基于罗森塔尔效应的护理干预对脑出血后遗症病人的心理状况和生活质量的影响

目的:探讨基于罗森塔尔效应的护理干预对脑出血后遗症病人的心理状况和生活质量的影响。方法:按照随机数字表法将2019年1月—2021年1月收治的98例脑出血后遗症病人分为对照组和观察组各49例,对照组实施常规护理,观察组在常规护理基础上给予基于罗森塔尔效应的护理干预。干预前后采用卒中量表(NIHSS)、功能独立性评定量表(FIM)、生活活动功能测量量表Barthel指数(BADL)评定两组病人康复情况,采用非精神病性焦虑量表(HADS-A)、非精神病性抑郁量表(HADS-D)、自我效能量表(GSES)评定两组病人心理状态,采用生活质量简明调查表(SF-36)评定两组病人生活质量。结果:观察组病人干预后NIHSS评分低于对照组,FIM和BADL评分高于对照组(P<0.05);观察组病人干预后HADS-A和HADS-D评分低于对照组,GSES评分高于对照组(P<0.05);观察组病人干预后生活质量各维度(躯体功能、躯体角色、肌体疼痛、总体健康、活力、社会功能、情绪角色、心理卫生)评分均明显高于对照组(P<0.05)。结论:基于罗森塔尔效应的护理干预应用于脑出血后遗症病人能有效促进病人康复,改善病人心理状态,提高病人生活质量。     

协同式早期运动干预在腹腔镜结直肠癌手术患者中的应用

目的 探讨协同式早期运动干预在腹腔镜结直肠癌手术患者中的应用效果。方法 使用随机数字表法将2020年5月-2021年5月于笔者所在医院进行腹腔镜结直肠癌手术的84例患者分为对照组和干预组,各42例。对照组术后采用常规运动干预,干预组术后采用协同式早期运动干预。比较2组术后恢复情况、身体状况、术后并发症发生情况。结果 干预组首次下床活动时间、术后排气时间、术后排便时间均早于对照组(χ²=11.823,P=0.001;χ²=4.687,P=0.001;χ²=7.611,P=0.001),术后7d干预组的多维度疲劳量表评分低于对照组(t=2.000,P=0.049),杜克活动指数高于对照组(t=2.256,P=0.027),2组术后并发症发生率比较,差异无统计学意义(χ²=0.343,P=0.558)。结论 协同式早期运动干预能够促进腹腔镜结直肠癌手术患者术后恢复,改善身体状况,值得推广应用。     

HBV-ACLF患者血清miR-122和 HMGB1水平及其与病情、预后的关系

[摘要]　目的　探究HBV相关慢加急性肝衰竭（HBV-related acute-on-chronic liver failure, HBV-ACLF）患者血清中微小核糖核酸（microRNA, miR）-122和高迁移率族蛋白1（high-mobility group box-B1, HMGB1）水平及其与病情、预后的关系。方法　回顾性分析2016年1月—2018年1月我院收治的120例HBV-ACLF患者的一般及临床资料。根据临床结局，将患者分为存活组（53例）和死亡组（67例）。比较2组患者的一般资料、实验室检查指标及血清miR-122、HMGB1水平。多因素Logistic回归分析影响患者预后的因素。Pearson检验分析miR-122、HMGB1水平分别与TBIL、PA、终末期肝病评分模型（the model of end-stage liver disease score, MELD）评分的相关性。ROC曲线分析miR-122和HMGB1水平对患者的死亡预测价值，获得最佳临界值。根据临界值将患者分为A组、B组和C组，用Kaplan-Meier法绘制生存曲线，比较3组患者在3年随访期间的生存率。结果　存活组和死亡组患者的年龄、身体质量指数、并发症、病情分期、MELD评分、ALB、球蛋白、TBIL、ALT、AST、LDH、PT、PTA、HBV DNA、miR-122、HMGB1相比，差异均具有统计学意义（P均＜0.05）。年龄、并发症、病情分期、MELD评分、TBIL、PT、PTA、miR-122、HMGB1均是影响患者预后的危险因素（P均＜0.05）。miR-122、HMGB1水平分别与TBIL、MELD评分呈显著正相关，与PTA呈显著负相关（P均＜0.05）。miR-122和HMGB1预测患者死亡的最佳临界值分别为31.42和14.56 μg/L。A组患者预后3年内生存率显著高于B组和C组（P均＜0.05）。结论　miR-122和HMGB1水平与HBV-ACLF患者的病情和死亡预后密切相关，可间接反映患者的病情严重程度，在HBV-ACLF的诊断及预后中具有重要价值。     

福建省新型冠状病毒肺炎中医证型探讨

按中医因地制宜的理论,根据武汉市与福建省不同的地理气候,福建省与武汉市新型冠状病毒肺炎中医证候差异,提出国家新型冠状病毒肺炎指南的证型不能完全覆盖福建省的全部病例,福建省应增加"湿热郁肺证",并提出"湿热郁肺证"的临床表现、治则治法与方药。     

Symptomatic palliative care for children with neurodisability

Paediatric palliative care and neurodisability are two relatively new, evolving paediatric sub-specialities that have increasing relevance in the current paediatric landscape. For many people palliative care has been synonymous with end of life care, but in paediatrics it encompasses much more and is for all children with life-threatening or life-limiting conditions, from the point of diagnosis. This breadth of focus is demonstrated well through the interface between paediatric palliative care and paediatric neurodisability. In this article we explore this unique interface through the three domains of complex symptom management, advanced care planning and end of life care. We describe the practicalities involved in all three areas and highlight the importance of early referral and the process of “dual” or “parallel” planning. We cover in more depth the specific management of the symptoms: dystonia/abnormalities of muscle tone, seizures, pain, agitation, secretions, respiratory failure, and gut failure.     

中医健康状态辨识模式的研究现状与展望

健康状态的辨识是把握健康的前提。当前学界已存在专家辨识模式、标准辨识模式、数字辨识模式、智能辨识模式以及微观辨识模式等。联合多种辨识方法,构建健康状态辨识体系,形成常态与动态结合、主观与客观结合、人机互参的中医健康状态个体化辨识方法是研究的趋势所在。文章对未来的研究方向进行展望,探讨了多元辨识模式、远程辨识模式、终身辨识模式、自动辨识模式的思路方法,以期促进全民健康事业,助力"健康中国"战略。     

Preparing IR for COVID-19: The Singapore Experience

This paper describes country-wide special measures undertaken for interventional radiology staff during the current coronavirus disease 2019 (COVID-19) pandemic. Although each interventional radiology service around the world faces unique challenges, the principles outlined in this article will be useful when designing or strengthening individual practices and integrating them within wider hospital and national measures. Moving beyond the current outbreak, these measures will be useful for any future infectious diseases which are likely to arise.     

Diagnostic potential of interleukin-40 (IL-40) in rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is the most common type of inflammatory arthritis. Newly emerging evidence has highlighted the role of B-cell produced cytokines in the development and progression of RA. Specifically, the expression of IL-40 has been shown to be significantly increased in affected patients.Patients and methodsThe study included 66 patients attending Rheumatology Unit, Baghdad Teaching Hospital and 66 matched controls. C-reactive protein (CRP), rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) were measured. Disease activity score (DAS28) was assessed. Serum IL-40 levels were assessed using an enzyme-linked immunosorbent assay (ELISA).ResultsThe mean ages of patients were 46.5 ± 10.2 years (23–68 years) and were 55 females and 11 males (F:M 5:1). 4 were smokers. Positivity of CRP, RF and anti-CCP were 75.8 %, 65.2 % and 62.2 % respectively. Steroids were received by 21.2 %, methotrexate by 56.1 %, biologics in the form of etanercept and adalimumab by 86.4 %. IL-40 was significantly higher in patients (9.1 ± 1.3 ng/ml) than in controls (7.5 ± 2.2 ng/ml; p < 0.001). The IL-40 level was comparable between females and males and was not related to smoking, CRP, RF or anti-CCP positivity or to receiving medications. Serum IL-40 showed good validity in diagnosing RA at a cut-off value (≥8.2 ng/ml) and area under curve (AUC) (0.74), the sensitivity was 73.2 %, specificity (66.7 %), and the accuracy (70.5 %)(p < 0.001).ConclusionThe increased level of serum IL-40 and its potential diagnostic role have been revealed in RA. Further studies are needed to be implement and elucidate the complete role of IL-40 in RA.