改良尺骨鹰嘴截骨治疗肱骨髁间骨折

目的:探讨改良尺骨鹰嘴截骨治疗肱骨髁间骨折的手术方法和疗效。方法:2007年5月至2012年12月采取改良尺骨鹰嘴截骨入路治疗肱骨髁间骨折32例,男21例,女11例;年龄18~65岁,平均46.3岁;右侧19例,左侧13例。AO分型,C1型7例,C2型11例,C3型14例;开放性骨折5例(GustiloⅠ型3例,GustiloⅡ型2例)。6例合并其他处骨折,4例合并尺神经损伤,2例合并桡神经损伤。术后定期复查及X线检查,按Cassebaum评分系统评定肘关节功能。结果:32例均获随访,时间9个月~5年,平均1.9年;截骨块愈合时间6~10周,平均7.4周。未发生尺骨鹰嘴关节内骨折,无截骨块不愈合。2例肘后内固定隆起处屈肘轻度疼痛不适,1例骨折块松动,2例出现异位骨化。肘关节功能评定:优19例,良8例,可4例,差1例。结论:改良尺骨鹰嘴截骨治疗肱骨髁间骨折具有不侵袭关节、术中截骨简便、固定简单、截骨块力学稳定性好、截骨并发症发生率低等优点。     

Immunological effect of aqueous extract of Vernonia amygdalina and a known immune booster called immunace® and their admixtures on HIV/AIDS clients: a comparative study

Objective

To investigate the immunological effect of Vernonia amygdalina (V. amygdalina) leaf extract and immunace^® on HIV infected patients taking highly active antiretroviral therapy.

Methods

Fresh V. amygdalina leaves were collected within Nsukka area in Enugu State. The leaves were rinsed with distilled water. Two handful of cleaned fresh leaves were soaked in 200 mL water and squeezed gently by hand to a mixture. Clients were divided into four groups and each group was given different combination. They took the medication for four weeks. The immune effect was tested against marketed immune booster in some retroviral clients.

Results

The mean absolute CD4 count was increased in the client who took the extract or supplement. And the clients who took both the extract and supplement had a greater increase in the CD4 count. The increased CD4 was significant as compared with the control group (P<0.05). The skin rashes were also improved in the entire groups.

Conclusions

It can be concluded that the aqueous extract of V. amygdalina and immunace or both have immunological effect on HIV infected patients. Therefore, we suggest that the V. amygdalina extract or immunace or both could be used as adjuvant in the management of HIV/AIDS clients.     

Rights and responsibilities in research supervision

Doctoral education in nursing and midwifery is expanding, placing higher demands on research supervision (RS). In this study, rights and responsibilities are examined, as well as academic supervisors' and postgraduate students' perceptions of important aspects of the RS process. A qualitative approach comprising 15 interviews and interpretative content analysis was employed. An overarching theme emerged: “the nature of the research supervisory relationship”, describing the creation of a caring, constructive, supportive, and empowering relationship. In addition, two categories were identified: “taking responsibility for engaging in transformational learning, creating a research culture, and contributing to knowledge development” and “taking responsibility for safeguarding rights, as well as for enhancing awareness of research ethics and codes of practice”. The findings suggest that a dynamic trusting supervisory relationship is a prerequisite for excellence in the RS process. In conclusion, this study provides evidence of the need for conceptualization of the RS process, and that it can be facilitated by a better understanding of how various ethical issues impact on research development.     

Systematic review of the emotional state and self‐management of widows

The death of a partner in later life is generally experienced as the most stressful normative life event. This study reviewed evidence about the emotional state of widows. Both qualitative and quantitative studies were included in the review. A systematic search was made of the OVID Medline, PubMed, ProQuest, and EBSCOhost/Academic Search Premier databases using the following search words: “depression”, “elderly”/“older”, “emotional state”, “mood”, “self‐management”, “widows”, and “women” for the period January 2000 to December 2010. Thirteen articles met the inclusion criteria, and a qualitative content analysis was used to review them. The findings revealed one main theme: “A struggle to perceive meaning in the meaningless”, which was based on three themes: “Numbing the pain and struggling to control feelings”, “Feeling sad, yet trying to maintain close emotional relationships and meaningful activities”, and “The process of change and self‐management dominated by resilience”. The widows seemed overwhelmed by the need to overcome an unbearable emotional state. The resilience process was experienced as a struggle, and they required time to improve their well‐being and self‐management. To achieve self‐management, nurses should strengthen widows' optimism, control, well‐being, and the pathways that lead to recovery.     

Nurses' views on situations related to privacy in providing home care for persons with long-term mental illness: an exploratory study

The main aim of this exploratory study was to explore the views of nurses and mental health care workers on situations related to patient privacy in the home care of persons with long-term mental illness in Sweden. A specifically designed questionnaire was developed from theoretical constructs obtained in a qualitative study and distributed to 1,139 respondents. Data from 660 district nurses, psychiatric nurses, and mental health care workers revealed significant differences in perceptions by age, gender, and professional groups. For example, psychiatric nurses and mental health care workers indicated to a greater extent than district nurses feelings that relate to intrusion on patient privacy. Respondents who were 41 years or younger also indicated to a greater extent than those who were older that they felt home care was an intrusion on patient privacy. Moreover, men indicated to a greater extent than women feelings of insecurity in their professional role. Further investigation is needed, especially into how nurses deal with situations that intrude on patient privacy and how nursing intervention impacts on the patients' own sense of privacy.     

1，25-二羟维生素D3对糖尿病大鼠肺脏的保护作用及机制

目的观察1,25-二羟维生素D3[1,25-（OH）：D,]对糖尿病大鼠炎性水平及肺组织Toll样受体4（TLR4）表达的影响,探讨其肺保护作用及机制。方法将90只SD大鼠随机分为对照组（C组）10只及模型组80只,模型组经尾静脉注射STZ制备糖尿病模型,C组注射等体积柠檬酸缓冲液;将模型组造模成功的75只大鼠随机分为糖尿病组（D组）,1,25-（OH）：D,大、中、小剂量干预组（H、M、L组）及精蛋白锌胰岛素干预组（Y组）各15只,其中H、M、L组分别予0．3、0．15、0．025μg/（kg·d）的1,25-（OH）：D3灌胃,Y组予胰岛素颈后皮下注射,c组和D组予蒸馏水2mL灌胃,均为1次/d、连续16周,16周后所有动物均采用股动脉放血处死,立即取肺脏组织置于10％甲醛及液氮中保存。测定各组血糖及血清CRP水平;采用HE、Masson染色法观察肺组织形态学变化,免疫组织化学法检测TLR4、NF-KBp65的蛋白表达;采用PCR法定量检测TLR4、MyD88、NF-KBp65的mRNA表达。结果①D组血糖及血清CRP水平均显著高于C组（P〈0．01）,各干预组均不同程度低于D组,尤以H组为著（P〈0．01）。②D组肺泡壁重度增厚、肺间质明显增生、大量炎症细胞浸润,H、Y、M及L组肺泡壁轻到中度增厚、炎细胞浸润明显;与c组比较,余5组TLR4、NF-KBp65蛋白表达有所升高,其中H、Y组显著低于D组。③D组,TLR4、MyD88和NF-KBp65的mRNA表达显著高于C组（P〈0．01）,各干预组表达水均低于D组。肺组织TLR4mRNA表达与MyD88mRNA（r=0．610）、NF-KBp65mRNA表达（r=0．744）均呈正相关,P均〈0．001;MyD88mRNA与NF-KBp65mRNA表达亦呈正相关（r=0．609）,P〈0．001。结论1,25-（OH）：D,可能通过TLR4介导的炎症途径对STZ诱导的糖尿病大鼠肺脏病变发挥保护作用。     

Attempting to find meaning in illness to achieve emotional coherence: the experiences of patients with colorectal cancer

The aim of the study was to explore the emotional and interactional perspectives of the meaning of illness in patients with colorectal cancer. Fifty-two respondents were included in the study. Data were obtained through an open-ended question at the time of diagnosis as well as 3 and 12 months after diagnosis. The constant comparative method of data analysis, consisting of an interpretation of the data, was used. The overall ascribed meaning was expressed in the main theme, attempting to find meaning in illness to achieve emotional coherence. The main theme consisted of 2 dimensions: unified and dichotomized embodiment. The unified embodiment dimension subthemes include gratefulness, confidence in oneself and others, and looking forward to creating a new future. The dichotomized embodiment dimension subthemes include altered self-value, loss of temporality, and infringement of body integrity. The characteristics of unified embodiment were hope and faith, a strong self-value, and an anticipated future. For dichotomized embodiment, the characteristics were the struggle, loss of temporality, nonmovement, and lack of hope and faith. The study provided a theoretical basis that is relevant for both nursing practice and nursing education.