CIC on harmful substances questionnaire(中文)
儿童神经源性膀胱管理的最佳证据总结
儿童神经源性膀胱管理的最佳证据总结李 珂,贾 勤,姚利锋,吴佳云,汪盈盈S u m m a r y o f t h e b e s t e v i d e n c e f o r n e u r o g e n i c b l a d d e rm a n a ge m e n t i n c h i l d r e n L IK e ,J I A Q i n ,Y A OL if e ng ,W UJ i a y u n ,W A N G Y i n g y i n g (S ch o o l o fN u r si n g ,Z h ej i a n g C h i n e s eM e d i c a lU n i v e r s i t y ,Z h e j i a n g 310053C h i n a )A b s t r a c t O b je c t i v e :T o s e a r c ha n d s u mm a r i z e t h eb e s t e v i d e n c e of b l a d d e rm a n ag e m e n t i n chi l d r e nw i t hn e u r o g e n i cb l a d d e r ,s o a s t o p r o v i d e e v i d e n c e -b a s e de v i d e n c ef o rc l i n i c a l p r a c t i c eo f m e d i c a ls t a f f .M e t h o d s :A s ys t e m a t i cs e a r c h w a sc o n d u c t e do n B M JB e s t P r a c t i c e ,C o c h r a n eL i b r a r y ,U p T o D a t e ,J o a n n aB r i g g s I n s t i t u t e ,N a t i o n a lG u i d e l i n eC l e a r i n gh o u s e ,G u i d e l i n e s I n t e r n a t i o n a lN e t w o r k ,S pi n aB i f i d a A s s o c i a t i o n ,N a t i o n a l I n s t i t u t ef o r H e a l t ha n d C l i n i c a lE x c e l l e n c e ,S c o t t i s hI n t e r s c h o o lG u i d e l i n e N e t w o r k ,C a n a d i a n A s s o c i a t i o no fU r o l o g y ,E u r o p e a n A s s o c i a t i o no fU r o l o g y ,E u r o p e a nS o c i e t y o fP e d i a t r i c U r o l o g y,B r i t i s h A s s o c i a t i o no fP e d i a t r i c U r o l o g i s t s ,I n t e r n a t i o n a l C h i l d r e nC o n t i n e n c eS o c i e t y ,P u b M e d ,Y i m a i t o n g ,C h i n aN a t i o n a lK n o w l e d g e I n f r a s t r u c t u r e ,W a n f a n g ,Ch i n a B i o m e d i c a l L i t e r a t u r e D a t a b a s e ,a n do t h e r g u i d e w e b s i t e sa n di n d u s t r y a g e n c y w e b s i t e sf o re v i d e n c eo fb l a d d e r m a n a g e m e n ti n c h i l d r e nw i t hn e u r o g e n i c b l a d d e r ,i n c l u d i n gg u i d e l i n e s ,c l i n i c a l d e c i s i o n s ,b e s t p r a c t i c e s ,s ys t e m a t i c r e v i e w s ,e v i d e n c e s u mm a r i e s ,m e t a -a n a l y s i s a n de x p e r t c o n s e n s u s e s .T h es e a r c h p e r i o d w a sf r o mi n c e p t i o nt o M a y 2022.R e s u l t s :At o t a lo f12a r t i c l e sw e r e i n c l u d e d ,i n c l u d i n g 5g u i d e l i n e s ,1e v i d e n c e s u mm a r y ,4e x p e r t c o n s e n s u s e s ,1c l i n i c a l d e c i s i o n a n d 1s ys t e m a t i c r e v i e w.At o t a l o f 32b e s t p i e c e s o f e v i d e n c e w e r es u mm a r i z e df r o m f i v ea s p e c t s :s c r e e n i n g a n dd i a g n o s i s ,t r e a t m e n t ,p r e v e n t i o na n dt r e a t m e n to fc o m p l i c a t i o n s ,t r a n s i t i o n a lm a n a g e m e n ta n df o l l o w -u p .C o n c l u s i o n :W h e n a p p l y i n g ev i d e n c e ,c l i n i c a l m e d i c a ls t a f fs h o u l d c o m b i n et h ec l i n i c a l e n v i r o n m e n t a n d t h ef a m i l y 'sw i l l i n g n e s st oh e l p c h i l d r e n w i t hb l a d d e r m a n a g e m e n t i nas c i e n t i f i cw a y ,i no r d e rt oi m p r o v et h e q u a l i t y of l i f e o f c h i l d r e n .K e yw o r d s n e u r o g e n i cb l a d d e r ;i l l c h i l d r e n ;b l a d d e rm a n a g e m e n t ;s u mm a r y o f e v i d e n c e 摘要 目的:检索和总结神经源性膀胱患儿膀胱管理的最佳证据,为护理人员临床实践提供循证依据㊂方法:计算机检索B M JB e s tP r a c t i c e ㊁C o c h r a n eL i b r a r y ㊁U pT o D a t e ㊁乔安娜布里格斯研究所㊁美国指南网㊁国际指南网㊁美国脊柱裂协会㊁英国国家卫生与临床优化研究所㊁苏格兰校际指南网㊁加拿大泌尿外科协会㊁欧洲泌尿外科学会㊁欧洲小儿泌尿外科学会㊁英国儿童泌尿医师协会㊁国际儿童尿控协会㊁P u b M e d㊁医脉通㊁中国知网㊁万方㊁中国生物医学文献数据库等数据库㊁指南网站及行业机构网站关于神经源性膀胱患儿膀胱管理的证据,包括指南㊁临床决策㊁最佳实践㊁系统评价㊁证据总结㊁M e t a 分析㊁专家共识,检索时限为建库至2022年5月㊂结果:共纳入12篇文献,其中指南5篇,证据总结1篇,专家共识4篇,临床决策1篇,系统评价1篇㊂从筛查与诊断㊁治疗㊁并发症防治㊁过渡期管理㊁随访5个方面共总结了32条最佳证据㊂结论:临床医护人员在应用证据时,应结合临床环境及患儿家庭意愿,以科学的方法帮助患儿进行膀胱管理,提升患儿生活质量㊂关键词 神经源性膀胱;患儿;膀胱管理;证据总结d o i :10.12104/j.i s s n .1674-4748.2023.11.003 儿童神经源性膀胱(n e u r o ge n i c b l a d d e r ,N B )是由于先天或后天等因素造成控制排尿功能的中枢神经系统损伤出现的下尿路功能障碍,早期表现为尿失禁异常,进一步发展可致上尿路恶化,最终可发展为肾衰竭,严重影响患儿的生活质量[1]㊂研究显示,该类患儿初期症状不明显,医护人员对其关注度不高,很多患儿直至成年才被重视,导致膀胱管理不理想,并发症发生率和住院率均高[2-3]㊂相关疾病数据显示,N B 患儿平均30d 的再入院次数是普通人群的2.5倍以上,34%是由于泌尿系统并发症入院[4],其中6%的患儿出现复发性泌尿道感染而导致肾衰竭死亡[5],平均医疗支基金项目 浙江省科技厅基础公益研究资助项目,编号:G F 18H 170011㊂作者简介 李珂,硕士研究生在读,单位:310053,浙江中医药大学护理学院;贾勤(通讯作者)单位:310014,浙江省人民医院 杭州医学院附属人民医院;姚利锋㊁吴佳云㊁汪盈盈单位:310053,浙江中医药大学护理学院㊂引用信息 李珂,贾勤,姚利锋,等.儿童神经源性膀胱管理的最佳证据总结[J ].全科护理,2023,21(11):1449-1453.出是普通患儿的13倍[6]㊂研究表明,患儿通过积极膀胱管理可以维持正常的肾功能,降低再入院率,减轻医疗负担[7-8]㊂已有研究汇总成人N B 管理的最佳证据[9-11],但儿童处于生长发育阶段,与成人存在差异,儿童N B 管理最佳证据尚不明确㊂本研究对儿童N B 管理相关证据进行总结,以期为护理人员临床实践提供循证依据㊂1 资料与方法1.1 检索策略 按照 6S 证据模型,自上而下进行证据检索㊂中文检索式为(神经源性膀胱O R 神经源性下尿路功能障碍O R 神经源性尿失禁)A N D (小儿O R 儿童O R 幼儿O R 患儿);英文检索式为(N e u r o ge n i cb l a d d e r O R N e u r o g e n i cl o w e ru r i n a r y t r a c td ys f u n c t i o n O R N e u r o g e n i cu r i n a r y in c o n t i n e n c e t )A N D (C h i l d O R C h i l d r e n O R p e d i a t r i c )㊂检索B M J B e s t P r a c t i c e㊁C o c h r a n eL i b r a r y ㊁U p T o D a t e ㊁乔安娜布里格斯研究所㊁美国指南网㊁国际指南网㊁美国脊柱裂协会(S B A )㊁英国国家卫生与临床优化研究所(N I C E )㊁苏格兰校际㊃9441㊃全科护理2023年4月第21卷第11期Copyright ©博看网. All Rights Reserved.指南网㊁加拿大泌尿外科协会(C U A )㊁欧洲泌尿外科学会(E A U )㊁欧洲小儿泌尿外科学会(E S P U )㊁英国儿童泌尿医师协会(B A P U )㊁国际儿童尿控协会(I C C S )㊁P u b M e d㊁医脉通㊁中国知网㊁万方㊁中国生物医学文献数据库等数据库㊁指南网站及行业机构网站㊂1.2 文献的纳入与排除标准 纳入标准:①研究类型为临床实践指南㊁专家共识㊁临床决策㊁系统评价㊁证据总结,研究语种为中文或英文;②研究主题为神经源性膀胱管理,研究人群全部或部分是儿童(年龄0~18岁)㊂排除标准:①翻译㊁重复收录或无法获取全文;②文献类型为综述㊁会议摘要等;③文献质量评价低的文献㊂1.3 文献的质量评价标准(方法) 研究指南采用A G R E E Ⅱ(2017版)[12]进行质量评价;系统评价㊁类实验研究和专家共识采用澳大利亚J o a n n a B r i g gs I n s t i t u t e (J B I )循证卫生保健中心的标准(2016版)[13]进行评价;证据总结采用证据总结质量评价工具(C r i t i c a l A p pr a i s a l f o r S u m m a r i e s o f E v i d e n c e ,C A S E )进行质量评价[14];临床决策来源于U pT o D a t e ,为 6S 证据金字塔中的顶层,证据质量高,直接纳入;1篇指南[15]缺乏方法学介绍,故同专家共识标准进行评价㊂1.4 文献质量评价过程 所有筛选及评价均由2名完成‘循证护理学“课程学习的护理研究生独立完成,意见分歧时,邀请第3名评价者参与评价㊂当不同来源的证据结论相冲突,按照高质量证据优先㊁最新发表权威文献优先㊁国内指南优先的原则㊂本研究采用2014版J B I 循证卫生保健中心证据预分级系统[16]将证据等级划分为1~5级,并根据研究F AM E 结构,依据证据的可行性㊁适宜性㊁临床意义和有效性划分为A 级推荐(强推荐)和B 级推荐(弱推荐)㊂2 结果2.1 纳入文献基本情况 本研究共纳入12篇文献,其中指南5篇[15,17-20],证据总结1篇[21],临床决策1篇[22],系统评价1篇[23],专家共识4篇[24-28](其中1篇专家共识分为两部分)㊂纳入文献基本情况见表1㊂2.2 纳入文献的质量评价结果表1 纳入文献的一般特征纳入文献发表/更新时间(年)文献来源文献类型 研究主题文建国等[15]2015年知网指南小儿神经源性膀胱诊断和治疗S B A [19]2018年S p i n a B i f i d aA s s o c i a t i o n 指南 脊柱裂患儿护理N I C E [20]2012年N I C E 指南 神经系统疾病中的尿失禁C U A [17]2021年梅斯医学指南 儿童膀胱功能障碍的治疗E A U /E S P U [18]2020年医脉通指南 儿童神经源性膀胱S a ge r 等[21]2022年P u b M e d 证据总结儿童神经源性膀胱功能异常功能障碍管理修波[28]2021年知网专家共识脊柱裂诊治B A P U [25]2016年医脉通专家共识儿童神经源性膀胱的管理I C C S [24,26]2012年P u b M e d 专家共识神经源性膀胱的评估㊁随访及治疗B o w e r 等[27]2017年P u b M e d 专家共识终生泌尿系统管理需求的儿童从儿科到成人医疗过渡B a s k i n 等[22]2021年U p T o D a t e 临床决策脊柱裂的泌尿系统并发症的评估与治疗E k e 等[23]2021年P u b M e d系统评价改善患有神经性疾病的儿童和青少年的尿失禁状况2.2.1 指南的质量评价(见表2)表2 指南的方法学质量评价纳入文献各领域标准化百分比(%)范围和目的参与人员指南开发的严格性指南呈现的清晰性指南的适用性指南编撰的独立性ȡ60%领域数(个)ȡ30%领域数(个)推荐级别E A U /E S P U [18]83.3360.1158.3372.9270.8340.0046B S B A [19]100.00 100.00 100.00 100.00 100.00 100.00 66A N I C E [20]100.00 100.00 73.1591.6795.84100.00 66A C U A [17]94.4480.5575.9375.0070.8345.8356B2.2.2 系统评价的质量评价结果 本研究共纳入1篇[23]系统评价,来源于P u b M e d ㊂所有条目的评价结果均为 是㊂2.2.3 专家共识的质量评价结果 文建国等[15,24-28]的所有条目评价结果均为 是㊂2.2.4 证据总结的质量评价结果 本研究纳入1篇[21]证据总结,所有条目的评价结果均为 是 研究整体质量较好㊂2.3 证据描述及汇总 采用澳大利亚J B I 循证卫生保健中心证据推荐级别系统(2014),对纳入的证据进㊃0541㊃C H I N E S EG E N E R A LP R A C T I C E N U R S I N G A pr i l 2023V o l .21N o .11Copyright ©博看网. All Rights Reserved.行级别划分㊂根据研究设计类型的不同,将证据等级划分为1~5级,并根据研究设计的严谨性与可靠性,将推荐等级划分为A 级推荐与B 级推荐㊂见表3㊂表3 神经源性膀胱患儿膀胱管理的证据总结证据类别 证据内容证据来源推荐级别筛查与诊断1.建议对患儿病史进行全面的评估,重点了解神经系统相关情况L e v e l 5A2.评估患儿膀胱功能障碍症状,包括尿潴留㊁尿失禁㊁频次㊁尿量等L e v e l 5A 3.尽早行泌尿系超声㊁膀胱尿道造影㊁肾脏二巯丁二酸(D M S A )㊁肾功能等检查作为基线评估L e v e l 5A 4.尿动力学检查是患儿诊断㊁治疗效果评价及随访的主要手段,开放性脊柱裂患儿建议手术后2~3个月内进行检查,闭合性脊柱裂出生后立刻进行L e v e l 5A 5.建议根据患儿尿动力学和尿道括约肌功能进行N B 分型L e v e l 5B 治疗6.膀胱管理的目标是保护患儿肾功能,最大限度提高其排尿独立自主性,达到青少年有效控尿时间4h ,婴幼儿不小于1hL e v e l 5A 7.N B 患儿应由儿科㊁泌尿外科㊁骨科㊁康复科及护理等多学科协同合作管理治疗L e v e l 5A 8.积极治疗原发的神经系统疾病,依据尿动力学分类制订治疗方案L e v e l 5A 9.确保安全的膀胱储存压力和低压下充足的膀胱排空是膀胱管理的重点L e v e l 5A 10.早期开始抗胆碱能药物联合清洁间歇导尿治疗可以有效降低膀胱压力,预防上尿路损害L e v e l 1A 11.建立患儿泌尿自我护理方案,由专业护士培训患儿及家长学会并坚持长期甚至终身规范的清洁间歇导尿,其既是患儿膀胱排空的首选方法,也是膀胱训练的一种重要方式L e v e l 5A 12.膀胱收缩无力患儿可按压下腹部(C r e d e s 动作)或屏气增加负压(V a l s a v a 动作)辅助膀胱排空L e v e l 2B 13.注射A 型肉毒毒素适用于膀胱活动亢进患儿,但其疗效不能长期维持,必须重复治疗L e v e l 3B 14.行为训练方式主要有延迟排尿和定时排尿两种,应考虑其适应证及禁忌证应用L e v e l 2B 15.盆底肌训练(K e ge l 运动)和生物反馈治疗适用于较大儿童压力性尿失禁治疗L e v e l 2B 并发症防治16.提示存在泌尿道感染(U T I )的症状包括实施清洁间歇导尿时疼痛㊁肉眼血尿㊁背/腹痛㊁嗜睡㊁发热或呕吐L e v e l 5A 17.怀疑U T I 患儿均应行血㊁尿常规检查㊁尿细菌培养和药物敏感试验等,以确定是否并发U T I 及指导抗生素的使用L e v e l 5A 18.无症状菌尿无需治疗,出现尿液浑浊或异味时,增加液体摄入量,并将清洁间歇导尿(C I C )频率增至每次1~2h ,共12hL e v e l 1A 19.出现复发性U T I 时应全面评估感染原因,必要时行泌尿系超声及尿动力学检查辅助评估L e v e l 5A 过渡期管理20.N B 患儿过渡期管理目的是让患儿及家属在参与成人医疗系统内实现最大的独立性和舒适性,其主要目标是保持患儿随访依从性,避免发生可预防的并发症[18,24]L e v e l 5A 21.建议指定一名专科护士为过渡协调员支持过渡计划,为患儿家庭提供信息咨询L e v e l 5A 22.定期与患儿及家庭讨论过渡计划,包括膀胱管理方案㊁教育和就业㊁医疗保险及支持性生活(住房和交通)㊁治疗决策等,及时调整以促进患儿自我管理L e v e l 5A 23.向成人医疗过渡年龄没有严格限制,可根据患儿生理㊁心理㊁环境及经济因素选择适当时机进行过渡L e v e l 5A 24.过渡前应评估患儿神经认知㊁过渡准备度㊁自我管理能力㊁心理㊁社会支持等㊂推荐使用过渡期准备度评估问卷(T r a n s i t i o n R e a d i n e s sA s s e s s m e n tQ u e s t i o n n a i r e ,T R A Q )㊁青少年自我管理和独立量表(A d o l e s c e n t /Y o u n g A d u l t S e l f -M a n a g e m e n t a n d I n d e p e n d e n c e ,A M I S )L e v e l 5A25.儿科与成人医疗团队对接应提供患儿转诊文件,内容包括全面病史㊁各项检查结果㊁治疗及多学科医疗团队信息L e v e l 5A 随访26.患儿应终生定期随访,随访内容包括神经系统检查㊁脊柱核磁共振成像(M R I )㊁D M S A ㊁泌尿系超声㊁尿动力学㊁尿常规及肾功能等L e v e l 5A 27.随访内容和频率取决其临床表现及膀胱功能情况L e v e l 5B28.出现复发性泌尿系感染㊁骨科或神经系统体征㊁治疗方案变化㊁青春期发育时应增加随访频率L e v e l 5A 29.稳定性N B 患儿只需进行泌尿系超声及导尿日记随访,频率为1岁前每隔3个月随访1次,2岁时每隔6个月随访1次,之后每年随访1次L e v e l 5B 30.尿动力学检查应根据临床参数进行风险分层选择性随访L e v e l 3B 31.D M S A 是肾瘢痕检查的金标准,出现复发性U T I ㊁尿动力学及泌尿系超声异常时应进行D M S A 随访L e v e l 5A 32.护理人员向患儿家庭强调标准化随访方案,宣教随访的重要性L e v e l 5A㊃1541㊃全科护理2023年4月第21卷第11期Copyright ©博看网. All Rights Reserved.3证据描述第1条~第5条证据总结了关于N B患儿的筛查与诊断内容㊂N B患儿由于该疾病初期症状不明显,出现尿失禁时,家属可能认为因患儿年龄较小的正常现象,容易忽视疾病的严重性[29]㊂若不早期进行膀胱管理,长期发展易导致多种长期并发症,如泌尿系统感染㊁膀胱输尿管反流等㊂因此,早期筛查确定有较大风险发展为泌尿系统损害的患儿亚群,对改善临床结局尤为重要[30]㊂相较于成年人,儿童N B临床表现与神经病变的平面及程度相关性较低,尿动力学表现分类更能反映病变的特点㊂E A U/E S P U指南[18]根据患儿逼尿肌和括约肌活跃程度进行分型,文建国等[15]根据膀胱尿道功能障碍情况进行分型,临床医务人员可根据个体情况进行分析,指导治疗决策㊂第6条~第15条证据总结了N B患儿非手术治疗方案㊂E A U/E S P U认为N B患儿都应被看作潜在高压的膀胱,早期干预对上尿路进行保护具有重要的意义㊂C I C为国际儿童失禁协会推荐排空膀胱的首选方法[24]㊂早期行C I C可以降低膀胱过度扩张的风险,且患儿及家庭成员的依从性和适应性更好,建议所有患儿应出生后尽早行C I C[22]㊂目前对于儿童C I C的执行频次㊁时间及导尿管的选择,国内外尚未有统一的标准㊂临床护理人员可根据患儿喜好㊁成本㊁便携性及使用难易程度选择导尿管的类型,但如果是脊柱裂导致N B患儿乳胶过敏率较高,应避免使用所有乳胶产品[31]㊂此外,行为训练㊁盆底肌训练及生物反馈治疗也是N B患儿膀胱功能训练的方法,但这些证据质量较低,未来还需要多中心大样本进行试验性研究㊂第16条~第19条证据总结了N B并发症的防治㊂U T I是实施C I C的患儿常见的并发症,复发性U T I可导致肾脏瘢痕形成,最终发展成肾衰竭[32]㊂N B患儿尿标本中检测细菌的发生率可高达76%[33],但大多都无症状,无需治疗㊂若出现复发性U T I时,临床护理人员应重视评估原因,U T I诱发因素包括对治疗方案不依从㊁便秘㊁膀胱动力学变化(可能由脊髓栓系导致)或治疗方案的调整需求等㊂第20条~第25条证据总结了患儿向成人医疗过渡管理㊂该证据主要来源于一篇美国脊柱裂协会指南[19]和B o w e r等[27]专家共识㊂该指南及专家共识方法学质量评价较好,纳入证据质量较高㊂但目前我国对于儿童向成人医疗过渡体系尚不完善,临床工作人员应用证据时应基于我国医疗背景,考虑证据的适宜性应用㊂第26条~第32条证据总结了随访的内容及时间㊂N B患儿膀胱功能会随着生长发育㊁治疗效果㊁依从性变化等改变,护理人员应向患儿家庭强调标准化随访方案的重要性,随访内容及频率取决于患儿的临床表现及膀胱功能情况[21]㊂值得一提的是,尿动力学检查作为一项有创的操作,国外对其作为常规随访内容有了不同的看法㊂一项对215例N B患儿7年追踪调查显示,只有24%的患儿出现尿动力学检查的指征[34]㊂因此,B A P U提出在进行初次诊断后尿动力学应该根据临床参数进行风险分层选择性随访[25]㊂4结论本研究总结了国内外N B患儿膀胱管理的最佳证据,为医护人员临床实践提供循证依据㊂但本研究只纳入了中英文文献,大多数来源于国外,且大部分文献属于描述性研究,证据等级不高㊂由于不同地域医疗服务系统之间有一定的文化差异,建议在证据转化与应用时,充分考虑证据的可行性㊁适用性,结合患儿的临床表现制订个性化的管理方案,改善患儿生活质量㊂今后尚需在循证方法的指导下,开展高质量家庭参与的干预性研究,为制订适宜我国国情的N B患儿膀胱管理提供依据㊂参考文献:[1] M O U S S A M,P A P A T S O R I S A G,C H A K R A M A,e ta l.P e r s p e c t i v e so nu r o l o g i c a l c a r e i ns p i n ab i f i d a p a t i e n t s[J].I n t r a c t a b l e&R a r eD i s e a s e sR e s e a r c h,2021,10(1):1-10.[2]何梦,张潍平,孙宁,等.脊髓脊膜膨出并发神经源性膀胱的诊疗现状及进展[J].中华小儿外科杂志,2017,38(12):947-951. 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All Rights Reserved.[8] H O B B SK T,K R I S C H A K M,T E J WA N I R,e t a l.T h e i m p o r t a n c eo f e a r l y d i a g n o s i s a n dm a n a g e m e n t o f p e d i a t r i c n e u r o g e n i c b l a d d e rd y s f u n c t i o n[J].Re s e a r c ha n d R e p o r t s i n U r o l o g y,2021,13:647-657.[9]周美玲,张荀芳,何炼英,等.卒中后患者神经源性膀胱管理的最佳证据总结[J].解放军护理杂志,2021,38(5):67-70. [10]叶丽,黄厚强,郭声敏,等.脑卒中后神经源性膀胱管理的最佳证据总结[J].护理学报,2021,28(10):40-44.[11]胡英杰,陈玲,陈晓敏,等.神经源性膀胱上尿路损害风险管理的最佳证据总结[J].护理研究,2019,33(14):2367-2373. 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[19]S p i n aB i f i d aA s s o c i a t i o n.G u i d e l i n e s f o r t h eC a r eo fP e o p l ew i t hS p i n aB i f i d a[E B/O L].(2018-11-15)[2022-05-10].h t t p://w w w.s p i n a b i f i d a a s s o c i a t i o n.o r g/g u i d e l i n e s/.[20] N a t i o n a l I n s t i t u t ef o r H e a l t h a n d C l i n i c a l E x c e l l e n c e.U r i n a r yi n c o n t i n e n c e i nn e u r o l o g i c a l d i s e a s e:a s s e s s m e n t a n dm a n a g e m e n t[E B/O L].(2019-01-15)[2022-05-10].h t t p s://w w w.n i c e.o r g.u k/g u i d a n c e/c g148.[21]S A G E RC,B A R R O S O U,B A S T O S JM N,e t a l.M a n a g e m e n t o fn e u r o g e n i c b l a d d e r d y s f u n c t i o n i n c h i l d r e n u p d a t e a n dr e c o mm e n d a t i o n so n m e d i c a lt r e a t m e n t[J].I n t B r a zJ U r o l, 2022,48(1):31-51.[22] B A S K I NLS.M y e l o m e n i n g o c e l e(s p i n a b i f i d a):U r i n a r y t r a c tc o m p l i c a t i o n s.[E B/O L].(2022-01-25)[2022-05-20].h t t p s://w w w.u p t o d a t e.c o m/c o n t e n t s/z h-H a n s/m y e l o m e n i n g o c e l e-s p i n a-b i f i d a-u r i n a r y-t r ac t-c o m p l i c a t i o n s c s i=5178f1f2-5789-4f c c-86e4-66427982b683&s o u r c e=c o n t e n t S h a r e.[23] E K E H,HU N T H,B A L L S,e t a l.I m p r o v i n g c o n t i n e n c ei nc h i ld re na n d y o u n g p e o p l e w i t h n e u r o d i s a b i l i t y:a s y s t e m a t i cr e v i e wa n ds u r v e y[J].H e a l t hT e c h n o lA s s e s s,2021,25(73):1-258.[24] R A W A S H D E H YF,A U S T I N P,S I G G A A R D C,e ta l.I n t e r n a t i o n a lC h i l d r e n'sC o n t i n e n c e S o c i e t y's r e c o mm e n d a t i o n s f o r t h e r a p e u t i ci n t e r v e n t i o n i n c o n g e n i t a l n e u r o p a t h i c b l a d d e r a n d b o w e ld y s f u n c t i o ni n c h i l d re n[J].N e u r o u r o l o g y a n d U r o d y n a m i c s,2012,31(5):615-620.[25] L E EB,F E A T H E R S T O N E N,N A G A P P A N P,e t a l.B r i t i s hA s s o c i a t i o no f P a e d i a t r i cU r o l o g i s t sc o n s e n s u ss t a t e m e n to nt h em a n a g e m e n t o f t h en e u r o p a t h i cb l a d d e r[J].J o u r n a lo fP e d i a t r i cU r o l o g y,2016,12(2):76-87.[26] B A U E RSB,A U S T I N PF,R A W A S H D E H Y F,e ta l.I n t e r n a t i o n a lC h i l d r e n's C o n t i n e n c e S o c i e t y's r e c o mm e n d a t i o n sf o ri n i t i a ld i a g n o s t i ce v a l u a t i o n a n df o l l o w-u p i n c o ng e n i t a ln e u r o p a thi cb l a d d e r a n db o w e l d y s f u nc t i o n i nc h i ld re n[J].N e u r o u r o l o g y a n dU r o d y n a m i c s,2012,31(5):610-614.[27] B OW E R W F,C H R I S T I E D,D E G E N N A R O M,e t a l.T h et r a n s i t i o no f y o u n g a d u l t s w i t hl i f e l o n g u r o l o g i c a ln e e d sf r o mp e d i a t r i c t oa d u l t s e r v i c e s:a n i n t e r n a t i o n a l c h i l d r e n'sc o n t i n e n c es o c i e t yp o s i t i o ns t a t e m e n t[J].N e u r o u r o l o g y a n d U r o d y n a m i c s, 2017,36(3):811-819.[28]修波.脊柱裂诊治专家共识[J].中国修复重建外科杂志,2021,35(11):1361-1367.[29]徐莲花,张芳.神经源性膀胱患儿家属照顾负担影响因素的路径分析[J].护理研究,2022,36(13):2429-2432.[30] L E H K,C A R D O N A-G R A U D,C H I A N G G.E v a l u a t i o na n dl o n g-t e r m m a n a g e m e n t o f n e u r o g e n i c b l a d d e r i n s p i n a l d y s r a p h i s m[J].N e oR e v i e w s,2019,20(12):e711-e724.[31] A U S I L IE,T A B A C C O F,F O C A R E L L IB,e ta l.P r e v a l e n c eo fl a t e x a l l e r g y i n s p i n a b i f i d a:g e n e t i c a n d e n v i r o n m e n t a lr i s kf a c t o r s[J].E u r o p e a n R e v i e w f o r M e d i c a la n d P h a r m a c o l og i c a lS c i e n c e s,2007,11(3):149-153.[32] MA R I A N IF,A U S I L I E,Z O N A M,e t a l.T h e i m p a c t o f c o n s t a n ta n t ib i o t ic p r o p h y l a x i si nc h i ld re naf f e c t e db y s p i n a ld y s r a p h i s mp e r f o r m i n g c l e a ni n t e r m i t t e n tc a t h e t e r i z a t i o n:a2-y e a r m o n o c e n t r i c r e t r o s p e c t i v e a n a l y s i s[J].C h i l d'sN e r v o u sS y s t e m,2022,38(3): 605-610.[33] F O R S T E RCS,S H A I K H N,H O B E R M A N A,e ta l.U r o p a t h o g e n sa n d p y u r i ai nc h i l d r e n w i t hn e u r o g e n i cb l a d d e r s[J].P e d i a t r ic s,2018,141(5):e20173006.[34] W I L S O NSN,K O N G N Y U Y M,J O S E P H D B,e ta l.U r o d y n a m i cu t i l i z a t i o n i n t h e a d u l t s p i n a b i f i d a p a t i e n t:a n i n s t i t u t i o n a l r e v i e w[J].J o u r n a lo fP e d i a t r i cR e h a b i l i t a t i o n M e d i c i n e,2021,14(4): 655-659.(收稿日期:2022-09-30;修回日期:2023-04-04)(本文编辑卫竹翠)㊃3541㊃全科护理2023年4月第21卷第11期Copyright©博看网. All Rights Reserved.。
真理来源于质疑英语作文
真理来源于质疑英语作文Possible English Version:The source of truth is often questioned, as different people may have different perspectives and interpretations. However, questioning is also a vital process for seeking and verifying truth. In this essay, I will discuss my views on the source of truth and the role of questioning in discovering and validating it.First of all, I believe that truth is not an absolute and fixed entity, but a dynamic and evolving concept thatis subject to revision and refinement. Truth can be based on facts, evidence, logic, and consensus, but it can also be influenced by bias, prejudice, ignorance, or manipulation. Therefore, we need to be open-minded, critical, and collaborative in our pursuit of truth, and be willing to adjust our beliefs and opinions when new information or perspectives emerge.Secondly, I think that questioning is an essential tool for exploring truth, as it allows us to challenge assumptions, test hypotheses, and expose fallacies.Questioning can take many forms, such as asking why, how, what if, or what else. Questioning can also involve listening, observing, researching, and reflecting. Through questioning, we can deepen our understanding, broaden our perspectives, and strengthen our reasoning.Thirdly, I acknowledge that questioning can be difficult and risky, especially when it challenges authority, tradition, or consensus. Questioning can provoke resistance, ridicule, or even repression from those who benefit fromthe status quo or the dominant ideology. Therefore, questioning requires courage, integrity, and empathy, aswell as a supportive and diverse community that values inquiry and pluralism.Fourthly, I recognize that questioning can also be misused or abused, especially when it serves narrow interests, spreads misinformation, or undermines trust in legitimate sources of knowledge. Questioning can become a tool of propaganda, conspiracy theory, or pseudoscience, which distort reality and harm society. Therefore, questioning needs to be based on reliable sources, soundmethods, and ethical principles that respect human rights and dignity.In conclusion, the source of truth comes from various channels, including our senses, reason, intuition, experience, and communication with others. However, the reliability and validity of these sources depend on how we question, verify, and integrate them into a coherent and comprehensive understanding of reality. Therefore, we need to cultivate a questioning mindset that values curiosity, skepticism, and humility, and apply it to all aspects of our lives, from personal beliefs to public policies. Only by doing so can we approach closer to the truth and make informed decisions that benefit ourselves and others.中文翻译：真理的来源常常受到质疑，因为不同的人可能有不同的观点和解释。
西宁2024年05版小学三年级下册Y卷英语下册试卷
西宁2024年05版小学三年级下册英语下册试卷考试时间：100分钟（总分:100）B卷考试人：_________题号一二三四五总分得分一、综合题(共计100题)1、填空题：The _____ (向日葵) is tall and bright.2、填空题：In spring, the ________ (花朵) bloom and the ________ (树叶) grow green.3、听力题：Mercury is the closest planet to the ______.4、听力题：Photosynthesis requires sunlight, water, and ________ dioxide.5、听力题：An emulsion is a mixture of two ______ liquids.6、听力题：In chemical terms, a "reactant" is a substance that undergoes a _____ in a chemical reaction.7、What is the name of the famous detective created by Arthur Conan Doyle?A. Hercule PoirotB. Sherlock HolmesC. Miss MarpleD. Sam Spade答案: B8、听力题：The _____ (bridge) is long.9、听力题：The girl sings very ________.10、填空题:My favorite thing to do is ________.11、How many stars are estimated to be in the Milky Way galaxy?A. 100 millionB. 200 billionC. 400 billionD. 1 trillion12、听力题：My favorite fruit is ______ (watermelon).13、听力题：A mixture of metals is called an ______.14、填空题：We have a ______ (精彩的) plan for the weekend.15、听力题：They are playing ________ in the park.16、填空题：What is your favorite __________ (玩具类型)?17、填空题：________ (树木) can live for many years.18、填空题：I enjoy collecting ______ (自然) items like shells and rocks.19、What do we call the person who repairs cars?A. PlumberB. ElectricianC. MechanicD. Carpenter答案: C. Mechanic20、听力题：The chemical bond formed by the transfer of electrons is called an __________ bond.21、填空题：A _____ (果蔬) plate is healthy and colorful.22、听力题：A mixture can be separated by _______ methods.23、What is the primary color of the sun?a. Greenb. Bluec. Yellowd. Red答案:C24、听力题：Many countries have _______ that connect them.25、Which planet is closest to the sun?A. EarthB. MercuryC. VenusD. Mars答案：B26、填空题：The invention of the radio transformed _____ communication.27、填空题：I enjoy building ______ (模型) of historic landmarks.28、听力题：I see a ___ (star/moon) shining.29、填空题：My ________ (玩具名称) has a cool design.30、听力题：The _______ has green leaves.31、填空题：The _______ (Scientific Revolution) changed the way people viewed the natural world.32、听力题：We are ___ to school. (walking)33、What is the name of the famous British rock band that included John Lennon?A. The WhoB. The Rolling StonesC. The BeatlesD. Pink Floyd答案: C. The BeatlesI enjoy riding my __________ on a sunny day. (自行车)35、What is the main ingredient in peanut butter?A. AlmondsB. PeanutsC. WalnutsD. Cashews答案:B36、听力题：The bunny hops around the _____ yard.37、填空题：A _____ (温室) helps plants grow in winter.38、填空题：The _____ (lettuce) grows quickly in cool weather.39、What is the name of the fairy in Peter Pan?A. CinderellaB. Tinker BellC. Snow WhiteD. Ariel答案:B. Tinker Bell40、听力填空题：I think staying positive is crucial. A positive mindset helps us overcome challenges and encourages others. I try to maintain a positive attitude by __________.41、听力题：An alloy is a mixture of two or more ________.42、听力题：The _______ of sound can change depending on the source of the sound.43、听力题：The chemical formula for aluminum oxide is _______.44、听力题：A ______ is a study of how substances interact.45、听力题：A cactus can survive in ______ conditions.An ion is an atom that has lost or gained ______.47、听力题：The sun is ___ (shining).48、听力题：The Earth's tilt affects the changing of the ______.49、What color is an orange?A. BlueB. GreenC. YellowD. Orange答案：D50、What do we call a person who plays music?A. ArtistB. MusicianC. PainterD. Dancer答案:B51、填空题：The ________ was a famous market in ancient Rome.52、听力题：A wheel helps reduce ______.53、What shape has four equal sides?A. RectangleB. TriangleC. SquareD. Circle答案:C54、选择题：What do you call the study of living things?A. BiologyB. ChemistryC. PhysicsD. Geography55、填空题：The __________ is a large forest area in the Pacific Northwest. (雨林)A solute is a substance that is ______ in a solvent.57、ic Ocean was crossed by explorers like _____. 填空题：The Paci58、听力填空题：I love going to the library to find new __________.59、What is the name of the famous bridge in San Francisco?A. Brooklyn BridgeB. Golden Gate BridgeC. London BridgeD. Sydney Harbour Bridge答案: B. Golden Gate Bridge60、What do we call the act of preparing food?A. CookingB. BakingC. GrillingD. Boiling答案:A61、填空题：A ____(habitat) is where an animal or plant lives.62、填空题：My favorite ________ is purple.63、听力题：The Earth's surface is home to a wide variety of ______.64、听力题：A _______ is a reaction that produces a pungent aroma.65、What do you call a person who studies the effects of chemicals on living organisms?A. ChemistB. ToxicologistC. PharmacologistD. All of the above答案: D66、听力题：My sister is very good at ____ (languages).67、 (79) River is important for trade in Europe. 填空题：The ____68、填空题：We saw many __________ (旅游者) at the famous landmark.69、听力题：I like to run in the _____ (公园).70、What do we call the seasonal change when trees lose their leaves?A. SpringB. SummerC. AutumnD. Winter答案: C71、听力题：We have a ______ of books at home. (shelf)72、填空题：A _____ (bouquet) of flowers makes a lovely gift.73、选择题：What do we call the animal that is often kept as a pet and purrs?A. DogB. CatC. RabbitD. Hamster74、What type of animal is a frog?A. MammalB. ReptileC. AmphibianD. Fish答案:C75、听力题：In a neutralization reaction, an acid and a base react to form _____ and water.76、填空题：The ______ (金色的蟾蜍) is often found near water.77、What is 14 7?a. 5b. 6c. 7d. 8答案:b78、填空题：Let’s build a __________ (名词) with our __________ (玩具名)!79、填空题：I enjoy creating art with my toy ________ (玩具名称).80、听力题：The main purpose of a catalyst is to speed up a _____.81、填空题：The ________ (植物特性分析) reveals traits.82、填空题：The _____ (marigold) deters pests in gardens.83、Which fruit is red and often mistaken for a vegetable?A. OrangeB. AppleC. TomatoD. Banana答案:C84、What do you call a place where you can see stars and planets?A. MuseumB. ObservatoryC. AquariumD. Library答案: B85、听力题：The dog is barking ________.86、What is the process of turning a solid into a liquid?A. FreezingB. MeltingC. EvaporationD. Condensation答案: B87、听力题：__________ are important for environmental sustainability.88、What is the opposite of "big"?A. LargeB. SmallC. TallD. Heavy89、填空题：My sister loves to plant _____ in pots.90、What is the name of the famous painting by Leonardo da Vinci?A. The ScreamB. The Starry NightC. Mona LisaD. Last Supper答案: C91、听力题：The cat curls up next to its _____ owner.92、填空题：A _____ (78) is an area with many trees and animals.93、填空题：My uncle is a __________. (作家)94、听力题：She is _____ (running) in the park.95、听力题：A beaker is a common piece of ______ glassware.96、What is the name of the famous ancient city in Greece?A. AthensB. MycenaeC. DelphiD. All of the above97、填空题：My puppy loves to bark at ______ (邮递员).98、填空题：The garden has many _______ that blossom beautifully all year round.99、填空题：________ (植物资源保护) is vital for sustainability.100、填空题：My pet _____ loves to cuddle.。
俞敏洪说：背完这100个句子,你已经背过7000个单词!!!
16.机械计时器的发展促使人们寻求更精确的日晷，以便校准机械计时器。
17. Anthropology is a science in that anthropologists use a rigorous set of methods and techniques to document observations that can be checked by others.
【四六级推荐】俞敏洪说：背完这100个句子，你已经背过7000个单词！！！（此贴无敌了，正犯愁英语不好但又不知每天该做些什么吗？赶紧收藏吧...校内超火精品日志，超过90000人分享~！！！） 2009-09-20 19:36 | (分类:道❤知識)
这个真的很不错，每天背诵一句也不累，第二天在复习前面的一句，这样就想滚雪球一样，背的越来越多。正所谓熟读唐诗三百首，不会作诗也会吟。更何况这只有100句呢。想学好英语的，一定不要错过。
23.在大量的实验中，某一事件发生的几率等于它不发生的几率。
24. Most substance contract when they freeze so that the density of a substance’s solid is higher than the density of its liquid.
22. The chief foods eaten in any country depend largely on what grows best in its climate and soil.
22.一个国家的主要食物是什么，大体取决于什么作物在其天气和土壤条件下生长得最好。
23. Over a very large number of trials, the probability of an event’s occurring is equal to the probability that it will not occur.
某地区儿童误食有害物的临床原因分析及文献复习
•182 •中国实用医药 2019年5 月第 14 卷第 15 期ChinaPracMe(i，M a v2019，V〇l. 14，N o. 15某地区儿童误食有害物的临床原因分析及文献复习赵■彦昌韦克金谢金荣余健全张栋武【摘要】目的了解分析本地区患儿误食有害物原因，为儿童误食有害物防控提供询证依据。
方法回顾性分析因误食有害物就诊的58例儿童的临床资料，对儿童误食原因等信息进行归纳分析，并采用多因素L ogistic回归分析误食有害物儿童的独立危险因素。
结果58例儿童误食的有害物中，纽扣电池(36.2%)、硬币（24.1%)和玩具部件（17.2%)占前3位，家长首饰（13.8%)及其他有毒物(8.6%)分列其后。
58例误食有害物儿童年龄1~7岁，平均年龄(2.8 ± 1.5)岁；男36例，女22例，男女比为1.64 :1，男性多于女性；家长文化程度：父母双方均高中及以上丨7例，双方均初中及以下41例，家长文化程度偏低；单亲家庭39例，双亲家庭19例，单亲家庭占比较大；家庭环境：农村40例，城镇1S例，农村：城镇为2.22 : 1，农村占比大；留守35例，非留守23例，留守：非留守为1.52 :1，留守儿童占比较大。
多因素L ogistic回归分析显示：儿童年龄<7岁（0尺=1.341，95%C/ : 0.872, 9.746)、单亲家庭(0/f=1.742,95%C/:1.287,丨1.476)、家长文化水平偏低(0/?=1.547,95%C/: 1.527, 10.647)是儿童误食有害物的独立危险因素(P<〇.〇5)。
结论留守儿童、单亲家庭儿童、家长文化水平较低儿童是导致儿童误食有害物的外在因素，加强对幼儿的看护教育，能够有效降低儿童误食。
【关键词】误食有害物；因素；文献复习D0I ：10.14163/ki.l l-5547/r.2019.19.103Clinical cause analysis and literature review of children' s accidental eating of harmful substances in acertain area ZHAO Yan-chang,WEI Ke-jin,XIE Jin-rong,et al.Foshan Gaoming District Peopled Hospital,Foshan528500, China【Abstract 】Objective To understand and analyze the causes of c h ild re n's accidental eating ofharmful substances,and to provide evidence for the prevention and control of children s accidental eatingharmful substances.Methods A retrospective analysis was made on the clinical data of58 children treated foraccidental eating harmful substances.The information about the causes of accidental eating harmful substanceswas summarized and analyzed.Multivariate logistic regression was used to analyze the independent risk factors ofchildren1s accidental eating of harmful substances.Results Among 58 cases of accidental harmful substanceseaten by children,button batteries (36.2%), coins (24.1%) and toy parts (17.2%) accounted for the top 3, followedby parent jewellery (13.8%) and other toxicants (8.6%). 58 children with accidental eating harmful substancesaged 1to 7 years,with average of(2.8 士 1.5)years.There were 36 males and 22 females,with a male-to-fem aleratio of 1.64 ：1and more males than females.Parents'educational level:17 parents were both high school andabove, 41 parents were both junior high school and below,parents'educational level was low; 39 single-parentfamilies, 19 double-parent families,single-parent families account for a larger proportion;family environment:40 cases in rural areas, 18 cases in urban areas,rural areas:urhan areas as2.22 ：1,mral areas account for a largeproportion; 35 cases of left-hehind, 23 cases of non-left-hehind,left-hehind children account for 1.52 ：1,left-hehind children account for a relatively large proportion.Multivariate Logistic regression analysis showed thatchildren^age<7 years old(OR= 1.341,95%Cl:0.872,9.746), single parent family(OR= 1.742, 95%CI: 1.287,11.476), parents'low educational level(OR = 1.547, 95%Cl: 1.527, 10.647) were independent risk factors forrhildren's accidental eating harmful substances (P<0.05). Conclusion The low level of education of left-hehindchildren,single-parent fam ilies and parents is an external factor that causes of children^accidental eatingharmful substances.Strengthening the nursing education for young children can effectively reduce children'saccidental eating.【Key words 】Accidental eating of harmful suhstances;Factors;Literature review•有害物误食所导致的儿童安全问题已经成为当今社会重 要的公共社会问题，文献报道显示：因食入有害物导致的伤 害是影响儿童健康成长的第二大危险因素；由于儿童对于各基金项目：佛山市卫生科技基金项目（项冃编号：20180413)作者单位：528500佛山市高明区人民医院种能够见到或拿到的物品均具有好奇的天性，且儿童缺乏对 有害物基本的辨识能力，再加上儿童往往通过舔舐外物来认 识外物，因此，儿童天生的好奇习惯及其监管的缺失导致了 儿童对有害物的误食u'2]。
真言与美言的辩证关系英语作文
真言与美言的辩证关系英语作文The Dialectical Relationship between Truthful Speech and Pleasant Words.In the intricate tapestry of human communication, the threads of truthful speech and pleasant words play pivotal roles. While both have their unique value and significance, their interplay and dialectical relationship offer profound insights into the dynamics of effective communication. This essay delves into the nuances of this relationship, examining how truth and pleasantries can complement each other in fostering harmonious and meaningful exchanges.Truthful speech, at its core, is the unvarnished expression of facts, ideas, and opinions, free from embellishment or distortion. It is the backbone of any meaningful conversation, as it serves to inform, educate, and challenge the beliefs and perspectives of others. Truth speaking is essential in fostering trust and establishing reliable relationships, as it creates a foundation oftransparency and mutual understanding. In professional settings, it is crucial for maintaining ethical standards and ensuring the efficient flow of information. However, the rawness of truth can sometimes lead to conflict and discomfort, as it may clash with individuals' preconceptions or egocentric interests.On the other hand, pleasant words are the lubricants of conversation, smoothing over rough edges and fostering positive interactions. They are the subtle touches that make a conversation flow more smoothly, the complimentsthat brighten someone's mood, and the encouraging wordsthat boost someone's morale. Pleasant words are often employed in social settings to foster warmth and camaraderie, creating an atmosphere conducive to deeper connections. They are also powerful tools in conflict resolution, as they can diffuse tense situations and open doors to productive dialogue. However, the excessive use of pleasantries can sometimes lead to a dilution of truth and sincerity, resulting in a superficial and disconnected communication.The dialectical relationship between truthful speech and pleasant words lies in their complementary nature. While truth speaking provides the substantive foundation of a conversation, pleasant words add the necessary emotional layer that makes the exchange richer and more meaningful. A balance between the two is crucial for effective communication. Too much truth can be jarring and abrasive, while too much pleasantry can lead to a lack of substance and sincerity.In everyday interactions, we often find ourselves navigating this delicate balance. For instance, when offering feedback to a friend, it is essential to strike a balance between being honest about their shortcomings and expressing our thoughts in a way that does not hurt their feelings. Similarly, in professional settings, we must ensure that our communication is rooted in truth while maintaining a professional tone and respecting the sensitivities of our colleagues.The art of mastering this dialectical relationship lies in developing a keen understanding of when and how to usetruthful speech and pleasant words effectively. It requires empathy, understanding, and the ability to read the subtleties of a conversation. It is about finding the right balance between being direct and honest while also being sensitive and compassionate.In conclusion, the dialectical relationship between truthful speech and pleasant words is an intricate and multifaceted one. It is about finding the harmonious blend of honesty and pleasantries that foster meaningful, enriching, and harmonious conversations. It is about understanding that while truth is the backbone of communication, pleasantries are the glue that binds people together. It is about learning to speak the truth with love and compassion, and to offer pleasant words with sincerity and genuineness. Only then can we create truly meaningful and enriching exchanges that lead to deeper understanding and stronger relationships.。
Cyagen Biosciences Neural Stem Cell Growth Medium产
Material Safety Data SheetRevision Date: 03-Feb-2012Product codeProduct name GUXNX-90011 Neural Stem Cell Growth Medium Company/Undertaking IdentificationCyagen Biosciences Inc.574 East Weddell Dr, Suite 6Sunnyvale, CA 94089, U.S.A.Tel: 800-921-8931Hazardous/Non-hazardous ComponentsThe product contains no substances which at their given concentration, are considered to be hazardous to health. We recommend handling all chemicals with caution.Ensure adequate ventilation, especially in confined areas Engineering measuresPersonal protective equipmentRespiratory protectionHand protectionIn case of insufficient ventilation wear suitable respiratory equipment Protective gloves Safety glasses with side-shields Eye protectionLightweight protective clothing.Skin and body protectionHandle in accordance with good industrial hygiene and safety practice Prevent product from entering drains.Hygiene measuresEnvironmental exposurecontrolsGeneral InformationLiquidForm Important Health Safety and Environmental Information °C No data available °C No data available °C No data available °C No data availableNo information available No data availableBoiling point/range Melting point/range Flash point Autoignition temperature Oxidizing propertiesWater solubility°F No data available°F No data available°F No data available°F No data availableStable. No information available No information available StabilityMaterials to avoidHazardous decompositionproductsPolymerizationHazardous polymerisation does not occur.Acute toxicity Principle Routes of Exposure/Potential Health effectsNo information available No information available No information available May be harmful if swallowed.EyeSkinInhalation Ingestion Specific effectsNo information available No information available No information availableCarcinogenic effectsMutagenic effectsReproductive toxicitySensitization No information available No information availableTarget Orcia Effects No information available. No information available. Inherently biodegradable. Does not bioaccumulate.Ecotoxicity effectsMobilityBiodegradationBioaccumulationDispose of in accordance with local regulationsIATANot classified as dangerous in the meaning of transport regulations No information available No information available No information availableNo information availableProper shipping nameHazard ClassSubsidiary ClassPacking group UN-NoInternational Inventories U.S. Federal ReciulationsSARA 313This product is not regulated by SARA. Clean Air Act, Section 112 Hazardous Air Pollutants (HAPs) (see 40 CIFIR 61)This product does not contains HAPs. U.S. State ReaulationsCalifornia Proposition 65This product does not contain chemicals listed under Proposition 65 WHMIS hazard class:Non-controlledThis product has been classified according to the hazard criteria of the CPR and the MSDS contains all of the information required by the CPRThis material is sold for research and development purposes only. It is not for any human or animal therapeutic or clinical diagnostic use. It is not intended for food, drug, household, agricultural, or cosmetic use. An individual technically qualified to handle potentially hazardous chemicals must supervise the use of this material.The above information was acquired by diligent search and/or investigation and the recommendations are based on prudent application of professional judgment. The information shall not be taken as being all inclusive and is to be used only as a guide. All materials and mixtures may be present unknown hazards and should be used with caution. Since Cyagen Biosciences Inc. cannot control the actual methods, volumes, or conditions of use, the Company shall not be held liable for any damages or losses resulting from the handling or from contact with the product as described herein. THE INFORMATION IN THIS MSDS DOES NOT CONSTITUTE A WARRANTY, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR ANY PARTCULAR PURPOSE.End of Safety Data Sheet。
2023年化学期末考试题目与解答(英文)
2023年化学期末考试题目与解答(英文) 2023 Chemistry Final Exam Questions and Answers1. Define the term "molecule" and provide an example.3. Describe the process of chemical bonding.4. Discuss the concept of chemical equilibrium.Chemical equilibrium is a state in a chemical reaction where the forward and reverse reactions occur at the same rate, resulting in no net change in the concentrations of reactants and products.5. Explain the difference between an exothermic and endothermic reaction.An exothermic reaction releases heat to its surroundings, while an endothermic reaction absorbs heat from its surroundings.6. Define the term "pH" and its significance in chemistry.pH is a measure of the acidity or alkalinity of a solution, indicating the concentration of hydrogen ions present. It is important in chemistry as it affects the properties and behavior of substances in a solution.7. Discuss the role of catalysts in chemical reactions.Catalysts are substances that increase the rate of a chemical reaction without being consumed in the process. They work by providing an alternative pathway with lower activation energy for the reaction to occur.8. Describe the properties and uses of the following elements: carbon, oxygen, and hydrogen.9. Explain the concept of oxidation and reduction in chemical reactions.Oxidation is the loss of electrons by a substance, while reduction is the gain of electrons. Together, they make up redox reactions where electrons are transferred between reactants.10. Discuss the environmental impact of chemical processes and the importance of green chemistry.Chemical processes can have negative effects on the environment through pollution and waste generation. Green chemistry aims to design chemical products and processes that minimize their impact on human health and the environment.These are just a few examples of the topics that may be covered in the 2023 Chemistry Final Exam. Make sure to review your notes, textbooks, and practice problems to prepare thoroughly for the exam.。
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海运包装有害物质（海洋污染物）的集中检查活动
(MARPOL Annex III, SOLAS VII and the IMDG Code)
检查机构
船名
IMO 编码船旗
呼号船舶类型
检查（实施）港口检查（实施）日期
问题清单是否不适应
1 船舶是否载有或将要装载海运包装有害物质（海洋污染物）？
文书检查
2 如果船舶载有海洋污染物，船舶是否持有满足SOLAS II-2/19要求的适装证书（DOC）?
船舶是否持有一份列明了所有该轮载运的海洋污染物的运输单证？
3a
如果问题3的回答是yes，运输单证是否列明了所有载运的海洋污
染物，是否使用每种物质的正确技术名称，所含信息是否正确？
3
3b
如果问题3的回答是yes，是否包含了一份经托运人签署的证明？
船舶是否制定当发生涉及海洋污染物的事故时遵守的应急程序？
4a
4b 如果问题4a的回答是yes,船员是否熟悉这些程序？
5 如果船舶载有海洋污染物，船舶是否持有一份特别清单或舱单，以列明这些货物的装载位置？
6
这份特别清单或舱单提供的信息是否满足国际危规第5.4.3款的要求？
货物的标示，积载与系固
7 如果船舶载有海洋污染物，这些货物是否按照特别清单或舱单的要求进行积载？
8 如果船舶载有海洋污染物，这些货物的积载是否满足国际危规第7章第1条的要求？
9
海洋污染物的积载是否满足适装证书和货物系固手册的要求？
10 盛装海洋污染物的容器或包装件是否被正确的标示以标明该容器或包装件载有海洋污染物？
11 船舶是否由于本次集中检查会战涉及的缺陷被滞留？。