社区卫生院护士静脉治疗知识技能横断面调查分析

目的了解社区卫生院护士对静脉治疗相关知识的掌握现状及实际操作水平。方法采用整群抽样方法,选择13家社区卫生院255名护士进行静脉治疗相关知识调查,并采取现场查看及抽考的方式,了解卫生院所使用的冲封管液肝素浓度和护士冲封管操作掌握情况。结果社区卫生院护士静脉治疗相关知识标准分17. 39～95. 65(53. 21±15. 03)分,60分以下有183人,占71. 76%。仅4家(30. 77%)卫生院使用的冲封管液稀肝素浓度0～10 U/m L,符合《静疗规范》要求。共计39名社区卫生院进行冲封管操作演示,护士脉冲式冲管的正确率为28. 20%;正压带液封管执行正确率为23. 08%。结论社区卫生院护士对静脉治疗相关知识的掌握情况欠佳,冲封管操作欠规范。护理管理者需要针对性地制订培训方案,并注重效果反馈和质量监督,规范护士的静脉治疗技术操作,促进静脉治疗护理安全。     

The elevation of the mucosal flap without additional anterior canal wall incisions for repairing anterior perforations using endoscopic cartilage tympanoplasty

European Archives of Oto-Rhino-Laryngology -     

不同类型的肺部磨玻璃结节患者术前免疫炎症指标和癌胚抗原的比较

目的：比较不同病理类型的肺部磨玻璃结节（GGO）患者术前中性粒细胞与淋巴细胞比率（NLR）、血小板与淋巴细胞比率（PLR）、淋巴细胞与单核细胞比率（LMR）和血清癌胚抗原（CEA）的差异及其临床意义。方法：收集接受手术治疗的494例患者的NLR、PLR、LMR，其中浸润性腺癌176例，微浸润性腺癌150例，腺体前驱病变117例，良性病变51例。仅收集到150例浸润性腺癌、127例微浸润性腺癌、95例腺体前驱病变和45例良性病变的血清CEA数值。分别比较各组之间的NLR、PLR、LMR、CEA。结果：腺体前驱病变组的NLR（2.32±1.59）较良性病变组（1.82±0.64）高（P＜0.05）。肺腺癌组的PLR（141.19±53.14）、腺体前驱病变组的PLR（145.94±51.92）较良性病变组（124.90±37.04）高（均P＜0.05）。肺腺癌组的CEA [1.83（1.18， 2.73）ng/mL]较腺体前驱病变+良性病变组 [1.49（1.03，2.08）ng/mL]高（P＜0.01）。浸润性腺癌组的CEA [2.14（1.29，2.92）ng/mL]分别较微浸润性腺癌组 [1.67（1.09，2.43）ng/mL]、腺体前驱病变组 [1.46（1.03，2.06）ng/mL]、良性病变组 [1.53（1.00，2.10）ng/mL]高（P＜0.05）。结论：全身免疫炎症指标在早期肺腺癌，甚至是腺体前驱病变阶段就开始发生变化，血清CEA在早期肺腺癌就开始发生变化。动态观察上述指标的变化，有利于早期发现恶性病变，从而尽早进行干预。     

LY3214996 relieves acquired resistance to sorafenib in hepatocellular carcinoma cells

Background: Sorafenib, an oral multi-kinase inhibitor of rapidly accelerated fibrosarcoma; vascular endothelial growth factor receptor-2/3, platelet-derived growth factor receptor, c-Kit, and Flt-3 signaling, is approved for treatment of advanced hepatocellular carcinoma (HCC). However, the benefit of sorafenib is often diminished because of acquired resistance through the reactivation of ERK signaling in sorafenib-resistant HCC cells. In this work, we investigated whether adding LY3214996, a selective ERK1/2 inhibitor, to sorafenib would increase the anti-tumor effectiveness of sorafenib to HCC cells.Methods: The Huh7 cell line was used as a cell model for treatment with sorafenib, LY3214996, and their combination. Phosphorylation of the key kinases in the Ras/Raf/MAPK and PI3K/Akt pathways, protein expression of the cell cycle, and apoptosis migration were assessed with western blot. MTT and colony-formation assays were used to evaluate cell proliferation. Wound-healing assay was used to assess cell migration. Cell cycle and apoptosis analyses were conducted with flow cytometry.Results: LY3214996 decreased phosphorylation of the Ras/Raf/MAPK and PI3K/Akt pathways, including p-c-Raf, p-P90RSK, p-S6K and p-eIF4EBP1 activated by sorafenib, despite increased p-ERK1/2 levels. LY3214996 increased the anti-proliferation, anti-migration, cell-cycle progression, and pro-apoptotic effects of sorafenib on Huh7^R cells.Conclusions: Reactivation of ERK1/2 appears to be a molecular mechanism of acquired resistance of HCC to sorafenib. LY3214996 combined with sorafenib enhanced the anti-tumor effects of sorafenib in HCC. These findings form a theoretical basis for trial of LY3214996 combined with sorafenib as second-line treatment of sorafenib-resistant in advanced HCC.