无创血流动力学监测指导严重脓毒症患者血管活性药物的应用

目的:探讨无创血流动力学监测技术在严重脓毒症患者液体复苏后指导血管活性药物使用的意义。方法:选择2014年6月至2016年6月我院急诊处收治的严重脓毒症患者56例为研究对象,分为观察组和对照组,每组各28例。对照组进行常规对症治疗,观察组在对照组治疗基础上使用无创血流动力学监测仪指导治疗。观察两组患者在治疗前及治疗后6 h血流动力学及微循环灌注指标、液体复苏6 h后液体平衡量及血管活性药物使用量,及在重症监护病房(EICU)的入住时间。结果:治疗后两组患者尿量均大于30 m L/h,提示复苏成功。两组患者治疗后血液动力学指标和微循环灌注指标较治疗前均明显好转(均P0.05);治疗后,两组间血液动力学指标和微循环灌注指标比较无明显差异(P0.05)。观察组液体复苏6 h后液体平衡量明显少于对照组(P0.05),观察组血管活性药物用量均明显高于对照组(P0.05),观察组患者在EICU病房住院时间明显短于对照组(P0.05)。结论:无创血流动力学监测对严重脓毒症患者的液体恢复管理和治疗过程具有指导意义,使血管活性药物得到有效利用,精确进行液体管理,减少盲目补液,缩短病程,减少患者的住院时间,经济高效,是指导治疗和评估治疗疗效的重要手段。     

近红外光谱技术在神经外科患者脑氧和血流动力学监测中的应用研究进展

神经外科患者,尤其是脑血流自动调节功能受损的重症患者,脑氧饱和度是反应患者脑组织氧代谢情况的重要指标,实时、准确的脑氧饱和度监测方法对于指导选择有效的治疗措施和判断患者预后具有重要价值。基于血红蛋白不同氧合状态,即氧合血红蛋白(oxyhemoglobin,Hb O2),还原血红蛋白(deoxygenated hemoglobin,Hb)具有的差异性分子光谱,近红外光谱技术near infrared spectroscopy,NIRS)可监测人体局部组织氧饱和度。由于近红外射线能穿透颅骨直接获得脑组织内平均氧饱和度的特性,可协助临床实现无创持续监测脑氧饱和度的目的,近年来该技术在神经外科领域的应用研究获得了迅速发展,在颅脑创伤和其它神经外科疾病的应用研究中均取得了显著的进展,本文将对最新研究结果及其意义和未来发展方向进行综述。     

CT全肝灌注的临床应用及进展

随着影像技术的发展和后处理功能的完善,肝灌注成像以研究组织、器官血流动力学变化已成为影像界关注的热点,然而CT灌注成像在肝脏等实质性器官中的应用尚处于探索阶段。肝脏具有双重血供,在各种病理生理情况下,肝脏动静脉之间及门静脉之间的血流动力学发生着复杂的变化。CT被认为是诊断肝脏病变最有价值的影像学方法,CT灌注成像能反映组织器官微循环内的血流动力学变化,是一种快速、准确、无创的功能成像方法。肝脏灌注CT检查可以同时获得形态和功能两方面的信息,使我们有可能早于形态学变化之前发现肝脏病变,有助于肝脏疾病的早期诊断和治疗,并能评价各种治疗手段对肝脏血流动力学变化的影响。本文针对全肝灌注CT扫描在临床的应用进行综述。     

有创-无创序贯机械通气对急性心源性肺水肿患者低氧血症和血流动力学的影响

目的:探讨有创-无创序贯机械通气对急性心源性肺水肿患者低氧血症及血流动力学的影响。方法:按照随机数字表法将2013年3月至2015年3月我院收治的49例急性心源性肺水肿患者分为两组,对照组行常规抗心衰治疗联合有创机械通气,观察组接受对照组治疗方案后,再给予无创鼻面罩双水平气道正压通气。比较两组患者治疗前后的动脉血气分析指标及血流动力学指标,以及有创机械通气时间、机械通气总时间、呼吸机相关肺炎(VAP)发生率、再发心衰率及死亡例数。结果:两组患者治疗过程中未出现死亡病例,治疗后,两组患者动脉血气分析指标、血流动力学指标较治疗前不同程度的改善,差异有统计学意义(P0.05),两组患者治疗后的动脉血气分析指标、血流动力学指标比较,差异无统计学意义(P0.05)。观察组患者有创通气时间、通气总时间少于对照组,VAP发生率低于对照组,差异有统计学意义(P0.05),两组患者再发心衰率差异无统计学意义(P0.05)。结论:有创-无创序贯机械通气能有效改善急性心源性肺水肿患者的低氧血症和血流动力学指标,安全有效,作为抢救急性心源性肺水肿的措施具有重要临床价值。     

超声在糖尿病肾病诊断中的应用价值

由于快速变化的生活方式,我国糖尿病的患病率呈逐年上升趋势。糖尿病肾病(diabetic nephropathy,DN)是糖尿病最常见、最严重的微血管病变并发症之一,并且已经成为全球终末期肾病的最常见病因。因此,早期诊断、早期治疗是延缓DN进展的重点。超声是临床评价肾脏形态、功能常用的检查方法,与血、尿实验室检查相比,具有方便、快捷、无创、经济的优势。随着科学技术的发展,越来越多的超声新技术应用于临床,极大的丰富了诊断信息。本文就各项超声检查技术在检测DN患者肾脏体积、实质回声、血流动力学改变中的应用价值作一综述。得出结论:在DN早期血、尿实验室检查正常时超声已经可以发现肾脏体积、血流动力学发生了变化。因此,超声在DN的早期诊断、动态监测病程进展方面所发挥的作用是其他检查方法所不可替代的。三维超声技术和超声弹性成像在DN患者肾脏功能评价方面有着广泛研究空间及临床应用前景。     

KF-3000脑循环分析仪

KF-3000脑循环分析仪是上海匡复医疗设备发展有限公司和复旦大学联合研究基础上开发的新一代的脑循环动力学检测与分析仪器。它通过无创检测颈动脉的血流速度、血液压力、血管管径和人体血压,以及颅内大脑两侧前、中、后动脉及椎动脉的血流速度,运用脑循环动力学模型和专用计算软件来计算分析反映脑循环功能状况的脑血管动力学参数。     

KF-3000脑循环分析仪

KF-3000脑循环分析仪是上海匡复医疗设备发展有限公司和复旦大学联合研究基础上开发的新一代的脑循环动力学检测与分析仪器。它通过无创检测颈动脉的血流速度、血液压力、血管管径和人体血压,以及颅内大脑两侧前、中、后动脉及椎动脉的血流速度,运用脑循环动力学模型和专用计算软件来计算分析反映脑循环功能状况的脑血管动力学参数。     

KF-3000脑循环分析仪

KF-3000脑循环分析仪是上海匡复医疗设备发展有限公司和复旦大学联合研究基础上开发的新一代的脑循环动力学检测与分析仪器。它通过无创检测颈动脉的血流速度、血液压力、血管管径和人体血压,以及颅内大脑两侧前、中、后动脉及椎动脉的血流速度,运用脑循环动力学模型和专用计算软件来计算分析反映脑循环功能状况的脑血管动力学参数。     

USCOM监测仪对心力衰竭患儿血流动力学的监测及其临床意义

目的探讨便携式超声心输出量监测仪(ultrasonic cardiac output monitor,USCOM)在心衰患儿血流动力学变化中的应用及临床价值。方法对我院收治的28例心力衰竭患儿应用USCOM监测仪监测相关血流动力学数据,包括心率(HR)、每搏输出量(SV)、外周血管阻力(SVR)、心肌收缩力指数(INO)等,判断其前负荷、后负荷以及心肌收缩力情况,以指导临床治疗用药。结果通过积极病因判断以及药物治疗后,28例心衰患儿中25例恢复良好,2例放弃治疗,1例死亡,总有效率为89.3%,整体预后良好。结论 USCOM监测仪对患儿心衰原因的判断、液体控制及正性肌力药、利尿剂、血管扩张药的使用具有一定指导作用。     

KF-3000脑循环分析仪

KF-3000脑循环分析仪是上海匡复医疗设备发展有限公司和复旦大学联合研究基础上开发的新一代的脑循环动力学检测与分析仪器。它通过无创检测颈动脉的血流速度、血液压力、血管管径和人体血压,以及颅内大脑两侧前、中、后动脉及椎动脉的血流速度．运用脑循环动力学模型和专用计算软件来计算分析反映脑循环功能状况的脑血管动力学参数。     

Do invasive species show higher phenotypic plasticity than native species and,if so,is it adaptive? A meta‐analysis

Do invasive plant species have greater phenotypic plasticity than non-invasive species? And, if so, how does this affect their fitness relative to native, non-invasive species? What role might this play in plant invasions? To answer these long-standing questions, we conducted a meta-analysis using data from 75 invasive/non-invasive species pairs. Our analysis shows that invasive species demonstrate significantly higher phenotypic plasticity than non-invasive species. To examine the adaptive benefit of this plasticity, we plotted fitness proxies against measures of plasticity in several growth, morphological and physiological traits to test whether greater plasticity is associated with an improvement in estimated fitness. Invasive species were nearly always more plastic in their response to greater resource availability than non-invasives but this plasticity was only sometimes associated with a fitness benefit. Intriguingly, non-invasive species maintained greater fitness homoeostasis when comparing growth between low and average resource availability. Our finding that invasive species are more plastic in a variety of traits but that non-invasive species respond just as well, if not better, when resources are limiting, has interesting implications for predicting responses to global change.     

Catecholamine and Volume Therapy for Cardiac Surgery in Germany – Results from a Postal Survey

Background

Management of cardiac surgery patients is a very standardized procedure in respective local institutions. Yet only very limited evidence exists concerning optimal indication, safety and efficacy of hemodynamic monitoring catecholamine and fluid therapy.

Methods

Between April and May 2013, all 81 German anaesthesia departments involved in cardiac surgery care were asked to participate in a questionnaire addressing the institutional specific current practice in hemodynamic monitoring, catecholamine and volume therapy.

Results

51 (63%) questionnaires were completed and returned. All participating centers used basic hemodynamic monitoring (i.e. invasive arterial blood pressure and central venous pressure), supplemented by transesophageal echocardiography. Pulmonary arterial catheter and calibrated trend monitoring devices were also routinely available. In contrast, non-calibrated trend monitoring and esophageal doppler ultrasound devices were not commonly in use. Cerebral oximetry is increasingly emerging, but lacks clear indications. The majority of patients undergoing cardiac surgery, especially in university hospitals, required catecholamines during perioperative care, In case of low cardiac output syndrome, dobutamine (32%), epinephrine (30%) or phosphodiesterase inhibitors (8%) were first choice. In case of hypotension following vasoplegia, norepinephrine (96%) represented the most common catecholamine. 88% of the participating centers reported regular use of colloid fluids, with hydroxyethyl starches (HES) being first choice (64%).

Conclusions

Choice of hemodynamic monitoring is homogenous throughout German centers treating cardiac surgery patients. Norepinephrine is the first line catecholamine in cases of decrease in peripheral vascular resistance. However, catecholamine choice for low cardiac output syndrome varies considerably. HES was the primary colloid used for fluid resuscitation. After conduct of this survey, HES use was restricted by European regulatory authorities in critically ill patients and should only be considered as second-line fluid in surgical patients without renal impairment or severe coagulopathy. Large clinical studies addressing catecholamine and fluid therapy in cardiac surgery patients are lacking.     

Non-invasive acoustic detection of wolves

Monitoring wolves (Canis lupus) is a difficult and often expensive task due to high mobility, pack dynamic, shyness and nocturnal activity of this species. Wolves communicate acoustically through howling, within pack and with packs of the neighbourhood. A wolf howl is a low-frequency vocalization that can be transmitted over long distances and thus it can be used for monitoring. Elicited howling survey is a current method to monitor wolves in different areas all over the world. Elicited howling, however, may be invasive to residential wolf packs and could create possible negative reactions from the human population. Here we show that it is possible to detect wolves by recording spontaneous howling events. We measured the sound pressure level of wolf howls by captive individuals and we further found that elicited howling may be recorded and clearly identified up to a distance of 3 km. We finally conducted a non-invasive acoustic detection of wolves in a free-ranging population. The use of passive sound recorders may provide a powerful non-invasive tool for future wolf monitoring and could help to establish sustainable management plans for this species.     

侵袭性和非侵袭性肺炎链球菌耐药率的比较分析

目的研究侵袭性和非侵袭性肺炎链球菌的耐药谱的差异,指导合理应用抗生素及感染管理。方法回顾性统计分析2009至2011年来天台县人民医院就诊患者分离肺炎链球菌的标本来源及耐药性,比较侵袭性和非侵袭性肺炎链球菌耐药率之间的差异。结果共分离出肺炎链球菌642株,痰液中分离出584株,非痰液中分离出58株,其中血液中分离出32株,脑脊液中分离出20株,其他分离出6株,所有肺炎链球菌对万古霉素和利奈唑胺均敏感,对青霉素、红霉素、克林霉素、四环素及复方新诺明耐药严重,对左氧氟沙星、氯霉素比较敏感;侵袭性分离株对青霉素、红霉素、克林霉素、左氧氟沙星、四环素及氯霉素的耐药率显著高于非侵袭性肺炎链球菌。结论该院分离的肺炎链球菌主要来自痰液标本,耐青霉素肺炎链球菌的检出率高,大环内酯类耐药严重,存在一定比例的侵袭性感染,非侵袭菌株与侵袭性菌株耐药谱之间存在一定差异,临床治疗应该区别对待,系统的监测细菌耐药性,合理选择抗菌药物。     

Hollow microneedle-based sensor for multiplexed transdermal electrochemical sensing

The development of a minimally invasive multiplexed monitoring system for rapid analysis of biologically-relevant molecules could offer individuals suffering from chronic medical conditions facile assessment of their immediate physiological state. Furthermore, it could serve as a research tool for analysis of complex, multifactorial medical conditions. In order for such a multianalyte sensor to be realized, it must be minimally invasive, sampling of interstitial fluid must occur without pain or harm to the user, and analysis must be rapid as well as selective. Initially developed for pain-free drug delivery, microneedles have been used to deliver vaccines and pharmacologic agents (e.g., insulin) through the skin. Since these devices access the interstitial space, microneedles that are integrated with microelectrodes can be used as transdermal electrochemical sensors. Selective detection of glucose, glutamate, lactate, hydrogen peroxide, and ascorbic acid has been demonstrated using integrated microneedle-electrode devices with carbon fibers, modified carbon pastes, and platinum-coated polymer microneedles serving as transducing elements. This microneedle sensor technology has enabled a novel and sophisticated analytical approach for in situ and simultaneous detection of multiple analytes. Multiplexing offers the possibility of monitoring complex microenvironments, which are otherwise difficult to characterize in a rapid and minimally invasive manner. For example, this technology could be utilized for simultaneous monitoring of extracellular levels of, glucose, lactate and pH, which are important metabolic indicators of disease states (e.g., cancer proliferation) and exercise-induced acidosis.     

Improved Methods for Capture,Extraction, and Quantitative Assay of Environmental DNA from Asian Bigheaded Carp (Hypophthalmichthys spp.)

Indirect, non-invasive detection of rare aquatic macrofauna using aqueous environmental DNA (eDNA) is a relatively new approach to population and biodiversity monitoring. As such, the sensitivity of monitoring results to different methods of eDNA capture, extraction, and detection is being investigated in many ecosystems and species. One of the first and largest conservation programs with eDNA-based monitoring as a central instrument focuses on Asian bigheaded carp (Hypophthalmichthys spp.), an invasive fish spreading toward the Laurentian Great Lakes. However, the standard eDNA methods of this program have not advanced since their development in 2010. We developed new, quantitative, and more cost-effective methods and tested them against the standard protocols. In laboratory testing, our new quantitative PCR (qPCR) assay for bigheaded carp eDNA was one to two orders of magnitude more sensitive than the existing endpoint PCR assays. When applied to eDNA samples from an experimental pond containing bigheaded carp, the qPCR assay produced a detection probability of 94.8% compared to 4.2% for the endpoint PCR assays. Also, the eDNA capture and extraction method we adapted from aquatic microbiology yielded five times more bigheaded carp eDNA from the experimental pond than the standard method, at a per sample cost over forty times lower. Our new, more sensitive assay provides a quantitative tool for eDNA-based monitoring of bigheaded carp, and the higher-yielding eDNA capture and extraction method we describe can be used for eDNA-based monitoring of any aquatic species.     

Trait Values,Not Trait Plasticity,Best Explain Invasive Species' Performance in a Changing Environment

The question of why some introduced species become invasive and others do not is the central puzzle of invasion biology. Two of the principal explanations for this phenomenon concern functional traits: invasive species may have higher values of competitively advantageous traits than non-invasive species, or they may have greater phenotypic plasticity in traits that permits them to survive the colonization period and spread to a broad range of environments. Although there is a large body of evidence for superiority in particular traits among invasive plants, when compared to phylogenetically related non-invasive plants, it is less clear if invasive plants are more phenotypically plastic, and whether this plasticity confers a fitness advantage. In this study, I used a model group of 10 closely related Pinus species whose invader or non-invader status has been reliably characterized to test the relative contribution of high trait values and high trait plasticity to relative growth rate, a performance measure standing in as a proxy for fitness. When grown at higher nitrogen supply, invaders had a plastic RGR response, increasing their RGR to a much greater extent than non-invaders. However, invasive species did not exhibit significantly more phenotypic plasticity than non-invasive species for any of 17 functional traits, and trait plasticity indices were generally weakly correlated with RGR. Conversely, invasive species had higher values than non-invaders for 13 of the 17 traits, including higher leaf area ratio, photosynthetic capacity, photosynthetic nutrient-use efficiency, and nutrient uptake rates, and these traits were also strongly correlated with performance. I conclude that, in responding to higher N supply, superior trait values coupled with a moderate degree of trait variation explain invasive species'' superior performance better than plasticity per se.     

Comparative accuracy of two new electronic devices for the noninvasive determination of blood pressure

Recent developments in behavioral approaches to cardiovascular disease have called for physiological monitoring devices that reduce experimenter bias, are easy to operate, can be used ambulatorily, and/or provide ongoing, automated monitoring of pertinent cardiovascular functions--i.e., blood pressure and heart rate. Neither the invasive monitoring (via catheterization) nor the standard auscultatory method of blood pressure determination, however, has these characteristics. In the present study, two new methods/devices--(1) a low-weight, low-cost, battery-operated sphygmomanometer (SM), and (2) a more expensive automated electronic SM with electrical pump-are compared with each other and with the more common auscultatory method and a standard mercury SM. Both new devices were also compared with a standard pulse count. Data were derived from 10 readings of 10 healthy subjects each across the three possible comparisons, thus totaling N = 30. Correlation coefficients and average differences were computed and indicated high intercorrelations (between r = .89 and r = .99) between each pairing of the new electronic devices and the mercury SM. Intercorrelations of blood pressure determination with the two new electronic devices, however, were only moderate. Potential reasons for the variability are discussed, and guidelines for the optimal use of the new, easy-to-operate electronic devices are presented.     

Novel chemistry of invasive exotic plants

Of the many exotic plants that have become naturalized in North America, only a small proportion are pests capable of invading and dominating intact natural communities. In the present study, we tested the hypothesis that the most invasive plants are phytochemically unique in their new habitats. A comparison of exotic plant species that are highly invasive in North America with exotics that are widespread, but non-invasive revealed that the invasive plants were more likely to have potent secondary compounds that have not been reported from North American native plants. On average, the compounds found in the invasive plants were reported from fewer species, fewer genera and fewer families than those from non-invasive plants. Many of the unique phytochemicals from invasive plants have been reported to have multiple activities, including antiherbivore, antifungal, antimicrobial and allelopathic (phytotoxic) effects, which may provide the plants with several advantages in their new environments.     

Comparative accuracy of two new electronic devices for the noninvasive determination of blood pressure

Recent developments in behavioral approaches to cardiovascular disease have called for physiological monitoring devices that reduce experimenter bias, are easy to operate, can be used ambulatorily, and/or provide ongoing, automated monitoring of pertinent cardiovascular functions—i.e., blood pressure and heart rate. Neither the invasive monitoring (via catheterization) nor the standard auscultatory method of blood pressure determination, however, has these characteristics. In the present study, two new methods/devices — (1) a low-weight, low-cost, battery-operated sphygmomanometer (SM), and (2) a more expensive automated electronic SM with electrical pump — are compared with each other and with the more common auscultatory method and a standard mercury SM. Both new devices were also compared with a standard pulse count. Data were derived from 10 readings of 10 healthy subjects each across the three possible comparisons, thus totalingN=30. Correlation coefficients and average differences were computed and indicated high intercorrelations (betweenr=.89 andr=.99) between each pairing of the new electronic devices and the mercury SM. Intercorrelations of blood pressure determination with the two new electronic devices, however, were only moderate. Potential reasons for the variability are discussed, and guidelines for the optimal use of the new, easy-to-operate electronic devices are presented.