Human aortic elastin from normal individuals and atherosclerotic patients: lipid and cation contents; susceptibility to elastolysis

Aortic elastins, isolated from 30 humans of different ages, were purified by alkaline extraction, and separated into two groups depending on the presence of atherosclerotic plaques and calcification (grades 0 and 1).

It was confirmed that the severity of atherosclerosis increases significantly with age (P < 0.001) and elastin content decreases with atherosclerosis (P < 0.001). The hydrolysis of the aortic elastins using pancreatic porcine elastase (PPE) was studied. It was observed that increased elastolytic activities are connected with severity of atherosclerosis (P < 0.001) and both V_m and K_m apparent kinetic parameters are affected (P < 0.001). Correlation tests have shown that enzymatic hydrolysis is significantly modified by cholesterol (P < 0.05), calcium (P < 0.001) and magnesium concentrations (P < 0.01) but only cholesterol changes significantly V_m and K_m parameters.     

Relationship between myocardial tissue density measured by microgravimetry and sound speed measured by acoustic microscopy

If myocardial tissue can be assumed to be fluid-like, myocardial tissue elasticity can be estimated by the sound speed of tissue based on the equation K=ρc², where K is the elastic bulk modulus, ρ is density, and c is the sound speed of tissue. However, little data exist regarding the relationship between the sound speed of tissue and tissue density. The purpose of the present study was to evaluate the relationship between the sound speed of tissue and tissue density of various diseased myocardia. Myocardial tissue specimens at autopsy were obtained from 10 control patients without cardiovascular disease, 8 patients with pressure overload left ventricular hypertrophy (POLVH), and 8 patients with cardiac amyloidosis (AMD). Myocardial tissue sound speed was measured using a scanning acoustic microscope operating in the frequency of 450 MHz, and tissue density was measured by microgravimetry. The sound speed in POLVH (1639 ± 17 m/s) was higher and that in AMD (1565 ± 11 m/s) was lower than that in control patients (1615 ± 15 m/s) (p < 0.001) at the temperature of 20–22°C. The density in POLVH (1.087 ± 0.004 g/cm³) was higher and that in AMD (1.072 ± 0.003 g/cm³) was lower than that in control patients (1.082 ± 0.003 g/cm³) (p < 0.001). Tissue density correlated with sound speed in all three groups (r = 0.96, p < 0.001). Therefore, myocardial tissue sound speed data obtained by acoustic microscopy enabled us to evaluate tissue elasticity without measuring tissue density directly.     

Absence of mutagenic effects of continuous and pulsed ultrasound in cultured (AL) human-hamster hybrid cells.

Mutagenic effects of continuous and pulsed ultrasound were looked for using an in vitro assay system, the A_L hybrid, that is up to 100 times more sensitive for mutagens such as x-rays and neutrons than the assays used previously to evaluate ultrasound. Cells in suspension in rotated plastic test tubes were insonated with continuous wave ultrasound at I MHz, I_SPTP, = 0.62–40 W/cm² for 0–40 min. Cells attached in the central region of culture flasks received pulsed exposures at f_c = 2.5 MHz, PRF = 1 kHz, 2 and 8 cycles per pulse, with p_ = 1.2 MPa (I_SPTA = 31–180 mW/cm²) for 0–30 min. Although these exposures were cytotoxic (the plating efficiency was decreased to 65% by the highest doses), induction of mutation, if any occurred, was less than would be expected in this test system from 10–30 cGy of x-ray.     

TR146 cells grown on filters as a model of human buccal epithelium: permeability of fluorescein isothiocyanate-labelled dextrans in the presence of sodium glycocholate

The aim of the present study was to characterize the TR146 cell culture model as an in vitro model of human buccal epithelium with respect to the permeability of test substances with different molecular weights (M_w). For this purpose, the apparent permeability (P_app) values for mannitol and for fluorescein isothiocyanate (FITC)-labelled dextrans (FD) with various M_w (4000–40 000) were compared to the P_app values obtained using porcine buccal mucosa as an in vitro model of the human buccal epithelium. The effect of 10 mM sodium glycocholate (GC) on the P_app values was examined. To identify the pathways by which FD of M_w 4000–40 000 were transported, the confocal laser scanning microscope (CLSM) was used.

The P_app values obtained with the TR146 cell culture model in the absence of a permeability enhancer linearly decreased with increasing M_w of the test substance from 0.65±0.055×10⁻⁸ to 44±7.5×10⁻⁸ cm/s, as the P_app values obtained with porcine buccal mucosa. In the presence of the permeability enhancer, GC, the permeability of the FD across the cultured TR146 cell culture model increased in a parabolic manner, reaching maximum at M_w 10 000. In the absence of the enhancer, only paracellular localization of FD was observed while, in the presence of GC, FD also could be detected in the cytosol of some of the superficial cells. The GC-induced enhancement of FD permeation may be partially attributed to changed permeation pathways. The present results indicate that the TR146 cell culture model is a suitable in vitro model for mechanistic permeability studies of human buccal drug permeability.     

剪切波弹性成像在辅助软组织松解术后跟腱功能评估中的应用

目的 利用高频超声剪切波弹性成像评估辅助软组织松解术(IASTM)对健康成人跟腱的作用。方法 2020年7月至12月,健康成人受试者52例随机分入对照组(n = 15)和试验组(n = 37)。试验组接受左侧跟腱IASTM治疗,隔天1次,共2周;对照组不作处理。治疗前、首次治疗后即刻、治疗后3 d,采用高频超声和超声剪切波弹性成像测量受试者左侧跟腱厚度和弹性模量。结果 末次治疗后,试验组5例脱失。治疗前,两组左跟腱厚度、弹性模量均无显著性差异(t < 0.63, P > 0.05)。治疗后即刻,试验组左跟腱厚度较对照组减少(t = 2.149, P < 0.05);治疗后3 d,左跟腱弹性模量平均值和最大值较对照组减少(t > 2.134, P < 0.05)。结论 超声剪切波弹性成像可以量化评估IASTM对跟腱的疗效。     

内镜专用吸氧口垫的设计及应用

目的 设计内镜专用吸氧口垫,评价其临床应用效果。 方法 设计的内镜专用吸氧口垫包括口垫、鼻吸氧管、口腔吸氧管等7个部件。便利选取2021年1月—2月上海市某三级甲等医院内镜中心收治的120例因胆总管结石行内镜逆行胰胆管造影术的患者作为研究对象,采用随机数字表法分为试验组和对照组,每组各60例。试验组使用内镜专用吸氧口垫,对照组使用普通吸氧管及口垫。比较两组口垫佩戴时间、SpO₂波动差值、鼻导管移位率及医护人员满意度。 结果 试验组口垫佩戴时间为（20.58±2.43） s,对照组为（27.30±2.89） s,两组比较,差异具有统计学意义（t=-13.795,P<0.001）;试验组SpO₂波动差值为2.00%（1.00%,2.75%）,对照组为3.00%（2.00%,4.00%）,两组比较,差异具有统计学意义（Z=-4.332,P<0.001）;试验组鼻导管移位率为0,对照组为18.33%,两组比较,差异具有统计学意义（χ²=-12.110,P=0.001）;试验组医护人员满意度得分为（28.35±1.39）分,对照组为（26.48±1.56）分,两组比较,差异具有统计学意义（t=6.933,P<0.001）。 结论 内镜专用吸氧口垫佩戴方便,能减少患者术中SpO₂波动,降低鼻导管移位率,提高医护人员满意度及手术安全性。     

The effect of ultrasound exposure in utero on the development of the fetal mouse testis: Adult consequences

The effects of exposure in utero to 1 MHz, continuous-wave ultrasound on adult growth and testicular development in the mouse was investigated. The spatial peak temporal average intensity (I ) employed ranged from 1 to 10 W/cm², with exposure durations (t) of 200 s to 20 s. Exposures were made on days 9, 12 or 15 of gestation. Results showed an increase in postpartum deaths, an increase in the number of stillbirths, and a decrease in litter size when I²t ≥ 1125 W² s/cm⁴, such that there was significant loss of pups. Birthweights of pups from nearly all dosage groups was significantly lower than that of the sham or cage control groups. Results also showed that males exposed to ultrasound in utero had decreased testis size and decreased daily sperm production ranging from 9% to 30%. This study showed that ultrasound exposure in utero is capable of disrupting fetal development and having potential subsequent effects on fertility in the adult male.     

不同频率振动训练对膝骨关节炎老年人下肢肌力和症状的影响

目的 探讨不同频率振动训练对膝骨关节炎(KOA)老年人下肢关节肌力和症状的影响。方法 2019年7月至10月,82例KOA老年人随机分成对照组(n = 20)、低频组(n = 20)、中频组(n = 21)和高频组(n = 21)。低频组、中频组和高频组进行振幅3 mm,频率分别为15 Hz、30 Hz和45 Hz的振动训练,每次15 min,每周3次,共16周。训练前后进行双侧下肢关节屈伸等速肌力测试,角速度为60°/s和180°/s;采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)进行评定。结果 训练后,中频组60°/s和180°/s下膝关节伸肌峰力矩均增加(|t| > 2.162, P < 0.05),高频组膝和踝关节伸肌峰力矩均增加(| t| > 2.227, P < 0.05);高频组髋和膝关节伸肌耐力均增加(| t| > 1.997, P < 0.05),WOMAC疼痛得分显著减少( t = 16.901, P < 0.001)。训练后,高频组60°/s下膝和踝关节伸肌峰力矩,髋和膝关节伸肌耐力值大于低频组和中频组( P< 0.05);高频组180°/s下髋、膝和踝关节伸肌峰力矩大于低频组(P< 0.05);高频组WOMAC疼痛得分小于其他三组(P< 0.05)。结论 45 Hz振动训练能提高KOA老年人膝和踝关节伸肌绝对力和爆发力,髋和膝关节伸肌耐力,减轻疼痛症状。     

肠内营养启动时间对重型脑外伤患者误吸率和免疫功能的影响

目的 探讨重型脑外伤患者不同时间开始肠胃营养支持对创伤后早期误吸事件和免疫功能的影响。方法 选取2018年6月至2021年2月在连云港市第二人民医院神经外科住院的急性脑外伤患者75例,随机分为早期喂养(24～48 h)组(n=35)和延迟喂养(48～120 h)组(n=40),比较两组14 d内反流率、误吸率、吸入性肺炎发生率、免疫指标、并发症等。结果 两组反流率、误吸率和吸入性肺炎发生率比较均无显著性差异(P> 0.05)。早期喂养组IgG、IgA、补体C3和C4水平显著高于延迟喂养组(|t|> 1.720, P <0.001)。早期喂养组非吸入性肺部感染发生率低于延迟喂养组(χ2=4.728, P <0.05)。结论 伤后24～48 h启动早期喂养可能会保护重型脑外伤患者的免疫功能,减少非吸入性肺部感染的发生。     

Influence of preoperative mechanical bone quality and bone mineral density on aseptic loosening of total hip arthroplasty after seven years

Objective. To test mechanical bone quality and bone mineral density of the femoral head at the day of implantation as indicators for femoral prosthesis loosening.

Methods. Mechanical bone quality of a femoral head slice was assessed by destructive compression testing combined with bone mineral density measurements using peripheral quantitative computed tomography. Fourteen patients with walking pains were attainable for a radiographical follow-up mean 7.1 years after implantation.

Results. Radiolucent lines along the stem were evident in 11 of 14 femurs, most of them seen in Gruen zones 7, 6, 1, 3, 14, and showed strong correlations to preoperative bone strength (r=−0.80; P<0.001) and axial stiffness (r=−0.75; P=0.002), yet not to bone mineral density (r=−0.67; P=0.009). Slight varus deviations <3° were noted in six femurs. Preoperative strength was reduced in this femurs to 54% (P=0.006), and stiffness to 61% (P=0.038), while bone mineral density did not differ significantly.

Conclusions. Femoral prosthesis loosening after seven years can be predicted by mechanical bone quality of the femoral head at the time of implantation. Bone mineral density measurements may also indicate future stem loosening but have to interpreted carefully, keeping in mind a poorer predictive value.

Relevance Indications and choice of type of hip arthroplasty should be balanced in osteoporotic bones in particular. While preoperative bone mineral density measurement allows the prediction of mechanical bone quality, its relevance in predicting failure in arthroplasty treatment remains unclear.     

The effect of auto-positive end-expiratory pressure on the arterial-end-tidal carbon dioxide pressure gradient and expired carbon dioxide slope in critically ill patients during total ventilatory support

To examine the effect of auto-positive end-expiratory pressure (autoPEEP) on the estimation of arterial carbon dioxide pressure (PaCO₂) from end-tidal carbon dioxide pressure (PetCO₂) during changes in minute ventilation (MV), we studied 24 consecutive sedated and paralyzed patients under controlled mechanical ventilation for acute respiratory failure. The patients were grouped according to whether they had autoPEEP: group I (n = 11) comprised non-autoPEEP patients and group II (n = 13) comprised autoPEEP patients. Patients were randomly ventilated at three different levels of MV: normal MV (basal tidal volume), high MV (tidal volume 2.5 mL/kg above basal), and low MV (tidal volume 2.5 mL/ kg below basal). Respiratory rate and inspiration to expiration ratio were kept constant during the study. In each condition, we measured arterial blood gases, expiratory capnograms, airway pressure, and autoPEEP. We determined PaCO₂-PetCO₂ gradient, predicted PaCo₂ (Pa'CO₂) [Pa'CO₂ = PetCO₂ for each condition + (PaCO₂ PetCO₂ gradient at normal MV)], and expired CO₂ slope. The PaCO₂-PetCO₂ gradient only remained stable in group I (mean values for low, normal, and high MV were 3.3, 3.3, and 3.5 mm Hg, respectively), while group II showed a significant difference during low MV (12.2 mm Hg) when compared with normal MV (8.4 mm Hg; P < .01) and high MV (8.9 mm Hg; P < .05). PaCO₂ and PetCO₂ showed significant correlations in both groups (r = .92 in group I and .79 in group II). However, Pa'CO₂ could only be safely estimated in patients without autoPEEP when the difference between PaCO₂ and Pa'CO₂, ranged between 1.6 and −1.9 mm Hg. Slopes of expired CO₂ greater than 3 mm Hg/s identified patients with autoPEEP of 89% sensitivity, 93% specificity, 94% positive predictive power, and 95% accuracy. A significant correlation was found between autoPEEP and expired CO₂ slope (r = .70; P < .001), between autoPEEP and PaCO₂-PetCO₂ gradient (r = .46; P < .001), and between CO₂ expired slope and PaCO₂ PetCO₂ gradient (r = .74; P < .001). These results indicate that in patients with acute respiratory failure under controlled mechanical ventilation, the presence of autoPEEP is associated with inaccuracy in the calculation of predicted PacoZ from PetcoZ after changes in MV at fixed respiratory rates.     

潍坊市养老院老年人吞咽障碍与误吸调查

目的 调查潍坊市养老院老年人吞咽障碍与误吸的发生情况及具体表现。方法 2021年1月至6月,随机抽取潍坊市10家养老院入住的837位老年人,采用基本情况调查问卷、Fried衰弱表型、Ohkuma问卷和容积-黏度吞咽测试进行调查。结果 养老院老年人吞咽障碍与误吸的发生率分别为44.2%、12.3%。不同年龄和健康状况老年人的吞咽障碍发生率有显著性差异(χ2> 8.437, P <0.05)。男性吞咽障碍与误吸的发生率均高于女性(χ2> 4.060, P <0.05)。男性口腔期吞咽功能障碍发生率显著高于女性,食管期吞咽功能障碍发生率显著低于女性(χ2> 20.830,P <0.001)。患有脑卒中、阿尔茨海默病和帕金森病的老年人以口腔期功能障碍为主(χ2=27.579, P <0.001),患有慢性呼吸道疾病老年人以咽期和气道保护功能障碍为主(χ2> 20.241, P <0.01)。结论 养老院老年人吞咽障碍与误吸发生率较高,不同性别、基础疾病间的吞咽障碍表现不同。     

成年残疾人参与体育活动状况及其影响因素的Logistic回归模型研究

目的 研究残疾人体育活动参与状况及其影响因素。方法 以2019年2 302 833名残疾人参与体育活动数据为样本,应用多重响应交叉列联表分析残疾人体育活动的参与状况,应用Logistic回归模型分析残疾人参与体育活动的影响因素。结果 残疾人体育活动参与率非常低(7.0%),其中,男性(7.3%)高于女性;18~59岁(7.6%)高于其他年龄段;农业户口(7.1%)高于非农业户口;言语残疾(7.7%)高于其他类型;四级残疾(8.6%)高于其他等级。在残疾人未经常参与体育活动的原因方面,农业户口残疾人报告没有适合自己的活动项目(14.4%)和没有适合的场所及设施(12.3%),高于非农业户口残疾人。Logistic回归模型显示,不同性别(B = 0.048,P< 0.001)、年龄(B = 0.178,P< 0.001)、户口性质(B = 0.078,P < 0.001)、残疾类别(B _视力= 0.055, P < 0.01; B _听力= 0.133, P < 0.001; B _言语= 0.282, P< 0.001; B_智力= -0.159, P < 0.001; B _精神= -0.062, P < 0.01)的残疾人体育活动参与状况的差异较小;残疾等级对残疾人体育活动的参与状况有显著影响( P < 0.001),一级残疾人是四级残疾人的0.571倍(B = -0.561, OR = 0.571),二级残疾人是四级残疾人的0.659倍(B = -0.417, OR = 0.659)。 结论 成年残疾人体育活动参与率较低,残疾人功能特点直接影响到其体育活动的参与状况。应根据ICF理论与方法,设计适应性体育项目,建设无障碍体育设施,培训具备专业知识的指导人员,以促进残疾人参与体育活动。     

临床相关浓度硫喷妥钠对大鼠脑胶质瘤细胞核因子-κB活性的影响

目的探讨临床相关浓度的硫喷妥钠及其不同作用时间对大鼠脑胶质瘤细胞核因子(NF)-κB活性的影响。方法取大鼠脑胶质瘤C6细胞株,分别与10^-3mol/L、10^-4mol/L、10^-5mol/L硫喷妥钠作用1h,在收集细胞前30min用10ng/ml脂多糖进行处理;取大鼠脑胶质瘤C6细胞株,分别与10^-5mol/L硫喷妥钠作用0.5h、1h、2h、4h,在收集细胞前30min用脂多糖进行处理。提取细胞总RNA,逆转录得到c-DNA,之后行PCR反应;NF-κB表达结果进行凝胶电泳分析(EMSA)并用Bio-Rad密度仪进行半定量分析。结果经10^-3mol/L、10^-4mol/L、10^-5mol/L硫喷妥钠处理的电泳带窄于对照,密度测量值低于对照(P<0.05),但各处理浓度之间密度测量值的无显著性差异。经10^-5mol/L硫喷妥钠作用0.5h、1h、2h、4h的各电泳带宽度依次递减,亮度依次递减;密度测量数值也依次递减(P<0.05),且低于对照(P<0.05)。结论硫喷妥钠对脑胶质瘤细胞NF-κB活性具有明显影响。这种影响与硫喷妥钠浓度无关,随硫喷妥钠作用时间的延长而增强。     

髌骨软化症患者膝关节等速肌力测试

目的 分析髌骨软化症患者膝关节周围肌力特征,并比较其与健康人的差异。方法 2021年3月,采用等速肌力测试与训练系统,对70例单膝发病髌骨软化症患者(观察组)和35例健康人(对照组)进行膝关节不同角速度(60°/s和180°/s)的屈、伸等速肌力测试。结果 60°/s和180°/s时,观察组患侧屈、伸肌峰力矩、峰力矩体质量比、总功均显著低于对照组(U> 1097.0,P <0.001);观察组患侧60°/s屈、伸肌和180°/s时伸肌峰力矩、峰力矩体质量比、总功均低于观察组健侧(|Z|> 2.121, P <0.05)。60°/s和180°/s时,观察组患侧屈伸肌力比值均明显大于健侧和对照组(U> 1810.0,|Z|>3.691, P <0.01)。结论 髌骨软化症患者的患膝屈、伸肌肌爆发力和耐力均减弱,膝关节肌力存在失衡现象。     

Treatment with N-acetylcysteine during acute respiratory distress syndrome: A randomized, double-blind, placebo-controlled clinical study

Intravenous N-acetylcysteine (NAC) has been reported to improve systemic oxygenation and reduce the need for ventilatory support in patients with an acute lung injury. In the more serious form, namely established adult respiratory distress syndrome (ARDS) (Pao₂/Fio₂ ≤ 200 mm Hg), we tested the hypothesis that treatment with intravenous NAC may be beneficial.

Respiratory dysfunction was graded daily according to the need for mechanical ventilation and Fio₂ and to the evolution of the lung injury score (LIS) and the Pao₂/Fi0₂ ratio in 42 patients with established ARDS receiving either NAC 190 mg/kg/day or placebo as a continuous intravenous infusion over the first 3 days of their clinical course.

NAC and placebo groups (22 and 20 patients, respectively) were comparable for demographic characteristics, ARDS categories, severity of illness (simplified acute physiology score [SAPS II]) LIS and Pao₂/Fio₂ ratio. Mortality rate was 32% for the NAC and 25% for the placebo group (difference not significant). At admission (day 1), 91% of patients in the NAC and 95% in the placebo group required ventilatory support; at days 2, 3, 5, and 7 after admission, the percentage of patients receiving ventilatory support was not significantly reduced for both groups in comparison with day 1. Moreover, there were no differences between the two groups at the same observation days. In both groups, the Fio₂ was significantly lower and the Pao₂/Fio₂ ratio was significantly higher than the initial values during the evolution (Fio₂ at day 3, P < .01 for NAC and P < .05 for placebo; Pao₂/Fio₂ at day 3: P < .01 for NAC and P < .02 for placebo), but this improvement was similar for both groups and, moreover, the between-group comparison was never significantly different at the various collection days. The LIS decreased significantly in NAC group between days 1 and 3 (2.23 ± 0.62 v 1.76 ± 0.17; P < .05), whereas no changes were observed in the placebo group; at day 5, there was a significant difference between the two groups (1.53 ± 0.21 for the NAC v 2.15 ± 0.19 for the placebo group; P < .05). In the prevalent sepsis category (10 patients in the NAC and 9 in the placebo group), the mortality rate, the need of ventilatory support, the intensive care unit stay, and the Pao₂/Fio₂ evolution did not differ significantly in both subgroups.

In this relatively small group of patients presenting with an established ARDS subsequent to a variety of underlying diseases, intravenous NAC treatment during 72 hours neither improved systemic oxygenation nor reduced the need for ventilatory support oxygenation nor reduced the need for ventilatory support.     

Effect of trabecular orientation on mechanical resistance and ultrasound propagation in specimens of equine vertebrae

Osteoporosis involves alterations, not only in density, but also in the architectural organisation of the bone; in particular, trabecular orientation, following the skeletal load directions, lends a high degree of stiffness to the whole bone. We investigated the relationship between trabecular orientation, density, stiffness and ultrasound (US) propagation in two orthogonal directions (par. = parallel to, and ort. = orthogonal to the main orientation of the trabeculae) in cylindrical equine bone specimens (thoracic vertebrae) where a preferential orientation is present. A total of 15 cylinders were progressively decalcified with 0.2 mol/L ethylenediaminetetraacetic acid (EDTA). At different levels of decalcification, we measured the apparent density (g/cm³), bone mineral density or BMD (g/cm²), stiffness coefficient (MPa) and various US parameters. Before decalcification, stiffness values were the same in all directions. As the decalcification proceeded, the stiffness declined and, at low BMD values, it was significantly different in the two directions, being the highest in the par. one. Different behaviours of US parameters were observed in the two directions: SoS (speed of sound) was closely related to apparent density, BMD and stiffness in the par. direction (r = 0.88, 0.92 and 0.88, respectively, p < 0.0001). In the ort. direction, no significant association has been found between SoS and apparent density, BMD or stiffness. In the same experimental setup, US fast wave amplitude (FWA) was related to apparent density and BMD in the par. direction (r = 0.72 and 0.67, respectively, p < 0.0001) and in the ort. direction (r = 0.83 and R = 0.84 respectively, p < 0.0001). FWA was also correlated to stiffness in both directions (r = 0.61 par.; 0.81 ort., p < 0.0001). These results show that trabecular orientation strongly influences both mechanical properties of bone and US propagation. Furthermore, we found that US parameters can be predictors of mechanical properties of the bone independent of bone density. (E-mail: fcavani@unimore.it)     

The relationship between the arteriovenous carbon dioxide gradient and cardiac index

It has been reported that under normal conditions, mixed venous blood gases have approximated arterial samples; however, during cardiac arrest or severe cardiogenic shock, marked differences between arterial and venous blood gases have been noted. To further assess the relationships between arterial and mixed venous blood gases and cardiac index, a study population was chosen consisting of patients with less severe states of cardiac impairment. The differences between arterial and mixed venous P ₂S and pHs were compared with cardiac indexes (CI) of 44 patients in an intensive care unit with arterial lines and Swan-Ganz catheters in place. Twenty-six patients with normal Cis (2.6 to 4.1 L/min/m²) had a mean difference in mixed venous-arterial P ₂ (ΔP ₂) of 4.88± 0.40 mm Hg. In patients with low Cis (< 2.6), the ΔP ₂ was 7.44 ± 0.63 mm Hg (P = .001). The difference of mixed venous and arterial pH (ΔpH) was 0.027 ± 0.004 pH units for patients with normal Cis and 0.04 ± 0.003 pH units for those with low Cis (P < .002). When the Cls of all patients were plotted against the ΔP ₂s, there was an inverse linear relationship wherein ΔP ₂ increased as Cl decreased (r = −.47, P = .0011). There is an inverse relationship between ΔP ₂ and Cl that has not been previously described. An elevated ΔP ₂ may be a marker of a low cardiac index.     

脊髓损伤清洁间歇导尿患者自我管理现状及影响因素

目的 调查脊髓损伤清洁间歇导尿患者自我管理现状并探讨其影响因素。方法 2020年5月至2021年2月,便利抽样选取某脊髓损伤病友俱乐部255例脊髓损伤患者为调查对象,采用一般资料调查表、自制自我管理量表、自我效能感量表进行网络问卷调查,多元线性逐步回归探讨其影响因素。结果 脊髓损伤清洁间歇导尿患者自我管理量表中疾病症状管理、日常生活管理、间歇导尿行为管理及情绪管理和社会回归各维度得分分别为(40.458±9.122)分、(33.945±6.800)分、(36.709±8.736)分、(25.011±4.932)分;日常生活管理维度单题平均得分最高(3.772±0.755),情绪管理和社会回归维度单题平均得分最低(3.573±0.705)。间歇导尿时长、患病后家人的态度、自我效能感、职业是疾病症状管理维度的主要影响因素(R² = 0.135, F = 7.744, P < 0.001);自我效能感、间歇导尿时长、使用亲水涂层导尿管、并发症是日常生活管理维度的主要影响因素(R² = 0.173, F = 13.042, P < 0.001);自我效能感、间歇导尿时长、使用亲水涂层导尿管、医疗费用支付方式是间歇导尿行为管理维度的主要影响因素(R² = 0.141, F = 10.259, P < 0.001);自我效能感、间歇导尿时长、并发症、近一周每日间歇导尿次数是情绪管理和社会回归维度的主要影响因素(R² = 0.282, F = 19.590, P < 0.001)。结论 脊髓损伤清洁间歇导尿患者自我管理能力处于中等水平。患者自我管理能力受诸多因素影响,医护人员应针对其中可控因素,制定相应策略。     

促进剖宫产术后产妇早期离床活动的循证实践

目的基于剖宫产术后产妇早期离床活动的证据,实施循证实践,并验证其在改善剖宫产术后产妇早期离床活动中的作用。方法以基于证据的持续质量改进模型为研究框架,于2019年2月—2020年1月通过证据获取、现况审查、证据引入和效果评价4个阶段将循证实践应用于剖宫产术后产妇,并采用中断时间序列设计,比较循证实践应用前后两组疼痛情况、首次离床活动时间、术后24 h离床率、肠梗阻发生率及术后住院时间。结果最终纳入8条证据,共12条审查指标。循证实践后,剖宫产术后产妇疼痛评分<3分的人数百分比由74.37%提升至83.68%,两组比较,差异具有统计学意义(χ²=1.77,P=0.041);首次离床活动时间从(31.89±9.50) h缩短至(20.01±4.65) h,两组比较,差异具有统计学意义(t=11.48,P<0.001);术后24 h离床率由30.94%提高至91.21%,两组比较,差异具有统计学意义(χ²=17.28,P<0.001);肠梗阻发生率由5.31%下降至1.70%,两组比较,差异具有统计学意义(χ²