识症急救护理联合溯源性心理疏导在重症急性胰腺炎患者中的应用

目的:探讨识症急救护理联合溯源性心理疏导在重症急性胰腺炎患者中的应用效果。方法:选择2019年11月1日~10月31日收治的80例重症急性胰腺炎患者,按照随机数字表法分为实验组和对照组各40例,对照组采用重症胰腺炎常规护理,实验组在常规护理基础上采用识症急救护理联合溯源性心理疏导;比较两组焦虑、抑郁程度[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)]、休克发生及疼痛控制情况、体温及肠鸣音恢复时间、腹胀腹痛消失时间、排便时间。结果:实验组SAS和SDS评分、休克发生率均低于对照组(P<0.05),体温及肠鸣音恢复时间、腹胀腹痛恢复时间与排便时间均短于对照组(P<0.05),疼痛控制率高于对照组(P<0.05)。结论:采用识症急救护理联合溯源性心理疏导对重症急性胰腺炎患者实施干预,可缓解其负性情绪,获得较为理想的病情控制与恢复效果。

诊病-辨证-识症三位一体诊疗模式的构建与意义

病、证、症是中医理论体系中层次有别的对人体疾病的反映,对于病证的诊断均不可或缺。应综合病、证、症(包含现代医学检查)三位于一体的诊断思维模式,逐渐发挥出中医学在疾病诊治方面的优势。自内涵至外延,厘清病、证、症的概念,强调以病证结合思想为基础,以辨证为核心,客观看待"症"、全面"识症",构建诊病-辨证-识症三位一体的诊疗模式,并论证其在临床实际中发挥的作用及意义。

高脂血症中医识症辨析

中医的识症是辨病和辨证的基础,症的规律探讨必将对高脂血症中医病机的确定起重要作用。突出中医的自身优势,充分发挥"非疾病诊断症状"作为中医辨证主要依据的优势,积极探索高脂血症中医识症的规律,可使识症的研究对高脂血症中医治疗水平的提高做出贡献。

肝纤维化的中医临证思辩

中医治疗肝纤维化近20年来已取得可喜的成果,从中药单体提取到单味中药,及中药复方制剂经实验室和临床观察研究,均表明中药对治疗肝纤维化有确切疗效。但从临证观之,对于肝纤维化的诊治,临床重视识症与辨证的关系,重视辩体与辨证、辩病相结合来治疗该病;这将对探讨中医治疗类似像肝纤维化样的,临床症状比较隐蔽的疾病,提供一条治疗思路。

Depression recognition using functional connectivity based on dynamic causal model

Dynamic casual modeling of functional magnetic resonance imaging（fMRI） signals is employed to explore critical emotional neurocircuitry under sad stimuli. The intrinsic model of emotional loops is built on the basis of Papez＇s circuit and related prior knowledge, and then three modulatory connection models are established. In these models, stimuli are placed at different points, which represents they affect the neural activities between brain regions, and these activities are modulated in different ways. Then, the optimal model is selected by Bayesian model comparison. From group analysis, patients＇ intrinsic and modulatory connections from the anterior cingulate cortex （ACC） to the right inferior frontal gyrus （rlFG） are significantly higher than those of the control group. Then the functional connection parameters of the model are selected as classifier features. The classification accuracy rate from the support vector machine（SVM） classifier is 80.73%, which, to some extent, validates the effectiveness of the regional connectivity parameters for depression recognition and provides a new approach for the clinical diagnosis of depression.

临证救误案析

识症与辨证是中医临床取得疗效的关键之一,然因临床病情复杂,多有误治,本文录余临证救误案例数则,冀益于同道。臌胀(血吸虫病肝硬化)洪××,女,50岁,农场工人,住院号:9785。“血吸虫肝病”史二十余年。三个月前始食欲减退,周身乏力,一月来腹部逐渐胀大,小溲量少,曾在当地医院作B超等检查,诊断为“血吸虫肝硬化,腹水”,经用利尿、护肝等药物,症情未能控制,遂于1989年8月16日收住我院。诊时症见:精神萎顿。

Antithrombotic therapy in TAVI

Transcatheter aortic valve implantation （TAVI） carries a significant thromboembolic and concomitant bleeding risk, not only during the procedure but also during the periprocedural period. Many issues concerning optimal antithrombotic therapy after TAVI are still under debate. In the present review, we aimed to identify all relevant studies evaluating antithrombotic therapeutic strategies in relation to clinical outcomes after the procedure. Four randomized control trials （RCT） were identified analyzing the post-TAVI antithrombotic strategy with all of them utilizing aspirin lifelong plus clopidogrel for 3-6 months. Seventeen registries have been identified, with a wide variance among them regarding baseline characteristics, while concerning antiplatelet therapy, clopidogrel duration was ranging from 3-12 months. Four non-randomized trials were identified, comparing single vs. dual antiplatelet therapy after TAVI, in respect of investigating thromboembolic outcome events over bleeding complications. Finally, limited data from a single RCT and a retrospective study exist with regards to anticoagulant treatment during the procedure and the optimal antithrombotic therapy when concomitant atrial fibrillation. In conclusion, due to the high risk and frailty of the treated population, antithrombotic therapy after TAVI should be carefully evaluated. Diminishing ischaemic and bleeding complications remains the main challenge in these patients with further studies to be needed in this field.

Early mobilization implementation for critical ill patients:A cross-sectional multi-center survey about knowledge,attitudes,and perceptions of critical care nurses

Objective To explore critical care clinicians’knowledge,attitudes and perceptions toward early mobilization of critically ill patients in ICUs.Design A cross-sectional national survey was conducted.From January to August 2020,ICU nurses in 11 hospitals were surveyed by using a questionnaire on the knowledge,attitudes and perceptions of ICU early mobilization.Results Totally 512 nurses completed the questionnaire.The respondents’mean score for knowledge of early mobilization was 6.89±2.91.The level of knowledge was good in 2.5%(13/512),fair in 52.3%(268/512).The attitudes toward early mobilization were positive in 31.4%(161/512).In terms of perceived implementation of ICU early mobilization,42.9%(220/512)of nurses did not believe that this should be a top priority in intensive care.The attitudes of nurses from different ICUs were significantly different(F=3.58,P<0.05).The knowledge(7.34±2.78 vs.6.49±2.97,t=3.37,P<0.001)and attitudes(3.82±0.58 vs.3.52±0.56,t=5.63,P<0.001)of nurses who had early mobilization related training were higher than those of nurses who had no training.Conclusions The importance of early ICU early mobilization is increasingly recognized by critical care providers.However,there is still a gap in the knowledge,attitudes and perceptions of ICU early mobilization among nurses.In future studies,it is necessary to further systematically identify the reasons leading to the gaps in these aspects and implement targeted interventions around these gaps.Meanwhile,more nurses should be encouraged to participate in decision-making to ensure the efficient and quality implementation of ICU early mobilization practices.

A survey of advanced medical students’ knowledge towards cancer pain management

Objective: The aim of the study was to investigate advanced medical students' knowledge towards cancer pain management, and understand the effect of specialisms and duration of oncology rotation on the advanced medical students' cognitive level towards cancer pain management. Methods: Randomly selected the respondents from a medical school in Wuhan, China. The educational background of the respondents should belong to one of these conditions: (1) clinical master degree candidate; (2) clinical doctor degree candidate; (3) the sixth or seventh year of clinical medicine for seven years. The respondents should also spend more than one year on internship. The self-developed questionnaire papers were distributed to respondents in the unit of dorms selected randomly and recovered them immediately after they're finished. The categori- cal data were expressed at the form of frequency (rate or constituent ratio). Chi-square test was required only as needed. Results: The survey was anonymous. We distributed 300 papers, recovered 300 papers and weeded out 8 invalid papers. Finally there were 292 valid papers, and the valid recovery rate was 97.3%. The 96.7% of oncological medical students and 47.6% non-oncological medical students relied on patients' description for cancer pain assessments; 90.0% of oncological medical students and 53.0% of non-oncological medical students prescribed strong opioid drugs firstly for patients suffering severe cancer pain; only 24.1% of non-oncological medical students recognized that pethidine was not safe and effective to treat cancer pain, which was much lower than oncological medical students (90.0%); 73.3% of oncological medical students and 28.9% of non-oncological medical students had the correct impression of drug addiction; 85.5% of non-oncological medi- cal students worried about the drug addiction, while 60.0% of oncological medical students worried about the strict control over opioid. In respect of the details of cancer pain management, only 66.7% of oncological medical students recognized that there was no upper limit of opioid prescribed clinically, and 16.3% of oncological medical students recognized that there was no psychological dependence if patients took opioid orally. The 69.8% of the students from no-less-than-two-week group relied on patients' description for cancer pain assessments, 76.7% prescribed strong opioid drugs firstly for patients suffer- ing severe cancer pain, 69.8% recognized that pethidine was not safe and effective to treat cancer pain, and 55.8% had the correct impression of drug addiction. All of the data were higher than that in no-rotation group and that in less-than-two-week group. The 51.2% of the students from no-less-than-two-week worried about drug addiction, which was the lowest of all. Conclusion: The cognitive level of advanced medical students towards cancer pain management is so low that it could not satisfy the clinical requirement, especially for the non-oncological medical students and the students spending little time on oncology rotation. Though the oncological medical students know something about cancer pain treatment, they know little about the details.

Mechanism of sex hormone level in biological clock disorder induced acne and analysis of TCM Pathogenesis

Acne vulgaris is a common chronic inflammatory disease of pilosebaceous units. And sex hormone level disorder has became a hot research topic in the pathogenesis of acne. Studies show that the biological clock disorder can result in the disorder of sex hormone levels which causes or aggravates acne. Biological clock disorder coincides naturally with "sleep rhythm disorder" in Traditional Chinese Medicine(TCM). In this paper, we will discuss the modern medical mechanism of the biological clock disorder resulting in acne from the angle of sex hormones, and analyze the TCM pathogenesis of the disease caused by the disorder of the biological clock.

The roles of toll-like receptors in carcinogenesis and cancer immunotherapy

Toll-like receptors （TLRs） are probably the most important class of pattern-recognition receptors. Members of the TLR family play key roles in the both innate and adaptive immune responses. Recognition of pathogen-associated molecular patterns （PAMPs） by TLRs, either alone or in heterodimedzation with other TLR or non-TLR receptors, induces the production of signals that are responsible for the activation of genes important for an effective host defense, especially those of proinflammatory cytokines. Thus, TLRs are involved in the development of many pathological conditions including infectious diseases, tissue damage, and cancer especially. In this review, the contribution of TLRs to tumorgenesis is evaluated. We hope to provide new insight into the progression of cancer and more importantly into the potential for TLRs as targets of therapeutics.

Media Influence Over the Transformation of Stigma Toward Depression in Japan

in Japan, the number of depression patients has markedly increased over the last 10 years, and depression is now a major social concern. Moreover, there are concerns that patients with depression are not always seeking the treatment they need, in part due to the stigma associated with the illness. Despite of increasing public awareness of depression, the stigma has not lessened, but has changed in form. Previous studies report that depression which was once viewed as a special psychiatric illness is now viewed as a ＂common＂ mental illness. The author, too, believes that the nature of the stigmatization has changed in recent years to become more complex and ultimately continues to present a barrier to treatment for people with depression. This study aims to explore how the stigmatization has changed by examining one specific aspect in society that may have contributed to this change, namely, the media＇s portrayal of depression. The author presents and discusses clear examples of how the Japanese media＇s portrayals of depression have changed, particularly over the last 20 to 30 years, and discusses how media influence could have contributed to the shifts in stigmatization, with reference to labeling theory and growing social isolation.

Effect of arousal methods for 175 cases of prolonged coma after severe traumatic brain injury and its related factors

Objective: To determine the effect of arousal methods for prolonged coma of 175 patients with severe traumatic brain injury and related factors.Methods: There were 175 cases with persistent coma longer than 1 month after severe traumatic brain injury. Coma lasted 1-12 months. Arousal procedures included hyperbaric oxygen, physical therapy and arousal drugs. Results: In the 175 prolonged coma patients 110 got recovery of consciousness; in 118 cases with coma of 1-3 months, 86 cases recovered consciousness ((72.9)%); in 42 cases with coma of 4-6 months, 20 cases recovered consciousness ((47.6)); and in 15 cases with coma of longer than 6 months, only 4 cases recovered consciousness ((26.7)%). The recovery of consciousness depended on patient’s primary brain stem damage, cerebral hernia, GCS score, and age. Conclusions: Application of appropriate arousal procedures improves recovery of consciousness in patients with prolonged coma.