【摘要】护理是一门科学性极强的应用性学科，在临床实习期运用好的带教方法为护理本科生实施带教，以帮助其更快、更好地完成从单纯接受知识到运用知识解决实际问题的转变。文章总结了近年来在护理本科生临床实习过程中所采用的创新带教方法，并对其科学依据和特点进行分析，为本科护理实习临床带教提供理论参考。【Abstract】 Nursing is a discipline of scientific application. In the clinical intern period, with better teaching methods, nursing students can faster and better complete the transformation from simple knowledge acceptance to use of knowledge to solve practical problems. We summarized some innovative teaching methods in the clinical intern period of the nursing undergraduate students in recent years, and analyzed the scientific base and advantages of each method, to provide a theoretical reference for the clinical teaching of undergraduate nursing practice.
Objective To examine the effects of pulmonary rehabilitation training on pulmonary function in patients post-stroke. Methods We searched Cochrane Library, PubMed, ProQuest, Embase, China National Knowledge Infrastructure, Wangfang Database, Chinese Biomedical Database, and VIP Chinese Science and Technology Journal Database for randomized controlled trials of investigating the effects of pulmonary rehabilitation training on pulmonary function in stroke patients published before September 2018. The patients in the training group were treated with pulmonary rehabilitation, including respiratory muscle training, chest breathing, or abdominal breathing training, with or without respiratory training device. The patients in the control group received conventional stroke rehabilitation. The outcome indicators included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1 percentage predicted (FEV1%pred), peak expiratory flow rate, maximal inspiratory pressure (PImax), maximal expiratory pressure, exercise endurance, and quality of life. Two researchers independently carried out literature retrieval and data extraction, using Physiotherapy Evidence Database scale, and standard data extraction forms adapted from Cochrane Collaboration model to evaluate the studies quality. The Meta-analysis was performed using Review Manager Version 5.3. Results Eleven studies met the study criteria with a total of 500 stroke patients, including 274 patients in the training group and 226 patients in the control group, respectively. The Meta-analysis showed that after pulmonary rehabilitation training, the values of FVC [mean difference (MD)=0.30 L, 95% confidence interval (CI)(0.26, 0.34) L, P<0.000 01], FEV1 [MD=0.28 L, 95%CI (0.25, 0.32) L, P<0.000 01], and 6-minute walking test [MD=43.43 m, 95%CI (7.92, 78.95) m, P=0.02] in the training group were significantly higher than those in the control group, as well as the change of PImax [MD=6.49 cm H2O (1 cm H2O=0.098 kPa), 95%CI (3.67, 9.32) cm H2O, P<0.000 1]. The advantages of pulmonary rehabilitation training had not been found in improving FEV1/FVC and FEV1%pred (P>0.05). Conclusions The implementation of pulmonary rehabilitation training in the way of respiratory muscle training combined with conventional rehabilitation therapy could improve two kinds of indicators of pulmonary function referring to FVC and FEV1, inspiratory muscle strength and 6-minute waking distance. The long-term effect of pulmonary rehabilitation training on stroke patients, the respiratory training mode of different prescriptions, the endurance of exercise and the quality of life need further study.
Speech enhancement methods based on microphone array adopt many microphones to record speech signal simultaneously. As spatial information is increased, these methods can increase speech recognition for cochlear implant in noisy environment. Due to the size limitation, the number of microphones used in the cochlear implant cannot be too large, which limits the design of microphone array beamforming. To balance the size limitation of cochlear implant and the spatial orientation information of the signal acquisition, we propose a speech enhancement and beamforming algorithm based on dual thin uni-directional / omni-directional microphone pairs (TP) in this paper. Each TP microphone contains two sound tubes for signal acquisition, which increase the overall spatial orientation information. In this paper, we discuss the beamforming characteristics with different gain vectors and the influence of the inter-microphone distance on beamforming, which provides valuable theoretical analysis and engineering parameters for the application of dual microphone speech enhancement technology in cochlear implants.
目前临床研究协调员（CRC）在完成高质量的临床试验中所扮演的角色越来越受到国内药物临床试验机构及药物申办者的广泛关注。作为临床试验过程中重要的一员，CRC承担着协调及管理临床试验项目的任务，具有“项目管理助手、后勤保障支持”的特点。四川大学华西医院国家药物临床试验机构在中医专业新药临床试验过程中，尝试配备CRC并在实际工作中取得了一定成效，同时也积累了实践经验。现就该机构中医专业新药临床试验过程中，CRC的运行机制和具体工作职责进行简要介绍，为各药物临床试验机构的建设和管理、药物临床试验的质量和整体水平的提高提供参考。
ObjectiveTo investigate the risk factors of internal mammary lymph node (IMLN) metastasis in breast cancer patients, and to provide evidence for clarifying the TNM stage of tumors and formulating precise treatment plans. Methods The female patients who were admitted to the First Affiliated Hospital of Chongqing Medical University from February 2019 to January 2020 and diagnosed with breast cancer by tissue biopsy pathology based on the new tracer technology were retrospectively collected. All IMLNs were dissected. The associations of IMLN metastasis with patients’ age, tumor size (long diameter), tumor location, tumor grade, estrogen and progesterone receptor statuses, human epidermal growth factor receptor-2 (HER2) status, number of axillary lymph node (ALN) metastasis, and pathological molecular typing were analyzed. ResultsA total of 28 patients were included in this study. The visualization rates in the ALN and IMLN by the new tracer technique were 96.4% (27/28) and 35.7% (10/28), respectively. The pathological results of IMLN biopsy confirmed that 6 patients (The 6 cases were all displaying) had IMLN metastases, with an IMLN metastasis rate of 21.4%. The IMLN metastasis was related to the tumor location and ALN metastasis number of patients with breast cancer (P<0.05). That is to say, when the tumor located in the medial quadrant and the number of ALN metastasis was 4 or more, the IMLN metastasis rates were higher than those in the lateral quadrant (57.1% vs. 10.0%, P=0.028) and in the patients with ALN metastasis number <4 (50.0% vs. 11.1%, P=0.038). It was not found that IMLN metastasis was related to age, tumor size, tumor grade, estrogen and progesterone receptor statuses, HER2 status, and pathological molecular typing of patients with breast cancer (P>0.05). And the area of the receiver operating characteristic curve of the number of ALN metastasis for assessing IMLN metastasis was 0.697. ConclusionFrom the summarized results of cases in this study, the visualization rate of IMLN is higher based on the new tracer technology. When breast cancer locates in the medial quadrant and the number of ALN metastasis is 4 or more, it is recommended to actively carry out IMLN biopsy to clarify the results of pathological diagnosis, so as to accurately assess the tumor stage and formulate appropriate individualized treatment plan.
Objective To explore feasibility and efficacy of laparoscopic microsurgery by transanal glove port for excision of rectal tumor. Methods Seventeen patients with rectal tumor underwent laparoscopic microsurgery by transanal glove port for local excision of rectal tumor were chosen from March 2015 to March 2016. This device was constructed by using a incision protective sleeve and standard surgical glove. The laparoscopy was used as lighting equipment. The ultrasonic scalpel, operation forceps and lens were separately inserted into the fixed sheath card from the 3 finger gloves. Results The operations of 17 cases were completed successfully. The operative time was 35–90 min with an average 54 min. The closed glove access time was 11 to 26 min with an average 18 min. The diameter of tumor was 1.4–3.5 cm with an average 2.4 cm. The results of postoperative pathology included 8 cases of villos adenemas, 3 cases of high-grade intraepithelial neoplasia, 1 case of low-grade intraepithelial neoplasia, 3 cases of carcinoid , and 2 cases of adenocarcinoma. All resection margins were negative. No infection, intestinal fistula, bleeding, and other complications were found. The hospital stay was 4–9 d with an average of 5 d. No recurrence was found during a follow-up of 1–6 months. Conclusions The preliminary results of limited cases in this study show that laparoscopic microsurgery by transanal glove port for excision of rectal tumor is easy, safe, and effective. It also provides a new choice for individualized comprhensive treatment of rectal tumor.
The measurement of network is one of the important researches in resolving neuronal population information processing mechanism using complex network theory. For the quantitative measurement problem of functional neural network, the relation between the measure indexes, i.e. the clustering coefficient, the global efficiency, the characteristic path length and the transitivity, and the network topology was analyzed. Then, the spike-based functional neural network was established and the simulation results showed that the measured network could represent the original neural connections among neurons. On the basis of the former work, the coding of functional neural network in nidopallium caudolaterale (NCL) about pigeon's motion behaviors was studied. We found that the NCL functional neural network effectively encoded the motion behaviors of the pigeon, and there were significant differences in four indexes among the left-turning, the forward and the right-turning. Overall, the establishment method of spike-based functional neural network is available and it is an effective tool to parse the brain information processing mechanism.
ObjectiveTo study the differential expression of minichromosome maintenance protein (MCM) gene family in hepatocellular carcinoma (HCC) and to explore its survival predictive value.MethodsTranscriptome data, clinical data, and survival information of patients with HCC were extracted from The Cancer Genome Atlas (TCGA), and the differential expression of MCM gene was analyzed. The prognostic value of differentially expressed of MCM gene was studied by Cox proportional hazards regression model, the prognostic model and risk score system were constructed. On the basis of risk score, a number of indicators were included to construct a nomogram to predict the3- and 5-year survival probability of HCC patients, and to verify and evaluate their predictive ability and accuracy.ResultsThe expressions of MCM2, MCM3, MCM4, MCM5, MCM6, MCM7, MCM8, and MCM10 in HCC tissues were higher than those of normal liver tissues (P<0.05), and univariate analysis showed that they were all related to prognosis (P<0.05). Multivariate analysis showed that MCM6 and MCM10 were independent factors affecting survival of HCC patients (P<0.05). Through multivariate analysis, a prognostic model consisting of MCM6, MCM8, and MCM10 was constructed, and a risk scoring system was established. It had been verified that this risk score was an independent risk factor affecting the prognosis of patients with HCC, and the prognosis of patients with high scores were worse than those of patients with low scores (P<0.001). We used TNM stage, T stage, and risk score to construct a nomogram with a consistency index (C index) of 0.723 and draw a time-dependent receiver operating characteristic curve, the results showed that area under the curve of 3- and 5-year were 0.731 and 0.704, respectively.ConclusionsMCM6,MCM8, and MCM10 in the MCM gene family have important prognostic value in HCC. The nomogram constructed in this study can better predict the survival probability of HCC patients.
Objective To systematically review the effectiveness and safety of power chain vs. nickel titanium coil springs in closing dental extraction space. Methods Databases including PubMed, EMbase, The Cochrane Library, Chinese Biomedicine Literature Database, Chinese Scientific Journals Full-text Database, and Chinese Journal Full-text Database were searched to collect the randomized controlled trials (RCTs) on comparing power chain with nickel titanium coil springs published before February 2012. Two reviewers independently screened literature, extracted data and assessed the quality of the included studies. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 4 RCTs involving 122 patients were included. The results of meta-analyses showed that there was a significant difference in the rate of space closure between the two groups (MD=0.30 mm per month, 95%CI 0.17 to 0.44, Plt;0.000 1); The results of subgroup analyses indicated that, both high-quality trials (MD=0.20, 95%CI 0.07 to 0.34, P=0.003) and low quality trials (MD=0.40, 95%CI 0.30 to 0.50, Plt;0.000 01) showed no significant difference in the rate of space closure. Conclusion Current clinical evidence indicates nickel titanium coil spring is superior to power chain in the rate of space closure, but its long-term effect still needs to be proved by more large-scale RCTs.
ObjectivesTo systematically review the influence of nifedipine combined with atorvastatin on hypertension in patients with hypertension.MethodPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of nifedipine combined with atorvastatin on hypertension in patients with hypertension from inception to November 20th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 17 RCTs involving 1 838 patients were included. The results of meta-analysis indicated that nifedipine combined with atorvastatin was superior to nifedipine alone on SBP (MD=−8.937, 95%CI−11.913 to −5.962, P<0.001), DBP (MD=−3.702, 95%CI−6.626 to −0.778, P=0.013) and total effective rate (RR=1.24, 95%CI 1.07 to 1.44, P=0.003). There was no significant difference between two groups in the incidence of adverse reactions (P>0.05).ConclusionsCurrent evidence shows that nifedipine combined with atorvastatin can significantly improve total effective rate, decrease the level of SBP and DBP, and increasing of dose not increase the incidence of adverse reactions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.