Joint Trauma System,Defense Committee on Trauma,and Armed Services Blood Program consensus statement on whole blood

Hemorrhage is the most common mechanism of death in battlefield casualties with potentially survivable injuries. There is evidence that early blood product transfusion saves lives among combat casualties. When compared to component therapy, fresh whole blood transfusion improves outcomes in military settings. Cold-stored whole blood also improves outcomes in trauma patients. Whole blood has the advantage of providing red cells, plasma, and platelets together in a single unit, which simplifies and speeds the process of resuscitation, particularly in austere environments. The Joint Trauma System, the Defense Committee on Trauma, and the Armed Services Blood Program endorse the following: (1) whole blood should be used to treat hemorrhagic shock; (2) low-titer group O whole blood is the resuscitation product of choice for the treatment of hemorrhagic shock for all casualties at all roles of care; (3) whole blood should be available within 30 min of casualty wounding, on all medical evacuation platforms, and at all resuscitation and surgical team locations; (4) when whole blood is not available, component therapy should be available within 30 min of casualty wounding; (5) all prehospital medical providers should be trained and logistically supported to screen donors, collect fresh whole blood from designated donors, transfuse blood products, recognize and treat transfusion reactions, and complete the minimum documentation requirements; (6) all deploying military personnel should undergo walking blood bank prescreen laboratory testing for transfusion transmitted disease immediately prior to deployment. Those who are blood group O should undergo anti-A/anti-B antibody titer testing.     

高血压与糖尿病慢性并发症

分析了５７７例ＮＩＤＤＭ患者中高血压的检出率及其对糖尿病并发症影响。５７７例中正常血压（＜１８．７／１２．０ｋＰａ）２９１例，轻度高血压（１８．７～２１．３／１２．０～１３．２ｋＰａ）１２２例，中度高血压（２１．３～２４．０／１３．３～１４．７ｋＰａ）８１例，重度高血压组（＞２４．０／１４．７ｋＰａ）４１例。４２例正在服降压药的血压正常者单独分组。高血压组的糖尿病患者视网膜和肾脏并发症的发生率明显高于血压正常组，且神经、视网膜和肾脏并发症的程度更严重。重度高血压组的患者中，这三种并发症的发生率分别达到５９％、６０％和３２％。正常眼底的糖尿病患者血压明显低于有视网膜病变组。无神经病变患者的血压值明显低于有神经病变组。高血压组的平均心率、尿白蛋白明显高于无高血压组，而前者心率变异值明显低于后者。逐步回归分析显示，收缩压是微血管病变的独立的危险因素。结论：必须加强糖尿病合并高血压检测和治疗。     

Guidelines for treating cardiac manifestations of organophosphates poisoning with special emphasis on long QT and Torsades De Pointes

Organophosphate poisoning may precipitate complex ventricular arrhythmias, a frequently overlooked and potentially lethal aspect of this condition. Acute effects consist of electrocardiographic ST-T segment changes and AV conduction disturbances of varying degrees, while long-lasting cardiac changes include QT prolongation, polymorphic tachycardia ("Torsades de Pointes"), and sudden cardiac death. Cardiac monitoring of organophosphate intoxicated patients for relatively long periods after the poisoning and early aggressive treatment of arrhythmias may be the clue to better survival. We present here a review of the literature with a focus on late cardiac arrhythmias (mainly "Torsades de pointes"), possible mechanisms, and treatment modalities, with special emphasis on postpoisoning monitoring for development of arrhythmias.     

月桂醇微小球制作及缓释机理的研究

本文用溶剂蒸发法制备了月桂醇缓释微小球。阐述了微球粒径与搅拌速度、温度、核心材料与基质材料比例以及乳化剂浓度、油水相体积比等制备条件的关系。测定了它在乙醇介质与空气中的释放速率;证明了它的释放机制属于整体型扩散渗透体系并用扫描电镜(SEM)观察了微球表现形态。     

Rehabilitation of Traumatic Brain Injury in Active Duty Military Personnel and Veterans: Defense and Veterans Brain Injury Center Randomized Controlled Trial of Two Rehabilitation Approaches

Vanderploeg RD, Schwab K, Walker WC, Fraser JA, Sigford BJ, Date ES, Scott SG, Curtiss G, Salazar AM, Warden DL, for the Defense and Veterans Brain Injury Center Study Group. Rehabilitation of traumatic brain injury in active duty military personnel and veterans: Defense and Veterans Brain Injury Center randomized controlled trial of two rehabilitation approaches.

Objectives

To determine the relative efficacy of 2 different acute traumatic brain injury (TBI) rehabilitation approaches: cognitive didactic versus functional-experiential, and secondarily to determine relative efficacy for different patient subpopulations.

Design

Randomized, controlled, intent-to-treat trial comparing 2 alternative TBI treatment approaches.

Setting

Four Veterans Administration acute inpatient TBI rehabilitation programs.

Participants

Adult veterans or active duty military service members (N=360) with moderate to severe TBI.

Interventions

One and a half to 2.5 hours of protocol-specific cognitive-didactic versus functional-experiential rehabilitation therapy integrated into interdisciplinary acute Commission for Accreditation of Rehabilitation Facilities–accredited inpatient TBI rehabilitation programs with another 2 to 2.5 hours daily of occupational and physical therapy. Duration of protocol treatment varied from 20 to 60 days depending on the clinical needs and progress of each participant.

Main Outcome Measures

The 2 primary outcome measures were functional independence in living and return to work and/or school assessed by independent evaluators at 1-year follow-up. Secondary outcome measures consisted of the FIM, Disability Rating Scale score, and items from the Present State Exam, Apathy Evaluation Scale, and Neurobehavioral Rating Scale.

Results

The cognitive-didactic and functional-experiential treatments did not result in overall group differences in the broad 1-year primary outcomes. However, analysis of secondary outcomes found differentially better immediate posttreatment cognitive function (mean ± SD cognitive FIM) in participants randomized to cognitive-didactic treatment (27.3±6.2) than to functional treatment (25.6±6.0, t₃₃₂=2.56, P=.01). Exploratory subgroup analyses found that younger participants in the cognitive arm had a higher rate of returning to work or school than younger patients in the functional arm, whereas participants older than 30 years and those with more years of education in the functional arm had higher rates of independent living status at 1 year posttreatment than similar patients in the cognitive arm.

Conclusions

Results from this large multicenter randomized controlled trial comparing cognitive-didactic and functional-experiential approaches to brain injury rehabilitation indicated improved but similar long-term global functional outcome. Participants in the cognitive treatment arm achieved better short-term functional cognitive performance than patients in the functional treatment arm. The current increase in war-related brain injuries provides added urgency for rigorous study of rehabilitation treatments. (http://ClinicalTrials.gov ID# NCT00540020.)     

深圳593名新兵心理健康调查与干预

目的：了解新兵的心理水平及干预方式，方法：采用ＳＣＬ－９０症状自评量表对驻深圳边防某部９７年入伍的新兵５９３名进行了心理调查，并尝试用不同方式对其中两个连队进行了心理干预对照研究。结果：新兵有诸多因子分高于国内常模，应属心理问题高发人群。单纯用群体教育的方法对新兵已经发生的心理困扰无明显作用，而采用个别咨询为主的干预方法效果比较理想。部队各级医务人员掌握心理咨询和治疗的技能，对提高我军整体素质十分必要。     

聚甲基丙烯酸甲酯-氧化锆复合材料经CAD-CAM 制作牙科修复体的研究

目的在牙科 CAD-CAM 系统上加工聚甲基丙烯酸甲酯-氧化锆复合材料得到牙科修复体.方法将氧化锆纳米粉体成型,制备出具有多孔结构的部分烧结体,然后将预聚甲基丙烯酸甲酯渗透入部分烧结体的开孔中,原位聚合,制备出聚甲基丙烯酸甲酯-氧化锆复合材料.测试部分烧结体和复合材料的机械性能与可切削性能.将复合材料在牙科 CAD-CAM 系统上加工,以得到牙科修复体.结果在部分烧结体密度为 71.44% TD 时,复合材料的弯曲强度、断裂韧性、弹性模量和维氏硬度分别为 (202.56±3.09)Mpa、(4.30±0.16)Mpa·m1/2 、(58.71±1.98)Gpa、(3.82±0.34)Gpa.在 CAD-CAM 系统上加工前磨牙冠所需时间约为 16 min,得到的修复体形态生动,无崩裂缺口或微裂纹.结论聚甲基丙烯酸甲酯-氧化锆复合材料机械性能良好,经牙科 CAD-CAM 系统加工能得到牙科修复体.     

浅析基于云计算的区域卫生信息系统的构建

在分析当前医疗卫生信息系统现状的基础上,对云计算的概念、特点及相关技术进行了简要概述。提出了基于云计算的区域卫生信息系统平台的架构;介绍了可用于实现区域医疗信息化云计算平台的重要软件技术。     

依那普利联合小剂量氢氯噻嗪治疗高血压的临床观察

目的探讨依那普利联合小剂量氢氯噻嗪治疗高血压患者的临床疗效。方法120例高血压患者随机分为小剂量氢氯噻嗪组(40例)、依那普利组(40例)、氢氯噻嗪联合依那普利组(40例),疗程4周,比较3组治疗前后降压疗效及达标率。结果3组血压下降显著(P<0.05),氢氯噻嗪组与依那普利组血压下降比较差异无显著性(P>0.05),联合用药组较单独用药组血压下降更显著(P<0.05)。联合用药组降压有效率75.00%,达标率72.50%,分别与单独用药组比较P<0.05。结论小剂量氢氯噻嗪和依那普利单用或联用治疗原发性高血压有效,但两药联用显著提高降压疗效及达标率,联用不良反应减少。