【摘要】 目的 探討胎兒宮內(nèi)窘迫對(duì)足月新生兒血清心肌酶變化的相關(guān)性分析。 方法 將2009年10月-2010年9月在我產(chǎn)科出生有宮內(nèi)窘迫史而羊水和Apgar評(píng)分均正常的足月新生兒20例為觀察組，同期出生的健康足月新生兒10例為對(duì)照組，分別測定兩組出生后1、5 d血清肌酸激酶同工酶（CK-MB）及心肌肌鈣蛋白I（cTnI）水平。 結(jié)果 觀察組出生后1 d血清cTnI高于對(duì)照組（Plt;0.001），CK-MB兩組差異無統(tǒng)計(jì)學(xué)意義（Pgt;0.05），出生后5 d血清CK-MB及cTnI均高于對(duì)照組（Plt;0.001）；觀察組和對(duì)照組出生后5 d血清cTnI水平均較1 d時(shí)升高，差異有統(tǒng)計(jì)學(xué)意義（Plt;0.001），血清CK-MB濃度均低于1 d時(shí)（Plt;0.001）。觀察組患兒經(jīng)過治療，1個(gè)月后復(fù)查血清cTnI除1例未恢復(fù)至正常水平外，其余血清CK-MB及心電圖均恢復(fù)正常?！〗Y(jié)論 單純宮內(nèi)窘迫可造成足月新生兒血清cTnI及CK-MB水平升高，常規(guī)檢測血清cTnI及CK-MB能及時(shí)了解此類新生兒的心肌受損情況，從而盡早予以保護(hù)心肌治療?！続bstract】 Objective To make a correlation analysis on effect of fetal distress on changes of cardiac enzyme in neonatal serum. Methods Twenty full-term newborns who met diagnostic criteria of fetal distress but were born with normal amniotic fluid and Apgar score between October 2009 and September 2010 were included in the observed group, another ten normal full-term newborns born at same period were in control group. The serum values of cardiac troponin I (cTnI) and creatine kinase (CK-MB) were collected and measured one and five days after birth. Results One day after the birth, the serum levels of cTnI was significantly higher in the observed group compared to that in the control group (Plt;0.001), but there was no difference in CK-MB between the two groups (Pgt;0.05). The values of cTnI five days after the birth were higher than those one days after the birth in both groups (Plt;0.001). The values of CK-MB were higher one day after birth than those five days after birth in both groups (Plt;0.001). In observation group after the treatment, serum cTnI in one patient did not return to normal, and the remaining neonatal serum CK-MB and ECG were normal. Conclusions Elevated level of serum cTnI and CK-mb could be caused by fetal distress in normal full-term newborns with normal amniotic fluid and Apgar score. Routine testing of serum cTnI and CK-MB may be useful to detect myocardial damage in newborns.
【摘要】 目的 觀察在腹腔鏡膽囊切除術(shù)中，氯胺酮超前鎮(zhèn)痛對(duì)瑞芬太尼麻醉后急性疼痛的影響。 方法 2009年10月-2010年1月，將擇期行腹腔鏡膽囊切除術(shù)患者90例，隨機(jī)分為對(duì)照組（C組）、氯胺酮超前鎮(zhèn)痛組（K組）、氯胺酮術(shù)畢鎮(zhèn)痛組（K1組），每組30例。所有患者均采用瑞芬太尼復(fù)合丙泊酚靜脈麻醉，K組在切皮前靜脈給予氯胺酮0.5 mg/kg，K1組在關(guān)腹前靜脈給予氯胺酮0.5 mg/kg，C組不給予任何藥物。記錄術(shù)畢患者麻醉恢復(fù)情況，各時(shí)間點(diǎn)疼痛程度。 結(jié)果 K組、K1組躁動(dòng)發(fā)生率均明顯低于C組（Plt;0.05）；術(shù)后2、4、8、24 h，K組VAS評(píng)分及鎮(zhèn)痛藥使用率明顯低于C組和K1組（Plt;0.05）。 結(jié)論 氯胺酮超前鎮(zhèn)痛能明顯降低瑞芬太尼術(shù)后疼痛，并且不增加并發(fā)癥發(fā)生率。【Abstract】 Objective To evaluate the preemptive analgesia of ketamine on remifentanil induced acute postoperative pain after laparoscopic cholecystectomy. Methods Ninty patients scheduled for laparoscopic cholecystectomy between october 2009 to Jannary 2010 were randomly assigned to three groups (n=30). Group K was administrated with 0. 5 mg/kg ketamine intravenously before skin incision, and Group K1 were administrated with 0. 5 mg/kg ketamine intravenously before abdominal closure, while Group C received nothing. The recovery and the side effects were recorded, the VAS at two, four, eight and 24 hours after surgery, and the use of anodyne were recorded. Results The incidence of restlessness in Groups K and K1 was remarkably lower than that of Group C (Plt;0. 05). The analgesic effects two, four, eight and 24 hours after surgery were obviously better in group K than those of Group C and Group K1 (Plt;0. 05). Conclusion Ketamine can produce preemptive analgesia to relieve remifentanil-induced acute pain, and it would not increase incidence of side effects.
目的 評(píng)價(jià)高PEEP 機(jī)械通氣策略對(duì)ARDS 患者死亡率和氣壓傷發(fā)生率的影響。方法 計(jì)算機(jī)檢索PubMed( 1966 年至2008 年9 月) 、EMBASE( 1980 年至2008 年9 月) 、Cochrane Database( 2008 年第2 期) 、中國Cochrane 中心臨床對(duì)照試驗(yàn)資料數(shù)據(jù)庫和中國生物醫(yī)學(xué)文獻(xiàn)光盤數(shù)據(jù)庫( 1978 年至2008 年9 月) , 手工檢索初步入選文獻(xiàn)的全文和參考文獻(xiàn)中所列的相關(guān)文獻(xiàn)和雜志、學(xué)術(shù)會(huì)議論文集、學(xué)位論文匯編。收集國內(nèi)外關(guān)于不同PEEP 水平機(jī)械通氣策略對(duì)ARDS 患者影響的隨機(jī)對(duì)照試驗(yàn), 進(jìn)行系統(tǒng)評(píng)價(jià)。結(jié)果 共5 篇文獻(xiàn)入選, 其中3 篇試驗(yàn)組采用了小潮氣量加高PEEP, 對(duì)照組采用了傳統(tǒng)潮氣量加低PEEP 通氣策略, 故歸為一個(gè)亞組( A 亞組) ; 2 篇試驗(yàn)組采用了高PEEP,對(duì)照組采用了低PEEP, 兩組均采用了小潮氣量通氣策略, 故歸為一個(gè)亞組( B 亞組) 。合并結(jié)果顯示, 小潮氣量加高PEEP 通氣策略可以降低A 亞組患者的死亡率[ RR 0. 59, 95%CI( 0. 43, 0. 82) ] 和氣壓傷發(fā)生率[ RR 0. 24, 95%CI( 0. 09, 0. 70) ] , 對(duì)B 亞組患者的死亡率[ RR 0. 97, 95%CI( 0. 83, 1. 13) ]和氣壓傷發(fā)生率[ RR 1. 13, 95%CI( 0. 78, 1. 63) ] 無顯著影響。結(jié)論 現(xiàn)有證據(jù)表明, 小潮氣量加高PEEP 通氣策略對(duì)ARDS 患者有益, 但單獨(dú)高PEEP 的作用尚需進(jìn)一步評(píng)價(jià)。
【摘要】 目的 觀察晚期糖基化終產(chǎn)物（advanced glycosylation end prodrcts，AGE）對(duì)人結(jié)腸癌細(xì)胞株SW-480增殖的影響，并探討其可能機(jī)制。 方法 不同濃度AGE干預(yù)SW-480細(xì)胞，噻唑藍(lán)（MTT）法比較各組細(xì)胞活力，流式細(xì)胞術(shù)觀察AGE對(duì)SW-480細(xì)胞周期的影響，蛋白質(zhì)印跡法觀察AGE對(duì)SW-480細(xì)胞CyclinD1表達(dá)的影響，端粒重復(fù)序列擴(kuò)增法（telomeric repeat amplification protocol，TRAP）銀染法觀察AGE對(duì)SW-480細(xì)胞端粒酶活性的影響。MTT測細(xì)胞活力的檢測設(shè)置空白對(duì)照組、100 μg/mL小牛血清白蛋白（bovine serum albumin，BSA）組及50、100、500 μg/mL AGE組，其余檢測只設(shè)置100 μg/mL BSA組和100 μg/mL AGE組。 結(jié)果 MTT結(jié)果示AGE促進(jìn)SW-480細(xì)胞的增殖，且呈濃度依賴性。100 μg/mL BSA組與100 μg/mL AGE組72 h后的細(xì)胞G0/G1期所占百分比分別為56.02%±0.58%、51.93%±1.01%，差異有統(tǒng)計(jì)學(xué)意義（Plt;0.05）。蛋白質(zhì)印跡法示100 μg/mL AGE組72 h后CyclinD1的表達(dá)較100 μg/mL BSA組增加，差異有統(tǒng)計(jì)學(xué)意義（Plt;0.05）。TRAP銀染法檢測示100 μg/mL AGE干預(yù)SW-480細(xì)胞72 h后可以增加端粒酶活性（Plt;0.05）?！〗Y(jié)論 AGE可促進(jìn)人結(jié)腸癌細(xì)胞SW-480生長，呈劑量依賴性。其作用機(jī)制可能與AGE上調(diào)CyclinD1的表達(dá)加速G1/S期轉(zhuǎn)換及增加端粒酶活性有關(guān)?！続bstract】 Objective To observe the effects of advanced glycosylation end products (AGE) on proliferation of SW-480 cells and study the possible mechanism. Methods Various concentrations of AGE were designed to have impact on SW-480 cells. Proliferation of SW-480 cells was assessed by thiazolyl blue tetrazolium bromide (MTT) assay; The impact of AGE on the cell cycle of SW-480 cells was analyzed by flow cytometry (FCM); the influence of AGE on expression of CyclinD1 was checked by Western blotting; and the impact of AGE on telomerase activity was examined by telomeric repeat amplification proctol (TRAP) sliver staining. For the MTT assay, blank control group, 100 μg/mL bovine serum albumin (BSA) group, 50, 100 and 500 μg/mL AGE groups were designed, while for other examinations, there were only 100 μg/mL BSA group and 100 μg/mL AGE group. Results MTT result showed that AGE increased the proliferation of SW-480 cells in a dose-dependent mode. The proportion of the cells at G0/G1 stage of the 100 μg/mL BSA group and the 100 μg/mL AGE experimental group were (56.02±0.58)% and (51.93±1.01)% respectively after 72 hours, with a significant difference (Plt;0.05); western blotting showed that the expression of CyclinD1 in the 100 μg/mL AGE group was significantly higher than that in the 100 μg/mL BSA group after 72 hours; TRAP silver staining demonstrated that telomerase activity increased significantly after treated with 100 μg/mL AGE for 72 hours. Conclusions AGE can promote the growth of SW-480 cells in a dose-dependent mode. Its mechanism is mainly by up-regulating the expression of CyclinD1 to shorten G0/G1 and increasing the telomerase activity significantly.
假肢是幫助截肢患者獲得或部分獲得健全人肢體功能的重要工具。與傳統(tǒng)的僅具裝飾性功能和僅有前饋控制通路的假肢相比，假肢的感知反饋功能是其正常工作和實(shí)現(xiàn)自身安全的重要保障，包括位置、力、紋理、粗糙度、溫度等環(huán)境信息及假肢自身信息感知能力。本文從感知信號(hào)識(shí)別方式和感知反饋方式兩個(gè)方面總結(jié)了近年來國內(nèi)外假肢在感知及反饋技術(shù)領(lǐng)域的發(fā)展和現(xiàn)狀。其中，在感知信號(hào)識(shí)別方式上，主要概況了當(dāng)前常用的與感知信息采集相關(guān)的傳感器及其在假肢中的應(yīng)用現(xiàn)狀。同時(shí)從力反饋刺激、侵入式與非侵入式電刺激、震動(dòng)刺激等方面對(duì)感知反饋方式進(jìn)行總結(jié)和分析。最后，提出假肢在感知及反饋技術(shù)方面目前仍存在的一些問題，并對(duì)其發(fā)展趨勢進(jìn)行展望。
基于運(yùn)動(dòng)想象腦電（EEG）的腦-機(jī)接口系統(tǒng)能夠?yàn)橛脩籼峁└鼮樽匀?、靈活的控制方式，已廣泛應(yīng)用到人機(jī)交互領(lǐng)域。然而，由于目前運(yùn)動(dòng)想象腦電的信噪比及空間分辨率較低，導(dǎo)致信號(hào)解碼正確率較低。針對(duì)這一問題，本文提出一種基于時(shí)空特征學(xué)習(xí)卷積神經(jīng)網(wǎng)絡(luò)（TSCNN）的運(yùn)動(dòng)想象腦電解碼方法。首先，針對(duì)經(jīng)過帶通濾波預(yù)處理的腦電信號(hào)，依次設(shè)計(jì)時(shí)間和空間維度上的卷積層，構(gòu)造出運(yùn)動(dòng)想象腦電的時(shí)空特征；然后，利用 2 層二維卷積結(jié)構(gòu)對(duì)腦電的時(shí)空特征進(jìn)行抽象學(xué)習(xí)；最后，通過全連接層和 Softmax 層對(duì) TSCNN 學(xué)習(xí)的抽象特征進(jìn)行解碼。利用公開數(shù)據(jù)集對(duì)該方法進(jìn)行實(shí)驗(yàn)測試，結(jié)果表明，所提方法的平均解碼精度達(dá)到 80.09%，分別比經(jīng)典的解碼方法共空間模式（CSP） + 支持向量機(jī)（SVM）和濾波器組 CSP（FBCSP） + SVM 提高了 13.75% 和 10.99%，顯著提升了運(yùn)動(dòng)想象腦電解碼的可靠性。
目的 評(píng)價(jià)近五年我國發(fā)表的臨床實(shí)踐指南（以下簡稱“指南”）的臨床適用性，為更好地制訂和實(shí)施指南提供建議。方法 采用橫斷面研究的方法，計(jì)算機(jī)檢索CNKI數(shù)據(jù)庫近5年（2015年1月—2020年12月）由中華醫(yī)學(xué)會(huì)、中國醫(yī)師協(xié)會(huì)發(fā)布的指南，按發(fā)表年份隨機(jī)抽取61部。每部指南均由來自東、中、西部醫(yī)療機(jī)構(gòu)的醫(yī)務(wù)人員采用指南臨床適用性評(píng)價(jià)工具（2.0版）共同評(píng)價(jià)。針對(duì)定量資料，采用均數(shù)、標(biāo)準(zhǔn)差或中位數(shù)、四分位數(shù)描述；針對(duì)定性資料，采用頻數(shù)、構(gòu)成比描述。結(jié)果 回收有效問卷6 904份，涵蓋26省醫(yī)療機(jī)構(gòu)119家?？色@得性標(biāo)準(zhǔn)化得分范圍54.4%～72.7%（中位數(shù)64.3%），可讀性標(biāo)準(zhǔn)化得分范圍66.1%～83.3%（中位數(shù)74.9%），可接受性標(biāo)準(zhǔn)化得分范圍53.7%~94.7%（中位數(shù)86.0%），可行性標(biāo)準(zhǔn)化得分范圍61.4%～81.0%（中位數(shù)72.5%）。4.3%的醫(yī)務(wù)人員認(rèn)為所在醫(yī)療機(jī)構(gòu)存在指南實(shí)施障礙，包括環(huán)境因素（32.1%）、醫(yī)務(wù)人員因素（26.5%）、指南因素（22.5%）和患者/家屬因素（18.9%）。結(jié)論 我國近五年發(fā)表的指南整體臨床適用性較好，但建議提高指南的可獲得性，開展針對(duì)醫(yī)務(wù)人員與患者的指南宣教培訓(xùn)，提供指南推廣實(shí)施的配套工具和設(shè)施，以提升指南臨床適用性。