手术室心理护理对手术患者精神状态的影响

目的探讨手术室心理护理对手术患者焦虑、抑郁状态及护理满意度的影响。方法以医院2017年1月—2019年4月在医院接受手术治疗的1200例患者展开研究,随机将其划分为研究组(n=600)与对照组(n=600),分别接受常规基础上的心理护理以及单纯常规护理,对比分析患者抑郁、焦虑评分、护理满意度。结果治疗后,与对照组比,观察组抑郁、焦虑评分均更低;且研究组(97.0%)患者护理满意度高于对照组(83.7%),差异有统计学意义(P<0.05)。结论心理护理干预对于手术患者精神干预结果比较好,不仅可以改善患者的抑郁、焦虑情况,也能提升其护理满意度。     

Subsystem macroarchitecture of the intrinsic midbrain neural network and its tectal and tegmental subnetworks

The midbrain is the smallest of three primary vertebrate brain divisions. Here we use network science tools to reveal the global organizing principles of intramidbrain axonal circuitry before adding extrinsic connections with the remaining nervous system. Curating the experimental neuroanatomical literature yielded 17,248 connection reports for 8,742 possible connections between the 94 gray matter regions forming the right and left midbrain. Evidence for the existence of 1,676 connections suggests a 19.2% connection density for this network, similar to that for the intraforebrain network [L. W. Swanson et al., Proc. Natl. Acad. Sci. U.S.A. 117, 31470–31481 (2020)]. Multiresolution consensus cluster analysis parceled this network into a hierarchy with 6 top-level and 30 bottom-level subsystems. A structure–function model of the hierarchy identifies midbrain subsystems that play specific functional roles in sensory–motor mechanisms, motivation and reward, regulating complex reproductive and agonistic behaviors, and behavioral state control. The intramidbrain network also contains four bilateral region pairs designated putative hubs. One pair contains the superior colliculi of the tectum, well known for participation in visual sensory–motor mechanisms, and the other three pairs form spatially compact right and left units (the ventral tegmental area, retrorubral area, and midbrain reticular nucleus) in the tegmentum that are implicated in motivation and reward mechanisms. Based on the core hypothesis that subsystems form functionally cohesive units, the results provide a theoretical framework for hypothesis-driven experimental analysis of neural circuit mechanisms underlying behavioral responses mediated in part by the midbrain.

According to the classical view, early in vertebrate development the neural plate invaginates to form the neural tube, which immediately displays three sequential swellings that were called the primary forebrain, midbrain (MB), and hindbrain vesicles by von Baer in 1837 (1) and that are followed by the presumptive spinal cord caudally. Together, these four differentiations or morphogenetic units of the neural tube go on to generate the entire adult central nervous system (2, 3). As a major part of a systematic research program to analyze the organizing principles of mammalian nervous system macroconnectivity, we recently completed a study of forebrain intrinsic circuitry (4), and here we present a similar study of MB intrinsic circuitry.Based on developmental and adult topographic features, the MB can be divided into two great parts: tectum (TC) dorsally and tegmentum (TG) ventrally (5, 6). In mammals, the TC in turn has two parts, the superior and inferior colliculi, which are important nodes in circuitry related to visual and auditory functions, respectively (3). The TG, in contrast, is much more differentiated structurally and functionally, with a variety of gray matter regions that have been intensively analyzed over the last 75 y. Among the most prominent are three cranial nerve nuclei (oculomotor nucleus, trochlear nucleus, and midbrain nucleus of the trigeminal nerve), as well as the pretectal region, red nucleus, substantia nigra and ventral tegmental area, midbrain raphe nuclei, periaqueductal gray, and midbrain reticular nucleus (3).This topographic approach to biological structure–function organization is like dividing the body in human anatomy into head, neck, trunk, and upper and lower limbs with hands and feet. Topographic anatomy is particularly useful for describing and mapping structure–function spatial relationships of body parts and for surgical procedures. For example, the hand is an obvious body part with especially important and intricate functions in humans. Systems anatomy, however, is an equally valid and complementary way of describing global principles of body organization. In human biology, the body is conveniently and systematically divided into about a dozen interrelated systems (skeletal, digestive, respiratory, nervous, and so on), and components of each typically play a role in topographic parts such as the hand. The systems approach is particularly useful for organizing vast amounts of data into simplified, readily understandable conceptual frameworks or models of how the body works as a whole.The nervous system can also be treated from the complementary topographic and systems perspectives (7), and it is the only bodily system remaining without a relatively simple global systems model, largely because its cellular network architecture is much more complex than the other systems. However, general network analysis tools, which can be applied to any complex system, from the internet to social interactions in a human population, offer one promising approach (8, 9). Basic requirements include a systematic parts list for the network, an understanding of how each part works, and an account of how the parts are connected to form a functional system (10). Our long-term strategy for the rat nervous system follows the time-honored approach to solving any difficult problem, that is, to proceed from coarser-grained to finer-grained analyses, analogous to the strategy used to sequence the human genome (11). Thus, using a nested approach, we have started at the coarse-grained macro level of analysis (axonal macroconnections from one gray matter region to another gray matter region), as a prelude and framework for analyses at the finer-grained meso level (connections between neuron types making up each gray matter region), micro level (connections between individual neurons making up each neuron type), and nano level (the set of synapses formed by each neuron) (12).     

Randomized trial of bupivacaine with epinephrine versus bupivacaine liposome suspension in patients undergoing minimally invasive lung resection

ObjectivesThoracic surgery can cause significant pain, and multiple strategies have been developed to control pain after surgery. We compared 2 bupivacaine formulations given intraoperatively: bupivacaine with epinephrine (1,200,000) or liposomal bupivacaine.MethodsThis was a randomized, open-label study (NCT03560362). Eligible patients were adults scheduled for a minimally invasive lung procedure. Incision sites were injected with bupivacaine with epinephrine or liposomal bupivacaine before incision, and each intercostal space was injected with 1 mL of bupivacaine with epinephrine or liposomal bupivacaine entering the thoracic cavity. Patient-controlled analgesia was initiated in the recovery room. Pain was recorded using a visual analog scale. The primary outcome was the amount of narcotics taken during the postoperative hospital stay.ResultsWe recruited 50 patients; 25 received bupivacaine with epinephrine, and 25 received liposomal bupivacaine. The treatment groups were similar in age, histology, and procedure performed. There were no statistical differences between the treatment groups in the amount of narcotics required during the hospital stay (36.3 mg for bupivacaine and 38 mg for liposomal bupivacaine) or in pain assessed the day of surgery (5 and 5), the first day (3.5 and 2.3), second day (3 and 2.6), 2 weeks (0 and 1), or 3 months (0 and 0) postoperatively. Hospital length of stay and complications were also similar.ConclusionsIn a small, randomized study, we did not find significant differences between bupivacaine with epinephrine or liposomal bupivacaine in mitigating pain after minimally invasive lung resection. We currently favor using the less expensive nonliposomal bupivacaine preparations until additional data are available.     

Fluorescence visualization of the intersegmental plane by bronchoscopic instillation of indocyanine green into the targeted segmental bronchus: determination of the optimal settings

ObjectiveTo determine the appropriate amount of indocyanine green for bronchial insufflation.MethodsWe enrolled 20 consecutive patients scheduled for anatomical segmentectomy in the Kochi Medical School Hospital. After inducing general anesthesia, 6 to 60 mL of 200-fold-diluted indocyanine green (0.0125 mg/mL) was insufflated into the subsegmental bronchi in the targeted pulmonary segmental bronchus. The volume of the targeted pulmonary segments was calculated using preoperative computed tomography. Fluorescence spread in the segmental alveoli was visualized using a dedicated near-infrared thoracoscope.ResultsThe targeted segment was uniformly visualized by indocyanine green fluorescence in 16/20 (80.0%) cases after insufflating indocyanine green. A receiver operating characteristic curve indicated that the area under the curve was 0.984; the optimal cut-off volume of diluted indocyanine green for insufflation was 8.91% of the calculated targeted pulmonary segment volume.ConclusionsThe setting for indocyanine green insufflation was optimized for near-infrared fluorescence image-guided anatomical segmentectomy. By injecting the correct amount of indocyanine green, fluorescence-guided anatomical segmentation may be performed more appropriately.     

CT机的性能及运行状态监测

介绍了CT机的性能及运行状态在临床诊断中的重要性，分析了CT机各部件的监测与维护特点。应用CT核心组件持续监测总结法，解决了CT机的性能及运行状态监测非系统化的问题，为医院掌握CT机的实时性能状况提供了有力的依据，保障了设备准确稳定地运行。     

胸骨左缘第二肋间切口微创治疗动脉导管未闭31例

摘要： 目的 评估经胸骨左缘第二肋间切口微创治疗动脉导管未闭的临床疗效和可靠性。方法 收集2014年1 月—2017年11月我科对31例婴儿期患儿行动脉导管结扎术的临床资料, 所有手术均采用经胸骨左缘第二肋间切口入路, 总结该术式的手术过程, 分析其临床转归。结果 本组病例手术过程顺利, 手术切口长度 （2.5±1.0） cm, 手术时间 （1.5±0.2） h, 术中出血不超过5 mL, 术后平均住院日 （15.1±4.2） d, 未出现死亡、 大出血等重大并发症, 术后无需放置胸腔引流管。术后随访1个月~4年, 无导管再通及动脉瘤形成。结论 胸骨左缘第二肋间切口微创治疗动脉导管未闭是一种安全可靠的方法, 并发症少, 远期疗效满意。     

European health inequality through the ‘Great Recession’: social policy matters

This paper investigates the association between the Great Recession and educational inequalities in self‐rated general health in 25 European countries. We investigate four different indicators related to economic recession: GDP; unemployment; austerity and a ‘crisis’ indicator signifying severe simultaneous drops in GDP and welfare generosity. We also assess the extent to which health inequality changes can be attributed to changes in the economic conditions and social capital in the European populations. The paper uses data from the European Social Survey (2002–2014). The analyses include both cross‐sectional and lagged associations using multilevel linear regression models with country fixed effects. This approach allows us to identify health inequality changes net of all time‐invariant differences between countries. GDP drops and increasing unemployment were associated with decreasing health inequalities. Austerity, however, was related to increasing health inequalities, an association that grew stronger with time. The strongest increase in health inequality was found for the more robust ‘crisis’ indicator. Changes in trust, social relationships and in the experience of economic hardship of the populations accounted for much of the increase in health inequality. The paper concludes that social policy has an important role in the development of health inequalities, particularly during times of economic crisis.     

琥珀酸美托洛尔缓释片在健康中国人体空腹和高脂餐后单次给药的药代动力学研究

目的评价单次口服琥珀酸美托洛尔缓释片在中国健康受试者体内的药代动力学特征和安全性。方法 7例中国健康志愿者空腹单次口服琥珀酸美托洛尔缓释片47. 5 mg,8例中国健康志愿者在高脂餐后单次口服琥珀酸美托洛尔缓释片47. 5 mg,用液相色谱-串联质谱联用法测定给药后不同时间美托洛尔的血药浓度,并用Win Nonlin 6. 4软件计算主要药代动力学参数。结果本研究未观察到药物相关的不良事件和严重不良事件。空腹单次口服琥珀酸美托洛尔缓释片后的药代动力学参数如下:C_max为(14. 63±8. 93) ng·m L^-1,t_max为(9. 43±2. 76) h,t1/2为(9. 36±5. 76) h,AUC_0-t为(343. 63±262. 07) ng·m L^-1·h,AUC_inf为(359. 65±259. 29) ng·m L^-1·h,清除率为(188. 58±109. 10) L·h^-1,表观分布容积为(3031. 36±4029. 78) L。高脂餐后单次口服琥珀酸美托洛尔缓释片后的药代动力学参数如下:C_max为(19. 56±14. 89) ng·m L^-1,t_max(6. 00±1. 07) h,t1/2为(6. 27±1. 37) h,AUC_0-t为(391. 07±307. 06) ng·m L^-1·h,AUC_inf为(395. 84±311. 42) ng·m L^-1·h,清除率为(225. 97±201. 53) L·h^-1,表观分布容积为(2022. 20±1842. 51) L。结论高脂餐后给予琥珀酸美托洛尔缓释片,t_max较空腹给药提前,暴露量未见明显差异。