冠心病患者的契约式健康教育

目的探讨提高冠心病患者健康教育效果的方法。方法将100例冠心病患者随机分为观察组与对照组各50例。对照组实施常规健康教育,主要采用口头宣教、健康教育处方、图文、示范教育等方法;观察组采用契约式健康教育,运用护患双方约定的契约方式进行健康教育。结果观察组健康教育效果显著优于对照组(P<0.01)。结论对冠心病患者采用契约式健康教育比常规方法更能提高健康教育效果。     

Reference output tracking control for a flexible air‐breathing hypersonic vehicle via output feedback

This paper addresses the problem of reference output tracking control for the longitudinal model of a flexible air‐breathing hypersonic vehicle (FAHV) by utilizing the output feedback control approach. The dynamic characteristics of the FAHV along with the aerodynamic effects of hypersonic flight make the flight control of such systems highly challenging. Moreover, there exist some intricate couplings between the engine and flight dynamics as well as complex interaction between rigid and flexible modes in the longitudinal model. These couplings bring difficulty to the flight control design for the intractable hypersonic vehicle systems. This paper deals with the problem of reference output tracking control for the longitudinal model of the FAHV. By utilizing the trim condition information including the state of altitude, velocity, angle of attack, pitch angle, pitch rate and so on, the linearized model is established for the control design objective. Then, the reference output velocity and altitude tracking control design problem is proposed for the linearized model. The flexible models of the FAHV system are hardly measured because of the complex dynamics and the strong couplings of the FAHV. Thus, by using only limited flexible model information, the reference output tracking performance analysis criteria are obtained via Lyapunov stability theory. Then, based on linear matrix inequality optimization algorithm, the static output feedback controller is designed to stabilize the closed‐loop systems, guarantee a certain bound for the closed‐loop value of the cost function, and can make the control output achieve the reference velocity and altitude tracking performance. Subsequently, the condition of dynamic output feedback controller synthesis is given in terms of linear matrix inequalities and a numerical algorithm is developed to search for a desired dynamic output feedback controller which minimizes the cost bound and obtains the excellent reference altitude and velocity tracking performance simultaneously. The effectiveness of the proposed reference output tracking control method is demonstrated in simulation part. Furthermore, the superior reference velocity and altitude performance commands could be achieved via using static and dynamic output feedback controllers under lacking some unmeasured flexible states information in the measurement output vector. Copyright © 2011 John Wiley & Sons, Ltd.     

Resveratrol induces apoptosis associated with mitochondrial dysfunction in bladder carcinoma cells

Objective: Resveratrol shows chemopreventive activity in a variety of human cancers by targeting mitochondria and triggering apoptosis. The purpose of this study was to investigate the antitumor action of resveratrol in bladder cancer and its underlying mechanism. Methods: Using two different bladder cell lines, BTT739 and T24, the cytotoxicity of resveratrol were determined by MTT assay. The apoptosis induced by resveratrol was assayed by transferase dUTP nick end labeling staining. To show whether the mitochondrial dysfunction involved in the effects of resveratrol, mitochondrial function was detected by mitochondrial membrane potential, reactive oxygen species production and adenosine 5′‐triphosphate content. In addition, the markers of apoptosis in the intrinsic mitochondrial‐dependent pathway were analyzed by the release of cytochrome c and the activities of caspase‐9 and caspase‐3. Results: Resveratrol effectively decreased cell viability and induced apoptosis in a concentration‐ and time‐dependent manner. In addition, resveratrol significantly disrupted the mitochondrial membrane potential in both intact cells and isolated mitochondria. Resveratrol also increased reactive oxygen species production and reduced adenosine 5′‐triphosphate concentrations. Western blot analysis showed that resveratrol provoked the release of cytochrome c from mitochondria to the cytosol. Furthermore, resveratrol significantly promoted the activation of caspase‐9 and caspase‐3.

Conclusions:

These findings suggest that resveratrol efficiently triggers apoptosis in bladder cancer cells through the intrinsic mitochondrial‐dependent pathway, which is associated with mitochondrial dysfunction. Resveratrol might have great pharmacological promise in the treatment of bladder cancer.     

The diagnostic accuracy of chromoendoscopy for dysplasia in ulcerative colitis: meta‐analysis of six randomized controlled trials

Aim The diagnostic accuracy of chromoendoscopy for dysplasia in ulcerative colitis (UC) was systematically evaluated. Method Original studies in any language were searched from PubMed and Embase. Meta‐analysis of prospective studies that compared chromoendoscopy with histological diagnosis was carried out. Sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each study and pooled together; summary receiver operating characteristic (ROC) and subgroup analyses were performed, while the quality of the study and heterogeneity were assessed. Results Six randomized controlled trials were included, which used methylene blue or indigo carmine dye spray. The meta‐analysis demonstrated a pooled sensitivity of 83.3% (95% confidence interval (CI), 35.9–99.6%), specificity of 91.3% (95% CI, 43.8–100%), and DOR of 17.544 (95% CI, 1.245–247.14). Subgroup analyses revealed that both the methylene blue dye spray subgroup and the unspecified endoscopist subgroup include the same studies, and their pooled sensitivity and specificity were 0.737 and 0.917, respectively. The other subgroup, which used indigo carmine dye spray, had overall higher sensitivity (0.930) and lower specificity (0.910). Conclusion Chromoendoscopy has medium to high sensitivity and a high diagnostic accuracy for dysplastic lesions in UC.     

Prostate‐specific antigen testing in older men in the USA: data from the behavioral risk factor surveillance system

Study Type – Diagnosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Previous studies from the USA reported that, in recent years, prostate cancer screening with PSA was very common among the elderly men, including those whose life expectancy was substantially limited by advanced age and known comorbidities. In 2008, the US Preventive Services Task Force (USPSTF) recommended against PSA screening after age 75. The purpose of this study was to examine the impact of the USPSTF 2008 recommendation on the frequency of PSA testing among elderly men in the USA. Our findings suggest that the USPSTF recommendation had no major impact on clinical practice.

OBJECTIVE

• ? To examine the frequency of PSA testing in men aged ≥75 years before and after the 2008 US Preventive Services Task Force (USPSTF) recommendation to stop prostate‐specific antigen (PSA) screening at age 75.

MATERIALS AND METHODS

• ? Data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) surveys completed in 2006, 2008 and 2010.
• ? Men aged ≥ 76 years at the time of survey and without a prostate cancer diagnosis were included in the study.
• ? The percentage of men who had a PSA test in the year before the survey was computed separately for survey years 2006, 2008 and 2010.

RESULTS

• ? The estimated percentages of men with a PSA test in the year before the survey were 60% (95% CI: 58–62%), based on 9033 respondents interviewed in 2006, 63% (95% CI: 62–65%), based on 12 063 respondents interviewed in 2008, and 60% (95% CI: 59–61%), based on 14 782 respondents interviewed in 2010.

CONCLUSION

• ? No substantial reduction in the frequency of PSA testing was observed in the BRFSS 2010 survey data compared with the earlier years, suggesting that the USPSTF 2008 recommendation had no major impact on the frequency of PSA testing in older men in the USA.

     

新疆某三级甲等医院护士长工作时间调查分析

目的了解护士长有效护理工时,为有效提高护理管理工作提供依据。方法用分层抽样法分别从内、外、妇、儿、重症监护病房和综合病区抽出10名护士长,通过10名经统一培训的调查员现场观察5个工作日和护士长自我记录法测量护士长有效护理工时。结果不同科室护士长日人均有效护理工时不同,最多为593.80min,最小为280.00min,多以直接护理工时为主。日人均耗时最长的前3个直接护理工作项目是床边交接班49.24min、巡视病房35.01min、护理质控30.22min,分别占总有效护理工时的11.94%、8.49%、7.33%。结论护士长直接护理工时大多超出间接护理工时,且工作范围超出了护理范畴。应合理分布有效护理工时,提高护理管理效率。     

Rictor-dependent AKT activation and inhibition of urothelial carcinoma by rapamycin

ObjectiveWe previously reported a very high cumulative incidence of urothelial carcinoma in Taiwanese kidney transplant recipients. Rapamycin, the inhibitor of mTOR Complex 1, provides alternative immunosuppressive therapy after kidney transplantation with less neoplastic potential. We examined the in vivo and in vitro effects of rapamycin on urothelial carcinoma.Materials and methodsThe rat model of urothelial carcinoma was induced by 0.05% N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) in Fischer F344 rats. The anti-tumor effect of rapamycin was assessed grossly, microscopically, and by Western blot analysis. The mechanism of rapamycin's attenuation of urothelial carcinoma was also evaluated by T24 cells.ResultsRapamycin significantly reduced urinary bladder tumor growth in the rat model of 0.05% BBN-induced urothelial carcinoma (P < 0.001). The blood trough levels of rapamycin were correlated with the occurrence of urothelial carcinoma. In vitro, rapamycin also inhibited the cell proliferation, migration, and invasion, as well as the protein expression of vascular endothelial growth factor-A of T24 urothelial carcinoma cells, whereas rapamycin did not induce significant apoptosis in T24 cells. Rapamycin decreased the expression of phospho-mTOR, phospho-S6K, cyclin D1, and VEGF-A. Rapamycin also activated AKT in T24 cells in the rat model of urothelial carcinoma. The rapamycin-associated activation of AKT was inhibited by rictor siRNA, but not raptor siRNA.ConclusionsThis study provides in vitro and in vivo evidence that rapamycin may inhibit the development of urothelial carcinoma. The present findings also suggest rictor-dependent AKT activation as a consequence of mTORC1 inhibition.     

Bivariate genome-wide association study suggests fatty acid desaturase genes and cadherin DCHS2 for variation of both compressive strength index and appendicular lean mass in males

Compressive strength index (CSI) is a newly established index for predicting hip fracture, the most serious consequence of osteoporosis. Appendicular lean mass (ALM), which influences skeletal strength of the lower limbs, is another trait associated with the risk of hip fracture. In this study, we performed a bivariate genome-wide association study (GWAS) to identify new candidate genes responsible for both CSI and ALM. In our discovery sample of 1627 unrelated Chinese subjects (802 males and 825 females), we scanned 909,509 SNPs using the Affymetrix Human Genome SNP 6.0 genotyping array. We successfully replicated our results in a sample of 2286 Caucasian subjects (558 males and 1728 females). The results indicated that five SNPs (rs174583, rs174577, rs174549, rs174548, rs7672337) in the FADS1, FADS2, and DCHS2 genes had significant bivariate associations with CSI and ALM in male subjects for both the GWAS discovery (with P < 8.42 × 10^? 6) and the Caucasian sample (with P < 0.07). We performed further replication analysis in a 2nd Caucasian sample with 501 Caucasian male subjects, using Affymetrix 500 k arrays, and found that two of the above SNPs (rs174548 and rs174549, P = 0.07) had bivariate associations with both CSI and ALM in males; the other 3 SNPs were not typed with the 500 k array. The above findings suggest that the 3 genes, FADS1, FADS2, and DCHS2, containing these SNPs might play dual roles influencing both CSI and ALM in males. Our findings provide new insights into our understanding of the genetic basis of bone metabolism and the pathogenesis of osteoporosis.     

A Parallel Domain Decomposition Algorithm for Simulating Blood Flow with Incompressible Navier-Stokes Equations with Resistive Boundary Condition

We introduce and study a parallel domain decomposition algorithm for the simulation of blood flow in compliant arteries using a fully-coupled system of nonlinear partial differential equations consisting of a linear elasticity equation and the incompressible Navier-Stokes equations with a resistive outflow boundary condition. The system is discretized with a finite element method on unstructured moving meshes and solved by a Newton-Krylov algorithm preconditioned with an overlapping restricted additive Schwarz method. The resistive outflow boundary condition plays an interesting role in the accuracy of the blood flow simulation and we provide a numerical comparison of its accuracy with the standard pressure type boundary condition. We also discuss the parallel performance of the implicit domain decomposition method for solving the fully coupled nonlinear system on a supercomputer with a few hundred processors.     

Possible interventional therapies in severe sepsis or septic shock

For many years, basic research with relatively straightforward pathophysiologic approaches has driven clinical trials using molecules that supposedly interfere positively with inflammatory processes. However, most of these trials have failed to demonstrate any outcome benefit. Indeed, we need to revisit current paradigms and to think about the possibility that outcome may be predetermined in severe sepsis or septic shock. In addition, an early diagnosis of sepsis prior to the onset of clinical decline is also of particular interest to health practitioners because this information increases the possibilities for early and specific treatment of this life threatening condition. Indeed, the time to initiate therapy is thought to be crucial and the major determent factor in surviving sepsis. Despite substantial progress in sepsis therapy, the gap between the discovery of new effective medical molecules and their implementation in the daily clinical practice of the intensive care unit remains a major hurdle. Fortunately, ongoing research continues to provide new information on the management of sepsis, in particular, severe sepsis or septic shock. High quality and effective management tools are necessary to bring evidence-based therapy to the bedside. On this basis, new therapies could be tested to reduce mortality rates with respect to recently published studies.