TREC-Rio trial: a randomised controlled trial for rapid tranquillisation for agitated patients in emergency psychiatric rooms [ISRCTN44153243]

Background  

Agitated or violent patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians and clinical practice all differ. Systematic reviews show that all relevant studies are small and none are likely to have adequate power to show true differences between treatments. Worldwide, current treatment is not based on evidence from randomised trials. In Brazil, the combination haloperidol-promethazine is frequently used, but no studies involving this mix exist.     

Aged venous thrombi: radioimmunoimaging with fibrin-specific monoclonal antibody

Radioimmunoimaging of fresh canine venous thrombi with a murine monoclonal antibody specific for human and dog fibrin has been reported. Successful imaging of canine deep venous thrombi 1, 3, and 5 days old at the time of antibody injection is reported. Images were positive in all dogs, and the uptake of fibrin-specific antibody was equivalent to that of fresh thrombi.     

The effect of anesthesia and surgery on diaphragmatic lymph vessel flow after endotoxin in sheep

Increases in diaphragmatic lymph vessel flow (Qdi) may be important in preventing ascites because diaphragmatic lymph vessels drain the peritoneal space. However, lymphatic vessel function may be depressed in anesthetized, open chested animals. To test this hypothesis, we cannulated diaphragmatic lymph vessels in five sheep which were anesthetized with 1-2% halothane. We performed a thoracotomy and cannulated a diaphragmatic lymph vessel in each sheep. Then we infused 0.75-1.0 micrograms/kg of E. coli endotoxin intravenously and we measured Qdi and the lymph protein concentration for 2-4 hrs. The data were compared to previously reported data for five unanesthetized sheep (J. Appl. Physiol. 62:706-710, 1987). At baseline Qdi = 0.8 +/- 0.7 (SD) in the anesthetized sheep and 1.0 +/- 0.8 ml/hr in the unanesthetized sheep. After endotoxin, Qdi increased to 4.5 +/- 3.1 ml/hr in the unanesthetized sheep (p less than 0.05) but Qdi did not change in the anesthetized sheep. However, the lymph protein concentration increased similarly in each group, indicating that endotoxin caused the same degree of injury in each group. Our results indicate that diaphragmatic lymph vessel function is depressed in anesthetized, open chested sheep.     

肺源性心脏病急性发作期免疫功能的改变

目的:观察肺源性心脏病(简称肺心病)急性发作期患者免疫功能的变化。方法:选择南华大学附属第一医院2004-11/2006-01收治慢性肺心病急性发作期患者60例为肺心病组,于急性加重期入院第2天7:00,空腹抽取静脉血,采用流式细胞仪检测T细胞亚群CD3 、CD4 、CD8 及自然杀伤细胞活性,免疫浊度法检测体液免疫指标(IgG,IgM,IgA及补体C3)。以同期60例健康体检者为对照。结果:120例是否受试者均进入结果分析。①T细胞亚群:肺心病组CD3 ,CD4 水平低于对照组(0.52±0.06,0.62±0.04;0.32±0.06,0.41±0.06;P均<0.05),CD4 /CD8 高于对照组(1.96±0.26,1.84±0.78,P<0.05)。②免疫血清指标:肺心病组IgA、补体C3及自然杀伤细胞活性低于对照组[(1.26±0.74),(2.45±0.85)g/L;(6200±217),(9960±302)mg/L;0.34±0.08,0.57±0.07;P均<0.05]。结论:肺源性心脏病急性发作期患者的细胞免疫和体液免疫功能均受损,尤以细胞免疫功能受损更突出,且与病情呈平行关系。     

Granulocyte transfusion therapy in a child with chronic granulomatous disease and multiple red cell alloantibodies

A 7-year-old, 17-kg child with chronic granulomatous disease and nocardial pneumonia and osteomyelitis did not respond to antibiotic therapy and developed multiple red cell (RBC) alloantibodies (anti-c, -E, and -Jka). To provide daily granulocyte concentrates, a method was devised to reduce the number of incompatible RBCs per transfusion. Leukapheresis was done with hydroxyethyl starch, and the apheresis product was allowed to sediment by gravity in a plasma expressor for 90 minutes. The leukocyte-rich plasma was separated from the sedimented RBCs by transfer to a satellite bag, and the volume of the product was reduced by centrifugation to approximately 80 ml. RBC content was reduced from 29 +/- 7 to 2.5 +/- 1.0 ml (n = 22, p less than 0.01) and was accompanied by a 70 percent recovery of white cells (range, 49-90%). The final product contained 1.6 +/- 1.0 X 10(10) granulocytes. There were no clinical or laboratory signs of hemolysis during the course of 46 granulocyte transfusions, 37 of which were derived from c-, E-, or Jka-positive donors. The size of most apheresis donor pools is insufficient to provide phenotypically matched granulocyte concentrates daily for patients with RBC alloimmunization. The rapid, simple method described here may allow daily therapy with mismatched concentrates to be administered safely to such patients.     

大学生静态平衡能力与运动及性别的关系:定量对比分析

目的:采用定量分析方法比较体育与非体育专业大学生静态平衡能力,分析运动及性别对大学生静态平衡功能的影响。方法:于2007-01/03选取首都体育学院在校大学生共78名为受试对象,其中体育(武术)专业学生40名,非体育(康复)专业学生38名。所有选取对象了解试验目的,并同意参与本实验。采用意大利PosturalEqua平静分析系统,对实验对象分别在睁眼60s、闭眼60s两种状态下测试其静态平衡的各项指标,包括压力中心,线形图总长度,最大摆幅,线形图面积,LFS指数,压力分布,稳定性图及隆伯格值。结果:78名为受试对象均进入结果分析。①两专业学生压力中心X轴短于Y轴、压力分布前(%)高于后(%)(P<0.01)。②在闭眼状态下,体育专业男大学生在指标LFS指数和额状面上大于非体育专业(P<0.05)。③非体育业大学生在睁眼状态下,Y值女性小于男性,额状面值女性大于男性。男、女生睁闭眼差值进行比较时,女性在线形图总长度、额状面和LFT指数均大于男性(P<0.01),而线形图面积小于男性(P<0.05)。④体育专业大学生在睁眼状态下,指标参数Y值女性小于男性,额状面值女性大于男性;闭眼状态下,指标参数Y值女性小于男性,额状面值和LFS值女性大于男性。男、女生睁闭眼差值比较,女性在线形图总长度、额状面和LFT指数均大于男性(P<0.05,P<0.01),而线形图面积小于男性(P<0.05)。结论:①运动训练对大学生静态平衡影响不大,但对男性大学生的某些平衡指标却有显著影响。②性别对大学生的静态平衡均产生影响,表现为男性平衡的微控制能力优于女性。     

Prothetische Versorgung der posttraumatischen oberen Sprunggelenkarthrose

The loss of integrity and function of the ankle joint has severe effects on the mobility and quality of life of affected patients. The mental and physical disability associated with end-stage ankle arthrosis is at least as severe as that associated with end-stage hip arthrosis. In fact, 70–80% of cases of ankle arthritis occur in an ankle that has suffered an injury, which in advanced stages a painless gait can be restored with arthrodesis with good results even in the medium and long term. The alternative option of total ankle replacement (TAR) remains current despite the overall decline in the number of cases in Germany, especially since new developments of prostheses have become available in recent years. Recent data from the arthroplasty registers show significantly better results in the survival rate, mobility, stability and improved gait in comparison to arthrodesis. There is also evidence that the risk of subsequent arthrosis of joints in the foot is lower. The data available in the scientific literature on the indications for total ankle replacement versus arthrodesis in posttraumatic end-stage arthritis of the ankle joint remain inconclusive and unclear. This article gives an overview of the topic and guidelines for the indications for decision for arthrodesis versus prosthesis.     

The effect of prestorage irradiation on posttransfusion red cell survival

Transfusion-associated graft-versus-host disease (TA-GVHD) may occur whenever immunologically competent allogeneic lymphocytes are transfused to an immunocompromised recipient. Irradiation of blood components eliminates the risk of TA-GVHD but may damage the cellular elements in the transfused component, particularly if the cells are stored for prolonged periods in the irradiated state. To study the effect of irradiation on long-term storage of red cells, AS-1 red cells from eight normal subjects were prepared on two occasions. On one occasion, the units were stored as standard AS-1 red cells for 42 days at 4 degrees C; on the other, they were exposed to 3000 cGy radiation within 4 hours of collection and then were stored as AS-1 red cells for 42 days at 4 degrees C. The donations were at least 12 weeks apart. Irradiated units demonstrated significant elevations in poststorage plasma hemoglobin (Hb) (623 +/- 206 vs. 429 +/- 194 g/dL [6230 +/- 2060 vs. 4290 +/- 1940 g/L], p less than 0.02) and plasma potassium (78 +/- 4 vs. 43 +/- 9 mEq/L [78 +/- 4 vs. 43 +/- 9 mmol/L], p less than 0.01) and significant decreases in red cell ATP (1.9 +/- 0.2 vs. 2.1 +/- 0.3 microM/g Hb, p less than 0.04) and 24-hour posttransfusion red cell recovery (68.5 vs. 78.4%, p less than 0.02), as compared to nonirradiated units. It can be concluded that irradiation with 3000 cGy damages red cells and that long-term storage in the irradiated state may enhance this damage. Red cells should not be stored for 42 days after irradiation with 3000 cGy.     

复合富血小板血浆的酶处理异种骨修复兔桡骨缺损

目的:自源性的富血小板血浆可促进骨组织及软组织的修复,又不存在疾病传播及免疫排斥的可能。实验拟验证应用复合富血小板血浆的酶处理异种骨修复节段性骨缺损的可行性。方法:实验于2006-07/12在解放军昆明总医院实验动物中心完成。①实验分组:选用新西兰大耳白兔20只,体质量2.0～2.5kg,共40只前肢,随机分为复合酶组,单纯酶组,脱蛋白骨组,空白组。每组共10个标本。②实验方法:制作富血小板血浆及酶处理的异种骨并制备桡骨中段15mm的节段性骨缺损模型,将上述骨材料植入兔桡骨缺损处,其中复合酶组:植入复合富血小板血浆的酶处理异种骨;单纯酶组:植入酶处理异种骨;脱蛋白骨组:植入部分脱蛋白骨;空白组:不植入任何材料。③实验评估:分别于术后4,8,12周取材,X线片及苏木精-伊红染色分别观察骨缺损区的新骨形成情况。同时对各组骨密度进行测定。结果:纳入新西兰大耳白兔20只,均进入结果分析,所有手术无术后感染,无动物死亡,植入骨无脱落。①所有动物麻醉苏醒后均恢复进食,2周伤口愈合,未出现感染及渗液等。富血小板血浆中的血小板含量均为全血的4倍以上。②在同一时间点,酶处理后异种骨与部分脱蛋白骨在成骨能力方面差异无显著性意义,而复合富血小板血浆的酶处理异种骨在8周时骨缺损部分修复;12周时完全修复。空白组骨缺损未修复。③8,12周时复合酶组骨密度较单纯酶组、脱蛋白骨组高,差异有显著性意义(P<0.05);单纯酶组与脱蛋白骨组比较无明显差异(P>0.05)。结论:经酶处理后异种骨可用于节段性骨缺损的修复,复合富血小板血浆后有明显加速骨愈合的作用。