上呼吸道感染致高热惊厥患儿的综合护理分析

目的 探讨综合护理在小儿上呼吸道感染致高热惊厥中的应用效果.方法 选取2017年5月—2019年6月在本院急诊科就诊的上呼吸道感染致高热惊厥患儿60例,其中2017年5月—2018年5月降温急救护理实施前收治的30例患儿为对照组,2018年6月—2019年6月降温急救护理实施后收治的30例患儿为观察组.对照组给予常规急...     

Correlation between echocardiographic superior vena cava flow and short-term outcome in infants with asphyxia

Objectives

To assess the relationship between superior vena cava (SVC) flow and short-term outcome in infants with perinatal asphyxia.

Methods

Infants in sequence born after more than 35 weeks of gestation who had been hospitalized at the NICU and normal neonatal wards of Wakayama Medical University between May 2005 and September 2010 were recruited for this observational cohort study. The study eligibility criterion was the presence of perinatal asphyxia, as evidenced by abnormal fetal heart rate monitoring and an Apgar score of 7 or less at 1 min or need for resuscitation using positive pressure ventilation. SVC flow was measured in the first three days of life by Doppler echocardiography as described by Kluckow and Evans. Short-term outcome was defined as poor if MRI demonstrated bilateral lesions of the basal ganglia and thalamus and/or multicystic encephalomalacia due to hypoxic ischemia.

Results

In the head cooling group, SVC flow in infants with a good outcome was lower than that in infants with a poor outcome at 12 h (36.9 ± 7.7 vs 113.4 ± 42.4 ml/kg/min (p = 0.01)), 24 h (75.2 ± 25.3 vs 155.6 ± 45.7 ml/kg/min (p = 0.03)), and 48 h (92.5 ± 34.2 vs 161.1 ± 46.7 ml/kg/min (p = 0.04)) after birth. SVC flow decreased promptly after introduction of head cooling in infants who had a good outcome, whereas it increased gradually after head cooling in those who had a poor outcome.

Conclusion

We speculate that regulation of brain circulation is disrupted in infants with asphyxia who show a poor outcome.     

10％的盐水冰袋用于体外循环术后高热患者降温效果的研究

目的探讨采用10％的盐水冰袋冰敷在体外循环术后高热患者物理降温中的效果。方法对124例体外循环术后高热患者的物理降温效果进行比较，研究组60例，应用10％的盐水冰袋作为物理降温的用具；对照组64例，使用传统的橡胶冰袋冰敷作为物理降温用具。记录降温后不同时间患者体温下降的情况。结果2组病例冰枕冰敷后0．5，1．5h降温效果差异无显著性（P〉0．05）；冰枕冰敷后2．5，4．0h降温效果差异有显著性（P〈0．05）。结论10％的盐水冰袋冰敷具有降温效果好、持续时间长，冰袋内为霜水，患者感觉舒适，值得临床推广应用。     

Atrial fibrillation ablation with esophageal cooling with a cooled water-irrigated intraesophageal balloon: a pilot study

Introduction: A left atrioesophageal fistula is an uncommon but devastating complication that may occur during atrial fibrillation (AF) ablation, and may be due to thermal injury occurring during the radiofrequency (RF) ablation. We examined the feasibility of an esophageal cooling (ECO) method using a cooled water-irrigated intraesophageal balloon (IB).
Methods and Results: Eight patients with drug-refractory AF underwent RF catheter ablation to encircle the ipsilateral pulmonary veins. During the RF ablation at the posterior left atrium, the esophageal lumen was cooled using a 9-Fr. IB catheter with a balloon length of 40 mm and diameter of 10 mm, in which cooled water, with a water temperature of 4.5 ± 3.1 °C, was irrigated while the luminal esophageal temperature (LET) was measured with an intraesophageal probe placed at a site close to the tip of the ablation catheter. In the control, the LET increased from 36.4 ± 0.8 °C to 40.5 ± 1.7 °C within 26.1 ± 8.2 seconds during 3.9 ± 1.2 RF energy applications, whereas with the ECO the LET decreased to 30.2 ± 2.9 °C at baseline (P<0.01 vs control), and increased only to 33.5 ± 2.9 °C (P<0.01 vs control) at most, within 30 seconds during 3.9 ± 1.2 RF energy applications. All pulmonary veins were successfully isolated in all patients without any complications. During a follow-up period of 3.1 ± 1.2 months, no esophageal injuries were observed and all but one patient have been free from any symptoms.
Conclusions: Use of an IB successfully lowers LET. This might have the potential of preventing esophageal injury, although further study is required.     

Fabrication of tissue‐engineered cell sheets by automated cell culture equipment

Most cells for regenerative medicine are currently cultured manually. In order to promote the widespread use of regenerative medicine, it will be necessary to develop automated culture techniques so that cells can be produced in greater quantities at lower cost and with more stable quality. In the field of regenerative medicine technology, cell sheet therapy is an effective tissue engineering technique whereby cells can be grafted by attaching them to a target site. We have developed automated cell culture equipment to promote the use of this cell sheet regenerative treatment. This equipment features a fully closed culture vessel and circuit system that avoids contamination with bacteria and the like from the external environment, and it was designed to allow 10 cell sheets to be simultaneously cultured in parallel. We used this equipment to fabricate 50 sheets of human oral mucosal epithelial cells in five automated culture tests in this trial. By analyzing these sheets, we confirmed that 49 of the 50 sheets satisfied the quality standards of clinical research. To compare the characteristics of automatically fabricated cell sheets with those of manually fabricated cell sheets, we performed histological analyses using immunostaining and transmission electron microscopy. The results confirmed that cell sheets fabricated with the automated cell culture are differentiated in the same way as cultures fabricated manually.     

冷热交替消融正常兔肝的影像学与病理学研究

目的 探讨正常兔肝冷热交替消融后消融灶的动态影像学和病理学变化。方法 对20只正常兔肝进行冷热交替消融。消融后1、3、7、14天行CT和CEUS,之后各处死5只兔,观察消融灶的病理学改变。结果 消融灶中心呈凝固性坏死。消融后7天内,坏死灶周围组织充血水肿和急性炎细胞浸润,CT平扫为低或等密度灶,常规超声为低回声为主的混合回声区;增强后均表现为无强化坏死灶和动脉期周边环状增强。消融后7~14天,坏死灶周围组织充血水肿好转,有纤维组织增生、慢性炎细胞浸润及钙化形成,表现为环形强化逐渐减轻消失,消融灶缩小。结论 冷热交替消融可在正常兔肝中产生凝固坏死灶;CT增强扫描和CEUS能有效反映不同时期肝脏消融灶的病理学变化,准确显示消融灶范围。     

Modularity of stress response evolution

Responses to extracellular stress directly confer survival fitness by means of complex regulatory networks. Despite their complexity, the networks must be evolvable because of changing ecological and environmental pressures. Although the regulatory networks underlying stress responses are characterized extensively, their mechanism of evolution remains poorly understood. Here, we examine the evolution of three candidate stress response networks (chemotaxis, competence for DNA uptake, and endospore formation) by analyzing their phylogenetic distribution across several hundred diverse bacterial and archaeal lineages. We report that genes in the chemotaxis and sporulation networks group into well defined evolutionary modules with distinct functions, phenotypes, and substitution rates as compared with control sets of randomly chosen genes. The evolutionary modules vary in both number and cohesiveness among the three pathways. Chemotaxis has five coherent modules whose distribution among species shows a clear pattern of interdependence and rewiring. Sporulation, by contrast, is nearly monolithic and seems to be inherited vertically, with three weak modules constituting early and late stages of the pathway. Competence does not seem to exhibit well defined modules either at or below the pathway level. Many of the detected modules are better understood in engineering terms than in protein functional terms, as we demonstrate using a control-based ontology that classifies gene function according to roles such as "sensor," "regulator," and "actuator." Moreover, we show that combinations of the modules predict phenotype, yet surprisingly do not necessarily correlate with phylogenetic inheritance. The architectures of these three pathways are therefore emblematic of different modes and constraints on evolution.     

Crossmodal reorganization in the early deaf switches sensory, but not behavioral roles of auditory cortex

It is well known that early disruption of sensory input from one modality can induce crossmodal reorganization of a deprived cortical area, resulting in compensatory abilities in the remaining senses. Compensatory effects, however, occur in selected cortical regions and it is not known whether such compensatory phenomena have any relation to the original function of the reorganized area. In the cortex of hearing cats, the auditory field of the anterior ectosylvian sulcus (FAES) is largely responsive to acoustic stimulation and its unilateral deactivation results in profound contralateral acoustic orienting deficits. Given these functional and behavioral roles, the FAES was studied in early-deafened cats to examine its crossmodal sensory properties as well as to assess the behavioral role of that reorganization. Recordings in the FAES of early-deafened adults revealed robust responses to visual stimulation as well as receptive fields that collectively represented the contralateral visual field. A second group of early-deafened cats was trained to localize visual targets in a perimetry array. In these animals, cooling loops were surgically placed on the FAES to reversibly deactivate the region, which resulted in substantial contralateral visual orienting deficits. These results demonstrate that crossmodal plasticity can substitute one sensory modality for another while maintaining the functional repertoire of the reorganized region.