ICU医师应用超声诊断危重患者气胸的价值研究

目的探讨ICU医师应用床旁超声诊断危重患者气胸的可行性及临床价值。方法2004—09～2005—07急诊ICU收治101例危重患者，由ICU医师进行床旁胸部超声检查，以“肺滑行”和“彗尾”征消失诊断气胸。在超声检查前后3h内行胸部CT和床旁X片检查，以CT结果为“金标准”比较超声和X片诊断气胸的价值。结果101例危重患者中，CT确诊气胸19例21侧，超声诊断17例18倒，X片诊断4例4侧，相应的诊断敏感性、特异性、阳性预测值、阴性预测值和准确度分别为85.7％时19.0％（P〈0.001）、98．9％对100％（P=0．499）、90．0％时100％（P=1．0）、98．4％对91．4％（P=0．002）和97.5％对91．6％（P=0．009）。超声与CT诊断气胸的一致性高于X片。结论ICU医师完成的超声检查诊断气胸具有较高的敏感性和特异性，为危重患者气胸的诊断提供了简单、快速而安全有效的手段。     

公共卫生硕士（MPH）研究生培养质量保障体系的构建研究

对中山大学MPH教育的一些经验进行了总结,在此基础上提出了构建MPH培养质量保证体系的设想,并对MPH培养质量保证体系的内容和运行方式进行了阐述,为提高MPH的培养质量提供参考。     

右美托咪啶对七氟醚麻醉患儿麻醉恢复期躁动的影响

目的 评价右美托咪啶对七氟醚麻醉患儿麻醉恢复期躁动的影响.方法 择期全麻下行耳鼻喉科手术患儿300例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄4～7岁,体重16～30 kg,采用随机数字表法,将其随机分为2组(n=150):对照组(C组)和右美托咪啶组(D组).D组麻醉诱导前经10min静脉输注0.5μg/kg右美托咪啶20 ml,C组输注生理盐水20 ml.给药结束后5 min时吸入8%七氟醚麻醉诱导,气管插管后行机械通气.吸人2%～ 3%七氟醚维持麻醉,术中维持BIS值40～60.记录麻醉恢复时间和术后2 h内躁动的发生情况.结果 与C组比较,D组麻醉恢复时间差异无统计学意义(P>0.05),躁动发生率降低(P<0.05).结论 右美托咪啶可降低七氟醚麻醉患儿麻醉恢复期躁动的发生.

Abstract：

Objective To investigate the effect of dexmedetomidine on agitation during recovery from sevoflurane anesthesia in children. Methods Three hundred ASA Ⅰ or Ⅱ children, aged 4-7 yr, weighing 16-30kg, scheduled for elective ear-nose-throat operation under general anesthesia, were randomly divided into 2 groups ( n = 150 each) : control group (group C) and dexmedetomidine group (group D) . Dexmedetomidine 0.5 μg/kg in 20 ml was infused intravenously over 10 min before anesthesia induction in group D, while equal volume of normal Saline was infused in group C. Anesthesia was induced with inhalation of 8 % sevoflurane 5 min after the end of administration . The children were tracheal incubated and mechanically ventilated. Anesthesia was maintained with inhalation of 2 % -3 % sevoflurane. BIS was maintained at 40-60 during operation. The recovery time and agitation within 2 h after operation were recorded. Results There was no significant difference in the recovery time between the two groups ( P > 0.05) . The incidence of agitation was significantly lower in group D than in group C ( P <0.05 ) . Conclusion Dexmedetomidine can reduce the occurrence of agitation during recovery from sevoflurane anesthesia in children.     

四川省地震灾区卫生适宜技术培训效果分析

目的评价地震灾区卫生适宜技术培训的效果,为进一步提高培训效果、改善培训方式和适宜技术的全面推广打下基础。方法组织5个地震灾区的医疗卫生人员进行培训,培训前后分别发放调查问卷对培训效果进行考评,并使用SPSS 17.0对问卷内容进行统计分析。结果培训后的答题正确率（75.29%）较培训前（46.08%）提高幅度较大（P〈0.001）;培训前后绝大多数项目（88.9%）的熟悉程度高于培训前;79.26%的学员表示需要再次培训。结论本次培训取得了较好的成效,但学员未完全掌握所培训内容,部分学员需进行二次培训;仍需继续探索卫生适宜技术的培训方式。     

Op18：一个潜在的肝癌诊断标志物

目的探讨人原癌基因蛋白18（Op18）在肝癌细胞和组织中的表达及临床意义。方法应用RT-PCR、Western blot和免疫组化染色法检测常见肝癌细胞和88对配对肝癌组织及癌旁组织中Op18的表达。结果 Hep3B、SMMC-7721、MHCC97L、MHCC97H、HCCLM3和HCCLM6等常见肝癌细胞株中均见Op18表达;配对肝癌及癌旁组织中,RT-PCR发现肝癌组织中Op18阳性率达68.75%（11/16）,Western blot发现Op18的阳性率为56.25%（9/16）,免疫组化检测发现肝癌组织中Op18的阳性率为65.28%（47/72）,P〈0.05;Op18的表达与肿瘤大小数目、临床分化、门脉侵犯和TMN分期相关（P〈0.05）。结论 Op18可能是一个潜在的肝癌诊断标志物。     

速度向量成像在冠状动脉粥样硬化性心脏病诊断中的临床应用

冠状动脉粥样硬化性心脏病的诊断检查技术在不断地发展,技术也在不断地更新,包括心血管造影、放射性核素显像及磁共振成像,但均为有创性检查或者费用昂贵。速度向量成像技术是近年来心血管超声技术发展的一项最新技术,它可以达到常规心血管超声技术对冠状动脉粥样硬化性心脏病的诊断要求,还可以通过软件分析心脏的变形运动,准确评价局部心肌速度和变形。对于定量分析局部和整体心肌功能来说,它是一种有前途的临床应用方法。     

Effects of dexmedetomidine or methylprednisolone on inflammatory responses in spinal cord injury

Background: The aim of this study was to compare the anti-inflammatory response of methylprednisolone and the α2-agonist dexmedetomidine in spinal cord injury (SCI).
Methods: Twenty-four male adult Wistar albino rats, weight 200–250 g, were included in the study. The rats were divided into four groups as follows: the control group ( n : 6) received only laminectomy; the SCI group ( n : 6) with trauma alone; the SCI+methylprednisolone group ( n : 6) with trauma and 30 mg/kg methylprednisolone, followed by a maintenance dose of 5.4 mg/kg/h; and the SCI+dexmedetomidine group ( n : 6) with trauma and 10 μg/kg dexmedetomidine treatment intraperitoneally. Twenty-four hours after the trauma, spinal cord samples were taken for histopathological examination and serum samples were collected for interleukin-6 (IL-6) and tumor necrosis factor (TNF)-α measurement.
Results: TNF-α ( P =0.009) and IL-6 ( P =0.009) levels were significantly increased in the SCI group. TNF-α and IL-6 levels were significantly decreased with methylprednisolone ( P =0.002, 0.002) and dexmedetomidine ( P =0.002, 0.009) treatment, respectively. Methylprednisolone and dexmedetomidine treatment reduced neutrophils' infiltration in SCI.
Conclusions: The current study does not clarify the definitive mechanism by which dexmedetomidine decreases inflammatory cytokines but it is the first study to report the anti-inflammatory effect of dexmedetomidine in SCI. Further studies are required to elucidate the effects of dexmedetomidine on the inflammatory response.     

Stress Cardiomyopathy (Tako‐Tsubo) Associated with Sustained Polymorphic Ventricular Tachycardia

We present a case of 38‐year‐old woman with stress cardiomyopathy presenting to the emergency department with a 1‐week history of recurrent syncope due to sustained polymorphic ventricular tachycardia.     

Prognostic value of the C-reactive protein to albumin ratio in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Background/aimThis study investigated whether baseline serum level of C-reactive protein (CRP)/albumin ratio is associated with infarct localization, number of vascular lesions, and in-hospital mortality in patients undergoing primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI).MethodsThe study population consisted of 116 patients diagnosed with STEMI. The CRP/albumin ratio at first admission, cardiac troponin-I (cTnI), PCI results, and clinical outcomes were recorded. ResultsThe mean CRP/albumin ratio, cTnI level, and mean number of vascular lesions were significantly higher in non-survivors than in survivors (p = 0.006, p = 0.004, and p = 0.007, respectively). Multivariate logistic regression analysis demonstrated that the CRP/albumin ratio and number of coronary artery lesions were independent predictors of mortality in STEMI patients. According to these analyses, the presence of ≥ 2 vessel lesions was the most important predictor of mortality, with an odds ratio of 2.009 (95% confidence interval: 1.191–3.387, p = 0.009). ConclusionThis study demonstrates the potential utility of the CRP/albumin ratio for predicting the clinical outcome of patients with STEMI. In addition, the presence of ≥ 2 vascular lesions contributed to a 2-fold increase in mortality rate in STEMI patients.