电话回访应用于边远藏区白内障术后患者的满意度调查分析

目的：通过电话回访评估在四川甘孜藏族自治州人民医院进行白内障手术患者对术后视力及舒适满意度的调查分析。

方法：对2012年于我院行白内障手术的患者建立档案,根据术前是否伴有其它眼科疾病和(或)在出院时是否伴有手术并发症进行分类,并对他们在术后3mo进行电话回访,回访评估术后视力恢复情况及是否伴有其它不适。

结果：我院在2012年总共行888例白内障手术,678位患者,其中女性364例(54%),大多数患者(93%)术前双眼视力视力严重下降或盲(<6/60)。在记录的881例手术中,主要的术前伴随眼疾：视网膜疾病30例,慢性虹膜疾病11例; 主要术中并发症：角膜水肿44例,玻璃体溢出19例。电话回访结果显示：3mo后508位患者(75%)被电话回访至少一次,在其中参加回访评估的588例手术中, 485(82%)叙述相比较与出院时“变好”的视力和(或)伴有不舒适, 85(15%)“一样”的视力和(或)伴有不舒适,18(3%)“变差”的视力和(或)伴有不舒适。回访结果显示：术后3mo后,伴有术前眼疾和(或)手术并发症患者中叙述视力差和(或)术后不适的比例相比较不伴有术前眼疾和(或)手术并发症患者显著升高(Chi-square=6.575, P=0.037).

结论：在出院时那些白内障患者特别需要术后3mo回访是可预料的,而电话回访增加了回访的可能性。而且需要提高处理患者手术并发症或治疗术前伴随眼疾的能力必须通过提高当地的眼科服务能力来实现。     

闭合性脾破裂39例非手术治疗体会

目的　总结闭合性脾破裂的非手术治疗经验。方法　对 1990～ 2 0 0 0年 12月采用非手术治疗的 39例脾破裂的临床资料进行回顾性分析。结果　 39例均痊愈出院。其中非手术治疗成功33例 (84 .8% ) ,住院时间 8～ 2 2d ,平均 15d。余 6例因在非手术治疗期间出现血液动力学不稳或延迟性出血而中转手术治愈。结论　在严格掌握适应证和密切动态观察伤情变化的条件下 ,非手术治疗脾破裂是安全可行的 ,对非手术治疗期间血液动力学不稳定或发生延迟性出血者应及时手术     

慢性阻塞性肺疾病患者住院时间延长危险因素的Meta分析

目的 明确慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者住院时间延长的危险因素,为临床患者的早期干预提供依据.方法 系统检索中国知网、万方、维普、Pubmed、Web of Science及Cochrane library数据库,收集COPD患者住院时间延长...     

肝脏损伤的外科治疗(附94例报告)

目的 总结肝脏损伤的治疗经验。方法 回顾性病例分析。结果 轻度肝损伤所占比例为５３／９４，重度肝损伤为４１／９４，总病死率为８．５％，轻、理两组死亡率分别为０％和１９．８％，大失血为主要死因。结论 肝损伤要积极救治估克，正确选择治疗方法，预防和治疗并发症，可望降低死亡率。     

Standardized nursing management of enzyme replacement therapy for late-onset Pompe disease

Pompe disease or glycogen storage disease type II is a rare autosomal recessive disorder caused by a deficiency of the lysosomal enzyme a-glucosidase. Although enzyme replacement therapy (ERT) with 2 weekly intervals following was considered an effective treatment for Pompe disease in 2006, few patients can afford to receive treatment in China because of the high cost. This study aimed to examine the standard management of enzyme replacement therapy for late-onset Pompe disease among patients over the age of 14 years from a nursing perspective in order to assess operating procedures. ERT injection fluid dispensing and infusion procedures using different methods were analyzed and compared in 3 patients with advanced Pompe disease for forming standard operation procedures. In addition, the impact of different methods on time consumption was analyzed by 1-way analysis of variance. There were significant differences in time consumption between different dispensing and infusion methods. The time of dispensing and infusing the injection fluids using the cooperative method was 15.97 minutes shorter than that using the conventional method (95% CI: 4.51–27.43, P = .012); the time using the modified method was 20.93 minutes shorter than that using the conventional method (95% CI: 9.47–32.39, P = .012); and there was no significant difference between the cooperative and modified methods (P = .431). Enzyme replacement therapy entails frequent treatment and strict nursing requirements related to the intravenous infusion process. In this context, a standard operating procedure can be used to control nursing times and labor costs effectively while ensuring a safe and effective infusion process.     

Sphingosine-1-Phosphate Mediates a Reciprocal Signaling Pathway between Stellate Cells and Cancer Cells that Promotes Pancreatic Cancer Growth

Sphingosine-1-phosphate (S1P) is produced by sphingosine kinase 1 and is implicated in tumor growth, although the mechanisms remain incompletely understood. Pancreatic stellate cells (PSCs) reside within the tumor microenvironment and may regulate tumor progression. We hypothesized that S1P activates PSCs to release paracrine factors, which, in turn, increase cancer cell invasion and growth. We used a combination of human tissue, in vitro, and in vivo studies to mechanistically evaluate this concept. Sphingosine kinase 1 was overexpressed in human pancreatic tissue, especially within tumor cells. S1P activated PSCs in vitro and conditioned medium from S1P-stimulated PSCs, increased pancreatic cancer cell migration, and invasion, which was dependent on S1P2, ABL1 (alias c-Abl) kinase, and matrix metalloproteinase-9. In vivo studies showed that pancreatic cancer cells co-implanted with S1P2 receptor knockdown PSCs led to less cancer growth and metastasis in s.c. and orthotopic pancreatic cancer models compared with control PSCs. Pancreatic cancer cell–derived S1P activates PSCs to release paracrine factors, including matrix metalloproteinase-9, which reciprocally promotes tumor cell migration and invasion in vitro and cancer growth in vivo.Sphingosine-1-phosphate (S1P) is a lipid-signaling molecule that governs growth, survival, and migration of epithelial cells.^1,2 S1P is converted from sphingosine through a reaction that is catalyzed by sphingosine kinase (SK), which exists in two isoforms: SK1 and SK2. S1P is produced intracellularly and then exported out, where it binds its receptors S1P1 and S1P2, which couple to distinct G proteins and signaling pathways.² Accumulating evidence indicates that excessive S1P signaling correlates with cancer phenotype, including up-regulation of S1P and/or SK1 in several cancer types³ and correlation of the levels of these molecules with patient prognosis. However, the mechanistic relationship of the S1P pathway with cancer growth remains incompletely developed.Additional lines of evidence link S1P signaling with fibrosis. Indeed, S1P induces extracellular matrix synthesis and profibrotic marker gene expression. Mice genetically deficient in S1P2 are resistant to liver fibrosis.^4,5 These observations are relevant to pancreatic cancer, in which the tumor microenvironment is characterized by dense fibrotic stroma owing to enhanced matrix production by activated pancreatic stellate cells (PSCs).^6–8 Indeed, the activation phenotype of PSCs, characterized by increased proliferation, migration, synthesis of matrix proteins, and secretion of growth factors and cytokines, is thought to occur in response to tumor cell–derived cues and, in turn, contribute to tumor growth through multiple postulated mechanisms.^6,9,10 This led us to explore whether S1P may mediate reciprocal interactions between tumor cells and PSCs that could sanction tumor growth.Herein, we found that SK1 is up-regulated in pancreatic cancer. S1P activates PSCs to produce matrix metalloproteinase-9 (MMP-9) through an S1P2-, c-Abl–, and NF-κB–dependent pathway. In turn, PSC-derived MMP-9 stimulates pancreatic cancer cell migration and invasion. Both s.c. and orthotopic pancreatic cancer models indicate that this molecular pathway regulates tumor growth in vivo. These studies highlight the importance of S1P signaling as a mechanism that links the tumor with its microenvironment to achieve tumor growth in pancreas.     

2015～2019年护理学科相关的国家自然科学基金资助项目分析

目的分析护理学科相关的国家自然科学基金资助项目研究热点,为护理学科国家自然科学基金项目的申请提供参考。方法登录国家自然科学基金网站、梅斯医学网以及科学网检索并筛选2015~2019年护理学科相关的国家自然科学基金资助项目,对资助项目总体分布情况以及研究现状进行分析。结果近5年护理学科相关的国家自然科学基金资助项目共计180项,资助总金额为7518.46万元。资助项目涉及管理科学部、医学科学部、信息科学部、工程及材料科学部,其下的三级学科代码共24个。资助项目热点主要包括慢性病管理、老年患者照护、医护人员管理及健康管理等。结论近5年来,护理学科相关的国家自然科学基金资助项目资助数量与资助金额波动上升。护理科技工作者应把握护理学科发展热点方向,加强跨学科合作项目研究,拓宽护理学科发展路径,促进护理学科持续发展。     

甘孜州藏族与彝族结膜囊细菌状况对照研究

目的:了解藏族与彝族中老年人结膜囊细菌状况的异同。方法:研究遵循统一的调查流程及方法。由经过培训的眼科医师整群抽取四川甘孜州两个藏族聚居点的中老年人145例290眼及居住地地域近似的2个彝族聚居地136例272眼进行眼科检查、问卷调查并睑结膜囊分泌物接种于血琼脂培养基上,培养48h后进行细菌分离鉴定,并对两组受检人群的结果进行比较。结果:藏族和彝族受检者的人口基线特征比较差异无统计学意义(P>0.05)。藏族中老年人结膜囊细菌培养阳性率为50.7%,彝族为69.9%,差异有统计学意义(P<0.05)。藏族结膜囊多种细菌共存者占11.6%,彝族为2.6%;藏族人群中多种细菌共存的构成比明显高于彝族(P<0.05)。藏族结膜囊中棒状杆菌培养的阳性率为15.9%,彝族的为22.4%,差异有统计学意义(P<0.05);藏族结膜囊中表皮葡萄球菌培养的阳性率为26.6%,彝族人群为26.1%,差异无统计学意义(P>0.05)。结论:藏族中老年人结膜囊细菌培养阳性率低于彝族,藏族和彝族中老年人结膜囊的细菌大多为单一菌株,但藏族人多种菌株共存的现象比彝族更为多见。藏族人与彝族人结膜囊细菌菌属有一定的区别。     

Comparison on conjunctival sac bacterial flora of the seniors with dry eye in Ganzi autonomous prefecture

AIM: To compare the bacterial flora in palpebral conjunctiva of xerophthalmia seniors of Tibetan, Yi and Han, and analyze the differences and similarities of the bacteria.METHODS:The test subjects were selected from 2 Tibetan, 2 Yi and 3 Han populated places, respectively. Total 222 seniors (444 eyes) with dry eye were examined. Secretion was collected from the palpebral conjunctiva of the subjects and then inoculated onto a blood agar plate. After 48h of incubation, the bacteria were examined for the differences and similarities between different ethnics.RESULTS: There was no significant difference (P>0.05) of Gram stain characterization, dominant bacteria and number of the bacterial species present in oxrophthalmia patients among Tibetan, Yi and Han nationalities. The bacteria presented in all groups include staphylococcus epidermidis, corynebacterium, micrococcus luteu, intracellular bacteria sphingomonas, pseudomonas aeruginosa. The bacteria detected from the two of three ethnic groups were staphylococcus aureus, staphylococcus haemolyticus, escherichia coli, kytococcus sedentarius, streptococcus angina, micrococcus lylae, and staphylococcus heads. The incidence rate of bacteria-associated dry eye in Tibetan population was significantly lower than that of Han and Yi population.CONCLUSION:There is no significant difference in the bacteria flora of palpebral conjunctiva observed among dry eye elder populations of Tibetan, Yi and Han people. All of staphylococcus epidermidis, corynebacterium, micrococcus luteu, intracellular bacteria sphingomonas, pseudomonas aeruginosa, staphylococcus aureus, staphylococcus haemolyticus, escherichia coli, kytococcus sedentarius, streptococcus angina, micrococcus lylae and staphylococcus heads are common bacteria flora of the three nationalities inhibiting in this area.     

干扰 Krüppel 样因子 8表达对肝癌 SMMC7721细胞中血管生成相关因子的调控作用

目的：构建Krüppel样因子8（Krüppel-like factor 8,KLF8）的真核表达质粒及干扰质粒,考查KLF8对人肝癌SMMC7721 细胞中血管生成相关因子的调控作用。方法：构建KLF8的真核表达质粒pcDNA3.1-KLF8,测序确认。构建靶向不同KLF8干扰位点的干扰质粒pGPU6/GFP/Neo-KLF8,筛选出干扰效率最高的pGPU6/GFP/Neo-KLF8。将pcDNA3.1-KLF8、相应的对照质粒 pcDNA3.1,pGPU6/GFP/Neo-KLF8、相应的对照质粒pGPU6/GFP/Neo-ShNC 分别转染人肝癌SMMC7721细胞,共４组。实时荧光定量PCR及Western blot检测KLF8的表达,qPCR检测各组细胞中低氧诱导因子（hypoxia-inducible factor,HIF）1-α、血管内皮生长因子（vascular endothelial growth factor,VEGF）、血管生成素（angiopoietin,Ang）1、Ang2、血管生成素受体Tie2及基质金属蛋白酶（matrix metallo-proteinase,MMP）2的mRNA表达。结果：pcDNA3.1-KLF8显著上调KLF8表达（相对表达量为68.8±6.5）,pGPU6/GFP/Neo-KLF8下调KLF8的表达（相对表达量 0.31±0.01）。转染pcDNA3.1-KLF8组与其对照组相比,VEGF、Ang2、HIF1-α及MMP2 mRNA表达增加（P<0.05）,血管生成素受体Tie2、Ang1的mRNA表达无差异（P ＞0.05）;转染pGPU6/GFP/Neo-KLF8组与其对照组相比,Ang2和HIF1-α表达降低（P<0.05）,VEGF、血管生成素受体Tie2、Ang1及MMP2的表达无差异（P ＞0.05）。结论：在肝癌中,KLF8可能通过调控VEGF、Ang2、HIF1-α及MMP2来调控血管生成。