Diagnosis and prognostic value of restrictive ventilatory disorders in the elderly: a systematic review of the literature

Although less extensively studied compared to pulmonary obstructive diseases, restrictive lung disease (RLD) is highly prevalent and frequently disabling in the adult and, more, the elderly population. The underlying conditions may be either primarily pulmonary diseases, such as idiopathic pulmonary fibrosis, or non respiratory conditions secondarily affecting the lung, e. g. congestive heart failure, or else conditions affecting the lung expansion, e. g. obesity or rib cage deformity. The diagnosis is frequently based on the measurement of surrogate indexes such as the forced vital capacity (FVC) used as a proxy for total lung capacity (TLC). As a consequence, diagnosis of RLD is often characterized by poor specificity. In the elderly, worsening in the quality of life and poor prognosis are variably, but significantly, associated to RLD, being the underlying condition an important source of variability. Several causes of RLD are preventable and treatable conditions. A prompt identification of these conditions may allow to slow the decline of respiratory reserve and, thus, to preserve both personal independence and resistance to acute respiratory infections. This review gives an update on the latest evidence available on the prevalence and the prognosis of RLD in the elderly. Studies were identified through systematic searches of the electronic database MEDLINE. Reference list of eligible papers were also manually searched.     

部分液体通气对无心跳供体肺的保护作用

目的 观察部分液体通气对无心跳供体(NHBD)肺的保护作用.方法 36只清洁级SD大鼠随机分为3组:氧气组(C组)、盐水组(B组)和部分液体通气组(A组).建立NHBD肺模型后行机械通气2h并监测大鼠气道压,2h后测量P-V曲线,切除大鼠左肺下叶,观察供体肺病理特点.行右肺支气管灌洗,测量灌洗液中肺表面活性物质相关蛋白B、C(SP-B、SP-C)的浓度.切除大鼠右肺上叶,并进一步行SP-B、SP-C的实时定量聚合酶链反应(Real-time PCR)检测.结果 A组大鼠动态顺应性和静态顺应性在2h热缺血期间都优于B和C组(P＜0.05);病理组织评分A组优于B组和C组(P＜0.05);肺泡灌洗液酶联免疫吸附试验(ELISA)检测和肺组织的Real-time PCR检测说明SP-B和SP-C蛋白和RNA含量差异有统计学意义,其中A组含量明显高于B组和C组(P＜0.05).结论 部分液体通气可以对热缺血期间供肺的肺功能和肺组织起到很好的保护作用,并对SP-B和SP-C有较好的保护作用.     

Defining the impaction frequency and threshold force required for femoral impaction grafting in revision hip arthroplasty

Background and purpose The two most common complications of femoral impaction bone grafting are femoral fracture and massive implant subsidence. We investigated fracture forces and implant subsidence rates in embalmed human femurs undergoing impaction grafting. The study consisted of two arms, the first examining the force at which femoral fracture occurs in the embalmed human femur, and the second examining whether significant graft implant/subsidence occurs following impaction at a set force at two different impaction frequencies.

Methods Using a standardized impaction grafting technique with modifications, an initial group of 17 femurs underwent complete destructive impaction testing, allowing sequentially increased, controlled impaction forces to be applied until femoral fracture occurred. A second group of 8 femurs underwent impaction bone grafting at constant force, at an impaction frequency of 1 Hz or 10 Hz. An Exeter stem was cemented into the neomedullary canals. These constructs underwent subsidence testing simulating the first 2 months of postoperative weight bearing.

Results No femurs fractured below an impaction force of 0.5 kN. 15/17 of the femurs fractured at or above 1.6 kN of applied force. In the second group of 8 femurs, all of which underwent femoral impaction grafting at 1.6 kN, there was no correlation between implant subsidence and frequency of impaction. Average subsidence was 3.2 (1–9) mm.

Interpretation It is possible to calculate a force below which no fracture occurs in the embalmed human femur undergoing impaction grafting. Higher impaction frequency at constant force did not reduce rates of implant subsidence in this experiment.     

Efficacy and safety of add-on levetiracetam in refractory childhood epilepsy

Purpose: The purpose of the present study was to evaluate the efficacy and safety of levetiracetam (LEV) in refractory epileptic children. Methods: The study group included 61 outpatients (7 generalized, 48 localization-related, 3 undetermined, 3 unclassified) aged between 16 months and 18 years. LEV was given twice daily at a total dose of 10 mg/kg/day. The final mean dose was 50.7 mg/kg/day. The mean number of prior anti-epileptic drugs was 5.2. The entire treatment period was more than 6 months after LEV administration. Results: Fifteen children (24.6%) became seizure-free for 6 months after starting LEV, and 18 (29.5%) had a seizure reduction of more than 50% for the entire 6 months. The response rate was 33/61 (54.1%). Responders included 2/3 of patients (66.7%) with epilepsy with continuous spikes and waves during slow sleep and 13/19 (68.4%) with frontal lobe epilepsy. The effective dosage of LEV in the responders demonstrated a wide range (mean, 46.1 mg/kg/day; range, 19.4–59.1 mg/kg/day), and showed bimodal distribution. Adverse events occurred in only two patients who did not require LEV discontinuation. Conclusion: LEV represents an important addition to the treatments available for refractory epileptic children.     

乳腺疏导推拿配合中药外敷治疗哺乳期急性乳腺炎的疗效观察

目的观察运用乳腺疏导推拿配合中药外敷治疗哺乳期急性乳腺炎患者的疗效。方法将符合标准的60例哺乳期急性乳腺炎患者,随机分成3组,推拿组、外敷组及观察组各20例。推拿组给予乳腺疏导推拿治疗,外敷组给予中药外敷治疗(乳香、香附、郁金、生白芷、青皮及皂角刺等),观察组给予乳腺疏导推拿配合中药外敷治疗。观察3组治疗1个疗程后的有效率、临床症状的恢复时间、白细胞(WBC)及C-反应蛋白(CRP)水平。结果 3组治疗前后的有效率、临床症状的恢复时间、WBC、CRP比较,差异均有统计学意义(均P<0.05),观察组明显优于推拿组及外敷组(P<0.05)。结论乳腺疏导推拿和中药外敷都可以改善哺乳期急性乳腺炎患者临床症状、WBC及CRP水平,但乳腺疏导推拿配合中药外敷的疗效更加显著。     

龙江韩氏妇科治疗胎盘前置状态合并妊娠宫腔积液经验撷粹

胎盘前置状态及妊娠宫腔积液是常见的妊娠合并症,严重者可导致流产。龙江韩氏妇科认为本病主要病机为脾肾两虚,兼有血热血瘀,故治疗以补肾健脾,固冲安胎,益气养血为大法,佐以补气升提,清热活血,临床屡获良效。     

2008-2012年围生儿死亡原因分析

目的：通过探讨2008-2012年该院围生儿死亡数、病死率及围生儿死亡的主要原因,提高围产保健工作质量,进一步降低围生儿死亡率。方法回顾性分析2008-2012年89例围生儿死亡资料,了解其特征。结果围生儿病死率7．79‰。本市户籍仅占全部围生儿死亡的7．87％,非本市户籍为92．13％,死胎比例最高,占总死亡数的52．81％,其次分别为新生儿死亡和死产。出生畸形居死亡因素中的首位,其次为脐带原因、早产、新生儿窒息、妊娠合并症及并发症等。结论提高非本市户口孕妇孕期保健意识,加强孕期筛查及监护,提高新生儿抢救能力,有助于降低围生儿病死率。     

Clinico-radiological spectrum of reversible splenial lesions in children

Recently, many cases of children presenting reversible splenial lesions during febrile illness (RESLEF) have been reported; however, their overall clinico-radiological features are unclear.     

妊娠期高血压综合征并发左心衰竭顺产产妇的护理方法及效果探讨

目的 探讨妊娠期高血压综合征并发左心衰竭顺产产妇的护理方法,并分析其临床效果.方法 选择41例产妇,分为两组,其中观察组实施有针对性的护理干预方法,对照组则实施常规护理,如心理护理、一般护理、药物治疗护理等.比较两组患者护理干预后新生儿Apgar评分及发生的严重并发症情况.结果 观察组新生儿出生时、出生后1 min及出生后5min的Apgar评分均显著高于对照组（P＜0.05）,观察组发生心律失常、产后出血及窒息、误吸的比例显著低于对照组（P＜0.05）.结论 对妊娠期高血压综合征并发左心衰竭的产妇进行分时段有针对性的护理干预,对提高新生儿Apgar评分和减少产妇严重并发症具有积极意义.