Utstein模式下心源性心脏骤停心肺复苏的危险因素研究

目的:探讨影响Utstein模式下急诊心源性心脏骤停(CA)患者心肺复苏(CPR)预后的危险因素。方法:选取按Utstein模式要求登记的228例CA患者,记录患者CPR预后情况,对影响CA患者CPR预后的相关因素进行单因素及Logistic多因素分析。结果:228例CPR患者中,自主恢复循环(ROSC)125例(54.82%)、24 h存活55例(24.12%)、出院存活28例(12.28%)、神经功能恢复良好出院20例(8.77%)。经Logistic多因素分析显示,CPR持续时间、创伤性、首次监测心律、肾上腺素应用剂量是ROSC的独立预测因子;CPR持续时间、创伤性、首次监测心律是影响患者24 h存活的独立危险因素;首次监测心律、CA前状态、CPR持续时间是影响患者神经功能恢复良好及出院后存活的独立预测因子。结论:创伤性是影响CA患者ROSC及24 h存活的独立危险因素,肾上腺应用剂量≤5 mg、可除颤心律、CPR持续时间≤15 min均是影响患者ROCS及24 h存活的保护因素。可除颤心律、CPR持续时间≤15 min是影响患者神经功能恢复及出院后存活的有利因素,而CA前多器官功能衰竭(MOF)/疾病终末期则是危险因素。     

重症监护病房耐碳青霉烯肺炎克雷伯菌感染情况的临床分析

目的了解我院重症医监护病房耐碳青霉烯类肺炎克雷伯(carbapenem-resistant Klebsiella pneumonia,CRKP)感染患者的临床特点及抗生素耐药情况,为CRKP防控提供依据,指导临床用药。方法收集我院2015年10月至2015年12月期间重症监护病房患者临床资料,回顾性分析其临床基本情况、临床表现、治疗方案及预后情况。结果我科CRKP发生率为27.42%,CRKP患者多为高龄男性(平均年龄64.14±14.45岁,男性占78.57%),发热(肺克组85.71%vs.非肺克组51.35%、非感染组9.09%,χ~2=14.484,P=0.001)、白细胞总数(肺克组15.70±6.92 vs.非肺克组10.09±4.33、非感染组9.41±4.48×109/L,χ~2=9.980,P=0.007)、C反应蛋白(肺克组142.00(50.50,240.00)vs.非肺克组71.10(27.00,107.50)、非感染组14.10(5.00,53.30)mg/L,χ~2=9.387,P=0.009)及降钙素原(肺克组3.50(1.07,27.05)vs.非肺克组0.71(0.20,3.14)、非感染组0.20(0.20,0.30)μg/L,χ~2=16.236,P0.001)升高为主要表现,经替加环素联合碳青霉烯治疗后病死率(肺克组35.71%vs.非肺克组45.95%、非感染组36.36%,χ~2=0.607,P=0.738)无明显增高,但会延长住院时间(肺克组33.00(18.75,44.50)vs.非肺克组7.00(4.00,11.50)、非感染组9.00(4.00,13.00)天,χ~2=15.398,P0.001)、增加住院费用(肺克组23.92(10.14,36.08)vs.非肺克组4.41(2.64,11.22)、非感染组2.80(1.94,3.19)万元,χ~2=21.370,P0.001)。结论重症监护病房易出现CRKP流行,减少广谱抗生素的不规范使用和不必要的侵入性操作,及时调整抗感染方案,是控制CRPK流行、减轻临床负担的重要措施。     

卒中单元超早期康复治疗对急性脑出血患者的疗效观察及治疗费用评价

目的 观察卒中单元超早期康复治疗对急性脑出血患者的治疗效果,并对治疗费用进行评价. 方法 选择符合入选条件的急性脑出血患者131例,进入卒中单元病房62例,普通病房69例,卒中单元病房组患者进行超早期康复训练,普通病房组无康复训练计划,且无专业治疗小组对患者进行治疗,依患者意愿进行康复.治疗前后评价两组神经功能缺损评分(NIHSS)和日常生活能力(ADL)Barthel指数.并比较住院期间的感染率、病死率、住院费用及住院时间. 结果卒中单元病房组患者治疗前NIHSS评分为(11.0±8.4)分,普通病房组患者治疗前NIHSS评分为(10.9±7.6)分,差异无统计学意义(t=0.114,P>0.05),出院时两组NIHSS评分分别为(4.3±3.5)分、(7.9±5.0)分,与普通病房组患者比较,卒中单元病房组患者NIHSS评分明显改善(t=-3.211,P<0.05).卒中单元病房组和普通病房组治疗前ADL Barthel指数评分分别为(49.4±25.8)分和(51.7±34.3)分,差异无统计学意义(t=-0.443,P>0.05),出院时两组分别为(85.9±29.6)分和(67.1±37.1)分,与普通病房组患者比较,卒中单元病房组患者ADL Barthel指数评分明显改善(t=3.194,P<0.05).与普通病房组比较,卒中单元病房组住院期间的肺部感染率(8.06%与15.94%,χ~2=3.901,P<0.05)、尿路感染率(6.45%与11.59%,χ~2=4.138,P<0.05)、病死率(4.84%与7.25%,χ~2=4.351,P<0.05)降低、人均住院费用[(17 506.9±954.1)元与(21 096.5±923.5)元,t=-20.786,P<0.01]减少及平均住院时间[(20.5±7.0)d与(31.4±8.1)d,t=-8.196,P<0.01]缩短. 结论 卒中单元模式下超早期康复治疗有利于脑出血患者的恢复.     

高度依赖病房降低重症肝病患者ICU重返率的临床研究

目的探讨真实世界中高度依赖病房(HDU)和普通病房中重症肝病(SLD)患者重症监护病房(ICU)重返率的差异, 反映HDU在SLD患者诊疗管理中的作用。方法连续纳入解放军总医院第五医学中心ICU从2017年7月至2021年12月降阶梯至HDU及普通病房的重症肝病患者, 比较两组间的主要肝功能指标、终末期肝病模型(MELD)评分等, 分析转入不同病房的SLD患者病情严重程度、ICU重返率等的差异, 阐明HDU病房在SLD患者等级病房管理中的作用;采用受试者操作特征曲线计算曲线下面积(AUROC), 探讨基线MELD评分界定HDU收治范围的可行性。结果 SLD患者转入HDU时国际标准化比值、总胆红素、丙氨酸转氨酶、MELD评分等水平均显著高于转入普通病房组(P值均< 0.05)。转入HDU组中有70.7%的SLD患者MELD评分> 17, 而普通病房组中有61.9%的SLD患者MELD评分≤17。本队列总体ICU重返率为11.4%, 按照MELD评分四分位数P75分组, MELD评分>23的SLD患者ICU重返率(20.0%)显著高于MELD评分≤23的SLD患者(8.6...     

血清生长分化因子15对心脏骤停后综合征患者近期预后的评估价值

目的探讨心脏骤停心肺复苏(CPR)成功后即心脏骤停后综合征(PCAS)患者的血清生长分化因子15(GDF-15)的水平变化,及与近期预后的关系。方法选取2012年1月至2015年4月承德市中心医院急诊科PCAS患者102例,检测CPR成功后即刻、12 h、24~48 h的血清GDF-15水平。根据血清GDF-15升高时间分为3组,A组:CPR后即刻、12 h、24~48 h血清GDF-15水平一直<1 200 ng/L,B组:CPR后12 h和24~48 h的GDF-15水平持续升高,且一直≥1 200 ng/L;C组:CPR后12 h和24~48 h的GDF-15水平持续升高,但24~48 h较12 h时降低。所有PCAS患者观察起点为CPR成功后即刻,随访终点为达到CPR后6个月或各种原因死亡。结果生存分析显示,B组(64.7%)患者6个月生存率低于A组(93.5%)和C组(89.2%),χ2=12.738和7.253,均为P<0.05;而A组与C组比较差异无统计学意义(P>0.05)。Cox风险比例模型显示,血清GDF-15表达水平是患者预后的独立危险因素(RR=1.536,95%CI:1.012~2.285,P=0.006)。结论血清GDF-15水平有望成为预测PCAS患者近期预后的良好指标。     

层流ICU病房对呼吸机相关性肺炎感染率的影响

目的观察层流ICU病房对呼吸机相关性肺炎（VAP）感染率的影响。方法选择ICU住院患者2142例,其中普通ICU为641例、层流ICU 1501例,分别观察两种ICU病房VAP的感染率及人工气道建立千导管日呼吸道感染率。结果普通ICU病房VAP感染225例,VAP感染率为10.50%,千导管日呼吸道感染率28.61‰;层流ICU病房VAP感染100例,VAP感染率为6.66%,千导管日呼吸道感染率19.44‰。层流ICU病房VAP感染率、千导管日VAP感染率明显低于普通ICU病房（χ2=662.19、7.88,P均〈0.05）。结论层流ICU病房可明显降低VAP的感染率。     

心肺复苏患者血清GDF-15、NT-proBNP、cTnI水平变化的临床意义及其与近期预后的关系

目的探讨心脏骤停心肺复苏(CPR)成功后的患者血清生长分化因子15(GDF-15)、N端B型利钠肽原(NT-proBNP)、心肌肌钙蛋白I(c Tn I)不同时间水平变化的临床意义及与近期预后的关系。方法分别检测102例CPR患者CPR后即刻、12 h、24~48 h的血清GDF-15水平,根据血清GDF-15升高时间分为3组:(1)A组:CPR后即刻、12 h、24~48 h GDF-15水平一直小于1200 ng/L;(2)B组:CPR后12 h和24~48 h GDF-15水平均升高,且大于1200 ng/L;(3)C组:CPR后即刻和12 h GDF-15水平升高,24~48 h GDF-15水平较12 h时降低。同时检测3组患者各时间点血清NT-proBNP、cTnI水平及左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)。随访3组患者CPR后6个月的死亡情况。结果 GDF-15与NT-pro BNP、cTnI具有交互作用(P=0.001)。LVEDD、LVEF随着GDF-15、NT-pro BNP、cTnI水平的变化而变化。GDF-15、NT-pro BNP、cTnI高水平组患者死亡率均高于GDF-15、NT-pro BNP、cTnI低水平组(P0.05)。生存率分析结果显示,6个月生存率A组高于B组(χ~2=12.738,P=0.001),B组较C组低(χ~2=7.253,P=0.009),A组和C组无显著差异(χ2=2.240,P=0.097)。结论血清GDF-15、NT-proBNP、cTnI水平是预测CPR患者近期预后的很好指标,联合检测意义更大。     

针对性护理对心脏骤停行心肺复苏患者的护理质量和并发症的研究

目的探讨针对性护理对心脏骤停行心肺复苏(CPR)患者的护理效果。方法用随机数字表法将我院60例心脏骤停行CPR患者均匀分入对照组和观察组,对照组给予常规护理,观察组实施针对性护理,对比两组患者的ICU入住时间、护理前后GCS评分和并发症发生率。结果观察组患者的ICU入住时间比对照组短,护理后的GCS评分分值比对照组高,并发症总发生率比对照组低(P0.05)。结论对心脏骤停行CPR患者实施针对性护理可提高其护理效果,减少并发症发生率,值得推广。     

65岁以上胆道疾病患者日间腹腔镜胆囊切除的安全性分析

目的探讨老年患者日间手术腹腔镜胆囊切除(LC/DS)的安全性。方法收集2009年11月-2015年7月于中国人民解放军总医院行LC/DS的4764例患者的临床资料。分析其中老年患者(≥65岁)的一般信息、手术时间、术中出血量、术后住院日、满意率、延迟出院原因、因心理因素延迟出院率、留置腹腔引流管延迟出院率、并发症发生率、中转开腹率、出院30 d内再入院率、病死率等,并与非老年患者(≤64岁)进行比较。非正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ~2检验。结果 710例老年患者与4054例非老年患者接受LC/DS,病死率为0。老年患者与非老年患者的手术时间[57.5(41.8~74.3)min vs 54.0(40.0~70.0)min,Z=-2.715,P=0.007]、术中出血量[10.0(5.0~20.0)ml vs 5.0(0~10.0)ml,Z=-8.604,P0.001]、术后住院时间[1.0(1.0~1.0)d vs 1.0(1.0~1.0)d,Z=-3.778,P0.001]、总延迟出院率(20.3%vs 14.8%,χ~2=13.637,P0.001)、因心理因素延迟出院率(8.6%vs 6.5%,χ~2=4.220,P=0.040)和留置腹腔引流管延迟出院率(4.4%vs 2.0%,χ~2=13.909,P0.001)比较,差异均有统计学意义;2组患者的并发症发生率(6.5%vs 5.9%,χ~2=0.334,P=0.563)、中转开腹率(0.8%vs 0.4%,χ~2=2.119,P=0.145)、出院30 d内再入院率(0.7%vs 0.5%,χ~2=0.190,P=0.663)比较,差异均无统计学意义。结论与非老年患者相比,老年患者LC/DS不存在更高的并发症、中转开腹和二次入院风险,是安全可行的。     

盐敏感性高血压合并高同型半胱氨酸血症的临床研究

目的观察盐敏感性高血压患者合并高同型半胱氨酸(Hcy)血症后各项指标变化及降压疗效。方法选取延安大学附属医院心内科、陕西省人民医院心内科、内蒙古自治区人民医院心内科2014年12月至2016年5月住院的1、2级原发性高血压患者,经盐负荷筛选试验及血Hcy检测选取单纯盐敏感性高血压(SSH)患者116例作为SSH组,SSH合并血Hcy≥10μmol/L的患者101例作为SSH合并高Hcy组,另外选取100例非SSH但血Hcy≥10μmol/L的高血压患者作为高Hcy组,100例非SSH且血Hcy10μmol/L的高血压患者作为对照组。观察4组患者基线临床资料、24 h动态血压监测结果、限盐前后24 h尿钠排泄量及降压疗效。结果与对照组比较,SSH组、高Hcy组和SSH合并高Hcy组的左室体质指数(LVMI)[(117.1±11.5)g/m~2、(115.8±11.7)g/m~2和(124.5±11.2)g/m~2比(93.2±10.8)g/m~2,q=2.56,P=0.032;q=3.21,P=0.021;q=2.85,P=0.014]、内膜中层厚度(IMT)[(1.1±0.1)mm、(1.1±0.1)mm和(1.1±0.2)mm比(0.8±0.2)mm,q=3.84,P=0.018;q=3.52,P=0.023;q=3.41,P=0.015]、尿微量白蛋白/尿肌酐比值(UACR)[(18.5±4.8)μg/mg、(21.2±4.4)μg/mg和(22.3±4.2)μg/mg比(12.7±3.5)μg/mg,q=7.12,P=0.039;q=6.85,P0.041;q=7.24,P=0.029]均较高。与对照组比较,SSH组、高Hcy组和SSH合并高Hcy组的收缩压夜间下降百分比(8.9%±3.2%、9.2%±2.1%和6.5%±1.8%比15.2%±3.5%,χ~2=5.84,P=0.045;χ~2=6.89,P=0.023;χ~2=8.12,P=0.021)和舒张压夜间下降百分比(7.6%±3.1%、9.2%±2.5%和2.7%±1.8%比13.2%±2.8%,χ~2=7.21,P=0.023;χ~2=6.23,P=0.026;χ~2=7.90,P=0.018)均较低。限盐治疗1个月后,对照组[(135.7±28.2)mmol比(192.5±41.8)mmol,q=9.21,P=0.012]、SSH组[(151.3±31.4)mmol比(208.2±45.3)mmol,q=11.23,P=0.009]、高Hcy组[(135.2±27.3)mmol比(193.8±38.5)mmol,q=8.71,P=0.035]和SSH合并高Hcy组[(162.5±28.7)mmol比(212.5±42.2)mmol,q=9.81,P=0.028]的24 h尿钠排泄量均低于入院时24 h尿钠排泄量。与对照组比较,高Hcy组和SSH合并高Hcy组入院服用相同剂量降压药物后和联合限盐治疗后的收缩压下降百分比(9.6%±2.1%和6.1%±2.8%比13.5%±3.2%,χ~2=7.21,P=0.035;χ~2=8.82,P=0.032;11.5%±3.5%和8.6%±3.5%比14.8%±4.1%,χ~2=8.12,P=0.019;χ~2=9.41,P=0.024)及舒张压下降百分比(10.5%±3.1%和5.5%±1.7%比15.5%±3.4%,χ~2=9.20,P=0.025;χ~2=6.82,P=0.045;13.1%±3.6%和9.3%±2.1%比20.6%±3.3%,χ~2=11.32,P=0.021;χ~2=9.87,P=0.018)均较低。SSH组、高Hcy组和SSH合并高Hcy组的降压药物联合限盐治疗后舒张压下降百分比均高于单纯应用降压药物后(17.6%±4.8%比14.7%±2.8%,13.1%±3.6%比10.5%±3.1%,9.3%±2.1%比5.5%±1.7%,χ~2=10.21,P=0.015;χ~2=8.29,P=0.032;χ~2=9.21,P=0.028)。对照组降压药物联合限盐治疗后仅舒张压下降百分比高于单独应用降压药物(20.6%±3.3%比15.5%±3.4%,χ~2=6.29,P=0.041)。结论 SSH患者24 h尿钠排泄量较单纯高血压患者及H型高血压患者增加,且夜间血压为"非勺型"改变,靶器官损害较重,口服血管紧张素Ⅱ受体拮抗剂联合利尿剂降压效果好,如进一步联合限盐治疗则血压下降较明显。如同时合并高Hcy血症则会进一步加重靶器官的损害,且夜间血压进一步加重"非勺型"变化,同时降压疗效较单纯盐敏感性高血压患者及H型高血压患者更差。     

Adult influenza epidemic is associated with out-of-hospital cardiac arrest: From the All-Japan Utstein Registry,a prospective,nationwide, population-based,observational registry

It has been reported that influenza infection is associated with out-of-hospital cardiac arrest of cardiac origin (OHCA-CA). However, the association between OHCA-CA and influenza epidemics in adults has not been well investigated.We analyzed data from the All-Japan Utstein Registry, a prospective, nationwide, population-based, observational study, regarding OHCA-CA cases and the Infectious Diseases Weekly Report for influenza cases: 17,710 OHCA-CA cases and 764,808 influenza cases were recorded between 2005 and 2015 in Fukuoka, Japan. The weekly average number of OHCA-CA cases was positively associated with the number of patients with influenza infection (r = 0.70, P < .0001). To eliminate the effects of season and age, we investigated only adults in winter. The weekly number of OHCA-CA cases was positively associated with the number of patients with influenza infection in weeks when there was a high frequency of influenza infection in adults (r = 0.36, P = .006), but not in weeks with a medium (r = 0.26, P = .05) or low frequency of influenza infection (r = 0.003, P = 1.0). In weeks during which there was a high frequency of influenza infection, the weekly number of OHCA-CA cases was positively associated with the number of influenza infections in males (r = 0.37, P = .006), but not females (r = 0.18, P = .2).The number of OHCA-CA cases was positively associated with the number of influenza infections in adult males during weeks in which there was a high frequency of influenza infections. To help prevent OHCA-CA in males, it might be beneficial to announce influenza epidemics specifically in adults, in addition to all ages.     

Do patient characteristics or factors at resuscitation influence long‐term outcome in patients surviving to be discharged following in‐hospital cardiac arrest?

INTRODUCTION: Few studies have focused on factors influencing long-term outcome following in-hospital cardiac arrest. The present study assesses whether long-term outcome is influenced by difference in patient factors or factors at resuscitation. METHODS: An analysis of cardiac arrest data collected from one Swedish tertiary hospital and from five Finnish secondary hospitals supplemented with data on 1 year survival. Multiple logistic regression analysis was used to identify factors associated with survival at 12 months. RESULTS: A total of 441 patients survived to hospital discharge following in-hospital cardiac arrest and 359 (80%) were alive at 12 months. Factors independently associated with survival [odds ratio (OR) >1 indicates increased survival and <1 decreased survival] at 12 months were; age [OR 0.95, 95% confidence interval (CI) 0.93-0.98], renal disease (OR 0.3, CI 0.1-0.9), good functional status at discharge (OR 4.9, CI 1.3-18.9), arrest occurring at (compared with arrests on general wards) emergency wards (OR 4.7, CI 1.4-15.3), cardiac care unit (OR 2.8, CI 1.2-6.4), intensive care unit (OR 2.4, CI 1.1-5.7), ward for thoracic surgery (OR 10.2, CI 2.6-40.1) and unit for interventional radiology (OR 13.3, CI 3.4-52.0). There was no difference in initial rhythm, delay to defibrillation or delay to return of spontaneous circulation between survivors and nonsurvivors. CONCLUSION: Several patient factors, mainly age, functional status and co-morbid disease, influence long-term survival following cardiac arrest in hospital. The location where the arrest occurred also influences survival, but initial rhythm, delay to defibrillation and to return of spontaneous circulation do not.     

Out-of-hospital cardiac arrests of non-cardiac origin: Epidemiology and outcome

AIMS: The aim of the study was to determine the epidemiology of out-of-hospitalcardiac arrests of non-cardiac origin and survival followingresuscitation, using the Utstein method of data collection. METHODS AND RESULTS: The study was of prospective cohort design and was conductedin a middle-sized urban city (population 525 000) served bya single emergency medical services system. Consecutive out-of-hospitalcardiac arrests of non-cardiac origin occurring between 1 January1994 and 31 December 1995 were included. Survival from cardiacarrest to hospital discharge, and factors associated with survivalwere considered as main outcome measures. Of the 809 patients,276 (34·1%) had a cardiac arrest of non-cardiac origin.The mean (SD) age of the patients was 49·8 (20·9)years. Resuscitation was attempted in 204 cases, 82 of whom(40·2%) were hospitalized alive and 23 (11·3%)were discharged. Thirteen (56·5%) of the survivors weredischarged neurologically intact or with mild disability (overallperformance category I or II). The survivors, during the studyperiod, who suffered an out-of-hospital cardiac arrest of non-cardiacorigin comprised 19·2% of all out-of-hospital cardiacarrest survivors. Trauma (62), non-traumatic bleeding (36),intoxication (31), near drowning (22) and pulmonary embolism(18) were the most common aetiologies, comprising 61·2%of cases. The non-cardiac aetiology was suspected pre-hospitalin 176 (63·8%) cases; in the remaining cases, the aetiologywas revealed only after in-hospital investigations or autopsy.In a logistic regression model, time interval to first respondingunit, collapse outside the home, and aetiologies of near-drowning,airway obstruction, intoxication and convulsions were associatedwith survival. CONCLUSIONS: These results indicate that sudden out-of-hospital cardiac arrestmore often has a non-cardiac cause than previously believed.Although survival is not as likely as from cardiac arrest ofcardiac origin, since non-cardiac-cause survivors comprise onefifth of all out-of-hospital cardiac arrest survivors, resuscitationefforts are worthwhile.     

The Shock Energy Required for Successful Defibrillation Depends on the Degree of Disorganization of the Reentrant Activation Pattern

Regardless of how it is initiated, the final stage of sudden cardiac death is ventricular fibrillation (VF), a completely disorganized electrical activity of the ventricles, characterized by multiple reentrant circuits. There is only one known therapy for VF, a strong electrical shock, normally referred to as electrical defibrillation. In this study we investigate the hypothesis that the energy level required to stop fibrillation is dependent on the actual level of organization of the underlying reentrant activity. A three-dimensional bidomain model with unequal anisotropy ratios incorporating stochastic variations of the conductivity tensor was used. The active membrane behavior was described by the Courtemanche model of the human atrial action potential incorporating an acetylcholin (ACh) dependent K ⁺ current and electroporation. A spatial variation of [ACh] was used to obtain repolarization gradients allowing to control the degree of disorganization. Depending on the ACh settings, either a single rotor developed or spiral wave breakup evolving into fibrillatory like activity was observed. Shocks of varying strength and timing were delivered to both activation patterns and the probability of shock success as a function of shock strength was determined. Results indicate that arrhythmias with a higher degree of disorganization need significantly higher shock strengths to defibrillate.     

早老性痴呆转基因小鼠的研究

目的 建立早老性痴呆的转基因小鼠,为进一步的发病机理研究及药物筛选提供动物模型。方法 显微注射方法制备转基因小鼠,通过ＰＣＲ、Ｓｏｕｔｈｅｒｎ杂交鉴定。结果 质粒ｐＰｄＡＰ７５１的Ｔｔｈ１１１Ⅰ＋ＸｂａⅠ双酶切片段长度为４．３ｋｂ,经回收、纯化后,注射到小鼠受精卵的雄性原核,经ＰＣＲ,Ｓｏｕｔｈｅｒｎ杂交鉴定,确定首建鼠一只。首建鼠现已传代建系。结论 通过显微注射的方法,建立了早老性痴呆的转基因动     

Factor Structure of the Chinese Version of the University of Rhode Island Change Assessment in Taiwanese Adolescents Who Abuse MDMA or Methamphetamine

Objective: The University of Rhode Island Change Assessment (URICA) is a widely used tool for measuring subjects’ readiness to change substance-using behaviors. The aim of this study was to examine the factor structure of the Chinese version of the URICA (C-URICA) in Taiwanese adolescents who have used methylenedioxymethamphetamine (MDMA) or methamphetamine (MAMP). Methods: Pre-test and post-test data from the C-URICA from 92 adolescents in a juvenile abstinence center who had used MDMA or MAMP were analyzed. We used confirmatory factor analysis (CFA) to examine the adequacy of the factor structure of the C-URICA. Results: CFA indicated that a three-factor structure (pre-contemplation, contemplation + action, maintenance) had a better goodness of fit than four-factor (pre-contemplation, contemplation, action, maintenance), and one-factor structures. Conclusions: The results indicated that the URICA may have different factor structures when used in the population different from the original adult population with alcohol drinking.     

Microencapsulated tumor assay: evaluation of the nude mouse model of pancreatic cancer

AIM: To establish a more stable and accurate nude mouse model of pancreatic cancer using cancer cell microencapsulation.METHODS: The assay is based on microencapsulation technology, wherein human tumor cells are encapsulated in small microcapsules (approximately 420 μm in diameter) constructed of semipermeable membranes. We implemented two kinds of subcutaneous implantation models in nude mice using the injection of single tumor cells and encapsulated pancreatic tumor cells. The size of subcutaneously implanted tumors was observed on a weekly basis using two methods, and growth curves were generated from these data. The growth and metastasis of orthotopically injected single tumor cells and encapsulated pancreatic tumor cells were evaluated at four and eight weeks postimplantation by positron emission tomography-computed tomography scan and necropsy. The pancreatic tumor samples obtained from each method were then sent for pathological examination. We evaluated differences in the rates of tumor incidence and the presence of metastasis and variations in tumor volume and tumor weight in the cancer microcapsules vs single-cell suspensions.RESULTS: Sequential in vitro observations of the microcapsules showed that the cancer cells in microcapsules proliferated well and formed spheroids at days 4 to 6. Further in vitro culture resulted in bursting of the membrane of the microcapsules and cells deviated outward and continued to grow in flasks. The optimum injection time was found to be 5 d after tumor encapsulation. In the subcutaneous implantation model, there were no significant differences in terms of tumor volume between the encapsulated pancreatic tumor cells and cells alone and rate of tumor incidence. There was a significant difference in the rate of successful implantation between the cancer cell microencapsulation group and the single tumor-cell suspension group (100% vs 71.43%, respectively, P = 0.0489) in the orthotropic implantation model. The former method displayed an obvious advantage in tumor mass (4th wk: 0.0461 ± 0.0399 vs 0.0313 ± 0.021, t = -0.81, P = 0.4379; 8th wk: 0.1284 ± 0.0284 vs 0.0943 ± 0.0571, t = -2.28, respectively, P = 0.0457) compared with the latter in the orthotopic implantation model.CONCLUSION: Encapsulation of pancreatic tumor cells is a reliable method for establishing a pancreatic tumor animal model.     

护士主导护理模式在原发性高血压患者的应用

目的：探讨护士主导护理模式在原发性高血压患者的应用方法与效果。方法：2012年2月到2015年6月选择在我院诊治的原发性高血压患者160例,将全部病人分成两组,即对照组和治疗组,每组病人均为80位,采取随机数字表法进行分配,医治时间为28日,将常规护理应用到对照组病人的治疗过程中,治疗组采用护士主导护理模式进行护理。结果：经过干预,在治疗有效率方面,对照组和治疗组各自是90.0%、98.8%,可见治疗组的数值更高,疗效更好,P<0.05。两组干预后的收缩压与舒张压都明显下降,与干预前对比差异明显,P<0.05,并且此方面的测定数值治疗组要比对照组小得多,P<0.05。干预期间治疗组的监测血压、控制体重、规律运动与行为转变评分都明显高于对照组(P<0.05)。出院时经过调查,治疗组对于护理服务、护理技术、护理效果与护理形式的满意度为100.0%、100.0%、98.8%和97.5%,而对照组分别为90.0%、90.0%、88.8%和88.8%,组间对比差异都有统计学意义(P<0.05)。结论：护士主导护理模式在原发性高血压患者的应用能有效降低血压,促进预后的改善,从而能有效转变患者的行为状况,改善护患关系,有很好的应用价值。     

脾气虚证动物模型规范化的初步研究——宏观症征部分

目的：通过脾气虚证动物模型规范化的初步研究,探讨其宏观症征改变。方法：首先完善脾气虚证模型的诊断标准,改进造模方法,观察改进后的模型的宏观症征（症状,大便,舌象,体重,体温,体长,食量,游泳时间）对诊断标准的符合程度。同时建立目前5种有代表性的脾（阳）气虚证模型,比较改进后的模型与这5种模型的宏观症征对诊断标准的符合程度。动物采用大鼠。结果：初步规范组的宏观症征与脾气虚证诊断标准基本符合。符合度明显高于5种脾（阳）气虚证模型。结论：初步达到规范脾气虚证动物模型的目的。