中药贴敷疗法在麻醉用药后静脉炎预防护理中的应用研究

目的：观察中药贴敷疗法在麻醉用药后静脉炎预防护理中的临床效果。方法：将麻醉用药的患者84 例，根据预防静脉炎时用药的不同进行分组，分为常规组和中医组，每组均42 例。常规组接受西药常规治疗，中医组接受中药贴敷治疗，比对2 组的静脉炎发生率、发生程度、疼痛程度以及护理满意度。结果：中医组静脉炎发生率低于常规组，中医组静脉炎发生程度不良率低于常规组，2 组比较，差异有统计学意义（P＜0.05）。中医组疼痛程度与常规组比较，差异有统计学意义（P＜0.05）。中医组疼痛发生率为7.14%，常规组为30.95%，2 组比较，差异有统计学意义（P＜0.05）。2 组护理满意评分比较，中医组优于常规组，差异有统计学意义（P＜0.05）。结论：中药贴敷疗法在预防麻醉用药后静脉炎预防护理中的应用效果较好，能有效降低静脉炎的发生率，并且能减轻静脉炎发生的程度，缓解了疼痛程度，有效提升护理满意度。     

局部晚期食管鳞癌新辅助放疗剂量与病理完全缓解关系分析

目的 探讨接受新辅助放化疗的局部晚期食管鳞癌患者新辅助放疗剂量与病理完全缓解(pCR)的关系。方法 收集2017-2019年间在四川大学华西医院肿瘤中心经病理确诊为食管鳞癌并接受新辅助放化疗和手术的 116例局部晚期患者临床资料。116例患者中 40~45Gy组 80例,≥45Gy组 36例,分析两组术后pCR率。结果 全组患者的pCR率为38.8%(45/116),40~45Gy组与≥45Gy组的pCR率分别为44%(35/80)和28%(10/36)(P=0.105)。结论 术前新辅助采用较高的放疗剂量不增加局部晚期食管鳞癌的pCR率,有必要进行前瞻性的临床研究确定合适的新辅助放疗剂量。     

Association Between Serum C-Reactive Protein Concentration and Nutritional Status of Malignant Tumor Patients

Background: The level of the systemic inflammatory marker C-reactive protein (CRP) is elevated in many patients with malignant disease and may be related to nutritional status.

Objective: To analyze the association between serum CRP levels in patients with malignant tumors and their nutritional status.

Method: A total of 3,692 cases were analyzed and the serum CRP levels were determined using an immunometric assay. Nutritional status was assessed by using patient-generated subjective global assessment (PG-SGA). The biochemical evaluation of prealbumin (PA), albumin (ALB), cholesterol (CHOL), and triglycerides (TG) were assayed within 48?h admission to the hospital. The association between serum CRP concentration and the nutritional status, the stage of the tumor and other factors was analyzed by univariate and multivariate logistic regression analysis.

Result: Elevated serum CRP was observed in 47.6% (1,548/3,269) of patients compared with the reference value, and the median CRP concentration was 18.29?mg/l. Patient serum CRP concentrations in the malnourished group (PG-SGA B?+?C) were higher than in the well-nourished (PG-SGA A) patients (P?<?0.05). The serum CRP level was related to the patients' age, gender, tumor stage, and was affected by hepatitis, liver cirrhosis, diabetes, but it has no effect on hypertension. The CRP high patients had lower PA and ALB levels, lower Karnofsky performance status scores, and higher PG-SGA scores (P?<?0.05), and there was no relationship with CHOL and TG levels. Weight loss in the previous 1?mo was seen with CRP positive patients (P?<?0.05).

Conclusion: Almost 50% of malignant tumor patients had elevated serum CRP levels indicating a systemic inflammatory state. The nutritional status was worse in cancer patients with higher concentrations of serum CRP. The level of CRP was associated with the tumor stage, and, as stage is a prognostic factor, so can CRP be used as a prognostic maker in malignant tumors patients.     

水针疗法联合清热祛毒汤治疗寻常型银屑病(血热证)的疗效及其作用机制分析

目的观察分析水针疗法联合清热祛毒汤治疗寻常型银屑病(血热证)的疗效及其作用机制。方法选择2018年8月—2019年7月在我院接收治疗的112例寻常型银屑病患者作为分析对象,采取随机分组的办法将其分为对照组56例和研究组56例,对照组患者采取水针疗法治疗,研究组在对照组的基础上联合清热祛毒汤治疗。比较分析2组患者的疗效;治疗前后的中医证候评分、皮肤病生活质量指数(DLQI)评分;治疗前后皮损面积、浸润、鳞屑、红斑等评分;治疗前后肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、血管内皮生长因子(VEGF)水平变化情况。结果研究组患者治疗总有效率89.29%明显高于对照组73.21%(P<0.05);治疗前,2组患者的中医证候评分、DLQI评分、皮损面积、浸润、鳞屑、红斑等评分及TNF-α、IL-6、VEGF等水平比较(P>0.05);研究组患者治疗后的中医证候评分与DLQI评分明显低于治疗前(P<0.05);研究组患者治疗后的皮损面积、浸润、鳞屑、红斑等评分明显低于对照组(P<0.05);研究组患者治疗后的TNF-α、IL-6、VEGF等水平明显低于对照组(P<0.05)。结论对寻常型银屑病患者采取水针疗法联合清热祛毒汤治疗的疗效显著,能有效改善中医证候表现,提高生活质量,减轻皮损程度,降低炎症反应,其作用机制可能与炎症因子水平、皮损血管增生相关。     

PBL联合CBL教学法在中医院校影像教学中应用的优势

随着影像技术的快速发展,影像检查已发展为临床诊断疾病的主要手段之一。所以作为未来医疗工作者的医学生,学好影像学变得越来越重要。目前影像教学大多采用传统的“满堂灌”的授课方式,学生处于学习的被动状态,效果并不尽人意。如何才能让学生真正掌握影像学知识,是值得每位任教老师深思的问题。作者结合多年的教学经验与实践,并针对中医院校医学生西医知识相对薄弱,课时少这一特点,认为PBL联合CBL教学法不但可以激发学生学习的主观能动性,培养学生的自学能力,增强学生解决问题的能力,提升临床思维能力,还可以提高课堂效率,有利于学生更好地学习、掌握影像知识,并学会将所学理论知识应用于临床实践。     

SNPs in the COX-2/PGES/EP signaling pathway are associated with risk of severe capecitabine-induced hand-foot syndrome

Cancer Chemotherapy and Pharmacology - Capecitabine is a widely used 5-fluorouracil oral prodrug. Hand-foot syndrome (HFS), one of the most common adverse events of capecitabine, impacts...     

Epidermal growth factor‐induced COX‐2 regulates metastasis of head and neck squamous cell carcinoma through upregulation of angiopoietin‐like 4

Epidermal growth factor receptor (EGFR) expression and activation are the major causes of metastasis in cancers such as head and neck squamous cell carcinoma (HNSCC). However, the reciprocal effect of EGF‐induced COX‐2 and angiopoietin‐like 4 (ANGPTL4) on HNSCC metastasis remains unclear. In this study, we revealed that the expression of ANGPTL4 is essential for COX‐2‐derived prostaglandin E₂ (PGE₂)‐induced tumor cell metastasis. We showed that EGF‐induced ANGPTL4 expression was dramatically inhibited with the depletion and inactivation of COX‐2 by knockdown of COX‐2 and celecoxib treatment, respectively. Prostaglandin E₂ induced ANGPTL4 expression in a time‐ and dose‐dependent manners in various HNSCC cell lines through the ERK pathway. In addition, the depletion of ANGPTL4 and MMP1 significantly impeded the PGE₂‐induced transendothelial invasion ability of HNSCC cells and the binding of tumor cells to endothelial cells. The induction of molecules involved in the regulation of epithelial‐mesenchymal transition was also dependent on ANGPTL4 expression in PGE₂‐treated cells. The depletion of ANGPTL4 further blocked PGE₂‐primed tumor cell metastatic seeding of lungs. These results indicate that the EGF‐activated PGE₂/ANGPTL4 axis enhanced HNSCC metastasis. The concurrent expression of COX‐2 and ANGPTL4 in HNSCC tumor specimens provides insight into potential therapeutic targets for the treatment of EGFR‐associated HNSCC metastasis.     

基于MRI动态图像观察吞咽时器官动度对头颈部肿瘤调强放疗靶区影响

目的 利用MRI技术连续采集头颈部肿瘤患者吞咽时图像,观察并测量软腭、舌、喉的运动规律及最大活动度。方法 随机选取2018年7月-10月在中国医学科学院肿瘤医院接受调强放疗的原发头颈部恶性肿瘤20例患者,其中男17例、女3例,中位年龄58.5岁(28~78岁)。20例患者中鼻咽癌7例,口腔癌3例,口咽癌5例,下咽癌3例,鼻腔鼻旁窦2例。根据AJCC第八版分期Ⅰ-Ⅱ期患者2例,Ⅲ期8例,Ⅳ期10例。结果 吞咽时软腭向上移动移动距离为(1.06±0.31) cm且服从正态分布,向后移动距离为(0.83±0.24) cm且近似正态分布。舌体向后移动距离为(0.77±0.22) cm,且服从正态分布。含压舌板行图像采集患者舌上移位移为0,无压舌板患者舌体中位上移距离为1.23 cm (0.59~1.41 cm)。喉向上移动距离为(1.14±0.22) cm且服从正态分布,向前移动的中位距离为0.4 cm (0.27~0.90 cm)。结论 吞咽运动有可能发生于头颈部肿瘤患者放疗过程中,并引起大体肿瘤体积(GTV)及周围正常组织移动;因此在制定放疗计划时应注意GTV至PGTV的个体化外放距离,以保证肿瘤处方剂量。     

益气活血化瘀方治疗高血压性脑基底节出血术后的临床研究

目的观察益气活血化瘀方治疗高血压性脑基底节出血术后的临床疗效。方法将60例高血压性脑基底节出血患者随机分为观察组28例与对照组32例,对照组予单纯手术治疗,观察组在手术基础上联合益气活血化瘀方治疗。观察两组患者在治疗前后格拉斯哥昏迷指数(GCS)评分、肌力、血肿体积、中医证候积分、住院时间,并评估疗效。结果经治疗后,两组患者GCS评分明显下降,血肿体积明显缩小,中医证候积分明显降低,术后瘫痪侧肌力均明显改善(均P<0.05),观察组改善程度优于对照组(P<0.05);观察组中医证候总有效率为75.00%,明显高于对照组的59.38%(P<0.05);观察组的住院时间明显短于对照组(P<0.05)。结论益气活血化瘀方联合手术治疗可明显改善高血压性脑基底节出血患者的GCS评分、肌力,降低中医证候积分,缩小血肿体积,缩短住院时间,提高中医证候疗效。     

利用电子顺磁波谱技术研究红参对羟自由基的清除作用

目的 探索电子顺磁波谱（electron paramagnetic resonance，EPR）技术检测红参清除自由基活性的适合产生体系，并研究红参对羟自由基（?OH）的清除作用及其物质基础。方法 采用电子顺磁共振波谱仪检测不同浓度的红参提取液对?OH的体外清除作用，并用液质联用技术（LC-MS）分析红参中的主要皂苷成分，然后研究这些人参皂苷成分对?OH的清除作用。结果 确定了羟自由基的生成体系为：Fe²⁺ 0.1 mmol?L^-1、H₂O₂ 500 mmol?L^-1、DMPO 225 mmol?L^-1；不同浓度的红参提取液对?OH具有明显的清除作用，且其清除?OH的效力与浓度成正相关；LC-MS分析显示该红参提取液中主要含有Rh1、Rf、Rb3、F1、F2、Rg3、Rg5等成分，其中人参皂苷Rg5的清除自由基活性最强。结论 本研究建立了用EPR技术研究红参清除自由基活性的适合产生体系，红参具有明显的清除?OH的能力，且人参皂苷Rg5是其清除自由基的活性成分之一，确定了红参抗自由基的主要物质基础，为红参及人参皂苷Rg5的开发、应用提供了科学依据和理论基础。