Early reperfusion strategy for acute myocardial infarction: a need for clinical implementation

Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care, and it is time-dependent. Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice. We need to improve upon the problems of low reperfusion rate, non-standardized treatment, and economic burden in STEMI care. This article briefly reviews the current status of reperfusion strategy in STEMI care, and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.     

后适应在接受直接PCI治疗的急性ST段抬高性心肌梗死患者中的临床疗效:基于随机对照试验的meta分析(英文)

目的:探讨后适应对接受直接经皮冠状动脉介入(PCI)治疗的急性ST段抬高性心肌梗死(STEMI)患者心血管不良事件的影响。创新点:进一步明确后适应处理对STEMI患者临床预后的影响。方法:对符合入选标准的随机对照临床试验进行meta分析。结论:缺血后适应显著降低ST段抬高性心肌梗死患者心衰风险。     

关爱教育的教学实施模式

关爱教育是学校德育的主旋律 ,人性关怀反映了德育人本化的趋势 ,关怀取向是对公正取向的合理补充。关爱教育本质上是一种情感教育 ,以情感体验与关爱实践为基本特征。关爱教育模式是以体验式学习建构的道德互动性结构化整体 ,包括情境体验、价值辨析、活动践行三种基本课型。关爱教育的实施需采取渗透性策略、生态性策略、仪式化策略与随机性策略。     

急性ST段抬高型心肌梗死继发心脏破裂的预测因素分析

研究目的：心脏破裂是急性ST段抬高型心肌梗死最严重的并发症之一,病情凶险,死亡率高。通过明确心肌梗死后出现心脏破裂并发症的危险因素,早期识别心脏破裂高危人群,有利于在急性心肌梗死的早期采取干预措施以减少心脏破裂的发生。创新要点：既往缺乏对中国sT段抬高型心肌梗死继发心脏破裂的系统风险评估,本研究采用回顾性队列研究的方法,完善并健全中国多中心的急性心肌梗死数据库,样本总量达到9798例,为国内同类研究中样本量最多。既往的国外文献报道：女性、高龄、心梗后就诊时间延迟、前壁心肌梗死、溶栓治疗等是心肌梗死后心脏破裂的独立危险因素。本研究在中国人群验证以上危险因素的基础上首次提出就诊时血色素下降及白细胞计数的升高与随后发生的心脏破裂密切相关。新的心脏破裂预测因素的发现有利于对心脏破裂更精细化的危险分层,早期识别心脏破裂高危人群。研究方法：建立中国多中心心肌梗死数据库,比较发生心脏破裂与未发生心脏破裂患者临床特点的差异,筛选敏感特异的心脏破裂的独立预测因素。重要结论：中国人群急性ST段抬高型心肌梗死后心脏破裂的发生率是1．82％,独立预测因素主要包括：高龄、女性、就诊时静息心率增快、前壁心肌梗死、心功能不全、就诊时间延迟、肾功能不全、贫血与白细胞计数升高。本文第一次提出就诊时贫血状态及白细胞计数的升高时与心脏破裂的发生直接相关。     

生命关怀：高校德育的起点和归宿

重视和加强大学生的生命关怀教育是当前高校德育工作的一个新的课题。本文主要探讨了大学生生命关怀教育的主要内容、必要性以及实施策略。     

“关爱”:让教育人性化——中小学教师职业道德规范新解读

对《中小学教师职业道德规范》中的"关爱"一词,用新理念进行了重新解读,提出了关爱的三个层次,阐述了关爱的教育学和心理学理论基础,并提出了关爱的行动策略。     

金融危机环境下企业员工思想政治教育策略研究

在金融危机环境下如何做好企业员工思想政治教育,帮助员工成长和发展成为重要的问题。大致而言,可以通过三大策略来实施:主体间性策略、人性关怀策略、文化渗透策略。     

The widening participation agenda: the marginal place of care

This paper is based upon two empirical studies, which identify care‐giving responsibilities as a key mediator of mature students’ – a target group within the widening participation strategy – experiences of higher education. Employing a feminist lens on care, we identify a disjuncture between how students experience the challenges of negotiating care and study, and the narrow and economistic way care is addressed within higher education policy. We point to the broader recognition of care emerging within New Labour’s policies on the reconciliation of paid work and family life and argue that in the context of increasing expectations that learning is for life, care needs to be recognised in a broader form at the interface of both education and employment. Drawing on the notion of a ‘political ethics of care’, we conclude by identifying elements that should be included in a higher‐education ‘care culture’.     

A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients

A meta-analysis was performed to address the efficacy and safety of paclitaxel-eluting stent (PES) in ST-segment elevation myocardial infarction (STEMI) patients. A systematic literature search was conducted to identify all randomized clinical trials in mortality, recurrent myocardial infarction (rMI), repeat revascularization (RR), and stent thrombosis (ST). A total of 4190 STEMI patients were enrolled in six randomized trials comparing PES with bare-metal stent (BMS). The pooled repeat revascularization rate was 5.7% in PES group, significantly lower than 10.0% in BMS group with an odds ratio (OR) of 0.56, 95% confidence interval (CI) [0.44, 0.72] (P<0.00001). No significant difference was found between PES and BMS groups in mortality at one year after the indexing procedure (3.9% vs. 5.1%, OR 0.88, 95% CI [0.63, 1.21], P=0.42). Similarly, rMI rate did not differ significantly between the two groups (3.4% vs. 4.1%, OR 0.80, 95% CI [0.56, 1.13], P=0.21). PES was also associated with the comparable pooled rate of definite stent thrombosis with BMS (2.3% vs. 2.4%, OR 0.81, 95% CI [0.52, 1.26], P=0.35). The results show that PES improved clinical outcomes in STEMI patients with a decreased need for repeat revascularization and no concerns for safety.     

Developing healthcare practice through action learning: individual and group journeys

Action Learning is now a well established strategy for reflective inquiry in healthcare. Whilst a great deal is know about action learning there has been inadequate research on the process of learning that takes place, and the impact that this holds for individuals, groups or organisations. This article reports on the findings of 15-month action learning program based in a special care nursery. A realistic evaluation of the program uncovered individual and group journeys and provide evidence that action learning is an effective strategy in practice development.     

Training day care program personnel in handling child abuse cases: intervention and prevention outcomes

Attempts have been made to provide day care services as part of a treatment plan and these services are also used as a preventive strategy. Day Care programs have the potential for providing growth experiences, supportive adult role models, and modeling parental skills in an atmosphere of understanding, respect and trust. There is a need, however, for day care professionals and paraprofessionals who come into contact with children to recognize problems of child abuse and neglect and to develop skills to deal with the range of inherent problems. A report on a training program for day care workers is presented in this article. A survey involving 84 day care programs in southeastern Pennsylvania was conducted and comparisons of intervention and prevention activities of two groups: those programs whose staff participated in the training and those whose staff did not, were made. Assessment of intervention activities shows that there is no difference between the groups. However, analysis of prevention activities shows that day care workers in the trained group were significantly more involved in prevention and high risk referral.     

To Tell a Tale: The Use of Moral Dilemmas to Increase Empathy in the Elementary School Child

Empathy, the ability to care about others, is a learned process and can be successfully modeled in the elementary classroom. Although there are various methods available for improving empathy and other aspects of moral development, one recommended strategy is the use of moral dilemmas and role-play. This strategy involves (a) the use of formal and informal observations, (b) informal interviews, (c) the choosing of appropriate stories, (d) various presentation methods, (e) large and small group discussions, and (f) closing techniques such as creative writing samples.     

Locally grounded,universally binding: The benefit of incorporating traditional care ethics,East and West,into current moral education

In this article, I am suggesting that one effective strategy for revitalizing moral education consists in incorporating classical traditions of care ethics, East and West, which are very much alive in contemporary culture, into sentiments, insights and practices of contemporary care ethics. In so doing we might make moral education much more accessible, natural and friendly to both teachers and students. First, it is associated with down to earth affective and relational elements rather than with highly theoretical philosophical reasoning; second, it is grounded in local cultural traditions that are very much alive in the ‘cultural DNA’ of millions of people in their traditional communities; third, in terms of its moral tenets it is humanistic and universally binding. The desirable outcome, if this model proves tenable, is moral education oriented by care ethics, locally grounded and universally binding.     

数学问题解决教学浅探

数学问题解决教学已在各国引起了广泛重视。问题解决是培养学生的数学才能,教会其思考,提高其学习能力的一条重要途径。在有高质量的知识贮备的基础上,要培养学生认知课题、表征课题的能力,进行显性的数学思维策略教学,并及时进行总结、反思。     

Basic fibroblast growth factor alleviates brain injury following global ischemia reperfusion in rabbits

The aim of this study was to explore the protective effect of basic fibroblast growth factor (bFGF) on brain injury following global ischemia reperfusion and its mechanisms. Brain injury following global ischemia was induced by four vessels occlusion and systemic hypotension. Twenty-four rabbits were randomized into three groups: group A, only dissection of vessels; group B, intravenous infusion of normal saline after reperfusion for 6 h; group C, 30 μg/kg bFGF injected intravenously at the onset of reperfusion, then infused with 10 μg/(kg·h) for 6 h. Serum neuron specific enolase (NSE), S-100B, tumor necrosis factor-α(TNF-α), interleukin-1 (IL-1), interleukin-8 (IL-8) were measured before ischemia, 30 min after ischemia, 0.5, 1, 3, 6 h after reperfusion. Brain water content was determined and cerebral histopathological damages were compared. NSE and S-100B were increased 1 h after reperfusion and reached their peaks 6 h after reperfusion, but were much higher in group B than those in group C 3, 6 h after reperfusion. In groups B and C, TNF-a was increased after ischemia and IL-1 and IL-8 were increased significantly 0.5 h after reperfusion, then reached their peaks 6 h, 3 h, 6 h after reperfusion respectively. TNF-a and IL-8 at the time points of 1 h and 3 h and IL-1 at 3 h and 6 h in group C were correspondingly lower than those in group B. These indices in group A were nearly unchanged. There were less severe cerebral histopathological damages in group C compared with group B, but no difference in brain water content. It could be concluded that bFGF alleviates brain injury following global ischemia and reperfusion by down-regulating expression of inflammatory factors and inhibiting their activities.     

美国儿童照料中心许可制度的特点、发展趋势及启示

儿童照料中心的准入许可制度是政府确保婴幼儿接受有质量的保教服务的重要举措.研究2008年以来美国50个州颁布的儿童照料中心许可标准和管理条例发现,这些许可制度呈现出共同的特点:强有力的法律法规保障、有效的管理办法、不断完善的标准以及对无资质幼教机构妥善的处理策略.近年,各州在标准修订和管理办法上也呈现出一些共同趋势.许可标准对婴幼儿的生活照料、安全和健康领域的专项培训、工作人员的资质等方面都提出了更高的要求.在许可管理实践中,各州提高了督查的频率,采用了新的技术和方法.     

神经生长因子对大鼠脑缺血再灌注后HIF-1α及HSP70表达的影响

采用大鼠大脑中动脉（MCAO）模型,肌肉内注射神经生长因子（NGF）,经过免疫组化和HE染色检测Sprague—Dawley（SD）大鼠脑缺血再灌注后HIF-1α（缺血诱导因子）及HSP70（热休克蛋白70）表达的变化及神经生长因子的影响。结果表明,肌肉注射神经生长因子对脑缺血再灌注有明显的保护作用,HIF—1α及HSP70表达增加可能是其机制之一。     

缺血后适应脑保护机制的研究进展

如今延长溶栓时间窗、减轻再灌注损伤是缺血性脑血管病亟待解决的的问题,缺血后适应提供了一种可能的解决方法,故成为研究的热点。缺血后适应通常指的是在组织缺血-再灌注之后进行的一系列短暂血管闭塞/血管再灌注,诱导组织针对缺血-再灌注损伤产生内源性保护作用,减少组织器官缺血-再灌注损伤。该文将综述缺血后适应脑保护的基本机制：减少缺血-再灌注后脑血流的改变,减少氧化应激产物的产生,抗炎,相关信号传导通路改变。     

Children's Use of Retreats in Family Child Care Homes

The use of retreat spaces by 65 children in 9 family child care homes was assessed in this study. Family child care providers used daily diaries to collect information about children's retreat frequency and associated behavior. The findings revealed that nearly half of the children used informal, readily available retreats during the research period. Playing with toys was the most frequent and stable retreat activity across age groups. Yet the number of passive and engaged behaviors varied based on child characteristics such as age, gender, and child's mood for the day. Retreat use can be viewed as a potentially adaptive environmental strategy that children apply as their needs change in a given day and from one developmental period to the next. Thus, it is recommended that child care professionals provide access to retreats and support children's varied use of retreat space.     

Children's Use of Retreats in Family Child Care Homes

The use of retreat spaces by 65 children in 9 family child care homes was assessed in this study. Family child care providers used daily diaries to collect information about children's retreat frequency and associated behavior. The findings revealed that nearly half of the children used informal, readily available retreats during the research period. Playing with toys was the most frequent and stable retreat activity across age groups. Yet the number of passive and engaged behaviors varied based on child characteristics such as age, gender, and child's mood for the day. Retreat use can be viewed as a potentially adaptive environmental strategy that children apply as their needs change in a given day and from one developmental period to the next. Thus, it is recommended that child care professionals provide access to retreats and support children's varied use of retreat space.