老年手术患者应用丙泊酚复合瑞芬太尼喉罩麻醉的临床效果观察

目的：探讨靶控输注丙泊酚复合瑞芬太尼喉罩麻醉在老年手术患者中的临床应用效果,为临床麻醉提供参考。方法：选取127例老年手术患者作为研究对象,随机分为A、B、C3组,A组43例（采用瑞芬太尼复合丙泊酚麻醉,喉罩通气）、B组42例（采用丙泊酚麻醉,喉罩通气）,C组42例（采用瑞芬太尼复合丙泊酚麻醉,面罩通气）,均采用靶控输注静脉麻醉法。观察麻醉诱导时间、术中反应、麻醉效果、镇静效果评分、苏醒时间、认知功能以及不良反应发生率等指标。结果：丙泊酚总用量：A组为（335．2±56．4）mg,B组为（466．5±64．8）mg,C组为（334．8±59．7）mg,经方差分析,差异有统计学意义,F=6．513,P〈0．05;Ramsay评分：A组6分的例数为37例（86．0％）,B组为30（71．4％）,C组为34（81．0％）,经卡方检验,差异有统计学意义,X^2=5．832,P〈0．05;不良反应发生率：A组为5例（11．6％）,B组为15例（35．7％）,C组为7例（16．7％）,经卡方检验,差异有统计学意义,X^2=7．546,P〈0．05。结论：老年手术患者应用丙泊酚复合瑞芬太尼喉罩麻醉效果显著,安全有效。     

Novel Vitamin and Gold-Loaded Nanofiber Facial Mask for Topical Delivery

l-ascorbic acid has been widely used in cosmetic and dermatological products because of its ability to scavenge free radicals and destroy oxidizing agents. However, it is chemically unstable and can easily be oxidized. The current cosmetic facial masks available in the market are pre-moistened, which means that the aqueous fluid content of the mask may oxidize some of the unstable active ingredients such as ascorbic acid. This work presents an anti-wrinkle nanofiber face mask containing ascorbic acid, retinoic acid, gold nanoparticles, and collagen. This novel face mask will only be wetted when applied to the skin, thus enhancing product stability. Once moistened, the content of the mask will gradually dissolve and release the active ingredients and ensure maximum skin penetration. The high surface area-to-volume ratio of the nanofiber mask will ensure maximum contact with the skin surface and help to enhance the skin permeation to restore its healthy appearance. Electrospun fiber mats may provide an attractive alternative to the commercial facial cotton masks.     

变蛋袋料液配方的研究

变蛋袋浸渍料液中NaOH浓度是决定变蛋凝固性的关键因子。在一定范围内 ,其浓度每增减 0 .65% ,始凝日期可增减一天。其中料液重 1 1 g、NaOH浓度 7.76%、始凝日期 1 1天组为最适配比。     

Bag culture: a method for root-root co-culture

A method named "bag culture" was developed for coculturing of Linum persicum (section Syllinum) and L. austriacum (section Linum) hairy roots. For this propose L. austriacum and L. persicum hairy root cultures were established using Agrobacterium rhizogenes in McCown medium. L. persicum hairy roots in bags (1 mm2 mesh) were successfully grown together with L. austriacum hairy roots. The amounts of podophyllotoxin (PTOX) and 6-methoxypodophyllotoxin (MPTOX) produced by L. persicum hairy root cultures were detected using HPLC. The results indicated that the amounts of both lignans and growth indexes of the two hairy roots decreased, that may be partly due to a competition between the two types of culture in using precursors of biosynthetic metabolites and the amount of culture medium which is available for each hairy root. However, MPTOX (0.17 g/100 g DW) and PTOX (0.02 g/100 g DW) levels of the L. persicum single culture in bag were significantly higher than of the other cultures which may be due to the immobilization effect of the bag.     

Improving the Quality of Maternal and Neonatal Care: the Role of Standard Based Participatory Assessments

Background

Gaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments.

Methods

Improvements in the quality of maternal and neonatal care following an action-oriented participatory assessment of 19 areas covering the whole continuum from admission to discharge were measured after an average period of 10 months in four busy referral maternity hospitals in Uzbekistan. Information was collected by a multidisciplinary national team with international supervision through visit to hospital services, examination of medical records, direct observation of cases and interviews with staff and mothers. Scores (range 0 to 3) attributed to over 400 items and combined in average scores for each area were compared with the baseline assessment.

Results

Between the first and the second assessment, all four hospitals improved their overall score by an average 0.7 points out of 3 (range 0.4 to 1), i.e. by 22%. The improvements occurred in all main areas of care and were greater in the care of normal labor and delivery (+0.9), monitoring, infection control and mother and baby friendly care (+0.8) the role of the participatory action-oriented approach in determining the observed changes was estimated crucial in 6 out of 19 areas and contributory in other 8. Ongoing implementation of referral system and new classification of neonatal deaths impede the improved process of care to be reflected in current statistics.

Conclusions

Important improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process.     

容量与压力控制通气模式对胸科手术单肺通气肺内分流及氧合的影响

目的:为观察术前肺功能正常的开胸手术病人在单肺通气(OLV)期间,定压控制通气模式(PCV)和定容控制通气模式(VCV)对气道压力、肺内分流及氧合的影响.方法:选择40例术前肺功能正常进行开胸手术的病人,随机分为A、B两组.A组:单肺通气采用VCV模式30 min后转换为PCV模式.B组:单肺通气采用PCV模式30 min后转换为VCV模式.在麻醉前(TI)、单肺通气前(T2),容量控制通气(压力控制通气)30min(T3)、转换为压力控制通气(容量控制通气)30min(T4)四个时间段测气道压力和采动脉及混合静脉血行血气分析及计算肺内分流.结果:发现;无论VCV还是PCV在单肺通气期间动脉血氧分压(PaO2)无统计学意义(P=0.534),两组间的肺内分流量(Qs/Qt)比较差异无显著性(p>0.05),PCV气道压力比VCV低((P<0.01).结论:肺功能正常的患者在OLV期间,PCV模式与VCV模式比较并不能提高氧合作用,但PCV模式气道压力低,有利于减少气道损伤.     

Optimizing Stimulation and Analysis Protocols for Neonatal fMRI

The development of brain function in young infants is poorly understood. The core challenge is that infants have a limited behavioral repertoire through which brain function can be expressed. Neuroimaging with fMRI has great potential as a way of characterizing typical development, and detecting abnormal development early. But, a number of methodological challenges must first be tackled to improve the robustness and sensitivity of neonatal fMRI. A critical one of these, addressed here, is that the hemodynamic response function (HRF) in pre-term and term neonates differs from that in adults, which has a number of implications for fMRI. We created a realistic model of noise in fMRI data, using resting-state fMRI data from infants and adults, and then conducted simulations to assess the effect of HRF of the power of different stimulation protocols and analysis assumptions (HRF modeling). We found that neonatal fMRI is most powerful if block-durations are kept at the lower range of those typically used in adults (full on/off cycle duration 25-30s). Furthermore, we show that it is important to use the age-appropriate HRF during analysis, as mismatches can lead to reduced power or even inverted signal. Where the appropriate HRF is not known (for example due to potential developmental delay), a flexible basis set performs well, and allows accurate post-hoc estimation of the HRF.     

A Two-Minute Paper-and-Pencil Test of Symbolic and Nonsymbolic Numerical Magnitude Processing Explains Variability in Primary School Children's Arithmetic Competence

Recently, there has been a growing emphasis on basic number processing competencies (such as the ability to judge which of two numbers is larger) and their role in predicting individual differences in school-relevant math achievement. Children’s ability to compare both symbolic (e.g. Arabic numerals) and nonsymbolic (e.g. dot arrays) magnitudes has been found to correlate with their math achievement. The available evidence, however, has focused on computerized paradigms, which may not always be suitable for universal, quick application in the classroom. Furthermore, it is currently unclear whether both symbolic and nonsymbolic magnitude comparison are related to children’s performance on tests of arithmetic competence and whether either of these factors relate to arithmetic achievement over and above other factors such as working memory and reading ability. In order to address these outstanding issues, we designed a quick (2 minute) paper-and-pencil tool to assess children’s ability to compare symbolic and nonsymbolic numerical magnitudes and assessed the degree to which performance on this measure explains individual differences in achievement. Children were required to cross out the larger of two, single-digit numerical magnitudes under time constraints. Results from a group of 160 children from grades 1–3 revealed that both symbolic and nonsymbolic number comparison accuracy were related to individual differences in arithmetic achievement. However, only symbolic number comparison performance accounted for unique variance in arithmetic achievement. The theoretical and practical implications of these findings are discussed which include the use of this measure as a possible tool for identifying students at risk for future difficulties in mathematics.     

Chest Diseases: Strategies for Home-Assisted Ventilation

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in chest diseases. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another.The epitomes included here were selected by the Advisory Panel to the Section on Chest Diseases of the California Medical Association, and the summaries were prepared under the direction of Dr Cosentino and the panel.