虚拟支气管镜技术在临床技能培训中的作用

目的:多个指标评价观察虚拟支气管镜模拟技术在临床医师技能培训中发挥的作用.对象:初次接触支气管镜的呼吸科医生及纤维支气管镜相关科室医生(硕士以上学历,均已获取医师资格证).方法:随机选择36名临床医生,在培训前、培训2小时和培训5小时后对其进行虚拟支气管镜的理论与操作考核.采用训练前、训练后自身对照研究.结果:36名医师均完成了虚拟支气管镜的操作培训.培训结束后,受训者在操作用时(秒)、碰壁次数(次)、吸引器使用时间(秒)、出现红视时间(秒)、观察到的亚段支气管树比例等多个评价指标考核结果显示中与训练前考核结果显示比较,差异性显著.结论:初次接触支气管镜的呼吸科医生及纤维支气管镜相关科室医生经过培训后,无论在操作的准确性、灵活性,还是速度方面都比训练前有显著提高,并能独立完成临床检查操作.     

生理驱动高仿真模拟技术在心肺复苏培训中的应用

目的:探讨生理驱动高仿真模拟技术对于提高医护人员心肺复苏能力的效果及必要性.方法:对126名新入院医护人员进行基本急救知识摸底测试,然后使用简单急救技能操作模拟器和生理驱动高仿真模拟人,应用"简短理论讲授+分项技术练习+综合模拟演练+录像回放分析"方法进行急救技能培训,分析培训效果,总结反馈意见.结果:培训前心肺复苏理论成绩45.81±5.23,心肺复苏操作技能及格率仅为11.36%.经短期培训后,再次以同等难度试卷测试,平均理论成绩为92.85±6.25,心肺复苏操作测试合格率为100.0%,与培训前平均成绩比较有显著的提高(P<0.01);对接受培训者的反馈意见进行分析,认为有必要加强急救培训者占95.2%;认为高仿真模拟急救培训对今后医疗工作中处理紧急突发事件或急危重病人有重要帮助者占98.4%.结论:生理驱动高仿真模拟培训对提高急救意识和实际应急能力有重要帮助作用,有必要对医护人员定期进行急救知识和技能培训.     

ECS结合情景模拟教学在社区医师急救技能培训中的应用效果分析

目的:探讨应用急救模拟人(Emergency Care Simulator,ECS)结合情景模拟教学法对社区医师进行急救技能培训的效果。方法:应用ECS结合情景模拟对27名社区医师按照2010年美国心肺复苏指南标准进行急救技能培训,急救技能内容包括心肺复苏,气管插管和4项技术(止血、包扎、固定、转运),比较培训前后成绩的区别;调查社区医师对ECS结合情景模拟教学法的认可程度。结果:社区医师胸外按压培训前后的成绩分别为59.61±12.35和81.42±13.26(P<0.05),气管插管的成绩分别为64.18±15.21和85.49±18.17(P<0.05),4项技术的成绩分别为62.15±12.28和89.32±15.34(P<0.05);96.2%认为该教学方法可以提高学习兴趣和团队合作精神。结论:应用ECS结合情景教学对社区医师进行培训可以提高急救技能,有利于培养团队精神和临床思维能力。     

纤维支气管镜吸痰对全肺切除术后心衰治疗效果的观察

目的:探讨规律纤维支气管镜吸痰对全肺切除术后心衰的治疗效果。方法:选取唐都医院胸外科于2012年1月至2014年1月行开胸全肺切除术,且术后并发心衰的患者184例进行前瞻性随机对照研究,将所选患者分为研究组(96例)和对照组(88例),前者除常规心衰治疗外,每天至少1次使用纤维支气管镜吸痰,必要时可根据痰量增加吸痰次数;后者仅采用利尿、强心、扩血管等常规疗法,比较两组患者的心指数、呼吸频率、动脉血气分析等指标,同时测定和比较两组患者治疗后72 h的血浆脑钠肽浓度。结果:治疗后1 h,对照组患者的心指数由(2.7±0.2)L/min·m2升高至(3.1±0.3)L/min·m2,呼吸频率由(35.4±2.9)次/分降至(21.3±2.5)次/分,Pa O2由(57.4±3.9)mm Hg升至(60.3±3.4)mm Hg,Sa O2由(83.5±7.1)%升至(86.3±3.7)%;研究组患者的心指数由(2.8±0.1)L/min·m2升高至(3.5±0.2)L/min·m2,呼吸频率由(34.2±3.1)次/分降至(19.2±2.2)次/分,Pa O2由(56.5±4.8)mm Hg升至(66.2±7.1)mm Hg,Sa O2由(84.5±6.5)%升至(91.6±3.5)%,差异具有统计学意义(P0.05),研究组患者治疗后的以上指标水平均明显优于对照组(P0.05)。治疗后24 h内,79.2%的研究组患者咳嗽、咳痰及肺部湿罗音基本缓解,对照组患者以上症状、体征的缓解率为47.7%,差异具有统计学意义(P0.05)。治疗后72 h,研究组患者的血浆脑钠肽浓度显著低于对照组患者(576.3±77.6 vs894.6±86.5,P0.01)。结论:支气管镜吸痰有助于改善全肺切除术后心衰患者的心肺功能。     

标准化病人结合情景模拟教学在超声规范化医师培训中的应用

目的 探讨超声住院医师规范化实践培训中引入标准化病人(SP)结合情景模拟教学的应用价值. 方法 选择2018年1月～2021年12月我院超声专业住培医师60名,随机分为实验组和对照组各30名,实验组采用SP结合情景模拟教学,对照组采用传统情景模拟教学.比较两组住培医师的教学效果(包括上机实践操作、临床思维能力、医患沟通...     

溪红点鲑的特殊动力作用

在水温(14.5±0.5)℃条件下,测定了平均体重(26.5±2.0)g(n=260)溪红点鲑(Salvelinus fontinalus)饱食和空腹状态下的耗氧率及排氨率.实验组共测定了260尾个体,空腹状态下标准耗氧率和标准排氨率分别为(175.00±8.49)mg/kg·h及(2.91±0.40)mg/kg·h;饱食后耗氧率和排氨率变化趋势均呈现迅速上升,到达最大值后再缓慢下降,然后恢复到初始水平,最大值分别为(375.93±9.73)mg/kg·h和(16.01±0.37)mg/kg·h,最大值出现时间分别为饱食后(6.0±0.3)h和(7.0±0.5)h,饱食后耗氧率和排氨率发生改变的持续时间分别为(23.0±1.5)h及(23.0±2.0)h,耗氧总增量和排氨总增量分别为(2641±137)mg及(164±10)mg.结果显示,溪红点鲑饱食排氨率的变化过程与其饱食耗氧率的特殊动力作用(SDA)具有类似的特征,表明二者在能量代谢机制上相互关联,溪红点鲑的SDA总耗能的18.8%±1.2%由蛋白质分解代谢所提供.     

杜衡的组织培养

1植物名称杜衡(Asarum foresii). 2材料类别幼嫩顶芽或侧芽. 3培养条件基本培养基为MS.(1)芽增殖培养基:MS 6-BA 5.0 mg.L-1(单位下同) NAA 0.1 GA35.0;(2)壮苗培养基:MS 6-BA 2.0 NAA0.1;(3)生根培养基:1/2 MS NAA 0.5.以上培养基中蔗糖浓度(1)和(2)为3.0％,(3)为2.0％;琼脂7.0g.L-1,pH 5.4～5.6.培养温度为(25±2)℃,连续光照12h·d-1,光照度2000lx.     

模拟失重降低大鼠心肌细胞对异丙肾上腺素的反应性

本文旨在研究模拟失重对大鼠单个心肌细胞无负荷收缩功能的影响以及对异丙肾上腺素(isoproterenol,ISO)反应性的变化.采用人鼠尾部悬吊法在地面模拟失重状态,4周后以胶原酶I消化分离心肌细胞,分别对左、右两心室心肌细胞进行收缩功能测量.结果显示,悬吊4周大鼠(悬吊组)左,右心室心肌细胞的长度和宽度与正常大鼠(对照组)相比均无显著差异.随刺激频率增加,对照组与悬吊组大鼠心肌细胞缩短幅值均逐步增加.在1.0、2.0与4.0 Hz刺激下,对照组大鼠左心室心肌细胞缩短幅值分别为(8.50±1.26)%、(9.00±1.38)%与(9.23±1.83)%,右心室心肌细胞缩短幅值分别为(9.80±2.48)%、(10.03±2.48)%与(10.28±2.27)%;与对照组大鼠相比,在1.0与2.0Hz刺激下,悬吊组大鼠左心室心肌细胞无负荷缩短幅值分别降低12.2%、10.9%(P《0.05),右心室则分别降低16.5%、16.3%(P《0.05);但是在4.0 Hz刺激下却无显著性改变.与同一频率刺激下的对照组大鼠相比,悬吊组大鼠左、右心室心肌细胞达到缩短峰值的时程(time to peak shortening,TPS)明显缩短(P《0.05);而从缩短峰值至75%舒张的时程(TR75)则明显延长(P《0.05).在各刺激频率下,悬吊组大鼠左、右心室心肌细胞缩短(+dL/dtmax)与舒张(-dL/dtmax)速度均未发生明显改变.用1、5、10 nmol/L ISO灌流达稳态水平后,对照组大鼠心肌细胞缩短幅值分别增加了(10.63±0.83)%、(35.06±5.22)%和(71.64±6.83)%;而悬吊组大鼠心肌细胞缩短幅值仅增加(5.75±0.76)%、(23.97±4.50)%和(26.38±8.13)%,均有显著性差异(P《0.05,P《0.01).用10、50、100 nmol/L forskolin 灌流达稳定水平后,对照组大鼠心肌细胞缩短幅值分别增加了(3.04±0.27)%、(9.81±2.66)%、(20.20±3.47)%;而悬吊组大鼠心肌细胞缩短幅值仅增加了(1.42±0.53)%、(3.83±1.71)%、(5.49±4.08)%,均有显著性差异(P《0.05).以上结果表明,模拟失重4周降低人鼠心肌细胞无负荷缩短幅值以及对ISO的反应性.     

硫柳汞SD 大鼠单次静脉注射药代动力学研究

目的:研究硫柳汞在SD大鼠静脉注射后的药代动力学特征。方法:SD大鼠单剂量(高、低2个剂量组)静脉注射硫柳汞,以冷原子吸收测汞法测定不同时间点的血药浓度,用DAS2.0软件获取各剂量组的主要药代动力学参数。结果:硫柳汞在高(30mg/kg)和低剂量(15 mg/kg)的消除半衰期t1/2z分别为171.61±0.33h,,156.54±18.61h;AUC0-144h分别为16748.65±7296.61mg/L*h,9131.94±1406.68 mg/L*h。结论:硫柳汞在大鼠体内的代谢过程呈线性动力学特征,半衰期约在130～170h左右。     

头孢氨苄胶囊制剂人体生物等效性研究

目的:研究新仿制的头孢羟氨苄胶囊制剂与市场在售的同类制剂在健康人体内的生物等效性。方法:采用随机交叉试验设计,20名健康男性志愿者分别口服受试制剂与参比制剂500 mg,HPLC法测定血浆中头孢氨苄的浓度,用DAS 2.0软件计算药动学参数并进行生物等效性评价。结果:受试制剂和参比制剂两药的主要药代动力学参数,Cmax分别为(18.12±3.17)μg/ml和(21.28±3.77)μg/ml,Tmax分别为(1.09±0.37)h和(1.04±0.33)h,t1/2分别为(1.15±0.22)h和(1.14±0.20)h,AUC0-t分别为(35.43±5.39)μg h/ml和(37.27±4.76)μg h/ml,AUC0-∞分别为(36.68±6.06)μg h/ml和(38.62±5.48)μg h/ml,受试制剂的平均相对生物利用度为(96.50±7.2)%。结论:受试制剂和参比制剂具有良好的生物等效性。     

Short-term exercise training augments sympathetic vasoconstrictor responsiveness and endothelium-dependent vasodilation in resting skeletal muscle

We tested the hypotheses that 4 wk of exercise training would diminish the magnitude of vasoconstriction in response to sympathetic nerve stimulation and augment endothelium-dependent vasodilation (EDD) in resting skeletal muscle in a training intensity-dependent manner. Sprague-Dawley rats were randomly assigned to sedentary time-control (S), mild- (M; 20 m/min, 5% grade), or heavy-intensity (H; 40 m/min, 5% grade) treadmill exercise groups. Animals trained 5 days/wk for 4 wk with training volume matched between groups. Rats were anesthetized and instrumented for study 24 h after the last training session. Arterial pressure and femoral artery blood flow were measured, and femoral vascular conductance (FVC) was calculated. Lumbar sympathetic chain stimulation was delivered continuously at 2 Hz and in patterns at 20 and 40 Hz. EDD was assessed by the vascular response to intra-arterial bolus injections of ACh. The response (% change FVC) to sympathetic stimulation increased (P < 0.05) in a training intensity-dependent manner at 2 Hz (S: -20.2 ± 9.8%, M: -34.0 ± 6.7%, and H: -44.9 ± 2.0%), 20 Hz (S: -22.0 ± 10.6%, M: -31.2 ± 8.4%, and H: -42.8 ± 5.9%), and 40 Hz (S: H -24.5 ± 8.5%, M: -35.1 ± 8.9%, H: -44.9 ± 6.5%). The magnitude of EDD also increased in a training intensity-dependent manner (P < 0.05). These data demonstrate that short-term exercise training augments the magnitude of vasoconstriction in response to sympathetic stimulation and EDD in resting skeletal muscle in a training intensity-dependent manner.     

ECS结合情景模拟教学在社区医师急救技能培训中的应用效果分析

目的：探讨应用急救模拟人（Emergency Care Simulator,ECS）结合情景模拟教学法对社区医师进行急救技能培训的效果。方法：应用ECS结合情景模拟对27名社区医师按照2010年美国心肺复苏指南标准进行急救技能培训,急救技能内容包括心肺复苏,气管插管和4项技术（止血、包扎、固定、转运）,比较培训前后成绩的区别;调查社区医师对ECS结合情景模拟教学法的认可程度。结果：社区医师胸外按压培训前后的成绩分别为59．61±12．35和81．42±13．26（P〈0．05）,气管插管的成绩分别为64．18±15．21和85．49±18．17（P〈0．05）,4项技术的成绩分别为62．15±12．28和89．32±15．34（P〈0．05）;96．2％认为该教学方法可以提高学习兴趣和团队合作精神。结论：应用ECS结合情景教学对社区医师进行培训可以提高急救技能,有利于培养团队精神和临床思维能力。     

Flexible Bronchoscopy with Multiple Modalities for Foreign Body Removal in Adults

Objectives

Aspiration of the lower airways due to foreign body is rare in adults. This study aimed to determine the outcome of patients who received flexible bronchoscopy with different modalities for foreign body removal in the lower airways.

Patients and Methods

Between January 2003 and January 2014, 94 patients diagnosed with foreign body in the lower airways underwent flexible bronchoscopy with different modalities, which included forceps, loop, basket, knife, electromagnet, and cryotherapy. The clinical presentation, foreign body location and characteristics, and applications of flexible bronchoscopy were analyzed.

Results

Forty (43%) patients had acute aspiration, which developed within one week of foreign body entry and 54 (57%) had chronic aspiration. The most common foreign bodies were teeth or bone. More patients with chronic aspiration than those with acute aspiration were referred from the out-patient clinic (48% vs. 28%), but more patients with acute aspiration were referred from the emergency room (35% vs. 6%) and intensive care unit (18% vs. 2%). Flexible bronchoscopy with different modalities was used to remove the foreign bodies (85/94, 90%). Electromagnet or cryotherapy was used in nine patients to eliminate the surrounding granulation tissue before foreign body removal. In the nine patients with failed flexible bronchoscopy, eight underwent rigid bronchoscopy instead and one had right lower lung lobectomy for lung abscess.

Conclusions

Flexible bronchoscopy with multiple modalities is effective for diagnosing and removing foreign bodies in the lower respiratory airways in adults, with a high success rate (90%) and no difference between acute and chronic aspirations.     

The effect of 40-m repeated sprint training on maximum sprinting speed, repeated sprint speed endurance, vertical jump, and aerobic capacity in young elite male soccer players

The purpose of this study was to examine the effect of 10 weeks' 40-m repeated sprint training program that does not involve strength training on sprinting speed and repeated sprint speed on young elite soccer players. Twenty young well-trained elite male soccer players of age (±SD) 16.4 (±0.9) years, body mass 67.2 (±9.1) kg, and stature 176.3 (±7.4) cm volunteered to participate in this study. All participants were tested on 40-m running speed, 10 × 40-m repeated sprint speed, 20-m acceleration speed, 20-m top speed, countermovement jump (CMJ), and aerobic endurance (beep test). Participants were divided into training group (TG) (n = 10) and control group (CG) (n = 10). The study was conducted in the precompetition phase of the training program for the participants and ended 13 weeks before the start of the season; the duration of the precompetition period was 26 weeks. The TG followed a Periodized repeated sprint training program once a week. The training program consisted of running 40 m with different intensities and duration from week to week. Within-group results indicate that TG had a statistically marked improvement in their performance from pre to posttest in 40-m maximum sprint (-0.06 seconds), 10 × 40-m repeated sprint speed (-0.12 seconds), 20- to 40-m top speed (-0.05 seconds), and CMJ (2.7 cm). The CG showed only a statistically notable improvement from pre to posttest in 10 × 40-m repeated sprint speed (-0.06 seconds). Between-group differences showed a statistically marked improvement for the TG over the CG in 10 × 40-m repeated sprint speed (-0.07 seconds) and 20- to 40-m top speed (-0.05 seconds), but the effect of the improvement was moderate. The results further indicate that a weekly training with repeated sprint gave a moderate but not statistically marked improvement in 40-m sprinting, CMJ, and beep test. The results of this study indicate that the repeated sprint program had a positive effect on several of the parameters tested. However, because the sample size in this study is 20 participants, the results are valid only for those who took part in this study. Therefore, we advice to use repeated sprint training similar to the one in this study only in periods where the players have no speed training included in their program. Furthermore, the participants in this study should probably trained strength, however, benefits were observed even without strength training is most likely to be caused by the training specificity.     

The influence of strength, flexibility, and simultaneous training on flexibility and strength gains

The purpose of this study was to examine the strength and flexibility gains after isolated or simultaneous strength and flexibility training after 16 weeks. Eighty sedentary women were randomly assigned to 1 of 4 groups: strength training (ST; n = 20), flexibility training (FLEX) (n = 20), combination of both (ST + FLEX; n = 20) and control group (CG; n = 20). All the groups performed pre and posttraining sit and reach test to verify the flexibility level and 10RM test for leg press and bench press exercises. The training protocol for all groups, except for the CG, included 3 weekly sessions, in alternated days, totaling 48 sessions. Strength training was composed of 8 exercises for upper and lower body, executed in 3 sets of periodized training. The flexibility training was composed of static stretching exercises that involved upper and lower body. Results showed that ST (30 ± 2.0 to 36 ± 3.0 cm), ST + FLEX (31 ± 1.0 to 42 ± 4.0 cm), and FLEX (32 ± 3.0 to 43 ± 2.0 cm) significantly increased in flexibility in relation to baseline and to CG (30 ± 2.0 to 30 ± 2.0 cm); however, no significant differences were observed between the treatment conditions. Strength tests demonstrated that ST and ST + FLEX significantly increased 10RM when compared to baseline, FLEX, and the CG. In conclusion, short-term strength training increases flexibility and strength in sedentary adult women. Strength training may contribute to the development and maintenance of flexibility even without the inclusion of additional stretching, but strength and flexibility can be prescribed together to get optimal improvements in flexibility.     

联合用药靶控静脉麻醉在纤维支气管镜检查术中的麻醉效果分析

目的：分析纤维支气管镜检查术中丙泊酚联合右美托咪啶靶控静脉麻醉的效果,为临床麻醉提供参考。方法：选取73例行纤维支气管镜检查术的患者作为研究对象,按麻醉方式不同分为观察组38例（采用右美托咪啶联合丙泊酚麻醉）和对照组35例（单用丙泊酚麻醉）。观察分析各时点心率、呼吸次数、平均动脉压、血氧饱和度、镇静效果评分、苏醒时间以及不良反应发生率等指标。结果：Ramsay评分：对照组6分的例数为22例（62．9％）,观察组为32（84．2％）,差异有统计学意义;丙泊酚总用量：观察组为（334．5±54．6）mg,对照组为（463．2±60．5）mg,差异有统计学意义,医生满意度：观察组为92．1％,对照组为74.3％,差异有统计学意义。结论：丙泊酚联合右美托咪啶靶控静脉麻醉安全有效,效果显著,适合纤维支气管镜检查术。     

Effects of exercise training on airway closure in asthmatics

We previously reported that responsiveness to methacholine (Mch) in the absence of deep inspiration (DI) decreased in healthy subjects after a short course of exercise training. We assessed whether a similar beneficial effect of exercise on airway responsiveness could occur in asthmatics. Nine patients (male/female: 3/6; mean age ± SD: 24 ± 2 yr) with mild untreated asthma [forced expiratory volume in 1 s (FEV(1)): 100 ± 7.4% pred; FEV(1)/vital capacity (VC): 90 ± 6.5%] underwent a series of single-dose Mch bronchoprovocations in the absence of DI in the course of a 10-wk training rowing program (6 h/wk of submaximal and maximal exercise), at baseline (week 0), and at week 5 and 10. The single-dose Mch was established as the dose able to induce ≥15% reduction in inspiratory vital capacity (IVC) and was administered to each subject at every challenge occasion. Five asthmatics (male/female: 1/4; mean age ± SD: 26 ± 3 yr) with similar baseline lung function (FEV(1): 102 ± 7.0% predicted; FEV(1)/VC: 83 ± 6.0%; P = 0.57 and P = 0.06, respectively) not participating in the exercise training program served as controls. In the trained group, the Mch-induced reduction in IVC from baseline was 22 ± 10% at week 0, 13 ± 11% at week 5 (P = 0.03), and 11 ± 8% at week 10 (P = 0.028). The Mch-induced reduction in FEV(1) did not change with exercise (P = 0.69). The reduction in responsiveness induced by exercise was of the same magnitude of that previously obtained in healthy subjects (50% with respect to pretraining). Conversely, Mch-induced reduction in IVC in controls remained unchanged after 10 wk (%reduction IVC at baseline: 21 ± 20%; after 10 wk: 29 ± 14%; P = 0.28). This study indicates that a short course of physical training is capable of reducing airway responsiveness in mild asthmatics.     

The effectiveness of traditional and sling exercise strength training in women

Strength training often combines closed-kinetic-chain exercises (CKCEs) and open kinetic-chain exercises (OKCEs). The CKCE may be more effective for improving performance in lower-body training. Recently, we reported upper-body CKCE (using a commercially available system of ropes and slings, Redcord AS, Staubo, Norway) was as effective as OKCE training for strength gains and that CKCE was more effective than OKCE for improving throwing performance. To our knowledge the effectiveness of a strength training program that uses exclusively CKCE is unknown. In this study, we examined the effectiveness of CKCE vs. OKCE strength training programs in women enrolled in an introductory strength training program. Twenty-six participants were randomized to OKCE (traditional exercises) or CKCE (sling-based exercises). Participants completed 6 sets per week for 13 weeks. Pre and posttraining evaluations included the following: 1 repetition maximum (1RM) leg and bench press; sling exercise push-ups; isokinetic dynamometry; lateral step-down test; and the Star Excursion Balance Test. Both groups significantly improved bench press (by an average of 4-6 kg) and leg press (by an average of 23-35 kg) (p < 0.001). There was a significant group × time interaction (p < 0.001) for sling exercise push-ups (OKCE pre = 5.5 ± 8.6, OKCE post = 6.1 ± 8.2, CKCE pre = 6.8 ± 6.0, CKCE post = 16.9 ± 6.6). Isokinetic measures of knee extension, knee flexion, shoulder internal rotation, and shoulder external rotation increased (improvements ranged from 2.7 to 27.7%), with no group differences. Both OKCE and CKCE strength training elicited similar changes in balance. We conclude that CKCE training is equally as effective as OKCE training during the initial phases of a strength training program in women. The fact that only CKCE improved sling exercise push-ups supports previous findings suggesting functional superiority of CKCE.