住院患者健康教育评价标准的应用研究

目的：形成完善的住院患者健康教育评价标准,对健康教育活动起到系统的监测作用。方法选取2013年7—12月1297例住院患者作为研究对象,按照随机数字表法分为研究组540例和对照组757例。对照组采用常规健康教育,研究组采用健康教育评价标准确定后的健康教育。比较两组患者健康教育评价标准结果及患者满意度。结果入院时两组患者健康知识的知晓率比较差异无统计学意义(P>0.05),出院时研究组健康知识知晓率为93.1%,高于对照组的82.6%,差异有统计学意义(χ2=31.20,P<0.05)。出院时研究组患者满意度得分为(98.88±2.88)分,高于对照组的(95.95±6.63)分,差异有统计学意义(t=-9.26,P<0.01)。研究组患者在参与计划、寻求健康教育方式、控制疾病疼痛的方法、病情自我观察、生活自理能力、执行药物计划、选择食物、健康及功能锻炼的健康行为评价积极率分别为88.9%,92.7%,91.1%,85.1%,80.4%,83.3%,87.2%,81.1%,均优于对照组,差异有统计学意义(χ2值分别为141.6,176.8,178.3,59.3,36.5,64.6,91.4,30.2;P<0.01)。结论住院患者健康教育评价标准的形成对临床护理人员实施系统化、规范化的健康教育与提高健康教育评价有很大帮助。     

Profiling of the pattern of the human TRB/IGH–CDR3 repertoire in primary biliary cholangitis patients

IntroductionPrimary biliary cholangitis (PBC) is characterized by lymphocyte cell-induced immune destruction of cholangiole. However, the immunological characteristics of peripheral blood cells in PBC patients remain unknown. This study was designed to reveal the differences in the immunological characteristics between PBC patients and healthy adults.MethodsWe performed high-throughput sequencing to determine the TRB–CDR3 and IGH–CDR3 repertoires of T and B cells in 19 healthy controls and 29 PBC patients. Different immunological characteristics, such as distinctive complementarity determining region 3 (TRB–CDR3) lengths, usage bias of V and J segments, and random nucleotide addition were identified in PBC and healthy control (HC) groups.ResultsThe diversity of TRB–CDR3 was significantly lower in the PBC group compared with the HC group. CDR3 and the N addition length distribution were significantly changed compared with the HC group. It appeared that the PBC group had more short N additions and the HC group had more long N additions in the TRB–CDR3 repertoire. The results also revealed a set of PBC-associated clonotypes compared with the HC group.ConclusionThis study suggested that PBC is a complex autoimmune disease process with evidence of different TRB–CDR3 rearrangements compared with healthy adults that share IGH–CDR3 peptides with some autoimmune diseases. This new insight may contribute to a better understanding of the immune functions of PBC patients and benefit efficient applications of PBC diagnosis and treatments.     

Asymmetrically Substituted Poly(diitaconates) Obtained by Reversible Addition‐Fragmentation Chain Transfer (RAFT) Polymerization: Synthesis,Copolymerization Parameters,and Antimicrobial Activity

Asymmetrically substituted poly(diitaconate) copolymers are synthesized from 1‐((N‐tert‐butoxycarbonyl)‐2‐aminoethyl)‐4‐propyl diitaconate (PrIA) and different comonomers (N,N‐dimethyl‐acrylamide, DMAA; acrylic acid; or ((N‐tert‐butoxycarbonyl)‐2‐aminoethyl)methacrylate) by reversible addition–fragmentation chain transfer polymerization (RAFT). The RAFT copolymerization parameters of PrIA and DMAA are r_DMAA = 0.49 and r_PrIA = 0.17, compared to r_DMAA = 0.52 and r_PrIA = 0.54 obtained by free radical copolymerization (FRP). Thus, the RAFT process has a stronger trend to alternating polymerization than the FRP process. The polydispersity index of the RAFT copolymers is around 1.2–1.8, compared to 2.8–2.9 for the corresponding FRP copolymers. After removal of the tert‐butoxycarbonyl protective groups, antimicrobially active synthetic mimics of antimicrobial peptides are obtained. The thus activated poly(PrIA‐co‐DMAA) copolymers (repeat unit ratio 1:1) have an increasing activity against Escherichia coli and Staphylococcus aureus with increasing molar mass. The RAFT copolymers are slightly more active and less toxic than comparable FRP polymers, leading to a higher selectivity for bacteria over mammalian cells. Higher molar fractions of PrIA in poly(PrIA‐co‐DMAA) copolymers (up to 80 mol%) do not increase their antimicrobial activity; reduction of the BuIA content in poly(BuIA‐DMAA) (down to 10 mol%) leads to a loss of activity against both E. coli and S. aureus.     

公立医院增设药事服务费的研究综述

新一轮医药卫生体制改革,提出了要探索有效方式,逐步改革以药补医机制,通过设立药事服务费等方式逐步改革或取消药品加成政策,同时采取适当增加政府投入、改革支付方式等措施,完善公立医院补偿机制。药事服务费的相关研究随之出现,但由于对药事服务费的定义存有不同理解,目前对药事服务成本的测算尚未有统一的方法。通过对药事服务费的概念及存在的争议、药事服务费的测算现况及存在问题的综述,有助于在总结现有不足的前提下,寻找新的思路。     

比马前列素用于睫毛增长的安全风险探讨

目的 探讨比马前列素用于睫毛增长的安全风险。方法 针对比马前列素的理化性质、药理作用和药动学、临床应用、不良反应、化妆品监管政策等方面进行梳理分析，为监管工作提供理论依据。结果 比马前列素是一种人工合成的前列腺素类似物——前列腺素F_2α类似物，可以有效降低眼压和促进毛发增长。其消除半衰期为45 min，主要通过尿液排泄。FDA孕期评级为C级，可能对胎儿有不利影响；上市后不良反应主要包括眼睛充血、眼睑红斑、眼刺激等，其安全性有必要进行进一步评估；不符合中国化妆品的定义和规定的功效宣称，欧盟和加拿大禁止比马前列素等药物成分用于化妆品，美国将其作为药品管理。结论 为了保证化妆品质量安全，规范和促进行业健康发展，建议中国监管部门跟踪关注比马前列素等前列腺素类似物的使用安全性，必要时调整管理措施。     

Complications and operative spine fusion construct length in Parkinson’s disease: A nationwide population-based analysis

There remains a dearth of information regarding the surgical complications following multilevel spine surgery in Parkinson’s disease (PD) patients. This retrospective cohort study was performed to address this issue on a nationwide level using the Nationwide Inpatient Sample from 2001 to 2012. More than 25 postoperative variables were analyzed to assess the impact of fusion construct length on each variable. Subsequently, the same analysis was performed on admissions without PD. 4301 PD patients with spine fusion were identified, of whom 934 (21.7%) underwent fusion of at least three levels; the remaining 3367 underwent fusion of 1–2 levels. Patients with 3+ level fusions were more likely to suffer paraplegia (P = .001; OR = 3.0; 95%CI = 1.5–6.1), hematoma/seroma (P = .009; OR = 1.9; 95%CI = 1.2–3.2), IVC filter placement (P = .018; OR = 2.1; 95%CI = 1.1–3.9), RBC transfusion (P < .001; OR = 3.2; 95%CI = 2.7–3.8), PE (P = .027; OR = 4.5; 95%CI = 1.2–16.9), postoperative shock (P = .023; OR = 7.3; 95%CI = 1.3–39.6), ARDS (P < .001; OR = 4.1; 95%CI = 2.7–6.3), VTE (P = .006; OR = 2.6; 95%CI = 1.3–5.4), acute posthemorrhagic anemia (P < .001; OR = 2.0; 95%CI = 1.7–2.4), device-related complications (P < .001; OR = 3.1; 95%CI = 2.3–4.2), and in-hospital mortality (P = .005; OR = 3.4; 95%CI = 1.5–7.4). 3+ level fusions were also more likely to have LOS > 1 week (P < .001; OR = 2.1; 95%CI = 1.8–2.5), and a nonroutine discharge (P = .005; OR = 1.9; 95%CI = 1.4–2.4). 692,173 non-PD patients with spine fusion were identified; 123,964 (17.9%) underwent 3+ level fusion. Differences between 3+ versus 1–2 level fusions were similar to those in PD patient, but unlike PD patients, postoperative infection was significant while in-hospital mortality, PE and VTE were not. Fusion of at least three levels increased morbidity, mortality, and adverse discharge disposition compared with 1–2 level fusions. Nearly 80% of all spine fusions performed in the United States are fewer than three levels. These findings are worth considering during operative decision-making in both PD and non-PD patients.     

急诊室小儿心搏呼吸骤停流行病学调查及初步复苏效果评估

目的 调查儿科急诊室内小儿心搏呼吸骤停情况,分析影响心肺复苏效果的因素,并对复苏效果做初步评估.方法 采用标准的院内Utstein格式(the in-hospital Utstein style)前瞻性收集数据,填写调查表,内容包括:心搏呼吸骤停的原因、影响心肺复苏效果的因素及复苏效果.用自主循环恢复(return of spontaneous circulation,ROSC)评估初步复苏效果.结果 2008年7月1日至2010年2月28日,北京儿童医院急诊室全部就诊患者(29 d至18岁)182 380例,心搏呼吸骤停237例(0.13％).实施心肺复苏169例,其中ROSC 88例(52.1％).性别和年龄对ROSC的影响差异无统计学意义.原发病和初始节律对ROSC的影响有显著性意义.有无院前转运的ROSC分别为64.1％和44.8％；CPR时间≤10 min、10 ～ 30 min及＞30 min的ROSC分别为67.5％、61.4％和30.5％,差异均具有统计学意义.多元逐步Logistic回归分析显示,初始节律和CPR持续时间对ROSC有明显影响.结论 急诊室内小儿心肺复苏的ROSC为52.1％.初始节律和CPR持续时间对ROSC有明显影响.     

基于UPLC-Q-TOF-MSn的化妆品中40种性激素非法添加分析方法及筛查数据库的建立

目的 建立基于UPLC-Q-TOF-MSⁿ的化妆品中40种性激素非法添加分析方法及筛查数据库。方法 色谱柱为Agilent SB-C₁₈(2.1 mm×50 mm，1.8 μm)，正离子模式以0.1%甲酸水溶液-乙腈为流动相，负离子模式以水-乙腈为流动相，梯度洗脱，流速0.2 mL·min^-1，柱温35 ℃；采用电喷雾电离源(ESI)，采集模式为Scan MS及Targeted MS/MS，将40种性激素的精确质量数、保留时间、二级质谱图导入PCDL软件建立筛查数据库。结果 采用所建立的数据库方法快速筛查100批化妆品，1批育发类产品检出少量黄体酮。结论 本研究所建立的40种性激素分析方法和筛查数据库具有简便、快速、灵敏和准确的特点，适合化妆品中非法添加性激素的高通量筛查和准确定性。     

中成药中非法添加物N-苄基他达拉非的结构确证

目的 鉴定中成药中一种新型他达拉非类似物。方法 采用HPLC-DAD初筛和制备液相色谱仪对中成药中非法添加物进行分离和纯化，采用高分辨质谱确定其精确分子量和结构碎片，结合碳谱和氢谱，最终确定该添加物的结构。结果 该添加物为N-苄基他达拉非。结论 N-苄基他达拉非的化学结构已有文献报道，但作为一种非法的中成药添加物首次被检出。