Tear of the distal biceps branchii tendon: A new method of ultrasound evaluation

Tear of the distal biceps brachii tendon is an uncommon injury. Ultrasound evaluation of the distal tendon using an anterior approach is often difficult because of technical factors. We describe a new method of ultrasound evaluation of the distal biceps tendon insertion. This involves a posterior approach with the forearm pronated. With pronation of the forearm, the radial tuberosity faces posteriorly, bringing the distal biceps tendon insertion into view. A surgically proven case of distal biceps tendon tear is presented to illustrate our technique.     

Nephrin、podocin在V型狼疮性肾炎肾组织中的表达

目的 探讨肾小球足细胞相关蛋白nephrin和podocin在V型狼疮性肾炎(V-LN)发病中的作用.方法 检测V-LN组11例和特发性膜性肾病(IMN)组8例患者的尿常规、24-h尿蛋白定量、尿补体C3及纤维蛋白原降解产物(FDP)、血脂、血清补体及肝肾功能,并行肾组织活检间接免疫荧光染色,激光共聚焦显微镜观察nephrin、podocin表达的变化.结果 24-h尿蛋白定量、血清白蛋白、肌酐、尿补体C3两组间无统计学差异;V-LN组血脂、血清补体C3、C4及尿FDP均低于IMN组;nephrin、podocin表达两组均减弱,但IMN组更明显.结论 Nephrin、podocin表达减弱可能参与V-LN蛋白尿的发生,但V-LN表达减弱不及IMN明显,推测V-LN蛋白尿的发生可能还有其他机制参与.     

参麦注射液联合川芎嗪对脓毒症小鼠肝脏的保护作用

目的探讨参麦联合川芎嗪注射液对脓毒症小鼠肝脏的保护作用。方法采用盲肠结扎穿孔(Cecal ligation and puncture,CLP)方法诱导形成脓毒症。将雄性成年的昆明小鼠随机分为5组,分别是假手术组、模型组、参麦注射液治疗组、川芎嗪注射液治疗组和参麦联合川芎嗪注射液治疗组。CLP术前24,12,1 h各组小鼠分别腹腔注射参麦注射液和川芎嗪注射液或者等计量的生理盐水。观察CLP造模后24 h各组小鼠血清中肿瘤坏死因子α(TNF-α)、白介素6(IL-6)含量、谷丙转氨酶(ALT)、谷草转氨酶(AST)活性以及肝脏组织中丙二醛(MDA)、髓过氧化物酶(MPO)水平,并观察各组小鼠的存活率及其肝脏组织的病理变化。结果参麦、川芎嗪及参麦联合川芎嗪三组药物治疗组的脓毒症小鼠其死亡率、血清中炎症因子(TNF-α、IL-6)含量、肝脂质过氧化(MDA、MPO)水平、ALT/AST及其肝脏病理损伤程度均较模型组明显减轻,尤以参麦联合川芎嗪给药治疗组疗效最为显著。此外,联合给药治疗组血清中的炎症因子(TNF-α、IL-6)水平较单一用药组显著降低。结论参麦联合川芎嗪注射液较单一用药能够更有效地抑制炎症反应,提高脓毒症小鼠的存活率、减轻肝脏损伤。     

痔瘘熏洗凝胶剂药效学初步研究

目的:观察痔瘘熏洗凝胶剂的抗炎、镇痛效果.方法:选取雌性大鼠分组后通过建立角叉菜胶肛周肿胀模型,观察痔瘘熏洗凝胶剂对实验性痔疮的抗炎作用;选取雌性小鼠分组后通过热板法观察痔瘘熏洗凝胶剂的镇痛作用.结果:痔瘘熏洗剂及其改进剂型--痔瘘熏洗凝胶剂对角叉菜胶所致大鼠肛周肿胀均有显著的抑制作用,对热传导引起的疼痛有确切的镇痛作...     

Capacity factors for electrical power generation from renewable and nonrenewable sources

Given the dire consequences of climate change and the war in Ukraine, decarbonization of electrical power systems around the world must be accomplished, while avoiding recurring blackouts. A good understanding of performance and reliability of different power sources underpins this endeavor. As an energy transition involves different societal sectors, we must adopt a simple and efficient way of communicating the transition’s key indicators. Capacity factor (CF) is a direct measure of the efficacy of a power generation system and of the costs of power produced. Since the year 2000, the explosive expansion of solar PV and wind power made their CFs more reliable. Knowing the long-time average CFs of different electricity sources allows one to calculate directly the nominal capacity required to replace the current fossil fuel mix for electricity generation or expansion to meet future demand. CFs are straightforwardly calculated, but they are rooted in real performance, not in modeling or wishful thinking. Based on the current average CFs, replacing 1 W of fossil electricity generation capacity requires installation of 4 W solar PV or 2 W of wind power. An expansion of the current energy mix requires installing 8.8 W of solar PV or 4.3 W of wind power.

Greenhouse gas emissions are the driving force behind climate change (1), which threatens biodiversity (2), food security (3), and cultural diversity (4). The main source of carbon emissions in electricity generation is the current mixture of inputs (5). The current state of affairs demands an energy transition, but numerous challenges emerge (6–8). Such a transition implicates different societies in different ways (9–11), but even the conservative United States wants a decarbonized future (12). Actions toward a sustainable future have been taken at different scales from city (13) to country level (14).The current energy system in place has a rigid structure with a modus operandi of “winner takes all” that hampers the establishment of alternatives (15). Policies can be implemented to overcome the status quo. However, unintended consequences can arise, e.g., carbon pricing policies tend to incentivize optimization of the current energy system instead of the required transformations to achieve a decarbonized one (16). This conclusion is not universally accepted (17–19). It seems, however, that renewables will lead the energy transition and solar photovoltaics will play a key role (20–22).Engaging different players in a society for the energy transition is essential. However, the diversity of stakeholders creates communication barriers, particularly when technical details are transmitted to a broad audience. The war in Ukraine and insufficient natural gas supply in Europe have added painful urgency to clear and truthful communication of the potential pitfalls of any energy transition that boil down to the clear understanding of what the different components of electricity generation systems can and cannot do. Regarding power-generation efficiencies of different sources, the use of CF is an excellent tool to connect with a broad set of audiences.CF is a measure of a power plant efficacy (23). In short, it is an indicator of how fully the power plant is used, relative to its thermodynamic and technological constraints and required spare capacity (24). For all technologies, CFs have typical values for a set time interval and input (a fuel, light, water, or wind).An electrical power plant’s CF gives this plant’s average output relative to its maximum capacity. This could be quite misleading for renewables. If a plant works at 50% of nominal capacity, its CF is 0.5. This does not mean that the plant worked 12 h at full capacity and was off over the remaining 12 h. This plant could be down for different reasons such as repairs, maintenance, refueling, or intermittency for renewables. Despite its limitations, CF is a straightforward indicator that can be easily calculated and predict the amount of electricity that will be obtained on average from a specific nominal capacity installed.Comparing CFs across different technologies can be tricky, mainly when some are well established and mature, while others are at pilot-scale or not fully deployed. In the last two decades, solar PV and wind have been growing exponentially. This explosive growth allows one to obtain reliably their CFs. When a technology is more established, the effects of pilot plants, learning curves (25–28), or optimal sites no longer dominate, giving reliable estimates about that technology’s performance. Field tests are the ultimate answer. Theoretical estimates can differ significantly from the measured ones. Such discrepancies have been presented for wind (29) and concentrated solar power plants (30) (SI Appendix, section 10). Knowing the real value of CFs is fundamental to estimating costs, power production, and the future roles of specific technologies.In this work, we analyze the average CFs of different electricity sources (i.e., biomass, fossil fuels, geothermal heat, water, uranium, solar light, and wind) over the period 2000–2017. Global and regional values are estimated to highlight the differences in the performance of different technologies. These average CF values are then used to calculate the required nominal capacity to be installed in the future for our unavoidable energy transition.     

Raciocínio Clínico em Cardiologia: Passado,Presente e Futuro

Clinical reasoning was born 2,500 years ago with Hippocrates, having evolved over the centuries, becoming a mixture of art and science. Several personalities throughout history have contributed to improving diagnostic accuracy. Nonetheless, diagnostic error is still common and causes a severe impact on healthcare systems. To face this challenge, several clinical reasoning models have emerged to systematize the clinical thinking process. This paper describes the history of clinical reasoning and current diagnostic reasoning methods, proposes a new clinical reasoning model, called Integrative Reasoning, and brings perspectives about the future of clinical reasoning.     

生长抑素联合清营汤治疗重症急性胰腺炎临床疗效

目的探讨早期应用生长抑素联合清营汤治疗重症急性胰腺炎患者的近期疗效。方法68例重症急性胰腺炎患者,随机分成两组。治疗组(n=34),对照组(n=34),并观察两组患者的近期疗效。结果重症急性胰腺炎早期联用清营汤组治疗1周后,患者APACHEⅡ评分明显下降,两周复查CT显示联用清营汤组,患者急性胰腺炎的CT严重度指数(CT severity index,CTSI)评分明显下降。而单纯施他宁组患者治疗一周后APACHEⅡ评分略有下降,两周复查CT显示患者急性胰腺炎的CTSI评分略下降。两组结果相比差异显著(P<0.05)。结论早期应用生长抑素联合清营汤治疗重症急性胰腺炎可改善临床症状,提高疗效,减少并发症,降低死亡率。     

高海拔地区急性呼吸窘迫综合征和多器官功能障碍综合征诊断标准的研究--附高海拔地区急性呼吸窘迫综合征诊断标准重修意见稿

目的：判别高海拔地区急性呼吸窘迫综合征（H－ARDS）和多脏器功能障碍综合征（H－MODS）诊断指标参数和平原的差异，重估原H－ARDS诊断标准（1999年兰州会议）的实用性和可操作性。方法：将资料齐全且符合庐山、Marshall ARDS/MODS诊断标准的360例患者，根据所在海拔高度分为平原对照组（CG，n=93),≥1517m高度组（H1G，n=223),2261-2400m高度组（H2G，n=44)。3组均按庐山、Marshall和自拟ARDS／MODS的标准（简称兰州标准）建成3个标准数据模型，绘制ROC曲线。根据曲线下面积、最佳截断点对比3个标准在不同海拔梯度上预测ARDS／MODS结局的准确性。结果：用庐山标准验证CG组ROC下面积、敏感度、特异度优于Marshall标准，两者相比ROC下面积、敏感度、特异度依次为0．823、0．833、0．731比0．815、0．767、0．763；但用于验证高海拔区如H2G则庐山标准明显低于兰州标准，两标准的ROC下面积、敏感度、特异度依次为0．855、0．583、0．969比0．914、1．000、0．657；氧合指数（PaO2/FiO2)的最佳界值在CG、H1G和H2G依次为198．32mmHg、131.50mmHg、97.58mmHg；3组ARDS／MODS按平原标准评分分级，CG比较均匀分布在1－3级，而H1G和H2G的病例多集中在3级，多构成比χ^2检验，P＜0．000。结论：（1）高海拔地区ARDS诊断标准与平原地区有明显差异，海拔高度≥1517m的兰州地区可能在区分平原与高原ARDS诊断标准是上一个有意义的分界线。已建立的H－ARDS诊断标准参数符合本地区实际，基本可行，参数范围仍宽，建议适度修改。MODS各项指标虽与平原有不同的变化趋向，但样本量较少，标准有待进一步完善。