集束化干预在低龄低体重先天性心脏病患儿微创手术的应用

目的 探讨集束化干预在低龄低体重先天性心脏病患儿微创手术围术期的应用。方法 对2014年1月~2015年12月收治65例拟行微创手术的先天性心脏病患儿,按入院时间分为对照组和实验组,各37例。对照组采取先天性心脏病常规护理措施;集束化护理组采取集束化综合护理方案,对比两组术后并发症及护理满意度。结果 试验组患儿术后肺部感染率低于对照组,护理工作的满意度则高于对照组,差异有统计学意义(P<0.05)。结论 婴幼儿先天性心脏病围术期患儿实施科学、完善的集束化护理,能提高护理质量、降低术后并发症,促进患儿康复。     

1Okg以下婴幼儿先天性心脏病的围手术期处理

目的总结探讨低体重（〈10kg）先天性心脏病患儿的围手术期处理经验。方法回顾分析了我科2002年10月至2007年6月间收治的86例低体重先天性心脏病患儿的临床资料。结果手术后死亡4例，死亡率4．7％。其中2例患儿术后死于肺动脉高压危象及呼吸衰竭；1例术后出现低心排血量综合征，后死于肾功能衰竭；1例死于术后低心排、心律紊乱。余82例均治愈出院，随访3～18个月，仅1例出现残余分流、心功能不全。均恢复良好。结论适时选择手术时机，完善的围手术期处理，对低体重先天性心脏病患儿可获得满意疗效。     

呼吸机治疗复杂先天性心脏病手术后顽固性低氧血症

复杂性先天性心脏病患儿术后早期出现顽固性低氧血症是较为常见而又极为严重的并发症之一 ,常常可以危及患儿的生命。如何纠正低氧血症是提高患儿术后存活率的关键。我院小儿恢复室自 1993年 12月1日至 1996年 12月 31日共收治 5岁以下小儿先天性心脏病心内直视手术后患儿 1914例 ,其中 18例 (0 .94 % )出现顽固性低氧血症 ,现报告如下。1　资料和方法18例患儿中男性 10例 ,女性 8例。平均年龄 2 .1± 1.2岁 (10月～ 3.3岁 ) ;平均体重为 9.5± 2 .0ｋｇ(6 .5～ 12ｋｇ) ;病种如下 :肺动脉闭锁 5例 ,重症法鲁氏四联症 10例 ,右室双出口 3例…     

新生儿先心病的围术期护理

目的探究适宜患先天性心脏病新生儿围术期护理方法。方法从我院儿科选取24例患先天性心脏病新生儿,对其进行围术期护理,并对病症引发的并发症进行探讨总结。结果选取24例新天性心脏病患儿样本中23例患儿完全治愈,1例死亡,死亡率为4.2%,痊愈患儿随访1~12个月,病情症状均大幅度改善并稳定保持。结论新生儿先天性心脏病的围术期护理对策主要有新生儿转运、前列腺素1(PGE1)应用及护理、心功能监测和护理、呼吸管理、基础护理及预防感染、对家属的指导和培训,以上方法均可降低死亡率,提高临床疗效。     

婴幼儿先天性心脏病合并肺动脉高压的围术期处理

1998年3月～2002年1月我院治疗45例体重在10kg以下的先天性心脏病(先心病)合并肺动脉高压(PH)患儿,现将其围术期处理体会报道如下.     

先天性心脏病合并重度肺动脉高压的外科治疗体会

目的总结先天性心脏病合并重度肺动脉高压的外科治疗及有关围手术期的处理经验。方法1998年12月~2006年12月手术治疗先心病合并重度肺动脉高压共121例,男56例,女65例,年龄2~54岁,平均(18.0±9.5)岁。术前肺动脉和体动脉收缩压比Pp/Ps均>0.75,平均(0.95±0.16),动脉血氧饱和度SaO275%~96%。结果手术死亡10例(8.26%)。主要并发症:低心排血量2例,肺高压危象8例。死亡原因:低心排血量,肺高压危象。术后SaO290%~97%,平均(94±2.1)%。患者心功能均较术前改善。结论低心排血量和肺高压危像是合并重度肺高压的先心病患者术后的主要并发症和死亡原因,围术期处理是提高生存率的关键。     

先天性心脏病患儿围手术期的营养评估与护理

目的研究和分析先天性心脏病患儿围手术期的营养评估，根据研究结果给手术方式和护理提供有效的依据。方法随机选取我院2010年1月~2013年1月胸心外科的先天性心脏病患儿100例，在围手术期针对这些患儿进行营养状况的评估，主要采用的方法是综合评价法。结果通过研究发现，所有的100例先天性心脏病患儿在手术前的营养不良率为42%，在手术之后的营养不良率为59%，这就说明在手术之后患儿的营养不良情况在加重。并且通过手术前后的各项指标对比发现，患儿的体重、头尾、上臀围以及淋巴细胞的数量都有所下降。结果的差异具有显著意义(<0.05)。结论先天性心脏病患儿在围手术期发生营养不良的几率比较高，因而在围手术期对先天性心脏病患儿进行营养评估和护理是非常有必要的。     

先天性心脏病合并重度肺动脉高压的外科治疗

目的：探讨先天性心脏病(CHD)合并重度肺动脉高压(PH)的外科治疗效果和围手术期处理方法。方法：在体外循环下，采用根治性手术治疗先天性心脏病合并重度肺动脉高压患者54例。结果：全组无死亡病例，无术后Ⅲ。房室传导阻滞、心包填塞、二次开胸止血、肾功能衰竭等严重并发症。结论：综合评价病情、正确掌握手术适应证、充分的术前准备、规范和恰当的围术期处理及手术技术的进步是提高外科治疗成功率的关键。     

低体质量婴儿先心病合并肺动脉高压术后的呼吸支持治疗

目的探讨体质量小于5 kg婴儿先天性心脏病合并肺动脉高压术后的呼吸治疗策略。方法针对低体质量先心病合并肺动脉高压患儿的特点,给予优化机械通气方式、特殊的呼吸道管理计划及合理的药物治疗。结果本组28例体质量小于5 kg婴儿先天性心脏病合并肺动脉高压术后的患儿中顺利拔管24例,再次插管3例,非呼吸系统原因死亡1例。结论低体质量先天性心脏病合并肺动脉高压婴儿的术后的呼吸支持治疗非常重要,运用合理的呼吸支持治疗方案可以降低并发症的发生率,显著提高此类重症患儿围术期的治愈率。     

5例完全性大动脉错位患儿术前应用前列腺素E1的护理观察

完全性大动脉错位(TGA)，属复杂型先天性心脏血管畸形之一，是常见的紫绀型先天性心脏病。其发病率仅次于法洛四联症，占先天性心脏病的7％～9％，一岁内死亡率为80％～90％。TGA患儿一般在出生后一个月内做Switch术。2001年笔者参与5例完全性大动脉错位患儿的围手术期护理，术前应用前列腺素E1(PGE1)，效果良好。报道如下。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.