慢性心衰患者电话干预的随机试验：DIAL试验

目的:明确集中的电话干预能否降低慢性心衰门诊患者死亡或因心衰加重而住院的发生率。设计:多中心、随机对照试验。地点:阿根廷的51个中心(包括公立、私立的医院及流动设施)。参与者:1518例患有稳定的慢性心衰且已接受最佳药物治疗方案治疗的门诊患者,由心脏科主治医师分层后随机分为电话干预组和常规治疗组。干预:在常规治疗的基础上,由一个中心通过护士频繁的电话随访对患者进行教育、辅导和监督。主要观察指标:全因死亡或由于心衰加重而住院。结果:99.5%的患者完成了全部随访。常规治疗组758例患者中由于心衰加重而住院或死亡的比例(235…     

How we do it: Implementing change – a multi‐centre audit of an evidence‐based protocol on post‐thyroidectomy calcium maintenance

? Our previous retrospective audit (Clinical Otolaryngology, December 2004) identified considerable variation in post‐thyroidectomy calcium assessment. This led to a well‐structured protocol. ? The protocol was introduced into two trusts. The results were prospectively collated for 64 thyroid procedures over a period of 6 months. ? All patients that warranted it were tested on day 1, and 71% were tested on day 2 – highlighting a more structured approach, and avoiding unnecessary vene‐ puncture in all thyroid lobectomy patients. ? Such protocols have been proven to be an important tool in the effort to improve the quality and lower the cost of care. ? Resistance to change, established practise and lack of data collection resources prevented this protocol from becoming established in more regional trusts.     

The effect of prolonged blood stasis on a microarterial repair

There is much controversy in the literature about the effect of blood stasis on the patency rate following microvascular repair. Sixty Sprague Dawley rats underwent transection and repair of their femoral arteries. The rats were divided into three groups, which had their repaired arteries clamped for 1 1/2, 2, and 2 1/2 hours. Patency was evaluated by the "stripping test," and the presence of a "flicker" both immediately and on the second day of the experiment. At the time of evaluation on the second day, all arteries in Group I were patent, in Group II two were thrombosed and in Group III, five out of 20 thrombosed. The only significant statistical difference was found between Groups I and III in both immediate (p less than 0.0025) and second day (p less than 0.05) evaluations. Results indicate that the "safe limit" for blood stasis in a repaired artery of 0.8 mm diameter is 1 1/2 hours.     

Enhanced antigen-specific antitumor immunity with altered peptide ligands that stabilize the MHC-peptide-TCR complex

T cell responsiveness to an epitope is affected both by its affinity for the presenting MHC molecule and the affinity of the MHC-peptide complex for TCR. One limitation of cancer immunotherapy is that natural tumor antigens elicit relatively weak T cell responses, in part because high-affinity T cells are rendered tolerant to these antigens. We report here that amino acid substitutions in a natural MHC class I-restricted tumor antigen that increase the stability of the MHC-peptide-TCR complex are significantly more potent as tumor vaccines. The improved immunity results from enhanced in vivo expansion of T cells specific for the natural tumor epitope. These results indicate peptides that stabilize the MHC-peptide-TCR complex may provide superior antitumor immunity through enhanced stimulation of specific T cells.     

The "S" Quattro in the management of fractures in the hand.

The "S" Quattro has shown its value in the management of displaced comminuted intra-articular phalangeal fracture dislocations. Since then the system has been used as a dynamic flexible external fixator in the treatment of five maluniting phalangeal fractures, five comminuted condylar and four severe compound fractures. These challenging fractures have been dealt with by easy operations, taking full advantage of the versatility of the "S" Quattro to achieve good results.     

Enhanced healing efficacy of an optimized gabapentin-melittin nanoconjugate gel-loaded formulation in excised wounds of diabetic rats

The present study aimed to design and optimize, a nanoconjugate of gabapentin (GPN)-melittin (MLT) and to evaluate its healing activity in rat diabetic wounds. To explore the wound healing potency of GPN-MLT nanoconjugate, an in vivo study was carried out. Diabetic rats were subjected to excision wounds and received daily topical treatment with conventional formulations of GPN, MLT, GPN-MLT nanoconjugate and a marketed formula. The outcome of the in vivo study showed an expedited wound contraction in GPN-MLT-treated animals. This was confirmed histologically. The nanoconjugate formula exhibited antioxidant activities as evidenced by preventing malondialdehyde (MDA) accumulation and superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymatic exhaustion. Further, the nanoconjugate showed superior anti-inflammatory activity as it inhibited the expression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). This is in addition to enhancement of proliferation as indicated by increased expression of transforming growth factor-β (TGF- β), vascular endothelial growth factor-A (VEGF-A) and platelet-derived growth factor receptor-β (PDGFRB). Also, nanoconjugate enhanced hydroxyproline concentration and mRNA expression of collagen type 1 alpha 1 (Col 1A1). In conclusion, a GPN-MLT nanoconjugate was optimized with respect to particle size. Analysis of pharmacokinetic attributes showed the mean particle size of optimized nanoconjugate as 156.9 nm. The nanoconjugate exhibited potent wound healing activities in diabetic rats. This, at least partly, involve enhanced antioxidant, anti-inflammatory, proliferative and pro-collagen activities. This may help to develop novel formulae that could accelerate wound healing in diabetes.     

基于批判性思维的综合护理在老年冠心病合并高血压患者中的应用评价

目的:基于批判性思维的综合护理在老年冠心病合并高血压患者中的应用评价.方法:选取2018年11月—2020年1月于河南科技大学第一附属医院就诊住院的92例冠心病合并高血压老年患者,按随机数表法分为观察组和对照组,每组各46例.对照组予以常规干预护理,观察组应用基于批判性思维的综合护理模式干预.观察两组情绪变化、血压变化及治疗依从性.结果:干预后,观察组负性情绪评分均低于对照组(P<0.05);观察组血压控制情况优于对照组(P<0.05);观察组治疗依从性高于对照组(P<0.05).结论:基于批判性思维的综合护理干预可减轻老年冠心病合并高血压患者的负性情绪影响,患者血压控制更理想,治疗依从性更高.     

Conjunctival flap advancement with or without scleral graft for hypotony maculopathy after trabeculectomy

AIM: To introduce a novel technique for transscleral fixation of the PC-IOL that requires no sutures on the IOL haptics. METHODS: Instead of suturing polypropylene onto the IOL haptics, the method simply winds the thread on the haptics. Fifteen eyes of 15 patients underwent this technique and were followed up for more than 18 months. Surgical outcomes and post-operative complications were evaluated and compared with those of the conventional transscleral fixation method. RESULTS: Postoperative cylinder was significantly lower in the thread winding group than in the conventional transscleral fixation method group (-1.02±0.46 diopters vs -1.57±0.77 diopters; P=0.01). Further, no postoperative complications, such as optic capture, IOL dislocation, and hyphema, were detected in the thread winding group. CONCLUSION: We believe that our thread winding technique is better than previously reported methods because it is simple, mechanically stable, and free from suture-related complications.