气管内插管全麻患者术后咽喉部并发症研究进展

全麻手术中采用气管内插管常常造成咽喉部的创伤和病变,并导致咽喉部术后并发症的产生,如咽喉炎、声嘶和吞咽困难等。本文针对气管内插管的全麻患者术后咽喉部并发症的发生原因及其主要干预措施进行综述,为临床治疗及护理此类患者,提高患者舒适度提供理论依据。     

临床路径在病人健康教育中的应用现状及展望

介绍了临床路径在病人健康教育中的应用范围及实施状况，提出健康教育路径将更好地契入诊疗临床路径中，以及病人健康教育路径书的规范化及变异管理规范化的发展方向。     

Cyclooxygenase inhibitors in urinary bladder cancer: in vitro and in vivo effects

More than 14,000 people die from invasive transitional cell carcinoma (TCC) of the urinary bladder yearly in the United States. Cyclooxygenase (COX)-inhibiting drugs are emerging as potential antitumor agents in TCC. The optimal in vitro or in vivo systems to investigate COX inhibitor antitumor effects have not been defined. The purpose of this study was to determine COX-1 and COX-2 expression and antitumor effects of COX inhibitors in human TCC cell lines (HT1376, RT4, and UMUC3 cells) and xenografts derived from those cell lines. COX-2 expression (Western blot, immunocytochemistry) was high in HT1376, modest in RT4, and absent in UMUC3 cells in vitro. Similarly, COX-2 expression was noted in RT4 but not UMUC3 xenografts. COX-2 expression in HT1376 xenografts was slightly lower than that observed in vitro. None of four COX inhibitors evaluated (celecoxib, piroxicam, valeryl salicylate, and NS398) reduced TCC growth in standard in vitro proliferation assays at concentrations that could be safely achieved in vivo (< or =5 micromol/L). Higher celecoxib concentrations (> or =50 micromol/L) inhibited proliferation and induced apoptosis in all three cell lines. Celecoxib or piroxicam treatment in athymic mice significantly delayed progression of HT1376 xenografts, which express COX-2, but not UMUC3 xenografts that lack COX-2 expression. In conclusion, standard in vitro assays were not useful in predicting COX inhibitor antitumor effects observed in vivo. Athymic mice bearing TCC xenografts provide a useful in vivo system for COX inhibitor studies. Results of this study provide justification for further evaluation of COX inhibitors as antitumor agents against TCC.     

Protective effect of ginsenoside Rh2 on scopolamine‐induced memory deficits through regulation of cholinergic transmission,oxidative stress and the ERK‐CREB‐BDNF signaling pathway

Rh2 is a rare ginsenoside and there are few reports of its effect on cognition compared with other similar molecules. This study aimed to establish the impact of Rh2 treatment on improving scopolamine (Scop)‐induced memory deficits in mice and illuminate the underlying mechanisms. First, memory‐related behavior was evaluated using two approaches: object location recognition (OLR), based on spontaneous activity, and a Morris water maze (MWM) task, based on an aversive stimulus. Our results suggested that Rh2 treatment effectively increased the discrimination index of the mice in the OLR test. In addition, Rh2 elevated the crossing numbers and decreased the escape latency during the MWM task. Moreover, Rh2 markedly upregulated the phosphorylation of the extracellular signal‐regulated kinase (ERK)‐cAMP response element binding (CREB)‐brain derived neurotrophic factor (BDNF) pathway in the hippocampus. Meanwhile, the administration of Rh2 significantly promoted the cholinergic system and dramatically suppressed oxidative stress in the hippocampus. Taken together, Rh2 exhibited neuroprotective effects against Scop‐induced memory dysfunction in mice. Rh2 activity might be ascribed to several underlying mechanisms, including its effects on modulating the cholinergic transmission, inhibiting oxidative stress and activating the ERK‐CREB‐BDNF signaling pathway. Consequently, the ginsenoside Rh2 might serve as a promising candidate compound for Alzheimer's disease.     

五常法在手术室腹腔镜管理中的应用

目的:探讨确保腹腔镜手术的顺利进行,提高手术质量,延长设备、器械使用寿命的方法。方法:总结我院自1993年3月开展腹腔镜手术以来,五常法在手术室腹腔镜管理中的应用情况。结果:无一例因腹腔镜器械故障或欠缺而影响手术的顺利进行。结论:五常法的应用减少了手术护理工作中的缺陷,增强了手术室护士工作的主动性和计划性,增强了手术护士的工作成就感。     

Evaluation of the vascular architecture of hepatocellular carcinoma by micro flow imaging: pathologic correlation.

OBJECTIVE: The purpose of this study was to evaluate micro flow imaging (MFI) in depicting the vascular architecture of hepatocellular carcinoma (HCC) and the correlation between pathologic differentiation and the intratumoral vascular architecture pattern. METHODS: Micro flow imaging and contrast harmonic imaging (CHI) were performed in 37 patients with HCC. A sulfur hexafluoride-filled microbubble contrast agent was used. The enhancement level and intratumoral vessels were evaluated on CHI. The vascular architecture of each tumor was evaluated on MFI. Pathologic differentiation of the tumors was classified according to the Edmondson grading system. RESULTS: All 37 HCCs showed hyperenhancement in the arterial phase and hypoenhancement in the portal and late phases on CHI. Intratumoral vessels in the arterial phase were visualized in 20 (54.1%) HCCs. On MFI, the vascular architecture in all lesions was clearly delineated and categorized into 3 patterns: cotton, shrubbery, and deadwood, identified in 12 (32.4%), 22 (59.5%), and 3 (8.1%) of the tumors evaluated, respectively. A chi(2) test showed that pathologic differentiation significantly correlated to the vascular pattern (P = .006). Three (75%) of 4 Edmondson grade I HCCs showed the cotton pattern; 18 (75.0%) of 24 Edmondson grade II HCCs showed the shrubbery pattern; and the deadwood pattern was shown only in Edmondson grade III and IV HCCs. CONCLUSIONS: The MFI technique is more effective in depicting the intratumoral vascular architecture. The vascular architecture pattern correlates with pathologic differentiation of HCC.     

Breathing frequency-independent effect of Tai Chi Chuan on autonomic modulation

Objective

This study investigates the breathing frequency (BF)-independent effect of Tai Chi Chuan (TCC) on autonomic nervous modulation in TCC practitioners.

Methods

Twenty-five TCC practitioners and 25 sedentary normal controls were recruited. The stationary heart rate variability (HRV) measures of TCC practitioners and controls were compared. The same HRV measures in TCC practitioners and among the controls, TCC practitioners before TCC and TCC practitioners 30 min after TCC were compared.

Results

In TCC practitioners, the BF, normalized high-frequency power (nHFP), and normalized very low-frequency power were significantly increased, while the normalized low-frequency power (nLFP) was significantly decreased 30 min after TCC. The BF correlated significantly and negatively with heart rate (HR), nHFP and nLFP, and correlated significantly and positively with mean RR interval (Mn_RR) before TCC in TCC practitioners. A slower BF is associated with a higher HR, a greater vagal modulation, and a greater combined sympatho-vagal modulation before TCC. To remove the effect of BF on HRV measures, new indices such as HR*BF, nHFP*BF, nLFP*BF, and Mn_RR/BF were introduced for comparison among the controls, TCC practitioners before TCC, and TCC practitioners 30 min after TCC. Thirty minutes after TCC, the Mn_RR/BF of TCC practitioner was smaller whereas HR*BF and nHFP*BF were greater than those before TCC.

Interpretation

The BF-independent effects of TCC on the autonomic nervous modulation of TCC practitioners are an increase in vagal modulation and HR, and a decrease in mean RR interval. The mechanism underlying the parallel increase in HR and vagal modulation in TCC practitioners is not understood yet at present.     

Auditory tasks for assessment of sensory function and affective prosody in schizophrenia

Schizophrenia patients exhibit impairments in auditory-based social cognition, indicated by deficits in detection of prosody, such as affective prosody and basic pitch perception. However, little is known about the psychometric properties of behavioral tests used to assess these functions. The goal of this paper is to characterize the properties of prosody and pitch perception tasks and to investigate whether they can be shortened. The pitch perception test evaluated is a tone-matching task developed by Javitt and colleagues (J-TMT). The prosody test evaluated is the auditory emotion recognition task developed by Juslin and Laukka (JL-AER). The sample includes 124 schizophrenia patients (SZ) and 131 healthy controls (HC). Properties, including facility and discrimination, of each item were assessed. Effects of item characteristics (e.g., emotion) were also evaluated. Shortened versions of the tests are proposed based on facility, discrimination, and/or ability of item characteristics to discriminate between patients and controls. Test–retest reliability is high for patients and controls for both the original and short forms of the J-TMT and JL-AER. Thus, the original as well as short forms of the J-TMT and JL-AER are suggested for inclusion in clinical trials of social cognitive and perceptual treatments. The development of short forms further increases the utility of these auditory tasks in clinical trials and clinical practice. The large SZ vs. HC differences reported here also highlight the profound nature of auditory deficits and a need for remediation.