胃肠癌GST-π mRNA的表达及临床意义的研究

目的:研究谷胱甘肽S转移酶-π(GST-π)mRNA在胃癌、大肠癌及其相邻正常组织中的表达,明确GST-π在胃癌、大肠癌发生、发展及自主性耐药中的作用.方法:采用RT-PCR方法,检测42例胃癌、34例大肠癌及其相邻正常组织中GST-π mRNA的表达.结果:GST-π mRNA在胃癌和大肠癌组织中的表达分别为38.1%和41.2%,明显高于其相邻正常组织中的表达(P＜0.05).结论:GST-π mRNA表达与胃肠癌发生、发展及内在性耐药有关.     

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多药耐药基因mdrl产物P-糖蛋白(P-gp)在正常胃、大肠组织及其肿瘤中表达水平均较高，表现为原发性耐药。通过肿瘤细胞个体的遗传背景预测肿瘤化疗敏感性是恶性肿瘤个体化治疗的基础。本文研究P-gp表达与K-ras基因表达的关系，为从基因水平逆转胃肠癌多药耐药提供理论依据。     

心肌梗死后坚持他汀药物治疗与再入院——6年随访研究

某些原发性和继发性预防CHD大型临床试验 ( 4S、CARE、WOSCOPS、LIPIDandAFCAPS)已证实 ,他汀药物可减少 3 0 %主要冠状动脉事件危险 ,并改善心肌梗死 (MI)后生存率 ,但是药物是否发挥作用不仅决定于医师处方 ,而且也依赖患者是否坚持服药及依从性 ,本文对首次MI后是否坚持他汀     

Experimental system for perfusion imaging and time-intensity processing based on ultrasound contrast agent

Objective： To present a self-developed experimental system for basic studies of blood perfusion imaging and time-intensity evaluating based on ultrasound contrast agent. Methods ： The experimental system performed the image reconstruction and time-intensity processing with radio frequency signals. The system was comprised of ultra-high speed hardware data acquisition interface and low computational cost algorithms. The self-made contrast agent ,blood mimic phantom and capillary phantom model were used to validate the experimental system. Results： The images acquired in blood phantoms with linear-array and curve-array transducers were given. The time-intensity curves corresponding to selected region of interestsequence were demonstrated. It was also shown the time-intensity based decay curves and a decay of ultrasound contrast agent under different ultrasound powers. Conclusion： Several suited from two in vitro phantom models show that the experimental system can be used to f blood perfusion and further clinical studies of microvasculature perfusion.     

体外肝切除自体肝移植在复杂肝切除中的应用

目的 评估体外肝切除自体肝移植在巨大肝癌患者复杂肝切除中的临床价值.方法 回顾性分析2008年1月至2010年5月首都医科大学附属北京朝阳医院收治的4例巨大原发性肝癌患者的临床资料.肿瘤最大直径10 ～ 18 cm,病灶不同程度地累及了第一、二、三肝门.患者难以耐受常规肝切除,均行体外肝切除自体肝移植.结果 4例患者顺利完成手术,手术时间690 ～840 min,无肝期250～300 min,术中出血量400～1400 ml,术中无肝期未行门、腔静脉转流术.4例患者在体外肝切除后行下腔静脉或肝静脉及门静脉修复成型,均应用成型异体血管来延长剩余肝脏肝上腔静脉以利于腔静脉吻合及第一肝门的重建.本组患者1例术后肝功能正常,1例出现腹腔出血再次手术止血,1例发生肝功能不全,1例出现肝肾功能不全于术后5d放弃治疗而死亡.3例术后生存的患者术后1～2个月间剩余肝脏均发生不同程度的代偿增生.术后生存的3例患者中2例分别于术后8、9个月发现肺部多发转移瘤,分别于术后13个月及15个月死亡.随访截至2012年4月,1例患者无瘤生存37个月.结论 体外肝切除自体肝移植为复杂肝切除的巨大肝癌患者提供了技术上的可行性,术后肝功能代偿不全及近期肿瘤的复发是限制该手术发展的主要问题.     

视频循环播放进行肾活检全程健康教育的效果

目的探讨利用视频循环播放系统进行肾活检全程健康教育的效果。方法方便性抽样选择2012年2～3月南京总医院解放军肾脏病研究所120例慢性肾脏疾病患者,按人院顺序分为对照组和观察组各60例。对照组采用常规健康教育模式,观察组利用视频循环播放系统进行全程健康教育,干预前后对两组患者的相关项目进行比较。结果观察组肾活检相关知识知晓率、满意度高于对照组,术前血压、焦虑程度均低于对照组,差异均有统计学意义（均P〈0．05）。结论将视频循环播放系统用于肾活检患者的健康教育中,有利于提高健康教育的效果及缓解患者焦虑程度,保证患者的安全,值得在临床推广应用。     

通过对老年痴呆照顾者的培训减少患者安全隐患的效果分析

目的 了解老年痴呆照顾者对安全知识的需求,实施相应的知识培训,以减少患者的安全隐患,提高家庭生活质量。 方法 根据要求制定安全培训课程,针对患者、家属及主要照顾者实施个性化、人性化的安全培训干预, 通过小组化的健康教育和护理指导,以培训前后患者发生不安全事件的多少,照顾者对安全知识的掌握得分、需求得分、焦虑抑郁评分等结果对比,评价培训干预效果。 结果 培训干预后照顾者焦虑抑郁情绪明显改善(P<0.05),相关知识掌握得分明显提高(P<0.05),患者发生不安全事件较明显减少,对护理满意度也较培训前明显提高(P<0.05)。 结论 安全培训是老年痴呆照顾者的迫切需求,通过培训不仅能降低老年痴呆患者的安全的隐患还能拉近医患关系,提高护理服务满意度。     

高脂血症性急性胰腺炎的临床特点与外科处理

急性胰腺炎指胰腺分泌的消化酶对胰腺及其周围组织自身消化所致的化学性炎症,临床表现为上腹痛、恶心、呕吐,重者出现休克、腹膜炎,胆管疾病和酗酒是常见的原因.近年来,随着生活水平的提高和饮食结构的改变,活动减少,肥胖和高脂血症人群增多,高脂血症所致的急性胰腺炎（hyperlipidemic pancreatitis,HLP）在我国发病率呈增加趋势,该病病情重,发展迅速,易致多脏器功能障碍,并发症多,疗效差,死亡率高.     

肝移植术后血清降钙素原监测的临床意义

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.