孕前和孕期保健（prenatal care and antenatal care）是降低孕产妇死亡和出生缺陷的重要措施。传统孕期保健特别是产前检查的次数、内容、孕周以及间隔时间等缺乏循证医学证据的支持，已经不能适应现代产前保健的要求，我国各地区和不...孕前和孕期保健（prenatal care and antenatal care）是降低孕产妇死亡和出生缺陷的重要措施。传统孕期保健特别是产前检查的次数、内容、孕周以及间隔时间等缺乏循证医学证据的支持，已经不能适应现代产前保健的要求，我国各地区和不同医院产前检查的方案存在较大差异，甚至同一医院不同的产科医师提供的产前检查方案也不一致，这也是导致目前我国孕产妇死亡率和新生儿出生缺陷率较高的重要原因。展开更多
前言
重症医学科（intensive care unit,ICU）收治的患者处于强烈的应激环境之中,其常见原因包括：（1）自身严重疾病的影响：患者因为病重而难以自理,各种有创诊治操作,自身伤病的疼痛;（2）环境因素：患者被约束于病床上,灯光长明,...前言
重症医学科（intensive care unit,ICU）收治的患者处于强烈的应激环境之中,其常见原因包括：（1）自身严重疾病的影响：患者因为病重而难以自理,各种有创诊治操作,自身伤病的疼痛;（2）环境因素：患者被约束于病床上,灯光长明,昼夜不分,各种噪音（机器声、报警声、呼喊声等）,睡眠剥夺,邻床患者的抢救或去世等;（3）隐匿性疼痛：气管插管及其他各种插管,长时间卧床;展开更多
Diabetic foot ulcer(DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime.Based on National Institute for Health and Clinical Excellence...Diabetic foot ulcer(DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime.Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it's suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications.展开更多
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for diff...Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inapp展开更多
新生儿转运（neonatal transport，NT）是危重新生儿救治中心（newborn care center，NCC）的重要工作内容之一，目的是安全地将高危新生儿转运到NCC的新生儿重症监护病房（neonatal intensive care unit，NICU）进行救治，充分发挥优...新生儿转运（neonatal transport，NT）是危重新生儿救治中心（newborn care center，NCC）的重要工作内容之一，目的是安全地将高危新生儿转运到NCC的新生儿重症监护病房（neonatal intensive care unit，NICU）进行救治，充分发挥优质卫生资源的作用。然而，转运过程中可能存在患儿病情变化和死亡的风险，要实现安全、展开更多
Hypoperfusion injury related to blood pressure decrease in acute hypertensive intracerebral hemorrhage continues to be a controversial topic. Aggressive treatment is provided with the intent to stop the ongoing bleedi...Hypoperfusion injury related to blood pressure decrease in acute hypertensive intracerebral hemorrhage continues to be a controversial topic. Aggressive treatment is provided with the intent to stop the ongoing bleeding. However, there may be additional factors, including autoregulation and increased intracranial pressure, that may limit this approach. We present here a case of acute hypertensive intracerebral hemorrhage, in which aggressive blood pressure management to levels within the normal range led to global cerebral ischemia within multiple border zones. Global cerebral ischemia may be of concern in the management of hypertensive hemorrhage in the presence of premorbid poorly controlled blood pressure and increased intracranial pressure.展开更多
Pharmaceuticals and personal care products(PPCPs)are a unique group of emerging environmental contaminants,due to their inherent ability to induce physiological effects in human at low doses.An increasing number of st...Pharmaceuticals and personal care products(PPCPs)are a unique group of emerging environmental contaminants,due to their inherent ability to induce physiological effects in human at low doses.An increasing number of studies has confirmed the presence of various PPCPs in different environmental compartments,which raises concerns about the potential adverse effects to humans and wildlife.Therefore,this article reviews the current state-of-knowledge on PPCPs in the freshwater aquatic environment.The environmental risk posed by these contaminants is evaluated in light of the persistence,bioaccumulation and toxicity criteria.Available literature on the sources,transport and degradation of PPCPs in the aquatic environment are evaluated,followed by a comprehensive review of the reported concentrations of different PPCP groups in the freshwater aquatic environment(water,sediment and biota)of the five continents.Finally,future perspectives for research on PPCPs in the freshwater aquatic environment are discussed in light of the identified research gaps in current knowledge.展开更多
近年来，连续性肾脏替代治疗（CRRT）技术日趋成熟，在复杂性急性肾衰竭（ARF）中的应用己达成共识，而其临床应用范围己远远超过肾脏替代治疗领域，拓展至非肾脏病领域，己成为重症监护病房（intensire care unit ICU）各种危重病救治...近年来，连续性肾脏替代治疗（CRRT）技术日趋成熟，在复杂性急性肾衰竭（ARF）中的应用己达成共识，而其临床应用范围己远远超过肾脏替代治疗领域，拓展至非肾脏病领域，己成为重症监护病房（intensire care unit ICU）各种危重病救治中多器官功能支持（MOST）的重要手段之一。展开更多
文摘孕前和孕期保健（prenatal care and antenatal care）是降低孕产妇死亡和出生缺陷的重要措施。传统孕期保健特别是产前检查的次数、内容、孕周以及间隔时间等缺乏循证医学证据的支持，已经不能适应现代产前保健的要求，我国各地区和不同医院产前检查的方案存在较大差异，甚至同一医院不同的产科医师提供的产前检查方案也不一致，这也是导致目前我国孕产妇死亡率和新生儿出生缺陷率较高的重要原因。
文摘前言
重症医学科（intensive care unit,ICU）收治的患者处于强烈的应激环境之中,其常见原因包括：（1）自身严重疾病的影响：患者因为病重而难以自理,各种有创诊治操作,自身伤病的疼痛;（2）环境因素：患者被约束于病床上,灯光长明,昼夜不分,各种噪音（机器声、报警声、呼喊声等）,睡眠剥夺,邻床患者的抢救或去世等;（3）隐匿性疼痛：气管插管及其他各种插管,长时间卧床;
基金Supported by Health Research Institute,Diabetes Research Center,Ahvaz Jundishapur University of Medical Sciences,Ahvaz,Iran
文摘Diabetic foot ulcer(DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime.Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it's suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications.
文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inapp
文摘新生儿转运（neonatal transport，NT）是危重新生儿救治中心（newborn care center，NCC）的重要工作内容之一，目的是安全地将高危新生儿转运到NCC的新生儿重症监护病房（neonatal intensive care unit，NICU）进行救治，充分发挥优质卫生资源的作用。然而，转运过程中可能存在患儿病情变化和死亡的风险，要实现安全、
文摘Hypoperfusion injury related to blood pressure decrease in acute hypertensive intracerebral hemorrhage continues to be a controversial topic. Aggressive treatment is provided with the intent to stop the ongoing bleeding. However, there may be additional factors, including autoregulation and increased intracranial pressure, that may limit this approach. We present here a case of acute hypertensive intracerebral hemorrhage, in which aggressive blood pressure management to levels within the normal range led to global cerebral ischemia within multiple border zones. Global cerebral ischemia may be of concern in the management of hypertensive hemorrhage in the presence of premorbid poorly controlled blood pressure and increased intracranial pressure.
文摘Pharmaceuticals and personal care products(PPCPs)are a unique group of emerging environmental contaminants,due to their inherent ability to induce physiological effects in human at low doses.An increasing number of studies has confirmed the presence of various PPCPs in different environmental compartments,which raises concerns about the potential adverse effects to humans and wildlife.Therefore,this article reviews the current state-of-knowledge on PPCPs in the freshwater aquatic environment.The environmental risk posed by these contaminants is evaluated in light of the persistence,bioaccumulation and toxicity criteria.Available literature on the sources,transport and degradation of PPCPs in the aquatic environment are evaluated,followed by a comprehensive review of the reported concentrations of different PPCP groups in the freshwater aquatic environment(water,sediment and biota)of the five continents.Finally,future perspectives for research on PPCPs in the freshwater aquatic environment are discussed in light of the identified research gaps in current knowledge.
