初产产妇母乳喂养知识掌握情况调查研究

目的调查初产产妇母乳喂养知识掌握情况。方法选取2010年9月-2012年3月于本院生产的初产产妇120例为研究对象,调查其母乳喂养知识掌握情况及实施情况,并将不同文化程度及是否接受产前培训者进行分类及比较。结果大专和以上文化程度的产妇喂养知识掌握优良率和实施较佳率高于其他产妇,而接受产前培训者也均高于未接受产前培训者,P均〈0.05,有显著性差异。结论初产产妇的文化程度及产前培训情况对母乳喂养知识掌握情况影响明显,从而影响到母乳喂养的实施情况。     

Preoperative predictors of mortality in adult patients with perforation peritonitis

Introduction:

There is paucity of data from India regarding the etiology, prognostic indicators, morbidity, and mortality patterns of perforation peritonitis. The objective of our study was to evaluate the predictors of mortality, preoperatively, for risk stratification of the patients and institution of an early goal-directed therapy.

Materials and Methods:

Eighty-four consecutive patients presenting with perforation peritonitis, in the age group of 14–70 years scheduled for emergency laparotomy were studied prospectively. The parameters studied were age and sex of the patients, associated co-morbidities, duration of symptoms, delay in initiating surgical intervention, and preoperative biochemical parameters such as hemoglobin, random blood sugar, blood urea, serum creatinine, pH, base excess, and serum lactate levels. In-hospital mortality was taken as the outcome.

Results:

We encountered a mortality of 17.8% in our study. Multiple linear (enter) regression identified the age, duration of symptoms, preoperative blood sugar levels, blood urea, serum creatinine levels, Mannheim Peritonitis Index, and the delay in instituting surgical intervention as independent predictors of mortality. Hyperlactatemia, acidosis and base excess were not found to be associated with mortality.

Conclusion:

Routine biochemical investigations, delay in presentation, and surgical intervention are good predictors of mortality. Recognizing such patients early may help the anesthesiologists in risk stratification and in providing an early goal-directed therapy.     

High incidence of optic canal involvement in tuberculum sellae meningiomas: rationale for aggressive skull base approach

Background

Current literature on TSMs underemphasizes the significance of OCI by the tumor. In this study, we aimed to document the incidence of OCI, its management using a SBT, and its significance with relation to the visual outcome.

Methods

Thirty-one patients with TSM were retrospectively analyzed. In 28 patients, SBT consisting of extradural anterior clinoidectomy with falciform ligament and optic nerve sheath opening was performed. Pre- and postoperative visual status was analyzed with respect to OCI.

Results

The incidences of OCI and preoperative visual deficit (VD) were 77.4% and 83.8%, respectively. With regard to preoperative visual status, OCI incidence was 84.6% in 26 patients with VD compared to 40% in 5 patients without (P = .016).Among the 23 patients with VD and detailed postoperative neuroopthalmologic evaluation, 78.3% had visual improvement; and in 21.7%, vision was unchanged on the operated side. In one patient (3.2% in the whole series), vision deteriorated on the side contralateral to the side of surgery. In the presence of OCI in 20 patients, vision improved in 80% and remained unchanged in 20%, whereas 1 of the 3 patients without OCI improved and the other 2 remained unchanged. Simpson grade I or II resection was achieved in 83.8%.

Conclusion

Optic canal involvement is very common in TSM (77.4%), and it correlates well with preoperative visual status. With the use of SBT, without which the tumor in the optic canal could not have been removed completely and safely, visual improvement of 78.3% and stability of 21.7% were achieved on the operated side.     

Branched Base‐Amplifying Oligomers Enhancing UV‐Curing of Epoxy Resins

This paper describes the preparation and the enhancing effect on anionic UV‐curing of epoxy resins of three and four‐armed oligomers bearing 9‐fluorenylmethyl carbamate residues, which displayed the autocatalytic formation of primary amino residues triggered by a photogenerated amine. The branched oligomers were readily synthesized by the Michael addition of the corresponding polythiol with 9‐fluorenylmethyl 2‐acryloyloxyethylcarbamate, which were obtained from 9‐fluorenylmethanol and commercially available 2‐isocyanatoethyl acrylate. Films of poly(glycidyl methacrylate) and a glycidylated novolac resin doped with a photobase generator exhibited boosted photosensitivity leading to photoinsolubilization in the presence of the base‐amplifying oligomers. The more marked effect of the branched oligomers on UV‐curing of epoxy resins was demonstrated by using films of a fluid epoxy, which were converted into hard films after UV exposure and post‐exposure baking, whereas no hardening occurred in the absence of the oligomers.

     

药学专业野外实践教学基地建设

实践教学基地及实践教学体系对于培养具有实践创新素质的药学人才具有重要作用。药用植物学作为一门药学专业必修的实践性课程,野外实践教学是一个重要环节。本文介绍了我院近几年药学专业野外实践教学基地的建设与应用。     

E-learning courses in epilepsy--concept, evaluation, and experience with the e-learning course "genetics of epilepsies"

PURPOSE: To evaluate the efficacy of the e-learning course "Genetics of Epilepsies" and to assess the experiences of the participants and e-moderators with this new approach. METHODS: Prospective, controlled study with waiting group (control group, n = 18) and e-learning group (n = 20). The control group got the same reference literature list as the e-learning group. Both groups were assessed twice: The e-learning group before and after the course; the control group was assessed at the same times. Primary outcome measure: increase in knowledge about genetics of epilepsies using questionnaires based on items formulated by experts (internal consistency, Cronbach's alpha = 0.86). Main hypothesis: greater increase of knowledge in the e-learning group compared to control group. Secondary outcome measures: assessment of the educational course and learning environment by participants and by tutors/e-moderators. RESULTS: Significant time x group interaction and group effect (ANOVA, each p < 0.01) with regard to knowledge. At baseline, the groups did not differ with respect to knowledge about genetics of epilepsy. In contrast to the control group, the increase of knowledge in the e-learning group was highly significant (p < 0.001). The majority of the participants of the e-learning course was content with their personal learning process (75% agree, 15% strongly agree). Most of them reported a gain in competence in the treatment and counseling of people with epilepsy (38.9% agree, 50% strongly agree). All participants would recommend this course to others and all but one participant are interested in other e-learning courses. CONCLUSION: The study indicates e-learning courses are an appropriate tool to improve knowledge of physicians in genetics of epilepsy.     

Regulated acid–base transport in the collecting duct

The renal collecting system serves the fine-tuning of renal acid–base secretion. Acid-secretory type-A intercalated cells secrete protons via a luminally expressed V-type H⁺-ATPase and generate new bicarbonate released by basolateral chloride/bicarbonate exchangers including the AE1 anion exchanger. Efficient proton secretion depends both on the presence of titratable acids (mainly phosphate) and the concomitant secretion of ammonia being titrated to ammonium. Collecting duct ammonium excretion requires the Rhesus protein RhCG as indicated by recent KO studies. Urinary acid secretion by type-A intercalated cells is strongly regulated by various factors among them acid–base status, angiotensin II and aldosterone, and the Calcium-sensing receptor. Moreover, urinary acidification by H⁺-ATPases is modulated indirectly by the activity of the epithelial sodium channel ENaC. Bicarbonate secretion is achieved by non-type-A intercalated cells characterized by the luminal expression of the chloride/bicarbonate exchanger pendrin. Pendrin activity is driven by H⁺-ATPases and may serve both bicarbonate excretion and chloride reabsorption. The activity and expression of pendrin is regulated by different factors including acid–base status, chloride delivery, and angiotensin II and may play a role in NaCl retention and blood pressure regulation. Finally, the relative abundance of type-A and non-type-A intercalated cells may be tightly regulated. Dysregulation of intercalated cell function or abundance causes various syndromes of distal renal tubular acidosis underlining the importance of these processes for acid–base homeostasis.