不同手术方案对脊髓型颈椎病合并椎管狭窄症患者术后疗效及颈椎矢状位参数的影响

目的探讨前路椎体次全切除术和后路椎管扩大椎板成形术对脊髓型颈椎病(CSM)合并椎管狭窄症患者术后疗效及颈椎矢状位参数的影响。方法回顾性分析2010年3月—2015年8月收治的147例CSM合并椎管狭窄症患者的临床资料,其中80例行前路椎体次全切除术治疗(A组),67例行后路椎管扩大椎板成形术治疗(B组)。比较2种手术方法治疗前后日本骨科学会(JOA)评分、Cobb角及矢状位垂直距离(SVA)。将2组患者根据T_1倾斜角分别分为高T_1倾斜角(≥25°)亚组和低T_1倾斜角( 25°)亚组,对不同亚组之间的疗效及手术安全性进行比较。结果 2组术后JOA评分和Cobb角均高于术前,差异有统计学意义(P 0.05)。A组术后SVA低于术前,差异有统计学意义(P 0.05),B组术后SVA与术前相比差异无统计学意义(P 0.05)。A组术后JOA评分和Cobb角均高于B组,SVA低于B组,差异均有统计学意义(P 0.05)。A组中,高T_1倾斜角亚组和低T_1倾斜角亚组JOA评分改善效果和后凸畸形发生率比较差异无统计学意义(P 0.05);B组中,低T_1倾斜角亚组JOA评分改善效果和后凸畸形发生率优于高T_1倾斜角亚组,差异均有统计学意义(P 0.05)。结论相较于后路椎管扩大椎板成形术,前路椎体次全切除术治疗CSM合并椎管狭窄症临床疗效更佳,且有助于改善颈椎矢状位平衡;在高T_1倾斜角水平下,应尽可能选择前路椎体次全切除术。     

解析安全护理管理模式在妇产科手术室护理中的效果

目的分析在妇产科手术室护理中采取安全护理管理模式的临床效果。方法选入该院于2017年8月-2019年3月期间妇产科进行手术的患者66例,以抽签法的形式将其分为研究组和对照组,分别为33例。对照组行常规护理,研究组在此基础上加行安全护理管理模式,对比两组患者的各类护理不安全事件的发生概率、各项护理质量评分。结果研究组各类护理不安全事件的发生概率低于对照组(P<0.05);研究组各项护理质量评分高于对照组(P<0.05)。结论在妇产科手术室护理中进行安全护理管理模式,可以减少不安全事件的发生,医患纠纷等,提高了护理质量,促使手术能够顺利的进行,值得在临床上推广和应用。     

How case law impacts risk management

Published decisions by federal and state appellate courts impact health care risk management in a number of ways, including overruling precedents, explaining and clarifying new laws and regulations, describing new and novel rules, describing new performance standards, and describing new civil rights.     

维生素D受体基因多态性与特发性癫痫的相关性

目的：探讨维生素D受体基因多态性与特发性癫痫的相关性。方法：通过病例对照研究方法，选取91例特发性癫痫患者作为病例组，另选取同期105例健康者作为对照组，抽取所有研究对象外周静脉血提取DNA，采用PCR直接测序法进行维生素D受体基因BsmI（rs1544410）、FokI（rs2228570）、Cdx2（rs11568820）位点多态性检测。结果：病例组与对照组的BsmI与FokI位点基因型频率和等位基因频率无显著差异（P>0.05）；Cdx2位点基因型频率存在显著差异（χ²=6.67，P=0.036），等位基因频率无显著差异，该位点发生A/G变异，分布不处于Hardy-Weinberg遗传平衡。在Cdx2位点基因型与特发性癫痫关联性分析中，病例组中Cdx2位点AG基因型是特发性癫痫发病的危险因素（OR=2.222，95% CI：1.190~4.150，P=0.027）。结论：维生素D受体基因Cdx2位点多态性与特发性癫痫具有关联性。     

Second Victim Experience and Perception Discordance of the Colonoscopic Perforation

Digestive Diseases and Sciences - Perforation is the most serious adverse event of colonoscopy, but rarely considered from the view of colonoscopists’ second victim experience and perception...     

RIP3/MLKL-mediated neuronal necroptosis induced by methamphetamine at 39℃

Methamphetamine is one of the most prevalent drugs abused in the world.Methamphetamine abusers usually present with hyperpyrexia (39℃),hallucination and other psychiatric symptoms.However,the detailed mechanism underlying its neurotoxic action remains elusive.This study investigated the effects of methamphetamine + 39℃ on primary cortical neurons from the cortex of embryonic Sprague-Dawley rats.Primary cortex neurons were exposed to 1 mM methamphetamine + 39℃.Propidium iodide staining and lactate dehydrogenase release detection showed that methamphetamine + 39℃ triggered obvious necrosis-like death in cultured primary cortical neurons,which could be partially inhibited by receptor-interacting protein-1 (RIP1) inhibitor Necrostatin-1 partially.Western blot assay results showed that there were increases in the expressions of receptor-interacting protein-3 (RIP3) and mixed lineage kinase domain-like protein (MLKL) in the primary cortical neurons treated with 1 mM methamphetamine + 39℃ for 3 hours.After pre-treatment with RIP3 inhibitor GSK’872,propidium iodide staining and lactate dehydrogenase release detection showed that neuronal necrosis rate was significantly decreased;RIP3 and MLKL protein expression significantly decreased.Immunohistochemistry staining results also showed that the expressions of RIP3 and MLKL were up-regulated in brain specimens from humans who had died of methamphetamine abuse.Taken together,the above results suggest that methamphetamine + 39℃ can induce RIP3/MLKL regulated necroptosis,thereby resulting in neurotoxicity.The study protocol was approved by the Medical Ethics Committee of the Third Xiangya Hospital of Central South University,China (approval numbers: 2017-S026 and 2017-S033) on March 7,2017.     

The RAS-RAL axis in cancer: evidence for mutation-specific selectivity in non-small cell lung cancer

Activating RAS mutations are common in human tumors. These mutations are often markers for resistance to therapy and subsequent poor prognosis. So far, targeting the RAF-MEK-ERK and PI3K-AKT signaling pathways downstream of RAS is the only promising approach in the treatment of cancer patients harboring RAS mutations. RAL GTPase, another downstream effector of RAS, is also considered as a therapeutic option for the treatment of RAS-mutant cancers. The RAL GTPase family comprises RALA and RALB, which can have either divergent or similar functions in different tumor models. Recent studies on non-small cell lung cancer (NSCLC) have showed that different RAS mutations selectively activate specific effector pathways. This observation requires broader validation in other tumor tissue types, but if true, will provide a new approach to the treatment of RAS-mutant cancer patients by targeting specific downstream RAS effectors according to the type of RAS mutation. It also suggests that RAL GTPase inhibition will be an important treatment strategy for tumors harboring RAS glycine to cysteine (G12C) or glycien to valine (G12V) mutations, which are commonly found in NSCLC and pancreatic cancer.