呼吸机相关性肺炎集束化护理方案实施不佳原因的质性研究

目的了解ICU护士预防呼吸机相关性肺炎集束化护理方案临床实施不佳的原因,为护理管理提供参考。方法采用质性研究的现象学方法,对在我中心ICU工作1年以上的19名护理人员进行深入访谈,按现象学研究方法整理分析资料。结果通过阅读、分析、反思、分类,提炼4个主题,包括病情限制不能实施相关护理、低学历低年资护士缺乏业务知识和临床经验、护理任务繁重而人员相对短缺的困扰、医嘱执行中的不规范问题。结论 ICU护士预防呼吸机相关性肺炎集束化护理方案实施不佳的主要原因有多方面,需引起护理管理者的重视,采取有效应对来促进护理质量持续改进。     

宫颈癌治疗后继发性双下肢淋巴水肿患者的护理

对19例宫颈癌治疗后继发性双下肢淋巴水肿患者行手法引流综合消肿治疗,包括手法淋巴引流、弹性绷带包扎、功能锻炼等,治疗1个疗程,患者下肢周径较治疗前明显减小、水肿程度减轻,皮肤肿胀感与肢体沉重感均减轻,皮肤纤维化程度明显降低,临床症状显著改善,住院16～23 d出院。提出加强双下肢水肿的评估、皮肤护理、手法淋巴引流的护理、绷带包扎护理、功能锻炼指导、心理护理及延续护理,可提高双下肢淋巴水肿患者治疗效果。     

Tumor-associated Macrophage-derived Interleukin-23 Interlinks Kidney Cancer Glutamine Addiction with Immune Evasion

Background

Glutamine addiction is a hallmark of clear cell renal cell carcinoma (ccRCC); yet whether glutamine metabolism impacts local immune surveillance is unclear. This knowledge may yield novel immunotherapeutic opportunities.

Deferoxamine promotes recovery of traumatic spinal cord injury by inhibiting ferroptosis

Ferroptosis is an iron-dependent novel cell death pathway. Deferoxamine, a ferroptosis inhibitor, has been reported to promote spinal cord injury repair. It has yet to be clarified whether ferroptosis inhibition represents the mechanism of action of Deferoxamine on spinal cord injury recovery. A rat model of Deferoxamine at thoracic 10 segment was established using a modified Allen's method. Ninety 8-week-old female Wistar rats were used. Rats in the Deferoxamine group were intraperitoneally injected with 100 mg/kg Deferoxamine 30 minutes before injury. Simultaneously, the Sham and Deferoxamine groups served as controls. Drug administration was conducted for 7 consecutive days. The results were as follows:(1) Electron microscopy revealed shrunken mitochondria in the spinal cord injury group.(2) The Basso, Beattie and Bresnahan locomotor rating score showed that recovery of the hindlimb was remarkably better in the Deferoxamine group than in the spinal cord injury group.(3) The iron concentration was lower in the Deferoxamine group than in the spinal cord injury group after injury.(4) Western blot assay revealed that, compared with the spinal cord injury group, GPX4, xCT, and glutathione expression was markedly increased in the Deferoxamine group.(5) Real-time polymerase chain reaction revealed that, compared with the Deferoxamine group, mRNA levels of ferroptosis-related genes Acyl-CoA synthetase family member 2(ACSF2) and iron-responsive element-binding protein 2(IREB2) were up-regulated in the Deferoxamine group.(6) Deferoxamine increased survival of neurons and inhibited gliosis. These findings confirm that Deferoxamine can repair spinal cord injury by inhibiting ferroptosis. Targeting ferroptosis is therefore a promising therapeutic approach for spinal cord injury.     

Application of neuroendoscopic surgical techniques in the assessment and treatment of cerebral ventricular infection

Cerebral ventricular infection(CVI) is one of the most dangerous complications in neurosurgery because of its high mortality and disability rates. Few studies have examined the application of neuroendoscopic surgical techniques(NESTs) to assess and treat CVI. This multicenter, retrospective study was conducted using clinical data of 32 patients with CVI who were assessed and treated by NESTs in China. The patients included 20 men and 12 women with a mean age of 42.97 years. NESTs were used to obliterate intraventricular debris and pus, fenestrate or incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation, and remove artificial material. Intraventricular irrigation with antibiotic saline was applied after neuroendoscopic surgery(NES). Secondary hydrocephalus was treated by endoscopic third ventriculostomy or a ventriculoperitoneal shunt. Neuroendoscopic findings of CVI were used to classify patients into Grade I(n = 3), Grade II(n = 13), Grade III(n = 10), and Grade IV(n = 6) CVI. The three patients with grade I CVI underwent one NES,the 23 patients with grade II/III CVI underwent two NESs, and patients with grade IV CVI underwent two(n = 3) or three(n = 3) NESs.The imaging features and grades of neuroendoscopy results were positively related to the number of neurosurgical endoscopic procedures.Two patients died of multiple organ failure and the other 30 patients fully recovered. Among the 26 patients with secondary hydrocephalus,18 received ventriculoperitoneal shunt and 8 underwent endoscopic third ventriculostomy. There were no recurrences of CVI during the 6-to 76-month follow-up after NES. Application of NESTs is an innovative method to assess and treat CVI, and its neuroendoscopic classification provides an objective, comprehensive assessment of CVI. The study trial was approved by the Institutional Review Board of Beijing Shijitan Hospital, Capital Medical University, China.     

Genomic and Transcriptomic Landscape of Triple-Negative Breast Cancers: Subtypes and Treatment Strategies

1. Download high-res image (232KB)
2. Download full-size image