出血中心重症监护室护理建设专家共识

【摘要】 本共识从护理管理层面对出血中心重症监护室硬件设施的配备需求、组织架构层级与人力配备原则、专科应急预案与规范化急救护理评估与处置流程、管理制度修订、人文关怀及质量控制措施与落实等方面进行了初步论述,并提出14条推荐意见,供各医疗单位参考,以推进出血中心重症监护室的标准化建设, 提高危急重症出血患者的救治成功率,促进患者康复。     

创伤性脾出血介入治疗专家共识

【摘要】 提出创伤性脾出血的诊疗流程,阐述创伤性脾出血的急救、内科治疗、介入治疗和外科治疗。对脾动脉栓塞术治疗创伤性脾出血的适应证和禁忌证、介入治疗操作步骤、血管栓塞注意事项和并发症防治进行归纳和说明。     

新型冠状病毒肺炎中医康复专家共识(第一版)

为了有效减轻新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者的症状、提高出院率及促进出院后身心健康的全面恢复,世界中医药学会联合会肺康复专业委员会和中国民族医药学会肺病分会组织专家,参照国际上公认的共识形成方法,制订了《新型冠状病毒肺炎中医康复专家共识》(第一版),其主要内容包括功法训练(八段锦、简式太极拳、呼吸导引和六字诀)、针刺与灸法(针刺、艾灸、耳针和穴位贴敷)、推拿/按摩(穴位按摩、经络推拿)、刮痧、拔罐、膳食指导和情志疗法,并介绍了推荐要点及证据概述。为中医康复技术在COVID-19治疗中的合理选择及规范应用提供了参考。     

脾修补或部分切除治疗脾破裂

目的经修补或部分切除脾脏而保脾;方法从1993年5月～2003年1月我们用明胶海棉夹凝血酶填塞创口褥式缝合或脾部分切除治疗脾破裂,创面用双极电凝协助止血;结果50例经上述方法治疗成功,全部或部分保留了脾脏;结论此手术方法可行,保全了脾脏功能.     

产前超声对胎儿畸形的诊断价值

目的探讨产前超声对胎儿畸形的诊断价值,分析误诊、漏诊原因,以提高胎儿畸形的检出率。方法使用GE公司VOLUSON730Expert超声诊断仪,探头频率2~7MHz,经腹部多切面超声检查。本组胎儿均接受常规产前超声检查,随访引产或分娩后的结果,并与产前超声诊断进行对比分析。结果25例胎儿畸形中,产前超声准确诊断23例,诊断符合率为92%。1例大动脉转位漏诊,1例胎粪性腹膜炎误诊为肠梗阻。结论产前超声检查简便、无创,能早期发现胎儿畸形,是产前诊断的重要方法。     

Significance of Histological Response to Preoperative Chemoradiotherapy for Pancreatic Cancer

Background Neoadjuvant (preoperative) chemoradiotherapy (CRT) for pancreatic cancer offers theoretical advantages over the standard approach of surgery followed by adjuvant CRT. We hypothesized that histological responses to CRT would be significant prognostic factors in patients undergoing neoadjuvant CRT followed by resection. Methods Since 1994, 193 patients with biopsy-proven pancreatic adenocarcinoma have completed neoadjuvant CRT, and 70 patients have undergone resection. Specimens were retrospectively examined by an individual pathologist for histological responses (tumor necrosis, tumor fibrosis, and residual tumor load) and immunohistochemical staining for p53 and epidermal growth factor receptor. Factors influencing overall survival were analyzed with the Kaplan-Meier (univariate) and Cox proportional hazards (multivariate) methods.Results The estimated overall survival (median±SE) in the entire group of patients undergoing resection was 23±4.2 months, with an estimated 3-year survival of 37%±6.6% and a median follow-up of 28 months. Complete histological responses occurred in 6% of patients. Overexpression of p53 was more common in patients with large residual tumor loads. Tumor necrosis was an independent negative prognostic factor, as were positive lymph nodes, a large residual tumor load, and poor tumor differentiation.Conclusions Histological response to neoadjuvant CRT—as measured by residual tumor load—may be useful as a surrogate marker for treatment efficacy. Characterization of the tumor cells that survive neoadjuvant CRT may help us to identify new or more appropriate targets for systemic therapy.     

Anger Mediates the Relation Between Violence Exposure and Violence Perpetration in Incarcerated Boys

Youth who are exposed to violence are more likely to perpetrate violence. Incarcerated youth are a special population that is at a significantly greater risk for violent offending because of their relatively greater rates of violence exposure. Two important outcomes of violence exposure that may help explain its link with violence perpetration are posttraumatic stress disorder and problematic anger. The primary aim of the current study is to examine whether these important risk factors mediate the relation between two types of violence exposure (i.e., witnessing and victimization) and various types of violence perpetration in a sample of 373 incarcerated male adolescent offenders. A second aim is to test whether another well-established correlate of violence in youth, callous-unemotional (CU) traits (lack of empathy, guilt), adds unique variance beyond violence exposure, anger, and PTSD symptomatology. Findings suggest that anger is a robust predictor of violence and appears to at least partially act as the mechanism through which violence exposure is linked with violence perpetration. CU traits also contribute unique variance, beyond the significant effect of anger, to the statistical prediction of community, but not institutional, violence.     

Outcome of treated pregnancies in women with antiphospholipid syndrome: an update of the Utah experience.

OBJECTIVE: To determine the outcome of treated pregnancies in women with well-characterized antiphospholipid syndrome. METHODS: We reviewed 82 consecutive pregnancies in 54 women with antiphospholipid syndrome who were treated during pregnancy with the following: 1) prednisone and low-dose aspirin; 2) heparin and low-dose aspirin; 3) prednisone, heparin, and low-dose aspirin; or 4) other combinations of these medications or immunoglobulin. RESULTS: The overall neonatal survival rate was 73%, excluding spontaneous abortions, but treatment failures (fetal and neonatal deaths) occurred in all treatment groups. Patients with successful treated pregnancies had fewer previous fetal deaths than those with unsuccessful treated pregnancies. There were no significant differences in outcome among the four treatment groups. Preeclampsia and fetal distress occurred in half of all pregnancies, and fetal growth impairment occurred in nearly one-third. Preterm delivery due to maternal or fetal indications was required in 37% of the pregnancies. Four pregnancies were also complicated by postpartum thrombosis during treatment. CONCLUSIONS: Pregnancy in women with antiphospholipid syndrome appears to be improved by treatment, but fetal loss may occur despite treatment. Preeclampsia, fetal distress, fetal growth impairment, and premature delivery are common. Because of the clinically significant risk of thrombotic episodes, thrombosis prophylaxis should be considered in these patients.