旋转法经鼻气管插管的临床观察

目的 观察使用插管钳辅助（插管钳法）和旋转气管导管末端（旋转法）实施经鼻气管插管时临床效果.方法 选取2012年2～8月中国医学科学院北京协和医学院整形外科医院颅颌面手术中心ASA分级Ⅰ～Ⅱ级需经鼻气管插管患者100例,随机分为两组,每组各50例,插管钳组使用插管钳辅助插管,旋转组旋转气管导管插管.观察两组患者的喉镜暴露时间、气管置入时间、插管时间、插管成功率、术后并发症的发生情况以及插管期间的血流动力学变化.结果 两组插管成功率均为100％;插管钳组和旋转组的气管置入时间分别为（16.26±10.32）、（10.32±6.17）s,插管时间分别为（26.58±11.80）、（21.48±8.29）s,差异均有统计学意义（P＜0.05）;插管钳组术后咽喉部疼痛发生率显著高于旋转组,差异有统计学意义（P＜ 0.05）;两种插管方式插管对血流动力学影响较小.结论 直接喉镜下旋转法可以安全有效地应用于经鼻气管插管,与插管钳辅助法相比操作简单快捷、成功率高、并发症少.     

Radiographic assessment of scapular rotational tilt in chronic shoulder impingement syndrome

This study presents an objective evaluation of both scapular upward and axial rotational tilts in shoulder impingement syndrome, using a scapular spine line defined on antero-posterior (AP) radiographs of the shoulder as the referential line. Twenty-seven patients with unilateral shoulder motion pain, who were diagnosed as having chronic shoulder impingement syndrome, were enrolled in the study. Scapular upward and axial rotational tilts were compared between the affected and contralateral shoulders. AP radiographs were obtained at shoulder abduction angles of 0°, 45°, and 90°, and the X-ray films were digitized by computer. The upward and axial rotational tilts of the scapula were then evaluated on the digital images. In shoulder impingement syndrome, both upward and axial external rotations of the scapula were impaired at the painful arc angle of abduction. This tended to be more apparent for the axial rotation of the scapula than for the upward rotation. These reductions in scapular rotations reduce available clearance for the rotator cuff and humeral greater tuberosity as the shoulder is abducted. Received: January 13, 2000 / Accepted: October 2, 2000     

应用拟人模体测量双轴旋转冠状动脉造影现场护理人员站立位置X线剂量的研究

目的对双轴旋转冠状动脉造影(DARCA)时,护理人员站立位置X线剂量进行评价。方法采用拟人模体进行DARCA,并采用射线剂量仪测量辐射剂量率,分别在护理人员站立位上和床面水平方向进行辐射剂量测定,每个测量点测量3次,取算数平均值。结果在护理人员站立位上,无防护措施时射线剂量率中位数为0.604μGy/s,变化范围为0.232～1.524μGy/s,并且随高度增加总体呈下降趋势。采取防护措施后剂量率减少69%～90%。无论是否采取防护措施,距离地面50～60cm处均为高剂量区。在水平方向上,射线剂量率中位数为0.060μGy/s,变化范围为0.014～1.483μGy/s,并且沿床面纵轴方向射线剂量率逐渐减少。结论在DARCA时导管室护理人员应该注重对诊疗床下方部位和胸部以上的辐射防护。防护措施主要包括屏蔽防护和距离防护。穿着防护衣站立于诊疗床尾部位置即可取得良好的辐射防护效果。     

Pubertal testosterone predicts mental rotation performance of young adult males

Robust sex differences in some spatial abilities that favor males have raised the question of whether testosterone contributes to those differences. There is some evidence for prenatal organizational effects of testosterone on male-favoring spatial abilities, but not much is known about the role of pubertal testosterone levels on adult cognitive abilities. We studied the association between pubertal testosterone (at age 14) and cognitive performance in young adulthood (at age 21-23), assessing male-favoring, female-favoring, and sex-neutral cognitive domains in a population-based sample of 130 male and 178 female twins. Pubertal testosterone was negatively associated with performance in the Mental Rotation Test in young adult men (r=-.27), while among women no significant associations between testosterone and cognitive measures were detected. The significant association among men remained after controlling for pubertal development. Confirmatory within-family comparisons with one-sided significance testing yielded a negative correlation between twin pair differences in testosterone levels and Mental Rotation Test performances in 35 male twin pairs (r=-.32): the twin brother with higher testosterone performed less well on the Mental Rotation Test. That association was evident in 18 pairs of dizygotic male twin pairs (r=-.42; analysis controlling for shared environmental effects). In contrast, the association of differences was not evident among 17 monozygotic male twin pairs (r=-.07; analysis controlling for shared genetic influences). Results suggest that pubertal testosterone levels are related specifically to male-favoring spatial ability and only among men. Within-family analyses implicated possible shared genetic effects between pubertal testosterone and mental rotation ability.     

速度向量成像评估正常小儿左室短轴节段心肌的旋转运动

目的:通过速度向量成像(VVI)评估正常小儿左心室各节段心肌旋转运动的特征.方法:选取健康儿童50名,采集胸骨旁左室短轴心尖和心底切面的二维超声图像,脱机分析旋转角度和旋转速度、旋转角度和速度达峰时间,计算左室扭转角度,比较不同心肌节段旋转运动的差异,并分析其和年龄、心率的关系.结果:①正常小儿左室短轴的旋转运动表现为心底水平的顺时针方向和心尖水平的逆时针方向运动,心底水平的旋转角度和旋转速度从前壁到下壁逐渐递增,心尖水平的旋转角度从后间隔到侧壁依次递增,旋转速度从后间隔到后壁依次递增;②心底水平的旋转角度和旋转速度大于心尖水平的相应节段.心底水平各节段的旋转角度与年龄、心率无相关性(P＞0.05).心尖水平的后间隔旋转角度和年龄(r=0.354,P=0.012)、心率相关(r=0.401,P=0.004);③心底水平各节段的旋转角度的重复性较心尖水平各节段好(P＜0.05).结论:心底水平的旋转角度不受年龄、心率的影响,且重复性好,可更加准确地反映左室的局部心肌运动.     

二维心肌可激媒质激发波的有效控制

利用奇异微扰分析,提出对耗散系统的有效控制,将其应用于FHN模型,研究二维心肌可激媒质激发波的控制问题,分别对行波和螺旋波施加旋性和漂移控制。结果表明:行波的传播方向被改变而螺旋波产生漂移,当施加的控制强度达到阈值时,螺旋波被驱除出边界。这些研究结果对临床上治疗心律失常和有效除颤具有理论价值。     

Neurochemical correlates of conditioned circling within localized regions of the striatum

Summary Two experiments were conducted to determine the effects of conditioned circling on the concentrations of dopamine (DA), 3,4-dihydroxy-phenylacetic acid (DOPAC) and homovanillic acid (HVA) within discrete regions of the striatum (STR). The first study assessed the inherent regional distributions of these compounds with respect to the three primary axes: anterior-posterior, dorsal-ventral and medial-lateral. Concentrations of DA, DOPAC and HVA and the ratios of each metabolite to DA were found to vary across each dimension. However, the topographical distribution of each compound was unique. The results of the first experiment confirm that the STR is not a homogeneous structure. It is possible that the regional variations in dopamine metabolism underly the diverse functions which the STR is thought to modulate. The second experiment determined whether specific regions of the STR were differentially involved in the mediation of conditioned circling. DA metabolism, as estimated by metabolite concentrations and metabolite to DA ratios, was bilaterally increased within the anterior dorsomedial and dorsolateral STR, relative to noncircling, water-deprived controls. DOPAC and the corresponding ratio were enhanced selectively within the dorsomedial region, whereas HVA and its ratio to DA were increased preferentially within the dorsolateral STR. The ratio of DOPAC to DA was also enhanced within the anterior ventromedial STR. No other significant neurochemical effects were detected. These results support the hypothesis that the dorsal STR critically subserves circling. Moreover, it is possible that the medial and lateral regions of the dorsal STR are differentially involved in circling. These results also confirm previous reports of bilateral augmentation of striatal DA metabolism in association with high rates of conditioned circling.