Venous thrombosis: clinical and experimental MR imaging

Five venous thrombi were induced in the external jugular veins of three laboratory dogs, and were repeatedly imaged over 3 weeks using a 0.35-T magnetic resonance (MR) imager. MR magnitude and phase images, T1 and T2 relaxation times, venography, and histologic sections of these thrombi were evaluated to determine the changes in appearance on MR images with time. Venous thrombi appeared hyperintense compared with muscle on both relatively T1- and T2-weighted spin-echo sequences regardless of the age of the clot. Organization of the thrombus beyond 1 week was manifested as increased prominence of flow signal void in and around the clot. Distinction between intraluminal thrombus and flow-related artifacts was aided by phase image reconstruction. Nineteen venous thrombi locations in 13 patients revealed an MR appearance similar to that of the experimental animal model. Three patients (six thrombi locations) had serial examinations over 4 weeks. No significant change in thrombus signal characteristics was noted with time. It is concluded that MR imaging at 0.35 T cannot be used to predict the age of thrombus (up to 3 weeks) but may be helpful in following its resolution.     

Measurement of fat digestion in early life using a stable isotope breath test

13C breath tests are a safe, non-invasive way of assessing nutrient digestion and absorption that can be used repeatedly in infancy and childhood. The aim of this study was to assess their value for measuring fat digestion in infants and young children with cystic fibrosis, and healthy controls whose pancreatic exocrine function is immature, and to monitor pancreatic enzyme supplementation. Six infants with cystic fibrosis (aged 10-18 months) and nine healthy controls (aged 6-19 months) were studied. After an overnight fast each child ingested 7.5 mg/kg 13C trioctanoin (99 atom % excess) followed by a known volume of milk. Breath samples were collected before and at 30 minute intervals thereafter for five hours. The 13C enrichment of expired carbon dioxide was measured by gas isotope ratio mass spectrometry. The mean (SD) percentage dose recovery of 13C was 13.5 (5.3) for the cystic fibrosis group and 24.2 (6.7) for the healthy controls. When those with cystic fibrosis were studied after supplementary pancreatic enzymes, the mean percentage dose recovery rose to 17.1 (6.9). Total intraluminal lipolysis was diminished by 44% in young children with cystic fibrosis. Pancreatic enzyme supplements improved digestion by 27%. The 13C trioctanoin breath test was effective in detecting fat maldigestion and can be used to measure the benefits of enzyme supplements in early life.     

Hypoxaemia in infants with respiratory tract infections

Nineteen infants who were graduates from special care baby units underwent two overnight tape recordings of oxygen saturation (SaO2) and breathing movements; one during an upper (n = 12) or lower (n = 7) respiratory tract infection and the other when free of infection. Baseline SaO2 was lower during infection (median 99.6 vs 100%, p less than 0.01), with four patients having values (84.3-95.5%) below the normal lower limit for full-term infants (97%). The median number of apnoeic pauses was also lower during respiratory tract infection (4.7 vs 15.7/h, p less than 0.02). The median number of episodic desaturations (SaO2 less than or equal to 80%) did not change significantly (1.3 vs 1.9/h, p greater than 0.05), with the exception of one patient who had extremely increased values during infection for both apnoeic pauses (63/h) and desaturations (112/h). No infant, however, was considered clinically hypoxaemic. Clinically unsuspected hypoxaemia may thus occur during respiratory tract infection in a proportion of infants graduating from special care baby units. Such hypoxaemia may have potentially deleterious effects.     

西部某医学院校医学生基层就业意向及原因分析

[目的]了解西部某医学院校医学本科生基层就业意向并探讨医学生到基层就业难的原因.[方法]运用问卷调查,采取随机整群抽样方法,调查医学生就业意向并作统计学分析.[结果]医学生就业期望高,热衷于大型医院,但不完全排斥基层医疗机构.[结论]需政府、高校等多部门协作采取措施,引导医学生到基层就业.     

临床常见革兰氏阴性杆菌的分布及耐药性分析

目的探讨临床常见革兰氏阴性杆菌的分布及耐药性，为临床防治细菌感染提供参考。方法选取2011年1月～2013年1月在我院微生物室分离的1468株革兰阴性杆菌为研究对象，对所选革兰氏阴性杆菌的分布及耐药情况进行分析。结果我院临床中主要分离的标本类型和构成比包括：痰液占49．9％，尿液占．21．2％，血液占6．7％，脓汁占5．5％，分泌物占5．2％，穿刺液占3．8％，引流液占3．7％．其他标本类型占4．1％。三年中共分离出革兰氏阴性杆菌1468株，其中，2011年共分离509株革兰氏阴性杆菌．年检出率为67．1％；2012年共分离498株革兰氏阴性杆菌，年检出率为60．7％；2013年共分离461株革兰氏阴性杆菌，年检出率为62．4％。从2011～2013年大肠埃希茵的产超广谱13一内酰胺酶的检出率逐年上升，分别为24．0％，28．4％和34．0％；从2011～2013年肺炎克雷伯茵的产超广谱B-内酰胺酶的检出率也逐年上升，分别为19．2％，21．8％和24．1％。结论随着抗生素的普遍使用，耐药菌株迅速增加，因此，合理应用抗生素是非常重要的，减缓耐药菌株的产生，并采取有效的措施来遏制耐药性的蔓延是亟待解决的问题。     

行为干预对新护士环境适应能力的影响

目的探讨行为干预对新护士环境适应能力的影响。方法对新护士自来院时开始实施以人性化管理为主的行为干预，即做好新护士来院后的第1次接待；开展新护士来院后的心理健康维护；丰富集体活动，培养团队意识；合理安排岗前培训。采用自行设计的新护士自我评价袁及护士长考核评估表进行评价。结果工作1年时，新护士自我评估及护士长考核评估新护士人际关系、工作熟练度、合作共事等指标评分较工作3个月时显著提高（均P〈0．01）。结论对新护士实施以人性化管理为主的行为干预，可提高她们的环境适应能力，稳定护理队伍。     

微创喙锁螺钉固定治疗肩锁关节脱位

肩锁关节脱位传统观点倾向于保守治疗,其结果并没有想象的乐观,Mouhsine等总结TossyⅠ、Ⅱ型37例,随访发现12例伴有肩锁关节处触痛,7例存在活动时疼痛,X线片示13例存在肩锁关节处退行性改变。手术是大势所趋,术式虽多,各家疗效不一。作者自2002年9月,采用微创喙锁螺钉技术治疗肩锁关节脱位43例,报告如下。     

中文版癌症生存者压力应对能力量表的建立

目的开发建立可用于评价我国癌症生存者压力应对能力的中文版压力应对能力量表。方法在对原始MSI进行翻译的基础上,通过专家评定和对180例癌症生存者的调查,对问卷中存在的文化差异、问卷的效度、信度进行分析评价。结果中文版MSI具有较好的表面效度、内容效度(CVI>0.8)和结构效度。压力应对能力和各构成要素之间呈显著相关(r0.853～0.894),4个构成要素之间也有很好的相关性r(0.584～0.735)。压力与压力应对能力及接受、成熟、变化之间呈负相关(r-0.180～-0.246)。Cronbach’α系数均高于0.8,项目和标题之间的相关系数均大于0.3(P<0.01),符合量表的基本要求。结论中文版MSI具有较好的效度和信度,尽管存在文化上的差异,但仍适用于中国癌症生存者的压力应对能力评估。     

Syndecan-1在小鼠结肠炎模型中的表达和意义

背景：Syndecan-1是一种由硫酸乙酰肝素链和硫酸软骨素链修饰的Ⅰ型跨膜蛋白,主要表达于上皮细胞和内皮细胞,与炎症发生的各个环节均有密切联系。目的：观察结肠炎模型小鼠结肠组织中Syndecan-1的表达,探讨其在炎症性肠病（IBD）中的作用。方法：以三硝基苯磺酸（TNBS）-乙醇溶液灌肠诱导小鼠结肠炎模型。于造模后3、7、14、21d分批处死各组小鼠,于光学显微镜下观察结肠组织学改变并评分;分别以逆转录聚合酶链反应（RT-PCR）和免疫组化方法检测结肠组织Syndecan-1mRNA和蛋白水平的表达。结果：各模型组结肠组织学评分均显著高于正常对照组（P〈0.01）,以造模后第3d最高,其后逐渐减低。各模型组结肠组织Syndecan-1mRNA表达水平与正常对照组相比差异无统计学意义,但蛋白表达评分均显著低于正常对照组（P〈0.01）,以造模后第3d最低,其后逐渐回升。结论：结肠组织Syndecan-1蛋白表达与模型小鼠结肠炎病变严重程度有关,有可能成为IBD诊治和病情监测的指标之一。     

大肠癌术后早期胃管拔出对患者血浆降钙素原变化及对胃肠功能恢复的影响

目的探讨大肠癌术后早期胃管拔出对患者血浆降钙素原变化及对胃肠功能恢复的影响。方法选取2010年2月至2014年8月西电集团医院普外科肿瘤科收治的大肠癌术后患者110例,采用随机数表法分为2组,其中研究组55例,予术后早期胃管拔出治疗,术后6h开始饮水,12h进流食,3d过渡到普通饮食;对照组55例,采取常规胃管拔出治疗,术后排气排便后拔出胃管,开始进食。比较术后及干预前后治疗前血浆降钙素原水平及术后并发症情况、术后排气排便时间、住院时间、住院费用等观察指标。结果 (1)治疗后2组血浆降钙素原均明显下降,但二者相比差异无统计学意义(P0.05);(2)治疗后,研究组排气时间(50.71±6.25)h、排便时间(66.43±5.87)h、住院时间(7.17±2.31)d及住院费用(41 562.87±274.36)元低于对照组(65.24±6.58)h、(74.56±5.69)h、(10.24±3.15)d、(47 893.57±314.82)元,差异有统计学意义(P0.05);(3)治疗后,研究组并发症发生率(9.09%)与对照组(7.27%)相近,差异无统计学意义(P0.05)。结论大肠癌术后早期胃管拔出有利于患者促进胃肠功能恢复,缩短住院时间,同时不影响降钙素原水平,不增加并发症发生风险,值得临床推广。