恒速滴注法在高龄卧床管饲患者中的应用效果

目的探讨恒速滴注法在高龄卧床管饲患者中的应用效果。方法2010年5月至2011年8月，方便性抽样选择在解放军总医院住院治疗的携带鼻胃管或鼻肠管行胃肠营养的老年患者60例，按入院先后分为观察组和对照组各30例，观察组采用恒速滴注法管饲肠内营养乳剂，对照组采用常规管饲方法即分次推注法，观察并比较两组患者堵管、腹胀、腹泻、反流、误吸等并发症的发生率。结果观察组患者发生堵管、反流及误吸的例数均少于对照组，差异均有统计学意义（均P〈0．05）；发生腹胀与腹泻的例数与对照组比较，差异无统计学意义（均P〉0．05）。结论恒速滴注法肠内营养可有效满足高龄长期卧床患者的营养需求，预防和减少并发症的发生，推荐在临床广泛应用。     

综合护理干预对慢性胃炎及消化性溃疡患者生活质量的影响

目的探讨综合护理干预对慢性胃炎及消化性溃疡患者生活质量的影响。方法 98例慢性胃炎及消化性溃疡患者按照随机数字表法分为观察组与对照组两组各49例,对照组患者给予消化内科常规护理,观察组患者给予综合护理措施,比较两组患者的临床疗效和生活质量。结果观察组患者的临床治疗总有效率及生活质量量表(SF-36)评分均高于对照组,两组相比差异均有统计学意义(均P0.05)。结论对慢性胃炎及消化性溃疡患者实施综合护理干预措施能改善患者的生活质量,提高临床治疗效果,值得临床推广应用。     

合肥市某医院住院医嘱不合理用药分析评价

目的了解合肥市某医院临床用药情况,分析存在的问题,促进临床合理用药。方法依据药品说明书、《新编药物学》等资料,对临床科室下达的针剂医嘱单进行审核,采取回顾性分析方法,对不合理使用情况进行统计分析。结果该医院2012年1月至2013年12月共统计不合理用药医嘱621条,类型分别为用量不合理、给药频次不合理、溶媒选择不合理、给药途经不合理、超说明书用法和重复给药6类。其中,用量不合理343条,占不合理用药比例55.23%,为主要不合理医嘱类型;给药频次不合理135条,比例为21.74%;溶媒不合理56条,比例为9.02%;给药途径不合理53条,比例8.53%;超说明书用法为33条,比例为5.31%;重复给药只有1例,比例仅为0.17%。结论该院临床用药存在不合理现象,基本反映住院医师针剂医嘱下达过程普遍存在的问题,需要进一步规范。     

一体化TOF-PET/MR的临床应用与挑战

精准化医疗是现代医学发展的趋势,而反映生命过程不同侧面信息的多模态影像学技术是实现精准化医疗的必要条件。PET及MRI的出现推动了多模态影像学的发展,特别是一体化TOF-PET/MR,可克服PET探测器与MRI强磁场相互干扰的技术难题、实现时间和空间上的同步扫描,对于从结构、功能、分子代谢等方面探索疾病的发生、发展及诊断具有重要意义。TOF技术有助于提高PET图像质量,降低假阳性或假阴性。本文就一体化TOF-PET/MR的临床应用及其面临的挑战进行综述。     

社会支持和应对方式对创伤性颅脑损伤患者家属的压力和心理健康的影响(英文)

目的：探讨社会支持和应对方式对创伤性脑损伤患者家属的压力与心理健康之间的影响。方法：采用 家属应激量表、症状自评量表、社会支持评定量表和简易应对方式量表对长沙300名创伤性脑损伤患者家属进行测 量。结果：创伤性脑损伤患者家属的心理问题与较高的应激水平、更多的消极应对、更少的积极应对和社会支持密 切相关。除家属的应激与心理问题直接相关外,应对方式和社会支持也起到了中介作用。这些因素的中介效应为 23.6%~43.0%,社会支持的中介效应要大于应对方式。结论：在对创伤性脑损伤患者家属进行心理护理时,应考虑社 会支持和应对方式的作用,以便预防和调节家属的心理问题,从而促进患者的治疗与康复。     

ω-3多不饱和脂肪酸对严重烧伤患者心肌功能的影响

目的 观察ω-3多不饱和脂肪酸(ω-3 PUFA)对严重烧伤患者心肌功能的影响。 方法 将2013年1月至2014年12月安徽医科大学第一附属医院烧伤科收治且符合纳入标准的24例危重患者随机分为两组。对照组12例为常规治疗的基础上使用20%中长链脂肪乳治疗,治疗组12例为常规治疗基础上使用ω-3 PUFA,均持续使用7 d。留取治疗前及治疗后1、4、7 d静脉血,并检测TNF-α、IL-6、cTnI、NF-κBp65值。对统计资料进行析因方差分析。 结果 治疗后,治疗组与对照组血标本中TNF-α、IL-6、cTnI、NF-κBp65值水平均较治疗前均降低,且治疗后,治疗组TNF-α、IL-6、cTnI、NF-κBp65值水平均明显低于对照组,差异有统计学意义(P <0.01)。 结论 ω-3 PUFA可改善严重烧伤患者心肌功能。     

Synthesis of High‐Molecular‐Weight Brush Polymers via RAFT Polymerization within the Micellar Nanoreactor of a PEG‐Based Macromonomer

The RAFT polymerization of an amphipathic PEG‐based macromonomer (mPEG‐g‐S) in water is performed. It is found that the polymerization proceeds via a micellar polymerization process. The polymerization kinetics, polymer chain extension, and polymer particle evolution of RAFT micellar polymerization are evaluated. It is demonstrated that the polymerization possesses a fast rate and high monomer conversion due to locally concentrating and orienting the hydrophobic polymerizing groups within the micellar nanoreactor. Moreover, the RAFT micellar polymerization is under good control since the polydispersity index (PDI) value of the synthesized brush copolymer is below 1.3 in most cases, even under polymerization conditions with the ratio of RAFT agent to macromonomer at 1:400. Polymerization leads to the formation of a completely grafted brush copolymer, and the as‐synthesized brush copolymer will self‐assemble into spherical particles during the polymerization process. This strategy is anticipated to be an efficient way for the controlled synthesis of completely grafted brush polymers with high molecular weights and their corresponding self‐assembled particles.

     

Propafenone-mexiletine combination for the treatment of sustained ventricular tachycardia.

OBJECTIVES. The purpose of this study was to explore the efficacy of combined therapy with propafenone and mexiletine for control of sustained ventricular tachycardia. BACKGROUND. Combination antiarrhythmic drug therapy may enhance efficacy and lead to control of ventricular arrhythmias in some patients. Few reports have studied the combination of class IB and class IC drugs. Thus, this study was designed to investigate a combination of mexiletine and propafenone in patients with refractory ventricular tachycardia. METHODS. Sixteen patients with sustained ventricular tachycardia had their clinical arrhythmia induced by programmed stimulation. Procainamide and propafenone alone failed to prevent reinduction of tachycardia in all. Mexiletine was subsequently added to propafenone and programmed stimulation was repeated. RESULTS. With combination therapy ventricular tachycardia was noninducible in three patients (19%). A fourth who had presented with polymorphic ventricular tachycardia had slow bundle branch reentry (cycle length 500 ms) induced. In the other 12, tachycardia cycle length increased from 262 +/- 60 ms at baseline to 350 +/- 82 ms with propafenone and to 390 +/- 80 ms with propafenone plus mexiletine (p less than 0.0001 compared with baseline). Hemodynamic deterioration requiring defibrillation occurred in six patients at baseline study, in five taking propafenone and in two taking both drugs. CONCLUSIONS. The combination of propafenone and mexiletine is effective in suppressing the induction of ventricular tachycardia in some patients refractory to procainamide and propafenone alone. In those in whom ventricular tachycardia could still be induced, the rate was slower and hemodynamically tolerated.     

Improvement of high-glucose and insulin resistance of chromium malate in 3T3-L1 adipocytes by glucose uptake and insulin sensitivity signaling pathways and its mechanism

Previous study has revealed that chromium malate could improve insulin resistance and the regulation of fasting blood glucose in type 2 diabetic rats. This study was designed to investigate the effect of chromium malate on hypoglycemic and improve insulin resistance activities in 3T3-L1 adipocytes with insulin resistance and investigate the acting mechanism. The result indicated that chromium malate exhibited direct hypoglycemic activity in vitro. Compared with the model group, chromium malate could significantly promote the expression levels of GLUT-4, Akt, Irs-1, PPARγ, PI3K and p38-MAPK and their mRNA, increase p-AKT/AKT level, AKT and AMPKβ1 phosphorylation and reduce Irs-1 phosphorylation and p-Irs-1/Irs-1 level in 3T3-L1 adipocytes (p < 0.05). Chromium malate is more effective in regulating the proteins and mRNA expressions than those of chromium trichloride and chromium picolinate. Compared to the model group, pretreatment with the specific p38-MAPK inhibitor completely inhibited the GLUT-4 and Irs-1 proteins and mRNA expressions induced by the chromium malate. In conclusion, chromium malate had a beneficial influence on improvement of controlling glucose levels and insulin resistance in 3T3-L1 adipocytes with insulin resistance by regulating proteins productions and genes expressions in glucose uptake and insulin sensitivity signaling pathways.

Chromium malate could increase the related protein and mRNA levels in 3T3-L1 adipocytes with insulin resistant. Pretreatment with the inhibitor completely/partially inhibited the GLUT-4 and Irs-1 proteins and mRNA expression compared to model group.