Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

Background:

Pelvic and acetabular fractures have been known as one of the high risk factors for developing deep vein thrombosis (DVT), but thromboprophylaxis for patients with such fractures remains underused despite its widely accepted benefits. Current guidelines have not been universally adopted in clinical practice. The purpose of this study is to introduce a Thrombotic Risk Assessment Questionary (assessment table) according to evidence-based guidelines and evaluate its impact on the use of thromboprophylaxis for patients with pelvic and acetabular fractures.

Materials and Methods:

We retrospectively reviewed 305 consecutive patients with pelvic and acetabular fractures from August 1, 2008 through September 30, 2010. The control group without using the assessment table included 153 patients admitted during the first 13 months, and the assessment group using the assessment table included 152 patients admitted during the following months. Data on clinical outcomes of DVT, the number of patients receiving prophylaxis, and the time of the first dose of anticoagulant were collected.

Results:

Compared with the control group, Patients using the assessment table were more likely to be given DVT prophylaxis (84.2% vs. 37.3%, P < 0.05) and the time of the first dose of anticoagulant was reduced (4.32 days ± 4.78 days vs. 6.6 days ± 5.96 days, P < 0.05). Patients in the assessment group had lower risk of developing DVT (8.6% vs. 20.3%, P < 0.05).

Conclusion:

The assessment table can significantly improve the use of thromboprophylaxis after pelvic and acetabular fractures, which will likely reduce the incidence of DVT. Developing individual hospital prophylaxis strategy is an effective way to determine whether hospitalized patients should receive pharmacologic and/or mechanical prophylaxis or not.     

经脐单一切口腹腔镜胆囊切除术：附35例报告

目的探讨经脐单一切口腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的可行性及安全性。方法2010年3月～2011年8月行经脐单一切口LC 35例。脐孔左缘做弧形3 cm开放切口,置入2.5 cm三通转换器,经三通转换器中孔置入5 mm腹腔镜,右孔置入10 mm弯曲操作钳作为主操作孔,左孔置入5 mm弯曲操作钳作辅助操作孔。解剖分离胆囊动脉、胆囊管,钛夹或可吸收夹处理胆囊管及胆囊动脉。将胆囊自肝床分离,切除胆囊,自3cm开放切口取出胆囊。结果2例因胆囊颈部结石嵌顿,胆囊三角解剖困难,中转开腹;33例顺利完成LC。手术时间45～125 min,平均65 min。术中出血量5～200 ml,平均20 ml。35例随访3～20个月,平均10个月,无术后大出血、胆漏等并发症发生。结论经脐单一切口LC操作可行、安全,美容效果明显。     

A型肉毒毒素治疗痉挛型脑性瘫痪患儿的护理

目的总结A型肉毒毒素治疗94例痉挛型脑瘫患儿的护理方法。方法在A型肉毒毒素治疗中实施相应的护理措施:注射前做好宣教、患儿的准备及药物的配制工作;注射中熟练配合医生,对患儿予以心理护理;注射后观察患儿反应,指导患儿在药效持续期继续康复训练。结果患儿均顺利完成A型肉毒毒素注射治疗,56例痉挛明显缓解,38例痉挛部分缓解,取得了预期治疗效果。结论积极有效的护理配合,保证肉毒毒素治疗顺利完成对促进脑瘫患儿的康复起着重要作用。     

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。