何为小儿“夏季热”

小儿“夏季热”又称“暑热症”,是炎夏酷暑时节婴幼儿常见的发热性疾病,多见于半岁～3岁的小儿。夏季热的发病原因主要是由于此年龄段的小儿神经系统发育不成熟,发汗机能不健全,体温调节功能较差,因而不能很好地保持正常的产热和散热的动态平衡,导致排汗不畅,散热较慢,体温升高。临床上常把夏季热的症状概括为“三多一少”,即多发热、多口渴、多尿少汗。其发热症状多呈迁延性,热程可持续1～3个月左右,热型不定或不规则,体温多在38～39.5℃之间。天气愈热,体温愈高。即使应用解热药,也无法使其体温下降。只有在气候凉爽或雨后,患儿体温才有所…     

手法联合臭氧消融治疗腰椎间盘突出症临床护理路径的应用

目的：设计建立手法联合臭氧消融治疗腰椎间盘突出症的临床护理路径表。方法对收治的手法联合臭氧消融治疗腰椎间盘突出症患者30例实施临床护理路径，对照组30例按常规手法治疗医嘱进行护理，观察2组患者VAS评分、JOA改善指数、症状反跳率、患者护理满意率。结果试验组患者VAS评分、JOA改善指数与对照组相比差异有统计学意义（P＜0.05），护理满意率提高。结论手法联合臭氧消融治疗腰椎间盘突出症患者应用临床护理路径，提高了护理工作质量和效率，患者满意度增加。     

夏训应防热射病

正夏季天气炎热,在高温条件下组织高强度训练容易引起热射病。在中暑的分级中,热射病就是重症中暑,是中暑中最严重的一种类型。患者的症状包括局部肌肉痉挛、高热、无汗、口干、昏迷、血压升高、咳嗽、哮喘、呼吸困难等,甚至出现呼吸衰竭等现象。热射病的发生主要是由于外界温度高,人体内的热量不能通过正常的生理性散热达到热平衡,从而致使体内热蓄积,引起体温升高。部队发生的热射病多属于劳力性热射病,多在从事军事作业后发病。患者     

环境因素对暖体假人模拟潮湿服装的蒸发散热性能分析

目的研究不同环境条件下重度体力劳动者显性出汗时的散热特性,为改善高温高湿劳动环境提供参考。方法基于暖体假人实验平台,运用SPSS软件进行回归分析,研究环境温度(10～34℃)、相对湿度(60%～96%)、风速(0～4m/s)及假人表面温度(31～37℃)对完全潮湿服装蒸发散热占模拟假人总散热比的影响。结果环境温度对完全潮湿服装蒸发散热占模拟假人总散热比有显著正向影响(P0.05);风速对其有显著负向影响(P0.05);相对湿度与假人表面温度则对其影响不大(P0.05);4个因素的影响程度排序:环境温度风速相对湿度假人表面温度。结论在环境温度、湿度不易改变的情况下,为提高重体力劳动者散热强度,保证工人健康,增加环境风速为较好方法。     

飞行人员坚持体能锻炼应对热应激的初步探讨

目的 通过在35℃,相对湿度70%的高温舱中进行热应激测试的方法对受试者进行热耐受能力的评估。方法 选择17名空军特色医学中心的工作人员,锻炼员8名为试验组,另外9名为对照组,在高温舱中进行热负荷运动（以75 W功率蹬自行车120 min,转速维持在60～70 r/min）,监测并记录其核心温度、皮肤温度、心率、出汗量等数据。结果 2组平均皮肤温度增长率、心率增长率、达到最大心率时间、出汗率和热应激时间比较差异有统计学意义（P<0.05）,肛温增长率比较差异无统计学意义（P>0.05）。结论 坚持体能锻炼可有效应对热应激,提高热耐受能力。     

飞行员高空代偿服和FTF-2通风服通风散热性能评价

目的　探讨DC 7/ 7A高空代偿服和FTF 2通风服的通风散热性能 ,为其进一步改进设计提供理论依据。方法　 5名健康志愿者分别参加A组和B组实验。A组和B组实验的环境气候条件分别为干球温度 4 0℃和 4 5℃ ,相对湿度 4 5 %和 4 0 % ,实验时间90min和 12 0min。结果　热暴露期间 ,两组实验均可维持加权平均皮肤温度在人体舒适范围 (31 5～ 34 5℃ ) ,下身平均皮肤温度 33 1～33 8℃ ,但小腿皮肤温度无明显变化或仅轻度降低。A组和B组心率增值分别为 12 /min和 14 /min ,出汗量分别为 0 2 88± 0 0 5 6kg/ 1 5h和 0 4 4 5± 0 0 77kg/ 2h,蒸发率分别为 77 4 %± 3 6 %和 84 2 %± 2 4 %。两组实验的主观不适感觉均随着热暴露时间的延长而加重。结论　两种通风服的通风散热效果尚可 ,但有待重新设计某些重要部位通风孔分布的数量。当飞行员暴露热环境配穿这两种通风服实施通风时 ,仍将遭受轻度热应激并有一定程度的主观不适。     

两种顺苯磺酸阿曲库铵用于腹腔镜麻醉的临床效果比较

目的 分析比较国产和进口顺苯磺酸阿曲库铵在腹腔镜麻醉过程中发挥的临床效果.方法 腹腔镜胆囊切除手术患者中随机抽取70例,平均分为对照组(国产组)和试验组(进口组)患者各35例.对患者进行气管插管时血压、心率及呛咳反射等变化进行详细记录,通过肌松检测患者的腕部尺神经,给氧去氨,运用芬太尼2μg?kg、丙泊芬2 mg/kg、咪达哇仑0.12 mg/kg配比实行诱导工作.在此基础上,对照组患者和试验组患者分别接受国产和进口顺苯磺酸阿曲库铵治疗,其规格选用0.15 mg?kg-1(3ED95).在进行监测的时候,如果患者肌松小于5%时,要采取气管插管项目,并地插管所需条件进行评分.观察对比两组患者血管系统的受影响程度、体内阻滞起效时间、作用时间、呛咳反射情况、术后残余等内容.结果 对照组和试验组患者在试验过程中的阻滞起效时间对比差异显著(P<0.05),试验组患者体内作用时间明显快于对照组,在接受手术治疗后,试验组患者的肌松残留也明显少于对照组.术后对照组患者有5例出现了不良反应,比例为14.3%,而试验组患者无不良反应现象出现.对比得知,试验组患者术后恢复情况明显比对照组理想.结论 进口的顺苯磺酸阿曲库铵在腹腔镜麻醉中的临床疗效术后情况相对比国产优秀,可以有效引进.     

二级前哨淋巴结技术在D2胃癌根治术中的临床应用

目的：观察腹腔镜下二级前哨淋巴结技术同期行D2胃癌根治术对手术效果的影响。方法选取我院2013年6月—2014年6月收治的行D2胃癌根治术患者78例,随机分为试验组和对照组,每组39例,对照组行D2胃癌根治术,试验组应用二级前哨淋巴结（secondany sentinel lymph node,SSLN）技术同期行D2胃癌根治术,术后对2组患者进行18个月的随访;比较2组手术基本情况,主要包括手术时间、术中出血量与清除淋巴结数量,比较2组术后恢复情况,主要包括肛门排气时间、下床活动时间与住院时间,观察和比较2组术后并发症及复发情况,并随访了解其无瘤生存与存活情况。结果与对照组相比,试验组手术时间明显较长（P＜0.01）,但术中出血量明显较少、清除淋巴结数量显著较多（P＜0.05）;试验组肛门排气时间、下床活动时间、住院时间均明显较对照组短（P＜0.01）;试验组复发率及并发症发生率分别为10.26%、15.38%,明显低于对照组的28.21%、38.46%（P＜0.05）;试验组无瘤生存率为73.68%,显著高于对照组的51.38%（P＜0.05）,存活率为92.11%,略高于对照组的86.49%,比较差异无统计学意义（P＞0.05）。结论SSLN同期行D2胃癌根治术可显著提高手术效果,促进患者术后恢复,且可明显降低并发症发生率与复发率,提高无瘤生存率,对胃癌患者的临床治疗及远期生存有重要价值。     

羊穿衣对青海毛肉兼用细毛羊生产性能的影响

从青海毛肉兼用细毛羊群中,随机选择1岁母羊一群（210只）、2岁母羊一群（220）只,进行了羊穿衣对比试验。结果表明：试验组除污毛量比对照组分另q低9．6％和7．6％外,羊毛长度试验组比对照组分剐提高了8．47％和3．95％,差异显著（P〈o．05）;羊毛油汗长度试验组比对照组分别提高了46．6％和37．7％,差异极显著（P〈O．01）;毛丛污染长度,试验组比对照组分别降低了41．0％和37．3％,差异极显著（P〈0．01）;净毛量试验组比对照组分别提高了14．5％和15．4,差异极极显著（P〈0．01）;净毛率试验组比对照组分别提高了26．9％和25．2％,差异极显著（P〈0．01）。     

思美泰治疗妊娠期肝内胆汁淤积症疗效观察

目的探讨思美泰治疗妊娠期肝内胆汁淤积症的疗效。方法 2006年1月至2008年12月我院收治的妊娠期肝内胆汗淤积症患者共108人,随机分为两组,分别予两种不同的方法治疗,以形成对照研究。结果治疗组总有效率91.07%,对照组71.15%,两组在疗效上差异显著（P〈0.05）。结论思美泰是治疗妊娠期肝内胆汗淤积症的安全有效的药物。     

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.