西沙必利联合复方芦荟胶囊治疗老年功能性便秘

目的:探讨西沙必利联合复方芦荟胶囊治疗老年功能性便秘的临床疗效。方法:将81例老年功能性便秘患者随机分为治疗组和对照组,治疗组43例,对照组38例。治疗组予以西沙必利联合复方芦荟胶囊治疗,对照组单纯应用西沙必利治疗,15 d为1个疗程。对两组患者排便次数、大便性状、排便间隔、排便时间及排便难易程度相关情况进行详细记录。结果:治疗组总有效率为95.35%,对照组为42.11%,两者差异有统计学意义(P<0.01)。治疗组治疗后排便间隔和排便时间明显缩短,差异有统计学意义(P<0.05);对照组治疗后排便间隔和排便时间有所缩短,但差异无统计学意义(P>0.05)。结论:西沙必利联合复方芦荟胶囊对老年功能性便秘患者的疗效肯定。     

左归丸和右归丸对实验性自身免疫性脑脊髓炎大鼠轴突再生过程中脑源性神经营养因子表达及环磷酸腺苷/蛋白激酶A信号转导通路的作用

Objective：To study the effects of Zuogui Pill（左归丸,ZGP）and Yougui Pill（右归丸,YGP）on the expressions of brain-derived neurotrophic factor（BDNF）and cyclic adenosine monophosphate（cAMP）/protein kinase A（PKA）signaling of axonal regeneration in the Lewis rats with experimental autoimmune encephalomyelitis（EAE）,in order to explore the possible mechanism of ZGP and YGP on promoting axonal regeneration.Methods：The rats were randomly divided into normal control（NC）,model（MO）,prednisone acetate（PA）,ZGP and YGP groups.The EAE model of rat was established by injecting antigen containing myelin basic protein（MBP）68-86.The brain and spinal cord were harvested on the 14th and 28th day postimmunization（PI）,the protein and mRNA expression of BDNF and PKA in the brain and spinal cord of rats were detected by Western blot analysis and real-time quantitative polymerase chain reaction（PCR）,and the cAMP levels were detected by using enzyme-immunoassay method.Results：（1）On the 28th day PI,the mRNA expression of BDNF in brain white matter and spinal cord of rats in ZGP and YGP groups were up-regulated,especially in YGP group（P〈0.05 or P〈0.01）.（2）On the 14th day PI,the cAMP levels in brain white matters significantly increased in PA and YGP groups compared with MO group（P〈0.05 or P〈0.01）,and the cAMP level in YGP group was higher than that in ZGP group（P〈0.05）.The cAMP level in spinal cord also significantly increased in YGP group compared with MO,PA and ZGP groups,respectively（P〈0.01）.（3）On the 14th day PI,the PKA expression in spinal cord of rats in ZGP group was significantly decreased compared with MO and YGP groups,respectively（P〈0.05）.（4）On the 28th day PI,there was a positive correlation between cAMP and PKA expression in the brain white matter of YGP rats.Conclusions：The results suggest that ZGP and YGP may promote axonal regeneration by modulating cAMP/PKA signal transduction pathway,but the targets of molecular mec     

Postmortem heart weight: relation to body size and effects of cardiovascular disease and cancer

BackgroundGender, body weight, and cardiovascular disease (CVD) are all variables known to influence human heart weight. The impact of cancer is less studied, and the influence of age is not unequivocal. We aimed to describe the relationship between body size and heart weight in a large autopsy cohort and to compare heart weight in patients with cancer, CVD, and other diseases.Methods and ResultsRegistered information, including cause of death, evidence of cancer and/or CVD, heart weight, body weight, and height, was extracted from the autopsy reports of 1410 persons (805 men, mean age 66.5 years and 605 women, mean age 70.6 years). The study population was divided in four groups according to cause of death; cancer (n=349), CVD (n=470), mixed group who died from cancer and CVD and/or lung disease (n=263), and a reference group with patients who did not die from any of these conditions (n=328). In this last group, heart weight correlated only slightly better with body surface area than body weight, and nomograms based on body weight are presented. Compared to the reference group (mean heart weight: 426 g and 351 g in men and women, respectively), heart weight was significantly lower (men: P<.05, women: P<.001) in cancer patients (men: 392 g, women: 309 g) and higher (P<.001) in patients who died from CVD (men: 550 g, women: 430 g). Similar results were obtained in linear regression models adjusted for body weight and age. Among CVD, heart valve disease had the greatest impact on heart weight, followed by old myocardial infarction, coronary atherosclerosis, and hypertension. Absolute heart weight decreased with age, but we demonstrated an increase relative to body weight.ConclusionThe weight of the human heart is influenced by various disease processes, in addition to body weight, gender, and age. While the most prevalent types of CVD are associated with increased heart weight, patients who die from cancer have lower average heart weight than other patient groups. The latter finding, however, is diminished when adjusting for body weight.SummaryThe present study demonstrates that the weight of the human heart is influenced by various disease processes like cancer and CVD, in addition to body weight, gender and, possibly, age.     

Evaluation of a porcine model of early aortic valve sclerosis

BackgroundCalcific aortic valve disease (CAVD) is associated with significant cardiovascular morbidity. While late-stage CAVD is well-described, early pathobiological processes are poorly understood due to the lack of animal models that faithfully replicate early human disease. Here we evaluated a hypercholesterolemic porcine model of early diet-induced aortic valve sclerosis.MethodsYorkshire swine were fed either a standard or high-fat/high-cholesterol diet for 2 or 5 months. Right coronary aortic valve leaflets were excised and analyzed (immuno)histochemically.ResultsEarly human-like proteoglycan-rich onlays formed between the endothelial layer and elastic lamina in the fibrosa layer of valve leaflets, with accelerated formation associated with hypercholesterolemia (P<.05). Lipid deposition was more abundant in hypercholesterolemic swine (P<.001), but was present in a minority (28%) of onlays. No myofibroblasts, MAC387-positive macrophages, or fascin-positive dendritic cells were detected in 2-month onlays, with only scarce myofibroblasts present at 5 months. Cells that expressed osteochondral markers Sox9 and Msx2 were preferentially found in dense proteoglycan-rich onlays (P<.05) and with hypercholesterolemia (P<.05). Features of more advanced human CAVD, including calcification, were not observed in this necessarily short study.ConclusionsEarly aortic valve sclerosis in hypercholesterolemic swine is characterized by the formation of proteoglycan-rich onlays in the fibrosa, which can occur prior to significant lipid accumulation, inflammatory cell infiltration, or myofibroblast activation. These characteristics mimic those of early human aortic valve disease, and thus the porcine model has utility for the study of early valve sclerosis.     

超声引导下射频消融术与腔镜微创手术治疗甲状腺良性结节的应用比较

目的比较超声引导下射频消融术与腔镜微创手术在甲状腺良性结节患者治疗中的应用。 方法收集2015年1月至2019年1月于中国人民解放军联勤保障部队第九二八医院接受手术治疗的甲状腺良性结节患者1 000例,根据手术方式分为超声引导下射频消融术组（594例）和腔镜微创手术组（406例）。比较两组患者手术时间,术中出血量,术后住院时间,手术前后6个月甲状腺功能变化情况,手术前后12 h白细胞介素6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）及术后并发症发生情况。 结果射频消融术组术后IL-6、CRP和TNF-α质量浓度水平显著低于腔镜微创手术组（t=-67.827、-117.340、32.192,均P<0.001）;射频消融术组手术时间、术后住院时间、手术出血量、术后并发症发生率均显著低于腔镜微创手术组（t=85.135、67.418、65.475,χ²=169.568,均P<0.001）。 结论超声引导下射频消融术与腔镜微创手术在甲状腺良性结节患者治疗中均对甲状腺功能损伤较小,且超声引导下射频消融术安全性好、创伤小、术后并发症较少。     

急性混合型下肢深静脉血栓机械性抽吸与溶栓疗效分析

目的:比较机械性血栓抽吸与系统溶栓对急性混合型下肢深静脉血栓形成(LEDVT)的疗效。资料与方法:回顾分析1998年4月—2010年1月458例急性混合型DVT病例的临床资料。机械性血栓抽吸327例(A组),其中合并髂总静脉狭窄或闭塞113例,采取PTA和支架植入辅助处理,术后辅以小剂量尿激酶溶栓、肝素抗凝治疗。系统溶栓131例(B组),均系统性应用尿激酶、肝素,溶栓、抗凝治疗。结果:出院时A组健、患肢膝上、下15 cm处周径差,分别由(10.51±7.53)cm和(5.86±3.26)cm,降为(1.34±1.07)cm和(0.93±0.52)cm,差异有统计学意义(u=21.80和27.00);B组由(10.68±7.67)cm和(5.52±3.37)cm降为(2.89±1.53)cm和(1.72±0.89)cm,差异有统计学意义(u=11.39和12.45)。平均随访(46±39)月,患肢膝下15 cm处周径差降为:A组(0.53±0.42)cm,B组(1.42±1.35)cm,差异有统计学意义(u=7.40)。水肿、色素沉着、溃疡等后遗症发生率,A组:27.83%(91/327)、13.15%(43/327)、0%;低于B组:55.73%(73/131)、83.97%(110/131)、9.16%(12/131),差异有统计学意义(u=3.14、14.52、5.58)。彩超发现,A组静脉通畅率(73.09+17.74)%=90.83%和瓣膜功能正常率(73.09%),均高于B组(15.27+22.14)%=37.41%和15.27%,差异均有统计学意义(u=12.04、11.28)。A组随访疗效为优(88.99%)显著高于B组(29.77%)(u=12.74)。B组治疗中2例因出血而危及生命,而A组无一例。结论:机械性血栓抽吸对急性混合型LEDVT的疗效,均好于系统溶栓,尤其在保护静脉瓣膜功能方面明显优于溶栓;但不是血栓清除的单一手段,应辅以溶栓、抗凝、祛聚等综合治疗,才能防止血栓再形成和提高中、远期疗效。     

How do nurses manage their work under time pressure? Occurrence of implicit rationing of nursing care in the intensive care unit: A qualitative study

ObjectivesThe aim of this study was to explore the experience of intensive care unit nurses under time pressure and the occurrence of implicit rationing under time pressure.MethodsIn-depth audio-recorded interviews were conducted with 18 intensive care unit nurses. Colaizzi seven-step analysis of phenomenological data was used.FindingsThree themes emerged from the analysis: the influence of internal and external environments, perceived differences in time pressure, and broad coping styles.ConclusionsUnder the influence of various factors, including continuous or intermittent time pressure, nurses employ strategies to deal with the pressure. Sometimes, these strategies allow them to complete all their necessary work. However, with the increase in time pressure, sometimes some work that must be done is changed into work that should be done in the consciousness of nurses. In such cases, nurses choose the strategy of implicit rationing to deal with time pressure.     

Impact of secondary sepsis on mortality in adult intensive care unit patients

RationaleSeptic patients admitted to the intensive care unit (ICU) suffer from immune dysregulation, potentially leading to a secondary sepsis episode. This study aims to (i) assess the secondary sepsis rate, (ii) compare the second with the first episodes in terms of demographics, clinical and laboratory characteristics, and outcomes, and iii) evaluate the outcome of secondary sepsis.MethodsA single-center, retrospective study (2014–2017) was conducted in a Greek ICU, including consecutive cases of adult patients admitted to the ICU for at least 48 h with a principal admission diagnosis of sepsis and stayed for at least 48 h. We searched for a secondary episode of sepsis following the primary-one. We performed survival analyses with Cox proportional hazard, Fine-Gray, and multistate models.ResultsIn this study, 121 patients that fulfilled the eligibility criteria were included. The secondary sepsis group included 28 (23.1 %) patients, with episode onset, median (interquartile range), 9.5 (7.7–16.2) days after ICU admission, who had less frequently had a medical admission diagnosis, a microbiologically confirmed first episode, and the C-reactive protein was lower. The overall ICU mortality of the cohort was 44.6 %. The group that developed secondary sepsis had higher mortality, but significance was lost in Cox regression [Hazard ratio (95 % CI) 0.59(0.31–1.16)]. However, after multistate modeling adjustment, the attributable mortality was estimated at 43.9 % (95 %CI ± 14.8 %).ConclusionSecondary sepsis was evident in a quarter of the study participants and may be associated with an increased risk of death.     

The effect of music on delirium,pain, sedation and anxiety in patients receiving mechanical ventilation in the intensive care unit

ObjectivesTo examine the effects of music for patients under mechanical ventilation support in the intensive care unit on their delirium, pain, sedation, and anxiety.Research methodology/designA single-blind, randomized, controlled trial.SettingThe study was conducted with delirium positive patients between August 2020 and September 2021 in the medical/surgical intensive care unit of a university hospital in Turkey.MethodsThe study sample was selected through a simple and stratified randomization method; patients who met the inclusion criteria were assigned to the music, noise reduction or control group. The data were collected by using a Confusion Assessment Method for the ICU (CAM-ICU), CAM-ICU-7, Critical Care Pain Observation Tool (CPOT), Richmond Agitation-Sedation Scale (RASS), Facial Anxiety Scale (FAS), PRE-DELIRIC model, and Glasgow Coma Scale (GCS). The interventions were repeated twice a day for five days.ResultsA total of 36 patients were included, with 12 patients in each group. Significant decreases were found in the severity of delirium and pain and the level of sedation and anxiety in the music compared to the other groups (p < 0.05). The number of patients with delirium and the number of days with mechanical ventilation was found to be significantly lower in the music group compared to the other groups (p < 0.05).ConclusionMusic intervention may be used as a nursing intervention to control delirium, pain, need for sedation and anxiety in intensive care unit patients. However, additional studies with larger sample is needed to validate findings.