Influence of Lung Aeration on Pulmonary Concentrations of Nebulized and Intravenous Amikacin in Ventilated Piglets with Severe Bronchopneumonia

Background: Pulmonary concentrations of aminoglycosides administered intravenously are usually low in the infected lung parenchyma. Nebulization represents an alternative to increase pulmonary concentrations, although the obstruction of bronchioles by purulent plugs may impair lung deposition by decreasing lung aeration.

Methods: An experimental bronchopneumonia was induced in anesthetized piglets by inoculating lower lobes with a suspension of 106 cfu/ml Escherichia coli. After 24 h of mechanical ventilation, 7 animals received two intravenous injections of 15 mg/kg amikacin, and 11 animals received two nebulizations of 40 mg/kg amikacin at 24-h intervals. One hour following the second administration, animals were killed, and multiple lung specimens were sampled for assessing amikacin pulmonary concentrations and quantifying lung aeration on histologic sections.

Results: Thirty-eight percent of the nebulized amikacin (15 mg/kg) reached the tracheobronchial tree. Amikacin pulmonary concentrations were always higher after nebulization than after intravenous administration, decreased with the extension of parenchymal infection, and were significantly influenced by lung aeration: 197 +/- 165 versus 6 +/- 5 [mu]g/g in lung segments with focal bronchopneumonia (P = 0.03), 40 +/- 62 versus 5 +/- 3 [mu]g/g in lung segments with confluent bronchopneumonia (P = 0.001), 18 +/- 7 versus 7 +/- 4 [mu]g/g in lung segments with lung aeration of 30% or less, and 65 +/- 9 versus 2 +/- 3 [mu]g/g in lung segments with lung aeration of 50% or more.     

创伤性休克病人的早期急救护理体会

目的:讨论在院前和急诊科对创伤性休克病人施行早期急救护理,对挽救病人的生命及伤情预后有重要的意义.方法:对我科1997年2月至2001年4月27例创伤性休克病人进行早期,快速,积极的补液,输血增加有效循环量,监测生命体征等综合性抢救治疗与护理措施.结果:经早期积极急救护理,26例病人收缩压维持在60mmHg以上,意识清醒,脉搏有力,转入手术室或专科治疗,1例病人伤势严重抢救无效死亡.结论:创伤性休克病人,伤势复杂,死亡率高,伤后早期院前与急诊科的有效救护,是提高抢救成功率的关键.     

染色内镜和放大内镜技术是提高早期大肠癌诊治水平的重要手段

应用常规内镜技术难以发现大肠平坦型病变和凹陷型病变。近年来染色内镜和放大内镜技术已经发展成熟,在国外已获广泛应用,可以发现大肠微小病变和早期大肠癌。应用腺管开口分型方法可以预测肿瘤病变的组织学类型及肿瘤的浸润深度,据此可确定行内镜下粘膜剥离术或分片粘膜剥离术将肿瘤切除,抑或行外科手术治疗。在当前我国的胃肠内镜医疗界,应广泛开展染色内镜和放大内镜的临床应用,以早期发现大肠病变,提高我国大肠癌的内镜诊治水平。     

Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort

Abstract   We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing vs. insulin-providing treatments for diabetes. A total of 2,368 patients with type 2 diabetes and CAD was evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression adjusted for multiple covariates including age, sex, hemoglobin A1c (HbA1c), and diabetes duration. Fifty-one percent of BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR = 1.57, 95% CI: 1.15–2.13). Patients on sulfonylurea (SU) or combination of SU/metformin (Met)/thiazolidinediones (TZD) had marginally higher rates of DPN than the Met/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control, and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN.     

慢性鼻窦炎患儿家长疾病知识认知度调查

目的了解鼻窦炎患儿家长对儿童鼻窦炎相关知识的认知情况,为进一步加强卫生宣教、预防儿童鼻窦炎提供理论依据。方法对65名鼻窦炎患儿家长进行关于儿童鼻窦炎发病因素、临床表现、并发症以及对儿童生长发育影响等问题的问卷调查。结果调查显示95.4%的家长对儿童鼻窦炎知识缺乏了解,且知识获得途径单一。结论应通过各种途径加强儿童鼻窦炎知识的宣教,积极预防儿童鼻窦炎。