A quality control circle process to improve implementation effect of prevention measures for high‐risk patients

The aim of the study was to analyse the influence of prevention measures on pressure injuries for high‐risk patients and to establish the most appropriate methods of implementation. Nurses assessed patients using a checklist and factors influencing the prevention of a pressure injury determined by brain storming. A specific series of measures was drawn up and an estimate of risk of pressure injury determined using the Braden Scale, analysis of nursing documents, implementation of prevention measures for pressure sores and awareness of the system both before and after carrying out a quality control circle (QCC) process. The overall scores of implementation of prevention measures ranged from 74.86 ± 14.24 to 87.06 ± 17.04, a result that was statistically significant (P < 0.0025). The Braden Scale scores ranged from 8.53 ± 3.21 to 13.48 ± 3.57. The nursing document scores ranged from 7.67 ± 3.98 to 10.12 ± 1.63; prevention measure scores ranged from 11.48 ± 4.18 to 13.96 ± 3.92. Differences in all of the above results are statistically significant (P < 0.05). Implementation of a QCC can standardise and improve the prevention measures for patients who are vulnerable to pressure sores and is of practical importance to their prevention and control.     

GRK5 deficiency leads to early Alzheimer-like pathology and working memory impairment

G-protein coupled receptor kinase-5 (GRK5) deficiency has been linked to early Alzheimer's disease in humans and mouse models of the disease. To determine potential roles of GRK5 in the disease pathogenesis, the GRK5 knockout mouse was evaluated at pathological and behavioral levels. We found that these mice displayed an age-dependent increase in hippocampal axonal defects characterized by clusters of axonal swellings that accumulated abnormal amounts of molecular motor proteins, microtubule-associated proteins, intracellular β-amyloid, and subcellular organelles. In severe cases, extracellular β-amyloid fibrillar deposits were occasionally observed, along with degenerating axonal components, and were tightly surrounded by reactive astrocytes. Moreover, significant loss of synaptic proteins and early signs of cholinoceptive neurodegeneration were evident in the hippocampus as well. Consistent with the moderate level of pathologic change, aged GRK5 knockout mice displayed selective working memory impairment, with other cognitive domains unaffected. Taken together, these findings not only strongly support an important role of GRK5 deficiency in early Alzheimer's pathogenesis, but also promote the GRK5 knockout mouse as an additional model for early Alzheimer-related studies.     

短波紫外线照射四肢火器伤后组织中羟脯氨酸含量的变化

目的:观察四肢火器伤受不同剂量短波紫外线照射后,组织中羟脯氨酸含量的变化,以期分析紫外线照射对胶原蛋白合成的影响。方法:实验于2003-09/2004-09在解放军总医院理疗科实验室和解放军军事医学科学院放射医学研究所完成。选用新西兰大白兔90只,随机数字法分为3组:30mJ/cm2照射组、60mJ/cm2照射组和对照组,每组30只。麻醉动物后,以“五四”式手枪击兔右股部肌肉丰满处,造成贯通伤模型。常规清创后采用紫外线治疗仪分别对3组实验动物伤道进行30s(30mJ/cm2)照射,60s(60mJ/cm2)照射和无照射干预。在致伤后第2和3天继续在伤道内进行照射,日增加前次照射剂量的30%。采用化学法在伤后7,14,21,28,42,56和70d测量肉芽组织中羟脯氨酸含量的变化。结果:实验动物82只进入结果分析。①致伤后7d,各组大白兔组织中羟脯氨酸的含量无差别。②伤后14d,60mJ/cm2照射组羟脯氨酸的含量高于30mJ/cm2照射组和对照组[(11.91±0.49)mg/g,(10.88±0.61)mg/g,(10.35±0.85)mg/g,P<0.05];伤后21～56d,60mJ/cm2照射组伤口中的羟脯氨酸含量均高于30mJ/cm2照射组伤口和未照射组(P<0.01)。③伤后70d时,各组羟脯氨酸的含量下降接近正常组织水平,60mJ/cm2照射组仍稍高于30mJ/cm2照射组和未照射组[(10.02±0.65)mg/g,(9.85±0.54)mg/g,(9.27±0.43)mg/g,P<0.05]。④在伤后21～56d30mJ/cm2照射组伤口中羟脯氨酸的含量高于对照组(P<0.05)。结论:短波紫外线照射能促进伤口中羟脯氨酸的合成,增加胶原含量,60mJ/cm2照射的作用强于30mJ/cm2。     

综合医院内脑卒中患者急性期的全面康复

脑卒中急性期的治疗与康复是全面康复的关键。我们对３０例脑出血及５０例脑梗塞急性期住院病人进行了常规治疗及早期康复训练，同时对有知觉障碍、语言障碍的病人进行特殊训练。在训练中运用运动疗法和作业疗法，并对不同时期的心理障碍进行心理治疗。经平均３３天住院治疗和训练，患者肌力提高２级以上，８７．５％的病例达到Ｂａｒｔｈｅｌ日常活动能力指数６０分以上，ＡＤＬ功能恢复６１分以上，生活基本自理。因此，对脑血管病急性期应及早进行康复训练并应以“全面康复”的思想为指导。     

特制假体在骨肿瘤保肢治疗中的应用

内蒙古医学院第二附属医院骨肿瘤科于1999-10/2006-08对33例骨肿瘤(恶性10例,良性23例)患者进行瘤段切除特制假体置换,假体材料为不锈钢或钴铬钼合金或钛合金,由北京力达康科技有限公司设计并定做.所有患者均同意外科手术并签订知情同意书和特制假体置换协议书.随访6～70个月,除1例髋骨体骨巨细胞瘤、2例滑膜肉瘤、1例恶性纤维组织细胞瘤患者死干肺转移外,其他病例无局部复发和转移,无骨折现象发生,1例膝关节术后感染并僵直,3例膝关节置换后大腿中段(假体与股骨连接处)疼痛:按Enneking肢体肌肉骨骼肿瘤外科治疗重建术后功能综合评分:上肢优良率80%;下肢优良率86.4%.肩关节疼痛缓解率为90%,主动活动增加;髋关节活动基本正常;膝关节屈伸活动0°～100°.1例膝关节不锈钢假体出现了排斥反应,2例考虑假体与股骨连接处松动,其他假体与组织的生物相容性较好.     

A Diaper Pad for Diaper-Based Urine Collection and Colorimetric Screening of Urinary Biomarkers

The high prevalence of urinary tract infection in aging adults is a challenging aspect of geriatric care. Incontinence and cognitive/functional impairment make collection of urine samples difficult and often require either catheterization for sample collection, which is a risk factor for infections, or more lenient criteria for initiating antibiotic treatment. We report the development of a diaper inlay with absorbent materials, superabsorbent polymer-based valve and chemical reaction pads for rapid screening of urinary tract infection of incontinent diaper-wearing elderly receivers of home care services. The developed diaper inlay was capable of collecting, isolating, analyzing samples and retaining results > 8 h. The diaper inlay can therefore be compatible with the diaper changing routines of nurses in home care services, without requiring much time or effort. A nurse can insert a diaper inlay in a diaper and the results can be recorded during a later diaper change. Although the research focuses on tools for home care services, the nursing home sector has similar problems and may benefit from technological development for rapid screening to avoid unnecessary catheterization and overuse of antibiotics.     

小儿股静脉采血的研究进展

从小儿股静脉的解剖特点、采血前准备、穿刺点定位、进针角度、持针方法、注意事项方面进行综述。     

Expression of EphA2 and EphrinA-1 in vulvar carcinomas and its relation to prognosis

AIMS: To examine the expression of EphA2 and EphrinA-1 in vulvar squamous cell carcinomas and investigate their prognostic relevance. METHODS: Tumours from 224 patients with vulvar squamous cell carcinomas were investigated for expression of EphA2 and EphrinA-1 using single and double immunostaining methods. RESULTS: High expression (strong/moderate staining intensity) of EphA2 and EphrinA-1 was observed in 114 (51%) and 126 (56%) vulvar carcinomas, respectively. In the three cases tested using the double immunostaining method, colocalisation of EphA2 and EphrinA-1 proteins was identified in the same neoplastic cells. High EphA2 expression was significantly correlated to high expression of EphrinA-1 (p<0.01) and cyclin A (p<0.01), large tumour size (p = 0.03), deep invasion (p<0.01) and higher FIGO stage (p = 0.05). A correlation between high EphrinA-1 expression and high levels of cyclin A (p<0.01) and p21 (p<0.01), deep invasion (p<0.01) and higher FIGO stage (p = 0.01) was also seen. In univariate analysis, high expression of EphrinA-1 was associated with poor survival (p = 0.03). However, in the multivariate analysis neither EphrinA-1 nor EphA2 were significantly correlated to survival. CONCLUSIONS: EphA2 and EphrinA-1 were overexpressed in 51% and 56% of the vulvar squamous cell carcinomas, respectively, and high levels of EphA2 and EphrinA-1 proteins were associated with deep tumour invasion and high FIGO stage. However, EphA2 and EphrinA-1 were not independently associated with clinical outcome in vulvar carcinomas.     

Selection and characterization of a precocious line of Eimeria media

Coccidiosis, caused by the infection of Eimeria parasites, is one of the most common diseases in domestic rabbits. Live anticoccidial vaccine formulated with attenuated precocious lines of pathogenic eimerian parasites is expected to be valuable for the control of rabbit coccidiosis as a similar strategy to produce anticoccidial vaccines against chicken coccidiosis has being used for several decades. Eimeria media, moderate pathogenic, is widespread in China. Therefore, attenuated anticoccidial vaccines against rabbit coccidiosis should contain vaccine strain(s) of E. media. In this study, a precocious line of E. media (Empre) was selected by collecting and propagating the early excreted oocysts with 16 successive generations. The prepatent period of Empre reduced from 108 h of its parental strain (Emwt) to 70 h. The fecundity of Empre was about 1/10 to 1/3 lower than that of Emwt. Each sporocyst of Empre sporulated oocyst contained only one large refractile body instead of two smaller ones seen in the parental strain. When vaccinated with 1 × 10³ or 1 × 10⁴ precocious line oocysts, the rabbits were completely protected against homologous challenge with the parental strain 14 days post challenge by terms of body weight gain and oocyst output counting, indicating the efficacy of Empre. Meanwhile, all immunized rabbits showed no clinical sign post immunization, indicating the safety of Empre. For co-immunization, 1 × 10³Empre oocysts and 5 × 10² oocysts of a precocious line of E. intestinalis (EIP8) were inoculated to each rabbit in a trial. No diarrhea or mortality was found after vaccination, and the weight gains of the vaccinated group were similar to that of unvaccinated-unchallenged control (UUC) group, while the weight gains of the vaccinated group were similar to that of unvaccinated-unchallenged control (UUC) group (P > 0.05), but significantly higher than that of UCC group (P < 0.01) after challenge, indicating it is safe and effective when using co-immunization. These results together show that Empre, as a precocious line, is a good candidate of precocious line of E. media for anticoccidial vaccine development.

     

外半规管良性阵发性位置性眩晕的诊疗

良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)是最常见的周围性眩晕,主要表现为随头位变化出现的短暂性眩晕发作,该病分为后半规管型、外半规管型、上半规管型及多半规管.其中后半规管BPPV最常见,其次为外半规管BPPVo外半规管BPPV根据发病机制、原理、眼震方向等有多种分类方法.近年来外半规管BPPV的手法复位逐渐被熟悉,但一些患者复位后效果不佳,如外半规管嵴帽结石症,部分患者行常规手法复位后发作性眩晕仍然存在.我们将这部分手法复位后眩晕症状改善不明显的类型归结为难治型外半规管嵴帽结石症.本文主要围绕外半规管BPPV的概念及分类、流行病学、病因、发病机制、诊断及复位方法,尤其对于难治型外半规管嵴帽结石症的复位方法做一综述.