经导管封堵先天性室间隔缺损术前后心律失常的变化与护理

目的观察经导管封堵先天性室间隔缺损术前后心律失常的变化及术前术后护理。方法选择在我院成功进行封堵术治疗的室间隔缺损（VSD）患者50例,对封堵术前后心率进行监测。结果50例患者中,18例于术前检测出22例次不同的心律失常,封堵术后心电监护早期发现不同的心律失常50例次,新发心律失常28例次,较术前明显增加（P〈0.001）。结论经导管封堵VSD术后心律失常发生率明显增加,有些心律失常相当严重,加强对室间隔缺损堵闭术前后病情的观测,加强护理是提高手术成功的重要保证。     

经胸食道超声引导下室间隔缺损封堵术的围术期护理

目的探讨经胸微创食道超声引导下行室间隔缺损（VSD）封堵术的围术期护理。方法对50例经胸微创食道超声引导下行VSD封堵术患儿的临床资料及护理体会进行回顾性分析。结果 50例患者手术均一次取得成功,术后无心律失常、残余分流、封堵器脱落等并发症发生,术后彩超复查,封堵器位置固定无移位。结论加强对围术期的护理管理,是预防VSD封堵术后并发症、保证手术成功的关键。     

小儿室间隔缺损封堵术并发心律失常的护理

目的探讨小儿室间隔缺损（VSD）经导管封堵术后心律失常的特征、防治,总结护理措施。方法选择2001年6月-2007年12月在我科住院并成功接受经导管封堵术的166例小儿VSD患者为研究对象,对封堵术中持续心电监护和术后1～7d常规心电图报告进行回顾性分析,总结心律失常发生的类型。结果166例小儿VSD患者术后心律失常明显增加;术后新发不完全性右束支传导阻滞（IRBBB）10例,完全性右束支传导阻滞（CRBBB）8例,加速性交界性心动过速伴干扰性房室分离4例,左前分支阻滞4例,CRBBB加左前分支阻滞2例,高度房室传导阻滞（AVB）5例。结论小儿VSD封堵术后新发生的心律失常以心脏传导阻滞为主,早期激素治疗有效,预后良好。     

超声心动图在室间隔缺损经导管封堵术中的应用价值

目的 探讨超声心动图在室间隔缺损（VSD）经导管封堵术中的应用方法和价值。方法 4例经导管治疗的室间隔缺损患者,缺损部位1例位于肌部,3例为膜周部。封堵器为Amplatzer式双盘片结构。在经胸超声心动图和X线的引导下,选择封堵器型号比VSD伸展径大1mm。结果 4例VSD成功封堵了3例,3例术前超声心动图测量的缺损大小与实际大小相符,相中2例经导管经右心路径放置封堵器,1例经左心路径放置封堵器成功。封堵术后观察封堵器呈“H”状夹闭VSD,术后即刻穿隔血液消失。术后1周超声心动图复查,3例封堵器位置良好、稳定,无残余分流。结论 超声心动图在VSD封堵术中对病例选择、术中引导和术后随访有重要的实用价值。     

经胸超声心动图在辅助室间隔缺损封堵术的应用价值

目的探讨经胸超声心动图在室间隔缺损封堵术中的应用价值。方法选择我院行经导管室间隔封堵术的患者45例,超声心动图用于封堵治疗前患者的筛选,封堵术中封堵器放置的引导和监测以及术后的随访。结果44例患者封堵器置入成功,术后即刻超声及造影显示完全封堵40例;微量残余分流4例,但10min后造影显示分流消失;1例嵴内型室间隔缺损（VSD）由于距主动脉较近,封堵未成功。结论超声心动图在室间隔缺损封堵术前、术中及术后随访中有重要作用。     

膜周部室间隔缺损介入治疗后并发高度房室传导阻滞的护理

室间隔缺损（VSD）是1种常见的先天性心脏病，其中膜周部室间隔缺损（PMVSD）是最常见的类型，约占80％。经导管室间隔缺损封堵术在临床应用日益广泛，VSD介入封堵治疗的成功率明显提高，但术后会出现各种并发症，心律失常是最常见的并发症之一，其中高度房室传导阻滞是封堵术中及术后严重的并发症之一，发生率为1．1％～8．6％，术后严密的观察与精心的护理可以及时发现和治疗此严重并发症。     

经胸小切口非体外循环下室间隔缺损封堵术38例围术期护理

目的:探讨经胸小切口非体外循环(CPB)下经食管超声心动图(TEE)引导室间隔缺损(VSD)封堵术患儿的围术期护理方法。方法:对38例经胸小切口非CPB下经TEE引导VSD封堵术患儿进行回顾性分析,并给予精心术前、术后护理。结果:本组均一次封堵成功,植入封堵器直径4～12 mm。术毕TEE证实所有VSD无残余,瓣膜情况较术前均无加重,无一例心律失常、血尿发生。随访2～4个月,经胸心脏超声未发现残余分流,无抗凝不足或抗凝过度等并发症发生。结论:加强围术期护理可提高一次封堵成功成功率,减少并发症发生。     

超声心动图对膜周部室间隔缺损封堵术前形态学分型的初步探讨

目的 探讨超声心动图对膜周部室间隔缺损(VSD)经导管封堵术前进行形态学分型的方法及其应用意义。方法 应用经胸超声心动图(TTE)对51例VSD患者行Amplatzer法封堵术前诊断筛选，根据VSD粘连形成瘤样程度，形态学上将VSD分为3型。封堵术中TTE全程监测引导，术后TTE复查评价封堵效果。结果 46例封堵成功，7例术后即刻存在少量残余分流，无明显并发症发生。5例封堵失败或放弃封堵。结论 VSD的形态结构变化对经导管封堵有一定影响，超声心动图术前对VSD进行形态学分型可在一定程度上对封堵结果作出预测。     

经导管封堵治疗膜部室间隔缺损的围术期护理

目的探索应用国产双盘状室间隔缺损封堵器经导管闭合膜部室间隔缺损术的术前、术中及术后护理措施。方法104例先天性心脏病膜部室间隔缺损患者,男48例,女56例,年龄2~56岁,平均(17.29±12.93)岁。经临床体检、心脏超声检查和左心室造影确诊。在X线和经胸超声引导下行经导管室间隔缺损封堵术。术前认真做好患者心理护理及有关术前准备,术中严密心电监护,备齐各种抢救药品和特殊导管,术后持续心电监护,并注意有无相关并发症。结果104例患者中,100例封堵成功,术中无并发症。术后心电监护示非阵发性室性心动过速2例,1周后恢复。所有患者无其他并发症。结论应用国产双盘状室间隔缺损封堵器经导管封堵治疗膜部室间隔缺损安全、有效。术前细致周到的心理护理、术中熟练配合和术后严密监护,对保证手术成功有重要作用。     

超声心动图在先天性心脏病封堵术中的应用11例分析

目的：探讨超声心动图在房间隔缺损（ASD）、室间隔缺损（VSD）及动脉导管未闭（PDA）等先天性心脏病封堵术中的应用。方法：6例VSD,4例ASD、1例PDA在经胸超声心动图测量缺损大小后行Amplatzer封堵器封堵。结果：11例患者在经胸超声心动图引导下放置封堵器9例获得成功,无封堵器漂移、栓塞、心律失常、心内膜炎、心包填塞等并发症。结论：经胸超声心动图对先天性心脏病封堵术术中的病例选择、术中监测及术后复查具有重大的意义。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。