pH值对低温肺保护液减轻体外循环未成熟肺损伤的影响

目的：观察不同pH值低温肺保护液对体外循环（CPB）未成熟肺急性肺损伤的保护作用。探求最适PH值的低温肺保护液,方法：实验用幼犬36只,随机分为6组：A组,单纯体外循环组：B至F组在体外循环阻断主,肺动脉期间分别用不同PH值的肺保护液进行肺动脉灌注。B组－F组PH值分别为6．6,7．0,7．4,7．8,8．2,阻断主,肺动脉60min,再灌注60min后,取标本,分别采用髓过氧化酶法,硫代巴比妥酸法和硝酸还原酶法测定髓过氧化物酶（MPO）,丙二醛（MDA）和一氧化氮（NO）,测定肺组织含水量和进行肺组织超微结构观察。结果：C,D,E,F组的MPO和MDA均较A组明显降低（P＜0．05,P＜0．01,P＜0．01,P＜0．05）,其中E组最低：NO含量明显上升（P＜0．05,P＜0．01,P＜0．01,P＜0．05）,肺组织含水量降低,其中D,E组相差显著（P＜0．01,P＜0．01）,同时发现灌注组的II型上皮细胞,肺血管内皮细胞损伤减轻,结论：低温肺保护液可减轻体外循环未成熟肺损伤,其中PH值为7．＝8的肺保护液,效果最好。     

儿童注意缺陷多动障碍的脑磁共振氢谱研究

目的：观察注意缺陷多动障碍患儿脑内可能存在的神经生化异常及哌甲酯对其的影响。方法：使用无创性的磁共振氢谱检查，测量了12例患注意缺陷多动障碍儿童顿服哌甲酯10mg前后双侧苍白球内天冬氨酸（NAA）、胆碱复合物（Cho）、肌醇（mI)、α－氨基酸（glutamate plus glutamine,α-Glx)与肌酸（Cr)的比值，并与12例同龄健康儿童的结果进行比较。结果：服药前注意缺陷多动障碍患儿双侧纹状体的NAA／Cr比值较健康儿童显著降低（左侧t＝7．01，P＜0．01；右侧t＝4．95，P＜0．01）；Cho/Cr比值有单侧显著性增高（t＝2．33，P＜0．05）；mI/Cr和α-Glx-Cr比值无显著性变化。服药后NAA／Cr比值增高，但与服药前相比差异无显著性意义（左侧t＝－1．34，P＞0．05）；右侧t＝－1．04，P＞0．05），与健康儿童间差异仍有显著性意义（左侧t＝3．68，P＜0．01；右侧t＝2．50，P＜0．05）；Cho/Cr比值降至正常水平，与健康儿童间差异不再有显著性意义（t＝0．87，P＞0．05）。结论：注意缺陷多动障碍患儿双侧纹状体存在神经元神经缺失或功能障碍，胆碱能神经系统可能有轻度失常。     

~(99m)Tc-MIBI肺心摄取比值在评价左心室收缩功能中的临床价值

本文旨在探讨99mTc－MIBI肺心摄取比值在评价左心室收缩功能中的临床价值。材料和方法：对145例（34例正常人，70例心绞痛，41例心肌梗塞）受检者，行99mTc－MIBI心肌灌注断层显像的同时测定肺、心区放射性计数比值（LHR），并与核素心室显像方法测得的左室射血分数（LVEF）进行相关分析。结果：正常对照组、冠心病组的LHR和LVEF分别为0．41±0，07、58．7％±9．4％和0．49±0．08、41．2％±7．4％。15例接受PTCA治疗者术后与术前的LHR和LVEF差值分别为△LHR＝－0．03±0．07、△LVEF＝5．6％±8．7％。LHR与LVEF的相关分析结果为：LVEF≥50％者，相关系数r＝－0．694（p＜0．05），LVEF＜50％、≥35％者，r＝－0．644（P＜0．05）；LVEF＜35％者，r＝－0．716（p＜0．01）；上述三级的LHR敏感性分别为74．5％、78．1％、94．7％。结论：LHR简便、易行．在评价心肌血流变化的同时，可对心肌收缩功能及其变化做出评估，为临床提供有意义的参考信息。     

陆军士兵自尊水平与应对方式的关系研究

目的：探讨陆军士兵自尊水平、应对方式的状况及两者的关系。方法采用随机抽样方法,从某军区5个陆军单位抽取士兵507名,使用自尊量表（ SES）和应对方式问卷（ CSQ）进行测查。结果陆军士兵的自尊水平在不同年龄组上存在显著差异（F＝3．207,P＜0．05）;家庭经济状况一般组的自尊水平、解决问题方式显著高于贫困组（t＝2．157,P＜0．05;t＝2．507,P＜0．05）;担任骨干组士兵的自尊水平显著高于非骨干组（t＝3．700,P＜0．001）。在不同学历上,士兵在自责、求助以及合理化因子上的得分存在显著差异（F＝3．560,P＜0．05;F＝3．169, P＜0．05;F＝4．317,P＜0．05）。自尊水平与解决问题、求助呈显著正相关（r＝0．459,P＜0．001;r＝0．353,P＜0．001）,与自责、幻想、退避、合理化呈显著负相关（r＝－0．471,P＜0．001;r＝－0．316,P＜0．001;r＝－0．381,P＜0．001;r＝－0．267,P＜0．001）。结论陆军士兵的自尊水平在年龄、家庭经济状况上差异显著;其应对方式在学历、是否担任骨干上差异显著,二者具有显著的相关性。     

体外循环中小剂量抑肽酶对肿瘤坏死因子的影响

目的 研究体外循环小剂量抑肽酶对炎症反应的影响。方法 20例择期瓣膜术病人，随机分为抑肽酶组（n=10)和对照组（n=10)。分别观察各时点TNF－α的活性，分别于术前，主动脉阻断前，主动脉阻断后30分钟，主动脉开放15分钟、60分钟分别从桡动脉采血5ml，测血浆中各时点TNF－α。结果 TNF－α各时点与术前相比，对照组在主动脉开放15分钟、60分钟明显升高（P＜0．05），而抑肽酶组各时点与术前相比，差异无显著性（P＞0．05），同一时点两组间比较差异无显著性（P＞0．05）。结论 小剂量抑肽酶用于体外循环时，不能有效抑制CPB诱发促炎因子TNF－α的反应。     

海拔4100m低氧条件下药物对血氧饱和度和心率的影响

目的：探讨高原低氧条件下药物对人体劳动能力的改善作用,为提高抗低氧药物筛选提供可靠依据;方法：对服用三普红景天组（A）、乙酰唑胺组（B）、NO吸入组（C）和对照组（D）,每组10人,于服药前运动前、服药后运动后重复检测血氧饱和度（SaO2)和心率（HR）,进行组间及服药前后的对比观察;结果：A组与B组SaO2服药后较服药前差异非常显著（P＜0．01或P＜0．001）,C组无显著差异（P＞0．05）,与对照组相比,A组差异非常显著（P＜0．01或P＜0．001）,B组差异显著（P＜0．05）,C组无显著差异（P＞0．05）;A组与B组服药后运动后较服药后运动前差异显著（P＜0．05）;与对照组相比,A组差异非常显著（P＜0．01或P＜0．001）,B组差异显著（P＜0．05）,C组无显著差异（P＞0．05）;A组心率服药后较服药前差异显著（P＜0．05）,B组、C组无显著差异（P＞0．05）;与对照级相比,A组差异显著（P＜0．05）,B组和C组无显著差异（P＞0．05）;服药后运动后较服药前运动后HR,A组与B组差异显著（P＜0．05）,C组无显著差异（P＞0．05）,与对照组相比,A组差异非常显著（P＜0．01或P＜0．001）,B组差异显著（P＜0．05）,C组无显著差异（P＞0．05）;结论：红景天和乙酰唑胺组均能有效地提高和改善低氧条件下人体劳动能力的客观指标,其作用前者优于后者。     

10kg以下婴幼儿法乐四联症根治术的体外循环管理

目的 系统性回顾总结我院2009～2011年48例10 kg以下婴幼儿法乐四联症(TOF)根治术的体外循环( ECC)管理.方法 本组48例TOF患儿中,男26例,女22例.年龄6～30个月,体重3.5～ 10 kg,均经超声心电图和心脏导管造影检查确诊,均在ECC下进行根治性手术.48例均采用进口膜式氧合器(MAQUET 30 000或10 000),体外循环时间50～166 min,阻断主动脉时间27 ～ 94 min.结果 48例患儿均顺利脱机,术后死亡3例,死亡与ECC技术无关;余45例痊愈出院.结论 低龄、低体重TOF患儿根治术的ECC应力求平稳,ECC中积极完善预充方案和改进体外循环方法,是减少术后并发症的关键.     

预适应对豚鼠受科里奥利加速度刺激后脑组织5-羟色胺含量的影响

目的 观察科里奥利加速度预适应训练对豚鼠受科里奥利加速度刺激后脑组织5－羟色胺（5－HT）含量的影响，从而探讨预适应对抗科里奥利错觉的生理机制。方法 28只健康花色豚鼠，随机分成4组（各组n=7)：空白对照组（对照I组）、科里奥利加速度预适应训练组（训练I组）、角速度训练组（训练Ⅱ组）、单纯科里奥利加速度刺激组（对照组Ⅱ）。在30min科里奥利加速度刺激后，对豚鼠受刺激后的行为学表现进行观察，然后处死，用荧光分光光度法测定各脑区（大脑皮层、脑干及小脑）的5－HT含量。结果 同对照I组相比，其它3组中枢内的5－HT含量均显著增高（P＜0．05）；同训练Ⅱ组相比，训练I组中枢内的5－HT含量显著降低（P＜0．05），而对照Ⅱ组中枢5－HT含量未有显著变化（P＞0．05）；对照Ⅱ组及训练Ⅱ组豚鼠，科里奥利加速度刺激后均表现迟缓，活动明显减少，反应迟钝，而训练I组豚鼠，在刺激后，行为活动力及反应性较对照Ⅱ组、训练Ⅱ组明显增加。结论 科里奥利加速度刺激可引起豚鼠大脑皮层、脑干和小脑5－羟色胺含量的增加，科里奥利加速度预适应训练可减弱其增加的程度。科里奥利错觉的发生及科里奥利加速度预适应对抗错觉的机制可能与此有关。     

自体血照射回输在鼻咽癌放射治疗中的作用

目的 对金石颗粒减低鼻咽癌放射反应的作用进行研究，为临床提供有效的治疗药物。方法 将90例鼻咽癌首次根治性放射治疗患者随机均衡地分为治疗1组（金石颗粒剂加放疗）、治疗2组（鼻咽清毒剂加放疗）、对照组（安慰剂加放疗）3组，各30例。结果 ①治疗1组对鼻咽癌的缓解率为93．33％、放疗完成率为96．67％，Karnofsky评分的提高稳定率为90．00％，分别高于其他两组（P＜0．05、P＜0．01）；②治疗1组出现的放射反应程度明显轻于其他两组（P＜0．05、P＜0．01）；其外周血象得到稳定（P＞0．05），且其稳定性优于其他两组（P＜0．05、P＜0．01）。结论 金石颗粒剂有显著的减毒作用，可改善生活质量，配合放疗对鼻咽癌有较好的治疗作用。     

特技飞行对血浆心钠素、环核苷酸及血管紧张素Ⅱ水平的影响

用放射免疫法测定了16名飞行员复杂特拉飞行前后的血浆心钠素（ANF）、环磷酸鸟苷（CGMP）、环磷酸腺音（cAMP）以及血管紧张素Ⅱ（ATⅡ）含量，并以16名地勤人员作对照。结果发现，飞行前空、地勤人员血浆ANF、cGMP、CAMP及ATⅡ含量均无明显差异（P＞0．05）。特技飞行后即刻，飞行组血浆ANF、cGMP、cAMP水平明显增高，与对照组相比，差异十分显著（P＜0．01），但血浆ATⅡ水平未见明显变化（P＞0．05）。至特技飞行后6h，飞行组血浆ANF含量恢复至对照组水平（P＞0．05），但cGMp及cAMP仍维持在较高水平，与对照组相比，差异仍较显著（P＜0．05）。以上结果提示，复杂特技飞行可以引起血浆ANF、cGMP及cAMP的显著升高。这些物质在循环血液中的含量增加对特拉飞行时的血液动力学改变可能会带来不利影响。     

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.