有创机械通气救治左心衰竭严重肺水肿的体会

呼吸机应用于治疗各类型呼吸衰竭，日益受到重视，有创呼吸机在急诊科应用尤为普遍，尽管基层医院缺少血气分析监测，妨碍呼吸机应用，但在急诊，抢救生命为主要目的，笔者利用有创通气救治17例因急性心衰造成严重肺水肿患者，取得意想不到的效果，现报告如下。[第一段]     

有症状颈动脉狭窄患者保护性支架血管成形术与颈动脉内膜切除术的比较：SPACE试验的30d结果

对于重度有症状颈动脉狭窄患者而言，颈动脉内膜切除术（carotid endarterectomy,CEA）是一种有效的卒中预防措施，颈动脉支架置入术已经被广泛用作一种替代治疗方法。由于尚无令人信服的证据表明2种治疗方法的相对疗效，因此保护性支架血管成形术与CEA比较（stent-protected angioplasty versus carotid endarterectomy,SPACE）试验对这2种治疗方法进行了比较。     

诚实是一种最好的保护

对于国家税务管理方面的改革:年收入超过12万元的个人要自行申报个税;内资和外资企业的所得税标准合并统——我有一些比较深刻的体会。诚实和信用是任何个人和企业美德和成绩的基础。所有的成绩如果离开了诚实,就像在这些成绩前面加了一个负号一样,走到了反面。没有诚实就谈不上信用,无论是自然人还是法人     

儿童护理法案：护理的关键及其他

参加实验项目的50名儿童中的绝大多数有可能受到虐待的报道，说明儿童保护仍是令人担忧的重要问题。这涉及全体护理人员的工作领域。护理人员应该把他们的成年患当作父母、家庭成员和社会一般公众，并且应该与病患家庭建立良好的工作关系，从而确保这些家庭的父母和为家操心的人能提供关于他们的孩子、他们自己以及他们周围的人的有效信息。     

产科的护理风险及预防对策

随着社会的不断发展与进步，人们的法律观念意识和自我保护观念不断增加，对医疗护理质量、服务质量、医疗护理安全的要求也日益提高。作为医院中风险大、事故高发的产科，存在着病人病情变化快、床位周转率高、不可预测因素多的特点，它时刻关系到产妇及新生儿两条生命的安危。所以，产科的护理工作尤其重要，任何疏忽都有可能造成严重的不良后果。因此，要及时查找、发现、护理工作中的隐患，并采取积极的预防措施，才能杜绝各种护理差错、事故的发生。     

服药要讲最佳时间

临床上有许多病人反映,同样是医生开的药,不同时间吃感觉效果不太一样。的确如此,因为人体的生理变化具有生物周期性,其变化与昼夜节律波动现象有关。所以出现了相同剂量、相同剂型、相同厂家     

Neuroprotective effect of estrogen after chronic spinal cord injury in ovariectomized rats

BACKGROUND: At present, there is still lack of effective drugs for chronic spinal cord injury, whereas it is found recently that estrogen has a neuroprotective effect on brain and spinal cord injuries. OBJECTIVE: To observe the effect of estrogen on the apoptosis of nerve cells after gradual chronic spinal cord injury in ovariectomized rats. DESIGN: A randomized controlled animal trial. SETTING: Institute of Orthopaedics, the Second Hospital of Lanzhou University. MATERIALS: Sixty-five female Wistar rats of common degree, weighing 220–250 g, were provided by the experimental animal center of Lanzhou University. The rats were randomly divided into sham-operated group (n =5), estrogen-treated group (n =30) and saline control group (n =30), and the latter two groups were observed at 1, 3, 7, 14, 28 and 60 days respectively, and 5 rats for each time point. METHODS: All the rats were treated with bilateral oophorectomy 2 weeks before the experiment. T10 vertebral lamina was revolved into using plastic screw. The spinal canal impingement was not induced initially. After that, the original incision was opened to expose the screw every 7–10 days. MAIN OUTCOME MEASURES: The apoptosis and Caspase-3 positive cells in the damaged spinal cord were detected using terminal deoxynucleotidal transferase-mediated dUTP-biotin nick end labeling (TUNEL) method and Caspase-3 immunohistochemical staining at 1, 3, 7, 14, 28 and 60 days after chronic spinal cord injury respectively. RESULTS: Totally 65 rats were used, and the deleted ones during the experiment were supplemented by others. Changes of Caspase-3 expression after spinal cord injury: In the sham-operated group, only a small amount of Caspase-3 proteins were observed in the rat spinal cord, mainly located in motor neurons of spinal cord anterior horn. In the estrogen-treated group and saline control group, positive cells expressed occasionally at 1 day postoperatively, began to increase obviously at 7 days after injury, strongly expressed at 14 and 28 days, but decreased at 60 days, mainly located in the neurons of spinal cord gray matter anterior horn, and they expressed fewer in the motor neurons and white matter of ventral horn, and there were obvious differences between the estrogen-treated group and saline control group at 7, 14, 28 and 60 days (P < 0.05). CONCLUSION: Estrogen can reduce the apoptosis of nerve cells and promote the recovery of neurological function following gradual chronic spinal cord injury.     

改良神经刺激仪定位在全麻下乳腺癌术中对神经的保护作用

目的探讨改良神经刺激仪对神经定位的效果，以防止乳腺癌手术对运动神经的损伤，提高手术成功率及术后生活质量。方法选择ASAⅠ～Ⅱ级，乳腺癌预计手术中难以辨认神经血管走行的女性患者20例。应用Stimuplex HNS 12／BRAUN周围神经刺激仪，改良为双极刺激电极在术前、术后均对胸背神经支配的背阔肌、胸长神经支配的前锯肌以及胸前神经支配的胸肌进行肌电检测，以确定手术中神经损伤情况。结果18例患者手术前胸大肌动作电位为（1．59±0．4）mv，手术后为（1．58±0．3）mv，前后比较差异无统计学意义（P〉0．05）。手术前神经传导速度为（40．57±2．33）m／s，手术后为（40．43±2．18）m／s，前后比较差异无统计学意义（P〉0．05）。仅2例出现轻度神经损伤。结论改良神经刺激仪能准确定位神经，避免了神经的直接损伤，基本上达到了肌电图仪的神经探测功能。     

听音乐时该如何保护耳朵

当MP3成为你的掌中宝,耳机永远塞在你耳朵里面的时候,你有没有发觉,自己的听力在下降?为什么?那是因为当你长期沉醉在美妙的音乐中时,耳朵却没有机会得到休息。