胎儿先天性心脏病的多普勒超声临床应用

目的 探讨应用多普勒超声诊断胎儿先天性心脏病的方法和声像学特点。方法 对３７例先天性心脏病胎儿和６１例正常胎儿进行多普勒超声心动衅检查。结果 单纯性间隔缺损多无四腔心异常,大血管十字交叉关系正常;复杂性心血管畸形多具有不同程度的四腔心和心胸比例异常。     

盆底肌锻炼对降低留置导尿患者再置管率的作用

目的探讨盆底肌锻炼对降低留置导尿患者再置管率的作用。方法选取2011年7～12月在同济大学附属同济医院留置导尿的患者50例,随机分为实验组与对照组各25例。实验组在留置导尿后进行盆底肌肉锻炼,对照组给予常规护理,比较两组患者尿潴留发生率与再置管率。结果经过盆底肌肉的锻炼,实验组患者尿潴留的现象得到了改善,再置管率明显减低,两组比较,差异有统计学意义（P〈0．01）。结论盆底肌肉锻炼可有效减少患者的尿潴留现象,降低留置导尿患者的再置管率。     

左室肥大心电图诊断重订新标准的探讨

为提高左室肥大心电图诊断的敏感性和准确率,采用超声法对照研究340例16项常用传统心电图左室肥大标准的诊断价值,发现多数单项标准敏感性和准确性不甚理想.提出“新综合记分法”(∑QRS≥175mm、Rv_6>Rv_5、PTFV_1≤-0.04mm·s、QRS≥0.16s各记3分,ST-T改变、电轴左偏 29°——30°各记2分,总记分≥5判为左室肥大),诊断的敏感性和准确性可分别提高至66%(P<0.05)和81%(P<0.01).     

The effects of combined treatment with sevoflurane and cisplatin on growth and invasion of human adenocarcinoma cell line A549

Sevoflurane, an inhalational anesthetic, and cisplatin (DDP)-based chemotherapy have been widely used during lung cancer surgery. However, the effect of sevoflurane on the sensitivity of lung cancer cells to DDP chemotherapy remains unclear. In this study, the effects of combined treatment with sevoflurane and cisplatin on the growth and invasion of human lung adenocarcinoma A549 cell line have been investigated. The underlying mechanism has also been explored. In our experiment, A549 cells were treated with 2.5% sevoflurane, 10 μmol/L DDP, or the co-treatment of sevoflurane and DDP for 4 h, respectively. Cell proliferation was evaluated by the MTT assay and colony formation assay. Apoptosis was assessed by flow cytometry. Cell invasion was detected by Transwell assay. The expressions of X-linked inhibitor of apoptosis protein (XIAP), Survivin, matrix metalloproteinase (MMP)-2 and MMP-9 were determined by western blotting. Our results showed that sevoflurane combined with DDP resulted in a more pronounced inhibition of tumor cells growth and invasion as compared with either drug alone. Besides, XIAP, Survivin, MMP-2, and MMP-9 were downregulated more significantly by the co-treatment of the two drugs as compared to sevoflurane treatment or DDP treatment alone. Taken together, the growth-inhibitory and invasion-inhibitory synergy between sevoflurane and DDP in human adenocarcinoma A549 cell line was found in this study. Furthermore, we showed that the growth-inhibitory synergy between sevoflurane and DDP might be associated with the downregulation of XIAP and Survivin, and the invasion-inhibitory synergy between sevoflurane and DDP might be involved in the downregulation of MMP-2 and MMP-9.     

Effects of different resuscitation fluids on the rheologic behavior of red blood cells,blood viscosity and plasma viscosity in experimental hemorrhagic shock

Background

Hemorrhagic shock is associated with severe rheological abnormalities. We hypothesized that in the setting of hemorrhagic shock, resuscitation can alter hemorheological characteristics dramatically, and different fluids cause different effects. The aim of this study was to investigate whether the type of fluid administered has an impact on hemorheological characteristics at the early stage of resuscitation in a rodent model of hemorrhagic shock.

Methods

Animals were randomized into five groups: (1) sham hemorrhage (SHAM); (2) shock and sham resuscitation (SHOCK); (3) shock and resuscitation with normal saline 32 ml/kg (NS); (4) shock and resuscitation with 7.5% hypertonic saline 4 ml/kg (HS); (5) shock and resuscitation with 7.5% hypertonic saline/6% Dextran 70 4 ml/kg (HSD). Hemorheological characteristics were measured at 60 min after resuscitation.

Results

Results showed that NS resuscitation deteriorated red blood cell (RBC) deformability compared with the SHOCK group. The HS group showed improved RBC deformability compared with the NS group, although the differences were not statistically significant. There were significant improvements of RBC deformability at all shear rates in the HSD group compared with the NS group. Whole blood and plasma viscosities decreased significantly in the SHOCK group compared with the SHAM group. At shear rates of 60 and 150 s⁻¹, the NS group decreased whole blood viscosity compared with the SHOCK group. The HSD group showed elevated plasma viscosity compared with the SHOCK, NS and HS groups.

Conclusion

These results suggested that at the early stage of hemorrhagic shock resuscitation, hypertonic–hyperoncotic resuscitation could improve RBC deformability compared with isotonic crystalloid resuscitation. Dextran 70 could elevate plasma viscosity to nearly baseline level. These effects of hypertonic–hyperoncotic resuscitation could be beneficial to maintain microcirculation.     

重庆三峡库区卫生人员血吸虫病防治能力现状调查

目的了解血吸虫病潜在流行区——重庆三峡库区血吸虫病防治能力现状及影响因素,发现工作中的问题和困难。方法采用多阶段分层整群抽样,抽取万州、开县及云阳3个区县卫生人员进行问卷调查和定性访谈。问卷调查主要研究一般情况如年龄、学历、血防工作经历、血防治知识知晓、培训等。定性访谈主要探讨血防工作中的困难、问题及建议。对卫生人员基本情况进行统计描述,对不同性别、年龄、职业等的卫生人员血防知识全部正确率进行χ2检验。访谈录音用定性分析软件MAXqda,运用主题框架分析法进行分析。结果问卷调查180名,访谈25名卫生人员。93.33%为大专或以下学历,73.33%未从事过血吸虫病防治工作,血吸虫病防治工作没有专职人员。47.78%对基本血防知识缺乏了解,影响因素为职业和学历。75.56%在最近1年未参加过培训。流动人口及本地居民的血清学监测难以开展,钉螺监测人员不足,缺乏专业技能。对居民的健康宣传限于在开展传染源或螺情监测时发放传单,学生的血吸虫病健康教育尚未开展。政府投入有限,部门间合作机制尚未形成。结论三峡库区的医疗卫生人员血防知识知晓率低,缺乏培训。传染源及钉螺监测,居民健康教育已逐步开展。需加强政府领导及投入,强化血防队伍防治能力建设,可派卫生人员到疫区学习。亟须有效完成各项监测,多形式开展健康教育,多部门合作,形成群防群控的良好局面。     

视网膜中央静脉阻塞的血流动力学研究(附30例报告)

对早期视网膜中央静脉阻塞（ＣＲＶＯ）患者应用美国Ａｃｕｓｏｎ┐１２８彩超仪行彩色多普勒超声成像（ＣＤＩ）检查,测量视网膜中央动脉的收缩期峰值速度（ＰＳＶ）及舒张末期速度（ＥＤＶ）,计算血流阻力指数（ＲＩ）;测量视网膜中央静脉血流的最大流速（Ｖｍａｘ）及最小流速（Ｖｍｉｎ）,计算静脉血流搏动指数（ＶＰＩ）,并与正常者做对照。结果显示,ＣＲＶＯ缺血型与非缺血型患者的动脉流速无显著差异,但静脉流速差异有显著性。本病患者的患眼与健眼比较,ＰＳＶ、ＥＤＶ、Ｖｍａｘ、Ｖｍｉｎ均降低,ＲＩ增高,ＶＰＩ降低;其健眼与正常人眼比较,ＲＩ增高,ＶＰＩ降低。     

北京某二甲医院非终末期晚期肿瘤患者营养风险、营养不足及营养支持情况前瞻性描述性研究

目的 前瞻性调查北京某二甲医院肿瘤内科非终末期晚期住院患者的营养风险、营养不足发生情况及营养支持应用现状,为今后营养支持改善临床结局研究奠定基础.方法 采用连续抽样方法对2011年10月至2013年4月北京某二甲医院肿瘤内科入院患者展开调查.对符合入选标准的患者,于入院次日采用营养风险筛查2002 （NRS2002）进行营养风险筛查和营养不足评估,并记录患者住院期间的营养支持情况.对没有营养风险患者每周重复筛查.出院后根据患者的临床及病理资料,将其分为早、中期（Ⅰ、Ⅱ、Ⅲa期）、非终末期晚期（Ⅲb、Ⅳ期）及终末期（预计生存期短于3个月）3组.本研究仅对非终末期晚期肿瘤患者的营养风险、营养不足发生率及营养支持应用情况进行统计学分析,所有数据进入EDC系统并经核查无误.结果 调查期间人院患者305例,排除不符合标准的患者后,共224例患者接受了营养风险筛查.其中,对非终末期晚期患者171例进行统计分析,结果营养风险发生率为67.8％ （116/171）,不同肿瘤类型患者营养风险发生率依次为肺癌45.7％ （21/46）,消化道肿瘤89.4％ （42/47）,肝、胆、胰腺肿瘤81.3％ （26/32）,头颈部肿瘤83.3％ （5/6）.以体质量指数（BMI） ＜18.5 kg/m2计算营养不足发生率为12.3％ （21/171）;以NRS2002营养受损部分评分达到3分汁算营养不足的发生率为19.9％ （34/171）.有营养风险的116例患者中,71例接受了营养支持,占61.2％;肠外与肠内营养的应用例数比为68∶3 （23∶1）;能量摄入为（56.78±8.20） kJ/（kg·d）,氮摄入为（0.06±0.01） g/（kg·d）.55例无营养风险患者中,5例接受了营养支持（9.1％）.结论 非终末期晚期肿瘤患者营养风险、营养不足的发生率较高,且与肿瘤类型相关.非终末期晚期肿瘤患者的营养支持亦存在不合理之处,以有营养风险患者的营养支持率偏低为主.对于有营养风险的患者,营养支持能否改善其临床结局,是今后需要进行研究的课题.