B超在眼后段异物测量中的准确性分析

目的：评估B超在不同性质眼后段异物大小测量中的准确性。

方法：回顾性分析2016-01/12在我院被诊断为眼后段异物的患者13例13眼。异物在取出后用直尺测量实际大小,并同术前B超所测数值进行比较,同时计算相关系数(B超测量值/实际大小)。为了排除手术操作损伤异物对真实大小测量的影响,选定长度为5mm的不同材质物体(分别为金属、玻璃和木质)放入直径约20～30mm的水囊中模拟眼内异物,同样进行以上的测量,测量重复4次。

结果：选取13眼内异物均经玻璃体手术完整取出,其中金属磁性异物12眼,玻璃异物1眼。12个金属异物术前B超所测长轴和实际长度的平均值分别为3.65±1.30和2.45±0.94mm,所有测量值均大于实际值(P=0.016)。相关系数的平均值为1.49。体外实验中,金属、玻璃和木质三种不同性质异物B超的平均测量值分别为6.76±0.15、6.55±0.04和6.02±0.07mm,相关系数分别为1.35、1.31和1.20。

结论：B超用于眼后段异物测量时,其所测量值会大于真实大小,尤其是对于金属和玻璃异物。因此在术中制作异物取出切口时需要进行考虑。     

TGF-β信号通路促进小鼠乳腺癌活检相关性肺转移的实验研究

目的探讨空芯针穿刺活检(core needle biopsy,CNB)对乳腺癌远处转移的影响及其可能机制。方法 30只BALB/c小鼠采用乳腺癌4T1细胞乳腺脂肪垫接种,分成活检与非活检两组,活检组应用CNB建立活检相关肺转移模型,采用流式细胞术、qPCR及形态学等检测技术从肿瘤组织局部和整体水平评价其生物学行为。结果成功建立稳定而可靠的乳腺癌肺转移模型,活检组小鼠肺转移结节数显著高于非活检组(P0.05);与非活检组相比,活检组小鼠TGF-β1、SOX-4及EZH2的m RNA表达上调(P0.05),流式细胞术检测的NK细胞增加,但差异无统计学意义(P0.05)。结论 CNB可通过TGF-β信号通路介导的上皮-间质转化(epithelial-mesenchymal transition,EMT)等机制促进乳腺癌的肺转移。     

新旧《医院财务制度》衔接的体会

镇江是全国两轮医改的试点城市。文章从6个方面总结镇江四院率先执行新《医院财务制度》所取得的经验,为全国顺利接轨服务。     

Improving the quality of transition and transfer of care in young adults with congenital heart disease

The transition and transfer from pediatric to adult care is becoming increasingly important as improvements in the diagnosis and management of congenital heart disease allow patients to live longer. Transition is a complex and continuous process that requires careful planning. Inadequate transition has adverse effects on patients, their families and healthcare delivery systems. Currently, significant gaps exist in patient care as adolescents transfer to adult care and there are little data to drive the informed management of transition and transfer of care in adolescent congenital heart disease patients. Appropriate congenital heart disease care has been shown to decrease mortality in the adult population. This paper reviews the transition and transfer of care processes and outlines current congenital heart disease specific guidelines in the United States and compares these recommendations to Canadian and European guidelines. It then reviews perceived and real barriers to successful transition and identifies predictors of success during transfer to adult congenital heart disease care. Lastly, it explores how disease‐specific markers of outcomes and quality indicators are being utilized to guide transition and transfer of care in other chronic childhood illnesses, and identifies existing knowledge gaps and structural impediments to improving the management of transition and transfer among congenital heart disease patients.     

Transition from fetus to neonate

This article provides an overview of the key physiological changes that take place as the fetus transitions to neonatal life. It provides and an overview of fetal transition with a focus on respiratory and cardiovascular changes.     

Being in transit and in transition The experience of time at the place,when living with severe incurable disease ‐ a phenomenological study

The aim of this study is to describe the experience of time as it presents itself at the place being situated when living with severe incurable disease and receiving palliative care. The empirical data consist of 26 open‐ended interviews with 23 patients receiving palliative care at home, at a palliative day care, in a palliative bed unit in hospital or in a nursing home in Norway. A common meaning of a shifting space for living emerged from the analysis and was revealed through three different aspects: (i) Transition from a predictable to an unpredictable time: To live with severe incurable disease marks a transition to a changed life involving an ongoing weakened and altered body with bothersome symptoms making experience of time different and unpredictable. (ii) Transition between a safe and unsafe time: When time is unpredictable, feeling safe is revealed as essential to how time is experienced at the place being situated. (iii) To be in transition from a homely to a homeless existence: In a time of increased bodily weakness, unpredictable ailments and displacements, the sense of belonging to the place is revealed as significant to the experience of time. Not knowing where to be in a time of change is like an existential cry of distress where the foothold in existence is lost. The findings are discussed and interpreted as an embodied experience originating from the passage of time continually affecting life sometimes so fundamentally that it marks a transition to a changed space of life that is reflected in the experience of time.     

The effects of pregnancy complications on the parental adaptation process

The current study examined the effects of high-risk pregnancies on the adaptation process of parents of full-term healthy infants. Gender similarities and differences were also addressed to determine the adaptation process of parents who experience a high-risk pregnancy. The sample consisted of 68 high-risk and 59 low-risk pregnancy couples, making a total of 254 new parents. Questionnaires measuring general issues related to the parental adaptation process as well as several specific components dealing with parental role attainment were administered. An effect of risk status and gender was detected on the parental adaptation process. The experience of high obstetrical risks also appeared to have an effect on the perception of life changes and on the development of a sense of competence among parents. Moreover, the findings demonstrated that the gender of the parent contributed to parental experience. Women experienced significantly more life changes than did men. Mothers also differed from fathers in the sense of satisfaction they experienced in their roles as parents.