建立人工气道实施机械通气是治疗严重呼吸衰竭过程中挽救患者生命最常用的措施之一，然而通过人工气道的机械通气也增加了相关并发症发生的机会，如呼吸机相关性肺炎（VAP）等[1]。多数患者在应用呼吸机进行通气支持治疗中，当呼吸衰竭及其病因的病情缓解或明显改善时就可以解除人工气道和终止通气支持，但20%~30%的患者需要逐渐解除呼吸机的通气支持，谓之撤机（Weaning）[1]。尽管文献中撤机的定义略有不同，但主要指的是需要逐步减弱及停止通气支持和解除人工气道的一个时间过程。有慢性呼吸功能不全的患者撤机尤为困难，撤机困难患者的撤机时间可占总机械通气时间的40%[2]。机械通气时间延长与VAP发生率和病死率增加相关。一般来说，机械通气时间gt;3 d，VAP的发生率增加；机械通气时间gt;5 d，并发的VAP为晚发性医院获得性肺炎（HAP），其感染的病原体多为耐多药细菌，治疗难度加大，病死率高于早发性HAP。因此，对于机械通气患者来说，一旦建立人工气道实施有创通气，就应该积极创造条件，尽快撤机，去除人工气道。然而过快地降低和停止通气支持以及过早的气管拔管，可导致撤机失败和再插管。因此时机不成熟的撤机和延时撤机同样可造成机械通气时间过长，导致VAP发生率和病死率升高，以及医疗费用增加[2]。撤机的模式和方法有多种，但最佳的撤机方式仍有争议[1]。近年来无创通气（NIV）作为一种撤机方式用于临床已引起人们的兴趣和关注，但至今临床研究所得结论并未达到一致，NIV是否可以作为一种常规撤机方式用于临床尚无定论。本文通过总结近年来相关的临床研究，评价NIV用于机械通气撤机的可行性和利弊，探讨需进一步优化研究方案来解决的有关问题。
Objective To provide the anatomic evidences and the choice of tendon graft for anatomic reconstruction of posterolateral complex through the morphological and biomechanical study on posterolateral structures of the knee in normal adult cadavers. Methods Twenty-three fresh lower l imb specimens from voluntary donators and 9 lower l imbs soaked by Formal in were selected for anatomic study on the posterolateral complex of the knee. Six fresh specimens were appl ied to measure the maximum load, intensity of popl iteus tendon, lateral collateral l igament, and popl iteofibular l igament, which were key components of the posterolateral complex. Results Popl iteus musculotendinous junction was located at 7.02-11.52 mm beneath lateral tibial plateau and 8.22-13.94 mm medially to fibular styloid process. The distances from femoral insertion of popl iteus tendon to the lower border of femoral condyle and to posterior edge of femoral condyle were 10.52-14.38 mm and 14.24-26.18 mm, respectively. Popl iteofibular l igament originated from popl iteus musculotendinous junction and ended at fibular styloid process. Lateral collateral l igament was located at 10.54-16.48 mm inferior to fibular styloid process, and the distances from femoral insertion to the lower border of femoral condyle and to posterior edge of femoral condyle were 14.92-19.62 mm and 14.66-27.08 mm, respectively. The maximum load and intensity were 579.60-888.40 N and 20.50-43.70 MPa for popl iteus tendon, were 673.80-1 003.20 N and 24.30-56.40 MPa for lateral collateral l igament, and were 101.56-567.35 N and 8.94-36.16 MPa for popl iteofibular l igament, respectively. Conclusion During anatomical reconstruction of posterolateral complex, the bony tunnel of the key components should be located according to the insertion mentioned above. On the basis of this study, the maximum load and intensity of selectable grafts should exceed 833 N and 36 MPa.
目的 探讨心理行为干预对痛风患者遵医行为的影响。 方法 2006年1月－2010年9月，选取痛风患者190例，随机分为干预组和对照组，两组均进行遵医行为评价和疾病相关检查；对干预组进行认知行为干预，分析患者存在的痛风饮食治疗的认知误区，有针对性地进行心理行为干预。 结果 干预后，干预组认知行为总分和各单项分均高于对照组（P＜0.05），胆固醇、甘油三酯和体质量指数均低于对照组（P＜0.05）；干预组19例（20.0%）复发，对照组36例（37.9%）复发，两组复发率比较，差异有统计学意义（χ2=7.390，P=0.007）。 结论 行为认知治疗可提高痛风患者的治疗依从性，从而有助于改善尿酸等相关指标。
【摘要】 目的 探讨心理干预对糖尿病患者血糖控制及情绪的影响。 方法 2001年3月-2009年7月将120例2型糖尿病患者随机分成干预组和对照组，每组各60例。两组均给予正规药物治疗，干预组同时予心理干预。8周后用焦虑自评量表（self-rating anxiety scale，SAS）、抑郁自评量表（self-rating depression scale，SDS）评定两组患者情绪变化，同时测定空腹血糖、餐后2 h血糖。 结果 干预前后干预组空腹血糖及餐后2 h 血糖下降值多于对照组，差异有统计学意义（Plt;0.05）；通过干预，干预组患者SAS、SDS评分均有明显改善，干预前后评分差异有统计学意义（Plt;0.05），对照组干预前后差异无统计学意义（Pgt;0.05）；患者血糖与SAS、SDS评分等因子呈现中等程度的相关性（|r|为0.4~0.6，Plt;0.05）。 结论 糖尿病患者血糖与SAS、SDS等情绪指标相关，心理干预能显著改善血糖和患者情绪。【Abstract】 Objective To study the effect of psychological intervention on blood-glucose control and emotions of diabetic patients. Methods A total of 120 patients with type 2 diabetes treated between March 2001 and July 2009 were randomly divided into the intervention group and the control group with 60 patients in each. Medicine treatment was carried out for patients in both groups, and psychological intervention was applied only to the intervention group. Eight weeks later, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate emotion changes of the patients. Fasting blood glucose, post-meal blood glucose (P2hBG) examination were conducted at the same time. Results The result showed a significantly larger decrease of both fasting blood glucose and post-meal blood glucose in the intervention group than the control group (Plt;0.05). Through these methods, the SAS and SDS evaluation of patients in the intervention group improved significantly (Plt;0.05); However, the change of these two scores was not statistically significant in the control group (Pgt;0.05). There was a mid-level correlation between the blood sugar level of diabetic patients and SAS, SDS evaluation scores (0.4lt;|r|lt;0.6, Plt;0.05). Conclusion The blood sugar level of patients with diabetes is closely related to SAS and SDS scores, and psychological intervention can significantly improve the control of blood glucose and emotions of the patients.
Based on peer-reviewed systematic reviews and randomized controlled trials published from January 1990 to April 2016 with regards to the management of osteoarthritis (OA) of the hip, the American Academy of Orthopaedic Surgeons (AAOS) developed the clinical practice guideline for the treatment of hip OA. This guideline provided practice recommendations including risk factors for hip OA, oral drugs and intraarticular injectables, physical therapies, perioperative hemostatic drug, anesthetic types, approach exposures, etc. The evidence of guideline was graded according to it’s strength. This article interpreted this guideline so as to provide reference for Chinese medical staffs and guideline developers.
In recent years, due to the dramatic increase in the number of surgical operations, there has been a clinically significant increase in the demand for medical adhesives capable of cohesion in a moist environment that can overcome blood or tissue fluids in vivo. As the understanding of the mechanisms and key elements of natural adhesion to aquatic organisms continues to develop, a variety of medical adhesives have been developed by mimicking adhesion procedures or utilizing key functional groups. This article will review the classification, adhesion mechanism, use, research progress and development prospects of biomedical adhesives inspired by aquatic organisms octopus and mussels.
ObjectiveTo summarize the epidemiology of nonalcoholic fatty liver disease (NAFLD) and the epidemiological and economic burdens of NAFLD, so as to provide a reference for hospital management decision-making. MethodThe domestic and foreign guidelines relevant to NAFLD and the literatures relevant to epidemiological investigation and disease burden researches were summarized and its research progress was reviewed. ResultsThe global prevalence of NAFLD was increasing over years. The incidence, mortality, and disability adjusted life years of liver cirrhosis and liver cancer caused by NAFLD had increased year by year. The patients relevant to NAFLD of inpatients and outpatients had increased obviously, and the overall medical expenses had also shown a rising trend. The possible reasons were health care awareness, new drug research, population aging, and excessive medical consumption. In addition, children and adolescents with NAFLD had a obviously increased risk of liver or extrahepatic diseases. ConclusionsBy understanding the epidemiological trend of NAFLD, it is a certain understanding of the disease burden of NAFLD and the related factors affecting the increase of its treatment cost. It is believed that it is necessary to further pay attention to and strengthen the genetic characteristics, pathogenesis, drug research and development, and early diagnosis of cirrhosis and liver cancer relevant to NAFLD in the future. At the same time, the NAFLD group of children and adolescents should not be ignored.
Objective To verify the technics of inactivating/removing pathogens in medical chitosan derived from shrimp shell. Methods Possible pathogen species were included according to the raw material of shrimp shell used in production, then bacillus cereus, porcine parvovirus (PPV) and pseudorabies virus (PRV) were selected as indicator pathogens.Pathogen solution was prepared in accordance with Technical Standard for Disinfection. The processing procedure of medical chitosan was analyzed to determine whether the alkal ization of chitin and the filter steril ization of chitosan were capable of inactivating/removing pathogens and their efficiencies were tested. Results Bacillus cereus was removed by 8 184 cfu/ mL after alkal ization and 30 818 cfu/mL after filter steril ization. The average logarithm inactivation value (LIV) of PPV and PRV after alkal ization were equal to or above 4.76 logTCID50/0.1 mL and 6.67 logTCID50/0.1 mL, respectively, and their average LIV after filter steril ization were 2.25 logTCID50/0.1 mL and 3.04 logTCID50/0.1 mL. The alkal ization of chitin inactivated/removed indicator pathogens effectively, while the filter steril ization of chitosan removed bacterial effectually but could not inactivate viruses completely. Conclusion The alkal ization of chitin can be used as the technics of inactivating/removing pathogens during the preparation process of medical chitosan to guarantee the safety of the product.
Objective To assess the efficacy and safety of parathyroid hormone (PTH) on bone mineral density (BMD) and fractures in postmenopausal women with osteoporosis. Methods We searched MEDLINE (1966 to March 2008), EMBASE (1974 to March 2008), The Cochrane Library (Issue 1, 2008), Current Controlled Trials, The National Research Register, CBM (1983 to March 2008) and CNKI (1994 to March 2008). Some related journals were hand searched as well. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by The Cochrane Collaboration’s software RevMan 4.2.10. Results Twelve studies involving 5550 patients were included. PTH alone or in combination with antiresorptive drugs reduced the risk of vertebral fracture (RR=0.34, 95%CI 0.26 to 0.45, Plt;0.000 01), and increased spine BMD (SMD 0.41, 95%CI 0.17 to 0.65, P=0.0009) and femoral neck BMD (SMD 0.13, 95%CI 0.03 to 0.22, P=0.008). The rate of drop out and loss to follow-up because of adverse events was significantly higher in the PTH group (Peto-OR=1.69, 95%CI 1.39 to 2.05, Plt;0.000 01). Conclusion PTH is effective in the prevention and treatment of postmenopausal osteoporosis, especially in patients with preexisting osteoporotic fractures or with very low bone density. PTH alone or in combination with antiresorptive drugs can reduce the risk of vertebral fractures and increase spine and femoral neck BMD. PTH is more effective than alendronate, but these two should not be used as a combined treatment.
Arrhythmia is a kind of common cardiac electrical activity abnormalities. Heartbeats classification based on electrocardiogram (ECG) is of great significance for clinical diagnosis of arrhythmia. This paper proposes a feature extraction method based on manifold learning, neighborhood preserving embedding (NPE) algorithm, to achieve the automatic classification of arrhythmia heartbeats. With classification system, we obtained low dimensional manifold structure features of high dimensional ECG signals by NPE algorithm, then we inputted the feature vectors into support vector machine (SVM) classifier for heartbeats diagnosis. Based on MIT-BIH arrhythmia database, we clustered 14 classes of arrhythmia heartbeats in the experiment, which yielded a high overall classification accuracy of 98.51%. Experimental result showed that the proposed method was an effective classification method for arrhythmia heartbeats.