专科颜色标识联合流程化管理在手术室精密器械管理中的应用

目的:探讨专科颜色标识联合流程化管理在手术精密器械管理中的应用效果。方法:对手术室中使用的精密器械依据专科和手术类型标上颜色,分类存放;使用电脑应用程序对器械的申购、验收、领用、归还进行严格管理,形成流程化管理制度,在各个专科普及。将2018年度上半年未实施专科颜色标识及流程化管理的780包器械设定为“实施前”,将下半年实施后的780包器械设定为“实施后”,比较实施前后器械完好率与使用差错率、器械回收时间、器械分类时间、医护人员对于器械管理的满意度。结果:实施后器械完整率高于实施前、使用差错率低于实施前(均P<0.05);实施后器械回收时间、器械分类时间短于实施前(P<0.05);实施后手术室医护人员对器械管理质量满意度高于实施前(P<0.05)。结论:对精密器械进行颜色标识,配合流程管理,能提高器械的使用寿命,降低精密器械损伤率,提高工作人员效率,提高管理质量及医护人员对器械管理的满意度。     

Fiberscope Assisted Videolaryngoscope Intubation in the Surgical Treatment of TMJ Ankylosis

Temporomandibular ankylosis is characterized by the formation of a bony mass which replaces normal temporomandibular joint (TMJ) articulation. Anaesthetic management in these patients requires expertise and dependable intubation technique that allows successful intubation due to anticipated difficulty in accessing the airway. A novel technique of endotracheal intubation is used for the successful airway management during the surgical treatment in patients with TMJ ankylosis with the assistance of fiberscope and GlideScope^® videolaryngoscope. GlideScope^® videolaryngoscope is a recently introduced system for tracheal intubation that has a dedicated video camera encased into a laryngoscope blade and provides better panoramic view than the conventional laryngoscopes. This technique avoids complications such as trauma to soft tissue structures surrounding the glottis during the passage of the tube over the fiberscope. It gives a clear view of the tube and its cuff position during intubation. It also abbreviates the time required for intubation which is a crucial determinant in this subset of patients owing to the difficult airway associated with paediatric age group.     

Functional characterization of calliphorid cell death genes and cellularization gene promoters for controlling gene expression and cell viability in early embryos

The New World screwworm fly, Cochliomyia hominivorax, and the Australian sheep blow fly, Lucilia cuprina, are major pests of livestock. The sterile insect technique was used to eradicate C. hominivorax from North and Central America. This involved area‐wide releases of male and female flies that had been sterilized by radiation. Genetic systems have been developed for making ‘male‐only’ strains that would improve the efficiency of genetic control of insect pests. One system involves induction of female lethality in embryos through activation of a pro‐apoptotic gene by the tetracycline‐dependent transactivator. Sex‐specific expression is achieved using an intron from the transformer gene, which we previously isolated from several calliphorids. In the present study, we report the isolation of the promoters from the C. hominivorax slam and Lucilia sericata bnk cellularization genes and show that these promoters can drive expression of a GFP reporter gene in early embryos of transgenic L. cuprina. Additionally, we report the isolation of the L. sericata pro‐apoptotic hid and rpr genes, identify conserved motifs in the encoded proteins and determine the relative expression of these genes at different stages of development. We show that widespread expression of the L. sericata pro‐apoptotic genes was lethal in Drosophila melanogaster. The isolated gene promoters and pro‐apoptotic genes could potentially be used to build transgenic embryonic sexing strains of calliphorid livestock pests.     

Contact X-ray brachytherapy for rectal cancer: Past,present, and future

The Papillon experience and the Lyon R96-02 trial have shown that contact X-ray brachytherapy of 50 kV is efficient and safe to achieve long term local control and organ preservation for cT1 and early cT2-3 rectal cancers. The OPERA trial, using the Papillon 50™ machine, brings further support to this preservation strategy for selected T2T3ab lesions. Future trials using a contact X-ray boost will try to consolidate and enlarge its place in organ preservation for rectal cancers.     

泌尿外科专科护士培训指标体系的构建

目的构建泌尿外科专科护士培训指标体系。方法2019年6—12月进行研究,首先成立研究小组,通过文献回顾、半结构式访谈初步构建指标体系,之后通过2轮Delphi专家咨询对指标进行修订,最终构建泌尿外科专科护士培训指标体系。结果构建的泌尿外科专科护士培训指标体系,包括一级指标3项,二级指标10项,三级指标48项。2轮专家的积极系数均为100%,2轮专家咨询的权威系数分别为0.856,0.903,2轮函询肯德尔和谐系数分别为0.302、0.337,差异具有统计学意义(P<0.001)。结论研究构建的泌尿外科专科护士培训指标体系具有可靠性及科学性,可作为评价泌尿外科专科护士培训的工具。     

Double S-Curve Versus Cusp-Overlap Technique: Defining the Optimal Fluoroscopic Projection for TAVR With a Self-Expanding Device

ObjectivesThe purpose of this study was to assess the concordance between transcatheter aortic valve implantation angles generated by the “double S-curve” and “cusp-overlap” techniques.BackgroundThe “double S-curve” and “cusp-overlap” methods aim to define optimal fluoroscopic projections for transcatheter aortic valve replacement (TAVR) with a self-expandable device.MethodsThe study included 100 consecutive patients undergoing TAVR with self-expanding device planned by multidetector computed tomography. TAVR was performed using the double S-curve model, as a view in which both the aortic valve annulus and delivery catheter planes are displayed perpendicularly on fluoroscopy. Optimal projection according to the cusp-overlap technique was retrospectively generated by overlapping the right and left cups on the multidetector computed tomography annular plane. The angular difference between methods was assessed in spherical 3 dimensions and on the left and right anterior oblique (RAO) and cranial and caudal (CAU) axes.ResultsThe double S-curve and cusp-overlap methods provided views located in the same quadrant, mostly the RAO and CAU, in 92% of patients with a median 3-dimensional angular difference of 10.0° (interquartile range: 5.5° to 17.9°). The 3-dimensional deviation between the average angulation obtained by each method was not statistically significant (1.49°; p = 0.349). No significant differences in average coordinates were noted between the double S-curve and cusp-overlap methods (RAO: 14.7 ± 15.2 vs. 12.9 ± 12.5; p = 0.36; and CAU: 27.0 ± 9.4 vs. 26.9 ± 10.4; p = 0.90). TAVR using the double S-curve was associated with 98% device success, low complication rate, and absence of moderate-to-severe paravalvular leak.ConclusionsThe double S-curve and cusp-overlap methods provide comparable TAVR projections, mostly RAO and CAU. TAVR using the double S-curve model is associated with a high rate of device success and low rate of procedural complications.     

基于基因表达谱相似性的四物汤重定位及抗乳腺癌有效成分群辨识＊

目的 发现四物汤的新药理作用并辨识其有效成分群。方法 于GEO和Cmap数据库获取四物汤和1309个小分子药物的基因表达谱，计算差异表达基因及四物汤与1309个小分子药物的基因表达谱间的相似性，相似性较高的小分子药物的药理作用为四物汤的新药理作用。相似性较高的小分子药物的靶点作为四物汤发挥新药理作用的靶标，利用分子对接技术辨识四物汤的有效成分群。结果 四物汤具有抗乳腺癌的作用，其有效成分群为荭草苷、芍药苷和半乳糖醛酸等，并通过文献调研验证了辨识结果的可靠性。结论 本研究将为扩大四物汤的临床应用范围及质量控制奠定基础，为乳腺癌的治疗提供新方法。     

The use of cardiac computed tomography angiography in the assessment of percutaneous left atrial appendage closure – Review and experts recommendations endorsed by the Société française d’imagerie cardiaque et vasculaire diagnostique et interventionnelle

Atrial fibrillation is the most common cause of arrhythmia which is responsible for over 15% of ischemic strokes, most of these being secondary to migration of a left atrial appendage (LAA) thrombus. In patient with contraindication to anticoagulant therapy, percutaneous closure system placement may be indicated. Cardiac computed tomography (CT) angiography plays a central role in the initial assessment as well as in the follow-up. The purpose of the pre-implantation cardiac CT angiography is to evaluate the anatomy of the LAA in order to select the most suitable prosthesis and check for any contraindication to device implantation. Image analysis is divided into four steps that include analysis of the approach; search for a thrombus in the LAA; investigation of the anatomy of the LAA (morphology of the LAA, dimensions of the LAA and choice of device) and cardiac and thoracic assessments. Follow-up involves CT examination to check for correct placement of the device and to detect any complications. On the basis of the results of currently available published research, a panel of experts has issued recommendations regarding cardiac CT angiography prior to percutaneous LAA closure device placement, which were further endorsed by the Société française d’imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV).     

子宫背带式缝合术治疗剖宫产术中产后出血的临床效果及对手术时间的影响

目的 观察子宫背带式缝合术治疗剖宫产术中产后出血的临床效果及对手术时间的影响。方法 回顾性分析2018年1月～2019年12月我院剖宫产产后出血患者，共计60 例，将常规止血处理的28 例患者作为对照组，子宫背带式缝合术治疗的32 例患者作为观察组，对比两组治疗相关指标、治疗前后凝血功能变化情况及术后并发症发生率。结果 观察组患者手术时间、住院时间均短于对照组，术后24 h 阴道出血量及总出血量少于对照组，差异有统计学意义（P＜0.05）；两组患者各项凝血功能指标在治疗前差异不显著，治疗后，观察组各项指标均改善，与对照组比较差异有统计学意义（P＜0.05）；在术后并发症发生率方面观察组明显少于对照组（6.25% vs 28.57%），差异有统计学意义（P＜0.05）。结论 子宫背带式缝合术治疗剖宫产术中产后出血，对患者凝血功能具有改善作用，能够减少产后出血量，降低术后并发症发生率，疗效确切，值得临床借鉴。