造影剂致PICC堵管的根原因分析

应用根原因分析法分析1例造影剂导致PICC导管堵管的原因。通过事件调查、直接原因分析,确认根原因是PICC维护宣教流程不合理、增强CT检查流程不合理、对医护人员缺乏导管维护知识的培训。针对原因制定并执行设计健康教育检核表、制定增强CT检查流程、对医护人员进行培训等改进措施以避免类似事件的发生,保证PICC的正确使用与维护。     

超声刀在腮腺肿物切除术中应用的比较研究

目的探讨超声刀在腮腺肿物切除术中应用的价值。方法在腮腺肿物切除术中,2010年1月~2011年6月28例使用传统手术方式(以结扎和缝扎为主要止血方式),2011年7月~2012年12月32例使用超声刀手术。比较2组手术时间、术中出血量、术后引流量和并发症。结果与传统组比较,超声刀组手术时间短[(51.7±5.3)min vs.(82.3±4.7)min,t=-23.534,P=0.000],出血量少[中位数21(18~30)ml vs.65(58~75)ml,Z=-6.653,P=0.000],2组术后引流量和并发症发生率差异无显著性。超声刀组1例暂时性面神经麻痹,传统组1例腮腺涎漏。结论超声刀应用于腮腺手术中,缩短手术时间,减少出血量,无明显并发症发生,安全,有效,值得推广应用。     

通讯技术在中青年哮喘人群教育管理应用模式中的研究

目的研究通讯技术在中青年哮喘人群教育管理的应用模式中对哮喘控制和肺功能的作用。方法2012年2—10月连续选择门诊中度的哮喘症状未控制的中青年患者60例,按随机数字表法分为传统管理组（A组）和通讯技术管理组（B组）,每组30例,分别以传统管理模式和通讯技术管理模式给予规范化治疗1年。对比研究两组患者急性发作次数、急诊就诊次数、住院次数、肺功能、圣乔治呼吸质量问卷（SGRQ）等指标。结果A组20例患者继续规范化治疗,完全控制者15例,部分控制者10例,未控制者5例。B组有26例继续规范化治疗,完全控制者21例,部分控制者7例,未控制者2例。B组患者的依从性高于A组,差异有统计学意义（r=6．331,P〈0．05）,哮喘控制情况优于A组,差异有统计学意义（r=6．490,P〈0．05）。B组患者对疗效的满意度评分为（9．12±O．61）分,A组患者对疗效的满意度评分为（7．41±1．31）分,B组患者的满意度评分高于A组,差异有统计学意义（t=6．051,P〈0．01）。A、B两组治疗后第1秒用力呼气容积较前分别升高（0．132±0．175）L和（0．326±0．125）L,差异有统计学意义（t=5．099,P〈0．01）。治疗后A、B两组患者的SGRQ总分均较治疗前下降,两组比较差异有统计学意义（f=4,316,P〈0．01）。结论通讯技术管理模式在中青年患者依从性、哮喘控制、肺功能和呼吸质量改善等方面的效果均优于医院传统管理模式,积极推广通讯技术管理模式有利于提高我国哮喘防治水平。     

急性淋巴细胞白血病患者FGFR3表达对循环内皮细胞增殖的影响

目的:了解急性淋巴细胞白血病(ALL)患者成纤维细胞生长因子受体3(FGFR3)表达对循环内皮细胞(CECs)增殖的影响。方法:通过RT-PCR法检测44例ALL患者骨髓中FGFR3 mRNA表达,分成FGFR3~+组及FGFR3~-组进行Kaplan-Meier生存分析。利用免疫磁珠结合流式细胞术分离计数CECs,对比两组CECs数量、表面抗原表达、生长曲线及集落生成数的差异。免疫荧光组化染色测定CECs表面FGFR3表达水平。结果:44例核型正常ALL患者中FGFR3 mRNA表达阳性率为43.2%,T-ALL组的FGFR3表达高于B-ALL组(P0.05)。19 d骨髓原始细胞比例≥5%的患者FGFR3表达升高(P0.05)。FGFR3阳性组的总生存率明显低于阴性组(P0.05)。分离出的CECs高表达CD31、CD144、VEGFR-2和CD146,基本不表达CD45。与FGFR3阴性组相比,阳性组CECs数量、CD133的阳性率及集落生成数均增多(P0.05)。体外培养中,FGFR3阳性组与阴性组相比,生长曲线3个时点上的细胞数差异有统计学显著性(P0.05)。19例ALL-FGFR3~+患者CECs表面均能检测到FGFR3表达,阳性率为29.00%±15.71%。结论:致癌基因FGFR3对ALL患者CECs的增殖有促进作用,可能具备了抗肿瘤及抗血管生成的双重靶点身份,可以为今后的分子治疗提供更多的选择。     

Co-expression of CXCL8 and HIF-1α is associated with metastasis and poor prognosis in hepatocellular carcinoma

Hypoxia inducible factor-1α (HIF-1α), induces cytokines such as CXCL8 and tumor dissemination, chemo- and radio-resistance. We analyzed correlation between HIF-1α and CXCL8 levels, tumor characteristics and overall survival in 102 hepatocellular carcinoma (HCC) patients. Levels of HIF-1α and CXCL8 were increased in HCC tissues and cell lines. Patients with high levels of HIF-1α and CXCL8 had worse outcome and poorer prognosis than those with lower levels. Co-overexpression of HIF-1α and CXCL8 was an independent negative prognostic factor for overall and disease-free survival. HIF-1α silencing and CXCL8 siRNA decreased migration under hypoxic conditions in vitro. Hypoxia-induced activation of AKT/mTOR/STAT3 pathways was reversed by depletion of CXCL8. We conclude that HIF-1α and CXCL8 induce HCC progression and metastasis, associated with activation of AKT/mTOR/STAT3. Co-expression of HIF-1α and CXCL8 is a prognostic marker and a potential therapeutic target in HCC.     

Epigenetic priming with decitabine followed by low dose idarubicin and cytarabine in acute myeloid leukemia evolving from myelodysplastic syndromes and higher-risk myelodysplastic syndromes: a prospective multicenter single-arm trial

Patients with acute myeloid leukemia (AML) evolving from myelodysplastic syndrome (MDS) or higher-risk MDS have limited treatment options and poor prognosis. Our previous single-center study of decitabine followed by low dose idarubicin and cytarabine (D-IA) in patients with myeloid neoplasms showed promising primary results. We therefore conducted a multicenter study of D-IA regimen in AML evolving from MDS and higher-risk MDS. Patients with AML evolving from MDS or refractory anemia with excess blasts type 2 (RAEB-2) (based on the 2008 WHO classification) were included. The D-IA regimen (decitabine, 20 mg/m² daily, days 1 to 3; idarubicin, 6 mg/m² daily, days 4 to 6; cytarabine 25 mg/m² every 12 hours, days 4 to 8; granulocyte colony stimulating factor [G-CSF], 5 μg/kg, from day 4 until neutrophil count increased to 1.0 × 10⁹/L) was administered as induction chemotherapy. Seventy-one patients were enrolled and treated, among whom 44 (62.0%) had AML evolving from MDS and 27 (38.0%) had RAEB-2. Twenty-eight (63.6%) AML patients achieved complete remission (CR) or complete remission with incomplete blood count recovery (CRi): 14 (31.8%) patients had CR and 14 (31.8%) had CRi. Six (22.2%) MDS patients had CR and 15 (55.6%) had marrow complete remission. The median overall survival (OS) was 22.4 months for the entire group, with a median OS of 24.2 months for AML and 20.0 months for MDS subgroup. No early death occurred. In conclusion, the D-IA regimen was effective and well tolerated, representing an alternative option for patients with AML evolving from MDS or MDS subtype RAEB-2.     

急性早幼粒细胞患者治疗前后循环内皮细胞的变化及其影响因素的分析

目的:探讨急性早幼粒细胞白血病(acute promyelocytic leukemia,APL)患者治疗前后循环内皮细胞(circulating endothelial cells,CECs)数量、表面抗原及生物学特性的变化,并分析其与临床指标的关系。方法:免疫磁珠结合三色流式细胞仪分选计数APL患者初诊及治疗后CECs的数量;免疫荧光染色检测APL患者初诊及治疗后CECs表面CD146、CD31、CD144、VEGFR-2、CD45及CD133的表达水平。体外培养CECs进行血管生成实验及细胞集落形成率的测定。结果:APL患者CECs在外周血白细胞10×10~9/L及CD34阳性患者中数量明显增多(P0.05),高危、低危及中危3组患者的CECs数量也呈现明显的差异(P0.05)。32例APL患者诱导化疗后均获得完全缓解,治疗后CECs数量及其表面CD133表达水平均明显下降(P0.05)。同时治疗后APL患者CECs体外形成血管数目及细胞的集落形成率均明显减少(P0.05)。APL患者CECs数量治疗后/治疗前的比值与As_2O_3治疗1周后的尿砷浓度呈现明显负相关性(P0.05)。结论:精确计数并深入了解CECs生物学特性可能有助于评价APL的预后及设计治疗策略。     

Hsa_circ_0003998 Promotes Chemoresistance via Modulation of miR-326 in Lung Adenocarcinoma Cells

Circular RNAs (circRNAs) represent a new class of noncoding RNAs that is involved in the development of cancer. However, little is known about their role in chemoresistance. In the present study, we found that hsa_circ_0003998 expression levels in lung adenocarcinoma (LAD) tissues and docetaxel-resistant cell lines (A549/DTX and H1299/DTX) were upregulated. Knockdown of hsa_circ_0003998 decreased chemoresistance, inhibited proliferation, and enhanced apoptosis in docetaxel-resistant LAD cells. Moreover, by using bioinformatics and luciferase reporter assays, we found that miR-326 was a direct target of hsa_circ_0003998. Functional analysis revealed that miR-326 mediated the effect of hsa_circ_0003998 on chemosensitivity. Our findings provide a molecular insight on understanding drug resistance in LAD cells. Therefore, inactivation of hsa_circ_0003998 or activation of miR-326 could be a novel approach for the treatment of LAD.     

玻璃体切割联合消毒空气填充术治疗特发性黄斑裂孔疗效的Meta分析

目的 系统评价玻璃体切割手术联合空气填充治疗特发性黄斑裂孔的疗效.方法 利用计算机检索Pubmed、Web of Science、Cochrane Library、Embase、中国知网及万方数据库,搜集玻璃体切割手术联合空气填充与全氟丙烷(C3F8)填充治疗特发性黄斑裂孔的相关文献.采用Cochrane系统评价的方法...