Case Report:A case of chylothorax treated curatively with Sapylin, a streptococcus preparation

Chylothorax is an uncommon disease where fatty fluid accumulates within the chest cavity. Conservative manage- ment, including repeated thoracentesis or pleurodesis, seems to be suitable to most cases. Herein, we present a case of efficacious pleurodesis by intrapleural injection of Sapylin, a streptococcus preparation, for the treatment of chylothorax. A 52-year-old non-smoking female farmer was diagnosed as idiopathic chylothorax after we ruled out possible causes including chest trauma, lymphoma, lung cancer, filariasis, tuberculosis, and etc. Two-time intra-thoracic injection of 3 Klinische Einheit (KE) Sapylin achieved rapid and effective control of chylothorax with no severe side effects. Sapylin may facilitate pleurodesis by producing a strong inflammatory response.     

Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax: report of twelve cases

Background: Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at present. Methods: Herein we share our experiences in the treatment of 12 patients with hepatic hydrothorax by video-assisted thoracoscopic surgery (VATS).Repair of the diaphragmatic defects, or pleurodesis by focal pleureetomy, talc spray, mechanical abrasion, electro-cauterization or injection was administered intraoperatively, and tetracycline intrapleural injection was used postoperatively for patients with prolonged (＞7 d) high-output (＞300 ml/d) pleural effusion. Results: Out of the 12 patients, 8 (67%) had uneventful postoperative course and did not require tube for drainage more than 3 months after discharge. In 4 (33%) patients the pleural effusion still recurred after discharge due to end-stage cirrhosis with massive ascites. Conclusion: We conclude that the repair of the diaphragrnatic defect and pleurodesis through VATS could be an alternative of transjugular intrahepatic portal systemic shunt (TIPS) or a bridge to liver transplantation for patients with refractory hepatic hydrothorax. Pleurodesis with electrocauterization can be an alternative therapy if talc is unavailable.     

恶性胸腔积液置管引流注药化疗的护理

目的总结43例恶性胸腔积液置管引流注药化疗的护理观察。方法采用Seldinger技术胸腔置管引流后,注入化疗药物,加强导管护理,注意临床观察。结果本组置管43例次,其中导管阻塞9例次（20.9%）,导管滑脱3例次（6.9%）,轻度穿刺点炎症4例次（9.3%）,未见导管断裂,近期胸腔积液完全清除15例（34.8%）,部分清除28例（65.1%）。结论加强对胸腔置管的护理及注意注药的方法是本组治疗的关键,此方法不良反应并发症少,患者痛苦少,治疗疗效佳,胸腔置管引流注入化疗药物是治疗恶性胸腔积液的最有效方法之一。     

Video-assisted thoracoscopic surgery （VATS） for bilateral primary spontaneous pneumothorax

Objective:To review our experience of the treatment of bilateral primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopic surgery (VATS). Materials and methods: Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results: Twelve males and one female, with age ranging from 15 to 36 years (mean 23.1 years), were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously (n=4) or sequentially (n=9). The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients (84.6%) had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was (45.6±18.3) min (range 25-96 min) and (120.6±28.7) min (range 84-166 min) respectively for the non-simultaneous (second VATS for the recurrence of contralateral side after first VATS) and simultaneous (bilateral VATS in one operation) procedures. There was no postoperative mortality. However, prolonged air leakage (>7 d) occurred in one patient (7.7%) who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions: VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.     

Sexual, physical, verbal/emotional abuse and unexplained chest pain

Objectives

Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained chest pain, and to identify whether any potential relationship is being driven by an association with psychological distress.

Methods

Subjects were identified from 2 previous random population surveys that included people with irritable bowel syndrome (IBS) and/or functional dyspepsia (FD) and healthy controls. People in the unexplained chest pain group (n = 27) had chest pain in the past 12 months that was not heartburn or heart disease. People in the comparison group (n = 60) did not have chest pain for more than 12 months. Self-reported abuse and psychological variables were assessed using validated measures.

Results

Emotional/verbal abuse (20.8% versus 4.4%, P = 0.032) and physical abuse (16.7% versus 2.2%, P = 0.028) were significantly more common in people with unexplained chest pain versus the comparison group. Only a history of emotional/verbal abuse was a significant independent predictor of meeting criteria for unexplained chest pain (OR = 5.66; 95%CI 1.01–31.80, P = 0.049) even after controlling for IBS and/or FD (OR = 5.45; 95%CI 0.96–30.83, P = .05), but not when depression was controlled for (OR = 4.70; 95%CI 0.90–27.61), P = 0.08.

Conclusions

A history of childhood emotional/verbal abuse is a risk factor for having unexplained chest pain but the association may be moderated by psychological distress, specifically depression.     

Oblique chest views as a routine part of skeletal surveys performed for possible physical abuse--is this practice worthwhile?

OBJECTIVE: To evaluate the utility of oblique chest views in the diagnosis of rib fractures when used as a routine part of the skeletal survey performed for possible physical abuse. METHODS: Oblique chest views have been part of the routine skeletal survey protocol at Primary Children's Medical Center since October 2002. Dictated radiology reports since that time were reviewed, and all cases with rib fractures documented were chosen for study. For each chosen case two pediatric radiologists identified and recorded rib fractures using only the PA and lateral chest radiographs (standard two-view chest series) from the skeletal survey for each case. In a separate session they identified and recorded rib fractures using the PA, lateral, right oblique, and left oblique radiographs (four-view chest series) from the skeletal survey for each case. The results were compared. RESULTS: Twenty-two cases with rib fractures were identified. Interpretation of the four-view chest series was different than interpretation of the two-view chest series in 12 of the 22 cases (54%). Overall, the four-view chest series differed significantly in the number of rib fractures diagnosed compared with the two-view chest series (p=.02, Wilcoxon matched-pairs signed-rank test) adding 19 rib fractures and excluding 6 rib fractures. CONCLUSIONS: The results indicate that use of the four-view chest series adds information to that obtained from the two-view chest series and increases the accuracy of diagnosing rib fractures in cases of possible physical abuse. Addition of oblique chest views to the routine protocol for skeletal surveys performed for possible physical abuse is recommended.     

新型太阳能热水器电控盒上盖注塑成型模拟分析

为了解决某新型太阳能热水器电控盒上盖因形状复杂带来的装配时发生翘曲变形等缺陷问题,利用有限元分析方法对其成型过程进行数值模拟.建立了太阳能热水器电控盒上盖零件的数学模型,并利用Moldflow软件对其进行流动、保压、冷却过程及翘曲分析,得到该零件注射成型的最佳工艺条件.结果表明:利用数值模拟方法可较大限度地消除产品设计、模具设计及制品成型过程中可能出现的缺陷,从而缩短产品开发周期.     

芯片毛细管电泳--电化学检测

芯片上的实验室是集样品的制备、进样、分离、衍生化、检测于一体的微型装置,在过去的十几年里受到广泛关注.本文综述了芯片毛细管电泳(CE)-电化学检则(CE)的进展,阐述了该系统的基本构成、进样方式、检测器安装及应用等.     

光动力学治疗光敏剂在动物体内浓度分布的实验研究

为了探讨光敏剂瘤内注射法在临床上的应用,本实验将高浓度血卟啉衍生物（HpD）直接注入荷瘤小鼠的肿瘤内,利用组织涂片法,通过荧光显微镜观察．结果,注射后1～5天内,局部注射组肿瘤内发橘红色荧光的细胞的百分比明显高于腹腔注射组,以1～4天为著．局部注射组的肝、脾、肾组织中发荧光细胞的百分比低于腹腔注射组．根据实验结果．肿瘤内注射可以提高瘤内HpD的浓度,而减少正常组织中HpD的含量,减轻毒副作用．     

普通型2019冠状病毒病的临床特征和HRCT表现

目的探讨普通型2019冠状病毒病(COVID-19)患者的临床表现与高分辨率CT(HRCT)的影像特征。方法回顾性分析我院收治的25例COVID-19确诊患者的临床资料及胸部CT检查,进一步分析其临床特征、实验室指标及HRCT影像学特征。结果我院收治的25例COVID-19患者均为普通型,发热(19/25,76%),干咳(18/25,72%);所有患者白细胞计数均正常,淋巴细胞计数不同程度减少(15/25,60%),血沉增快(12/25,48%),C反应蛋白升高(10/25,40%),出现降钙素原降低(2/25,8%);平均住院日为19.8±3.9天,从出现临床症状到CT检查阳性平均时间为4.9±2.7天。首次胸部HRCT病灶分布为单侧9例(36%,左肺4/25,16%;右肺5/25,20%),双侧16例(64%);20例(80%)病灶分布位于周边,5例(20%)位于周边为主及中心同时受累。HRCT表现中单纯磨玻璃影(GGO)为25例(100%),GGO伴局灶性实变为5例(20%),4例(16%)伴片状实变影。在第二次HRCT检查中,大部分患者病灶增多、范围变广,局部病灶融合,并见支气管充气征。结论普通型COVID-19患者临床表现相对较轻,HRCT是其诊断和评估的重要手段。     

基于胜任力的多学科协作培训模式在急性胸痛规范化培训教学中的应用探讨

目的探讨基于岗位胜任力的多学科协作(MDT)培训模式在急性胸痛规范化培训教学中的应用效果。方法南京医科大学第二附属医院心内科在住院医师急性胸痛规范化培训中采用基于胜任力的MDT培训模式,培训结束后采用技能操作、理论考试和问卷调查的方法对学生进行考核。结果以岗位胜任力为基础的MDT教学法更能强化规培医师多学科综合知识,增强团队合作精神,激发学习热情,提高临床实践技能。结论在急性胸痛规范化培训教学中采取基于胜任力的MDT教学法能提高规培教学质量,使规培学员更好地掌握急性胸痛的规范化诊治。     

手机后壳的注塑模具设计

以手机后壳注塑模具设计为例,介绍了注塑模具的设计方法和流程。首先根据塑件材料及工艺特性用MOLDFLOW软件对零件进行模流分析,然后选择注塑机并确定型腔数目,接着确定成形方案:总体结构设计、分型面设计、浇注系统设计、脱模机构设计、冷却系统设计等。最后进行注塑机工艺参数校核,包括注射量、锁模力、注射压力、模具厚度和注射机闭合高度等方面。该设计方法对其它不同结构产品的注塑模具设计有一定的参考价值。     

奥扎格雷钠联合黄芪注射液治疗糖尿病肾病的疗效观察

目的：观察奥扎格雷钠与黄芪注射液联合治疗糖尿病肾病的疗效。方法：将84例早期糖尿病肾病患者随机分为3组，每组28例，在常规治疗的基础上，A组加用黄芪注射液，B组加用奥扎格雷钠注射液，C组加用黄芪注射液与奥扎格雷钠注射液，疗程均为20d。观察治疗前后各组尿白蛋白排泄率（UAER），血尿素氮（BUN），血清肌酐（SCr），糖化血红蛋白（HbAlc）的变化。结果：糖化血红蛋白，血清肌酐，血尿素氮，尿白蛋白排泄取：3组治疗后均比治疗前显著下降（P〈0．01），C组下降幅度优于A组和B组（P〈0．05）。结论：奥扎格雷钠联合黄芪注射液治疗糖尿病肾病能降低糖化血红蛋白，显著降低尿白蛋白排泄率，同时改善肾功能。     

缺血修饰白蛋白在急性胸痛患者鉴别诊断中的价值

目的探讨血清缺血修饰白蛋白（IMA）在急性胸痛患者鉴别诊断中的价值。方法通过检测163例由于急性胸痛来我院就诊的患者血清中IMA水平,根据患者最终诊断结果,从而判断IMA在急性胸痛患者中的鉴别诊断价值。结果研究显示在163例患者中,心源性胸痛患者为102例,IMA值为（98．37±19．12）。非心源性胸痛为61例,IMA值为（32．54±12．11）。结论IMA在急性胸痛患者的检测中可以有效地鉴别心源性胸痛和非心源性胸痛,对于减少心源性胸痛的漏诊起到了显著的作用。     

Competition between ethanol-induced reward and aversion in place conditioning

Previous place conditioning studies in mice have shown that injection of ethanol immediately before a conditioned stimulus (CS+) produces conditioned preference, whereas injection of ethanol immediately after CS+ produces conditioned aversion. In the present experiments, we examined the learning that occurs when ethanol is injected in “ambiguous“ procedures that provide the opportunity for both types of conditioning. When ethanol was given midway through the CS (Experiments 1 and 2) or both before and after the CS (Experiment 3), the direction of place conditioning was the same as when mice were exposed only to whichever contingency occurred first (a primacy effect). That is, injection of ethanol in the middle of the CS conditioned aversion, whereas injection both before and after the CS conditioned preference. Because these results support the idea that ethanol elicits both aversive and rewarding effects, they are most consistent with conditioning theories that conceptualize unconditioned stimuli (USs) as events that can activate multiple representational components.     

模腔压力对注塑工艺参数的响应

通过实验分别研究模腔压力对注射速度、注射压力、熔体温度及模腔表面温度等工艺参数变化的响应,并总结响应规律。     

Influence of injection of Chinese botulinum toxin type A on the histomorphology and myosin heavy chain composition of rat gastrocnemius muscles

Background and objective

Botulinum toxin type A (BoNT/A) is a metalloprotease that blocks synaptic transmission via the cleavage of a synaptosomal-associated protein of 25 kDa (SNAP-25). It has gained widespread use as a treatment for cerebral palsy and skeletal muscle hypertrophy. In China, Chinese botulinum toxin type A (CBTX-A), a type of BoNT/A, is in widespread clinical use. However, the changes in the morphological and biochemical properties of treated muscles and in remote muscles from the CBTX-A injection site are relatively unknown. Therefore, we investigated the changes in histomorphology and myosin heavy chain (MyHC) isoform composition and distribution in rat gastrocnemius muscles after intramuscular injection of CBTX-A.

Methods

The weakness of the injected muscles was assessed periodically to identify their functional deficiency. Muscle slices were stained with hematoxylin-eosin (HE) and adenosine triphosphatase (ATPase). MyHC isoform composition was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) to uncover changes in morphological and biochemical properties.

Results

Our findings demonstrate that following injection of CBTX-A 5 U into rat gastrocnemius muscles, shifts in MyHC isoform composition emerged on the third day after injection and peaked in the fourth week. The composition remained distinctly different from that of the control group after the twelfth week. More specifically, there was a decrease in the proportion of the type IIb isoform and an increase in the proportions of type IIx, type IIa, and type I isoforms.

Conclusions

Data revealed that CBTX-A led to a shift in MyHC composition towards slower isoforms and that the MyHC composition remained far from normal six months after a single injection. However, no noticeable remote muscle weakness was induced.     

芯片上的流动注射分析

流动注射分析(Flowinjection analysis,FIA)打破了分析化学必须在物理化学平衡条件下进行的传统,具有广泛的适应性、高效率、低消耗、重现性好及自动化程度高等优点.目前异军突起的微型全分析系统为流动注射分析理论与技术的发展注入了新的动力.本文总结了十余年来在微流控分析芯片上进行流动注射分析操作的方法与...     

润神口服液对小鼠生长状况的影响

润神口服液1号和2号给小鼠腹腔注射,结果显示试验早期对小鼠生长有增重效应(P<0.05),晚期无明显影响。体重增长似与饮食量无关。实验提示注射口服液的小鼠对植物血凝素(PHA)刺激可能有一定稳定和调理机体机能状态的作用。     

聚合物驱转后续水驱时机和方法

以往注聚区块转后续水驱技术政策并没有规范,也没有深入的研究,转后续水驱的时机和方法各不相同;部分区块转后续过早,导致停注聚后含水上升过快,转后续水驱过晚聚合物成本高、经济效益差。该文对以往转后续水驱区块停注聚效果进行对比分析,得出转后续水驱的最佳时机,又根据以往转后续水驱积累的经验,总结出了停注聚的方法。