西部地区养老院护理现状分析及前景展望

[目的]对西部欠发达地区养老院护理现状进行调查分析。[方法]采用自制表格对老年公寓内老人进行问卷调查。[结果]内蒙古自治区赤峰市老年公寓现状统计,院内入住率达到95%,共入住180名老人,生活完全自理老人120人,养护员15名,与入住老人的比例为1∶12,远在全国平均水平之下。[结论]西部地区养老院护理主要需要在健康指导、心理护理和养护员培训方面有待提高。     

Appropriate radial clearance of ceramic-on-ceramic total hip prostheses to realize squeeze-film lubrication

OBJECTIVE: Estimation of appropriate radial clearance of ceramic-on-ceramic total hip prostheses to realize squeeze-film lubrication. BACKGROUND: Some clinical results show that severe wear occurs at ceramic-on-ceramic interfaces of total hip prostheses if the design parameters are improper. Appropriate design is required to realize the optimum lubrication of joint prostheses. DESIGN: Squeeze-film thickness of total hip prostheses with different radial clearances was numerically estimated under the physiological conditions of normal walking. METHODS: The changes in the fluid film thickness between ceramic balls and a ceramic cups with radial clearances of various values from 10 to 80 microm were numerically estimated under the assumption of normal walking conditions by means of elastohydrodynamic squeeze-film lubrication theory including the three-dimensional theory of elasticity. RESULTS: The minimum film thickness remained over 0.02 microm during a few walking steps with a radial clearance under 20 microm and a head diameter of 28 mm. On the other hand, the fluid film was squeezed out during a few steps when the radial clearance was greater than 30 microm. CONCLUSIONS: Squeeze-film lubrication can be realized in a ceramic-on-ceramic total hip prosthesis if the radial clearance is smaller than 20 microm on a head of 28 mm diameter. RELEVANCE: Fluid film lubrication is necessary to prevent the severe wear of ceramic joint prostheses. The present investigation shows which radial clearance of ceramic-on-ceramic hip prostheses is appropriate for squeeze-film lubrication under physiological conditions in daily action.     

Superficial Surgical Site Infection in Hepatobiliary-Pancreatic Surgery: Subcuticular Suture Versus Skin Staples

Purpose

Postoperative superficial surgical site infection is a major complication in hepatobiliary-pancreatic surgery. We aimed to compare the efficacy of subcuticular sutures versus staples for skin closure in preventing superficial surgical site infection in hepatobiliary-pancreatic surgery.

Methods

Consecutive patients who underwent hepatobiliary-pancreatic surgery at our hospital from October 2006 to March 2011 and from April 2012 to March 2015 were reviewed retrospectively. Superficial surgical site infection incidence was evaluated in patients who received subcuticular sutures and those who received staples for skin closure. Propensity score matching analysis was used to adjust bias from confounding factors.

Results

A total of 691 patients were included. Patients with skin staple closures (n?=?346) were compared with patients with subcuticular suture closures (n?=?345). After a propensity score matching analysis, a significant difference in superficial surgical site infection incidence was found between the skin stapler group (11.3%) and subcuticular sutures group (2.6%). The same comparison was performed by a subgroup analysis and supported this finding in patients after hepatectomy without biliary reconstruction, pancreatoduodenectomy, or open laparotomy surgeries and in patients with body mass index <?25.

Conclusions

Subcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.

     

Antibacterial properties of dermaseptin S4 derivatives with in vivo activity

Derivatives of the cytotoxic peptide dermaseptin S4 have recently emerged as potential antimicrobial agents. Here, we report on the antibacterial properties of three derivatives with improved toxicity profiles: a 28-residues K4K20-S4 and two shorter versions, K4-S4(1-16) and K4-S4(1-13). The range of MICs of K4K20-S4 against clinical isolates of Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli were, respectively, 1 to 4, 1 to 4, and 1 to 16 microg/ml. MICs of the short derivatives were rather similar or two to fourfold higher. Each of the three peptides was rapidly bactericidal in vitro, reducing the number of viable CFU of either E. coli or S. aureus by 6 log units in 30 min or less. Compared with MSI-78 or PG-1, K4-S4(1-13) was at least as potent against bacteria (assessed at two MIC multiples) but displayed lesser toxicity against human erythrocytes. Serial passage in subinhibitory concentrations led to emergence of resistance to commercial antibiotics but not to the L- or D isomer of either of the dermaseptin derivatives. The short derivatives were further investigated for antibacterial activity in vivo, using a peritonitis model of mice infected with P. aeruginosa. Naive mice in the vehicle control group exhibited 75% mortality, compared to 18 or 36% mortality in mice that received a single intraperitoneal injection (4.5 mg/kg) of K4-S4(1-16) or K4-S4(1-13), respectively. In vivo bactericidal activity was confirmed in neutropenic mice, where intraperitoneal administration of K4-S4(1-16) reduced the number of viable CFU in a dose-dependent manner by >3 log units within 1 h of exposure, and this was sustained for at least 5 h. Overall, the data suggest that dermaseptin S4 derivatives could be useful in treatment of infections, including infections caused by multidrug-resistant bacteria.     

An algorithm for the classification of mRNA patterns in eosinophilic esophagitis: Integration of machine learning

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beta2-adrenergic receptor stimulation-induced immunosuppressive effects possibly through down-regulation of co-stimulatory molecules, ICAM-1, CD40 and CD14 on monocytes

We examined the effects of beta2-adrenergic receptor (beta2-AR) agonists on the expression of co-stimulatory molecules on lipopolysaccharide (LPS)-stimulated human peripheral blood mononuclear cells. The study found that beta2-AR agonists inhibited the expression of intercellular adhesion molecule-1 (ICAM-1), CD40 and CD14 on monocytes, and that AR agonist activity was antagonized by the selective beta2-AR antagonist, butoxamine. The selective beta2-AR agonists salbutamol and terbutaline induced a similar co-stimulatory molecule expression pattern. The LPS-induced production of tumour necrosis factor-alpha was inhibited by AR agonists, and this was also antagonized by butoxamine, and mimicked by salbutamol and terbutaline. The AR agonists also inhibited T-cell proliferation through beta2-AR stimulation. This study clearly demonstrated that endogenous catecholamines elicited immunosuppressive effects through beta2-AR stimulation, possibly due to down-regulation of the expression of ICAM-1, CD40 and CD14 on monocytes. These results suggested that the sympathetic nervous system might regulate the T-helper cell balance via the peripheral end-effectors of the stress system.     

Cognitive and brain reserve in conversion and reversion in patients with mild cognitive impairment over 12 months of follow-up

Introduction: Two reserve hypotheses have been proposed to account for the observed disjunction between the degree of brain pathology and its clinical manifestations. This study investigated whether cognitive reserve (CR), taken here as educational attainment and premorbid IQ, or brain reserve (BR; i.e., brain volume) is associated with progression and regression in patients with mild cognitive impairment (MCI) over a 12-month follow-up. Method: Patients with MCI (n = 123) were prospectively enrolled. The Mini-Mental State Examination, the Japanese version of the Cognitive subscale of the Alzheimer’s Disease Assessment Scale, the Clinical Dementia Rating (CDR), the Frontal Assessment Battery, the Neuropsychiatric Inventory, magnetic resonance imaging (MRI), and quantitative single-photon emission computed tomography were performed at intake and again at 12-month follow-up. Patients were classified into three groups: no change, conversion, and reversion. Conversion was defined as a change in CDR from 0.5 to 1, and reversion as a change from 0.5 to 0. Results: Voxel-based morphometry MRI revealed no significant differences in entorhinal and hippocampal gray matter loss among the groups. Patients with reversion had higher premorbid IQ (p = .03, η_p² = .35) as measured by the Japanese version of the National Adult Reading Test, higher atrophy ratio (hippocampal volume/whole brain volume; p = .04, η_p² = .89) at baseline, and better cognitive performance (p < .001) during the 12-month follow-up than those with conversion did. There were no statistically significant differences among the three groups in terms of years of education. Conclusion: Multinomial logistic regression analysis revealed that higher CR contributed to protecting against cognitive decline during the 12-month follow-up, whereas higher BR at baseline was the strongest predictor for reversion and conversion.     

Intracranial EEG potentials estimated from MEG sources: A new approach to correlate MEG and iEEG data in epilepsy

Detection of epileptic spikes in MagnetoEncephaloGraphy (MEG) requires synchronized neuronal activity over a minimum of 4cm2. We previously validated the Maximum Entropy on the Mean (MEM) as a source localization able to recover the spatial extent of the epileptic spike generators. The purpose of this study was to evaluate quantitatively, using intracranial EEG (iEEG), the spatial extent recovered from MEG sources by estimating iEEG potentials generated by these MEG sources. We evaluated five patients with focal epilepsy who had a pre‐operative MEG acquisition and iEEG with MRI‐compatible electrodes. Individual MEG epileptic spikes were localized along the cortical surface segmented from a pre‐operative MRI, which was co‐registered with the MRI obtained with iEEG electrodes in place for identification of iEEG contacts. An iEEG forward model estimated the influence of every dipolar source of the cortical surface on each iEEG contact. This iEEG forward model was applied to MEG sources to estimate iEEG potentials that would have been generated by these sources. MEG‐estimated iEEG potentials were compared with measured iEEG potentials using four source localization methods: two variants of MEM and two standard methods equivalent to minimum norm and LORETA estimates. Our results demonstrated an excellent MEG/iEEG correspondence in the presumed focus for four out of five patients. In one patient, the deep generator identified in iEEG could not be localized in MEG. MEG‐estimated iEEG potentials is a promising method to evaluate which MEG sources could be retrieved and validated with iEEG data, providing accurate results especially when applied to MEM localizations. Hum Brain Mapp 37:1661–1683, 2016. © 2016 Wiley Periodicals, Inc .