冬季中药煮沸熏蒸消毒儿科病房空气效果观察

目的:探讨冬季中药煮沸熏蒸对儿科病房空气消毒效果。方法:采用细辛等数味中药煮沸熏蒸消毒与紫外线灯消毒法,对儿科8间病房进行空气消毒各30次。于消毒前后采样行细菌培养,比较消毒效果;应用访谈法了解病房患者对两种消毒方法的接受情况。结果:两种消毒法消毒后细菌菌落数差异无显著性意义(P>0.05),患者对中药煮沸熏蒸消毒法接受程度明显优于紫外线消毒法(P<0.01)。结论:中药煮沸熏蒸对病室空气消毒可达到与紫外线消毒同等的效果,且患者接受。     

基于UPLC-Q-TOF-MS技术的刺五加叶血清药物化学初步研究

目的对刺五加Acanthopanax senticosus叶进行血清药物化学初步研究。方法大鼠ig给予刺五加叶提取液,采集含药血清。采用超高效液相色谱-四级杆-飞行时间串联质谱(UPLC-Q-TOF-MS/MS)技术,通过比较相同色谱、质谱条件下刺五加叶提取物、空白血清及给药血清图谱,并利用Peakview和MetabolitePilot数据处理软件,根据质谱所提供的保留时间、精确相对分子质量及二级质谱裂解碎片来鉴定和推测其血中移行成分。结果刺五加叶提取液ig给药后从血清中检测出19个入血成分,其中9个为原型成分,10个为代谢产物。结论初步确定了刺五加叶的入血成分,为阐明其药效物质基础提供依据。     

北京市医学伦理审查互认现场督导检查评分标准的制订与初步应用

目的 为检验伦理审查互认的实施效果,北京市卫生健康委员会决定对联盟中25家具备主审资质的医疗机构进行现场督导检查,为此联盟制定了伦理审查互认现场督导检查的评分标准,以保证检查的客观性和一致性。方法 评分标准主要参考《北京市医学伦理审查互认联盟工作规则》及25家医疗机构前期基本调研情况制订。结果 评分标准由3个一级指标、10个二级指标和13个三级指标构成。3个一级指标分别为制度建设(30分)、互认情况(25分)和审查效率(45分)。结论 评分标准为北京市医学伦理审查互认推进的重要工具,尽管个别指标在现阶段有使用上的局限性,但总体能较全面地考察伦理审查互认的实施情况及效果,且有一定可操作性。     

基于医院的晚期癌症患者居家延伸服务的可行性研究

目的探讨对晚期癌症患者实施居家延伸服务的可行性及其效果。方法由医院专科医生、护士组成的疼痛专科护理小组与社区护士合作为居家癌痛患者提供居家延伸服务,为期6个月。评价患者对延伸护理服务的满意度及服务前后患者癌痛知识掌握程度。结果 2015年、2016年、2017年1~6月分别有42、81、27例患者完成居家延伸服务,满意度分别为78.6%、95.1%、96.3%。服务后晚期癌症患者癌痛知识掌握程度显著高于服务前(P<0.01)。结论通过居家延伸服务可有效提高晚期癌症患者的癌痛知识掌握度及服务满意度,具有可行性。     

转化生长因子-β和Smad4在绝经过渡期大鼠卵巢颗粒细胞中的表达

目的 探讨转化生长因子-β（TGF-β）、Smad4 在绝经过渡期大鼠卵巢颗粒细胞中的表达,分析其与卵巢功能衰退的关系。 方法 雌性SD大鼠分为对照组（C组,6月龄,阴道涂片筛选,n=9）、绝经过渡期组（MT组,12~14月龄,阴道涂片筛选,n=8）,大鼠麻醉处死后迅速取出卵巢,采用机械分离方法释放卵泡颗粒细胞,于CO₂培养箱中培养,利用免疫细胞化学法检测促卵泡刺激素受体（FSHR）蛋白的表达,鉴定卵巢颗粒细胞;免疫细胞化学法检测TGF-β、Smad4蛋白在两组卵巢颗粒细胞的表达;采用Real-time PCR的方法检测各组颗粒细胞中TGF-β、Smad4 mRNA的表达。 结果 免疫细胞化学显示分离培养的颗粒细胞纯度＞95%,MT组TGF-β、Smad4蛋白表达水平低于对照组（P<0.05）;Real-time PCR结果显示,两组均有TGF-β、Smad4 mRNA的表达,MT组TGF-β、Smad4 mRNA表达水平显著低于对照组（P<0.05）。 结论 TGF-β、Smad4参与绝经过渡期大鼠卵巢功能的衰退过程,绝经过渡期大鼠功能衰退的部分原因可能与卵巢颗粒细胞中TGF-β、Smad4 的表达降低有关。     

A Comparative Immunohistochemical Study of Anal Canal Epithelium in Humans and Swine,Focusing on the Anal Transitional Zone Epithelium and the Anal Glands

To better understand the cellular origins and differentiation of anal canal epithelial neoplasms, the immunohistochemical profiles of the anal canal epithelium in humans and swine were evaluated. Formalin‐fixed tissue sections were immunostained for mucin (MUC: MUC2, MUC5AC, MUC5B), desmoglein 3 (DGS3), p63, CDX2, SOX2, and α‐smooth muscle actin (α‐SMA). The anal transitional zone (ATZ) epithelium covered the anal sinus and consisted of a stratified epithelium with mucous cells interspersed within the surface lining. Anal glands opened into the anal sinus. Ducts and acini of intraepithelial or periepithelial mucous type were the main structures of human anal glands, whereas those of swine were compound tubuloacinar mixed glands. Distal to the ATZ epithelium, non‐keratinized stratified squamous epithelium merged with the keratinized stratified squamous epithelium of the perianal skin. MUC5AC expression predominated over MUC5B expression in the ATZ epithelium, while MUC5B expression was higher in the anal glands. SOX2 was positive in the ATZ epithelium, anal glands, and squamous epithelium except in the perianal skin. In humans, DGS3 was expressed in the ATZ epithelium, anal gland ducts, and squamous epithelium. p63 was detected in the ATZ epithelium, anal glands, and squamous epithelium. Myoepithelial cells positive for α‐SMA and p63 were present in the anal glands of swine. Colorectal columnar cells were MUC5B⁺/MUC2⁺/CDX2⁺/MUC5AC^?/SOX2^?. The ATZ epithelium seems to be a distinctive epithelium, with morphological and functional features allowing smooth defecation. The MUC5AC⁺/SOX2⁺/MUC2^?/CDX2^? profile of the ATZ epithelium and anal glands is a useful feature for diagnosing adenocarcinoma arising from these regions. Anat Rec, 301:796–805, 2018. © 2017 Wiley Periodicals, Inc.     

Transsacral screw safe zone size by sacral segmentation variations

Variations in sacral segmentation may preclude safe placement of transsacral screws for posterior pelvis fixation. We developed a novel automated 3D technique to determine the safe zone size for transsacral screws in the upper two sacral segments in 526 adult pelvis computed tomography scans. Safe zone sizes were then compared by gender and sacral segmentation variations (number of neuroforamen and the presence/absence of lumbosacral transitional vertebrae, ±LSTV). Ten millimeters was used as the safety threshold for a large screw. 3 (0.6%), 366 (70%), and 157 (30%) sacra had 3, 4, or 5 neuroforamen, respectively. Eighty‐eight (17%) were +LSTV. Safe zone size depended on gender, number of neuroforamen in −LSTV sacra and presence of LSTV (p < 0.001) but not on the uni‐ or bilateral nature of the LSTV. 17% of −LSTV sacra were below the safety threshold in S1, 27% in S2, whereas 3% of +LSTV sacra were below in S1, 74% in S2. Of −LSTV sacra that cannot take an S1 screw safely, 77% can do so in S2, leaving only 4% of sacra that cannot accommodate a screw safely in either upper segment. The results demonstrate a predictable pattern of safe zone size based on gender and sacral segmentation variations. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:277–282, 2015.

     

三级医院延续性护理服务质量评价指标体系的构建

目的建立三级医院延续性护理服务质量评价指标体系,为客观评价与规范三级医院延续性护理服务提供参考。方法以"结构-过程-结果"模式为基础,结合现行延续性护理服务内容和患者需求,参考国内外文献和专家访谈形成问卷初稿;采用德尔菲(Delphi)法,通过2轮23名专家咨询初步确立三级医院延续性护理服务质量评价指标体系。结果专家咨询的权威系数、判断系数、熟悉系数分别为0.882,0.942,0.822;确定三级医院延续性护理服务质量评价指标体系,包括一级指标3项,二级指标10项,三级指标41项;一、二、三级指标的协调系数分别为0.736、0.521、0.627,具有统计学意义(均P0.01)。结论三级医院延续性护理服务质量评价指标体系内容科学可靠,有助于客观评价延续性护理服务质量,促进护理质量提升。     

新型护理流程在腹股沟疝日间手术患者中的应用

目的探讨新型护理流程在腹股沟疝日间手术患者中的应用。 方法选取2018年6月至2019年6月,首都医科大学附属北京朝阳医院疝和腹壁外科日间腹股沟疝手术患者224例,采用随机数字表法将患者分为试验组和对照组,每组112例。2组患者均行腹股沟疝修补术,对照组患者采用普通病房日常管理模式,给予常规护理;试验组患者应用新型护理流程。2组术后均随访2～6个月,比较2组患者对护理的满意度、患者对腹股沟疝疾病知识知晓率及护士错误率、工作时间。 结果试验组总满意度高于对照组,差异有统计学意义（P<0.05）。试验组患者对疾病知晓率高于对照组,试验组护士错误率低于对照组,试验组护士工作时间明显少于对照组,差异均有统计学意义（P<0.05）。 结论对日间腹股沟疝手术患者运用新型护理流程进行病房管理,优化了医护人员工作流程,提高护理工作质量,提高了患者对疾病知晓程度,增加了参与感,整体就医感受满意度明显提高。同时护理资源得到有效利用,具有推广的价值。     

Single and multiple respiratory virus infections and severity of respiratory disease: A systematic review

IntroductionThere are suggestions that virus co-infections may influence the clinical outcome of respiratory virus illness. We performed a systematic review of the literature to summarise the evidence.MethodsMEDLINE, EMBASE, Ovid and WEB of Science databases, major organisation websites and reference lists of published studies were searched. The quality of studies was assessed using the STROBE tool (von Elm et al., 1) Individual study data was analyzed using odds ratios and 95% confidence intervals as a measure of association between exposure (co-infection), patient outcome and results summarised using forest plots and tablesResultsNineteen (19) studies from all over the world were identified and included in the review. Most of the studies 73.7% (14/19) recruited children ≤6 years old. Evidence on the role of co-infection in increasing disease severity was inconclusive. In five out of eight studies, co-infection significantly increased risk of admission to general ward (OR: 2.4, 95% CI: 1.3 - 4.4, p = 0.005; OR: 2.4, 95% CI: 1.1 - 7.7, P = 0.04; OR: 3.1, 95% CI: 2.0 - 5.1, p = <0.001; OR: 2.4, 95% CI: 1.7-3.4, p = <0.0001 and OR: 2.3, 95% CI: 1.1 - 5.1, p = 0.34), one found it did not (OR: 0.59, 95% CI: 0.4 - 0.9, p = 0.02) and the other 2 had insignificant results. Similarly on risk of admission to ICU, some studies found that co-infection significantly increased risk of admission to ICU (OR: 2.9, 95% CI: 1.4 - 5.9, p = 0.004 and OR: 3.0, 95% CI: 1.7 - 5.6, p = <0.0001), whereas others did not (OR: 0.18, 95% CI: 0.05 - 0.75, p = 0.02 and OR: 0.3, 95% CI: 0.2 - 0.6, p = <0.0001). There was no evidence for or against respiratory virus co-infections and risk of bronchiolitis or pneumonia.ConclusionThe influence of co-infections on severe viral respiratory disease is still unclear. The observed conflict in outcomes could be because they were conducted in different seasons and covered different years and periods. It could also be due to bias towards the null, especially in studies where only crude analysis was conducted. Future studies should employ stratified analysis.