Sex difference in effects of typical and atypical antipsychotics on glucose-insulin homeostasis and lipid metabolism in first-episode schizophrenia

OBJECTIVE: The present study was to investigate the sex difference in effects of clozapine, olanzapine, risperidone, and sulpiride on glucose and lipid metabolism in first-episode schizophrenia. METHOD: One hundred twelve patients with schizophrenia were assigned randomly to receive clozapine, olanzapine, risperidone, or sulpiride for 8 weeks. Planned assessments included body mass index, waist-hip ratio, fasting glucose, insulin, C-peptide, insulin resistance index (IRI), cholesterol and triglyceride levels. All measures were collected at baseline and at the end of the 8-week treatment. RESULTS: After treatment, waist-hip ratio and triglyceride and IRI levels of men were increased higher than that of women in clozapine and olanzapine groups. In sulpiride group, body mass index and triglyceride, insulin, and IRI levels of women increased higher than those of men. There was no significant sex difference for all assessments in risperidone group. Insulin, C-peptide, and IRI, but not fasting glucose levels, were significantly increased in the 4 groups. Cholesterol and triglyceride levels were significantly increased in the clozapine and olanzapine groups. Patients treated with clozapine and olanzapine had higher fasting insulin, C-peptide, and IRI levels than those treated with risperidone and sulpiride. CONCLUSIONS: These results suggest that clozapine, olanzapine, and sulpiride had effects on glucose and lipid metabolism in first-episode schizophrenia with sex difference. Clozapine and olanzapine seem to have the greatest potential to induce glucose and lipid metabolism abnormalities, and risperidone has the least.     

广东省急诊护士灾害护理核心能力现状及其影响因素分析

目的　调查广东省急诊护士灾害护理核心能力现状并分析其影响因素。方法　采用便利抽样法,选取2021年11月10日至2021年11月20日期间在广东省各大医院临床工作的286名急诊科护士为研究对象,由性别分布统计得出：其中男护士45（15.7％）名,女护士241（84.3％）名。由年龄分布统计得出：20岁以下的护士7（2.4％）名,20～29岁的护士100（35.0％）名,30～39岁的护士139（48.6％）,40～49岁的护士36（12.6％）名。采用一般资料问卷、灾害护理核心能力问卷、护士创新行为量表对其进行调查,使用t检验、方差分析、秩和检验进行单因素分析,使用Pearson相关分析进行相关性分析,使用多元线性回归分析进行多因素分析等统计学方法,检验水准为双侧α=0.05,分析其灾害护理核心能力现状及其影响因素。结果　286 名急诊科护士灾害护理核心能力总均分为（3.210±0.735）分;单因素关联性分析显示不同特征的灾害护理核心能力得分比较结果为：性别（t=3.049、 P=0.003）、年龄（t=4.159、 P=0.003）、婚姻状况（t=6.285、 P<0.001）、工作年限（t=3.508、 P=0.008）、科室职务（t=5.091、 P=0.007）等差异均有统计学意义（均P<0.05）。影响灾害护士护理核心能力的多元线性回归分析结果为：年龄（t=2.766、 P=0.006）、创新能力（t=15.902、 P<0.001）是急诊护士灾害护理核心能力的主要影响因素（ P<0.05 ）,可解释总变异的 52％ 。结论　广东省急诊科护士灾害护理核心能力有待提高。急诊护理管理者应根据实际情况创建和优化灾害救援队伍,强化急诊护士灾害护理核心能力的培养,并重视培养灾害护士的创新能力,提高灾害救护质量。     

角膜病患者滴眼液使用规范现况的调查分析

目的　调查角膜病患者滴眼液规范使用现况,为正确使用滴眼液的健康教育提供指导。方法　将2021年8月至2022年2月在济南市第二人民医院眼科病房接收的角膜病患者346例作为调查对象,由经过培训后的1名眼科专科护士观测患者未开展滴眼液使用相关教育前的滴眼液使用过程,并评价其眼药水滴注行为的规范性;采用济南市第二人民医院眼科病房设计的《滴眼液规范使用认知调查表》调查角膜病患者滴眼液规范使用相关认知。结果　346例患者中,男156例（45.09%）,女190例（54.91%）;年龄30岁及以下36例（10.40%）,>30～40岁32例（9.25%）,>40～50岁47例（13.58%）,>50～60岁87例（25.14%）,>60～70岁94例（27.17%）,>70岁50例（14.45%）。专科护士对346例角膜病患者1次滴眼液使用行为观测发现,43.93%（152/346）的患者在滴注眼药水前未洗手;41.53%（49/118）的患者滴注混悬液型眼药水前未摇匀;41.62%（144/346）的患者滴注眼药水未选择正确的仰卧头后仰位;43.93%（152/346）的患者滴注眼药水时眼睛未向头顶方向看;43.06%（149/346）的患者眼药水孔直接与眼球接触;53.47%（185/346）的患者滴注时瓶口和睫毛接触;63.29%（219/346）的患者眼药水滴注时未按压鼻泪管;仅27.27%（42/154）的患者在眼药水外溢后正确选择了纸巾擦拭;36.13%（125/346）的患者滴注后立即揉按眼睛;69.08%（239/346）的患者滴注完毕后未执行牵拉眼睑并闭眼1 min以上的正确行为。问卷调查显示,346例患者中,34.97%（121/346）的患者认为滴注2种及以上眼药水时,间隔时间>10 min;53.18%（184/346）的患者认为滴眼液需兼顾温度、光线,参考说明书妥善保存;56.36%（195/346）的患者认为需根据医生或滴眼液说明书的建议滴眼;55.49%（192/346）的患者认为滴眼液开封后,需注意保质期;56.07%（194/346）的患者认为在2种及以上滴眼液滴注时需先滴刺激性弱的,后滴刺激性强的;58.96%（204/346）的患者认为每次眼药水滴注量为1～2滴;73.41%（254/346）的患者认为滴眼后出现异常症状需立即停药/就医;73.70%（255/346）的患者认为滴眼液药品颜色改变、浑浊时立即停用;47.40%（164/346）的患者认为滴眼液使用期间,无需限制饮食,52.60%（182/346）的患者认为滴眼液使用期间应根据说明书或医嘱限制某些食物摄入;仅56.36%（195/346）的患者在使用滴眼液前阅读了说明书。结论　角膜病患者滴眼液规范使用行为及认知并不理想,眼科护理人员需重视滴眼液使用的相关宣教,促进滴眼液的规范使用。     

山东省药品零售连锁企业存在问题、整治对策及建议

：为防控药品零售连锁企业的经营质量安全风险,本文采用查阅文献、问卷调查、专家座谈等方法,分析了山东省药品零售连锁企业的经营质量管理现状,探讨了零售连锁企业存在的经营质量管理问题,结合全省的专项整治对山东省药品零售连锁企业提出了合理化、专业性的对策和建议。     

基于FMEA模式的康复护理对支气管哮喘急性发作患者的疗效

目的:探讨支气管哮喘急性发作患者应用基于失效模式和效果分析(failure mode and effect analysis,FMEA)模式的康复护理的效果。方法:选取2015年10月至2020年10月于青岛市市立医院西院区诊治的126例支气管哮喘急性发作患者为研究对象,按照随机单双数法将其分成对照组与研究组,每组各63例。对照组患者予以常规护理,研究组患者予以基于FME A模式的康复护理。护理1周后,对比两组患者的临床症状改善时间、护理前后肺功能指标[包括第1秒用力呼吸容积(forced breathing volume,FEV₁)、用力肺活量(forced vital capacity,FVC)及呼气流速峰值(peak expiratory flow rate,PEFR)]及生活质量综合评定问卷(Generic Quality of Life Inventory-74,GQOLI-74)评分,并分析两组患者并发症状况及对护理的满意度。结果:研究组患者咳嗽、喘息、肺部啰音及哮鸣音的改善时间分别为(5.14±0.51)d、(2.99±0.29)d、(4.70±0.46)d、(4.80±0.47)d,均明显短于对照组[(6.81±0.67)d、(4.36±0.43)d、(5.78±0.57)d、(5.97±0.60)d;P<0.05];护理1周后,两组患者的FEV₁、FVC及PEFR均明显升高(P<0.05),且研究组患者的FEV₁、FVC及PEFR分别为(2.24±0.20)L、(2.40±0.23)L、(3.58±0.35)L/s,均明显高于对照组[(1.60±0.15)L、(1.82±0.17)L、(2.70±0.26)L/s;P<0.05];护理1周后,两组患者的GQOLI-74评分均明显提高(P<0.05),且研究组患者的GQOLI-74评分为(95.43±9.44)分,明显高于对照组的(79.24±7.85)分(P<0.05);研究组患者的并发症发生率为1.59%,明显低于对照组(11.11%,P<0.05);研究组患者对护理的满意度为96.83%,明显高于对照组(73.02%,P<0.05)。结论:基于FMEA模式的康复护理可以明显缩短支气管哮喘急性发作患者临床症状的改善时间,促进肺功能的快速恢复,且有效减少并发症的发生,进一步提高其生活质量及对护理的满意度。     

骨质疏松症患者血清H2S的变化及临床意义

目的 探讨骨质疏松症患者血清硫化氢（H₂S）的变化及临床意义。方法 收集骨质疏松症患者128例作为骨质疏松组,另选取腰背部疼痛但排除骨质疏松的患者110例作为对照组。采用双能X线骨密度仪检测腰椎（L_1~4）和双侧股骨颈骨密度,亚洲人骨质疏松自我筛查工具（OSTA）筛查骨质疏松风险。采集空腹静脉血5 mL,检测血清H₂S、碱性磷酸酶（ALP）、骨特异性碱性磷酸酶（BALP）、血磷、血钙、血清骨钙素、甲状旁腺素（iPTH）、Ⅰ型原胶原N-端前肽（P1NP）、Ⅰ型胶原C-末端肽交联（P1CP）、Ⅰ型胶原羧基端肽β特殊序列（β-CTX）等骨代谢标志物水平。Pearson相关分析骨质疏松症患者血清H₂S与骨代谢标志物的相关性。结果 与对照组相比,骨质疏松组患者腰椎骨密度、股骨颈骨密度、OSTA指数和血清H₂S浓度下降,血清ALP、BALP、骨钙素、P1NP、P1CP、iPTH水平下降,β-CTX水平升高（P<0.05）。骨质疏松症患者血清H₂S与ALP、BALP、血清骨钙素、P1NP、P1CP、iPTH呈正相关,与β-CTX呈负相关（均P<0.05）。结论 骨质疏松症患者血清H₂S水平出现明显下降,检测H₂S有助于评估患者骨代谢水平。     

Artificial intelligence-aided diagnosis and treatment in the field of optometry

With the rapid development of computer technology, the application of artificial intelligence (AI) to ophthalmology has gained prominence in modern medicine. As modern optometry is closely related to ophthalmology, AI research on optometry has also increased. This review summarizes current AI research and technologies used for diagnosis in optometry, related to myopia, strabismus, amblyopia, optical glasses, contact lenses, and other aspects. The aim is to identify mature AI models that are suitable for research on optometry and potential algorithms that may be used in future clinical practice.     

Independent temporal lobe epilepsy in patients with tuberous sclerosis complex

Tuberous sclerosis complex(TSC)is a rare disease that involves multiple organs,including the brain;approximately 80%-90%of TSC patients exhibit TSC-associated epilepsy.Independent temporal lobe epilepsy(TLE),TSC-unrelated epilepsy,is particularly rare in patients with TSC.Here,we describe three patients with TSC with independent TLEs that were confirmed by stereo-electroencephalography(EEG),postoperative pathological findings,and seizure outcome at follow-up.The patients were retrospectively enrolled at two centers;their ictal epileptiform discharge onsets were determined using electrode contacts in the hippocampus during stereo-EEG.The three patients underwent anterior temporal lobectomies and remained seizure-free at 1-5 years after surgery.Postoperative pathological examinations confirmed hippocampal sclerosis in all three patients.Furthermore,postoperative intelligence quotient improvement was evident in one patient,while the quality of life was improved in two patients at 12 months after surgery.     

Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China

Background:Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.Methods:The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD.Results:A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082–4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606–3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044–1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061–2.424), DRI (OR, 2.094; 95% CI, 1.328–3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679–4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777–6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996–0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379–0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160–0.467) were preventive factors for BPD (all P < 0.05).Conclusion:Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.