Hcy、LPA及TGF-β1在创伤性骨折下肢静脉栓塞中的预测价值

目的分析同型半胱氨酸(Hcy)、溶血磷脂酸(LPA)及转化生长因子-β1(TGF-β1)在创伤性骨折下肢静脉栓塞中的预测价值。方法选取2019年3月至2020年2月商丘市第一人民医院收治的104例创伤性骨折者(观察组),根据有无DVT:有DVT组33例,无DVT组71例;根据创伤严重程度:轻度组61例,重度组43例。另选取本院同期92例健康体检者设为对照组。比较不同人群、不同病情程度以及有无DVT者血浆Hcy、LPA及血清TGF-β1水平,分析Hcy、LPA及TGF-β1对DVT的预测价值。结果观察组Hcy、LPA及TGF-β1表达水平均明显高于对照组,差异均有统计学意义(P<0.05)。重度组Hcy、LPA及TGF-β1表达水平明显高于轻度组,差异均有统计学意义(P<0.05)。有DVT组者Hcy、LPA及TGF-β1表达水平明显高于无DVT组,差异均有统计学意义(P<0.05)。依据ROC曲线分析可知,Hcy+LPA+TGF-β1三者联合预测创伤性骨折后发生DVT敏感度和特异度分别为88.90%、8130%,明显高于三者单独检测(P<0.05)。结论Hcy、LPA及TGF-β1在创伤性骨折发生下肢静脉栓塞时水平均明显升高,三者联合检测对下肢静脉栓塞早期诊断有重要的临床价值。     

精神科护士夜班经历创伤事件后成长体验的质性研究

目的 探讨精神科护士夜班经历创伤事件后的成长体验,以期为护士不同阶段心理情况进行针对性干预和指导,并为护士职业生涯早期心理建设提供方向。方法 采用扎根理论的研究方法,2020年3月—7月对广东省某三级甲等医院12名夜班经历创伤事件的精神科护士进行深度访谈,采用Strauss和Corbin扎根理论分析资料,分为开放式登录、轴心式登录和选择式登录3个阶段,持续比较分析资料。结果 发现精神科护士夜班经历创伤事件后经历了应激期、调适期、成长期3个不同阶段。结论 精神科护士夜班经历创伤事件后的成长为动态过程,管理者或干预者可根据不同阶段进行针对性干预和指导,并在护士早期培训中促使其提前做好相关知识、技能的储备和必备心理素质的塑造。     

1例重型弥漫性轴索损伤伴肺挫裂伤患者的肺康复护理

总结1例重型弥漫性轴索损伤伴肺挫裂伤患者的肺康复护理经验。护理要点包括：组建多学科肺康复管理团队,实施个性化呼吸支持与降阶梯序贯氧疗护理,精准廓清呼吸道,开展一体化的早期肺功能康复锻炼。经过多学科团队合作,患者入院后第12天撤离呼吸机,第17天拔除气管插管,第20天下床活动,第37天顺利出院,随访6个月,患者恢复良好。     

外伤性晶状体脱位合并周边隐匿性视网膜病变的临床特征及预后分析

目的观察分析眼球钝挫伤合并外伤性晶状体脱位患者周边隐匿性视网膜病变的临床特点及预后。 方法本研究纳入2013年1月至2020年1月在柳州市人民医院眼科住院诊断为眼球钝挫伤合并外伤性晶状体脱位，并行23G微创玻璃体切割联合白内障摘除手术的72例（72眼）患者。根据裂隙灯和超声生物显微镜（UBM）检查，将患者分为晶状体不全脱位组和全脱位组，详细记录2组患者的术中周边视网膜病变情况，并分析其临床特征及疗效。 结果眼球钝挫伤合并外伤性晶状体脱位患者中有周边隐匿性视网膜病变的占72.22%，其中晶状体不全脱位组发生率高达80.95%，显著大于晶状体全脱位组的60.00%（P＜0.05）。2组患者的周边隐匿性视网膜病变均以隐匿性视网膜裂孔、变性和出血为最常见。所有患者术后视网膜情况稳定，视力预后较好。 结论眼球钝挫伤合并外伤性晶状体脱位患者常出现周边隐匿性视网膜病变，最常见的是视网膜裂孔、出血、变性。23G微创玻璃体切割联合白内障摘除手术是有效治疗手段，具有创伤小、并发症少的优势。     

新型驱动基因融合阳性非小细胞肺癌脑转移的研究进展北大核心

肺癌是我国最常见且死亡率最高的恶性肿瘤之一,随着表皮生长因子受体(EGFR)、间变性淋巴瘤激酶(ALK)及活性氧1(ROS1)等驱动基因及其相应分子靶向药物的出现,晚期非小细胞肺癌的治疗和预后发生了革命性变化。此外,一些少见新型驱动基因融合,包括神经调节蛋白1(NRG1)、神经营养酪氨酸受体激酶(NTRK)和转染重排因子(RET),正逐渐发展成为全身性治疗选择。然而,这些罕见新型融合驱动基因在NSCLC脑转移中的作用机制,以及优化控制和预防脑转移的意义人们所知甚少。因此,本文就近几年罕见驱动基因融合在NSCLC脑转移中的研究进行综述。     

Multiscale quantification of morphological heterogeneity with creation of a predictor of longer survival in glioblastoma

Intratumor heterogeneity is a main cause of the dismal prognosis of glioblastoma (GBM). Yet, there remains a lack of a uniform assessment of the degree of heterogeneity. With a multiscale approach, we addressed the hypothesis that intratumor heterogeneity exists on different levels comprising traditional regional analyses, but also innovative methods including computer-assisted analysis of tumor morphology combined with epigenomic data. With this aim, 157 biopsies of 37 patients with therapy-naive IDH-wildtype GBM were analyzed regarding the intratumor variance of protein expression of glial marker GFAP, microglia marker Iba1 and proliferation marker Mib1. Hematoxylin and eosin stained slides were evaluated for tumor vascularization. For the estimation of pixel intensity and nuclear profiling, automated analysis was used. Additionally, DNA methylation profiling was conducted separately for the single biopsies. Scoring systems were established to integrate several parameters into one score for the four examined modalities of heterogeneity (regional, cellular, pixel-level and epigenomic). As a result, we could show that heterogeneity was detected in all four modalities. Furthermore, for the regional, cellular and epigenomic level, we confirmed the results of earlier studies stating that a higher degree of heterogeneity is associated with poorer overall survival. To integrate all modalities into one score, we designed a predictor of longer survival, which showed a highly significant separation regarding the OS. In conclusion, multiscale intratumor heterogeneity exists in glioblastoma and its degree has an impact on overall survival. In future studies, the implementation of a broadly feasible heterogeneity index should be considered.     

胶质瘤复发与放射性脑损伤的MRI鉴别诊断探讨

目的:讨论胶质瘤复发与放射性脑损伤的MRI鉴别诊断。方法:回顾性分析2018年1月~2020年2月本院收治的68例胶质瘤术后患者,对所有患者进行MRI平扫、增强以及灌注加权成像(PWI)扫描,记录影像学特征,对脑血容量中位数最大值(rCBV_max)、表观扩散系数(ADC_mean、ADC_min)指标进行对比。结果:有15例患者复发,其胶质瘤复发率为22.06%,其放射性脑损伤的发生率为8.82%(6例);胶质瘤复发与放射性脑损伤患者rCBV_max、ADC_min值有明显差异(P<0.05),ADC_mean比较无明显差异(P>0.05)。结论:进行MRI检查临床效果较好,可准确鉴别胶质瘤复发与反射性脑损伤。     

Glycaemic control for patients with severe acute brain injury: Protocol for a systematic review

Background

Hyperglycaemia is common in patients with acute brain injury admitted to an intensive care unit (ICU). Many studies have found associations between development of hyperglycaemia and increased mortality in hospitalised patients. However, the optimal target for blood glucose control is unknown. We want to conduct a systematic review with meta-analysis and trial sequential analysis to explore the beneficial and harmful effects of restrictive versus liberal glucose control on patient outcomes in adults with severe acute brain injury.

Methods

We will systematically search medical databases including CENTRAL, Embase, MEDLINE and trial registries. We will search the following websites for ongoing or unpublished trials: http://www.controlled-trials.com/ , http://www.clinicaltrials.gov/ , www.eudraCT.com , http://centerwatch.com/ , The Cochrane Library's CENTRAL, PubMed, EMBASE, Science Citation Index Expanded and CINAHL. Two authors will independently review and select trials and extract data. We will include randomised trials comparing levels of glucose control in our analyses and observational studies will be included to address potential harms. The primary outcomes are defined as all-cause mortality, functional outcome and health-related quality of life. Secondary outcomes include serious adverse events including hypoglycaemia, length of ICU stay and duration of mechanical ventilation, and explorative outcomes including intracranial pressure and infection. Trial Sequential Analysis will be used to investigate the risk of type I error due to repetitive testing and to further explore imprecision. Quality of trials will be evaluated using the Cochrane Risk of Bias tool, and quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

Discussion

The results of the systematic review will be disseminated through peer-reviewed publication. With the review, we hope to inform future randomised clinical trials and improve clinical practice.