三维路径图技术在支架辅助栓塞颅内宽颈动脉瘤中的应用

目的探讨三维路径图技术在支架辅助栓塞颅内宽颈动脉瘤治疗中的应用。方法回顾性分析利用三维路径图技术对10例颅内宽颈动脉瘤患者进行介入栓塞治疗的过程和效果。结果10例动脉瘤均成功栓塞,术后即刻栓塞结果按改良的Raymond分级：动脉瘤完全栓塞7例（Ⅰ级）,瘤颈残留2例（Ⅱ级）,瘤体显影1例（Ⅲ级）。术后随访1～6个月,临床无再出血,急性缺血1例表现为下肢单瘫。结论三维路径图技术具有实时跟踪、高清晰度和精确度等优势,对栓塞治疗起着重要的指导作用。     

肝硬化脾切除术后门静脉血栓形成相关因素的Meta分析

目的 评价肝硬化脾切除术后门静脉血栓形成的相关因素,为脾切除术后血栓的预防提供参考.方法 计算机检索Web of Science、PubMed、EMBASE、Science Direct、CNKI、VIP、CSCD、万方等数据库,检索时间截止2014年4月.并辅以手工检索、文献追溯等方法.纳入有关肝硬化脾切除术后门静脉血栓形成相关因素的病例对照研究,并进行文献质量评价.由两位研究者独立提取数据并采用Stata 12软件进行Meta分析.结果 共纳入24项符合标准的病例对照研究,病例数为4 335例.其中脾切除术后发生血栓的患者1 028例,血栓发生率为25.0％.Meta分析结果显示,肝硬化脾切除术后门静脉血栓的形成与脾脏体积(WMD=13.75,95％ CI:6.47 ～ 21.00)、脾静脉直径(WMD=1.34,95％ CI:0.39～2.30)、手术前后门静脉直径(术前WMD＝ 1.54,95％ CI:0.56～2.52;术后WMD=2.09,95％CI:0.55 ～ 3.64)、手术前后门静脉血流速度(术前WMD=-5.78,95％ CI:-10.46～-1.10;术后WMD=-5.57,95％ CI:-5.92～-5.22)、手术前后门静脉压力差(WMD=1.90,95％CI:1.29～2.50)、腹水(OR=1.83,95％ CI:1.19～2.82)以及术后抗凝干预(OR=0.63,95％CI:0.50 ～0.79)等有关;而与患者的性别、年龄、肝功、血小板计数、术前总胆红素、手术前后门静脉压力、手术前后凝血酶原时间及D-二聚体、手术时间以及糖尿病无关.结论 肝硬化脾切除术后门静脉血栓形成的主要危险因素为脾脏体积、脾静脉直径、门静脉直径、门静脉血流速度、腹水等,与患者基本情况、凝血相关指标、手术时间等无直接相关性.     

应用NCCLS EP9-A文件评价两种磷试剂

目的探讨在生化分析仪上使用国产试剂替代进口原装试剂检测血清磷(Phosphor)的可行性。方法按照EP9-A文件提供的方法,每天取临床标本8份,分别用两种试剂测定样本磷,共测定5天,记录检测结果,并对两种试剂进行偏差评估。结果采用两种试剂测定的血清磷结果的相关系数为0.996,截距a=0.019,斜率b=0.999,无方法内、间的离群点,测定结果的偏差在允许误差范围内。结论经过方法对比及偏差评估确定在本实验室使用国产试剂替代进口原装试剂是可行的。     

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

Purpose

To determine the risk factors of neurologic deficits during PVCR correction, so as to help improve safety during and after surgery.

Methods

A consecutive series of 76 patients with severe and rigid spinal deformities who were treated with PVCR at a single institution between October 2004 and July 2011 were included in our study. Of the 76 patients, 37 were male and 39 female, with an average age of 17.5 years (range 10–48 years). There were 52 adolescent patients (with an age <18 years) and 24 adult patients (with an age ≥18 years). Preoperatively, postoperatively and 6 months after surgery, we performed systemically neurologic function evaluations of each patients through meticulous physical examination. Any new abnormality or deterioration in evaluation of neurologic function than preoperative is reckoned postoperative neurologic deficits. Ten variables that might affect the safety of neurologic deficits during PVCR procedures, including imaging factors, clinical factors and operational factors, were analyzed using univariate analysis. Then the variables with statistical difference were analyzed by using multi-factor unconditional logistic regression analysis.

Results

No patient in this series had permanent paraplegia and nerve root injury due to operation. Change of neurologic status was found in six patients after surgery. Results of single-factor comparison demonstrated that the following seven variables were statistically different (P < 0.05): location of apex at main curve (X ₃), Cobb angle at the main curve at the coronal plane (X ₄), scoliosis associated with thoracic hyperkyphosis (X ₅), level of vertebral column resected (X ₆), number of segmental vessels ligated (X ₇), preexisting neurologic dysfunction (X ₈), and associated with intraspinal and brain stem anomalies (X ₉). The multi-factor unconditional logistic regression analysis revealed that X ₈ (OR = 49.322), X ₉ (OR = 18.423), X ₅ (OR = 11.883), and X ₆ (OR = 8.769) were independent and positively correlated with the neurologic deficit.

Conclusions

Preexisting neurologic dysfunction, associated with intraspinal and brain stem anomalies, scoliosis associated with thoracic hyperkyphosis and level of vertebral column resected are independent risk factors for neurologic deficits during PVCR procedure.     

预前护理计划之“让我说说”对养老院老人死亡及维持治疗态度的影响

目的探究预前护理计划之"让我说说"对养老院老人死亡及维持治疗态度的干预效果。方法便利抽取武汉市16所养老院259名老人,根据楼层将其分成干预组和对照组。干预组实施预前护理计划之"让我说说",对照组不实施干预,比较干预后两组老人对待死亡及生命维持治疗态度的差异。结果干预前,两组老人对待死亡及维持生命治疗态度差异无统计学意义(均P0.05)。干预后,在对待死亡问题上,干预组(34.0%)比对照组(8.6%)更多地表现出恐惧,同时干预组(18.0%)比对照组(24.1%)较少表现出求死心态(P0.05)。在对待维持生命治疗上,干预组(49.0%)比对照组(29.3%)更愿意接受维持生命治疗(P0.05)。结论预前护理计划之"让我说说"可以给老人提供情感和行为支持,促使老人表达内心对死亡的真实想法,接受维持生命治疗。     

Astragaloside IV attenuates renal tubulointerstitial fibrosis by inhibiting p38 MAPK signaling

Objective To investigate the effect of astragaloside IV (AS-IV) on renal tubulointerstitial fibrosis and its regulation on p38 MAPK signaling. Methods In vivo, UUO model with renal tubulointerstitial injury was constructed. Mice in AS-IV group were orally administrated AS-IV 20 mg•kg-1•d-1 for 7 days after operation, and mice in other groups were administrated the equal volume vehicle. Bilateral kidneys were collected in 7 and 14 days after operation. Transverse kidney slices were stained with Masson trichrome to evaluate the severity of renal tubule injury. In vitro, normal human renal tubular epithelial cells (HK-2) were stimulated with recombinant TGF-β1 (10 ng/ml) and simultaneously treated with different concentrations of AS-IV (0, 50, 100, 200 μg/ml) for 24 h. SB203580 (10 μmol/L) was also ultilized to pre-treat HK-2 cells for 1 h to inhibit phosphorylation of p38 MAPK signaling. The expression of FN, Col IV, and α-SMA were investigated by western blotting and real-time PCR. The expression of p-p38 MAPKs were also observed by Western Blotting. Results Astragaloside IV morphologically ameliorated renal tubulointerstitial fibrosis. The proteins and mRNA expression of FN, Col IV, α-SMA, and TGF-β1 were also increased significantly in UUO kidney tissues (all P＜0.05), which could be reversed by AS-IV administration (all P＜0.05). In vitro, the expression of FN, Col IV, and α-SMA were up-regulated by TGF-β1 after stimulating for 24 h (all P＜0.05), which were decreased by AS-IV. The inhibition effect on FN and α-SMA were similar between AS-IV and MAPK inhibitor SB203580. AS-IV inhibited p-p38 MAPK signals both in vivo and in vitro. Conclusions AS-IV could attenuate renal tubulointerstitial fibrosis induced by UUO and TGF-β1 through reducing FN、Col IV、α-SMA expression in renal tubular cells. The mechanism of AS-IV protective effect might be associated with inhibition of p38 MAPK phosphorylation.     

早期康复对脑卒中患者功能活动能力的影响

采用FIM量表对68例急性脑卒中患者功能活动能力进行临床对照研究。两组患者在病后3月时的功能活动能力均有不同程度的改善，但康复组优于对照组（P＜0．001），在恢复独立功能活动者中，康复组16例（47．06％），对照组4例（11．76％）。研究结果表明，早期康复干预有助于脑卒中患者独立功能活动能力的恢复；患者在病后1月内，FIM评定为72．25±20．96分考，经早期康复治疗有可能达到功能活动独立。     

Oridonin induces ferroptosis by inhibiting gamma‐glutamyl cycle in TE1 cells

Oridonin (Ori) is a natural tetracyclic diterpenoid active compound with excellent antitumor activity, but the mechanism of Ori on esophageal cancer cell, TE1, remains unclear. In this study, we examined the levels of intracellular iron, malondialdehyde, and reactive oxygen species after Ori treatment, while interfering with the effects of Ori with ferroptosis inhibitor, demonstrating that Ori's inhibition of TE1 cell proliferation is associated with ferroptosis. To understand the molecular mechanism of Ori, we performed UPLC–MS/MS metabolomics profiling on TE1 cells, which show that gamma‐glutamyl amino acids (gamma‐glutamylleucine, gamma‐glutamylvaline), 5‐oxoproline, glutamate, GSH, and GSSG are changed significantly after Ori treatment. Meanwhile, the activity of gamma‐glutamyl transpeptidase 1 (GGT1) decreased. This revealed that Ori inhibited the gamma‐glutamyl cycle in TE1 cells. Furthermore, we found that Ori can covalently bind to cysteine to form the conjugate oridonin‐cysteine (Ori‐Cys), resulting in the inhibition of glutathione synthesis, which is consistent with the decrease in the enzymatic activity of glutamate cysteine ligase catalytic subunit (GCLC). Eventually, the value of intracellular GSH/GSSG was reduced, and the enzymatic activity of the glutathione peroxidase 4 (GPX4) was significantly decreased. In conclusion, our experiments indicated that Ori can inhibit the gamma‐glutamyl cycle, thereby inducing ferroptosis to exert anti‐cancer activity.     

重症急性胰腺炎病人下肢深静脉血栓预防的护理进展

综述了重症急性胰腺炎合并腹腔间室综合征病人下肢深静脉血栓形成的危险因素及预防性护理进展。提出认真的护理评估、严密的病情观察、积极的药物及机械性预防护理措施,是降低下肢深静脉血栓发生率的关键。