目的 结合老龄化背景,探讨事业单位高知退休人员再社会化问题并给予建议.方法 采取随机抽样方法,对河海大学和江苏省人民医院进行问卷调查与访谈,并对退休前后社会交往对象与社会活动变化、再社会化过程中遇到的困难、希望得到的帮助进行调查.结果 事业单位高知退休人员的主观幸福感自评分受到已退休时间长度、养老金水平、身体健康状况、子女探望频率、是否有孙辈等因素的影响,目前事业单位高知退休人员再社会化过程整体较好,但存在不再工作的心理适应、空闲时间大量增加导致生活安排混乱、与原有交往圈子的交往减少而新的交往圈子尚未建立、社区等社会老年服务机构的缺位及"看病难"等问题.结论 建议政府、社区、原单位离退休处应多方联合发力,构建老年友好的环境支持系统.

Rapid on-site evaluation(ROSE),an auxiliary sampling quality evaluation technology,can be used to evaluate the adequacy and diagnostic category of samples,judge the histological type of lung cancer,and optimize the gene type of lung cancer.Applying ROSE to endobronchial ultrasound-guided transbronchial needle aspiration of suspected lung cancer can improve the puncture success rate and diagnostic rate and reduce complications and puncture attempts.Rose performed via remote cytopathology technology or by trained respiratory specialists may become the future trends.

Objective To investigate the effect of target-oriented liquid therapy on tissue perfusion and prognosis in patients with hepatectomy.Methods From March 2017 to March 2019,86 patients who underwent elective open hepatectomy in our hospital were selected as the study objects.The patients were divided into routine infusion group (n=43) and target-oriented liquid tissue perfusion group (GDFT group) (n=43).The hemodynamic indexes and postoperative complications were compared between the two groups.Results After liquid therapy,the intraoperative cerebral blood flow (CBF) in the GDFT group was (129.16±15.89) ml/min,cardiac output (SV) was (71.69±8.36) ml,SVV was (10.21±1.45)％,central venous pressure (CVP) was (8.16±4.89)kH2O,mean arterial pressure (MVP) was (90.35±4.29) mmHg,and heart rate (HR) was (89.36±11.36) beats/min,which were all better than those in the routine group,there were statistically significant differences between the two groups except for MVP,HR (P＜0.05).The incidence of complications in the routine group was 55.81％,and the incidence of complications in the GDFT group was 16.28％,there was statistically significant difference between the two groups (P＜0.05).Conclusion Target-oriented liquid therapy can stabilize the hemodynamic indexes during operation,shorten the occlusion time of hepatic blood flow,reduce the risk of complications,and improve the long-term treatment effect after operation,worthy of clinical reference.

目的:探讨局灶性机化性肺炎(focal organizing pneumonia,FOP)的临床特征以提高该病的诊断水平.方法:回顾性分析南京医科大学第一附属医院经病理证实的65例FOP患者临床特征、影像学特点及治疗效果.结果:65例中,男45例,女20例,年龄(56.9±9.7)岁.对患者进行分组,43例为隐源性机化性肺炎(cryptogenic organizing pneumonia,COP),22例为继发性机化性肺炎(secondary organizing pneumonia,SOP)(16例与感染相关、4例与肿瘤相关、2例与结缔组织病相关).FOP的常见症状为咳嗽(78.46％)、咳痰(49.23％)、咯血(24.62％)、发热(24.62％)和胸痛(20.00％),SOP组患者咳痰、发热症状及肺部湿性啰者体征多于COP组(P＜0.01).SOP组白蛋白及血红蛋白水平低于COP组(P＜0.01),而乳酸脱氢酶和C反应蛋白水平高于COP组(P＜0.05).影像学显示:FOP中39例呈结节型,26例呈肿块型,右下肺(38.46％)及胸膜下(49.23％)分布多见;常见征象为毛刺征(58.46％)、分叶征(43.08％)、支气管充气征(38.46％)和胸膜凹陷征(32.31％).30例通过胸腔镜手术切除病灶,随访无复发患者.非手术治疗35例:21例予糖皮质激素治疗,其中18例5个月内病灶基本吸收;另14例非激素治疗者,9例在随访中病灶无明显变化,3例在6个月内病灶吸收,l例死亡,l例复发.结论:FOP常见症状为咳嗽、咳痰、咯血、发热和胸痛,病灶多呈右下肺及胸膜下分布.手术切除后无复发,激素治疗疗效佳,但考虑FOP为良性病变,应避免不必要的手术.

Objective To get a preliminary understanding of trainees' knowledge on palliative medicine's basic concepts in resident standardized training (referred to as "training") and propose suggestions for improvement.Methods Using self-made questionnaire,263 residents' standardized training trainees were investigated and conducted data summary in the First Affiliated Hospital of Nanjing Medical University from 2015 to 2017 by "questionnaire star" in their wechat group.Through the investigation targeted at basic concepts of palliative medicine and the professional attitude.Results The residents of 49.0％ (129/263) had a flawed understanding of the basic concepts of palliative medicine,and there was no significant difference between different age groups,different academic qualifications and different training time (x2test with all P＞ 0.100).Only 34.2％ (90/263) agree that medical staff should play an "authoritative role" in palliative medicine.Assuming that they are in the end of lives,65.4％ (172/263) 、80.2％ (211/263) and 31.9％ (84/ 263) of those are willing to take the initiative to implement palliative treatment for themselves,their families and patients,and the difference was significant (x2 =133.240,P＜ 0.05).Only 28.1％ (74/263) of the respondents think that the time is ripe for our country to promote palliative medicine and only 50.2％ (132 /263) are confident in the implementation of palliative care in our country.Condusions There is a lack of palliative medicine education in the current medical education system now and this is one of the important reasons that affect the palliative medicine in mainland China.Therefore,the implementation of palliative medicine education in the medical education system needs to be popularized,strengthened and standardized.

Objective To observe the effect of nursing mode based on Omaha system theory on the recovery of gastrointestinal function,HAMD score,and WHOQOL-100 score in postoperative liver cancer patients.Methods 100 patients with Liver cancer treated at our hospital from January,2015 to January,2018 were selected.According to the principle of complete randomization,the patients were divided into an observation group and a control group,50 cases for each group.The control group received routine care,and the observation group nursing care based on Omaha system theory.The postoperative gastrointestinal function,HAMD score,and WHOQOL-100 score were observed in the two groups.Results The recovery time of bowel sounds,the first anal exhaust time,and the first anal defecation time were (25.31±7.63) h,(49.32±7.20) h,and (64.24±6.62) h in the observation group,and were (36.36±5.23) h,(58.21±6.96) h,and (80.93±8.98) h in the control group,with statistical differences (all P ＜ 0.05).The HAMD scores were (24.36±5.23) and (25.02±4.93) during hospitalization and were (6.74±3.55) and (11.14±2.51) when discharge in the observation group and the control group,respectively,with statistical differences between before and after the nursing care in both groups and between these two groups after the nursing care (all P ＜ 0.05).The scores in the physiological field,the psychological field,the independence field,the social relationship field,the environmental field,and the belief field in the observation group were higher when discharge than during hospitalization,and were higher than those in the control group,with statistical differences (all P ＜ 0.05).Conclusions Nursing mode based on Omaha system theory for patients with liver cancer can effectively improve their gastrointestinal function,mental health,and quality of life,so it is worth for clinical promotion.

基于参与南京医科大学第一附属医院医联体建设的12家成员单位的145份医护人员问卷调查数据,对比接受"组团式"援疆模式成员单位和其他医联体成员单位的医护人员对医联体的知晓度和满意度.结果表明",组团式"援疆受援单位的医护人员对于医联体的了解程度、参与度高于其他医联体成员单位(P<0.05),且"组团式"援疆可提升医护人员对医联体的满意程度(P<0.05).未来可以通过参考"组团式"援疆的"院包科""传帮带""师带徒"等工作模式,探索医联体推行的优质经验,促进医护人员对医联体的参与和建设.

Tuberculosis remains a serious threat to human health .Although the existing anti-tuberculosis drugs can control the development of most tuberculosis ,some tuberculosis ,especially multidrug-resistant tuberculosis ,still can not be completely controlled .The immune checkpoints refer to some inhibitory receptors expressed on immune cells .They can induce immunosuppressive signals ,by binding to their specific ligands ,hence leading to the 〞exhaustion〞 of effective immune cells ,especially T cells .It will probably make mycobacterium tuberculosis more prone to growth and reproduction .The immune cell dysfunction and immune escape ,mediated by immune checkpoints , may be one of the important mechanisms of the failure control for tuberculosis .The immune checkpoint may become a promising target for the host-directed therapy of tuberculosis ,as an adjunct to conventional anti-tuberculosis treatment .This article aims to review the role of immune checkpoints in the pathogenesis and treatment of tuberculosis .

Objective To investigate the correlations of risk factors of age,delirium-inducing factors,dementia,delirium severity,and disease severity with the prognosis of elderly patients with delirium.Methods A total of 112 patients aged 70 years and older with initial onset of delirium during hospital stay were enrolled in this study.They were hospitalized in Dalian Municipal Central Hospital from Jan.2013 to Dec.2015.The severity of delirium was evaluated by delirium rating scalerevised-98(DRS-R-98).The acute physiology and chronic health enquiry(APACHE-Ⅱ)score and the sequential organ failure assessment(SOFA)score were recorded within 48 h after delirium onset.After periods of hospitalization of Jan.2013 to Dec.2015,patients were followed up until 31 Dec 2017.Correlations of age,delirium-inducing factors and dementia with survival time and long-term viability after delirium onset were statistically analyzed.Results Age,delirium-inducing factors,cognitive impairment,duration of cognitive impairment,type of dementia,and delirium severity had no correlations with the lifetime and long-term viability in patients with delirium.While,APACHE Ⅱ score for assessment of severity degree of delirium(P ＜0.001,r =-0.390) and SOFA score(P ＜0.001,r=-0.638)were negatively correlated with the lifetime in patients with delirium.SOFA score (P =0.004) and delirium recurrence (P ＜ 0.001) were significantly correlated with the long-term viability in patients with delirium.Conclusions The severity and recurrence of delirium are strongly correlated with the lifetime and quality of life in patients with delirium.Compared with APACHE Ⅱ score,SOFA score may have a more important clinical application value in predicting the prognosis of patients with delirium.

目的:研究肺腺癌伴发静脉血栓栓塞症(venous thromboembolism,VTE)的危险因素,提高对肺腺癌伴发VTE的认识.方法:回顾分析2012年1月-2016年12月南京医科大学第一附属医院住院的2 930例肺腺癌患者临床资料,发现96例伴发VTE.将伴发VTE肺腺癌患者纳入VTE组,未发生VTE患者纳入非VTE组,对肺腺癌伴发VTE的危险因素进行分析.结果:96例(3.3％)肺腺癌伴发VTE.VTE患者中,男57例,女39例,平均年龄(60.8±10.1)岁;非VTE组中男1 477例,女1 357例,平均年龄(61.0±10.5)岁.两组比较发现,吸烟、中心静脉置管、合并有慢性肺部疾病、肺腺癌分期的差异有统计学意义(P＜0.05).多因素Logistic回归分析示肺腺癌Ⅲ～Ⅳ期、合并慢性肺部疾病是肺腺癌伴发VTE的高危因素.96例中,单独发生肺血栓栓塞(pulmonary thromboembolism,PTE)26例(27.1％),单独发生深静脉血栓(deep vein thrombosis,DVT)51例(53.1％),同时存在DVT和PTE 19例(19.8％).45例PTE患者中,37例(82.2％) 出现明显临床症状,8例(17.8％)无明显症状.70例DVT患者中,66例(94.3％)表现为患侧肢体肿胀或疼痛.96例中,71例为肺癌治疗后伴发VTE,0～3个月、3～6个月、6～9个月、9～12个月、＞12个月VTE发生例数分别为37、8、8、4、14例.截至随访时间,52例(54.17％)死亡,伴发VTE的中位生存时间为5个月.结论:肺腺癌Ⅲ～Ⅳ期、合并有慢性肺部疾病与肺腺癌伴发VTE显著相关.肺腺癌诊断后的前3个月内最容易发生VTE.

OBJECTIVE:To investigate the clinical efficacy of acupotomy stress position percutaneous dynamic release for severe shoulder periarthritis.METHODS:From April 2012 to August 2016, 160 patients with severe shoulder periarthritis were randomly divided into treatment group and control group. Among them, 80 patients in treatment group were treated with acupotomy stress position percutaneous dynamic release including 32 males and 48 females with an average of(52.47±9.04)years old ranging from 40 to 74 years old;the courses of disease was(20.72±9.55)months on average. The other 80 patients in control group were treated with simple joint loosening according to Maitland technique in grade III-IV therapy, once a day, 15 to 20 min each time, and 10 d for 1 course, for a total of 2 courses, including 33 males and 47 females with an average of (53.19±10.18) years old ranging from 42 to 75 years old; the average course of disease was (21.98 ±8.99) months. After operation, the shoulder muscles training and shoulder joint activity training were routinely conducted, the treatment lasted for 3 weeks. The visual analogue scale(VAS) and Constant-Murley shoulder function score were observed and compared between the two groups before treatment and 3 weeks, 3, 6 months after treatment.RESULTS:The VAS scores of the treatment group at 3 weeks, 3 and 6 months after treatment were all lower than those of the control group(P<0.05). The shoulder joint function Constant-Murley scores of the treatment group at 3 weeks, 3 and 6 months after treatment were higher than those of the control group (P<0.05); the result was excellent in 59 cases, good in 18 cases, fair in 3 cases in the treatment group; excellent in 15 cases, good in 31 cases, fair in 23 cases, poor in 11 cases in the control group, and the difference between the two groups was statistically significant(P<0.01).CONCLUSIONS:Treatment of severe shoulder periarthritis with acupotomy stress position percutaneous dynamic release can obviously improve the shoulder joint function and pain, according to the different parts of the shoulder joint pain and function limitation, the corresponding shoulder stress and body position should be designed and maintained during the treatment process, and the angle of stress position gradually increased by loosening the adhesion, which is the key to ensure the curative effect.

Objective To investigate the effect of hierarchical nursing management on quality of care and complications in patients at department of hepatobiliary surgery. Methods Seventy-eight patients treated at the department of hepatobiliary surgery at our hospital from March 2015, to March 2016 were selected as a control group and 78 from April, 2016 to April, 2017 as an observation group. The nursing quality, nursing satisfaction, and incidence of complications were compared between the two groups. Results After 4 weeks’ nursing care, the scores of ward management, basic nursing care, special nursing care, disinfection and isolation, and nursing record were (18.74±1.71), (18.24±1.47) , (18.47±1.66) , (17.73±2.37), and (17.64±2.52) in the observation group, which were all higher than those in the control group (all P<0.05). After 4 weeks’ nursing care, the nursing satisfaction was 93.59% in the observation group and was 66.67% in the control group (P<0.05); and the incidence of complications was 2.56% in the observation group and was 15.38% the control group (P<0.05). Conclusion Applying hierarchical nursing management mode in patients at deprtment of hepatobiliary surgery can significantly improve the nursing quality and nursing satisfaction and reduce the incidence of complications, so it is worth being clinically generalized. Key words: Hierarchical nursing management; Hepatobiliary surgery; Nursing quality; Nursing satisfaction; Complications

Pulmonary arterial hypertension(PAH)is featured as persistent elevation of pulmonary artery pressure, with a progressive pulmonary vascular remodeling, leading to severe right heart failure and premature death.The pathogenesis is not fully clear.Current available therapies cannot completely relief the symptoms of PAH.The ras homolog family member A (RhoA)-Rho kinase (ROCK) axis is one of the most important pathways involved in the development of PAH.Recently, Rho kinase inhibitors have gained much attention for its therapeutic potential in PAH.This review focused on the research progress of Rho kinase inhibitors in PAH. Key words: Pulmonary arterial hypertension; Rho kinase inhibitors; Pulmonary vascular remodeling; Combination therapy

随着实体器官移植和造血干细胞移植等在临床的广泛开展、接受化疗的肿瘤患者大量增加以及人类免疫缺陷病毒感染者的增多,造成患者免疫功能受损的机会明显增加,临床上侵袭性真菌感染也日趋常见.侵袭性真菌感染治疗复杂而困难,这类患者往往合并复杂的基础疾病,预后较差.目前治疗侵袭性真菌感染的药物包括多烯类、三唑类、棘白菌素类和核苷类似物.各类抗真菌药物分子结构差异、靶点不同导致其药动学、药效学不一致,在临床应用、适应证、安全性和不良反应等方面也存在差异.综述侵袭性真菌感染治疗药物的研究进展,为相关药物的研发与临床应用提供参考.

南京医科大学第一附属医院不断探索完善优质医疗资源和政府主导双重效应的“院府合作模式”,即一方面强调“府为主导”,突出政府保障民生的主体责任;另一方面强调“院为载体”,突出医院提供医疗服务的载体作用.自2007年以来,共发展出盛泽模式、栖霞模式、宿迁模式、溧阳模式四种模式“院府合作”可实践、可复制、可推广,形成了政府促民生、群众享实惠、医院共发展、社会得满意的四赢局面,为护佑全民健康、助J全面小康探索了一条全新路径.

OBJECTIVES:This study aimed to explore the dynamic changes of lesion patterns and hemodynamic characteristics in patients with internal carotid artery stenosis (ICAS). PATIENTS AND METHODS:Patients who had suffered an acute ischemic stroke in the distribution of ipsilateral ICAS were included. Computed tomography (CT) and transcranial doppler ultrasound (TCD) were conducted to evaluate the degree of ICAS and the hemodynamic characteristics of the intracranial and extracranial arteries. RESULT:A total of 424 patients were included in the study. With the aggravation of ICAS, blood velocity in ipsilateral ICA was increased, while blood flow in the ipsilateral middle cerebral artery (MCA) was decreased. In the same degree of ICAS, patients with opened communicating arteries showed relatively higher blood perfusion in MCA compared with those without communicating arteries. In the average stage of ICAS, small lesions (D=0-1.5cm), middle lesions (1.5cm3.0cm) commonly existed. The number of small and large lesions significantly increased when the blood flow of ipsilateral MCA decreased. In the same degree of stenosis, the number of small lesions and large lesions, and the total area of all lesions, evidently increased with the decrease of ipsilateral MCA blood velocity. CONCLUSION:Hypoperfusion is an independent risk factor for ischemic lesions in patients with ICAS. Whether or not the communicating arteries are open influences the blood flow of the intracranial arteries. TCD was a convenient and rapid tool to assess intracranial perfusion and vascular compensatory status.

In recent years,molecular targeted drugs(MTD) were increasingly used in cancer treatment with the exact curative effect,high selectivity and less adverse reaction.Interstitial lung disease (ILD) is a rare adverse reaction,but as to its severe symptoms,poor prognosis and high fatality rate,it had more and more caused the public attention.In this paper,we will introduce the pathogenesis,clinical manifestation,underlying pathogenesis mechanism and therapy about MTD related ILD.In this way,the clinical workers may improve the awarance of the MTD related ILD.

In the “Twelfth Five-year” period, the state has made it clear in the medical and health system that a combination should be achieved among prevention, treatment and rehabilitation. It is required that a layered and staged rehabilitation medical service system should be set up. Jiangsu Provincial Hospital and Nanjing Qixia District People’s Government analyze the background and foundation of their cooperation and draft a cooperation plan to actively practice and study the establishment of a regional rehabilitation medical service system by deepening “hospital-government cooperation”.

当今世界,人才是第一资源.人才实力能深刻地反映出一个国家的综合国力,人才对于医院而言,同样意味着内涵、根本、核心竞争力以及可持续发展的力量源泉. 正是深刻地认识到了人才建设的重要性与复杂性,江苏省人民医院自上个世纪九十年代就启动实施了“人才强院”战略,形成了较好的人才发展氛围和基础.随着社会的发展,人民群众的健康需求不断增加,新医改的深化也对公立医院提出了更高的要求.面对新形势、新挑战,该院始终坚持将“人才强院”战略作为医院发展五大战略之首,同时赋予其新的内涵,确立了“以用为本、创新机制、高端引领、整体开发”的方针,加快了人才布局和结构的调整,实现了医院的跨越式发展.

目的 波生坦及其联合用药治疗肺动脉高压(PAH )患者的临床观察.方法 PA H患者23例 ,给予波生坦62. 5 mg ,每日2次 ,治疗4周后改为125 mg ,每日2次.随访期间根据病情 ,必要时联合磷酸二酯酶-5抑制剂、前列环素类、内皮素受体拮抗剂药物.监测肝功能、氨基端脑利钠肽原(NT-proBNP)变化 ,评估WHO 心功能分级 ,测量6 min步行距离(6MWD) ,二维超声心动图测量肺动脉收缩压变化.结果 波生坦治疗时间为(21 ± 4 )个月 ,波生坦单药治疗至需要联合或更换药物治疗时间为(17 ± 4)个月.波生坦及其联合用药能有效改善PAH病情 ,总体生存率达95.7% .治疗后患者的WHO心功能分级、6 MWD和肺动脉收缩压(P<0 .01或P<0 .05);NT-proBNP呈下降趋势 ,但差异无统计学意义(P>0 .05).结论 波生坦及其联合用药可以长期用于PAH治疗 ,能够改善心功能 ,提高患者的运动能力 ,降低肺动脉压力 ,治疗PA H安全有效.