奥氮平、奎硫平与阿立哌唑对精神分裂症患者血清甲状腺激素和催乳素水平的影响

目的:探讨非典型抗精神病药奥氮平、奎硫平、阿立哌唑对精神分裂症患者血清甲状腺激素和催乳素(PRL)水平的影响方法:将150例精神分裂症患者随机分为奥氮平、奎硫平及阿立哌唑组并接受相应的药物治疗8周。治疗前后分别检测血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(T3)、总甲状腺素(T4)、促甲状腺激素(TSH)及PRL水平。结果:治疗后3组血清FT4、T3、T4水平较治疗前明显下降(P均0.01);T4组间主效应有统计学意义(P0.05);治疗后奎硫平组血清T4水平较奥氮平组下降更明显(P0.05);治疗后奥氮平组血清PRL水平明显高于治疗前及奎硫平及阿立哌唑组(P均0.01),并具有交互作用(P0.01)。结论:奥氮平、奎硫平、阿立哌唑都降低甲状腺激素水平,奎硫平更易降低T4水平;奥氮平显著影响血清PRL水平。     

Randomized Comparison of FFR-Guided and Angiography-Guided Provisional Stenting of True Coronary Bifurcation Lesions: The DKCRUSH-VI Trial (Double Kissing Crush Versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions VI)

ObjectivesThis study sought to compare the outcomes of fractional flow reserve (FFR)–guided and angiography (Angio)–guided provisional side-branch (SB) stenting for true coronary bifurcation lesions.BackgroundAngio-guided provisional SB stenting after stenting of the main vessel provides favorable outcomes for the majority of coronary bifurcation lesions. Whether an FFR-guided provisional stenting approach is superior has not been studied.MethodsA total of 320 patients with single Medina 1,1,1 and 0,1,1 coronary bifurcation lesions undergoing stenting with a provisional SB approach were randomly assigned 1:1 to Angio-guided and FFR-guided groups. SB stenting was performed for Thrombolysis In Myocardial Infarction flow grade <3, ostial SB stenosis >70%, or greater than type A dissection after main vessel stenting in the Angio-guided group and for SB-FFR <0.80 in the FFR-guided group. The primary endpoint was the 1-year composite rate of major adverse cardiac events (cardiac death, myocardial infarction, and clinically driven target vessel revascularization).ResultsComparing the Angio-guided and FFR-guided groups, treatment of the SB (balloon or stenting) was performed in 63.1% and 56.3% of lesions respectively (p = 0.07); stenting of the SB was attempted in 38.1% and 25.9%, respectively (p = 0.01); and, when attempted, stenting was successful in 83.6% and 73.3% of SBs, respectively (p = 0.01). The 1-year composite major adverse cardiac event rate was 18.1% in both groups (hazard ratio: 0.91, 95% confidence interval: 0.48 to 1.88; p = 1.00). The 1-year target vessel revascularization and stent thrombosis rates were 6.9% and 5.6% (p = 0.82) and 1.3% and 0.6% (p = 0.56) in the Angio-guided and FFR-guided groups, respectively.ConclusionsIn this multicenter, randomized trial, angiographic and FFR guidance of provisional SB stenting of true coronary bifurcation lesions provided similar 1-year clinical outcomes. (Randomized Study on DK Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions; ChiCTR-TRC-07000015)     

血清肿瘤标志物在肺癌诊断中的价值

支气管肺癌具有高发病率和高死亡率的特点,肺癌的早期发现、早期诊断以及早期治疗对于降低肺癌的病死率,改善预后具有重要的意义,而血清肿瘤标志物的检测对诊断肺癌有重要作用。该文对肺癌血清肿瘤标志物的研究进展进行综述。     

Delta-Shaped Gastroduodenostomy in Fully Laparoscopic Distal Gastrectomy: A Retrospective Study

This study aims to explore the technical feasibility, safety, and clinical efficacy of delta-shaped anastomosis for digestive tract reconstruction during totally laparoscopic distal gastrectomy.Clinical data of 24 patients who received totally laparoscopic distal gastrectomy with delta-shaped anastomosis (laparoscopic gastrectomy group, LG group) and 30 patients who received open distal gastrectomy for gastric cancer (open gastrectomy group, OG group) from April 2013 to April 2014 were retrospectively analyzed. Operation time, intraoperative blood loss, postoperative time to intestinal function recovery, postoperative pain, postoperative hospital stay, and incidence of postoperative complications (infection, obstruction, and delayed gastric emptying) were compared between these 2 groups.Patients in both groups were discharged without marked complications. No patients who initially selected laparoscopy were converted to laparotomy. Patients in the LG group had longer operation times (175.3 ± 64.7 minutes versus 120.1 ± 43.4 minutes, P < 0.05), lower intraoperative blood loss (50.8 ± 25.3 mL versus 95.6 ± 20.7 mL, P < 0.05), faster recovery of intestinal function (1.2 ± 0.5 days versus 2.6 ± 1.0 days, P < 0.05), less postoperative pain (5.6 ± 0.7 versus 9.5 ± 0.3, P < 0.05), and shorter length of postoperative hospital stay (8.5 ± 2.2 days versus 12.2 ± 3.8 days, P < 0.05), compared with patients in the OG group. There were no significant differences with respect to surgical margins achieved, the number of lymph nodes retrieved or incidence of postoperative complications (infection, obstruction, and delayed gastric emptying) between the 2 groups (P > 0.05).Laparoscopic reconstruction of the digestive tract through delta-shaped anastomosis appears to be safe, feasible, and associated to rapid recovery. These data argue for more wide-spread implementation of this procedure.     

心脑苏提取物对异丙肾上腺素诱导大鼠心肌缺血的保护作用及机制

目的:研究心脑苏提取物对大鼠心肌缺血的治疗作用,并探讨其作用机制。方法:SD大鼠,按体重随机分为6组,即正常组,模型组,阳性对照0.135 g·kg~(-1)组(麝香保心丸组0.135 g·kg~(-1)),心脑苏提取物高、中、低剂量组(0.055,0.276,1.38 g·kg~(-1)),各组n≥10。异丙肾上腺素(isoproterenol,ISO)尾静脉注射建立大鼠心肌缺血模型。造模第2天开始ig给予心脑苏提取物剂量(0.055,0.276,1.38 g·kg~(-1)),连续给药14 d,大鼠腹主动脉取血,测定血清乳酸脱氢酶(LDH),肌酸激酶(CK),超氧化物歧化酶(SOD),丙二醛(MDA)的含量。取心脏进行苏木素和伊红(HE)染色,光镜观察其组织形态学变化。通过CD34单克隆抗体进行免疫组化技术标记心脏微血管内皮细胞,计算微血管密度(MVD)。结果:与正常组比较,模型组大鼠血清中CK,LDH酶活力及MDA含量显著升高,SOD活力显著降低(P0.01);与模型组比较,心脑苏提取物中、高剂量组显著降低大鼠血清中CK,LDH酶活力及MDA含量(P0.01),SOD活性显著增加(P0.01),内皮血管数及MVD显著增加(P0.01)。结论:心脑苏提取物能明显改善大鼠心肌缺血损伤,其机制可能为减轻氧化损伤、促进微血管再生。     

痔瘘洗必灵袋泡剂治疗血栓外痔30例

目的:观察痔瘘洗必灵袋泡剂熏洗坐浴治疗血栓外痔的临床疗效。方法:将58例血栓外痔患者随机分为治疗组30例和对照组28例,治疗组给予痔瘘洗必灵袋泡剂熏洗坐浴治疗,对照组给予1:5 000高锰酸钾熏洗坐浴治疗。结果:治疗后,治疗组疼痛评分优于对照组,差异均有统计学意义(P0.05);治疗组有效率96.7%,对照组有效率78.6%,治疗组明显优于对照组(P0.05)。结论:痔瘘洗必灵袋泡剂熏洗坐浴治疗血栓外痔有明显疗效。     

跨理论模型指导下的护理干预对COPD患者戒烟及生活质量的影响

目的:探讨跨理论模型指导下的护理干预对COPD患者戒烟依从性及生活质量的影响。方法:将在某医院肺病科住院的吸烟COPD患者65例随机分为干预组32例和对照组33例,干预组实行针对性跨理论模型指导下的护理干预,对照组实施常规护理。观察2组患者16周内戒烟行为改变阶段的不同及生活质量变化情况。结果:干预组出院后16周内戒烟行为改变阶段较入组时提高(P0.05),对照组干预前后比较差异无统计学意义(P0.05);2组患者的生活质量评价比较无统计学差异(P0.05)。结论:跨理论模型指导下护理干预模式可提高吸烟COPD患者的戒烟依从性。     

Influence of N-acetyl cysteine (NAC) and 2-methylene-1,3-dioxepane (MDO) on the properties of polymethyl methacrylate (PMMA) bone cement

The properties of polymethyl methacrylate (PMMA) bone cement make it a popular bone filling material. However, its disadvantages, such as lack of biodegradability and osteogenesis, restrict its clinical application. Studies have indicated the osteogenic properties of N-acetyl cysteine (NAC) and the biodegradability of 2-methylene-1,3-dioxepane/methyl methacrylate-based (MDO/MMA) copolymers. In this study, we developed bioactive PMMA cements through modification with fixed concentrations of NAC and different proportions of MDO. The purpose of this study was to compare the mechanical properties, morphology, NAC release, biocompatibility, degradability and mineralization capability of modified bone cements with those of conventional cement. The specific-modified specimens (NAC-p (5% MDO-co-MMA)) exhibited a lower bending modulus but had little effect on compressive strength. This material was morphologically compact and nonporous, similar to conventional PMMA bone cement. NAC could be released from NAC-p (5% MDO-co-MMA) continuously and appropriately. NAC-p (5% MDO-co-MMA) was biologically safe and showed satisfactory tissue compatibility. Ester was introduced into the polymer, which reinforced the degradation properties of NAC-p (5% MDO-co-MMA). NAC-p (5% MDO-co-MMA) enhanced the mineralization capability of osteoblastic cells.

The properties of polymethyl methacrylate (PMMA) bone cement make it a popular bone filling material.     

CIK细胞治疗放化疗后的肿瘤患者的临床观察

目的 观察放化疗后的肿瘤患者回输CIK细胞后生活质量及细胞免疫功能变化,探讨CIK细胞治疗对放化疗后的肿瘤患者的治疗作用.方法 收集放化疗治疗后肿瘤患者患者31例,分别抽取CIK细胞回输治疗后外周血作细胞免疫指标检测,正常人14例作对照,并比较CIK细胞回输治疗后生活质量改善情况.结果 放化疗后的肿瘤患者外周血CD3+、CD4+细胞百分率下降,CD8+细胞百分率上升;CD4+/CD8+比值下调,CD16+CD56+细胞减少,与正常人相比差异有统计学意义(P＜0.05),CIK治疗后上述指标较治疗前有改善(P＜0.05).CIK细胞回输治疗后患者治疗后生活质量评分均较治疗前明显改善(P＜0.05).结论 放化疗后的肿瘤患者免疫功能下降,而CIK细胞回输治疗安全可靠,可以改善放化疗后肿瘤患者近期免疫功能及生活质量,可作为放化疗后肿瘤患者维持治疗的一种选择.     

张家港市人群乙型病毒性肝炎血清流行病学调查

目的 了解张家港市人群乙型病毒性肝炎流行状况,为乙肝防制提供参考依据.方法在张家港市随机整群抽取20个村(社区)的常住人口共50 886人,开展问卷调查,采集静脉血,进行乙肝血清学实验室检测.结果 全人群HBsAg阳性率为5.15％,抗-HBs阳性率为52.69％.各地区间HBsAg阳性率和抗-HBs阳性率差异无统计学意义.男女HBsAg阳性率分别为5.72％和4.68％,抗-HBs阳性率分别为51.56％和53.62％,两者间差异均有统计学意义.各年龄组间HBsAg阳性率和抗-HBs阳性率差异均有统计学意义,0～14岁人群HBsAg阳性率较低,25 ～59岁人群HBsAg阳性率较高.有明确免疫史人群的HBsAg阳性率明显低于未免疫或免疫不详人群,抗-HBs阳性率明显高于未免疫或免疫不详人群.结论 接种乙肝疫苗是控制人群HBV感染的有效措施,应进一步加强对25～59岁组青壮年人群的乙肝干预措施.