我国延续性护理的概念分析

目的 通过文献对延续性护理的发展、概念应用、属性、案例、前因、后果等进行系统分析，从护理实践的角度厘清我国延续性护理的概念内涵。方法 收集2009~2019年中国知网、万方、维普、中国生物医学数据库、PubMed、CINAHL、Embase、PsycINFO等数据库中延续性护理相关文献，采用Walker和Avant的概念分析法进行分析。 结果 通过分析相关文献并结合我国护理发展新形势特点，归纳出我国延续性护理的概念属性：患者发生不同医疗机构转移或不同照护层次转变；提供连续性、协调性、整体性的照护服务；目的是维护患者健康或满足其健康需求；存在信息、关系和管理三方面的延续。结论 我国延续性护理的概念属性从护理实践角度出发，结合新形势下护理发展特点，可为我国具体开展延续性护理服务实践或研究提供清晰的概念支持，并为各级医院和社区开展相关延续性护理工作提供一定的理论和实践指导。     

Rhythmic interlimb coordination of the lower limbs in multiple sclerosis during auditory pacing to three different frequencies

BackgroundMultiple sclerosis (MS) is a demyelinating disorder of the central nervous system with heterogeneous symptoms. Persons with MS (PwMS) show reduced walking capacity with changes in their gait pattern. It is unknown to which extent coordination deficits are present in PwMS, which can be measured by seated lower leg interlimb coordination tasks, and to which extent they are related to motor and cognitive function.Research questionHow is the control of interlimb coordination of the lower limbs characterized in PwMS compared to healthy controls (HC) during a seated rhythmical coordination task and what is the relationship between interlimb coordination, motor or cognitive function?MethodsRhythmical interlimb coordination was assessed during a single session in 38 PwMS and 13 HC, using a seated rhythmical coordination task, comprising of antiphase flexion-extension of the lower limbs, to metronomes at 0.75 Hz, 1.00 Hz, 1.50 Hz. Outcomes were phase coordination index (PCI), movement amplitude and movement frequency. Correlations between interlimb coordination, motor, and cognitive function were examined.ResultsPwMS showed impaired walking capacity but preserved cognitive function. Mixed model analysis revealed a significant effect of group and metronome frequency for PCI, attenuated by the variability in generating knee (antiphase flexion-extension) movements. Movement amplitude was highest at metronome frequency 1.00 Hz. In PwMS significant correlations were found between PCI and cognitive function when performing the task at metronome frequencies 0.75 Hz and 1.50 Hz, as well as motor function at 1.50 Hz.SignificancePwMS had a higher variability in interlimb coordination compared to HC. The most stable interlimb antiphase coordination mode was performed at 1.00 Hz. Significant correlations support the existence of a relationship between information processing speed, as well as walking impairment, with interlimb coordination. While cognitive and motor control are always needed for interlimb coordination movements, associations are strongest in the deviant higher and lower metronome rhythms.     

Care coordination needs for deprescribing benzodiazepines and benzodiazepine receptor agonists

Deprescribing of medications such as benzodiazepines and benzodiazepine receptor agonists (z-drugs) can be a complex process that varies across practices, specialties, and health care systems. Care coordination among healthcare providers, patients, families, and other healthcare system components is critical to achieving high levels of deprescribing and person-centered care. We present a framework for promoting care coordination in the context of benzodiazepine/z-drug deprescribing. Future efforts are needed to study the impact of better care coordination on benzodiazepines/z-drug discontinuation and other outcomes that are important to stakeholders.     

Myotonic dystrophy: surgical and anesthetic considerations during orthognathic surgery

The surgical and anesthetic considerations of orthognathic surgery for a patient with myotonic dystrophy are discussed. A case report is presented demonstrating how a surgical treatment plan can be modified to avoid the potential postoperative problems associated with this disease.     

表面活性剂加氟化钠涂料对牙骨质表面显微硬度的体外研究

目的 :探讨表面活性剂加氟化钠涂料防治根面龋是否优于单独用氟化钠涂料或洗必泰涂料。方法 :在离体牙釉 -牙骨质界下开窗 4mm× 4mm ,分别经洗必泰加氟化钠涂料 (简称氟泰涂料 )、洗必泰涂料、氟化钠涂料等处理后进行矿化实验和抗龋实验 ,然后测定各组牙骨质表面的显微硬度。结果 :3组矿化实验前、后牙骨质表面硬度相比 ,氟泰涂料组和氟化钠涂料组较洗必泰组均有显著差异 ,且氟泰组比氟化钠组硬度值显著增加。抗龋实验前、后牙骨质表面显微硬度值相比 ,氟泰组、氟化钠组无显著差异 ,洗必泰组、对照组均有显著差异。结论 :用氟泰涂料改善牙骨质表面硬度与氟化钠组具相同效果 ,且优于氟化钠组。     

Development and validation of the computerized bilateral motor coordination test

The purpose of this study was to explore the validity of computerized scaling of bilateral, motor coordination in children 4–6 years of age. There were 623 children with an average age of 5, years and 2 months (standard deviation = 6 months) that participated. The 290 girls (46.5%) and 333, boys (53.5%) were from a purposive sample taken from public and private kindergartens in Taiwan. The computerized bilateral motor coordination test included two subtests, bilateral coordination, movements and projected actions. The motion analysis, with mark position and contour motion, was, used to collect important variables from the subtests. Using the judgments of the experts as the, criterion standards, the accuracy, sensitivity, and specificity of the tool were calculated to evaluate the, validity of the computerized bilateral motor coordination test. The accuracy, sensitivity, and, specificity of the bilateral coordination movement subtests were on average 83.9%, 86.4%, and 83.1%, respectively. The accuracy, sensitivity, and specificity of the projected action subtests were on average, 90.5%, 88.1%, and 90.4%, respectively. The computerized bilateral motor coordination tests showed, an average accuracy of 86.3%, a sensitivity of 87.0%, and a specificity of 85.8%. The computerized, bilateral motor coordination test could be a valuable tool when used to identify problems of bilateral, motor coordination and in permitting early intervention to remedy these problems.     

Photoinduced transformations of stiff-stilbene-based discrete metallacycles to metallosupramolecular polymers

Control over structural transformations in supramolecular entities by external stimuli is critical for the development of adaptable and functional soft materials. Herein, we have designed and synthesized a dipyridyl donor containing a central Z-configured stiff-stilbene unit that self-assembles in the presence of two 180° di-Pt(II) acceptors to produce size-controllable discrete organoplatinum(II) metallacycles with high efficiency by means of the directional-bonding approach. These discrete metallacycles undergo transformation into extended metallosupramolecular polymers upon the conformational switching of the dipyridyl ligand from Z-configured (0°) to E-configured (180°) when photoirradiated. This transformation is accompanied by interesting morphological changes at nanoscopic length scales. The discrete metallacycles aggregate to spherical nanoparticles that evolve into long nanofibers upon polymer formation. These fibers can be reversibly converted to cyclic oligomers by changing the wavelength of irradiation, which reintroduces Z-configured building blocks owing to the reversible nature of stiff-stilbene photoisomerization. The design strategy defined here represents a novel self-assembly pathway to deliver advanced supramolecular assemblies by means of photocontrol.Natural systems provide many examples of self-assembled biosupramolecules that respond to external stimuli through conformational changes that ultimately play a role in carrying out their various biological functions. Mimicking this stimuli-responsive behavior in artificial systems is a promising route toward obtaining sophisticated molecular-based architectures with functional and structural tunability (1–3). Using the absorption of photons as a trigger is particularly attractive in that light-induced transformations maintain high spatial and temporal resolution without producing waste products even during multiple reversible switching sequences (4). In materials science, one of the most appealing characteristics of photochromic molecules is the direct conversion of light into mechanical energy based on their photo-reversible structural transformations (5). Among such chromophores, a stiff-stilbene moiety (1,1′-biindane) is useful owing to its unique characteristics (6). First, stiff stilbene can adopt either a cis or trans configuration with respect to its central double bond. Second, the high activation barrier between the two isomers (∼43 kcal⋅mol⁻¹, corresponding to a half-life of ∼10⁹ y at 300 K) makes thermal E/Z isomerization negligible at temperatures of 420 K and lower. Third, the quantum yield for the photoisomerization of either isomer is high (50%). Fourth, the stiff-stilbene core is readily substituted using well-established synthetic methods. Owing to these promising characteristics, Boulatov and coworkers (7) constructed a molecular force probe by integrating the moiety into a stretched polymer to mimic the strain generated in diverse functional groups. Yang and coworkers (8) reported hydrogen-bonded supramolecular polymers and studied their polymerization mechanisms and physical properties based on the photoisomerization of the stiff-stilbene units. Nevertheless, stiff-stilbene-based supramolecular entities are underexplored despite exhibiting properties that make the functionality potentially useful in the construction of photoresponsive supramolecular materials.Coordination-driven self-assembly is a powerful method of constructing supramolecular coordination complexes (SCCs) by the spontaneous formation of metal–ligand bonds that draws inspiration from the design principles of natural systems (9–20). This approach organizes metal acceptors and organic donors to prepare well-defined cavity-cored 2D metallacycles and 3D metallacages, which can be functionalized on their interior or exterior vertices for applications in host–guest chemistry (21, 22), catalysis (23), molecular flasks (24), bioengineering (25), amphiphilic self-assembly (26), and so on. The versatility of coordination-driven self-assembly can be enhanced by designs that allow for post-self-assembly modifications that in some cases result in complete structural transformations. For example, the Stang group previously demonstrated the transformation of self-assembled polygons by changing the angle between the bonding sites of a ligand from 180° to 120° upon treatment of Co₂(CO)₆ with an acetylene moiety (27). Yang and coworkers (28) reported the construction of multibisthienylethene hexagons capable of reversible supramolecule-to-supramolecule conversions induced by ring-open and ring-closed conformational changes of the bisthienylethene units. Herein we expand upon the transformations established by the systems described above designing SCCs capable of evolving from discrete metallacycles into infinite constructs using external stimuli.Supramolecular polymers can be defined as dynamically reversible polymeric arrays (29–37) that form from the explicit manipulation of noncovalent forces between monomeric units (38–43). Supramolecular polymer chemistry can readily complement coordination-driven self-assembly, as exemplified by our efforts to design hierarchical supramolecular polymerizations of discrete organoplatinum(II) metallacycles, thus accessing novel supramolecular polymeric materials, such as macroscopic hexagonal supramolecular polymer fibers (44), dendronized organoplatinum(II) metallacyclic polymers (45), and a responsive, cavity-cored supramolecular polymer network metallogel (46). Herein, we report photoresponsive supramolecular transformations between discrete organoplatinum(II) metallacycles and infinite metallosupramolecular polymers induced by a cis/trans conformational transition of a stiff-stilbene-based dipyridyl ligand. The self-assembly behaviors, physical properties, topologies, and morphologies of these SCCs can be regulated by photoisomerization, demonstrating this powerful approach to prepare advanced supramolecular coordination complexes.     

In vivo anticancer activity of rhomboidal Pt(II) metallacycles

The development of novel antitumor agents that have high efficacy in suppressing tumor growth, have low toxicity to nontumor tissues, and exhibit rapid localization in the targeted tumor sites is an ongoing avenue of research at the interface of chemistry, cancer biology, and pharmacology. Supramolecular metal-based coordination complexes (SCCs) have well-defined shapes and geometries, and upon their internalization, SCCs could affect multiple oncogenic signaling pathways in cells and tissues. We investigated the uptake, intracellular localization, and antitumor activity of two rhomboidal Pt(II)-based SCCs. Laser-scanning confocal microscopy in A549 and HeLa cells was used to determine the uptake and localization of the assemblies within cells and their effect on tumor growth was investigated in mouse s.c. tumor xenograft models. The SCCs are soluble in cell culture media within the entire range of studied concentrations (1 nM–5 µM), are nontoxic, and showed efficacy in reducing the rate of tumor growth in s.c. mouse tumor xenografts. These properties reveal the potential of Pt(II)-based SCCs for future biomedical applications as therapeutic agents.Molecular assemblies of nanoscale-size and well-defined geometries have recently emerged as an interesting new paradigm in drug design and drug delivery. To date, liposomes, the self-assembled lipid nanoparticles held together by weak interactions, are among the most widely studied and clinically successful nanoparticle-based drug carriers. Their use allows the drug to achieve sustained plasma levels while encapsulated, with the size preventing the fast clearance by the kidneys that often occurs with the free drug. However, liposomes themselves do not produce a therapeutic effect and their application as drug carriers for medical purposes has often been hindered by poor loading capacity (<5 wt %) and the inability to pass through biological barriers (1, 2). Inorganic and hybrid porous materials, such as molecular organic frameworks (MOFs), have also shown promise due to their higher loading capacities (>25 wt %) (3–5), but MOFs have poor hydrolytic stability (6, 7). Recent studies on materials from Institut Lavoisier (MIL)-100(Cr) and MIL-100(Fe), however, suggest that MOFs can persist in biologically relevant environments and can act as vehicles for some anticancer and antiviral agents (8–10). These early findings have prompted further investigations into the biomedical applications of supramolecular coordination complexes (SCCs) (11–24). SCCs preserve the attractive properties of MOFs, such as building block modularity (22, 23, 25), yet afford an increased solubility in the biological milieu and lend themselves to small-molecule characterization techniques due to their well-defined structure.Although development of SCCs for biomedical applications is in its infancy, some SCCs, such as trigonal prisms self-assembled from p-cymene and ruthenium-based metal fragments with pyridyl donors, have shown the ability to act as effective carriers of some chemotherapeutic agents (26–28). Moreover, a library of cytotoxic to cancer cells p-cymene ruthenium-based polygons and cages has also been developed (11). For biomedical applications, the information about the cellular uptake, delivery of a guest, and metabolism of the drug delivery vehicle is critical, although currently the fate of SCCs in biological environments is not well understood. In a rare report, a systematic investigation of the structural stability of a water-soluble, hexacationic ruthenium-based trigonal prism was performed; however, it was determined that the ruthenium-based trigonal prisms decompose in the presence of amino acids histidine, lysine, and arginine (29).An intriguing approach is the design of tumor-targeted modalities that combine detection and treatment through the self-assembly of emissive, metal-based coordination complexes. Such modalities can be especially valuable as they often do not require photoexcitation to elicit cytotoxicity. Recently Gray, Gross, and Medina-Kauwe and coworkers reported HerGa, a self-assembled tumor-targeted particle that bears the Ga(III)-metalated derivative of the sulfonated corrole (30, 31). The particle, which contained Ga(III)-corrole noncovalently bound to the tumor-targeting cell penetration protein HerPBK10, provided both tumor detection and elimination. Systemic injection of this protein–corrole complex resulted in tumor accumulation, which can be visualized in vivo due to the red corrole fluorescence. Cytotoxic and cytostatic properties of these targeted Ga(III) corroles were found to be cell-line dependent, with the ability to induce late M-phase arrest in several cancer cell lines (32).Despite the well-known cytotoxic properties of mono- and multinuclear platinum complexes (33–35), studies of the antitumor properties of platinum-based SCCs are rare (17, 36). Moreover, recent reports have demonstrated that platinum-based SCCs can act as effective hosts for guests and have interesting photophysical properties (37–42). In particular, highly emissive rhomboids based on aniline-containing donors and Pt-based metal acceptors have been developed that display different photophysical properties from those of their constituent subunits (40). These assemblies are interesting targets to investigate the cytotoxicity of organoplatinum SCCs, whereas their emission spectra could be used for interrogating the structural integrity in vitro. Here, for the first time to our knowledge, we report the uptake of SCCs in vitro in cell-based assays, determined by using laser-scanning confocal microscopy, and an in vivo assessment of the anticancer activity of SCCs in mouse s.c. tumor xenograft models.