腹腔镜治疗未生育女性巨大卵巢囊肿86例疗效观察

目的：探讨腹腔镜治疗未生育女性巨大卵巢囊肿手术疗效。方法选择未生育女性患者46例,根据手术方式不同分为两组,腹腔镜组和开腹组各23例。腹腔镜组采用腹腔镜下气腹穿刺手术治疗,开腹组采用传统开腹方式。手术前给予两组患者阴道冲洗和脐部清洗。术前给予预防性抗生素。比较两组手术时间、术后出血量、排气时间、住院时间、术后疼痛例数、月经情况和日常生活能力恢复时间。结果开腹组的手术时间为（68．3±12．3）min;腹腔镜组（59．6±11．5）min;腹腔镜组手术时间均少于开腹组（t＝4．26, P＜0．05）;腹腔镜组术后疼痛例数为11例（47．8％）,开腹组术后疼痛21例（91．3％）。腹腔镜组术后疼痛发生率小于开腹组（χ2＝10．3,P＜0．05）。结论腹腔镜治疗未生育女性巨大卵巢囊肿手术时间短、手术出血少、排气时间快、住院时间短、疼痛小、日常生活能力恢复快,值得推广使用。     

以患者为中心的护患沟通在老年患者胃镜检查中的作用

目的 观察以患者为中心的护患沟通在老年患者胃镜检查中的作用.方法 将2010年6月至2012年10月收治的971例胃镜检查的老年患者分为无沟通需求组（284例）和护患沟通组（687例）.无沟通需求组采用传统方式沟通,护患沟通组进行以患者为中心的护患沟通.记录两组患者体位摆放时间、胃镜检查时间、恶心次数、咽部黏膜损伤情况和胃镜检查成功率,监测患者血压和脉搏;调查两组患者心理状况、胃镜检查满意度和检查后反应.结果 护患沟通组胃镜检查成功率高于无沟通需求组,差异有统计学意义（χ2=4.033,P〈0.05）;体位摆放时间、胃镜检查时间均较无沟通需求组缩短,差异均有统计学意义（t=21.85、60.98,P〈0.01）.与无沟通需求组比较,护患沟通组患者对胃镜检查满意度升高,差异有统计学意义（χ2=59.290,P〈0.01）.胃镜检查时,两组患者血压、脉搏较检查前均明显升高,且护患沟通组检查时血压和脉搏低于无沟通需求组,差异均有统计学意义（P〈0.01）.胃镜检查时,在心理状态Ⅲ、Ⅳ级中,护患沟通组患者的比例均低于无沟通需求组,差异均有统计学意义（χ2=4.280,P=0.039;χ2=4.033,P=0.045）.两组患者不良反应发生率比较,差异无统计学意义（χ2=0.047,P=0.828）.结论 以患者为中心的护患沟通是一种促进老年患者胃镜检查顺利进行的有效方式.     

乙型肝炎病毒DNA定量检测对乙型肝炎产妇母乳喂养的临床指导价值

目的探讨乙型肝炎（乙肝）病毒DNA（HBV—DNA）定量检测对乙肝产妇母乳喂养的临床指导价值。方法选择2012年1～lO月检测乙肝表面抗原（HBsAg）阳性（＋）的产妇100例设为研究组,其中大三阳组产妇32例,小三阳组产妇41例,HBsAg（＋）,乙肝核心抗体（＋）组产妇27例。选择同期健康产妇100例设为对照组,分别检测各组产妇血清及乳汁中HBV—DNA水平情况,并对结果进行综合分析。结果研究组3个小组产妇血清和乳汁HBV—DNA阳性率均在85．0％以上,明显高于对照组的0．0％,差异均有统计学意义（P〈0．05）;研究组各组产妇血清和乳汁HBV—DNA水平分别两两比较,差异均有统计学意义（P〈0．05）;研究组产妇乳汁HBV—DNA水平与血清HBV—DNA水平呈正相关f相关系数（r）=0．9569,P〈0．05]。结论乙肝产妇产后能否实施母乳喂养与产后产妇血清及初乳中HBV—DNA的水平有关,因此,必须依据检测结果决定喂养方式．以保证婴儿的哺乳安全。     

Diallyl disulfide inhibits proliferation,epithelial–mesenchymal transition,and invasion through RORα-mediated downregulation of Wnt1/β-catenin pathway in gastric cancer cells

Overactivation of Wnt/β-catenin pathway due to dysfunction of retinoid-related orphan receptor α (RORα) is related to cancer development and progression. Diallyl disulfide (DADS), an active component of garlic, has been reported in our previous study for upregulation of RORα expression in gastric cancer (GC) cells. It remains to be elucidated the role and mechanism of RORα in DADS against GC. This study revealed that DADS treatment resulted in reduced expression levels of Wnt1, β-catenin, TCF-4, intranuclear β-catenin and p-β-catenin in GC cells, concomitant with the compromised expression of β-catenin target genes (Axin, c-Jun, and c-Myc). RORα overexpression augmented DADS-induced downregulation of Wnt1/β-catenin pathway, G2/M phase arrest, and cell growth inhibition in vitro and in vivo. Contrarily, knockdown of RORα attenuated these effects of DADS. Interestingly, DADS induced an increase in the binding of RORα to β-catenin, which may lead to reduction of β-catenin phosphorylation and nuclear translocation. This interplay modulated by DADS may affect β-catenin target gene expression for that the opposite results were observed in DADS-treated RORα knockdown and overexpression cells. DADS caused a decrease in vimentin, snail and MMP-9, as well as an increase in E-cadherin and TIMP3 expression, which restricted epithelial–mesenchymal transition (EMT), migration, and invasion. The aforementioned effects of DADS were weakened simultaneously when the suppression of DADS on the Wnt1/β-catenin pathway was resisted by knockdown of RORα. In contrast, overexpression of RORα enhanced the effects of DADS. Therefore, RORα-mediated downregulation of Wnt1/β-catenin pathway could undertake an important role in anticancer activity of DADS against GC cell proliferation, EMT, migration, and invasion.     

2013年药品不良反应报告分析

目的：探讨民营医院ADR报告。方法：统计2013年该院ADR报告。结果：涉及药品11大类30种;皮肤及其附件损害发生率最高。结论：民营医院应重视药品不良反应报告。     

乳腺癌术后康复期心理问题分析及护理对策

目的：了解乳腺癌术后康复期存在的心理问题,制订切实可行的心理护理对策,提高生存质量。方法：以128例乳腺癌术后康复期患者为研究对象,采用黄铎香教授设计的心理健康调查表问卷调查,测定其心理状态。针对其心理状态,给予心理干预,同时比较心理干预前后的心理状态。结果：患者心理反应主要表现为：焦虑（80.5%）,烦躁不安（47.7%）、悲观（64.8%）。给予心理干预后,患者抑郁、焦虑、疑病、神经衰弱评分明显低于心理护理前,经过t检验,均有显著差异。结论：做好乳腺癌术后康复期患者的心理护理,可以消除乳腺癌患者抑郁、焦虑等情绪,减轻心理负担,保持良好心理、社会功能,提高生活质量。     

A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty

Purpose

A prospective study was conducted to detect whether a relationship exists between metal allergy and post-operative pain in total hip and knee arthroplasty patients. We postulated that to some extent a relationship does exist between them.

Materials and methods

Patients who had undergone total hip and knee arthroplasty surgery because of hip and knee disease were included. The exclusion criteria were patients who were treated with immunosuppressor two weeks pre-operatively, skin conditions around the patch testing site, and other uncontrollable factors. Each patient agreed to patch testing for three days before surgery. Photographic images before patch testing, two and three days after patch testing were obtained to evaluate the final incidence of metal allergy. The patch tests contained 12 metal elements; chromium, cobalt, nickel, molybdenum, titanium, aluminium, vanadium, iron, manganese, tin, zirconium, and copper. Two independent observers evaluated the images. The results were divided into a non-metal allergy group and a metal allergy group. Pre-operative and postoperative VAS score, lymphocyte transforming test, and X-rays were collected to detect the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty.

Results

There were 96 patients who underwent pre-operative patch testing. The overall metal allergy rate was 51.1 % (49/96) in our study. Nickel, cobalt, manganese, and tin were the most common allergic metal elements in our study. Nine inappropriate cases were excluded, and 87 patients were finally included in our study. There were 36 metal allergy and 26 non-metal allergy patients in the THA group, while 11 metal allergy and 14 non-metal allergy patients were found in the TKA group. We found no relationship existed between metal allergy and post-surgery pain in total hip and knee arthroplasty.

Conclusion

Pain caused by metal allergy usually presents as persistent and recurrent pain. The white cell count, C-reactive protein, erythrocyte sedimentation rate and postoperative radiographs were not affected. Currently, patch testing and lymphocyte transforming tests are used for metal allergy diagnosis. We deemed that a relationship between post-surgery pain and metal allergy in total hip and knee patients may exist to some extent. Larger samples and longer follow-up time are essential for further study.