“3S2E”护理管理及服务模式在脑卒中吞咽功能障碍患者中的应用

目的探讨"3S2E"护理管理模式在脑卒中吞咽功能障碍患者中的应用效果。方法选择2017年1—12月江苏省徐州市中心医院康复科收治的脑卒中伴吞咽功能障碍患者93例,将2017年1—6月的患者设为对照组(n=42),2017年7—12月的患者设为观察组(n=51),对照组患者住院期间、出院时给予常规护理措施及出院指导;观察组患者在对照组基础上实施"3S2E"护理管理模式,主要包括提高护理人员的业务技能、强化护理人员的服务意识、保障护理安全、对患者进行吞咽功能评估及健康教育。结果治疗4周后,观察组患者的吞咽功能障碍风险程度、吞咽功能障碍评分低于于对照组(P均0.05),观察组患者的误吸人次数和吸入性肺炎人次数均少于对照组(P均0.05),观察组患者血红蛋白、血清白蛋白水平高于对照组(P均0.05),且两组患者在护理满意度等级分布上存在统计学差异(P0.05)。结论 "3S2E"护理管理模式的实施,不仅改善了脑卒中吞咽障碍患者的吞咽功能,降低了患者不良事件的发生率,也提升了患者的护理满意度,保障了护理安全。     

Significance of arginase determination in body fluids of patients with hepatocellular carcinoma and liver cirrhosis before and after surgical treatment

Objective

To assess the utility of arginase activity and expression in diagnosis of liver diseases.

Design and methods

Arginase activity, sensitivity and specificity were determined in serum of 140 patients including 50 with HCC, 60 with LC, 30 with choledocholithiasis (CDL) and 90 healthy controls. In HCC and LC arginase activity in serum was studied before and after tumor resection or liver transplantation. Arginase sensitivity in HCC was compared to that of alpha-fetoprotein (AFP) and aminotransferases (AST, ALT). In LC the activity was determined also in bile before and after transplantation. The expression of arginase isoenzymes in serum was studied by Western blotting.

Results

In HCC and LC the preoperative arginase activity was significantly higher compared to controls, and it decreased after surgery. The sensitivity of arginase in HCC was much higher than that of AFP, AST and ALT (96, 40, 20 and 18%, respectively). In HCC it was higher than in LC (93%) and CDL (33%). The specificity of arginase was above 80%. In bile of cirrhotic patients the highest activity was immediately after liver transplantation. It decreased with time but increased dramatically at the time of the graft rejection. Arginase AII was present in serum of HCC and LC but not the control cases.

Conclusions

The increase of arginase activity in serum accompanied by the presence of isoenzyme AII can be useful in HCC and LC diagnosis. The determination of arginase activity in bile may be helpful in monitoring liver graft recipients.     

Fatigue failure load of immature anterior teeth: influence of different fiber post-core systems

Odontology - The aim was to explore the fracture-behavior, survival and marginal-microgaps within the root-canal of immature anterior teeth restored with different fiber-reinforced post-core...     

Spontaneous remission in adult acute myeloid leukemia in association with systemic bacterial infection—case report and review of the literature

Spontaneous remission of acute myeloid leukemia in the adult is a rare event. We report on a 31-year-old male patient suffering from acute myeloid leukemia (AML) M5a according to the French-American-British (FAB) classification with biphenotypic features in flow cytometric examination and severe bacterial infection with group G streptococci at the time of diagnosis. Because of sepsis and stable clinical conditions, chemotherapy was delayed and antibiotics were administered intravenously. Within 6 weeks a spontaneous remission of AML occurred. Remission lasted for about 2 months. At the time of relapse, a change in phenotype of the leukemic blasts with a loss of B-lymphoid markers could be demonstrated by flow cytometry. The patient was treated with an induction therapy according to the multicentric German AMLCG 2000 schedule. To our knowledge, this is the first report of a spontaneous remission in an AML FAB M5a associated with coexpression of myeloid- and lymphoid-associated antigens on the leukemic blasts. Possible mechanisms of this phenomenon are discussed with a review of the literature.     

Long-term doxycycline-controlled expression of human tyrosine hydroxylase after direct adenovirus-mediated gene transfer to a rat model of Parkinson’s disease

Developments of technologies for delivery of foreign genes to the central nervous system are opening the field to promising treatments for human neurodegenerative diseases. Gene delivery vectors need to fulfill several criteria of efficacy and safety before being applied to humans. The ability to drive expression of a therapeutic gene in an adequate number of cells, to maintain long-term expression, and to allow exogenous control over the transgene product are essential requirements for clinical application. We describe the use of an adenovirus vector encoding human tyrosine hydroxylase (TH) 1 under the negative control of the tetracycline-sensitive gene regulatory system for direct injection into the dopamine-depleted striatum of a rat model of Parkinson's disease. This vector mediated synthesis of TH in numerous striatal cells and transgene expression was observed in a large proportion of them for at least 17 weeks. Furthermore, doxycyline, a tetracycline analog, allowed efficient and reversible control of transgene expression. Thus, the insertion of a tetracycline-sensitive regulatory cassette into a single adenovirus vector provides a promising system for the development of successful and safe therapies for human neurological diseases. Our results also confirm that future effective gene replacement approaches to Parkinson's disease will have to consider the concomitant transfer of TH and GTP-cyclohydrolase transgenes because the synthesis of the TH cofactor tetrahydrobiopterin may be crucial for restoration of the dopaminergic deficit.     

Establishing an ad hoc COVID-19 mortality surveillance during the first epidemic wave in Belgium, 1 March to 21 June 2020

BackgroundCOVID-19-related mortality in Belgium has drawn attention for two reasons: its high level, and a good completeness in reporting of deaths. An ad hoc surveillance was established to register COVID-19 death numbers in hospitals, long-term care facilities (LTCF) and the community. Belgium adopted broad inclusion criteria for the COVID-19 death notifications, also including possible cases, resulting in a robust correlation between COVID-19 and all-cause mortality.AimTo document and assess the COVID-19 mortality surveillance in Belgium.MethodsWe described the content and data flows of the registration and we assessed the situation as of 21 June 2020, 103 days after the first death attributable to COVID-19 in Belgium. We calculated the participation rate, the notification delay, the percentage of error detected, and the results of additional investigations.ResultsThe participation rate was 100% for hospitals and 83% for nursing homes. Of all deaths, 85% were recorded within 2 calendar days: 11% within the same day, 41% after 1 day and 33% after 2 days, with a quicker notification in hospitals than in LTCF. Corrections of detected errors reduced the death toll by 5%.ConclusionBelgium implemented a rather complete surveillance of COVID-19 mortality, on account of a rapid investment of the hospitals and LTCF. LTCF could build on past experience of previous surveys and surveillance activities. The adoption of an extended definition of ‘COVID-19-related deaths’ in a context of limited testing capacity has provided timely information about the severity of the epidemic.     

Safety and outcome using endoscopic dilatation for benign esophageal stricture without fluoroscopy

AIM:To investigate the use of Savary-Gilliard marked dilators in tight esophageal strictures without fluoros-copy. METHODS:Seventy-two patients with signif icant dysphagia from benign strictures due to a variety of causes were dilated endoscopically. Patients with achalasia, malignant lesions or external compression were excluded. The procedure consisted of two parts. First, a guide wire was placed through video endoscopy and then dilatation was performed without fluoroscopy. In general, "the rule of three" was followed. Effective treatment was defi ned as the ability of patients, with or without repeated dilatations, to maintain a solid or semisolid diet for more than12mo. RESULTS: Six hundred and sixty two dilatations in a total of72patients were carried out. The success rate for placement of a guide wire was100%and for dilatation97%,without use of fluoroscopy, after6mo to4years of follow-up.The number of sessions per patient was between1and7,with an average of2sessions.The ability of patients, after 1 or more sessions of dilatation, to maintain a solid or semisolid diet for more than 12mo was obtained in70patients(95.8%).For very tight esophageal strictures, all patients improved clinically without complications after the endoscopic procedure without fluoroscopy, but we noted3failures. CONCLUSION:Dilatation using Savary-Gilliard dilators without fluoroscopy is safe and effective in the treatment of very tight esophageal strictures if performed with care.     

Circulating ghrelin levels in obese women: a possible association with hypertension

Objective. The orexigenic hormone ghrelin induces weight gain by stimulating food intake. Ghrelin has been shown to modulate sympathetic activity, to exert vasodilative effects and to counterreact with leptin on both food intake and blood pressure. Of these two hormones, ghrelin levels are decreased in obesity, whereas leptin levels are increased. In this cross‐sectional study, differences in serum ghrelin and leptin levels were examined in normotensive and hypertensive obese women. Material and methods. Sixty‐one normotensive and hypertensive women were classified according to the body mass indices as follows: (a) 18 healthy subjects with BMI 21.5–27.5?kg/m²; (b) 22 normotensive subjects with BMI 30–47?kg/m²; (c) 21 hypertensive obese subjects (BMI 30–48?kg/m²) with systolic blood pressure ?140?mmHg or diastolic blood pressure ?90?mmHg. Anthropometric measurements including height, weight, BMI, waist and hip circumferences and blood pressure were recorded. The levels of ghrelin and leptin were determined in sera using the commercial ELISA kits. Results. In normotensive obese subjects, ghrelin levels were significantly lower than in controls (0.21±0.13 vs 0.60±0.3?ng/mL), whereas hypertensive obese women had elevated ghrelin levels (0.64±0.36?ng/mL). Ghrelin concentration was decreased despite the presence of hypertension in the patients who had BMIs above 35?kg/m². Leptin levels were significantly higher in both normotensive and hypertensive obese groups (19.54±11.19 and 21.61±12.7?ng/mL, respectively) than in controls (7.61±3.3?ng/mL), and were not affected by the presence of hypertension in obese subjects. Conclusion. Ghrelin was positively associated with hypertension in obese women and this association was inversely influenced by the increase of BMI.     

Multivessel Coronary Thrombosis in a Patient with Idiopathic Thrombocytopenic Purpura

A 49-year-old woman who had idiopathic thrombocytopenic purpura was admitted to our hospital with severe chest pain. Electrocardiography revealed inferolateral myocardial infarction. The patient underwent immediate coronary angiography, which revealed thrombi in the left coronary system. Percutaneous intervention was not indicated, because the thrombi had occluded the distal segments of multiple coronary arteries. Administration of tirofiban satisfactorily dissolved the thrombi.Key words: Coronary thrombosis, multivessel; myocardial infarction; platelet aggregation inhibitors/therapeutic use; purpura, thrombocytopenic, idiopathic/therapy; tirofibanIdiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which autoantibodies bind platelets, leading to their sequestration by the reticuloendothelial system.¹ Patients with ITP typically have mucocutaneous bleeding. Although such reports are rare, thrombotic complications such as acute myocardial infarction (MI) and stroke also occur in patients with ITP.^2–4 We present the case of a middle-aged woman with ITP who sustained an acute MI caused by multivessel coronary thrombosis.     

左心声学造影诊断二尖瓣血囊肿一例

病例：患者男性,32岁,发现心脏杂音17年,间断胸痛气短1年。患者于17年前体检发现心脏杂音,未重视;1年前患者劳累后出现胸痛气短不适,伴恶心,胸痛呈绞痛样,持续约15分钟,休息后好转,后频繁发作晕厥不适,1年内发作3次,近来患者频发夜间阵发性呼吸困难。入院查体：体温：36.6℃,脉搏：60次/分,呼吸：18次/分,血压：110/67mmHg。心界向左下扩大,心尖部可闻及 3/6级收缩期吹风样杂音。