Left Atrial Appendage Occlusion,A Misnomer?: Where Do We Go From Here?

The importance of the left atrial appendage (LAA) as the source of thromboembolism including stroke in patients with nonvalvular atrial fibrillation is well documented, with more than 90% of ischemic strokes related to a LAA thrombus. Although oral anticoagulation has been the standard of care, approximately 50% to 60% of patients either have contraindications to oral anticoagulation or do not continue the medication beyond the first year. This led to the development of local site-specific therapy to occlude the LAA by either surgical or transcatheter means. Despite marked advancements, incomplete LAA closure with surgical and transcatheter approaches remains frequent. The etiology of incomplete LAA closure and its clinical implications remain unclear. Multiple strategies are in development including changes in deployment techniques, a new device design, and alternative approaches to leak closure.     

Prosthetic choice in mitral valve replacement for severe chronic ischemic mitral regurgitation: Long-term follow-up

BackgroundProsthetic choice for mitral valve replacement is generally driven by patient age and patient and surgeon preference, and current guidelines do not discriminate between different etiologies of mitral valve disease. Our objective was to assess and compare short- and long-term outcomes after mitral valve replacement among patients with biological or mechanical prostheses in the setting of severe ischemic mitral regurgitation.MethodsBetween 2000 and 2016, 424 patients underwent mitral valve replacement for severe ischemic mitral regurgitation at our institution, using biological prosthesis in 188 (44%) and mechanical prosthesis in 236 (56%). A 1:1 propensity score match (n = 126 per group) and inverse probability of treatment weighting were used to compare groups. Short-term outcomes included in-hospital mortality and other cardiovascular adverse events. Long-term outcomes included survival and hospital readmission for cardiovascular causes, stroke, and major bleeding.ResultsIn-hospital mortality and early postoperative adverse events were similar between groups in the propensity score match and inverse probability of treatment weighting cohorts. Overall long-term survival was similar at 5 and 9 years, but mechanical prosthesis recipients were more frequently readmitted to hospital for cardiovascular causes, including stroke and non-neurological bleeding in propensity score matching and inverse probability of treatment weighting analyses (all P values < .004). Type of prosthesis did not independently influence all-cause mortality (hazard ratio, 1.01; 95% confidence interval, 0.71-1.43; P = .959), but placement of a mechanical prosthesis was associated with increased risk of readmission for cardiovascular events (hazard ratio, 1.65; 95% confidence interval, 1.17-2.32; P = .004) among matched patients.ConclusionsThe type of prosthesis has no influence on long-term survival among patients with severe ischemic mitral regurgitation undergoing mitral valve replacement. There may be an increased risk of neurologic events and serious bleeding associated with mechanical prostheses.     

内囊预警综合征的临床特征和预后

目的 分析内囊预警综合征（capsular warning syndrome，CWS）的临床特点、影像学特征及治疗预后，
以提高对此病的认识。
方法 回顾性分析战略支援部队特色医学中心神经内科2013年1月-2018年12月收住院治疗的CWS的
临床资料、影像学特征及治疗预后情况。
结果 共12例患者，男性8例（66.67%），中位年龄为60岁。高脂血症9例（75.0%），高血压8例
（66.67%），糖尿病4例（33.33%），肿瘤病史3例（25.0%）。纯运动性卒中4例（33.33%），运动伴有构
音障碍者4例（33.33%），运动及感觉性障碍3例（25.00%），纯感觉障碍1例（8.33%）。影像学示豆纹
动脉供血区新发脑梗死6例（50%）。所有患者给予口服双联抗血小板治疗，其中3例症状复发患者又
给予静脉溶栓和静脉抗血小板治疗。3个月随访，所有患者均未再出现症状发作，10例mRS评分为0
分，2例mRS评分分别为4分及3分。
结论 CWS主要表现为运动障碍，发作刻板，常见原因为动脉粥样硬化性。在本组病例中发现双重
抗血小板治疗有效，静脉溶栓效果不肯定。     

The relationship between workplace violence,job satisfaction and turnover intention in emergency nurses

BackgroundEmergency department personnel are exposed to high risk of workplace violence (WPV) and nurses are the main victims. Few researchers have investigated the effects of WPV on job satisfaction and turnover intention among nurses.AimsTo describe WPV, job satisfaction and turnover intention of emergency nurses and clarify the relationship between them.MethodsA cross-sectional study was used to collect data on WPV, job satisfaction and turnover intention among 385 nurses working in emergency department in 13 general hospitals in Beijing. Structural equation modeling was used to test the relationship between them.ResultsAmong them, 89.9% had experienced WPV in the previous year. WPV had short-term and long-term impacts on over 80% of them. The score of job satisfaction and turnover intention was 2.48 ± 0.49, 2.75 ± 0.58 respectively. WPV had significant direct effect on turnover intention (β = 0.105) and job satisfaction (β = −0.161). Job satisfaction had a significant negative effect on turnover intention (β = −0.604) and it mediated the relationship between WPV and turnover intention.ConclusionEmergency nurses in China are at great risk of WPV. Their job satisfaction is low and turnover intention is high. Job satisfaction plays the mediator role between WPV and turnover intention among emergency nurses.     

中西医结合治疗慢性支气管炎急性发作临床观察

目的研究中西医结合治疗慢性支气管炎急性发作的效果。方法选取2018年11月-2019年11月就诊的60例慢性支气管炎急性发作期患者作为此次研究的对象,其中2018年11月-2019年4月到院的30例患者归为对照组,予以常规西医给药治疗;2019年4月-2019年11月到院的30例患者归为观察组,在对照组的基础身上予以清化止咳汤治疗,对比2组的临床疗效、不良症状改善的时间变化情况及不良反应的发生情况。结果观察组患者的临床总有效率(93.33%)显著高于对照组(73.33%)(P<0.05)。观察组患者不良症状改善的时间均短于对照组(P<0.05)。观察组患者的不良反应发生率(6.67%)显著低于对照组(26.67%)(P<0.05)。结论予以慢性支气管炎急性发作期患者中西结合治疗,能够有效的减轻其临床症状,使不良症状能够更快速的得到改善,并且减少不良反应的发生现象,进一步提高患者身体健康的恢复。     

‘Brain attacks’ and acute stroke in childhood: a practical approach in a time of proposed thrombolysis

Sudden focal neurological symptoms or ‘brain attacks’ in children are a common scenario for acute paediatric care givers. A small proportion will have had a vascular stroke. Suspected stroke in adults, signalled by FAST (Face, Arms, Speech, Time) test positivity, is an accepted medical emergency. Children are rarely dealt with urgently unless there is coma. Barriers to stroke recognition and response in children are multifactorial. Childhood stroke is rare and may be ‘FAST negative’. Overall, there is low awareness, low clinical suspicion and many logistic obstacles to timely detection and aspired treatment delivery. Yet stroke continues to affect hundreds of children in the UK each year, causing life-changing disability and, in some, death. This article highlights current key recommendations for the diagnosis and management of acute stroke set out in the 2017 Royal College of Paediatrics and Child Health (RCPCH) Stroke in childhood guideline. Evidence and rationale are discussed, and important practice points offered. There is focus on arterial ischaemic stroke in light of the proposed hyperacute management pathway, which includes thrombolysis. Ongoing challenges on the ground and how these may be overcome are considered.     

Study on Adsorption Properties of Calcined Mg–Al Hydrotalcite for Sulfate Ion and Chloride Ion in Cement Paste

In the marine environment, sulfate ions and chloride ions are abundant. Therefore, sulfate attack and chloride ion attack are common failure forms of marine concrete. Mg–Al hydrotalcite is a layered bimetallic hydroxide, which can be used as guest molecular adsorbent. In this experiment, we synthesized Mg–Al hydrotalcite, and the crystal state, surface morphology, and composition of this adsorbent were investigated by modern micro-analysis technology. Mg–Al hydrotalcite was added into the prepared target ion solution, to explore the influence of various factors on the adsorption performance of Mg–Al hydrotalcite, and then calcined Mg–Al hydrotalcite was added into cement paste, to study the mechanical properties and durability of the paste samples. The experimental results show that the optimum conditions for adsorption of chloride ions by calcined Mg–Al hydrotalcite are an adsorption time of 4 h, temperature of 35 °C, LDO (calcined Mg-Al hydrotalcite) dosage of 3.5 g/L, and a pH of 8. The adsorption effect of sulfate ion is best when the adsorption time is 6 h, the temperature is 35 °C, the dosage of LDO is 4 g/L, and the pH = 8. The optimal adsorption conditions of calcined Mg–Al hydrotalcite for chloride ion and sulfate ion are not completely the same, and the adsorption of these two ions in mixed solution shows competitive adsorption. Compared with the common paste specimens without Mg–Al hydrotalcite, the mechanical properties and deformation properties of cement specimens can be significantly improved by adding Mg–Al hydrotalcite.     

精细化护理对小儿哮喘急性发作期治疗的作用

目的了解精细化护理模式对小儿哮喘急性发作期雾化吸入治疗效果。方法将我院2017年2月-2018年8月的60例小儿哮喘急性发作期雾化吸入治疗患儿,随机分组,常规组给予传统护理,精细组开展精细化护理模式。比较两组满意度;小儿哮喘急性发作得到控制的时间、住院的平均时间;护理前后哮喘症状积分、生活质量积分;哮喘急性发作次数。结果精细组的满意度更高,P<0.05。精细组的满意度是100%,常规组的满意度是70%。护理前两组哮喘症状积分、生活质量积分接近,P>0.05;护理后精细组哮喘症状积分、生活质量积分优于常规组,P<0.05。精细组小儿哮喘急性发作得到控制的时间、住院的平均时间优于常规组,P<0.05,精细组小儿哮喘急性发作得到控制的时间、住院的平均时间是(1.21±0.21)d,(5.30±2.24)d。对照组小儿哮喘急性发作得到控制的时间、住院的平均时间是(2.27±0.51)d,(7.89±2.77)d。精细组哮喘急性发作次数更少,P<0.05。精细组哮喘急性发作次数(2.31±0.31)次。对照组哮喘急性发作次数(5.31±0.79)次。结论小儿哮喘急性发作期雾化吸入治疗患儿实施精细化护理模式效果确切。