42例室性心动过速治疗的临床分析

本文介绍了42例室性心动过速的临床资料和特点,讨论了早期后除极与室性心动过速的关系,并探讨各型室速的治疗。     

Recognition of the critically ill patient and escalation of therapy

Critical illness often involves multiple organ failures and is associated with significant morbidity and mortality. In the vast majority of patients, there is a recognizable period of physiological deterioration which heralds the development of organ failure and critical illness. Despite efforts to improve the detection and management of critical illness, signs of deterioration are often missed and decisions to move patients to critical care units are delayed. Standardized approaches which implement an effective ‘chain of response’ are now utilized worldwide. They focus on attempting to reduce the incidence of serious adverse events (SAEs) such as in-hospital cardiac arrest and unplanned intensive care unit (ICU) admission using preventative measures. These systems should include: accurate recording and documentation of vital signs, recognition and interpretation of abnormal values, rapid bedside patient assessment by trained teams and appropriate interventions. Early warning systems (EWS) are an important part of this and can help identify patients at risk of deterioration and SAEs. Assessment of the critically ill patient should be undertaken by an appropriately trained clinician and follow a structured ABCDE (airway, breathing, circulation, disability and exposure) format. This facilitates correction of life-threatening problems by priority and provides a standardized communication framework between professionals. Lastly, timely support and input from members of the critical care team are vital to ensure optimal outcomes for critically ill patients.     

Impact of physical therapists’ instructions on function and the perception of post-dry needling soreness in mechanical cervical pain; a randomized clinical trial

BackgroundTo investigate the impact of physical therapists’ instructions on the perception of post dry needling (DN) soreness and function in patients with mechanical neck pain.MethodsSeventy-five patients with neck pain were randomly assigned to three groups: “positive” group (n = 25) received positive verbal input; “negative” group (n = 25) received negative verbal input, and control group (n = 25) did not receive any input about post-needling soreness. All three groups received DN of a trigger point in the upper trapezius muscle. The subjective pain experience, pressure pain threshold (PPT), and neck disability Index (NDI) were assessed before and after DN.ResultsPatients in all groups showed improvement in pain, PPT and NDI. There were no significant differences in pain (P = 0.41) and PPT (P = 0.68) in the positive and negative groups compared with the control group. Significant difference in function was seen with the NDI after DN of patients in the positive and negative groups compared with the control group (P = 0.011, standard error: 1.08–1.5).ConclusionConsidering that the power of our study may be too low to draw more definitive conclusions, DN appears to be an effective technique to improve pain and mechanical hyperalgesia. The experience of post-needling soreness does not appear to influence the outcome of DN on pain, PPT, and NDI. Post-needling soreness does not seem to be a limiting factor in achieving acceptable outcomes, especially when clinicians offer DN within a therapeutic emphasizing a positive patient response. This study questions whether any treatments need to be offered to patients receiving DN.     

Chaperone domains convert prolyl isomerases into generic catalysts of protein folding

The cis/trans isomerization of peptide bonds before proline (prolyl bonds) is a rate-limiting step in many protein folding reactions, and it is used to switch between alternate functional states of folded proteins. Several prolyl isomerases of the FK506-binding protein family, such as trigger factor, SlyD, and FkpA, contain chaperone domains and are assumed to assist protein folding in vivo. The prolyl isomerase activity of FK506-binding proteins strongly depends on the nature of residue Xaa of the Xaa-Pro bond. We confirmed this in assays with a library of tetrapeptides in which position Xaa was occupied by all 20 aa. A high sequence specificity seems inconsistent with a generic function of prolyl isomerases in protein folding. Accordingly, we constructed a library of protein variants with all 20 aa at position Xaa before a rate-limiting cis proline and used it to investigate the performance of trigger factor and SlyD as catalysts of proline-limited folding. The efficiencies of both prolyl isomerases were higher than in the tetrapeptide assays, and, intriguingly, this high activity was almost independent of the nature of the residue before the proline. Apparently, the almost indiscriminate binding of the chaperone domain to the refolding protein chain overrides the inherently high sequence specificity of the prolyl isomerase site. The catalytic performance of these folding enzymes is thus determined by generic substrate recognition at the chaperone domain and efficient transfer to the active site in the prolyl isomerase domain.     

基于电刺激的大鼠肌筋膜疼痛触发点的发生机制

目的:探究电刺激下肌筋膜疼痛触发点肌纤维的兴奋性和耐疲劳表现。方法:将48只雄性SD大鼠随机分为对照组(CG1、CG2、CG3)和触发点组(TG1、TG2、TG3)。CG1和TG1测试刺激阈值强度和最大收缩力量(MCF)以及其最适刺激强度;CG2和TG2测试不同刺激强度下MCF的变化;CG3和TG3测试不同刺激频率下MCF的变化。钝性打击结合离心运动造模8周,恢复4周后将大鼠接入生物机能测试系统,给予肌纤维一系列电刺激,测量比较各组引起肌肉收缩的阈值强度、MCF、刺激强度和频率诱导的肌肉疲劳等指标。结果:TG1组引起肌肉开始收缩的阈值强度和最大收缩力量(MCF)的最适刺激强度比CG1组低,具有显著性差异(P0.05);TG1组与CG1组的MCF无显著性差异(P0.05)。TG2组电刺激引起的MCF第15、20次增量电刺激低于第1、5、10次增量,具有高度显著性差异(P0.01);TG2组电刺激引起的MCF第10、15、20次增量CG2组,具有高度显著性差异(P0.01);TG2组电刺激引起的MCF第1、5、10次增量无显著性差异(P0.05);TG2组电刺激引起的MCF第1、5次增量与CG2组相比无显著性差异(P0.05)。TG3组电刺激引起MCF所需的刺激频率比CG3组低,呈高度显著性差异(P0.01);TG3组电刺激引起的MCF比CG3组低,具有显著性差异(P0.05)。结论:与正常肌纤维相比,触发点肌纤维对电刺激反应更敏感,受到连续电刺激时更易疲劳。