PDCA循环在提高肿瘤患者输液港护理依从性的应用

目的 探讨PDCA循环在提高肿瘤患者输液港护理依从性的应用效果.方法 选取2018年2～8月我院收治的504例输液港置管的肿瘤患者按随机分配原则分为对照组240例和观察组264例,对照组给予一般治疗和常规管理,观察组在对照组基础上实施PDCA循环管理,观察两组患者的并发症发生情况、输液港护理依从性,并进行统计分析.结果...     

Projecting the future of an alpine ungulate under climate change scenarios

Climate change represents a primary threat to species persistence and biodiversity at a global scale. Cold adapted alpine species are especially sensitive to climate change and can offer key “early warning signs” about deleterious effects of predicted change. Among mountain ungulates, survival, a key determinant of demographic performance, may be influenced by future climate in complex, and possibly opposing ways. Demographic data collected from 447 mountain goats in 10 coastal Alaska, USA, populations over a 37‐year time span indicated that survival is highest during low snowfall winters and cool summers. However, general circulation models (GCMs) predict future increase in summer temperature and decline in winter snowfall. To disentangle how these opposing climate‐driven effects influence mountain goat populations, we developed an age‐structured population model to project mountain goat population trajectories for 10 different GCM/emissions scenarios relevant for coastal Alaska. Projected increases in summer temperature had stronger negative effects on population trajectories than the positive demographic effects of reduced winter snowfall. In 5 of the 10 GCM/representative concentration pathway (RCP) scenarios, the net effect of projected climate change was extinction over a 70‐year time window (2015–2085); smaller initial populations were more likely to go extinct faster than larger populations. Using a resource selection modeling approach, we determined that distributional shifts to higher elevation (i.e., “thermoneutral”) summer range was unlikely to be a viable behavioral adaptation strategy; due to the conical shape of mountains, summer range was expected to decline by 17%–86% for 7 of the 10 GCM/RCP scenarios. Projected declines of mountain goat populations are driven by climate‐linked bottom‐up mechanisms and may have wide ranging implications for alpine ecosystems. These analyses elucidate how projected climate change can negatively alter population dynamics of a sentinel alpine species and provide insight into how demographic modeling can be used to assess risk to species persistence.     

Thermographic mapping of the skin surface of the head in bald-headed male subjects

Thermal patterns on the skin are related to skin blood perfusion. While knowledge concerning thermal distribution patterns of the face are well established, the thermal distribution patterns of the skin surface of other aspects of the head has only been investigated once previously in a study employing low resolution thermographic equipment [van Dulken, H., van Voss, S.F.C.H, 1971. The normal thermographic patterns of the human head. Acta Neurochir. 23, 247–58.] The purpose of the study was to re-examine the thermal distribution patterns of the surface of the entire head in 12 healthy bald headed male subjects (mean age 39±7.8 (SD) years) using a high definition infrared (IR) thermographic camera. The thermal distribution patterns were monitored using dynamic infrared thermography (DIRT) before, during and after a 2 min local skin cooling procedure with a pair of fans. Infrared thermal images (thermograms) were taken of the superior, anterior, lateral and posterior aspects of the head. The thermal patterns in general followed the anatomical location of the main superficial arteries and veins of the head as described in anatomy books although there were some variations, especially with regard to the forehead and top of the head (superior aspect), ranging from an asymmetrical distribution pattern to a lack of a clear thermal pattern. The thermal patterns in the left and right lateral thermograms in each individual were relatively symmetrical. During the rewarming period the helix, auricular lobule of the auricles and the nose were relatively cold. The frontal thermograms were characterized by cool nasal and cheek areas and a clear warm area surrounding the eyes, especially around the inner canthus.     

A new global biome reconstruction and data-model comparison for the Middle Pliocene

Aim To produce a robust, comprehensive global biome reconstruction for the Middle Pliocene (c. 3.6–2.6 Ma), which is based on an internally consistent palaeobotanical data set and a state‐of‐the‐art coupled climate–vegetation model. The reconstruction gives a more rigorous picture of climate and environmental change during the Middle Pliocene and provides a new boundary condition for future general circulation model (GCM) studies. Location Global. Methods Compilation of Middle Pliocene vegetation data from 202 marine and terrestrial sites into the comprehensive GIS data base TEVIS (Tertiary Environmental Information System). Translation into an internally consistent classification scheme using 28 biomes. Comparison and synthesis of vegetation reconstruction from palaeodata with the outputs of the mechanistically based BIOME4 model forced by climatology derived from the HadAM3 GCM. Results The model results compare favourably with available palaeodata and highlight the importance of employing vegetation–climate feedbacks and the anomaly method in biome models. Both the vegetation reconstruction from palaeobotanical data and the BIOME4 prediction indicate a general warmer and moister climate for the Middle Pliocene. Evergreen taiga as well as temperate forest and grassland shifted northward, resulting in much reduced tundra vegetation. Warm‐temperate forests (with subtropical taxa) spread in mid and eastern Europe and tropical savannas and woodland expanded in Africa and Australia at the expense of deserts. Discrepancies which occurred between data reconstruction and model simulation can be related to: (1) poor spatial model resolution and data coverage; (2) uncertainties in delimiting biomes using climate parameters; or (3) uncertainties in model physics and/or geological boundary conditions. Main conclusions The new global biome reconstruction combines vegetation reconstruction from palaeobotanical proxies with model simulations. It is an important contribution to the further understanding of climate and vegetation changes during the Middle Pliocene warm interval and will enhance our knowledge about how vegetation may change in the future.     

Conceptus ecobiometry and triplex Doppler ultrasonography of uterine and umbilical arteries for assessment of fetal viability in dogs

The objectives were to: 1) evaluate blood flow in the uterine (UA) and umbilical (Uma) arteries in the pregnant bitch, by measuring the resistive index (RI) and pulsatility index (PI); 2) to note the presence or absence of the early diastolic notch and diastolic flow in the UA and Uma flow waveforms, respectively; and 3) perform conceptus ecobiometry for fetal growth assessment during pregnancy. Six healthy bitches were examined on approximately Days -44, -42, -36, -31, -28, -25, -21, -18, -14, -8, -4, and -2 of pregnancy (whelping = Day 0). Triplex Doppler and B-mode ultrasonography were used to assess blood flow and conceptus ecobiometry. All pregnancies ended with a normal whelping and birth of live puppies. Prior to whelping, all conceptus dimensions increased significantly, whereas RI and PI of both the Uma and UA decreased significantly. For the UA, RI and PI were (mean ± SEM) 0.95 ± 0.02 and 2.75 ± 0.41, respectively, on Day -44, and were 0.60 ± 0.01 and 0.99 ± 0.03 on Day -4. For the Uma, RI and PI were 0.99 ± 0.01 and 2.42 ± 0.03 on Day -31, and were 0.62 ± 0.01 and 1.15 ± 0.02 on Day -4. The complete disappearance of the early diastolic notch in the UA, and the appearance of diastolic flow in the Uma occurred on Days -16 ± 5 and -21 ± 1. The authors concluded that UA and Uma perfusion were important end points to assess fetal vitality in bitches. Furthermore, the current reference values provided a baseline for monitoring normal and abnormal pregnancies in bitches.     

Pulmonary vasoreactivity in spontaneously hypertensive rats - Effects of endothelin-1 and leptin

Background

Systemic hypertension may be associated with an increased pulmonary vascular resistance, which we hypothesized could be, at least in part, mediated by increased leptin.

Methods

Vascular reactivity to phenylephrine (1 μmol/L), endothelin-1 (10 nmol/L) and leptin (0.001–100 nmol/L) was evaluated in endothelium-intact and -denuded isolated thoracic aorta and pulmonary arteries from spontaneously hypertensive versus control Wistar rats. Arteries were sampled for pathobiological evaluation and lung tissue for morphometric evaluation.

Results

In control rats, endothelin-1 induced a higher level of contraction in the pulmonary artery than in the aorta. After phenylephrine or endothelin-1 precontraction, leptin relaxed intact pulmonary artery and aortic rings, while no response was observed in denuded arteries. Spontaneously hypertensive rats presented with increased reactivity to phenylephrine and endothelin-1 in endothelium-intact pulmonary arteries. After endothelin-1 precontraction, endothelium-dependent relaxation to leptin was impaired in pulmonary arteries from hypertensive rats. In both strains of rats, aortic segments were more responsive to leptin than pulmonary artery. In hypertensive rats, pulmonary arteries exhibited increased pulmonary artery medial thickness, associated with increased expressions of preproendothelin-1, endothelin-1 receptors type A and B, inducible nitric oxide synthase and decreased endothelial nitric oxide synthase, together with decreased leptin receptor and increased suppressor of cytokine signaling 3 expressions.

Conclusions

Altered pulmonary vascular reactivity in hypertension may be related to a loss of endothelial buffering of vasoconstriction and decreased leptin-induced vasodilation in conditions of increased endothelin-1.     

An ethanol extract of Ramulus mori improves blood circulation by inhibiting platelet aggregation

Inappropriate platelet aggregation can cause blood coagulation and thrombosis. In this study, the effect of an ethanol extract of Ramulus mori (ERM) on blood circulation was investigated. The antithrombotic activity of ERM on rat carotid arterial thrombosis was evaluated in vivo, and the effect of ERM on platelet aggregation and blood coagulation time was evaluated ex vivo. To evaluate the safety of ERM, its cytotoxicity to platelets and its effect on tail bleeding time were assessed; ERM was not toxic to rat platelets and did not prolong bleeding time. Moreover, administering ERM to rats had a significant preventive effect on carotid arterial thrombosis in vivo, and significantly inhibited adenosine diphosphate- and collagen-induced platelet aggregation ex vivo, whereas it did not prolong coagulation periods, such as prothrombin time and activated partial thromboplastin time. The results suggest that ERM is effective in improving blood circulation via antiplatelet activity rather than anticoagulation activity.     

A new approach to blood flow simulation in vascular networks

A proper analysis of blood flow is contingent upon accurate modelling of the branching pattern and vascular geometry of the network of interest. It is challenging to reconstruct the entire vascular network of any organ experimentally, in particular the pulmonary vasculature, because of its very high number of vessels, complexity of the branching pattern and poor accessibility in vivo. The objective of our research is to develop an innovative approach for the reconstruction of the full pulmonary vascular tree from available morphometric data. Our method consists of the use of morphometric data on those parts of the pulmonary vascular tree that are too small to reconstruct by medical imaging methods. This method is a three-step technique that reconstructs the entire pulmonary arterial tree down to the capillary bed. Vessels greater than 2 mm are reconstructed from direct volume and surface analysis using contrast-enhanced computed tomography. Vessels smaller than 2 mm are reconstructed from available morphometric and distensibility data and rearranged by applying Murray's laws. Implementation of morphometric data to reconstruct the branching pattern and applying Murray's laws to every vessel bifurcation simultaneously leads to an accurate vascular tree reconstruction. The reconstruction algorithm generates full arterial tree topography down to the ?rst capillary bifurcation. Geometry of each order of the vascular tree is generated separately to minimize the construction and simulation time. The node-to-node connectivity along with the diameter and length of every vessel segment is established and order numbers, according to the diameter-de?ned Strahler system, are assigned. In conclusion, the present model provides a morphological foundation for future analysis of blood flow in the pulmonary circulation     

清醒狗短暂缺血心肌复灌注时舒缩功能的变化

在狗的心脏上装入微超声探头和高精度微压力传感器,手术后两星期,在清醒状态下给予左冠状动脉旋支阻断三分钟。在复灌注过程中,观察到血液动力学指标与收缩期心室壁厚度(WT)迅速恢复正常;但在 dWT/dt—WT 环形图上出现舒张早期异常相,其形状与缺血过程不同。低氧和急遽冠状动脉过度充盈可以产生此种异常图形。我们推测,心肌缺血可能促使一些产物的形成,复灌注时它使冠脉过度舒张,冠脉灌注增加,从而造成舒张早期急遽充盈而形成了此种异常的形图。