Video-assisted thoracoscopic surgery for thoracic empyema in patients on maintenance hemodialysis

Thoracic empyema in uremic patients on maintenance hemodialysis is a challenging situation. The clinical characteristics are rarely reported, and the surgical outcomes remain unclear. We report our experience with video-assisted thoracoscopic surgery in these patients during 10-year period of time. Between 2005 and 2015, we retrospectively reviewed the clinical characteristics, bacteriological studies, and thoracoscopic surgical results of 23 empyema patients undergoing maintenance hemodialysis. The mean patient age was 67.1 ± 12.9 years. All patients had additional preexisting systemic diseases. The mean duration of hemodialysis was 34.7 ± 25.8 months. The infections causing empyema were pneumonia in 11 (47.8%), blood stream infection in 8 (34.8%), and uremic pleuritis in 4 (17.4%). Among the 22 identified microorganisms, the most common pathogen was methicillin-resistant Staphylococcus aureus (31.8%). After thoracoscopic surgery, 8 patients (34.8%) required additional procedures for complications, including 2 patients who required repeated thoracoscopy for hemothorax and 6 (26.1%) patients who required open drainage for residual empyema. The mean hospital stay was 62.4 days, and 6 patients (26.1%) died in the hospital. Univariate and multivariate analyses revealed that maintenance hemodialysis longer than 5 years was a significant factor associated with in-hospital mortality (odds ratio: 14.8, 95% confidence interval 1.5–151.6; p < 0.0001). While surgical management of thoracic empyema in uremic patients undergoing maintenance hemodialysis is associated with high rates of complication and mortality, thoracoscopic surgery is feasible, especially for patients undergoing hemodialysis for less than 5 years.     

细胞力学在压力性损伤中的作用及影响因素研究进展

随着压力性损伤的研究重心逐渐向细胞水平转移，发现力学因素下细胞结构和功能改变在压力性损伤发展过程中起重要作用。综述力学因素下压力性损伤发生机制、影响因素、评估以及预防管理。旨在提高护理人员对压力性损伤更为深入地认知，从而推动压力性损伤研究多元化发展。     

Intravenous Thrombolysis Is Safe and Effective for the Cryptogenic Stroke in China: Data From the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

Background

The intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) therapy is safe and efficient during the treatment of acute ischemic stroke. Nonetheless, the different outcomes among various stroke subgroups have limited data with regard to the safety and efficacy of cryptogenic stroke (CS). The present study compared the safety and efficacy when IVT with rt-PA was used for the treatment of CS and the other stroke subtypes.

四方联动防跌护理在社区跌倒高危老年人中的应用

目的探讨专科护士-社区护士-个体-家庭四方联动防跌护理模式在社区跌倒高危老年人中的应用与效果。方法选取深圳市龙岗区的2个社区,随机分为观察组和对照组,从两个社区登记建档的跌倒高风险老年居民中分别随机抽选45名进行干预。观察组采用"专科护士-社区护士-个体-家庭"四方联动推进的综合干预方案。对照组接受社区防跌倒常规护理。于干预前及干预后12个月使用修订版社区老年人跌倒危险评估量表、步态和平衡测试量表对两组老年人进行评测,记录两组1年内跌倒发生例次。结果干预期间跌倒发生情况:观察组1人次,对照组6人次。观察组步态和平衡测试得分提高,跌倒危险评估表得分降低,与对照组比较,差异有统计学意义(均P0.01)。结论四方联动的综合干预方案应用于社区居家老年人,能有效降低老年人跌倒风险,提升其防跌能力,对预防社区老年人跌倒的发生有积极作用。     

阿魏酸对创伤性脑损伤小鼠的神经保护作用

目的本研究利用创伤性脑损伤(traumatic brain injury,TBI)小鼠模型观察阿魏酸(FA)对TBI的神经保护作用,为防治TBI继发性损伤的药物开发提供新思路。方法利用C57/BL6小鼠采用小鼠重复轻度脑损伤模型进行造模。通过干湿重比值法检测脑组织水肿、水迷宫实验检测小鼠学习记忆能力、HE染色法观察小鼠脑组织形态学变化、采用免疫组化法检测小胶质细胞的激活情况。结果与TBI组小鼠比较,阿魏酸组小鼠:脑含水量明显降低(P<0.05),Morris水迷宫实验中逃避潜伏期较TBI模型组明显缩短,原象限停留时间明显延长,活化的小胶质细胞减少。结论阿魏酸可改善TBI小鼠的空间学习记忆能力,降低TBI小鼠脑含水量,改善TBI小鼠的脑组织形态学变化,其机制与阿魏酸抑制小胶质细胞活化有关。     

Entitlement: The big problem in medical education we will not talk about

Abstract

Entitlement is a problem in medical education that has received relatively little attention. First, it is felt by educators, who often feel pressured to conform curricula and evaluations to satisfy learner demands and administrative pressures lest their careers are penalized. Second, entitlement affects the medical system, as entitled physicians are less empathetic and focus more on personal goods rather than patient needs. This shifts the humanistic basis for medicine. Thirdly, entitlement is problematic for learners, as constant accommodations ironically undermine self-reliance and adaptability. Constantly meeting these demands can diminish gratitude and overall happiness. To address this issue, learners must acknowledge the problem and seek remedies to it themselves, as top-down interventions will likely be rebuffed. Rather than focusing solely on the learning environment, solutions should also empower learners to engage their environment in effective and productive ways. This should include correcting cognitive distortions that lead learners to expect administrative interventions in all circumstances perceived as harmful. Other solutions include practicing gratitude and developing work friendships. While certainly not all learners are entitled and some environmental amendments should be made, learners and educators must realize that entitlement is shaping medical culture and collectively take steps to mitigate its negative effects.