成人全身麻醉患者缩短术前禁饮时间的效果观察

目的 探讨成人全身麻醉患者缩短术前禁饮时间的应用效果。方法 选取200名成人全身麻醉择期手术患者,按进入麻醉准备间单双数序号分为观察组和对照组。观察组患者麻醉前按常规禁食12 h,麻醉前4 h至麻醉前30 min内分次少量饮用5%葡萄糖水;对照组患者麻醉前按常规禁食12 h禁水4 h。分别评价2组患者口渴程度、麻醉前低血糖发生率、呕吐及误吸发生率。结果 麻醉诱导前观察组患者口渴程度低于对照组（P<0.001）,观察组患者麻醉诱导前口渴程度明显低于麻醉前4 h（P<0.001）。观察组麻醉前低血糖发生率低于对照组（P<0.05）,观察组呕吐及误吸发生率与对照组相比较差异无统计学意义（P>0.05）。结论 成人全身麻醉患者缩短术前禁饮时间可降低患者口渴程度及麻醉前低血糖发生率,不增加患者呕吐及误吸发生,具有安全性和可行性。     

腹内压监测在ICU重症患者肠内营养管理中的应用

目的: 探讨腹内压监测在指导ICU重症患者早期肠内营养（EN）的应用效果。方法: 将2018年1至12月236例入住ICU并实施EN的危重患者,随机分成对照组和观察组。对照组采用ICU常规的护理方法。观察组在对照组基础上采用自制一次性膀胱内压测量器监测腹内压,并根据腹内压情况给予相应的对症治疗。比较两组患者喂养不耐受并发症的发生率和7 d喂养达标率。结果: 观察组患者腹泻、胃残余量增加、呕吐/返流、便秘等喂养不耐受并发症低于对照组,7 d喂养达标率高于对照组,差异有统计学意义（P<0.05）,两组患者在肠鸣音减弱上差异无统计学意义（P>0.01）。结论: 使用自制一次性膀胱内压测量器监测腹内压能减少ICU危重患者早期EN的并发症发生。     

基于昼夜节律机制对ICU老年患者肠内营养延续性护理的对照研究

目的 以昼夜节律机制为理论基础为ICU老年患者探索一套肠内营养延续性护理方案,从而降低该类患者经口进食早期消化道事件的发生风险。方法 随机抽取我院58例行肠内营养治疗的老年患者展开非同期随机对照研究,在肠内营养治疗结束前对照组患者采用常规护理措施,观察组患者采用延续性护理方案,比较2组患者经口进食早期腹胀评分、肠鸣音听诊、促胃动力药物应用事件、夜间饥饿事件以及患者满意度评分是否存在差异性。结果 2组患者经口进食早期在腹胀评分、肠鸣音听诊、累计用药频数、夜间饥饿事件累计频数以及操作护理评分差异存在统计学意义（P<0.05）,在每日促胃动力药物使用频数以及夜间饥饿事件发生频数差异无统计学意义（P>0.05）。结论 肠内营养延续性护理方案对于ICU老年患者饮食过渡具有良好的适用性。     

家庭肠内营养对微创食管癌根治术后患者营养状况的影响

目的 探讨家庭肠内营养对微创食管癌根治术后患者营养状况的影响。方法 选取2017年5月-2019年3月在我院胸外科接受微创食管癌切除术后的104例患者为研究对象, 采用随机数字表法将其分为观察组46例和对照组48例, 对照组出院后采用经口进食, 观察组在对照组基础上增加肠内营养输注, 共2个月。监测并比较2组BMI、血清白蛋白、血清总蛋白、血红蛋白及营养状况评分情况。结果 干预2个月后, 2组BMI、患者血清白蛋白、血清总蛋白在时间效应和组间效应上比较, 均有统计学差异(P<0.05);2组血红蛋白水平在时间效应上比较, 具有统计学差异(F_时间=22.935, P<0.001);2组出院后2个月营养状况比较, 差异具有统计学意义(Z=-2.835, P=0.005)。结论 家庭肠内营养干预能显著改善微创食管癌根治术后患者的营养状况, 值得在临床进一步推广。     

集束化护理在降低脑卒中患者肠内营养并发症中的应用效果

目的探讨集束化护理在降低脑卒中患者肠内营养并发症的应用效果。方法选取2012年10月-2013年10月需要行肠内营养的脑卒中患者68人为对照组,用传统护理方法;2013年11月-2014年11月需行肠内营养的脑卒中患者70人为观察组,用集束化护理方法。观察两组患者肠内营养并发症的发生率的差异。结果观察组患者腹泻、便秘、胃潴留、返流误吸、堵管、恶心、呕吐、腹胀的发生率明显低于对照组,差异有统计学意义(P0.05)。结论对脑卒中患者实施肠内营养输注时实行集束化护理管理,可以降低肠内营养并发症发生,提高患者肠内营养的耐受性。     

老年专科护士主导的吞咽障碍患者转介模式的建立与效果评价

目的 通过建立吞咽障碍患者规范化转介流程,诠释老年专科护士的角色定位,缩短多学科成员参与的路径。方法 成立多学科项目管理小组,制定吞咽障碍患者转介流程,应用工作分解结构模式分解项目,制定并落实干预方案。结果 实施流程干预方案后,护士吞咽知识达标率从56.3%上升至92.5%,吞咽障碍患者置管率从57.6%上升至75.0%;观察组吞咽障碍患者转介率51.5%相对对照组转介率3.1%,差异有统计学意义（P<0.05）。结论 老年专科护士主导的吞咽障碍患者转介模式,可有效的识别吞咽障碍患者,实现患者的成功转介。     

肠内营养并发胃潴留规范化处理流程对危重症患者喂养达标率的影响

目的 探讨实施肠内营养并发胃潴留规范化处理流程对危重症患者喂养达标率的影响。方法 选取2016年1月-2018年3月于湖州市第一人民医院急诊ICU住院,接受肠内营养治疗并发胃潴留的危重患者50例。按入院时间分为试验组和对照组,每组各25例。试验组接受肠内营养并发胃潴留规范化处理流程护理,对照组接受常规护理;比较两组7 d内预期喂养达标率、肠内营养占肠内与肠外营养总能量比例、促胃动力药物使用量及误吸发生率的差异,及两组ICU住院时间、28d病死率的差异。结果 试验组7 d内肠内营养预期喂养达标率高于对照组 (P<0.001);肠内营养占肠内与肠外营养总能量比例高于对照组（P<0.05);促胃动力药物使用量明显低于对照组 (P<0.05);两组误吸发生率、ICU住院时间及28 d病死率差异无统计学意义（P>0.05)。结论 实施肠内营养并发胃潴留规范化处理流程能够提高危重患者7 d内预期喂养达标率及肠内营养占肠内与肠外营养总能量比例,降低促胃动力药物使用量,但对误吸发生率、ICU住院时间及28 d病死率无明显改变。     

基于口渴管理安全策略饮少量冰水对经口气管插管患者口渴影响的研究

目的 基于口渴管理安全策略,探讨饮少量冰水缓解经口气管插管患者口渴症状的安全性和有效性。方法 采取随机对照试验,选取江西省某三级甲等综合医院ICU行经口气管插管患者76例,随机分为观察组和对照组,各38例。观察组在常规护理基础上从口腔给予少量冰水,对照组在常规护理的基础上给予棉签蘸水湿润口唇。收集并比较2组受试者口渴程度评分及呛咳误吸发生情况。结果 干预前,观察组及对照组的基线资料及口渴程度比较无统计学意义（P>0.05）。干预后,观察组口渴评分为（3.30±0.88）分,低于对照组（6.50±1.25）分（P<0.01）。患者呛咳误吸发生情况,2组比较差异无统计学意义（P>0.05）。结论 饮少量冰水可以有效缓解经口气管插管患者口渴症状,不增加呛咳及误吸的发生。     

慢性肝病住院患者营养筛查评估与管理循证实践

目的 制定慢性肝病住院患者营养不良风险筛查、评估及管理的最佳证据,并应用于临床实践,以规范肝病患者的营养筛查、评估与管理策略,提高患者营养水平。方法 遵循JBI临床证据实践应用模式,将最佳证据本土化后制定慢性肝病患者营养筛查、评估与管理的审查指标,通过培训与考核不断指导并规范临床实践,比较最佳证据实施前后患者营养状况、知信行情况及质量审查指标完成情况。结果 证据应用后,观察组慢性肝病患者营养不良发生率低于对照组,血清白蛋白水平高于对照组（P<0.05）;慢性肝病患者营养知信行水平均有所提高（P<0.05）;证据应用后医护人员对肝病营养筛查、评估及管理相关知识和态度情况优于证据应用前（P<0.05）;证据应用后6项审查指标执行情况优于证据应用前（P<0.05）。结论 通过应用最佳证据,并将证据科学地筛查、评估和管理慢性肝病住院患者营养问题,能改善患者营养水平,提升临床护理质量。     

不同时长低纤维饮食对功能性便秘患者肠道准备的效果观察

目的 探讨结肠镜检查前3种不同时长低纤维饮食对功能性便秘患者肠道准备的应用效果。方法 选取功能性便秘患者180例,采用随机数字表法分为对照组、观察A组、观察B组各60例。对照组结肠镜检查前低纤维饮食持续1 d,观察A组低纤维饮食持续2 d,观察B组低纤维饮食持续3 d。观察比较3组功能性便秘患者肠道清洁效果及不良反应发生率。结果 观察B组肠道清洁效果优于观察A组及对照组（P<0.05）;3组患者出现低血糖、腹痛、腹胀、恶心、呕吐、心悸、出冷汗、头晕等不良反应比较,差异无统计学意义（P>0.05）。结论 功能性便秘患者结肠镜检查前低纤维饮食持续3 d的肠道清洁效果优于低纤维饮食持续2 d和1 d,可以更好地达到结肠镜检查前的肠道准备标准,安全性较高。     

Evaluation of intervention strategy of thalassemia for couples of childbearing ages in Centre of Southern China

BackgroundTo describe the free intervention strategy of thalassemia for childbearing couples in Guangzhou.MethodsRoutine hematology examinations were conducted for 137,222 couples. Among them, 37,501 couples who had mean corpuscular volume (MCV) <82 fL or mean corpuscular hemoglobin <27 pg were elected for Hb analysis and the deletions of four common α‐thalassemia mutation. Reverse dot blot for common nondeletional α‐thalassemia and β‐thalassemia was selectively used. Three thousand twenty‐two couples randomly selected were offered all those tests as a control group. Sanger sequencing, multiplex ligation‐dependent probe amplification and next‐generation sequencing were used for rare thalassemia. High‐risk couples were offered prenatal diagnosis at 10–13 weeks’ gestation based on informed consent.ResultsThe carrier rates of α‐, β‐, and αβ‐thalassemia and δβ thalassemia/deletional HPFH were 7.7%, 3.02%, 0.5% and 0.059% respectively. Of them, 1.37% were identified as at‐risk couples and 345 couples terminated the pregnancy. No severe α‐ and β‐thalassemia births were observed. In the control group, two β‐ thalassemia carriers and one case with −α^3.7/αα^QS were misdiagnosed, but all at‐risk couples were found, and we could save 1,523,774 ¥ using our strategy. The cut‐off points of 73.46 fL and 23.25 pg would be useful to find −α⁺/α^T thalassemia.ConclusionThe intervention strategy was cost‐effective and offered reference in population thalassemia screening.     

Evaluation of radical scavenging properties of shikonin

With the aim of developing effective anti-inflammatory drugs, we have been investigating the biochemical effects of shikonin of “Shikon” roots, which is a naphthoquinone with anti-inflammatory and antioxidative properties. Shikonin scavenged reactive oxygen species like hydroxyl radical, superoxide anion (O₂^•−) and singlet oxygen in previous studies, but its reactivity with reactive oxygen species is not completely understood, and comparison with standard antioxidants is lacking. This study aimed elucidation of the reactivity of shikonin with nitric oxide radical and reactive oxygen species such as alkyl-oxy radical and O₂^•−. By using electron paramagnetic resonance spectrometry, shikonin was found unable of reacting with nitric oxide radical in a competition assay with oxyhemoglobin. However, shikonin scavenged alkyl-oxy radical from 2,2''-azobis(2-aminopropane) dihydrochloride with oxygen radical absorbance capacity, ORAC of 0.25 relative to Trolox, and showed a strong O₂^•−-scavenging ability (42-fold of Trolox; estimated reaction rate constant: 1.7 × 10⁵ M⁻¹s⁻¹) in electron paramagnetic resonance assays with CYPMPO as spin trap. Concerning another source of O₂^•−, the phagocyte NADPH oxidase (Nox2), shikonin inhibited the Nox2 activity by impairing catalysis when added before enzyme activation (IC₅₀: 1.1 µM; NADPH oxidation assay). However, shikonin did not affect the preactivated Nox2 activity, although having potential to scavenge produced O₂^•−. In conclusion, shikonin scavenged O₂^•− and alkyl-oxy radical, but not nitric oxide radical.     

Development of the Measure of Experiential Aspects of Participation for People With Physical Disabilities

Objectives

To create a parsimonious, psychometrically sound measure of experiential aspects of participation (MeEAP) for people with physical disabilities.

Evaluation of anticonvulsant activity of hydroalcoholic extract of Mussaenda philippica on animals

ObjectiveTo evaluate the anticonvulsant activity of hydroalcoholic extracts of leaves and sepals of Mussaenda philippica (M. Philippica) and its fractions (methanol, dioxin and aqueous) against pentylene tetrazole (PTZ), maximal electroshock (MES), Strychnine (STR), Picrotoxin induced convulsions at different dose levels.MethodsThe anticonvulsant effect of extracts was studied by the MES, PTZ, STR and Picrotoxin-induced seizure.ResultsThe extract at 100 and 200 mg/kg, produced a significant (P <0.01) dose dependent increase in onset of convulsion compared to the control in MES, PTZ, strychnine and picrotoxin-induced seizures.ConclustionsThe data obtained indicates that Hydroalcoholic extracts of M. philippica leaves and sepals may help to control grandmal and petitmal epilepsy.     

Patterns of pain: meta-analysis of microarray studies of pain

Existing microarray gene expression profiling studies of tonic/chronic pain were subjected to meta-analysis to identify genes found to be regulated by these pain states in multiple, independent experiments. Twenty studies published from 2002 to 2008 were identified, describing the statistically significant regulation of 2254 genes. Of those, a total of 79 genes were found to be statistically significant “hits” in 4 or more independent microarray experiments, corresponding to a conservative P < 0.01 overall. Gene ontology-based functional annotation clustering analyses revealed strong evidence for regulation of immune-related genes in pain states. A multi-gene quantitative real-time polymerase chain reaction experiment was run on dorsal root ganglion (DRG) and spinal cord tissue from rats and mice given nerve (sciatic chronic constriction; CCI) or inflammatory (complete Freund’s adjuvant) injury. We independently confirmed the regulation of 43 of these genes in the rat-CCI-DRG condition; the genetic correlates in all other conditions were largely and, in some cases, strikingly, independent. However, a handful of genes were identified whose regulation bridged etiology, anatomical locus, and/or species. Most notable among these were Reg3b (regenerating islet-derived 3 beta; pancreatitis-associated protein) and Ccl2 (chemokine [C-C motif] ligand 2), which were significantly upregulated in every condition in the rat.     

Investigation of health perspectives of those with physical disabilities: the role of spirituality as a determinant of health

Summary

Lymphoedema of the arm is a disabling complication of surgery for cancer of the breast. It occurs in a significant proportion of patients and tends to occur later after the operation. Radiation increases the incidence. It needs to be differentiated for tumour recurrence and venous obstruction. Aetiology may include surgical technique, radiation and infection. Prevention is important as treatment is difficult. Treatment may include drugs, particularly benzopyrones, and enzymes, physiotherapy, elastic sleeves and surgery.

Zusammenfassung

Das Arm-Lymphoedem ist eine meist irreversible, verunstaltende und invalidisierende Komplikation nach Mastektomie wegen Mammakarzinom. Es tritt bei einer beträchtlichen Zahl mastektomierter Patientinnen auf, oft erst nach längerer Latenzzeit. Zusätzliche Bestrahlung erhöht die Häufigkeit des Vorkommens. Tumor-Rezidiv oder venöse Stauung müssen sets ausgeschlossen werden. Die Ursachen des Lymphoedems liegen im chirurgischen Eingriff, der Radiotherapie und komplizierenden Infekten. Prävention ist sehr wichtig, da die Behandlung schwierig ist. Sie kann mit Medikamenten erfolgen, insbesondere mit Benzopyrenen und Enzymen, mit Physiotherapie, komprimierenden Gummiärmeln oder durch chirurgische Korrektureingriffe.

Résumé

Le lymphoedème du bras est une complication de l'intervention chirurgicale pour le traitement du cancer du sein. Il se déclare chez un nombre important de patients et dans de nombreux cas n'apparait qu'un certain temps aprés l'operation. La radiothérapie augmente sa fréquence. On doit distinguer entre récurrence de la tumeur et occlusion véneuse. La méthode de détermination de ses causes comprend les techniques chirurgicales, la radiothérapie et l'infection. Sa prévention est importante étant donné que son traitement est difficile. Il peut ětre traité à l'aide de médicaments, en particulier benzopyrènes et enzymes, de physiothérapie, de gaines élastiques et d'interventions chirurgicales.     

Development of a Computerized Adaptive Testing System of the Functional Assessment of Stroke

Objective

To develop a computerized adaptive testing system of the Functional Assessment of Stroke (CAT-FAS) to assess upper- and lower-extremity (UE/LE) motor function, postural control, and basic activities of daily living with optimal efficiency and without sacrificing psychometric properties in patients with stroke.

动态增强MRI定量参数与乳腺癌分子亚型的关系

目的 探讨不同分子亚型乳腺癌动态对比增强MRI(DCE-MRI)定量参数及其与预后因子的关系。 方法 回顾性分析78例乳腺浸润性癌患者治疗前的MRI,测量定量参数K^trans、K_ep和V_e。测定免疫组化指标ER、PR和HER-2,并对分子亚型进行归类。比较不同分子亚型间及雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体(HER-2)不同表达状态时的DCE-MRI定量参数。 结果 最终68例入组,其中Luminal A型24例,Luminal B型19例,HER-2+型10例,三阴性乳腺癌(TNBC)15例。K_ep值在不同分子亚型间差异有统计学意义(P<0.01)。Luminal A型和TNBC的K^trans、K_ep和V_e值的差异均有统计学意义(P均<0.05)。4个亚型中,TNBC的K^trans和K_ep值最大,V_e值最小。ER-者K_ep值高于ER+者;PR-者K_ep值亦高于PR+者,PR-者与PR+者K^trans差异有统计学意义。 结论 通过K^trans、K_ep和V_e值可鉴别Luminal A型乳腺癌和TNBC;不同分子亚型及不同ER、PR表达状态的乳腺癌的K_ep值不同。     

Validation of the Japanese Version of the Functional Assessment of Cancer Therapy-Cognitive Function Version 3

ContextCancer therapy–induced cognitive impairment adversely affects the quality of life of patients with cancer but cannot be detected by neuropsychological tests.ObjectivesThis study aimed to validate a Japanese version of the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) version 3, which is a self-report measure of the cognitive concerns of patients with cancer.MethodsThe FACT-Cog was translated into Japanese and pilot tested with five patients with breast cancer and five patients with hematologic malignancy. Study participants were recruited in Hiroshima University Hospital and Kagawa Breast Clinic in Hiroshima, Japan. Patients with breast cancer (N = 236) responded to the resultant assessment and Functional Assessment of Cancer Therapy-General version 4. The internal consistency and concurrent and construct validity of the FACT-Cog were examined.ResultsThe Cronbach's alphas of the four FACT-Cog subscales, namely, CogPCI, CogOth, CogPCA, and CogQOL, were 0.95, 0.73, 0.93, and 0.88, respectively. The item-to-domain correlations ranged from 0.211 to 0.920. Most of the FACT-Cog subscales were significantly correlated with other subscale and total scores (r = 0.133–0.425). Structural equation modeling was barely acceptable (χ2 = 1361.8, df = 489, P < 0.001; goodness of fit index = 0.731, adjusted goodness of fit index = 0.691, comparative fit index = 0.848, root-mean-square error of approximation = 0.087).ConclusionThe Japanese version of the FACT-Cog is a valid and reliable self-report measure of the cognitive function of patients with breast cancer. Its utility to clinicians and researchers in measuring the cognitive concerns of patients with cancer in Japan will serve as a further test of its validity.     

Brazilian versions of the Measure of Processes of Care-20 and Measure of Processes of Care-Service Providers: translation,cross-cultural adaptation and reliability

BackgroundThe Measure of Processes of Care (MPOC) questionnaires evaluate Family-Centered Practice (FCP) in services for children with developmental disorders. The MPOC-20 and MPOC-SP are completed by parents and by rehabilitation professionals, respectively, and are widely used in several countries.ObjectivesTo translate and cross-culturally adapt the MPOC-20 and MPOC-SP to Brazilian Portuguese and evaluate their reliability and internal consistency.Methodsthis study included translation, back-translation, cognitive interviews, testing of the pre-final versions, analysis of reliability and of internal consistency of the final versions. Respondents included parents and rehabilitation professionals from rehabilitation centers in four capital cities in Brazil.ResultsTranslation and cultural-adaptation procedures ensured the Brazilian versions were understandable and semantically equivalent to the original MPOC-20 and MPOC-SP. Pre-final and final versions were analyzed and vetted by the original authors. The MPOC-20 internal consistency Cronbach's alpha varied between 0.61 and 0.91 (n = 107), the test-retest reliability ICC varied between 0.44 and 0.83 and the standard error of measurement varied between 0.66 and 0.85 (n = 50). The MPOC-SP internal consistency Cronbach's alpha varied between 0.52 and 0.83 (n = 92), the test-retest reliability ICC between 0.83 and 0.90, and the standard error of measure between 0.34 and 0.46 (n = 62).ConclusionThe Brazilian versions of the MPOC-20 and the MPOC-SP are in general stable and sufficiently reliable. They are relevant to the evaluation of FCP and provide information that can improve health services and ensure better care.