护士工作家庭冲突、控制感与职业倦怠的相关研究

目的:研究护士职业倦怠与工作家庭冲突、控制感之间的关系。方法:采用李小妹翻译的MaslachBurnout Inventory(MBI)的系列问卷中的人类服务版MBI-Human Services Survey(MBI-HSS),内特迈耶(Nete-meyer 1996)等编制的工作家庭冲突量表,托马斯和甘斯特(Thomas&Ganster,1995)编制控制感量表对长沙市10家综合性医院不同科室工作一年以上的护士500人进行测查。对测查采集的数据进行描述性分析、单因素方差分析、相关分析和路径分析。结果:被研究护士的职业倦怠程度比较高,情绪衰竭平均得分为24.5,属于中度倦怠;去人格化平均得分为8.94,属于中度倦怠;个人成就感平均得分为27.67,属于高度倦怠。护士工作家庭冲突程度较严重,工作家庭冲突、控制感、职业倦怠之间显著相关。结论:护士职业倦怠达到中、高水平,工作家庭冲突、控制感是护士职业倦怠产生的重要影响因素。     

突发性群体暴力事件后一线救援医护人员心理健康状况调查

目的 探讨突发性群体暴力事件后一线救援医护人员的心理健康状况,为制定有针对性的心理干预措施提供依据.方法 将突发性群体暴力事件后某部队医院55名一线救援医务人员设为研究组,随机抽取同期普通病房医护人员82名设为对照组,采用事件冲击量表、睡眠量表及症状自评量表对两组进行测评分析.结果 两组事件冲击量表及睡眠量表评分均显著高于正常人群,研究组事件冲击量表总分及各因子分、睡眠量表总分均显著高于对照组(P＜0.05或0.01).研究组症状自评量表总分及焦虑、偏执因子分显著高于对照组(P＜0.05或0.01),总分、总均分、阳性项目数及除强迫症状因子外的8个因子分显著高于中国常模(P＜0.01),总均分、阳性项目数及躯体化、焦虑、敌对、恐怖因子分显著高于军人常模(P＜0.01);对照组症状自评量表总分、总均分、阳性项目数及除强迫症状、偏执因子外的其他因子分均显著高于中国常模(P＜0.05或0.01),阳性项目数及强迫症状、焦虑、敌对、恐怖、偏执因子分与军人常模比较差异有显著性(P＜0.05或0.01).结论 突发性群体暴力事件后一线救援医护人员普遍存在不同程度的心理问题,及时开展有针对性的心理健康教育对提高其心理健康水平具有重要意义.     

二甲双胍在妊娠期应用的研究进展

近年研究不断证实二甲双胍治疗妊娠期糖尿病的有效性。在近期安全性上,研究发现二甲双胍不增加不良妊娠结局的发生率,且较胰岛素相比,可减少母体孕期增重和低血糖发生率;在远期安全性上,随访研究尚未发现二甲双胍相关的不良结局。本文主要介绍二甲双胍妊娠期使用的有效性和安全性证据,并对国内外指南的建议进行总结,以及对二甲双胍具体用药方案进行说明。     

宽体探测器联合全模型实时迭代重建在肥胖患者上腹部扫描中的应用

目的 探讨宽体探测器联合全模型实时迭代重建技术（ASIR-V）在肥胖患者上腹部低辐射剂量扫描中的应用价值。方法 根据体模实验找出常规上腹部扫描（管电压为120 kVp,噪声指数为10 HU）最佳前置及后置ASIR-V比例;在体模实验基础上,前瞻性收集需行上腹部CT增强的87例肥胖患者（体质量指数≥30 kg/m²）,依随机数表法分为试验组（43例）和对照组（44例）。试验组采用宽体探测器（80 mm）CT联合前置40% ASIR-V行上腹部双期增强扫描获得A1组图像（默认为后置40% ASIR-V）,再联合60%后置ASIR-V技术重建获得A2组图像。对照组采用常规探测器CT（40 mm）扫描后联合40%自适应统计迭代重建技术（ASIR）重建获得B组图像。比较试验组和对照组的辐射剂量、图像的对比噪声比（CNR）、图像噪声和主观评分（5分制法）。结果 常规上腹部扫描最佳前置及后置ASIR-V比例分别为40%及60%。试验组的有效剂量E为（4.55±0.95）mSv,低于对照组的（9.58±2.04）mSv（t=-14.773,P<0.001）。A2组除双期肝脏外,各部位CNR均高于A1及B组（q=2.160~3.209,P<0.05）,双期图像噪声低于A1及B组（q=-4.212~-3.202,P<0.05）,双期总体图像质量评分高于A1及B组（Z=-5.155~-2.561,P<0.05）。A1组双期各部位CNR及图像噪声与B组差异均无统计学意义（P>0.05）,双期总体图像质量评分低于B组（Z=-3.298~-3.030,P<0.05）。A组双期图像质量评分均>3分,均能满足临床诊断需求。结论 肥胖患者采用宽体探测器联合前置40% ASIR-V技术,可比常规探测器扫描减少约53%的辐射剂量;联合后置ASIR-V重建技术,可在保持或提高图像CNR的同时优化总体图像质量。     

The clinical pathology of severe acute respiratory syndrome (SARS): a report from China

In order to investigate the clinical pathology of severe acute respiratory syndrome (SARS), the autopsies of three patients who died from SARS in Nan Fang Hospital Guangdong, China were studied retrospectively. Routine haematoxylin and eosin (H&E) staining was used to study all of the tissues from the three cases. The lung tissue specimens were studied further with Macchiavello staining, viral inclusion body staining, reticulin staining, PAS staining, immunohistochemistry, ultrathin sectioning and staining, light microscopy, and transmission electron microscopy. The first symptom was hyperpyrexia in all three cases, followed by progressive dyspnoea and lung field shadowing. The pulmonary lesions included bilateral extensive consolidation, localized haemorrhage and necrosis, desquamative pulmonary alveolitis and bronchitis, proliferation and desquamation of alveolar epithelial cells, exudation of protein and monocytes, lymphocytes and plasma cells in alveoli, hyaline membrane formation, and viral inclusion bodies in alveolar epithelial cells. There was also massive necrosis of splenic lymphoid tissue and localized necrosis in lymph nodes. Systemic vasculitis included oedema, localized fibrinoid necrosis, and infiltration of monocytes, lymphocytes, and plasma cells into vessel walls in the heart, lung, liver, kidney, adrenal gland, and the stroma of striated muscles. Thrombosis was present in small veins. Systemic toxic changes included degeneration and necrosis of the parenchyma cells in the lung, liver, kidney, heart, and adrenal gland. Electron microscopy demonstrated clusters of viral particles, consistent with coronavirus, in lung tissue. SARS is a systemic disease that injures many organs. The lungs, immune organs, and systemic small vessels are the main targets of virus attack, so that extensive consolidation of the lung, diffuse alveolar damage with hyaline membrane formation, respiratory distress, and decreased immune function are the main causes of death.     

Cartilage‐Specific Autophagy Deficiency Promotes ER Stress and Impairs Chondrogenesis in PERK‐ATF4‐CHOP–Dependent Manner

Autophagy is activated during nutritionally depleted or hypoxic conditions to facilitate cell survival. Because growth plate is an avascular and hypoxic tissue, autophagy may have a crucial role during chondrogenesis; however, the functional role and underlying mechanism of autophagy in regulation of growth plate remains elusive. In this study, we generated ^TamCartAtg7^–/– (Atg7cKO) mice to explore the role of autophagy during endochondral ossification. Atg7cKO mice exhibited growth retardation associated with reduced chondrocyte proliferation and differentiation, and increased chondrocyte apoptosis. Meanwhile, we observed that Atg7 ablation mainly induced the PERK‐ATF4‐CHOP axis of the endoplasmic reticulum (ER) stress response in growth plate chondrocytes. Although Atg7 ablation induced ER stress in growth plate chondrocytes, the addition of phenylbutyric acid (PBA), a chemical chaperone known to attenuate ER stress, partly neutralized such effects of Atg7 ablation on longitudinal bone growth, indicating the causative interaction between autophagy and ER stress in growth plate. Consistent with these findings in vivo, we also observed that Atg7 ablation in cultured chondrocytes resulted in defective autophagy, elevated ER stress, decreased chondrocytes proliferation, impaired expression of col10a1, MMP­13, and VEGFA for chondrocyte differentiation, and increased chondrocyte apoptosis, while such effects were partly nullified by reduction of ER stress with PBA. In addition, Atg7 ablation‐mediated impaired chondrocyte function (chondrocyte proliferation, differentiation, and apoptosis) was partly reversed in CHOP^–/– cells, indicating the causative role of the PERK‐ATF4‐CHOP axis of the ER stress response in the action of autophagy deficiency in chondrocytes. In conclusion, our findings indicate that autophagy deficiency may trigger ER stress in growth plate chondrocytes and contribute to growth retardation, thus implicating autophagy as an important regulator during chondrogenesis and providing new insights into the clinical potential of autophagy in cartilage homeostasis. © 2017 American Society for Bone and Mineral Research.     

婴幼儿急性胃肠炎伴良性惊厥临床分析及远期随访观察

目的：探讨急性胃肠炎伴婴幼儿良性惊厥的临床特点及远期预后。方法：选择2012年2月至2015年12月我院收治的98例急性胃肠炎伴良性惊厥患儿,总结、分析其临床及实验室检查资料,并进行远期随访观察。结果：98例急性胃肠炎伴良性惊厥患儿发病年龄集中在1~2岁,占全部患儿的78.6%;全年均有发病;惊厥在急性胃肠炎3 d内的发病率高,占86.7%;惊厥平均发作次数为1.8次,期间无癫痫持续状态,为全身强直-阵挛形式发作。血生化检测、血常规检查、脑脊液常规、生化及培养检查等均正常,大便轮状病毒检测阳性者12例。脑电图检测结果显示,4例背景活动慢化,3例额中央区或中央顶区尖-慢波发放或有尖波,其他患儿脑电图均正常。随访结果显示,4例患儿复发,其中1例为热性惊厥,1例为癫痫,其他无复发。结论：急性胃肠炎伴婴幼儿良性惊厥高发于1~2岁幼儿,惊厥发作早期易于控制,预后良好,不需进行长期抗惊厥治疗。     

通腑理肺汤结肠透析联合纤维支气管镜肺泡灌洗对肺炎合并脓毒症患者HMGB-1、IL-10水平影响

目的 探讨通腑理肺汤结肠透析联合纤维支气管镜肺泡灌洗对肺炎合并脓毒症患者高迁移率蛋白(HMGB-1)、白细胞介素(IL)-10水平的影响.方法 将90例患者分为治疗组A、治疗组B、对照组,每组30例.治疗组A在常规治疗基础上给予通腑理肺汤结肠透析联合纤维支气管镜肺泡灌洗治疗,治疗组B在常规治疗基础上给予温水结肠透析联合纤维支气管镜肺泡灌洗治疗,对照组在常规治疗基础上给予温水结肠透析治疗.于治疗前,治疗后1周末、2周末留取肺泡灌洗液检测HMGB-1、IL-10水平.结果 HMGB-1水平:3组患者治疗前差异无统计学意义(P＞0.05);治疗后1周末,治疗组A明显低于治疗组B及对照组;治疗后2周末,治疗组A、治疗组B水平均低于对照组,且治疗组A降低最为明显,差异有统计学意义(P＜0.05).IL-10水平:3组患者治疗前差异无统计学意义(P＞0.05);治疗后1周末、2周末3组患者均有不同程度升高,治疗组A、治疗组B均高于对照组,且治疗组A水平升高最为明显,差异有统计学意义(P＜0.05).结论 通腑理肺汤结肠透析联合纤维支气管镜肺泡灌洗能显著降低患者HMGB-1水平,提高IL-10水平,调节患者促炎/抗炎因子的平衡,减轻炎症反应和组织损伤,改善患者预后.     

顺铂加西艾克配合外照射治疗鼻咽癌的临床研究和护理

将６４例鼻咽癌患者随机分为两组（各３２例）。实验组采用放疗加化疗;对照组采用单纯放疗。结果表明,实验组在放疗量达４０Ｇｙ、放疗结束时和三个月后颈淋巴转移灶全消率已高于对照组（Ｐ〈０．０５）。毒副反应的出现,经过对症处理和护理,均未中断放疗。放疗联合应用顺铂＋西艾克方案,有利于提高晚期鼻咽癌病人淋巴转换灶的全消率,减少残余,此方案是治疗鼻咽癌的有效方案。     

胃肠激素的研究概况

胃肠激素是来源于生物体的多肽类激素 ,现已用于多种疾病机制的研究、诊断和治疗。对胃肠激素的研究进展及其应用进行了综述