脱中性粒细胞温血心脏停搏液连续灌注在心脏手术中心肌保护的研究

目的 :研究体外循环期间常温血脱中性粒细胞心脏停搏液微流量连续灌注对心脏瓣膜置换术中心肌的保护作用。方法 :临床随机选取体外循环时间在 60min以上的风湿性心脏瓣膜病人 2 0例 ,随机分为实验组和对照组 (每组 10例 ) ,分别检测不同时间点血浆心肌肌钙蛋白I(cTnI)水平和血浆MDA水平的变化。结果 :①两组病人在CPB前cTnI含量组间差异无显著性 ,而在主动脉阻断后及主动脉开放后各时间点差异显著 ,对照组cTnI值高于实验组 (P <0 .0 5 ) ;②两组病人在体外循环前及主动脉阻断 3 0min时MDA的含量组间差异无显著性 ,而在主动脉开放各时间点组间差异具有显著性 (P <0 .0 5 ) ,对照组高于实验组。结论 :实验研究证实 ,脱除心脏停搏液中的中性粒细胞后 ,可减轻中性粒细胞介导的心肌损伤 ,有利于心肌保护     

A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third molar removal

OBJECTIVE: This study compared the clinical efficacy of 4% articaine (A200) and 0.5% bupivacaine (B200), both with 1:200,000 epinephrine, for lower third molar removal. STUDY DESIGN: Fifty patients underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia either with A200 or B200, in a double-blind, randomized, and crossover manner. Time to onset, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated. RESULTS: A statistically significant difference between the time to onset of A200 (1.66 +/- 0.13 minutes) and B200 (2.51 +/- 0.21 minutes) was found (P < .05). There was no statistically significant difference in the duration of analgesia, whether the patient was subjected to osteotomy or not, regardless of the local anesthetic used (3 to 4 hours; P > .05). However, when patients received B200 they experienced a statistically significant longer period of anesthesia on the soft tissues as compared with when they had received A200 (around 5 hours and 4 hours, respectively, P < .05). The surgeon's rating of intraoperative bleeding was considered very close to minimal for both anesthetics. In the surgeries with osteotomy, the comparison between A200 and B200 showed statistically significant differences in the diastolic (64 mm Hg and 68 mm Hg, respectively, P = .001) and mean arterial pressure (86 mm Hg and 89 mm Hg, respectively, P = .031) when data from all the surgical phases were pooled. Additionally, the mouth opening at the suture removal was statistically different for A200 and B200 solutions (91.90% +/- 3.00% and 88.57% +/- 2.38% of the preoperative measure, respectively) when surgeries required bone removal (P < .05). CONCLUSIONS: In comparison with 0.5% bupivacaine, 4% articaine (both with 1:200,000 epinephrine) provided a shorter time to onset and comparable hemostasis and postoperative pain control with a shorter duration of soft tissue anesthesia in lower third molar removal.     

The haemodynamic, renal excretory and hormonal changes induced by resting in the left lateral position in normal pregnant women during late gestation

Objective  To characterise the haemodynamic, renal-electrolyte and hormonal parameters in normal near-term pregnancy.
Design  Observational prospective case-series study.
Setting and population  Eleven women with normal pregnancies at 35–39 weeks gestation.
Methods  Following baseline laboratory assessments and placement of a right-atrial catheter, serial measurements were obtained for 2 hours in the supine position (SP) followed by a change to the (LLP) and subsequent observations for 2 hours.
Main outcome measures  Blood pressure (BP), central venous pressure (CVP), atrial natriuretic peptide (ANP), plasma renin activity (PRA), plasma aldosterone (ALDO), diuresis, creatinine clearance, sodium and potassium excretion.
Results  In the SP, the subjects' BP remained stable while their CVP decreased. In the LLP, the subjects' systolic and diastolic BP consistently decreased by about 15 mmHg and their CVP increased within the first 60 minutes. ANP levels doubled in the subjects while they rested in the LLP, whereas the subjects' PRA and ALDO levels decreased by half compared with when they rested in the SP. In the LLP, the subjects' creatinine clearance significantly increased by 12% and their sodium excretion and diuresis increased by 38% and 59% respectively.
Conclusion  Rest in the LLP induces systemic and intra-renal haemodynamic and hormonal changes that may play a central physiological role in the renal excretory response to restore excessive sodium/water retention in late pregnancy.     

温氧合血连灌与冷晶体液间灌心肌线粒体量化计分及形态改变的对比研究

目的：对温血连续灌注与冷晶体液间断灌注下心肌线粒体结构及量化计分进行了对比研究。方法：病人分两组（每组７例），主动脉阻断６０分钟后及再灌注２０分钟各取２ｍｍ直径心室壁肌肉置入４℃２．５％戊二醛液中固定２小时。在Ｈ６００型电镜下选择５个视野、每视野随机观察２０个线粒体。依受损程度分为０～４级（０级为正常结构，４级受损程度最重），将１００个线粒体按级得分总和除以１００即为该组得分数。结果：阻断６０分钟线粒体量化计分冷晶组为２．５１４３±０．２８６３，温血组计分为１．５４８６±０．０９１５（Ｐ＜０．００１）。再灌注２０分钟后冷晶组记分为３．０１４３±０．１７９２，温血组记分为１．６８２９±０．１５８１（Ｐ＜０．０１）。阻断６０分钟再灌２０分钟电镜下冷晶组线粒体嵴断裂、溶解、基质颗粒丢失明显、内外膜完整性消失；温血组线粒体嵴无断裂、外膜完整、基质颗粒略少。结论：电镜下线粒体超微结构及量化计分证明温血组心肌保护作用明显优于冷晶组。     

Comparison of the effects of pilocarpine and cevimeline on salivary flow

Abstract: Objective: The aim of the present study was to compare the effect of low‐dose pilocarpine and cevimeline as stimulants for salivary flow in healthy subjects. Methods: In this cross‐over clinical trial with a 1‐week washout period, 40 male volunteers were submitted to an oral dose of pilocarpine 1% (Salagen?) ?60 μg kg^?1 body‐weight (Group 1) or Cevimeline (Evoxac?) ?30 mg (Group 2). Saliva samples were collected and the salivary flow rate was measured (ml min^?1) at baseline and 20, 40, 60, 80, 140 and 200 min after administration of drugs. In addition, salivary secretion was also measured under mechanical stimulation to observe salivary gland function. Results: The data were analyzed by Friedman and Wilcoxon signed‐rank tests (significance level = 5%). Pilocarpine and cevimeline significantly increased salivary flow 140 min after intake. There was a significant higher secretion with cevimeline 140 and 200 min after administration. There were no differences seen among subjects in the salivary glands function by mechanical stimulation. Conclusion: Both drugs showed efficacy in increasing the salivary flow in healthy volunteers, but cevimeline was more effective than pilocarpine.     

The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity

Objective

To analyse preterm birth rates worldwide to assess the incidence of this public health problem, map the regional distribution of preterm births and gain insight into existing assessment strategies.

Methods

Data on preterm birth rates worldwide were extracted during a previous systematic review of published and unpublished data on maternal mortality and morbidity reported between 1997 and 2002. Those data were supplemented through a complementary search covering the period 2003–2007. Region-specific multiple regression models were used to estimate the preterm birth rates for countries with no data.

Findings

We estimated that in 2005, 12.9 million births, or 9.6% of all births worldwide, were preterm. Approximately 11 million (85%) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean. The highest rates of preterm birth were in Africa and North America (11.9% and 10.6% of all births, respectively), and the lowest were in Europe (6.2%).

Conclusion

Preterm birth is an important perinatal health problem across the globe. Developing countries, especially those in Africa and southern Asia, incur the highest burden in terms of absolute numbers, although a high rate is also observed in North America. A better understanding of the causes of preterm birth and improved estimates of the incidence of preterm birth at the country level are needed to improve access to effective obstetric and neonatal care.     

Peritoneal inclusion cysts: ovarian fluid in peritoneal adhesions

In four women pelvic peritoneal inclusion cysts were diagnosed with ultrasound or computed tomography. Three patients had a history of multiple surgical procedures, whereas the fourth had prior severe abdominal trauma. Imaging studies showed large cystic structures contiguous with the adnexa. The normal ovarian appearance was distorted in two women. Pathologic confirmation was obtained in all cases. When large adnexal cystic structures are identified in young women with a history of surgery or trauma, the diagnosis of peritoneal inclusion cysts should be entertained. Recognition should result in conservative therapy rather than salpingo-oophorectomy.     

依恋风格对临床护士触摸舒适感的影响

目的：调查临床护士的依恋风格及触摸舒适感现状并分析其依恋风格对触摸舒适感的影响,为护理管理者制定有效干预措施改善护理人员触摸舒适感,提高护理质量提供理论依据。方法：采用一般资料调查表、亲密关系经历量表（ECR）、护士触摸舒适感量表（NCTS）对234名天津市三级甲等医院临床护士进行调查。结果：234名护士的触摸舒适感得分为（4.51±1.08）分,依恋回避得分为（3.00±0.88）分,依恋焦虑得分为（3.02±0.98）分,安全型依恋护士的触摸舒适感得分高于不安全型依恋护士（P<0.01）。多元回归分析结果显示,依恋回避、依恋焦虑是护士触摸舒适感的影响因素（P<0.05）。结论：天津市三级甲等医院临床护士的触摸舒适感处于中等水平,依恋风格是护士触摸舒适感的影响因素,依恋回避、依恋焦虑对护士触摸舒适感具有负向预测作用。护理管理者可通过制定针对性干预措施促进临床护士安全依恋关系的形成,改善其依恋风格,从而提高其触摸舒适感水平。     

Infected bilomas and hepatic artery thrombosis in infant recipients of liver transplants. Interventional radiology and medical therapy as an alternative to retransplantation

Fifteen children less than 12 kg in weight underwent transplantation of the liver for biliary atresia; eight survived. Five of the eight survivors had thrombosis of the hepatic artery without portal vein thrombosis. Three of the five patients with hepatic artery thrombosis developed infected bilomas, which were drained percutaneously under ultrasonographic (US) or computed tomographic (CT) guidance. Concurrent therapy with antibiotics and hyperoxygenation resulted in resolution of these intrahepatic collections. Although it had been thought that thrombosis of the hepatic artery most often results in necrosis of the graft and requires retransplantation, the five patients in this study survived without retransplantation. Diagnosis of hepatic artery thrombosis was achieved with the use of Doppler US in four cases, CT in four cases, and angiography in two cases. Duplex Doppler US is the preferred imaging modality.