Pressure levels in the trochanter area according to repositioning at different degrees of inclination in healthy subjects

ObjectivesPatient repositioning is a recommended intervention to prevent or treat pressure ulcers (PUs). One option under consideration is the tailored repositioning according to patient characteristics, but more knowledge is needed on how different repositioning patterns influence on skin pressure. To determine what degree of inclination of the body in bed generates more pressure in the trochanteric region. Additionally, to analyze the influence of factors such as gender, age and anthropometric characteristics in the variations of this pressure.MethodsAnalytical cross-sectional study. Body Mass Index (BMI), lean mass and fat mass were measured in healthy volunteers subject to different inclinations (90°, 60° and 30°) in right lateral decubitus. Pressure was measured with a capacitive surface.ResultsIn total, 146 subjects were included, of which 45 were men and 101 women. The results showed pressure differences due to the inclination according to gender and anthropometric values, being statistically significant in men at 90° and 60°, and in women at 30°. (hombres 90° p = 0,026, 60° p = 0,049; mujeres 30° p = 0,036) según prueba Brown-Forsythe.ConclusionsThere are differences in the pressures of the trochanteric zone depending on anthropometric factors and by gender, in different body positions. Obese people exerted a higher pressure in the trochanter area at 30° of body inclination than overweight, normal weight and underweight people, respectively. From the clinical point of view, these findings invite to consider a possible differentiation in the repositioning interventions of the patients, according to gender and BMI, as a preventive strategy for PUs.     

Skin temperature and vascular attributes as early warning signs of pressure injury

ObjectivesThis study aimed to validate the skin temperature on sacral region and vascular attributes as early warning signs of pressure injury.MethodsTotally 415 patients admitted to the adult intensive care unit from August 2018 to April 2019 were prospectively screened. Daily blood pressure and blood glucose affecting vascular attributes and the relative skin temperature of sacral region were measured for 10 consecutive days. Collect the changes of these indicators during the occurrence of pressure injury. The optimal cut-off values of indicators were determined by X-tile analysis. The risk ratios of indicators associated with pressure injury were compared using the Cox proportional hazards regression model.ResultsThere were no obvious interactions among blood pressure, blood glucose and relative skin temperature (P > 0.05). The optimal cutoff value for above indicators was 63.5 mmHg, 9.9 mmol/L and −0.1 °C, respectively. The incidence of pressure injury peaked on the 4th and 5th day after hospitalization when categorizing the patients into low- and high-risk groups according to the cutoff values (P < 0.05). Based on relative skin temperature, patients in the high-risk group were more likely to develop pressure injury (hazard ratio = 6.36, 95% confidence interval = 3.91, 10.36), when compared to the other two indicators of blood pressure and blood glucose.ConclusionStringent skin temperature and vascular attributes measurements were necessary for preventing pressure injury. Nursing measures should be taken according to warning sings to reduce the incidence of pressure injury.     

Lomitapide for the treatment of hypertriglyceridemia

Introduction: Severe genetic forms of hypertriglyceridemia carry a risk of life-threatening pancreatitis and lack available effective treatments. Lomitapide is a microsomal triglyceride transfer protein inhibitor currently approved for treatment of homozygous familial hypercholesterolemia that may be useful in the management of severe hypertriglyceridemia.

Areas covered: Published trials of lomitapide that reported plasma triglyceride response were reviewed, as was a case report of a patient with hypertriglyceridemia who was treated for 13 years with lomitapide. ClinicalTrials.gov was also reviewed for any unpublished results and ongoing trials.

Expert opinion: Lomitapide demonstrates effective triglyceride lowering and may be a useful treatment for patients with genetic hypertriglyceridemia and recurrent acute pancreatitis who are refractory to traditional treatment. However, long term hepatic safety may be a concern and direct clinical trial-level data are lacking for this indication.     

基于图书馆知识资本循环系统支持的隐性知识转移机制研究

概述知识资本理论的主要观点；分析图书馆知识资本构成、循环的特点；构建图书馆知识资本循环系统知识转移模型和隐性知识转移机制模型；对图书馆知识资本内部结构和外部结构及其对应的内循环和外循环机制进行分析；揭示了图书馆隐性知识转移机制是系统综合机制。     

Quantitative chemical exchange saturation transfer (qCEST) MRI – omega plot analysis of RF‐spillover‐corrected inverse CEST ratio asymmetry for simultaneous determination of labile proton ratio and exchange rate

Chemical exchange saturation transfer (CEST) MRI is sensitive to labile proton concentration and exchange rate, thus allowing measurement of dilute CEST agent and microenvironmental properties. However, CEST measurement depends not only on the CEST agent properties but also on the experimental conditions. Quantitative CEST (qCEST) analysis has been proposed to address the limitation of the commonly used simplistic CEST‐weighted calculation. Recent research has shown that the concomitant direct RF saturation (spillover) effect can be corrected using an inverse CEST ratio calculation. We postulated that a simplified qCEST analysis is feasible with omega plot analysis of the inverse CEST asymmetry calculation. Specifically, simulations showed that the numerically derived labile proton ratio and exchange rate were in good agreement with input values. In addition, the qCEST analysis was confirmed experimentally in a phantom with concurrent variation in CEST agent concentration and pH. Also, we demonstrated that the derived labile proton ratio increased linearly with creatine concentration (P < 0.01) while the pH‐dependent exchange rate followed a dominantly base‐catalyzed exchange relationship (P < 0.01). In summary, our study verified that a simplified qCEST analysis can simultaneously determine labile proton ratio and exchange rate in a relatively complex in vitro CEST system. Copyright © 2015 John Wiley & Sons, Ltd.     

自制气管套管固定装置对气管切开患者颈部皮肤保护作用观察

目的 观察自制气管套管固定装置对气管切开患者颈部皮肤的保护作用，探讨用于固定气管套管的可行性。方法60例气管切开患者采用随机数字法分为两组，每组30例。研究组使用自制气管套管固定装置固定气管套管；对照组使用传统棉布带固定。分别于固定后1、2、3周评价两组患者颈部皮损、切口皮损情况，并于第3周评价患者舒适度和家属满意度。结果研究组患者颈部皮损程度明显低于对照组，且皮损出现时间晚于对照组，差异均有统计学意义（Z=-5.183、-8.214，均P＜0.01）；切口皮损程度研究组比对照组明显减轻，差异有统计学意义（P＜0.01）；研究组患者舒适度及家属满意度分别为（7.57±1.01）、（7.77±0.86）分，对照组分别为（5.90±1.16）、（6.03±1.10）分，两组比较差异均有统计学意义（均P＜0.01）。结论使用自制的气管套管固定装置，可有效减轻患者颈部及切口皮肤损害，同时提高患者舒适度及家属满意度。     

40岁以上高龄女性体外受精-胚胎移植妊娠结局分析

目的：探讨40岁以上高龄女性体外受精-胚胎移植（IVF-ET）的妊娠结局，旨在为高龄女性提供生育咨询以及为改善高龄女性个体化辅助生殖治疗结局提供临床依据。方法：选择我院生殖中心2015年1月—2017年12月女方年龄≥40岁且使用自身卵子行体外受精的共2 467个治疗周期资料，对各项临床数据进行回顾性分析。结果：40岁及以上行辅助生殖治疗的患者，随着女性年龄增加获卵数明显减少（40～48岁女性平均获卵数分别为2.97、 2.69、2.17、2.01、1.77、1.61、1.68、1.29和1.00，44～48岁与40～43岁依次组间比较均P＜0.05），尤其是44岁以上女性胚胎发育潜能明显降低（40～48岁囊胚形成率分别为48.90%、43.72%、33.67%、34.29%、24.39%、21.14%、26.32%、16.67%和0%，44～48岁与40～43岁组间依次比较均P＜0.05）。共有518个周期行新鲜胚胎移植，结果显示，随女性年龄增加，临床妊娠率（40～48岁临床妊娠率分别为26.92%、21.15%、20.79%、10.96%、18.87%、11.11%、5.88%、0%和0%，43～48岁与40～42岁组间依次比较均P＜0.05）、种植率（40～48岁种植率分别为23.65%、19.51%、17.70%、8.54%、7.49%、10.81%、5.56%、0%和0%，43～48岁与40～42岁组间依次比较均P＜0.05）和活产率均显著降低（40～46岁活产率分别为18.46%、10.58%、9.90%、5.48%、5.66%、2.78%和5.88%，43～46岁与40～42岁组间依次比较均P＜0.05），43岁以上者结局更差。44岁以上女性自然流产率明显增高（40～45岁流产率分别为31.43%、50.00%、52.38%、50.00%、70.00%和75.00%，44～45岁与40～43岁组间依次比较均P＜0.05）。46岁女性仅1例妊娠并分娩，47岁和48岁女性均无成功妊娠。与抗苗勒管激素（AMH）＞1.0 ng/mL组相比，AMH≤1.0 ng/mL组妊娠率、种植率及活产率均显著下降（27.04% vs. 14.74%，22.99% vs. 13.50%，15.88% vs. 7.37%；均P＜0.05），流产率明显升高（41.27% vs. 50.00%，P＜0.05）。结论：≥40岁高龄女性随年龄增长生育力逐渐降低。40～43岁年龄段女性助孕仍有一定的价值，尤其是卵巢仍有一定储备者（AMH＞1.0 ng/mL），但44岁以上女性原则上不再建议ART助孕，对于46岁以上卵巢功能衰竭的女性强烈建议卵子捐赠或收养。