钛夹联合内镜下黏膜切除术治疗重度胃黏膜脱垂症的临床观察

目的：观察钛夹联合内镜下黏膜切除术对重度胃黏膜脱垂症的治疗效果及安全性。方法：对53例经胃镜确诊的重度胃黏膜脱垂症患者采用钛夹联合内镜下黏膜切除术治疗,并分别于术后4周、8周行临床症状随访和胃镜复查。结果：53例患者治疗成功率100％,4周有效率98．1％,8周有效率100％,无出血、穿孔等并发症发生。结论：钛夹联合内镜下黏膜切除术治疗重度胃黏膜脱垂症疗效确切,安全性高,是目前比较先进的微创治疗方法之一。     

Monitoring transfusionist practices: a strategy for improving transfusion safety

BACKGROUND: Data from New York State indicate that about 1 of every 33,000 red cell units transfused is ABO-incompatible with the recipient. National application of these data suggests that as many as 360 ABO-incompatible whole blood and red cell transfusions might occur annually in the United States. Phlebotomy and blood bank laboratory errors cause some of these ABO-incompatible transfusions, but the greatest number result either partially or solely from the failure of transfusionists to identify properly either a patient or the blood component a patient receives. STUDY DESIGN AND METHODS: A quality assessment/quality improvement (QA/QI), process is described that allowed for the direct oversight (monitoring) of transfusionists' practices and for the assessment of institutional policies for blood administration. RESULTS: At the beginning of the QA/QI process, monitoring of blood administration practices revealed that a variance from institutional blood administration policy occurred during 50 percent of blood and component transfusions. As a result of the QA/QI process, the percentage of transfusions with an associated variance from institutional policy dropped to nearly zero. CONCLUSION: The QA/QI process described in this report, or one similar to it, could improve transfusion safety and serve as a model for increased involvement by transfusion service medical directors in the oversight of transfusionists' practices.     

Safety and efficacy of liraglutide in patients with type 2 diabetes with elevated liver enzymes: individual patient data meta-analysis of the LEAD programme

BackgroundFatty liver disease has reached epidemic proportions in type 2 diabetes. Glucagon-like peptide-1 (GLP-1) analogues are licensed for treatment of type 2 diabetes, yet little data exist on efficacy and safety in liver injury. We aimed to assess the safety and efficacy of 26 weeks' liraglutide on liver function compared with an active placebo.MethodsIndividual patient data meta-analysis was done with patient level data combined from six 26-week, phase 3, double-blind randomised controlled trials on type 2 diabetes, which comprise the Liraglutide Effect and Action in Diabetes (LEAD) programme. In addition, the LEAD-2 sub-study was analysed to assess the effect on CT-measured hepatic steatosis.FindingsOf 4442 patients analysed, 2241 (50·8%) had an abnormal alanine aminotransferase (ALT) at baseline (mean 33·8 IU/L [SD 14·9] in female participants; 47·3 [18·3] in male participants). Liraglutide 1·8 mg reduced ALT in these patients compared with placebo (?8·20 vs ?5·01 IU/L, p=0·003), and was dose dependent (no significant differences vs placebo with liraglutide 0·6 or 1·2 mg). This effect was lost after adjustment for liraglutide's effect on reduction of weight (corrected mean ALT difference vs placebo ?1·41 IU/L, p=0·21) and HbA1c (corrected mean ALT difference vs placebo 0·57 IU/L, p=0·63). Adverse effects with 1·8 mg liraglutide were similar between patients with and without baseline abnormal ALT. In the LEAD-2 sub-study, liraglutide 1·8 mg (26 weeks) improved hepatic steatosis (CT-measured liver:spleen attenuation ratio) from baseline (0·10, p=0·001) and showed a trend towards improvement compared with placebo (0.10 vs 0·00, p=0·07).Interpretation26 weeks of liraglutide (1·8 mg) is safe, well tolerated, and improves liver enzymes compared with placebo in patients with type 2 diabetes.FundingWellcome Trust.     

Early and late components of error monitoring in violent offenders with psychopathy

BACKGROUND: One of the most recognizable features of psychopathy is the reduced ability to successfully learn and adapt overt behavior. This might be due to deficient processing of error information indicating the need to adapt controlled behavior. METHODS: Event-related potentials (ERPs) and behavioral components of error-monitoring processes were investigated in 16 individuals with psychopathy and in 18 healthy subjects. A letter version of the Eriksen flanker task was used in two conditions. The first condition (normal condition) required participants to press one of two buttons depending on the identity of the target stimulus. The second condition (signaling condition) required them to signal each time they had committed an error by making a second press on a signaling button. Early stages of error monitoring were investigated by using the error-related negativity (ERN/Ne) and post-error slowing as indexes. Later stages were explored by examining the error positivity (Pe) and signaling rates. RESULTS: Both groups showed similar ERN amplitudes and amounts of post-error slowing. The psychopathic group exhibited both reduced Pe amplitudes and diminished error-signaling rates compared with the control group. CONCLUSIONS: Individuals with psychopathy show intact early error processing and automatic behavioral adaptation but have deficits in later stages of error processing and controlled behavioral adaptation. This is an indication that individuals with psychopathy are unable to effectively use error information to change their behavior adequately.     

能谱CT虚拟平扫在肾癌中的应用

目的：探讨能谱CT虚拟平扫(VNC)替代常规平扫在肾癌中的临床应用价值。方法回顾分析32例经病理证实为肾癌的患者影像资料,均行能谱CT常规平扫及动脉期、静脉期能谱成像(GSI),采用MSI软件生成动脉期VNC和静脉期VNC图像。分别测量3组图像(常规平扫、动脉期VNC、静脉期VNC)肾脏病灶的CT值、病灶-正常肾脏的对比噪声比(CNR),同层面病灶的长径、橫径,采用单因素方差分析;由2位放射科医师对3组图像分别行5分制图像质量主观评分,3分制影像学征象主观评分,对2位医师评价结果的一致性行Kappa 检验,对3组图像的图像质量主观评分行单因素方差分析。结果2位医师对3组图像评价结果的一致性较好(Kappa 值均>0.700);3组图像间图像质量主观评分无统计学差异(P>0.05);影像学征象主观评分动脉期 VNC为2.88±0.34,静脉期VNC为2.84±0.37,均可接受。3组图像的CNR分别为0.52±0.11、0.72±0.16、0.69±0.12,动脉期VNC、静脉期 VNC的对比噪声比(CNR)均高于常规平扫,有统计学差异(P<0.05)。3组图像同层面病灶的长径和横径无统计学差异(P>0.05)。3组图像肾脏病灶的CT值分别为(30.04±4.09)HU、(32.69±4.07)HU、(32.56±3.52)HU,有统计学差异(P<0.05),常规平扫病灶的CT值低于动脉期 VNC和静脉期 VNC,但差值均在5 HU内。结论在肾癌检查中 VNC能替代常规平扫,可减少患者的扫描次数,降低辐射剂量。     

慢性乙肝患者健康教育效果评价

目的探讨健康教育对慢性乙型病毒性肝炎（CHB）患者的影响。方法对89例2次住院的CHB患者。通过指导阅读健康教育手册、个别指导、集体座谈的形式进行系统的健康教育，并其出院时、再次入院时采用CHB相关知识测试题、自我管理能力测评表进行健康教育效果评价。结果教育后患者CHB相关知识掌握优良率、自我管理能力明显提高。与教育前比较。差异有显著性意义（均P〈0．01）。再次入院时．患者虽对CHB相关知识掌握优良率有所下降，但与出院时比较，差异无显著性意义（P〉0．05）；而患者自我管理能力明显下降．与出院时比较，差异有显著性意义（P〈0．05，P〈0．01）。结论健康教育能提高患者CHB相关知识掌握水平和自我管理能力，但须强化教育．使患者在自身健康方面达到知识、信心及行为的长久统一，并指导其处理好隐私与传染意识的对立统一关系。     

稀有放线菌产生的抗生素

由于从链霉菌中发现新抗生素的几率越来越小，从稀有放线菌中寻找新抗生素成为研究的重点。稀有放线菌是新生物活性物质的重要产生菌，其产生的抗生素具有结构多样及活性独特的特点。本文概述近年来稀有放线菌中的小单孢菌属、诺卡菌属、马杜拉放线菌属、游动放线菌属、拟无枝菌酸菌属、小双孢菌属及糖多孢菌属等产生的抗生素种类及其活性。     

室间隔缺损部分修补的大动脉调转术的护理配合

总结了5例室间隔缺损部分修补的大动脉调转术的护理配合经验。洗手护士熟悉手术方法及步骤，充分准备所需器械和缝线，熟练配合；巡回护士注意手术进展，按要求配置心血管活性药物，正确使用降温厦复温辅助设施，预见可能出现的问题并做好应急准备，才能确保手术顺利进行。