压脉带在低出生体重儿PICC置管长度体外测量中的应用研究

目的：探讨低出生体重儿经外周静脉置入中心静脉导管（PICC ）置管最佳体外测量方法。方法2012年1月18日～2013年12月18日，对在我院进行PICC置管的低出生体重儿按置管时间随机分为观察组和对照组，观察组测量方法是经头静脉穿刺时，压脉带自穿刺点沿静脉走向，在右侧上肢外侧上行至锁骨中线，弯曲向下至右侧乳头与前正中线中点，经正中及贵要静脉穿刺时，压脉带自穿刺点沿静脉走向，在右侧上肢内侧上行至锁骨中线，弯曲向下至右侧乳头与前正中线的中点，再测量压脉带的长度，为导管预留置长度。对照组测量方法是自穿刺点至右胸锁关节长度，再加0．5 cm ，为导管预留置长度。比较两组患儿置管的准确率。结果观察组PICC置入上腔静脉中下段的准确率为77．8％，对照组PICC置入上腔静脉中下段的准确率为44．4％，两组比较 P＜0．05，差异有显著意义。结论低出生体重儿PICC置管使用压脉带进行体外测量，可提高PICC置入上腔静脉中下段的准确率。     

Placental Hofbauer cells assemble and sequester HIV-1 in tetraspanin-positive compartments that are accessible to broadly neutralizing antibodies

Introduction

Within monocyte-derived macrophages, HIV-1 accumulates in intracellular virus-containing compartments (VCCs) that are inaccessible to the external environment, which implicate these cells as latently infected HIV-1 reservoirs. During mother-to-child transmission of HIV-1, human placental macrophages (Hofbauer cells (HCs)) are viral targets, and have been shown to be infected in vivo and sustain low levels of viral replication in vitro; however, the risk of in utero transmission is less than 7%. The role of these primary macrophages as viral reservoirs is largely undefined. The objective of this study is to define potential sites of viral assembly, accumulation and neutralization in HCs given the pivotal role of the placenta in preventing HIV-1 infection in the mother-infant dyad.

Methods

Term placentae from 20 HIV-1 seronegative women were obtained following caesarian section. VCCs were evaluated by 3D confocal and electron microscopy. Colocalization R values (Pearson''s correlation) were quantified with colocalization module of Volocity 5.2.1. Replication kinetics and neutralization studies were evaluated using p24 ELISA.

Results

We demonstrate that primary HCs assemble and sequester HIV-1_BaL in intracellular VCCs, which are enriched in endosomal/lysosomal markers, including CD9, CD81, CD63 and LAMP-1. Following infection, we observed HIV-1 accumulation in potentially acidic compartments, which stained intensely with Lysotracker-Red. Remarkably, these compartments are readily accessible via the cell surface and can be targeted by exogenously applied small molecules and HIV-1-specific broadly neutralizing antibodies. In addition, broadly neutralizing antibodies (4E10 and VRC01) limited viral replication by HIV-1-infected HCs, which may be mediated by FcγRI.

Conclusions

These findings suggest that placental HCs possess intrinsic adaptations facilitating unique sequestration of HIV-1, and may serve as a protective viral reservoir to permit viral neutralization and/or antiretroviral drug entry in utero.     

改良体位在ICU人工气道患者留置胃管中的应用

目的 探讨改良体位(抬颌仰额)加导丝引导置管法在ICU人工气道患者留置胃管中的应用效果.方法 将实施人工气道的180例ICU住院患者按留置胃管顺序奇偶数分为对照组和观察组各90例,对照组采用常规体位加导丝引导置管法留置胃管,观察组采用改良体位加导丝引导置管法,观察两组一次性置管成功率、置管时间的差异.结果 观察组留置胃管一次性置管成功率显著高于对照组、置管时间显著短于对照组(均P＜0.01).结论 采用抬颌仰额位加导丝引导置管法能有效提高ICU人工气道患者留置胃管一次性置管成功率,缩短置管时间,进而减轻对患者食管损伤,提高护士工作效率.     

基于Goldstein模型分析不同岗位临床护士的培训需求

目的 以Goldstein模型分析不同岗位临床护士培训需求,为开展护士岗位培训提供参考.方法 基于Goldstein模型设计“护士岗位培训需求评估问卷”,并对50名护理专家进行不同岗位护士培训目标调查,同时对350名临床护士进行培训知识掌握情况和培训需求调查.结果 专家认为,不同岗位临床护士的培训目标得分为(4.68±2.73)～(4.94±1.36)分;不同岗位临床护士培训知识掌握得分为(3.69±0.23)～(4.93±0.07)分、培训需求得分为(4.93±0.20)～(4.98±0.08)分;不同岗位护士培训知识掌握与培训目标存在差异(P＜0.05,P＜0.01).结论 不同岗位护士的培训目标与培训需求差异较小,但其培训知识掌握与培训目标存在差距.对护理人员培训时应根据不同岗位人员的培训目标及其相关知识掌握情况、培训需求进行安排和规划,以提高培训效果.     

Unifying account of visual motion and position perception

Despite growing evidence for perceptual interactions between motion and position, no unifying framework exists to account for these two key features of our visual experience. We show that percepts of both object position and motion derive from a common object-tracking system—a system that optimally integrates sensory signals with a realistic model of motion dynamics, effectively inferring their generative causes. The object-tracking model provides an excellent fit to both position and motion judgments in simple stimuli. With no changes in model parameters, the same model also accounts for subjects’ novel illusory percepts in more complex moving stimuli. The resulting framework is characterized by a strong bidirectional coupling between position and motion estimates and provides a rational, unifying account of a number of motion and position phenomena that are currently thought to arise from independent mechanisms. This includes motion-induced shifts in perceived position, perceptual slow-speed biases, slowing of motions shown in visual periphery, and the well-known curveball illusion. These results reveal that motion perception cannot be isolated from position signals. Even in the simplest displays with no changes in object position, our perception is driven by the output of an object-tracking system that rationally infers different generative causes of motion signals. Taken together, we show that object tracking plays a fundamental role in perception of visual motion and position.Research into the basic mechanisms of visual motion processing has largely focused on simple cases in which motion signals are fixed in space and constant over time (e.g., moving patterns presented in static windows) (1). Although this approach has resulted in considerable advances in our understanding of low-level motion mechanisms, it leaves open the question of how the brain integrates changing motion and position signals; when objects move in the world, motion generally co-occurs with changes in object position. The process of generating coherent estimates of object motion and position is known in the engineering and computer vision literature as “tracking” (e.g., as used by the Global Positioning System) (2). Conceptualizing motion and position perception in the broader context of object tracking suggests an alternative conceptual framework—one that we show provides a unifying account for a number of perceptual phenomena.An optimal tracking system would integrate incoming position and motion signals with predictive information from the recent past to continuously update perceptual estimates of both an object’s position and its motion. Were such a system to underlie perception, position and motion should be perceptually coupled in predictable ways. Signatures of such a coupling appear in a number of known phenomena. On one hand, local motion signals can predictively bias position percepts (3–8). On the other hand, we can perceive motion solely from changes in object position (9–12). For example, motion can be perceived in stimuli with no directional motion signal by tracking position changes along a specific direction (10). These phenomena, however, are currently regarded as arising from independent mechanisms (11–14).Given the interdependency of motion and position and the inherent noisiness of sensory signals, it is advantageous for vision to exploit the redundancy between motion and position signals and integrate them into coupled perceptual estimates. This is complicated by the fact that local motion signals can result from a combination of motions (of which object translations are only one) (15, 16). A flying, rotating soccer ball provides a prototypical example of this problem (Fig. 1A). Because the ball rotates as it flies through the air, the local retinal motion signals created by ball texture are sums of two world motions: translation and rotation of the ball. Relating local motion signals to object motion requires the solution of the “source attribution” problem (17, 18)—determining what part of a local retinal motion pattern is due to object translation and what part is due to object-relative motion of the texture pattern. To solve this attribution problem, the brain can exploit the redundant information provided by the changing stimulus position. Moreover, integrating motion and position information over time with an internal model of motion dynamics can mitigate both the uncertainty created by ubiquitous sensory noise (19) and that created by the motion source attribution problem. Although object-relative pattern motion is not a property of all moving objects, understanding how pattern motion interacts with object motion and position can help elucidate how the brain integrates motion and position signals into coherent perceptual estimates—a problem associated with all moving objects.Open in a separate windowFig. 1.Schematic illustration of the object-tracking model and its behavior. (A) An example of an object with both object boundary motion and pattern motion. (B) A generative model of the Bayesian observer. White nodes indicate hidden variables and gray nodes indicate observable variables that are noisy measurements of the connected hidden variables. Arrows indicate causal links. (C) Model behavior for a typical MIPS stimulus containing a moving pattern within a static envelope. The steady-state estimates of the three object states (position, object velocity, and pattern velocity) are plotted for different positional uncertainties. At low positional uncertainty, most of the retinal texture motion is correctly attributed to the pattern motion. Consequently, illusory object motion and MIPS are negligible. At high positional uncertainty, much of the texture motion is attributed to object motion (reflecting a prior that object motion is more likely than pattern motion). This results in relatively low estimated pattern velocity and large MIPS.Here, we propose and test a computational framework in which motion and position perception derive from a common mechanism that integrates sensory signals over time to track objects and infer their generative causes. The consequence of this process is a strong, bidirectional coupling between motion and position perception that provides a unifying account for a range of perceptual phenomena. These include motion-induced shifts in perceived position (3–6), perceptual speed biases (20), slowing of motions shown in visual periphery (21, 22), and the curveball illusion (16). The presented model also makes novel predictions about interactions between position and motion perception—predictions confirmed here. Importantly, we do not fit the model to each experiment, but fit the parameters to data from experiment 1 and show that the resulting model accurately predicts subjects’ performance in qualitatively different and more complex tasks (experiments 2 and 3).     

Effects of Adult Romantic Attachment and Social Support on Resilience and Depression in Individuals with Spinal Cord Injuries

Background:

Spinal cord injury (SCI) can cause psychological consequences that negatively affect quality of life. It is increasingly recognized that factors such as resilience and social support may produce a buffering effect and are associated with improved health outcomes. However the influence of adult attachment style on an individual’s ability to utilize social support after SCI has not been examined.

Objective:

The purpose of this study was to examine relationships between adult romantic attachment perceived social support depression and resilience in individuals with SCI. In addition we evaluated potential mediating effects of social support and adult attachment on resilience and depression.

Methods:

Participants included 106 adults with SCI undergoing inpatient rehabilitation. Individuals completed measures of adult attachment (avoidance and anxiety) social support resilience and depression. Path analysis was performed to assess for presence of mediation effects.

Results:

When accounting for the smaller sample size support was found for the model (comparative fit index = .927 chi square = 7.86 P = .01 β = -0.25 standard error [SE] = -2.93 P < .05). The mediating effect of social support on the association between attachment avoidance and resilience was the only hypothesized mediating effect found to be significant (β = -0.25 SE = -2.93 P < .05).

Conclusion:

Results suggest that individuals with SCI with higher levels of attachment avoidance have lower perceived social support which relates to lower perceived resilience. Assessing attachment patterns during inpatient rehabilitation may allow therapists to intervene to provide greater support.     

Placental pathology and neurological morbidity in preterm infants during the first two weeks after birth

Background

The placenta plays a crucial role during pregnancy and dysfunction causes long-term neurological problems. Identifying placenta-related risks for neurological problems shortly after birth may provide clues for early interventions aiming to improve neurological outcome.

Objective

To determine the association between placental pathology and neurological morbidity in preterm infants during the first two weeks after birth.

Study design

Placentas of 52 singleton, preterm infants (GA: 25–31 weeks, BW: 560–2250 grammes) were examined for histopathology. The infants' neurological condition shortly after birth was determined by assessing the quality of their general movements (GMs): normal, abnormal, or hypokinetic, on days 5, 8, and 15. A motor optimality score (MOS) was also assigned.

Results

Examination of the placentas revealed maternal vascular underperfusion (n = 29), ascending intrauterine infection (AIUI) (n = 19), villitis of unknown aetiology (n = 6), chronic deciduitis (n = 11), foetal thrombotic vasculopathy (FTV) (n = 9), and elevated nucleated red blood cells (NRBCs) as a marker for foetal hypoxia (n = 7). None of the placental lesions were significantly associated with the quality of GMs or MOS.

Conclusions

This study indicated that placental lesions were not associated with infants' neurological condition as measured by the quality of their general movements during the first two weeks after birth.     

The relation of infant attachment to attachment and cognitive and behavioural outcomes in early childhood

Background

In China, research on the relation of mother–infant attachment to children's development is scarce.

Aims

This study sought to investigate the relation of mother–infant attachment to attachment, cognitive and behavioural development in young children.

Study design

This study used a longitudinal study design.

Subjects

The subjects included healthy infants (n = 160) aged 12 to 18 months.

Outcome measures

Ainsworth's “Strange Situation Procedure” was used to evaluate mother–infant attachment types. The attachment Q-set (AQS) was used to evaluate the attachment between young children and their mothers. The Bayley scale of infant development-second edition (BSID-II) was used to evaluate cognitive developmental level in early childhood. Achenbach's child behaviour checklist (CBCL) for 2- to 3-year-olds was used to investigate behavioural problems.

Results

In total, 118 young children (73.8%) completed the follow-up; 89.7% of infants with secure attachment and 85.0% of infants with insecure attachment still demonstrated this type of attachment in early childhood (κ = 0.738, p < 0.05). Infants with insecure attachment collectively exhibited a significantly lower mental development index (MDI) in early childhood than did infants with secure attachment, especially the resistant type. In addition, resistant infants were reported to have greater social withdrawal, sleep problems and aggressive behaviour in early childhood.

Conclusion

There is a high consistency in attachment development from infancy to early childhood. Secure mother–infant attachment predicts a better cognitive and behavioural outcome; whereas insecure attachment, especially the resistant attachment, may lead to a lower cognitive level and greater behavioural problems in early childhood.     

在手术室护理管理中运用岗位管理的价值

目的:探讨手术室护理管理中应用岗位管理的价值。方法:将2014年7月至2016年7月手术室护理管理中实施岗位管理(研究组)与2012年6月至2014年6月未实施岗位管理(对照组)进行对照研究,2组均抽取手术室患者100例与护理人员30名进行调查,比较2组患者手术满意率与护理人员岗位满意率。结果:研究组患者在术前访视、入室接待、服务态度、指导工作、服务持续性方面满意率均高于对照组(P0.05);研究组护理人员在岗位认知、绩效分配、排班模式方面满意率均高于对照组(P0.05)。结论:在手术室护理管理中实施岗位管理,不仅可提高患者对护理的满意率,而且可提高护理人员对岗位管理的满意率。     

人工关节置换术后患者不同体位的实施与护理效果

目的:探讨人工关节置换术后患者不同体位的实施与护理效果。方法:将90例患者随机分为观察组、对照组各45例,所有患者均行人工关节置换术治疗,对照组术后给予常规体位护理干预,观察组术后给予半悬浮式体位护理干预,观察2组患者预后恢复与并发症发生情况。结果:切口引流量、术前术后血红蛋白差、总输血量观察组分别为(419.45±36.39)m L、(21.98±4.84)g/L和(902.84±61.34)m L,均明显少于对照组(P0.05)。术后肺内感染、假体脱位、深静脉血栓形成、体位性低血压等并发症发生率观察组均低于对照组(P0.05)。髋关节功能优良率观察组、对照组分别为93.3%、80.0%,2组比较差异有统计学意义(P0.05)。结论:人工关节置换术后患者半悬浮式体位的实施与护理能减少出血量和术后并发症的发生,促进髋关节功能的改善。