步行运动锻炼干预对乳腺癌患者化疗相关认知障碍的影响

目的 探讨步行运动锻炼干预对乳腺癌患者化疗相关认知障碍及睡眠质量的影响。方法 采用整群随机法将2个科室首次进行化疗的乳腺癌患者分为两组，各28例。对照组接受化疗期常规护理，干预组在对照组基础上接受步行运动锻炼干预。干预前及干预12周后采用癌症治疗功能评估-认知功能量表、蒙特利尔认知评估量表、匹兹堡睡眠质量指数量表进行效果评定。结果 两组各有26例患者完成全程研究，干预后干预组患者主观认知得分、客观认知得分显著高于对照组，睡眠质量得分显著低于对照组(均P<0.05)。结论 步行运动锻炼干预可一定程度改善乳腺癌化疗患者认知功能及睡眠质量。     

妊娠期妇女体质量自我管理的定性用户画像研究

目的 探究妊娠期妇女体质量自我管理特征及人群差异,为制定针对性干预措施提供参考。方法 采用目的抽样法选取15名孕产妇进行半结构式访谈,通过Colaizzi 7步法分析资料;基于自我管理理论,人工抽取妊娠期妇女体质量自我管理特征构建画像,采用词云与表格形式完成画像的可视化。结果 提取5个特征：基本特征、认知特征、行为特征、社会支持特征、心理调适特征;构建4类妊娠期妇女体质量自我管理的典型画像：自主自律型、无能为力型、放任无为型、盲目实践型。结论 妊娠期妇女体质量自我管理存在较大的群体差异性,可根据不同的用户画像群体特征,给予个性化、精准化的管理方案。     

认知行为干预对乳腺癌化疗患者生活质量的探讨

目的探讨认知行为干预对乳腺癌术后化疗患者生活质量的影响。方法随机将60例女性乳腺癌术后患者分为2组,各30例。对照组采用常规治疗和健康康复指导教育。干预组在对照组基础上给予认知行为干预。采用乳腺癌患者生活质量量表(QLQ-BR53)检测比较患者化疗前、后各期的生活质量。结果化疗前2组患者的生活质量差异均无统计学意义(P0.05)。化疗结束后1周内(T2)及6个月(T3)干预组患者的生活质量功能维度得分均高于对照组,其中认知功能、情绪功能、总体健康状况、角色功能、未来看法评分比较差异有统计学意义(P0.05)。干预组患者T2、T3期症状维度得分均低于对照组,其中烦恼、疲倦、睡眠评分比较差异有统计学意义(P0.05)。结论对乳腺癌术后化疗患者给予行为干预,有利于提高患者的生活质量。     

乳腺癌患者化疗期间性行为认知及需求的质性研究

目的了解乳腺癌患者化疗期间性行为认知及需求状况。方法采用质性研究中的现象学研究方法,以半结构式访谈对19例乳腺癌患者进行深入访谈,利用Colaizzi分析程序进行分析、归纳、提炼和萃取主题。结果乳腺癌患者化疗期间性行为认知及需求主要归纳出5个主题:不良性生理心理体验;性行为的不确定感;体像紊乱对性心理的冲击;配偶性态度的转变;对健康性行为知识的需求。结论乳腺癌患者化疗期间缺乏正确的性认知,医务人员应对化疗期乳腺癌患者开展性教育,提高患者及家属的性知识水平,改善其整体生活质量。     

乳腺癌患者化疗期间体质量增加的研究进展

乳腺癌患者化疗期间的体质量增加严重影响了患者的预后和生活质量。本文就乳腺癌患者化疗期间体质量增加的现状、影响因素、体质量增加的机制以及体质量增加的干预模式进行综述,为乳腺癌患者化疗期间体质量管理的进一步研究提供指导。     

运动干预对乳腺癌患者术后体能、心理及生活质量的影响(附3例报道)

目的探讨运动干预对乳腺癌患者术后体能、心理及生活质量的影响。方法回顾性分析笔者所在诊所对3例乳腺癌患者术后进行运动干预后的临床数据。结果 3例患者均完成了3次/周的运动训练。运动干预12次(4周)时及运动开始至第3个月时,除1例患者在运动干预至第12次时的生活质量评分有下降及1例患者因用药导致1 min心率回落速度降低外,3例患者的体质量、心肺运动测试结果、功能性运动模式筛查结果、生活质量及心理状态均得到了改善。结论运动干预可能有利于乳腺癌患者术后的康复,待进一步积累病例验证。     

乳腺癌术后化疗对血浆D-二聚体的影响及临床意义

目的:探讨乳腺癌患者化疗后对血浆D-二聚体的影响及其临床意义.方法:检测100例乳腺癌患者化疗前后的血浆D-二聚体,并与100例健康体检者和良性肿瘤患者进行对比分析.结果:乳腺癌患者的D-二聚体水平显著高于对照组(P<0.05),Ⅰ、Ⅱ期患者化疗前明显低于Ⅲ、Ⅳ期患者两者有显著性差异(P<0.05).化疗后Ⅲ、Ⅳ期患者三周期化疗后与化疗前比较有显著性差异 (P <0.05).结论:乳腺癌晚期患者血液处于高凝状态,血浆D-二聚体的水平可作为观察乳腺癌患者的严重程度、化疗疗效判定及预后的指标.     

乳腺癌患者术后化疗期间的乳房重建认知态度及其相关影响因素分析

目的:探讨乳腺癌患者术后化疗期间的乳房重建认知态度及其相关影响因素分析。方法:选取2016年10月-2017年9月笔者医院收治的178例乳腺癌术后化疗患者为研究对象,对其进行乳房重建认知及态度的评估,并比较不同年龄、文化程度、职业、收入及社会支持程度者的评估结果,同时以多因素Logistic回归分析处理上述因素与患者乳房重建认知态度的关系。结果:178例乳腺癌术后化疗患者的乳房重建认知及态度较好者分别为80例及94例,占44.94%及52.81%,不同年龄、文化程度、职业、收入及社会支持程度者的乳房重建认知态度比较,差异均有统计学意义(P0.05)。多因素Logistic回归分析显示,年龄、文化程度、职业、收入及社会支持程度是乳腺癌术后化疗期间对乳房重建认知态度的影响因素。结论:乳腺癌术后患者化疗期间对乳房重建认知态度一般,且其相关影响因素较多,应根据影响因素进行针对性干预。     

化疗诱导的周围神经病变患者多模式运动干预

目的 探讨多模式运动在化疗诱导的周围神经病变患者中的应用效果。方法 便利抽取82例结直肠癌化疗诱导的周围神经病变患者,按病区分为对照组和干预组各41例。对照组采用步行运动,每次30 min,每周至少3次;干预组采用多模式运动干预,每次30~40 min,每周至少3次。干预前及干预12周,采用化疗诱导的周围神经病变评估工具、Berg平衡量表、修正版跌倒效能量表、起立-行走计时测试 进行效果评价。结果 对照组38例、干预组36例完成研究。干预12周后,干预组患者化疗诱导的周围神经病变得分、Berg平衡得分<45分发生率、起立-行走计时测试结果显著低于对照组,跌倒自我效能得分显著高于对照组（均P＜0.05）。结论 多模式运动有利于改善结直肠癌患者化疗诱导的周围神经病变症状体验及对日常生活能力的影响,提高患者的平衡功能、跌倒自我效能和移动能力。     

芳香疗法联合穴位按摩缓解乳腺癌术后化疗患者疲乏与睡眠障碍

目的 探讨芳香疗法联合穴位按摩对乳腺癌术后化疗患者疲乏及睡眠的影响。 方法 以抛硬币法将2个病区随机分为试验组和对照组，各纳入38例乳腺癌术后化疗患者。对照组给予常规护理，试验组在此基础上给予芳香疗法联合穴位按摩。干预前及干预21 d后，采用Piper疲乏修订量表、匹兹堡睡眠质量指数比较两组患者疲乏与睡眠状况。 结果 干预后，试验组患者疲乏总分及4个维度得分显著低于对照组，睡眠质量、入睡时间、睡眠障碍、日间功能障碍得分及睡眠总分显著低于对照组（均P＜0.05）。 结论 芳香疗法联合穴位按摩可改善乳腺癌术后化疗患者癌因性疲乏程度，提高睡眠质量。     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.