PICCO在重型颅脑损伤患者容量管理中的临床应用价值研究

目的:探讨脉搏指数连续心输出量(PICCO)技术在重型颅脑损伤患者液体管理中的临床应用价值。方法:回顾性分析重型颅脑损伤患者46例(男性27例,女性19例),以应用PICCO技术监测血流动力学指标指导液体管理的患者为治疗组(n=26),未应用PICCO技术指导液体管理的患者为对照组(n=20)。比较两组患者的日平均液体量、格拉斯哥昏迷评分(GCS)、急性生理与慢性健康评分(APACHE II)、肺水肿发生率、住院时间、住院总费用以及治疗6个月后的格拉斯哥预后评分(GOS)、生存率、颅脑损伤恢复良好率。结果:治疗期间,治疗组的GCS评分以及APACHEII评分均优于对照组,而治疗组的住院总费用高于对照组,但差异并无统计学意义(P0.05)。治疗组的日平均液体量、肺水肿发生率及住院时间均明显少于对照组,差异有统计学意义(P0.05)。治疗6个月后,治疗组患者的GOS评分、生存率和颅脑损伤恢复良好率均高于对照组,但差异亦无统计学意义(P0.05)。结论:应用PICCO技术监测血流动力学指标指导重型颅脑损伤患者的容量管理可在一定程度上缩短危重患者的住院时间并降低肺水肿的发生率,但并不能明显改善患者的预后。     

重度颅脑损伤的气道监测护理干预

目的:探讨气道监测护理干预对重症颅脑外伤患者预后的影响。方法:回顾分析2010年1月-2012年1月重症颅脑外伤入住我院ICU病房均行气管切开机械通气的患者189例,随机分为两组,对照组和干预组,其中对照组采用常规护理方法进行护理,干预组在常规护理的基础上加强气道监测护理干预,观察比较两组患者ICU治疗时间、肺部感染情况、呼吸机使用时间、ICU花费等情况。结果:两组患者比较:干预组肺部感染控制情况明显优于对照组(x2=4.006,P<0.05),考虑差异有统计学意义。干预组患者呼吸机使用时间及ICU治疗时间均较对照组时间缩短(t=12.9,3.82,3.95 P<0.05),有统计学差异。结论:合理的的气道监测护理能有效减少患者肺部疾病感染等并发症发生率,促进患者病情恢复,临床上值得推广。     

腰大池持续引流术对老年重型颅脑损伤患者颅内压和并发症及预后的影响

目的:探讨腰大池持续引流术对老年重型颅脑损伤患者颅内压、并发症和预后的影响。方法:选取2014年8月～2018年8月期间成都医学院第一附属医院收治的老年重型颅脑损伤患者60例为研究对象。根据随机数字表法将患者分为对照组(n=30)与研究组(n=30),其中对照组术后给予常规的脱水对症治疗,研究组则在此基础上给予腰大池持续引流术。比较两组术后临床疗效以及并发症,术后3d、5d、7d颅内压,随访半年,观察两组患者预后。结果:研究组治疗后总有效率为90.00%,显著高于对照组患者的66.67%(P0.05)。两组患者术后3d、5d、7d颅内压均较术前降低,且研究组低于对照组(P0.05)。研究组脑梗死、脑水肿、硬膜下积液、癫痫、纵裂积液等并发症发生率均低于对照组(P0.05),而颅内感染比较差异无统计学意义(P0.05)。研究组良好例数高于对照组,而重残以及死亡例数均低于对照组,差异有统计学意义(P0.05);而两组轻残、植物生存例数比较差异无统计学意义(P0.05)。结论:腰大池持续引流术治疗老年重型颅脑损伤患者,疗效满意,可显著改善患者颅内压,减少并发症发生率,改善患者预后,适于临床推广。     

重度颅脑损伤患者并发肺部感染的病原菌及耐药性研究

目的:观察重度颅脑损伤患者并发肺部感染的病原菌特点及耐药性,为临床诊治提供参考依据。方法:对我院2010年2月~2012年2月收治的62例重度颅脑损伤患者的病例资料进行回顾性分析,观察其病原菌分布特点及药敏检查结果。结果:重度颅脑损伤患者62例,发生肺部感染者28例,肺部感染发生率45.16%。共分离病原菌31株,其中革兰阴性杆菌21株,占67.74%;革兰阳性球菌6株,占19.35%;真菌4株,占12.9%。经药敏试验分析,革兰阴性杆菌对亚胺培南高度敏感;革兰阳性球菌对利福平、万古霉素、呋喃妥因高度敏感。经单因素分析,气管切开操作史、住院天数延长、基础疾病、休克、呼吸机使用均是导致重度颅脑损伤发生肺部感染的危险因素(P0.05)。结论:重度颅脑损伤患者并发肺部感染病原菌以革兰阴性杆菌为主,临床发生率较高,针对病原菌特点采用敏感抗生素对提高治疗效果具有重要作用。     

Therapeutic mechanism of intracranial infection in patients with hydrocephalus after craniocerebral injury based on decompressive craniectomy

The objective of this study is to analyze the treatment mechanism of decompressive craniectomy for intracranial infection in patients with hydrocephalus after craniocerebral injury, and to provide a treatment plan for intracranial infection in patients with hydrocephalus after craniocerebral injury. In this study, literature screening and data acquisition were carried out firstly based on the research content, and then heterogeneity analysis, Meta-analysis, sensitivity analysis, and publication bias analysis were performed using statistical methods for the unilateral and bilateral decompressive craniectomy. Heterogeneity analysis, Meta-analysis and sensitivity analysis of indiscriminate unilateral decompressive craniectomy was performed; heterogeneity analysis, Meta-analysis, cumulative Meta-analysis, and sensitivity analysis for bilateral decompressive craniectomy were performed. In this study, the order of influence on patients with hydrocephalus after brain injury was as follows: bilateral decompressive craniectomy > unilateral and bilateral decompressive decompression > indiscriminate unilateral decompressive. Intracranial infection in patients with hydrocephalus after the craniocerebral injury should be comprehensively evaluated before the surgery and given clinical treatment in time.     

益生菌联合早期肠内营养对重型颅脑损伤患者临床疗效及肠道免疫水平的影响

目的探讨益生菌与早期肠内营养联合使用对重型颅脑损伤患者的临床疗效及肠道免疫功能的影响。方法选取在东南大学医学院附属江阴医院进行诊治的86例重型颅脑损伤患者,随机分为对照组和观察组,每组43例。对照组患者营养支持方案为伤后经鼻胃管持续泵入康全力肠内营养混悬液,观察组则在对照组的基础上加用益生菌,所有患者均治疗2周。对治疗过程中患者并发症发生情况以及治疗后的GOS评分、免疫功能指标进行评价和比较。结果(1)治疗过程中,观察组患者感染、腹胀腹泻、消化道出血、糖代谢紊乱和应激性溃疡的发生率均明显少于对照组,差异有统计学意义(P0.05);治疗后观察组患者GOS评分明显高于对照组,差异有统计学意义(P0.05)。(2)治疗后,2组患者血清IgA、IgG、IgM和补体C3、C4以及Th1/Th2水平的改善情况均明显优于同组治疗前,差异有统计学意义(P0.05),且观察组患者各项指标改善程度明显优于对照组,差异有统计学意义(P0.05)。结论对重型颅脑损伤患者联合使用益生菌与早期肠内营养,不仅可以明显减少感染、消化道不良反应等并发症的发生、改善预后,而且可以明显提高患者的免疫功能,值得推广。     

血清HBP和PTX3在重度脑损伤继发性肺部细菌性感染 诊断中的应用价值

目的探讨血清肝素结合蛋白(HBP)与正五聚蛋白3(PTX3)对重度脑损伤继发性肺部细菌性感染的诊断价值。方法选择2015年3月至2019年1月我院重症医学科收治的重型颅脑损伤患者96例,对所有患者进行肺部感染情况判断,将出现继发性肺部细菌感染的患者纳入感染组,未出现继发性肺部细菌感染的患者纳入未感染组。分别检测两组患者入院后第1、3、5、7天的HBP、PTX3、白细胞(WBC)和C反应蛋白(CRP)水平,探讨其对于重度脑损伤患者继发肺部细菌感染的诊断价值,并对HBP、PTX3与WBC、CRP的相关性进行分析。结果共有39例重度脑损患者纳入感染组,57例患者纳入未感染组,患者肺部细菌感染的发生率为40.6%。入院第1天感染组患者HBP、WBC及CRP水平明显高于未感染组,同时入院后第3、5、7天时感染组患者HBP、PTX3、WBC、CRP水平均显著高于未感染组,差异均具有统计学意义(均P0.05)。单独采用HBP或PTX3对重度脑损伤继发性肺部细菌性感染进行诊断的约登指数为0.586和0.655,诊断的敏感性、特异性、阳性预测值、阴性预测值为74.3%、84.2%、76.3%、82.7%和79.5%、86.0%、79.5%、86.0%。联合检测的约登指数为0.776,诊断的敏感性、特异性、阳性预测值、阴性预测值为84.6%、93.4%、89.2%、89.8%。Spearman相关性分析显示HBP、PTX3水平与CRP水平均呈正线性相关(r=0.362、0.284,均P0.05)。结论 HBP和PTX3均为重度脑损伤患者继发肺部细菌感染诊断的敏感指标,联合检测能够提高其检测价值,对重度脑损伤患者肺部感染的早期诊断具有一定临床意义。     

dl-3-正丁基苯酞对脑损伤大鼠的神经保护作用的实验研究

目的:研究dl-3-正丁基苯酞(NBP)对脑损伤大鼠的神经保护作用。方法:将100只7周龄清洁级雄性Sprague-Dawley(SD)大鼠随机分成5组,分别为假手术组、模型组、NBP低、中和高剂量组,每组20只。使用控制性皮层撞击损伤建立中型大鼠颅脑损伤模型。将NBP溶解在大豆油中,NBP低、中和高剂量组分别按照每天20、40和80 mg/kg的剂量灌胃,假手术组和模型组灌胃等体积的大豆油,共给药2周。采用改良神经功能缺损评分(m NSS)对大鼠的神经系统状况进行评价。检测各组大鼠治疗后的脑组织含水量以及脑组织中丙二醛(MDA)、超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)水平。TUNEL方法鉴定细胞的凋亡。通过RT-PCR、Western blot或免疫组化检测脑组织中Nrf2、NQO-1、HO-1、ApoJ、MMP9、AQP4、Caspase-3和AKT的表达。结果:NBP治疗2周后,NBP低、中和高剂量组大鼠的m NSS评分和神经元凋亡率以剂量依赖性方式显著降低(P0.05)。与模型组比较,NBP低、中和高剂量组大鼠的脑含水量均显著降低(P0.05)。与模型组比较,NBP低、中和高剂量组大鼠的MDA显著降低,而SOD和GSH-Px显著升高(P0.05)。与模型组比较,NBP低、中和高剂量组大鼠的细胞核Nrf2显著升高,而细胞质Nrf2显著降低(P0.05)。与模型组比较,NBP低、中和高剂量组大鼠的NQO-1和HO-1蛋白表达水平显著升高(P0.05)。与模型组比较,NBP低、中和高剂量组大鼠的AQP4、MMP-9、ApoJ和Caspase-3的m RNA和蛋白表达水平均显著降低,而AKT显著升高(P0.05)。结论:NBP对创伤性颅脑外伤大鼠具有一定的神经保护作用。     

Sequential sampling for adult coccinellids in wheat

Adult aphidophagous coccinellids are important predators of cereal aphids in wheat in the Great Plains of the United States for which sampling methods are needed to facilitate improved management. An equation relating the mean number of adult coccinellids per m² in a wheat field to its variance was obtained using Taylor's power law. A sequential sampling procedure was developed to estimate the number of adult coccinellids per m² with constant average statistical precision (standard error/mean). The procedure was constructed by an equation relating the number of adult coccinellids per m² to the number of adult coccinellids per minute of counting incorporating into the Taylor's power law relationship. The procedure involves conducting a series of 1-min counts while walking through a field at a constant velocity of 10 m per minute. After each 1-min count sequential sampling stop-lines are consulted to determine if the specified level of precision has been achieved. Two methods, a statistical procedure and comparison with independent data, were used to assess the consistency with which the specified level of precision was achieved by the procedure. Results indicated that observed precision was close to that specified by the user over a wide range of adult coccinellid density.     

Accelerated Immunofluorescence Procedure for the Detection of Salmonella in Foods and Animal By-Products

An accelerated, direct immunofluorescent-antibody procedure was developed for the detection of Salmonella in food products. This method includes pre-enrichment and selective enrichment but eliminates many of the washing and smear treatments present in existing methods. Commercially available fluorescein-conjugated somatic antiserum was used in comparing this method with conventional culture, biochemical, and serological procedures. The 894 samples tested represented 39 different products. The fluorescent-antibody procedure detected Salmonella in 216 test samples as compared to 205 positives recovered by using the standard culture procedures. In no instance did the fluorescent-antibody procedure fail to detect a Salmonella positive which had been detected by the standard procedure. With a three-tube, most-probable-number procedure, the fluorescent-antibody method was able to detect Salmonella at a level of 0.036 organism per g. In addition to being a more rapid method for the detection of Salmonella, it has proven to be comparable to conventional culture procedures.     

Monitoring of Systemic and Hepatic Hemodynamic Parameters in Mice

The use of mouse models in experimental research is of enormous importance for the study of hepatic physiology and pathophysiological disturbances. However, due to the small size of the mouse, technical details of the intraoperative monitoring procedure suitable for the mouse were rarely described. Previously we have reported a monitoring procedure to obtain hemodynamic parameters for rats. Now, we adapted the procedure to acquire systemic and hepatic hemodynamic parameters in mice, a species ten-fold smaller than rats. This film demonstrates the instrumentation of the animals as well as the data acquisition process needed to assess systemic and hepatic hemodynamics in mice. Vital parameters, including body temperature, respiratory rate and heart rate were recorded throughout the whole procedure. Systemic hemodynamic parameters consist of carotid artery pressure (CAP) and central venous pressure (CVP). Hepatic perfusion parameters include portal vein pressure (PVP), portal flow rate as well as the flow rate of the common hepatic artery (table 1). Instrumentation and data acquisition to record the normal values was completed within 1.5 h. Systemic and hepatic hemodynamic parameters remained within normal ranges during this procedure.This procedure is challenging but feasible. We have already applied this procedure to assess hepatic hemodynamics in normal mice as well as during 70% partial hepatectomy and in liver lobe clamping experiments. Mean PVP after resection (n= 20), was 11.41±2.94 cmH₂O which was significantly higher (P<0.05) than before resection (6.87±2.39 cmH₂O). The results of liver lobe clamping experiment indicated that this monitoring procedure is sensitive and suitable for detecting small changes in portal pressure and portal flow rate. In conclusion, this procedure is reliable in the hands of an experienced micro-surgeon but should be limited to experiments where mice are absolutely needed.     

Feasibility,effectiveness, and safety of a novel cryo-balloon targeted lung denervation technique in an animal model

Background and objectiveTargeted lung denervation (TLD) is a pulmonary interventional procedure for COPD that aims to disrupt parasympathetic nerve input to the lung to reduce the clinical consequences of cholinergic hyperactivity. TLD has been proven to be a safe procedure and effectively alleviate symptoms and reduce the onset of exacerbation. In the present study, we developed a novel cryo-balloon TLD system and evaluated its feasibility, safety, and effectiveness.MethodsA preclinical study was performed on twelve sheep, four were tested for airway resistance alterations before and after TLD, two were tested for the Hering-Breuer reflex (HBR) and the remaining six sheep were evaluated for 28 days to assess the safety and effectiveness of the procedure.ResultsAfter an observation period of 28 days, significant disruption of vagal innervation to the lung could be validated by both histological and physiological assessments. The operation time was shorter than traditional procedure, with minimal adjacent tissue injury and no device-related adverse events.ConclusionsThe novel cryo-balloon TLD procedure was feasible, safe, and effective. In comparison with the traditional procedure, this treatment system required shorter operation time and caused less denervation-induced damage to adjacent tissues.     

Application of Sequential Classification of Prey/Predator Ratio Test to Tetranychus urticae and Phytoseiulus persimilis System in Greenhouse Roses

A sequential sampling procedure for classifying the ratio of prey/predators developed by Nyrop (1988) was examined to implement for a biological control in the greenhouse roses. The procedure was combined with a sequential density classification procedure for use in monitoring a phytophagous mite, Tetranychus urticae Koch, and a phytoseiid predator, Phytoseiulus persimilis Athias-Henriot. This procedure was required four parameters: Means and variances for T. urticae and P. persimilis, correlation coefficient between densities of prey and predator and critical ratio of prey and predator. The parameter values used in this study were 0.725 for the correlation coefficient and 10 for the critical ratio. The variances for each species were estimated using a Taylor's power law model. The procedure is proven to be successfully applicable to T. urticae and P. persimilis system in greenhouse roses at two action threshold levels of 5 and 10 T. urticae per three-leaflet leave. The limitations and implementation of this procedure is also discussed.     

Stepwise Variable Selection in Classification Problems

Two variable selection procedures are evaluated for classification problems: a forward stepwise discrimination procedure, and a stepwise procedure preceded by a preliminary screening of variables on the basis of individual t statistics. Expected probability of correct classification is used as the measure of performance. A comparison is made of the procedures using samples from multi-variate normal populations and from several nonnormal populations. The study demonstrated some situations where the use of all variables is preferable to the use of a stepwise discriminant procedure stopping after a few steps, though usually the latter procedure was superior in performance. However where the stepwise procedure performed better than using all variables, the modified stepwise procedure performed still better. The use of modified stepwise procedures in which not all the covariances of the problem need be estimated seems promising.     

An assay for osteoclast-activating factor (OAF) in biological fluids: Detection of OAF in the serum of myeloma patients

A procedure is described for the partial purification and biological assay of a lymphokine, osteoclast-activating factor, in samples of serum. This procedure involves two steps of ultra-filtration of samples, followed by polyacrylamide gel electrophoresis and bioassay of fractions eluted from the gels. The procedure effectively discriminates between osteoclast-activating factor and other agents with similar biological activities (parathyroid hormone, prostaglandin E₂, and 1, 25-dihydroxyvitamin D₃), when each agent is added to normal human serum. Using this procedure as a specific assay for osteoclast-activating factor, serum from normal individuals and myeloma patients was examined. The activity was detected in 11 of 23 myeloma sera but in none of 12 normal sera.     

CT灌注成像技术用于重型颅脑损伤患者脑室型颅内压探头植入的临床价值评估

目的:探讨CT灌注成像技术用于重型颅脑损伤患者脑室型颅内压(Intracranial Pressure, ICP)探头植入的临床价值。方法:选取60例重型颅脑损伤患者,均行患侧开颅去骨瓣减压和颅内压监测探头置入术。其中,行普通型颅内压监测探头置入术28例,脑室型颅内压监测探头置入术32例。比较两组术后甘露醇应用剂量和应用时间,术后局部脑血流参数区域脑血流量(regional Cerebral Blood Flow, r CBF)、相对脑血容量(relative Cerebral Blood Volume, r CBV)、平均通过时间(Mean Transit Time, MTT)、对比剂达峰时间(time to peak, TTP)恢复情况。结果:脑室型颅内压监测组患者术后应用甘露醇的剂量和天数较普通颅内压监测组明显缩短(P0.05),术后3个月随访提示脑室型ICP监测组预后良好比例较普通型ICP组显著增加(P0.05)。并且螺旋CT灌注成像结果提示脑室型颅内压监测组患者术后局部脑血流参数r CBF、r CBV、MTT、TTP恢复情况明显优于普通型颅内压监测组(P0.05)。结论:重型颅脑损伤患者应用脑室型颅内监测探头改变了脱水剂在临床应用中的治疗模式,通过螺旋CT灌注成像检测患者损伤部位的r CBF、r CBV、MTT和TTP可评估脑损伤的程度以及预后,对重型颅脑损伤的临床治疗和改善患者预后具有重要意义。     

Role of stimulus-stimulus pairing in matching-to-sample procedure: cross-species comparison of humans and pigeons

The present experiment examined whether, in a matching-to-sample (MTS) procedure, a relation between two stimuli, a sample and a comparison, could be established as a result of just stimulus–stimulus pairing, even if back up reinforcers were never provided for the conditional relation between the sample and comparison stimuli, but rather only for the comparison stimulus. A procedure called “pseudo matching-to-sample” was used in which, when S1 was presented as a sample stimulus, two comparison stimuli (C1 and C2) were presented, and only responses to C1 were reinforced. Conversely, when S2 was presented, only responses to C3 (and not C4) were reinforced. In other words, organisms experiencing this procedure could discriminate C1 from C2, and C3 from C4, by simple discrimination without regard to the conditional sample stimuli. In order to examine cross-species differences, responding by humans in this procedure was compared to that by pigeons. Although the humans developed a discriminative function for the sample stimuli, that is, the humans’ responding was affected by both the sample stimuli and the reinforcers, responding by the pigeons was affected solely by the reinforcers. These data suggest that, in this procedure, humans (but not pigeons) are able to learn relations among stimuli simply as a result of stimulus–stimulus pairing.     

急性颅脑损伤大鼠脑组织ATP酶活性及TNF-α的变化及意义

目的 观察大鼠急性颅脑损伤后脑组织ATP酶活性及肿瘤坏死因子-α（TNF-α）的变化,探讨急性颅脑损伤后脑水肿的发病机制.方法 将72只SD大鼠随机分为正常组（N组）、假手术对照组（S组）、急性颅脑损伤模型组（ACI组）,其中S组和ACI组于造模后分为2、6、24、72 h时间点,每个时间点8只大鼠;取大鼠伤灶区脑组织测定Na＋-K＋-ATP酶和Ca2＋-ATP酶活性、TNF-α含量及脑组织含水量.结果 急性颅脑损伤后脑组织Na＋-K＋-ATP酶、Ca2＋-ATP酶活性降低（P〈0.05）,TNF-α含量升高（P〈0.05）;颅脑损伤后24 h脑水肿较严重.相关性分析提示,Ca2＋-ATP酶活性与TNF-α含量呈负相关（P〈0.05）.结论 急性颅脑损伤后可引起脑组织ATP酶活性降低、TNF-α含量增加,两者可能协同参与了急性颅脑损伤后脑水肿.     

Influence of storage time and temperature on in vitro digestion of neutral detergent fibre at 48 h, and comparison to 48 h in sacco neutral detergent fibre digestion

The effect of within-day delays of 0.5, 2.5, 4.5 and 6.5 h between collection of rumen fluid from a cow and initiation of in vitro fermentation, as well as storage of rumen fluid for 48 h at either −24°C or 6, 22 and 39°C, on in vitro digestion of neutral detergent fibre (NDF) at 48 h was determined. In addition, the 48 h in vitro digestion of NDF, determined with a minimum time delay (i.e., 0.5 h) between collection from the cow and initiation of incubation, was compared to NDF digestion determined in sacco at 48 h. Rumen inoculum from a single cow was utilized in a thrice replicated incubation with whole crop alfalfa, corn, cereal and sudangrass forages of a lower and higher quality. The same cow was used as the host for the in sacco bags. The in vitro procedure used a bulk procedure with 5.0 cm × 5.5 cm multi-weave polyethylene polyester polymer bags that retained particles of 25 mm and larger. The in sacco procedure used the same bags retained in a large mesh bag. A within-day time delay of up to 6.5 h between collection of rumen fluid from the cow and initiation of in vitro fermentation had no impact on measured 48 h in vitro digestion of NDF. In contrast, no temperature dependent storage procedure maintained 48 h in vitro digestion of NDF at levels determined with no 48 h storage, although high quality alfalfa was least affected by any storage procedure. The 48 h in vitro digestion of NDF, determined using the minimum time delay between collection from the cow and initiation of the incubation, was higher than values obtained in sacco. Results show that this bulk in vitro procedure resulted in higher 48 h digestion of NDF than those determined with a similar in sacco procedure, thereby suggesting that laboratories located some distance from the donor animal can utilize in vitro procedures to accurately estimate 48 h digestion of NDF. However, storage of rumen fluid for 48 h, by any temperature dependent procedure examined, in order to facilitate fewer trips to the donor animal, or trips of substantially longer duration, will underestimate 48 h digestion of NDF to an extent that depends upon the forage incubated.