传染病报告管理的浅见

我院通过对医务人员进行传染病报告的宣教和对传染病报告管理的监督、检查传染病防治知识，并进行传染病报告管理监督检查，使疫情报告管理的报告率、填卡完整率、准确率和及时率均达95％以上，医务人员掌握传染病报告卡的内容。报告程序和报告管理时限，疫情报告管理质量得到提高。     

犬骨髓间质干细胞体外诱导及非诱导培养后向心肌细胞的分化

目的：骨髓间质干细胞体外诱导和非诱导培养向心肌细胞分化的结果的对比。方法：实验于2003-03／2004-12在阜外心血管病医院中心实验室完成。①分离犬骨髓间质干细胞。②于体外培养，应用不同浓度（0，6，8，10，12，14，20μmol／L）的5-氮胞苷定向诱导并连续传代培养4周，未诱导的细胞培养8周。③进行细胞形态学、细胞免疫组织化学、透射电镜鉴定。结果：（D骨髓间质于细胞于5-氮胞苷诱导培养2周时，α-肌动蛋白、TroponinI染色阴性；4周时，α-肌动蛋白染色阳性，Troponin I阴性；电镜下可见肌丝结构，其中8mmol／L 5-氮胞苷诱导的间质干细胞肌丝结构排列较规则。②骨髓间质干细胞非诱导培养8周时，α-肌动蛋白染色阳性，Troponin I阴性，电镜下亦可见肌丝结构形成；而培养4周时全部为阴性。结论：骨髓间质干细胞经5-氮胞苷诱导培养4周及未诱导连续培养8周均可定向转化为具有肌丝结构的肌样细胞，而非心肌样细胞。     

导乐陪伴式分娩的临床观察

[目的]探讨导乐陪伴式分娩在产程中的疗效。[方法]选取2005年1月—2005年6月住院分娩的正常足月初产妇200例,随机分为导乐组和对照组各100例,导乐组采用专职助产师陪伴下的导乐式分娩,对照组采用传统的待产、接产方法,比较两组分娩方式、产后出血量、产程时间等情况。[结果]两组产妇的剖宫产率、产程时间、产后出血量相比有统计学意义。[结论]导乐陪伴式分娩是提高产科服务质量的一项技术。     

Issues Facing Child Psychiatric Nursing in the 1990s

JCPN Commentary presents a series of observations, opinions, and analyses of issues and trends in education and practice in psychiatric and mental health nursing, and social policy factors that influence, families, or the delivery of health services to youth and their families.     

Comparisons between heavily T2-weighted MR and CT myelography studies in two patients with spontaneous intracranial hypotension

Our previous study demonstrated that heavily T2-weighted magnetic resonance (MR) myelography could successfully detect abnormal cerebrospinal fluid (CSF) collections in patients with spontaneous intracranial hypotension (SIH); however, its ability to demonstrate ongoing CSF leakage sites is uncertain. Currently, computed tomographic (CT) myelography is still considered the study of choice for such a purpose. In this study, we compared the results of the two imaging modalities in two patients with SIH. CSF leakages, such as C1-2 extraspinal collections, CSF along nerve root sleeves, and epidural fluid collections were noted on both studies with minor discrepancies. CSF collection along nerve root sleeves demonstrated by MR myelography was the most likely ongoing leakage site in comparison with CT myelography. Targeted epidural blood patches in both patients resulted in complete headache resolution. Non-invasive, non-contrasted and time-saving MR myelography is a promising study for patients with SIH. Further large-scale validation studies are needed.     

Increased plasma/serum levels of prolactin in systemic lupus erythematosus: a systematic review and meta-analysis

Background: Prolactin (PRL), a polypeptide hormone produced by the pituitary gland, is involved in the regulation of humoral and cell mediated immune responses. PRL levels have been investigated in several autoimmune diseases including systemic lupus erythematosus (SLE), however, yielded different and inconsistent results. This study aims to derive a more precise evaluation on plasma/serum PRL levels in SLE patients, as well as the potential influential factors.

Methods: Studies published from 1 January 1987 to 31 December 2015 in English, which comparing plasma/serum PRL levels between SLE group and control group were searched in PubMed, EMBASE and The Cochrane Library databases. Pooled standard mean difference (SMD) with 95% confidence interval (CI) was calculated by fixed-effects or random-effect model analysis. Heterogeneity test was performed by the Q statistic and quantified using I², publication bias was evaluated using a funnel plot and Egger’s linear regression test.

Results: Five-hundred and forty-seven articles were obtained after searching databases, and 12 studies with 429 SLE patients and 326 controls were finally included. Meta-analysis revealed that, compared with the control group, the SLE group had significantly higher plasma/serum PRL levels (P < 0.001), with the SMD of 1.26 and 95%CI (0.70,1.82). Subgroup analyses showed that SLE patients from Asia and Europe had higher plasma/serum PRL levels. However, no significant change in plasma/serum PRL levels was observed in SLE patients from America (P > 0.05).

Conclusions: Overall, our study suggests that SLE patients have higher plasma/serum PRL level, but with a regional difference.     

Usefulness of N-terminal pro-brain natriuretic peptide and C-reactive protein to predict ICU mortality in unselected medical ICU patients: a prospective, observational study

Introduction

The performance of N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) to predict clinical outcomes in ICU patients is unimpressive. We aimed to assess the prognostic value of NT-proBNP, CRP or the combination of both in unselected medical ICU patients.

Methods

A total of 576 consecutive patients were screened for eligibility and followed up during the ICU stay. We collected each patient's baseline characteristics including the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, NT-proBNP and CRP levels. The primary outcome was ICU mortality. Potential predictors were analyzed for possible association with outcomes. We also evaluated the ability of NT-proBNP and CRP additive to APACHE-II score to predict ICU mortality by calculation of C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices.

Results

Multiple regression revealed that CRP, NT-proBNP, APACHE-II score and fasting plasma glucose independently predicted ICU mortality (all P < 0.01). The C-index with respect to prediction of ICU mortality of APACHE II score (0.82 ± 0.02; P < 0.01) was greater than that of NT-proBNP (0.71 ± 0.03; P < 0.01) or CRP (0.65 ± 0.03; P < 0.01) (all P < 0.01). As compared with APACHE-II score (0.82 ± 0.02; P < 0.01), combination of CRP (0.83 ± 0.02; P < 0.01) or NT-proBNP (0.83 ± 0.02; P < 0.01) or both (0.84 ± 0.02; P < 0.01) with APACHE-II score did not significantly increase C-index for predicting ICU mortality (all P > 0.05). However, addition of NT-proBNP to APACHE-II score gave IDI of 6.6% (P = 0.003) and NRI of 16.6% (P = 0.007), addition of CRP to APACHE-II score provided IDI of 5.6% (P = 0.026) and NRI of 12.1% (P = 0.023), and addition of both markers to APACHE-II score yielded IDI of 7.5% (P = 0.002) and NRI of 17.9% (P = 0.002). In the cardiac subgroup (N = 213), NT-proBNP but not CRP independently predicted ICU mortality and addition of NT-proBNP to APACHE-II score obviously increased predictive ability (IDI = 10.2%, P = 0.018; NRI = 18.5%, P = 0.028). In the non-cardiac group (N = 363), CRP rather than NT-proBNP was an independent predictor of ICU mortality.

Conclusions

In unselected medical ICU patients, NT-proBNP and CRP can serve as independent predictors of ICU mortality and addition of NT-proBNP or CRP or both to APACHE-II score significantly improves the ability to predict ICU mortality. NT-proBNP appears to be useful for predicting ICU outcomes in cardiac patients.     

Respiratory stimulant effects of ethamivan and picrotoxin.

The respiratory stimulant effects of ethamivan and picrotoxin were studied in unanesthetized decerebrate cats. It was found that neither compound exhibited selective stimulant action on the respiratory neurons. Ethamivan evoked increases in respiratory rate but not in tidal volume, whereas picrotoxin profoundly altered both of these variables. The increases in respiratory rate evoked by ethamivan required intact vagus nerves since midcervical vagotomy abolished this effect. It is conceivable that ethamivan stimulated pulmonary chemoreflexes which then led to increased respiratory rate. Picrotoxin had no discernible effect on peripheral chemoreflexes. It altered, however, the central respiratory rhythmicity, or rate, depth and rhythm of respiration. There was a marked effect on central respiratory control which led to cycling between slow and deep, and rapid and shallow breathing. These were interspersed with periods of rapid and deep respiration.