血清可溶性上皮型钙黏附蛋白与进展期胃癌术后复发及预后的关系

目的 探讨血清可溶性上皮型钙黏附蛋白(sE-cad)水平变化与进展期胃癌术后复发及预后的关系.方法 以酶联免疫吸附试验法检测85例进展期胃癌患者(进展期胃癌组)根治术前、术后1个月及30例健康体检者(对照组)血清sE-cad水平;术后随访3年,胃癌复发患者(28例)及未复发患者(57例)复查血清sE-cad水平.分析影响术前血清sE-ad水平升高的因素,探讨其变化与术后复发及预后的关系.结果 进展期胃癌组术前血清sE-cad水平显著高于对照组[(24.3±14.8) μg/L比(9.4±3.8) μg/L,P＜0.01],术后1个月血清sE-cad水平显著降低[(12.5±6.4) μg/L比(24.3± 14.8) μg/L,P＜0.01].进展期胃癌术后复发患者血清sE-cad水平显著高于术后1个月和术后未复发患者[(20.7±9.8)μg/L比(12.5±6.4)、(14.8±6.2) μg/L,P＜0.01].单因素分析显示术前血清sE-cad水平升高与肿瘤最大径、分化程度、淋巴结转移率、浸润深度相关(P＜0.05),而与肿瘤组织学分型无关(P＞0.05).术前高血清sE-cad水平负面影响术后生存率和复发率.Logistic多因素回归分析显示术前血清sE-cad水平是影响进展期胃癌术后3年复发率的独立危险因素(相对危险度为2.068,P=0.013).结论 进展期胃癌术前血清sE-cad水平升高与多种重要肿瘤病理特征相关,是影响预后的重要因素,检测血清sE-cad水平有助于预后评价与术后复发监测.     

食管癌患者血清细胞因子和免疫球蛋白水平的动态观察

目的 研究白细胞介素-2(IL-2)、白细胞介素-8(IL-8)及免疫球蛋白(IgG、IgA、IgM)在食管癌患者血清中的水平变化,并探讨IL-2、IL-8、IgG、IgA、IgM水平在食管肿瘤临床分期之间的相关关系.方法 用酶联免疫吸附试验(ELISA)方法检测了72例食管癌早期(I-II)患者、68例食管癌晚期(Ⅲ-Ⅳ)患者和120例对照者血清IL-2、IL-8水平,同时对食管癌患者血清免疫球蛋白IgG、IgA、IgM指标进行动态观察.结果 血清IL-2水平食管癌早期患者组[(1.69±0.53)ng/m1]和食管癌晚期组患者[(1.11±0.60)ng/m1]显著低于正常对照组[(2.78±0.51)ng/m1](P＜0.01),晚期患者较早期明显降低(P＜0.05);血清IL-8水平食管癌早期患者组[(85.48±6.14)ng/L]和食管癌晚期患者组[(121.41±6.22) ng/L]均显著高于正常对照组[(54.48±12.20)ng/L](P＜0.01),晚期患者较早期升高(P＜0.01);食管癌患者血清IL-2及IL-8水平与肿瘤的恶性化程度有明显相关性.而食管癌患者IgG[(12.23±2.50)g/L]、IgM[(1.60±0.80)g/L]含量与正常对照组IgG[(11.65±3.70)g/L]、IgM[(1.46±0.71)g/L]比较差异无统计学意义(P＞0.05),IgA的含量[(3.50±1.10)g/L]与正常对照组[(1.88±1.08)g/L]比较差异有统计学意义(P＜0.01),且随病情的恶化程度IgA水平的变化有增高趋势.结论 IL-8在食管癌发病过程中可能起着促进作用,而IL-2可能起着抑制作用,IgA 在食管癌病人中呈正相关;三者的免疫失调状态可能与食管癌密切相关;IL-2、IL-8、IgA 水平可作为食管癌病情监测的指标,同时对肿瘤的临床分期、疗效和预后的判断也有一定的帮助.     

胃癌浸润转移与血清促血管生成素-2的关系

目的 探讨血清促血管生成素-2(Ang-2)的含量变化在胃癌诊断、复发与浸润转移中的临床意义.方法 采用酶联免疫吸附试验(ELISA)法分别检测158例胃癌患者(胃癌组)及30例健康志愿者(对照组)血清Ang-2与CEA的含量,并检测胃癌患者术后2周血清Ang-2与CEA含量的变化.术后随访2年,检测肿瘤复发患者(复发转移组,38例)与未复发患者(未复发组,93例)血清Ang-2与CEA含量.分析血清Ang-2含量变化与胃癌病理特征的关系.结果 胃癌组术前和复发转移组血清Ang-2含量[(331.8±64.3)、(318.7±72.9)μ g/L]和CEA含量[(42.6±37.3)、(40.5±36.7)μ g/L]均显著高于对照组[(187.4±32.7)、(4.2±3.1)μg/L](P＜0.01).术后2周血清Ang-2含量[(211.6±75.1)μg/L]与对照组比较差异无统计学意义(P＞0.05),而CEA含量[(33.4±30.6)μg/L]仍显著高于对照组(P＜0.01).血清Ang-2对胃癌诊断的敏感度显著高于CEA(P＜ 0.01).血清Ang-2含量与肿瘤分化程度、TNM分期、有无淋巴结转移、有无远处转移、浸润深度和肿瘤直径均相关(P＜0.01),而与组织学类型、肿瘤部位无相关性(P＞0.05).结论 血清Ang-2可作为一种新的具有一定临床价值的胃癌肿瘤标志物,有助于临床诊断、术后复发的监测和预后评价.     

细胞角蛋白多肽-19水平对新发甲状腺乳头状癌患者预后的影响

目的 探讨细胞角蛋白多肽-19(CK19)水平对新发甲状腺乳头状癌(PTC)患者预后的影响.方法 选择60例PTC患者,根据PTC是否复发分为复发组(27例)与非复发组(33例),测定并比较两组患者的CK19水平和临床资料.结果 单因素分析结果显示,两组年龄、女性、吸烟史、毒性弥漫性甲状腺肿病史、职业暴露史、甲状腺过氧化物酶抗体(TPOAb)水平、甲状腺球蛋白抗体(TGAb)水平、三酰甘油(TG)水平及CK19水平比较差异有统计学意义(P＜0.05).多因素Logistic 回归分析结果显示,女性、吸烟史、职业暴露史、TPOAb水平升高、TGAb水平升高、CK19水平升高是患者12个月内PTC复发的独立危险因素(P=0.01).CK19≥4.12 μg/L患者复发率为79.31％(23/29),显著高于CK19 ＜4.12μg/L患者的12.90％(4/31),差异有统计学意义(x2=5.17,P＜0.05).CK19≥4.12 μg/L时,PTC复发率较CK19 ＜4.12 μg/L时显著增加(x2=4.11,P＜0.05).结论 CK19水平升高是PTC患者复发的独立危险因素,可对新发PTC患者复发情况进行有效预测.     

急性冠状动脉综合征患者血清新蝶呤水平的临床研究

目的 研究血清新蝶呤对急性冠状动脉综合征(ACS)患者早期诊断和判断预后的临床意义.方法 选取2009年9月至2011年12月急诊就诊的ACS患者400例,其中不稳定型心绞痛(UAP)组325例,急性心肌梗死(AMI)组75例,选取同期健康体检者400例(对照组).检测ACS患者入院第1、3、7天和对照组血清新蝶呤水平及血脂、肝功能、肾功能等,并对各组检验结果进行比较.结果 AMI组和UAP组入院第1天血清新蝶呤水平显著高于对照组[(8.21±4.31)、(6.18±3.37)μg/L比(2.31±0.76) μg/L],差异有统计学意义(P＜0.01),而各组之间的年龄、性别构成、收缩压、舒张压、血糖、血脂、肝功能、肾功能等比较差异无统计学意义(P＞0.05).AMI组血清新蝶呤水平于入院第1、3、7天均显著高于UAP组[(8.21 ±4.31)μg/L比(6.18±3.37)μg/L、(5.87±2.34) μg/L比(4.04±1.73) μg/L、(3.35±1.67)μg/L比(2.85±0.75) μg/L],差异有统计学意义(P＜0.05),且两组血清新蝶呤水平随患者入院时间延长呈逐渐下降趋势(P＜0.05).结论 血清新蝶呤水平升高与ACS的发生有关,可能是不稳定斑块及ACS的预测因子.     

胃癌及术后随访患者血清可溶性上皮型钙黏附蛋白检测的临床意义

目的 探讨胃癌及术后随访患者血清可溶性上皮型钙黏附蛋白(sE-cad)含量变化的临床意义.方法 检测158例胃癌患者及30位正常对照者血清sE-cad含量,并检测术后2年血清sE-cad含量变化,分析其与胃癌病理特征的关系.结果 胃癌组血清sE-cad含量显著高于正常组[(23.2±6.4)μg/L vs (8.7±3.3)μg/L,P＜0.01].复发组及转移组术前血清sE-cad含量明显高于未复发组[(24.7±5.9)μg/L,(26.9 ±4.7)μg/L vs(22.2 ±4.0)μg/L,P均＜0.05];未复发组术后1个月至2年sE-cad含量无明显升高;复发组术后6个月至2年和转移组术后1个月至2年sE-cad含量均显著高于未复发组及正常组(P＜0.01);未复发组2年存活率显著高于复发组和转移组.sE-cad含量变化与胃癌分化程度、TNM病理分期、有无淋巴结转移、有无远处转移、浸润深度和肿瘤大小有关(t=6.208,4.841,4.860,5.854,3.641,10.705,P＜0.01).结论 血清sE-cad可成为具有一定临床价值的胃癌肿瘤标志物,有助于术后复发、转移的监测和预后评价.     

MRI联合PSA在前列腺癌骨转移中的诊断价值研究

目的 探讨MRI联合PSA检测在诊断前列腺癌骨转移中的应用价值.方法 选择某院收入的前列腺癌患者共74例,患者入院后检测血清PSA水平及MRI情况,从而检测前列腺癌骨转移患者表达情况.结果 所有74例患者中,前列腺癌骨转移阳性共43例(58.1％),PSA≥20 μg/L组患者前列腺癌骨转移阳性率为69.6％,显著高于PSA＜ 20 μg/L组的22.2％,两组对比差异有统计学意义(P＜0.05).PSA≥20 μg/L组敏感度显著高于PSA(μg/L)＜20 μg/L组,两组患者敏感性对比差异有统计学意义(P＜0.05).结论 PSA具有较好的预测前列腺癌骨转移的作用,当PSA≥20 μg时,患者发生前列腺癌骨转移的概率显著增加.PSA≥20μg/L时再结合MRI检测,能显著提高前列腺瘤骨转移的诊断水平.     

脑梗死患者同型半胱氨酸和血栓状态与临床疗效的关系

目的 探讨脑梗死患者不同阶段同型半胱氨酸(Hcy)水平.方法 选择132例脑梗死患者(脑梗死组),其中初次发作89例(初发组),再次发作43例(复发组),选择60例健康体检者(对照组).比较各组血清Hcy水平.结果 初发组高同型半胱氨酸血症(HHe)患者31例,发生率34.83％(31/89);复发组HHe患者25例,发生率58.14％(25/43),复发组HHe发生率高于初发组,差异有统计学意义(x2=6.449,P＜0.05).初发组治疗前后血清Hcy水平分别为(14.66±3.13)、(8.12±4.31)μmol/L,两者比较差异有统计学意义(P＜0.05);复发组治疗前后血清Hcy水平分别为(21.17±4.49)、(17.03±3.55)μmol/L,两者比较差异有统计学意义(P＜0.05).初发组和复发组治疗前血清Hcy水平均高于对照组[(5.24± 1.38) μmol/L],差异有统计学意义(t=6.629、9.496,P＜0.05);复发组治疗前血清Hcy水平明显高于初发组(t=13.145,P＜0.05).初发组和复发组治疗后血清Hcy水平均明显降低,复发组治疗后血清Hcy水平高于对照组,差异有统计学意义(t=11.548,P＜ 0.05).结论 多数脑梗死患者伴有HHe,且脑梗死患者不同阶段血清Hcy水平不同.     

神经元特异性烯醇化酶对非溶栓脑梗死出血性转化的预测意义

目的 探讨神经元特异性烯醇化酶(NSE)对非溶栓脑梗死出血性转化的预测作用.方法 153例非溶栓治疗脑梗死患者,根据头颅CT复查有无出血情况分为出血性转化组和非出血性转化组,用电化学发光法测定两组患者入院时血清NSE水平,并结合患者临床症状及头颅CT改变进行分析.同时与68例健康体检者(对照组)作比较.结果 出血性转化组、非出血性转化组与对照组血清NSE水平分别为(29.4±14.4)、(18.3±12.3)、(7.9±8.1) μg/L,出血性转化组、非出血性转化组血清NSE水平高于对照组(P＜0.01),出血性转化组血清NSE水平高于非出血性转化组(P＜0.01).出血性转化组不同亚型及有无症状性出血性转化患者血清NSE水平比较差异无统计学意义(P＞0.05).相关分析表明,血清NSE水平与美国国立卫生研究院卒中量表评分呈正相关(r=0.46,P＜0.01).结论 通过检测血清NSE水平可以对脑梗死出血性转化进行早期预测,增加临床溶栓治疗的安全性,预防出血性转化,改善患者预后.     

降钙素原对院外低危社区获得性肺炎患者抗生素使用的指导意义

目的 探讨血清降钙素原(PCT)水平对院外低危社区获得性肺炎(CAP)患者抗生素使用剂量和时间的指导意义.方法 选择院外低危CAP患者155例,采用抽签法随机分为观察组(79例)和对照组(76例).所有患者在完成评估24 h内予以出院.对照组按照现有的指南接受抗生素治疗；观察组则根据血清PCT水平给予或不给予抗生素治疗:PCT＜ 0.10 μg/L,不予抗生素；PCT0.10～0.25 μg/L,不推荐使用抗生素；PCT＞ 0.25 μg/L,建议给予抗生素.主要研究指标为抗生素暴露时间及抗生素暴露率,次要研究指标为治疗总有效率及严重并发症发生率.结果 共124例患者完成试验,对照组63例,观察组61例.对照组抗生素暴露率为98.4％(62/63),显著高于观察组的73.8％(45/61),差异有统计学意义(x2=15.91,P＜0.01)；同时,对照组抗生素暴露时间为(8.3±2.2)d,远超出观察组的(5.8±1.9)d,差异有统计学意义(t=6.78,P＜0.01).两组治疗总有效率及严重并发症发生率比较差异均无统计学意义(P＞0.05).结论 对于院外低危CAP患者,以血清PCT水平为指导原则,可有效降低抗生素使用率,缩短使用时间,且不增加严重并发症发生率.     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.