以家庭为中心护理模式在造口患儿中的应用研究

目的探讨以家庭为中心护理模式在造口患儿护理中的应用效果。方法将67例肠造口患儿按时间段分为对照组(34例)和观察组(33例),对照组按照常规方法护理,观察组采取以家庭为中心护理模式,包括心理护理和人文关怀,鼓励照护者参与全程护理,多途径的健康教育,建立出院指导标准。比较两组患儿术后住院时间,造口周围皮肤情况,以及家庭造口护理能力。结果观察组术后住院时间显著短于对照组(P0.01),造口周围皮肤情况显著优于对照组(P0.01),家庭造口护理能力4个维度及总分显著高于对照组(P0.05,P0.01)。结论以家庭为中心护理模式可有效改善患儿造口周围皮肤问题,缩短患儿术后住院时间,提高家庭造口护理能力。     

认知行为疗法改善学龄前儿童牙科畏惧症

目的观察认知行为疗法在学龄前牙科畏惧症儿童口腔治疗中的临床效果。方法采用"儿童畏惧调查量表牙科分量表"对口腔科门诊初诊3~6岁龋病患儿开展问卷调查,筛选出牙科畏惧症患儿105例。随机分为对照组53例,予龋齿充填治疗;观察组52例,予龋齿充填治疗+认知行为疗法。比较两组治疗过程中行为分级及配合情况。结果观察组患儿治疗过程中Venham临床焦虑及合作行为级别显著低于对照组;观察组配合治疗患儿比例69.2%,高于对照组的35.8%,两组比较,差异有统计学意义(P0.01)。结论运用认知行为疗法进行心理干预,可缓解学龄前儿童口腔诊疗过程中的紧张情绪、增加对口腔诊疗的配合度。     

明清医家论治不孕不育症的用药规律研究

目的:基于明清医家文献,明确不孕不育症中医常用中药及其四气、五味和归经,为临床实践提供经验。方法:用关键词对中国基本古籍库进行检索,根据纳入和排除标准筛选合格文献。建立明清种子方数据库并对原始文献进行规范化处理,整理和分析明清种子方治疗类别、剂型、药物组成、四气、五味和归经,应用软件进行统计分析,得到明清治疗不孕不育症的用药规律。结果:本研究共纳入明清种子方剂235首,明清治疗不孕不育症文献中,1)常见剂型为丸剂;2)治疗类别主要为不孕;3)出现频率最高的方剂为五子衍宗丸;4)使用的药物主要是补虚药,其次为清热药和活血化瘀药;5)使用药物的四气主要为温,五味主要为甘,归经主要为肾、脾、肝;6)常用药对为白芍、当归;药物组合为白芍、当归、川芎、熟地黄。结论:明清医家治疗不孕不育以丸药为主,治方思路针对肾、脾、肝以甘温补虚为主流,同时也兼以清热药和活血化瘀药。此研究为现代临床治疗不孕不育提供了参考。     

异位妊娠药物保守治疗适应证的新评分法研究

目的 :探讨彩色多普勒超声 (CDFI)筛选适合药物保守治疗异位妊娠的临床价值。方法 :4 8例生命体征平稳的异位妊娠患者 ,在行CDFI检查后接受甲氨喋呤 (MTX) 5 0mg/m2 单次肌肉注射配合口服米非司酮 15 0mg ,随访直至临床结局。分析成功与失败病例CDFI的特点和绒毛膜促性腺激素 (hCG)水平 ,并制作CDFI评分。结果 :CDFI能直接反映胚胎生命力 ,CDFI图像和血清hCG水平不同者 ,保守治疗成功率有很大差异。结论 :CDFI评分可应用于适合保守治疗异位妊娠病例的筛选。对评分 >9者因失败率高 ,不推荐药物保守治疗。     

2013年国际麻醉领域指南回顾

背景 麻醉学发展日新月异,麻醉指南的更新与发布对推动临床麻醉发展至关重要. 目的 介绍2013年国际麻醉学界内6部相关指南. 内容 将麻醉后恢复或管理、困难气道管理、手术室火灾预防或管理、围手术期严重出血管理及凝血功能异常患者区域麻醉风险评估共6部指南的概况、要点及精华予以回顾介绍. 趋向 熟悉麻醉领域内指南更新,既有助于麻醉医师更好地规范临床实践,也有助于在临床中思考与总结,以进一步提高临床麻醉安全,保证麻醉质量.     

奎宁与三种逆转剂联合对耐药细胞系K562/HHT多药耐药逆转作用的研究

目的：寻找有效的多药耐药联合逆转剂。方法：用ＭＴＴ法、联合效应分析和流式细胞仪测定技术研究奎宁（Ｑｕｉｎ）分别与环孢菌素Ａ（ＣｓＡ）、他莫西酚（Ｔａｍ）、潘生丁（ＤＰＭ）联合逆转耐药细胞系Ｋ５６２／ＨＨＴ对柔红霉素（ＤＮＲ）和高三尖杉酯碱（ＨＨＴ）耐药。结果：逆转倍数是单用药的２～３倍，达到或超过单用２倍剂量的逆转效果，逆转剂间有联合协同作用，其中Ｑｕｉｎ与ＤＰＭ或Ｔａｍ联合的协同作用大于Ｑｕｉｎ与ＣｓＡ联合，可增加细胞内ＤＮＲ浓度。结论：Ｑｕｉｎ与ＣｓＡ、ＤＰＭ或Ｔａｍ联合具有协同作用，不同机制逆转剂联合的协同作用更为显著。     

70岁以上住院老年慢性病病人抑郁和焦虑的调查

随着医学科学技术的飞速发展和人民物质精神生活水平的日益提高，我国人口的平均预期寿命不断增长，现已接近70岁。据统计：目前我国老年病人口（我国以60岁以上为老年病人）总数已近I．3亿，约占总人口数的10．09％，而75岁以上老年病人以每年平均3．62％的速度增长，预测到2025年将上升到20％，2050年将达到顶峰25．5％。老年人是慢性病的主要患病人群。因此，本研究针对70岁以上患慢性病的住院普通老年人和住院离休干部进行调查，采用Brink老年抑郁量表（GDS）、Zung焦虑自评量表（SAS），以了解住院老年人中存在的焦虑、抑郁情况以及分析两组病人的性别、年龄、文化程度、婚姻状况、个人习惯和经济收入情况。现将结果报道如下。[第一段]     

Non-continuous versus continuous wound drainage after total knee arthroplasty: a meta-analysis

Purpose

So far, controversy still exists regarding the use of non-continuous or continuous wound drainage after total knee arthroplasty. The aim of this study was to assess the efficacy and safety of these two drainage techniques after total knee arthroplasty.

Methods

We searched the established electronic literature databases of Pubmed, Embase, Cochrane Library, CNKI, VIP and WANFANG. Nine RCTs including a total of 761 patients involving 811 knees were eligible for this meta-analysis.

Results

Our results showed that non-continuous drainage was associated with less haemoglobin loss (WMD,  −0.43, 95 % CI −0.62 to −0.24; P < 0.00001) and postoperative visible blood loss (WMD,  −305.09, 95 % CI −408.10 to −202.08; P < 0.00001) compared with continuous drainage. No significant difference was found between the two groups in terms of range of motion (WMD, 0.99, 95 % CI −1.01 to 2.98; P = 0.33), incidence of blood transfusion (OR, 0.63, 95 % CI 0.38 to 1.06; P = 0.80) or postoperative complications (OR, 1.09, 95 % CI 0.35 to 3.40; P = 0.89).

Conclusion

The existing evidence indicates that non-continuous drainage can achieve less haemoglobin loss (especially the four- to six-hour drain clamping) and postoperative visible blood loss with no increased risk of postoperative complications compared with continuous drainage.     

Selective degeneration of a physiological subtype of spinal motor neuron in mice with SOD1-linked ALS

Amyotrophic lateral sclerosis (ALS; Lou Gehrig’s disease) affects motor neurons (MNs) in the brain and spinal cord. Understanding the pathophysiology of this condition seems crucial for therapeutic design, yet few electrophysiological studies in actively degenerating animal models have been reported. Here, we report a novel preparation of acute slices from adult mouse spinal cord, allowing visualized whole cell patch-clamp recordings of fluorescent lumbar MN cell bodies from ChAT-eGFP or superoxide dismutase 1-yellow fluorescent protein (SOD1YFP) transgenic animals up to 6 mo of age. We examined 11 intrinsic electrophysiologic properties of adult ChAT-eGFP mouse MNs and classified them into four subtypes based on these parameters. The subtypes could be principally correlated with instantaneous (initial) and steady-state firing rates. We used retrograde tracing using fluorescent dye injected into fast or slow twitch lower extremity muscle with slice recordings from the fluorescent-labeled lumbar MN cell bodies to establish that fast and slow firing MNs are connected with fast and slow twitch muscle, respectively. In a G85R SOD1YFP transgenic mouse model of ALS, which becomes paralyzed by 5–6 mo, where MN cell bodies are fluorescent, enabling the same type of recording from spinal cord tissue slices, we observed that all four MN subtypes were present at 2 mo of age. At 4 mo, by which time substantial neuronal SOD1YFP aggregation and cell loss has occurred and symptoms have developed, one of the fast firing subtypes that innvervates fast twitch muscle was lost. These results begin to describe an order of the pathophysiologic events in ALS.Amyotrophic lateral sclerosis (ALS; Lou Gehrig’s disease) is a progressive and usually lethal neurodegenerative condition prominently featuring loss of motor neurons (MNs) and muscle denervation (1–3). Inherited forms of ALS, accounting for ∼10% of cases, potentially inform about disease mechanisms, including: protein folding and quality control [e.g., mutant superoxide dismutase 1 (SOD1), ubiquilin2, and VCP]; RNA binding proteins (e.g., TDP43, FUS, and HNRNPA1); or a DNA expansion (C9ORF72 hexanucleotide expansion). The clinical courses of the various heritable forms and the 90% of cases that are considered sporadic are not distinct, however, reflecting a potentially shared progressive loss of MNs and motor circuit dysfunction (4).ALS has been modeled in mice that are transgenic for a variety of mutant forms of SOD1, allowing for the study of the trajectory of the condition at various time points (5, 6). Among the studies conducted to date are a number addressing electrophysiological changes. From these studies, however, there does not appear to be a clear consensus on the changes that occur in MNs before and during the development of symptoms (7). For example, whereas research on the neuromuscular junction has revealed preferential denervation of fast twitch (type IIb) muscle fibers (8–10), the relationship of this selective susceptibility at the muscle level to pathophysiologic change in the spinal cord is not clear.A major challenge to understanding spinal cord physiology of the mouse models of ALS arises from difficulty in distinguishing the individual features of neurons in the anatomically and physiologically heterogeneous motor system. For example, the usefulness of in vivo recordings requires ensuring adequate sampling of anatomically and functionally heterogeneous spinal cord MNs. For the ex vivo alternative, slice physiology is challenging because most mouse models develop disease after 1 mo of age, a time when spinal cord tissue becomes more sensitive to ischemia (11, 12), making isolation of viable slices difficult. In addition, the spinal cord becomes heavily myelinated in the first few weeks of postnatal life (13), making visualization of individual neurons difficult. Hence, most research regarding cellular electrophysiology in mouse models of ALS has been carried out with primary cultures of embryonic (E13–14) spinal cord MNs (14) or induced pluripotent stem (iPS) cell-derived MNs (15). Although they provide a basis for further study, these models may lack the changes that occur progressively in the context of an intact spinal cord. These models may also lack the diversity of MN physiology present in the mature spinal cord.Here we studied a transgenic strain of ALS mice, G85R SOD1YFP (16), that develops motor symptoms by ∼3 mo of age, associated with progressive accumulation of aggregates in MN cell bodies (from ∼1 mo of age), attended by MN cell loss. The mice paralyze uniformly by 5–6 mo of age. We first developed, using ChAT- EGFP mice that express GFP fluorescence in MNs (17), an acute slice preparation of adult mouse spinal cord that yielded healthy MNs in animals up to and beyond 6 mo of age, readily visualized by their fluorescence, enabling whole cell patch-clamp recordings when coupled with differential interference contrast (DIC) imaging. This preparation allowed extensive characterization of normal MN electrophysiology and enabled grouping of MNs, distinguishing four firing types. We then recorded from MNs in slices from ALS animals at two time points: during the course of aggregation at 2–3 mo of age, before symptoms, and after the onset and initial progression of symptoms at 4 mo of age. At the early time, the four distinct clusters of MNs were present, albeit the fastest firing type (cluster 4) exhibited a significant hyperpolarization. At the later time point, this firing type was no longer detectable, with only the other three types observable, the fastest of which (cluster 3) was now hyperpolarized. Retrograde tracing from fast and slow twitch muscles of the lower extremity revealed that aggregates form preferentially in MN cell bodies attached to fast twitch muscle. These observations suggest a possible sequence of events in which hyperpolarization of the cluster 4 MNs, innervating fast twitch muscle, is associated with aggregate formation in these neurons, which then die, denervating fast twitch muscle.