永久性人工心脏起搏器植入术后并发症原因分析及健康教育对策

目的 分析永久性人工心脏起搏器植入术后并发症及其原因,探讨心脏起搏器植入患者的健康教育方法及策略.方法 总结分析130例永久性人工心脏起搏器植入术患者的临床资料,了解起搏器并发症情况及其原因,针对性进行健康教育.结果 术后发生并发症15例,发生率11.5%,其中电极脱位7例（46.7%）,囊袋血肿5例（33.3%）,囊袋感染1例（6.7%）,起搏器综合征1例（6.7%）,起搏器感知功能障碍1例（6.7%）.并发症经相应处理及有效健康教育后,患者均恢复正常.结论 永久性人工心脏起搏器植入术后并发症以电极脱位最多见,加强对起搏器常见并发症的了解,重视健康教育,可早期发现并积极处理各种并发症,提高临床治愈率和患者的生活质量.     

高龄老年患者置入起搏器的安全性及可行性研究

目的探讨高龄老年患者置入起搏器的安全性和可行性,以及如何预防其并发症的发生。方法对2009年1月至2011年12月共计256例初次置人起搏器患者的临床资料进行回顾性分析,依据年龄不同,分为高龄组（〉75岁,168例）和低龄组（60～74岁,148例）。观察术中、术后起搏器阈值、感知情况,随访术中及术后7d、3个月、半年穿刺并发症及电极脱位、感染等并发症发生情况。结果2组患者性别、糖尿病病史、BMI、心房感知和起搏阈值、右心室感知和起搏阈值等方面差异均无统计学意义（均P〉0．05）。高龄组患者年龄、肺部疾病史患者所占比例均明显高于低龄组老年患者[（84±9）岁比（68±7）岁,63,9％（69／108）比10．1％（15／148）],差异均有统计学意义（均P〈0．05）。2组发生并发症共计13例,低年龄组6例,高龄组7例。与起搏器置入相关并发症5例,低龄组2例,1例穿刺过程中出现气胸,1例术后7d内出现囊袋血肿;高龄组3例,1例置入术后24h出现气胸,1例置入过程中出现血气胸,1例术后5个月发生起搏器感染。与电极导线相关并发症2例,低龄组和高龄组各I例。与起搏器相关并发症6例,其中低龄组3例,分别为电池提前耗竭2例,起搏器综合征1例;高龄组3例,分别为起搏器移位2例,起搏器感知、起搏功能障碍1例。2组并发症发生情况比较,差异无统计学意义（P〉0．05）。结论高龄患者置人起搏器安全可靠,但同时要了解高龄老年患者的特殊性以及注意围手术期管理。     

永久起搏器植入术后并发症的原因分析及护理对策

目的探讨减少永久起搏器植入术后并发症发生的护理对策。方法回顾分析284例安装永久起搏器患者的临床资料，总结降低并发症发生的有效护理措施。结果术后发生并发症共33例，发生率为11．6％，其中囊袋血肿10例、电极脱位10例、起搏器综合征5例、感知＋起搏障碍2例、囊袋破溃2例、亚急性感染性心内膜炎2例、脑梗死2例。结论术中规范熟练操作、加强术后严密观察与护理，早期发现并发症先兆并及时处理，可显著减少并发症的发生。     

205例高龄患者永久起搏器植入术并发症分析

目的 探讨高龄患者永久起搏器植入术的并发症及其防治方法。方法 男103例，女102例，年龄70～98岁。205例起搏器中单腔起搏器162例．双腔起搏器43例。分析并发症的发生原因。结果 发生并发症21例．术后常见的并发症分别是囊袋血肿12例、电极导线脱位4例、囊袋破溃及感染2例。囊袋血肿的发生与术前使用阿司匹林有关，电极导线脱位、囊袋破溃及感染等大部分与手术有关。结论 充分的术前准备，严密的术中操作，及时有效的处理并发症，高龄患者行永久起搏器植入术是安全的。     

早期活动方案联合起搏器胸带对永久起搏器植入术后并发症的影响

目的:探讨起搏器胸带联合早期活动方案对永久起搏器植入术后并发症的影响。方法:选择2015年2月-2017年12月在我科行永久起搏器被动电极植入术患者120例,按方便抽样的方法分为观察组和对照组,各60例。观察组给予起搏器胸带联合早期活动方案,24h取坐位或下床活动,对照组予常规护理联合早期活动方案,72h下床活动。比较两组患者切口渗血、囊袋积血、上肢深静脉血栓、导尿、肠梗阻和电极脱位等情况。结果:观察组切口渗血、囊袋积血、上肢深静脉血栓、导尿、肠梗阻发生率显著低于对照组(P0.05),两组电极脱位差异无统计学意义(P0.05)。结论:起搏器胸带能减少永久起搏器植入术后并发症,增加患者生理舒适度,从而提高临床护理质量。     

老年患者永久起搏器安装术后卧床时间对并发症的影响

目的分析老年患者永久起搏器安装术后卧床时间对并发症的影响。方法选取2013年3月至2015年3月间在本院接受永久性起搏器安装术的老年患者40例为研究对象,根据卧床时间不同随机分为观察组及对照组,每组20例。观察组术后6 h下床活动,对照组术后24 h下床活动,对比两组患者的术后并发症发生率及舒适度评分差异。结果观察组患者尿潴留、食欲减退、便秘、腰背酸痛、囊袋出血、电极脱位等并发症发生率低于对照组(P<0.05);观察组生理、心理、精神、社会文化及环境等舒适度评分值均高于对照组(P<0.05)。结论老年患者永久起搏器安装术后早期下床活动,可以减少相关并发症发生,提升患者舒适感受,具有积极的临床意义。     

永久性心脏起搏器置入术后并发症临床观察

目的探讨永久性起搏器安置术后并发症的相关因素及对策。方法 78例安置永久性人工心脏起搏器患者,所有起搏电极均采用Seldinger法通过穿刺锁骨下静脉置入,观察置入手术成功率及并发症。结果 78例患者手术均成功。随访期间无1例死亡。并发症发生率为6.4%,包括起搏电极脱位1例,囊袋出血1例,囊袋破溃1例,起搏器综合征1例,植入起搏器后植入侧上肢活动受限1例。结论及时发现并排除起搏治疗相关并发症,术后加强随访并进行起搏器程控监测,永久性人工心脏起搏术是一种安全、有效、可靠的治疗方法。     

急性心肌梗死老年患者临床分析

目的探讨老年急性心肌梗死患者临床处理方法与并发症处理原则。方法回顾性分析我院住院急性心肌梗死患者,老年组52例,均为60岁以上老年患者,对照组52例,为同期住院非老年患者。分析两组患者临床资料及并发症并存病情况,对比分析两组患者患者急性心梗临床疗效。结果老年组有效率、无效率和病死率分别为73．1％、17．3％和9．6％,有效率低于对照组的86．5％,病死率显著高于对照组,有效率高于对照组的14．1％,（P〈0．05）。两组患者并发症和伴发病的构成比及患病率亦具差异有显著性（P〈0．05）。结论积极谨慎防治老年急性心肌梗塞患者并发症具有重要临床意义。     

螺旋电极对起搏器植入术患者的影响

目的探讨永久起搏器植入术患者应用螺旋电极与传统冀状电极对病人舒适度及并发症的影响。方法永久起搏器植入术患者80例，随机分为螺旋电极组（观察组）及冀状电极组（对照组），观察2组病人术后并发症及舒适度的发生率。结果螺旋电极组舒适度明显高于冀状电极组（P〈0．01，P〈0．001），螺旋电极组术后并发症发生率明显少于冀状电极组（P〈0．01）。结论螺旋电极用于起搏器植入术患者安全有效。     

中青年与老年直肠癌的临床及病理特征对比研究

目的分析中青年与老年直肠癌患者的临床及病理特征差异。方法回顾性分析经手术病理或肠镜活检确诊并行手术治疗的42例中青年直肠癌患者（中青年组,年龄〈60岁）和65例老年直肠癌患者（老年组,年龄≥60岁）的临床、病理及随访资料,分析两组患者的生存情况。结果中青年组直肠癌家族史发生率较老年组高（P〈0．05）,首发症状中黏液脓血便、排便习惯改变发生率较老年组高（P〈0．05）,便秘发生率较老年组低（P〈0．05）．发病至确诊时间较老年组长（P〈0．05）。两组在腹痛、腹部肿块为首发症状方面比较差异有统计学意义（P〈0．05）。与老年组比较,中青年组肿瘤多位于腹膜返折下（P〈0．05）,腺癌发生率显著降低（P〈0．05）,黏液和印戒细胞癌发生率显著升高（P〈0．05）;高分化肿瘤发生率显著降低,低分化发生率显著升高（P〈0．05）;两组患者肿瘤Dukes分期、平均生存时间、3年生存率比较差异无统计学意义（P〉0．05）。结论中青年直肠癌患者较老年患者发现晚．恶性程度高,受遗传因素影响大,首发症状较老年患者有明显差异,如能及早诊断和手术治疗,两者预后差异无统计学意义。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.