Dragons as amulets, dragons as talismans, dragons as counselors

In diverse historical and cultural settings, dragons have served as protective amulets or powerful talismans to protect or enhance the powers of those who possess them. The use of such personal symbols in dealing with personal adversity is explored, and methods in which the dragon symbol can he used to promote discussion of feelings, problems, and solutions to life crises are suggested.     

放射性核素与载体以及放射性滑膜切除术

目的:介绍放射性核素、载体的选择以及放射性滑膜切除术的适应证、禁忌证、并发症以及临床应用中的注意事项,为放射性滑膜切除术的临床应用提供一定的参考。资料来源:应用医学文献王软件在PubMed上检索所有字段中包含“radiation suynovectomy”或“radiosynovectomy”的文章,不设置其他限制,检索到277篇文章题录。资料选择:对检索到的文章进行初审。通过阅读所有文章的文题和大部分文章的摘要,选择内容与放射性核素、载体和滑膜切除密切相关的文章,在相关数据库上查找全文。主要以Science Direct和OVID两个数据库为主。资料提炼:经过初审得到58篇文章,排除重复性研究,同一领域的文章选择近期发表或权威杂志的文章。共41篇文章纳入分析。资料综合:放射性核素目前研究的热点:一是载体的选择,硅酸盐、枸橼酸盐、草酸盐、大颗粒氢氧化铁、羟磷灰石、聚乳酸、硫胶体、中心体等广泛被用作载体。良好的载体能够控制放射性药物的剂量和稳定性,减少核素从关节中的泄漏。二是包含核素和载体的放射性药物。理想的用于放射性滑膜切除术的药物应具备以下条件:①核素较小可以被细胞吞噬。但也不能太小,否则在被吞噬之前易从关节中泄漏。通常认为核素合适的大小应该是2～10μm。②在放射治疗的全程中放射性核素和载体的结合是不可逆的,这种结合由放射性核素的物理半衰期决定。③放射性标记的颗粒应该能够均匀分布于关节中,并且不促使炎症的发生。④载体的半衰期应长于所结合的核素的半衰期。载体应可以生物降解,以便在治疗后能够被机体清除。⑤稳定性好,成本低也是其重要特性。三是许多临床实验均已证明放射性化膜切除术是治疗多种慢性关节炎的有效方法。结论:正确选择放射性药物、合理选择适应证、规范操作,放射性滑膜切除术是类风湿性关节炎,血友病性关节炎,绒毛结节性色素滑膜炎等多种关节疾病安全、低成本的有效治疗方法。     

N-GAL: Diagnosing AKI as soon as possible

Early diagnosis of acute kidney injury (AKI) is often problematic, due to the lack of suitable early biomarkers of renal damage and kidney function. Neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of AKI partially overcomes such limitations and seems to demonstrate that diagnosing AKI in its early stages is possible and useful. Using genomic and protein microarray technology, a series of molecules have been identified as potential markers for AKI; among them NGAL has been demonstrated to rise significantly in patients with AKI but not in the corresponding controls. Furthermore, this rise in NGAL occurs in various studies at 24 to 48 hours before the rise in creatinine is observed. NGAL both in urine and plasma is an excellent early marker of AKI with an area under the receiver operator characteristic curve (AUC) in the range of 0.9. The study of Zappitelli et al. in critically ill children combines for the first time the new RIFLE classification (Risk, Injury, Failure, Loss, End-stage renal disease) of AKI with the validation of NGAL as an early marker of kidney injury. This innovative approach brings a new hope for a timely diagnosis of AKI and thus a timely institution of measures for prevention and protection.     

We stop aggression as soon as it starts

It's a sad reality, but all too many of today's nurses find themselves in a workplace where verbal abuse, threats, and physical assaults are common-place. The attacks seem to come from all sides: unruly patients, volatile family members, abrasive doctors, and angry colleagues.     

Contract law--it's only as good as the people

There is a frequently spoken phrase in law known as "Res Ipsa Loquitur." This Latin phrase translates in English to mean, "The thing speaks for itself." It is hoped the title of this article speaks for itself. The simple truth is that a contract is only as good as the people and institutions it binds. This does not mean that contracts should not exist or that important details of a contractual relationship should not be in writing. In essence, contracts are society's best attempt to memorialize the details of a business relationship between people and entities.