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 management, 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.     

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。     

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。     

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。     

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.     

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。     

大型注塑模具使用寿命影响因素分析及改进方法

大型注塑模具失效有自然失效、人为损坏和异常破坏三种形式。从大型注塑模具失效的普遍现象,分析了影响大型注塑模具使用寿命的主要因素是定位导向件、滑动件、分型面等刚性接触摩擦、型腔过量变形和人为损坏,并据此提出了一些从模具结构设计、模具材料选择、模具制造过程和模具使用与维护方面提高大型注塑模具使用寿命的改进办法。     

浅析历史教学方法的选择与运用

目前，对中学生历史教学方法的探讨取得了长足进步，可以说形成了历史教学方法的“百宝箱”，但每一种方法都有其特定的功能或局限。在历史教学中，如何选择与运用恰当的教学方法?本试图从教学的目的、内容、指导思想、学生的特点，以及情感因素等方面作一点有益的探索。     

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.     

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.     

低渗透储层裂缝方位综合分析方法研究

在对低渗透油田的开发以及注水的深入研究中,发现在有些注水井井区内,部分注水井尽管生产正常,但对应的油井一直没有见效,储层裂缝则成为说明这些注水井井区无效（或低效）注水的重要依据,而有效识别裂缝则成为至关重要的问题。文章介绍了裂缝识别的几个方法,包括见水动态分析法、注入压力动态分析法、微地震裂缝检测和同位素示踪剂法。     

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．     

在医学影像技术学课程中开展大学生自主创新性实验

通过在医学影像技术学实验课程中开展降低胸部MDCT扫描辐射剂量优化方案的自主设计性、创新性实验项目,改革传统实验内容和方法,变学生被动学习为主动学习,提高学生的综合素质、实践技能以及创新精神和能力。     

贵妃鸡等三种优质鸡母鸡肌纤维特性与肉品质关系的研究

本试验随机选取了在相同条件下饲养的120日龄贵妃鸡、怀乡鸡和北京油鸡三种优质鸡母鸡各24只,分别取其胸肌和腿肌做成切片,用于对三种优质鸡的母鸡肌纤维密度、肌纤维长度和肉品质进行比较,同时对肌纤维特性与肉品质的相关性进行研究,结果表明:(1)肌纤维特性方面:三种优质鸡腿肌直径大于胸肌直径,相差范围在0.73～2.6μm之间,其中怀乡鸡>北京油鸡>贵妃鸡;三种优质鸡胸肌密度大于腿肌密度,相差范围在43.18～181.56根/mm2之间,其中北京油鸡>怀乡鸡>贵妃鸡.(2)肉品质方面:三种优质鸡腿肌肉色大于胸肌肉色,差异极显著(P<0.01),相差范围在2.62～9.01之间,其中北京油鸡胸肌肉色大于怀乡鸡,而怀乡鸡胸肌肉色大于贵妃鸡,分别大1.33和3.2,腿肌肉色上,北京油鸡大于贵妃鸡,贵妃鸡大于怀乡鸡,分别大3.64和3.19;三种优质鸡胸鸡和腿肌pH值差异不显著(P>0.05),范围在6.1～6.2之间;三种优质鸡胸肌滴水损失大于腿肌,差异极显著(P<0.01),其中胸肌上,贵妃鸡滴水损失大于怀乡鸡,怀乡鸡大于北京油鸡,分别大0.82和3.09,腿肌滴水损失上,怀乡鸡滴水损失大于贵妃鸡,贵妃鸡大于北京油鸡,分别大2.3和3.49.(3)相关性方面:总体上看,肌纤维直径与密度呈负相关关系(r<0),肌纤维特性与肉色呈正相关关系(r>1),肌纤维特性与肌肉pH值和滴水损失呈负相关关系(r<0).     

结核性胸腔积液两种引流方法的比较

目的观察胸腔置管引流术与间断性胸水穿刺术两种方法治疗结核性胸腔积液的疗效。方法大量结核性胸腔积液患者48例,随机分为胸腔置管引流术治疗组24例和间断性胸水穿刺术组24例,比较并发症发生率及其疗效。结果胸腔置管引流术组有效率明显高于胸腔穿刺术组;胸腔置管引流术组胸水吸收较快、并发症较少,二者有显著统计学意义（P〈0.05）。结论胸腔置管引流术治疗结核性胸腔积液并发症少,住院治疗时间短,是比较理想的辅助治疗方法。     

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。