Lack of Benefit of Very Short Basic Drive Train Cycle Length or Repetition of Extrastimulus Coupling Intervals for Induction of Ventricular Tachycardia

Stimulation Protocol for VT Induction. Introduction: There are considerable variations of uncertain importance in basic drive train cycle lengths and degree of repetition of extrastimuli used in programmed ventricular stimulation protocols in different laboratories. We compare prospectively three different stimulation protocols to examine the influence of a short basic drive train cycle length and repetition of extrastimuli on induction of ventricular tachycardia. Methods and Results: Thirty consecutive patients who had documented ventricular tachycardia or fibrillation based on underlying coronary artery disease underwent programmed ventricular stimulation with each of the three study protocols. Protocol A used a basic drive train cycle length of 400 msec with each extrastimulus coupling interval delivered only once. Protocol B used the same basic drive train cycle length, but with each extrastimulus coupling interval repeated three times before decrementing. Protocol C used 300 msec as the cycle length of basic drive trains without repetition of extrastimuli. Sixty-three percent, 67%, and 63% of the study patients bad ventricular tachycardia inducible with protocols A, B, and C, respectively (P = NS). Ventricular fibrillation was induced in 23% of the 30 patients in all three protocols. There were no significant differences in the mean cycle lengths of induced ventricular tachycardia, the number of extrastimuli used, and the coupling interval of the last extrastimulus inducing ventricular tachycardia among the three protocols. Conclusion: This study showed no clinical benefit for repetition of extrastimuli that have failed to induce a ventricular tachyarrhythmia during programmed ventricular stimulation. A short basic cycle length of 300 msec was not superior to 400 msec for induction of ventricular tachyarrhythmias. We recommend the use of basic cycle length 400 msec with delivery of each extrastimulus interval only once as the initial protocol for programmed ventricular stimulation.     

中药湿敷及盆底肌肉锻炼对痔疾孕产妇的效果观察

目的观察使用中药湿敷及盆底肌肉锻炼对减轻痔疾孕产妇痛苦的效果。方法选取我院84例痔疾孕产妇,均分为观察组与对照组。观察组使用中药湿敷及盆底肌肉锻炼,对照组使用1∶5000高锰酸钾溶液清洗温水湿敷。结果观察组治愈6例、显效17例、好转17例、无效2例;疼痛时间平均为5．38±0．22 d;肛周水肿时间平均为22．67±3．17 d。对照组治愈3例、显效11例、好转20例、无效8例;疼痛时间平均为5．73±0．25 d;肛周水肿时间平均为28．3±3．34 d （ P＜0．05）。结论中药湿敷及盆底肌肉锻炼可消肿止痛,促进痔疮的消退。     

康复训练指导对脑卒中恢复期患者生活质量的影响

目的研究康复训练指导对脑卒中恢复期患者生活质量的影响。方法选择重庆市永川区中医院就诊的急性脑梗死患者作为研究对象,随机分为给予康复训练指导的观察组和常规生活指导的对照组,观察神经功能、精神状态以及生活质量。结果治疗后3个月,观察组患者的CSS评分（16．94±2．0r7）分、NIHSS（18．83±1．97）分明显低于对照组,MMSE评分（27．26±2．94）分明显高于对照组（P〈0．05）;观察组躯体功能、心理功能、社会功能、认知功能和总体生活质量评分明显高于对照组。结论康复训练指导能够提高恢复期脑卒中患者的生活质量,具有积极的临床价值。     

Does ketamine affect intraoperative electrophysiological monitoring in children undergoing selective posterior rhizotomy?

Objective: Direct dorsal rootlet stimulation with intraoperative electrophysiological monitoring is an adjunct to clinical evaluation during selective posterior rhizotomy. The purpose of this study was to evaluate the impact of ketamine on intraoperative electrophysiological monitoring during selective posterior rhizotomy. Specifically, we sought to determine if low dose ketamine given as part of the anesthesia was associated with changes in intraoperative electrophysiological monitoring in patients who underwent selective posterior rhizotomy. Methods: A retrospective cohort study was conducted using anesthetic records and electrophysiological records of 32 children who had intraoperative electrophysiological monitoring during selective posterior rhizotomy under general anesthesia. Administration and dosage of ketamine preceding the stimulation of dorsal roots was determined from the anesthetic record. A pediatric neurologist, blinded to patient, and to ketamine exposure, evaluated different electrophysiological criteria. Results: Eight children received ketamine and 24 did not receive it. The mean average dose of ketamine was 0.18 mg·kg^?1 (sd : 0.04). We did not find any statistically significant difference in intraoperative electrophysiological response between the ketamine and the control groups. However, we noted some trends: Administration of ketamine preceding the stimulation of dorsal roots was associated with a lower maximal threshold (2.7 mA vs 3.5 mA, P = 0.663) and root thresholds compared with children who did not receive ketamine. In addition, the train response following delivery of the suprastimulation tended to last longer with the presence of ketamine. Conclusions: Administration of low dose ketamine preceding the stimulation of dorsal roots during selective posterior rhizotomy might be associated with lower maximal thresholds and a more sustained train response following stimulation. Physicians should be aware of this finding in order to avoid misinterpreting intraoperative electrophysiological monitoring.     

沪九直通车运行途中突发公共卫生事件的应对处置

〔目的〕提高国际列车应对突发公共卫生事件的能力。〔方法〕对2003年10月—2008年3月期间沪九直通车行驶途中发生的12起突发公共卫生事件应对处置过程进行回溯性分析。〔结果〕沪九直通车途中突发的公共卫生事件5起为疑似传染病;7起为急性非传染性疾病。11起卫生事件是按照《处置预案》规定进行处置。未对腹泻病人呕吐物和粪便进行检验,也未对上车后饮食情况进行调查。对呼吸道病人移交防护措施未见报告。〔结论〕加强铁路部门与检验检疫部门的联系与沟通。加强对腹泻病人的呕吐物、粪便实验室检查和流行病学调查以及对呼吸道病人移交时加强防护。建议对沪九直通车途中突发卫生事件进行分级化管理。     

青藏铁路客运值乘人员职业健康检查分析

目的为了解高原客运值乘人员不宜值乘主要原因,为确定该人群职业健康检查生理筛选指标提供依据。方法依据铁道部办公厅和劳卫司（铁劳卫[2006]49号）《关于进一步加强青藏铁路卫生保障工作的通知》,对1400名青藏客运列车值乘人员进行岗前职业健康检查。结果岗前体检中不宜值乘人员有142人,占体检总人数的10．1％。不宜值乘主要原因有心血管系统、血液系统、呼吸系统、消化系统、泌尿系统、内分泌系统、运动系统及妇科等方面疾患。进入高原后的适应性体检中有11人不宜值乘,总不宜值乘人员为153人,占体检总人数的10．9％。结论现行的体检生理指标较适用,可及时发现职业禁忌证,有效地防止职业性高原病的发生。     

旅客列车空气品质评价现状及对策思考

目前对旅客列车空气品质方面的研究方法较为单一,如何综合有效地评价我国旅客列车空气质量水平成为亟待解决的问题。作者借鉴国内外室内空气品质评价研究方向,探讨主、客观评价相结合的旅客列车空气品质综合评价方法,希望有助亍更为全面、客观地衡量旅客列车总体空气质量水平,从而为进一步改善旅客列车空气品质提供理论依据。     

神经肌肉阻滞程度对上肢运动诱发电位的影响

目的 探讨不同神经肌肉阻滞程度对上肢前臂运动诱发电位(MEP)的影响.方法 随机选择40例自2007年1-3月期间于华山医院择期行神经外科手术的ASA Ⅰ～Ⅱ级患者,全麻诱导后均给予丙泊酚+芬太尼+维库溴铵全凭静脉麻醉,术中维持脑电双频指数(BIS)值于50±10,芬太尼以2μg·kg-1·h-1持续静脉输注,肌松维持用维库溴铵静脉持续输注并行TOF监测,分别于TOF4(TOF=4)、TOF2(TOF=2)及TOF0(TOF=0)时,监测上肢前臂各肌群的MEP,记录并比较潜伏期和波幅的变化.结果 随着肌松程度的不断增加,MEP的波幅显著减小(P<0.05),潜伏期在TOF2较TOF4差异无统计学意义(P>0.05),而TOF0>绝大部分患者已无法记录到MEP波形(P<0.01).结论神经肌肉阻滞剂能明显抑制MEP的产生,且呈显著的剂量依赖性.     

军事训练致隐匿性膝关节损伤的低场MRI诊断

目的探讨低场MRI对军事训练所致隐匿性膝关节损伤的诊断价值。方法 52例经临床或手术证实、X线和CT检查均为阴性的军事训练膝关节损伤患者,采用0.35T永磁开放式MRI检查。结果发现骨挫伤28例,半月板损伤46例,交叉韧带损伤13例,副韧带损伤15例,关节软骨骨折6例,关节积液51例。结论低场MRI能较好地显示膝关节的半月板损伤、韧带损伤、关节软骨损伤、骨挫伤及关节腔积液等改变,对发现隐匿性的损伤及增加检出率很有帮助。     

The effect of descending theta rhythmic input from the septohippocampal system on firing in the supramammillary nucleus

The supramammillary nucleus (SUM) is part of an ascending pathway conveying behavior-dependent drive to the septal generator of limbic theta rhythm. The SUM is, however, reciprocally connected to the septohippocampal system and there is strong evidence that both septum and SUM are capable of generating theta rhythmic activity. The present study examined the possible role of a descending rhythmic input to the SUM using simultaneously recorded hippocampal EEG and SUM neuronal activity in anesthetized rats. Fourier based phase analysis was performed on recordings in which fast theta rhythmic activity was elicited by tail pinch and in which a slower theta rhythm persisted after cessation of the sensory stimulus. It was found that the firing of a subpopulation of SUM neurons followed the hippocampal theta waves with a constant time delay, rather than a constant phase, suggesting that during deceleration associated with a shift from sensory-elicited theta to spontaneous theta rhythm they followed a descending rhythmic input, most likely from the medial septum. Neurons of a second group, which fired at the hippocampal theta peaks, did not show such relationship demonstrating heterogeneity in the population of rhythmic SUM neurons and their possible roles in theta generation. Combined with previous studies focusing on the role of the ascending theta drive from the SUM, these results demonstrate dynamic bidirectional coupling between subcortical theta generators. Thus, during certain states, rhythmically firing SUM neurons lead the septal theta oscillator, in others the direction may reverse and SUM follows a theta drive of septal origin.