缩短院内延迟在缺血性脑卒中静脉溶栓治疗中的临床价值研究

目的：探讨通过卒中绿色通道建立,缩短院内延迟在急性脑梗死静脉溶栓治疗中的临床价值。方法收集2012年9月~2013年8月本科51例急性脑梗死患者接诊后进入卒中绿色通道,在4.5 h内接受重组组织型纤溶酶原激活物（rt-PA）静脉溶栓的急性脑梗死患者,评价就诊至溶栓时间,溶栓前、溶栓后2 h、14 d NIHSS 评分,溶栓后90 d mRS 评分,并分析危险因素与静脉溶栓预后的相关性。结果51例急性脑梗死患者从接诊至溶栓治疗的平均时间为（62.6±11.7）min,60 min 内接受溶栓治疗24例（47%）,44例完全或部分好转出院,院内延迟时间（DNT）〈62.6 min 组和〉62.6 min 组的 NIHSS 和 mRS 评分的差异明显（P 〈0.05）,即 DNT≤62.6 min 组预后较好。结论卒中绿色通道建立可有效缩短院内延迟时间,增加急性脑梗死患者溶栓治疗机会,具有较高的临床应用价值。

Treating delayed endoscopic sphincterotomy-induced bleeding:Epinephrine injection with or without thermotherapy

AIM： To compare the hemostatic efficacy between epinephrine injection alone and epinephrine injection combined with thermotherapy for delayed postendoscopic sphincterotomy （ES） bleeding. METHODS： Cases with delayed post-ES bleeding undergoing epinephrine injection alone （epinephrine injection group, n = 26） or epinephrine combined with thermotherapy （combination therapy group, n = 33） in our institution between 1999 and 2007 were retrospectively investigated. The main outcome measurements were： initial endoscopic hemostasis, rebleeding, complications, requirement of angiographic embolization or surgery, requirement for blood transfusion, and mortality. RESULTS： The initial hemostatic efficacy was 96.2% for epinephrine injection alone and 100% for combination therapy （P = 0.44）. There were four patients with re-bleeding in each group （16.0% vs 12.1%, P = 0.72）. There was only one complication of pancreatitis from the combination therapy group. Three patients （11.5%） in the epinephrine injection group and one patient （3%） in the combination therapy group required angiographic embolization or surgery （P = 0.31）. The total number of blood transfusions was not significantly different between the two groups （3.5 ± 4.6 U vs 3.5 ± 4.5 U, P = 0.94）. There was no bleeding-related death in either group. CONCLUSION： Epinephrine injection alone is as effective as epinephrine injection combined with thermotherapy for the management of delayed post- ES bleeding.

EFFECTS OF EARLY NUTRITION INTERVENTION ON IGF1, IGFBP3,INTESTINAL DEVELOPMENT, AND CATCH-UP GROWTH OF INTRAUTERINE GROWTH RETARDATION RATS

To investigate the effects of early nutritional intervention on the serum insulin-like growth factor-1 (IGF1),insulin-like growth factor binding protein 3 (IGFBP3), intestinal development, and catch-up growth of intrauterine growth retardation (IUGR) rats by giving the IUGR new born rats different protein level diet. Methods IUGR rat model was built by starvation of pregnant female rats. Twenty-four IUGR pups and 8 normal pups were divided randomly into 4 groups: normal control group (C group); IUGR control group(S group), IUGR low-protein diet group (SL group), and IUGR high-protein diet group (SH group). Detected the serum IGF1, IGFBP3, body weight, body length, intestinal weight length, intestinal villi height (VH), crypt depth (CD), villi absorbing area (VSA), mucous thickness (MT), and disaccharidase at the 4th week. Results (1) The SH group showed the fastest catch-up growth, serum IGF1, IGFBP3, VH, and VSA were significantly higher than those of normal control group and IUGR control group. The intestinal weight and length, and the activities of lactase and saccharase of the SH group also reached the normal control group level. (2) The SL group kept on small size, the serum IGF1, IGFBP3, and most of intestinal histological indexes were all significantly lower than other groups. (3) IGF-1, IGFBP3 were positively correlated to intestinal VH, VSA, saccharase, body weight and length. Conclusions The serum IGF1 was a sensitive index to the catch-up growth. The early nutritional intervention of high-protein diet after birth is helpful for the catch-up growth of IUGR through promoting the intestinal development and the ab-sorption of nutrition

Effect of thermal storage performance of concrete radiant cooling room on indoor temperature

A building model with radiant cooling system was established and the cooling load, indoor temperature, surface temperature of the wails and other parameters in non-cooling and radiant cooling room were calculated by TRNSYS. The comparative analysis of the characteristics of attenuation and delay proves that the operation of radiant cooling system increases the degree of temperature attenuation of the room and reduces the inner surface temperature of the wall significantly, but has little effect on the attenuation coefficient and delay time of wall heat transfer. The simulation results also show that the inner surface temperature of the walls in the radiant cooling room is much lower than that in non-cooling room in the day with the maximum cooling load, which reduces the indoor operation temperature largely, and improves the thermal comfort. Finally, according to the analysis of indoor temperature of the rooms with different operation schedules of cooling system, it can be derived that the indoor mean temperature changes with the working time of radiant cooling system, and the operation schedule can be adjusted in practice according to the actual indoor temperature to achieve the integration of energy efficiency and thermal comfort.

T-condylar fracture delayed for 10 days in a 5-year-old boy： a case report and review of the literature

T-condylar fracture is rare in paediatric age group, especially in skeletally immature children less than 9 years old. with very few cases reported in available literature. We present such a case in a 5 year old child that was initially managed as a supracondylar fracture at another centre before referral to us, 10 days after the injury. The child was diagnosed as having a displaced T-condylar fracture on plain radiograph. Open reduction and internal fixation with K-wires was performed. At 2 years follow-up, the child had good range of motion at elbow with 5°of cubitus varus. With this background we discuss the pertinent principles of management ofT-condylar fractures in skeletally immature children.