Liquid Guayule Natural Rubber,a Sustainable Processing Aid,Enhances the Processability,Durability and Dynamic Mechanical Properties of Rubber Composites

Petroleum-based oils are widely used as processing aids in rubber composites to improve processability but can adversely affect rubber composite performance and increase carbon footprint. In this research, liquid guayule natural rubber (LGNR), produced from guayule natural rubber, was used as a renewable processing aid to replace naphthenic oil (NO) in Hevea natural rubber, styrene-butadiene rubber (SBR) and guayule natural rubber (GNR) composites. The rheological properties, thermal stability, glass transition temperature, dynamic mechanical properties, aging, and ozone resistance of rubber composites with and without NO or LGNR were compared. Natural and synthetic rubber composites made with LGNR had similar processability to those made with NO, but had improved thermal stability, mechanical properties after aging, and ozone resistance. This was due to the strong LGNR–filler interaction and additional crosslinks formed between LGNR and the rubber matrices. The glass transition temperature of SBR composites was reduced by LGNR because of its increased molecular mobility. Thus, unlike NO, LGNR processing aid can simultaneously improve rubber composite durability, dynamic performance and renewability. The commercialization of LGNR has the potential to open a new sustainable processing-aid market.     

浅谈医患有效沟通与和谐医患关系

探讨有效医患沟通的方式,建立医患之间相互信任、相互了解的关系,从而减少医疗纠纷的发生.探讨医患关系紧张原因,探索语言沟通的技巧.希望通过有效沟通,帮助病人了解、认识、配合医生的治疗.良好的医患沟通,有助于建立良好的医患关系,有利于开展高质量的医疗护理工作,全方位地为患者服务.     

Nutritional Ergogenic Aids in Combat Sports: A Systematic Review and Meta-Analysis

Nutritional ergogenic aids (NEAs) are substances included within the group of sports supplements. Although they are widely consumed by athletes, evidence-based analysis is required to support training outcomes or competitive performance in specific disciplines. Combat sports have a predominant use of anaerobic metabolism as a source of energy, reaching peak exertion or sustained effort for very short periods of time. In this context, the use of certain NEAs could help athletes to improve their performance in those specific combat skills (i.e., the number of attacks, throws and hits; jump height; and grip strength, among others) as well as in general physical aspects (time to exhaustion [TTE], power, fatigue perception, heart rate, use of anaerobic metabolism, etc.). Medline/PubMed, Scopus and EBSCO were searched from their inception to May 2022 for randomised controlled trials (RCTs). Out of 677 articles found, 55 met the predefined inclusion criteria. Among all the studied NEAs, caffeine (5–10 mg/kg) showed strong evidence for its use in combat sports to enhance the use of glycolytic pathways for energy production during high-intensity actions due to a greater production of and tolerance to blood lactate levels. In this regard, abilities including the number of attacks, reaction time, handgrip strength, power and TTE, among others, were improved. Buffering supplements such as sodium bicarbonate, sodium citrate and beta-alanine may have a promising role in high and intermittent exertion during combat, but more studies are needed in grappling combat sports to confirm their efficacy during sustained isometric exertion. Other NEAs, including creatine, beetroot juice or glycerol, need further investigation to strengthen the evidence for performance enhancement in combat sports. Caffeine is the only NEA that has shown strong evidence for performance enhancement in combat sports.     

长春瑞滨单药与联合铂类一线治疗老年晚期非小细胞肺癌临床观察

目的观察长春瑞滨单药和长春瑞滨联合顺铂一线治疗老年晚期非小细胞肺癌的疗效和毒性反应。方法 44例晚期非小细胞肺癌,其中21例予长春瑞滨25mg/m2,第1.8天给药,每21天为1周期,23例予长春瑞滨联合顺铂,长春瑞滨25mg/m2,第1,8天,顺铂25mg/m2第1～3天,随访至进展后患者死亡。结果单药组CR、PR、SD、PD、总有效率,1年生存率分别为0%,28.6%,38.1%,33.3%,37.5%和43.6%。联合组CR、PR、SD、PD、总有效率,1年生存率分别为4.3%,26.0%,34.8%,30.1%和47.5%。两者之间无统计学差异;不良反应以粒细胞减少,消化道反应,口腔黏膜炎为主,两者之间对比差异有统计学意义(P<0.05)。结论应用单药长春瑞滨一线治疗老年晚期非小细胞肺癌不仅疗效与长春瑞滨联合顺铂方案大致相同且患者有良好的耐受性,因不良反应稍多,因引起重视。     

音乐疗法对第一产程的影响

目的：探讨音乐疗法对第一产程的影响。方法将92例临产的初产妇按随机分为观察组和对照组各46例,对照组按常规护理,观察组在此基础上接受音乐疗法。观察两组疼痛程度、第一产程时间、产妇焦虑、抑郁评分。结果观察组第一产程阵痛比对照组缓和,第一产程时间明显短于对照组, SAS、SDS评分与对照组比较明显下降,差异有统计学意义（均P〈0.05）。结论音乐疗法可缓解分娩过程中的疼痛,缩短第一产程时间,缓解产妇焦虑、抑郁情绪,减轻产妇的痛苦。     

First trimester serum inhibin A in normal pregnant women

Objectives To establish reference ranges for maternal serum inhibin A in normal first trimester pregnant women. Materials and methods This was a cross-sectional study. We measured maternal serum inhibin A in normal pregnant women gestation age between 6⁺⁰ and 14⁺⁶ weeks using the enzyme-linked immunosorbent assay (ELISA) method. Maternal serum inhibin A was analyzed according to gestational ages (GA). Results Serum of 300 pregnancies was analyzed and the outcome demonstrated the median of maternal serum inhibin A according to gestational age. The levels of maternal serum inhibin A during the 6⁰–6⁺⁶ week of gestations are lowest when compared with other gestational age. The levels of maternal serum inhibin A during 9⁰–9⁺⁶ week of gestations are maximal. Maternal serum inhibin A then declined until 14 weeks of gestation. Conclusion Serum inhibin A can be measured during the first trimester of pregnancy by using the recent ELISA technique. Our reference ranges might be useful for further studies, such as prediction of adverse pregnancy outcome in threatened abortion.     

Caesarean delivery at full cervical dilatation versus caesarean delivery in the first stage of labour: comparison of maternal and perinatal morbidity

OBJECTIVE: To compare perinatal and maternal morbidity associated with caesarean sections performed in the first with that performed in the second stages of labour. PATIENTS AND METHODS: Comparative analyses between nulliparous women with singleton term pregnancies who had a caesarean section in the first stage of labour and those who had a second stage caesarean section were completed using standard statistical methods. A subgroup analysis, according to indication for caesarean section, was also performed. RESULTS: Of 627 women, 81% had caesarean delivery in the first stage and 19% had caesarean delivery in the second stage of labour. Women undergoing caesarean delivery at full cervical dilatation were 1.9 times more likely to have an augmented labour (95% CI 1.2-3.4, P < 0.001) and 2.8 times more likely to have epidural anaesthesia in labour (95% CI 1.5-5.2, P < 0.001) than those in the first stage. Compared with caesarean delivery in the first stage of labour, women undergoing caesarean delivery at full cervical dilatation were 4.6 times more likely to have composite intraoperative complications (95% CI 2.7-7.9, P < 0.001), 3.1 times more likely to have blood loss greater than 1,000 ml (95% CI 1.3-7.4, P = 0.01), and 2.9 times more likely to have a blood transfusion (95% CI 1.5-5.6, P < 0.001). The risk of neonatal morbidity was higher in first stage caesareans when they were performed for presumed fetal compromise (66.3 vs. 26.3%, P = 0.002), and lower when they were performed for failure to progress (18.4 vs. 42%, P = 0.02). CONCLUSION: Caesarean section in the second stage of labour is associated with a higher risk of maternal but not perinatal morbidity.     

首发精神障碍家庭照顾者经历的系统评价

目的：系统评价首发精神障碍家庭照顾者的经历,为患者早期康复及照顾者心理健康问题的干预提供循证依据。方法：计算机检索The Cochrane Library、Ovid、PubMed、Embase、Web of Science、CBM、CNKI、VIP和WANFANG DATE数据库,检索时限均从建库至2021年7月31日,使用“JBI循证卫生保健中心质性研究质量评价标准”评价符合纳入标准的文献,并采用汇集性整合法对研究结果进行整合。结果：纳入12篇文献,提炼出60个研究结果,整理成8个类别,得出3个整合结果。分别是多维度的挑战、成长或缺如的角色结局、急需的社会支持。结论：亟需提高全民心理健康素质及去精神障碍疾病污名化,营造患者及家属无障碍化就医环境;关注家庭照顾者早期心理健康的干预,满足其社会支持的需要,提高该类人群应激应对能力,促进照顾者心理康复。     

医院建筑应急功能的建设实践

对于区域性、地区性的大型急救中心建设是非常必要的。此类急救中心在应对突发公共急救事件时因能够起到中流砥柱的作用,急救效果往往事半功倍,因而各级政府应给予重视与扶持。