护理工作中引入护理哲理

介绍了哲理、护理哲理及重要性,提出在护理教育和临床护理工作中引入护理哲理可促进护理人员护理价值观与信念的形成。     

关于吸入性肺炎的治疗研究现状

吸入性肺炎 (aspiration pneumonitis,AP)是一个古老而又有新进展的课题 ,这里所讨论的 AP是指胃酸吸入性肺炎 ,又称 Mendelson综合征。反流性胃内容物 (主要是无菌性胃酸 )吸入肺内 ,引起的急性化学性肺损伤 ,常发生在禁食后全麻且意识不清时 ,或意识障碍患者。根据吸入物的性质、吸入量、吸入频率以及机体对吸入物的反应不同 ,可能诱发不同的肺部并发症。肺吸入常引起 4种情况 :轻微肺损伤 ,亚临床肺炎 ,严重肺炎 ,进行性急性呼吸窘迫综合征 (ARDS)。后两者常伴低氧血症 ,病死率高达 3 0 % ,是造成手术后肺损伤因素之一。 1 946年 Men…     

Mid-term outcomes of surgical management of complex,isolated radial head fractures: a multicentre collaboration

European Journal of Orthopaedic Surgery & Traumatology - The available literature discussing optimal surgical management of Mason II and III radial head (RH) fractures without concomitant bone...     

心血管手术相关急性肾损伤患者行连续性肾脏替代治疗后的预后因素分析

目的探讨心血管手术相关急性肾损伤患者行连续性肾脏替代治疗后不同预后的相关因素。 方法本研究纳入2015年1月至2018年12月在南京医科大学第一附属医院住院行心血管手术治疗且接受连续性肾脏替代治疗的患者,按90 d是否死亡和90 d内RRT治疗天数(≤14 d,15～90 d,>90 d)将患者分为4组,分析90 d死亡、90 d透析依赖、90 d延迟摆脱透析的相关影响因素。 结果本研究共纳入210例患者,平均随访400 d。其中90 d死亡114例,90 d生存且14 d内摆脱透析37例,90 d生存15～90 d内摆脱透析46例,90 d生存且透析依赖13例。多因素Cox回归显示：90 d死亡的独立危险因素包括高龄(HR＝1.029,95%CI: 1.013～1.045,P<0.001)、术前血清肌酐低(HR＝0.993,95%CI: 0.987～0.998,P＝0.008)、CRRT前APACHE Ⅱ高评分(HR＝1.043, 95%CI: 1.004～1.084,P＝0.028)、CRRT前SOFA评分高(HR＝1.130, 95%CI: 1.052～1.213,P<0.001)、CRRT前脓毒症(HR＝2.327, 95%CI: 1.591～3.403,P<0.001)、CRRT前过低的舒张压(HR＝0.979,95%CI: 0.963～0.996,P＝0.013)。90 d存活患者透析依赖的独立危险因素包括术前较低的eGFR(HR＝0.962,95%CI: 0.940～0.984,P<0.001)。90 d存活患者中延迟摆脱透析的危险因素有血清白蛋白低(OR＝0.837,95%CI: 0.717～0.977,P＝0.024)、机械通气时间长(OR＝1.434,95%CI: 1.175～1.749,P<0.001)、CRRT前尿量少(OR＝0.739,95%CI: 0.623～0.876,P<0.001)。 结论心血管手术相关急性肾损伤并行连续性肾脏替代治疗患者中,90 d死亡与高龄、CRRT前疾病的严重程度、脓毒症和过低的舒张压有关;90 d存活患者透析依赖与患者术前较差的肾功能有关;90 d存活患者延迟摆脱透析与血清白蛋白低、机械通气时间长、CRRT前尿量少有关。     

Phylogeny,pathogenicity and transmissibility of a genotype XII Newcastle disease virus in chicken and goose

Although Newcastle disease virus (NDV) has a worldwide distribution, some NDV genotypes have more regional geographical ranges within continents. In this study, we isolated a subgenotype XIIb NDV strain, Goose/CH/GD/E115/2017 (E115), from geese in Guangdong province, Southern China, in 2017. Phylogenetic analysis showed that E115 and six other NDVs from geese in China were grouped under subgenotype XIIb and were distinct from subgenotype XIIa, isolated from chickens in South Africa, and subgenotype XIId, isolated from chickens in Vietnam. To better understand the pathogenicity and transmission of the subgenotype XIIb NDVs from geese in Guangdong province, we inoculated chickens and geese with 10⁶ EID₅₀ of the E115 virus. Eight hours after inoculation, three naïve chickens and three naïve geese were co‐housed with the infected chickens or geese to assess intraspecific and interspecific horizontal transmission of the E115 virus. The E115 virus induced significant clinical signs without mortality in chickens, while it was not pathogenic to geese. Intraspecific and interspecific horizontal transmission of the E115 virus was observed among chickens and geese via direct contact. Furthermore, although the current vaccines provided complete protection against disease in chickens after challenging them with the E115 virus, the virus could also be transmitted from vaccinated chickens to naïve contact chickens. Collectively, our findings highlight the need for avoiding the mixing of different bird species to reduce cross‐species transmission and for surveillance of NDV in waterfowl.