某三级甲等医院监护仪使用规范性调查分析及安全对策

[目的]调查护士使用多参数监护仪各重点实践环节规范性,发现使用中可能导致病人安全风险的不规范操作,分析相关因素并提出安全对策。[方法]采用自行编制的调查问卷对162名护士进行调查,对护士一般资料、监护仪使用各重点环节得分进行统计描述和单因素方差分析,并针对问题环节及相关因素提出安全对策。[结果]护士使用多参数监护仪重点实践环节总得分为(72.39±6.93)分,得分率为72.39%。各重点环节得分率最高的是监护仪设置(84.42%),最低的是持续使用监护仪,仅为57.25%,其中定时更换电极片得分率最低(39.25%)。单因素方差分析结果表明不同年龄、护龄、职称、科室对重点实践环节总得分比较差异有统计学意义(P<0.05)。针对出现的问题提出制定统一监护仪操作规范,加强护士培训,完善监护仪使用相关管理措施等病人安全对策。[结论]目前护士使用监护仪存在诸多不规范环节,易造成监护仪使用相关病人安全风险,需积极制定并实施安全对策。     

Constructing an In Silico Three-Class Predictor of Human Intestinal Absorption With Caco-2 Permeability and Dried-DMSO Solubility

Absorption of drugs is the first step after dosing, and it largely affects drug bioavailability. Hence, estimating the fraction of absorption (Fa) in humans is important in the early stages of drug discovery. To achieve correct exclusion of low Fa compounds and retention of potential compounds, we developed a freely available model to classify compounds into 3 levels of Fa capacity using only the chemical structure. To improve Fa prediction, we added predicted binary classification results of membrane permeability measured using Caco-2 cell line (Papp) and dried–dimethyl sulfoxide solubility (accuracy, 0.836; kappa, 0.560). The constructed models can be accessed via a web application.     

Exploring the effectiveness of a specialized therapy programme for burnout using subjective report and biomarkers of stress

The increasing prevalence of stress-related disorders such as burnout urges the need for specialized treatment approaches. Programmes combining psychotherapy and regenerative interventions emerge to be the most successful. However, evaluated therapy programmes are scarce and usually involve subjective symptom quantification without consideration of physiologic parameters. The aim of the present exploratory, single-group study was the multimodal investigation of the effectiveness of a specialized holistic therapy programme by assessing symptoms and biological markers of chronic stress. Seventy-one in-patients (39 men/32 women; age 46.8 ± 9.9 years) of a specialized burnout ward with the additional diagnosis of burnout (Z73.0) in conjunction with a main diagnosis of depressive disorder (F32 or F33) according to the International Classification of Diseases (ICD)-10 were included in the study. In addition to symptomatology, the stress-responsive biomarkers heart rate variability (HRV) and serum brain-derived neurotrophic factor (BDNF) were measured in patients at admittance to and discharge from the burnout ward applying a 6-week specialized treatment programme. At discharge, patients showed a significant reduction of symptom burden and a significant increase in serum BDNF, while HRV remained unchanged. The findings implicate that the therapy programme may have beneficial effects on symptomatology and neuroplasticity of patients with burnout. As therapy was often supplemented by psychopharmacological treatment, a relevant influence of antidepressant medication especially on BDNF has to be considered.     

Comparison of ultrathin bronchoscopy with conventional bronchoscopy for the diagnosis of peripheral lung lesions without virtual bronchial navigation

BackgroundFor the precise management of advanced lung cancers, bronchoscopy with a high diagnostic yield and abundant tumor specimens are required. In recent years, new devices and techniques have been rapidly developed, including the endobronchial ultrasound (EBUS) using a guide sheath, virtual bronchoscopic navigation (VBN), and ultra-thin bronchoscope (UTB), for the diagnosis of peripheral pulmonary lesions (PPLs). These techniques increase the diagnostic yield for PPL, thus requiring fewer biopsy specimens.VBN is generally not available at the city hospitals in Japan. In this study, using fluoroscopy without VBN, we studied whether the histologic diagnostic yield of radial EBUS for PPLs would be higher using a UTB (without guide sheath) or conventional bronchoscope (CB) (with guide sheath).MethodsWe retrospectively reviewed consecutive patients with suspected lung cancer who underwent bronchoscopy at the Hakodate Goryoukaku Hospital from April 2017 to March 2019. We analyzed 168 patients—102 using UTB and 66 using CB.ResultsThe diagnostic yields for PPL were significantly higher in the UTB group than in the CB group (74.5% vs. 59.1%; P = 0.04). The median examination time was significantly longer in the UTB group than in the CB group (24 vs. 20 min; P = 0.01). There were no statistically significant differences in the complication rate between the UTB and CB groups (3.9% vs. 3.0%; P = 0.69).ConclusionsUTB had a significantly higher tissue diagnostic yield than CB, without the use of VBN.     

南宁市某高校大学生的手机依赖情况及其影响因素分析

目的 了解大学生的手机依赖情况及其影响因素,从而针对改善大学生手机依赖提出相关建议.方法 采用整群抽样方法选择广西南宁市某高校大学生680人,采用UCLA孤独感量表(ULS-8)以及手机依赖量表(MPAI)进行调查,分析MPAI得分的影响因素.结果 共635名大学生参与调查,MPAI得分为17~82(41.08±11.91)分,存在手机依赖共191人,手机依赖率为30.08%.ULS-8总分、每天手机上网时间、每月手机消费费用对手机依赖得分MPAI有影响(P<0.05).结论 大学生手机依赖程度深,孤独感及手机的合理使用均可影响手机依赖程度;大学生应该审慎手机使用行为,社会、学校、家庭应该给予正确引导.     

A review of toxicity studies on graphene-based nanomaterials in laboratory animals

We summarized the findings of toxicity studies on graphene-based nanomaterials (GNMs) in laboratory mammals. The inhalation of graphene (GP) and graphene oxide (GO) induced only minimal pulmonary toxicity. Bolus airway exposure to GP and GO caused acute and subacute pulmonary inflammation. Large-sized GO (L-GO) was more toxic than small-sized GO (S-GO). Intratracheally administered GP passed through the air-blood barrier into the blood and intravenous GO distributed mainly in the lungs, liver, and spleen. S-GO and L-GO mainly accumulated in the liver and lungs, respectively. Limited information showed the potential behavioral, reproductive, and developmental toxicity and genotoxicity of GNMs. There are indications that oxidative stress and inflammation may be involved in the toxicity of GNMs. The surface reactivity, size, and dispersion status of GNMs play an important role in the induction of toxicity and biodistribution of GNMs. Although this review paper provides initial information on the potential toxicity of GNMs, data are still very limited, especially when taking into account the many different types of GNMs and their potential modifications. To fill the data gap, further studies should be performed using laboratory mammals exposed using the route and dose anticipated for human exposure scenarios.     

电针胃俞募配穴对胃扩张模型大鼠海马c-fos表达水平及神经细胞活动的影响

目的 探讨海马参与电针胃俞募配穴调节胃扩张模型大鼠胃运动的中枢机制。 方法 将40只7周龄SD大鼠随机分为模型组、胃俞组、中脘组、中脘+胃俞组、非经非穴组,每组8只。采用胃内球囊扩张法复制胃扩张模型。模型组不予针刺,其余各组进行电针干预,每日1次,每次20 min,连续干预7 d。采用压力换能器检测大鼠胃内压,用双导智能胃肠电图仪测定大鼠体表胃电。采用免疫荧光法检测大鼠海马c-fos的表达水平,采用微阵列电极技术记录大鼠海马神经细胞放电变化。结果 与模型组比较,中脘组、胃俞组及中脘＋胃俞组大鼠胃内压、胃电振幅均显著升高（P<0.05）,海马CA1区c-fos表达水平及海马CA1区神经细胞放电频率均显著增加（P<0.05）,但非经非穴组上述指标均无明显变化（P>0.05）。与中脘组、胃俞组比较,中脘+胃俞组大鼠胃内压、胃电振值均显著上升（P<0.05）,海马CA1区c-fos表达水平显著增加（P<0.05）,海马CA1区神经细胞放电频率显著增加（P<0.05）。结论 海马CA1区神经细胞参与电针胃俞募配穴对胃运动的调节机制。     

Metabolic tumor burden predicts prognosis of ovarian cancer patients who receive platinum‐based adjuvant chemotherapy

Volumetric parameters of positron emission tomography–computed tomography using 18F‐fludeoxyglucose (¹⁸F‐FDG PET/CT) that comprehensively reflect both metabolic activity and tumor burden are capable of predicting survival in several cancers. The aim of this study was to investigate the predictive performance of metabolic tumor burden measured by ¹⁸F‐FDG PET/CT in ovarian cancer patients who received platinum‐based adjuvant chemotherapy after cytoreductive surgery. Included in this study were 37 epithelial ovarian cancer patients. Metabolic tumor burden in terms of metabolic tumor volume (MTV) and total lesion glycolysis (TLG), clinical stage, histological type, residual tumor after primary cytoreductive surgery, baseline serum carbohydrate antigen 125 (CA125) level, and the maximum standardized uptake value (SUV_max) were determined, and compared for their performance in predicting progression‐free survival (PFS). Metabolic tumor volume correlated with CA125 (r = 0.547, P < 0.001), and TLG correlated with SUV_max and CA125 (SUV_max, r = 0.437, P = 0.007; CA125, r = 0.593, P < 0.001). Kaplan–Meier analysis showed a significant difference in PFS between the groups categorized by TLG (P = 0.043; log–rank test). Univariate analysis indicated that TLG was a statistically significant risk factor for poor PFS. Multivariate analysis adjusted according to the clinicopathological features was carried out for MTV, TLG, SUV_max, tumor size, and CA125. Only TLG showed a significant difference (P = 0.038), and a 3.915‐fold increase in the hazard ratio of PFS. Both MTV and TLG (especially TLG) could serve as potential surrogate biomarkers for recurrence in patients who undergo primary cytoreductive surgery followed by platinum‐based chemotherapy, and could identify patients at high risk of recurrence who need more aggressive treatment.     

探讨中药处方分析运用在中药药学服务中的效果

目的:探讨中药处方分析运用在中药药学服务中的临床效果。方法:选取2018年3月-2018年6月-门诊中药房接受存在处方问题的164张中药处方作为研究对象。对所有处方进行中药处方分析,明确处方中存在的问题,并统计被干预处方的来源科室,最终与来源科室沟通纠正处方中存在的问题。结果:164例中药处方分析结果显示超量是主要的处方问题(占54.88%),其次为配伍禁忌(26.83%),二者均明显高于其他处方问题发生率(P<0.05);而问题处方来源主要集中在消化与肾病科、儿科、名中医科以及肿瘤与风湿科;164张问题处方经分析以及与来源科室沟通、修正后均满足中医药合理用药要求。结论:临床中药处方中超量、配伍禁忌等问题现象较为普遍,经中药处方分析可及时发现处方中存在的问题,对提高中医药应用的合理性与安全性、有效性具有重要的临床意义。