Prognostic Value of Computed Tomography Versus Echocardiography Derived Right to Left Ventricular Diameter Ratio in Acute Pulmonary Embolism

BackgroundComputed Tomography (CT) Pulmonary Angiography is the most commonly used diagnostic study for acute pulmonary embolism (PE). Echocardiogram (ECHO) is also used for risk stratification in acute PE, however the diagnostic performance of CT versus ECHO for risk stratification remains unclear.MethodsCT and ECHO right ventricle (RV) and left ventricle (LV) diameters were measured in a retrospective cohort of patients with acute PE. RV:LV diameter ratios were calculated and correlation between CT and ECHO RV:LV ratio was assessed. Sensitivity and specificity for the composite adverse events endpoint of mortality, respiratory failure requiring intubation, cardiac arrest, or shock requiring vasopressors within 30 days of admission were assessed for CT or ECHO derived RV:LV ratio alone and in combination with biomarkers (troponin or B-type natriuretic peptide).ResultsA total of 74 subjects met the inclusion criteria and had a mean age of 62±18 years. The proportion of patients with RV:LV >1 was similar when comparing CT (37.8%) versus ECHO (33.8%) (P = 0.61). A statistically significant correlation was found between CT derived and ECHO derived RV:LV diameter ratio (r = 0.832, P < 0.001). The sensitivity and specificity to predict 30-day composite adverse events for CT versus ECHO derived RV:LV diameter ratio >1 together with positive biomarker status was similar with sensitivity and specificity of 87% and 41% versus 87% and 42%, respectively.ConclusionsIn patients with acute PE, CT and ECHO RV:LV diameter ratio correlate well and identify similar proportion of PE patients at risk for early adverse events. These findings may streamline risk stratification of patients with acute PE.     

论卫生船舶在登陆作战中的配置

在大规模登陆作战中需要大量的卫生船舶实施各种保障,因此必须对卫生船舶进行合理的配置,保证其既能有效地完成保障任务,又能避免重叠配置造成浪费．卫生船舶的配置应与指挥关系、保障任务战时分类相适应,具体配置时按医院船、卫生运输船、卫生救护艇的保障要求配置,并可根据保障任务的变化进行相应的调整．     

黄柏及中成药中小檗碱和巴马亭的高效液相色谱法测定

本文以正相高效液相色谱法,用窗口图解技术对色谱条件进行了优化。对黄柏及其中成药中的有效成分——小檗碱、巴马亭的提取、测定条件、标准曲线进行了研究。并对两种含黄柏的中成药样品进行了分析。其中小檗碱的回收率均在97%以上,巴马亭的回收率均在96%以上。     

Detection of colonic polyps on single-contrast barium enema study: emphasis on the elderly

A systems approach was employed to improve results of the single-contrast barium enema examination for detection of colonic polyps. Improvements were made in each of the following areas: radiographic-fluoroscopic equipment, fluoroscopic-television images, screen-film combinations, barium suspensions, examination techniques, imaging sequences, and quality controls. Radiologic-endoscopic correlation was undertaken for 137 colonic polyps seen endoscopically in 91 patients. The average age of the patients was 69 years. The sensitivity of the single-contrast examination for detection of all polyps was 80%. Polyps 5-9 mm in size were detected with 66% sensitivity, while 94% of polyps 10 mm or larger were detected. The results indicate that the sensitivity of a suitably performed single-contrast barium enema examination may approach that of the double-contrast study for the detection of colonic polyps, even in an elderly and infirm patient population.     

A Novel Therapeutic Strategy for Attenuating Neutrophil-Mediated Lung Injury In Vivo

OBJECTIVE: To evaluate the effect of inhalation of aerosolized opsonized dead Escherichia coli on inflammatory pulmonary neutrophil (PMN) apoptosis, lung injury, and survival in a PMN-mediated lung injury model in vivo. SUMMARY BACKGROUND DATA: Neutrophils that have transmigrated into an inflammatory focus display increased functional capacity and delayed apoptosis, resulting in an increased capacity to injure normal host tissue. The authors have previously shown that E. coli induces PMN apoptosis in vitro. METHODS: Lung injury mediated by PMNs was established by aortic occlusion and reperfusion. Adult male Sprague-Dawley rats were randomized into four groups: sham ischemia-reperfusion (I/R) treated with intratracheal inhalation of aerosolized normal saline, I/R treated with aerosolized normal saline intratracheally, I/R treated with aerosolized opsonized dead E. coli intratracheally, and I/R treated with aerosolized opsonized dead E. coli and the caspase inhibitor zVAD-FMK intratracheally 5 minutes before reperfusion. Both systemic and bronchoalveolar lavage PMNs were isolated and apoptosis was quantified at 0, 6, 12, 18, and 24 hours. Lung injury parameters including wet/dry lung weight ratio, histology, myeloperoxidase activity, and protein content were also assessed. In addition, a survival study was performed, both in a prophylactic and in a therapeutic setting. RESULTS: Administration of aerosolized dead E. coli before the reperfusion injury induced pulmonary PMN apoptosis and reversed the delayed apoptosis evident in the I/R plus normal saline group. There was also a significant improvement in lung injury parameters as well as in survival, both prophylactically as well as therapeutically. CONCLUSIONS: Directly modulating PMN cell death represents a novel mechanism for attenuating PMN-mediated lung injury and may ultimately benefit the outcome in patients with adult respiratory distress syndrome.     

肺源性心脏病急性发作期免疫功能的改变

目的:观察肺源性心脏病(简称肺心病)急性发作期患者免疫功能的变化。方法:选择南华大学附属第一医院2004-11/2006-01收治慢性肺心病急性发作期患者60例为肺心病组,于急性加重期入院第2天7:00,空腹抽取静脉血,采用流式细胞仪检测T细胞亚群CD3 、CD4 、CD8 及自然杀伤细胞活性,免疫浊度法检测体液免疫指标(IgG,IgM,IgA及补体C3)。以同期60例健康体检者为对照。结果:120例是否受试者均进入结果分析。①T细胞亚群:肺心病组CD3 ,CD4 水平低于对照组(0.52±0.06,0.62±0.04;0.32±0.06,0.41±0.06;P均<0.05),CD4 /CD8 高于对照组(1.96±0.26,1.84±0.78,P<0.05)。②免疫血清指标:肺心病组IgA、补体C3及自然杀伤细胞活性低于对照组[(1.26±0.74),(2.45±0.85)g/L;(6200±217),(9960±302)mg/L;0.34±0.08,0.57±0.07;P均<0.05]。结论:肺源性心脏病急性发作期患者的细胞免疫和体液免疫功能均受损,尤以细胞免疫功能受损更突出,且与病情呈平行关系。     

在缝合基础上局部应用纤维蛋白胶对周围神经再生的影响

目的:在缝合的基础上局部应用纤维蛋白胶治疗损伤的周围神经,观察纤维蛋白胶对周围神经再生的影响。方法:实验于2005-03/07在大连医科大学中心实验室完成。实验材料:纤维蛋白胶(广州倍绣生物技术有限公司,主要成分:纤维蛋白原50～70mg/支和凝血酶400U/支,从哺乳动物血中提纯,经过灭菌消毒,冻干制成,不含致热源)。实验分组:选择健康SD大鼠48只,按随机数字表法分为两组,每组24只:单纯缝合 纤维蛋白胶组、单纯缝合组。实验方法:大鼠麻醉后,于左大腿后外侧做2cm纵切口,显露坐骨神经。距梨状肌下缘远侧约1.5cm处切断坐骨神经,切除远端1～2mm,采用10-0无创伤线缝合神经外膜,使远近端保留约1～2mm间隙。单纯缝合 纤维蛋白胶组:对称缝合2针,将纤维蛋白胶注入缝合周围在神经对合端生成凝胶环,混合物固化形成再生室。单纯缝合组:单纯外膜缝合。实验评估:①术后连续观察动物行为学:手术侧后肢及足趾的运动情况,有无溃疡形成,足趾、趾甲的溃疡愈合情况,观察展爪反射。②术后8周两组各取4只大鼠行神经电生理检查,检测神经传导速度、潜伏期。③术后2,4,6,8周两组各取2只大鼠行苏木精-伊红染色后光镜下观察神经再生情况。④术后8周两组各取4只大鼠采用LUZEX-F彩色图像分析仪对甲苯胺蓝染色神经组织切片中轴突数目及轴突直径进行分析。⑤术后8周两组各取4只大鼠行醋酸铀枸橼酸铅染色,Phlip-10型透射电镜下观察轴突再生情况。⑥术后8周两组各取4只大鼠行辣根过氧化物酶标记观察脊髓前角运动神经元情况。结果:纳入大鼠48只,均进入结果分析。①术后大鼠行为学观察:术后8周单纯缝合 纤维蛋白胶组大鼠除足趾略见下垂、屈曲现象外,步态基本正常,展爪反射基本正常,下肢活动已接进正常,单纯缝合组下肢活动略差。②神经电生理检查:术后8周单纯缝合 纤维蛋白胶组神经传导速度快于单纯缝合组[分别为(11.13±0.37),(9.26±0.44)m/s],潜伏期短于单纯缝合组[分别为(1.83±0.18),(2.17±0.19)ms],差异有显著性意义(F=27.78,5.53,P<0.05)。③光镜下神经再生情况:单纯缝合 纤维蛋白胶组再生的有髓神经纤维髓鞘较厚、直径较大、数量多、排列规则,再生良好。单纯缝合组再生的有髓神经纤维髓鞘较薄、直径较小、数量少、排列不规则,再生较差。④轴突数目及轴突直径:单纯缝合 纤维蛋白胶组在轴突数目、轴突直径大于单纯缝合组[分别为(2187±107),(1847±96)个/400倍视野;(2.79±0.15),(2.05±0.17)μm],差异有显著性意义(F=80.70,42.92,P<0.05)。⑤透射电镜下轴突再生情况:术后8周单纯缝合 纤维蛋白胶组大鼠再生轴突发育良好,排列有序,轴突直径大小相差小,髓鞘厚薄一致,轴突染色均匀,雪旺细胞核呈卵圆型。单纯缝合组大鼠轴突发育差,排列不规则,髓鞘薄,可见扩张血管,部分区域有出血水肿。⑥辣根过氧化物酶标记观察脊髓前角运动神经元情况:单纯缝合 纤维蛋白胶组在实验侧腰骶段前角可见辣根过氧化物酶标记的大型运动神经元,且数目较多。单纯缝合组标记的数量较少。结论:在修复神经过程中应用纤维蛋白胶,可明显促进损伤的周围神经修复与再生,优于单纯缝合的效果。