肺表面活性物质联合鼻塞式持续气道正压通气治疗新生儿呼吸窘迫综合征的护理

目的探讨肺表面活性物质(固尔苏)联合鼻塞式持续气道正压通气(NCPAP)对新生儿呼吸窘迫综合征(NRDS)的疗效及其相关护理策略。方法选取本院2012年1月至2013年12月收治的58例NRDS患儿并随机分为两组各29例,对照组行机械通气+固尔苏治疗,观察组行NCPAP+固尔苏治疗,两组患儿治疗期间均给予新生儿儿科常规性护理,观察两组患儿的病情转归及预后情况。结果观察组患儿抢救成功率为89.66%、死亡率为10.34%,对照组分别为75.86%、24.14%,两组比较P<0.05。观察组患儿机械通气时间、住院时间、家属满意度评分显著优于对照组(P<0.05)。结论固尔苏与NCPAP治疗NRDS效果显著,在治疗期间给予患儿科学、全面的护理可提高患儿预后,缩短患儿住院时间,提高患儿家属满意度。     

Treatment of tumors involving the optic nerves and chiasm

An approach toward treatment of tumors involving the optic apparatus is presented. When tumors cause mass effect, microsurgical excision or debulking is generally recommended. Radiosurgery has been controversial yet advances in imaging and high speed computer planning allow treatment of lesions involving the optic apparatus with low morbidity. Microsurgical and radiosurgical approaches to tumors involving the globe, orbit, suprasellar region and third ventricle are discussed. Gamma Knife radiosurgery for choroidal melanomas spares orbital excenteration. We have used a marginal dose of 20–25 Gy for choroidal melanomas and generally limit the optic nerves and chiasm to less than 10 Gy in other cases. The effective dose for cavernous hemangiomas remains unclear, however we have had success with marginal doses in the range of 16–20Gy. Lower doses may prove successful yet better spare vision in cases where vision is useful. Our combined microsurgical and radiosurgical approach to tumors involving the apparatus has had an excellent rate of sparing vision, a low overall morbidity and excellent success.     

Automatic Methods for Carotid Contrast-Enhanced Ultrasound Imaging Quantification of Adventitial Vasa Vasorum

Adventitial vasa vasorum are physiologic microvessels that nourish artery walls. In the presence of cardiovascular risk factors, these microvessels proliferate abnormally. Studies have reported that they are the first stage of atheromatous disease. Contrast-enhanced ultrasound (CEUS) of the carotid allows direct, quantitative and non-invasive visualization of the adventitial vasa vasorum. Hence, the development of computer-assisted methods that speed image analysis and eliminate user subjectivity is important. We developed methods for automatic analyses and quantification of vasa vasorum neovascularization in CEUS and tested these methods in a cohort of 186 individuals, 63 of whom were healthy volunteers. We implemented alternative automatic strategies for using the images to stratify patients according to their risk group and compare the strategies with respect to diagnostic performance. An automatic single-parameter strategy performs less effectively than the corresponding Arcidiacono method based on manual interpretation of the images (68 < area under the receiver operating characteristic curve [AUROC] for the manual Arcidiacono method < 82; 60 < AUROC for the automatic single-parameter strategy < 63). However, by use of additional image parameters, an automatic multiparameter strategy has significantly improved performance with respect to the manual Arcidiacono method (78 < AUROC < 90). The automatic multiparameter strategy is a valuable alternative to the manual Arcidiacono method, improving both diagnostic speed and diagnostic accuracy.     

The sensitivity of biomarkers for genotoxicity and acute cytotoxicity in nasal and buccal cells of welders

Welders are inhalatively exposed to fumes which contain genotoxic carcinogens and it was found in epidemiological studies that they have increased cancer rates which may be causally related to DNA damage. In order to assess their health risks and to find out which chemicals cause the adverse effects, bioassays can be performed which enable the detection of genetic damage. The aim of the present study was a comparative investigation with exfoliated buccal and nasal cells in regard to induction of chromosomal alterations and acute cytotoxicity in welders and unexposed controls (n = 22 per group). To elucidate the factors which account for genotoxic and cytotoxic effects, additional biochemical parameters were monitored reflecting the redox status as well as concentrations of different metals and 1-hydroxypyrene (1-OHP) in body fluids. We found in the nasal cells significant induction of alterations which are indicative for DNA damage, i.e. of micronuclei (MNi) and nuclear buds, while elevated rates of nuclear anomalies reflecting cytotoxic effects (condensed chromatin, karyorrhexis, karyolylsis) were detected in cells from both organs. The levels of certain metals (Cr, Cu, Mn, Mo, Ni), but not markers of oxidative damage were significantly higher in the body fluids of the welders. Multivariate Poisson regression analyses indicate that exposure to Mo (15% MNi increase by one standard deviation increase of Mo in serum), Ni (9% increase) and Mn (14% increase) are positively associated with the induction of MNi in nasal cells while Ni was associated with cytotoxic effects in both types of cells (12 and 16% increase). Taken together, our findings indicate that epithelial cells from the respiratory tract are suitable for the detection of DNA-damaging and cytotoxic effects in welders and can be used to assess health risks associated with genomic instability.     

Effect of a one‐step self‐etch adhesive on endogenous dentin matrix metalloproteinases

Degradation of the hybrid layer created in dentin by dentin adhesives is caused by enzyme activities present within the dentin matrix that destroy unprotected collagen fibrils. The aim of the present study was to evaluate the effect of a one‐step self‐etch adhesive system on dentinal matrix metalloproteinases 2 and 4 (MMP‐2 and MMP‐9, respectively) using in situ zymography and an enzymatic activity assay. The null hypothesis tested was that there are no differences in the activities of dentinal MMPs before and after treatment with a one‐step adhesive system. The MMP‐2 and MMP‐9 activities in dentin treated with the one‐step adhesive, Adper Easy Bond, were quantified using an enzymatic activity assay system. The MMP activities within the hybrid layer created by the one‐step adhesive tested were also evaluated using in situ zymography. The enzymatic assay revealed an increase in MMP‐2 and MMP‐9 activities after treatment with adhesive. In situ zymography indicated that gelatinolytic activity is present within the hybrid layer created with the one‐step self‐etch adhesive. The host‐derived gelatinases were localized within the hybrid layer and remained active after the bonding procedure. It is concluded that the one‐step self‐etch adhesive investigated activates endogenous MMP‐2 and MMP‐9 with the dentin matrix, which may cause collagen degradation over time.