1例新型冠状病毒肺炎危重症患者人工气道的管理

目的总结新型冠状病毒肺炎(以下简称新冠肺炎)危重症患者人工气道的管理经验。方法2019年1月28日,某院收治了1例新冠肺炎危重症患者,予紧急有创机械通气治疗。结果经过积极治疗9 d,患者病情逐渐平稳,予试脱机试验。结论人工气道建立前的评估准备、个人防护要点,建立时的注意事项及建立后的气道管理工作的经验,可为以后收治烈性传染病提供参考。     

预防性输注新鲜冰冻血浆对胰十二指肠切除术患者的近期疗效观察

目的探讨胰十二指肠切除术患者术后预防性输注新鲜冰冻血浆的临床疗效。方法回顾性分析中南大学湘雅三医院2015年1月至2018年12月收治的112例接受十二指肠切除术治疗的胰腺恶性肿瘤患者,根据术后6 h是否预防性输注新鲜冰冻血浆(FFP)分为对照组65例和FFP组47例。比较2组患者术后3 d平均生命体征和凝血指标及患者术后肛门排气时间、首次进流食时间、72 h伤口引流量、术后拔除引流管时间、术后住院天数、围手术期费用和术后并发症发生率。结果FFP组患者术后血白蛋白浓度显著高于对照组[(36.7±1.4)g/L vs(33.2±1.0)g/L,t=15.109,P<0.001],术后72 h伤口引流量、术后拔除引流管时间、术后住院天数、围手术期费用、总并发症发生率均小于对照组[(131.1±54.6)ml vs(212.0±67.8)ml,t=-6.749,P<0.001;(6.0±1.3)d vs(9.0±1.6)d,t=-10.81,P<0.001;(14.1±1.8)d vs(18.9±3.6)d,t=-9.334,P<0.001;(89531.0±7789.4)元vs(105743.3±7440.8)元,t=-11.16,P<0.001;10.6%(5/47)vs 36.9%(24/65),χ~2=9.821,P=0.002]。2组患者术后均未出现围手术期死亡,FFP组患者未出现输血相关并发症。结论胰十二指肠切除术患者术后预防性输注FFP,具有使患者术后出血少、恢复快、缩短住院时间、减少住院费用和降低并发症发生率等优点,对患者近期临床效果显著。     

规范化疼痛管理在肝胆外科术后患者疼痛控制中的应用

目的探讨规范化疼痛管理在肝胆外科术后患后疼痛控制中的应用效果。方法选取2017年11月—2018年4月住院行肝胆外科手术治疗的患者547例,分为对照组369例和观察组178例。对照组采用常规疼痛管理,观察组采取规范化疼痛管理。比较2组患者中重度静息疼痛的发生率、活动性疼痛评分等指标。结果观察组患者术后3天内中重度静息痛的发生率为20.22%,低于对照组的23.31%,差异有统计学意义(P<0.05)。术后6、12、24、48 h时观察组活动性疼痛评分低于对照组,差异有统计学意义(P<0.01)。结论规范化疼痛管理能有效控制肝胆外手术患者术后疼痛程度,有利于患者的快速康复。     

陕西省精神科床位资源现状的调查分析

目的在考虑精神科住院治疗“急慢分治”的前提下,提出适合陕西省的床位配置方案,为陕西省精神卫生资源配置提供参考依据。方法通过对陕西省所有的精神卫生专业机构进行问卷调查,掌握精神卫生床位资源现状。结合文献综述获取目前精神科住院的主要病种患病率和急慢性住院治疗的比例、住院日等数据,根据WHO推荐的精神科床位配置计算公式,计算精神科床位需求量,并将其与实际情况进行比较。结果陕西省精神科实际开放床位数为9584张(2.53张/万人),理论较低配置为7825张(2.06张/万人),其中急性床位3352张,慢性床位4473张;中等配置需16462张(4.34张/万人),其中急性床位11989张,慢性床位4473张;较高配置34156张(9.01张/万人),其中急性床位20747张,慢性床位13409张。结论陕西省精神科开放床位总数达到最低理论配置水平,不同地区间存在明显差异。建议精神科床位资源配置分阶段进行,在满足最低配置的前提下,逐步加强床位建设。根据病情需要,实行急慢分治,合理布局,实现床位资源的优化配置。     

Nursing of adverse effects in patients treated with liver resection plus sorafenib for hepatocellular carcinoma： 5 cases report

There were very few reports of adverse effects in patients treated by liver resection in combination with sorafenib. We present 5 cases of hepatocellular carcinoma treated with liver resection plus sorafenib , trying to observing the adverse effects and seeking the nursing options to the adverse effects. The 5 patients were all males, and the mean age was (38.6±13.4) years. Tumor sizes were (6.7±2.2) cm, and liver function was Child-Pugh class A. Diagnosis of Hepatocellular carcinoma (HCC) was confirmed by postoperative pathology. During the follow-ups, all the 5 patients had different degrees of adverse effects, of which 5 patients had diarrhea, 3 had hand-foot skin reaction, 1 had hypertension and 1 had alopecie. Diarrhea seems common in these patients, and it appeared early after treatment. For those patients with adverse effects, management measures were given immediately, including nursing interventions and some medicines. Psychological and symptomatic nursing guidance can help patients overcome the adverse effects. No patients suffered dose reduction or treatment discontinuation.     

HLA‐A2‐restricted Cytotoxic T Lymphocyte Epitopes from Human Hepsin as Novel Targets for Prostate Cancer Immunotherapy

Hepsin is a type II transmembrane serine protease that is overexpressed in prostate cancer, and it is associated with prostate cancer cellular migration and invasion. Therefore, HPN is a biomarker for prostate cancer. CD8⁺ T cells play an important role in tumour immunity. This study predicted and identified HLA‐A2‐restricted cytotoxic T lymphocyte (CTL) epitopes in human hepsin protein. HLA‐A2‐restricted CTL epitopes were identified using the following four‐step procedure: (1) a computer program generated predicted epitopes from the amino acid sequence of human hepsin; (2) an HLA‐A2‐binding assay detected the affinity of the predicted epitopes to the HLA‐A2 molecule; (3) the primary T cell response against the predicted epitopes was stimulated in vitro; and (4) the induced CTLs towards different types of hepsin‐ or HLA‐A2‐expressing prostate cancer cells were detected. Five candidate peptides were identified. The effectors that were induced by human hepsin epitopes containing residues 229 to 237 (Hpn229; GLQLGVQAV), 268 to 276 (Hpn268; PLTEYIQPV) and 191 to 199 (Hpn199; SLLSGDWVL) effectively lysed LNCaP prostate cancer cells that were hepsin‐positive and HLA‐A2 matched. These peptide‐specific CTLs did not lyse normal liver cells with low hepsin levels. Hpn229, Hpn268 and Hpn199 increased the frequency of IFN‐γ‐producing T cells compared with the negative peptide. These results suggest that the Hpn229, Hpn268 and Hpn199 epitopes are novel HLA‐A2‐restricted CTL epitopes that are capable of inducing hepsin‐specific CTLs in vitro. Hpn229, Hpn268 and Hpn199 peptide‐based vaccines may be useful for immunotherapy in patients with prostate cancer.     

Smoking prevalence and seizure control in Chinese males with epilepsy

Smoking has a negative effect on most diseases, yet it is under-investigated in people with epilepsy; thus its role is not clear in the general population with epilepsy. We performed a retrospective pilot study on males with epilepsy to determine the smoking rate and its relationship with seizure control using univariate analysis to calculate odds ratios (ORs) and also used a multi-variate logistic regression model. The smoking rate in our sample of 278 individuals was 25.5%, which is lower than the general Chinese population smoking rate among males of 52.1%. We used two classifications: the first classified epilepsy as generalized, or by presumed topographic origin (temporal, frontal, parietal and occipital). The second classified the dominant seizure type of an individual as generalized tonic clonic seizure (GTCS), myoclonic seizure (MS), complex partial seizure (CPS), simple partial seizure (SPS), and secondary GTCS (sGTCS). The univariable analysis of satisfactory seizure control profile and smoking rate in both classifications showed a trend towards a beneficial effect of smoking although most were not statistically significant. Considering medication is an important confounding factor that would largely influence seizure control, we also conducted multi-variable analysis for both classifications with drug numbers and dosage. The result of our model also suggested that smoking is a protective factor. Our findings seem to suggest that smoking could have a potential role in seizure control although confounders need exploration particularly in view of the potential long term health effects. Replication in a much larger sample is needed as well as case control studies to elucidate this issue.     

A massive hepatic tumor demonstrating hepatocellular,cholangiocarcinoma and neuroendocrine lineages: A case report and review of the literature

IntroductionMixed hepatocellular and cholangiocarcinoma tumors (MHCC) are described in the literature, as are the more rare mixed adenoneuroendocrine carcinomas (MANC) of hepatobiliary origin. Only two cases of tumors with characteristics of all three histologies/phenotypes have been previously described in one Chinese study.Presentation of caseHerein we report clinical, microscopic and molecular features of a 25 cm mixed hepatic tumor with hepatocellular, cholangiocarcinoma and neuroendocrine differentiation arising in an otherwise healthy 19-year-old North American Caucasian male without any identifiable risk factors.DiscussionThe patient underwent multimodality imaging and the tumor was biopsied preoperatively, and it was initially interpreted to be hepatocellular carcinoma fibrolamellar type. A left trisegmentectomy with lymphadenectomy was performed and the tumor was definitively diagnosed based on the surgically resected specimen. Integrated microscopic and molecular features defined the differing biological aggressiveness of growth pattern components. Cases in the literature of MHCC and rare cases of MANC have largely undergone aggressive surgical resection as well, however the majority of studies on mixed hepatic tumors to date reflect Eastern patient cohorts and populations with underlying liver disease, thereby limiting extrapolation on management or outcomes in this case.ConclusionThis is one of the only reports of a hepatic tumor arising from hepatocellular carcinoma, cholangiocarcinoma and neuroendocrine lineages. Increased awareness of this tumor type may optimize improve future management.