PDCA在医院试用期考核工作中的应用与思考

目的:探索PDCA循环在医院试用期考核工作中的应用效果.方法:以吉林省某三甲医院为例,2014年—2019年新入职的1250名员工为研究对象,自2017年起将PDCA管理工具引入试用期考核.通过分析现状、制定方案、组织实施、回顾检验、数据对比与持续优化等步骤建立健全考核机制.SPSS21.0做统计学分析.结果:通过数据...     

Vascular air embolism during percutaneous nephrolithotomy without pneumopyelogram: a case report of successful rescue

Vascular air embolism (VAE) is a rare complication of percutaneous nephrolithotomy. Paradoxical air embolization resulting from VAE may be more likely to occur in patients with an atrial-septal defect, such as patent foramen ovale. Here, the case of a female patient with VAE that occurred during percutaneous nephrolithotomy is presented. Although the patient was diagnosed with patent foramen ovale, she recovered well without any severe paradoxical air embolization symptoms. To our knowledge, this is the first report of VAE with paradoxical air embolization that occurred in a patient with patent foramen ovale during percutaneous nephrolithotomy that was conducted without pneumopyelography.     

原发性局灶节段性肾小球硬化预后相关因素的研究进展

近年来局灶节段性肾小球硬化（FSGS）发病率增加,且治疗困难,预后较差,是导致终末期肾疾病的主要原因之一。肾脏病学家试图探索某些指标来拟诊和预测预后,该文简述了原发性FSGS预后相关因素如蛋白尿程度、血肌酐水平、肾小管间质病变、病理类型、治疗方法、治疗反应、基因、足细胞及足细胞蛋白等的研究进展。     

输尿管镜下尿道会师术治疗尿道骑跨伤体会

目的 探讨输尿管镜下尿道会师术治疗尿道骑跨伤的临床价值.方法 对17例尿道骑跨伤患者采用输尿管镜引导放置导尿管,随访观察手术的效果.结果 17例中,3例因尿道完全断裂,镜下会师失败后,2例改行开放会师术,1例行耻骨上膀胱穿刺造瘘术;其余14例采用输尿管镜下尿道会师术均1次成功.术后均获随访 0.5~1年,除2例排尿明显变细、需定期尿道扩张外,其余患者未出现尿道狭窄、尿失禁、性功能障碍等并发症.结论 输尿管镜下尿道会师术手术时间短、创伤小、恢复快、效果好,是治疗尿道骑跨伤的有效方法.     

长骨液在下肢骨延长中的疗效观察

目的:观察“长骨液”对下肢骨延长术后的治疗效果。方法:56例患者分为长骨液组和对照组进行配对对照观察。于术后第3天开始口服长骨液。观察骨延长区新骨生长情况、肢体伤后肿胀及并发症发生的情况。结果:①对照组平均骨延长愈合指数为41.797±3.5862(d/cm),治疗组平均骨延长愈合指数为36.291±2.8969(d/cm)(P<0.01)。②治疗组的46例病例平均骨延长愈合指数为37.121±2.2176(d/cm),明显低于国内报道指数。结论:“长骨液”有明显促进骨延长区新骨再生与成熟及减少并发症的作用。     

Sarcopenia with systemic inflammation can predict survival in patients with hepatocellular carcinoma undergoing curative resection

BackgroundThis study aimed to examine the prognostic significance of sarcopenia combined with systemic inflammation in patients who underwent curative hepatectomy for hepatocellular carcinoma (HCC).MethodsBetween January 2010 and July 2019, we identified 159 patients with HCC who underwent curative hepatectomy at three institutional centers. We retrospectively analyzed clinicopathological outcomes, surgical outcomes, platelet lymphocyte ratio (PLR) as a systemic inflammatory marker, and computed tomography (CT)-assessed sarcopenia at the third lumbar vertebra level (L3).ResultsSarcopenia was noted in 74 (46.5%) of 159 patients and was significantly associated with male sex, low body mass index (BMI), and high PLR. In the multivariate analysis, sarcopenia [hazard ratio (HR): 2.127, P=0.026] and high PLR (HR: 1.971, P=0.038) were associated with a decrease in overall survival (OS) but not in recurrence-free survival (RFS). The combination of sarcopenia and PLR status stratified the 5-year OS into 82.0% (non-sarcopenia and a low PLR), 68.3% (sarcopenia or a high PLR), and 44.4% (sarcopenia and a high PLR) (P=0.001). In the multivariate analysis, “sarcopenia and a high PLR” and “sarcopenia or a high PLR” were revealed to be significant predictors of OS (HR: 4.300, P=0.001 and HR: 2.723, P=0.010, respectively).ConclusionsSarcopenia and high PLR were significantly associated with poor OS. The combination of these two factors may be useful for predicting survival of patients with HCC undergoing curative hepatectomy.     

Clinical significance and correlation of miR-200c and P-gp expression in gastric cancer and the effects on multidrug resistance

BackgroundPoor prognosis is common in gastric cancer patients due to multidrug resistance (MDR)-induced recurrence and metastasis. In the present study, we investigated the expression of microRNA (miR)-200c in gastric cancer tissues and cell lines and its relationship with the expression of the drug resistant gene ABCB1, which encodes P-glycoprotein (P-gp).MethodsThe basic characteristics of 102 patients with gastric cancer were reviewed. Real time-polymerase chain reaction (PCR), immunohistochemistry, and Western blot were employed to detect the expression levels of miR-200c and P-gp in gastric carcinoma tissues and cell lines. The correlation of miR-200c messenger RNA (mRNA) level with clinicopathological characteristics and P-gp protein expression were analyzed. SGC7901/vincristine (VCR) cells were transfected with miR-200c mimics or a specific small interfering RNA (siRNA) targeting the ABCB1 gene. The methyl thiazolyl tetrazolium (MTT) assay and flow cytometry were used to determine the role of miR-200c and ABCB1 on the viability and apoptosis of gastric carcinoma cell lines.ResultsThe level of miR-200c in carcinoma tissues was significantly lower than that in adjacent tissues, and the expression level of P-gp in carcinoma tissues was obviously higher than that in adjacent tissues (P<0.01, P=0.029). The expression levels of miR-200c and P-gp were associated with the malignant characteristics of gastric cancer, and patients with high expression of miR-200c or negative expression of P-gp had a better prognosis (P=0.006, P=0.022). MiR-200c negatively regulated the ABCB1 gene in gastric cancer cell lines. MiR-200c overexpression and ABCB1 down-regulation increased the sensitivity of SGC7901/VCR cells to VCR and reversed MDR by promoting cell apoptosis.ConclusionsThe expression level of miR-200c decreases in gastric carcinoma tissues and drug-resistant gastric cancer SGC7901/VCR cells. Overexpression of miR-200c may enhance the sensitivity of SGC7901/VCR cells to VCR by regulating the expression of P-gp.     

Changes in imatinib plasma trough level during long-term treatment of patients with advanced gastrointestinal stromal tumors: correlation between changes in covariates and imatinib exposure

A pharmacokinetic study in patients with gastrointestinal stromal tumors (GIST) suggested that imatinib plasma concentration may decrease following long-term exposure. We assessed changes in imatinib plasma trough levels (C(min)) during long-term treatment. Follow-up (FU) imatinib C(min) was measured in 65 patients who received the same dose of imatinib for at least 9 months after previous (initial) tests. After exclusion of 7 patients who had been treated with imatinib for over 2 years at the time of initial testing, 58 patients were included in this analysis. The median intervals from initiation of imatinib to initial testing and from initial to FU testing were 5.5 months (range, 0.5-24.0 months) and 13.0 months (range, 9.6-17.9 months), respectively. Mean inter- and intra-subject variability values were 47.7% and 20.9%, respectively, at initial measurements, and 45.2% and 19.4%, respectively, at FU. Mean FU imatinib C(min) (1,370 ± 661 ng/mL) was significantly higher than mean initial C(min) (1,171 ± 573 ng/mL; p = 0.003). Compared with initial C(min), FU C(min) was decreased in 22 patients and increased in 36, with median changes of 13% and 32%, respectively. Multivariate analysis showed a significant correlation between the ratio of FU to initial imatinib C(min) and that of albumin (r = -0.39, p = 0.003). During long-term treatment, imatinib C(min) did not decrease significantly but remained stable or increased in most patients. Changes in imatinib C(min) were associated with changes in albumin concentration. Monitoring of imatinib C(min) only for concerns about time-dependent increases in imatinib clearance is not necessary.     

Comparative Genomics of Korean Infectious Bronchitis Viruses (IBVs) and an Animal Model to Evaluate Pathogenicity of IBVs to the Reproductive Organs

The K-I and nephropathogenic K-II genotypes of infectious bronchitis virus (IBV) have been isolated since 1995 and 1990, respectively, in Korea and commercial inactivated oil-emulsion vaccines containing KM91 (K-II type) and Massachusetts 41 strains have been used in the field. To date, genomic analyses of Korean IBV strains and animal models to test the pathogenicity of Korean IBVs to the reproductive organs have been rare. In the present study, comparative genomics of SNU8067 (K-I type) and KM91 IBVs was performed, and an animal model to test the pathogenicity of SNU8067 was established and applied to vaccine efficacy test. The genome sizes of SNU8067 (27,708 nt) and KM91 (27,626 nt) were slightly different and the nucleotide and amino acid identities of the S1 (79%, 77%), 3a (65%, 52%), and 3b (81%, 72%) genes were lower than those of other genes (94%–97%, 92%–98%). A recombination analysis revealed that SNU8067 was a recombinant virus with a KM91-like backbone except S1, 3a, and 3b genes which might be from an unknown virus. An SNU8067 infection inhibited formation of hierarchal ovarian follicles (80%) and oviduct maturation (50%) in the control group, whereas 70% of vaccinated chickens were protected from lesions.