老年急性肺损伤/急性呼吸窘迫综合征患者侧卧位通气疗效观察

目的评价侧卧位通气对老年急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者的临床疗效。方法26例老年患者施行侧卧位通气,监测体位改变前、后的呼吸循环指标并进行比较。结果体位改变1h后动脉血氧分压由(98±11)mmHg上升到(127±13)mmHg(P<0.01);治愈率为69.33%(18/26)。结论侧卧位通气可显著改善老年ALI/ARDS患者的预后且实施容易。     

侧卧位和分侧肺通气对单侧急性肺损伤犬的影响

目的观察体位和分侧肺通气对单侧急性肺损伤(ALI)犬的影响,探讨单侧ALI时合理的机械通气方式。方法健康杂种犬28只,建立盐酸所致单侧ALI,行容量控制通气(VCV),分为常规通气组(A组)、常规通气+健侧卧位组(B组)、不同步分侧肺通气组(C组)、同步分侧肺通气组(D组)。通气240min后,每组随机选取4只犬行核素显像。监测氧合、血流动力学、呼吸力学和肺损伤指标。结果(1)通气30min后B、C、D组氧合指数(PaO2/FiO2)[(277±23)、(296±31)、(299±22)mmHg,1mmHg=0.133kPa]显著高于A组[(180±25)mmHg,P均<0.01],通气60min后C、D组PaO2/FiO2[(348±34)、(343±29)mmHg]显著高于B组[(314±33)mmHg,P均<0.05]。(2)通气120min后B组静态肺顺应性(Cst)[(23±4)ml/cmH2O]较A组[(19±2)ml/cmH2O]显著改善,通气60min后C、D组左侧Cst[(11±1)、(11±1)ml/cmH2O]均较ALI状态时显著改善[(7±2)、(6±1)ml/cmH2O,P均<0.01]。(3)B、C、D组损伤侧血流/总血流(Q损伤/Q总)[(31.3±4.6)%和(27.5±1.3)%、(27.3±2.8)%]与A组比较差异均有统计学意义[(38.3±2.2)%,P均<0.01]。结论健侧卧位和分侧肺通气均能明显改善单侧ALI犬的氧合和肺的顺应性,分侧肺通气改善氧合较健侧卧位更有效,改善氧合的机制可能与影响双侧血流分布有关。     

Comparative study of cephalometric measurements using 3 imaging modalities

Background

The authors conducted a study to compare 2-dimensional (2D) lateral cephalometric radiography (LCR), 2D cone-beam computer tomographic (CBCT)–generated cephalogram and 3-dimensional (3D) CBCT for assessing cephalometric measurements.

Are three-dimensional airway evaluations obtained through computed and cone-beam computed tomography scans predictable from lateral cephalograms? A systematic review of evidence

Objective:To systematically review the literature correlating upper airway parameters between lateral cephalograms (LC) and cone-beam computed tomography (CBCT) or computed tomography (CT) scans to determine the utility of using LC to predict three-dimensional airway parameters.Materials and Methods:Both electronic and manual searches of the included studies were performed by two reviewers, and the quality of the studies that met selection criteria were assessed.Results:A total of 11 studies from the literature met the selection criteria. Assessed outcome variables showed correlation r < .7 between the LC and CT scans. The correlation between the LC and CBCT ranged from weak to strong with −.78 ≤ r and r ≤ .93 reported in the nasopharyngeal segment. In the oropharyngeal segment, a weak to strong correlation was reported with a range of −37 ≤ r and r ≤ .83 between the CBCT and LC. All associations in the hypopharyngeal segment showed a weak correlation. Four of studies were of weak quality, five were of moderate quality, and two were rated to be of strong quality.Conclusion:No strong correlations were reported between the LC and CT scans. However, the LC-derived adenoid-nasopharyngeal ratio and the linear measurement (posterior nasal spine, PNS, to posterior pharyngeal wall) had a strong correlation with upright nasopharyngeal area and volume in the CBCTs. The area measurement in conventional LC can be also used as an initial screening tool to predict the upright three-dimensional oropharyngeal volumetric data. The variability of the hypopharyngeal segment cannot be predicted by LCs. However, more well-designed studies are needed to determine the clinical utility of using LC to predict airway size.     

Radiographic and computed tomographic evaluation of bone union after medial opening wedge high tibial osteotomy with filling gap

Background

We evaluated bone union and remodelling in patients undergoing opening-wedge high tibial osteotomy (OWHTO) with bone gaps filled with beta-tricalcium phosphate. We examined the effectiveness of radiography and computed tomography (CT) for the evaluation of bone union and remodelling, and investigated whether lateral hinge fractures affected bone union.

不同牙 合 位时翼外肌对颞下颌关节盘的生物力学影响

目的　研究在牙尖交错位和最大张口位时可复性关节盘前移位中翼外肌对关节盘的生物力学影响及两牙合 位之间的差异。 方法　对已经建立的可复性关节盘前移位的颞下颌关节数字化仿真模型,在不同牙合 位时进行翼外肌加载,通过三维有限元的方法进行生物力学分析。 结果　最大张口位时,关节盘应力集中区较牙尖交错位时向前外侧移动,集中于关节盘中间带偏外侧区;关节盘中间带与关节盘后带之间存在明显位移差,形成位移撕裂带,而在牙尖交错位时则无类似位移差现象。 结论　在可复性关节盘前移位中,最大张口位时翼外肌可导致关节盘中间带偏外侧区的应力集中,在关节盘中间带形成位移撕裂带,导致此区域变薄、穿孔甚至撕裂。     

侧脑室置管外引流持续脑室灌注给药加腰大池引流治疗颅内感染的临床应用观察

目的：探讨侧脑室置管外引流持续脑室灌注给药加腰大池引流治疗颅内感染临床效果。方法选取2012－01～2013－10间我院神经外科收治手术后发生颅内感染60例患者,随机分为观察组和对照组,对照组采用反复多次腰穿鞘内注射给药治疗颅内感染,观察组采用侧脑室置管外引流持续脑室灌注给药加腰大池引流治疗颅内感染,比较两组治疗效果、后遗症发生情况及生活质量等。结果两组患者治疗后均无死亡,观察组治疗总有效率为93.33％,明显高于对照组70.00％的总有效率,两组比较差异有统计学意义（ P＜0.05）;观察组后遗症发生率为6.67％,明显低于对照组33.33％的发生率,两组比较差异有统计学意义（P＜0.05）;观察组生活质量各项评分均高于对照组,两组间各值比较差异有统计学意义（P＜0.05）。结论侧脑室置管外引流持续脑室灌注给药加腰大池引流治疗颅内感染可提高治疗效果,降低后遗症发生率,改善患者生活质量,具有显著的临床治疗效果,值得临床推广应用。     

Behavioral Symptoms in Motor Neuron Disease and Their Negative Impact on Caregiver Burden

Background:

The spectrum of abnormal behaviors in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) has been described, but its practical meaning, namely its impact on caregiver burden, has not been clearly documented in Chinese population. This study aimed to assess the distribution of abnormal behaviors in Chinese population, and to analyze the relationship between behavior changes and caregiver burden.

Methods:

Sixty-five patients with ALS/MND have been consecutively enrolled into registry platform of Peking Union Medical College Hospital. An investigation was performed to these patients and their caregivers using the revised ALS function rating scale, Frontal Behavioral Inventory-ALS version, the Frontal Assessment Battery, and the Caregiver Burden Inventory.

Results:

Twenty-eight (43.1%) patients displayed abnormal behaviors of varying degrees, with one fulfilling the diagnostic criteria of frontotemporal lobe degeneration. Irritability, logopenia, and inflexibility ranked top 3 of abnormal behavior list. Correlation analysis revealed that the degree of behavioral change and frontal cognitive status were significantly associated with caregiver burden, with more extensive impact from disinhibitive behaviors. Analysis of covariance analysis showed that after associated factors were corrected, caregivers of patients with moderate to severe behavior change reported significantly heavier developmental burden, physical burden, and total burden than those with no behavioral change.

Conclusions:

Neurobehavioral symptoms could present in around 40% of Chinese patients with ALS/MND, and the distribution of these behaviors was also unique. Besides, abnormal behaviors were highly related to caregivers’ burden.     

CT辅助下人工耳蜗植入患儿面神经隐窝发育研究

目的了解人工耳蜗植入患儿面神经隐窝的发育情况.方法对217例人工耳蜗植入患儿分别术前CT测量,术中实际测量面神经隐窝宽度.结果 CT测量面神经隐窝宽度在圆窗龛水平为(3.90±0.17)mm,手术中实际测量值为(3.87±0.16)mm.CT测量值与术中测量数据之间差异无统计学意义(P>0.05);人工耳蜗植入患儿各年龄阶段面神经隐窝宽度数据之间差异无统计学意义(P>0.05).结论术前通过CT可以对面神经隐窝宽度进行准确评估,有利于术中面神经隐窝开放及减少面神经垂直段损伤.各年龄阶段人工耳蜗植入患儿面神经隐窝宽度之间差异无统计学意义,提示面神经隐窝于出生后已基本无变化.