Comparison of defibrillation efficacy between two pads placements in a pediatric porcine model of cardiac arrest

Objective

The placement of defibrillation pads at ideal anatomical sites is one of the major determinants of transthoracic defibrillation success. However, the optimal pads position for ventricular defibrillation is still undetermined. In the present study, we compared the effects of two different pads positions on defibrillation success rate in a pediatric porcine model of cardiac arrest.

Methods

Eight domestic male pigs weighing 12–15 kg were randomized to receive shocks using either the anterior–posterior (AP) or the anterior–lateral (AL) position with pediatric pads. Ventricular fibrillation (VF) was electrically induced and untreated for 30 s. A sequence of randomized biphasic electrical shocks ranging from 10 to 100 J was attempted. If the defibrillation failed to terminate VF, a 100 J rescuer shock was then delivered. After a recovery interval of 5 min, the sequence was repeated for a total of approximately 30 test shocks were attempted for each animal. The dose response curves were constructed and the defibrillation thresholds were compared between groups.

Results

The aggregated success rate was 65.6% for AP placement and 43.0% for AL one (p = 0.0005) when shock energy was between 10 and 70 J. A significantly lower 50% defibrillation threshold was obtained for AP pads placement compared with traditional AL pads position (2.1 ± 0.4 J/kg vs. 3.6 ± 0.9 J/kg, p = 0.041).

Conclusion

In this pediatric porcine model of cardiac arrest, the anterior–posterior placement of pediatric pads yielded a higher success rate by lowering defibrillation threshold compared to the anterior–lateral position.     

Affective picture processing as a function of preceding picture valence: an ERP analysis

Event-related brain potential (ERP) studies consistently revealed that a relatively early (early posterior negativity; EPN) and a late (late positive potential; LPP) ERP component differentiate between emotional and neutral picture stimuli. Two studies examined the processing of emotional stimuli when preceded either by pleasant, neutral, or unpleasant context images. In both studies, distinct streams of six pictures were shown. In Study 1, hedonic context was alternated randomly across the 180 picture streams. In Study 2, hedonic context sequences were blocked, resulting in 60 preceding sequences of pleasant, neutral, and unpleasant context valence, respectively. The main finding was that the valence of the preceding picture sequence had no significant effect on the emotional modulation of the EPN and LPP components. However, previous results were replicated in that emotional stimulus processing was associated with larger EPN and LPP components as compared to neutral pictures. These findings suggest that the prioritized processing of emotional stimuli is primarily driven by the valence of the current picture.     

苦参碱对兔晶状体上皮细胞内胶原合成的影响

目的探讨苦参碱（Mat）对体外培养的兔晶状体上皮细胞（RLECs）内Ⅰ型和Ⅲ型胶原蛋白合成的影响。方法 RLECs培养后分为3组：空白对照组以DMEM为培养基;重组人表皮生长因子（rhEGF）组以DMEM＋50μg/L rhEGF为培养基;Mat组以含50μg/L rhEGF和1.0 g/L Mat的DMEM为培养基。利用50μg/LrhEGF诱导RLECs增殖,加入1.0 g/L Mat培养24 h后,采用酶联免疫吸附测定法（ELISA）检测RLECs内Ⅰ型和Ⅲ型胶原蛋白表达。结果 50μg/L rhEGF作用后,RLECs内Ⅰ型和Ⅲ型胶原蛋白浓度分别为57.65±4.54μg/L和1.59±0.19μg/L,较空白对照组明显升高（P〈0.01）。Mat作用后,RLECs内Ⅰ型和Ⅲ型胶原蛋白浓度分别为21.74±3.96μg/L和0.56±0.21μg/L,较rhbFGF组和空白对照组明显下降（P〈0.01）。结论 Mat能抑制体外培养的RLECs内Ⅰ型和Ⅲ型胶原蛋白的合成。     

Venous ablation therapy: indications and outcomes

Venous disease has long been recognized as a progressive, debilitating, and recurrent problem. Until recently, venous insufficiency was often undertreated due to a lack of therapeutic modalities. During the past decade, an explosion in the treatment options has occurred. Endovenous ablation therapy has nearly replaced the conventional surgical treatments for patients with superficial venous insufficiency. Dramatic changes in therapy are also available for deep venous thrombosis but are not the subject of this review. These newer techniques are much less invasive and consequently have reduced risks of wound complications or bleeding. In addition, they can be performed easily in the office setting with local anesthesia. Higher-risk patients can now be considered for these less invasive treatments to reduce their ambulatory venous hypertension. With the lower procedural risks and the dramatically shortened recovery times, earlier intervention can be entertained. This helps prevent the development of venous stasis ulceration and other sequelae of progressive venous insufficiency.     

前后联合入路Ⅰ期治疗脊柱结核的疗效

目的探讨前后联合入路Ⅰ期治疗脊柱结核的临床疗效。方法采用前后联合入路内固定行病灶清除椎体间植骨融合术治疗胸腰段脊柱结核患者31例,术前术后均抗痨治疗。后路内固定采用椎弓根钉系统。前路病灶清除后,全部采用自体髂骨植骨。结果全部患者得到随访,时间为16个月。所有患者切口均一期愈合。伤口愈合良好无感染及窦道。骨性融合时间平均4个月。植骨块无滑脱,内固定无松动,无腰痛及功能受限,结核局部病灶无复发。结论前后联合入路Ⅰ期治疗胸腰段脊柱结核的疗效确切,能达到彻底清除病灶和重建腰骶稳定的目的 。     

JOA评分在后纵韧带骨化合并颈髓损伤患者护理中的应用

目的探讨JOA评分在颈椎后纵韧带骨化（OPLL）患者外伤后脊髓损伤的临床特点及护理要点。方法对38例OPLL合并脊髓损伤的患者依据日本矫形外科协会（JOA）评分进行量化分型和护理。结果 38例患者无一例死亡,无一例因检查搬动而加重神经的损伤,为脊髓损伤的后续治疗创造了良好条件。结论临床应用中分型简单明了,易于掌握,是一种针对慢性脊髓压迫基础上出现急性脊髓损伤患者实用性很强的护理方法     

胎儿小脑延髓池间隔的超声检测及其临床意义

目的 探讨不同孕龄胎儿小脑延髓池间隔(CMS)的正常声像图表现及正常值,并评估CMS的临床意义.方法 前瞻性选择416例不同孕周正常胎儿,采用二维超声对CMS的长径和宽径进行检测,并对其测值与孕周进行回归分析.回顾性总结我院6年间25例CMS消失的病例和12例CMS增大胎儿的临床资料.结果 ①胎儿CMS的长径和宽径在14～22孕周随着孕周的增加而增大,在23～36孕周变化不大,在37孕周后有变小趋势,与菱脑胚胎发育过程一致.②CMS消失常见于Dandy-Walker畸形、全前脑、严重脑积水、神经管缺陷、菱脑融合症、Arnold-Chiari畸形;CMS增大可见于小脑延髓池生理性增大.结论 CMS是菱脑发育正常的标志之一.CMS增大和消失与多种胎儿中枢神经系统畸形有关,尤其是后颅窝畸形.

Abstract：

Objective To establish normative data for the fetal cisterna magna septa (CMS) at various gestational age,and to evaluate its clinical significance.Methods A total of consecutive fetal between 14 and 40 gestational week(GW) were included in this prospective study.The length and width of CMS were measured by two-dimensional ultrasonography.Regression analysis was used to study the relationship between the width and length of the fetal cisterna magna septa and gestational age.Twenty-five case of fetuses with the absence of CMS and 12 case of fetuses with the enlargement of CMS were retrospectively analyzed in the past six years in our hospital.Results ①The fetal CMS length and width increased gradually between 14 and 22 GW,then plateaued between 23 GW and 36 GW,and decreased after 37 GW.This ultrasonographic pattern was in agreement with normal development of rhombencephalon.②The absence of CMS in the fetuses were common in Dandy-Walker syndrome,holoprosencephaly,severe hydrocephalus,neural tube defects,rhombencephalon synapsis and Arnold-Chiari malformation.The enlargement of CMS in the fetuses may be shown in physiologic enlargement of posterior fossa.ConclusionsCMS is a potential new marker for normal development of rhombencephalon.The enlargement and absence of CMS are related to various malformations of central neural system,especially in the abnormalities of posterior fossa.     

颅内后循环动脉瘤的血管内治疗

目的回顾分析19例后循环动脉瘤血管内治疗结果,探讨颅内后循环动脉瘤的介入治疗方法和安全性。方法 19例患者中15例表现为蛛网膜下隙出血,均为急性期;2例表现为搏动性头痛经CTA检查发现,2例表现为共济障碍,后组颅神经症状。其中10例采用GDC栓塞治疗,7例采用Neuform支架结合GDC治疗,2例椎动脉小宽颈动脉瘤采用单纯Neuform支架瘤颈成形术。结果本组无并发症及死亡患者。100%栓塞12例9,0%栓塞5例2,例椎动脉小宽颈动脉瘤单纯行支架成形术,7例复查脑血管造影,显示载瘤动脉通畅,动脉瘤无复发,2例单纯支架成形患者两个月后复查动脉瘤消失。结论血管内治疗是治疗后循环动脉瘤的安全有效的措施,对于宽颈动脉瘤应采用球囊辅助或支架成形栓塞以提高栓塞率。     

家兔SPR术后H反射与F波变化的研究

目的 研究选择性脊神经后根切断术（SPR）对所支配肌肉的肌电图的变化,并对家兔的肌电图应用进行探讨.方法 采用体重近似的成年家兔15只,不分组,在相同浅层麻醉方法下对L4～S1实施腰段SPR手术,术前术后对腓肠肌的肌电图f波与H反射的变化进行观察与比较.结果 实施腰段SPR手术后腓肠肌的H反射与F波潜伏期平均值较术前均明显增加（P＜0.05）,具有统计学意义;Hmax,Hmax/Mmax,F-CD平均值及F波出现率较术前比较不存在统计学差异（P＞0.05）.结论 1）SPR术后H反射与F波的潜伏期会明显延长,说明SPR手术可以有效降低α神经元的兴奋性,降低肌张力,改善痉挛.2）家兔的α神经元兴奋性维持在较高的兴奋水平,Hmax,Hmax/Mmax,F-CD及F波出现率尚不能反映α神经元的兴奋性的改变状况.