加服米非司酮预防药物流产后蜕膜残留的临床疗效比较

目的 探究妇女加服不同剂量的米非司酮预防药物流产后蜕膜残留的临床疗效.方法 选取2016年1月至10月期间,我院收治的共1200例要求药物流产终止妊娠的妇女,随机将其分为对照组、A组、B组和C组,每组各300例.各组妇女药流后均予复方益母片5 d及头孢拉定3 d,同时A组妇女于排胚后第1 d早晚各加服米非司酮25 mg(共50 mg),B组妇女于排胚后第1~3 d早晚各加服米非司酮25 mg(共150 mg),C组妇女于排胚后第1~5 d早晚各加服米非司酮25 mg(共250 mg),对照组不服用.比较各组妇女行药流后蜕膜残留情况以及不良反应.结果 A组、B组和C组的总有效率明显要比对照组更好(P<0.05),同时,B组的总有效率与C组相当,均更优于A组(P<0.05),各组妇女均未出现不良反应.结论 行药流妇女可于排胚后第1~3 d早晚各加服米非司酮25 mg(共150 mg)能够有效减少药流后蜕膜残留,避免不良反应的发生,安全性较好.     

伤科洗方熏洗治疗软组织损伤的临床研究

目的：为了验证伤科洗方的最佳熏洗组合，改进伤科洗方剂型，探讨伤科洗方治疗软组织损伤的部分作用机理。方法：以本院门诊和住院软组织损伤病例120例被随机均分为6组，其中4个试验组(A组：熏洗时间30分 酒 浓缩剂；B组：熏洗时间30分 醋 散剂；C组：熏洗时间60分 酒 散剂；D组：熏洗时间60分 醋 浓缩剂。)和1个空白对照组(E组0．9％生理盐水)，1个最佳熏洗组合组(F组：由试验组得出)；试验组采用3因素2水平正交设计，分别进行熏洗治疗，每日1次，每连续7天为1个疗程，治疗后分别观察症状和体征，6—酮—前列腺素F1a和血栓素B2的变化。结果：最佳熏洗组合：熏洗时间60分 酒 浓缩剂，浓缩剂优于散剂；结论：伤科洗方治疗软组织损伤有临床效果。     

Cilazapril对高血压病患者左心舒张功能、细胞内钙和血管张素Ⅱ关系的影响

对26例原发性高血压（EHT）患者口服血管紧张素转换酶抑制剂（ACEI）Cilazapril2.5～5mg每日1次，治疗8周，观察治疗前后血压、左室舒张功能、淋巴细胞胞荣游离钙浓度［Ca2＋］、血浆血管紧张素Ⅱ浓度［AT1］的变化、结果提示：治疗后在血压降低的同时，［Ca2＋］i［AT1］显著降低，心脏舒张功能有显著改善，包括：舒张早期峰值流速（E）上升，心房收缩期的峰值流速（A）下降，E／A比值增高，舒张早期减速度（DC）上升，左室重量指数（LVMI）下降等，［Ca2＋］i、［AT1］的下降幅度分别与E／A、DC的改善幅度呈正相关，间接证明：ACEICilazapril可能通过减少AT1对心肌组织的影响及纠正心肌细胞钙超负荷状态这两种机理使心脏舒张功能改善。     

唑来膦酸在骨质疏松性椎体压缩骨折经皮椎体成形术后的临床应用

目的：通过对比研究,观察骨质疏松性椎体压缩骨折的患者在经皮椎体成形术后应用唑来膦酸的临床治疗效果。方法2010年7月至2013年2月,将中山市中医院骨一科240例椎体压缩性骨折行PVP手术治疗的患者随机分成两组,治疗组在术后3日予以静滴唑来膦酸针;对照组单纯予以椎体成形术。两组患者自入院起均予以口服碳酸钙／维生素D3片,600 mg／d。分别于术前1周及术后1月、3月、6月、9月、一年行腰椎骨密度、血清PINP及β－CTX浓度检查,并进行统计分析。结果随访1年,两组患者共240例获得随访,治疗后治疗组患者在VAS评分、腰椎骨密度、血清PINP及β－CTX浓度等的变化与对照组相比均具有显著性差异,且治疗组患者的依从性较好,新发椎体骨折少。结论唑来膦酸治疗骨质疏松性椎体压缩骨折可增加患者椎体骨密度、改善患者疼痛、预防新发椎体骨折、提高患者生活质量,可用于骨质疏松性椎体压缩骨折患者PVP术后的巩固治疗。     

The effect of simulation in improving students’ performance in laparoscopic surgery: a meta-analysis

Background

There is increasing interest in using simulators for laparoscopic surgery training, and simulators have rapidly become an integral part of surgical education.

Methods

We searched MEDLINE, EMBASE, Cochrane Library, and Google Scholar for randomized controlled studies that compared the use of different types of simulators. The inclusion criteria were peer-reviewed published randomized clinical trials that compared simulators versus standard apprenticeship surgical training of surgical trainees with little or no prior laparoscopic experience. Of the 551 relevant studies found, 17 trials fulfilled all inclusion criteria. The effect sizes (ES) with 95?% confidence intervals [CI] were calculated for multiple psychometric skill outcome measures.

Results

Data were combined by means of both fixed- and random-effects models. Meta-analytic combined effect size estimates showed that novice students who trained on simulators were superior in their performance and skill scores (d?=?1.98, 95?% CI: 1.20–2.77; P?<?0.01), were more careful in handling various body tissue (d?=?1.08, 95?% CI: 0.36–1.80; P?<?0.01), and had a higher accuracy score in conducting laparoscopic tasks (d?=?1.38, 95?% CI: 0.30–2.47; P?<?0.05).

Conclusion

Simulators have been shown to provide better laparoscopic surgery skills training for trainees than the traditional standard apprenticeship approach to skill development. Surgical residency programs are highly encouraged to adopt the use of simulators in teaching laparoscopic surgery skills to novice students.     

Elephant Endotheliotropic Herpesvirus 1, 4 and 5 in China: Occurrence in Multiple Sample Types and Implications for Wild and Captive Population Surveillance

Elephant endotheliotropic herpesviruses (EEHVs) are important causes of death in both captive and wild Asian elephants (Elephas maximus). Nothing is known about the prevalence of EEHVs in wild or domestic elephants in China. To determine if EEHVs are present in elephants in China, 126 wild elephants from three populations and 202 captive individuals from zoos (n = 155) and the Wild Elephant Valley (n = 47) were screened using semi-nested polymerase chain reaction assays with EEHV-redundant and EEHV1/4/5-specific primers. EEHV1B and EEHV4 were detected in samples from both wild (EEHV1B:8/126; EEHV4:2/126) and captive (EEHV1B:5/155; EEHV4:9/155) elephants, while EEHV1A (six cases) and EEHV5 (one case) were only present in the captive elephants from the Wild Elephant Valley. EEHV1 was detected in blood and trunk and oral swabs; EEHV4 was detected in trunk and oral swabs as well as feces; EEHV5 was found in trunk and oral swabs. No significant age or sex association with EEHV1A, EEHV1B, or EEHV5 positivity was observed. An age association with EEHV4 positivity was found, with all unweaned elephants being EEHV4 positive, but an association with the sex of the elephant was not observed. These findings represent the first documentation of EEHV presence in captive and wild elephants in China. These findings also document EEHV1B and EEHV4 shedding in feces and demonstrate the utility of fecal screening as a tool for investigating EEHV4 infection in wild populations of elephants. It is recommended that EEHV testing be included in surveillance programs for captive and wild elephants in China.     

儿科重症监护病房中影响机械通气成功的相关因素

目的 探讨儿科重症监护病房(PICU)中影响机械通气成功的相关因素。方法 将lll例行机械通气的危重病儿分成治疗成功组与失败组，对其相关因素进行回顾性分析。结果两组患儿在上机前危重病例评分、是否伴有心跳呼吸骤停和(或)休克及并发多系统器官功能衰竭(MODS)等方面差异有权显著意义(P＜0．001)；超过48h的机械通气患儿是否继发呼吸机相关肺炎(VAP)亦有显著意义(P＜0.05)。结论 PICU中影响机械通气成功率的因素主要是原发病的性质及严重程度，并与MODS与VAP有密切关系。     

影响医院开展产前教育相关因素的调查研究

我国孕产妇死亡者中74%未接受过任何保健服务,40%死于家中或送往医院的途中,而其中很重要的一点是作出就诊决定延误[1].     

宫颈癌术后带尿管出院患者家庭访视效果探讨

目的 探讨宫颈癌术后带尿管出院患者的家庭访视护理效果.方法 对30例宫颈癌术后带尿管出院患者于出院后3 d、残余尿量测量及拔除尿管、拔尿管后次日共3次访视患者,以了解患者的一般情况;指导患者正确进行外阴清洁、放尿、预防尿路感染,盆底肌肉锻炼,排尿训练;测量残余尿和拔除尿管等.结果 残余尿测量合格27例(90.0%),一次成功拔除尿管;3例顺延1周后测量残余尿合格,遂拔除尿管.30例均未发生泌尿系感染.访视后患者相关知识和技能掌握率较访视前显著提高(P＜0.05,P＜0.01),患者对家庭访视护理形式、服务态度及护理能力满意率为96.7%～100%.结论 家庭访视可促进宫颈癌术后患者自主排尿功能的恢复,是患者欢迎的护理服务形式.     

阿霉素导致兔血清肌钙蛋白T变化的实验研究

目的 观察逐渐增量注射阿霉素(ADR)对兔血清心肌肌钙蛋白T(cTnT)动态变化的影响,籍以了解ADR对心脏毒性的量效关系.方法 将新西兰兔18只,随机分成阿霉素(ADR)组(10只)和对照组(8只).ADR组每周从兔耳静脉注射ADR 1次(2mg/kg,用生理盐水配制成1mg/ml),共6次.对照组注射生理盐水.两组分别在第1、28、35、42天(ADR累积量为0、8、10、12 mg/kg)抽血检测cTnT.结果 当阿霉素的累积达到10mg/kg后,cTnT明显升高,且与ADR的累积量正相关(P＜0.005,r=0.79).结论 动态检测血清cTnT的变化可以反映阿霉素对心脏毒性的严重程度.