加入冠心病介入俱乐部对经皮冠状动脉介入治疗术后患者的影响研究

目的 成立冠心病介入俱乐部,建立合理的护理干预模式,使经皮冠状动脉介入治疗术(PCI)后的患者建立健康的生活方式,提高出院随访率及治疗依从性,以减少冠心病患者心血管事件的发生.方法 动员238例已行PCI的患者,加入介入俱乐部,经过健康教育干预、生活方式干预、个体化的用药监控,分别在1年、2年进行危险因素指标评价.结果 加入俱乐部患者1年及2年后,不良的生活方式明显改善;血压、血脂、空腹血糖均较加入俱乐部前明显下降,有统计学意义.每月1次随访率由原来的53.8%上升至84.9%.服药依从性由原来56.7%上升至89.1%.结论 建立冠心病介入俱乐部对PCI术后患者进行护理干预,达到帮助患者建立良好的生活方式,控制原发病,以期可达到预防心血管事件,降低再狭窄率,降低再住院率及医疗费用.     

血管封堵器的临床应用效果观察

目的探讨血管封堵器的止血效果及护理观察。方法共有86例患者,41例患者接受血管封堵器止血,为血管封堵器组;45例行人工压迫止血,为人工压迫组。观察两组止血效果、卧床时间及并发症。结果两组止血成功率(人工压迫组86%,血管封堵器组95%)、止血时间[人工压迫组(19.3±5.5)min,血管封堵器组(1.0±0.3)min]、肢体制动时间[人工压迫组(8.0±2.7)h,血管封堵器组(2.0±1.5)h]均有显著性差异(P<0.001)。人工压迫组3例患者局部形成血肿。血管封堵器组仅2例患者拆线后伤口局部有少量渗血,无1例患者出现血肿或大出血。结论血管封堵器止血安全有效,可缩短介入治疗后卧床时间,减轻患者的痛苦,减少护士的护理工作量。     

颈椎手术后良性阵发性位置性眩晕的诊治

目的探讨颈椎术后良性阵发性位置性眩晕（BPPV）的诊治。方法回顾分析2012年度颈椎术后后半规管BPPV（PC-BPPV）患者的临床资料。结果4例患者于颈椎术后2—4个月出现单侧PC-BPPV发作,改良侧躺诱发试验提示左侧受累1例、右侧受累3例。给予改良Semont方法治疗经1—3个循环后,患者眩晕症状消失。结论改良侧躺诱发试验和改良Semont方法对颈椎术后BPPV患者安全、有效,颈椎手术不是BPPV诊治的禁忌证。     

一氧化碳中毒患者高压氧治疗中的护理管理

一氧化碳中毒是指短时间内吸入过多或过长时间吸入一氧化碳引起的局部和全身中毒疾病,大脑和心脏受累最为明显,轻者头昏、头痛、恶心、呕吐,重者意识不清、尿失禁或尿潴留、大便失禁、昏迷甚至死亡[1].急性一氧化碳中毒为临床常见病,发病急、症状重,如不及时救治就会有生命危险,目前高压氧治疗是当今各种急救措施中效果最佳方法之一[2].一氧化碳中毒后高压氧治疗的目的:①迅速排除体内一氧化碳.②恢复Hb运输氧的能力.③促进脑、心脏、肝等重要器官功能恢复,防治迟发脑病导致的精神神经系统损害[1].在患者进行高压氧治疗过程中实施有效的护理管理,可有效缓解患者的心理压力,减少高压氧意外及并发症的发生,提高抢救成功率和护理水平.现将高压氧治疗中的护理管理总结如下.     

Triptolide-induced apoptosis by inactivating nuclear factor-kappa B apoptotic pathway in multiple myeloma <Emphasis Type="Italic">in vitro</Emphasis>

The effect of triptolide on proliferation and apoptosis of human multiple myeloma RPMI-8226 cells in vitro,as well as the roles of nuclear factor-kappa B(NF-κB) and IκBα was investigated.The effect of tritptolide on the growth of RPMI-8226 cells was studied by MTT assay.Apoptosis was detected by Hoechest 33258 staining and Annexin V/PI double staining assay.The expression of NF-κB and IκBα was observed by Western blot and confocal microscopy.The results showed that triptolide inactivated NF-κB apoptotic pathway in human multiple myeloma RPMI-8226 cells.Triptolide at nM range induced proliferation inhibition in a dose-and time-dependent manner and apoptosis in a dose-dependent fashion in RPMI-8226 cells.Besides,we observed the inhibition of NF-κB /p65 in the nuclear fraction was correlated with the increase in the protein expression of IκBα in the cytosol.These results suggested that triptolide might exhibit its strong anti-tumor effects via inactivation of NF-κB/p65 and IκBα.     

2014年美国临床肿瘤学会指南更新：激素受体阳性乳腺癌的辅助内分泌治疗

大多数乳腺癌为激素依赖性肿瘤,ER阳性乳腺癌约占全部乳腺癌的60%-75%,其中约65%为PR阳性。激素受体阳性肿瘤对内分泌药物敏感,内分泌治疗在乳腺癌综合治疗中占有重要地位。美国临床肿瘤学会（American Society of Clinical Oncology,ASCO）曾于2010年更新激素受体阳性女性乳腺癌患者辅助内分泌治疗指南,迄今为止,另有5项他莫昔芬维持治疗的相关研究数据问世。     

雷公藤内酯醇对多发性骨髓瘤RPMI 8226细胞周期及P21wap1/cip1和P27kip1表达的影响

目的 观察雷公藤内酯醇对多发性骨髓瘤细胞 RPMI 8226 增殖和周期的影响,探讨细胞周期调控蛋白 P21wap1/cip1 和 P27kip1 在其中的作用和意义。方法 采用 MTT 比色法和流式细胞术检测雷公藤内酯醇对 RPMI 8226 细胞增殖、凋亡和细胞周期的影响,半定量 RT-PCR 和 Western blotting 法检测 RPMI 8226 细胞中 P21wap1/cip1、P27kip1 mRNA 和蛋白表达。结果 雷公藤内酯醇能明显抑制 RPMI 8226 细胞增殖,其抑制作用呈时间、剂量依赖性,雷公藤内酯醇作用 48 h 的 IC₅₀ 值为 (71.18±2.01) nmol/L。雷公藤内酯醇还可以诱导 RPMI 8226 细胞周期阻滞于 G₀/G₁ 期,随着雷公藤内酯醇浓度的增加,G₀/G₁ 期细胞逐渐增多,S 期细胞逐渐减少。经雷公藤内酯醇干预后周期调节蛋白 P21wap1/cip1 和 P27kip1 的 mRNA 和蛋白表达水平明显上调。结论 雷公藤内酯醇可以抑制 RPMI 8226 细胞增殖,该抑制作用是通过调控 P21wap1/cip1 和 P27kip1 的表达,从而阻止细胞周期 G₀/G₁ 期过渡实现的。     

减速注射76%泛影葡胺对静脉肾盂造影的影响

目的:探讨静脉肾盂造影时76%泛影葡胺注射速度与不良反应的关系,以期降低不良反应发生而保证检查顺利完成,提高检查成功率。方法:按预约检查顺序将428例静脉肾盂造影患者随机交替分为观察组和对照组各214例。两组均采用注射泵控制76%泛影葡胺注射速度,观察组为6ml/min,对照组为10ml/min。比较两组不良反应发生率、检查完成率及检查成功率情况。结果:对照组患者不良反应发生率明显比观察组高,两组比较P=0.000,差异有高度显著统计学意义;检查完成率及成功率观察组比对照组高,P=0.000,差异有高度显著统计学意义。结论:静脉肾盂造影时的不良反应主要为高渗反应,控制静脉注射76%泛影葡胺的速度,可以有效降低不良反应的发生,从而保证检查顺利完成且不影响图像质量。     

组织蛋白酶B诱导HIF-1α表达对结肠癌细胞侵袭行为的影响

 目的 探讨组织蛋白酶B(CatB)诱导缺氧诱导因子-1α(HIF-1α)表达对直肠癌细胞侵袭行为的影响.方法 将CatB cDNA转染人结肠癌细胞系Lovo,通过Transwell侵袭小室实验检测癌细胞的侵袭能力,Western blot法检测癌细胞不同缺氧时点HIF-1α表达水平.结果 CatB转染组癌细胞穿透Transwell滤膜细胞数为(14.8±4.2),明显多于空载体转染组(8.6±3.7)和对照组(8.4±3.2)癌细胞(P<0.05).在缺氧0 时点,各组癌细胞无HIF-1α表达;缺氧6 时点HIF-1α仅有微量表达;在缺氧12 与24 时点,CatB转染细胞组HIF-1α表达水平明显提高,对照组和空载体转染组癌细胞HIF-1α表达水平无显著变化.比较同一缺氧时相,在缺氧0 与6 时点,各组癌细胞HIF-1α表达水平差异无统计学意义(P>0.05);在缺氧12 与24 时点,CatB转染组HIF-1α表达水平显著高于空载体组和对照组(P<0.01).结论 CatB可诱导结肠癌细胞HIF-1α表达,促进癌细胞对缺氧的适应并增强癌细胞的侵袭能力.     

FasL基因表达对缺氧状态下直肠癌细胞增殖凋亡的影响

Objective To elucidate the effect of FasL gene expression on the proliferation and apoptosis of hypoxic rectal carcinoma cells. Methods The normoxic expression level of FasL in HR-8348 subtype cells (HR-8348B, HR-8348L, HR-8348F and HR-8348As) with different invasive power were verified by Western blot. Hypoxia models for HR-8348B, HR-8348L, HR-8348F and HR-8348As were constructed with chemical modeling, then the FasL levels in all groups at 12 h after hypoxia were quantitated by Western blot. Distribution of different cell life cycles was determined with flow cytometry. Cell reproductive activities were detected with MTT method, and cell apoptesis was assessed with TUNEL. Results FasL protein was pigmentized at the position of 40 000 by Western blot, and the expression level of FasL was significantly higher in HR-8348F cells than those in HR-8348B, HR-8348L and HR-8348As cells(F=361.149, P<0.01) in normoxia. At 12 h after hypoxia, the FasL level was also significantly higher in HR-8348F cells than those in other groups (F=278.766, P<0.01), but was not markedly different as compared to themselves in normoxia (t=1.762, P>0.05). The proliferation index was significantly higher in HR-8348F (60.43±3.72) than those in HR-8348B (40.01±3.30), HR-8348L (41.30±4.06) and HR-8348As cells (35.87±4.39), respectively (F=39.477, P<0.01). However, both inhibition rate of proliferation and apoptotic index were remarkably lower in HR-8348F (17.30±1.98 and 13.10±1.04) than those in HR-834B (33.70±4.33 and 21.60±1.31), HR-8348L (34.20±3.92 and 20.10±1.15), and HR-8348As (38.00±4.55 and 23.90±1.23), respectively (F=28.811 and 76.462, respectively, P<0.01). Conclusion The expression enhancement of intracellular FasL in rectal carcinoma in hypoxia can lead to accelerated proliferation and reduced apeptosis of cells, which will promote tumor cells to adapt microenvironmental hypoxia.