Objective To investigate the indication, approaches andpreventionof complications in treatment of female stress urinary incontinence(SUI) with tension-free vaginal tape (TVT). Methods From September 2003 to December 2004, 40 cases of female stress urinary incontinence were treated, including 8 cases in association with cystocele or rectocele and 1 case in association with uterine prolapse. They ranged from 30 to 70 years in age with an average of 56.3years. The disease course was 1.42 years(7.2 years on average). All patients received TVT. In the patients suffering from uterine prolapse and cystocele or rectocele, butterfly-shaped mesh patch was applied. Results All patients achieved satisfactory results.The complications included slight dysuria(2 cases),vesical perforation(1 case) and pelvic hematoma(1 case) and cleared up after treating. All cases were followed up 1 to 15 months and the results were satisfactory. No urinary incontinence and no dysuria reoccurred. Conclusion TVT is effective for SUI.
Objective To set up the experimemtal model with superior segmentalbone defect in acetabulum and implant the three-fin acetabular component, and examine the Von Mises stresses of pelvis bone with simulating single leg position in vitro using rosette strain gages method(RSGD). Methods Four kinds of three-fin components were made based on measurement of diameter, depth and roof thickness of acetabular specimens. These kinds of threefin acetabular components based on spreaded degrees of lateral fins(0,36,45 and 60°). The superiorsegmental bone defect of acetabulum in 4 cadaver pelvis specimens was made,then simulated the actual position to place implant into acetabular bone.A blank control group was set up.After being fit up the 7 sets of rosette strain gages,then specimen to test the pelvic Von Mises stresses simulating the static load of single leg on the mechanic machine.Progressive load was graded into 150, 300,450, 600, 750 and 900 N.We obtained the strains informations about loaded andun-loaded pelvis bone. Results Based on computed the strains informations,we were informed the Von Mises stresses about pelvis bone.The maximal Von Mises stresses of selected local position was 6.93 MPa and the minimal Von Mises stresses of selected local position was 1.08 MPa. Conclusion Providing the data about the mainpart of threefin acetabular component to optimize spreaded degrees of lateral fins.
Objective To assess the efficacy and safety of histamine H2 receptor antagonist (H2RA) for the prevention of stress ulcer bleeding (SUB) in critically ill patients. Methods Trials were identified by searching Cochrane Controlled Trials (Issue 4, 2006), MEDLINE (1980 to October 2006),EMbase (1984 to October 2006) and the Chinese Biological Medicine Database (1978 to October), Chinese VIP Database (1989 to October 2006) and Chinese EBM Database. We also handsearched the proceedings of relevant conferences, 5 kinds of important Chinese journals and the references of all included trials. Two reviewers assessed the quality of studies and extracteddata independently. Disagreement was resolved by discussion . The primary outcomes included were incidence of SUB, incidence of nosocomial pneumonia (NP), mortality and adverse events. Secondary outcomes were gastric pH, length of hospital stayand length of ICU stay. RevMan4.2.7 software was used for meta-analyses. Results Sixteen trials involving 2 014 patients were included. Most of the trials were of poor quality. Meta-analyses showed that H2RA significantly less SUB comparedwith patients in the placebo or non-prophylaxis group (RR 0.39, 95%CI 0.28 to 0.56; Plt;0.000 01, NNT=6), but but there was no significant difference in the incidence of clinically important bleeding (RR 0.51 , 95%CI 0.17 to 1.53; P=0.11). No significant difference was observed in the incidence of NP(RR 1.02, 95%CI 0.55 to 1.89,P=0.95). H2RA significantly decreased mortality in comparison with placebo or non-prophylaxis (RR 0.68, 95%CI 0.52 to 0.90; P=0.007, NNT=18). H2RA had a good safety profile. We did not perform meta-analysis for gastric pH due to the methodological limitations. Conclusion H2RA may significantly reduce the incidence of SUB and mortality, but cannot reduce the incidence of clinically important bleeding. Due to the poor quality of included studies, the conclusion should be interpreted cautiously. More randomized controlled trials with sufficient sample size, uniform standards, higher quality and scientifically sound methodology should be performed.
Objective To explore the change of gene expression of stress activated protein kinase (SAPK) and its upstream signalregulated molecule ——mitogen activated protein kinases(MAPKs) (MKK4 and MKK7) in hypertrophic scar and autocontrol normal skin. Methods The total RNA was isolated from 8 hypertrophic scars and 8 auto-control skin, and then mRNA was purified. The gene expressions of MKK4, MKK7 and SAPK were examined with reverse transcriptionpolymerase chain reaction(RT-PCR) method. Results In hypertrophic scar, both MKK7 and SAPK genes weakly expressed. In auto-control skin, the expression of these 2 genes was significantly elevated in comparison with hypertrophic scar (Plt;0.01). The expression levelsof these 2 genes were 1.5 times and 2.6 times as long as those of hypertrophic scar, respectively. Gene expression of MKK4 had no significant difference between autocontrol skin and hypertrophic scar (Pgt;0.05). Conclusion Decreased gene expression of MKK7 and SAPK which results in reducing cell apoptosis might be one of the mechanisms for controlling the formation of hypertrophic scar.
Objective To explore the influence of different stress environmentson the growth of tissue engineering blood vessels in vivo． Methods The engineering vascular scaffolds were prepared with the porcine small intestinal submucosa(SIS) wrapping vascular endothelial cells and smooth muscle cells，which were implanted into the subcutaneous tissue(subcutaneous group), the femoral quadriceps(intramuscular group), and sheathed the femoral artery(perivascular group) respectively. Four weeks postoperatively, these cultured tissues were harvested, and evaluated by macroscopic observation and histology detection. Results The cultivated tissues in different stress environments had obvious difference in respectof the tubular configuration, cellular proliferation and tissue shape. In subcutaneous group, the wall structure integrity, seed cell proliferation and SIS scaffold decomposition were poor, lumen surface was covered without endothelial cells; in intramuscular group, integrity tubular structure had formed, seed cell proliferation was found to a certain extent, lumen surface was covered with sparseendothelial cells, and a little SIS scaffold was found, cellular and fiber structured arranged irregularly; in perivascular group, vascular-like structure formed, the seed cell growth and proliferation were good, the lumen surface was completely covered with endothelial cells, the smooth muscle cells were in good morphologicaldistribution, the antihydrostatic pressure was 247.0±35 kPa，showingsignificant differences when compared with subcutaneous group(67.0±5.8 kPa) and intramuscular group(104.0±7.6 kPa) (Plt;0.01).The total scoring of tissue engineering blood vessel formation in subcutaneous group, intramuscular group and perivascular group were 5.529±0.272，8.875±0.248 and 14.824±0.253 respectively, and the differences among them were significant (P lt; 0.05). Conclusion Stress excitation has a great influence on the cellular proliferation and the growth of tissue engineering blood vessel in vivo.
ObjectiveTo investigate the current situation of stress load and professional benefit of hemodialysis nurses during the outbreak period and the remission period of coronavirus disease 2019 (COVID-19) epidemic, and discuss the differences in stress load and professional benefit of hemodialysis nurses between the two periods.MethodsIn February 2020, 119 hemodialysis nurses from three hemodialysis centers in Sichuan Province were selected as the respondents. Using the Stress Overload Scale and the Questionnaire of Nurses’ Perceived Professional Benefits, questionnaire survey was conducted in February 2020 and April 2020, respectively. Paired-sample t test was used for analysis.ResultsA total of 109 valid questionnaires were collected. The scores of stress load of hemodialysis nurses in outbreak period and remission stage were 3.00±1.26 and 2.17±1.16, respectively, of which the scores of event load dimension were 3.49±1.15 and 2.31±1.27, respectively, and the scores of individual vulnerability dimension were 2.59±1.19 and 2.05±1.06, respectively; the professional benefit scores of hemodialysis nurses in outbreak and remission were 4.19±0.83 and 4.21±0.78, respectively. The difference in stress load of the same group of hemodialysis nurses between different time periods was statistically significant (P<0.05), while there was no significant difference in professional benefit (P>0.05).ConclusionsDuring the outbreak of COVID-19 epidemic, the stress load of hemodialysis nurses was ata medium level, and that in the remission stage of COVID-19 epidemic was at a low level; the professional benefit of nurses in the outbreak and remission period was at a high level. The stress load status of hemodialysis nurses was different between different periods of the epidemic. We should take incentive mechanism or targeted psychological intervention measures to improve the professional benefit level of nurses.
【Abstract】ObjectiveTo review the research advance of intestinal barrier changes and its pathogenesis in stress conditions.MethodsThe literatures in recent years on the changes of the intestinal barrier,and its pathogenesis in stress conditions were reviewed.Results In some severe stress conditions, such as trauma, severe inflammation and acute severe pancreatitis, etc, a series of pathophysiologic disorders of intestinal barrier， even systemic inflammatory response syndrome and multiple organ dysfunction syndrome or multiple organ failure were induced. The pathogenesis was a result of a series of neurologic, immunologic and endocrine factors making one another. ConclusionRecognizing the changes and pathogenesis have an important clinical significance for treating and preventing the intestinal barrier dysfunction induced by stress.
Objective To assess the clinical efficacy and safety of proton pump inhibitor （PPI） and H2RA for stress ulcer bleeding in stroke patients. Methods Randomized controlled trials （RCT） were identified from MEDLINE （ 1966- Oct. 2005 ） ,EMBASE （ 1984- Oct. 2005 ）, The Cochrane Library （ Issue 4,2005 ）, CBMdisc （ 1980- Oct. 2005 ） and VIP（ 1980- Oct. 2005 ）. We handsearched the related published and unpublished data and their references. The quality of included trials was evaluated. Data were extracted by two reviewers independently with a designed extraction form. RevMan 4. 2.7 software was used for data analysis. Results Twenty RCT were included with 2 624 patients. The results of meta-analysis were listed as follows： （1） stress ulcer bleeding （SUB） ： PPI （ OR 0.14,95% CI 0.08 to 0.24, NNT = 3 ） and H2RA （OR 0.24,95% CI 0.15 to 0.39, NNT =5） significantly reduced the incidence of SUB in comparison with control group. PPI significantly reduced the incidence of SUB compared with H2R.A（P 〈0. 00001 ）. （2） Mortality： PPI （OR 0.22,95% CI 0. 11 to 0.47, NNT =8） and H2RA （OR 0.53,95% CI 0. 34 to 0.81, NNT =16） significantly decreased the mortality compared with non-prophylaxis group. PPI significantly decreased the mortality compared with H2RA （OR 0.28,95% CI 0.09 to 0. 89）. （3） Adverse effect： There were not evident adverse effects in both PPI and H2RA groups. Conclusions PPI and H2RA may reduce the incidence and mortality of SUB in stroke patients, and PPls are better in reducing incidence of SUB than H2RA.
ObjectiveTo compile the information overload severity scale in the situation of coronavirus disease 2019 epidemic, and evaluate the reliability and validity.MethodsFrom February to March 2020, according to the procedures of literature analysis, semi-structured interview, and expert consultation, an initial scale was formed; and then the online scale was measured, and the scale items were screened based on the measured results of the scale. The reliability was evaluated by Cronbach’s α coefficient, and the validity was tested by exploratory factor analysis.ResultsThere were 8 items in the initial scale. The scale items were screened based on the degree of dispersion, the correlation coefficient with the total score, and the factor-load-related indicators, and finally a 7-item scale was formed. The factor analysis results of the scale showed that one component could be extracted from the scale, and the reliability analysis showed that the total Cronbach’s α coefficient of the scale was 0.863.ConclusionThe information overload severity scale has good reliability and validity, which can provide strong support for related research after the outbreak of coronavirus disease 2019 and other major public events.
Objectives The Faculty of Medicine of National Yang-Ming University is committed to helping students enhance intellectual, personal, and professional development while fully supporting students during this time of intense training and personal growth. The student portfolio system has sprung from the Faculty’s devotion to innovative medical education initiatives and is one attempt to fulfill our obligations to our past and future, to our society and to the rest of the world. The basic approach toward helping students enhance their cognitive, personal and professional development while coping with internal or external environmental stressors would be to identify and provide supportive elements within medical education. In order to achieve the goal, we explore possible factors, both micro and macro elements of the students’ environment, which may contribute to their stress, mental disturbances and status attainment. Methods We established a multi-dimensional and multi-functional “student portfolio” framework that integrated dynamic, timely, and continuous exploration as well as modification of students’ learning processes, mental status and environmental impact. The first step in this project was to locate and validate students’ “red flag”: factors that contributed to their stress, mental disturbances and status attainment. Self reports by the students were used for the “risk factor” analyses. Results Status achievement by students was associated with their parents’ educational attainment, in particularly the educational attainment of their mothers. This was associated with the student’s stress, mental disturbance, attitude toward life and status achievement. The educational attainment of the parents of our students increased yearly, suggesting that the social economic status and marital matching situation of individuals were associated with social environment and time. Conclusions The associations of cognitive processes, family condition, societal values, mental status and learning behaviors are intertwined dynamically with time and environment. However, longitudinal and multi-dimensional research in this area is very limited. It is important for contemporary medical education to develop a framework for the theory and practice of the development of medical students that leads to their attainment of professional, sociological, and psychological competencies. This study suggests that particular social economic status factors may increase the risk that medical students will experience stress, mental disturbances, and status attainment.