Remodeling Adult Nursing

This article describes a nursing education experience in which a critical thinking approach was planned and implemented. Background discussion on critical thinking concepts and related research provides a foundation for presentation of the Mackie teaching model. The model uses a community-based, family-centered scenario as the basis for developing problemfocused nursing intervention skills from a holistic viewpoint. Role expectations of students and faculty are outlined, and related implementation difficulties, together with their resolution strategies, are described. Evaluation methods and outcomes are reviewed in the conclusion.     

Comparison of the use of nalbuphine and fentanyl during third molar surgery

In a double-blind, randomized plan of drug administration, nalbuphine, fentanyl, and a placebo were compared for efficacy in sedation and analgesia during third molar removal. Fifty-eight patients participated in this study. Using accepted intravenous sedation and surgical techniques, fentanyl and nalbuphine were found to be better than placebo for anxiety and pain control in third molar surgery. Fentanyl had a longer duration of pain relief postoperatively than did nalbuphine. The study confirmed the need for a narcotic supplement to sedation techniques for third molar surgery.     

Intraoperative cytologic evaluation of lipid in the diagnosis of parathyroid adenoma

Analysis of intraoperative air-dried imprints or smears of 20 cases of parathyroid adenoma revealed that the cells of the parathyroid adenomas did not contain extra- or intracellular lipid, but the cytologic material from accompanying normal or atrophic parathyroid glands had large amounts of intracellular lipid and variable amounts of extracellular lipid. Thus, rapid intraoperative cytologic preparation is not only effective in determining whether the specimen is parathyroid or not, but also in specifying the nature of the individual parathyroid glands. These observations again confirm that intraoperative cytologic evaluation of parathyroid tissue is an effective and important pathologic consultation method during parathyroid exploration.     

An evaluation of the effectiveness of four mechanical plaque-removal devices when used by a trained care-provider

Many care-dependent elderly individuals live in nursing homes and must depend on nursing home aides for oral hygiene care. It is generally agreed that the level of oral hygiene care among care-dependent nursing home residents is less than optimal. Two reasons are time constraints and the difficulty involved in brushing other individuals' teeth. The identification of effective and efficient plaque-removal devices for use by care-providers should make it easier for nursing home aides to incorporate effective oral hygiene care into their daily routines. This pilot study was undertaken to determine the relative effectiveness of four plaque removal devices with different basic designs when used by a non-professional careprovider on 10 healthy volunteers. A brush with curved bristles on the lateral aspect of the brush head and short straight bristles in the center (Collis-curve) and an electric toothbrush with tuffs that rotate reciprocally (Interplak) were the most effective, a conventional brush (Oral-B) was somewhat less effective, and a disposable foam brush (Abco) was least effective and similar to the prebrushing plaque score (baseline). All the volunteers reported that the Collis-curve as the most comfortable brush, and the care-provider reported that it was the easiest to use.     

大鼠移植心脏组织中血小板衍生生长因子A mRNA表达及雷帕霉素的干预效应

目的:血小板衍生生长因子在平滑肌细胞的表型转化过程中起重要作用。观察大鼠移植心脏组织中血小板衍生生长因子AmRNA表达的变化及雷帕霉素的干预效应。方法:实验于2005-10/2006-01在中南大学湘雅二医院胸心外科实验室完成。将60只SD大鼠、24只Wistar大鼠按随机数字表法分为3组:①同系移植组:供、受体各12只,均为SD大鼠。②异系移植组:供体为Wistar大鼠(n=24),受体为SD大鼠(n=24),受体大鼠随机分为雷帕霉素组(n=12)和环孢霉素组(n=12),术后分别给予雷帕霉素1.25mg/(kg·d)灌胃及环孢霉素A10mg/(kg·d)皮下注射,给药60d,给药结束后留取移植心脏待检。③另12只SD大鼠直接取心脏组织作为正常对照组。指标检测:①对移植心脏组织行VanGieson染色后采用Miassystem4.1医学图像分析管理系统分析血管狭窄程度。②应用反转录-聚合酶链反应检测血小板衍生生长因子AmRNA在移植心脏组织中的表达情况。结果:36只受体SD大鼠及12只正常SD大鼠全部进入结果分析,无脱失。①同系移植组、环孢霉素组及雷帕霉素组大鼠的冠状动脉狭窄指数均显著高于正常对照组[(13.12±0.72)%,(62.45±8.12)%,(28.91±3.24)%,(0.09±0.02)%(P<0.01)],环孢霉素组及雷帕霉素组高于同系移植组(P<0.05),环孢霉素组高于雷帕霉素组(P<0.01)。②正常对照组、同系移植组、环孢霉素组及雷帕霉素组大鼠的血小板衍生生长因子AmRNA相对含量分别为0.19±0.06,0.21±0.08,1.12±0.22及0.47±0.11,环孢霉素组、雷帕霉素组显著高于同系移植组(P<0.01),环孢霉素组高于雷帕霉素组(P<0.05)。结论:血小板衍生生长因子AmRNA的高表达与移植心脏的血管硬化有关;雷帕霉素具有预防大鼠心脏移植物血管病变的作用,其作用可能与抑制心脏组织中血小板衍生生长因子AmRNA的表达有关。     

Liposomal 1,25 (OH)2 vitamin D3 compounds block proliferation and induce differentiation in myelomonocytic leukaemia cells

The vitamin D₃ derived hormone 1,25 (OH)₂ vitamin D₃ (1,25 D₃) is able to induce growth arrest and differentiation in myelomonocytic leukaemia cells. In order to allow for specific delivery to leukaemic cells the lipophilic compound was incorporated into the lipid membranes of liposomes. Liposomal 1,25 D₃ reduced proliferation as measured by ³H-thymidine incorporation in HL60 leukaemia cells by up to 60%. When liposomes were prepared at different concentrations of 1,25 D₃ 65% inhibition was achieved at 48 n M . The MC 1288 stereoisomer of 1,25 D₃ was more potent and had the same activity at 48 n M .
The effect of the liposomal compounds was specific to myeloid cells as they reduced proliferation in myelomonocytic HL60, monoblastic U937 and monocytic Mono Mac 6 cells but not in the T-cell lines Jurkat and Molt 4.
The antiproliferative effect of liposomal 1,25 D₃ was associated with an induction of differentiation since treated HL60 cells showed a monocytic morphology, increased expression of CD14 and decreased expression of CD33.
When peripheral blood leukaemic cells from M4 and M5 acute myeloid leukaemia (AML) patients were admixed with liposomal compounds an antiproliferative effect was seen in all five cases, including the two cases where free compounds led to enhanced growth. Liposomal delivery of 1,25 (OH)₂ vitamin D₃ may offer a novel approach to treatment of myelomonocytic leukaemia.     

Dissociation Between Changes in Intramyocardial Function and Left Ventricular Volumes in the Eight Weeks After First Anterior Myocardial Infarction

Objectives. We sought to examine the relation between regional changes in intramyocardial function and global left ventricular (LV) remodeling in the first 8 weeks after reperfused first anterior myocardial infarction (MI).

Background. Because of limitations in imaging methods used to date, this relation has not been thoroughly evaluated.

Methods. We studied 26 patients (21 men, 5 women; mean age 51 years) by magnetic resonance imaging (MRI) on day 5 ± 2 (mean ± SD) and week 8 ± 1 after their first anterior MI. All patients had single-vessel left anterior descending coronary artery disease and although they had received reperfusion therapy, all had regional LV dysfunction and an initial ejection fraction (EF) ≤50%. Short-axis magnetic resonance tagging was performed spanning the LV. Percent intramyocardial circumferential shortening (%S) on a topographic basis, LV mass index, LV end-diastolic volume index (LVEDVI), LV end-systolic volume index and LV ejection fraction (LVEF) were measured.

Results. Left ventricular mass index tended to decrease, whereas the LVEDVI increased from 82 ± 24 to 96 ± 27 ml/m² (p = 0.002). Left ventricular end-systolic volume index remained unchanged, whereas LVEF increased from 39 ± 12% to 45 ± 14% (p = 0.002). Apical %S improved from 9 ± 6% to 13 ± 5% (p < 0.0001), as it did in the midanterior (6 ± 6% to 10 ± 7%, p < 0.02) and midseptal regions (8 ± 7% to 12 ± 6%, p < 0.02). Early dysfunction in remote midinferior and basal lateral regions resolved by 8 weeks. By multivariate analysis, the only significant predictor of an increase in LVEDVI over the study period was peak creatine kinase (p = 0.04).

Conclusions. In the first 8 weeks after a large, reperfused anterior MI, %S improved in the apex, midanterior and midseptal regions and normalized in remote noninfarct-related regions, but LV end-diastolic volumes also increased. This increased LVEDVI correlated with infarct size by peak creatine kinase and was not related to changes in global and regional LV function.