Autophagy limits activation of the inflammasomes

Inflammasomes are multiprotein complexes that control the maturation and production of interleukin-1 family members and play crucial roles in host defense against pathogens. However, dysregulated activation of inflammasomes is associated with intense inflammation, leading to the development of inflammatory diseases. Therefore, inflammasomes must be activated at a proper strength to protect against infection and avoid tissue damage. Recent studies have highlighted the cross-talk between inflammasome activation and autophagy, the cellular machinery associated with the degradation of intracellular components and maintenance of cellular homeostasis. Notably, deficiencies in autophagy-related proteins induce the aberrant activation of inflammasomes, causing severe tissue damage. In contrast, autophagy inducers ameliorate symptoms of inflammasome-related diseases. In this review, we discuss recent advances in the involvement of autophagy in regulating inflammasomes activation and in the development of inflammatory diseases.     

外固定架治疗高能量胫骨开放骨折的康复护理

目的探讨外固定架治疗高能量胫骨开放骨折的术后康复护理方法。方法2004年6月-2006年6月共计52例胫骨开放粉碎性骨折的患者,平均年龄42.6岁,其中左小腿33例,右小腿19例;男31例,女21例。全部采用单臂外固定架治疗。对52例患者术后做好心理护理、制定护理措施、加强病情观察和功能锻炼。结果所有患者获得12~18个月的随访(平均14.7个月),其中2例保肢成功后因严重开放伤术后感染最终截肢,2例出现外固定架针道后期感染,5例发生骨不连,其他患者骨折全部愈合,骨折愈合时间为10~32周,平均18.5周。结论外固定架是一种有效的、适宜于高能量胫骨骨折的治疗方法,配合有效护理,可提高手术成功率,促进患者康复。     

凹槽交锁髓内钉治疗开放性胫骨骨折

目的评价凹槽交锁髓内钉治疗开放性胫骨骨折的疗效.方法应用德国aap公司Birigid非扩髓凹槽交锁髓内钉治疗57例开放性胫骨骨折.髓内钉直径平均7.8mm.结果所有患者得到4～22个月随访.骨折平均愈合时间28周.1例Ⅲa型伤口感染,2例Ⅲ型骨折延迟愈合,经改动力化后获得骨性愈合,无断钉发生,无骨不连.结论Biorigid凹槽交锁髓内钉治疗胫骨开放性骨折,只要严格掌握手术时机,彻底清创,具有操作简单,创伤小,适应症范围广,术后早期活动,骨折愈合率高,感染率低以及不扩髓等优点.     

房颤或房扑病人行心内直视手术在主动脉开放后静脉注射胺碘酮的效用

目的：观察术前存在房颤或房扑病人行心内直视手术在主动脉开放后静脉注射胺碘酮的作用及对血流动力学的影响。方法：选择术前存在房颤和房扑病人行心内直视手术100例，随机分为胺碘酮组（A组，在主动脉开放、自主心跳已恢复、并减少腔静脉回流的部分循环始10min内经静脉推注胺碘酮150mg，其后24h静脉滴注10mg／kg）和对照组C组，将胺碘酮替换为安慰剂。监测心电图、桡动脉压（ASP）、中心静脉压（CVP）、心输出指数（CI）以及中心静脉压（CVP），随访术后情况。结果：房颤的转复率与房颤病史密切相关。两组心律转复成功率有显著差异（P〈0．05），且A组与c组比较心率较慢（P〈0．01），CVP较低（P〈0．05），CI较高（P〈0．05）而ICU滞留时间较短（P〈0．01）。结论：在主动脉开放且自主心跳已恢复后静脉给予胺碘酮，对原有房颤或房扑病人，心内直视手术后心律转复成功率有显著作用，并能更好控制心室率，从而达到较好稳定血流动力学的效果并改善病人的预后。     

Orem自理模式在食管癌放疗饮食护理中的应用研究

目的 探讨在放疗期间对早中期食管癌患者进行自我饮食护理的有效性。方法 选择进行放疗的食管癌患者78例，随机分成自我饮食护理组和传统饮食护理组各39例。对自我饮食护理组患者，通过营养、自理能力评估，制订自我饮食护理计划；传统饮食护理组采用常规护理。分别评估2组患者的自护能力、观察营养监测指标和生存质量的变化。结果 自我饮食护理组的自护能力和营养指标改善明显。生存质量评分2组比较差异有显著性。结论 食管癌放疗期间的自我饮食护理可以帮助患者尽快满足自理需要，完善自我照顾进程，能明显改善患者的营养状况，避免焦虑不安，使患者在精神和心理上充实愉快，放疗进程顺利，明显提高了患者的生存质量。     

Time to Initial Debridement and wound Excision (TIDE) in severe open tibial fractures and related clinical outcome: A multi-centre study

BackgroundRecent national (NICE) guidelines in England recommend that initial debridement and wound excision of open tibial fractures take place within 12 h of the time of injury, a change from the previous target of 24 h. This study aims to assess the effect of timing of the initial debridement and wound excision on major infective complications, the impact of the new guidance, and the feasibility of adhering to the 12 h target within the infrastructure currently existing in four major trauma centres in England.MethodsA retrospective review was performed of Gustilo-Anderson grade 3B open tibial fractures presenting acutely to four Major Trauma Centres (MTCs) in England with co-located plastic surgery services over a ten-month period. The incidence of deep infective complications was compared between patients who underwent initial surgery according to the new NICE guidance and those who did not. Patients warranting emergency surgery for severely contaminated injury, concomitant life-threatening injury and neurovascular compromise were excluded. Multi-variable logistic regression analysis was performed to assess the effect of timing of surgical debridement on development of deep infective complications.Results112 patients with 116 fractures were included. Six fractures (5.2%) developed deep infective complications. 38% (n = 44) underwent primary debridement within 12 h and 90% within 24 h. There was no significant difference in the incidence of major infective complications if debrided in less than or greater than 12 h (4.5% vs 5.6%, p = 1.00). Logistic regression found no significant relationship between timing of wound excision and development of deep infection. There was no significant decrease in mean time to debridement following introduction of new national guidance (13.6 vs 16.1 h) in these four MTCs.ConclusionOverall, the rate of deep infection in high energy open tibial fractures managed within the four major trauma centes is low. Achieving surgical debridement within 12 h is challenging within the current infrastructure, and it is unclear whether adhering to this target will significantly affect the incidence of severe infective complications. Debridement within 24 h appears achievable. If a 12-h target is to be met, it is vital to ensure dedicated orthoplastic capacity is adequately resourced.     

Algorithmic treatment of Busch-Hoffa distal femur fractures: A technical note based on a modified Letenneur classification

Treatment of distal femur fractures in the coronal plane can be challenging. Depending on fracture line orientation, topography and associated comminution, decision-making regarding approach and fixation is not straightforward and can result in complications. Therefore, treatment of coronal plane distal femur fractures (Busch-Hoffa fractures) should be approached in a systematic manner, leading to efficient planning and operative execution. Here, we offer a proposed treatment algorithm, guiding treatment, approach and fixation based on the modified Letenneur classification of coronal plane distal femur fractures.     

The concept of interpersonal pattern in Peplau's Theory of Nursing

Interpersonal pattern, defined as the category in which separate interpersonal acts are linked by similar, defining characteristics, is a critical, data-rich concept that is used in the therapeutic nurse-client relationship. If this concept is studied within the framework of aesthetic knowing in nursing, the processes of deliberate involvement that form the crux of the nurse-client relationship become illuminated. An illustrative case study brings this concept to life by demonstrating the use of interpersonal pattern as the focus of intervention with a frail, elderly woman. In this case study, the nurse practices aesthetic knowing to assess and respond to the woman, and ultimately assist in her forward movement towards optimum function and health. Linkages of this type of intervention to all of nursing practice are made by integrating the use of interpersonal pattern with aesthetic knowing in nursing.     

Assessing paedophilia based on the haemodynamic brain response to face images

Objectives: Objective assessment of sexual preferences may be of relevance in the treatment and prognosis of child sexual offenders. Previous research has indicated that this can be achieved by pattern classification of brain responses to sexual child and adult images. Our recent research showed that human face processing is tuned to sexual age preferences. This observation prompted us to test whether paedophilia can be inferred based on the haemodynamic brain responses to adult and child faces. Methods: Twenty-four men sexually attracted to prepubescent boys or girls (paedophiles) and 32 men sexually attracted to men or women (teleiophiles) were exposed to images of child and adult, male and female faces during a functional magnetic resonance imaging (fMRI) session. Results: A cross-validated, automatic pattern classification algorithm of brain responses to facial stimuli yielded four misclassified participants (three false positives), corresponding to a specificity of 91% and a sensitivity of 95%. Conclusions: These results indicate that the functional response to facial stimuli can be reliably used for fMRI-based classification of paedophilia, bypassing the problem of showing child sexual stimuli to paedophiles.