多学科合作模式下PICC导管体内断裂漂移入心脏的急救护理与原因分析

总结1例淋巴瘤病人经外周静脉置入中心静脉导管后41 d体内断管漂移入心脏的护理。护理要点包括断管后的紧急处理、病情观察、心理护理、健康宣教等。通过多学科合作急救和护理,导管断端顺利取出,病人安全出院。     

规范化介入护理配合在TAVR股动脉入路与心尖入路手术患者中的应用

目的:探讨规范化介入护理配合措施在经导管主动脉瓣置换术(TAVR)股动脉入路与心尖入路手术患者中的应用效果。方法:回顾性分析25例经股动脉入路与经心尖入路两种手术路径下TAVR患者的护理方法,手术室介入护士分别给予患者术前访视,入室后术前、术中及术后规范化护理配合措施,术后观察患者康复情况并随访其生存状态。结果:25例TAVR患者中,22例采用经股动脉路径、3例采用经心尖路径,所有患者手术过程顺利,术后均未发生相关并发症,随访6个月患者生存状态良好。结论:围术期规范化护理配合方法可以对并发症做到早预防、早识别、早治疗,为患者手术顺利完成提供保障。     

Experimental evolution of conflict mediation between genomes

Transitions to new levels of biological complexity often require cooperation among component individuals, but individual selection among those components may favor a selfishness that thwarts the evolution of cooperation. Biological systems with elements of cooperation and conflict are especially challenging to understand because the very direction of evolution is indeterminate and cannot be predicted without knowing which types of selfish mutations and interactions can arise. Here, we investigated the evolution of two bacteriophages (f1 and IKe) experimentally forced to obey a life cycle with elements of cooperation and conflict, whose outcome could have ranged from extinction of the population (due to selection of selfish elements) to extreme cooperation. Our results show the de novo evolution of a conflict mediation system that facilitates cooperation. Specifically, the two phages evolved to copackage their genomes into one protein coat, ensuring cotransmission with each other and virtually eliminating conflict. Thereafter, IKe evolved such extreme genome reduction that it lost the ability to make its own virions independent of f1. Our results parallel a variety of conflict mediation mechanisms existing in nature: evolution of reduced genomes in symbionts, cotransmission of partners, and obligate coexistence between cooperating species.     

经胸非体外小切口室间隔缺损封堵术患儿的术中配合

目的:总结经胸非体外小切口室间隔缺损(VSD)封堵术的配合体会。方法:对2013年6~11月我院收治59例行经胸非体外小切口VSD封堵术的患儿术中配合体会进行回顾性总结。结果:56例均一次封堵成功,经食管超声心动图提示无残余分流,3例改为心脏直视手术,所有手术均顺利完成,效果满意。结论:做好术中配合及充分的心脏直视手术准备,对保证手术成功及减少术后并发症有重要意义。     

门诊外科手术护理配合对手术安全性及患者满意度的影响

目的：探讨护理配合对门诊手术安全性及患者满意度的影响。方法将我院门诊2013年12月至2014年2月收治的200例患者随机分为观察组和对照组,对照组采用常规护理配合,观察组在对照组的基础上采用人性化的护理配合模式,比较两组患者的手术安全性及患者的满意度。结果观察组进入手术室时的恐惧评分低于对照组,心率、血压、肌肉紧张程度、疼痛反应程度小于对照组,术中体温高于对照组,差异有统计学意义（ P＜0．05）。观察组在健康教育、心理护理、护理过程等护理满意度方面均高于对照组,差异有统计学意义（ P＜0．05）。结论人性化的手术护理配合能够提高手术的安全性,保证手术的顺利进行,提高患者的护理满意度。     

校园网络环境下的病理生理学自主学习模式研究

目的探讨校园网络环境下的病理生理学自主学习模式。方法随机选取学院2012级临床医学6-7班、10-11班分别为对照组(传统教学模式)和教改组。教改组实施以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式,对学生考核成绩进行对比分析和问卷调查。结果教改组学生成绩高于对照组,学生的自主学习能力明显提高(P<0.05)。结论以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式可以实现以学助教,有利于学生的终身发展。     

精细化护理干预在腹腔镜食管裂孔疝修补术护理配合中的作用

ObjectiveTo explore the role of fine nursing in laparoscopic repair of hiatal hernia. Methods the clinical data of 300 patients who underwent laparoscopic esophageal hiatus repair in the operating room of people's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were retrospectively analyzed. Methods150 cases of patients with laparoscopic hiatal hernia repair from January to December 2018 were selected as the control group, and 150 cases from January to December 2019 were selected as the experimental group. The operation nursing cooperation of the experimental group was treated with fine nursing, while the control group was treated with conventional management methods. The occurrence of intraoperative complications, operating room efficiency, patient satisfaction and physician satisfaction of the two groups before and after the implementation were compared It's a matter of intention. The measurement data were expressed as mean ± standard deviation (±s) by t test, and the count data were expressed as percentage (%) by chi square test. Resultsthe incidence of intraoperative pressure injury, hypothermia, deep venous thrombosis and other complications in the experimental group was lower than that in the control group, and the difference was statistically significant (χ²=4.147, 4.253, 4.124; P＜0.05). The turnover time, preparation time and operation time of the experimental group were shorter than those of the control group (F=69.437, 48.394; P＜0.05). The difference of satisfaction between the two groups was statistically significant (χ²=4.353, P＜0.05). There was a significant difference in the satisfaction of the two groups (χ²=0.605, P＜0.05). Conclusionthe application of fine nursing intervention in laparoscopic hiatal hernia repair has obvious effect, which is worthy of promotion.     

Collapse of cooperation in evolving games

Game theory provides a quantitative framework for analyzing the behavior of rational agents. The Iterated Prisoner’s Dilemma in particular has become a standard model for studying cooperation and cheating, with cooperation often emerging as a robust outcome in evolving populations. Here we extend evolutionary game theory by allowing players’ payoffs as well as their strategies to evolve in response to selection on heritable mutations. In nature, many organisms engage in mutually beneficial interactions and individuals may seek to change the ratio of risk to reward for cooperation by altering the resources they commit to cooperative interactions. To study this, we construct a general framework for the coevolution of strategies and payoffs in arbitrary iterated games. We show that, when there is a tradeoff between the benefits and costs of cooperation, coevolution often leads to a dramatic loss of cooperation in the Iterated Prisoner’s Dilemma. The collapse of cooperation is so extreme that the average payoff in a population can decline even as the potential reward for mutual cooperation increases. Depending upon the form of tradeoffs, evolution may even move away from the Iterated Prisoner’s Dilemma game altogether. Our work offers a new perspective on the Prisoner’s Dilemma and its predictions for cooperation in natural populations; and it provides a general framework to understand the coevolution of strategies and payoffs in iterated interactions.Iterated games provide a framework for studying social interactions (1–6) that allows researchers to address pervasive biological problems such as the evolution of cooperation and cheating (2, 7–12). Simple examples such as the Iterated Prisoner’s Dilemma, Snowdrift, and Stag Hunt games (13–18) showcase a startling array of counterintuitive social behaviors, especially when studied in a population replicating under natural selection (16, 19–25). Despite the subject’s long history, a systematic treatment of all evolutionary robust cooperative outcomes for even the simple Iterated Prisoner’s Dilemma has only recently emerged (21, 26–29).Understanding the evolution of strategies in a population under fixed payoffs already poses a steep challenge. To complicate matters further, in many biological settings the payoffs themselves may also depend on the genotypes of the players. Changes to the payoff matrix have been studied in a number of contexts, including one-shot two-player games (13), payoff evolution without strategy evolution (30, 31), under environmental “shocks” to the payoff matrix (32–34), and using continuous games (22, 23, 35). Here we adopt a different approach, and we explicitly study the coevolutionary dynamics between strategies and payoffs in iterated two-player games. We decouple strategy mutations from payoff mutations, and we leverage results on the evolutionary robustness of memory-1 strategies with arbitrary payoff matrices to explore the relationship between payoff evolution and the prevalence of cooperation in a population. We identify a feedback between the costs and benefits of cooperation and the evolutionary robustness of cooperative strategies. Depending on the functional form (35) of the relationship between costs and benefits, this feedback may either reinforce the evolutionary success of cooperation or else precipitate its collapse. In particular, we show that cooperation will always collapse when there are diminishing returns for mutual cooperation.     

Heterogeneous networks do not promote cooperation when humans play a Prisoner's Dilemma

It is not fully understood why we cooperate with strangers on a daily basis. In an increasingly global world, where interaction networks and relationships between individuals are becoming more complex, different hypotheses have been put forward to explain the foundations of human cooperation on a large scale and to account for the true motivations that are behind this phenomenon. In this context, population structure has been suggested to foster cooperation in social dilemmas, but theoretical studies of this mechanism have yielded contradictory results so far; additionally, the issue lacks a proper experimental test in large systems. We have performed the largest experiments to date with humans playing a spatial Prisoner's Dilemma on a lattice and a scale-free network (1,229 subjects). We observed that the level of cooperation reached in both networks is the same, comparable with the level of cooperation of smaller networks or unstructured populations. We have also found that subjects respond to the cooperation that they observe in a reciprocal manner, being more likely to cooperate if, in the previous round, many of their neighbors and themselves did so, which implies that humans do not consider neighbors' payoffs when making their decisions in this dilemma but only their actions. Our results, which are in agreement with recent theoretical predictions based on this behavioral rule, suggest that population structure has little relevance as a cooperation promoter or inhibitor among humans.     

Iterated Prisoner's Dilemma contains strategies that dominate any evolutionary opponent

The two-player Iterated Prisoner's Dilemma game is a model for both sentient and evolutionary behaviors, especially including the emergence of cooperation. It is generally assumed that there exists no simple ultimatum strategy whereby one player can enforce a unilateral claim to an unfair share of rewards. Here, we show that such strategies unexpectedly do exist. In particular, a player X who is witting of these strategies can (i) deterministically set her opponent Y's score, independently of his strategy or response, or (ii) enforce an extortionate linear relation between her and his scores. Against such a player, an evolutionary player's best response is to accede to the extortion. Only a player with a theory of mind about his opponent can do better, in which case Iterated Prisoner's Dilemma is an Ultimatum Game.