Sildenafil Prevents Cardiovascular Changes after Bone Marrow Fat Embolization in Sheep

Background: Sudden, intraoperative cardiovascular deterioration as a result of pulmonary embolization of bone marrow fat is a potentially fatal complication during total hip and knee arthroplasty, intramedullary nailing, and spine surgery. Anesthetic management is challenging in the presence of increased right ventricular afterload due to pulmonary hypertension. Selective pulmonary vasodilation may be an appropriate prophylactic or therapeutic measure. The effect of sildenafil (phosphodiesterase inhibitor) on cardiovascular deterioration after bone marrow fat embolization was therefore investigated.

Methods: Bone cement (polymethylmethacrylate) was injected into three lumbar vertebrae in 12 sheep. Invasive blood pressures and heart rate were recorded continuously until 60 min after the last injection. Cardiac output and arterial and mixed venous blood gas variables were measured at selected time points. Before the first cement injection, 6 animals received a bolus injection (0.7 mg/kg) of sildenafil, with continuous infusion (0.2 mg [middle dot] kg-1 [middle dot] h-1) thereafter. Postmortem lung and kidney biopsies were taken for semiquantitative analysis of intravascular fat.

Results: Fat embolism was associated with a transient increase (21 +/- 7mmHg) in pulmonary arterial pressure. A transient decrease in arterial blood pressure and temporary increases in central venous pressure and dead space were also observed. No significant changes in any cardiovascular variable were observed after fat embolism in the sildenafil group. There was significantly (P < 0.05) less intravascular fat in the lungs of the sildenafil (median count of 5 emboli per microscopic view) compared with the control group (median count of 1).     

623例慢性前列腺炎患者的性功能状况调查

目的:了解慢性前列腺炎对早泄(PE)和勃起功能障碍(ED)的影响,探讨它们之间的关系。方法:依据美国国立卫生研究院慢性前列腺炎症状指数评分表(NIH-CPSI)、中国早泄患者性功能评分表(C ISFPE)、国际勃起功能问卷评分表(IIEF-5);采用和患者面对面交谈、询问,并分别记录623例慢性前列腺炎患者的NIH-CPSI评分、C ISFPE评分、IIEF-5评分。结果:623例18~57岁的慢性前列腺炎患者中,PE发生率为39.0%,其中轻度占26.2%、中度占12.0%、重度占0.8%;ED发生率为16.9%,其中轻度占14.9%、中度占1.0%、重度占1.0%。慢性前列腺炎患者PE的发生率以年轻者为多,18~29岁组为42.9%(103/240)、30~39岁为37.0%(95/257)、40~57岁组为35.7%(45/126);ED发生率以年龄高者为多,18~29岁组为13.8%(33/240)、30~39岁为11.3%(29/257)、40~57岁组为34.1%(43/126)。统计学分析发现,NIH-CPSI评分与早泄评分以及与IIEF-5评分均无明显相关性。结论:慢性前列腺炎的症状轻重与PE和ED的轻重程度无明显的相关性。     

Seasons and other factors affecting the quality of life of asthmatic children.

OBJECTIVE: To study the effect of seasons on the health-related quality of life (HRQL) of asthmatic children. METHODS: Four groups of asthmatic children 7 to 14 years old were recruited by pediatricians during each season of the year. Their HRQL was assessed by means of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ). Other factors surveyed were asthma severity, atopy, medical treatment, immunotherapy, obesity, parental smoking, and anti-allergic measures. RESULTS: The mean (SD) overall PAQLQ score was highest in summer at 6.2 (1.0) and lowest in autumn at 5.5 (1.2). The same trend was found for domains in summer and autumn, respectively: symptoms, 6.2 (1.0) vs 5.4 (1.4); emotions, 6.5 (0.8) vs 6.0 (1.0); and activities, 5.9 (1.4) vs. 5.0 (1.5). Factors such as male gender (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.41-0.87), being on immunotherapy (OR, 0.59; 95% CI, 0.38-0.92), living in an urban environment (OR, 0.56; 0.33-0.93), and residing on the northern coast of Spain along the Bay of Biscay (OR, 0.56; 0.36-0.89) were independent protective factors against having a total PAQLQ score in the lower tertile. Conversely, being recruited in a primary care setting (OR, 1.55; 1.01-2.38) and having more severe asthma were risks for being in the lower tertile. CONCLUSIONS: Irrespective of the severity of the disease, season has a significant influence on the HRQL of asthmatic children.     

小型颅内动脉瘤的临床特点及血管内栓塞治疗

目的总结小型颅内动脉瘤的临床特点以及血管内栓塞的技术要点与疗效。方法对45例小型颅内动脉瘤患者采用电解可脱性弹簧圈(GDC)或Trufill DCS Orbit微型三维填塞型水解铂金弹簧圈进行动脉瘤囊内栓塞。结果45个动脉瘤中41个瘤腔100%闭塞,3个95%闭塞,1个90%闭塞。术后44例临床痊愈,其治疗结果根据Glasgow预后评分:Ⅰ级29例,Ⅱ级11例,Ⅲ级3例,Ⅳ级1例,Ⅴ级1例;全组死亡率2.2%。栓塞术中并发脑血管痉挛6例。术后随访3-69个月均无再出血及复发。结论对小型颅内动脉瘤采用GDC或Truffill DCS Orbit微型三维填塞型水解铂金弹簧圈进行血管内囊内栓塞疗效可靠;根据小型颅内动脉瘤的临床特点进行栓塞是提高治愈率、降低并发症及死亡率的重要方法。     

社区皮肤擦伤患者创面处理方法探讨

目的探讨效果好、经济、简单、方便的社区皮肤擦伤处理方法.方法将148例(180处创面)皮肤擦伤患者随机分为A、B、C三组各60处.经常规清创处理后,A组采用0.25%碘伏外涂,4～5次/d;B组采用0.25%碘伏涂搽后,用"优拓"覆盖创面,再加盖无菌敷料,胶布固定,每日更换1次;C组采用0.25%碘伏涂搽后,用无菌干纱块覆盖,胶布固定,每日换药1次.结果A组、B组创面愈合时间显著短于C组(均P＜0.01).A组胶布过敏、创面感染率为0,且费用显著低于B组和C组(均P＜0.01).结论社区皮肤擦伤患者创面采用0.25%碘伏涂搽疗效好,且经济、简单、方便.     

推动医疗改革应制定分区医疗系统战略

医疗改革是一个世界性难题，各国在医疗改革中都会遇到各自相关的问题。改革艰巨，但并不是不可能完成，本文作者认为，通过关注以分区的方式提供医疗服务可以让医疗改革取得实效。本文从划定分区边界的方式出发，介绍了制定分区医疗战略的五个步骤，并讨论了各医疗系统成功实施各自战略所需采取的措施，这也可以为我国正在推行的医疗改革提供一定的借鉴和参考。     

脑源性神经生长因子和神经干细胞联合移植对大脑中动脉阻塞大鼠神经功能恢复的作用

目的 将脑源性神经生长因子(BDNF)和神经干细胞(NSCs)单独及联合移植应用于大脑中动脉阻塞(MCAo)模型大鼠,观察BDNF和NSCs移植对大鼠缺血性脑卒中神经功能恢复的作用及BDNF对内源性和外源性NSCs增殖、迁移及分化的影响.方法 体外分离、培养新生大鼠海马NSCs,BrdU标记.实验动物随机分为A组(MCAo组);B组(MCAo+BDNF组);C组(MCAo+NSCs组);D组(MCAo+BDNF+NSCs组),每组16只,移植后进行神经功能损害评分(NSS),用免疫组织化学行BrdU、nestin、BrdU/NSE检测,分析结果.结果 移植后的2、4周神经功能评分分别为:A组5.3±0.5、5.3±0.5;B组4.0±0.8、3.8±0.5;C组3.5±0.6、3.5±0.6;D组2.0 ±0.8、1.8±1.0,D组显著好于其他3组(P<0.05),B组与c组显著好于A组(P<0.05).nes.tin阳性细胞数:A组1.24±1.13,B组2.59±1.44(P<0.05),BrdU阳性细胞数:A组0.52±0.68,B组1.65±1.10(P<0.05).BrdU阳性细胞数:C组6.08±1.52,D组10.26±1.96(P<0.05),BrdU/NSE双阳性细胞数:C组1.74±1.04,D组3.58±1.20(P<0.05).结论 BDNF和NSCs移植单独及联合应用对MCAo大鼠的神经功能恢复均有作用,两者联合具有协同作用.BDNF对内源性NSCs的激活、增殖有促进作用,对外源性NSCs的增殖、迁移及分化有促进作用.