂升高趋势,各个时间点数据均优于观察组(P0.05)。在SIG方面,观察组患者SIG水平波动变化不大,随访后的各个时间点均明显高于康复组(P0.05)。经Pearson直线回归分析,SIG与第12个月的DLco和第12和18个月的6分钟步行实验呈中等正相关(rDLco(12)=0.369,PDLco(12)0.05;r6mwt(12)=0.404,P6mwt(12)0.05;r6mwt(18)=0.338,P6mwt(18)0.05)。结论 IPF患者血清SIG水平明显升高,且随着肺功能恶化程度的加重而升高,与DLco和6分钟步行试验存在一定的相关性,对IPF患者风险评估及治疗评价均具有指导意义。