会阴侧切改良技术防止新生儿分娩性肩损伤临床效果观察

目的:观察会阴侧切改良技术在经阴分娩中防止新生儿分娩性肩损伤的效果。方法:选择入我院经阴分娩产妇, 963例为观察组, 1140例为对照组Ⅰ, 400例为对照组Ⅱ。观察组会阴侧切术改良为15°~40°的小角度, 2~4cm的短切口,对照组Ⅰ采用传统会阴侧切术,对照组Ⅱ不行会阴切开术。三组观察指标同为:娩肩困难、CF、臂丛神经损伤等发生情况。统计学处理应用SPSS10. 0统计软件处理。计数资料χ2 检验。结果:新生儿出现娩肩困难,观察组明显低于对照组,P<0. 01,观察组、对照组Ⅱ为0,对照组Ⅰ发生25例,P<0.01,有显著性差异。结论改良技术可有效的防止经阴分娩中新生儿肩性损伤,值得临床推广。     

改良振荡烧瓶杀菌试验方法的可行性观察

目的改良振荡烧瓶杀菌试验方法,并在实验室进行实用可行性观察。方法参照振荡烧瓶抑菌试验方法,按杀菌试验方法原理进行改进,建立非溶出性消毒制剂杀菌试验方法。结果改良振荡烧瓶法杀菌试验主要程序是将作用体系样液量扩大到50 ml,以便经过充分振荡溶出杀菌成分;取作用后样液加入到中和剂内,然后进行活菌计数培养。经采用改良振荡烧瓶杀菌试验方法检测一种微溶出性消毒剂的杀菌效果与常规悬液定量杀菌试验法检测结果比较,有显著统计学意义,改良振荡烧瓶杀菌试验方法检测的结果能反应出该消毒剂真实杀菌效果。结论改良振荡烧瓶杀菌试验方法可以替代悬液定量杀菌试验方法,用于评价微溶出性消毒剂杀菌效果评价。     

150例重度功能性便秘患者围术期护理

目的总结重度功能性便秘经腹腔镜辅助下结肠次全切除＋改良Duhamel术的护理经验。方法对150例重度功能性便秘经腹腔镜辅助下结肠次全切除联合改良Duhamel术患者的临床资料进行分析。结果术后7例出现肛门便血,12例出现大便次数增多,2例出现肠梗阻症状。结论耐心细致的术前准备,完善的术中、术后护理对提高手术治愈率、减少术后并发症起着关键作用。     

Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates

Venous thromboembolism (VTE) is common but often unrecognized in medically ill patients. Over the past 5 years, three large-scale placebo-controlled trials enrolling a total of 5500 medically ill patients have highlighted the risk of VTE in this group. These trials have helped to define a specific at-risk patient profile, including those admitted to the hospital with severe congestive heart failure, respiratory illness, acute infection, and inflammatory bowel disease. We performed a retrospective review of patients admitted to the medical service at our tertiary care center to define how common the at-risk medical patient is and to evaluate and improve prophylaxis rates in this patient group. The study was conducted in two phases. Based on admission characteristics, patients were stratified into high-risk or low-risk groups for the development of VTE. During the pre-intervention phase, 75% of patients admitted to the medical service were characterized as increased risk for VTE, yet only 43% of these high-risk patients received prophylaxis of any sort. After interventions designed to increase awareness of VTE, we conducted a second review period. In this post-intervention phase, where 79% of patients were at risk for VTE, prophylaxis rates improved to 72%. Based on these results, we conclude that the majority of patients admitted to the medical service at our tertiary care center constitute a high-risk population that warrants consideration for VTE prophylaxis. Implementation of strategies to improve prophylaxis rates, including educational sessions and risk stratification guidelines, can be successful and improve identification and prophylaxis of this population.     

二氧化氯消毒剂检测方法的改进研究

目的改进二氧化氯含量检测方法,以提高其测定准确性。方法采用控制溶液pH值、加入稳定剂、活化剂和掩蔽剂等措施对其检测方法进行了改进。结果改进碘量法通过严格控制溶液pH值,消除了溶液中ClO2、Cl2、ClO2-、ClO3-各成分的相互干扰,保证了测定准确性。经比较,选出硼酸钠作为二氧化氯溶液的稳定剂,既可保证二氧化氯稳定,又易于其重新释放,便于分析测定。用传统碘量法测得二氧化氯含量明显高于改进的碘量法测定的结果,但改进的碘量法测得的含量基本接近产品实际标示量。结论本研究改进碘量法测定消毒剂溶液中二氧化氯含量,测定含量准确、容易操作。     

改良护理法预防腰椎融合术患者并发压疮的效果评价

目的探讨改良压疮护理法在预防腰椎融合术患者并发压疮中的应用效果。方法选取行腰椎融合术的32例患者为研究对象,按入院顺序随机分为干预组16例和对照组16例。干预组患者术中采用改良压疮护理干预措施,对照组采用传统护理措施,比较2组患者压疮发生情况以及患者对2种护理方法的满意程度。结果干预组患者压疮发生率（6.25%）显著低于对照组（37.50%）,差异有统计学意义（P〈0.05）;干预组患者压疮的发生时间（25.16±4.22）d显著长于对照组的（12.63±3.74）d,差异有统计学意义（P〈0.05）;干预组患者对压疮护理的满意度81.25%显著高于对照组的25.00%,差异有统计学意义（P〈0.05）。结论改良压疮护理法可以降低腰椎融合术患者的压疮发生率,延缓压疮的发生时间,同时提高患者的满意度。     

腹腔镜辅助下小儿巨结肠改良Soave术围术期的护理

目的总结腹腔镜辅助下改良Soave术治疗先天性巨结肠患儿的护理经验,以提高护理质量。方法做好患儿心理护理、完善术前准备、术后加强营养支持、会阴护理等。结果 66例患儿治愈出院,1例患儿家长放弃治疗。结论手术前后全面而专业的护理是保证腹腔镜辅助改良Soave术成功的关键。     

Bioinformatic method for protein thermal stabilization by structural entropy optimization

Engineering proteins for higher thermal stability is an important and difficult challenge. We describe a bioinformatic method incorporating sequence alignments to redesign proteins to be more stable through optimization of local structural entropy. Using this method, improved configurational entropy (ICE), we were able to design more stable variants of a mesophilic adenylate kinase with only the sequence information of one psychrophilic homologue. The redesigned proteins display considerable increases in their thermal stabilities while still retaining catalytic activity. ICE does not require a three-dimensional structure or a large number of homologous sequences, indicating a broad applicability of this method. Our results also highlight the importance of entropy in the stability of protein structures.     

Sildenafil improves health-related quality of life in patients with pulmonary arterial hypertension

BACKGROUND: Sildenafil inhibits phosphodiesterase-5, enhancing cyclic guanosine monophosphate- mediated relaxation of pulmonary vasculature and is effective in treating patients with pulmonary arterial hypertension (PAH). METHODS: Patients with PAH (n = 278) received oral sildenafil (20, 40, or 80 mg three times daily) in a 12-week, double-blind, placebo-controlled study and an open-label extension. Health-related quality of life (HRQoL) was recorded by patients using the Medical Outcomes Study 36-item short form (SF-36) and EuroQol 5D (EQ-5D) questionnaires at baseline and after 12 and 24 weeks of therapy. Data are presented for patients who received sildenafil for up to 24 weeks. RESULTS: Sildenafil-treated patients, compared with placebo-treated patients, exhibited significant improvement in exercise capacity at week 12 (p < 0.001). Increases from baseline to week 12 were observed in all SF-36 domains for sildenafil-treated patients, with statistically significant improvements, compared with placebo-treated control subjects, in physical functioning (p < 0.001), general health (p < 0.001), and vitality (p < 0.05). Statistically significant improvements were also observed for the EQ-5D current health status (p < 0.01) and utility index (p < 0.01). These benefits were maintained for 24 weeks. Treatment groups were pooled for analyses as the results for the 6-min walk distance, SF-36, and EQ-5D were not dose dependent. CONCLUSIONS: Sildenafil improves HRQoL of PAH patients. These improvements appear to be maintained for at least 24 weeks. The effects are strongest in domains addressing the physical impact of health on daily activities and patients' overall perception of health.     

序贯性机械通气治疗COPD所致严重呼吸衰竭治疗切换点时间窗的研究

目的探索早期拔管改换无创机械通气策略的技术可行性并评价其治疗效果。方法选择接受气管插管和机械通气的慢性阻塞性肺疾病（COPD）病例36例,随机分为治疗组20例和对照组16例,治疗组20例以同步间歇强制通气十压力支持通气（SIMV＋PSV）方式行机械通气,待＂改良GCS评分达15分标准＂稳定2h窗口期出现,此时拔除气管导管,改用经鼻面罩压力支持通气十呼气末正压（PSV＋PEEP）通气,以后渐减PSV水平直至脱离呼吸机。对照组16例待肺部感染明显控制时判为＂肺部感染控制窗＂出现,此时拔除气管导管,改无创通气直至脱离呼吸机。动态观察两组病例机械通气前通气及氧合指标,两组接受有创机械通气时间、总机械通气时间、总住院时间、重新插管率、VAP发生例数。结果治疗组与对照组的治疗前各指标相仿（P〉0.05）;两组有创通气时间分别为（3.2±1.1）和（5.4±2.3）d,P〈0.05;呼吸机相关肺炎发生例数分别为0和3例,P〈0.05;住院时间分别为（17士3）和（21士5）d,P〈0.05。结论对COPD合并呼吸衰竭插管上机病例,以＂改良GCS评分达15分标准＂窗口期为时机,早期拔管改用经鼻面罩无创通气可以显著改善治疗效果。