1例全内脏反位子宫内膜癌患者围手术期护理

总结一例全内脏反位患者实施子宫内膜癌根治术的护理经过。在查阅文献基础上根据患者具体情况进行个性化护理措施。在护理过程中,针对患者全内脏反位的情况,针对性得给予围手术期护理措施,改变固定左右的思维,帮助患者安全渡过围手术期,顺利康复出院。     

The effects of a postural supporting “New Nesting Device” on early neurobehavioral development of premature infants

BackgroundExtended positioning is believed to have negative impacts on the neurodevelopment of the infants. Currently, many neonatal intensive care unit (NICU) in China do not have adequate posture supporting device for premature infants. Positional support has been done often by using bed sheet, washcloth or blanket. Inadequate posture support can hinder the neurobehavioral development of premature infants.PurposeThe study aims to compare the effects of neurobehavioral development outcomes between a “New Nesting Device” and a “Traditional-Nest” posture supporting interventions, for premature infants from NICU admission to 36th week of gestational age after birth.MethodsThe study followed the Quasi-experimental study design. A total of 95 participants were randomized to either a “New Nesting Device” group (n = 49) or “Traditional-Nest” group (n = 46) after admission. All participating premature infants were assessed at 34th and 36th weeks of gestational age, and posture, body movements and early neurobehavioral outcomes were measured. Posture and body movements were recorded once at 34th weeks and again at 36th weeks. Digital video camera was used at the bedside to record an uninterrupted 12-h-long session to obtain posture and behavioral data. All participating premature infants received aEEG and cranial ultrasonography examinations at bedside to evaluate early neurobehavioral outcomes when they reached 34th weeks and again 36th weeks of gestational age.ResultsThe “New Nesting Device” group had better effects on posture (p＜0.001 for both), and demonstrated more smooth body movements (p = 0.018, p＜0.001) than premature infants of the “Traditional-Nest” group at both 34th and 36th weeks of gestational age. The “New Nesting Device” group also captured higher frequencies of “sleep-wake cycling” (p = 0.049, p = 0.037) through aEEG examination compared to the “Traditional-Nest” group at 34th and 36th weeks of gestational age.Conclusions“New Nesting Device” can provide premature infants a comfortable posture support similar to the flex posture they had while in the uterus. Smooth body movements and non-extended extremities can promote early neurobehavioral development. This study demonstrates the effects of the newly designed posture support device on premature infants. It also introduced the features of the newly designed nesting device for clinical nurse to understand how the nesting device can enhance comfort and support the neurobehavioral development of premature infants.Implications for practice and researchFurther research is needed to determine the cost and long-term effect contribution to the overall neurobehavioral development of premature infants by continued use of this soothing posture support device after discharge from NICU. The study also provides reference for the selection of posture supporting intervention and outcome measurements for future similar clinical studies.     

茯苓-薏苡仁对慢性心力衰竭作用机制研究

目的:运用网络药理学研究茯苓-薏苡仁对慢性心力衰竭作用机制.方法:运用TCMSP数据库挖掘茯苓-薏苡仁有效成分及药物预测靶点,采用GeneCards、OMIM数据库检索CHF的疾病预测靶标,随后获取药物靶点-疾病靶标交集,使用Cytoscape3.8.2软件绘制"成分-靶点-疾病"网络,基于STRING数据库构建"药物-疾病"蛋白互作网络,并进行GO和KEGG生物信息学分析.结果:筛选后得到茯苓-薏苡仁有效成分24个,药物靶点367个,CHF疾病靶标10749个,构建药物靶点-疾病靶标交集25个,与CHF密切相关的GO富集条目75个,KEGG信号通路25条,主要涉及神经活性配体受体相互作用、钙信号通路、心肌细胞的肾上腺素能信号传导、cGMP-PKG信号通路、cAMP信号通路、甲状腺激素信号通路等.结论:茯苓-薏苡仁与CHF密切相关,能够通过多靶点、多通路协同发挥药效作用,可能是通过干预神经活性配体受体相互作用来达到的.     

可视防护喉镜的研发及在咽拭子采样中的应用

咽拭子培养作为筛查新型冠状病毒肺炎的重要方法,在急诊、发热门诊和感染科中应用广泛。医护人员在抗击新型冠状病毒肺炎的最前线,有诊治、护理患者的责任和义务,同时也面临着病毒感染的巨大风险。在咽拭子采样过程中,患者咳嗽等产生的飞沫可能会导致医护人员通过呼吸道感染病毒,增加职业暴露的危险[1-2]。可视喉镜具有光线可控、视野广、操作空间大等优点,在临床中可方便医护人员进行相关治疗操作[3-4]。     

Different effects of soil bacterial communities affected by biocontrol agent YH-07 on tomato Fusarium wilt inhibition

Bio-organic fertilizers based on biocontrol microorganisms have been widely applied to suppress soilborne diseases and improve crop yields. Studies on beneficial biocontrol agents have promoted the development of the bio-organic fertilizers in China. Our previous study demonstrated that a biocontrol agent, Erythrobacter sp. YH-07, can inhibit the growth of the plant pathogen Fusarium oxysporum. In the present study, we investigated the effects of this biocontrol agent on tomato wilt and used the illumina-based sequencing approach to characterize the variations in soil bacterial communities in a potted experiment. The aim of our study was to explore the potential correlation among bacterial communities, Fusarium wilt suppression, and soil properties after application of the biocontrol agent YH-07. The results showed that application of Erythrobacter sp. YH-07 effectively controlled outbreaks of tomato Fusarium wilt. The illumina MiSeq sequencing showed that Proteobacteria was the predominant phylum in the soil samples. Bacterial community composition and structure varied under different soil treatments, e.g., the relative abundance of Erythrobacter and Salinimicrobium was significantly increased in the YH treatment, and Acidobacteria were decreased in the YH treatment compared with the CK treatment. Additionally, the correlation results showed that the soil organic matter and available phosphorus and potassium were higher after YH-07 application, and they were positively correlated with bacterial community. The redundancy analysis showed Erythrobacter and Acidobacteria were the dominant genera after YH and CK treatments, respectively, and correlations with tomato Fusarium wilt incidence were negative and positive, respectively.

The model plant tomato was used to verify the effect and mechanism of a novel discovered strain YH-07 which is a potential agent for biological control of soil borne disease named tomato Fusarium wilt.     

LiDCOrapid监测下目标导向血流动力学管理对老年胃肠手术患者术后转归的影响

目的 观察LiDCOrapid监测下目标导向血流动力学管理对老年胃肠手术患者术后转归的影响。方法 选择2018年2月至2019年7月入住安徽中医药大学第一附属医院的90例胃肠手术患者,采用随机数字表法分为LiDCOrapid监测下目标导向血流动力学管理组（L组）与经验麻醉组（E组）,每组45例。L组采用LiDCOrapid监护仪监测心脏指数（CI）、每搏量变异率（SVV）,以SVV（≤ 12%）、CI[≥ 2.5 L/（min·m²）]、平均动脉压（维持在基础值±20%）为目标,调整补液和心血管药物的使用;E组仅凭医师临床经验实施血流动力学管理。记录术中血流动力学相关指标,以及术后恢复和相关并发症发生情况。结果 L组患者术中液体输注总量为（859.16±178.61）mL、尿量为（257.83±149.22）mL,均少于E组,差异有统计学意义（P<0.05）。L组患者术后拔管时间和麻醉苏醒室留观时间分别为（25.29±10.63）min和（40.44±10.12）min,短于E组,差异有统计学意义（P<0.05）。L组患者术后首次通气时间、住院时间分别为（4.35±1.47）d和（11.91±1.89）d,均短于E组,差异有统计学意义（P<0.05）。L组患者术后第24小时血乳酸为（0.86±0.29）mmol/L,低于E组,差异有统计学意义（P<0.05）。结论 LiDCOrapid监测下的目标导向血流动力学管理,能够减少老年胃肠手术患者术中输液总量,加快术后胃肠功能恢复,缩短住院时间。     

不孕症应用经阴道子宫输卵管四维超声造影检查 70例效果观察

目的观察经阴道子宫输卵管四维超声造影( TVS 4D?HyCoSy)检查在不孕症诊断中的应用效果。方法回顾性分析驻马店市中心医院 2018年 4月至 2019年 4月收治的女性不孕症病人 140例,将病人按检查方法的不同分为试验组和对照组,各 70例,对照组采用子宫输卵管碘油造影检查,试验组采用经阴道子宫输卵管四维超声造影检查,观察两组病人的子宫输卵管的通畅性,比较两组病人的诊断符合率。结果试验组病人的子宫输卵管检查符合率( 95.7%)及显像数( 68.75±3.64)个显著高于对照组病人的子宫输卵管检查符合率( 87.1%)及显像数( 62.13±4.57)个( P＜0.05)试验组病人实施阴道检查时所受阻力［(18.53±1.12)N比( 23.12±2.17)N］及液体反流次数明显低于对照组病人( P＜0.05)试验,组病人的不良反应发生率 1.4%明显低于对照组病人的不良反应发生率 10.0%,两组比较差异有统计学意义( P＜0.05)。结论,经阴道 TVS 4D?HyCoSy检查图像显示清晰,能准确反映子宫及输卵管的走向及形态结构,且 TVS 4D?HyCoSy检查方式便捷、无辐射、耗时短,在不孕症临床诊断中具有良好的应用价值。     

子宫腺瘤样瘤 67例临床病理分析

目的探讨子宫腺瘤样瘤(Adenomatoid Tumors,ATs)临床病理特征、免疫表型、鉴别诊断、治疗及预后。方法回顾性分析安徽医科大学附属妇幼保健院病理科 2012年 1月至 2018年 1月 67例子宫 ATs的临床特点、病理形态学及免疫表型特征,并复习相关文献。结果病人均为女性,年龄范围 24～64岁,中位年龄 39岁。肿瘤位于子宫浆膜下或肌壁间,其中 66例呈结节状(直径 1.0～8.0 cm),平均直径 2.7 cm,1例呈巨大囊实性(直径 12.0 cm)。肿块切面灰白,质韧,类似平滑肌瘤,与周围组织界限不清。肿瘤由大小不等的管腔或乳头状结构构成,被覆扁平或立方上皮细胞,呈单个或巢状分布于平滑肌组织之间。所有病例肿瘤细胞均无明显异型性,核分裂象罕见。免疫组织化学结果显示肿瘤细胞角蛋白广谱抗体(CKAE1/AE3)、钙网膜蛋白(Calretinin)、跨膜唾液酸糖蛋白(D2?40)、细胞角蛋白(CK5/6)的阳性率分别为 100.0%(67/67)、 100.0%(67/67)、 100.0%(67/ 67)、 19.4%(13/67)肿瘤增殖抗原(Ki?67)增殖指数低,约 1%～5%之间,高度糖基化的 i型跨膜糖蛋白(CD34)不表达。结论子宫 ATs是一种少见的,间叶来源的良性肿瘤,但组织学特征多样,尤其出现腺腔样结构难与腺癌相鉴别,结合镜下形态特点及免疫组化有助于提高诊断准确率,治疗以手术切除为主。     

84例抗凝药物致不良反应的帕累托图分析

目的： 分析抗凝药物不良反应（ADR）发生的规律、特点,探讨ADR发生与变化的可能原因及影响因素,为临床应用提供参考。方法： 对上海交通大学附属第一人民医院2012年1月-2018年12月上报至国家药品不良反应监测系统的84例抗凝药物所致ADR进行帕累托图分析。结果： 84例抗凝药物ADR报告中,男性比例较高为46例（54.76%）;60岁以上人群ADR发生例次较多,有62例（73.81%）;新的ADR报告4例（4.76%）,严重的ADR报告19例（22.62%）;发生ADR的抗凝药物共4个种类,其中低分子肝素类药物最多（41.84%）,其次为维生素K拮抗剂类（27.55%）;以血液系统损害最为常见（74.23%）;以药师上报为主。结论： 抗凝药物引发ADR与多种因素有关,临床用药时应全方位监控,以减少ADR的发生,确保用药安全。