CT肺动脉阻塞指数与血气分析值评价急性肺栓塞严重性的研究

目的研究CT阻塞指数与血气分析评价急性肺栓塞(APE)严重性的价值。方法接受CTPA和动脉血气分析检查并且无基础心肺疾病的APE患者共59例。利用肺动脉CT阻塞指数评价肺动脉栓子阻塞程度与范围。动脉血气分析包括PaCO2、PaO2、SaO2及P(A-a)O2。严重APE组和非严重APE组患者之间的CT阻塞指数、动脉血气分析指标之间的统计学差异用t检验评价。阻塞指数与动脉血气分析指标之间的相关性使用Spearman相关系数评价。结果严重APE组患者的PaCO2、PaO2及SaO2明显低于非严重APE组患者(P<0.01),而P(A-a)O2明显高于非严重APE患者(P<0.01)。阻塞指数分别与PaCO2、PaO2、SaO2及P(A-a)O2的相关性有统计学意义(P<0.01)。结论综合分析APE患者的肺动脉阻塞指数、血气分析指标有利于评价APE患者的严重性。     

CT肺动脉阻塞指数在急性肺栓塞严重程度评估中的价值

目的探讨CT阻塞指数(CT index,CTI)在急性肺栓塞(APE)严重程度评估中的价值。方法 62例APE患者根据临床表现分为重症组(n=28例)和轻症组(n=34例)。比较两组患者CTI和动脉血气分析指标,分析CTI与Pa CO2、Pa O2、Sa O2及P(A-a)O2等动脉血气分析指标的相关性。结果重症组患者CTI、P(A-a)O2明显高于轻症组(P<0.05),而Pa CO2、Pa O2、Sa O2等动脉血气分析指标明显低于轻症组(P<0.05);CTI与Pa CO2、Pa O2、Sa O2呈负相关性关系(r=-0.560、-0.435、-0.364,P<0.05),而与P(A-a)O2呈正相关性关系(r=0.602,P<0.05)。结论CTI与动脉血气分析指标具有明显的相关性,在APE严重程度评估中具有较高的临床价值。     

西宁地区肺心病酸碱失衡判断和呼吸衰竭血气诊断标准的探讨

本文对西宁地区(海拨2260m)184例276例次慢性肺心病急性发作期病人作了血气和酸碱失衡的分析研究。认为平原酸碱失衡预计代偿公式中的正常值和呼吸衰竭(呼衰)的血气诊断标准不适用于高原地区。提出了本地区肺心病酸碱失衡判断意见相呼衰的血气诊断标准,并对有关问题进行了讨论。     

急性肺栓塞的CT阻塞指数与动脉血气分析指标的相关性研究

目的:探讨急性肺栓塞(APE)患者CT肺血管成像(CTPA)肺动脉CT阻塞指数和血气分析指标之间的相关性。方法:73例临床疑诊的APE患者中,行CTPA、动脉血气分析检查确诊为APE并且无基础心肺疾病的患者32例。采用肺动脉CT阻塞指数评价肺动脉栓子数量,动脉血气分析指标包括动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、肺泡-动脉血氧分压差[P(A-a)O2]及动脉血氧饱和度(SaO2)。利用Spearman等级相关系数评价CT阻塞指数与动脉血气分析指标之间的相关性,用Mann-Whitney U检验来评价高于和低于不同阻塞指数值(35%、45%、55%及65%)时的动脉血气分析指标之间的差异。结果:CT阻塞指数与PaCO2、PaO2、P(A-a)O2及SaO2的相关系数(r)值分别为-0.563、-0.425、0.608和-0.358(P<0.05)。分别以CT阻塞指数35%、45%、55%及65%为阈值,在高于和低于这4种阈值时PaCO2、P(A-a)O2的差异均有显著性意义(P<0.05);在高于和低于35%、55%及65%这3种阈值时,PO2差异有显著性意义(P<0.05)。在高于和低于55%及65%这2种阈值时,SaO2的差异有显著性意义(P<0.05)。结论:无基础心肺疾病的APE患者,CT阻塞指数与动脉血气分析指标之间有相关性,以PaCO2和P(A-a)O2能更敏感地反映肺动脉阻塞的严重性。     

高海拔地区急性呼吸窘迫综合症的临床研究

目的：探讨高海拔地区急性呼吸窘迫综合征（ARDS）发病机理、临床特点、诊断标准及治疗措施;方法：40例ARDS,其中多器官功能障碍14例,单纯用HFV治疗2例,IPPV治疗10例,交替通气方式HFV、IPPV或CMV治疗16例,CMV或PSV治疗12例,血气分析：PaO2 35mmHg-60mmHg(4.66kPa-7.98kPa),平均55mmHg(7.32kPa),PaCO2 25mmHg-80mmHg(3.33kPa-10.64kPa),平均45mmHg(5.99kPa),PaO2/FiO2 40mmHg-200mmHg(5.32kPa-26.60kPa), 平均180mmHg(23.94kPa),P(A-a)O2(FiO2=1)150mmHg-250mmHg(19.95kPa-33.25kPa),平均200mmHg(26.60kPa),SaO2 40%-90%,平均85％;结果：全组治愈33例,死亡7例,死亡率17．5％;结论：高海拔、低氧更易诱发急性肺损伤（ALI）、ARDS,并且起病急、进展快,早期合并心功能障碍者多,PaO2/FiO2≤250mmHg(33.25kPa)(ALI),≤180mmHg(23.94kPa)(ARDS)为本地区临界值,及早应用机械通气可提高治愈率,中医中药可防治ARDS。     

西宁地区2型糖尿病胃轻瘫患者血浆胃动素水平的分析

目的 :比较西宁地区、平原地区 2型糖尿病胃轻瘫患者与健康对照组三组血浆胃动素水平与疾病相关性。方法 :选择西宁地区 2型糖尿病胃轻瘫患者 32例 ,平原地区 2型糖尿病胃轻瘫患者 2 0例及健康志愿者 2 0例 ,测定血浆胃动素水平。结果 :西宁地区糖尿病胃轻瘫患者中血浆胃动素水平 2 4例升高、5例降低、3例正常 ,平原组 15例升高、2例降低、3例正常 ,血浆胃动素水平健康组与平原及西宁地区之间、西宁与平原地区之间比较P <0 .0 1,差别有高度显著性。结论 :西宁组、平原组 2型糖尿病胃轻瘫患者血浆胃动素均高于健康对照组 ,而西宁地区组血浆胃动素低于平原组 ,考虑与中度高原地区缺氧有关。     

高原地区慢性阻塞性肺疾病患者体重对呼吸困难的影响

目的探讨高原慢性阻塞性肺疾病(COPD)低体重(UW)和正常体重(NW)患者肺功能、呼吸肌力量和血气与呼吸困难的关系.方法对高原地区COPD缓解期体重指数(BMI)＜21kg/m2的36例和BMI在21～26kg/m2的32例两组患者测定一秒钟用力呼吸气容积(FEV1)占预计值百分比(FEV1%预计值)、FEV1/用力肺活量(FVC)比值(FEV1/FVC)、口腔最大吸气压(PImax)、最大呼气压(PEmax)、最大跨膈压(Pdimax)、呼吸肌力量指数(RMS)、动脉血氧分压(PaO2)和二氧化碳分压(PaCO2),并评估了呼吸困难等级.结果UW组平均BMI(17.8±1.2)kg/m2显著低于NW组(23.2±1.4)kg/m2,P＜0.01.UW组呼吸困难平均等级(3.9±0.9)显著高于NW组(2.9±0.7),P＜0.01.两组FEV1%预计值、FEV1/FVC差异无显著性(P＞0.05).UW组PaO2(53.7±6.2)mmHg显著低于、PaCO2(37.5±3.6)mmHg显著高于NW组[分别为(57.2±6.5)mmHg、(35.2±3.4)mmHg],P均＜0.05.UW组PImax(48.2±14.4)cmH2O、PEmax(62.7±16.2)cmH2O、Pdimax(54.3±15.6)cmH2O和RMS(55.5±15.1)cmH2O较NW组显著降低[分别为(61.7±15.9)cmH2O、(72.4±18.5)cmH2O、(66.9±17.2)cmH2O、(67.1±16.5)cmH2O](P＜0.01或P＜0.05).呼吸困难等级与PImax、PEmax、Pdimax、RMS、FEV1%预计值、FEV1/FVC呈显著负相关(P均＜0.01).结论高原地区COPD低体重患者呼吸困难较正常体重患者严重,其原因与营养不良所致的呼吸肌力量降低有重要关系.     

高原现场作业期间中心动脉血气与酸碱变化趋势

目的:研究青年士兵高原现场作业过程中的血气变化规律.方法:将来自海拔800m以下的青年士兵分为非军事作业组和军事作业组.按海拔高度分为2900m组、3200m组、4400m组、5060m组.采用阶梯式进驻作业现场, 对比观察相同、不同高度的血气酸碱变化趋势.结果:作业和非作业状态中心动脉血气,PaO2,PaCO2,HCO3-,PAO2,A-aDO2等参数均随海拔高度上升出现不同程度变化;相同高度(4400m)军事作业组的上述参数与非军事作业组相比差异显著(P<0.05,P<0.01),但pH值在4个梯度无统计学差异.结论:青年群体阶梯式进驻高原现场作业,中心动脉血气和酸碱变化显著,明显异于非作业组,大部分符合呼吸代偿性酸中毒标准,个别病例也接近呼酸代酸标准.在海拔高度4400m以上作业状态下, PaO2≥45mmHg,SaO2≥0.8,7.30≤pH≤7.48,可能是作业状态可允许的最大限值.     

复方红景天参芪花粉制剂对高原大鼠严重烧伤后动脉血气变化的影响

目的 :探讨高海拔地区大鼠严重烧伤后动脉血气变化及复方红景天参芪花粉对其影响 ;方法 :在海拔 3 480m甘南地区建立大鼠 3 0 %Ⅲ度烧伤模型 ,1 0 4只大鼠随机分为试验组 (红景天组 )、对照组及正常组 ,造模前灌胃给药 ,伤后不同时相点剖腹经腹主动脉穿刺抽血测 pH、PO2 、PCO2 、BE和O2 st;结果 :pH :红景天组与对照组伤后 3h开始低于正常组 (P <0 .0 5) ,伤后 2 4h～ 48h逐渐升至正常 ;PO2 :两组于伤后 3h～ 2 4h均高于正常组 ,72h接的正常 ;PCO2 :两组于伤后明显低于正常组 (P <0 .0 1 ) ,48h后红景天组与正常组接近 (P >0 .0 5) ;BE :两组于伤后 3h较正常组明显降低 (P <0 .0 1 ) ,伤后 6h ,红景天组高于对照组 (P <0 .0 5) ;O2 st:三组对照比较差异无显著性 ;结论 :高原大鼠严重烧伤后存在严重混合型酸碱失衡 ,以代谢性酸中毒为主 ,PO2 增高可能与过度换气和呼吸代偿有关 ,并不意味着组织不缺氧 ,实验组与对照组在各项指标中差异很大。证明复方红景天参芪花粉制剂对抗组织缺氧、疏通微循环及纠正酸中毒人有重要临床意义     

吸入纯氧对快速进入高原猪血流动力学及血气的影响

目的 :了解吸入纯氧对高原急性缺氧的治疗作用 ;方法 :对快速进入高原猪吸入纯氧 3 0min,设时相点 ,在各时相点观察急性缺氧动物血流动力学及血气各指标的变化情况 ;结果 :吸入纯氧后高原急性缺氧动物肺动脉压 (PAP)、肺动脉压楔压 (AWP)及肺血管阻力 (PVR) ,均较吸纯氧前显著下降 (P值均 <0 .0 0 5) ,体动脉SaO2 、PaO2 及PaCO2 显著升高 (P <0 .0 0 1 ) ;结论 :吸入纯氧可明显降低高原急性缺氧动物肺动脉压 ,提高SaO2 、PaO2 及PaCO2 。     

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.     

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).     

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.     

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.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.