Multiple brain networks support processing speed abilities of patients with multiple sclerosis

Objectives: Many people affected by multiple sclerosis (MS) experience cognitive impairment, especially decreases in information processing speed (PS). Neural disconnection is thought to represent the neural marker of this symptom, although the role played by alterations of specific functional brain networks still remains unclear. The aim is to investigate and compare patterns of association between PS-demanding cognitive performance and functional connectivity across two MS phenotypes.

Methods: Forty patients with relapsing-remitting MS (RRMS) and 25 with secondary progressive MS (SPMS) had neuropsychological and MRI assessments. Multiple regression models were used to investigate the relationship between performance on tests of visuomotor and verbal PS, and on the verbal fluency tests, and functional connectivity of four cognitive networks, i.e. left and right frontoparietal, salience and default-mode, and two control networks, i.e. visual and sensorimotor.

Results: Patients with SPMS were older and had longer disease history than patients with RRMS and presented with worse overall clinical conditions: higher disease severity, total lesion volume, and cognitive impairment rates. However, in both patient samples, cognitive performance across tests was negatively correlated with functional connectivity of the salience and default-mode networks, and positively with connectivity of the left frontoparietal network. Only the visuomotor PS scores of the RRMS group were also associated with connectivity of the sensorimotor network.

Conclusions: PS-demanding cognitive performance in patients with MS appears mainly associated with strength of functional connectivity of frontal networks involved in the evaluation and manipulation of information, as well as the default mode network. These results are in line with the hypothesis that multiple neural networks are needed to support normal cognitive performance across MS phenotypes. However, different PS measures showed partially different patterns of association with functional connectivity. Therefore, further investigations are needed to clarify the contribution of inter-network communication to specific cognitive deficits due to MS.     

护理实验室开放管理模式的探索与体会

分析传统护理实验室管理的主要问题,探索护理实验室开放管理的实施方法,充分发挥实验室的功能,以提高实验教学效果及学生的综合素质、提升实验教学资源的利用率等。     

Angiotensin receptor antagonists in patients with nephropathy due to type 2 diabetes

In the past few years diabetes has become the leading cause of end-stage renal disease in all Western countries. A correlation between blood pressure and rate of progression in diabetic nephropathy was noted very early, and increased local activity of the renin angiotensin system was identified as a major pathophysiological mechanism for proteinuria and nephrosclerosis in diabetic patients. Angiotensin converting enzyme (ACE) inhibitors have been shown to slow progression of nephropathy in type 1 diabetic patients. The majority of diabetic patients with nephropathy, however, are suffering from type 2 diabetes and until last year there was no convincing evidence of ACE inhibitors being able to slow progression in type 2 diabetic patients with nephropathy. Three new studies now fill this gap, showing that angiotensin receptor blockers (ARB) are nephroprotective in patients with type 2 diabetes, independently of blood pressure. This review provides an in-depth discussion of the results of these studies and provides recommendations for patient management.     

某三甲教学医院手术病人手术部位感染危险因素及人工网络模型探讨

目的 统计某医院外科病人手术部位感染发生率,找出导致术后感染的相关因素,对外科病人发生术后感染的机率进行科学预测。方法 研究对象选取2012—2015年某三甲教学医院术后病人,发生275例手术部位感染的病人为病例组,另按照1∶1比例选取术后无感染266例病人为对照组,进行病例回顾性调查研究,统计检出致病菌和手术感染部位情况,探讨手术部位感染综合因素,结合术后感染统计分析数据构建人工网络模型。结果 手术部位感染率0.35％。多因素分析结果表明,手术部位感染的独立危险因素分别是手术类型、是否有原发疾病、切口类别、ASA病情分级、病人年龄、手术时长、手术例次(OR=11.043,9.587,2.136,1.818,1.299, 1.293,1.041,P<0.05)。最终确定网络模型运行结果如下,平均误差为0.040%,网络错分率 0.038% ;通过曲线下面积(ROC)大于0.9。结论 部位感染危险因素前三位是手术类型、是否患有原发疾病、切口类别。人工网络模型针对手术部位感染危险度的预测结果较理想,建立与其相关预报信息平台系统,为临床院感管控决策提供指导依据。     

四年制中专涉外护理教育模式探讨

目的：构建以能力为本的涉外护理教学体系，培养适应医学模式转变和护理学科发展的涉外护理人才，方法：以涉外护理四年制中专学生为对象进行课程设置，教学方法和实践教学的改革。结果：涉外护理班英语，医学基础知识，护理学基础课程及综合能力测试成绩均优于普通护理班（P＜0．05或P＜0．01），结论：涉外护理教育模式有利于护生能力的培养及综合素质的提高。     

抗纤灵冲剂对慢性肾衰竭肾功能及纤维化指标影响的临床研究

目的 :研究抗纤灵冲剂对慢性肾衰竭 (CRF)患者肾纤维化、肾功能的作用。方法 :观察抗纤灵冲剂对慢性肾衰竭患者的肾功能指标即血清肌酐 (Scr)、尿素氮 (BUN)和纤维化指标即血清层粘连蛋白 (LN)、纤维连结蛋白(FN)、Ⅲ型前胶原 (PC -Ⅲ )、Ⅳ型胶原 (C -Ⅳ )的影响。结果 :与服用包醛氧淀粉的对照组患者比较 ,抗纤灵冲剂有明显的降低慢性肾衰竭患者的血清Scr、BUN、LN、PC -Ⅲ、C -Ⅳ和升高FN的作用 ,二者有统计学意义 (P <0 .0 5 )。结论 :该方能改善肾纤维化、延缓慢性肾衰竭的进程。     

经输尿管镜治疗输尿管上段结石失败原因的分析及对策

目的通过分析输尿管镜治疗输尿管上段结石的失败原因,提高对输尿管上段结石治疗的效果和成功率。方法我院自2003年5月至2007年6月,共经输尿管镜治疗输尿管上段结石347例,其中碎石失败83例。本组病例年龄23～65岁,平均46岁;男性49例,女性34例。66例患者在术前30d内有过肾绞痛病史。术前曾行体外冲击波碎石治疗失败者14例。术前均行静脉肾盂造影检查,结石直径0.6～1.6cm,平均1.0cm。所有病例使用STORZ产8F输尿管镜。结果1例因结石粉碎不完全,双J管放置未达肾盂,引起梗阻感染,5d后急诊开放手术治愈。3例因结石远端息肉,输尿管镜不能到达结石或术中息肉出血视野不清而中转开放手术取石。63例因结石大部或全部返入肾盂,追加体外冲击波碎石。15例因输尿管狭窄经扩张后或扭曲仍不能到达结石,其中10例中转开放手术取石,5例改行经皮肾镜取石术。1例因术中输尿管穿孔而中转开放。结论经输尿管镜治疗输尿管上段结石失败的原因较多,但通过相应的技术改进和病例选择,可以得到满意的疗效。     

建立整形外科病房分级心理护理模式的研究

目的：探讨适用于整形外科病房的分级心理护理模式。方法：将120例整形外科患者入院后随机分为试验组和对照组,试验组给予分级心理护理,对照组给予常规心理护理,监测不同时段两组患者的脉搏、呼吸和血压。结果：两组患者在入院时脉搏、呼吸和血压无统计学意义,试验组在术前1天、术后4天的脉搏、呼吸和血压变化均显著低于对照组（均P〈0.01）。结论：分级心理护理模式对于整形外科住院患者具有专业性强,连贯性好、重点突出的特点,能够有效地稳定患者的心理状态,显著提高护理效果。     

失效模式和效应分析在髋关节置换术后护理中的应用

目的探讨失效模式和效应分析(FMEA)在髋关节置换术后护理中的应用效果。方法将2009年1～6月收治的28例全髋关节置换术患者设为对照组,围手术期按骨科护理常规护理;2009年7～12月收治的30例髋关节置换术患者设为观察组,在围手术期除执行骨科护理常规外,还运用FMEA对髋关节置换术后可能发生脱位的失效模式进行前瞻性原因和操作流程分析、评估、计算,找出导致术后关节脱位的最高危因素及高危操作步骤,制定防范的优先行动计划和改进措施。结果观察组6个高危因子的危机值显著低于对照组(均P0.01);两组患者对防脱位相关知识掌握程度、住院时间、满意度比较,差异有统计学意义(P0.05,P0.01)。观察组住院期间人工关节未发生脱位,对照组发生脱位1例。结论应用FMEA对髋关节置换手术后患者进行评估、分析和采取相关措施,能有效防范风险,降低术后脱位的发生,提高护理质量,促进患者康复。     

整形外科临床教学模式浅析

随着整形美容外科专业在我国的蓬勃发展,国内不同等级的医疗机构对经过正规培训的整形美容外科医生的需求逐年在增加。为了提高教学效果,针对整形外科不同层次的学生,我们采用了多种形式、有针对性的教学模式,并取得了一定的效果。本文分别从教学查房、手术带教、读书报告、技能培训、学术交流、专题讲座等多个层面浅析了整形外科临床教学模式。