Determinants of post-intensive care mortality in high-level treated critically ill patients

Objective To assess the predictive ability of preillness and illness variables, impact of care, and discharge variables on the post-intensive care mortality.Setting and patients 5,805 patients treated with high intensity of care in 89 ICUs in 12 European countries (EURICUS-I study) surviving ICU stay.Methods Case-mix was split in training sample (logistic regression model for post-ICU mortality: discrimination assessed by area under ROC curve) and in testing sample. Time to death was studied by Cox regression model validated with bootstrap sampling on the unsplit case-mix.Results There were 5,805 high-intensity patients discharged to ward and 423 who died in hospital. Significant odds ratios were observed for source of admission, medical/surgical unscheduled admission, each year age, each SAPSII point, each consecutive day in high-intensity treatment, and each NEMS point on the last ICU day. Time to death in ward was significantly shortened by different source of admission; age over 78 years, medical/unscheduled surgical admission; SAPSII score without age, comorbidity and type of admission over 16 points; more than 2 days in high-intensity treatment; all days spent in high treatment; respiratory, cardiovascular, and renal support at discharge; and last ICU day NEMS higher than 27 pointsConclusions Worse outcome is associated with the physiological reserve before admission in the ICU, type of illness, intensity of care required, and the clinical stability and/or the grade of nursing dependence at discharge.This study was supported in part, by the Foundation for Research on Intensive Care in Europe (FRICE) and by a grant from the Commission of the European communities (BMH1-CT93-1340)     

死亡相关蛋白激酶在结肠癌耐药中的作用

目的 探讨死亡相关蛋白激酶（DAPK）在结肠癌耐药中的作用.方法 应用免疫组织化学（免疫组化）SP法检测61例结肠癌组织及32例癌旁组织中DAPK的表达.以氟尿嘧啶（5-FU）诱导建立的结肠癌耐药细胞系HCT116/5-FU为模型.通过转染DAPK-siRNA下调DAPK的表达（DAPK-siRNA组）,转染FAM-siRNA（FAM-siRNA组）作为对照;通过过表达载体上调DAPK的表达（DAPK过表达组）.采用实时定量荧光PCR及蛋白质印迹法检测3组的DAPK、多药耐药蛋白（MRP）和P-糖蛋白（P-gp）的mRNA及蛋白表达水平;MTT法及流式细胞法分别测定3组细胞在未经5-FU处理及浓度为8 μg/ml的5-FU处理下的细胞增殖和凋亡情况.结果 DAPK在结肠癌组织中的阳性表达率明显低于癌旁组织[18.0％（11/61）比90.6％（29/32）,P＜0.05].与FAM-siRNA组比较,DAPK-siRNA组细胞中DAPK mRNA水平及蛋白表达水平均明显降低,DAPK过表达组则均显著升高（均P＜0.05）.在5-FU处理下,相比FAM-siRNA组,DAPK过表达组细胞增殖受到明显抑制,细胞凋亡率明显升高（均P＜0.05）;DAPK-siRNA组细胞增殖和细胞凋亡率均无明显变化（均P＞0.05）.与FAM-siRNA组比较,DAPK过表达组两种耐药蛋白的mRNA和蛋白表达水平均明显降低（P＜0.05）,而DAPK-siRNA组与FAM-siRNA组间差异无统计学意义（P＞0.05）.结论 DAPK能够抑制结肠癌耐药细胞的增殖,促进其凋亡,并可能通过抑制MRP和P-gp的mRNA和蛋白表达,来增强结肠癌细胞对药物的敏感性。     

Trends in reporting injury as a cause of death among people with epilepsy in the U.S., 1981–2010

PurposeTo examine trends in reporting injury as a cause of death among people with epilepsy in the U.S. during the past three decades.MethodWe analyzed the U.S. multiple causes of death data from death certificates in 1981–2010 to compare rate and odds ratios (OR) of reporting injury as cause of death among cases with vs. without mention of epilepsy across years.ResultsThe trends in reporting epilepsy with and without injury were similar in most age groups but were inconsistent in most external causes of injury. The OR of reporting injury was 1.02 (95% confidence intervals (CI) 0.97–1.07) in 1981–1985 and decreased to 0.52 (95% CI 0.48–0.55) in 2006–2010. The decline in OR was prominent among people aged 15–24 followed by people aged 25–44. For the five external causes of injury, the OR of suffocation and drowning were 6.32 (95% CI 5.91–6.75) and 5.64 (95% CI 5.16–6.16) in 1981–1985 and decreased to 3.03 (95% CI 2.74–3.35) and 2.56 (95% CI 2.18–3.00) in 2006–2010. The OR for poisoning and traffic crashes were 0.70 (95% CI 0.57–0.85) and 0.08 (95% CI 0.07–0.09) in 1981–1985 and 0.21 (95% CI 0.18–0.25) and 0.06 (95% CI 0.05–0.08) in 2006–2010.ConclusionThe risk of fatal injury among people with epilepsy decreased drastically during the past three decades in most age groups and for most external causes of injury except falls. People with epilepsy had lower risks of dying from injury due to poisoning or traffic crashes, had higher risks of dying from suffocation and drowning.     

The attitude toward xenocorneal transplantation in wait‐listed subjects for corneal transplantation in Korea

Shortage of donor cornea is a significant problem in Asia, and xenocorneal transplantation is being actively studied to alleviate this problem. However, the attitudes of subjects who await corneal transplants toward xenocorneal transplantation are not known at all. Thus, this study aimed to investigate the attitudes of subjects on the waiting lists for corneal transplants, toward corneal xenotransplantation. A telephone questionnaire survey comprising six items was conducted in 132 subjects among the wait‐listed individuals (n = 590) who were awaiting corneal transplantation or had undergone corneal transplantation at Seoul National University Hospital from July, 2003 to August, 2012. Among six inquiries, four questions were used to analyze attitudes toward corneal xenotransplantation. Each question pertained to (1) the acceptance of xenocorneal transplantation, (2) willingness to participate in clinical trials, (3) worries in xenocorneal transplantation, and (4) the concern of self‐identity or social life after xenocorneal transplantation. To analyze demographic factors influencing the question, the subjects were arbitrarily divided into two groups: the young (age < 60 yr, n = 58) and the elderly (age ≥ 60 yr, n = 74) or the less‐educated (n = 53) and the well‐educated with high school diploma, college graduation, or higher education (n = 79). Collected demographic data were analyzed as influencing factors on each question using a chi‐square and logistic regression tests. In this study, 42.4% of the subjects (n = 56) expressed favorable views on xenocorneal transplantation using porcine corneas to cure visual loss from corneal blindness. Among those subjects expressing favorable views (n = 56), the willingness to participate in clinical trials, knowing they and their spouses must undergo long‐term surveillance, was 62.5% (n = 35). There were 76.5% of subjects (n = 101) expressing worries regarding xenocorneal transplantation, while 28.8% of subjects (n = 38) expressed their concerns about self‐identity or social life after xenotransplantation. Younger subjects expressed more worry about xenotransplantation than elderly subjects. The well‐educated expressed less concern over self‐identity and social life than the less‐educated. This survey among subjects who are wait‐listed for corneal transplant or who have received a corneal transplant demonstrates that there is an interest in xenocorneal transplantation as an alternate procedure, although there are worries about the procedure that should be further explored in educational campaigns and future studies of the general population.     

护生艾滋病知识与态度的调查分析

目的 了解护生对艾滋病(acquired immunodeficiency syndrome,AIDS)知识的掌握情况及对AIDS患者的态度。方法 采用自行设计的问卷对203名即将进入临床实习的护生进行调查。结果 护生AIDS知识分数为(8.7±1.8),对HIV经性、静脉途径传播的认识正确率高,对不会传播HIV的途径回答正确率低。态度分值为(44.2±3.4),其中同意HIV感染者在社区应该被隔离者占91％,86％害怕护理AIDS患者时被感染,愿意去护理AIDS患者的为47.3％。知识与态度之间有显著的正相关性(r=0.17,P=0.013)。结论 护生对AIDS存在错误的认识,害怕护理患者时被感染的心理普遍存在,护理AIDS患者的意愿不高。对护生开展针对性AIDS专题培训很有必要。     

神经内科护士失禁性皮炎知信行的访谈分析

目的：探讨神经内科护士对失禁性皮炎(IAD)的知识、态度、信念及行为现状,为 IAD 的培训、教育及规范管理提供参考依据。方法采用随机抽样,运用半结构式访谈法,对50名神经内科护理人员进行一对一深入访谈,记录、整理并分析资料,归纳主题。结果被访者对于 IAD 知识缺乏,态度积极,护理行为有待提高。结论降低 IAD 发生率、减少 IAD 患者痛苦需多部门合作,护理人员需进行相关知识培训,对家属行健康指导,管理部门需制定相关处理策略,从而提高 IAD 护理质量。     

如何判断脑死亡

80年代初，英国学者提出脑死亡的概念，此后20余年间，确定脑死亡或成为重要的医学命题之一。脑死亡的基本条件是脑干功能不可回逆的丧失，WHO提出的确定标准为：需要不停地维持人工呼吸，对外界刺激无反应，无自发性的肌肉活动，无反射活动，脑电图长时间出现平直线。确定脑死亡，必须与持续植物状态和闭锁综合征相鉴别。     

四川省第三次全国死因流调人群循环系统疾病死亡特征分析

目的了解四川省居民循环系统疾病死亡现状，为制定预防控制措施提供依据。方法对四川省十个调查点全人群进行死因调查，使用国家统一软件分析调查数据。结果调查人群死亡第一位是循环系统疾病，粗死亡率175、62／10万^-1，标化死亡率为118．04／10万^-1。结论制订心血管疾病防治方案，采取一系列防治措施是非常重要的。     

干预前后居民心脑血管病、糖尿病知信行水平分析

目的了解人群对心脑血管病和糖尿病相关知识的掌握情况,评价以社区为基础的以健康教育为手段的干预效果。方法干预Methods为创造社区健康支持环境、家庭动员、家庭行为干预和健康讲座。干预前后采用随机抽样的方法抽取杭州市常住居民,进行心脑血管病糖尿病防治知信行调查,干预前调查798例,干预后调查500例;结果初查显示杭州市六个区的常住居民对心脑血管病和糖尿病防治知信行水平较低;通过一年的综合干预,28项知信行指标均有了显著提高。结论健康促进是控制心脑血管病和糖尿病的重要措施,行为干预的效果优于一般的健康教育,以社区为基础的心脑血管病和糖尿病综合干预在我国是切实可行且行之有效。