护理人文关怀对维持性血液透析患者焦虑状态的影响

目的探讨护理人文关怀对维持性血液透析患者焦虑状态的影响。方法对72例在院长期维持性血液透析患者采用护理人文关怀进行干预,包括成立人文关怀小组、制定护理人文关怀细则、评估患者焦虑状况、心理干预、提高社会支持度等措施。结果干预6个月后,患者焦虑发生率显著下降(P0.01);与干预前焦虑得分比较,差异有统计学意义(P0.01)。结论实施护理人文关怀能改善维持性血液透析患者的焦虑状态,提高生存质量。     

Polar metabolite of cholesterol induces rat cognitive dysfunctions

24-hydroxycholesterol, a major polar metabolite of brain cholesterol, has neurotoxic effects. However, little is known about the effects of this polar metabolite on the CNS. In the present study, the effects of 24-hydroxycholesterol on behavior changes were investigated. Rats were divided into three groups: (i) a control group; (ii) a sham group: 0.5 ml PBS was infused into the cerebral ventricle; (iii) a model group: 0.5 ml 24-hydroxycholesterol (10 μM) was infused into the cerebral ventricle. 24-hydroxycholesterol can obviously impair rats' acquisition and probe trial in the Morris Water Maze task. Compared with rats in the sham group, rats in the model group had longer escape latency time and traveled more distance, and performed worse in the probe trial task manifested by spending less time in the annulus and training quadrant, which probably was attributed to the neuronal degeneration in hippocampal CA1 area induced by 24-hydroxycholesterol as examined by histological assay and apoptotic assay. Our results revealed that the polar metabolites, such as 24-hydroxycholesterol, exert neurotoxic effects and exacerbate the neuron injury with their abnormal accumulation. These findings suggest that measures taken promptly to eliminate or inhibit the accumulation of polar metabolites should be a potential strategy to prevent neurological dysfunctions and promote the recovery of functional deficits after neurotoxic insult.     

Reconstruction of traumatic composite skull defect by free serratus anterior muscle and rib flaps

The management of traumatic craniofacial defects, especially that involving the skull base with a dura defect and cerebrospinal fluid (CSF) rhinorrhoea, remains a challenge. The main goal of surgery is to obliterate the abnormal communication as a result of bony and soft tissue defects. We present a patient with significant skull defects and CSF rhinorrhoea from traumatic head injuries. The free serratus anterior muscle and rib flap with an arteriovenous loop was successful and provided a solution to complex 3‐D defects requiring both soft‐tissue coverage and a vascularized bone graft. On 13‐month follow up, an adequate coverage and an anatomical contour restoration were shown.     

ADAM-17 over-expression in gallbladder carcinoma correlates with poor prognosis of patients

The ADAMs is a multi-functional gene family of membrane proteins possessing a disintegrin and metalloprotease domain. They have potential implications for the metastasis of human tumor cells via cell adhesion and protease activities. However, no studies have yet comprehensively examined the expression of ADAMs in gallbladder carcinoma. The aim of this study was to test the hypothesis that ADAM-17 (otherwise known as tumor necrosis factor-α converting enzyme) is involved in the progression of gallbladder carcinoma. Two hundreds samples of gallbladder carcinoma and sixty non-cancerous gallbladder samples were used to measure the expression of total ADAM-17 by enzyme-linked immunosorbent assay, and the precursor and active forms by western blotting analysis. Expression of ADAM-17 was significantly increased in tumors with high histological grade and pT stage compared with low histological grade and pT stage tumors and was not associated with patients’ gender, age, histological type, and resection margin involvement. Patients with high expression of ADAM-17 had a significantly shorter overall survival compared with those with low expression. Significantly, the prognostic impact of ADAM-17 was independent of conventional prognostic factors for gallbladder carcinoma. The current study demonstrated that the over-expression of ADAM-17 in patients with gallbladder carcinoma was linked closely with histological grade, pT stage and prognosis, and thus provides further impetus for exploiting ADAM-17 as new target for the treatment of gallbladder carcinoma.     

Atrial fibrillation: An anesthesiologist's perspective

Atrial fibrillation (AF) is not only the most common arrhythmia in the global population but also the most frequent one encountered in the operating room. For an anesthesiologist, it is crucial to have the ability to maintain hemodynamics and prevent complications of patients who present AF perioperatively. Here we provide a brief review in the novel concept of the classification, pathophysiology, and management of AF to provide a practical approach for physicians coming across this arrhythmia during the perioperative period.     

创建学习型妇幼保健院,提升妇幼卫生人才素质

妇幼卫生是立足现代,面向未来的事业,妇幼卫生人才的素质将直接影响中国妇幼卫生事业的发展。文章通过四川省妇幼保健机构与全国妇幼保健机构人力资源情况的对比,以及四川省妇幼保健机构的科研能力、教学管理、继续医学教育和"5.12"灾后重建现状,说明了创建学习型妇幼保健院的重要性和必要性,并通过运用学习型组织的理论和方法,对创建学习型妇幼保健院提出了思考和措施。     

Computer-aided diagnosis of intracranial hematoma with brain deformation on computed tomography

Physicians evaluate computed tomography (CT) of the brain to quantitatively and qualitatively identify various types of intracranial hematomas for patients with neurological emergencies. We propose a novel method that can perform this task in a totally automatic fashion, based on a multiresolution binary level set method. The skull regions are segmented in downsized images generated with a maximum filter. The intracranial regions are located using the average gray levels and connectivity. These regions compose the regions of interest (ROIs) for segmenting the hematoma from the normal brain. The gray levels of the voxels within these ROIs are generated with an averaging filter in a multiresolution fashion. After identifying the candidate hematoma voxels using adaptive thresholds and connectivity, binary level set algorithm is applied repeatedly until the original resolution is reached. We apply our method to non-volumetric non-contrast CT images of 15 surgically proven intracranial hematomas and the results were quantitatively evaluated by a human expert. The correlation coefficient between the volumes measured manually and automatically is 0.97. The overlap metrics ranged from 0.97 to 0.74, with an average of 0.88. The average precision and recall are 0.89 and 0.87, respectively. We use decision rules to classify these hematomas and were able to make correct diagnoses in all cases.     

Study on Tracheal Collapsibility,Compliance, and Stress by Considering Nonlinear Mechanical Property of Cartilage

Tracheal cartilage has been widely regarded as a linear elastic material either in experimental studies or in analytic and numerical models. However, it has been recently demonstrated that, like other fiber-oriented biological tissues, tracheal cartilage is a nonlinear material, which displays higher strength in compression than in extension. Considering the nonlinearity requires a more complex theoretical frame work and costs more to simulate. This study aims to quantify the deviation due to the simplified treatment of the tracheal cartilage as a linear material. It also evaluates the improved accuracy gained by considering the nonlinearity. Pig tracheal rings were used to exam the mechanical properties of cartilage and muscular membrane. By taking into account the asymmetric shape of tracheal cartilage, the collapse behavior of complete rings was simulated, and the compliance of airway and stress in the muscular membrane were discussed. The results obtained were compared with those assuming linear mechanical properties. The following results were found: (1) Models based on both types of material properties give a small difference in representing collapse behavior; (2) regarding compliance, the relative difference is big, ranging from 10 to 40% under negative pressure conditions; and (3) the difference in determining stress in the muscular membrane is small too: <5%. In conclusion, treating tracheal cartilage as a linear material will not cause big deviations in representing the collapse behavior, and mechanical stress in the muscular part, but it will induce a big deviation in predicting the compliance, particularly when the transmural pressure is lower than −0.5 kPa. The results obtained in this study may be useful in both understanding the collapse behavior of trachea and in evaluating the error induced by the simplification of treating the tracheal cartilage as a linear elastic material.