以病例为导向的客观结构化临床考试在卒中急救护士培训中的应用

目的 探讨以病例为导向的客观结构化临床考试(OSCE)在卒中急救护士培训考核中的应用效果.方法 2018年6月至2019年6月,选择我院符合卒中急救护士岗位要求的71名护士作为研究对象.应用以病例为基础、以脑卒中急救过程为主线、以卒中急救护士急诊室岗位能力要求为本位的OSCE对卒中急救护士的急性缺血性脑卒中急诊绿色通道能力进行考核,考核共设6个站点,考核内容分别为预检初判评估、护理技术操作、患者从急诊预检台至CT室的转运、CT和多模态CT检查前后护士与影像科技师的配合、静脉溶栓药物的使用情况、静脉溶栓过程中对患者的病情观察与宣教.考试结束后计算各站点得分率和考试的难度系数、区分度系数,并通过调查问卷了解考生对本次考核的反馈.结果 71名卒中急救护士的考试成绩为78.6～95.8分,平均考试成绩为(82.9±3.2)分.考试的难度系数为0.17,区分度系数为0.36.6个站点的平均得分率为86.1％,其中第2站点的得分率最高(92.2％),第5站点的得分率最低(74.3％).大部分考生认为这种考试模式符合临床实际(97.2％,69/71),能够反映急性缺血性脑卒中急救思维能力(95.8％,68/71)和综合急救护理能力(95.8％,68/71),且应进行临床推广(98.6％,70/71).结论 以病例为导向的OSCE模式能客观地反映卒中急救护士的急性缺血性脑卒中综合急救能力,并得到了考生认可.     

超声对视网膜脱离的诊断价值

视网膜脱离是导致视力下降及失明的原因之一．我院自1998年开始至今采用高频探头超声检查出43例视网膜脱离病人．其中完全脱离35例．部分脱离8例。     

Stability analysis and observer design for discrete‐time systems with interval time‐varying delay

The problem of observer design for a class of nonlinear discrete‐time systems with time‐varying delay is considered. A new approach of nonlinear observer design is proposed for the class of systems. By using Lyapunov's stability theory and Schur complement lemma, the novel sufficient conditions that guarantee the observer error converge asymptotically to zero are obtained in terms of linear matrix inequalities. The computing method for observer gain matrix is given. Finally, simulation examples are provided to demonstrate the effectiveness of the proposed method. Copyright © 2015 John Wiley & Sons, Ltd.     

Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized,double‐blind,placebo‐controlled trial

Three recent studies demonstrated the positive effect of extracorporeal shock wave therapy (ESWT) for treating carpal tunnel syndrome (CTS). However, none have entirely proved the effects of ESWT on CTS because all studies had a small sample size and lacked a placebo‐controlled design. Moreover, radial ESWT (rESWT) has not been used to treat CTS. We conducted a prospective randomized, controlled, double‐blinded study to assess the effect of rESWT for treating CTS. Thirty‐four enrolled patients (40 wrists) were randomized into intervention and control groups (20 wrists in each). Participants in the intervention group underwent three sessions of rESWT with nightly splinting, whereas those in the control group underwent sham rESWT with nightly splinting. The primary outcome was visual analog scale (VAS), whereas the secondary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross‐sectional area (CSA) of the median nerve, sensory nerve conduction velocity of the median nerve, and finger pinch strength. Evaluations were performed before treatment and at 1, 4, 8, and 12 weeks after the third rESWT session. A significantly greater improvement in the VAS, BCTQ scores, and CSA of the median nerve was noted in the intervention group throughout the study as compared to the control group (except for BCTQ severity at week 12 and CSA at weeks 1 and 4) (p < 0.05). This is the first study to assess rESWT in a randomized placebo‐controlled trial and demonstrate that rESWT is a safe and effective method for relieving pain and disability in patients with CTS. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:977–984, 2016.     

Modified stool color card with digital images was efficient and feasible for early detection of biliary atresia—a pilot study in Beijing,China

Background

The aim of this pilot study in Beijing, China, was to validate a screening system for early detection of biliary atresia (BA) by using a modified version of the stool color card (SCC).

Methods

From 2013 to 2014, a total of 29 799 live born infants were screened. SCC was distributed in maternal facilities. Guardians were asked to check their infants’ stool colors daily using SCC up until four months after birth. The screening results among 92.5% of participants were reported. Cases deemed as high risk were referred to a surgical department immediately.

Results

Based on the results reported by the guardians, 24 infants showed pale-pigmented stools, of which two males without obvious signs of jaundice were diagnosed with BA at 52 and 55 days of age, respectively. The sensitivity was 100% and specificity was 99.9%. Four infants were confirmed as having other diseases. Two female patients failed to be screened by the SCC because they had severe jaundice and were referred to the Neonatal Intensive Care Unit after birth. They were diagnosed as BA at 14 and 17 days after birth, respectively. The overall prevalence of BA in this study was 1.3 in 10 000 live births.

Conclusion

The modified SCC was effective and feasible for early detection of BA, especially for patients with no apparent jaundice.

     

肺癌患者围手术期无痛性留置导尿管的前瞻性队列研究

目的探讨肺叶切除术中在麻醉状态下(无痛性)留置尿管临床应用效果和优势。方法前瞻性纳入2014年4~12月在四川大学华西医院胸外科单个医疗组行肺癌肺叶切除术患者133例。根据手术结束患者麻醉苏醒前是否留置尿管留将患者分为对照组(68例,常规留置尿管)和试验组(65例,不留置尿管)。比较两组患者临床效果。结果对照组全身麻醉苏醒后诉尿道刺激和苏醒期躁动发生率(13.24%,26.47%)均高于试验组(3.08%,10.77%),且差异有统计学意义(P=0.041,P=0.022)。试验组术后尿潴留发生率(10.77%)与对照组(4.41%)的差异无统计学意义(P=0.403);试验组术后尿道感染发生率(9.23%)低于对照组(26.47%),差异有统计学意义(P=0.047)。试验组术后舒适度(0度,87.69%)优于对照组(48.53%),差异有统计学意义(P=0.001)。试验组术后平均住院时间(5.00±1.60)d短于对照组(6.48±3.14)d,差异有统计学意义(P=0.004)。结论肺癌围手术期无痛性尿管留置有助于改善患者的住院舒适度并促进快速康复。     

Administration of Pigment Epithelium-Derived Factor Inhibits Airway Inflammation and Remodeling in Chronic OVA-Induced Mice via VEGF Suppression

Purpose

Pigment epithelium-derived factor (PEDF) is a recently discovered antiangiogenesis protein. PEDF possesses powerful anti-inflammatory, antioxidative, antiangiogenic, and antifibrosis properties. It has been reported that PEDF can regulate vascular endothelial growth factor (VEGF) expression. This study aimed to evaluate whether recombinant PEDF protein could attenuate allergic airway inflammation and airway remodeling via the negative regulation of VEGF using a murine model of chronic ovalbumin (OVA)-induced asthma and BEAS-2B human bronchial epithelial cells.

Methods

In an in vivo experiment, mice sensitized with OVA were chronically airway challenged with aerosolized 1% OVA solution for 8 weeks. Treated mice were given injections of recombinant PEDF protein (50 or 100 µg/kg body weight) via the tail vein. In an in vitro experiment, we investigated the effects of recombinant PEDF protein on VEGF release levels in BEAS-2B cells stimulated with IL-1β.

Results

Recombinant PEDF protein significantly inhibited eosinophilic airway inflammation, airway hyperresponsiveness, and airway remodeling, including goblet cell hyperplasia, subepithelial collagen deposition, and airway smooth muscle hypertrophy. In addition, recombinant PEDF protein suppressed the enhanced expression of VEGF protein in lung tissue and bronchoalveolar lavage fluid (BALF) in OVA-challenged chronically allergic mice. In the in vitro experiment, VEGF expression was increased after IL-1β stimulation. Pretreatment with 50 and 100 ng/mL of recombinant PEDF protein significantly attenuated the increase in VEGF release levels in a concentration-dependent manner in BEAS-2B cells stimulated by IL-1β.

Conclusions

These results suggest that recombinant PEDF protein may abolish the development of characteristic features of chronic allergic asthma via VEGF suppression, providing a potential treatment option for chronic airway inflammation diseases such as asthma.     

Comparison of Undernutrition Prevalence of Children under 5 Years in China between 2002 and 2013

Objective To describe the undernutrition status of children under 5-year in China, and study the trend between 2002 and 2013. Methods The study was based on two national surveys. Undernutrition wasdetermined against WHOs 2006 growth standards.The prevalence in 2013 and 2002 was weighted by China sixth National Population Census (2010). The relationship between undernutrition and gender/age groups/different areas use weighted logistic regression. Results The results indicated the overall prevalence of stunting, underweight, and wasting of Chinese children under 5-year was 8.1%, 2.4%, and 1.9% in 2013, respectively. The prevalence of stunting was higher for children aged 12-47 month, while underweight was higher for children aged 48-59 month. The prevalence of undernutrition was higher in rural areas than in urban areas, especially in poor rural areas. There was a decline of stunting, underweight, and wastingbetween 2002 and 2013 among the children, with greater reduction in rural areas than in urban areas. Conclusion The prevalence of undernutrition of children under 5-year remains high in rural areas especially in poor rural areas in China. It is urgent totake action to control undernutrition in the vulnerable areas and subgroups.     

C-reactive Protein Level,Apolipoprotein B-to-apolipoprotein A-1 Ratio,and Risks of Ischemic Stroke and Coronary Heart Disease among Inner Mongolians in China

Objective We aimed to investigate the cumulative effect of high CRP level and apolipoprotein B-to-apolipoprotein A-1(ApoB/ApoA-1) ratio on the incidence of ischemic stroke(IS) or coronary heart disease(CHD) in a Mongolian population in China.Methods From June 2003 to July 2012,2589 Mongolian participants were followed up for IS and CHD events based on baseline investigation.All the participants were divided into four subgroups according to C-reactive protein(CRP) level and ApoB/ApoA-1 ratio.Cox proportional hazard models were used to estimate the hazard ratios(HRs) and 95% confidence intervals(CIs) for the IS and CHD events in all the subgroups.Results The HRs(95% CI) for IS and CHD were 1.33(0.84-2.12),1.14(0.69-1.88),and 1.91(1.17-3.11) in the ‘low CRP level with high ApoB/ApoA-1',‘high CRP level with low ApoB/ApoA-1',and ‘high CRP level with high ApoB/ApoA-1' subgroups,respectively,in comparison with the ‘low CRP level with low ApoB/ApoA-1' subgroup.The risks of IS and CHD events was highest in the ‘high CRP level with high ApoB/ApoA-1' subgroup,with statistical significance.Conclusion High CRP level with high ApoB/ApoA-1 ratio was associated with the highest risks of IS and CHD in the Mongolian population.This study suggests that the combination of high CRP and ApoB/ApoA-1 ratio may improve the assessment of future risk of developing IS and CHD in the general population.