经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）是经外周贵要静脉、肱静脉、正中静脉或头静脉穿刺置管,送管体达上腔静脉中下1/3处的中心静脉导管置入术,因其操作安全,留置时间长,目前被广泛应用于临床。...经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）是经外周贵要静脉、肱静脉、正中静脉或头静脉穿刺置管,送管体达上腔静脉中下1/3处的中心静脉导管置入术,因其操作安全,留置时间长,目前被广泛应用于临床。在穿刺和导管组合导入鞘置入过程中患者会感受不同程度的疼痛,随着以人为本整体护理观念的深入,展开更多
Objectives This study was designed to determine if a subset of patients who ha ve undergone bidirectional cavopulmonary anastomosis could be identified in whic h catheterization was of little benefit before completion...Objectives This study was designed to determine if a subset of patients who ha ve undergone bidirectional cavopulmonary anastomosis could be identified in whic h catheterization was of little benefit before completion of the Fontan procedur e. Background Diagnostic evaluation before Fontan procedure has typically includ ed cardiac catheterization. However, the overall management strategy for patient s with functional single ventricle has evolved to include staging bidirectional cavopulmonary anastomosis in most, and it has become uncommon to exclude patient s from Fontan based on catheterization data. Methods Patients who underwent bidi rectional cavopulmonary anastomosis and had complete echocardiograms and cathete rizations within three months of each other between January 1992 and October 199 7 were evaluated with a series of clinical and echocardiographic characteristics to identify a subset in whom catheterization was predicted to be of little adde d value (“no-cath”group). The predictive value and sensitivity of these crite ria in excluding patients who required additional intervention, were excluded fr om Fontan, or died within 30 days of Fontan was determined. Results A total of 9 9 patients who underwent bidirectional cavopulmonary anastomosis at 6.7 months ( range 2.9 months to 14 years) were studied; 46 met criteria for the “no-cath” group. Noninvasive criteria stratified all patients who died (n=5) or did not pr oceed to Fontan (n =1) and 9 of 11 who required additional interventions to the “cath”group. Thus, the negative predictive value of these criteria was 93%. C onclusions Our data suggest that catheterization before Fontan could be avoided in a large percentage of patients without adversely affecting outcome; prospecti ve evaluation of this strategy is warranted.展开更多
Aortic valve stenosis （AS） is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, fra...Aortic valve stenosis （AS） is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation （TAVI） has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the ef-fect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular in-jures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality.展开更多
Objective To examine the expression of cell division cycle associated 2(CDCA 2) in pancreatic ductal adenocarcinoma(PDAC) and investigate its role in prognosis of PDAC patients.Methods This retrospective study include...Objective To examine the expression of cell division cycle associated 2(CDCA 2) in pancreatic ductal adenocarcinoma(PDAC) and investigate its role in prognosis of PDAC patients.Methods This retrospective study included 155 PDAC patients who underwent surgical treatment and complete post-operative follow-up.Clinicopathologic data were collected through clinical database.Tissue microarray was constructed and immunohistochemistry was performed to detect CDCA2 expression in the PDAC tumor tissues and adjacent non-tumor tissues.Clinicopathological characteristics between high and low CDCA2 expression were compared.Correlation of CDCA2 expressions with patients' survival was analyzed using Kaplan-Meier method and Cox regression analysis.Results Expression of CDCA2 in PDAC cells was significantly higher than that in adjacent non-tumor tissues(U=4056.5,P<0.001).Univariate analysis showed that CDCA2 expression [hazard ratio(HR)=1.574,95% confidence interval(CI)=1.014-2.443,P=0.043] and node metastasis(HR=1.704,95%CI=1.183-2.454,P=0.004) were significantly associated with prognosis.Cox regression analysis showed CDCA2 expression was not an independent prognostic risk factor(HR=1.418,95%CI=0.897-2.242,P=0.135) for PDCA patients.Stratification survival analysis demonstrated CDCA2 expression as an independent prognostic risk factor in male patients(HR=2.554,95%CI=1.446-4.511,P=0.003) or in non-perineural invasion patients(HR=2.290,95%CI=1.146-4.577,P=0.012).Conclusions CDCA2 is highly expressed in PDAC tumor tissue.Although CDCA2 is not an independent prognostic risk factor for PDAC patients,it might be used to help predict prognosis of male or non-perineural invasion patients of PDAC.展开更多
We aimed to study the appropriate posture of peripherally inserted central catheter （PICC） patients, to reduce the incidence of internal jugular vein heterotopia. Methods： From 2009 to 2013, a total of 290 cases wi...We aimed to study the appropriate posture of peripherally inserted central catheter （PICC） patients, to reduce the incidence of internal jugular vein heterotopia. Methods： From 2009 to 2013, a total of 290 cases with PICC were enrolled in our study. They were divided into two groups. The patients in control group took regular position, which mean pros- tration, upper limb of tube side was abduction 90°, head moved to puncture side in order to block the internal jugular vein. On the basis of conventional body position putting, posture of patients in observation group was improved, the head remain neutral, and had 180° angle with trunk longitudinal axis, not favor any side. After ensuring the upper limb abduction, had 90° angle with the trunk, then catheter was inserted slowly. The jugular venous catheter heterotopia rate was judged by X.ray results. Results： The jugular venous catheter heterotopia rate of control group and observation was 12.8% and 0.68%, respectively. The difference between two groups was statistically significant （P 〈 0.01）. Conclusion： The body posture improvement can prevent discomfort of patients and reduce the jugular venous catheter heterotopia rate of PICC.展开更多
In recent years, the status of leaders has been highlighted and their role has been often overstated. The aim of the contribution is to show that in conditions of the armed forces, the role and the competence of the m...In recent years, the status of leaders has been highlighted and their role has been often overstated. The aim of the contribution is to show that in conditions of the armed forces, the role and the competence of the manager are often more important than competence of a leader. On the basis of the experience of the authors and more experienced officers, and by means of methods of targeted interviews and discussions, the areas have been identified where management capabilities are more important than leadership capabilities. More than 30 experienced officers have contributed their views on the presented results. There are areas, such as strategy, environment, organizational culture, external and internal changes, efficiency, and results and performance. In conclusion, authors suggested solution for nomination of leaders and managers to command positions.展开更多
The present work aims to evaluate the increase in the number of spot welds in the 16 × 16 type fuel assembly structure that connects guide thimbles and spacer grids, in order to provide a proper joint for this co...The present work aims to evaluate the increase in the number of spot welds in the 16 × 16 type fuel assembly structure that connects guide thimbles and spacer grids, in order to provide a proper joint for this connection. This new and improved process can provide more stiffness to the whole structure, since the number of spots raised from four to eight. A 3-D geometric model of a guide thimble section was generated in a CAD （computer aided design） program （SolidWorks）. After that, the geometric model was imported to a CAE （computer aided engineering） program （ANSYS Mechanical APDL, Release 14.0）, where the finite element model was built, considering the guide thimble geometry assembled with the spacer grid through the welded connections. Boundaries conditions were implemented in the model in order to simulate the correct physical behavior due to the operation of the fuel assembly inside the reactor. The analysis covered specific loads and displacements acting on the entire structure. The method used to solve this finite element analysis was a linear static simulation in order to perform the connection between a spacer grid cell and a guide thimble section. Hence, four models was evaluated, differing on the spot weld number in the spacer grid and guide thimble connection. The rotational stiffness results of each model were compared. The results acquired from four and eight spot weld were validated with physical test results. The behavior of the structure under the acting force/displacement and the related results of the analysis, mainly the stiffness, were satisfied. The results of this analysis were used to prove that the increasing spot welds number is an improvement in the dimensional stability when submitted to loads and displacements required on the fuel assembly design. This analysis aid to get more information of extreme importance such as, the pursuance to develop better manufacturing process and to improve the fuel assembly performance due to the increasing of the bum-up.展开更多
Objective: We studied the alterations in the expression of estrogen receptor alpha (ER) in the progression from ductal carcinoma in situ (DCIS) to invasive ductal carcinomas (IDC). Methods: The mastectomy specimens of...Objective: We studied the alterations in the expression of estrogen receptor alpha (ER) in the progression from ductal carcinoma in situ (DCIS) to invasive ductal carcinomas (IDC). Methods: The mastectomy specimens of 120 cases containing both DCIS and IDC were examined. The expression of ER proteins were examined by immunohistochemistry. The difference of the expression of ER proteins between DCIS and IDC were compared. Results: There were 58.33% of the cases with DCIS expressing ER proteins, and 40.00% of the cases IDC expressing ER proteins. There was a significant decrease of ER expression in IDC compared to DCIS (χ2 = 4.034, P = 0.045). Conclusion: These findings substantiate the notion that breast cancer progression is often associated with alterations in expressions of ER. The underlying mechanisms of these alterations need further investigation.展开更多
文摘经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）是经外周贵要静脉、肱静脉、正中静脉或头静脉穿刺置管,送管体达上腔静脉中下1/3处的中心静脉导管置入术,因其操作安全,留置时间长,目前被广泛应用于临床。在穿刺和导管组合导入鞘置入过程中患者会感受不同程度的疼痛,随着以人为本整体护理观念的深入,
文摘Objectives This study was designed to determine if a subset of patients who ha ve undergone bidirectional cavopulmonary anastomosis could be identified in whic h catheterization was of little benefit before completion of the Fontan procedur e. Background Diagnostic evaluation before Fontan procedure has typically includ ed cardiac catheterization. However, the overall management strategy for patient s with functional single ventricle has evolved to include staging bidirectional cavopulmonary anastomosis in most, and it has become uncommon to exclude patient s from Fontan based on catheterization data. Methods Patients who underwent bidi rectional cavopulmonary anastomosis and had complete echocardiograms and cathete rizations within three months of each other between January 1992 and October 199 7 were evaluated with a series of clinical and echocardiographic characteristics to identify a subset in whom catheterization was predicted to be of little adde d value (“no-cath”group). The predictive value and sensitivity of these crite ria in excluding patients who required additional intervention, were excluded fr om Fontan, or died within 30 days of Fontan was determined. Results A total of 9 9 patients who underwent bidirectional cavopulmonary anastomosis at 6.7 months ( range 2.9 months to 14 years) were studied; 46 met criteria for the “no-cath” group. Noninvasive criteria stratified all patients who died (n=5) or did not pr oceed to Fontan (n =1) and 9 of 11 who required additional interventions to the “cath”group. Thus, the negative predictive value of these criteria was 93%. C onclusions Our data suggest that catheterization before Fontan could be avoided in a large percentage of patients without adversely affecting outcome; prospecti ve evaluation of this strategy is warranted.
文摘Aortic valve stenosis （AS） is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation （TAVI） has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the ef-fect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular in-jures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality.
基金Supported by the National High Technology Research and Development Program of China(863 Program)(2012AA02A212)
文摘Objective To examine the expression of cell division cycle associated 2(CDCA 2) in pancreatic ductal adenocarcinoma(PDAC) and investigate its role in prognosis of PDAC patients.Methods This retrospective study included 155 PDAC patients who underwent surgical treatment and complete post-operative follow-up.Clinicopathologic data were collected through clinical database.Tissue microarray was constructed and immunohistochemistry was performed to detect CDCA2 expression in the PDAC tumor tissues and adjacent non-tumor tissues.Clinicopathological characteristics between high and low CDCA2 expression were compared.Correlation of CDCA2 expressions with patients' survival was analyzed using Kaplan-Meier method and Cox regression analysis.Results Expression of CDCA2 in PDAC cells was significantly higher than that in adjacent non-tumor tissues(U=4056.5,P<0.001).Univariate analysis showed that CDCA2 expression [hazard ratio(HR)=1.574,95% confidence interval(CI)=1.014-2.443,P=0.043] and node metastasis(HR=1.704,95%CI=1.183-2.454,P=0.004) were significantly associated with prognosis.Cox regression analysis showed CDCA2 expression was not an independent prognostic risk factor(HR=1.418,95%CI=0.897-2.242,P=0.135) for PDCA patients.Stratification survival analysis demonstrated CDCA2 expression as an independent prognostic risk factor in male patients(HR=2.554,95%CI=1.446-4.511,P=0.003) or in non-perineural invasion patients(HR=2.290,95%CI=1.146-4.577,P=0.012).Conclusions CDCA2 is highly expressed in PDAC tumor tissue.Although CDCA2 is not an independent prognostic risk factor for PDAC patients,it might be used to help predict prognosis of male or non-perineural invasion patients of PDAC.
文摘We aimed to study the appropriate posture of peripherally inserted central catheter （PICC） patients, to reduce the incidence of internal jugular vein heterotopia. Methods： From 2009 to 2013, a total of 290 cases with PICC were enrolled in our study. They were divided into two groups. The patients in control group took regular position, which mean pros- tration, upper limb of tube side was abduction 90°, head moved to puncture side in order to block the internal jugular vein. On the basis of conventional body position putting, posture of patients in observation group was improved, the head remain neutral, and had 180° angle with trunk longitudinal axis, not favor any side. After ensuring the upper limb abduction, had 90° angle with the trunk, then catheter was inserted slowly. The jugular venous catheter heterotopia rate was judged by X.ray results. Results： The jugular venous catheter heterotopia rate of control group and observation was 12.8% and 0.68%, respectively. The difference between two groups was statistically significant （P 〈 0.01）. Conclusion： The body posture improvement can prevent discomfort of patients and reduce the jugular venous catheter heterotopia rate of PICC.
文摘In recent years, the status of leaders has been highlighted and their role has been often overstated. The aim of the contribution is to show that in conditions of the armed forces, the role and the competence of the manager are often more important than competence of a leader. On the basis of the experience of the authors and more experienced officers, and by means of methods of targeted interviews and discussions, the areas have been identified where management capabilities are more important than leadership capabilities. More than 30 experienced officers have contributed their views on the presented results. There are areas, such as strategy, environment, organizational culture, external and internal changes, efficiency, and results and performance. In conclusion, authors suggested solution for nomination of leaders and managers to command positions.
文摘The present work aims to evaluate the increase in the number of spot welds in the 16 × 16 type fuel assembly structure that connects guide thimbles and spacer grids, in order to provide a proper joint for this connection. This new and improved process can provide more stiffness to the whole structure, since the number of spots raised from four to eight. A 3-D geometric model of a guide thimble section was generated in a CAD （computer aided design） program （SolidWorks）. After that, the geometric model was imported to a CAE （computer aided engineering） program （ANSYS Mechanical APDL, Release 14.0）, where the finite element model was built, considering the guide thimble geometry assembled with the spacer grid through the welded connections. Boundaries conditions were implemented in the model in order to simulate the correct physical behavior due to the operation of the fuel assembly inside the reactor. The analysis covered specific loads and displacements acting on the entire structure. The method used to solve this finite element analysis was a linear static simulation in order to perform the connection between a spacer grid cell and a guide thimble section. Hence, four models was evaluated, differing on the spot weld number in the spacer grid and guide thimble connection. The rotational stiffness results of each model were compared. The results acquired from four and eight spot weld were validated with physical test results. The behavior of the structure under the acting force/displacement and the related results of the analysis, mainly the stiffness, were satisfied. The results of this analysis were used to prove that the increasing spot welds number is an improvement in the dimensional stability when submitted to loads and displacements required on the fuel assembly design. This analysis aid to get more information of extreme importance such as, the pursuance to develop better manufacturing process and to improve the fuel assembly performance due to the increasing of the bum-up.
基金Supported by a grant from the National Science Foundation of China (No. 30772100)
文摘Objective: We studied the alterations in the expression of estrogen receptor alpha (ER) in the progression from ductal carcinoma in situ (DCIS) to invasive ductal carcinomas (IDC). Methods: The mastectomy specimens of 120 cases containing both DCIS and IDC were examined. The expression of ER proteins were examined by immunohistochemistry. The difference of the expression of ER proteins between DCIS and IDC were compared. Results: There were 58.33% of the cases with DCIS expressing ER proteins, and 40.00% of the cases IDC expressing ER proteins. There was a significant decrease of ER expression in IDC compared to DCIS (χ2 = 4.034, P = 0.045). Conclusion: These findings substantiate the notion that breast cancer progression is often associated with alterations in expressions of ER. The underlying mechanisms of these alterations need further investigation.
