Role and value of laparoscopic training devices in assessing nondominant and two-handed dexterity

Background and objectives: To determine improvement in hand dexterity with targeted laparoscopic skill exercises desirable for use in the operating rooms among in-training laparoscopic gynaecological surgeons and medical students. Design: Cross-sectional study with paired analysis. Setting: Kiel School of Gynaecological Endoscopy and Reproductive Medicine, Germany, between February and April 2005. Subjects: Twenty third-year medical students and 20 in-training gynaecological endoscopic surgeons from various parts of the world. Interventions: Demonstration and explanation of a set of five laparoscopic skill exercises desirable for use in the operating rooms before administering a pretest. This was followed by voluntary practice of these exercises for at least 10 times over 1 day. The posttest was performed the next day once the participant was comfortable performing the skill. Pre- and posttest assessments were conducted by independent supervisors. Main outcome measures: Time to completion of tasks with minimal errors. Results: There was significant reduction in mean time for all the laparoscopic skill exercises performed with dominant, nondominant, and both hands, before and after the training and practice (p-value <0.01; paired t-test). Moderate to high correlation (0.617–0.901) was seen with the intermediate and complex/difficult tasks, whereas low correlation was seen with the simple/easy task (0.200–0.336). Medical students and gynaecologists both showed improvement in performance from pretest to posttest in terms of reduction in mean time taken to perform all the tasks with minimal errors. Conclusions: Simple laparoscopic training devices can substantially help an individual hand’s improvement and acquisition of laparoscopic skills. Simple laparoscopic training devices along with animal models will continue to provide an efficient and effective environment for learning and teaching laparoscopic surgical skills. With this training, performance improves progressively with practice.     

早期应用无创性通气治疗老年Ⅱ型呼吸衰竭的护理

目的　探讨应用无创性通气治疗老年Ⅱ型呼吸衰竭的护理。方法　在常规治疗的同时 ,实验组与对照组分别应用无创通气和呼吸兴奋剂治疗 ,观察 2组患者治疗前、后、治疗间歇期动脉血气变化及康复例数。结果　实验组患者治疗后血气明显改善 (P <0 .0 1) ,康复例数明显多于对照组 (P <0 .0 1)。结论　应用无创通气可促进呼吸衰竭患者的康复 ,护士要加强对患者的心理支持 ,严密监测生命体征 ,保持呼吸道通畅 ,熟练掌握无创通气呼吸机的性能、使用方法 ,防止并发症     

失血性休克大鼠肠上皮细胞线粒体DNA腺苷三磷酸酶6,8基因表达及线粒体功能的改变

目的　探讨失血性休克大鼠肠上皮细胞线粒体DNAATPase 6 ,8基因表达及线粒体功能的改变 ,为阐述休克肠道靶学说和线粒体能量代谢提供分子生物学基础。　方法　 2 4只Wistar大鼠随机分为休克前组和休克 1,2 ,3,4 ,5h组。采用RT -PCR方法观察线粒体ATPase 6 ,8mRNA量的改变。用透射电镜观察、生物体视学测量线粒体形态 ,用Clark氧电极测线粒体呼吸功能。　结果　失血性休克 1,2h ,ATPase 6 ,8基因表达增强 ,以后渐减弱 ,至休克 5h表达最低 ,ATPase 6 ,8基因表达分别降为正常的 6 9.3%和 78.4 % (P <0 .0 1和P <0 .0 5 )。失血性休克 2h和5h ,线粒体平均截面积、长径、面密度、体密度均显著增加 (P <0 .0 1) ,休克 5h时分别为休克前的2 .0 ,1.4 5 ,1.4 7,2 .2 2倍。休克 5h ,线粒体比表面和数密度分别下降 32 %和 2 4 % (P <0 .0 1和P <0 .0 5 ) ,嵴和基质破坏明显。失血性休克后肠上皮细胞线粒体呼吸控制率和氧化磷酸化效率比休克前显著降低 (P <0 .0 1)。　结论　失血性休克时大鼠肠上皮细胞线粒体DNAATPase 6 ,8基因表达下调 ,线粒体呼吸功能出现障碍 ,线粒体超微结构发生了改变     

舰艇部队军事训练伤分布特点与干预效果研究

目的：查明海军舰艇部队特殊军事训练伤的发生率和分布特征，以及施加干预措施后军事训练伤发生率的变化。方法：以整群抽样方式选取海军某舰艇部队官兵1648人，对全年军事训练伤进行前瞻性流行病学调查；以每个参试支队各抽2艘舰艇为干预试验单位，设同期对照组和历史对照组。结果：全年军事训练伤累积发生率为14．62％，时间分布以7月份为高峰；46．53％的伤者为机电部门人员；损伤部位以下肢为主，占32．64％；受伤类型以急性创伤性损伤为主；干预试验的军事训练伤发生率为8．96％，低于同期对照组(12．21％，P＜0、05)和历史对照组(14．62％，P＜0．01)。结论：舰艇部队军事训练伤发生情况与其它军兵种有较大的区别。施加干预措施可显著降低舰艇部队的军事训练伤。     

机械通气患者的呼吸道护理

目的：探讨机械通气患者呼吸道的护理以及并发症的预防；方法：查阅有关机械通气护理的文献；结果：呼吸衰竭患者在使用机械通气治疗的过程中护理不当可引起呼吸机相关肺炎、气管阻塞、气管损伤、低氧血症等；结论：加强机械通气患者的呼吸道护理可避免呼吸道并发症的发生。     

儿童呼吸道苛养菌分离培养及药敏分析

目的：分析儿童呼吸道苛养菌的感染率及常用抗生素的耐药状况。方法：采用儿童呼吸道2050份咽拭子及痰标本进行苛养菌分离培养与鉴定，并对其中617株苛养菌做了药敏试验，结果：显示275株肺炎链球菌，耐药率较高的有红霉素81.1%，苯唑西林76.9%，复方磺胺甲恶唑76.9%，四环素65.4%；104株流感嗜血杆菌、184株副流感嗜血杆菌、54株卡他莫拉菌对氨苄西林耐药率分别为17.6%,28.9%,64.9%，对亚胺培南/西司他丁耐药率分别为16.4%，16.5%，0，同时复方磺胺甲恶唑的耐药率也分别高达56.7%，56.7%，64.9%。结论：提示苛养菌在儿童呼吸道感染中占有重要的地位，及时掌握这类细菌的耐药动态，对合理使用抗生素，延缓耐药株的产生有极其重要的临床意义。     

21 d-6°头低位卧床期间运动训练对动态姿态平衡的影响

目的探讨21 d-6°头低位卧床和卧床运动训练对动态姿态平衡和控制功能的影响. 方法 10名健康男性青年被试者分为卧床对照组和卧床训练组,每组5人,卧床期间训练组每天进行2次、每次30 min逐级增加负荷的头低位功率自行车训练;分别于卧床前和卧床后21 d进行了动态姿态平衡和双膝等速肌力的测试. 结果与卧床前相比,对照组动态本体感觉得分和运动控制适应能力明显降低,双膝相对峰力矩明显降低,同时伴有腘绳肌与股四头肌峰力矩屈/伸比值的明显增加;训练组动态本体感觉得分和运动控制适应能力明显高于对照组,而腘绳肌与股四头肌峰力矩屈/伸比值无明显改变. 结论 21 d-6°头低位卧床运动训练能够明显改善卧床后动态姿态平衡及其动态运动适应功能.     

α-黑色素细胞刺激素对急性呼吸窘迫综合征大鼠血清细胞因子水平的影响

目的 研究α-黑色素细胞刺激素(α-MSH)对急性失血性休克合并肺内毒素损伤两次打击致急性呼吸窘迫综合征大鼠血清细胞因子水平的影响。方法 30只雄性SD大鼠随机分成生理对照组(A组)、急性呼吸窘迫综合征组(B组)和给药组(C～F组,在不同时间点静脉注射α-MSH 1.7 mg·kg-1)。观察各组血清细胞因子(TNF-α、IL-1、IL-6、IL-10)水平的变化。结果 生理对照组(A组)大鼠血清细胞因子水平各时间点间差异无显著性(P>0.05);急性呼吸窘迫综合征组(B组)大鼠随打击因素和病程进展,血清细胞因子TNF-α、IL-1、IL-6、IL-10水平均显著增高(P<0.01),促/抗炎细胞因子平衡失衡;给药组(C、D、F组)与B组相比能显著降低血清TNF-α、IL-1水平(P<0.01),增加IL-6、IL-10浓度(P<0.01);其中多次给药组(F组)作用最明显,而内毒素致伤后1 h给药组(E组)各细胞因子水平与B组各时间点相比差异无显著性(P>0.05)。结论 α-MSH可降低急性呼吸窘迫综合征大鼠血清促炎细胞因子水平促进抗炎细胞因子产生。α-MSH可能通过调节促/抗炎细胞因子平衡而发挥其保护作用。     

The development and evaluation of Student Training, Education and Practice for Dietetics CD-ROM: a computer-assisted instruction programme for dietetic students

The Student Training, Education and Practice for Dietetics (STEP‐DIET) CD‐ROM was developed at the University of Surrey to prepare dietetic students for the practical dietetic training component of their Nutrition/Dietetics degree. This study aimed to evaluate student response to the programme and its effectiveness as a teaching tool, based on the evaluation framework of D.L. Kirkpatrick (Evaluating a Course, 2nd edn. London, Kogan Page). Quantitative and qualitative methodologies were employed, with 41 dietetic students, separated by year group, completing questionnaires and taking part in six focus groups, at the University of Surrey. Student attitudes towards the instruction method and the STEP‐DIET programme itself were investigated, in conjunction with their perceived learning achievements. Students rated the programme highly in terms of design and content, however, there was a reluctance to accept computer‐assisted instruction (CAI) as a sole teaching method. A number of learning achievements relevant to dietetic practice were reported including a perceived increase in ability to conduct a dietetic interview and an increased understanding of the management of Type 2 diabetes. In general students reacted positively to the STEP‐DIET programme and it was perceived by students to be effective in preparing them for the practical component of their dietetic training.     

间歇性低氧训练对男子赛艇运动员大负荷训练期间生理机能的影响

目的:探讨在大负荷训练期间进行间歇性低氧训练对男子赛艇运动员生理机能的影响。方法:12名男子赛艇运动员分成低氧组和对照组,低氧组在赛前大负荷训练期间进行为期4周、每周5天、每天1小时的间歇性低氧训练,其余日常训练两组相同。实验期间每周测试运动员的睡眠质量、耐缺氧能力以及血红蛋白、血尿素、肌酸激酶等指标。结果:4周间歇性低氧训练后,低氧组运动员血红蛋白含量显著高于对照组,血尿素水平和肌酸激酶活性显著低于对照组;低氧组在耐缺氧实验中血氧饱和度显著高于对照组,心率显著低于对照组;低氧组睡眠质量指标得分显著低于对照组。结论:间歇性低氧训练可以提高男子赛艇运动员大负荷训练期间的耐缺氧能力,改善睡眠质量,间接促进机体在承受大负荷训练负荷时的恢复能力。