心理干预及癌痛规范化治疗对癌症患者T细胞表面PD-1、Tim-3的影响

目的 探究心理干预及癌痛规范化治疗对癌症患者T细胞表面PD-1、Tim-3的影响.方法 方便选取2015年6月—2016年11月该院接受规范化镇痛治疗的80例癌痛患者,按随机数字表法分为研究组和对照组,每组40例.两组患者均接受规范化癌痛治疗,对照组实施常规护理,研究组接受心理医师的心理干预.采用疼痛强度数字分级法(NRS)评价两组患者治疗前后的疼痛情况;流式细胞仪检验两组患者治疗前后外周血CD4+T细胞和CD8+T细胞表面PD-1和Tim-3表达情况.结果 NRS评分统计显示,研究组与对照组治疗前分别为(4.76±1.10)分和(4.75±0.91)分,治疗后分别为(1.31±0.42)分和(2.03±0.71)分,治疗后研究组患者的NRS评分显著低于对照组,差异有统计学意义(P<0.05);治疗后研究组患者CD4+T细胞表面PD-1、Tim-3表达水平显著低于对照组,CD8+T细胞表面PD-1水平显著低于对照组,差异有统计学意义(P<0.05).结论 心理干预联合癌痛规范化治疗能够有效的减轻患者的疼痛程度,同时能够影响T细胞亚群的分布,降低癌痛患者外周血中Tim-3+、PD-1+表达的T细胞数量,提高患者的免疫力,减轻患者的疼痛.     

规范化流程护理对肿瘤晚期患者癌痛发生的干预效果观察

目的:探讨规范化流程护理对肿瘤晚期患者癌痛发生的干预效果。方法:选取研究对象为82例肿瘤晚期患者,按照抽签方式分为两组,即观察组给予规范化流程护理、对照组给予一般护理,各41例,且对两组患者的服药依从性、入院时疼痛评分、爆发痛评分及疼痛持续时间进行观察及评估。结果:观察组服药依从性高于对照组,差异有统计学意义(P<0.05)。两组患者在入院时疼痛评分、爆发痛评分对比差异无统计学意义(P>0.05);而观察组疼痛持续时间短于对照组,差异有统计学意义(P<0.05)。结论:规范化流程护理应用于肿瘤晚期患者中具有较高临床价值,能够在提高用药依从性的基础上缓解癌痛症状,值得应用及推广。     

氢吗啡酮、舒芬太尼及吗啡在难治性癌痛合并口服困难患者静脉自控镇痛中的疗效比较研究

背景 难治性癌痛患者常伴有口服困难,增加了治疗难度,患者静脉自控镇痛(PCIA)可实现持续、有效及安全镇痛。目的 探讨氢吗啡酮、舒芬太尼及吗啡在难治性癌痛合并口服困难患者PCIA中的疗效及安全性。方法 选取武汉钢铁(集团)公司第二职工医院肿瘤科及安宁疗护中心2020年5月至2022年1月收治的102例难治性癌痛合并口服困难患者为研究对象。将102例患者按随机数字表法分为三组：氢吗啡酮PCIA组、舒芬太尼PCIA组、吗啡PCIA组,各34例。比较三组患者治疗前后的疼痛数字评分表(NRS)评分、爆发痛发作次数、每日等效口服吗啡剂量(MEDD)、匹兹堡睡眠质量指数(PSQI)评分、癌症患者生命质量测定量表(QLQ-C30)评分及不良反应发生率。结果 102例难治性癌痛合并口服困难患者中男51例、女51例,平均年龄(60.2±6.3)岁。三组患者性别、年龄、疼痛程度、NRS评分、MEDD、原发肿瘤类型、疼痛类型、TNM分期比较,差异均无统计学意义(P>0.05)。与治疗前相比,三组患者治疗后NRS评分、爆发痛发作次数均降低,组别与时间对NRS评分、爆发痛发作次数均存在交互作用(P<...     

舒适干预护理在股骨干骨折患者中的应用及效果分析

目的探究舒适干预护理在股骨干骨折患者中的应用效果。方法选取我院2018年1月至2019年2月治疗的股骨干骨折患者76例,其中38例接受常规护理干预,为对照组;另外38例接受舒适干预护理,为观察组。比较分析两组的疼痛程度(NRS)和膝关节功能(HSS)。结果观察组干预后NRS评分(2.88±0.62)分低于对照组(3.45±0.65)分,HSS评分(75.34±4.67)分高于对照组(67.58±5.19)分,差异有统计学价值(P0.05)。结论对股骨干骨折患者实施舒适干预护理有利于减轻患者疼痛,提高其膝关节功能,在临床上值得推广使用。     

护理干预对晚期肿瘤患者心理状态影响的临床研究

目的:观察护理干预对晚期肿瘤患者心理状态的影响。方法:将我院肿瘤科符合晚期肿瘤诊断标准的100例住院患者,采用随机数字表法(1:1)分为2组,各50例。对照组给予常规护理;观察组在对照组基础上给予肿瘤患者特制的护理干预。2组均以4周为1个疗程,分别记录2组患者护理前后的VAS疼痛评分SAS(焦虑自评量表)及SDS评分(抑郁自评量表)。结果:⑴2组护理后总有效率分别为,观察组为92.00%,对照组70.00%,经统计学比较x2=7.862,υ=1,P=0.005。⑵2组护理后VAS疼痛评分为:对照组3.07±1.21分,观察组1.67±0.88分,经统计学比较P0.05,观察组优于对照组。⑶2组SAS及SDS评分比较,对照组为45.55±5.63、44.28±5.23,治疗组为39.56±4.67、39.82±4.73,2组比较:P0.05、P0.05,治疗组明显优于对照组。结论:为肿瘤晚期患者制定的护理方案,可以有效缓解肿瘤晚期患者疼痛及焦虑抑郁情绪。     

肿瘤深部热疗联合羟考酮缓释片治疗骨转移癌痛的临床疗效观察

目的肿瘤深部热疗联合羟考酮缓释片治疗骨转移癌痛临床效果以及安全性研究。方法将在我院确诊的120例骨转移癌患者随机分为实验组和对照组,实验组给予肿瘤深部热疗联合羟考酮缓释片治疗,对照组给予羟考酮缓释片口服治疗。观察每天吗啡缓释片用药剂量情况、骨转移癌痛每天爆发痛次数、每天生活质量评分(Karnofsky评分)、疼痛缓解率以及不良反应状况。结果实验组患者治疗后Karnofsky行为状况评分为(60.72±6.08)分,而对照组为(30.37±5.31)分,明显低于实验组,差异具有统计学意义(P<0.05);治疗前两组每天骨转移癌痛爆发痛次数大致相当。随着病情进展,治疗第7天与治疗前比较,骨转移癌痛爆发痛次数实验组没有变化,对照组增加,两组比较差异有显著性(P<0.05);第14天两组骨转移癌痛爆发痛次数均增加,但实验组爆发痛增加次数较对照组少,差异有显著性(P<0.05);实验组患者经治疗后的总有效率65.08%明显大于对照组(19.30%)(P<0.05)。两组患者的不良反应无明显差异(P>0.05)。结论肿瘤深部热疗联合羟考酮缓释片治疗骨转移癌痛的临床疗效显著,有效改善患者的生活质量,其过程中副作用小,值得在临床推广。     

临终综合护理干预在晚期肝癌患者护理中的应用效果

目的探究临终综合护理干预在晚期肝癌患者护理中的应用效果。方法选取2014年5月至2016年2月河南省肿瘤医院收治的78例晚期肝癌患者,根据入院顺序分为两组,各39例。对照组接受常规护理干预,观察组于对照组基础上接受临终综合护理干预。统计对比两组的护理满意度,并对比两组干预前后的疼痛程度(VAS评分)。结果干预前,观察组与对照组的VAS评分比较[(6.4±1.6)分比(6.7±1.4)分],差异无统计学意义(P>0.05);干预后,观察组的VAS评分[(2.8±0.3)分]低于对照组[(3.7±0.5)分],且两组治疗后均低于治疗前,差异有统计学意义(P均<0.05);观察组护理满意度高于对照组(89.74%比69.23%),差异有统计学意义(P<0.05)。结论临终综合护理干预能减轻晚期肝癌患者疼痛程度,提高护理满意度,值得推广应用。     

护理心理干预对晚期癌症患者镇痛治疗的影响

目的探讨护理心理干预对晚期癌症患者镇痛治疗效果的影响。方法将100例晚期癌症疼痛患者随机分为干预组和对照组各50例,对照组进行常规癌痛治疗和护理,干预组在此基础上进行护理心理干预,采用数字评分法(NRS)进行疼痛程度的评估,比较两组患者的镇痛效果和按需按时用药情况。结果干预组患者按需按时用药和各阶段睡眠情况优于同期对照组,用药前后NRS降分幅度也大于同期对照组,其差异有显著性意义。结论护理心理干预,可提高镇痛治疗效果,减少止痛药剂量或推迟升级,提高晚期癌症疼痛患者生存质量。     

吗啡、甲强龙及氨茶碱治疗晚期肿瘤患者呼吸困难疗效比较

目的 比较吗啡、甲强龙(甲泼尼龙)和氨茶碱治疗晚期肿瘤患者呼吸困难的疗效.方法 170例晚期肿瘤呼吸困难者随机分三组,分别给予5 ～ 10 mg吗啡皮下注射(吗啡组,n=60)、40 mg甲强龙静脉点滴(甲强龙组,n=55)和0.25 g氨茶碱静脉点滴(氨茶碱组,n =55)治疗,通过视觉模拟评分(VAS)比较三种药物在治疗晚期肿瘤患者呼吸困难中的优劣.结果 治疗前三组患者间VAS评分比较差异无统计学意义(P＞0.05);但治疗后三组的VAS评分均显著低于治疗前,差异有统计学意义(P＜0.01).治疗后,吗啡组、甲强龙组和氨茶碱组的VAS评分分别为(12.82±11.40)、(24.58±17.51)和(34.25±17.75)mm,吗啡组显著低于甲强龙组和氨茶碱组,差异有统计学意义(P＜0.01);吗啡组控制呼吸困难有效率明显高于甲强龙组和氨茶碱组,差异有统计学意义(86.67％、67.27％和50.91％,P＜0.05或P＜0.01).结论 吗啡用于治疗晚期肿瘤患者呼吸困难的疗效优于甲强龙和氨茶碱,能提高预计生存期较短的晚期肿瘤患者的生存质量.     

疼痛护理干预应用于带状疱疹后神经痛的效果分析

目的:探讨对带状疱疹后神经痛患者行疼痛护理干预的临床效果.方法:将2015年10月至2016年10月我院收治的130例带状疱疹后神经痛患者作为研究对象,根据患者个人意愿分为对照组和实验组,各65例.对照组行常规护理,实验组则行疼痛护理干预,观察比较两组疼痛(NRS)评分以及控制疼痛的满意度.结果:两组护理前的NRS评分均无显著差异(P>0.05),护理后实验组NRS评分(1.08±1.31)分显著低于对照组(2.29±1.33)分,实验组对于控制疼痛的满意度61例(93.85%)显著高于对照组[50例(76.92%,P<0.05].结论:对带状疱疹后神经痛患者行也疼痛护理干预,能够有效缓解患者的疼痛感受,提高患者对于控制疼痛的满意度.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.