Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy

Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and metaanalyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures.

Immunomodulatory function of orally administered thymosin α1

Objective： To investigate the immunological function of a yeast expression system for thymosin α1 （Tα1）. Methods： A constructed Tetl yeast expression system was used to investigate the immunological function of orally administered Tα1. Dried yeast containing three different concentration of Tα1 was fed to normal Balb/c mice and other Balb/c mice whose immunities were inhibited in advance by cyclophosphamide. Synthesized Tα1 peptide was used as positive control and dried yeast with empty plasmid was used as negative control. CD4^＋ and CD8^＋ levels were detected by flow cytometry assay. TNF-α, IFN-γ, IL-2, IL-6 and IL-10 levels were detected by liquid chip. Results： In normal Balb/c mice or immune inhibition Balb/c mice, CD8^＋ levels were significantly increased. Especially in immune inhibition Balb/c mice, CD8^＋ levels in synthesized Tα1 group （18.77%±4.72%）, small dose group （13.48%±6.17%） and large dose group （22.74%±1.09%） were significantly higher than that in empty yeast control group （7.49%±2.14%）. Conclusion： Orally administered Tα1 has its certain immunomodulatory function.

Computer Administering of the Psychological Investigations: Set-Relational Representation

Computer administering of a psychological investigation is the computer representation of the entire procedure of psychological assessments—test construction, test implementation, results evaluation, storage and maintenance of the developed database, its statistical processing, analysis and interpretation. A mathematical description of psychological assessment with the aid of personality tests is discussed in this article. The set theory and the relational algebra are used in this description. A relational model of data, needed to design a computer system for automation of certain psychological assessments is given. Some finite sets and relation on them, which are necessary for creating a personality psychological test, are described. The described model could be used to develop real software for computer administering of any psychological test and there is full automation of the whole process: test construction, test implementation, result evaluation, storage of the developed database, statistical implementation, analysis and interpretation. A software project for computer administering personality psychological tests is suggested.

Reflections on Advanced Practice of Nurse Administered ECT as a Treatment Resource during the COVID-19 Pandemic

Background: With Electro-Convulsive Therapy (ECT) during the COVID-19 pandemic at risk, nurse administered ECT has become a treatment resource. This study aims to investigate the experiences of two senior ECT nurses practicing Nurse Administered ECT. Method: Qualitative reflective interviews were conducted;the data was then analyzed and presented as corresponding themes for inductive data driven analysis. Each nurse was asked to recall positive and negative events from their practice and describe how their experiences have enabled them to cope. Results: Theme 1: The nurse’s competence is positively influenced by feedback, leading to enhancement of personal and professional development. Theme 2: During the COVID-19 pandemic, nurses report an increased sense of teamwork among staff, and feel that “we are all in this together”. Theme 3: The nurse’s ability to manage difficult situations is dependent on their education, individual knowledge, and experience. Limitations: The authors had the role of both researcher and participant. Conclusion: This study found that both nurses valued feedback above any medical and technical skills they had acquired. This strengthened their advanced practice enabling them to handle difficult situations with confidence. The COVID 19 pandemic has led to advanced nursing practice replacing the junior doctor role within ECT treatment. The nurses felt this had been recognised by their organisation and has led to an increased pride in their work. This paper would suggest that Nurse administered ECT is a valuable resource and that, future nurses could be at the forefront of delivering ECT services.

Effect of a Four-Week Self-Administered Acupressure Intervention on Perceived Stress over the Past Month

The use of relaxation techniques in daily life is an effective means for the self-management of stress. Acupressure is a traditional technique where pressure is applied to acupuncture points instead of puncturing the skin. Self-administered acupressure is a potential method for dealing with stress. The effect of self-administered acupressure on anxiety has been examined but whether it can reduce perceived stress over longer periods is unknown. This study aimed to examine whether a self-administered, four-week acupressure intervention would reduce perceived stress over the past month. Fifteen male and nine female college students (age, 28.9 ± 8.51 yr) majoring in acupuncture and moxibustion medicine were randomly assigned to self-acupressure (AG) and control groups (CG). AG participants were instructed to conduct five sessions of acupressure in the morning, midday, and night. Each session included pressing six acupressure points on the neck (three points on the left and right side each) for five seconds. CG participants were asked to spend their daily life as usual. The outcome was the perceived stress level during the past month, which was assessed using a reliable and valid four-item scale. Perceived stress was measured at baseline, two weeks later, and after intervention. The stress level did not significantly differ between the two groups at baseline. In the AG, the stress level decreased from baseline to two weeks later and remained constant until the end of intervention. The stress level was significantly lower in the AG than in the CG only after intervention. These results provided initial evidence that self-administered acupressure reduces perceived stress over the past month.

The Clinical Value of the Self-Administered Kamath and Stothard’s Questionnaire in the Diagnostics of Carpal Tunnel Syndrome

The clinician-administered Kamath and Stothard’s questionnaire is a recommended tool for assessing Carpal Tunnel Syndrome (CTS). The authors investigated whether the self-administered Kamath and Stothard’s questionnaire (KSQ) can categorize the severity of CTS according to the Nerve Conduction Study (NCS) and predict the outcome of Carpal Tunnel Release (CTR). One hundred and forty-two consecutive patients were enrolled in this prospective study, who completed the KSQ and were referred for NCS. Symptom relief after CTR was considered as the reference standard. KSQ’s scores were compared with the severity of CTS confirmed by NCS and the effectiveness of the surgery, Sensitivity and Positive Predictive Value (PPV) of the KSQ was calculated. The sensitivity of KSQ in each NCS severity category (mild, moderate, and severe CTS) was low (11.9% - 50.0%), however, the sensitivity and PPV of KSQ in the moderate + severe CTS category was 88.9% and 95.5%. The KSQ score of 5 or greater was found to be correlated with a successful CTR (sensitivity 92.8%, PPV of 90.2%). The study revealed that the KSQ with a score of 5 or greater is able to distinguish the mild conditions from moderate and severe ones. The KSQ’s score of 5 or greater also can predict the successful outcome of CTR. The authors believe that in addition to reducing the duration and cost of diagnostics, the KSQ can also reduce patient appointments and clinic time. Application of the KSQ may be of paramount importance in the current Covid pandemic era.

新时代全面从严治党对治理传统的历史继承与创新发展

几千年治国实践孕育出我国内容丰富、独具特色的国家治理传统,其中治理者率先垂范可谓是典型代表。在新时代全面从严治党的伟大实践中,习近平总书记十分重视对传统文化中治理智慧的继承与发展。一方面,强调在党的先进性保持、优良作风传承中积极借鉴德法共治、率先垂范治理模式的优势;另一方面,重点实现对率先垂范治理模式从“自觉自省”到“制度规范”,从“风行草偃”到“人民民主”的改造和发展,为全面从严治党战略的顺利推进奠定了坚实根基。

中央苏区时期中国共产党制度管党治党的实践探索与演进脉络

中央苏区时期,中国共产党适应革命发展趋势,健全党内法规、开展法制建设、加强监督执纪,大力推进制度管党治党探索实践,从而奠定了局部执政制度管党治党的基础、确立了党内法规制度体系基本框架、形成了制度管党治党新特点新动向,为当时严峻形势下的革命斗争和苏区红色政权建设构筑了坚实保障。总结分析这一时期党在制度管党治党上的探索实践,并从中汲取营养,对新时代新征程上不断推进制度管党治党实践仍然具有重要意义。

长三角一体化发展:演变历程、现状分析与对策建议

作为推进中国式现代化的重要引擎,长三角一体化主要经历了初步探索、合作深化、持续拓展、高质量发展四个发展阶段,并实现了治理模式从分割式治理到一体化协同式治理的转型,主要体现在区域治理组织、区域治理内容、区域治理形态三个方面。近年来,长三角一体化建设不断取得实质性发展,区域协同治理绩效日益显现,但仍存在“行政区行政”产生区域分割和地方主义、一体化的体制机制障碍、一体化的领域发展不够均衡等现实问题。为推进长三角一体化发展,应围绕建构跨域治理模式、优化区域一体化体制机制、有序推进各领域一体化建设等方面综合施策。

专病队列人群中精神症状筛查问卷评估方式对评估结果的影响

目的探讨采用自填法和访谈法对运动损伤患者焦虑和抑郁心理量表评估结果的影响。方法2022年11月至2023年5月四川大学华西医院运动医学中心收治的运动损伤患者532例,随机分为访谈组(n=270)和自填组(n=262),分别填写广泛性焦虑量表(GAD-7)和患者健康问卷(PHQ-9)。比较两组患者量表得分和不同程度焦虑、抑郁的患病率。结果两组患者性别、职业和手术部位差异均无统计学意义(P均>0.05)。自填组GAD-7、PHQ-9量表得分高于访谈组(P<0.001,P<0.001)。自填组报告轻、中度焦虑和抑郁的比例高于访谈组(P<0.001,P=0.002)。两组患者中重度焦虑(GAD-7≥10分)、抑郁(PHQ-9≥10分)患病率差异无统计学意义(P=0.761,P=0.086)。结论自填组评估的焦虑和抑郁症状相对较严重。

水力发电机定子绕组泄漏电流分析及电腐蚀治理研究

发电机长期运行后,定子绕组会逐渐出现老化或电腐蚀现象,需要科学的试验分析方法诊断设备健康状况。通过分析多台大型贯流式发电机定子绕组直流耐压试验泄漏电流数据,提出了绝缘性能评估方法及预防绕组击穿措施;根据贴壁式结构定子绕组电腐蚀及运行温度偏高状况,研究一系列定子改造创新设计及创新工艺,并对定子温度场进行有限元仿真计算。温升试验数据表明定子改造后的发电机运行温度有效降低,各测点温度偏差大幅减小。研究结果接近仿真计算值,证明了定子改造采用的新工艺有效可行。

成品输液物理稳定性与相容性检查指标专家共识

成品输液是通过无菌操作技术将一种或数种静脉药物进行混合调配,可供临床直接用于患者静脉输注的药液。静脉药物在溶解和(或)稀释调配、保存和使用过程中,由于多种因素的影响,可能导致成品输液稳定性和相容性发生变化,存在用药安全风险。目前没有统一的成品输液稳定性与相容性控制技术及质量标准或相应的指导性文件,为提高成品输液质量,保障静脉用药安全性和有效性,降低患者用药风险,安徽省药师协会静脉用药调配专业委员会在试验研究、文献复习、专家咨询的基础上,结合国内静脉药物调配实践,编写《成品输液物理稳定性与相容性检查指标专家共识》,旨在为成品输液质量检查和研究提供科学、简单、快速、可行的检查方法及标准。

应势而变:系统视阈下地方政府的执行策略研究——基于M省全面“省直管县”的调研分析

针对地方政府为何对同一政策在不同时期呈现不同的执行样态问题,过往研究对政策执行中内部与外部复杂环境的系统关注不够。本研究基于“政策-主体-环境”的分析框架,通过对M省全面“省直管县”进行历时五年的追踪调查,对地方政府执行策略的驱动因素进行了系统识别,并提出“应势而变”概念以理解执行策略的内在机理。研究表明,国家治理目标下压力型体制与强激励结构并存、科层组织结构中的权力竞合、地方政府的多重角色,是地方政府执行策略的生成逻辑与作用机制。这一发现有助于阐释地方政府为何在同一政策背景下采取多元化的行动策略,为理解地方政府政策执行策略提供了新的切入点。

依法治藏背景下西藏传统法律文化的现代化路径探析

西藏传统法律文化很长一段时期在维系西藏社会秩序稳定、解决民众纠纷、促进社会发展等方面发挥着十分重要的作用,但藏传佛教的深刻影响、习惯法与国家法之间的冲突、以及部分传统法律文化缺乏理性的法律观念阻碍了西藏传统法律文化的发展。在依法治藏背景下,如果能对影响西藏传统法律文化的藏传佛教文化进行合理引导,对具有深厚民意基础的习惯法进行调处,对西藏传统法律文化中的优秀思想进行吸收和利用,让古老的传统法律文化重新焕发生机与活力,则能够促进西藏传统法律文化为西藏社会发展服务,有利于依法治藏的顺利推进。

糖尿病胃轻瘫与“脾阴”“脾气散精”二者间关系

文章从“脾阴”与“脾气散精”的解剖学、病理生理学等方面阐述二者与糖尿病胃轻瘫的相关性。何绍奇先生提出“脾胰同源”学说,指出主运化是脾的生理功能之一,认为胰的功能包含于脾的转输与散精之中。脾阴的充足是脾正常转运的基础,唐宗海在《血证论》中提到脾的运化不仅需要脾阴的滋润,同时也需要脾阳的温煦,二者缺一不可。脾阴具有促消化作用,在饮食水谷进入人体内之后,脾阴开始发挥作用,将饮食水谷转化为水谷精微,输送至人体五脏六腑、四肢百骸,以达营养全身的作用,维持各个脏腑的正常生理活动功能。脾运的本质为脾气散精,散精不足则精微物质布散失常,导致血糖等精微物质停聚于脉中,导致高血糖,引发糖尿病。而精微物质布散失常也会导致脾失健运,脾气不升,胃气不降,最终导致胃动力障碍、胃排空延迟,形成糖尿病胃轻瘫。糖尿病日久会引起多种并发症,糖尿病胃轻瘫便是其中一种。脾阴虚是糖尿病的发病基础,脾阴虚导致脾阳虚,进而导致脾阴阳两虚,从而影响脾散精功能,所以说从脾论治成为治疗糖尿病的重中之重。有较多专家提出自己的独到理解,为今后治疗糖尿病提供可以借鉴的临床经验。

恢复高考以来我国依法治考研究述评与展望

1977年恢复统一高考后,依法治考研究开始成为学界关注的课题,研究过程大致经历初步探索、全面铺开、专业化发展3个阶段。40多年来,学界紧跟时代发展需要,围绕考试立法、执法、定罪量刑、诚信考试教育、比较依法治考等领域开展研究,同时存在研究内容不够丰富、研究方法相对单一、比较研究成果缺乏、专业化程度不够高等问题,需要在加强考试立法、深入开展依法治考比较研究、专业化研究等方面重点着力。

褪黑素类保健食品经营及使用中的问题和对策研究

总结分析了褪黑素类保健食品在经营和消费者使用过程中存在的主要问题。经营中存在的主要问题有:夸大宣传、非法添加、剂量超标和质量不合格等;消费者使用过程中存在的主要问题有:代药使用、违规使用、乱搭配、乱服用和认知错误等。从加强褪黑素类保健品上市后监管角度提出严格审查产品功能声称及广告宣传、加强上市后质量控制、加强保健食品的不良反应监测等建议;从重视消费者健康教育角度提出制定褪黑素产品相应服用指南、宣传睡眠卫生教育、重视保健食品健康教育等建议,以期促进褪黑素产品相关行业健康发展。

基于共识法的湿证诊断标准研究

目的通过科学、规范的研究方法建立湿证诊断标准。方法通过文献研究运用结构化工具全面集成湿证辨证依据,并通过问卷调查及共识会议法就湿证内涵及外延、判定依据以及标准构建等开展深入调查,达成共识。结果经过文献研究获得湿证辨证依据36项。通过问卷调查有专家建议应探索更贴近临床实际的湿证诊断模式,据此本研究就“如何确立诊断”这一关键问题深入思考。分析发现,湿证存在特异性/敏感性指标;经深入调查,在文献研究基础上确定了11项特异性及19项敏感性指标,并根据专家建议将特异性指标以湿性特征分为3类。同时,本研究系统梳理了证候标准的诊断属性并相应归纳为4种模式,据此经调查决定湿证标准宜采用特异性模式和相似度/一致性模式,并进一步明确了符合湿证诊断属性的判定形式。结论本标准可为湿证临床诊断提供依据;同时,本研究探索了证候的诊断属性,可为其他证候标准的研制提供参考。

“双减”背景下西安市科技类校外培训机构治理对策

“双减”背景下大量学科类培训机构向非学科类培训机构转型,其中科技类培训机构是近来年培训行业新兴起的一种类型,对于这类机构如何界定其性质、明确其特点,分析其存在问题并进行有效监管,成为各省市亟待解决的问题。现阶段,西安市科技类校外培训机构存在机构底数不清、机构运营中乱象频现、准入和管理缺乏规范性及呈现多头管理等问题。治理对策包括系统规划,摸清科技类培训机构底数;尽快出台文件,明确主管部门;建立联合长效监管机制;加强优质科技类教育资源的供给等。

右美托咪定静脉泵注在腰-硬联合麻醉剖宫产手术中的应用探讨

目的分析右美托咪定静脉泵注在腰-硬联合麻醉剖宫产手术中的应用价值,旨在为相关研究工作提供参考依据。方法选择接受腰-硬联合麻醉下剖宫产手术的产妇72例为研究样本,结合产妇术中是否应用右美托咪定分为新式组(36例)、传统组(36例)。传统组产妇术中不应用镇静镇痛药物,新式组产妇术中应用右美托咪定。对比两组产妇各阶段[麻醉前(T0)、麻醉药注射完毕后10 min(T1)、麻醉药注射完毕后30 min(T2)]心率、平均动脉压(MAP)水平,麻醉镇痛效果,新生儿Apgar评分。结果T0时,两组产妇MAP以及心率对比无明显差异(P>0.05);T1和T2时,传统组的MAP和心率较T0时显著上升(P<0.05);新式组T1以及T2时的MAP和心率比T0时有波动,但无明显差异(P>0.05)。和传统组相比,新式组T1以及T2时的MAP以及心率更低(P<0.05)。新式组麻醉镇痛总有效率为100.00%,比传统组的88.89%高(P<0.05)。新式组新生儿出生后1、5、10 min的Apgar评分分别为(9.55±0.66)、(9.77±0.18)、(9.98±0.03)分,传统组分别为(8.36±0.72)、(8.88±0.42)、(9.18±0.29)分。两组新生儿出生后1、5、10 min的Apgar评分对比,新式组高于传统组(P<0.05)。结论对于接受腰-硬联合麻醉剖宫产手术的产妇而言,术中为其应用右美托咪定能取得满意的镇痛效果,且该用药方案对于产妇的MAP、心率影响较小,有助于改善产妇的围术期舒适度,并且对于新生儿不存在显著影响,安全性强,值得进一步在产科临床内推广和应用。