一体化管理的老年综合评估护理模式对前列腺癌患者心理因素和生活质量的影响

目的探讨对前列腺癌患者采用一体化管理老年综合评估(CGA)护理模式对其心理因素和生活质量的影响。方法选取2020年3月至2021年3月在南京市第一医院就诊,确诊为前列腺癌,且首次行腹腔镜下前列腺癌根治术的患者96例,随机分为对照组、观察1组、观察2组,各32例。对照组为住院后采用常规护理模式进行护理,观察1组为入院后行CGA干预组,观察2组为一体化管理的CGA干预组。三组患者分别在干预前、出院时,进行焦虑自评量表(SAS)、抑郁自评量表(SDS)测评;在干预前、术后30 d,进行生活质量核心量表QLQ-C30(V3.0)和前列腺癌特异性补充量表QLQ-PR25测评。结果出院时,观察2组SAS、SDS评分显著优于对照组及观察1组(P<0.05);术后30 d,观察2组生活质量QLQ-C30、QLQ-PR25评分显著优于对照组及观察1组(P<0.05)。结论一体化管理CGA护理模式可有效改善前列腺癌患者的心理状态,提高其术后生活质量。     

基于踝臂指数构建下肢动脉硬化闭塞症介入围术期护理方案的探讨

【摘要】 目的 探讨基于踝臂指数（ABI）构建下肢动脉硬化闭塞症（ASO）介入围术期护理方案的临床应用价值。方法 便利抽样法纳入2018年5月至2020年12月南京市第一医院介入科80例下肢ASO患者，对照组40例，实施常规护理方案；试验组40例，依据ABI量化分析结果构建并落实预见性分层次护理方案。结果 两组组内术后不同时点ABI比较差异均有统计学意义（均P＜0.01）；两组ABI（第12周）、无痛行走距离（第12周）、最大行走距离（第4周、第12周）差异均有统计意义（均P＜0.05）。结论 ASO围术期规范采集ABI能够客观、有效反映术后患肢循环改善程度。基于ABI量化分析构建适合个体的围术期护理方案，有利于预防术后患肢高灌注损伤，改善远期患肢步行距离，提高整体运动能力。     

注射催产素对小鼠骨密度和成骨细胞分化影响的实验研究

目的通过建立雌性小鼠骨质疏松模型并给予催产素(oxytocin,OT)腹腔注射来验证催产素对骨代谢的调控作用。方法选取同批次2月龄雌性C57/B6小鼠15只,随机分成3组,每组5只:①对照组(C),②造模组(OVX),③造模+催产素注射组(OVX+OT)。注射催产素前和注射8周后分别测定各组小鼠左股骨和腰椎L4～6的骨密度,并提取小鼠骨髓细胞定向诱导分化,进行碱性磷酸酶(alkaline phosphatase,ALP)和Von Kossa染色以鉴定成骨细胞分化水平,通过q PCR检测分化相关因子表达水平。结果 OVX组小鼠骨密度较C组显著降低(P0. 001),OVX+OT组小鼠骨密度较OVX组显著升高(P0. 001)。ALP染色显示,OVX组成骨细胞分化较C组差,细胞集落最少; OVX+OT组成骨细胞分化情况较OVX组好,染色面积增加了322. 5%。Von Kossa染色发现OVX组细胞集落和钙结节较C组少且小,OVX+OT组细胞集落和钙结节较OVX组多,染色面积增加了62. 3%。而进一步添加催产素体外培养的成骨细胞其分化水平均比未加入催产素组有所提高。q PCR结果显示催产素能够促进成骨相关基因OPN、Runx2和Osterix的表达(P0. 001)。结论催产素促进小鼠体内的骨合成代谢作用,提示其对骨质疏松症治疗具有潜在用途。     

双长效支气管扩张剂在慢性阻塞性肺疾病治疗中的研究进展

长效支气管扩张剂是稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)治疗的基石。固定剂量长效β2受体激动剂(long actingβ2 agonist,LABA)/长效抗胆碱能药物(long acting muscarinic antagonist,LAMA)复方制剂被慢性阻塞性肺疾病全球倡议推荐用于COPD的治疗。为了更深入了解已经上市的多种LABA/LAMA复方制剂如维兰特罗/乌美溴铵、茚达特罗/格隆溴铵、福莫特罗/格隆溴铵及奥达特罗/噻拖溴铵等的疗效和安全性,本文对LABA/LAMA一些重要临床研究作一综述,旨在为COPD患者提供个体化的治疗方案。     

Endovascular treatment combined with vertebral artery endarterectomy for patients with acute tandem vertebrobasilar artery occlusion

PurposeTo evaluate the safety and efficacy of endovascular treatment combined with vertebral artery endarterectomy in patients with acute tandem vertebrobasilar artery occlusion.MethodsFrom April 2017 to March 2019, three patients with acute basilar artery occlusion combined with ostial vertebral occlusion in our institution were enrolled in the study. They underwent endovascular treatment combined with vertebral artery endarterectomy. The clinical, technical and functional outcomes of the patients were retrospectively analysed.ResultsAll three patients in the study underwent complete recanalization. The modified Thrombolysis in Cerebral Infarction (mTICI) grade was 2b/3 in all patients. The modified Rankin Scale (mRS) score was 0–2 for the three patients at 3 months. Follow-up CT scans revealed no cerebral haemorrhage, and no patients died during follow-up. All patients achieved good clinical outcomes after the combined treatment.ConclusionEndovascular treatment combined with vertebral artery endarterectomy is a feasible method to treat patients with acute basilar artery occlusion combined with ostial vertebral occlusion, especially when the guidewire cannot pass through the ostium of the dominant vertebral artery occlusion.     

急性心肌梗死后左心室游离壁破裂患者临床特点分析

目的探讨急性心肌梗死(acute myocardial infarction,AMI)后发生左心室游离壁破裂(free wall rupture,FWR)患者的临床特点及危险因素。方法入选2010年12月至2018年12月南京医科大学附属南京医院明确诊断为AMI的患者4221例,其中发生FWR的患者81例(FWR组),按照1:5匹配原则,随机选取未发生心脏破裂(且未发生室间隔穿孔)的患者405例作为非FWR组,比较两组患者临床基线资料及预后。结果(1)AMI患者中出现FWR的风险为1.9%。(2)与非FWR组相比,FWR组患者年龄偏大,前壁心肌梗死较多,心功能更差,接受手术治疗(包括经皮支架植入和冠状动脉旁路移植术)的患者比例偏低,且所有患者均出现院内死亡。(3)91.4%的患者FWR发生在AMI起病1周之内,其中24 h内发生FWR 37例(45.7%)。(4)COX回归分析发现,年龄(HR=1.055,95%CI:1.032~1.078,P<0.001)、急性前壁心肌梗死(HR=1.907,95%CI:1.211~3.002,P=0.005)和手术治疗(HR=0.126,95%CI:0.072~0.220,P<0.001)是AMI患者出现FWR的独立预测因子。结论AMI患者发生FWR的风险约为1.9%,而且通常发生在心肌梗死1周内,高龄和急性前壁心肌梗死患者容易发生FWR,而手术治疗能明显降低FWR风险。     

Aberrant functional and effective connectivity of the frontostriatal network in unilateral acute tinnitus patients with hearing loss

Brain Imaging and Behavior - The present study combined resting-state functional connectivity (FC) and Granger causality analysis (GCA) to explore frontostriatal network dysfunction in unilateral...     

Ischémie reperfusion en transplantation rénale

Ischemia-reperfusion injury is an inescapable phenomenon in kidney transplantation. It combines lesional processes of biochemical origin associated with oxydative stress and of immunological origin in connection with the recruitment and activation of innate immunity cells. Histological lesions associate acute tubular necrosis and interstitial œdema, which can progress to interstitial fibrosis. The extent of these lesions depends on donor characteristics (age, expanded criteria donor, etc.) and cold ischemia time. In the short term, ischemia-reperfusion results in delayed recovery of graft function. Cold ischemia time also impacts long-term graft survival. Preclinical models, such as murine and porcine models, have furthered understanding of the pathophysiological mechanisms of ischemia-reperfusion injury. Due to its renal anatomical proximity to humans, the porcine model is relevant to assessment of the molecules administered to a donor or recipient, and also of additives to preservation solutions. Different donor resuscitation and graft perfusion strategies can be studied. In humans, prevention of ischemia-reperfusion injury is a research subject as concerns donor conditioning, additive molecules in preservation solutions, graft reperfusion modalities and choice of the molecules administered to the recipient. Pending significant advances in research, the goal is to achieve the shortest possible cold ischemia time.     

基于计算流体动力学大脑中动脉闭塞急性缺血性脑卒中再灌注治疗后出血转化初步研究

目的探讨基于计算流体动力学(computational fluid dynamics,CFD)大脑中动脉闭塞引起的急性缺血性脑卒中的血流动力学与再灌注治疗后出血转化的关系。材料与方法纳入磁共振血管造影(magnetic resonance angiography,MRA)证实的大脑中动脉闭塞的急性缺血性脑卒中患者共38例,搜集治疗前MRA数据和入院时一般临床资料进行回顾性分析。基于MRA-CFD模型模拟血流动力学,获得血流动力学参数如下:血压(pressure)、壁切应力(wall shear stress,WSS)及壁切应力梯度(wall shear stress gradient,WSSG)。Rpressure、RWSS及RWSSG分别为大脑中动脉起始处与闭塞处正常管径压力、WSS及WSSG的比值。所有患者接受标准治疗。根据治疗后48 h内随访CT或MRI有无出血分为出血组和未出血组。比较两组间临床及血流动力学参数差异并进行相关性分析。结果总共纳入38例患者,出血组17例,未出血组21例。与未出血组相比,出血组有更多的高血压患者(P=0.008)、更高的入院收缩压[(149.1±23.9) mm Hg与(139.3±16.3) mm Hg比较,P=0.024]及舒张压[(90.2±16.7) mm Hg与(87.7±8.5) mm Hg比较,P=0.008]、更高的血浆同型半胱氨酸[(16.6±11.1)μmol/L与(13.2±3.5)μmol/L比较,P=0.024]。出血组较未出血组,RWSS和RWSSG更高(P<0.05),而Rpressure无统计学差异(P>0.05)。相关性分析显示高血压(r=-0.428,P=0.007)、RWSS(r=-0.341,P=0.036)与脑梗再灌注治疗后出血转化有统计学差异。结论高血压及局部血管内RWSS与大脑中动脉闭塞急性缺血性脑卒中患者再灌注治疗后出血转化有关,且入院时高血压及再灌注治疗前局部血管内高RWSS更可能导致再灌注治疗后出血转化。     

MDT模式下PBL教学法在老年髋部骨折教学中的应用

目的分析在MDT模式下对老年髋部骨折临床教学中应用PBL教学法的实际效果。方法利用分组研究法对我院在2017年1月—2019年8月接收的80名临床实习学生进行研究,对比组学生(n=40)行常规教学,观察组学生(n=40)行PBL教学法,对比两组学生最终学习成果。结果观察组学生最终教学效果评价好于对比组(P<0.05);观察组学生最终教学满意度97.5%高于对比组患者最终教学满意度75%(P<0.05)。结论在MDT模式下对老年髋部骨折临床教学中应用PBL教学法的实际效果显著,采用该种方法教学后学生的自主学习能力得到明显提升,且教师的教学满意度得到极大的提升,故值得广泛应用和推广。