乳腺癌患者外周血淋巴细胞rDNA转录活性的图像分析

本实验应用计算机图像分析系统对乳腺癌患者外周血淋巴细胞中核仁的银染强度进行测试,并同乳腺纤维腺瘤和正常人进行比较。结果发现,由核仁银染强度所反映出的淋巴细胞rDNA转录活性在体内癌变过程中显著下降,明显低于乳腺纤维腺瘤和正常人。表明淋巴细胞rDNA转录活性可以反映出体内癌变进展程度与机体免疫状况的相互关系。     

Recurrence or metastasis of HCC:predictors, early detection and experimental antiangiogenic therapy

AIM To investigate the predictors for recurrence or metastasis of HCC, and to evaluate the effect of antiangiogenic therapy on the growth of transplantable human HCC in nude mice. METHODS RT-PCR was used to measure the expression of matrix metalloproteinase-9 (MMP-9) and vascular endothelial growth factor (VEGF) in 56 pairs of nontumorous liver and tumor samples. Sixty blood samples from human HCC were examined by nested RT-PCR to find out AFP mRNA. Recombinant human endostatin and polyclonal antibody against VEGF were administered to treat human HCC transplanted in nude mice. RESULTS Thirty of 56 HCC samples showed stronger expression of MMP-9 in tumorous tissues than in nontumorous tissues. Fifteen of the 26 patients with relative expression level of MMP-9 more than 0.34 developed tumor recurrence or metastasis, whereas only 7 of 30 patients with relative expression level less than 0.34 developed tumor recurrence (P＜0.05).There was no significant difference in the relative expression level of VEGF between patients with postoperative recurrence or metastasis and those without recurrence. AFP mRNA was detectable in 53.3% of patients with HCC. The sensitivity and specificity of AFP mRNA as a marker to detect hematogenous dissemination of HCC cells was 81.8% and 84.4%, respectively. Recombinant human endostatin and polyclonal antibody against VEGF inhibited the growth of transplantable HCC in nude mice by 52.2% and 45.7%, respectively.CONCLUSION MMP-9 expression in HCC correlates with the postoperative recurrence or metastasis of HCC. Patients with high level of MMP-9 expression in HCC are susceptible to metastasis. AFP mRNA could serve as an indicator of hematogenous spreading of HCC cells in circulation and a predictor of recurrence or metastasis of HCC. Antiangiogenesis may be an adjuvant therapy for HCC.     

妊娠合并帆状胎盘血管破裂临床分析

介绍我院自１９８８－１９９７年共分娩１６７３２例，其中帆状胎盘１２例，４例发生脐血管破裂。分娩结局，１例胎死宫内，３例因救及时，新生儿存活，但均出现青紫窒息。认为本病力争早期发现，并迅速以剖宫产结束分娩，同时做好新生的抢救工作。     

Competence in Mental Health Care: A Hermeneutic Perspective

In this paper we develop a hermeneutic approach to the concept of competence. Patient competence, according to a hermeneutic approach, is not primarily a matter of being able to reason, but of being able to interpret the world and respond to it. Capacity should then not be seen as theoretical, but as practical. From the perspective of practical rationality, competence and capacity are two sides of the same coin. If a person has the capacity to understand the world and give meaning to the situation, he or she is able to make decisions, and is thus competent. People can fail in the area of practical rationality. They can feel ill at ease, uncomfortable or not at home in the situation. Under such conditions, they appear as incompetent, and urge caregivers to respond in such a way that their competence can be raised. The issue is not how to measure their incompetence, but how to help them to become more competent, that is to get a practical grip on their situation and to be able to live out their lives in such a way that they develop their identity in relations with others. From a hermeneutic point of view, assessing a patient's capacity implies focusing on the patient's way of meaning making and regarding her behavior from the perspective of practical rationality. The focus should not be on the assessment as a matter of fact, but on improving capacity. This requires allowing the patient to experience the world meaningfully and affording her, in the context of a supportive and trustful institutional environment, the possibility of developing a personal narrative where her choices are expressed verbally or non-verbally.     

肾癌的CT诊断(附15例分析)

本文分析了病理证实的14例肾细胞癌和1例肾盂癌的CT表现。检查方法包括增强前、后CT扫描。肾细胞癌常见的CT表现为:(1)增强前为低密度肾实性肿块;(2)增强后低密度肿块显示更清楚;(3)肿块与周围。肾实质分界不清;(4)转移性改变为肾静脉增粗、局部淋巴结肿大、下腔静脉受累以及远处转移。肾盂癌的CT表现颇具特征。增强前扫描扩张的肾盂内可见到软组织肿块。增强后肾盂壁呈新月形增厚并突向扩大的肾盂形成密度增高的软组织块影。文中讨论了肾癌各种CT表现的意义及其与其他肾占位病变的鉴别诊断。     

肝动脉化疗栓塞联合部分脾动脉栓塞治疗肝癌合并脾功能亢进的临床研究

目的探讨肝动脉化疗栓塞（TACE）联合部分脾动脉栓塞（PSE）治疗原发性肝癌合并脾功能亢进（脾亢）的临床应用价值及意义。方法将10例明确诊断为原发性肝癌合并脾亢患者作为治疗组。在给予TACE的同时行PSE：并在同期患者中随机抽取10例仅诊断为原发性肝癌患者作为对照组。20倒患者均有乙型肝炎病史：肝功能Child分级A、B、C级分别为12、7、1例。观察治疗组术后1周、1个月白细胞、血小板计数变化情况,以及治疗组与对照组术后1周、1个月肝功能损害情况。结果20例患者均一次性插管成功,无术中、术后严重并发症发生。治疗组术后1周、1个月白细胞、血小板计数较术前有不同程度升高,差异有统计学意义（P〈0．05）;对照组术后1周丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）与术前比较,差异有统计学意义（P〈0．01）,总胆红素（TBIL）、清蛋白（Alb）及术后1个月肝功能与术前比较,差异无统计学意义（P〉0．05）。治疗组术后1周、1个月肝功能与术前比较,差异无统计学意义（P〉0．05）。结论TACE联合PSE治疗原发性肝癌合并脾亢,手术操作简便安全,对减轻术后肝功能的进一步损害、缓解脾亢临床效果满意．值得推广。     

脑心通胶囊干预经皮冠状动脉介入术后抗栓治疗27例临床研究

目的 探讨脑心通胶囊干预经皮冠状动脉介入术(PCI)后抗栓治疗的疗效. 方法 选取行PCI成功且符合纳入标准的冠心病患者54例,随机分为治疗组和对照组各27例.对照组进行术后规范抗栓治疗,治疗组在对照组基础上加用脑心通胶囊,每次4粒,每天3次,连续使用1个月.观察治疗前、治疗后10天气虚证、血瘀证积分及远近期抗栓疗效,同时评估安全性. 结果 与治疗前比较,治疗组治疗后10天气虚证积分明显降低(P＜0.01),对照组明显升高(P＜0.01);两组患者治疗后10天血瘀证积分、最大血小板聚集率(MPA)、血浆遗传性假血友病因子(vWF)、血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)、凝血酶原片段1+2[F(1+2)]和纤维蛋白原(Fg)均明显降低(P＜0.01),但治疗组下降更趋明显(P＜0.05);对照组3例发生主要不良心血管事件(MACE),治疗组均未发生MACE,两组比较差异无统计学意义(P＞0.05);两组在服药期间均无主要出血事件和次要出血事件发生.结论 脑心通胶囊可明显降低PCI术后10天气虚证、血瘀证积分,抑制血小板活化,保护血管内皮细胞,改善机体凝血功能,且不引起血小板减少和出血等药物不良反应.     

个性化护理对肱骨骨折手术预后的影响

目的探讨个性化护理对肱骨骨折患者术后恢复情况及并发症发生的影响。方法将500例肱骨骨折的患者随机分两组,每组250例,对照组给予常规护理,观察组在常规护理的基础上给予个性化护理。结果观察组术后功能恢复良好238例,术后有12例发生并发症,对照组术后功能恢复良好188例,术后62例出现并发症,2组比较有统计学意义（x^2=21．11,P〈0．05）。结论个性化护理可以改善肱骨骨折患者术后恢复情况,同时减少了临床上并发症的发生。