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.     

Hepatitis B immunity in adolescents and necessity for boost vaccination: 23 years after nationwide hepatitis B virus vaccination program in Taiwan

The first universal hepatitis B vaccination program for newborns in the world was launched in Taiwan in July 1984. Most studies on the effectiveness of hepatitis B vaccination focused on the seroprevalence of HBs Ag among children under 14 years old. Only few studies focused on the seropositivity of anti-HBs among adolescents aged 15–18 years old. The present study aimed to evaluate the impact of the nationwide hepatitis B vaccination program on the immunity to HBV infection and the necessity of boost among adolescents. In this study including eight annual seroprevalence surveys from 2000 to 2007, 2342 college entrants (1589 15-year-olds in group I and 753 18-year-olds in group II) and 1851 university freshmen (18-year-olds in group III) participated. Subjects identified anti-HBs, HBs Ag and anti-HBc negative were given boost three doses of HBV vaccine. The HBs Ag seroprevalence was 11.6%, 3.5% and 1.0% for participants who were born before 1984, 1984–1986 and after 1986. The anti-HBs-seropositive rates were significantly higher in group II (83.1%) than in group I (53.0%) and group III (53.5%). All 572 participants who were seronegative for anti-HBs, HBs Ag and anti-HBc became anti-HBs-seropositive after catch-up vaccination. It is concluded that the anti-HBs-seropositive rate decreased to 50% in 15 years after vaccination, and boost vaccination was 100% effective. The necessity and age for boost among anti-HBs negative adolescents and the timing of the first immunization should be further evaluated.     

高度近视的病因学研究进展

高度近视发生的内因、外因，包括遗传倾向，相关基因定位，巩膜胶原白体免疫学说，视网膜生物活性物质失调学说，环境因素等，本研究就这些因素对高度近视发病的影响做一综述。现统一的认识有：①高度近视具有明显的遗传倾向。②迄今为止，已找到4个高度近视相关基因，它们的遗传方式均为常染色体显性遗传。③高度近视的巩膜组织病理改变和胶原代谢障碍引发了人们对高度近视免疫相关基因的深入研究。已发现HLAⅡ类基因与部分高度近视具有相关性。④视网膜中存在的生物活性物质直接或间接参与了形觉剥夺性近视的形成。⑤环境因素并非高度近视发病的决定因素，它仅起一定程度的促进作用。将今后的工作重点放在高度近视基因定位的研究，基因表达的调控及巩膜胶原代谢、网膜生物活性物质之间的关系研究上，无疑会进一步揭示高度近视的病因，为防治高度近视开辟新途径。     

体育游戏在体育教学中的运用

体育游戏是小学体育教学的重要内容,是教育学生最好的方法之一。我国现代著名教育家陈鹤琴先生说过：＂小孩生来是好动的,是以游戏为生命的。＂毛泽东同志在给《新体育》一书的题词中写道：＂要活动,要游戏,是儿童的天性。＂这充分说明了学生对游戏有着特殊的感情。     

Incidence of Chest Tube Malposition in the Critically Ill: A Prospective Computed Tomography Study

Background: Malposition of percutaneously inserted chest tubes is considered as a rare complication in critically ill patients. Its incidence, however, remains uncertain. The aims of the study were to assess the true incidence of chest tube malposition in critically ill patients and to identify predicting factors.

Methods: The authors prospectively studied 122 chest tubes percutaneously inserted in 75 consecutive critically ill patients. For clinical reasons independent of the study, thoracic computed tomography scanning was performed in 63 patients, allowing direct visualization of 106 chest tubes. Based on these findings, chest tube position was classified as intrapleural, intrafissural, or intraparenchymal. Factors predicting chest tube malposition were analyzed by univariate and multivariate analysis.

Results: The mean delay between chest tube placement and thoracic scan was 3.5 +/- 2.9 days. Twenty-two chest tubes were diagnosed as being intrafissural (21%), and 10 were diagnosed as being intraparenchymal (9%). The only predicting factor associated with the risk of malposition was the use of a trocar for the percutaneous insertion of the chest tube (P = 0.032).     

男性青少年性腺功能减退症患者短期雄激素替代治疗对血脂和hsCRP水平的影响

目的 探讨性腺功能低减的青少年男性，短期雄激素替代治疗对血脂和超敏C反应蛋白（hsCRP）的影响。方法 本研究为前瞻性自身对照研究，共纳入33例性腺功能减退青少年男性。行短期（9个月）雄激素替代治疗，比较治疗前后血睾酮水平、第二性征发育程度、身高、握力、血红蛋白、血脂和hsCRP的差异。结果 （1）替代治疗后，睾酮水平明显升高，第二性征明显发育，身高、握力、血红蛋白显著增加（P值均〈0.05）；（2）短期雄激素替代治疗后，总胆固醇（TC），低密度脂蛋白（LDL-c），高密度脂蛋白（HDL-c）和甘油三酯（TG）部有所下降，但无统计学差异（P〉0．5）。超敏CRP显著下降（P=0.025）。结论 （1）性腺功能低减的青少年男性，短期雄激素替代治疗，可以促进第二性征发育，增加身高、握力和血红蛋白；（2）短期雄激素替代治疗，对血脂无显著性影响。但是，可以使hsCRP明显下降。     

梗阻性黄疸高危因素分析

目的 :通过探讨梗阻性黄疸临床指征 ,了解其病程中的高危因素。并及时降低并发症及死亡率 ,提高临床疗效。方法 :对我科 1993年— 2 0 0 0年收治的 2 92例梗阻性黄疸病人进行性分析 ,统计年龄、梗阻时间、性质、手术时间 ,入院 2 4小时内测尿素氮 (BUN)、白蛋白 (A)、总胆红素(TBIL)、白细胞 (WBC)、血红素 (HB)、腹水 ,分析其高危因素。结果 :年龄 >6 5岁并发症发生率为2 5 .2 0 % ,病死率 3.2 5 % ;梗阻时间超过 2 0天以上者 ,并发症 2 8.87% ,病死率 5 .15 % ;肝功能Child氏B级、C级者 ,并发症发生率为 2 9.2 0 % ,病死率为 5 .31% ,延期手术并发症发生率为 2 9.4 1% ,病死率为 4 .90 %。结论 :梗阻性黄疸病人年龄越大 ,梗阻时间越长 ,肝功能越差 ,不及时手术是各种并发症发生及病死率增高的高危因素     

大鼠移植胰腺冷缺血再灌注后细胞凋亡的变化

目的　探讨移植胰腺冷缺血再灌注后胰腺细胞凋亡的变化过程。方法　 6 5只SD大鼠随机分成 7组 :假手术组 ,冷缺血 2h组 ,冷缺血 2h再灌注 1、3、6、9、12h组。通过HE染色后光镜及电镜观察各组的胰腺组织的病理变化 ;采用脱氧核糖核苷酸末端转移酶介导的缺口末端标记法(TUNEL)检测凋亡细胞的分布及计数。结果　胰腺移植后早期即可观察到细胞凋亡的典型改变 ,胰腺冷缺血再灌注后发生凋亡的高峰期为再灌注后 3h[AI为 (9.4 6± 2 .91) % ,P <0 .0 1) ,再灌注 6h较 3小时细胞凋亡有所减少 [AI为 (5 .74± 1.6 6 ) % ,P <0 .0 1],再灌注 9h及 12h细胞凋亡进一步减少 [AI分别为 (3.6 0± 1.6 4 ) %及 (3.2 6± 1.35 ) % ,P <0 .0 5 ]。结论　细胞凋亡是胰腺移植后的早期事件 ,移植胰腺冷缺血再灌注后早期主要的死亡方式是凋亡 ;移植胰腺冷缺血再灌注后的凋亡高峰发生在再灌注后 3h。     

弥漫性轴索损伤病人的护理

弥漫性轴索损伤 (DAI) ,在脑损伤中发生率高 ,病死率高 ,占脑外伤死亡病人总数的 3 5 %。全部DAI病人中植物生存率为 15 % ,重残 14 % [1] 。为了降低病死率 ,提高病人的生存质量 ,现将 1999年 1月— 2 0 0 2年 1月我院收治的 5 5例DAI昏迷病人的护理体会总结如下。1　临床资料　　本组 5 5例 ,男 3 8例 ,女 17例 ,年龄 6岁～ 68岁 ,平均 40 .9岁。格拉斯哥 (GLS)计分均 <8分 ,其中评分为 3分～ 5分的特重型病人 3 2例。致伤原因 :车祸 44例 ,高处坠落 8例 ,打击伤 3例。 5 5例病人中有 17例因合并颅内血肿而行开颅手术 ,其他病人为保…