高原新兵集训致阑尾炎189例分析

2005年12月~2007年3月,我们共收治高原新兵集训致急性阑尾炎189例,经手术治疗,疗效满意。现分析报告如下。1临床资料1.1一般情况189例中,男175例,女14例;年龄16~20岁,平均18.8岁。1.2治疗方法本组病例均采取手术治疗,其中急性化脓穿孔性阑尾炎8例和阑尾周围脓肿2例,采用甲硝唑局部冲洗腹腔,并于右髂窝放置引流管,于3~5天拔管。术后主要对症治疗。1.3结果189例全部治愈,其中急性单纯性阑尾炎97例和急性化脓性阑尾炎82例,于7~9天拆线出院,均未发生其他并发症;急性化脓穿孔性阑尾炎8例及阑尾周围脓肿2例,行急诊手术或择期手术,其中并发肠梗阻8例,经保守治疗或再次手术治疗后全部治愈。2讨论我们认为,高原地区新兵集训期间急性阑尾炎高发的主要原因:(1)在海拔3000m高原缺氧环境下,从内地进藏的新兵短期内机体对环境、气候不适应,睡眠不佳,抵抗力降低,细菌易侵入引发急性炎症。(2)新兵集训期间训练运动量大、时间长,运动后通常缺乏恢复性训练,分配至运动肌肉的血液不能及时回至胃肠道。另外,运动与进餐间隔时间短,容易引起胃肠道功能紊乱,阑尾反射性痉挛收缩,加之高原缺氧,阑尾组织缺血缺氧更为严重...     

高原新兵基础训练期间心理状况调查

目的　了解高原新兵基础训练期间的心理健康状态。方法　应用症状自评量表 (SCL 90 )调查某部 2 0 0 2年度集训的新兵 14 41人 ,收回有效问卷 14 0 2份 (合格率 97 2 9% )。结果　高原新兵基础训练期间躯体化、焦虑、恐惧、精神病性因子得分明显高于内地集训的新兵 (P<0 0 5 )。结论　高原新兵是心理障碍和心理疾病的高发人群。     

高原急性阑尾炎32例

急性阑尾炎是最多见的急腹症,一般经手术治疗后可获良好预后。然而,高原阑尾炎却有其自身特点,如病情危重,合并症、并发症多,预后相对较差,甚至危及患者生命。我部在执行任务期间,驻守海拔3100m以上的高原地区,20个月中共收治急性阑尾炎患者32例。笔者对这32例急性阑尾炎的特点回顾性分析如下。     

新兵胫骨骨膜炎23例

新兵胫骨骨膜炎是新兵集训过程中胫骨骨膜的急性损伤性炎症。近年来随着训练强度的增加，兵源素质变化及训练过程中卫生防护不足，胫骨骨膜炎已成为部队训练的常见病。我院3年来共诊治新兵胫骨骨膜炎23例，报告如下。     

驻川部队集训期南北方籍新兵冻疮发病情况调查

目的：调查驻川部队新兵冬季集训期间冻疮的发病情况。方法：采用问卷调查和巡诊体检的方式,分组调查北方和南方籍新兵入伍前1年和入伍当年冬季集训期间冻疮发病情况。结果：入伍前,南方组新兵冻疮发生率高于北方组,分别为41．89,6和18．09,6（P〈0．01）;集训期间两组人员冻疮发生率均高于入伍前1年,分别为49．1％和30．9％。在相同集训条件下,南方组新兵更容易患冻疮。入伍前冻疮多发部位依次为手、脚和耳,集训期依次为耳、手和脚。结论：四川地区冬季新兵集训期间易发生冻疮,应采取相应防护措施。     

高原新兵训练伤的原因分析与健康指导

军事训练是提高军事素质的根本途径，而训练伤是影响战士健康和部队战斗力的重要因素。为指导战士在训练中能正确地进行自我防护，减少高原新兵军事训练伤。现就我院2000年至2003年住院的386例新兵集训期间训练伤员进行分析。     

高原阑尾炎119例临床分析

目的:分析高原阑尾炎病例的特点、发病原因、治疗及预后。方法:采集2002~2005年3月3年间收治的高原阑尾炎119例,进行临床诊断分析。结果:本组119例急性单纯性阑尾炎及化脓性阑尾炎,均经急诊手术或择期手术治愈。有并发症者经保守治疗或再次手术治疗而痊愈。其中肠瘘1例,死亡1例。结论:高原地区人烟稀少、交通不便,加之风俗习惯及迷信思想的误导,致使误诊误治。故应加强宣传教育、破除迷信,改善医疗条件,提高医务人员责任心和业务水平积极为少数民族防病治病。     

新兵集训期间防控甲型H1N1流感的做法

陕西西安61346部队卫生队徐勇、陕西西安61068部队医院张晓明、徐新华来稿：新兵集训期间防控甲型H1N1流感的做法。文章说，新兵到达军营第2天，出现发热患者1例，体温达39℃，送上级医院检测甲型HINI流感病毒阳性，确诊为甲型HINI流感；之后3天内又确诊5例。为做好相关防控工作，他们采取了以下措施：（1）加强领导，积极协调。疫病情发生后，他们及时上报领导及上级相关业务部门，使上级领导及相关业务部门及时了解发病动态，并启动防控预案，     

武警新兵集训期疾病谱的调查分析

目的　了解新兵集训时发病规律。方法　采用普查的方式对新兵进行体检 ,同时与老兵加以对比。结果　新兵在集训期外伤发病率较高 ,另外一些内科疾病如癔病 ,神经衰弱等心理性疾患发病率高于老兵 ,皮肤病发病率也较高 ,而重大伤亡与老兵无差异 ,胃炎发病率低于老兵。结论　需进一步加强安全卫生教育 ,减少训练时意外 ,注重心理辅导及伤病后及时医治。     

新兵集训期间皮肤病1 166例分析

新兵入伍后须进行3个月的集训，期间皮肤病发病率很高，尤其在亚热带地区，严重时可影响训练和部队战斗力。为了解其发病情况和特点，探讨相应的防治措施，我们对1998～2001年4年间入伍的全部集训新兵的皮肤病流行特点进行了调查分析。     

Radiology 1984. A conflict of high technology and high cost

Radiology is confronted now by exciting but challenging times. The excitement derives from dramatic technological advance; the challenge from the economic constraints on health care delivery. The large and growing expense of providing health care is readily apparent and high technology medicine can too easily be blamed for the growth. The pressures for improved service at no extra cost will demand much of the negotiating skills of our specialty and our ability to survive administrative confusion and fragmentation. Equally, manpower planning is a feature of modern medicine. Often this is done from inadequate data and as a specialty we must continue to think constructively about our own future in this context, not least in recognizing the contribution of women to our specialty. Forces also to be recognized are decentralization, electronic information transfer, concerns about radiation exposure and litigation. Not least we need to be better able to define our specialty as its scope is now changing rapidly. For the future I hope that we can be part of the development of the controls which we must inevitably face; we should lead in instituting cost-accounting in our departments; we must be at the leading edge of technological change in both imaging and data transfer, and we must be both more business-like as well as act effectively as the patient's advocate. Radiology has an important and growing responsibility in patient care and most of the technological advances both improve that care and can be justified economically. I am proud to be a radiologist in 1984.     

高原环境下高原病再发的流行病学研究

目的了解在高原环境下住院高原病患者的预后。方法以医院(海拔3658m)40年间收治、并符合筛选标准的19118例住院病历为样本,随访1～15年,样本中以高原病首次住院为病例组,以非高原病首次住院者为对照组。随访两组高原病的发病情况,并进行临床流行病学的分析。结果(1)对照组的急性高原病发病率、总体发病率随观察年限延长而增加且呈正相关(r急=08259,P<001,r总=06815,P<005);急性高原病组和慢性高原病组的慢性高原病发病率随观察年限延长而减低,且呈负相关(r急1～7=08993,P<001;r慢1～9=09068,P<0001)。(2)病例组总体高原病逐年发病率在急性高原病组和慢性高原病组均显著高于对照组(P<001),RR=1129。(3)各型高原病发病率在急性高原病组和慢性高原病组均显著高于对照组(P<001)。急性高原病组以急性轻型高原病和高原肺水肿发病率最高,达1712%和2766%,RR=759;慢性高原病组以急性轻型高原病和Monges病发病率最高,达1284%和1119%,RR=531。结论高原病患者再发生高原病的风险显著增加,不适宜长期滞留高原地区。     

高性能战斗机飞行员高+GZ综合防护进展

目的 概述国内外高性能战斗机飞行员高＋Gz综合防护的现状和发展趋势；提出我国相关技术，装备的改进建议。资料来源与选择 根据国内外的文献报道，主要介绍了高＋Gz防护措施的研究进展。资料引用 作者引用文献26篇。资料综合 重点论述了提高飞行员自身的抗荷能力，提高抗荷装备的抗荷性能，后倾座椅应用，＋Gz引起的意识丧失（G－LOC）监测与自动恢复系统，推拉效应等高＋Gz综合防护研究上的进展。结论 国内外在高性能战斗机飞行员高＋Gz综合防护的研究与应用上均取得很大进展，我国在该领域的工作与国外最先进水平相比尚有差距，应进一步改进提高相关技术，装备的研究与应用水平。     

Effect of high cardiorespiratory fitness and high body fat on insulin resistance

PURPOSE: High cardiorespiratory fitness (CRF) dramatically lowers risk for cardiometabolic disease in overweight and obese individuals. This effect is likely attributable to the inverse relationship between high CRF and insulin resistance. In this study, the independent effects of high body fat and high CRF on insulin resistance were assessed. METHODS: The blood glucose and insulin responses to an oral glucose tolerance test were measured in 10 overweight women with high CRF (OF), 9 lean women with high CRF (LF), and 10 overweight women with low CRF (OU). RESULTS: Fasting plasma glucose (P = 0.77), insulin (P = 0.23), and triacylglycerol (P = 0.99) concentrations were similar between OF and LF, with mean values in both groups lower than in OU. The glucose area under the curve (AUC) was not different between LF and OF (P = 0.28) and was significantly higher in OU. Insulin sensitivity, estimated from the composite insulin-sensitivity index (C-ISI), was slightly but significantly lower in OF compared with LF. Similarly, insulin AUC was 43% lower in LF compared with OF, although this difference was not statistically significant (P = 0.08). Insulin AUC was 50% higher (P = 0.04) and C-ISI was 35% lower (P = 0.09) in OU compared with OF. CONCLUSION: Compared with lean fit women, estimated insulin sensitivity was only slightly lower and plasma triacylglycerols were almost identical in overweight women with equally high CRF despite a twofold elevation in body fat percentage.     

Sexual assault consultations - from high risk to high reliability

The sexual assault consultation is a high-risk procedure with the potential for errors resulting in harm to both patients and staff. As such, it can be likened to practices in highrisk industries such as aviation and surgery. In contrast to these domains however, the focus on performance safety and Threat and Error Management has not been widely adopted. This is despite a growing recognition of the vulnerabilities of the investigative and prosecutorial stages of alleged sexual assaults. In the context of “high risk” sexual assault consultations, the notion of safety refers not only to the risk of patient morbidity and mortality, but also to physical, psychological and judicial outcomes that affect patients, staff, and the wider community. This article identifies the latent threats present in sexual assault consultations and suggests a conceptual framework for application of Threat and Error Management in this specialised area of medicine. This will enable practitioners to be better equipped to recognise the risks and improve the performance and safety of sexual assault consultation processes. In an era of growing medicolegal concerns regarding issues such as environmental safety and the potential for contamination of cases, focussing on education and safety culture components within the investigative systems will allow sexual assault consultation processes to progress towards a new level of organisational reliability.     

高性能战斗机飞行员离心机高G训练方案

目的制定我国高性能战斗机飞行员离心机高Ｇ训练方案。方法拟定离心机高Ｇ训练方案，对４７名飞行员进行训练，训练后检验训练效果，提出训练方案。结果训练后受试者采用综合抗荷措施时的Ｇ耐力比基础Ｇ耐力高４．３Ｇ～４．７Ｇ，比训练前提高了１．９Ｇ～３．３Ｇ（Ｐ＜０．０１）。结论按本研究提出的高Ｇ训练方案进行训练，可显著提高飞行员的Ｇ耐力，该训练方案有效可行。     

急进高原新兵对高原及急性高原病的认知调查及防病建议

目的 调查新兵对高原地理及急性高原病（AHAD）认知情况,为降低新兵AHAD发病率、提高高原适应能力和作战能力提供建议和参考.方法 对急进海拔3650 m高原地区的280名新兵进行平原及高原跟踪问卷调查,并对结果进行分析.结果 新兵对高原地理及AHAD的认知率普遍较差,只有18.92%的新兵了解,71.79%的新兵渴望了解.结论 应该采取多种措施,加强对新兵高原地理及AHAD的认知教育.     

Suicidal high falls

There are few data on committing suicide by jumping from a height. Information on suicidal high falls in southeast Scotland was prospectively gathered over 7 years (1992-1998). Data sources included ambulance, police, hospital and forensic records. Injuries sustained were scored according to the Abbreviated Injury Scale, generating Injury Severity Scores (ISS). Sixty-three individuals (50 males), appeared to have committed suicide by falling from a height. The backgrounds were diverse, but 44 individuals had known previous psychiatric illness, 18 having attempted suicide before. The most common locations were high bridges, with two accounting for 23 deaths (37%). Only nine individuals (14%) reached hospital alive. ISS range was 16-75, including 22 scores of 75. These individuals had a total of 24 injuries acknowledged to be unsurvivable, comprising 10 thoracic aortic ruptures, eight massive brain/brainstem injuries, four cardiac injuries, and two high spinal cord transections. The high rate of prehospital death reflects the heights of the falls and consequent major injuries. Prevention of suicide is acknowledged to be difficult - these results suggest that hospital treatment of injuries sustained has little to offer in terms of reducing the death rate from suicidal high falls.     

特高海拔14例急性高原肺水肿救治体会

目的 总结在特高高原组织救治急性肺水肿的经验教训.方法 对2009年7月在海拔5400 m高原所发生的14例急性高原肺水肿(4例合并急性高原脑水肿)救治经过进行回顾总结.结果 1例急性肺水肿患者在由基层部队组织后送途中死亡,其余13例由驻军医院组织低转至医疗站(海拔3700 m)均治愈.结论 在特高海拔地区,早期诊断、就地治疗、前接后送、阶梯治疗是提高救治水平的关键措施.     

Biomechanics of high tibial osteotomy

Purpose

This paper is a review of the biomechanical principles that support limb realignment surgery via osteotomy around the knee, principally high (proximal) tibial osteotomy.

Methods

The basic biomechanical principles have been described, and the related literature examined for evidence to support the recommendations made.

Results

The forces on the knee when walking are shown to lead to most of the load acting through the medial compartment, the most frequent site of degeneration of the knee, due to the adduction moment that acts during the weight-acceptance phase. Realignment of the limb to move the mechanical axis to a desired point within the knee is described, and the resulting joint contact pressures in the medial and lateral compartments are shown to be higher in the less-congruent lateral articulation when the load passes through the centre of the knee. At the same time, there can be changes of the posterior slope of the tibial plateau, and a slope of ten degrees can induce a shearing force, which stretches the ACL, of 0.5 body weight when the knee force is 3 times body weight. The options regarding tibial or femoral or even double osteotomies are discussed in relation to medial–lateral slope of the joint line. Secondary effects such as alteration of collateral ligament tension or of the height of the patella are described.

Conclusion

Critical review of the publications supporting osteotomy surgery suggests that many of the accepted ‘rules’ have little scientific evidence to show that they represent the best practise for long-term preservation of the joint.