深海真菌Phomopsis tersa的次级代谢产物及其细胞毒活性研究

目的 研究深海真菌Phomopsis tersa FS441的次级代谢产物及其细胞毒活性。方法 采用正、反相硅胶柱、凝胶柱和高效液相等多种色谱技术对菌株FS441的固体发酵产物进行分离纯化,并通过NMR、MS等波谱方法鉴定化合物结构,采用SRB法对得到的单体化合物进行细胞毒活性测试。结果 从发酵物中分离纯化得到11个化合物,分别鉴定为：5α, 8α-表二氧麦角甾-6,22-二烯-3β-醇（1）、麦角甾醇（2）、12-hydroxydehydrobotrydienol（3）、5,6-二羟基-2,3,6-三甲基环己-2-烯酮（4）、1,2-二羟基-3,4-脱氢蒽酮（5）、（1S,2S,3S,4R） -3-氯-4-（2-羟基丙吡啶-2-基）-1-甲基环己烷-1,2-二醇（6）、（-）-5-methylmellein（7）、酪醇（8）、胸腺嘧啶核苷（9）、（R）-（+）-甘油1-9 （Z）,12 （Z）-十八碳二烯酸酯（10）、亚油酸（11）。结论 化合物3～6为首次从Phomopsis属分离得到,化合物1和2对SF-268、MCF-7、HepG-2和A549 4种肿瘤细胞株具有弱的细胞毒活性。     

目标与关键结果管理法在护士规范化培训新模式持续改进中的应用

目的 观察目标与关键结果(OKR)管理法在护士规范化培训新模式持续改进中的应用效果。方法 将2019年新入职护士59名设为对照组,2020年新入职护士55名设为观察组,2组护士在科室实践能力培训12个月后增加病例汇报专项培训与考核。对照组按照常规方法进行为期6个月的培训与考核,观察组引入OKR管理思想和工具进行为期4个月的培训与考核。培训结束后比较2组护士的合格率、优秀率、核心胜任力及培训满意度。结果 观察组病例汇报培训考核合格率、优秀率比对照组均有提高,差异有统计学意义(P<0.05);缩短培训时长对2组护士的核心胜任力没有影响,2组比较差异无统计学意义(P>0.05);观察组培训满意度高于对照组,差异有统计学意义(P<0.05)。结论 应用OKR工作法提高了培训考核的合格率、优秀率,缩短了培训时间,提升了新入职护士对培训新模式的满意度,可用于持续改进规范化培训新模式的培训质量。     

神经阻滞治疗带状疱疹相关性疼痛回顾性研究

目的：探讨神经阻滞治疗带状疱疹相关性疼痛(zoster-associated pain, ZAP)的疗效。方法：回顾性分析南京大学医学院附属金陵医院疼痛科2018年6月至2022年6月接受神经阻滞治疗的ZAP病人共153例,按带状疱疹病程分为急性期组(acute herpetic neuralgia, AHN)(1～30天)、亚急性期组(subacute herpetic neuralgia, SHN)(31～90天)和慢性期组(postherpetic neuralgia, PHN)(> 90天)。所有病人均行2次神经阻滞治疗,每次间隔7天。记录病人入院时、出院时、出院后1个月和3个月疼痛视觉模拟评分法(visual analogue scale, VAS)评分、口服药用量、匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)、病人满意度评分(likert scale)和药物不良反应。结果：三组病人出院时各项评分均较入院时明显改善(P <0.05),1个月和3个月时AHN组和SHN组普瑞巴林用量较出院时降低(P <0.05)...     

术中综合保温护理对手术患者术中低体温和术后感染的影响分析

目的 分析在手术患者护理中应用术中综合保温护理模式,对手术患者术中低体温、术后感染的影响。方法 选取 2021 年 8 月至 2022 年 8 月期间在本院进行手术治疗 110 例患者作为研究对象。采用随机摸球分组方式将患者分为对照组与实验组, 每组 55 例。对照组采用常规护理;实验组采用术中综合保温护理。分析对比两组的手术情况、术中体温及术后感染情况以及 护理满意度。结果 实验组术毕体温显著高于对照组,拔管时间和苏醒时间均显著短于对照组（P<0.05）。实验组护理总满意 度显著优于对照组（P<0.05）。结论 采用术中综合保温护理模式对进行手术治疗的患者实施护理干预,能减少手术患者出现 低体温及术后感染,提高护理满意度。     

贝伐单抗在新生血管性青光眼中的应用

目的 观察贝伐单抗在新生血管性青光眼治疗中的作用. 方法 选择2008年3月至2010年6月入住本院的15例(15眼)NVG患者,玻璃体腔内注射贝伐单抗1.25 mg/0.05 ml,前房角及虹膜新生血管消失后接受小梁切除术(联用抗代谢药丝裂霉素C).随访观察患者视力、眼压、虹膜、前房角新生血管情况. 结果 所有患者平均随访12个月,注射后7d所有患者前房角及虹膜表面新生血管均消失,平均眼压为(27.53±5.25) mmHg,术后1d、1周、1个月、6个月、12个月时平均眼压分别为(14.93±4.11)、(16.40±3.48)、(17.33±3.15)、(19.27±4.54)、(19.60±3.68) mmHg,均明显低于注药前水平[( 37.80±6.25) mmHg,P＜ 0.01].随访结束时眼压完全控制10只眼,部分控制5只眼;视力无变化或较术前改善,虹膜新生血管无复发. 结论 术前使用贝伐单抗可以有效清除虹膜和前房角新生血管,减少术中、术后出血风险,有助于后期通过显微外科技术来治疗NVG.     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.     

胃泌素对结肠癌细胞中粘着斑激酶通路下游E-钙粘蛋白/β-连环蛋白复合物的影响

目的探讨胃泌素对结肠癌细胞CoLo320WT中粘着斑激酶（FAK）通路下游E-钙粘蛋白／β-连环蛋白（E-cadherin／β-catenin）复合物分布的影响；方法脂质体转染表达胃泌索受体CCK-2R的pCR3．1／OR质粒于结肠癌细胞CoLo320中。G418筛选出稳定表达CCK-2R的阳性克隆，RT-PCR鉴定，转染成功命为CoLo320WT。应用10^-8mmol／L 胃泌素（G17）以时间梯度（0h、1h、6h、12h、24h、48h）干预CoLo320WT细胞，同时应用10^-6mmol／L胃泌素受体拮抗剂L365，260干预CoLo320WT细胞30min，再予10^-8mmol／L胃泌素干预。采用免疫印迹法检测磷酸化的FAK Tyr397和总FAK的表达。采用免疫共沉淀和免疫印迹法检测CoLo320WT中TX-100溶解和未溶部分中的E-钙粘蛋白和β-连环蛋白的表达。用免疫细胞化学法观察E-钙粘蛋白和β-连环蛋白的在胞膜、胞质和胞核的分布。结果随着胃泌素干预时间的延长，细胞中磷酸化的FAK Tyr397的表达量呈增加趋势，12h达最大值。胃泌素受体拮抗剂L365，260阻断后磷酸化的FAK Tyr397表达减少。而胃泌素对总FAK没有明显影响。TX-100可溶性部分中E-钙粘蛋白和酽连环蛋白的量在胃泌素干预后表达减少，拮抗剂L365，260阻断后又增加。而TX-100不溶解部分中表达却相反。免疫细胞化学观察到在胃泌素干预下CoLo320WT细胞中E-钙粘蛋白和β-连环蛋白的分布发生胞质和胞核转移。结论胃泌素与其受体CCK-2受体结合，磷酸化的FAK Tyr397、激活FAK通路进而影响结肠癌细胞中E-钙粘蛋白和β-连环蛋白的分布，促进结肠癌细胞侵袭和转移。     

肛门外超低位结直肠吻合术治疗中低位直肠癌33例临床观察

对33例中低位直肠癌患者行肛门外结直肠吻合的保肛术,结果33例患者均成功完成肛门外结直肠吻合保肛术,术后发生吻合口瘘1例,无吻合口狭窄和吻合口出血.随访5 a局部复发1例,所有患者肛门控便功能在术后3～6月恢复.认为本术式在保证彻底根治的前提下明显提高了保肛率,降低了并发症的发生率,可在临床上推广应用.