护生自身练习护理操作的伦理问题及对策

自身练习护理操作就是以护生作为练习对象,相互间在各自身上完成注射、输液等操作练习项目,以达到教学要求[1]。在基础护理的教学中,自身练习对于调动护生的参与感,增加真实感,满足成就感方面起着十分重要的作用。但是,也必须看到在积极效果背后的种种矛盾以及由这些矛盾可能导     

慢性泪囊炎经鼻腔逆行插管术的护理体会

慢性泪囊炎为眼科常见病之一，需行手术治疗。我科近2年来对86例慢性泪囊炎患者经鼻腔逆行插管术进行了整体护理，取得了良好的效果。现报告如下：     

影像学分型与急性脑梗死患者认知功能关系的研究

目的探讨影像学分型与急性脑梗死患者认知功能关系。方法对136例急性大脑梗死患者于发病后24～72h内行颅脑MRI检查确定梗死部位、测量病灶大小并作出影像学分型，于发病1周内，在患者床前采用简易精神状态检查法（mini—mentalstate examination，MMSE），检测患者的认知功能，并同步进行事件相关电位P300的检测，判断患者认知功能的情况，对比分析应用MRI进行的影像学分型与认知功能关系。结果额叶、颞叶脑梗死患者的MMSE和WAIS—RC评分明显低于顶枕叶和基底节区梗死患者，P300潜伏时明显长于顶枕叶和基底节区梗死的患者，但其P300波幅低于顶枕叶和基底节区梗死的惠者；中梗死和多发性梗死患者的MMSE和WAIS—RC评分明显低于顶枕叶和基底节区梗死患者，B300潜伏时明显长于顶枕叶和基底节区梗死的患者，但其P300波幅低于顶枕叶和基底节区梗死的患者。结论影像学分型与急性脑梗死患者认知功能有相关性。     

手部爆炸伤的临床分型与治疗

目的探讨手部爆炸伤新的临床分型以指导治疗、提高疗效。方法1997～2004年收治106例手部爆炸伤,按爆炸伤的严重程度和伤情特点将其划分四型：Ⅰ型：仅有皮肤灼伤、挫裂伤或手部的小面积皮肤缺损,治疗选用清创缝合或植皮修复;Ⅱ型：手部皮肤软组织缺损合并肌腱或骨关节损伤,但无手指血运障碍,治疗选用骨与关节复位固定、肌腱修复的同时必须采用皮瓣覆盖;Ⅲ型：手部广泛皮肤软组织缺损,伴有肌腱、血管、神经及骨关节损伤,手指缺血、离断或缺失,治疗必须应用显微外科技术实施血管吻合、断指再植或拇手指再造和皮瓣移植;Ⅳ型：手广泛毁损,治疗选择截肢术。结果本组Ⅰ型12例,手功能恢复正常;Ⅱ型31例,手功能恢复较好,14例遗留皮瓣臃肿或肌腱粘连,需二期治疗。Ⅲ型57例,无1例截肢,45例进行了二期功能重建手术,手功能恢复达正常的30%～80%不等;Ⅳ型6例,手功能完全丧失。结论该分型方法简明具体,便于临床判断受伤类型和选择治疗方法,并可估计愈合,对临床处理手部爆炸伤具有较好的指导意义。     

核苷类衍生物的合成

以尿嘧啶核苷和HIV-逆转录酶抑制剂扎西他宾为先导化合物,对其5-羟基进行磷酸化修饰,然后以磷原子为桥,引入各种氨基酸酯及取代苯环,从而试图克服这类药物对核苷激酶的依赖性,提高药物的生物活性,降低药物对细胞的毒性,以此为设计思路合成了7个新的核苷类衍生物,其结构经IR,1HNMR,13CNMR,MS分析确定.     

Migraine is associated with enhanced arterial stiffness.

Migraine is a common subtype of headache. Epidemiological studies have revealed that migraine could be an independent risk factor for ischemic stroke even in elderly subjects. Arterial stiffness is one of the major pathophysiological bases of stroke. In the present study, we cross-sectionally investigated the possible relationship between migraine and arterial stiffness in community-dwelling subjects. The study subjects were independently recruited from two sources (Group A, n=134, 68+/-5 years; Group B, n=138, 68+/-7 years). Augmentation index (AI), the ratio of augmented pressure by the reflection pressure wave to the pulse pressure, was obtained from the radial arterial waveform as an index of arterial stiffness. Brachial blood pressure was also measured simultaneously. Migraine was diagnosed using a previously validated questionnaire. The prevalence of migraine was 5.2% (Group A) and 16.7% (Group B). Subjects with migraine had higher radial AI in both Group A (migraine, 101+/-15%; other headache, 88+/-12%; no headache, 86+/-12%, p=0.003) and Group B (95+/-11%, 90+/-11%, 91+/-14%, p=0.058). Multiple linear regression analysis revealed that migraine was an independent determinant of AI (beta=0.154, p=0.002) after adjustment for other confounding factors: age (beta=-0.024, p=0.654); sex (beta=0.141, p=0.069); body height (beta=-0.215, p=0.005); systolic blood pressure (beta=0.174, p=0.001); medication for hypertension, hyperlipidemia, and diabetes mellitus (beta=-0.014, p=0.787); and heart rate (beta=-0.539, p<0.001). In a separate analysis by sex, migraine was also a significant determinant for AI (male, beta=0.246, p=0.019; female, beta=0.159, p=0.008). Migraine in the elderly could be a clinical manifestation of enhanced arterial stiffness.     

Temperature dependence of spurious pulses in use of plastic scintillation detectors.

Pulse-height and time spectra of afterpulses from a scintillation detector with NE102A scintillator sandwiching a 60Co source were observed at several different temperatures. From time analysis with a slow amplifier followed by a conventional TAC, spurious pulses are grouped into two types; time-dependent afterpulses and random noise. The intensity of afterpulses decreased considerably with increasing temperature, while the intensity of random noise pulses increased abruptly above 50 degrees C. Experiments, in which the temperatures of scintillator sheets and of the photomultiplier tube were changed separately, suggested that the time-dependent afterpulses were produced in the scintillator itself, while the random component arose from photomultiplier tube.     

Localized wall thickening of the gallbladder mimicking a neoplasm

Clinical diagnosis of chronic cholecystitis is made based on diffuse hyperechoic thickening of the gallbladder wall as shown by ultrasonographic examination. We herein report three cases of chronic cholecystitis showing localized hypoechoic thickening of the gallbladder wall that mimicked gallbladder cancer by ultrasonography. Histologically, hypertrophy of the muscularis propria was a common characteristic finding in these three patients. A smooth surface of the inner hypoechoic layer of the thickened wall was considered to be a reliable finding in the differential diagnosis between this type of chronic cholecystitis and gallbladder cancer.     

Monitoring the protective effects of minocycline treatment with radiolabeled annexin V in an experimental model of focal cerebral ischemia.

Minocycline is an antibiotic now recognized to have antiapoptotic and antiinflammatory properties. Because of these properties, minocycline may be of benefit in reducing neuronal apoptosis from ischemia and subsequent postischemic inflammation if administered soon after a stroke. We now explore the feasibility of using (99m)Tc-annexin V, an in vivo marker of apoptosis, with SPECT to monitor the antiapoptotic effects of minocycline therapy. METHODS: CB6/F1 adult male mice underwent unilateral distal middle cerebral artery occlusion (dMCA) occlusion and were imaged and sacrificed at 1, 3, 7, or 30 d after injury. Animals were given minocycline (or vehicle) 30 min and 12 h after dMCA occlusion and then given 22.5 mg/kg twice daily for up to 7 d. Before imaging, behavioral tests were performed to evaluate the neurologic function. After imaging, brains were collected for histology and assessed for the degree of apoptosis and microglial activation. RESULTS: (99m)Tc-Annexin V uptake in injured hemispheres was significantly decreased 2- to 3-fold by minocycline at all time points. Minocyline reduced infarct size as seen histologically and improved behavioral indices as late as 30 d. Infarct volume as seen histologically correlated with radiolabeled annexin V uptake seen by SPECT. In situ fluorescent microscopy demonstrated that annexin V bound primarily to neurons at 1 and 3 d, with a shift toward microglia by 7 and 30 d. CONCLUSION: We found that minocycline significantly reduces neuronal apoptosis and infarct size and improves neurologic outcome in mice after acute focal cortical ischemia.     

Hepatic pseudotumor in long-standing biliary atresia patients undergoing liver transplantation.

A pseudotumor, giant regenerative nodule, or macroregenerative nodule is an unusual benign hepatic lesion in biliary atresia (BA) patients. This tumor may mimic malignant transformation and may preclude liver transplantation (LT). The clinical and imaging surveillance of patients after the Kasai procedure is therefore an important aspect of management of BA patients. Our objective is to report our experience and describe the incidence, imaging, and pathologic features of pseudotumors in BA patients awaiting LT. From August 1990 to December 2006, 133 LTs for BA were performed. Five (3.8%; 4 female, 1 male) patients were diagnosed with pseudotumor. The patients' records were reviewed. The diagnostic imaging modalities used were abdominal ultrasound (US), computed tomography (CT) scan, and magnetic resonance imaging (MRI). Histologic confirmation of the lesions was obtained in all cases. All underwent the Kasai operation in early infancy. Six of 7 lesions in 4 of 5 patients were demonstrated by pretransplant imaging. Two of 7 tumors were detected by US. Five of 7 lesions were detected by CT, and 5 of 7 lesions were demonstrated by MRI. In 1 patient, the lesion was not seen in the US, CT, or MRI but was found during surgery and confirmed by histology. An additional tumor was found incidentally during histologic examination in a patient previously diagnosed to have 2 tumors by CT and MRI. In another patient diagnosed to have 2 tumors on imaging, pathology revealed only a single tumor. In conclusion, although unusual, pseudotumor should be included in the differential diagnosis of liver masses in BA children.