BMP-2和p21WAF1的表达与乳腺癌临床病理特征及其发生骨转移的关系

目的 检测骨形成蛋白-2(bone morphogenetic protein-2,BMP-2)和p21WAF1在乳腺癌患者原发灶及骨转移灶中的表达,探讨它们在乳腺癌骨转移发生中的意义.方法 选择临床及病理资料完整的乳腺癌患者126例,其中未发生骨转移者88例,发生骨转移者38例.应用免疫组织化学方法检测原发灶及骨转移灶中BMP-2和p21WAF1的表达情况,并结合患者年龄、肿瘤大小、淋巴结转移、临床分期等,探讨它们之间的相互关系.结果 ①乳腺癌组织中BMP-2和p21WAF1的阳性表达率在有骨转移、有淋巴结转移组中均低于无骨转移、无淋巴结转移组(P＜0.01).②临床Ⅲ~Ⅳ期的乳腺癌组织BMP-2和p21WAF1的阳性表达率分别为20.59%、23.53%,明显低于其在临床Ⅱ期乳腺癌组织中的表达(P＜0.01).③BMP-2阳性表达率在骨转移灶中的表达明显低于其在原发灶中的表达(P＜0.05),p21WAF1阳性表达率在骨转移灶中也低于原发灶,但差异无统计学意义(P＞0.05).④BMP-2和p21WAF1蛋白阳性表达率呈正相关(r=0.887,P＜0.01).结论 ①乳腺癌合并淋巴结转移时骨转移的发生率高.②临床分期越晚,骨转移的发生率越高.③BMP-2和p21WAF1高表达者淋巴结转移少,发生骨转移的机会较少;而BMP-2和p21WAF1的低表达预示具有形成骨转移的潜能.     

未成熟网织红细胞在小儿贫血中的应用价值

目的探讨未成熟网织红细胞在小儿贫血中的临床应用价值。方法应用Syrsmex XE-2100全自动血细胞分析仪检测578例儿童血液病患儿的网织红细胞计数（RET）、网织红细胞百分比（RET）、未成熟网织红细胞比率（IRF）、低荧光强度网织红细胞比值（LFR）、中荧光强度网织红细胞比值（MFR）、高荧光强度网织红细胞比值（HFR）等参数。结果营养性缺铁性贫血、溶血性贫血、ABO溶血组和血小板减少性紫癜患儿RET，IRF等指标显著增高（P〈O．05），再生障碍性贫血、白血病患儿RET显著降低（P〈0．05），IRF显著增高（P〈0．05）。结论测定网织红细胞及未成熟网织红细胞比率有助于判断骨髓生成红细胞的活动度，对贫血类型的鉴别诊断有一定价值。     

Seizure Deterioration with Increased Levetiracetam Blood Concentration during the Postpartum Period in Refractory Temporal Lobe Epilepsy

We evaluated a 39-year-old pregnant woman with right temporal lobe epilepsy. During the second trimester, seizure deterioration was responsive to an increased daily dose of levetiracetam (LEV). However, immediately after delivery, new non-habitual seizures emerged along with a sharply increased LEV concentration. The frequency of habitual seizures also slightly increased. The non-habitual seizures completely disappeared, and the frequency of the habitual seizures improved to the baseline level after the LEV dosage was reduced. Thus, a paradoxical effect of an increased LEV blood concentration was assumed to be a potential cause of these events. Peripartum pharmacokinetic fluctuations in LEV levels should be monitored carefully.     

护理风险层级安全干预机制的建立与实施

目的建立护理风险层级安全干预机制并评价应用效果。方法以心内科为试点,建立护理部主任、护理部质控人员(三级),片区总护士长(二级),科室护士长和安全员(一级)组成的护理风险层级安全管理网络,实行由一级到三级逐级报告制度。结果实施护理风险层级安全干预前发生护理差错、纠纷19例,实施后发生护理差错、纠纷4例。实施前后护理差错、纠纷发生率比较,差异有统计学意义(P<0.01)。结论护理风险层级安全干预机制的建立,充分发挥了各部门的职能作用,提高了护理人员对风险的识别与应对能力,降低和避免了护理风险,确保了护理安全。     

Determinants for a low health-related quality of life in asthmatics

People with asthma suffer from impaired health-related quality of life (HRQL), but the determinants of HRQL among asthmatics are not completely understood. The aim of this investigation was to study determinants of low HRQL in asthmatics and to study whether the determinants of HRQL differ between sexes and age groups. A cohort of three age groups in Sweden was investigated in 1990 using a questionnaire with focus on respiratory symptoms. To study quality of life, the generic instrument Gothenburg Quality of Life was used. The participants were also investigated with interviews, spirometry, and allergy testing. Asthma was diagnosed in 616 subjects. Fifty-eight per cent (n = 359) of the subjects were women; and 24% were smokers, 22% ex-smokers, and 54% were non-smokers. Women were more likely than men to report poor health-related quality of life. Respiratory symptoms severity was another independent determinant of a lower quality of life as well as airway responsiveness to irritants. Current and former smokers also reported lower quality of life. Finally, absenteeism from school and work was associated with lower quality of life. Factors such as sex, smoking habits, airway responsiveness to irritants, respiratory symptom severity, allergy, and absenteeism from school and work were associated with low HRQL in asthmatics.     

Prevalence of asthma and allergic disorders in regional,rural, and indigenous children aged 6–8 years in Tasmania

Objective: Asthma and allergic diseases are poorly described in rural areas. The objective of this study was, therefore, to determine the prevalence of wheezing, asthma, and other allergic disorders among children living in regional and rural Tasmania. Methodology: Data from a cross-sectional survey using standardized questionnaires of asthma, allergic conditions and food allergies were collected from 39 primary schools across North West Tasmania. We enrolled 1075 children between 6 and 8?years. The main outcomes were prevalences of wheezing, asthma, and other allergic disorders further stratified by sex and indigenous status. Results: Baseline characteristics were as follows: median age 8.1?years (IQR: 7.6, 8.7) with equal sex distribution, most (80.1%) attended public schools and 11.0% identified as indigenous. We report prevalences of current wheezing (22.7%), allergic rhinoconjunctivitis (16.3%) and atopic eczema (16.6%), with higher prevalences among boys (except eczema). Food allergies were reported in 8.6% and food-related anaphylaxis in 1.6% of the sample. Indigenous children had significantly higher prevalence of current wheezing (indigenous 31.1% versus non-indigenous 21.6%; p?=?0.02). Further, children with current wheezing and no asthma diagnosis, had similar prevalence of other atopic diseases (hayfever 31.4%, eczema 44.0%, and food reaction 23.2%) compared with diagnosed asthmatics, although likely shared the illness. Conclusions: Childhood asthma is more prevalent in regional Tasmania compared with national estimates, especially among indigenous children. This appears not to be driven by an allergic response. Also, a significant proportion of children are likely to have undiagnosed asthma which has implications for rural health service delivery.     

Factors Associated With Health Care Personnel Influenza Vaccination Behavior

Influenza vaccination is recommended for all health care personnel (HCP), but immunization rates for this group continue to be suboptimal. This study explores relationships between individual characteristics, beliefs, knowledge, attitudes, and vaccination behavior through 2 surveys conducted at a university health center. The findings suggest that HCP who were vaccinated the year before, intended to be vaccinated next year, believed influenza vaccination was important, and were more knowledgeable are more likely to receive a vaccine.     

Efficacy and Safety of Liposomal Clarithromycin and Its Effect on Pseudomonas aeruginosa Virulence Factors

We investigated the efficacy and safety of liposomal clarithromycin formulations with different surface charges against clinical isolates of Pseudomonas aeruginosa from the lungs of cystic fibrosis (CF) patients. The liposomal clarithromycin formulations were prepared by the dehydration-rehydration method, and their sizes were measured using the dynamic-light-scattering technique. Encapsulation efficiency was determined by microbiological assay, and the stabilities of the formulations in biological fluid were evaluated for a period of 48 h. The MICs and minimum bactericidal concentrations (MBCs) of free and liposomal formulations were determined with P. aeruginosa strains isolated from CF patients. Liposomal clarithromycin activity against biofilm-forming P. aeruginosa was compared to that of free antibiotic using the Calgary Biofilm Device (CBD). The effects of subinhibitory concentrations of free and liposomal clarithromycin on bacterial virulence factors and motility on agar were investigated on clinical isolates of P. aeruginosa. The cytotoxicities of the liposome preparations and free drug were evaluated on a pulmonary epithelial cell line (A549). The average diameter of the formulations was >222 nm, with encapsulation efficiencies ranging from 5.7% to 30.4%. The liposomes retained more than 70% of their drug content during the 48-h time period. The highly resistant strains of P. aeruginosa became susceptible to liposome-encapsulated clarithromycin (MIC, 256 mg/liter versus 8 mg/liter; P < 0.001). Liposomal clarithromycin reduced the bacterial growth within the biofilm by 3 to 4 log units (P < 0.001), significantly attenuated virulence factor production, and reduced bacterial twitching, swarming, and swimming motilities. The clarithromycin-entrapped liposomes were less cytotoxic than the free drug (P < 0.001). These data indicate that our novel formulations could be a useful strategy to enhance the efficacy of clarithromycin against resistant P. aeruginosa strains that commonly affect individuals with cystic fibrosis.     

颈椎手术中并发椎动脉损伤的诊断与治疗

 目的 探讨颈椎手术中并发椎动脉损伤的发生原因、治疗及预防。方法 回顾性分析2002年10月至2012年4月颈椎手术中并发椎动脉损伤的7例患者资料,男6例,女1例;年龄23～65岁,平均48.9岁;脊髓型颈椎病5例,颈椎外伤合并C^4,5半脱位1例,氟骨症致颈椎管狭窄1例。椎动脉损伤均为单侧,左侧4例,右侧3例。分析颈椎手术中并发椎动脉损伤的原因、处理过程及预后。结果颈椎前路手术4例,其中2例用环钻减压时偏离中线损伤椎动脉,1例切除椎间盘时刮匙过于偏外损伤椎动脉,1例颈椎外伤患者由于Ｃ^4,5半脱位造成椎动脉迂曲,减压时冲击式咬骨钳损伤椎动脉。颈椎后路手术3例,其中2例为行C4侧块螺钉固定时钻头偏外损伤椎动脉;1例氟骨症致颈椎管狭窄者在切除寰椎后弓时咬骨钳损伤椎动脉,术中出现椎动脉损伤后,迅速填塞压迫止血并关闭伤口,但术后4周发生迟发性出血,采用椎动脉栓塞止血及颈后路血肿清除术治疗。7例患者均未发生脑梗塞,其中2例患者术后出现一过性头晕。结论 椎动脉损伤是颈椎手术的严重并发症,其损伤原因与手术失误、解剖变异等有关;采用直接压迫及椎动脉栓塞治疗效果确切。