护理干预对减少小儿静脉留置针并发症的护理效果分析

目的探讨护理干预对减少小儿静脉置管并发症的护理效果。方法 100例应用静脉留置针输液患儿,随机分为观察组和对照组,每组50例。对照组患儿给予静脉留置针常规护理干预,观察组患儿给予综合性的静脉留置针护理干预措施。观察静脉留置针并发症发生情况。结果观察组患儿应用静脉留置针过程中导管脱出渗液发生共1例,发生率为2.0%;观察组患儿静脉炎发生2例,发生率为4.0%;观察组导管阻塞发生2例,发生率为4.0%;对照组患儿应用静脉留置针过程中导管脱出渗液发生共6例,发生率为12.0%;对照组患儿静脉炎发生7例,发生率为14.0%;对照组导管阻塞发生7例,发生率为14.0%。观察组患儿的导管脱出渗液发生率、静脉炎发生率、导管阻塞发生率均低于对照组,差异有统计学意义（P〈0.05）。结论护理干预对减少小儿静脉置管并发症的护理效果效果显著,值得借鉴。     

数据库加密技术

在信息化时代来临、 Internet高速发展的今天,信息资源的经济和社会价值越来越明显.而数据库系统所管理、存储的数据恰好是各个部门宝贵的信息资源.所以其安全保密性已成为目前所迫切需要解决的问题.本文从数据库安全性需求分析着手,首先对数据库安全与保密作出阐述并重点讨论数据库的加密技术.详细描述了数据库加密的基本流程特点、技术限制、加密对 DBMS的影响、加密方式以及数据库的加密方法.     

内蒙古乌海市良性乳腺疾病患病及危险因素分析

目的了解内蒙古乌海市女性患良性乳腺疾病情况及其危险因素,为明确高危人群、有效促进防治工作开展提供依据。方法2014年6-11月以多阶段复合抽样方法抽取乌海市6 553名成年女性,采用自填式健康问卷了解其患病情况,并由专业人员进行身高、体重等身体测量,采用t检验/χ²检验、多因素logistic回归方法对调查结果进行分析。结果乌海市成年女性良性乳腺疾病患病率为22.5%。多因素分析结果显示,相比<35岁者,35~44岁（OR=2.35,95%CI=1.96~2.82）、45~54岁（OR=2.52,95%CI=2.06~3.09）、55~65岁者（OR=1.78,95%CI=1.34~2.35）患病风险增高;相比初中及以下文化程度者,高中（OR=1.57,95%CI=1.29~1.91）、大学及以上者（OR=2.90,95%CI=2.39~3.51）患病风险增高;流产史为1次（OR=1.39,95%CI=1.19~1.62）、≥2次（OR=1.56,95%CI=1.32~1.85）者相比无流产史女性患病风险增高;而月经初潮年龄≥14岁（OR=0.79,95%CI=0.68~0.91）、不婚状态（OR=0.42,95%CI=0.29~0.63）可能为保护因素。结论为预防良性乳腺疾病发生,应加强乳腺疾病知识的宣传教育,缓解妇女压力,降低流产率,并定期筛查。     

运动对肿瘤康复及防治的探讨

近年来,恶性肿瘤已成为严重威胁人类生命健康的公共卫生问题,其发病率和病死率呈逐年上升趋势,已成为严重危害人类生命与健康的常见病。经常运动对健康的益处已经被临床医学领域所认可,合理的运动对肿瘤患者存在积极作用,可直接影响肿瘤的发病率和进展,降低肿瘤患者的复发率和病死率。本文重点综述了近年来国内外关于运动与肿瘤研究的最新进展,总结归纳了一些有关运动预防肿瘤发生、发展及促进肿瘤患者康复的研究,并对当前国内外提出的一些关于运动防治肿瘤的机制进行探讨,虽然其作用机制并不完全清楚,但可能与调整免疫、增加自由基的清除以及增加机体对胰岛素的敏感性等有关。本文还对肿瘤患者运动康复管理提出建议,如推荐肿瘤患者的运动类型、做好运动风险筛查与评估以及充分利用移动互联网技术等,全流程管理患者运动康复,提示使用运动疗法对肿瘤患者进行干预已成为医务人员的重要任务,为科学、合理地防治肿瘤、促进肿瘤患者的康复提供理论依据。     

腰椎间盘突出症的康复指导

腰椎间盘突出症主要是由于椎间盘病变纤维环破裂后髓核脱出,刺激或压迫脊神经根部的病症,临床以腰痛和坐骨神经痛为主要特征表现。     

慢性活动性EB病毒感染编码探讨

慢性活动性EB病毒感染作为一类难治性淋巴增殖性疾病,既往临床和疾病编码领域对之认识不清,相关编码准确性有待探讨。从临床背景着手,查找核对ICD-10和ICD-11的双编码,其难点在于主导词选择,基于定义和诊断标准,首先查找主导词“病”,进而根据提示转换查找主导词“肿瘤”、“免疫缺陷”,注意查验临床信息核对编码。根据患者是否存在遗传性免疫基因缺陷拟推荐两种编码思路,分别分类于肿瘤(ICD-10为D47.9,ICD-11为2B32.Y)或免疫缺陷疾病(ICD-10为D82.3,ICD-11为4A01.22),并需与普通EB病毒感染编码鉴别。该疾病的准确编码直接影响到DRG分组结果的真实性,编码员提高主导词选择技能、结合临床核对编码及合理运用ICD-11等编码工具将会是保证病案首页数据质量的重要前提和机遇。     

紫金龙氯仿-甲醇组分对脂多糖诱导RAW264.7细胞炎症的抑制作用

目的探讨紫金龙氯仿-甲醇组分对脂多糖诱导RAW264. 7细胞炎症的抑制作用。方法脂多糖刺激RAW264. 7细胞建立体外炎症模型后,加入不同质量浓度(50、100、200、400 mg/L)紫金龙氯仿-甲醇组分,ELISA法或比色法检测白介素-6 (IL-6)、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、一氧化氮(NO)、前列腺素E2(PGE2)含有量,Western blot法测定诱导型一氧化氮合酶(i NOS)、环氧化酶-2 (COX-2)蛋白表达,以及核转录因子κ转抑制蛋白α(IκBα)、p38丝裂原活化蛋白激酶(p38)、c-Jun氨基端激酶(JNK)、细胞外调节蛋白激酶1/2(Erk1/2)磷酸化水平。结果紫金龙氯仿-甲醇组分可显著抑制TNF-α、IL-6、IL-1β、NO、PGE2释放(P 0. 05,P 0. 01),下调i NOS、COX-2蛋白水平(P 0. 01),降低p38、JNK、Erk1/2、IκBα磷酸化水平(P 0. 05,P 0. 01)。结论紫金龙氯仿-甲醇组分可有效抑制脂多糖诱导RAW264. 7细胞炎症,其机制可能与抑制NF-κB、MAPKs信号通路激活、减少炎症因子释放有关。     

烧伤病房鲍氏不动杆菌耐药性趋势和同源性分析

Objective To monitor genotypes and drug-resistance trend of Acinetobacter baumannii (AB) isolated from burn wards. Methods Twenty-six strains of AB isolated from wound secretion, venous catheter, and blood were collected from burn patients hospitalized in our burn wards from November 2008 to February 2009, and June to September 2010. Homogeneous genotype analysis was performed with repetitive extragenic palindromic PCR, and drug-resistance rate to 13 antibiotics including amikacin, gentamicin, etc. , which were commonly used in clinic, was tested by K-B paper disk diffusion. The data of drugresistance rate were processed with chi-square test. Results ( 1 ) Sixteen AB strains were multi-drug resistant (MDR), 9 AB strains were pan-drug resistant (PDR). Among all strains, the resistance rate to gentamicin, piperacillin, piperacillin/tazobactam, cefuroxime, cefotaxime, ceftazidime, cefepime, ciprofloxacin, imipenem, and meropenem was respectively higher than 90.00%; the resistance rate against cefoperazone/sulbactam was the lowest (11/26, 42.31% ). There were obvious difference among the drug-resistance rates of AB strains to 13 antibiotics (with rates from 42.31% to 100.00% , x 2 = 97. 371, P ＜ 0.05 ). (2)There were 7 genotypes among 26 AB strains, respectively type A ( 17), type B (3), type C (2) , type D (1), type E (1), typeF (1), and typeG (1). Out of the 17 AB strains inAgenotype, 1 strain was from 2008, 1 strain was from 2009, 15 strains were from 2010, and among them 11 strains were collected from wound secretion and 6 strains were obtained from blood and venous catheter. Conclusions AB strains in A genotype are dominant in our burn wards in recent years, which are MDR or PDR to commonly used antibiotics. Cefoperazone/sulbactam is the drug of choice for burn patients with AB infection.     

烧伤患者鲍氏不动杆菌pgaABC基因簇表达及生物膜表型变化

Objective To observe expressions of pgaABC gene clusters and changes in biofilm (BF) phenotype in Acinetobacter baumannii (AB) isolated from burn patients. Methods From January 2009 to October 2010, 24 strains of AB isolated from burn patients hospitalized in our burn wards were collected for the study, while the standard strain ATCC 19606 was used as control. Expressions of pgaABC gene clusters were detected by real time fluorescence quantitative RT-PCR. All strains were cultured for 16 hours in vitro, BF with semi-quantitative detection was respectively evaluated by modified microtiter-plate test under stable condition and tube test under shaking condition for expression of absorbance value. All strains were cultured for 48 hours in vitro, then stained with fluorescent agent and collected for measurement of BF thickness with confocal laser scanning microscopy ( CLSM ). Data were processed with t test. Results ( 1 ) The expression of pgaB gene (27.91 ± 7.93 ) in clinical AB strains was much higher than that of standard strain ATCC 19606 (1.00, t = 5.77, P ＜ 0.05 ). There was no statistical difference in expression of pgaA and pagC genes between standard strain ATCC 19606 (1.00) and clinical AB strains (1.01 ± 0.28,1.15 ±0.38, with t value respectively 0.04, 0.64, P values all above 0.05). (2) After being cultured for 16 hours, BF of clinical AB strains cultured under shaking condition formed distinct "purple circle" , and its absorbance value ( 1.25 ±0.31 ) was higher than that in standard strain ATCC 19606 (0.76 ± 0.03, t =2.67, P ＜ 0.05 ). There was no obvious difference in absorbance value between clinical AB strains and standard strain ATCC19606 cultured under stable condition. (3) After being culture for 48 hours, green fluorescence intensity and distribution in extracellular matrix of clinical AB strains were stronger as compared with those of standard strain ATCC 19606, and BF thickness in clinical AB strains [(27.3 ± 9.4) μm] was thicker than that in standard strain ATCC 19606 [( 15.6 ± 1.7) μm, t = 2.09, P ＜ 0. 05]. Conclusions The high expression of pgaB gene in AB strains isolated from burn patients can induce production of extracellular matrix, which may be related to increase in the ability and thickness of BF formation.     

国产伊布利特治疗心房颤动和扑动的有效性及安全性系统评价

目的评价国产伊布利特与普罗帕酮对治疗心房颤动和扑动的有效性及安全性。方法计算机检索CBM(1978～2011.10)、VIP(1989～2011.10)、CNKI(1994～2011.10)和WanFang Data(1998～2011.10),查找所有有关国产伊布利特与普罗帕酮治疗心房颤动和扑动的临床随机对照试验(RCT)。对符合纳入标准的RCT,由两位评价员按Cochrane系统评价的方法,独立进行资料提取、质量评价并交叉核对后,采用RevMan 5.0软件对数据进行Meta分析。结果最终纳入16个研究,1 196例患者。Meta分析结果显示:与普罗帕酮相比,①在疗效方面:国产伊布利特90 min内、4 h及24 h内房颤、房扑总体转复率更高[OR分别为3.32、2.69、3.08,P均<0.0001],亚组分析结果显示90 min内房颤转复率及90 min内房扑转复率也更高,且差异有统计学意义;转复时间方面更短[MD=–25.12,95%CI(–30.43,–19.82),P<0.000 01];②在安全性方面,两者致心律失常发生率差异有统计学意义[OR=3.15,95%CI(1.97,5.05),P<0.000 01];其他不良反应发生率差异亦有统计学意义[OR=0.16,95%CI(0.08,0.33),P<0.000 01]。结论现有临床证据表明,国产伊布利特与普罗帕酮相比,其治疗房颤、房扑可取得较好疗效,能明显提高转复率,缩短转复时间,致心律失常发生较为常见。由于纳入研究方法学质量、样本量所限,该结论尚需大样本、高质量的随机对照试验进一步证实。