利多卡因混合不同剂量肾上腺素局部浸润麻醉对全麻下鼻内窥镜手术患者血液动力学的影响

目的 观察利多卡因混合不同剂量肾上腺素局部浸润麻醉对全麻下鼻内窥镜手术患者血液动力学的影响。方法 69例拟在全身麻醉下行鼻内窥镜手术的患者随机分为3组（n=23），采用含不同剂量肾上腺素的1％利多卡因进行鼻粘膜下多点浸润注射。Ⅰ组：含1：20万肾上腺素的1％利多卡因4ml（20μg）；11组：含1：10万肾上腺素的1％利多卡因4ml（40μg）；Ⅲ组：1％利多卡因4ml（不含肾上腺素）。采用阻抗心动图（ICG）测量并记录浸润麻醉开始前（基础值）、浸润麻醉开始后0．75、1．5、2．25、3、3．75、4．5、5．25、6min平均动脉压（MAP）、心率（HR）、心脏排血指数（CI）、外周血管阻力指数（SVRI）和加速度指数（ACI），同时评价术中出血状况。结果与基础值比较，Ⅰ组和Ⅱ组在浸润麻醉开始后1．5min时MAP下降，HR增快（P〈0．01）；从浸润麻醉开始后1．5minSVRI下降，CI、ACI上升，到浸润麻醉开始后6min时仍未恢复（P〈0．05或0．01）。与Ⅱ组比较，Ⅰ组在浸润麻醉开始后2．25、3、3．75minMAP下降，从2．25min起CI下降（P〈0．01或〈0．05）。与Ⅲ组比较，Ⅰ组、Ⅱ组出血较少（P〈0．01）；Ⅰ组和Ⅱ组之间差异无统计学意义。结论 全身麻醉下鼻内窥镜手术中局部浸润麻醉时，局麻药中肾上腺素的吸收会引起明显的血液动力学变化，推荐在鼻内窥镜手术中使用含有5μg/ml肾上腺素的利多卡因。     

Corticosteroids for multiple sclerosis: II. Application for disease-modifying effects

Physicians who treat multiple sclerosis (MS) face the challenge of patients exhibiting ongoing disease activity, including exacerbations, loss of functional capabilities, intellectual decline, and radiologic progression, despite being on a disease-modifying agent (DMA). After searching for factors that might at least in part explain these changes—such as nonadherent drug-taking behavior, or the presence of interfer-on-neutralizing antibodies—some providers may ultimately decide to switch the patient to another DMA. In most circumstances, patients likely derive only partial effects from these agents, even in the absence of compromising factors. Thus, a number of factors must be considered in order to intensify the treatment regimen in response to disease progression. In the context of an inadequate treatment response to a DMA, some clinicians will convert the patient to an alternative therapy, and others will instead use a second agent in combination with the first (the so-called platform agent). In the first of this two-part series, we explored the use of anti-inflammatory CS and ACTH to treat MS exacerbations. Although we underscored the limited availability of evidence-based studies to support specific regimens for this purpose, there is an even greater paucity of data to support the routine use of these agents in order to achieve chronic disease-modifying effects in those who continue to deteriorate clinically, radiographically, or both. Without doubt, a number of factors influence the formulation of combination treatment plan for MS. Nevertheless, we will focus on the rationale and practical schemes that can be considered for using corticosteroids (CS) (and perhaps even ACTH) in an attempt to modify various domains of ongoing disease activity.     

大鼠体外循环模型的建立与应用

由于操作简便、节省人力物力，大鼠体外循环模型的应用愈加广泛。大鼠在小型呼吸机辅助下，应用颈静脉插管入右心房引流血液至贮血瓶，在蠕动移液泵作用下，经膜式氧合器氧合、变温器变温，通过股动脉或尾动脉插管注入动脉系统，建立体外循环回路。有血预充、减少总预充量和维持足够的转流流量是建立大鼠体外循环模型的关键。     

提高《物理诊断学》教学质量的探索与实践

总结了物理诊断学的基本特点和教授本课程时需把握好的几个环节 ,就提高物理诊断学教学质量进行了一些思考 ,并结合我院经验提出了物理诊断学教学改革的创新思路     

PACS系统中IBM磁带库存储故障维修

介绍了一例PACS系统中磁带库因通信通路问题引起的故障及维修过程。     

Technical Note: A comparison of a novel direct ophthalmoscope, the OptyseTM, to conventional direct ophthalmoscopes

Despite the current popularity of binocular indirect ophthalmoscopy, direct ophthalmoscopes are still commonly used by clinicians for fundus examination. They are considered to be expensive, however, and it has been suggested that this cost can prevent their use by healthcare professionals in developing countries. The Optyse Lens Free Ophthalmoscope is a novel direct ophthalmoscope, without a lens focus system, that allows for comparatively inexpensive manufacture and supply. We compared the clarity of view with the Optyse to that with standard direct ophthalmoscopes, over a sequential cohort of patients with a variety of refractive errors and ocular conditions. The grade of clarity of view with the Optyse Lens Free Ophthalmoscope was less than conventional ophthalmoscopes (Wilcoxon signed rank test, p < 0.0001). This grade of clarity of view was not associated with the ametropia of the ophthalmoscopic observation (Spearman r < or = 0.03, p > or = 0.28) but was with the presence of cataracts (chi2 test, p < 0.0001) with both the Optyse and the conventional ophthalmoscopes. Despite its limitations, the retinal view with Optyse was often within acceptable clinical limits suggesting that this relatively inexpensive ophthalmoscope may have a place when cost prohibits any other type of ophthalmoscope use.     

Calcium antagonists and blood glucose in normal rabbits

The effects of the calcium antagonists verapamil and nifedipine on blood glucose levels, glucose tolerance, insulin secretion during glucose tolerance and hypoglycaemic effect of tolbutamide were studied in normal nondiabetic rabbits. Daily dosage of 40 mg/kg verapamil and 5 mg/kg nifedipine given orally up to 7 days did not affect blood glucose level, glucose tolerance, insulin secretion during glucose tolerance and hypoglycaemic activity of tolbutamide 250 mg/kg p.o.     

自杀基因联合中医药疗法治疗肿瘤的设想

自杀基因疗法是一种具有良好应用前景的肿瘤治疗新措施。但如何有效提高疗效是目前仍须解决的关键性问题。由于免疫机制在自杀基因疗法旁杀伤效应中的重要作用，激活荷瘤机体的免疫功能，改善自杀基因抗肿瘤作用的炎症免疫微环境，是提高肿瘤自杀基因疗法疗效的主要策略。中医中药在调节机体免疫状态方面具有肯定的作用，与其他方法比较具有明显优势。因而，将自杀基因疗法与中医中药联合应用，有可能起到提高肿瘤自杀基因疗法疗效，防止肿瘤复发的作用。提出了自杀基因联合中医药疗法治疗肿瘤的新设想，为肿瘤基因治疗提供了一种新的思路和模式。     

肺炎克雷伯菌致婴幼儿腹泻发病动态观察

目的观察肺炎克雷伯菌所致婴幼儿腹泻的发病动态与流行趋势，探索有效治疗措施。方法取腹泻患儿新鲜大便，送作细菌培养，从中筛查出肺炎克雷伯菌所致病例，进行整理分析。结果从大便培养阳性的1005例病例中，筛查出肺炎克雷伯菌322例，占32％，居同期病原菌之首。年龄均在3岁以下，其中1岁以内婴儿占71．7％，夏秋季为发病高峰。结论肺炎克雷伯菌是人体肠道正常寄居菌之一，当机体抵抗力低下时，可致婴幼儿腹泻，成为重要的条件致病菌，其发病的流行因素与年龄、免疫力、季节、喂养方式及抗生素的应用等多种因素有关。近几年来，发病人数呈逐年上升趋势，提请临床儿科医生引起关注。