ObjectiveTo establish a model of portal hypertension with hypersplenism in SD rats by portal vein binding combined with splenic vein ligation. MethodsSixty healthy male SD rats were randomly divided into three groups: sham operation group （only laparotomy, n=20）, portal vein binding group (only binding, n=20), and portal vein binding combined with splenic vein ligation group (combined operation group, n=20). The counts of platelet, erythrocyte, and leukocyte were examined just before operation and once a week after operation for 7 weeks. Portal pressure, shortaxis, and longaxis diameter of spleen were examined just before operation and seven weeks after operation. At the seventh week, all the animals were sacrificed, spleen index and pathology changes of each group were examined. ResultsErythrocyte and platelet counts in combined operation group were significantly lower than those in the other two groups on the third week （Plt;0.05）, and there was no significant difference in leukocyte count among three groups （Pgt;0.05）. Compared with the preoperative value, portal pressure increased significantly on the seventh week in both portal vein binding group and combined operation group, and was higher than that in the sham operation group （Plt;0.05）. The two diameters of spleen also increased significantly in combined operation group on the seventh week （Plt;0.05）, and were larger than those in the other two groups （Plt;0.05）. The same result was found in spleen index （Plt;0.05）. Typical pathological changes of hypersplenism presented only in combined operation group on the seventh week after operation. ConclusionsPortal vein binding combined with splenic vein ligation can induce experimental secondary hypersplenism successfully. This procedure is simple and stable, and helpful to the scientific research.
Occupational therapy practice should be informed by the model of practice, with a focus on the needs of the clients and conducting activity analysis and occupational analysis on these needs. Intervention plans are developed in collaboration with clients/family members and they should be in control in decision making. In occupational therapy, the client is the active agent of activity, and the therapist serves as a helper or a facilitator. The design of therapeutic activities should not only consider restoring lost function and using residual functions but also pay attention to the impact of environmental factors on the client’s role and occupational performance. Occupational therapy helps the clients to return to family and society through improving their occupational performance via grading and adapting activities, providing information such as social resources, and implementing individualized interventions. This paper reviews the clinical reasoning and implementation of occupational therapy.
A acute partial obstructive hepatocholangitis model by selective ligation and injection of E coli into left hepatic bile duct was successfully founded in rat. Using parameters including mortality, mitochondrial glutamic oxalacetic transaminase and ornithine carbamoytransferase activity, pathological observation and blood culture of bacteria, we evaluated the model. The authors emphasize that this models is superior to the wole-bile-duct-challenged cholangitis model, which is characterized by liver injury.
ObjectiveTo study a new method for establishing the rat model of incomplete adhesive intestinal obstruction. MethodsThe serosal stripping method was adopted, the general health condition changes of rats were observed on day 3, 5, and 7 after modeling, meanwhile the weight was measured, the superior mesenteric artery flow velocity and small intestine wall thickness were observed via the color Doppler ultrasound and orthostatic X ray. The level of D-lactate acid in the blood plasma, and the activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) in the intestine tissue were tested. The pathological changes of the intestine tissue were observed. ResultsCompared with the normal group (no treatment was done), the general health conditions of rats were worse, the weight significantly decreased (Plt;0.01), the superior mesenteric artery blood flow velocity significantly increased and small intestinal wall was thickened (Plt;0.05, Plt;0.01), airfluid level or a great deal of seroperitoneum and pneumatosis flat appeared via orthostatic abdominal X-ray, the level of D-lactic acid in the blood plasma and the content of MDA in the intestine tissue significantly increased on day 5 after modeling (Plt;0.05, Plt;0.01), the activity of SOD in the intestine tissue significantly decreased on day 7 after modeling in the model group (Plt;0.05). The pathological changes consistented with adhesive intestinal obstruction via pathological observation. On the 7th day, the rat model of incomplete adhesive intestinal obstruction was successfully built . ConclusionThe rat model of incomplete adhesive intestinal obstruction is completed by serosal stripping method.
Objective To evaluate the safety and efficacy of steroid withdrawal in modern triple immunosuppressant (Cycloproine/Tacrolimus, Mycophenolate Mofetil and Steroid) on renal transplantation recipients. Methods We searched MEDLINE (1966-Sep. 2005), OVID (1966-2004), EMBASE (1984-2004), The Cochrane Library (Issue 4, 2005), CBMdisc (1994-2005), and handsearched 7 Chinese Journals. Randomized controlled trials (RCTs) adopting modern triple immunosuppressant, and comparing steroid withdrawal (SW), group and steroid continuing group (SC) were selected. The quality of included studies was evaluated and graded according to Cochrane Reviewer’s Handbook 4.2.5, and meta-analysis was performed by using RevMan 4.2.7 software. Results Nine RCTs including 1 681 patients (845 in SW and 836 in SC) were identified. The average follow-up time was 6-12 months. No significant difference was found in using CsA or Tac in modern triple immunosuppressant. The results of our meta-analysis showed: ① the risk of acute rejection was two times higher in SW than SC (RR 2.05, 95% CI 1.54 to 2.72, P lt;0.000 01), mainly Banff grade I (mild) (RR 1.92, 95% CI 1.16 to 3.17, P =0.01); but no significant differences were found on Banff grade II and III between the two groups. ② the rate of graft and patient survival and chronic rejection were the same between two groups. ③ Steroid withdrawal decreased the incidence of opportunistic infection (mainly caused by simplex herpes virus and Candida) and urinary tract infection. While the incidence of CMV and sepsis infection has no significant difference between two groups. Conclusion Steroid withdrawal within 3 months in modern immunosuppressive regimen ① increases the risk of Banff Grade I rejection reaction, but the moderate and severe rejection are similar between the two groups; ② doesn’t affect the rate of graft, patient survival, and chronic rejection; ③ decreases the incidence of opportunistic and urinary tract infection, but doesn’t improve the CMV infection and sepsis. To prophylaxis serious infection, steroid withdrawal is worth considering under sufficient immunosuppressive regimen. The key point is to balance the benefit and harm for individual recipients.
ObjectiveTo develop and modify a rat model of partial liver transplantation with hepatic arterialization and to investigate the postoperative histopathologic changes of the grafts. MethodsModified twocuff technique was applied to establish a rat model of partial liver transplantation, and the donor’s celiac artery was anastomosed with the recipient’s right renal artery. The biopsy of the grafts was performed on the day 1,2,4 and 7 after transplantation. Results85.4% of the recipients had survived for one week.Nuclear mitoses were seen on the postoperative day 2 by microscopy, while on the day 4 they were found occasionally. Two nucleus cells were seen on the day 4 and 7. Conclusion The stability of the model is improved by modifying the technique. Liver acupuncture biopsy is a simple, safe and feasible way to be applied in the research of postoperative problems of liver transplantation. Reconstruction of hepatic artery is possible to enhance the regeneration of liver grafts.
Epilepsy is one of the chronic central nervous system diseases that can occur repeatedly for a long time. About 70 million people worldwide suffer from epilepsy. Two thirds of epileptic patients do not receive proper treatment because of inadequate health care services and social discrimination based on cultural beliefs. Effective health management mode can reduce the morbidity and mortality of patients and improve the quality of life of patients. This article divides management modes into five types: Hospital-based health management model, community-based health management model, family health management model, self-health management model and health management model based on network technology. By referring to relevant literature, the research status of epilepsy health management model at home and abroad was summarized, which provides reference for the health management and reasonable intervention of patients with epilepsy.
ObjectiveTo systematically review the risk prediction model of intensive care unit (ICU) readmissions. MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Web of Science and The Cochrane Library databases were electronically searched to collect the related studies on risk prediction models of ICU readmissions from inception to June 12th, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, the qualitative systematic review was performed. ResultsA total of 15 studies involving 23 risk prediction models were included. The area under the ROC curve of the models was 0.609-0.924. The most common five predictors of the included model were age, length of ICU hospitalization, heart rate, respiration, and admission diagnosis. ConclusionThe overall prediction performance of the risk prediction model of ICU readmissions is good; however, there are differences in research types and outcomes, and the clinical value of the model needs to be further studied.
ObjectiveTo understand the cognition and mediation tendencies of health care workers in terms of third-party mediation for medical disputes, analyze the factors influencing the trust of both doctors and patients on third-party mediation, and propose suggestions on building third-party mediation mechanisms for medical disputes. MethodsBetween August and December 2012, we made the cognition questionnaire on third-party mediation for medical disputes based on the past medical literature, and the knowledge of doctor-patient relationship as well as third-party mediation agency's organizational structure (including locations and management authorities), staffing, mediation basis, validity sources and fund ensuring. We performed the random cluster sampling survey on all health care workers in five hospitals of different levels. The original data were put into the computer for statistical analysis by SPSS 18.0. ResultsThe knowledge of health care workers on third-party mediation was high. They believed that the best place for solving medical disputes should be the court or judicial administrative department, and the management authorities should be health administrative departments. In case of mediation failure, the majority of health care staff chose to continue to solve the dispute through legal channels. For the effectiveness of mediation conclusion, most health care workers tended to believe in the form of arbitration. They thought that mediators should have professional background of medicine and law; the majority of those surveyed doctors tended to accept forensic conclusions as a basis for mediation. For determining the compensation, doctors were in favor of Applicable Regulations for Medical Malpractice. Over 40% of medical staff believed that third-party mediation should be financed by government financial allocation, and more than half of the medical staff believed that it should be paid by the insurance company. ConclusionThird-party mediation should be set in and managed by the court or judicial and administrative departments. Mediator group should be formed by professionals of law and medical sciences. In the mediation process, it is recommended that the focus of controversy should be identified by forensic identification in order to form a clear division of responsibilities and high mediation efficiency. We recommend that the government introduce in financial allocations at all levels on the basis of medical liability insurance system, and force medical institutions to purchase medical liability insurance through the regulations of law, in order to provide funding support for the operation of third-party mediation organizations. Meanwhile, medical liability insurance companies should be operated under strict supervision to avoid their interference on the mediation work.