1例多胎妊娠合并妊高征致早产病人的围产期心理护理

１例多胎妊娠合并妊高征致早产病人的围产期心理护理ＰｅｒｉｎａｔａｌＰｓｙｃｈｏｌｏｇｉｃａｌＮｕｒｓｉｎｇＣａｒｅｏｎａＣａｓｅｏｆＰｒｅｍａｔｕｒｅＬａｂｏｒＩｎｄｕｃｅｄｂｙＭｕｌｔｉｐｌｅＰｒｅｇｎａｎｃｙａｎｄＰｒｅｇｎａｎｃｙＨｙｐｅｒｔ...     

武汉市4～16岁儿童青少年行为问题发生情况的调查与分析

目的：了解儿童青少年行为问题的流行病学情况，探讨行为问题发生的相关因素。方法：采取整群随机抽样方式于2003—09／12在武汉市随机抽取2所幼儿园、2所小学、2所初中、2所高中。选取其中幼儿园中班、大班，小学1-6年级，初中1-3年级，和高中一年级共12个年级，按年级名册各随机选取男50名，女50名，共2400名。均为年龄4-16岁儿童，监护人同意参加。调查工具为行为问题调查量表。该量表包括：①一般项目：有性别、年龄、儿童生活主要照顾者、父母职业等。②环境量表：有亲子关系、父母经济状况、家庭大小、父母心理知识认知、教育认知、环境、父母对自己与孩子相处是否需要建议等项目（对各项目进行同趋势化处理，转换为低优即分越低越好，按1～5分共5个等级进行评分，并采用合计方式计算各纬度的得分，按人数计算各维度的平均分）。③应用Achenbach儿童行为量表中国标准化版做父母调查（113条行为问题，每条有0，1或2分称为粗分，113条粗分加起来称总粗分，再归纳为8～9个因子，计量其因子分），将该量表因子分与Achenbach儿童行为量表中国标准化版（父母用）诊断标准对照，判断该儿童是否具有该项行为异常。由各班主任将调查表分发给所选调查对象的家长，并负责向家长讲解调查表内容和填写方法，在发表1周后负责回收表格。结果：纳入儿童2400名，发放调查表2400份，回收调查表2205份，其中内容完整的2199份。由于年龄不符合的有71名，对2128名符合年龄条件和填写完整符合要求的调查表进入结果分析。①男童行为问题发生率明显高于女童（x^2CMH=1722．6350，P〈0．01）。不同年龄段儿童行为异常发生率相似（P〉0．05）。②12～16岁行为异常儿童中非父母照顾者所占百分比明显高于行为正常儿童（17．07％，3．64％,x^2CMH=15．7005,P〈0．01）。③4～5岁行为异常男童父母的精神心理认知、家周围噪音污染和亲子关系评分和正常儿童相近（P〉0．05）；6～16岁行为异常儿童上述3项指标平分普遍高于正常儿童（t=-2．06--6．77,P〈0．05～0．01），随着年龄的增加，呈上升趋势。④4～5岁行为异常女童父母的精神心理认知和亲子关系评分均明显高于正常儿童（t=-2．26，-2．10,P〈0．05）。结论：①儿童行为问题发生率存在性别差异，男性高于女性。②12～16岁行为异常儿童中非父母照顾者多于由父母照顾的正常儿童。③行为问题发生率可能与儿童的生活照顾者、亲子关系、父母的精神心理认知及家周围的噪音有关。④4～5岁儿童行为异常的发生与父母的精神心理认知、家周围噪音污染和亲子关系无关，但与性别有关。     

High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study

Introduction  

The pathophysiology of postoperative delirium remains poorly understood. The purpose of this study was to examine the relationship between serum cortisol level and occurrence of early postoperative delirium in patients undergoing coronary artery bypass graft (CABG) surgery.     

Role for cathepsin F in invariant chain processing and major histocompatibility complex class II peptide loading by macrophages

The major histocompatibility complex (MHC) class II-associated invariant chain (Ii) regulates intracellular trafficking and peptide loading of MHC class II molecules. Such loading occurs after endosomal degradation of the invariant chain to a approximately 3-kD peptide termed CLIP (class II-associated invariant chain peptide). Cathepsins L and S have both been implicated in degradation of Ii to CLIP in thymus and peripheral lymphoid organs, respectively. However, macrophages from mice deficient in both cathepsins S and L can process Ii and load peptides onto MHC class II dimers normally. Both processes are blocked by a cysteine protease inhibitor, indicating the involvement of an additional Ii-processing enzyme(s). Comparison of cysteine proteases expressed by macrophages with those found in splenocytes and dendritic cells revealed two enzymes expressed exclusively in macrophages, cathepsins Z and F. Recombinant cathepsin Z did not generate CLIP from Ii-MHC class II complexes, whereas cathepsin F was as efficient as cathepsin S in CLIP generation. Inhibition of cathepsin F activity and MHC class II peptide loading by macrophages exhibited similar specificity and activity profiles. These experiments show that cathepsin F, in a subset of antigen presenting cells (APCs), can efficiently degrade Ii. Different APCs can thus use distinct proteases to mediate MHC class II maturation and peptide loading.     

六西格玛管理理念在护士长绩效管理中的应用

护士长是医院基层科室护理工作的领导者、组织者、管理者,在医院护理质量、护理安全、护理教学、护理科研、护理人力资源应用、护士人才(业务技能)培养、护理团队气氛的营造中起到关键性的作用[1]。护士长综合素质是管理作用充分发挥乃至增值的基础、是保证医院护理指挥系统正常运行的关键[2]、是护理工作顺利开展和确保质量的前提。六西格玛是一种卓有成效的管理方法,是一个综合管理体系和发展战略全新的管理模式[2]。其管理理念以“顾客”为中心,质量持续改进,以数据为基础,追求完美为目标[3]。为促进护士长管理绩效持续提升,我院护理部创…     

Molecular prenatal diagnosis in 2 pregnancies at risk for spondyloepiphyseal dysplasia congenita

BACKGROUND: Spondyloepiphyseal dysplasia congenita (SEDC) is an autosomal dominant skeletal dysplasia characterized by short stature, abnormal epiphyses, and flattened vertebral bodies. Secondary prevention of SEDC can be achieved by prenatal diagnosis. Reports of antenatally-diagnosed SEDC fetuses have been very rare and molecular prenatal diagnosis even rarer. We previously reported a familial G504S mutation in the type II collagen (COL2A1) gene resulting in SEDC. In this study, molecular prenatal diagnosis was performed to 2 couples in this family with pregnancies at risk for SEDC. METHODS: Amniotic fluid was sampled by amniocentesis under ultrasound guidance at 19+3 and 18+6 weeks' gestation, respectively. Karyotype and molecular genetic analysis were performed on cultured amniotic fluid cells. Maternal cell contamination was excluded by short tandem repeat (STR) analysis. Direct DNA sequencing and DHPLC were conducted to detect the potential mutation in exon 23 of COL2A1 gene. Both women underwent serial sonograms because they insisted that the molecular diagnosis should be confirmed by another method, although they had been informed that mutation analysis is predictive of the disease. RESULTS: Karyotype of both fetuses was normal and molecular genetic analysis revealed that fetus 1 carried a G504S mutation in exon 23, while fetus 2 was normal. In case 1, femur length of the fetus was markedly below the 5th centile at 23 weeks' gestation, which confirms the accuracy of molecular diagnosis. A medical termination was carried out at 27+5 weeks' gestation and a male fetus with a relatively large head and short limbs was delivered. The fetal radiograph demonstrated a number of features, including generalised platyspondyly, absent ossification of the vertebral bodies in the cervical region and significant shortening of the long bones. The diagnosis of SEDC was thus confirmed clinically. Ultrasound monitoring of fetus 2 showed that its femur length was normal for gestational age at repeated scans, which was consistent with the molecular diagnosis. CONCLUSIONS: Molecular analysis allows early and accurate prenatal diagnosis for SEDC once mutation is known in a family. However, considering the poor genotype/phenotype correlation in many cases of SEDC, the combination of ultrasound as well as molecular genetic approach might be needed.     

Elongation of esophageal segments by bougienage stretching technique for long gap esophageal atresia to achieve delayed primary anastomosis by thoracotomy or thoracoscopic repair: A first experience from China

Objectives

The treatment of long gap esophageal atresia (LGEA) is one of the most challenging congenital malformations in neonatal surgery. A preoperative bougienage stretching technique for elongation of the two segments of esophagus is applied to achieve utilizing the native esophagus to establish esophageal continuity by open or thoracoscopic approach.

Association of androgen receptor gene CAG and GGN repeat polymorphism with cryptorchidism: A meta‐analysis

Researches on association between variations in the androgen receptor (AR) gene repeat polymorphisms and cryptorchidism (CO) had conflicting results. The aim of this meta‐analysis was to analyse the potential effects of AR CAG and/or GGN repeat polymorphism on CO. Studies were independently appraised by two investigators on PubMed, Web of Science, EBSCO databases and Foreign Medical Retrieval System. Case–control studies with measurement of CAG and/or GGN repeat length were included. Weighted mean difference (WMD) and 95% confidence intervals (CIs) for the CAG or GGN repeat polymorphism and CO were calculated. Five reports were included in this analysis. Overall, no difference was identified between patients and fertile men in CAG repeat length. However, when the CO was divided into unilateral and bilateral, longer CAG repeat region was significantly associated with CO in bilateral group (WMD = 0.74; 95% CI, 0.01–1.47; p < .05). In addition, GGN lengths were significantly higher in patients compared with those in controls (WMD = 1.17; 95% CI, 0.28–2.06; p < .05). No obvious effect was found in the GGN length when compared unilateral or bilateral group with control respectively. The results in this meta‐analysis indicated that AR CAG and GGN repeat polymorphisms may be an important pathogenesis of CO.     

Safety and feasibility study of holmium laser enucleation of the prostate (HOLEP) on patients receiving dual antiplatelet therapy (DAPT)

Objective

To evaluate the safety and feasibility of Holmium laser enucleation of the prostate (HoLEP) in patients receiving dual antiplatelet therapy (DAPT).

Methods

From March 2013 to August 2016, we retrospectively analyzed 1124 benign prostatic hyperplasia (BPH) patients undergoing HoLEP and divided into four groups: 56 cases receiving DAPT therapy (group A); 72 patients treated with continuous single antiplatelet (AP) therapy (group B); 41 patients treated with single AP therapy but intermittent during preoperative time (group C) and 955 cases had no AP therapy (group D). Patients’ baseline characteristics, 1-year clinical outcomes, rates of postoperative bleeding and complications were presented in this study.

Results

All patients received successful operations and no severe postoperative complications occurred. Only one patient in Group D required transfusion. The enucleation time and catheterization time for the DAPT patients were the longest among four groups (p < 0.001, respectively). The overall complications rates within 30 days were 23.2% (13/56) in Group A, 27.8% (20/72) in Group B, 19.5% (8/41) in Group C, and 27.0% (258/955) in Group D, respectively (p = 0.678). By the 12 months, the international prostate symptom scores (IPSS), quality of life scores (QOL) and residual urine volume (RUV) in all groups have been significantly improved.

Conclusion

HoLEP in patients receiving DAPT after coronary artery stunting showed similar results to those achieved in patients receiving single AP therapy or non-AP therapy. It can be a good option, which the urologists can offer to those patients with symptomatic benign prostatic hyperplasia refractory to medical treatment.