危重病患者营养支持的研究进展

营养支持治疗危重病患者有着悠久的历史,早在300年前人们使用直肠内营养对危重病患者实施救治,到20世纪60年代末,肠内、外营养相继应用于临床,使许多危重病患者得到康复。人们逐渐认识到有效地调节危重病患者的代谢,对其进行合理、有效的营养支持,已经成为危重症病患者救治成功的关键。营养支持治疗亦存在不同时期对肠外营养支持及肠内营养支持治疗的认识。现就近年来危重病患者营养支持治疗方面的相关进展进行简要概述。     

Health-information exchange: why are we doing it,and what are we doing?

Health-information exchange, that is, enabling the interoperability of automated health data, can facilitate important improvements in healthcare quality and efficiency. A vision of interoperability and its benefits was articulated more than a decade ago. Since then, important advances toward the goal have been made. The advent of the Health Information Technology for Economic and Clinical Health Act and the meaningful use program is already having a significant impact on the direction that health-information exchange will take. This paper describes how interoperability activities have unfolded over the last decade and explores how recent initiatives are likely to affect the directions and benefits of health-information exchange.     

A divide-and-combine method for large scale nonparallel support vector machines

Nonparallel Support Vector Machine (NPSVM) which is more flexible and has better generalization than typical SVM is widely used for classification. Although some methods and toolboxes like SMO and libsvm for NPSVM are used, NPSVM is hard to scale up when facing millions of samples. In this paper, we propose a divide-and-combine method for large scale nonparallel support vector machine (DCNPSVM). In the division step, DCNPSVM divide samples into smaller sub-samples aiming at solving smaller subproblems independently. We theoretically and experimentally prove that the objective function value, solutions, and support vectors solved by DCNPSVM are close to the objective function value, solutions, and support vectors of the whole NPSVM problem. In the combination step, the sub-solutions combined as initial iteration points are used to solve the whole problem by global coordinate descent which converges quickly. In order to balance the accuracy and efficiency, we adopt a multi-level structure which outperforms state-of-the-art methods. Moreover, our DCNPSVM can tackle unbalance problems efficiently by tuning the parameters. Experimental results on lots of large data sets show the effectiveness of our method in memory usage, classification accuracy and time consuming.     

早期肠内营养支持对胃癌术后患者肠黏膜屏障功能保护的研究进展

胃癌患者在手术应激状况下，内脏血流减少，肠黏膜处于低灌注状态，易发生肠黏膜损伤。此外，手术刺激可导致肠黏膜充血、水肿、糜烂，加重肠黏膜损伤。近年来，肠内营养被作为保护肠黏膜屏障功能的有效手段。早期肠内营养在肠黏膜屏障功能保护中的作用机制已被证实，然而不同研究结果有一定差异。本研究综述了国内外有关胃癌术后患者行早期肠内营养支持的相关研究，整理、分析既往研究的结论和争议，为早期肠内营养支持的推广应用提供参考。     

Improvements in Extracorporeal Membrane Oxygenation for Primary Graft Failure After Heart Transplant

BackgroundSevere primary graft failure is a life-threatening complication of heart transplantation that may require venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. Surgical practices and management strategies regarding VA-ECMO vary between and within centers.MethodsWe performed a single-center retrospective cohort study on adult patients who received VA-ECMO for primary graft failure between 2013 and 2020. Clinical data were obtained from chart review and national databases. Patients were stratified by transplantation before or after 2017, when our center adopted additional objective criteria for VA-ECMO, adopted partial-flow support, and changed from central cannulation to chimney graft arterial cannulation of brachiocephalic, axillary, or aorta. The primary outcome was survival to device weaning. Secondary outcomes were survival to discharge, survival to 1 year, complications on support, and time to sedation weaning and extubation.ResultsFrom 276 heart transplant recipients, 39 severe primary graft failure patients requiring VA-ECMO were identified. Incidence of graft failure was 13% (n = 18 of 135) pre-2017 and 15% (n = 21 of 141) post-2017. Survival at all time points improved significantly after 2017, with greatest difference in survival to device weaning (61% pre-2017 vs 100% post-2017). After controlling for other factors in multivariable Cox regression modeling, transplantation after 2017 was a predictor of reduced mortality (hazard ratio, 0.209; 95% CI, 0.06-0.71; P = .01). Significant differences were not observed in other secondary outcomes of recovery.ConclusionsThe new VA-ECMO strategy displayed reasonable survival and a remarkable improvement from the prior system.     

Basic Management of Medical Emergencies: Recognizing a Patient's Distress

Background and OverviewMedical emergencies can happen in the dental office, possibly threatening a patient's life and hindering the delivery of dental care. Early recognition of medical emergencies begins at the first sign of symptoms. The basic algorithm for management of all medical emergencies is this: position (P), airway (A), breathing (B), circulation (C) and definitive treatment, differential diagnosis, drugs, defibrillation (D). The dentist places an unconscious patient in a supine position and comfortably positions a conscious patient. The dentist then assesses airway, breathing and circulation and, when necessary, supports the patient's vital functions. Drug therapy always is secondary to basic life support (that is, PABCD).Conclusions and Clinical ImplicationsPrompt recognition and efficient management of medical emergencies by a well-prepared dental team can increase the likelihood of a satisfactory outcome. The basic algorithm for managing medical emergencies is designed to ensure that the patient's brain receives a constant supply of blood containing oxygen.     

Women's experiences with vaginal pessary use

Title.  Women's experiences with vaginal pessary use.
Aim.  This paper is a report of a study of the lived experiences of women using vaginal pessaries for the treatment of urinary incontinence (UI) and/or pelvic organ prolapse.
Background.  The use of a vaginal pessary offers a non-surgical treatment option to provide physical support to the bladder and internal organs. As the literature asserts, a woman's choice to use a pessary is very individual and involves not only physical, but also psychological and emotional considerations.
Method.  Narrative inquiry was used to conduct face-to-face semi-structured interviews in 2007 with 11 postmenopausal women who accessed services from a Urogynecology Clinic in Eastern Canada.
Findings.  The women's stories revealed that living with a pessary is a life-changing experience and an ongoing learning process. The women's comfort level and confidence in caring for the device figured prominently in their experiences. Psychosocial support provided by the clinic nurses also played a primary role in the women's experiences.
Conclusion.  Women and healthcare professionals need to be aware of the personal isolation and embarrassment, and social and cultural implications that urinary incontinence may cause as well as the subjective experiences of using a pessary. With appropriate support, vaginal pessaries can provide women with the freedom to lead active, engaged and social lives.     

新疆地区应急卫生防疫保障辅助决策系统研制

针对新疆地区军事作战行动、反恐维稳和突发公共事件处置等应急卫生防疫保障的需求,建立应急卫生防疫保障辅助决策系统,为卫生防疫机构管理者在应急状态下实施科学、准确、及时的卫勤组织指挥提供辅助决策依据。笔者从卫生防疫机构管理者的需求出发,基于Windows平台,运用SQL server、Visual Foxpro决策模型等技术,构建应急卫生防疫辅助决策系统。整个系统由1个应急卫生防疫保障基础数据库模块和检索查询、突发公共卫生事件处置、疫情预警和卫生防疫保障、专家知识库和系统维护等功能模块构成。基础数据库包含应急处置力量信息、疫情处置地域信息和类似事件处置经验信息以及各类卫生防疫标准等;各功能模块从应用的角度进行设计,能够为卫生防疫机构管理提供信息查询,智能判断、疫情预警、方案生成、专家咨询等功能,每个功能模块即可自成体系,又可互相连接,具有高效实用、可扩充、便于维护等特点。总之,该系统是卫勤管理者应对突发事件的组织指挥平台,有助于提高卫生防疫指挥者的决策质量和水平,增强新疆地区应急卫生防疫综合保障能力。     

静脉-静脉体外膜肺氧合对无氧呼吸犬的供氧效果

目的探讨静脉(V)-V体外膜肺氧合(ECMO)对犬在无氧呼吸条件下的供氧效果。方法8只健康家犬,麻醉后建立股V-颈VECMO途径,停止犬的自主呼吸,以简易呼吸器维持呼吸,建立V-VECMO转流后,以氮气(N2)代替氧气(O2)造成无氧呼吸状态。实验中观察(1)V-VECMO通路所能达到的最大转流率(体外循环血量/心输出量);(2)转流率一定时相对应的动脉血氧饱和度(SaO2);(3)以转流率为自变量X,SaO2为应变量Y,以Spearman秩相关算出其相关系数rs,并采用rs界值表检验,P<0.05有统计学意义。结果(1)体外循环转流率与SaO2高度正相关(rs=0.951,P<0.01)。(2)转流率最大值的平均值为44.6%(95%可信限区间为43.3～45.9%)。(3)维持SaO2为90.0%时转流率预测值为22.5%,肛温36.2℃时实测值为21.5%。结论股V(插入下腔V)-颈内V途径ECMO对无氧呼吸犬提供氧支持有较大安全空间。