极重度骨髓型和肠型急性放射病细菌感染的防治

目的 探讨极重度骨髓型和肠型急性放射病细菌感染的防治经验,为今后急性放射病的治疗提供治疗经验.方法 2例急性放射病患者整个病程中均合并不同菌种的感染,通过观察患者的临床症状、影像学检查及相关的病原体检测而给予不同强度的抗细菌和真菌治疗,通过观察临床症状、影像学检查及病原学检测评价疗效.结果 2例急性放射病患者在治疗中均出现多次反复的细菌感染,同时伴有持续的真菌感染,经强有力的抗细菌和真菌治疗后细菌感染得到暂时控制,真菌感染始终没有控制.病例A于受照后14天出现急性腹膜炎,照后19天出现肺部感染,经泰能加万古霉素等抗生素治疗细菌感染得到控制,于照后33天死于真菌感染败血症和多脏器功能衰竭.病例B于受照后反复出现肺部感染,且于照后55天和照后71天出现G-杆菌败血症,经泰能加万古霉素等抗生素治疗后细菌感染均控制,但真菌感染一直存在,于照后75天因多脏器功能衰竭抢救无效死亡.结论 极重度骨髓型和肠型急性放射病患者的细菌感染呈阶段性.全身性阶段性应用高强抗生素是防治细菌感染的主要有效措施.     

HPLC测定洛伐他汀烟酸缓释片中两组分含量

 目的建立洛伐他汀烟酸缓释片中2个组分(洛伐他汀、烟酸)含量的高效液相色谱法。方法采用Hypersil C₁₈色谱柱(4.6 mm×250 mm,5μm),以0.005 mol·L^-1己烷磺酸钠溶液-乙腈(35:65)为流动相,检测波长为239 nm。结果烟酸和洛伐他汀的浓度分别在49.8～249和2～10 mg·L^-1有良好的线性关系(r=0.999 6),样品的回收率分别为99.93%(n=6,RSD=0.73%)和101.3%(n=6,RSD=1.61%)。结论本法简便、快速,重现性好,灵敏度高,适用于洛伐他汀烟酸缓释片的质量控制。     

Direct detection of unamplified hepatoma upregulated protein RNA in urine using gold nanoparticles for bladder cancer diagnosis

ObjectiveTo develop a gold nanoparticle (AuNP) assay for direct detection of unamplified HURP RNA in urine.Design and methodsHURP RNA was extracted from urine samples (50 bladder carcinoma patients, 25 benign bladder lesions, and 25 controls) and further purified using magnetic nanoparticles (MNPs), functionalized with HURP RNA-specific oligonucleotides, and then detected by RT-PCR or gold nanoparticles.ResultsThe developed HURP RNA AuNP assay has a sensitivity and a specificity of 88.5% and 94%, respectively, and a detection limit of 2.4 nmol/L. The concordance between the HURP AuNP assay with RT-PCR after RNA purification using functionalized MNPs was 97%.ConclusionsThe developed colorimetric HURP RNA AuNP assay is sensitive, simple, and can aid noninvasive diagnosis of bladder cancer.     

造血干细胞移植病人极期阴囊处皮肤损伤的护理

白细胞是人体防御细菌入侵的重要防线,中性粒细胞占白细胞总数50%～70%,机体抵御病原体,特别是处于化脓性细菌入侵的第一线,是一道天然免疫屏障。病人极期白细胞及中性粒细胞计数持续下降,一般有头晕、乏力、四肢酸软、食欲减退、低热、失眠或极度衰弱等非特异性症状[1,2]。尤其是病人虚弱多汗,阴囊处皮肤的特性及经钴60全身照射对皮肤的特异性损害,导致阴囊处发生皮肤损伤的几率增加。此期病人易发生     

Statistical controversies in clinical research: statistical significance—too much of a good thing …

The use and interpretation of P values is a matter of debate in applied research. We argue that P values are useful as a pragmatic guide to interpret the results of a clinical trial, not as a strict binary boundary that separates real treatment effects from lack thereof. We illustrate our point using the result of BOLERO-1, a randomized, double-blind trial evaluating the efficacy and safety of adding everolimus to trastuzumab and paclitaxel as first-line therapy for HER2+ advanced breast cancer. In this trial, the benefit of everolimus was seen only in the predefined subset of patients with hormone receptor-negative breast cancer at baseline (progression-free survival hazard ratio = 0.66, P = 0.0049). A strict interpretation of this finding, based on complex ‘alpha splitting’ rules to assess statistical significance, led to the conclusion that the benefit of everolimus was not statistically significant either overall or in the subset. We contend that this interpretation does not do justice to the data, and we argue that the benefit of everolimus in hormone receptor-negative breast cancer is both statistically compelling and clinically relevant.     

医院医学工程科科室建设探究

目的：医院医学工程科是为医院开展医疗、科研、教学工作提供物质保障的重要科室之一,研究医学工程科科室建设对医院的科学发展有重要的意义。方法：分析医学工程科的现状,并研究出现阻碍医学工程科发展问题的原因所在。结果：结合医院的实际情况以及工作经验,得出改善医学工程科现状的对策,并对其进行进一步的分析和探讨。结论：提高医学工程科的工作质量是促进医疗卫生事业发展的一项重要工作,同时也是医院全面建设、科学发展的可靠保证。     

Quality of Life in Pediatric Moyamoya Disease

BackgroundMoyamoya disease (MMD) is a progressive intracranial arteriopathy with high risk of stroke. Its impact on quality of life is unstudied. We surveyed children with moyamoya disease and compared their quality of life to chronically ill children and children with stroke to better understand the impact of this diagnosis.MethodsChildren with moyamoya disease aged seven to 17 years from Stanford's Moyamoya Clinic between June 2014 and March 2015 were included. Children with syndromic neurodevelopmental diagnoses were excluded. Patients were surveyed using the Pediatric Quality of Life 4.0, in addition to the Pediatric Stroke Outcome Measure or Recovery Recurrence Questionnaire. Mean scores were compared to normative data sets. Linear regression models compared total quality of life scores in patients with and without stroke, after adjusting for confounders.ResultsThis cross-sectional study included 30 children with moyamoya disease; ten were male, and the median age was 13.5 years (range, 7 to 17 years). Twenty children (67%) had a stroke, and 14 of these had good neurological outcome (70%). Mean parent-proxy Pediatric Quality of Life scores were lower in all domains compared to healthy controls (P < 0.05), and all scores were comparable to chronically ill children and children with non–moyamoya disease stroke. There was no significant difference in total quality of life between patients with and without stroke.ConclusionsEven in the absence of stroke, children with moyamoya disease have lower quality of life than healthy controls and a similar quality of life to chronically ill children and those with non–moyamoya disease stroke. Children with moyamoya disease would benefit from mental health support beyond what a mild physical presentation may indicate.     

舒尼替尼抑制小鼠骨髓来源树突状细胞表面PD-L1和PD-L2的表达

目的观察小鼠髓源性树突状细胞(DC)在舒尼替尼刺激下,其表面程序性死亡分子1配体1(PD-L1)和PD-L2的表达变化。方法取小鼠骨髓细胞,对照组加入二甲基亚砜,实验组分别加入(100、200、300)ng/m L舒尼替尼,刺激48 h,用流式细胞术检测DC表面PD-L1和PD-L2的表达水平。结果与对照组相比,实验组中成熟DC(m DC)和总DC(包括m DC和im DC)表面PD-L1的表达水平显著降低;表达PD-L1的未成熟DC(im DC)、m DC和DC百分比均显著降低,表达PD-L2的m DC百分比显著降低;表达PD-L2的DC百分比在100 ng/m L、300 ng/m L舒尼替尼组中显著降低。结论舒尼替尼可显著降低小鼠DC表面PD-L1、PD-L2的表达。     

临床药师对2例肿瘤患者使用PD-1抗体制剂致不良反应的分析和思考

目的探讨新型抗肿瘤药物免疫检查点抑制剂相关不良反应的药学实践,为临床安全用药提供参考。方法对2例患者使用免疫抑制剂治疗后出现的不良反应进行分析及评价。结果临床药师从药学角度对免疫相关不良反应提供合理化建议,并提醒临床治疗前建立基线,临床采纳。结论临床药师协助医师制订及优化免疫相关不良反应的用药方案,提高了新型抗肿瘤药物在临床使用的安全性和有效性。