快速康复外科理念在胰十二指肠切除术患者中的应用效果

目的探讨快速康复外科理念在胰十二指肠切除术患者中的应用效果。方法将2016年6月至2017年6月在医院接受胰十二指肠切除术的74例患者随机等分为观察组和对照组,观察组采用快速康复外科理念进行围手术期干预,对照组采用常规护理进行围手术期干预。对比两组患者手术时间、术中出血量、肛门排气时间、腹腔引流管拔除时间、术后1周血清C反应蛋白(CRP)、血清淀粉酶、总胆红素、谷丙转氨酶、住院时间、住院费用及术后并发症发生情况。结果与对照组比较,观察组手术时间及住院时间较短,术中出血量较少,住院费用较低,术后引流管拔除时间、肛门排气时间更早,术后1周CRP、血清淀粉酶、总胆红素、谷丙转氨酶水平更低,术后并发症发生率更低,差异均具有统计学意义(P 0. 05)。结论快速康复外科理念在胰十二指肠切除术围手术期应用,对于提高手术速度、减少患者出血、减轻创伤、促进术后康复、缩短住院时间、减少医疗费用方面均具有重要的临床意义,且术后并发症发生率也较低,安全有效,值得推广。     

“以人为本”理念在产妇产后护理中的应用效果

目的探讨"以人为本"理念在产妇产后护理中的应用效果。方法选取2018年8月至2019年8月本院收治的94例产妇作为研究对象,按照电脑数字表法将其随机分为对照组与试验组,各47例。对照组给予常规护理,试验组给予基于"以人为本"理念护理。比较两组产妇的产后并发症发生情况、干预前、后的自我护理能力测定量表(ESCA)、爱丁堡产后抑郁量表(EPDS)评分、护理满意度。结果试验组的产后并发症总发生率为4.26%,显著低于对照组的17.02%,差异具有统计学意义(P<0.05)。干预前,两组产妇的ESCA、EPDS评分比较,差异无统计学意义(P>0.05);干预后,两组的ESCA评分均升高,而EPDS评分均降低,且试验组优于对照组,差异具有统计学意义(P<0.05)。试验组的护理满意度为97.87%,显著高于对照组的80.85%,差异具有统计学意义(P<0.05)。结论"以人为本"理念可有效减少产妇产后并发症的发生,并改善其自我护理能力、产后抑郁情况,进而提升护理满意度,值得临床推广应用。     

Sudden cardiovascular death following myocardial infarction: the importance of left ventricular systolic dysfunction and congestive heart failure

BACKGROUND: To study the prognostic information of congestive heart failure (CHF) and left ventricular systolic dysfunction regarding sudden and non-sudden cardiovascular death (SCD and non-SCD) in patients with acute myocardial infarction (MI), as this may indicate the potential benefit of implantable defibrillators. METHODS: Data from consecutive patients with acute MI screened in 1990-92 for the TRAndolapril Cardiac Evaluation (TRACE) study were entered into a registry. A total of 5502 patients were alive 30 days after the MI and were followed for up to 4 years with respect to cause of death. SCD was defined as cardiovascular death within 1 h of onset of symptoms. An echocardiography was performed 1-6 days after the admission and evaluated centrally using the wall motion index (WMI). RESULTS: Half of the patients had CHF and 17% of the patients had WMI < or =1.0 (corresponding to an ejection fraction < or =0.30). During follow-up 431 patients died from SCD and 606 from non-SCD. The risk ratios for SCD and non-SCD associated with WMI < or =1.0 were 3.17 and 2.95, transient CHF 2.01 and 1.46, and permanent CHF 3.71 and 4.42, respectively. No risk factor was a specific marker of SCD or non-SCD. The 3-year probability of SCD was 7.9% for patients with transient CHF, 13.3% for permanent CHF, and 15.5% for WMI < or =1.0. CONCLUSIONS: CHF and low WMI identify a relevant proportion of patients with MI who are at high absolute risk of SCD. This study indicates the relevance of defibrillators in consecutive post-MI patients with left ventricular dysfunction or clinical signs of heart failure.     

Endobiliary brush biopsy: Intra- and interobserver variation in cytological evaluation of brushings from bile duct strictures

OBJECTIVE: Obtaining cytological specimens by wire-guided endobiliary brushing at the time of endoscopic retrograde cholangiopancreatography (ERCP) is a convenient way to reach a diagnosis. Sensitivity for malignant disease is generally around 50% and specificity around 100%. The present study was designed to assess the reproducibility of the cytological examination. MATERIAL AND METHODS: Samples were obtained from 55 consecutive patients with biliary duct strictures that eventually turned out to be caused by malignant disease in 41 patients (73%). The cytology specimens were evaluated twice in different random order with an interval of at least 4 months by two pathologists blinded to the final diagnoses. Suitability for diagnosis (suitable, suboptimal or unsuitable) and cytologic diagnosis (benign, atypical, suspicious for malignancy and malignant cells) were registered. Kappa analysis was applied. RESULTS: Regarding suitability for diagnosis, the two observers reproduced their findings in 84% (kappa 0.76) and 87% (0.59) (p>0.05), while the interobserver variations on the two occasions were 76% and 78% (kappa 0.49 and 0.58, respectively) (p>0.05). Five percent of samples were rated as inadequate for diagnosis in at least one reading; 18% were suboptimal and 62-82% were suitable. The observers reproduced their cytological diagnosis in 77% and 71% (weighted kappa 0.83 and 0.75) (p>0.05), and agreed on the cytological diagnosis in 65% and 73% (weighted kappa 0.65 and 0.75) (p>0.05). CONCLUSIONS: The intra- and interobserver agreement in cytological evaluation of endobiliary brushings from bile duct strictures is generally good. The rates of inadequate and suboptimal samples can probably be reduced by modifications of the brush design.     

Protein C pathway in infants and children

The protein C pathway comprises a major physiological anticoagulant system. Its major congenital defects, heterozygous deficiencies of protein C and protein S as well as activated protein C resistance due to G1691A mutated factor V (Factor V Leiden), are associated with pediatric venous thromboembolic disease. The protein C pathway is centrally involved in the control of both coagulation and inflammation during sepsis and other inflammatory conditions presenting with disseminated intravascular coagulation. This article reviews the physiology of the protein C pathway with special emphasis on pediatric aspects. Clinical implications of the protein C pathway defects in pediatric venous thromboembolism as well as acquired disturbances of protein C pathway during sepsis are discussed.     

Laminin isoforms in fetal and adult human adrenal cortex

Laminin has been proposed to influence the function of human adrenal cortex. We have studied the distribution of laminin (Ln) chains using immunofluorescence in human fetal and adult adrenal cortex. In the fetal gland Ln alpha2- and alpha5-chains were weakly expressed in the definitive zone, whereas Ln alpha4-, beta1-, and gamma1-chains occurred around vessels. In the adult gland, Ln alpha2-, alpha5-, and gamma1-chains were found in epithelial basement membranes (BM) in all cortical zones, Ln alpha4-chain in vessels, Ln beta1-chain in outer zone, and Ln beta2-chain in the two inner zones of the cortex, respectively. Among the integrins in adult gland, integrin alpha(3)-subunit was confined to basal surfaces of cortical cells, alpha(6) to vessels, alpha(1) to the stroma, and alpha(2) diffusely to epithelial cells. Lutheran glycoprotein and dystroglycan occurred in the fetal gland diffusely in the definitive zone and throughout the epithelium in the adult. The isoform composition of BM of the adult adrenal gland is distinct, with Ln-2 and -10 in BM of the outer zone and Ln-4 and -11 in BM of the two inner zones. The results suggest that integrin alpha(3)beta(1) and Lutheran are candidate receptors for Ln-10 and -11, whereas dystroglycan probably binds Ln-2 and -4.     

Natural resistance-associated macrophage protein 1 polymorphisms are associated with microscopy-positive tuberculosis

The natural resistance-associated macrophage protein 1 (NRAMP1) is implicated in the pathophysiology of mycobacterial infections. We investigated by polymerase chain reaction previously published Nramp1 genotypes at 4 loci-INT4, N543D, 3'UTR, and 5'(CA)(n) microsatellite markers-in 104 human immunodeficiency virus-negative patients with tuberculosis and 176 healthy control subjects living in Denmark. No significant difference in genotype frequency was found between white patients with tuberculosis and control subjects (P>.16), but carriage of Nramp1 variant alleles at loci INT4 and 5'(CA)(n) conferred a significantly increased risk of having microscopy-positive compared with microscopy-negative tuberculosis (65% vs. 35% [P=.0004] and 63% vs. 38% [P=.047], respectively). The Nramp1 alleles were not associated with increased risk for the development of cavities seen on chest radiographs, or with extrapulmonary tuberculosis. These results indicate that variant alleles in the Nramp1 gene are associated with increased mycobacterial replication rather than susceptibility for tuberculosis and may thus confer increased risk of severe disease.     

68例儿童恶性淋巴瘤临床病理分析

目的 探讨小儿恶性淋巴瘤的临床和病理特点。方法对68例经病理活检或免疫组化确诊的儿童恶性淋巴瘤患者的临床病理资料作回顾性分析。结果本组以非霍奇金淋巴瘤（NHL）与霍奇金淋巴瘤（HL）比例为1．83：1,发病年龄高峰为6—9岁,男女比例3．9：1。NHL主要以淋巴母细胞型、间变性大细胞型、弥漫性大B细胞型及Burldtt’s型枭见,以周围淋巴结肿大、纵隔和腹部包块、骨髓受累等为主要表现,临床分期以Ⅲ-Ⅳ期为主;HL主要以混合细胞型为主,大部分以颈淋巴结无痛性大为首发症状,可伴腹腔淋巴结、脾脏及骨髓浸润,临床分期以Ⅰ-Ⅱ期为主。结论儿童NHL的临床特点及病理学类型与成人存在差异,而HL病理类型与成人相似。     

Increased serum β2-microglobulin is associated with clinical and immunological markers of disease activity in systemic lupus erythematosus patients

The objective of this study was to explore the relationship between serum levels of β2-microglobulin (β2MG), which some studies suggest reflect disease activity in systemic lupus erythematosus (SLE), and various clinical and immunological markers of disease activity in SLE. Twenty-six SLE patients and 10 healthy controls were included. Disease activity was assessed by: SLEDAI, 24?hr-proteinuria, circulating levels of complement C3, anti-double-stranded DNA (anti-dsDNA), β2MG and various pro-inflammatory and anti-inflammatory cytokines (IL-6, IL-8, IL-10, IL-18) measured with a multiplex assay, IFN-α assessed with a reporter gene assay, and a combined expression score of 12 IFN-α inducible genes in peripheral blood mononuclear cells. Median serum levels of β2MG were significantly higher in SLE patients vs controls (2.8?mg/L, range: 1.1-21.6 and 1.2?mg/L, range: 0.9-1.7, respectively, p?相似文献   

《感爱nurse的爱抚》之十一——《罗伯特》

罗伯特因工作时被电击伤,出现休克,上肢严重烧伤,而于受伤当口被收治入院。我接班时,罗伯特的房间指示灯(即红灯)一直亮着。交班的责任护士告诉我:“他要止痛药。” 我是一个刚到这个内外科病室工作的注册护士。在接受工作安排后,我开始巡视我所管的病人。说实在的,我有点紧张,害怕见到我的第一个病人。我犹豫不决地推开了326E病房,映入我眼帘的正是罗伯特,一个36岁、已婚的电工。 罗伯特独自呆在病房里,他的眼神很专注,十分警觉,一副害怕的样子,不愿跟我说话 他的双手包扎着