单指数、双指数和拉伸指数模型扩散加权成像在眼眶良、恶性肿瘤鉴别诊断中的价值

目的探讨单指数、双指数及拉伸指数模型DWI在眼眶良恶性肿瘤鉴别中的价值。材料与方法纳入2019年1月至2019年12月经手术病理证实的眼眶肿瘤患者51例,在术前行3.0 T常规磁共振及多b值DWI检查,其中良性26例,恶性25例。利用GE ADW 4.6 Functiontool后处理软件测量单指数模型表观扩散系数(apparent diffusion coefficient,ADC)图,双指数模型的慢速表观扩散系数(slow apparent diffusion coefficient,ADCslow)值、快速表观扩散系数(fast apparent diffusion coefficient,ADCfast)值、灌注分数(perfusion fraction,f)值,以及拉伸指数模型的分布扩散系数(distributed diffusion coefficient,DDC)、扩散异质性指数(the heterogeneity of intravoxel diffusion,α)值,比较各参数值的差异。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估有统计学差异的参数对眼眶良、恶性鉴别诊断的效能。结果ADC、ADCslow、DDC及α值在良性肿瘤与恶性肿瘤鉴别诊断中均有显著统计学差异(P<0.05),其中DDC和ADCslow的受试者工作特征曲线下面积最大,分别为0.84和0.81,诊断阈值分别为1.15×10^-3mm²/s(敏感度,79.20%;特异度,92.60%)和0.60×10^-3mm²/s(敏感度87.50%;特异度66.70%)。结论双指数及拉伸指数模型扩散加权成像为眼眶肿瘤良、恶性的鉴别诊断提供更多信息,ADCslow、DDC与传统单指数DWI生成的ADC值相比,在眼眶肿瘤良、恶性鉴别诊断中具有更大价值,ADCslow、DDC、α三参数联合诊断效能最高。     

拉伸指数和单指数模型DWI应用于前列腺癌和前列腺增生鉴别诊断的对照

目的探讨拉伸指数模型扩散加权成像(diffusion weighted imaging,DWI)应用于前列腺癌和前列腺增生鉴别诊断的价值,并与传统单指数模型进行对比。材料与方法回顾性分析经病理学证实的前列腺癌患者61例和前列腺增生患者49例的多b值(0～2000s/mm^2)DWI检查,获得病变的表观扩散系数(apparent diffusion coefficient,ADC)、分布扩散系数(distributed diffusion coefficient,DDC)和拉伸指数α。采用独立样本t检验比较两组之间各参数的差异,并用受试者工作特征(receiver operating characteristic,ROC)曲线分析评价各参数鉴别前列腺癌和前列腺增生的能力。结果前列腺癌的ADC、DDC和α值分别为(0.714±0.170)×10^-3mm^2/s、(0.711±0.262)×1 0^-3m m^2/s和0. 7 3 0±0. 0 7 0,前列腺增生分别为(1. 1 3 9±0. 1 6 3)×1 0^-3m m^2/s、(1.435±0.267)×10^-3mm^2/s和0.766±0.067,前列腺癌的各参数均低于前列腺增生,差异具有统计学意义(P<0.01)。DDC值和ADC值的曲线下面积(area under the curve,AUC)分别为0.955、0.950,两者无统计学差异(P>0.05)。α值的AUC明显低于DDC值和ADC值(P<0.05)。前列腺癌的ADC值和DDC值与Gleason评分呈负相关(P<0.05)。结论拉伸指数模型的DDC值可用于鉴别前列腺癌和前列腺增生。与单指数模型比较,拉伸指数模型并未展现出更多优势。     

DWI不同指数模型在肝细胞癌及肝血管瘤鉴别诊断中的应用价值

目的探讨弥散加权成像单指数模型、体素内不相干运动成像双指数模型及拉伸指数模型对肝细胞癌与肝血管瘤鉴别诊断的应用价值,并比较不同模型对两者鉴别的优越性。材料与方法回顾性分析66例行肝脏1.5 T MRI-DWI、e DWI、HB DWI序列患者资料,测量比较肝细胞癌和肝血管瘤单指数模型ADC值、Standard ADC值、双阶单指数模型D-mono、D*-mono、fmono值、双阶双指数模型D-Bi、D*-Bi、fBi值、HB DWI拉伸指数模型DDC、α值的差异。结果肝细胞癌和肝血管瘤组的ADC、Standard ADC、D-mono、D*-mono、fmono、D-Bi、D*-Bi、fBi值、DDC值差异均有统计学差异(P0.05)。ADC、Standard ADC、D-mono、fmono、D-Bi值ROC曲线下面积均大于0.9,Standard ADC值诊断效能优于ADC值(P0.05),D*-Bi、fBi、HB DDC诊断效能明显弱于ADC值(P0.05)。结论对于肝细胞癌及肝血管瘤两者鉴别,单指数模型ADC、Standard ADC,双指数模型D-mono、fmono、D-Bi值的诊断效能较好,其中多b值单指数模型Standard ADC值诊断效能相对优于传统单b值单指数模型ADC值。     

单双指数及拉伸指数模型在鉴别布氏杆菌性脊柱炎与脊柱结核中的价值

目的定量分析单指数、体素内不相干运动(introvoxel incoherent motion,IVIM)双指数及拉伸指数模型各参数在鉴别布氏杆菌性脊柱炎与脊柱结核中的潜力。材料与方法回顾性分析我院2016年12月至2018年12月经血凝集实验1∶100++以上或虎红平板实验++以上确诊的布氏杆菌性脊柱炎(Brucella Spondylitis,BSD) 34例、结核菌培养或手术病理证实脊柱结核(spinal tuberculosis,STB) 31例的临床资料。65例患者均行常规脊柱扫描、扩散加权成像(diffusion weighted imaging,DWI)及多b值DWI扫描,以测量两组单指数模型参数:ADC值,双指数模型参数:D、D*、f及拉伸指数模型参数:DDC、a值,采用t检验或Wilcoxon秩和检验进行组间比较;ROC曲线分析各参数鉴别诊断效能;相关性采用Pearson检验。结果 (1) BSD组的ADC、D、D*、f、DDC、a值均高于STB组,ADC、D、D*、DDC、a值差异有统计学意义(P=0.000、0.000、0.004、0.000、0.002),f差异无统计学意义(P=0.237)。(2)在BSD与STB鉴别时ADC、D、DDC、D*、a均具有较高效能,曲线下面积AUC分别为:0.87、0.85、0.76、0.71、0.71,其阈值分别为:0.000889、0.000664、0.00106、0.00309、0.81。(3) BSD组和STB组中ADC、D、DDC均具有较好相关性,两组中ADC与DDC相关性均最强,相关系数分别为:0.81、0.89,均有统计学意义。结论单指数模型ADC值、双指数模型D,D*值及拉伸指数模型DDC,a值在鉴别布氏杆菌脊柱炎与脊柱结核均具有较高效能。双指数模型同时提供灌注信息,拉伸指数模型同时提供扩散异质性信息,但双指数模型及拉伸指数模型诊断效能并未高于传统的单指数模型,所以临床仍推荐应用单指数模型DWI。     

外周带前列腺癌与正常组织的广延指数和单指数模型扩散加权成像的比较

目的:比较前列腺外周带癌与正常组织的广延指数和单指数模型弥散加权成像(diffusionweighted imaging,DWI)参数的差异。方法:25例外周带前列腺癌确诊患者行DWI检查,b值为0、500、1 000、2 000 s/mm2。通过单指数模型计算前列腺癌和正常组织的表观扩散系数(apparent diffusion coefficient,ADC),广延指数模型计算分布扩散系数(distributed diffusion coefficient,DDC)和校正系数α值。比较癌组织与正常组织之间ADC值、DDC值和α值(范围0~1)的差异,评价各组织中ADC值与DDC值的差异和相关性,并比较前列腺癌与正常组织之间A D C值和D D C值标准化差值。结果:共3 0个前列腺癌病灶、3 4个正常外周带组织纳入研究。前列腺癌组织ADC值[(0.73±0.14)×10~(-3)mm~2/s]、DDC值[(0.62±0.20)×10~(-3)mm~2/s]和α值(0.65±0.10)均显著低于正常外周带[(1.43±0.25)×10~(-3)mm~2/s、(1.49±0.20)×10~(-3)mm~2/s、0.86±0.09;均P0.05)]。前列腺癌组织的ADC值明显高于DDC值,正常外周带组织的ADC值低于DDC值(均P0.05)。在前列腺癌及正常组织中,ADC值与DDC值均密切相关(R2=0.98、0.98,均P0.05),前列腺癌组织的ADC值和DDC值的标准化差值明显高于正常组织。结论:广延指数模型DWI为鉴别前列腺癌与正常组织提供了更多信息,有助于提高前列腺癌的诊断率。     

体素内不相干运动扩散加权成像在脑胶质瘤中的应用研究

目的:分析体素内不相干运动扩散加权成像(intra-voxel incoherent motion diffusion weighted imaging, IVIM DWI)在胶质瘤中的应用。方法:选择19例经手术病理证实胶质瘤患者,测量肿瘤实质区及肿瘤对侧相对正常脑白质区单指数模型扩散系数ADC值和双指数模型扩散系数D、灌注分数f值、灌注系数D*值,分析脑胶质瘤的IVIM DWI特点。探究不同参数对于胶质瘤的分级能力的影响。结果:单指数模型中肿瘤实质区ADC值较对侧正常脑白质ADC值略增高,P<0.05;双指数模型中,胶质瘤肿瘤实体的平均f值高于正常脑白质,P<0.05。低级别胶质瘤肿瘤实体的平均ADC值和D值均在高级别胶质瘤肿瘤实体的相应值之上(P<0.05);单指数模型中ADC值、双指数模型的D值均有明显的差异(P<0.05)。D值的敏感度最高100%,ADC和f的特异度最高100%。结论:IVIM-DWI技术可以评估脑胶质瘤血流动力学情况,有助于临床脑胶质瘤术前分级评估及治疗方案的选择。     

动脉自旋标记及体素内不相干运动成像在胶质瘤分级中的应用

目的评价动脉自旋标记联合体素内不相干运动(intravoxel incoherent motion,IVIM)成像在胶质瘤分级中的诊断价值。材料与方法纳入32例经病理证实的胶质瘤患者,进行3D动脉自旋标记技术(artery spin labeling,ASL)及多b值(分别为0 s/mm~2、20 s/mm~2、50 s/mm~2、100 s/mm~2、150 s/mm~2、200 s/mm~2、400 s/mm~2、800 s/mm~2、1000 s/mm~2、1200 s/mm~2)IVIM成像,测量所有患者脑血流量(cerebral blood flow,CBF)值及IVIM双指数模型扩散系数D值,灌注相关扩散系数D*及灌注分数f值,比较高、低级别胶质瘤的CBF及IVIM模型参数。结果高级别胶质瘤CBF值显著高于低级别胶质瘤[分别为(75.6±12.3)ml/(100g·min)和(55.8±8.9)ml/(100g·min),P0.001]。在IVIM参数中,高级别胶质瘤的D*值亦高于低级别胶质瘤[分别为(40.3±23.5)×10~(-3) mm~2/s和(19.2±7.5)×10~(-3) mm~2/s,P0.01],而D值[分别为(0.59±0.15)×10~(-3) mm~2/s和(0.73±0.26)×10~(-3) mm~2/s,P0.05]与f值(分别为11.1±6.9和7.2±4.1,P0.05)差异无统计学意义。联合CBF及D*值对胶质瘤分级的曲线下面积(area under curve,AUC)为0.935,其敏感性和特异性分别为91.5%及89.6%。结论通过3D ASL及IVIM多参数联合分析,进一步提高了术前肿瘤分级评估的敏感性和特异性,为临床提供一种无创的更准确的胶质瘤分级方法。     

3D ASL技术结合DWI在脑胶质瘤术前诊断分级中的评估价值

目的 探究三维动脉自旋标记成像(3D ASL)技术结合弥散加权成像(DWI)在脑胶质瘤术前诊断分级中的评估价值。方法 回顾性选取2017年3月至2023年4月在鄂尔多斯市中心医院进行诊疗的65例脑胶质瘤患者的临床影像学检查资料,所有入组患者均进行3D ASL及DWI检查,根据患者活检或手术后病理检验结果对患者进行分组,其中35例低级别脑胶质瘤患者纳入低级别组,30例高级别脑胶质瘤患者纳入高级别组。分析两组患者术前3D ASL[总脑血流量(TBF)、局部总脑血流量(rTBF)、健侧脑白质血流(CBF)、相对脑血流量(rCBF)]及DWI[表观弥散系数(ADC)、相对ADC(rADC)]检查结果的异同,探究3D ASL及DWI技术对在术前分级中的评估价值。结果 高级别组的3D ASL检查CBF、rCBF、TBF、rTBF值分别为88.11±13.26、6.22±1.98、2.88±0.83、4.23±0.98,均高于低级别组(60.11±15.56、3.77±1.22、1.45±0.21、1.82±0.14),差异均有统计学意义(P<0.05)。以患者术后病理学检验结果为金标准,3D...     

评估单指数、双指数及拉伸指数DWI模型在鉴别肾透明细胞癌与肾乏脂性错构瘤中的价值

目的探讨单指数、双指数及拉伸指数DWI模型在肾乏脂肪性错构瘤与肾透明细胞癌鉴别诊断中应用价值。方法回顾性分析131例经病理证实为肾乏脂肪性错构瘤(27例)与透明细胞肾癌(104例)的临床资料,所有病人均在3.0 T MRI上接受多b值DWI检查(b值为0~1700 s/mm~2)。基于单指数模型计算出各向同性的表观扩散系数(ADC);应用双指数模型计算出假扩散系数(D_p),纯扩散系数(D_t)和灌注分数(f_p);应用拉伸指数模型计算出水分子扩散异质性指数(α)扩散分布系数(DDC)。所有扩散参数在乏脂肪性错构瘤与肾透明细胞癌两组中的比较采用Student’s t检验进行分析。同时采用ROC曲线及组内相关系数等方法比较诊断效能。结果肾乏脂肪性错构瘤组的ADC,Dt,α值显著低于肾透明细胞癌组,差异有统计学意义(P0.001);虽然D_p,f_p及DDC值略高于肾透明细胞癌组,差异无统计学意义(P=0.136,0.090,0.424)。鉴别两类肿瘤,α(0.953)和D_t(0.964)的曲线下面积(AUC)都显著高于ADC(0860),D_p(0.605),f_p(0.596)及DDC(0.477)的AUC值(P0.001)。结论与传统扩散参数相比,水分子扩散异质性指数(α)与D_t在鉴别乏脂肪性错构瘤与透明细胞肾癌可以提供更多信息并提高诊断敏感性与特异性。     

DWI和最小ADC值对成人颅内室管膜瘤分级诊断的价值

目的探讨扩散加权成像(diffusion weighted imaging,DWI)和最小表观扩散系数(apparent diffusion coefficient,ADC)值鉴别诊断成人颅内室管膜瘤与间变性室管膜瘤的价值。材料与方法回顾性分析我院2015年1月至2019年3月经手术病理证实的成人颅内15例室管膜瘤与10例间变性室管膜瘤的术前临床资料、DWI特征、测量肿瘤实质部分的最小ADC值并比较两者之间的差异,运用受试者工作特征(receiver operatingcharacteristic,ROC)曲线分析最小ADC值的诊断效能。结果 15例室管膜瘤中,DWI上有9例肿瘤实质部分呈稍高信号,6例呈等低信号,最小ADC值为(0.992±0.191)×10^-3mm^2/s;10例间变性室管膜瘤中,DWI上有7例肿瘤实质部分呈稍高或高信号,3例呈略低信号,最小ADC值为(0.725±0.101)×10^-3mm^2/s,两种肿瘤实质部分的最小ADC值差异有统计学意义(t=4.563,P<0.001)。ROC曲线结果显示:曲线下面积(area undercurve,AUC)值为0.883,以最小ADC值=0.872×10^-3mm^2/s为临界值,鉴别诊断两种肿瘤的敏感度为80%,特异度为90%。结论 DWI和最小ADC值可作为成人颅内室管膜瘤与间变性室管膜瘤鉴别诊断的新方法。     

Test of the health promotion model as a causal model of construction workers' use of hearing protection

The health promotion model (HPM) was tested as a causal model of construction workers' use of hearing protection (N = 359). Theoretical and exploratory models fit well, with the theoretical model accounting for 36.3% of variance and the exploratory model accounting for 50.6% of variance in hearing protection use. Value of use (benefits of using hearing protection), barriers to use, and self-efficacy were significant predictors in both the theoretical and exploratory models, but perceived health status was a predictor only in the theoretical model. In the exploratory model, where modifying factors were allowed direct relationships with use of hearing protection, two modifying factors—noise exposure and interpersonal influences-modeling—were significant predictors. Results of this test of the HPM are consistent with the revised HPM (Pender, 1996). There were significant direct paths from modifying factors to behavior. Use of hearing protection was best predicted by behavior-specific predictors, such as perceived barriers to use of hearing protection. Results support the use of the HPM to predict use of hearing protection. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 183–194, 1997     

护理模式与医学模式的比较研究

[目的]探讨现在的护理模式是否体现了护理的特色和价值,为护理模式的完善提供参考依据。[方法]应用文献资料法、历史法和比较研究法,从历史的角度将不同阶段的护理模式与医学模式进行比较。[结果]两者构建发展的出发点和终结点、包含内容形式、影响其形成及实践的宏观因素相同,在模式形成时间、产生的背景、产生及转变的动因、模式实践程度、意义和影响方面不同。[结论]护理模式体现了护理的特色,但未充分显现其价值,可借鉴美国的护理发展模式探索出适合我国国情的护理发展之路。     

肛门失禁大动物模型的建立

目的探讨肛门失禁动物模型的造模方式及其临床意义。 方法本文采用两种方法进行肛门失禁巴马小型猪模型的创建,分别为通过外科手术操作对小型猪的肛门括约肌离断致猪肛门失禁动物模型的创建和骶神经麻醉药物注射的方法对小型猪的骶神经损伤所致猪肛门失禁动物模型的创建,对猪肛门失禁动物模型进行肛门静息压测定,并取肛门括约肌组织进行组织形态学检测及可变剪接基因检测。 结果括约肌离断法与骶神经损伤法均诱导巴马小型猪发生肛门失禁,具体表现为大便不能自行控制（括约肌离断组：第1天出现肛门失禁,第2~14天保持肛门失禁。骶神经损伤组：第1天出现不完全大便失禁,第2~6天开始大便失禁情况逐渐加重,至第7天出现完全肛门失禁,第8~14天均保持肛门失禁状态）、肛门静息压显著降低（骶神经损伤组10.29±0.23 mmHg,括约肌离断组7.32±0.53 mmHg均＜对照组26.31±2.58 mmHg）和括约肌组织形态破坏（肛门括约肌组织形态结构异常,括约肌全层变薄,固有层结缔组织变厚,肌纤维数量明显减少、变细、断裂,横纹肌致密程度明显下降）。括约肌离断法较骶神经损伤法诱导肛门失禁速度更快,并且肛门静息压更低。模型组与对照组肛门组织可变剪接基因检测结果显示存在可变剪接差异基因,京都基因和基因组百科全书（KEGG）富集分析表明,差异可变剪接基因富集于Regulation of lipolysis in adipocytes、PPAR signaling pathway、TGF-beta signaling pathway、Spliceosome等信号通路。 结论括约肌离断法和骶神经损伤均可有效的进行猪肛门失禁动物模型的建立,Regulation of lipolysis in adipocytes、PPAR signaling pathway、TGF-beta signaling pathway、Spliceosome等信号通路异常的可变剪接可能参与肛门失禁的发生,具体机制有待深入研究。     

A multidimensional model of optimal participation of children with physical disabilities

Abstract

Purpose: To present a conceptual model of optimal participation in recreational and leisure activities for children with physical disabilities. Methods: The conceptualization of the model was based on review of contemporary theories and frameworks, empirical research and the authors’ practice knowledge. A case scenario is used to illustrate application to practice. Results: The model proposes that optimal participation in recreational and leisure activities involves the dynamic interaction of multiple dimensions and determinants of participation. The three dimensions of participation are physical, social and self-engagement. Determinants of participation encompass attributes of the child, family and environment. Experiences of optimal participation are hypothesized to result in long-term benefits including better quality of life, a healthier lifestyle and emotional and psychosocial well-being. Conclusion: Consideration of relevant child, family and environment determinants of dimensions of optimal participation should assist children, families and health care professionals to identify meaningful goals and outcomes and guide the selection and implementation of innovative therapy approaches and methods of service delivery.

• Implications for Rehabilitation

• Optimal participation is proposed to involve the dynamic interaction of physical, social and self-engagement and attributes of the child, family and environment.

• The model emphasizes the importance of self-perceptions and participation experiences of children with physical disabilities.

• Optimal participation may have a positive influence on quality of life, a healthy lifestyle and emotional and psychosocial well-being.

• Knowledge of child, family, and environment determinants of physical, social and self-engagement should assist children, families and professionals in identifying meaningful goals and guiding innovative therapy approaches.

     

Scopolamine model of dementia: electroencephalogram findings and cognitive performance

Background

Memory and cognitive functions are known to decline with advancing age. Studies have suggested that this may be due to a decrease in cholinergic function in the brains of elderly people. This review aims to assess studies documented in the literature dealing with the ‘scopolamine model’ of dementia.

Methods

Sources included MedLine searches from the last 10 years (search for ‘scopolamine model’, ‘dementia’, ‘electroencephalogram’, ‘cognition’) and references from original and review articles. The aim was to include human and animal studies occupying the cholinergic hypothesis in cognitive dysfunction. Electroencephalographic (EEG) and cognition findings were considered.

Results

Scopolamine influences delta, theta, alpha and beta activity in EEG and partially mimics the EEG changes found in patients with senile dementia or dementia of the Alzheimer type. Effects on different cognitive functions have been extensively documented.

Conclusion

Scopolamine produces similar memory deficits seen in the elderly, but the drug cannot induce the full range of deficits seen in patients with Alzheimer's disease. Various aspects of memory were unaffected by scopolamine administration. Memory improvements in elderly subjects can be achieved after cholinergic stimulation.

     

A social purpose model for nursing

The very current international debate regarding the construction of professional role‐identity in nursing involves analysis of context, competency, reflection, and theory. PROBLEM. What most of the literature shows is that nursing continues to struggle with inherited moral and behaviorist constructs in which essential is in opposition to essentialist caring values and remains part of a convoluted argument. Each of these two types of caring either figure or pre‐figure in the “future of nursing,” which, in the 21st century is contained within the market economy of healthcare reforms and international change. Therefore, how nursing's past is mapped is germane to any current or future understanding of nursing in a multidisciplinary workforce. METHODS. The paper takes a theoretical position employing a nursing model, newly constructed by the author, to examine 21st century nursing. The model seeks to gain an informed knowledge of practice to develop a means of evaluating nursing within its social context. The model is called a social purpose model. This article provides a historical mapping of the concept of new nursing from when it was utilized in another context nearly 18 years ago to now in the United Kingdom. This article includes a critical discussion of nursing's purposeful future to make the discussion more meaningful from an international perspective. Cartographically linking the past to the present is important, but if there is opportunity to define and identify the profession for a purposeful future, appropriate tools are needed to do so. FINDINGS. This article offers a social purpose model in which a subjective, objective, and contextual ideal of what nursing is today can be explored critically and applied both to the student and mentor's practice arena. CONCLUSION. To extend a definition of nursing for pragmatic purposes, nursing needs to be defined in relation to the social context within which it is practiced. Theory and experiential evaluation must inform action as a working adjunct to governmental documentation, taking 21st century nursing from the desktop to the bedside.     

中性粒细胞减少小鼠侵袭性肺曲霉病模型的构建

目的构建中性粒细胞减少合并侵袭性肺曲霉病（IPA）的动物模型。方法40只小鼠随机分为4组：A组为模型组，环磷酰胺150mg／kg于接种前4d及接种前1d腹腔注射，接种当天给予1％戊巴比妥45mg／kg腹腔注射麻醉后，1×10^8个／mL烟曲霉孢子悬液40μL滴鼻。B组为非免疫抑制接种对照组，除以生理盐水代替环磷酰胺外，其余操作同模型组。C组为免疫抑制对照组，除以生理盐水代替烟曲霉孢子悬液滴鼻外，其余操作同模型组。D组为空白对照组，以生理盐水代替环磷酰胺腹腔注射并以生理盐水代替烟曲霉孢子滴鼻，其余操作同模型组。模型建立成功的判断标准：肺病理切片见坏死灶、肺泡内出血，PAS染色见45。角分叉的分隔菌丝或孢子；组织培养烟曲霉阳性。结果肺大体观察、病理切片H—E染色及PAS染色和肺组织培养结果表明，A组10只小鼠在接种烟曲霉3d后均发生了IPA，B、C、D组小鼠均无IPA发生。结论本法可成功构建中性粒细胞减少小鼠IPA模型。     

A cognitive learning model of clinical nursing leadership

Cognitive modeling of competencies is important to facilitate learning and evaluation. Clinical nursing leadership is considered a competency, as it is a "complex know-act" that students and nurses develop for the quality of care of patients and their families. Previous research on clinical leadership describes the attributes and characteristics of leaders and leadership, but, to our knowledge, a cognitive learning model (CLM) has yet to be developed. The purpose of our research was to develop a CLM of the clinical nursing leadership competency, from the beginning of a nursing program to expertise. An interpretative phenomenological study design was used 1) to document the experience of learning and practicing clinical leadership, and 2) to identify critical-learning turning points. Data was gathered from interviews with 32 baccalaureate students and 21 nurses from two clinical settings. An inductive analysis of data was conducted to determine the learning stages experienced: awareness of clinical leadership in nursing; integration of clinical leadership in actions; active leadership with patient/family; active leadership with the team; and, embedded clinical leadership extended to organizational level and beyond. The resulting CLM could have significant impact on both basic and continuing nursing education.     

坏死性小肠结肠炎简易高效动物模型的建立

目的 研究坏死性小肠结肠炎(NEC)动物模型的简易制作方法.方法 新生大鼠称重后随机分为三组,分别予0.9％氯化钠注射液(NS)、150 mmol/L乙酸(AA)、300 mmol/L AA灌肠,观察其症状表现,24 h后称重,然后断颈处死;取出近端结肠用以组织病理学评分,并留取血清标本做髓过氧化物酶(MPO)活性检测和白细胞介素6(IL-6)浓度检测.结果 300 mmol/L AA组与NS组比较,MPO活性、IL-6浓度、组织病理学评分各方面明显增加,差异均有统计学意义(t分别=3.56、6.34,x2=30.50,P均＜0.05);试验前后24 h体重增长明显减少,差异有统计学意义(t=3.75,P＜0.05).150 mmol/L AA组与NS组比较,试验前后24 h体重变化、MPO活性、IL-6浓度、组织病理学评分各方面,差异均无统计学意义(t分别=1.41、0.94、2.16,x2=5.30,P均＞0.05).结论 这种简单易行的方法能成功地建立NEC动物模型,且具有可重复性好、成功率高、建模周期短等特点,可应用于NEC的相关研究.