Developments in near‐infrared‐guided hepatobiliary,pancreatic and other upper gastrointestinal surgery

With the development of near‐infrared (NIR) technology, real‐time utility of NIR and its fluorophores has gained vast interest among surgeons of various sub‐disciplines. The purpose of this review is to assess and explore the most recent developments in NIR‐guided surgery in an upper gastrointestinal (UGI) surgical setting. Queries of PubMed and Medline literature databases was performed for experimental and clinical studies relevant to NIR use in the context of UGI surgery. NIR‐guided UGI surgeries have been reported to be valuable in: (1) esophageal anastomosis; (2) sentinel lymph node biopsy in gastric cancer; (3) detection of liver and pancreatic tumors; and (4) detection of extra bile duct and bile duct injuries. Although NIR technology has shown tremendous promise in UGI surgery, its full clinical translation and wider adaptation remains to be seen. Copyright © 2013 John Wiley & Sons, Ltd.     

2010年至2012年我院上呼吸道感染抗生素使用分析

目的 了解医院抗生素治疗上呼吸道感染的临床使用情况及用药趋势,为抗生素的临床使用及其科学管理提供参考.方法 通过医院信息管理系统（HIS）,以2010年至2012年上呼吸道感染抗生素的用药频率、限定日费用、药物利用指数等为指标,对其临床使用情况进行统计,并分析其用药趋势.结果 2010年至2012年抗生素销售金额逐年减少,头孢菌素类、青霉素类、喹诺酮类、硝咪唑类及大环内酯类药物的用药频率较高,用药量较大;在统计中用药频率较高的前5种药品的药物利用指数均小于1.0.结论 该院使用抗生素治疗上呼吸道感染的用量有减少趋势,且使用情况较为合理.     

心脏颤动的进展(一):心房颤动的治疗进展

心房颤动(房颤)是临床上最常见的心律失常之一,房颤患者发生缺血性脑卒中、心衰等疾病的机会明显增加,其致残、致死率极高,使患者的生活质量明显下降.房颤的高发性和诸多严重的并发症,使其成为危害人类健康的主要杀手之一.抗心律失常药物可以使部分房颤转复,然而,与控制心室率相比,房颤转复并不能降低各种严重并发症的发生率.最近,随着射频消融技术的发展,房颤的治疗出现了新的转机,但射频消融治疗房颤的有效性及根治率仍存在争议.针对房颤发生和维持的基质因素来预防房颤发作及复发也成为近年房颤研究的热点之一,如房颤的上游治疗等.本文就房颤的并发症防治如抗凝治疗,房颤的抗心律失常药物治疗、射频消融治疗以及房颤的上游治疗作一简要介绍.     

Coffee Grounds Emesis: Not Just an Upper GI Bleed

Background: Acute upper gastrointestinal (UGI) bleeding manifests as hematemesis, melena, or hematochezia. Initial management is identical, irrespective of nasogastric (NG) aspirate results. Current practice includes early upper endoscopy. Significantly fewer high-risk bleeding lesions are found on endoscopy in patients with coffee grounds vs. bloody NG aspirates. Objective: We present a case series to illustrate that patients with coffee grounds emesis (CGE) often have other unsuspected illnesses that may be overlooked due to preoccupation with the GI bleed. Case Reports: A retrospective chart review of a series of 6 patients presenting with CGE and admitted for upper GI bleeding was performed. All 6 patients were hemodynamically stable at admission. NG lavage showed coffee grounds that cleared easily. None of the patients required blood transfusions during their hospital stay. Endoscopy in 3 of 6 patients failed to find any significant UGI lesions or stigmata of recent bleed. Conclusion: Although patients were admitted for UGI bleeding, the more significant associated diagnoses included acute myocardial infarction, urosepsis, small bowel obstruction, bilateral pulmonary emboli, and acute renal failure. Hemodynamically stable patients presenting with coffee grounds NG aspirate and no fall in hemoglobin/hematocrit should be evaluated for other non-GI bleeding-related conditions even as the GI bleed is being managed.     

急性上呼吸道感染患者用药情况调查分析

目的：探讨急性上呼吸道感染患者抗菌药物应用的合理性。方法：对本院2010年7月份门急诊处方260例上呼吸道感染患者进行回顾性分析。结果：260张处方中,应用抗菌药物225例,使用率为86.5%,多为单一用药与静脉注射给药。上呼吸道感染抗菌药物使用率头孢菌素居首位,其次为青霉素类和大环内酯类,用药导致的不良反应稍多。结论：我院医师在治疗急性上呼吸道感染时,医院应加强对临床医师抗菌药物知识的培训与再教育,提高抗菌药物的临床合理应用水平。     

An investigational tetravalent meningococcal serogroups A, C, W-135 and Y-tetanus toxoid conjugate vaccine co-administered with Infanrix™ hexa is immunogenic, with an acceptable safety profile in 12-23-month-old children

Tetravalent meningococcal serogroups ACWY conjugate vaccines will provide an advantage to those at most risk of invasive meningococcal disease; namely young children. Co-administration of ACWY-TT with DTaP-HBV-IPV/Hib was assessed in a randomized trial in 793 children aged 12-23 months. Pre-specified criteria for non-inferiority of immunogenicity following co-administration versus separate ACWY-TT and DTaP-HBV-IPV/Hib administration were reached. One month post-vaccination, ≥97.3% of ACWY-TT vaccinees had rSBA titres ≥1:8 (all serogroups). Seroprotection/seropositivity rates against DTaP-HBV-IPV/Hib antigens were ≥98.2%. The safety profile of co-administration was similar to that of DTaP-HBV-IPV/Hib alone. ACWY-TT and DTaP-HBV-IPV/Hib co-administration during the second year would facilitate introduction of ACWY-TT into routine toddler vaccination schedules.     

神经源性膀胱合并上尿路扩张患者尿动力学检查的护理

目的探讨神经源性膀胱合并上尿路扩张患者尿动力学特点及检查过程中的护理配合。方法回顾性分析150例神经源性膀胱合并上尿路扩张患者膀胱功能测定的护理配合要点、检查结果和并发症发生情况。结果上尿路扩张患者多表现为膀胱低顺应性、逼尿肌过度活动、高逼尿肌漏尿点压、相对安全容量显著降低、残余尿量显著增多、膀胱活动低下等,尿动力学检查后患者并发泌尿系感染的风险和严重程度明显增加。结论神经源性膀胱合并上尿路扩张患者行尿动力学检查时需加强相关的护理配合,如严格控制膀胱充盈速度及重复检测次数、及时留置导尿管持续引流尿液或进行清洁间歇导尿、预防性使用抗生素等,以保证检查结果的准确性,并有效预防检查后泌尿系感染的发生。     

高压氧治疗上肢周围神经损伤的疗效观察

目的 观察早期应用高压氧结合常规康复治疗对上肢周围神经损伤术后的疗效.方法 选取上肢周围神经完全损伤术后的患者60例,等量随机分为治疗组、对照组各30例.对照组采用常规药物和系统康复治疗;治疗组在常规药物和系统康复治疗基础上采用高压氧治疗,并在治疗前及治疗后3、6个月时分别做手功能评定及神经传导速度（MCV）和肌电图（EMG）检查.结果 治疗后3、6个月时手功能评定及神经传导速度和肌电图检查结果显示,治疗组疗效优于对照组,差异有显著性（P均〈0.05）.结论 早期系统康复治疗结合高压氧治疗是上肢周围神经损伤术后患者恢复功能的有效治疗措施.     

Freezing in Parkinson's disease: a spatiotemporal motor disorder beyond gait

Freezing of gait (FOG) is an incapacitating problem in Parkinson's disease that is difficult to manage therapeutically. We tested the hypothesis that impaired rhythm and amplitude control is a common mechanism of freezing which is also present during other rhythmic tasks. Therefore, we compared the occurrence and spatiotemporal profiles of freezing episodes during upper limb motion, lower limb motion, and FOG. Eleven freezers, 12 non-freezers, and 11 controls performed a rhythmic bilateral finger movement task. The triggering effect of movement speed, amplitude, and coordination pattern was evaluated. Regression slopes and spectral analysis addressed the spatial and temporal kinematic changes inherent to freezing episodes. The FOG Questionnaire score significantly predicted severity of upper limb freezing, present in 9 freezers, and of foot freezing, present in 8 freezers. Similar to gait, small-amplitude movements tended to trigger upper limb freezing, which was preceded by hastened movement and a strong amplitude breakdown. Upper limb freezing power spectra were broadband, including increased energy in the "freeze band" (3-8 Hz). Contrary to FOG, unilateral upper limb freezing was common and occurred mainly on the disease-dominant side. The findings emphasize that a core motor problem underlies freezing which can affect various movement effectors. This deficit may originate on the disease-dominant body side and interfere with amplitude and timing regulation during repetitive limb movements. These results may shift current thinking on the origins of freezing as being not exclusively a gait failure.