国外护理教育中批判性思维数学策略实践研究进展

批判性思维及其教学模式的探索是护理教育研究的热点。文章在简要概述批判性思维概念及测评的基础上,结合批判性思维教学策略在国外护理教育中的应用现况,重点介绍概念图示、以病例为基础的学习、以问题为基础的学习、以网络为基础的学习、反思日记写作、循证模式、合作学习在提高学生批判性思维能力方面的实践研究。     

多发性骨髓瘤患者血清sFLC、LDH及β2-MG水平及其与预后的关系

目的探讨多发性骨髓瘤(MM)患者血清游离轻链(sFLC)、乳酸脱氢酶(LDH)、β2-微球蛋白(β2-MG)水平及其与预后的关系。方法选取2014年1月至2019年2月四川省第五人民医院收治的94例MM患者及100例体检健康者,测定受试者血清sFLC、LDH及β2-MG水平,随访记录MM患者总生存时间。结果κ-MM组患者sFLC-κ水平及sFLC-κ/sFLC-λ(sFLC-κ/λ)比率显著高于健康对照组(P<0.05);λ-MM组患者sFLC-κ、sFLC-λ水平明显高于健康对照组,sFLC-κ/λ比率低于健康对照组(P<0.05);MM组患者血清LDH及β2-MG水平均显著高于健康对照组(P<0.05)。入组94例患者均获得随访,Kaplan-Meier生存曲线分析显示国际分期系统(ISS)分期、轻链比率、LDH水平与患者总生存时间相关(P<0.05)。Cox多因素分析显示,校正ISS分期等因素后,轻链高比率(sFLC-κ/λ≥100.00或≤0.01)及LDH≥225 U/L是MM患者预后不良的独立危险因素(P<0.05)。结论MM患者存在血清sFLC-κ、sFLC-λ表达异常及LDH、β2-MG水平升高。sFLC-κ/λ比率及LDH水平与MM患者预后相关,可作为判断患者预后的指标。     

蓝光对维甲酸致骨质疏松大鼠的影响

目的：探讨蓝光照射后维甲酸致大鼠骨质疏松模型的骨代谢指标及骨微结构的改变情况。方法：将24只9月龄SD大鼠随机分为正常组、模型组、蓝光1组和蓝光2组，每组6只。蓝光组和模型组每天用100 mg/kg的维甲酸连续灌胃14 d，正常组用同体积的蒸馏水灌胃14 d，14 d后各组均恢复正常饮食、饮水。正常组和模型组全程采用日光灯光照模式照射，蓝光1组和2组在维甲酸造模完成后分别采用蓝色光照模式（460 nm）照射14 d和21 d。非蓝光照射时日光灯照射补齐至总照射天数（35 d）。所有大鼠均于35 d后取眼眶血，测定血清钙、磷、碱性磷酸酶（alkaline phosphatase，ALP）、β-胶联降解物（β-bonded degradation products，β-CTX）和Ⅰ型前胶原氨基端肽（amino terminal peptide of procollagen type 1，P1NP）水平。采用CO₂麻醉处死大鼠后取股骨，用microCT测定骨密度、骨小梁数量、骨小梁厚度和骨小梁分离度。结果：与正常组相比，模型组钙、磷、ALP、β-CTX和P1NP水平以及骨密度、骨微结构显著改变（P<0.01），说明造模成功。与模型组相比，蓝光1组的体质量、血钙水平、血磷水平、ALP、β-CTX，P1NP、骨小梁数量、骨小梁厚度、骨小梁分离度发生显著变化（P<0.05），但两组骨密度差异无统计学意义；蓝光2组大鼠的体质量、骨密度、骨微结构及骨代谢等各项指标均改变（P<0.05）。蓝光1组和蓝光2组间β-CTX、骨小梁数量和骨小梁分离度差异均有统计学意义（P<0.05）。结论：蓝光可在大鼠骨质疏松早期抑制成骨和影响钙磷代谢，促进维甲酸诱导骨质疏松的进程，提示骨质疏松患者在日常生活中需要减少蓝光暴露。     

多发性骨髓瘤病人血清游离轻链检测的临床意义

目的探讨血清游离轻链（sFLC）在多发性骨髓瘤（MM）病人诊断、疗效判断中的临床意义。方法应用免疫散射比浊法,测定40例初诊MM病人、30例正常对照及30例IgG型MM病人化疗后不同疾病阶段的sFLC水平。结果初诊MM病人的sFLC水平较正常对照明显异常（t=18.69、18.09,P〈0.01）。IgG型MM病人化疗3个疗程后随着疗效的提高,sFLC浓度逐渐降低（F=558.39、766.59,P〈0.01）。结论应用免疫比浊法测定sFLC对MM诊断和疗效判断有重要价值。     

Anorexia nervosa: Towards an integrative neuroscience model

We reviewed the evidence for emotion‐related disturbances in anorexia nervosa (AN) from behavioural, cognitive, biological and genetic domains of study. These domains were brought together within the framework of an integrative neuroscience model that emphasizes the role of emotion and feeling and their regulation, in brain organization. PsychInfo and Medline searches were performed to identify published peer‐reviewed papers on AN within each domain. This review revealed evidence for ‘Emotion’, ‘Thinking and Feeling’ and ‘Self‐regulation’ disturbances in AN that span non‐conscious to conscious processes. An integrative neuroscience framework was then applied to develop a model of AN, from which hypotheses for empirical investigation are generated. We propose that AN reflects a core disturbance in emotion at the earliest time stage of information processing with subsequent effects on the later stages of thinking, feeling and self‐regulation. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Evaluation of blood purification and bortezomib plus dexamethasone therapy for the treatment of acute renal failure due to myeloma cast nephropathy

Aggressive removal of circulating free light chains (FLC) by blood purification accompanied by chemotherapy is a promising approach for the treatment of acute renal failure due to myeloma cast nephropathy. Plasma exchange has been performed to remove serum FLC; in order to examine an alternative strategy we performed hemodiafiltration using protein-leaking dialyzers for the treatment of dialysis-dependent acute renal failure due to myeloma cast nephropathy. In the first case with κ-light chain cast nephropathy, the pre-treatment serum creatinine was 9.65 mg/dL, and the serum κ-FLC was 27100 mg/L. Plasma exchange or hemodiafiltration was performed from Monday to Friday during the first several weeks. Chemotherapy was started with high-dose dexamethasone and then switched to bortezomib plus dexamethasone. The mean removal rates of κ-FLC were 45.8% (one plasma volume) and 66.9% (one-and-a-half plasma volumes) by plasma exchange. The removal rates of κ-FLC by hemodiafiltration (66.9%, FB210UHβ; 71.6%, PES210Dα; 75.2%, FXS220) were comparable to those by plasma exchange. In the second case with λ-light chain cast nephropathy, the pre-treatment serum creatinine was 4.14 mg/dL, and the serum λ-FLC was 4140 mg/L. The mean removal rates of λ-FLC were 60.2% (FXS140) and 64.2% (FB210UHβ) by hemodiafiltration. Both cases became dialysis-independent. The combination of an intense blood purification regimen and bortezomib plus dexamethasone therapy appears to be an efficient approach to renal recovery. Hemodiafiltration using protein-leaking dialyzers could become an alternative to plasma exchange as a method of removing FLC.     

New optical technologies for earlier endoscopic diagnosis of premalignant gastrointestinal lesions

Gastrointestinal malignancies continue to be the second leading cause of cancer-related deaths in the developed world. The early detection and treatment of gastrointestinal preneoplasms has been demonstrated to significantly improve patient survival. Conventional screening tools include standard white light endoscopy (WLE) and frequent surveillance with biopsy. Well-defined endoscopic surveillance biopsy protocols aimed at early detection of dysplasia and malignancy have been undertaken for groups at high risk. Unfortunately, the poor sensitivity associated with WLE is a significant limitation. In this regard, major efforts continue in the development and evaluation of alternative diagnostic techniques. This review will focus on notable developments made at the forefront of research in modern gastrointestinal endoscopy based on novel optical endoscopic modalities, which rely on the interactions of light with tissues. Here we present the 'state - of - the - art' in fluorescence endoscopic imaging and spectroscopy, Raman spectroscopy, optical coherence tomography, light scattering spectroscopy, chromoendoscopy, confocal fluorescence endoscopy, and immunofluorescence endoscopy. These new developments may offer significant improvements in the diagnosis of early lesions by allowing for targeted mucosal excisional biopsies, and perhaps may even provide 'optical biopsies' of equivalent histological accuracy. This enhancement of the endoscopist's ability to detect subtle preneoplastic changes in the gastrointestional mucosa in real time and improved staging of lesions could lead to curative endoscopic ablation of these lesions and, in the long term, improve patient survival and quality of life.     

Light at night increases body mass by shifting the time of food intake

The global increase in the prevalence of obesity and metabolic disorders coincides with the increase of exposure to light at night (LAN) and shift work. Circadian regulation of energy homeostasis is controlled by an endogenous biological clock that is synchronized by light information. To promote optimal adaptive functioning, the circadian clock prepares individuals for predictable events such as food availability and sleep, and disruption of clock function causes circadian and metabolic disturbances. To determine whether a causal relationship exists between nighttime light exposure and obesity, we examined the effects of LAN on body mass in male mice. Mice housed in either bright (LL) or dim (DM) LAN have significantly increased body mass and reduced glucose tolerance compared with mice in a standard (LD) light/dark cycle, despite equivalent levels of caloric intake and total daily activity output. Furthermore, the timing of food consumption by DM and LL mice differs from that in LD mice. Nocturnal rodents typically eat substantially more food at night; however, DM mice consume 55.5% of their food during the light phase, as compared with 36.5% in LD mice. Restricting food consumption to the active phase in DM mice prevents body mass gain. These results suggest that low levels of light at night disrupt the timing of food intake and other metabolic signals, leading to excess weight gain. These data are relevant to the coincidence between increasing use of light at night and obesity in humans.     

Evidence for a role of the 5-HT1B receptor and its adaptor protein, p11, in L-DOPA treatment of an animal model of Parkinsonism

Parkinson's disease (PD) is characterized by a progressive degeneration of substantia nigra dopaminergic neurons projecting to the striatum. Restoration of dopamine transmission by L-DOPA relieves symptoms of PD but causes prominent side effects. There is a strong serotonin innervation of the striatum by serotonergic neurons that remains relatively preserved in PD. The study of this innervation has been largely neglected. Here, we demonstrate that chronic L-DOPA administration to 6-OHDA-lesioned rodents increases, via D1 receptors, the levels of the 5-HT1B receptor and its adaptor protein, p11, in dopamine-denervated striatonigral neurons. Using unilaterally 6-OHDA-lesioned p11 WT and KO mice, it was found that administration of a selective 5-HT1B receptor agonist, CP94253, inhibited L-DOPA-induced rotational behavior and abnormal involuntary movements in a p11-dependent manner. These data reveal an L-DOPA-induced negative-feedback mechanism, whereby the serotonin system may influence the symptomatology of Parkinsonism.