一氧化氮吸入联合药物及机械通气治疗海水淹溺肺水肿的临床研究

目的观察低浓度一氧化氮(NO)吸入联合3种药物及机械呼吸末正压通气治疗海水淹溺肺水肿的临床疗效。方法常规治疗组15例,无创性鼻／面罩双水平气道正压(BiPAP)通气,加东莨菪碱、纳络酮、甲基强的松龙治疗;综合治疗组12例,在常规治疗组基础上,一次性吸入0．002% NO气体30 min;比较两组病例肺部哕音、X片胸部阴影消失时间以及病程。结果综合治疗组肺部I罗音消失时间为(0．70±0．56)d,X片胸部阴影消失时间为(0．58±0．13)d,病程(2．50±1．30)d,常规治疗组分别为(2．15±1．66)d、(5．21±0．50)d、(5．80±3．00)d,差异有统计学意义(分别为P<0．05,P<0．01, P<0．01)。综合治疗组吸入NO前后SaO2值分别为79．0％±8．7％和90．0％±5．5％,两组比较差异有统计学意义(t=3．72,P<0．01)。结论短时间吸入低浓度NO联合3种药物及机械呼吸末正压通气治疗海水淹溺肺水肿,能迅速改善低氧血症和肺水肿,是一种有效、安全的方法。     

左旋精氨酸治疗高原肺水肿疗效观察

在海拔 370 0m高度采用静脉滴注左旋精氨酸 (L Arg)治疗高原肺水肿患者 10例 ,并与吸入一氧化氮 (NO)混合气体治疗的 11例和常规治疗的 2 4例作对照。NO组肺部湿音和X线阴影消失时间较精氨酸组缩短 (P <0 .0 1) ,但病程日差异无显著性意义 (P >0 .0 5 ) ;常规组肺部湿音和X线阴影消失时间及病程日较NO组延长 (P <0 .0 5或P <0 .0 1) ;精氨酸组肺部X线阴影消失时间和病程日较常规组缩短 (P <0 .0 1)。作者认为 ,静脉滴注L Arg治疗高原肺水肿经济简便、无毒性 ,便于基层推广应用。     

特布他林对海水淹溺性肺水肿兔的治疗作用

目的观察特布他林对海水淹溺性肺水肿（PE-SWD）的治疗作用。方法将24只新西兰兔制作成海水淹溺性肺水肿机械通气模型，随机分成对照组（C组）和特布他林治疗组（T组）。在不同时间点观察动脉血气分析、呼吸动力学指标。同时检测两组的血管外肺水含量指数（EVLWI）、伊文思兰漏出（ELI）指数、肺泡灌洗液中TNF-α和中性粒细胞计数及肺组织匀浆Na^＋ -K^＋ -ATP酶活性，并进行病理学检查。结果特布他林治疗后PE—SWD兔血氧分压（PaO2）、二氧化碳分压（PaCO2）、呼吸动力学指标等均较对照组有明显改善（P〈0．05）。T组EVLWI、ELI及肺泡灌洗液中TNF-α、中性粒细胞计数均低于C组（P〈0．05），而肺组织匀浆Na^＋ -K^＋ -ATP酶活性明显高于C组。结论特布他林可改善海水淹溺所致的低氧血症，减轻肺水肿。     

两种机械通气方式在兔海水型肺水肿中的应用比较

目的　观察不同通气方式对海水淹溺型肺水肿的救治作用。方法　应用常规机械通气和高频喷射通气对 4 2只海水淹溺型肺水肿兔进行分组救治。不同时间点观察血气分析、呼吸动力学、血流动力学、肺损伤指标 ,并进行病理学检查和观察存活时间。结果　两种通气方式治疗后血氧分压、血氧饱和度、二氧化碳分压均较未治疗组有明显改善 (P <0 .0 1) ,呼吸动力学、血流动力学异常得到一定程度纠正 ,肿瘤坏死因子 α、肺泡灌洗液中性粒细胞计数等肺损伤指标也显示通气治疗后肺损伤情况减轻。两种通气方式之间比较显示常规机械通气较高频喷射通气治疗能更好地改善海水淹溺型肺水肿时的低氧情况。结论　常规机械通气和高频喷射通气治疗海水淹溺型肺水肿时低氧血症均取得满意效果 ,并减轻了肺损伤的程度。     

静滴精氨酸治疗高原肺水肿对比观察

目的：研究静脉滴注左旋精氨酸（L－arg)对高原肺水肿的治疗价值;方法：75例高原肺水肿患者随机分为3组,硝苯吡啶组（24例）,口服硝苯吡啶、吸氧、静脉注射速尿、氨茶碱和地塞米松治疗;一氧化氮（NO）组（25例）,在硝苯吡啶治疗的基础上一次性吸入10ppmNO30分钟;精氨酸组（26例）,在硝苯吡啶治疗的基础上,以L－arg 20g加入5％葡萄糖溶液500ml,一次性4h静脉滴注,比较各组病例肺部罗音、X线胸片阴影消失时间及病程长短;结果：精氨酸组肺部湿性罗音消失时间较NO组长,较硝苯吡啶组短,差异显著（P＜0．05）;精氨酸组肺部X线阴影消失时间及病程时间较NO组长,较硝苯吡啶组短,差异非常显著（P＜0．01或P＜0．001）;结论：静脉滴注L－arg是治疗高原肺水肿比较有效的方法。     

海水淹溺型肺损伤与淡水淹溺型肺损伤特征的比较

目的 通过复制海水和淡水淹溺型急性肺损伤大鼠模型,比较海水淹溺与淡水淹溺造成的急性肺损伤的特征与区别.方法 90只大鼠用随机数字法分为3组,即对照组、淡水淹溺组和海水淹溺组,每组在吸入淡水或海水后30min、1、2、4、8h时间点进行观察,每个时相点取6只大鼠用于实验.气管内灌注淡水或海水4ml/kg,建立急性肺损伤模型,分别检测动脉血气分析、肺湿/干重比值(W/D)、肺微血管通透性(PVMP)、血清及支气管肺泡灌洗液(BALF)中肿瘤坏死因子α(TNF-α)的含量,并观察肺组织病理变化.结果 大鼠吸入淡水或海水后,动脉血氧分压(PaO2)明显降低(P<0.05),海水淹溺组比淡水淹溺组降低更为明显(P<0.05).海水淹溺组和淡水淹溺组大鼠的肺W/D值、肺PMVP、血清和BALF中TNF-α含量均明显高于对照组(P<0.05),海水淹溺组较淡水淹溺组升高更明显(P<0.05).病理观察显示,海水淹溺组可见肺间质和肺泡水肿,肺组织灶性出血,并有以中性粒细胞为主的炎性细胞浸润;淡水淹溺组病理学改变与海水淹溺组相似,但损伤程度较轻.结论 海水淹溺较淡水淹溺所引起的肺微血管通透性增加更为明显,低氧血症、肺水肿和炎症反应更严重.     

山莨菪碱对海水淹溺兔外周血单核细胞NF-κB表达的干预作用

目的：探讨山莨菪碱对海水淹溺后兔外周血中单核细胞核转录因子κB（NF-κB）的表达以及海水淹溺性肺水肿（PE-SVCD）治疗作用。方法：家兔气管切开后模拟海水淹溺造成急性肺损伤,于淹溺前（T1）,淹溺后15、30、60、120、240、480min（T2～T7）7个时间点采集外周血进行血气分析,并测定外周血炎症介质含量和单核细胞中NF-κB的淹溺前后表达变化,并采集肺组织。结果：海水淹溺致兔急性肺损伤各时间点肺组织中性粒细胞大量浸润,淹溺后外周血单核细胞NF-κB的表达开始增高,90 min后达到最高峰,而山莨菪碱可降低NF-κB以及炎症因子表达（P〈0.01）。结论：海水淹溺急性肺损伤可能与NF-κB高表达有关。山莨菪碱可降低NF-κB表达,减轻肺损伤程度。     

气管内灌注海水对犬血浆电解质的影响

淹溺患者的复苏受多种因素影响，海水由于渗透压和电解质含量较高，发生淹溺时其病理生理变化有其独特之处。为了解海水淹溺时血浆电解质的变化规律，探讨其对复苏的可能影响，我们用犬制作海水淹溺和窒息濒死模型进行了观察。一、材料与方法1．动物分组：杂种犬21只，胸部X线摄片正常，随机分为海水淹溺组（seawaterdrowninggroup，DG）和窒息组（suffocationgroup，SG）。DG组14只，体重1245±2.13kg，参照Moded[1]j方法，由气管内导管灌注海水10Im／kg，灌注压为10CtnHzO，1分钟内完成；急救前，气管内导管开放，不吸引、不排水。S…     

兔海水淹溺肺水肿时肺损伤及其机理研究(论著)

目的：观察急性海水淹溺所致肺损伤并探讨其发生机理。方法：向兔肺内灌入海水造成急性淹溺肺水肿模型。采用全自动血气分析仪和计算机图像分析系统，对兔动脉血气、酸碱等６项指标和肺毛细血管内皮细胞Ｎａ＋－Ｋ＋－ＡＴＰ酶等９项参数进行自动检测和定量测量。结果：灌海水后兔动脉血ｐＨ、ＰａＯ２、血氧饱和度（ＳＯ２）、实际碳酸氢盐（ＡＢ）和碱剩余（ＢＥ）等５项指标明显降低（Ｐ＜０．０１）。ＰａＣＯ２在灌海水后１０～３０分钟呈短暂性升高。在海水淹溺肺水肿（ＰＥ－ＳＷＤ）组中，肺毛细血管内皮细胞Ｎａ＋－Ｋ＋－ＡＴＰ酶活力显著降低，肺泡Ⅰ、Ⅱ型上皮细胞和肺毛细血管内皮细胞内Ｃａ２＋沉淀颗粒明显增加。结论：低氧血症和代谢性酸中毒可认为是海水淹溺后肺损伤发生的主要原因，细胞内钙超载和肺内Ｎａ＋－Ｋ＋－ＡＴＰ酶活力降低与ＰＥ－ＳＷＤ的发生发展密切相关，应引起临床医生的高度重视     

海水淹溺肺损伤的影像表现(附12例报告)

目的 探讨海水淹溺肺损伤的影像表现.方法 对本院近8年收治的12例海水淹溺患者的影像资料进行回顾性分析.结果 首次拍片或CT检查于离水后2～12 h,X线表现两肺纹理增多,肺内小片影,两肺呈现广泛分布斑片影;CT表现:肺内大片"磨玻璃样"密度影,两肺弥漫性斑片状、絮状阴影,肺气肿.大部分病灶治疗1～3 d后复查有明显吸收好转,1例病变后来形成肺脓肿.结论 X线和CT检查可清晰显示肺部损伤轻莺及发展演变,为临床诊治提供重要信息.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.