心理社会治疗干预对癌症患者抑郁、焦虑反应的影响

目的探讨癌症患者心理反应对化疗所致恶心、呕吐的影响。方法对85例化疗的癌症患者的心理状况及化疗后恶心、呕吐进行评定。结果显示忧郁和焦虑状态对化疗所致恶心、呕吐的影响较正常状态有显著差异。结论提示通过心理社会治疗干预,改善心理状态可减轻化疗的毒副反应。     

芳香疗法防治化疗后恶心呕吐的研究进展

综述芳香疗法防治化疗后恶心呕吐的研究进展。分别阐述芳香疗法概况、化疗后恶心呕吐的危害和发生机制、临床中用于治疗化疗后恶心呕吐的芳香植物以及芳香疗法作用途径及机制。     

按摩疗法对化疗引起的恶心、呕吐的影响

目的探讨按摩疗法对化疗患者恶心、呕吐的影响。方法对150例乳腺癌术后化疗的患者进行按摩前后恶心、呕吐的评估。结果经过按摩治疗后患者的恶心、呕吐症状较前缓解。结论运用按摩疗法可有效缓解化疗患者的恶心、呕吐。     

穴位按压缓解胃肠道肿瘤化疗患者恶心呕吐的效果观察

目的探讨穴位按压对缓解胃肠道肿瘤化疗患者恶心、呕吐的效果。方法对78例胃肠道恶性肿瘤患者化疗期间进行内关穴按压,用中文版恶心呕吐干呕症状评估量表评估患者化疗后出现的恶心、呕吐和干呕症状。结果统计分析显示,穴位按压对缓解化疗患者恶心、呕吐等不良反应有一定效果,且具有统计学意义(P0.01)。结论穴位按压能有效地降低患者恶心、呕吐的发生频率,缩短经历时间及减轻症状的严重程度,提高患者对化疗的耐受性,减轻痛苦。     

护士主导的标准化无呕吐管理模式在头颈部鳞癌化疗患者中的应用

目的：探讨护士主导的标准化无呕吐管理模式对头颈部鳞癌患者化疗所致的恶心、呕吐及生活质量的影响。方法：选择2020年8月至2022年7月接受紫杉醇联合顺铂（TP方案）化疗的328例头颈部鳞癌患者，使用随机数字表法分为观察组和对照组各164例。对照组接受常规化疗恶心、呕吐护理，观察组实施护士主导的标准化无呕吐管理，比较两组患者恶心、呕吐的发生率、发生程度以及对生活质量的影响。结果：观察组患者化疗后5天内恶心、呕吐的发生率、恶心及呕吐的程度均低于对照组，观察组患者生活功能指数量表恶心、呕吐维度得分均高于对照组，差异具有统计学意义（P<0.05）。结论：护士主导的标准化无呕吐管理可以降低头颈部鳞癌化疗患者恶心、呕吐的发生率及发生程度，降低化疗所致恶心、呕吐对患者生活质量的影响。     

化疗患者阶段性止吐护理效果评价

目的探讨阶段性止吐护理对预防化疗患者恶心、呕吐及干呕的效果。方法便利抽取我院肿瘤科化疗所致恶心、呕吐及干呕的患者120例,试验组和对照组各60例。试验组采用基于阶段性止吐护理,即采用前期预防、中期护理、后期随访评估的护理方法;对照组给予恶心、呕吐的常规护理。结果 4个化疗周期后,试验组患者的恶心呕吐及干呕的发生频率及严重程度、持续时间优于对照组,差异有统计学意义(P<0.05)。结论阶段性止吐护理能有效提高患者的生活质量,减少化疗所致恶心、呕吐的发生。     

晕海宁对防治肝癌肝动脉灌注化疗栓塞术后恶心呕吐的临床研究

目的:观察晕海宁对肝动脉灌注化疗栓塞术后恶心、呕吐的疗效及不良反应.方法:将126例行肝动脉灌注化疗栓塞治疗的原发性肝癌患者随机分为3组各42例;A组术前口服晕海宁,B组、C组在术中未灌注化疗药物前肝动脉内分别注射格拉司琼,甲氧氯普胺;观察术后恶心、呕吐发生率及药物不良反应.结果:A,B组分别与C组比较,术后恶心、呕吐发生率差异有统计学意义(P<0.05); A,B纽间差异无统计学意义(P>0.05).C组4例发生药物不良反应.结论:晕海宁对防治肝癌肝动脉灌注化疗栓塞术后恶心、呕吐疗效好,不良反应轻,且价格低廉,有可能成为治疗肝癌肝动脉灌注化疗栓塞术后恶心、呕吐的一线方案.     

柠檬生姜香薰吸入对乳腺癌患者化疗相关性恶心呕吐的临床疗效观察

目的探讨柠檬生姜香薰吸入对乳腺癌患者化疗相关性恶心呕吐的疗效。方法采用随机数字表法将56例乳腺癌首次化疗患者分为对照组和实验组,每组28例,对照组行常规治疗及护理,实验组在对照组的基础上行柠檬生姜汁香薰吸入,应用INVR量表及自制化疗相关性恶心呕吐观察表收集2组患者化疗后恶心呕吐情况及化疗相关伴随症状。结果实验组与对照组比较恶心、干呕症状得分于化疗后12、24、48 h时差异均有统计学意义(P0.05),呕吐症状于化疗后12、24 h比较差异有统计学意义(P0.05);化疗后12、24、48 h时实验组患者CINV症状经历时间、发生频率及严重程度维度得分均低于对照组(P0.05);且实验组患者情绪低落得分,头晕、头痛发生率均低于对照组(P0.05)。结论柠檬生姜香薰吸入可有效缓解患者化疗相关性恶心呕吐症状,改善患者化疗后低落情绪及头晕、头痛症状。     

预见性护理干预对白血病病人化疗后恶心呕吐的影响

[目的]观察护理干预对病人化疗后出现恶心呕吐的影响。[方法]对化疗过程中出现恶心、呕吐的35例白血病病人从心理、饮食、环境、止吐药物的应用及化疗药物不良反应的观察等方面进行预见性护理干预。[结果]35例病人经过预见性护理干预,显效9例,有效15例,无效11例。[结论]对接受化疗的病人进行预见性护理干预可明显减少恶心、呕吐的发生,提高病人对恶心、呕吐的耐受性。     

渐进式肌肉放松训练缓解乳腺癌化疗期恶心呕吐的效果

目的探讨渐进式肌肉放松训练对缓解乳腺癌化疗所致恶心呕吐的治疗效果。方法选取2017年1—6月收治于武汉大学人民医院乳腺甲状腺外科,行表阿霉素联合环磷酰胺(EC)方案化疗的乳腺癌术后患者68例,随机分为观察组和对照组各34例。对照组给予托烷司琼注射液、地塞米松止吐治疗;观察组在此基础上指导患者进行渐进式肌肉放松训练。采用MASCCA止吐评价工具比较两组患者化疗后24 h内及4 d后恶心、呕吐的发生情况。结果两组患者化疗后急性恶心、呕吐发生率及延迟性恶心发生率比较,差异均无统计学意义(P 0. 05);观察组患者延迟性呕吐发生率及呕吐频次明显低于对照组,恶心缓解率明显高于对照组,差异有统计学意义(P 0. 05)。结论渐进式肌肉放松训练能显著降低乳腺癌EC方案化疗后延迟性呕吐的发生率及呕吐频次,提高恶心缓解率,对于提高患者化疗依从性有积极促进作用。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

VEGF和NSE在良恶性嗜铬细胞瘤中的表达及意义

目的探讨肿瘤标志物血管内皮生长因子（VEGF）和神经元特异性烯醇化酶（NSE）在良、恶性嗜铬细胞瘤组织中的表达,分析其可能的临床价值及病理学意义,为临床鉴别良、恶性嗜铬细胞瘤提供辅助依据。方法应用免疫组化（SP法）检测16例恶性嗜铬细胞瘤、18例良性嗜铬细胞瘤及17例正常肾上腺髓质组织中细胞因子VEGF和NSE表达情况,显微镜下判断组织切片的染色结果。结果①恶性嗜铬细胞瘤VEGF表达明显强于正常肾上腺髓质和良性嗜铬细胞瘤（P〈0.01）。良性肿瘤和正常肾上腺髓质的VEGF表达差异无统计学意义（P〉0.05）。恶性嗜铬细胞瘤强阳性率明显高于良性嗜铬细胞瘤（P〈0.01）。②良、恶性嗜铬细胞瘤NSE表达差异有统计学意义（P〈0.05）,良性嗜铬细胞瘤NSE的表达高于正常肾上腺髓质的NSE表达（P〈0.05）。恶性嗜铬细胞瘤强阳性率高于良性嗜铬细胞瘤（P〈0.05）。③VEGF和NSE共同阳性表达在良、恶性嗜铬细胞瘤之间差异有统计学意义（P=〈0.01）。结论临床上检测VEGF和NSE可能为鉴别良、恶性嗜铬细胞瘤提供辅助依据,共同检测VEGF和NSE可能提高良、恶性嗜铬细胞瘤鉴别的敏感性。