遗传算法与变邻域搜索混合模型在护士排班中的应用

目的在探讨基于层级管理的护士APN排班模型的基础上,引入具有精确的全局搜索能力的遗传算法与变邻域搜索混合模型来解决护士排班过程中人员层级复杂、不同班次人员需求量不同等问题。方法首先,初始化排班表,然后利用遗传算法对初始化的排班表进行搜索,得到一个初步的排班表,最后利用变邻域搜索优化排班表,得到满足要求的排班表。结果使用该混合模型得到的排班表,能满足每日护士的人数需求和每名护士的工作量要求。同时,基于层级管理,各层级护士分开排班,能降低排班难度,在增加护士人员时,效率仍然较高。结论遗传算法与变邻域搜索的混合模型能解决护士排班中的各种复杂问题,是一种符合实际需求的模型。基于此模型来编制护士排班软件,能提升护理工作效率和满意度,便于对护理人员进行量化考核统计分析。     

糖尿乐胶囊联合地特胰岛素治疗2型糖尿病的临床研究

目的探讨糖尿乐胶囊联合地特胰岛素注射液治疗2型糖尿病的临床疗效。方法选取2018年5月-2019年5月在大连市第五人民医院治疗的2型糖尿病患者86例,根据用药的差别分为对照组(43例)和治疗组(43例)。对照组皮下注射地特胰岛素注射液,0.1~0.2 U/kg/次,1次/d;治疗组在对照组基础上口服糖尿乐胶囊,1.2 g/次,3次/d。两组患者均治疗4周。观察两组患者临床疗效,同时比较治疗前后两组患者血糖相关指标、血清学指标、血糖波动情况和氧化应激指标。结果治疗后,对照组和治疗组临床有效率分别为81.40%和97.67%,两组比较差异有统计学意义(P<0.05)。经治疗,两组患者空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、餐后2 h血糖(2 h PG)、胰岛素(FINS)、超敏C反应蛋白(hs-CRP)、γ-谷氨酰转移酶(γ-GT)、人颗粒蛋白前体(PGRN)、瘦素(LP)、血糖标准差(SDBG)、平均血糖波动幅度(MAGE)、24 h血糖波动次数(NGE)、24h血糖平均绝对差(MODD)和丙二醛(MDA)水平均显著下降(P<0.05),而脂联素(APN)、分泌型卷曲相关蛋白5(SFRP5)、谷胱甘肽过氧化物酶(GSH-PX)和超氧化物歧化酶(SOD)水平均显著升高(P<0.05),且治疗组这些指标较对照组改善更明显(P<0.05)。结论地特胰岛素注射液联合糖尿乐胶囊治疗2型糖尿病能够明显效控制血糖,促进机体氧化应激状态的改善。     

Urinary endometriosis: MR Imaging appearance with surgical and histological correlations

ObjectivesThe goals of the study were to describe the MR imaging features of endometriosis of the urinary tract and identify those that suggest intrinsic involvement of ureteric wall.Materials and methodsThirty-five women with proven urinary tract endometriosis and who had preoperative MR imaging between 2001 and 2011 were included retrospectively. MR images were intrepreted by one junior and one senior radiologists. To characterize the intrinsic parietal involvement, the ureteric circumference involved by the lesion of endometriosis was noted.ResultsThirty-eight ureteric and 13 bladder lesions were analyzed. They were found in association in nine women. Ureteric lesions were bilateral in seven women. Of the 38 ureteric lesions, 27 were extrinsic and 11 intrinsic at histopathological analysis. Sixteen women with extrinsic lesions and 10 with intrinsic ones were correctly identified on MR imaging. When the ureter was included less than 360° in the lesion, extrinsic involvement was confirmed in 80% of cases.ConclusionMR imaging appears to be more sensitive (91%vs 82%) but less specific (59% vs 67%) than surgery for the diagnosis of intrinsic form of ureteric location.     

血清脂联素及CRP／APN比值的变化在腹部创伤患者病情监测中的意义

目的：探讨血清脂联素（ APN）及C反应蛋白（ CRP）与APN比值（ CRP／APN比值）的变化在腹部创伤患者病情监测中的意义。方法将本科室收治的80例腹部外伤患者依据AIS－ISS评分分为轻伤组及重伤组,将来本院体检的正常成年人30例作为对照组。分别于入院后即刻及第1 d、2 d、4 d、7 d共5个时间点,采用放射免疫法检测患者APN、CRP水平及CRP／APN比值,并同步进行全身炎症反应综合征（ SIRS）评分,对所得结果进行统计学分析及相关性分析。结果与对照组相比,轻伤组和重伤组患者的APN水平均明显降低（ P＜0.05）,重伤组APN水平明显低于轻伤组（ P＜0.05）;血清CRP与CRP／APN比值与SIRS评分呈正相关,相关系数分别为0.81（P＜0.05）和0.91（P＜0.05）,而APN水平与SIRS评分呈负相关（r＝－0.88,P＜0.05）。结论APN与CRP／APN比值可以作为评估腹部伤情严重程度的客观指标,有助于准确及时地评估病情。     

口服磷酸钠盐(OSP)致急性磷酸盐肾病(APN)1例

急性磷酸盐肾病（acute phosphate nephropathy,APN）是口服磷酸钠盐（oral sodium phosphate,OSP）行肠道准备之后的肾脏并发症,小管和间质中有磷酸钙盐沉积是其独特的组织病理学表现。本文报道了1例OSP后发生APN的病例,从临床和病理分析诊断的要点,为肠道准备药物的选择提供借鉴。     

渴乐宁胶囊联合格列齐特治疗2型糖尿病的临床研究

目的探讨渴乐宁胶囊联合格列齐特缓释片治疗2型糖尿病临床疗效。方法选取2017年3月—2018年3月在漯河市中心医院治疗的2型糖尿病患者92例,根据入院号分为对照组(46例)和治疗组(46例)。对照组口服格列齐特缓释片,初始剂量30 mg/次,1次/d,根据患者血糖情况每间隔14 d增加1片,血糖控制后30 mg/次,1次/d;治疗组在对照组基础上口服渴乐宁胶囊,1.80g/次,3次/d。两组均治疗4周。观察两组患者临床疗效,同时比较治疗前后两组患者空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、胰岛素(FINS)、超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)、单核细胞趋化蛋白-1(MCP-1)、肿瘤坏死因子-α(TNF-α)、脂联素(APN)、瘦素(LP)和皮质醇(Cor)水平。结果治疗后,对照组和治疗组临床有效率分别为82.61%和97.82%,两组比较差异具有统计学意义(P0.05)。治疗后两组FPG、2 h PG、HbAlc、FINS、hs-CRP、MCP-1、IL-1β和TNF-α水平均显著下降(P0.05),且治疗后治疗组上述血糖和炎性指标水平明显低于对照组(P0.05)。治疗后,两组LP、Cor水平均显著下降(P0.05),APN水平显著上升(P0.05),且治疗组LP、Cor和APN水平明显好于对照组(P0.05)。结论渴乐宁胶囊联合格列齐特缓释片治疗2型糖尿病可有效控制患者血糖水平,降低机体炎症反应,具有一定的临床推广应用价值。     

脂联素介导 APPL1／AMPK 信号通路对小鼠肾脏缺血再灌注损伤后期纤维化的影响

目的：研究脂联素（APN）介导 APPL1／AMPK 信号通路对小鼠肾脏急性缺血再灌注损伤后期纤维化的影响。方法雄性 C57BL／6小鼠48只,随机分为假手术组（Sham 组）、肾脏急性缺血再灌注组（IRI 组）、肾脏急性缺血再灌注＋APN 组（APN／IRI 组）和肾脏急性缺血再灌注＋生理盐水组（NS／IRI 组）,每组各12只。 APN／IRI 组在术前15 min、术后每24 h 分别经腹腔注射 APN 蛋白球状片段5μg／g,共3次;NS／IRI 组在相应时点经腹腔注射等量生理盐水。 IRI 组均行双侧夹闭肾蒂30 min 后开放肾灌注,Sham 组分离肾蒂但不夹闭。各组大鼠分别在术后2 d 随机各取6只小鼠,留取血液及肾组织标本。 PAS 染色观察肾组织病理变化;全自动生化分析仪检测血尿素氮（BUN）及血肌酐（Scr）含量;Western blot 检测肾脏组织 APPL1蛋白表达和 AMPK 磷酸化水平。术后14 d 每组取剩余6只小鼠肾脏标本,天狼星红苦味酸（Sirus red）染色观察肾组织病理变化,real time PCR 检测α平滑肌肌动蛋白（α－SMA）和转化生长因子β1（TGF －β1）的 mRNA 表达。结果术后2 d,与 Sham 组相比,IRI组、APN／IRI 组和 NS／IRI 组小鼠肾组织小管间质损害加重,血 BUN、Scr 升高（P ＜0．05）,APPL1蛋白表达和AMPK 磷酸化水平明显增高（P ＜0．05）;与 IRI 组相比,APN／IRI 组小鼠肾小管损害明显减轻,血 BUN、Scr 明显降低（P ＜0．05）,APPL1蛋白表达和 AMPK 磷酸化水平明显增高（P ＜0．05）。术后14 d,与 Sham 组相比,IRI 组、APN／IRI 组和 NS／IRI 组小鼠肾组织纤维化程度明显增高,α－SMA 和 TGF －β1的 mRNA 的表达明显增多（P ＜0．05）;与 IRI 组相比,APN／IRI 组小鼠肾组织纤维化程度明显降低,α－SMA 和 TGF －β1的 mRNA 的表达量明显减少（P ＜0．05）。结论APN 介导 APPL1／AMPK 信号通路减轻小鼠肾脏急性缺血再灌注损伤后期纤维化。     

APN排班层级管理模式在肿瘤科实施的探讨

目的：改革护理管理模式。探讨APN排班在肿瘤科的应用效果。方法：肿瘤科人力资源不变的前提下,优化工作流程,修订护士工作职责,建立以护士长,护理组长,责任护士,助理护士为层级的管理梯队,实行APN连续性排班。结果：护士的交接班时间减少,因中间环节多而出现的护理缺陷减少,年轻护士的工作压力减少,护士的工作效率及护理满意度提高。结论：实施APN排班,充分利用人力资源,达到最佳的护理管理目标,利于护理人员的培养与梯队建设。顺应现代护理模式的发展,值得推广。     

Production of a monoclonal antibody,DF-5, that identifies cells at the epithelial-mesenchymal interface in normal human skin. APN/CD13 is an epithelial-mesenchymal marker in skin

Epithelial-mesenchymal interactions play a critical role in skin development and differentiation, and similar interactions may also regulate the day-to-day proliferation and differentiation events of the epidermis that occur in normal adult skin. This study was directed at identifying molecules that are selectively located at the dermal-epidermal junction in normal adult skin as they may be involved in regulating these homeostatic events. To this end, monoclonal antibodies were raised against the crude cell membrane fraction of cultured human dermal fibroblasts. Screening of antibodies that recognized cell surface antigen on cultured human dermal fibroblasts was followed by determining which of these antibodies selectively localized cells at sites of epithelial-mesenchymal interactions. Antibody DF-5 fit these criteria and was further characterized. This antibody was found to recognize the cell surface ectopeptidase aminopeptidase N (APN), a molecule homologous to the cluster differentiation antigen CD13. Antibody DF-5 and anti-CD13 antibodies both identified cells at sites of epithelial-mesenchymal interactions in fetal, neonatal, and adult human skin, and the APN/CD13 enzyme activity was also identified at these sites. A second ectopeptidase, dipeptidyl peptidase IV (DPPIV) or CD26, presented a significantly different immunohistochemical and histochemical pattern in skin samples, confirming the specificity of the APN/CD13 studies. The function of APN/CD13 in skin has yet to be determined. Its invariant localization at sites of epithelial-mesenchymal interactions argues for a role particular to this region. It may play a role in regulating the activity of neuropeptides or other signaling peptides that are released in this region of skin or it may have an as yet undefined role in mediating communication between dermal and epidermal cells.     

APN连续性护理排班模式的探讨

目的探讨实施APN连续性护理排班模式的效果。方法在全院18个病区改革传统的护士排班方式，实施APN连续性排班，比较两种排班模式的上班时段、交接班次数、交接班所占用时间、病人及医生对护理工作满意度等。结果APN连续性排班模式比传统的排班模式每天交接班次数少，交接班所占用时间少，病人及医生对护理工作满意度高（P〈0．05）。结论APN连续性护理排班模式符合病人的需要，有利于合理利用护理人力资源，保证病人安全，提高护理服务和护理质量。