膀胱肿瘤切除术后尿路感染病原学和危险因素

目的观察膀胱肿瘤切除术后患者尿路感染发生情况与病原学特征,分析诱发尿路感染的危险因素,并提出合理且具备针对性的冲洗对策,为未来膀胱肿瘤切除术后尿路感染的预防提供合理参考。方法回顾性分析连云港市第一人民医院2016年1月-2019年1月接受经尿道膀胱肿瘤切除术治疗的451例膀胱肿瘤患者的临床资料,收集患者病例资料,全部患者术后均定期取尿液标本进行细菌培养,参照相关标准判定患者尿路感染情况,记录患者一般情况,包括一般人口学资料(性别、年龄、体质量、受教育程度等),同时记录患者糖尿病的疾病合并情况,将术后尿路感染可能的危险因素纳入初步分析,Logistic多因素回归分析膀胱肿瘤切除术后发生尿路感染的危险因素。结果451例膀胱肿瘤切除术患者术后第3天尿液中细菌培养阳性例数为80例,阳性率为17.74%,在使用抗菌药物后,患者尿液中细菌培养阳性率逐渐降低,各时点尿液细菌阳性培养率比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析检验证实,高龄、血糖水平控制不佳、术前留置导尿管、多发肿瘤是膀胱肿瘤切除术后尿路感染的危险因素(OR>1,P<0.05);80例术后尿液细菌培养阳性患者共分离出87株菌株,其中革兰阴性菌66株占75.86%,革兰阳性球菌21株占24.14%。结论膀胱肿瘤切除术后患者有较高的尿路感染风险,革兰阴性菌是主要的感染病原菌,年龄、基础疾病、肿瘤位点、术前导尿管留置等是影响因素,这类患者应引起临床高度重视。     

The spontaneous decay and persistence of mental contamination: An experimental analysis

Background and objectives

It has recently been identified that feelings of contamination can arise in the absence of physical contact with a stimulus. This concept, known as ‘mental contamination’ has particular relevance to Obsessive Compulsive Disorder in which compulsive cleaning is a common symptom presentation. Experimental studies have begun to examine the psychopathology of mental contamination. The aims of the two experiments reported here were to explore the evocation and spontaneous decay of mental contamination.

Methods

In Experiment 1, a variant of the autobiographical memory task was used in which 40 non-clinical participants were asked to recall autobiographical memories associated with betrayal, harm, humiliation and violation of moral standards. In Experiment 2, 60 participants with moderate levels of mental contamination were asked to complete five short tasks designed to induce mental contamination, including recalling unwanted memories and images.

Results

In both experiments, participants reported significant increases in mental contamination, anxiety, urges to wash and actual washing behaviour. In experiment 1, the effect of the induction decayed spontaneously. Experiment 2 found that re-evoking contamination and repeated washing led to the persistence of mental contamination.

Limitations

The studies were conducted on non-clinical samples.

Conclusions

These findings demonstrated that repeated triggers may be causally connected to the maintenance of mental contamination fears in non-clinical samples.     

重组人酸性成纤维细胞生长因子对剖宫产妇女腹部切口愈合影响的临床研究

目的 评价不同给药方式的重组人酸性成纤维细胞生长因子（rh-aFGF）对剖宫产妇女腹部切口愈合的近期影响及瘢痕形成的远期影响.方法 入选5 16例剖宫产妇女,按随机数字表法分为安慰剂组、喷雾组和冲洗组,每组172例,安慰剂组术后给予0.9％氯化钠冲洗腹部切口后缝合;喷雾组于切口缝合后直接给予rh-aFGF喷雾,3～4喷/cm2,3～5次/d;冲洗组术中腹壁缝合前给予2支rh-aFGF溶于0.9％氯化钠直接冲洗后缝合切口,然后给予喷雾治疗.近期随访15d观察产妇腹部切口愈合情况,远期随访3个月观察切口瘢痕形成情况.结果 冲洗组腹部切口完全愈合时间为（8.6±3.5）d,较喷雾组的（10.4±3.7）d及安慰剂组的（12.7±4.9）d均明显缩短,差异有统计学意义（P＜0.05）;冲洗组延迟愈合占4.2％（7/166）,显著低于安慰剂组的20.2％（34/168）及喷雾组的9.7％（16/165）,差异有统计学意义（P＜0.05）;三组脂肪液化、术后感染发生率比较差异无统计学意义（P＞0.05）;冲洗组渗出、腹壁粘连发生率低于安慰剂组和喷雾组[2.4％（4/166）比10.1％（17/168）、5.5％（9/165）,3.6％（6/166）比17.3％（29/168）、9.7％（16/165）],差异有统计学意义（P＜0.05）.远期随访发现,冲洗组瘢痕面积比喷雾组减少13.5％,比安慰剂组减少27.2％.结论 rh-aFGF近期可缩短剖宫产产妇腹部切口愈合时间以及减少腹壁粘连及渗出;rh-aFGF的最佳给药方式为术中冲洗联合术后喷雾进行治疗.     

Intolerance of uncertainty and obsessive-compulsive symptom expression

Background and objectivesResearch suggests a relationship between intolerance of uncertainty (IU) and obsessive-compulsive disorder (OCD), though this has been limited to self-report measures of OCD symptoms. The current investigation examined the relationship between IU and multiple symptom domains of OCD using self-report and in vivo assessments of OC symptoms.MethodsFive separate studies are presented in which undergraduate students (N = 603) were administered a self-report measure of IU and tasks related to either ordering and arranging, checking, washing, contamination avoidance, or neutralization.ResultsIntolerance of uncertainty was found to be significantly related to each self-report measure of the OCD symptom domains (ps < .01). Further, IU was predictive of performance on all in vivo tasks (ps < .05) except one concerning neutralizing/harm-related obsessions.LimitationsThis study relied on an unselected sample and was correlational in design.ConclusionsThe current study demonstrates that IU is related to multiple OC symptom dimensions. Future experimental research is warranted to evaluate the causal role of IU in OCD.     

1例直肠癌患者术后继发腹壁多处坏死性软组织感染的护理

总结1例直肠癌患者术后继发腹壁多处坏死性软组织感染的护理经验。护理要点：感染性休克的早期识别和有效控制;坏死性软组织感染的识别及护理,控制全身性感染再次发生;分阶段落实个体化镇痛,改善疼痛症状;分阶段动态落实营养支持方案;实施全程心理干预。经过122 d的精心护理,8处伤口全部愈合,患者恢复良好。     

不同病区医护手监测的结果与评价

大量流行病院调查证明:医院感染通常是直接或间接经手传播的,医护人员接触带菌病人,极易成为病菌载体,再次与其他病人接触,可能发生经手交叉感染,增大医院感染传播几率。据统计调查显示由医务人员洗手不彻底,导致细菌传播而造成感染占医院感染发生率的30%。采用肥皂加流动水洗手,可使手上的细菌数量减少60%～90%,基本上达到清除细菌的要求。为了加强对医护人员手清洁及消毒效果的管理工作,降低和控制医院感染发生率,特将2000年2月至2003年2月期间对本院重点科室医护人员手的微生物监测情况总结分析如下。1资料与方法1.1研究对象对2000年2月…     

Controlled release of antifungal drug terbinafine hydrochloride from poly(N-vinyl 2-pyrrolidone/itaconic acid) hydrogels

In the present study, a new microwave-enhanced dehydration and solvent washing purification of penicillin G sulfoxide technique has been developed. The results show that microwave irradiation can dehydrate penicillin G sulfoxide from a water content of 14–26 to below 0.5% in 40–60 min in N₂ or air. After washing with ethyl acetate to remove impurities and residual water, the penicillin G sulfoxide can be used to synthesize cephalosporanic acid. The recovery of cephalosporanic acid was equal to and the purity of cephalosporanic acid was higher by 2% than that of the current dehydration technique. FTIR spectroscopy was used to study the process of microwave-enhanced dehydration and solvent washing purification of penicillin G sulfoxide.     

中药熏洗加针刺治疗髌骨软骨软化症97例

目的观察中药熏洗及针剌治疗髌骨软骨软化症的，临床疗效。方法采用中药熏洗及针刺治疗两周。结果97例中，治愈63例，占64．9％；好转28例，占28．9％，未愈6例，占6．2％，有效率93．8％。结论中药熏洗及针刺治疗髌骨软骨软化症临床疗效满意.     

不同温度冲洗液对前列腺电切术患者体温的影响

目的 探讨不同温度冲洗液对经尿道前列腺汽化电切术(TUVP)患者术中体温的影响.方法 选择行TUVP的患者57例,将其随机分为加温组29例和室温组28例.加温组术中使用冲洗液的温度维持在30℃～35℃,室温组术中使用冲洗液的温度维持在20℃ ～ 25℃.观察患者的中心体温、寒战反应等指标.结果 加温组患者的中心体温在术中0.5、1h以及术终均比室温组的中心体温高,差异有显著性(P＜0.05).加温组患者的寒战发生率(13.8％)比室温组(46.4％)低,差异有显著性(P＜ 0.01).结论 在行TUVP术中使用加温冲洗液有预防患者术中低体温的作用.