上胸段硬膜外阻滞治疗慢性心力衰竭合并房颤的临床研究

目的:比较上胸段硬膜外阻滞对有无合并房颤的扩张型心肌病心衰患者的疗效差异。方法:入选40例扩张型心肌病心衰患者,根据入院心电图有无房颤分为房颤组和非房颤组。所有患者均在抗心力衰竭常规治疗基础上,给予胸段硬膜外阻滞治疗4周,比较治疗前、后NYHA心功能分级、血浆N末端脑钠肽前体(NT-pro BNP)水平、左室射血分数(LVEF)、左室舒张期内径(LVEDD)及左房前后径(LAD)的变化情况。结果:与治疗前比较,两组患者经治疗后的NYHA心功能分级、NT-pro BNP、LVEF、LVEDD及LAD均明显改善(均P0.05),差异有统计学意义,但两组间各指标治疗前后的差值无统计学意义(P0.05)。结论:对于慢性心力衰竭合并房颤的患者而言,给予抗心力衰竭常规治疗基础上联合上胸段硬膜外阻滞治疗有效,且房颤的存在与否不影响上胸段硬膜外阻滞的疗效。     

Bringing the “General Strike” Back In: DuBois,Slavery and Emancipation

ABSTRACT

The “general strike” of slaves in the Civil War was a direct action that involved millions of small and large acts of defiance by slaves. These actions pushed President Lincoln from hesitation to full on military action, although this chapter of history has been neglected. The work of W.E.B. Du Bois reinserted the agency of slaves in their own liberation through the “general strike” but this analysis has also been pushed to the margins. David Roediger's “Seizing Freedom: Slave Emancipation and Liberty for All' is an important corrective to this historical omission.     

救治人员总协调制度在严重多发伤早期救治中的作用

目的 探讨院内救治人员总协调制度对严重多发伤早期救治的作用,以进一步优化创伤病患救治流程。方法 选取2013—2014年在苏州市立医院救治的严重多发伤病人共130例为研究组,同时回顾2011—2012年苏州市立医院救治的严重多发伤病人共123例为对照组,比较研究组与对照组在院内术前时间、在院监护时间、早期漏诊率、早期死亡率及并发症发生率等指标的变化。结果 研究组病人的院内术前时间、在院监护时间较对照组显著缩短,早期漏诊率、早期死亡率和并发症发生率均显著降低。结论 院内救治人员总协调制度的执行可有效提高严重多发伤早期救治效率。     

右美托咪定对老年恶性肿瘤全麻手术患者术后细胞免疫功能、认知功能及炎症因子水平的影响

目的:探讨右美托咪定对老年恶性肿瘤全麻手术患者术后细胞免疫功能、认知功能及炎症因子水平的影响。方法:选取2017年2月～2019年6月期间到我院择期行手术治疗的老年恶性肿瘤患者119例,根据随机数字表法将患者分为对照组(n=59)和研究组(n=60),研究组麻醉中输注右美托咪定,对照组麻醉中输注同容量等速率的生理盐水,比较两组患者围术期指标、细胞免疫功能、不良反应、炎症因子指标、简易智力状态量表(MMSE)评分。结果:两组患者术后第3 d的CD4~+/CD8~+、CD3~+、CD4~+较术前下降,CD8~+较术前升高(P0.05);研究组术后第3 d的CD4~+/CD8~+、CD3~+、CD4~+高于对照组,CD8~+则低于对照组(P0.05)。两组术后第3 d的血清高迁移率族蛋白1(HMGBl)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均升高,但研究组低于对照组(P0.05)。两组手术时间、术中出血量、麻醉时间比较无差异(P0.05)。两组患者术前、术后第1 d、术后第3 d的MMSE评分呈先下降后升高趋势(P0.05),且研究组术后第1 d、第3 d的MMSE评分高于对照组(P0.05)。两组不良反应发生率比较无统计学差异(P0.05)。结论:老年恶性肿瘤全麻手术患者术中输注右美托咪定,可减轻细胞免疫抑制及炎症反应,对术后早期的认知功能下降有一定预防作用。     

一例喉真菌病病例报道并文献复习

目的:探讨喉真菌病的临床特征、诊断要点和治疗方案。方法:回顾我院收治的一例喉真菌病患者的临床病例资料,并对1992年至今国内外报道的类似病例33例进行文献复习。本研究共纳入患者34例,男性16例,女性18例,年龄14-67岁,临床表现以声嘶为主,可伴有咽痛、咽干等咽喉不适感,其中有16例患者被误诊为急性喉炎,27例患者有不同程度的抗生素和(或)糖皮质激素使用史。结果:34例患者中,13例通过病理确诊为喉真菌病。所有患者均予抗真菌药物治疗,其中有1例同时行手术治疗,均治愈。结论:喉真菌病临床罕见,症状无特异性,易误诊,但病理学检查可靠,全身或局部使用抗真菌药物疗效佳,预后良好。     

Assessment of cartilage invasion in case of laryngeal cancer by means of longitudinal sectioning for histopathology – Clinical implications

AimThe aim of the study was to assess the accuracy of radiological diagnosis of laryngeal cartilage infiltration by histopathological examination of laryngeal specimen after total laryngectomy.BackgroundDespite the development of new medical technologies and significant clinical advances allowing early diagnosis and treatment of laryngeal cancer, mortality is still on the rise. Neoplastic infiltration of the laryngeal cartilages is the most common source of error in the assessment of cancer staging. Furthermore, cartilage invasion is listed as a contraindication to partial surgical techniques as well as radiotherapy.Materials and methodsThe study was carried out on 21 larynges following total laryngectomy. Before taking the decision to perform surgery, high-resolution CT scans were performed in all cases. An extended histopathological examination was conducted using a unique vertical cross-section of the whole larynx.ResultsPathology reported 2 cases of arytenoid cartilage invasion, 5 cases of cricoid cartilage invasion, 12 cases of thyroid cartilage penetration, 1 case of internal cortex invasion and 9 cases of extra-laryngeal spread. CT imaging identified 8 of 13 cases (61.5%) of pathologically proven invasion of thyroid cartilage and only 2 cases (2/9, 22%) of extra-laryngeal spread. According to CT results, arytenoid cartilage invasion was correctly identified in 2 cases, cricoid cartilage invasion in 4 (4/5, 80%). The positive predictive values for thyroid, cricoid and arytenoid cartilage invasion and penetration were 80%, 66.7% and 50%, respectively. In case of pre-laryngeal spread the positive predictive value was 100%.ConclusionDespite increasingly advanced methods involved in the diagnosis of laryngeal cancer, many discrepancies may be observed between the radiological and histopathological assessments. CT imaging has limitations especially in thyroid cartilage penetration and extra-laryngeal spread assessment in advanced laryngeal cancer cases. An extended histopathological examination, involving vertical cross-sections of the whole larynx is a very precise study that allows a precise determination of local cancer staging (T).     

非人灵长类个性化麻醉方案的探讨

目的 比较氯胺酮、舒泰、速眠新Ⅱ、戊巴比妥钠等4种全身麻醉药或其组合对非人灵长类的麻醉效果,探寻能替代或者减少氯胺酮使用的个性化麻醉方案。方法 以单独使用氯胺酮麻醉的方案作为对照,另设单独使用舒泰、氯胺酮复合速眠新Ⅱ、舒泰复合速眠新Ⅱ和戊巴比妥钠复合速眠新Ⅱ等麻醉4个实验组,每组选取5只食蟹猴进行实验,记录麻醉后的心率、体温、血氧饱和度、以及麻醉诱导时间和维持时间,以比较各方案的麻醉效果。结果 与单独使用氯胺酮麻醉比较,其他四种麻醉方案在心率、体温、血氧饱和度和麻醉诱导时间上均无显著性差异,不同方案麻醉维持时间分布在30~200min之间。在非人灵长类的全身麻醉中,舒泰可以很好地替代氯胺酮;氯胺酮复合速眠新Ⅱ麻醉可取得较长的麻醉维持时间,并减少氯胺酮的使用量;舒泰与速眠新Ⅱ联用、戊巴比妥钠与速眠新Ⅱ联用的方案也可替代氯胺酮,且麻醉维持时间较长。结论 在一定的麻醉时间内,联合用药可以降低氯胺酮的使用量,不同麻醉方案灵活运用可满足不同实验对麻醉维持时间的需求。     

Niche differentiation among clones in asexual grass thrips

Many asexual animal populations comprise a mixture of genetically different lineages, but to what degree this genetic diversity leads to ecological differences remains often unknown. Here, we test whether genetically different clonal lineages of Aptinothrips grass thrips differ in performance on a range of plants used as hosts in natural populations. We find a clear clone‐by‐plant species interactive effect on reproductive output, meaning that clonal lineages perform differently on different plant species and thus are characterized by disparate ecological niches. This implies that local clonal diversities can be driven and maintained by frequency‐dependent selection and that resource heterogeneity can generate diverse clone assemblies.