分隔膜无针输液接头预防导管相关血流感染的Meta分析

目的 系统性评价分隔膜无针输液接头与肝素帽预防导管相关血流感染发生率的差异。方法 检索万方数据库、中国知网(CNKI)、维普数据库(VIP)、PubMed、CINAHL Complete、Cochrane Library建库至2018年1月1日以来国内外有关分隔膜无针输液接头与肝素帽的所有随机对照试验;对符合纳入标准的文献进行质量评估后使用ReVMan5.3进行Meta分析。结果导管相关血流感染发生率:OR=0.13,5%CI(0.06,0.27),P＜0.000 01;静脉炎发生率:OR=0.10,5%CI(0.03,0.34),P=0.000 20;堵管发生率:OR=0.12,5%CI(0.07,0.19),P＜0.000 01。结论 分隔膜无针输液接头与肝素帽相比较,分隔膜无针输液接头可明显减少导管相关血流感染、静脉炎、堵管发生率。     

Ventral stream sensitivity in “healthy” preterm-born adolescents: Psychophysical and neuropsychological evaluation

Background

Deficits of motion processing have been reported in premature and very low birth-weight subjects during infancy, childhood and adolescence. Less is known about ventral stream functioning in preterms.

Aim

The aim of this study is to investigate ventral stream functioning in a sample of “healthy” adolescents born preterm with normal outcome and without brain damage.

Study design

We enrolled thirty preterm-born adolescents (mean age: 14.2 years, mean gestational age 28.9 weeks, mean birth weight 1097 g), and 34 age-matched term-born controls (mean age: 14.5 years). All subjects were administered a psychophysical test known as “Form Coherence Task” and a comprehensive standardized battery of neuropsychological tests suitable for investigating ventral stream functioning including Street Completion Test, Poppelreuter–Ghent Test and the first part of the Visual Object and Space Perception (VOSP) battery. Dorsal stream visual functioning was investigated by the second part of the VOSP.

Results

Preterm (PT) subjects showed the same results in all “ventral” tasks with respect to full-term controls without any correlation to gestational age or birth weight. We found a significant negative correlation between Form Coherence Task and Letters Task (p = .014) and between Form Coherence and Silhouette Tasks (p = .017). No correlation was observed between Form Coherence Task and Street and Ghent Tests. A statistical difference was instead found between PTs and controls in two tasks of the VOSP battery that mostly involve the dorsal stream.

Conclusions

Preterm birth per se (in absence of evident brain lesions) is not sufficient to compromise the development of ventral pathway.     

Distribution of preproenkephalin,preprotachykinin A,and preprodynorphin mRNAs in the rat nucleus accumbens: Effect of repeated administration of nicotine

The effects of a repeated treatment with nicotine on the expression of mRNAs encoding preproenkephalin (PPE), preprotachykinin-A (PPT-A), and preprodynorphin (PPDYN) were examined by in situ hybridization histochemistry in various subregions of the nucleus accumbens (Acb). In saline-treated rats, optical density measurements on autoradiographic films showed marked anteroposterior decreasing gradients for PPE and PPT-A mRNAs in the rostral pole and the core, in the cone, and in the ventral shell of the Acb, whereas a lower anteroposterior gradient was observed for PPDYN mRNA signals. The intensity of the three mRNA signals also varied according to Acb subregion. However, analysis of percentages of prepropeptide mRNA-containing neurons as compared to total neurons showed, in the rostral pole, the core, and the cone, a similar percentage of PPE mRNA (around 45%)- and PPT-A mRNA (around 40%)- expressing neurons. The ventral shell can be distinguished from the other subregions by a lower percentage of PPE mRNA (35.8%)- and PPT-A mRNA (30.6%)-expressing neurons. The percentage of PPDYN mRNA-containing neurons, by contrast, was similar (around 37%) in the core, the cone, and the ventral shell. Repeated nicotine administration increases the PPE mRNA level in the rostral pole and the anterior third of the core without any change in PPT-A and PPDYN mRNA levels in the various Acb subregions examined. The PPE mRNA increase does not support an effect mediated through an interaction of nicotine with DA neurons. The effect could be linked to a nicotine activation of other afferents to the anterior Acb and/or to a direct nicotine stimulation of PPE mRNA neurons. © 1996 Wiley-Liss, Inc.     

Bridging the Local Persistence and Long-Range Dispersal of Highly Pathogenic Avian Influenza Virus (HPAIv): A Case Study of HPAIv-Infected Sedentary and Migratory Wildfowls Inhabiting Infected Premises

The past two decades have seen the emergence of highly pathogenic avian influenza (HPAI) infections that are characterized as extremely contagious, with a high fatality rate in chickens, and humans; this has sparked considerable concerns for global health. Generally, the new variant of the HPAI virus crossed into various countries through wild bird migration, and persisted in the local environment through the interactions between wild and farmed birds. Nevertheless, no studies have found informative cases associated with connecting local persistence and long-range dispersal. During the 2016–2017 HPAI H5N6 epidemic in South Korea, we observed several waterfowls with avian influenza infection under telemetric monitoring. Based on the telemetry records and surveillance data, we conducted a case study to test hypotheses related to the transmission pathway between wild birds and poultry. One sedentary wildfowl naturally infected with HPAI H5N6, which overlapped with the home range of one migratory bird with H5-specific antibody-positive, showed itself to be phylogenetically close to the isolates from a chicken farm located within its habitat. Our study is the first observational study that provides scientific evidence supporting the hypothesis that the HPAI spillover into poultry farms is caused by local persistence in sedentary birds, in addition to its long-range dispersal by sympatric migratory birds.     

持续质量改进在ICU危重患者护理质量管理中的应用效果

目的 探讨持续质量改进(continuous quality improvement,CQI)在ICU危重患者护理质量管理中的应用效果.方法 采用柏拉图分析法对2015年1-12月收住解放军第98医院ICU的313例患者的临床资料进行动态分析.针对非计划性拔管(unplanned excubation,UEX)发生率、导管相关性血流感染(catheter related blood stream infection,CRBSI)发生率[包括经锁骨下静脉置入中心静脉导管(central venous catheter,CVC)感染率、经外周静脉置入中心静脉导管(peripherlly inserted centra lcatheter,PICC)感染率]、呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发生率等进行护理质量控制与改进,以2014年1-12月收治的314例患者为对照组.比较两组患者上述指标、患者住院及经济运行状况等的差异,并分析患者满意度和3项敏感指标的相关性.结果 UEX发生率与护士专业技能的满意度、护士服务态度的满意度及护理服务质量综合满意度呈负相关(均P＜0.05);CRBSI中的CVC感染发生率与护理质量的满意度、护士专业技能的满意度呈负相关(均P＜0.05);CRBSI中的PICC感染发生率与就医环境的满意度、护理质量的满意度、护士专业技能的满意度、护理服务质量综合满意度呈负相关(均P＜0.05);VAP发生率与患者就医环境的满意度、护士专业技术技能的满意度及护理服务质量综合满意度呈负相关(均P＜0.05).结论 针对UEX、CRBSI、VAP等3项护理质量敏感指标的质量控制与改进能进一步提高护理质量.     

Evidences for the regulation of GnRH and GTH expression by GnIH in the goldfish, Carassius auratus

Gonadotrophin-inhibitory hormone (GnIH) plays an important role in regulating of reproduction in teleosts. To clarify the mode of action of GnIH on the synthesis of gonadotropin releasing hormone (GnRH) and gonadotrophin (GtH), three GnIHR cDNAs were cloned from the goldfish brain. In situ hybridization results showed that GnIHRs were localized to the hypothalamus and pituitary. In the hypothalamus, GnIHRs were found in the NPP, NPO and NLT, whereas sGnRH neurons were reported to be located, and potentially regulated by GnIH. In the pituitary, only two GnIHRs were observed and they were localized to the PI instead of the adenohypophysis where GtH-expressing cells are localized, suggesting indirect regulation of GtH by GnIH. In vivo, intraperitoneal (i.p.) injections of synthetic goldfish GnIH-II peptide and GnIH-III peptide significantly decreased sGnRH and FSHβ mRNA levels. Only GnIH-II decreased LHβ mRNA levels significantly. In vitro, both GnIH-II and GnIH-III showed no effect on GtH synthesis, but an inhibition of GnRH-stimulated LHβ and FSHβ synthesis was observed when GnIH-III was applied to primary pituitary cells in culture. Thus, GnIH could contribute to the regulation of gonadotropin in the brain and pituitary in teleosts.     

异位妊娠246例临床资料回顾与分析

目的探讨异位妊娠的主要病因及各种治疗方法对异位妊娠治疗的临床价值,提高对异位妊娠的认识。方法回顾分析2010年1-12月1年间所收治的246例异位妊娠病例的临床资料,其中药物保守治疗136例,转手术治疗33例。手术治疗共141例,55例腹腔镜下病灶切除或输卵管造口。结果本研究246例异位妊娠患者,有人流或药流病史的190例,占77.24%,腹腔镜下病灶切除或输卵管造口术55例,占手术比例的41.78%。结论人流或药流若并发感染可造成慢性输卵管炎、盆腔炎等增加异位妊娠的发病率。腹腔镜技术损伤小,恢复快,住院时间短,用药少,外观好,在治疗异位妊娠中已发挥越来越重要的作用。     

血流感染分子诊断的研究进展

血流感染是一种严重的全身感染性疾病,血培养仍是目前诊断细菌性血流感染的金标准,但仅有30%~40%的血流感染可通过培养发现致病菌。分子生物学方法可通过分析患者血液标本中病原微生物的核酸成分,快速提供准确的细菌、真菌或病毒感染信息,甚至提供常见病原菌的耐药基因检测结果。目前,应用于临床实验室血流感染检测的分子生物学技术主要包括核酸杂交技术、核酸扩增及DNA序列分析、基因芯片和质谱检测技术等。对常见致病菌、分枝杆菌、苛养菌、少见病原菌等使用多种检测技术联合应用进行快速鉴定及耐药分析,可以在较短时间内为临床提供可靠的诊断结果,提示临床合理用药,提高血流感染患者的存活率。     

降钙素原联合C反应蛋白检测对早期血流感染的诊断价值

目的探讨降钙素原(PCT)联合C反应蛋白(CRP)检测早期诊断血流感染的价值。方法选择109例血流感染患者为研究组,109例其他局部感染患者为对照组,检测两组血清PCT、CRP水平,并进行血培养与菌种鉴定,评价PCT联合CRP检测的诊断效能。结果研究组血清PCT、CRP水平和检测阳性率显著高于对照组(P<0.05)。在血流感染患者中,革兰阴性菌感染患者血清PCT水平显著高于革兰阳性菌感染患者(P<0.05)。以0.35ng/mL和10mg/L分别作为PCT和CRP的cut-off值时,二者联合诊断血流感染的ROC曲线下面积最大(0.81)。结论 PCT联合CRP检测对血流感染的早期诊断价值较高,必要时可调低PCT的判断水平,从而提升诊断效能。     

Spatiotemporal Dynamics of Covert Attention With Different Degrees of Central Visual Field Defects: An ERP and sLORETA Study

PurposeThe present study aimed to investigate the spatiotemporal dynamics of covert attention by simulating different degrees of central visual field defects in healthy subjects.MethodsAn electroencephalogram (EEG) was recorded while 40 normal-sighted subjects performed a target discrimination task. Target stimuli simulated different defect degrees of the central visual field by artificially central scotomas (5, 10, 20, and 30 degrees of visual angle) masked on the center of black-and-white checkerboards. Event-related potentials (ERPs) and standardized low-resolution brain electromagnetic tomography (sLORETA) based on ERPs were analyzed.ResultsERP results indicated that during early perceptual processes, compared with 5-degree and 10-degree defects, N1 amplitudes of 20-degree and 30-degree defects decreased, whereas P2 amplitudes significantly reduced in 30-degree defects. During later discrimination and decision processing, N2 amplitudes gradually increased from 5-degree to 30-degree defects, whereas P3 amplitudes gradually decreased. Source localization indicated that 5-degree and 10-degree defects had stronger activations than 20-degree and 30-degree defects from the occipital cortex to the ventral stream and dorsal streams. Especially, 30-degree defects primarily recruited additional activations in the ventrolateral prefrontal cortex and ventral stream and later caused the disconnection of dorsolateral prefrontal-posterior parietal cortices in the dorsal stream.ConclusionsDifferent degrees of central visual field defects differed in distinct spatiotemporal characteristics at multiple stages of covert attention, from top-down forward feedback and attentional allocation to executive controls through ventral and dorsal processing streams, suggesting that the combination of ERP and source localization can reveal the spatiotemporal control capacity of the cortex on central visual field defects.