大黄素对全身炎性反应综合征时中性粒细胞凋亡异常治疗的研究

目的研究大黄素对全身炎性反应综合征(SIRS)时中性粒细胞即多形核白细胞(polymorphonuc lear neutro-ph il,PMN)凋亡异常的治疗作用。方法32例SIRS患者(均为急性胰腺炎)提取外周血PMN后分为四组,即对照组、大黄素治疗组、白细胞介素(IL)-10治疗组、地塞米松治疗组,分别培养24 h后观察两组的PMN凋亡情况(采用流式细胞仪和TUNEL方法定量检测)。结果对照组外周血PMN细胞凋亡率为(42±8)%,大黄素治疗组PMN细胞凋亡率为(54±10)%,两组比较差异有统计学意义(P<0.05);对照组凋亡指数(AI)为25±7,大黄素治疗组外周血PMN的AI为33±9,两组比较差异有统计学意义(P<0.005)。而IL-10治疗组、地塞米松治疗组与对照组比较则无明显变化。结论大黄素对SIRS患者外周血的PMN凋亡延迟有治疗作用。     

巴曲酶治疗急性脑梗死的临床分析

目的：探讨巴曲酶治疗急性脑梗死的临床疗效。方法：将64例急性脑梗死患者随机分为两组，分别给予东菱克栓酶为主治疗 和川芎嗪+胞二磷胆碱为主治疗，观察临床疗效、纤维蛋白原及凝血酶原时间的变化，所获数据采用 x~2检验和 t 检验。结果：观察组 有效率93． 4%，对照组有效率80． 2%，两组基本痊愈和显效比较有显著差异(P＜0． 05) ，观察组血浆纤维蛋白原明显降低(P＜0． 05) 。 结论：巴曲酶治疗急性脑梗死效果肯定，能明显促进神经功能缺损的恢复，减少了并发症和后遗症，疗效优于对照组。     

大鼠心肌肌质网DNA结合蛋白的提取及在急性气胸时的变化

目的：探讨心肌细胞肌质网是否存在DNA结合蛋白，并观察它在急性气胸时的变化。方法：Wistar大鼠随机分为对照组、急性气胸组，差速离心法分离大鼠心肌细胞和后肢骨骼肌肌纤维肌质网（sarcoplasmic reticulum,SR)膜蛋白，采用Western免疫印迹技术分离出SR DNA结合蛋白，并观察此蛋白在急性气胸时的变化特征。结果；大鼠心肌SR上存在DNA结合蛋白，相对分子质量分别为60kD。急性气胸时，此蛋白的量增加。结论：大鼠心肌SR上存在DNA结合蛋白，该DNA结合蛋白与心肌功能状态密切相关。     

Evaluation of severity scoring systems in ICUs—translation,conversion and definition ambiguities as a source of inter-observer variability in Apache II,SAPS and OSF

Objective To explore translation, conversion and definition ambiguities, when using severity scoring systems in patients admitted to intensive care units (ICUs).Design A prospective study of the prognosis of acute renal failure in ICUs.Setting The study was conducted in 20 French ICUs.Patients 360 patients presenting with severe acute renal failure were studied during their ICU stay.Measurements and results The inter-observer variability of Apache II (acute physiology and chronic health evaluation), SAPS (simplified acute physiology score), and OSF (organ-system failure) was considered. For Apache II, we explored the uncertainty of measurements arising from conversion into SI units, the rounding procedures used for the non-inclusive intervals defined for quatitative parameters such as age, mean arterial pressure (MAP) or serum creatinite, the absence of definition of acute renal failure (ARF) and its consequence on doubling serum creatinine values, and the absence of guidelines in the case of spontaneous ventilation when arterial blood gases (ABG) and forced inspiratory oxygen (FIO₂) were not measured. The resulting variability was evaluated, calculating the lowest and the highest value of the scoring system for each patient. The mean difference by patient was greater than 1.5 (p<0.0001). Other examples were presented and discussed for SAPS and OSF.Conclusions Translation, conversion and definition ambiguities are a source of inter-observer variability and increase the risk of classification and/or selection biases. This gives rise to particular concern in the design and analysis of multicenter trials or meta-analysis, and improvement of these scoring systems should be envisaged in the future.     

A study of police operated dispatch to acute coronary syndrome cases arising from 112 emergency calls in Aarhus county, Denmark

Background

The accuracy of the Danish police operated "112" emergency call system was studied. Dispatch of the anaesthesiologist staffed mobile emergency care unit (MECU) to acute coronary syndrome (ACS) cases was used as an indicator of accuracy of dispatch to life threatening emergencies.

Methods

This was an observational cohort study of patients given a 112 system report of heart attack and patients with a provisional diagnosis of ACS made on scene by the MECU. Sensitivity, specificity, and positive predictive value with 95% confidence intervals (CI) were calculated.

Results

There were 341 reports of “heart attack” and 205 patients with ACS. Sensitivity was 75% (95% CI 68% to 80%) specificity 90% (89% to 92%) and positive predictive value 45% (40% to 50%).

Conclusion

The accuracy of 112 dispatch of the MECU was found to be moderate. We suggest more training of dispatch staff and medical supervision.     

脑血管病急性期的康复与护理

对４７例脑血管病患者采用急性期康复治疗，并与非急性期康复治疗组４４例进行对比观察，Ｐ＜０．０１，差异非常显著。结果提示：脑血管病患者的康复治疗宜早期进行。     

11例急性早幼粒细胞性白血病全反式维甲酸治疗疗效观察

目的观察11例急性早幼粒细胞性白血病患者经全反式维甲酸治疗后的临床效果。方法予全反式维甲酸40～60mg/d,持续服药至缓解,缓解后与化疗药物序贯治疗,用药前后检察患者血象及骨髓象。结果用全反式维甲酸诱导缓解率达91%,达缓解天数平均44d,所需维甲酸总剂量2648mg。结论全反式维甲酸对急性早幼粒细胞性白血病患者的预后有很大改善。     

Inadequate preoperative nutrition might be associated with acute kidney injury and greater illness severity postoperatively

Objective

Nutrition is vital for maintaining optimal cellular and organ function, particularly in neonates who undergo cardiac surgery. Achieving nutritional goals preoperatively can be challenging because of fluid restrictions, suboptimal oral intake, and concerns for inadequate gastrointestinal circulation. We examined preoperative caloric intake and its effects on postoperative course in neonates who underwent cardiac surgery.