Colon ischemia: A comprehensive review

The clinical and endoscopic features of colon ischemia (CI) are non-specific. CI is correctly identified at the time of presentation in only 9% of patients is. The true incidence is likely underestimated because many mild cases resolve spontaneously without medical treatment. Furthermore, since most cases of CI are transient, and no specific cause is detected they are often considered to be “idiopathic”. In the setting of severe CI correct diagnosis and prompt recognition and therapy as well as identification of underlying causes are crucial for a favourable outcome. Although less severe, mild cases may present with similar symptoms, the prognosis and management are completely different and managed conservatively rather than with surgery. Unfortunately, data from most studies and current guidelines do not provide recommendations on the long-term management of CI or about the need for endoscopic follow-up to detect the development chronic, recurrent and/or ischemic colonic strictures. In this review, we focus on the definition of CI, its aetiology, and patterns of presentation. We highlight the pharmacological and/or endoscopic management as determined severity of disease that allow for improved outcomes. Prompt recognition and treatment using a multidisciplinary approach are essential for successful management of severe CI because mortality rates are significantly higher when the diagnosis is delayed.     

军事高技术对军事医学的影响及其对策

军事高技术在军事医学领域中的广泛应用,对军事医学发展提出了新的要求和挑战.本文对军事高技术的特点及其对军事医学的影响进行了探讨,并提出了加强军事医学研究的几点启示与思考.     

Development and validation of an instrument for measuring junior nurses’ recognition and response abilities to clinical deterioration (RRCD)

BackgroundNurses of all levels are expected to be competent in managing clinical deterioration. Given their limited experience and basic-level knowledge, there is a concern about junior nurses' clinical and patient management skills. However, junior nurses’ abilities to recognise and respond to clinical deterioration have not been adequately explored because of the absence of a comprehensive tool.ObjectivesThe aim of this study was to develop a new self-assessment scale to assess the junior nurses’ recognition and response abilities to clinical deterioration and to examine its reliability and validity.MethodsScale items were based on literature reviews and interviews. The preliminary scale was generated through two rounds of expert review. A panel of five experts evaluated content validity. After a pilot study, the questionnaire was distributed to 168 junior nurses via convenience sampling. Subsequent statistical analysis of results included construct validity, internal consistency, and test–retest reliability.ResultsSix factors were included, and 69.310% of the total variance was explained by the 25 items comprising the scale. The Cronbach's alpha coefficient was 0.905 (95% confidence interval [CI]: 0.812–0.979) for the overall scale and 0.655–0.838 for its subscales. The Guttman split-half reliability was 0.856 (95% CI: 0.806–0.894). The test–retest reliability of the scale was 0.878 (95% CI: 0.836–0.911).ConclusionWe developed a scale for measuring the abilities of junior nurses to recognise and respond to clinical deterioration and confirmed its reliability and validity. More experimental studies are needed to further evaluate this instrument.     

Expertise modulates local regional homogeneity of spontaneous brain activity in the resting brain: An fMRI study using the model of skilled acupuncturists

Studies on training/expertise‐related effects on human brain in context of neuroplasticity have revealed that plastic changes modulate not only task activations but also patterns and strength of internetworks and intranetworks functional connectivity in the resting state. Much has known about plastic changes in resting state on global level; however, how training/expertise‐related effect affects patterns of local spontaneous activity in resting brain remains elusive. We investigated the homogeneity of local blood oxygen level‐dependent fluctuations in the resting state using a regional homogeneity (ReHo) analysis among 16 acupuncturists and 16 matched nonacupuncturists (NA). To prove acupuncturists' expertise, we used a series of psychophysical tests. Our results demonstrated that, acupuncturists significantly outperformed NA in tactile‐motor and emotional regulation domain and the acupuncturist group showed increased coherence in local BOLD signal fluctuations in the left primary motor cortex (MI), the left primary somatosensory cortex (SI) and the left ventral medial prefrontal cortex/orbitofrontal cortex (VMPFC/OFC). Regression analysis displayed that, in the acupuncturists group, ReHo of VMPFC/OFC could predict behavioral outcomes, evidenced by negative correlation between unpleasantness ratings and ReHo of VMPFC/OFC and ReHo of SI and MI positively correlated with the duration of acupuncture practice. We suggest that expertise could modulate patterns of local resting state activity by increasing regional clustering strength, which is likely to contribute to advanced local information processing efficiency. Our study completes the understanding of neuroplasticity changes by adding the evidence of local resting state activity alterations, which is helpful for elucidating in what manner training effect extends beyond resting state. Hum Brain Mapp 35:1074–1084, 2014. © 2013 Wiley Periodicals, Inc.     

Serous neoplasms of the pancreas share many,but not all aspects of their microvascular and angiogenic profile with low-grade clear cell renal cell carcinomas

Similarly to clear cell renal cell carcinomas (CCRCC), serous neoplasms (SN) of the pancreas frequently show inactivation of VHL gene, clear cell histology and abundant microvasculature. Data on the microvascular and angiogenic profile of SN are scarce. Aiming to examine further the striking resemblance of clear cell epithelial neoplasia in pancreas and kidney, we compared the microvascular profile and expression of pro-angiogenic factors in SN and in CCRCC using immunohistochemical stains. SN and CCRCC shared a predominance of differentiated blood vessels, scarcity of lymphatic vessels, presence of CD105 and claudin-5 in tumoral vessels, expression of vascular endothelial growth factor (VEGF)-A, cyclooxygenase-2 (COX-2), carbonic anhydrase IX in tumoral cells, and lack of VEGF-C in tumoral cells. In contrast to CCRCC, SN showed lower pericyte coverage of vessels, lower blood vessel endothelial cell proliferaction fraction, more pronounced VEGF receptor (VEGFR)-2 and glucose transporter-1 expression, higher inducible (iNOS) but lower endothelial nitric oxide synthase (eNOS) expression, as well as presence of VEGFR-3 and D2-40 expression in epithelial cells. In conclusion, we found a significant similarity but not equality of microvascular biology of SN and CCRCC. We recognized VEGFR-2, VEGFR-3, COX-2, iNOS, eNOS and D2-40 as new markers of epithelial cells of SN of the pancreas.     

抗击新型冠状病毒肺炎护理人员自我防护培训方案建立与实践

目的建立新型冠状病毒肺炎护理人员自我防护培训方案,总结培训实践体会,为医疗机构在突发公共事件中有效组织培训提供借鉴。方法建立针对四个层面护理人员的自我防护培训方案,开展及时、高效、严格、针对性强的培训,包括理论知识培训和操作技能培训,采用在线授课、操作视频VCR教学、实时防护督导和培训的方式实施培训。结果通过培训,四个层面人员自我防护技术及理论考核通过率100%;进驻武汉一线、发热门诊、感染科隔离病房及全院护理人员至今未发生感染;拍摄制作的“医护人员自我防护技术”在全院得到推广使用。结论在抗击新型冠状病毒肺炎的疫情期间,加强护理人员自我防护能力的培训,可以提高护理人员的自我防护意识及自我防护技能,是确保医护人员“零感染”的重要保障。     

基于Delphi法急诊护士健康工作环境影响因素问卷的编制

目的编制急诊护士健康工作环境影响因素调查问卷,确定该问卷从守恒模式理论不同角度分析的可行性,为进一步调查分析急诊科工作环境影响因素提供依据。方法通过文献调研、小组讨论、3轮专家咨询完成问卷编制。结果问卷包含4个方面,共50个条目。23位专家参与函询,三轮专家积极系数分别为87.5%、89.3%和88.9%;专家权威系数分别为81.8%、82.4%和83.9%。专家意见协调程度和意见集中程度好。不同分类影响因素的信度为0.880~0.915,内容效度为0.994~1.000。结论问卷函询结果专家权威程度高,专家意见协调程度好,信效度检验好,问卷具有科学性,可从守恒模式理论的角度调查分析急诊科工作环境影响因素。     

医学生临床实习质量的影响因素与对策研究

临床实习是培养医学生成为临床医生的关键时期,是培养医学生具有良好医德医风、巩固专业基础理论知识和提高临床基本技能的重要环节,其质量的好坏直接关系到医学生毕业后的医疗能力,影响到医学人才的培养。本文通过对实习生的问卷调查,分析了影响临床实习质量的因素,并提出了一些对策。