医院离退休干部参与社会治理现状

通过文献研究、问卷调查、专家访谈、现地调研等方法,分析医院离退休干部参与社会治理的现状及影响因素,探讨社区对离退休干部参与社会治理的需求,提出通过党建引领医院离退休干部参与社会治理的“1235”模式,并给出具体的操作路径,以期为推动医院离退休干部积极参与社会治理提供参考。     

Research progress on accelerator-based stereotactic body radiotherapy

Stereotactic body radiotherapy (SBRT) has become an important radiotherapy technology. In recent years, with the continuous improvement of the mechanical properties of the linear accelerator (LINAC), LINAC-based SBRT is gradually emerging. In this article, the history, technological progress, radiation physics, clinical application of LINAC-based SBRT were elaborated, aiming to promote the development of LINAC-based SBRT.     

Prevalence of hereditary breast and ovarian cancer (HBOC) predisposition gene mutations among 882 HBOC high‐risk Chinese individuals

Identification of deleterious variants in hereditary breast and ovarian cancer (HBOC) susceptibility genes allows for increased clinical surveillance and early detection, and could predict the response to poly (ADP‐ribose) polymerase (PARP) inhibitor in patients with advanced ovarian carcinomas. To determine the prevalence and clinical prediction factors for HBOC syndrome, 882 selected individuals underwent multigene panel testing for HBOC risk assessment during the period from January 2015 to March 2018. Overall, 176 deleterious mutations were observed in 19.50% (n = 172) of individuals. Twenty‐six of 176 mutations could not be retrieved in related public databases and were considered to be novel. Among patients with ovarian cancer, 115 deleterious mutations were identified in 429 patients (48.6%) with significant enrichment for a family history of breast or ovarian cancer syndrome (P < .05). In the breast cancer subgroup, 31 deleterious mutations were identified in 261 patients. Besides BRCA1 (8; 25.8%) and BRCA2 (11; 35.5%), the most frequently occurring genes, an additional 12 deleterious mutations (38.7%) were found in seven other susceptibility genes. Higher mutation incidence (57.9%) was observed in subjects with histories of breast and ovarian cancer. Our results highlighted the genetic heterogeneity of HBOC and the efficiency of a multigene panel in carrying out risk assessment.     

Risk factors associated with delayed methotrexate clearance and increased toxicity in pediatric patients with osteosarcoma

High‐dose methotrexate (HD‐MTX; 12 g/m²) is part of standard therapy for pediatric osteosarcoma (OS). Risk factors associated with MTX toxicity in children with OS are not well defined. We investigated the association between peak MTX levels (four‐hour) and delayed MTX clearance or treatment toxicity. Information was retrieved from electronic medical records of 33 OS patients treated with HD‐MTX at Texas Children's Hospital from 2008 to 2015. We found that the four‐hour MTX level did not contribute to toxicity or delayed MTX clearance. We demonstrated that certain demographic characteristics are associated with delayed clearance and increased toxicity.     

Additional bedtime H2‐receptor antagonist for the control of nocturnal gastric acid breakthrough: A Cochrane systematic review

OBJECTIVES: To assess the effectiveness and safety of additional bedtime H₂‐receptor antagonists (H₂RAs) in suppressing nocturnal gastric acid breakthrough (NAB) via a systematic review. METHODS: Eligible trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2004), MEDLINE (January 1966–June 2004), EMBASE (January 1980–June 2004) and CINAHL (January 1982–June 2004). Additional hand‐searching was conducted on the proceedings of correlated conferences, eight important Chinese journals and references of all included trials. All randomized controlled trials evaluating H₂RAs for the control of NAB were eligible for inclusion. The systematic review was conducted using methods recommended by The Cochrane Collaboration. RESULTS: Only two randomized crossover studies, comprising 32 participants, met the inclusion criteria. Because the design, dosage and duration of the treatments were different between the studies, it was not possible to conduct meta‐analysis. There were no consistent conclusions found between the two included studies in evaluating H₂RAs for the control of NAB. CONCLUSIONS: No implications for practice at this stage can be concluded. Appropriately designed large‐scale randomized controlled trials with long‐term follow up are needed to determine the effects of additional bedtime H₂RAs in suppressing NAB.     

脊椎转移瘤增强减影MR成像

目的评估增强减影在脊椎转移瘤MR I中的应用价值。方法50例脊椎转移瘤病人进行MR I增强扫描,对比剂采用Gd-DTPA(0.1 mmol/kg),然后用T1W I增强后的图像与增强前的图像进行减影。通过对比噪声比(CNR)、信噪比(SNR)以及肿瘤边界清晰程度的比较,对MR I减影与否进行评估。结果MR I对比增强减影图像比传统的T1W I增强图像显示更清晰、更直观。所有脊椎转移瘤图像MR I减影的CNR和SNR比常规T1W I增强图像的CNR和SNR高。MR I减影CNR为155.05±24.73(x±SD),常规T1W I增强图像的CNR为11.11±14.26(t=35.65,Ρ<0.001)。MR I减影SNR为192.82±32.89(x±SD),常规T1W I增强图像的SNR为46.03±28.22(t=23.95,Ρ<0.001))。MR I对比增强减影图像比传统的T1W I增强图像能更好地显示脊椎转移瘤的边界和侵犯情况(2χ=29.34,Ρ<0.005)。结论MR I增强减影为探查和评估脊椎转移瘤提供了一个新的诊断方法。     

颈肩背轴型反流皮瓣修复儿童颏颈瘢痕挛缩

目的探讨修复儿童颏颈瘢痕挛缩一种实用而较理想的方法.方法以颈横动脉浅支为蒂,利用其与旋肩胛动脉皮支的丰富吻合,反流形成超长的轴型皮瓣,向前旋转修复瘢痕松解后的颈前创面.结果采用本皮瓣修复30例儿童颏颈瘢痕挛缩,其中18例随访2年,颈部活动自如,颌骨发育无明显异常,皮瓣色泽良好,效果令人满意.结论本皮瓣轴型血管恒定,反流灌注动脉压高有保证,供瓣面积充足,供区多可直接拉拢缝合,是修复儿童颏颈瘢痕挛缩的较理想方法.     

碳酸酐酶Ⅲ的生物学特性及与临床疾病的关系

碳酸酐酶(carbonicanhydrase,CA)是一种含锌的金属蛋白酶家族,至少有11种CA同工酶、3种与CA相关的蛋白质和1种受体型蛋白酪氨酸磷酸酶。其中CAⅢ在细胞内的分布、分子的理化特性、生理功能都有不同于其他CA的特点,其功能主要是清除骨骼肌中的CO2,参与细胞内磷酸化、信号转导及调节能量代谢,但在临床中特别是在神经科疾病中的应用还没有足够的认识。     

肾移植术后严重肺部感染患者血液滤过的护理

对10例肾移植术后合并急性呼吸窘迫综合征(ARDS)的严重肺部感染患者实行连续性高容量血液滤过(CHVHF)治疗.结果4例痊愈出院,6例存活时间超过15 d(15 d后5例死亡,1例放弃治疗);CHVHF治疗过程中,患者血压、心率平稳,APACHEⅡ评分48 h后显著改善(P＜0.05,P＜0.01).提示肾移植术后合并ARDS的严重肺部感染患者应用CHVHF治疗是一种安全有效的方法,加强护理评估与监测,保持体外循环通畅,做好心理护理是使治疗顺利进行,取得满意疗效的重要保障.