Water is the key medium to transport numerous constituents and to provide a platform for physiological processes to take place in the living organisms in general;it also participates actively in many of these processe...Water is the key medium to transport numerous constituents and to provide a platform for physiological processes to take place in the living organisms in general;it also participates actively in many of these processes. In humans, there are different vehicles to contain water and its constituents. Our objective is to find out whether there is an overall water-base circulation system in the human body by analyzing the updated findings of different research groups on the physiological functions of various seemingly isolated fluid systems. By 1963, there were five separate fluid systems discovered in mammalians: (i) The Primo Vasculature Fluid (PVF) with protein precursors and micro cells held in the Primo Vasculature System (PVS). (ii) Blood with its constituents held in the cardio vasculature. (iii) Extracranial interstitial fluid (ISF) whose vehicle had a very irregular structure—the interstitium all over the body. (iv) The cerebrospinal fluid had been considered to be within the brain ventricles and spinal canal. (v) The extra-cranial lymphatic system which drained ISF, and had been known to join the subclavian vein. Fluid (i) was first reported in 1963 and fluids (ii) to (v) have been known for many decades, but the failure to detect a lymphatic system inside the skull has also been a mystery for many decades. The intra-cranial ISF (which we name as BISF) has drawn little attention, apart from discussing the mechanism of the blood-brain-barrier. During the past decade, there has been direct evidence indicating that CSF and BISF are actually mixed. After that, the intracranial lymphatic system was discovered and confirmed in animal models only slightly over one year back, and we called such fluid as glymphatic-fluid. After reviewing the stated “classical” five fluid systems together with the new findings in Sections 2 - 7, we propose, for the first time, that the PVF, the blood, ISF, a mixture of CSF-BISF, and a mixture of glymphatic-fluid and lymph form an integrative circulation system in water base in the human and other mammalian bodies, as schematically represented in the last section. In this paper, we point out the positive correlation of chronic neuro degenerative diseases such as Alzheimer’s disease, Parkinson’s diseases and the insufficient brain wastes clearance by the glymphatic system. We also discuss the role played by the venous vessels as part of such clearance in upright posture. Moreover, simple non-invasive maneuver techniques are introduced here, as one example of enhancement of glymphatic fluid flow out of the skull to join the lymphatic system. A series of questions are raised in Section 8, the answers to which would help us to understand the transition from physio- to pathological states in the development of many diseases. Detailed analysis of this paper leads us to consider that research in understanding this integrative circulation system is only at the infancy stage, and fluid dynamics investigation seems to be the plausible modality of approach in the near future.展开更多
目的探讨运用根本原因分析法(root cause analysis,RCA)联合循环质量管理法(plan-do-check-action,PDCA)解决血液透析中心置换液存在的细菌含量超标问题,明确RCA-PDCA在血液透析中心质量风险控制中的应用效果。方法选择2023年6—8月江...目的探讨运用根本原因分析法(root cause analysis,RCA)联合循环质量管理法(plan-do-check-action,PDCA)解决血液透析中心置换液存在的细菌含量超标问题,明确RCA-PDCA在血液透析中心质量风险控制中的应用效果。方法选择2023年6—8月江苏大学附属金坛医院血液净化中心置换液检测结果进行分析。2023年6月采集样本14份为首次采样。2023年7月起运用RCA-PDCA的管理工具进行质量改进,发现问题,成立改进小组,明确现行的流程,查找最新知识和有效的信息,从采样环节、设备与结构、消毒程序、质控环节等方面进行根本原因分析,采取酒精棉片擦拭置换液出口、多点分布采样、增加机器冷消毒等措施,解决透析用置换液细菌含量超标问题,并明确超标端口,采取针对性的干预措施。持续2个月,共进行3个周期。于2023年7月15日、8月5日、8月25日先后采集3次,共计126份样本。比较实施不同措施后采样结果与首次采样结果的合格率。结果本次质量改进共分为3个周期,持续时间2个月,取样126份。措施1后采样42个端口显示其中14个端口细菌数超标,其中A14细菌数达到10 CFU/mL,合格率为66.67%,较首次采样合格率35.71%高,差异有统计学意义(P<0.05);增加措施2采取单端口多点采样,分别采集各端口的A、B、C个部位,采样结果显示仍有6个端口细菌数超标,其中5个为B端口,1个为C端口,A端口、C端口合格率分别为100%、92.86%,均较首次采样合格率35.71%高,差异有统计学意义(P<0.05);在措施1+2的基础上,增加机器的冷消毒一次后,进行第4次采样,结果显示无细菌超标,合格率为100%,与首次采样合格率35.71%比较,差异有统计学意义(P<0.05)。结论运用RCA-PDCA循环管理模式,成功解决置换液细菌含量超标问题,有效提高血液透析中心置换液质量风险控制的能力。展开更多
文摘Water is the key medium to transport numerous constituents and to provide a platform for physiological processes to take place in the living organisms in general;it also participates actively in many of these processes. In humans, there are different vehicles to contain water and its constituents. Our objective is to find out whether there is an overall water-base circulation system in the human body by analyzing the updated findings of different research groups on the physiological functions of various seemingly isolated fluid systems. By 1963, there were five separate fluid systems discovered in mammalians: (i) The Primo Vasculature Fluid (PVF) with protein precursors and micro cells held in the Primo Vasculature System (PVS). (ii) Blood with its constituents held in the cardio vasculature. (iii) Extracranial interstitial fluid (ISF) whose vehicle had a very irregular structure—the interstitium all over the body. (iv) The cerebrospinal fluid had been considered to be within the brain ventricles and spinal canal. (v) The extra-cranial lymphatic system which drained ISF, and had been known to join the subclavian vein. Fluid (i) was first reported in 1963 and fluids (ii) to (v) have been known for many decades, but the failure to detect a lymphatic system inside the skull has also been a mystery for many decades. The intra-cranial ISF (which we name as BISF) has drawn little attention, apart from discussing the mechanism of the blood-brain-barrier. During the past decade, there has been direct evidence indicating that CSF and BISF are actually mixed. After that, the intracranial lymphatic system was discovered and confirmed in animal models only slightly over one year back, and we called such fluid as glymphatic-fluid. After reviewing the stated “classical” five fluid systems together with the new findings in Sections 2 - 7, we propose, for the first time, that the PVF, the blood, ISF, a mixture of CSF-BISF, and a mixture of glymphatic-fluid and lymph form an integrative circulation system in water base in the human and other mammalian bodies, as schematically represented in the last section. In this paper, we point out the positive correlation of chronic neuro degenerative diseases such as Alzheimer’s disease, Parkinson’s diseases and the insufficient brain wastes clearance by the glymphatic system. We also discuss the role played by the venous vessels as part of such clearance in upright posture. Moreover, simple non-invasive maneuver techniques are introduced here, as one example of enhancement of glymphatic fluid flow out of the skull to join the lymphatic system. A series of questions are raised in Section 8, the answers to which would help us to understand the transition from physio- to pathological states in the development of many diseases. Detailed analysis of this paper leads us to consider that research in understanding this integrative circulation system is only at the infancy stage, and fluid dynamics investigation seems to be the plausible modality of approach in the near future.
文摘目的探讨运用根本原因分析法(root cause analysis,RCA)联合循环质量管理法(plan-do-check-action,PDCA)解决血液透析中心置换液存在的细菌含量超标问题,明确RCA-PDCA在血液透析中心质量风险控制中的应用效果。方法选择2023年6—8月江苏大学附属金坛医院血液净化中心置换液检测结果进行分析。2023年6月采集样本14份为首次采样。2023年7月起运用RCA-PDCA的管理工具进行质量改进,发现问题,成立改进小组,明确现行的流程,查找最新知识和有效的信息,从采样环节、设备与结构、消毒程序、质控环节等方面进行根本原因分析,采取酒精棉片擦拭置换液出口、多点分布采样、增加机器冷消毒等措施,解决透析用置换液细菌含量超标问题,并明确超标端口,采取针对性的干预措施。持续2个月,共进行3个周期。于2023年7月15日、8月5日、8月25日先后采集3次,共计126份样本。比较实施不同措施后采样结果与首次采样结果的合格率。结果本次质量改进共分为3个周期,持续时间2个月,取样126份。措施1后采样42个端口显示其中14个端口细菌数超标,其中A14细菌数达到10 CFU/mL,合格率为66.67%,较首次采样合格率35.71%高,差异有统计学意义(P<0.05);增加措施2采取单端口多点采样,分别采集各端口的A、B、C个部位,采样结果显示仍有6个端口细菌数超标,其中5个为B端口,1个为C端口,A端口、C端口合格率分别为100%、92.86%,均较首次采样合格率35.71%高,差异有统计学意义(P<0.05);在措施1+2的基础上,增加机器的冷消毒一次后,进行第4次采样,结果显示无细菌超标,合格率为100%,与首次采样合格率35.71%比较,差异有统计学意义(P<0.05)。结论运用RCA-PDCA循环管理模式,成功解决置换液细菌含量超标问题,有效提高血液透析中心置换液质量风险控制的能力。
