序贯培养体系和单一培养体系对人卵母细胞受精和早期胚胎发育的影响

目的：比较在体外受精/卵胞质内单精子显微注射（IVF/ICSI）治疗周期中序贯培养体系和单一培养体系对人类早期胚胎发育的影响，为人类辅助生殖技术中胚胎培养体系的选择和评估提供参考。方法：选取155例行IVF/ICSI助孕的患者，将同一个患者的卵子分为2组，分别在Vitrolife的序贯培养体系G-IVF/G1/G2培养液（序贯培养组）和Irvine的单一培养体系CSCC培养液（单一培养组）中进行体外受精和胚胎培养，观察2组不同培养体系中胚胎受精和胚胎早期发育情况。结果：与单一培养组比较，序贯培养组受精率、双原核（2PN）受精率和多核受精率差异均无统计学意义（P>0.05）。在IVF患者中，序贯培养组和单一培养组的卵裂率、可用胚胎率、优质胚胎率和囊胚形成率比较差异均无统计学意义（P>0.05）；在ICSI患者中，序贯培养组和单一培养组的卵裂率、可用胚胎率和囊胚形成率比较差异均无统计学意义（P>0.05），但序贯培养组优质胚胎率明显高于单一培养组（P=0.015）。在IVF和ICSI患者中，单一培养组第3天胚胎致密化的比例均明显高于序贯培养组（P=0.001）。在序贯培养组中胚胎形态表面光滑均匀，单一培养组中胚胎表面较为粗糙且有颗粒状。结论：G-IVF/G1/G2序贯培养体系和CSCC单一培养体系对人卵母细胞受精和早期胚胎发育的影响无明显差异。     

Effects of exercise dose and type during breast cancer chemotherapy on longer-term patient-reported outcomes and health-related fitness: A randomized controlled trial

The Combined Aerobic and Resistance Exercise (CARE) Trial compared different types and doses of exercise performed during breast cancer chemotherapy. Here, we report the longer-term follow-up of patient-reported outcomes, health-related fitness and exercise behavior at 6, 12 and 24 months postintervention. A multicenter trial in Canada randomized 301 breast cancer patients initiating chemotherapy to thrice weekly, supervised exercise consisting of a standard dose of 25–30 min of aerobic exercise (STAN; n = 96), a higher dose of 50–60 min of aerobic exercise (HIGH; n = 101) or a combined dose of 50–60 min of aerobic and resistance exercise (COMB; n = 104) performed for the duration of chemotherapy (median of 17 weeks). Primary outcomes were patient-reported outcomes including quality of life, cancer-related symptoms and psychosocial outcomes. Secondary outcomes were objective health-related fitness (assessed at 12 months only) and self-reported exercise behavior. A total of 269 (89.4%) participants completed patient-reported outcomes at all three follow-up time points and 263 (87.4%) completed the health-related fitness assessment at 12-month follow-up. COMB was significantly superior to (i) STAN for sleep quality at 6-month follow-up (p = 0.027); (ii) HIGH for upper body muscular endurance at 12-month follow-up (p = 0.020); and (iii) HIGH for meeting the resistance exercise guideline at 6-month follow-up (p = 0.006). Moreover, self-reported meeting of the combined exercise guideline during follow-up was significantly associated with better patient-reported outcomes and health-related fitness. Performing combined exercise during and after breast cancer chemotherapy may result in better longer-term patient-reported outcomes and health-related fitness compared to performing aerobic exercise alone.     

妇产科住院医师临床技能培训体系构建

妇产科学是一门涉及面广、实践性和操作性均很强的学科,对医生临床操作能力的要求也格外严格。妇产科住院医师临床技能操作水平的高低是评价其岗位胜任力的重要指标,开展全面、规范的临床技能培训,有利于切实提高其临床操作能力,是培养合格妇产科专科医师的必经途径。研究以南京医科大学附属妇产医院为例,讲述了该院从目标体系、过程管理体系、考核评价体系和质量控制体系4个方面出发,探索构建适合专科医院特色的妇产科住院医师临床技能培训体系,并在实践过程中不断完善该体系,以期不断提升妇产科住院医师的临床工作能力,有效增强其岗位胜任力和综合素质。     

Polypharmacy among patients with multiple sclerosis: a qualitative systematic review

ABSTRACT

Objectives: The consequences of polypharmacy (intake of ≥ 5 drugs) are diverse, including drug interactions, rising costs and side effects. Risk groups for polypharmacy are multimorbid and chronically ill people, such as patients with multiple sclerosis (MS). MS is the most common neuroimmunological disease in young adults worldwide. We aimed to provide a systematic overview of the current research status regarding frequency and predictors of polypharmacy in MS patients.

Methods: A systematic literature search in the databases PubMed, Cochrane Library and Scopus was carried out according to the PRISMA guidelines. English and German original research articles were included.

Results: Seven studies fulfilled the inclusion criteria of this review, while the research objectives and methods were very heterogenous. The polypharmacy rates in these studies ranged from 15% to 59%. Polypharmacy correlated with comorbidities, increased disability, cognitive deficits, increased hospitalization, higher relapse rate and lower quality of life.

Conclusions: In MS patients, polypharmacy is common and closely associated with health issues. There is a great need for research in this area, especially regarding longitudinal changes in drug utilization. Effective networks between physicians and pharmacists are needed to optimize medication management for patients and to achieve the best possible therapy results.     

薄层色谱法在当前中药质量标准中的应用探讨

薄层色谱鉴别在历版《中国药典》中的应用经历了从无到有、从少到多的过程；而薄层扫描含量测定在最近几版《中国药典》中的应用比例逐渐降低。随着对中药质量标准体系要求的进一步提高，薄层色谱法的不足之处陆续显现，如仪器普及率低、设备并不简单、结果重复性和稳定性较差、鉴别速度及准确性不及高效液相色谱法、展开剂毒性大等，逐渐不合时宜。在制定中药质量标准时，研究者不应该墨守成规，薄层色谱鉴别也不应该是雷打不动的定性鉴别必备选项。高效液相色谱法具备完全取代薄层色谱法的可行性，薄层色谱法可作为高效液相色谱法的补充。为充分降低检测成本、缩短检测周期、提高鉴别效率，笔者建议中药质量标准体系应该大幅减少薄层色谱鉴别方法的应用，增加高效液相特征图谱鉴定，尽量做到“一个条件，一张图谱”；除非确有必要，《中国药典》等国家质量标准体系应将薄层色谱鉴别作为推荐方法，而非强制标准。     

卒中溶栓绿色通道优化研究及实施效果分析

目的探讨卒中溶栓绿色通道的构建、整改对发病到实施溶栓的时间（onset to treatment time,OTT）、院内溶栓时间（door to needle time，DNT）、临床疗效及预后的影响。 方法收集通过绿色通道溶栓患者118例的临床资料，以时间为界分为对照组57例和观察组61例。比较2组OTT、DNT、DNT≤60 min比率、临床疗效、并发症发生情况、美国国立卫生研究院卒中量表（the National Institutes of Health Stroke Scale,NIHSS）评分、Barthel指数（Barthel index，BI）评分、改良Rankin量表（Modified Rankin Scale,mRS）评分等。 结果观察组OTT、DNT短于对照组，DNT≤60 min比例高于对照组（P＜0.01）。经过溶栓治疗72 h后，观察组临床疗效优于对照组，总有效率高于对照组（P＜0.01）。2组总并发症发生率和病死率差异均无统计学意义（P＞0.05）。2组NIHSS评分均呈逐渐降低趋势，观察组NIHSS评分低于对照组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.01）。2组BI评分均呈逐渐升高趋势，观察组BI评分高于对照组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.01）。治疗3个月以后，观察组mRS评分明显低于对照组，≤2分比例高于对照组（P＜0.01）。 结论卒中溶栓绿色通道的建立，能够显著缩短OTT、DNT，提高临床疗效，减轻残障程度，取得良好的社会效益。     

对确保中医古籍编校质量的思考

中医药的发展离不开对中医古籍的研读,高质量中医古籍的整理出版至关重要。中医药图书编辑要做好中医古籍出版工作并确保图书编校质量,必须高度重视体现古籍整理原则和方法的辅文,并且具备相当的古代汉语基础、扎实的医学知识及丰富的中国古代文化知识。     

品管圈在植入式静脉输液港患者护理中的应用

目的探讨品管圈在植入式静脉输液港(IVAP)患者护理中的应用。方法选取本院2018年10月-2018年12月IVAP患者30例作为对照组,2019年1月-2019年3月品管圈活动干预后IVAP患者30例作为观察组。对照组采用常规护理措施,观察组采用品管圈活动干预后的护理措施。比较两组IVAP患者并发症的发生率和对护理工作的满意度。结果观察组导管堵塞1例;并发症发生率为3.33%(1/30)。对照组感染4例,血栓2例,导管堵塞4例;并发症发生率为33.33%(10/30)。观察组并发症发生率低于对照组(P <0.05)。观察组对优质服务、技术水平、关怀、出院指导、护理总满意度评分分别为(42.39±5.27)分、(31.49±4.32)分、(22.25±4.69)分、(20.26±4.91)分、(112.24±10.38)分;对照组分别为(38.65±4.91)分、(28.68±4.26)分、(19.96±4.30)分、(19.94±4.63)分、(103.37±10.12)分;观察组对优质服务、技术水平、关怀、出院指导、护理总满意度评分均高于对照组(P <0.05)。结论通过品管圈活动干预后的护理措施明显降低IVAP患者并发症的发生率,提高患者对护理工作的满意度。     

中医康复护理对中风肢体功能障碍患者的疗效

目的分析脑卒中肢体功能障碍患者应用中医康复护理干预后,上下肢功能、生活品质以及神经功能损伤症状变化情况。方法选取本院2017年3月-2019年3月收治的160例脑卒中肢体功能障碍患者为研究对象,将其随机均分为采用传统康复护理的常规组,与采用中医康复护理的研究组。对比两组患者护理干预前后上下肢力指标、神经功能损伤评估分值以及生活品质评估分值。结果干预前,两组患者上、下肢肌力差异无统计学意义(P>0.05),干预后,两组患者上、下肢肌力全部明显增加,并且研究组增加幅度优于常规组,差异均具有统计学意义(P<0.05);干预后,研究组与常规组脑卒中患者神经功能缺损评分标准(CSS)评估分值均显著降低,且常规组降低幅度低于研究组;两组生活自理能力评估分值全部显著增加,且研究组提升幅度明显高于常规组,差异均具有统计学意义(P<0.05)。结论脑卒中肢体功能障碍患者应用中医康复护理干预,能够显著提高患者肢体肌肉能力以及生活品质,促进神经功能的修复。     

中药生产过程质量控制关键技术研究进展

中医药发展已上升到国家战略层面,在医药行业贯彻实施"中国制造2025"战略的新形势下,中药生产过程质量控制是中药工业需要加快突破的关键领域之一。对中药生产过程质量控制领域在工艺设计、分析检测、过程建模、制造装备等方面的关键共性问题进行解析,综述了中药生产过程质量控制体系中工艺过程理解、生产过程实时分析方法开发、过程控制策略建立3个方面的研究进展;并结合企业研究实践,介绍了质量源于设计(quality by design,Qb D)、过程分析技术(process analytical technology,PAT)、实验设计(design of experiment,DOE)、多变量统计分析等关键技术在上述3个研究方向中的应用进展,分析了实际工业应用的难点问题并对其应用前景进行展望,旨在为中药企业应用和提升生产过程质量控制技术提供参考。