血清CA125、CA153及CEA联合检测对卵巢癌的诊断价值

目的探讨肿瘤标志物CA125、CA153及CEA联合检测在卵巢癌诊断中的价值。方法选择55名拟诊为卵巢癌患者,采用放射免疫法进行CA125、CA153及CEA检测,比较三种检测指标单独检测及联合检测对卵巢癌的阳性预测值及阴性预测值。结果 CA125、CA153及CEA单独检测对卵巢癌的阳性预测值分别为85.3%,62.5%及66.7%,阴性预测值分别为76.2%,38.5%及12.9%,CA125、CA153及CEA联合检测对卵巢癌阳性预测值为96.2%,阴性预测值94.7%,CA125、CA153及CEA联合检测对卵巢癌阳性预测值及阴性预测值均高于单独检测。结论血清CA125、CA153及CEA联合检测能够提高卵巢癌诊断的准确率,有助于卵巢癌的临床诊断。     

原发性纵隔非典型脑膜瘤一例分析并文献回顾

［摘要］ 目的 探讨原发性纵隔非典型脑膜瘤的临床及影像学表现。方法 分析我院一例原发性纵隔非典型脑膜瘤的临床表现、实验室检查、影像学及病理学特征,并结合文献进行回顾,总结该病的临床、病理及影像学特征。结果 患者进行实验室及影像学检查后,行纵隔肿物切除术,术后恢复良好。结论 原发性纵隔非典型脑膜瘤的组织来源及结构与颅内钙化型脑膜瘤一致,故有脑膜瘤的影像学特征,熟悉其影像学特征及病理改变,有助于对该病的诊断及鉴别诊断。     

踝及后足关节融合术应用进展

目的综述踝及后足关节融合术的应用进展。方法查阅国内外踝及后足关节融合术相关研究文献,并进行总结分析。结果踝及后足关节融合术包括多关节融合与单关节融合,涉及胫距、距下、距舟及跟骰关节;固定方式包括螺钉、钢板、髓内钉及外固定架固定。结论不同踝及后足疾病在融合部位及固定方式上均有不同选择,适当的融合方式在达到治疗目的的同时能有效减少并发症。     

难治性肝癌射频消融治疗策略

射频消融(RFA)治疗肝肿瘤的安全性及有效性已得到广泛认可。但对于难治性肝癌,RFA治疗难度及风险大幅提高。重视影像指导下的规范化治疗及个体化治疗及策略,对难治性肝癌将同样可获得较好的疗效及安全性。     

社会关系质量对肺癌患者社交回避及苦恼的影响

目的了解肺癌患者社会关系质量与社交回避及苦恼现状,探讨社会关系质量对其社交回避及苦恼的影响。方法采用社会关系质量量表和社交回避及苦恼量表对212例肺癌患者进行问卷调查。结果肺癌患者社会关系质量总分(44.09±6.46)分,社交回避及苦恼总分(15.27±6.15)分。分层回归分析显示,性别、职业、临床分期、是否知情及社会关系质量3个维度均为肺癌患者社交回避及苦恼的影响因素(P0.05,P0.01)。结论肺癌患者社会关系质量较低,而社交回避及苦恼处于较高水平,社会关系质量为其社交回避及苦恼的影响因素,可从社会关系质量入手来改善其社交回避及苦恼。     

假肢安装康复程序探讨

[目的]分析目前工伤截肢者假肢安装及康复治疗的优点，存在的问题及解决问题的对策；假肢安装前后日常生活能力比较及心理康复。探讨一条适合于我国工伤患者假肢安装及康复训练程序。[方法]通过对上下肢截肢患者30例临床资料统计，广州工伤康复医院3a多工伤患者假肢安装、康复训练假肢安装前后的生活能力比较及心理治疗。[结果]30例工伤患者，经过假肢安装及康复训练，身体机能和生活能力及生活质量提高，最大限度的恢复了患者的生活及工作能力。[结论]对截肢术后要尽可能早的安装假肢及康复训练，针对不同情况同时给予病人必要的心理疏导，可取得满意的疗效。     

持续质量改进对CCU住院患者满意度的影响分析

目的:通过持续质量改进,探讨住院患者对医院CCU的访视制度、环境设施及服务意识等方面的满意情况。方法:选择2011年上半年及2011年10月～2012年3月入住CCU的患者及家属进行满意度调查。结果:比较改造CCU前后入住患者及家属的满意度,发现入住改造后CCU的患者及家属对CCU各项制度及环境设施的满意度较入住改造前CCU的患者及家属满意度增加,差异有统计学意义(P<0.05)。结论:通过持续质量改进,CCU在各项制度及环境设施方面做了改善,提高了患者及家属的满意度。     

癌症晚期患者及家属对预前指示态度的一致性研究

目的 调查并分析癌症晚期患者及家属对预前指示及预前指示所含的生命维持治疗、死亡地点、诊断告知等态度的一致性。方法 便利抽取北京市某三甲医院肿瘤科268对癌症晚期患者及家属,采用预前指示态度及终末生命意愿量表调查患者及家属对预前指示及生命维持治疗、死亡地点、诊断告知的态度。结果 59.0%的患者愿意做预前指示,有88.4%的家属愿意遵守患者制定的预前指示意愿,患者及家属对预前指示态度的一致性系数Kappa值为0.010。患者及家属对生命维持治疗、死亡地点及诊断告知态度的Kappa值分别为0.158~0.235,0.227,0.056,一致性较差。结论 癌症晚期患者及家属对预前指示态度一致性较差,家属对生命维持治疗、死亡地点、诊断告知的态度不能代表患者本人的意愿。临床医护人员应加强与患者及家属的沟通,提高患者及家属对预前指示态度的一致性。     

眼科专科护士资格认证及培训的研究进展

随着医疗护理行业的改革发展及大众健康需求的逐渐提升,护理人员的职责及角色分工不断细化完善,各专业专科护士的发展及培养已成为护理行业进步的必然。本研究对眼科专科护士资格认证及培训的相关研究进行综述,以期为我国眼科专科护士的发展及培训提供依据。     

序贯性早期床上运动对ICU老年患者肌力及自理能力的影响

目的探讨序贯性早期床上运动对ICU老年患者肌力及自理能力的影响。方法将80例ICU老年患者按随机数字表法分为干预组42例和对照组38例。对照组予ICU常规护理及运动,干预组在对照组基础上实施序贯性早期床上运动。比较两组干预前及转出ICU时MRC肌力评分、Barthel指数评分及机械通气时间、ICU住院时间及总住院时间。结果干预组转出ICU时MRC肌力评分及Barthel指数评分显著高于对照组,机械通气时间及ICU住院时间显著短于对照组(P0.05,P0.01)。结论序贯性早期床上运动有利于提高老年患者肌力,改善其自理能力,缩短机械通气时间及ICU治疗时间。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.