20. Stumpfe Herzverletzungen

Zusammenfassung 16% der Patienten mit stumpfem Thoraxtrauma erlitten eine Herzverletzung, 25 % von ihnen ohne gleichzeitige Rippenfrakturen. In der Akutsituation ist die Sonographie unerläßlich geworden. Bei der Herzkontusion finden sich im EKG vor allem Repolarisationsstörungen (66 von 108 Patienten) und Rhythmusstörungen (59 Patienten). Ein Anteil CK-MB über 8 % der Total-CK scheint beweisend. Die Überwachung auf einer Intensivstation ist unerläßlich, wobei Begleitverletzungen die Prognose bestimmen. Herzwandrupturen und eine Herzluxation bedingen ein sofortiges operatives Vorgehen. Von den Herzklappen sind am häufigsten die Aortenklappen verletzt.     

Retroperitoneal approach in selective surgery of the infrarenal aorta]

In recent years, there has been a resurgence of interest in the retroperitoneal approach to the aorta; however, there has been only few prospective studies in the literature and the results are controversial. For this reason, we assessed peri- and postoperative problems associated with both procedures and compared the results of each one in a prospective study. Between 1989 and 1990, 163 patients underwent operative procedure because of an aortic or aorto-iliac lesion. 121 were operated on through the "classical" transperitoneal method (87 had aortic aneurysm, 34 aorto-iliac occlusive disease) whereas in 42 patients, retroperitoneal approach of the aorto-iliac bifurcation was performed (28 because of aortic aneurysm and 14 because of occlusive disease). Early mortality was 0 in the group with retroperitoneal approach, despite the fact that 66% of these patients were classified as high-risk patients (American Society of Anesthesia risk classification III or IV); it was 0.8% in the group with classical approach. Retroperitoneal group demonstrated significant decrease in blood (630 vs 1300 ml) and crystalloids (1700 vs 3250 ml) requirement, shorter nasogastric intubation time (1.6 vs 4.4 d) and quicker peroral intake. Significant pulmonary and cardiac complications were less often observed in the group of patients after retroperitoneal approach to the abdominal aorta. Mean postoperative hospital stay was significant shorter when compared with the transperitoneal group (8.5 vs 13.9 d). Our results confirm that retroperitoneal approach is an excellent alternative to the transperitoneal method for elective reconstructive surgery of the abdominal aorta. It is associated with better tolerated incisional pain, decrease in cardiac and pulmonary complications and thereby decreased hospitalization time.(ABSTRACT TRUNCATED AT 250 WORDS)     

虚拟视景系统在广泛性焦虑障碍中的开发与应用

目的开发虚拟视景生物反馈系统用于治疗广泛性焦虑障碍(generalized anxiety disorder,GAD)。方法针对GAD患者心理特点,设计一套3D虚拟视景生物反馈系统。将该系统应用于15例广泛性焦虑障碍患者的治疗,观察患者治疗前后汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)与症状自评量表(SCL-90)评分变化。结果虚拟视景生物反馈系统由心率信号采集模块、呼吸信号采集模块、脑电信号采集模块、信号统一处理模块等9大模块组成,集呼吸、心率、脑电、视觉和听觉为一体;15例广泛性焦虑障碍患者通过虚拟视景生物反馈系统治疗3个月后,HAMA总分、SCL-90总分较治疗前均明显降低,差异有统计学意义(P<0.01)。结论运用虚拟视景生物反馈系统治疗GAD,临床效果显著,为广泛性焦虑障碍的治疗提供了创新有效的非药物治疗方法。     

HOXB1基因转染对HL-60细胞视黄酸代谢和α-干扰素表达的影响

目的探讨同源盒基因B1(HOXB1)转染对HL-60细胞视黄酸代谢和α-干扰素表达的影响.方法采用脂质体介导的质粒转染、RT-PCR及高效液相色谱(HPLC)分析等方法进行分析检测.结果 2.5×10-7 mol/L全反式视黄酸(ATRA)能抑制HOXB1转染及非转染HL-60细胞的增殖,HOXB1的高表达能明显减弱ATRA对HL-60细胞的增殖抑制作用;HPLC分析显示,转染细胞ATRA的代谢减慢;ATRA处理能诱导HOXB1转染及未转染HL-60细胞IFNα表达,加用外源性IFNα能上调ATRA处理HL-60细胞IFNα基因表达.结论 HOXB1转染使HL-60细胞ATRA代谢受抑,ATRA增殖抑制作用减弱,外源性IFNα能上调HL-60细胞IFNα表达.     

2种茶饮料的研制及营养评价

茶是我国的传统饮料 ,它含有机化合物４５０多种 ,无机矿物质１５种以上［１］。在许多国家（地区）十分流行 ,开发茶饮料具有广阔的前景。根据茶叶的保健作用 ,结合传统的中医学理论 ,我们组方了山楂茶和红姜茶。作者简介 :黄国荣（１９６４．８） ,重庆市开县人 ,实验师 ,主要从事营养与食品卫生及保健方面的研究 ,发表论文８篇。电话 :（０２３）６８７５２２９１收稿日期 :１９９９ ０９ １５;修回日期 :２０００ ０１ ０５１材料与方法１．１原料①山楂、绿茶、蜂密及甜密素等（山楂茶） ;②红茶、生姜、红糖、蜂密等（红姜茶）。１．…     

左向右分流性先天性心脏病患儿围术期肺功能变化

目的 检测动脉导管未闭（ＰＤＡ）、室间隔缺损（ＶＳＤ）患儿围术期呼吸力学及血气指标变化,探讨围术期肺功能变化及其影响因素。方法 以２０例ＰＤＡ患儿（非体外循环组）及２０例ＶＳＤ患儿（体外循环组）为研究对象,测定术前、术后即刻、术后４ｈ肺动态顺应性（Ｃｄｙｎ）,在同一时点检测吸入氧浓度（ＦｉＯ２）,并查血气得ＰａＯ２、ＰａＣＯ２值,计算呼吸指数（ＲＩ）。结果 体外循环组术后Ｃｄｙｎ较术前明显降低,Ｒ     

学术与评审:学术论文评审的演变及专家画像定量化指标的构建

【目的】 为了提高同行评审专家与所审学术论文研究方向的匹配度,改进和完善现有同行评审方法,探寻与时代和科学技术发展相适应的稿件评审模式。【方法】 调研分析传统同行评审存在的问题、同行评审的演变和发展趋势,并对专家匹配度中的定量化指标进行分析。【结果】 论文评审形式正经历从封闭性到开放性、从被动性到主动性,评审意见从静态化到动态性发展,从拒稿到分级评审以及从人工到智能等形式的演变。互联网和多媒体技术的快速发展和应用将推动构建健全、规范、合理、高效的同行评审体系,实现优秀科研成果的快速筛选和广泛传播。【结论】 论文引证标准化指数可以实现不同学科、不同年度论文之间的比较,h指数弥补了传统文献计量学单项数量指标只能体现数量的缺陷,可作为评审专家画像的定量化参数指标。     

移动医疗应用程序产品安全性评价研究进展

随着移动智能手机的广泛应用,医疗健康领域中移动应用程序(APP)产品日益增多。参考美国食品药品监督管理局(FDA)对移动APP产品的监管,根据我国对医疗器械的定义,移动APP产品可以分为移动健康APP(非医疗器械产品)和移动医疗APP(医疗器械产品)。阐述移动APP在医疗健康领域的应用现状,从监管科学的角度分析移动APP在医疗器械应用中需考虑的安全性风险,探索建立适合移动医疗APP特点的评价体系,为企业和监管部门提供该类产品安全有效性的评价方法,推动其在医疗卫生领域的规范化发展。     

Sleeve gastrectomy or gastric bypass: a “post-code” lottery? A comprehensive national analysis of the utilization of bariatric surgery in Switzerland between 2011–2017

BackgroundSleeve gastrectomy (SG) recently became the most frequently performed bariatric surgery (BS) worldwide, overtaking the long-time standard Roux-en-Y gastric bypass (RYGB). Main indications for one or the other procedure show large inter-center variations and warrant further investigations.ObjectivesThe aim of this study was to identify the influencers of primary BS selection in Switzerland.SettingSwitzerland.MethodsRetrospective analysis of all hospitalizations in Switzerland January 1, 2011 through December 31, 2017 with anonymized data provided by the Swiss Federal Statistical Office. BS procedures were identified based on ICD-10 and national surgical codes. Statistical analyses were performed with R.ResultsDuring the study period 27,375 BS were performed. The annual BS caseload doubled over time, whereas inpatient complications decreased (～?33%). RYGB was the prevailing procedure, although its annual proportion decreased from 80% to 70% over 7 years. Meanwhile, use of SG increased from 14% to 23%. Primary RYGB and SG had similar rates of inpatient mortality (～.05%) and morbidity (8.0 versus 7.4%, P =.148), with the exception of higher ileus rates following RYGB (.7 versus .1%, P < .001). Patient-related factors favoring the indication of SG were male sex, extremes of age, and metabolic co-morbidities , while gastroesophageal reflux disease and private insurance–favored RYGB. Strikingly, differences between geographic regions outweighed patient-related factors in procedure selection: inhabitants of German- and Italian-speaking areas had higher likelihood (OR 4.6; 3.9, P < .001) to receive SG than those in French-speaking areas.ConclusionGeographic differences in primary BS procedure selection indicate a lack of objective rationales. Long-term risk-benefit and cost-effectiveness analyses are needed to assist evidence-based decision making.     

不同来源国产血竭的薄层色谱和紫外光谱鉴别

目的：比较6种不同来源国产血竭的质量差异。方法：以剑叶龙血树含皮及木质部为原料，采用回流提取、索氏提取，超声提取，低温膨化提取，并与市售的通过传统工艺提取的云南血竭和海南血竭为对照，对它们进行薄层层析和紫外光谱鉴别。结果：薄层对应斑点基本相同，紫外光谱基本一致。结论：6种不同来源的国产血竭的成分基本一致，而以龙血素C作为评价指标，其质量存在一定差异。