生理性溶液对角膜上皮细胞微绒毛的影响

扫描电镜下观察了生理盐水、Hanks液及平衡盐溶液(BSS)以滴速30滴/分滴浴0.5～3小时的兔眼角膜上皮细胞微绒毛的变化。生理盐水滴浴0.5小时,角膜上皮微绒毛减少并皱缩成圆钮状;Hanks液及BSS滴浴1.5～3小时,大部分角膜上皮细胞的微绒毛保持正常的细长指状,偶见上皮细胞的微绒毛皱缩变短或呈簇状。讨论了生理性溶液对角膜上皮细胞微绒毛影响的意义。     

幼儿园健康儿童中空肠弯曲菌的带菌情况调查

于1985年6~7月对重庆郊区11所幼儿园中无腹泻的856名6岁以内健康儿童进行空肠弯曲菌带菌调查,阳性检出率为2.92%,无年龄,性别的显著差异。粪便排菌绝大多数4周内转阴性,个别儿童持续排菌在一月以上,未发现慢性带菌的案例。     

视网膜分支静脉阻塞和新生血管形成

分析视网膜分支静脉阻塞240例245只眼(5人为双眼)，其中主干分支阻塞208只眼，黄斑分支阻塞37只眼。79只眼产生了新生血管，占总数的32.2%，占主干分支阻塞的37.9%．玻璃体出血39只眼，占分支阻塞的15.9%，占新生血管的49.4%。新生血管的危险因素是无灌注区形成、动脉灌注不良、阻塞处静脉严重受压．新生血管的发生随病程时间延长而增高，病程5年以上者高达83.3%。分支静脉阻塞盲目者20只眼占8.2%，其中因新生血管及并发症致盲者14只眼，占盲目的70%，占分支静脉阻塞的5.7%. （中华眼底病杂志，1994，10：67-70）     

A Study of Hemorrheologic Changes in Patients with Severe Viral Hepatitis

The study of the micro and macro-hemorrheologic changes and theflow conditions of the nail-fold microcirculation in 30 patients with severe viralhepatitis was reported.Normal individuals,and patients with acute icterichepatitis or chronic active hepatitis were employed as the controls.The changes observed in the patients with severe viral hepatitis were asfollows:The reduced viscosity of the whole blood and the plasma viscosityincreased markedly;the dispersion rate of the values of blood viscosity increasedas the clinical state of the patient became worse;and the factors increasing theblood viscosity(i.e.increase of the immuno-globulin level,prolongation of theerythrocyte electrophoretic mobility time,and increase of RBC sedimentation rate)and those decreasing the blood viscosity(i.e.decrease of hematocrit reading,fibrinogen level and platelet aggregation ratio)existed simultaneously in thepatient.The changes of the flow conditions of the nail-fold microcirculation werein close correlation with the increase of blood viscosity and the severity of thedisease.The etiology and mechanism of the above mentioned changes were discussed     

急性非结石性胆囊炎病因和手术时机探讨

目的 探讨急性非结石性胆囊炎(ACC)发病原因和手术时机。方法 回顾性总结22例接受手术治疗的ACC病例，分析术前、术中影像学及术后病理检查结果。结果 22例中有9例(40．9％)发现胆固醇息肉、颗粒，或结晶。术中见胆囊穿孔5例(22．7％)。2例在胆总管内发现漂浮的微小结石。结论 胆囊内未被发现的微小结石可能是ACC发病的主要原因，ACC穿孔率高，应早期手术治疗。     

地塞米松对肺癌切除术病人血清过氧化脂质胰岛素皮质醇的影响

４０例肺癌切除术病人，随机分为对照（Ｓ）组和地塞米松（Ｓ－Ｄ）组，采用氯胺酮－安氟醚静吸复合麻醉，对血清中过氧化脂质、胰岛素和皮质醇进行了初步观察。结果表明，血清过氧化脂质Ｓ－Ｄ组于手术毕显著低于Ｓ组（Ｐ〈０．０５）；血清胰岛素两组间没有统计学差异；血清皮质醇Ｓ－Ｄ组于气管插管后显著高于Ｓ组（Ｐ〈０．０５）。作者认为肺癌切除术病人术前给地塞米松可有效地降低血清中过氧化脂质含量，利于维护脏器功能。     

Penetration moxibustion for postpartum subinvolution of uterus: Two case reports and mechanism analysis: 透灸法成功治疗产后子宫复旧不良:两则病例报告及机制分析

This article introduced the application of penetration moxibustion in successfully treating two cases of postpartum subinvolution of uterus. The main complaint of one case was increasing volume of abnormal vaginal bleeding for five days after delivery. The bleeding stopped after the patient received 7 times treatment of warming needle and penetration moxibustion on Zhōngjí (中极CV3), Guānyuán (关元CV4) and Qìhăi (气海CV6). The other case complained about persistent abdominal pain for 15 days, which was worsening for the recent 2 days. The symptom of abdominal pain was relieved after the penetration moxibustion was applied on CV4, CV6 and Zǐgōng (子宫 EX-CA1) for 5 times for the case. Penetration moxibustion can relieve abdominal pain during the postpartum period, accelerate lochia discharge, and recovery of menstrual and uterine cavity. Àiyè (艾叶 Artemisiae Argyi Folium) was proved to have antibacterial, hemostatic, and analgesic effects. The warming function and radiation features of moxibustion can help to alleviate spasm of the smooth muscle in the uterus and enhance the metabolism of the uterine tissue by expanding microvessels and improving the circulations of both blood and lymph. It can also activate cells in the uterine tissue by increased temperature in order to enhance the decomposition and elimination of pathological wastes, such as inflammation and hematoma. In addition, it can also relieve pelvic pain by inhibiting neuronal excitability.     

Evaluation of high protein intake to improve clinical outcome and nutritional status for patients with burns: a systematic review

Background and aimPatients with severe burns undergo a local and systemic response to the injury. As part of this response the patient becomes hypermetabolic. Current guidelines advise high protein intakes to counteract the catabolic response to burns, but this appears to be based on minimal experimental evidence. Hence the aim of this review was to examine the evidence for improvements in nutritional status and clinical outcome with the administration of high protein intakes for patients with burns.MethodsEight databases were searched for clinical trials with burn patients receiving two or more levels of protein intake at or above the level recommended for healthy individuals (0.75 g/kg/d) and presenting results for at least one of the following pre-defined outcomes: nitrogen balance, length of stay, weight change, survival, physical therapy index, protein fractional synthetic rate, immunological measurements, bacteraemic days, systemic antibiotic days and net protein synthesis.ResultsSix studies were included, 4 of which were randomized trials. All had major methodological limitations, in particular none was blinded. There was too much heterogeneity in study design, patient characteristics and the timing and magnitude of the interventions to justify formal meta-analysis. There was no reliable evidence of improvement in nitrogen balance, but there was some evidence of increased weight gain on higher protein diets. One small study reported an increase in survival and significant improvements in infection rates and some indicators of immune function in children. Length of stay was not significantly improved. There was weak evidence of an improvement in muscle strength and endurance but no significant increase in protein synthesis in muscle or skin, or net protein synthesis in the whole body.ConclusionThere is currently only very weak evidence to justify administering high protein diets to patients following burns.     

Adoption of rescue colloid during burn resuscitation decreases fluid administered and restores end-organ perfusion

IntroductionTraditionally, lactated Ringer’s solution (LR) has been utilized for the resuscitation of thermally injured patients via the Parkland or Brooke formulas. Both of these formulas include colloid supplementation after 24 h of resuscitation. Recently, the addition of albumin within the initial resuscitation has been reported to decrease fluid creep and hourly fluids given. Our institution has previously advocated for a crystalloid-driven resuscitation. Given reports of improved outcomes with albumin, we pragmatically adjusted these practices and present our findings for doing so.MethodsOur burn registry, consisting of prospectively collected patient data, was queried for those at least 18 years of age who, between July 2017 and December 2018, sustained a thermal injury and completed a formal resuscitation (24 h). At the attending physician’s discretion, rescue colloid was administered using 25% albumin for those failing to respond to traditional resuscitation (patients with sustained urine output of <0.5 mL/kg over 2–3 h, or unstable vital signs and ongoing fluid administration). We compared the total volume of the crystalloid-only and rescue colloid resuscitation fluids given to patients. We also examined the in/out fluid balances during resuscitation. Statistical analysis was performed using Stata software.ResultsA total of 91 patients with thermal injuries were included: the median age was 40 (IQR 31–57), 73% were male, and 30 patients received rescue albumin. The percentage of total body surface area burned (%TBSA) was greater in those who received rescue albumin (40.3% vs. 34%; p = 0.047). Despite a higher %TBSA in the albumin group, the total LR given during resuscitation was not significantly different between groups (15,914.43 mL vs. 11,828.71 mL; p = 0.129) even when normalized for TBSA and weight (ml LR/kg/%TBSA: 4.31 vs. 3.66; p = 0.129. The average in/out fluid ratio for the rescue group was higher than for the crystalloid group (0.83 ± 0.05 vs. 0.59 ± 0.11; p = 0.06) and returned to normal after colloid administration.ConclusionRescue albumin administration decreases the amount of fluid administered per %TBSA during resuscitation, and also increases end organ function as evidenced by increased urinary output. These effects occurred in patients who sustained larger burns and failed to respond to traditional crystalloid resuscitation. Our findings led us to modify our current protocol and a related prospective study of clinical outcomes.     

以骨间背侧动脉为蒂逆行岛状皮瓣的应用解剖学

在60侧灌注血管染料的新鲜成人上肢标本上,观察了骨间背侧血管在前臂背侧的起点、走行和分支,发现该动脉终末支在腕上2.5cm 水平,与骨间掌侧动脉背侧支之间有恒定的吻合支相连,并以此吻合支为蒂,设计了前臂骨间背侧血管逆行岛状皮瓣。