丝裂霉素C在LASIK术后角膜上皮植入手术治疗中的应用

目的:探讨丝裂霉素C(mitomycin C,MMC)在准分子激光原位角膜磨镶术(laserin situkeratomileusis,LASIK)术后角膜上皮植入手术治疗中应用的临床疗效。方法:在31例31眼LASIK术后角膜上皮植入患者手术治疗中应用0.2g/L MMC,观察术后裸眼视力及角膜瓣愈合情况。结果:术后6mo裸眼视力平均为0.82±0.19,较术前明显提高(P<0.05)。绝大部分患者角膜瓣愈合良好,4例患者角膜瓣边缘部分融解,但中心视力无明显影响。结论:在LASIK术后角膜上皮植入手术治疗中应用0.2g/LMMC可以取得良好的临床疗效。     

护理实习生岗前培训的调查与实施

目的切实开展护生岗前培训,加强质量控制,提高教学效果。方法培训前调研护生对培训的需求,有针对性地安排培训内容,并制订护理实习生岗前培训手册供全院护生参考。结果 99.3%的护生对培训满意;99.7%的护生认为岗前培训手册帮助非常大;与培训前比较,护生岗前培训知识掌握程度显著提高(P<0.01);岗前培训考试不合格率显著低于往届护生(P<0.05)。结论在全面调查评估的基础上开展规范化岗前培训,可提高教学效果。     

Endovascular repair of the half aortic arch in pigs with an improved, single-branched stent graft system for the brachiocephalic trunk

The objective of this study was to evaluate the feasibility of endovascular repair of half of the aortic arch in pigs using an improved, integrated, single-branched stent graft for the ascending aorta and brachiocephalic trunk (BCT). We designed an improved stent graft in an integrated fashion and deployed the stent grafts into the ascending aortas and BCT of eight pigs. The feasibility of the stent graft deployments was evaluated three months after the procedures using arteriography, computed tomography angiography (CTA) and animal autopsy. The stent grafts were successfully deployed in eight pigs. All animals survived for at least three months. Arteriography, CTA and animal necropsy revealed good stent fixation in eight cases. Their head CT scans found no evidence of cerebral infarction. In conclusion, endovascular repair of the half aortic arch with the integrated single-branched stent graft system appears to be safe and feasible in pigs.     

跟腱断裂修补术后再断裂与感染的发病率、危险因素及临床预后

目的:探讨跟腱断裂修补术后再断裂与感染的发病率、危险因素及临床预后。方法:回顾性研究1994年1月至2008年12月在我所行跟腱断裂修补术后发生再断裂和(或)感染的患者,记录其性别、年龄、职业、生活习惯、内科合并症、受伤机制、断裂及手术时间、断裂形态、治疗方式、术后康复等数据,分析总结跟腱再断裂与感染的发病率、危险因素与临床预后。结果:跟腱断裂行修补手术共计916例,术后发生跟腱再断裂和(或)感染28例(其中4例再断裂合并感染),再断率2.3%(21例),感染率1.2%(11例)。跟腱再断裂多发生于运动员或戏剧演员;跟腱感染多见于高龄,合并糖尿病、高脂血症,跟腱炎、局部激素治疗以及断裂后治疗延迟(>14天)的患者。术后随访16例(9例再断裂,5例感染,2例再断裂合并感染),平均随访49.4个月(12～124个月),优良率87.5%。其中3年以上患者全部为优,结果明显好于1～3年的患者(P=0.019),感染组预后略差于再断组。结论:跟腱术后再断裂和感染是跟腱断裂修补术后的两大常见且严重的并发症。从事运动或戏剧表演职业的患者易于发生跟腱术后再断裂,而高龄、高脂血症、跟腱炎、激素治疗史,及伤后延迟治疗等是跟腱术后感染的高危险因素。治疗得当,长期(3年以上)临床预后较好;跟腱感染患者预后略差于跟腱再断裂患者。     

High on-clopidogrel platelet reactivity and chronic kidney disease: a meta-analysis of literature studies

Background. The efficacy of clopidogrel is often attenuated in the setting of renal impairment. High on-treatment platelet reactivity (HPR) is an independent correlate of adverse event. Here we performed a quantitative evaluation of the prevalence and impact of HPR in patients with chronic kidney disease (CKD). Methods. We systematically searched PubMed, EMBASE and the Cochrane Library from their inception to 1 March 2018 for cohort studies assessing the risk ratio (RR) of prevalence of HPR in CKD versus non-CKD patients and association of cardiovascular outcome with HPR in CKD patients treated with clopidogrel. Outcome measures included major adverse cardiac event, myocardial infarction and stent thrombosis. RRs and 95% confidence intervals (CIs) were used as estimates of effect size in random-effect models. Results. Ten studies comprising a total of 3028 CKD patients and 11138 non-CKD patients were included in the evaluation. Compared to patients with normal renal function, patients with CKD had a significantly higher risk of HPR (OR: 1.34, 95% CI: 1.23–1.46). In CKD patients, HPR was associated with increased risk of MACE (RR 2.99, 95% CI 1.19 to 7.53; p?p?=?0.0002), and stent thrombosis (RR 2.98, 95% CI 1.42 to 6.26; p?=?0.004). Conclusions. Based on pooled analysis, CKD appeared correlated with HPR and this association had prognostic significance. Further studies with standardised laboratory methods and specifically defined protocols are required to validate the clinical relevance of such response variability to clopidogrel in CKD patients.     

团队合作降低康复科住院患者跌倒发生率及跌倒伤害

目的降低康复科住院患者跌倒发生率及跌倒伤害。方法成立由医生、护士、治疗师组成的预防跌倒管理小组,调查并分析2014年康复科住院患者跌倒发生率及跌倒伤害情况,2015年通过医护治三方团队合作模式有针对性进行预防跌倒的干预。结果2014年跌倒发生率为1.17‰,跌倒患者伤害发生率为35.7%,2015年跌倒发生率降低至0.68‰,跌倒患者伤害发生率降低至12.5%。结论医护治三方团队合作模式可有效降低康复科住院患者跌倒发生率及跌倒伤害。     

共情四步法培训提高眼科护士护患冲突应对能力

目的探讨符合眼科病房护理特点的共情培训方法及效果。方法对眼科病房30名护士进行共情四步法培训,包括共情四步法的理论培训、共情应答培训、共情体验、情景模拟演练及经典案例解析。结果培训后护士同理心、人际反应指针及整合的冲突处理模式得分显著提高,让步的冲突处理模式得分显著降低(P0.05,P0.01);培训后6个月护士层面未能解决的护患冲突由264例次下降至72例次。结论共情四步法培训可提高眼科病房护士的同理心水平,改善护患冲突应对形态,降低护患冲突的发生。     

Genetic diversity of porcine circovirus type 2 in China between 1999–2017

Porcine circovirus type 2 (PCV‐2), is linked to PCV‐2 associated disease, which has caused considerable economic loss in the swine industry. Here, we report the genetic diversity of PCV‐2 in China. A total of 74 Chinese PCV‐2 strains sequenced between 1999 and 2017 were studied. Based on the ORF2 and complete genomes, we found that apart from the PCV‐2a, PCV‐2b, and PCV‐2d genotypes, two unstable recombination genotypes also exist, referred to as IM1 and IM2 genotypes. We found that the patterns of PCV‐2 genetic shift in China are similar to the patterns at the global level. Additionally, for the PCV‐2 ORF2 gene of Chinese isolates, we found a similar time to the most recent common ancestor and evolutionary rate to the global values. This indicates that PCV2 genetic diversity in China is driven by genetic drift/recombination of local strains and by the sporadic introduction of foreign genotypes from other countries. Overall, our study illustrates the genetic diversity and evolution dynamics of PCV‐2 in China.     

手术室应对突发性群体事件应急预案的制定

为迅速应对突发性群体事件,为批量伤员提供安全、快捷的手术环境,制定手术室应急预案：包括成立手术室应急小组并组织演练,做好人员准备及建立紧急报告制度,制定成批伤员抢救流程,规范现场管理及制定伤员转运流程。