临床护士共享治理在给药安全管理中的实践

目的 将共享治理的管理理念运用到给药安全管理中,提高护士给药安全的风险管理意识和参与度,降低给药错误隐患事件和给药错误发生率.方法 2019年7～12月将共享治理应用于病房给药安全管理中,并与2019年1～6月未实施共享治理时的给药隐患事件、给药错误发生率、护理人员决策参与程度等进行对比.结果 实施共享治理后给药隐患事件、给药错误发生率显著低于实施前(P＜0.05,P＜0.01);实施共享治理后护理人员决策参与度和给药安全理念得分显著高于实施前(均P＜0.01).结论 共享治理能有效提高护士给药安全的风险管理意识,降低给药错误及隐患事件的发生.     

Evolutionary Action Score of TP53 Enhances the Prognostic Prediction for Stage I Lung Adenocarcinoma

Study overview. 83 patients with stage I lung adenocarcinoma were included in this study. Whole-exome sequencing was performed on surgical samples of these patients. Patients were further divided into 4 groups according to their TP53 mutational status. Tumor mutational burden, recurrence-free survival and overall survival were compared among different groups.

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基于相火理论探讨慢性咽炎发病机制及治疗

慢性咽炎多由五志过极、饮食劳倦、情志不舒等因素,引起相火妄动离位,客于咽喉而发病.本文以"相火相关理论"为依据,以"相火安位"为治疗目的,从清降心火,肃降肺气,疏肝理气,健运脾胃,滋养肝肾,引火归元辨证论治,达到相火安位,脏腑功能调和,气血津液正常输布,慢性咽炎诸症痊愈的目的.     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合糖皮质激素治疗急性泛发性发疹性脓疱病一例

患者女，64岁，因全身红斑脓疱半月余于2017年10月20日至我科就诊。患者3个月前于外院诊断为抗中性粒细胞胞质抗体相关性血管炎，口服泼尼松片40 mg/d治疗。1个月前因四肢关节疼痛口服硫酸羟氯喹片0.2 g/d，治疗10 d后前胸、后背出现散在分布的红色斑疹，伴剧烈瘙痒……     

Humanized C3 Mouse: A Novel Accelerated Model of C3 Glomerulopathy

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如何正确运用χ~2检验——两种单向有序二维列联表资料线性趋势χ~2检验

本文目的是介绍两种单向有序二维列联表资料线性趋势χ~2检验以及SAS与R软件实现的方法。两种单向有序二维列联表是指原因变量为R值有序变量的"R×2列联表"和结果变量为C值有序变量的"2×C列联表",对它们进行线性趋势检验分别需要采用Cochran-Armitage’s线性趋势χ~2检验和Lee’s线性趋势χ~2检验。     

Bioinformatics and immunohistochemistry analyses of expression levels and clinical significance of CXCL2 and TANs in an oral squamous cell carcinoma tumor microenvironment of Prophyromonas gingivalis infection

The present study aimed to detect the immunoexpression and clinical significance of Porphyromonas gingivalis (P. gingivalis) in the tumor microenvironment (TME) of oral squamous cell carcinoma (OSCC). The immunoexpression of P. gingivalis in OSCC tissues was detected via immunohistochemistry (IHC) after P. gingivalis was infected into the TME of OSCC. To identify the differentially expressed genes in the carcinogenesis and progression of OSCC with P. gingivalis infection, microarray datasets ({"type":"entrez-geo","attrs":{"text":"GSE87539","term_id":"87539"}}GSE87539 and {"type":"entrez-geo","attrs":{"text":"GSE138206","term_id":"138206"}}GSE138206) were downloaded from the Gene Expression Omnibus database. The immunoexpression levels of C-X-C motif chemokine ligand 2 (CXCL2) and tumor-associated neutrophils (TANs) were also evaluated via IHC, and the immunoexpression levels of all three clinical variables were analyzed using χ² or Fisher''s exact tests. The survival rates were calculated using the Kaplan-Meier method and the survival curves were compared using log-rank tests. Predominantly strong immunoexpression of P. gingivalis was identified in OSCC samples. CXCL2 was considered to be a differential gene in the two datasets. Immunoexpression of P. gingivalis was positively associated with CXCL2 and TANs expression. Furthermore, P. gingivalis was associated with survival status (P<0.001) and differentiation (P<0.001). CXCL2 was associated with age (P=0.038) and survival status (P=0.003), while TANs were associated with T stage (P=0.015) and clinical stage (P=0.002). These clinical variables were considered to be independent risk factors for the poor prognosis of patients with OSCC. Collectively, the results suggested that the immunoexpression of P. gingivalis may be positively associated with CXCL2 and TANs. In addition, the strong immunoexpression levels of P. gingivalis, CXCL2 and TANs may be associated with a poor prognosis in patients with OSCC.     

Hematological toxicities in immune checkpoint inhibitors: A pharmacovigilance study from 2014 to 2019

Immune checkpoint inhibitors (ICIs) have shown remarkable clinical effects in many cancer types. However, ICIs could also induce severe organ system toxicities, including those of the hematological system. The present study aimed to extensively characterize the hematological toxicities of ICIs immunotherapy. Data were extracted from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database from January 1, 2014, to March 31, 2019. Disproportionality analysis, including information component (IC) and reporting odds ratio (ROR), was used to detect potential disproportionality signal. The lower boundary of the 95% confidence interval of IC (IC₀₂₅) exceeding zero or that of ROR (ROR₀₂₅) exceeding one was considered statistically significant for detecting disproportionality signal. A total of 29 294 335 records were extracted from the database, with 132 573 related to ICIs. Overall, hematological adverse events (AEs) were more frequently reported in ICIs (IC₀₂₅: 0.81; ROR₀₂₅: 1.80). On further analysis, hematological AEs were overreported in female patients (female vs male, ROR₀₂₅: 1.04) and anti-CTLA-4 monotherapy groups (anti-CTLA-4 vs anti-PD-1, ROR₀₂₅: 1.33) and polytherapy groups (polytherapy vs monotherapy, ROR: 1.20, ROR₀₂₅: 1.11). Moreover, class-specific hematological AEs were also detected and differed in unique ICI regimens. Notably, disseminated intravascular coagulation had the highest proportion of death outcomes among the top 10 most frequently reported ICI-associated hematological AEs. Our study shows a high reporting frequency of hematological AEs induced by ICI monotherapy (especially by anti-CTLA-4 therapy) and reinforced by polytherapy. A spectrum of class-specific disproportionality signal was also detected; some were fatal and reported for the first time. The heterogeneous clinical spectrum of hematological toxicities, including the non-negligible proportion of death as reported outcome, are warranted to be reminded by clinicians. Early recognition and management of ICI-related hematological AEs are highly important and further studies are needed to confirm the results of our study.     

气不摄血证免疫性血小板减少症患者血管活性物质及相关炎症因子变化与临床意义

目的 本研究旨在探讨气不摄血证免疫性血小板减少症(ITP)患者血管活性物质及相关炎症因子在ITP发病中的作用及其临床意义。方法 气不摄血证ITP患者30例（ITP组），根据2016版ITP出血评分量表,分为未出血组、低危组（≤2分）及高危组（＞2分），健康正常人20例（对照组）。酶联免疫吸附（ELISA）法检测外周血血管活性物质一氧化氮(NO)、一氧化氮合成酶（NOS）及内皮素-1（ET-1）含量，AimPlex流式高通量技术检测外周血血管活性物质VEGF-A,VEGF-D及相关炎症因子IL-8,IL-10,IL-17A以及TNF-α含量。结果 与对照组相比较，气不摄血证ITP患者NOS、VEGF-A及IL-10含量显著降低（P＜0.05)，ET-1、IL-8、IL-17A以及TNF-α含量显著升高（P＜0.05)。同时，气不摄血证ITP患者中，高危组ET-1含量显著高于未出血组（P＜0.05），ET-1、VEGF-A含量与气不摄血证ITP患者出血显著相关（OR=1.012,95%CI:0.92-1.31；OR=1.065, CI:0.98-1.22,P＜0.05)。结论 血管活性物质及相关炎症因子在气不摄血证ITP患者的发病过程中具有重要作用，ET-1、VEGF-A可能是反应气不摄血证ITP患者出血风险的重要客观指标。