危重症评分量表对急诊病人转入ICU及死亡的预测能力研究

目的:探讨危重症评分量表对急诊病人转入重症监护室(ICU)及死亡的预测能力。方法:采用方便抽样法选取2019年1月—2019年12月在我院急诊科就诊的250例病人作为研究对象,最终纳入228例病人,按转入科室分为ICU组(68例)及普通病房组(160例)。应用改良早期预警评分(MEWS)量表和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评估病人病情,记录病人ICU转入率及死亡率,并应用受试者工作特征曲线(ROC)分析MEWS量表、APACHEⅡ量表在急诊病人ICU转入率及死亡率中的预测价值。结果:与普通病房组相比,ICU组MEWS评分、APACHEⅡ评分更高(P<0.001)。死亡组MEWS评分、APACHEⅡ评分高于非死亡组(P<0.001)。经ROC曲线分析可知,MEWS评分、APACHEⅡ评分诊断急诊病人转入ICU的最佳截断值分别为4分和20分,两者联合诊断急诊病人转入ICU的敏感度及特异度明显高于MEWS评分、APACHEⅡ评分单项诊断。MEWS评分、APACHEⅡ评分诊断急诊病人死亡最佳截断值分别为6分和25分,两者联合诊断急诊病人死亡的敏感度及特异度高于...     

微格教学法在口腔癌游离皮瓣修复术后临床护理教学中的应用

目的:观察微格教学法应用于口腔癌病人游离皮瓣修复术后临床护理的教学效果。方法:选取2018年1月—2020年12月,山西省某三级甲等综合医院和山西省某三级甲等中医院收治的80例口腔癌病人,采用随机数字表法分为试验组和对照组,各40例。对照组护士接受常规护理教学方法,试验组护士接受微格教学法,学习掌握口腔癌病人游离皮瓣修复术后护理。评价两组护士实践能力以及病人并发症发生率、住院时间及护理满意度。结果:试验组护士无菌操作、气道管理、吸痰法、导尿术、鼻饲法及静脉输液实践操作考核成绩均高于对照组,差异有统计学意义(P<0.05),试验组病人并发症发生率低于对照组,住院时间短于对照组,病人满意度高于对照组,差异均有统计学意义(P<0.05)。结论:微格教学法应用于口腔癌游离皮瓣术后护理的教学中,能更好地指导护士进行正确地护理,提高病人满意度,缩短病人住院时间,降低病人并发症发生率,促进病人康复。     

灾害护理知信行量表的编制及信效度检验

目的:编制灾害护理知信行量表,并对其进行信效度检验。方法:根据知信行理论模型编制灾害护理知信行量表。随机抽取500名护生实施问卷调查并进行因子分析及信效度评估,3周后,随机抽取200名护生检验重测信度。结果:灾害护理知信行量表包括知识、态度及行为3个维度,共30个条目,总量表及各维度Cronbach′sα系数分别为0.96,0.92,0.95,0.96;分半信度为0.82,总量表及各维度重测信度分别为0.90,0.82,0.83,0.85。量表总内容效度指数为0.93,各条目内容效度指数为0.85～1.00。结论:灾害护理知信行量表具有良好的信效度,可作为评估护生灾害护理知信行水平的工具,可作为灾害护理教育的形成性评价指标。     

儿童局灶节段性肾小球硬化

局灶节段性肾小球硬化（FSGS）近年来有增多趋势,FSGS不仅是一种形态学描述,而被视为一种临床病理综合征,表现为蛋白尿,常为肾病水平蛋白尿,并有局灶节段分布的肾小球硬化和足突融合。FSGS可为原发性（特发性）、继发性和遗传家族性。最近FSGS被区分为5种变异型,提示其不同的发病机制和预后,这5型包括特异FSGS、门周型、细胞型、顶端病变和塌陷型。该文还就FSCS的治疗和预后进行了讨论。     

75%酒精按摩治疗小儿输液渗漏肿胀的效果观察

目的探讨75%酒精湿润按摩治疗小儿静脉输液局部渗漏肿胀的可行性。方法将67例输液肿胀患儿随机分为实验组和对照组,分别采用75%酒精湿润按摩和50%硫酸镁湿敷进行比较。结果实验组肿胀消退速度优于对照组(P<0.05)。结论75%酒精湿润按摩治疗输液渗漏肿胀,效果显著,经济、实用,患儿和家长易接受。     

基于谱效关系的款冬花祛痰活性成分研究

目的：研究款冬花提取物的高效液相色谱指纹图谱与祛痰作用的谱效关系,筛选款冬花的祛痰活性成分。方法：采用高效液相色谱法建立款冬花提取物的指纹图谱并获得其化学成分含量信息,采用小鼠酚红排泌模型获得款冬花提取物的祛痰药效指标信息,采用偏最小二乘回归法对款冬花提取物的化学成分含量信息与祛痰药效指标信息进行谱效相关分析。结果：初步判断芦丁、异槲皮苷、绿原酸、新绿原酸、隐绿原酸、异绿原酸A、异绿原酸B、异绿原酸C及峰3成分、峰17成分构成款冬花的祛痰活性成分群。结论：款冬花的祛痰作用是多成分共同作用的结果。本研究结果可为关联药效的款冬花质量标准的建立提供参考。     

Early changes in corneal densitometry after FS-LASIK combined with accelerated corneal cross-linking for correction of high myopia

AIM: To observe the effects of femtosecond laser-assisted excimer laser in situ keratomileusis combined with accelerated corneal cross-linking (FS-LASIK Xtra) on corneal densitometry after correcting for high myopia. METHODS: In this prospectively study, 130 patients underwent FS-LASIK or FS-LASIK Xtra for high myopia. Their right eyes were selected for inclusion in the study, of which 65 cases of 65 eyes in the FS-LASIK group, 65 patients with 65 eyes in the FS-LASIK Xtra group. Patients were evaluated for corneal densitometry at 1, 3, and 6mo postoperatively using Pentacam Scheimpflug imaging. RESULTS: Preoperative differences in corneal densitometry between the FS-LASIK and FS-LASIK Xtra groups in different ranges were not statistically significant (P>0.05). Layer-by-layer analysis revealed statistically significant differences in the anterior (120 μm), central, and total layer corneal densitometry between the FS-LASIK and FS-LASIK Xtra groups at 1 and 3mo postoperatively (all P<0.05), the FS-LASIK Xtra group is higher than that of the FS-LASIK group. Analysis of different diameter ranges showed statistically significant differences between the FS-LASIK group and the FS-LASIK Xtra group at 1mo postoperatively in the ranges of 0–2, 2–6, and 6–10 mm (both P<0.05); At 3mo postoperatively, the FS-LASIK Xtra group is higher than that of the FS-LASIK group in the ranges of 0–2 and 2–6 mm (P<0.05). At 6mo postoperatively, there were no statistically significant differences in corneal densitometry between the FS-LASIK group and the FS-LASIK Xtra group in different diameter ranges (all P>0.05). CONCLUSION: There is an increase in internal corneal densitometry during the early postoperative period after FS-LASIK Xtra for correction of high myopia. However, the densitometry values decreased to the level of conventional FS-LASIK at 6mo after surgery, with the most significant changes observed in the superficial central zone.     

改良腭黏膜瓣整复软腭裂的临床观察

目的:探讨整复软腭裂的新术式,重建腭咽闭合的效果。方法:采用腭黏膜瓣后推术对25例软腭裂患者进行整复治疗,并对其进行随访,以了解术后腭咽闭合的情况。结果:所有患者术后腭部创口愈合良好,瘢痕不明显,软腭的活动度良好,且均有良好的腭咽闭合功能。结论:对先天性软腭裂的患者实施该术式整复,能较好地恢复腭咽闭合功能,是较为理想的手术整复方法之一。     

L-Serine Treatment is Associated with Improvements in Behavior,EEG, and Seizure Frequency in Individuals with GRIN-Related Disorders Due to Null Variants

Pathogenic missense variants in GRIN2A and GRIN2B may result in gain or loss of function (GoF/LoF) of the N-methyl-D-aspartate receptor (NMDAR). This observation gave rise to the hypothesis of successfully treating GRIN-related disorders due to LoF variants with co-agonists of the NMDAR. In this respect, we describe a retrospectively collected series of ten individuals with GRIN2A- or GRIN2B-related disorders who were treated with L-serine, each within an independent n-of-1 trial. Our cohort comprises one individual with a LoF missense variant with clinical improvements confirming the above hypothesis and replicating a previous n-of-1 trial. A second individual with a GoF missense variant was erroneously treated with L-serine and experienced immediate temporary behavioral deterioration further supporting the supposed functional pathomechanism. Eight additional individuals with null variants (that had been interpreted as loss-of-function variants despite not being missense) again showed clinical improvements. Among all nine individuals with LoF missense or null variants, L-serine treatment was associated with improvements in behavior in eight (89%), in development in four (44%), and/or in EEG or seizure frequency in four (44%). None of these nine individuals experienced side effects or adverse findings in the context of L-serine treatment. In summary, we describe the first evidence that L-serine treatment may not only be associated with clinical improvements in GRIN-related disorders due to LoF missense but particularly also null variants.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-021-01173-9.     

银汞桩核与分体式铸造桩核用于磨牙修复的疗效对比观察

目的:比较银汞桩核和分体式铸造桩核用于修复磨牙严重缺损病例的临床疗效.方法:将78例磨牙牙体严重缺损病例随机分为银汞桩核修复组40个牙和分体铸造桩核修复组41个牙,并随访观察2～3年.结果:两种桩核修复的临床疗效无显著差异(P＞0.05).结论:银汞桩核和分体式铸造桩核用于修复牙体严重缺损的磨牙都能取得较好的临床效果.