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Objective:To retrieve, appraise and summarize the evidence for the airway humidification management of the inpatient with laryngectomy and tracheotomy but nonmechanical ventilation and to provide references for the clinical nursing.Methods:The evidence question was raised based on the study objective. The evidence was retrieved from some databases according to the evidence pyramid model during inception to December, 2018. The literature types included clinical practice guideline, evidence summary, best practice information sheet, recommended practice and systematic review. The quality of the literature were evaluated by the suitable evaluated tool based on their types. The level and recommedation grade of the evidence were appraised by the suitable tools of JBI.Results:Thirteen studies were recruited, including one clinical practice guideline, two evidence summaries, one best practice information sheet and nine systematic reviews. Totally thirteen items of best evidence were summarized and generalized to four categories including assessment, method, liquid and operation of airway humidification.Conclusion:The evidences of the studies are scientific and practical, but on the one hand, it is recommended that when applying the evidences in clinic, it is necessary to assess the clinical situation and chose the proper evidence. And on the other hand, there are lacking of some evidences of airway humidification and the level of some evidences is low. So it needs to create more high level evidences.
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Objective To investigate the clinic effect of tunnel technique on endoscopic submucosal dissection(ESD)for massive colorectal laterally spreading tumor(LST). Methods A retrospective study was conducted on the data of patients with colorectal large area LST(the shortest diameter>4 cm) undergoing ESD by tunnel technique from January 2015 to June 2016 in Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine. The size of resected specimens, operation time, complications, pathology results, the number of en bloc resection and curative resection were analyzed. Results A total of 14 cases were collected, including 7 males and 7 females. The longest diameters of resected specimens were from 4.0 to 7.0 cm with mean size of 5.18 ± 0.49 cm. The operation times were from 40 to 120 min with mean time of 63.57±12.95 min. Intraoperative perforation occurred in 2 cases but no delayed perforation and bleeding occurred. Postoperative pathology showed 1 patient with adenoma hyperplasia with crypt abscess,3 patients with low grade intraepithelial neoplasia,6 patients with high grade intraepithelial neophasia,1 patient with carcinoma in situ, 1 patient with carcinoma in M3, and 2 patients with carcinoma in SM1. The number of cases who received en bloc resection, complete resection, and curative resection were 13, 13, and 13, respectively. Conclusion ESD by tunnel technique is safe and effective in the treatment of colorectal large area LST,which is worth popularizing in clinics.
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[Summary] Sodium glucose cotransporter 2 (SGLT2) inhibitors have been developed as a new antidiabetic agent .The antihyperglycemic effect of SGLT 2 inhibitors is independent of insulin secretion and insulin action .SGLT2 inhibitors improve IS and islet βcell function with the possible mechanisms of reducing glucotoxicity ,weight loss and increasing GLP‐1 response .
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This article was aimed to study the stability of hesperidin in alkaline solution, in order to provide experi-ment evidences for quality control of extraction and purification as well as formulation development. RP-HPLC was applied to determinate content changes of hesperidin in alkaline solution by changing the temperature, pH and heat-ing time. The results showed that hesperidin was degraded in alkaline solution by heating. The content of hesperidin decreased along with the increasing of heating temperature and heating time. The hesperidin appeared to be more stable in a weak base. It was concluded that for the purpose of ensuring of the stability of hesperidin in alkaline so-lution, it should be kept at low temperature (below 50℃), weak base conditions and shorten the heating time during the preparation process.
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ObjectiveTo investigate the combined effects of one to one whole process companion delivery model on emotional status and postnatal recovery of parturients.Methods350 cases adopted one to one whole process companion delivery model were set as the observation group,another 350 cases who did not received companion delivery model were set as the control group.The emotional state and postpartum recovery (the amount of vaginal bleeding after childbirth,time of the uterus return to normal size,and the incidence of urinary retention 6 h after delivery,colostrum time and fasting time) were compared between the two groups.ResultsIn the observation group,312 cases were mild anxiety(89.1％),24 cases were with moderate anxiety (6.9％),14 cases were with severe anxiety (4.0％).In the control group,32 patients with mild anxiety (9.1％),237 cases were with moderate anxiety(67.7％),81 patients were with severe anxiety(23.2％),the difference was significant.In the observation group,postpartum vaginal bleeding was(48.6 ± 9.7) ml,time length of the size of the uterus return to normal was(4.5 ± 3.1 ) weeks,the incidence of postpartum urinary retention 6 hours after delivery was 1.4％,colostrum time (16.4 ± 5.3) h,and fasting time was (12.4 ± 2.1 ) h.In the control group,postpartum vaginal bleeding was (56.5 ± 11.2) ml,time length of the size of the uterus return to normal was(7.1 ± 4.2) weeks,the incidence of postpartum urinary retention 6 hours after delivery was 6.9％,colostrum time was (23.5 ± 4.7) h,and fasting time was (15.3 ± 2.6) h,the difference was significant.Conclusions One to one whole process companion delivery model helps reduce maternal anxiety,fears,reduce the incidence of postpartum unfavorable situation effectively and promote early resumption of maternal,it is worthy of clinical application.
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D-psicose 3-epimerase (DPEase) is demonstrated to be useful in the bioproduction of D-psicose, a rare hexose sugar, from D-fructose, found plenty in nature. Clostridium cellulolyticum H10 has recently been identified as a DPEase that can epimerize D-fructose to yield D-psicose with a much higher conversion rate when compared with the conventionally used DTEase. In this study, the crystal structure of the C. cellulolyticum DPEase was determined. The enzyme assembles into a tetramer and each subunit shows a (β/α)(8) TIM barrel fold with a Mn(2+) metal ion in the active site. Additional crystal structures of the enzyme in complex with substrates/products (D-psicose, D-fructose, D-tagatose and D-sorbose) were also determined. From the complex structures of C. cellulolyticum DPEase with D-psicose and D-fructose, the enzyme has much more interactions with D-psicose than D-fructose by forming more hydrogen bonds between the substrate and the active site residues. Accordingly, based on these ketohexose-bound complex structures, a C3-O3 proton-exchange mechanism for the conversion between D-psicose and D-fructose is proposed here. These results provide a clear idea for the deprotonation/protonation roles of E150 and E244 in catalysis.
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Binding Sites , Biocatalysis , Catalytic Domain , Clostridium cellulolyticum , Hexoses , Chemistry , Manganese , Chemistry , Protein Structure, Quaternary , Racemases and Epimerases , Chemistry , Metabolism , Substrate SpecificityABSTRACT
Objective To investigate the possibility of gestational body weight intervention and its influence on pregnancy outcomes.Methods 300 healthy primiparae with normal pregestational BMI and living monoeyesis and head presentation were randomly divided into the observation group (n = 120) and control group ( n = 180).Both groups were received general health education and regular obstetric examination, in addition, the observation group received body weight intervention.The data about changes in BMI and body weight from pregestation to ante partum were collected and pregnancy outcomes were assessed.Results The incidence of △ BMI≥6,gestensive hypertension, diabetes, cesarean section,large-for-date infant,intrauterine fetal distress,postparum hemorrhage in the observation group was significantly lower than those of the control group( x2 = 19.265,4.903,6.875,13.522,7.354,4.545,3.993, all P < 0.05).Conclusion Body weight intervention had a preferable feasibility and could improve pregnancy outcome.
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Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage (PTCD) pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth Ⅱ gastrectomy. The levels of liver enzymes significantly decreased (P<0.01) after stents implacement. The levels of amylase (plasma and urine) and lipase increased in 15 cases, but they were corrected to normal levels after adequate treatments. Rates of abdominal pain relieving and diahhrea improvement were 82.4% (28/34) and 88.2% (15/17), respectively. Conclusion The combined implacement of biliary tract prosthesis and pancreatic duct stents is safe and effective in relieving malignant obstruction in periampullary carcinoma.