Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

本刊现已实行“中华医学会信息管理平台"在线投稿

本刊的审稿专家可使用同一个用户名作为审稿人进行稿件审理和作者投稿。(3)作者投稿请直接登录中华医学会业务巾心下信息管理平台的稿件远程管理系统，点击“作者在线投稿”。投稿成功后，系统自动发送回执邮件。作者可随时点击“在线查稿”，获知该稿件的审稿情况、处理进展、审稿意见、终审结论等；有关稿件处理的相关结果编辑部不再另行纸质通知。     

A quantitative evaluation of sealing ability of 4 obturation techniques by using a glucose leakage test.

OBJECTIVE: The aim of this study was to evaluate the sealing ability of 4 different obturation techniques by using a glucose leakage test. STUDY DESIGN: Eighty extracted single-rooted maxillary incisors were selected for the study. The teeth were decoronated and the root canals prepared using ProFile rotary instruments to an apical dimension of size 40 (0.06 taper). The specimens were then randomly divided into 4 experimental groups (n = 15) and filled with gutta-percha and sealer by using either cold lateral compaction, warm vertical compaction, Thermafil, or the E & Q Plus system. Another 10 teeth each served as the positive and negative controls. A glucose leakage model was used for quantitative evaluation of the coronal-to-apical microleakage at 24 hours, 1, 2, 3, 5, 8, and 12 weeks. RESULTS: No significant difference in the cumulative amount of leakage was found among the 4 groups at 24 hours and 1 week (Kruskal-Wallis test, P > .05). Lateral compaction showed significantly more leakage than the other 3 techniques at longer intervals (Mann-Whitney U test, P < .008). No significant difference was found between vertical compaction, Thermafil, and E & Q Plus at all observation times. CONCLUSIONS: Warm vertical compaction, Thermafil, and the E & Q Plus system showed a better sealing result than cold lateral compaction of gutta-percha at extended observation periods. The glucose leakage method used in this study was able to provide a nondestructive, quantitative, and long-term evaluation of the sealing ability of root canal fillings.     

靶重建放大扫描对肺孤立性结节病变的诊断意义

目的：探讨靶重建放大扫描技术对肺孤立性结节病变的诊断价值。方法：对63例患者先行常规CT平扫，选定结节处为兴趣区，行薄层靶重建放大扫描，层厚、层距为2mm，FOV为160。结果：42例恶性病变中有37例表现为深分叶，占88．1％；21例良性病变中有15例表现为浅分叶，占71．4％。恶性结节中15例内部出现条状低密度支气管征；7例出现血管集中征；8例出现空泡征；病变内部出现液化坏死13例，其中恶性病变ll例。22例出现钙化，包括12例良性病变和10例恶性病变。2例错构瘤内均见小面积脂肪性低密度影。结论：靶重建放大扫描比普通CT扫描可提供更多的信息，对良恶性病变的鉴别诊断有一定价值。恶性病变大多数为深分叶，良性病变大多数为浅分叶或无分叶。     

铁打的营盘VS流水的人才空军总医院的"激将法"

“铁打的营盘流水的兵”,到哪儿都是这个理。可当“铁打的营盘”遭遇“流水的人才”结果会怎样?曾几何时,一度人才防线牢不可破的公立医院,在面临外资和民营医疗机构强大的“挖角”攻势下,不得不仓促应战。虽然目前公立医院在这场人才拔河较量中仍具优势,只是不知这种优势还能维持多久?     

高血压病患者动态脉压与左心室肥厚的关系

OBJECTIVE: To evaluate the relationship between the left ventricular hypertrophy (LVH) and the ambulatory pulse pressure and aortic root dimension (AOD) in essential hypertensive patients. METHODS: We monitored the 24-hour ambulatory blood pressure and applied echocardiography in 107 essential hypertensive patients. Using the left ventricular mass index (LVMI) as an index in evaluating LVH, the patients were divided into 2 groups: 29 cases in the LVH group and 78 in the non-LVH group. RESULTS: The average levels of 24-hour pulse pressure, daytime pulse pressure, nighttime pulse pressure and AOD were significantly different between patients with LVH and without LVH (P < 0.05). Multiple stepwise regression analysis showed that the changes in nighttime pulse pressure and AOD were closely related to LVMI (P < 0.001). CONCLUSION: The pulse pressure and AOD are important factors leading to LVH in patients with essential hypertension.     

二氧化碳吸收剂中水分对七氟醚分解反应的影响

目的　研究模拟紧闭反应器内干燥的二氧化碳 (CO2 )吸收剂及自身含水对七氟醚分解的影响。方法　在紧闭反应器 (1 6 0ml)内 ,分别装钠石灰、钡石灰、干燥钠石灰和干燥钡石灰 (各 2 5g)。在密闭状态下注入液态的七氟醚 4 0 0 μl,放入 5 0℃水浴内反应 6h ,分别在 5、1 5、30、4 5、6 0min、以后每 30分钟至 36 0分钟采样 ,用气相色谱法分析。测定七氟醚的分解产物。结果　钠石灰组出现复合物A、B ,在其他组七氟醚产生 5种分解产物。复合物A∶干燥钡石灰 >干燥钠石灰 >钡石灰和钠石灰组。干燥钡石灰组明显高于其他两组 (P <0 0 5 )。复合物B∶干燥钡石灰组 <钡石灰组 <干燥钠石灰组 (P <0 0 5 )。复合物C、D、E ,以干燥钡石灰组最为明显 (P <0 0 5 )。各组均未检测到CO。结论　在 5 0℃的紧闭反应器内 ,七氟醚与干燥的CO2 吸收剂反应剧烈 ,未产生CO ;国产钠石灰优于钡石灰 ,在紧闭容器内自身含水可以抑制分解反应     

Validity and reliability of the Bengali version of the Hepatitis Quality of Life Questionnaire

Purpose  

Hepatitis B virus (HBV) is endemic in Bangladesh, and the quality of life (QoL) of these patients remains unknown as there is no instrument available in the native language. In this study, we translated the 56-item Hepatitis Quality of Life Questionnaire (HQLQ) into Bengali and evaluated its validity and reliability.     

桡骨远端关节内骨折外固定器治疗的相关机制和原则探讨

目的 分析和探讨桡骨远端关节内骨折外固定器治疗的相关机制和原则.方法 笔者采用Orthofix外固定器和国产组合式外固定器治疗桡骨远端关节内骨折45例46肢,以齐藤英彦法对资料完整的37例38肢病例进行分型,分析其影像学表现、损伤和治疗相关机制以及特点.结果 各型复位方向和外固定腕关节位置均与致伤暴力方向相反.骨折愈合时间平均为43 d(37～62 d),平均随访时间14个月(3～56个月),按Dienst标准评估腕关节功能及疗效:优21例22肢,良10例10肢,可6例6肢.结论 闭合复位外固定能很好地解决桡骨远端关节内骨折的治疗问题,特别适用于粉碎型关节内骨折.其治疗原则是复位方向及腕关节外固定位置与损伤机制、移位情形相反,个别骨折块辅以切开复位时须强调有限切开,必须重视部分病例伴有的同侧桡骨中远段骨折和同侧尺骨远段骨折的处理.     

丹芎瘢痕涂膜的临床应用研究

目的:本文通过769例病人应用丹芎瘢痕涂膜防治瘢痕增生的治疗效果,为烧烫伤后瘢痕增生提供一种新的治疗手段.方法:我们根据中医、中药活血化淤原理,经多年临床实践研制而成的丹芎瘢痕涂膜,由丹参、川芎等复方组成.药物使用,将丹芎瘢痕涂膜直接均匀涂于瘢痕表面上,形成药膜,次日揭去药膜,重新涂药,每日1次,连续用药5个月.疤痕止痒软化膏对照,每日1次,连续用药5个月.结果:(1)创面愈合后瘢痕刚开始增生者,丹芎瘢痕涂膜治疗组共415例,显效77例,有效323例,总有效率96.39%;疤痕止痒软化膏同体对照组51例,显效0例,有效20例,总有效率39.22%,治疗组显著优于对照组.(2)创面愈合后瘢痕已增生者,丹芎瘢痕涂膜治疗组354例,显效88例,有效257例,总有效率97.46%;疤痕止痒软化膏对照组63例,显效4例,有效34例,总有效率60.32%,治疗组显著优于对照组.(3)丹芎瘢痕涂膜治疗组与疤痕止痒软化膏对照组综合疗效比较,丹芎瘢痕涂膜治疗组769例,显效165例,有效580例,总有效率96.88%;疤痕止痒软化膏对照组114例,显效4例,有效54例,总有效率50.88%,治疗组显著优于对照组.(4)60例丹芎瘢痕涂膜治疗组与同体空白对照组比较,治疗组显效25例,有效34例,总有效率98.33%;对照组显效0例,有效11例,总有效率18.33%;治疗组显著优于对照组.(5)未发现不良反应.结论:经769例病人临床应用丹芎瘢痕涂膜,并与已知疤痕止痒软化膏比较,丹芎瘢痕涂膜治疗效果显著优于疤痕止痒软化膏,丹芎瘢痕涂膜是一种安全、有效、新的创面瘢痕外用药.