雷公藤内脂醇对人卵巢癌耐顺铂细胞株超微结构的影响

目的探讨雷公藤内脂醇对体外培养的人卵巢上皮性癌耐顺铂细胞株（COC，／DDP）超微结构的影响。方法空白对照组加入9mLCOC，／DDP专用细胞培养液培养，雷公藤内脂醇作用组加入9rnL含50μg／L雷公藤内脂醇溶液培养，2组作用48h后收集细胞，通过透射电子显微镜观察COC，／DDP的超微结构。结果透射电子显微镜下观察可见空白对照组中COC1／DDP细胞膜表面有丰富的微绒毛，细胞核大而明显，染色质丰富；雷公藤内脂醇作用组中COC1／DDP细胞表面微绒毛消失，细胞核固缩、染色质凝集成新月状，有凋亡小体形成。结论50μg／L雷公藤内脂醇可诱导COC1／DDP呈凋亡改变。     

The value of variable number of tandem-repeat polymorphisms in cases of disputed paternity not resolved by conventional markers: two case reports

Disputed paternity cases are routinely tested in the authors' laboratory for red cell antigen, plasma protein, red cell enzyme, and HLA polymorphisms. This report concerns two cases in which the above test results made exclusion of paternity doubtful. In one case, exclusion of paternity was based on one discrepancy in the Duffy blood group system only, a unique situation in the investigators' experience of more than 2500 cases; the investigators were, therefore, reluctant to use this as the only evidence of exclusion. In the other case, it was necessary to postulate the presence of a rare haplotype, MSu, in the MNS blood group system to explain paternity. It was therefore decided to investigate allelic variable number of tandem-repeat (VNTR) DNA polymorphisms in these disputed paternity trios. VNTR DNA typing convincingly excluded these accused men from paternity.     

Effect of simulation on knowledge,self‐confidence,and skill performance in the USA: A quasi‐experimental study

In health care, high‐fidelity simulation has been shown to result in increased student learning outcomes when compared to low‐fidelity simulation. With educational facilities investing significant amounts of money into purchasing high‐fidelity simulators, it is imperative to identify if the midlevel simulator, which is less costly, will result in the same learning outcomes. In this study, we examined the effect of midlevel‐fidelity simulation versus low‐fidelity simulation on Bachelor of Science in Nursing nursing students' knowledge, self‐confidence, and skill performance. A quasi‐experimental design examined the effects of midlevel‐fidelity simulation (n = 37) versus low‐fidelity simulation (case study) (n = 37) in junior‐level nursing students. There was a significant difference for both groups in knowledge and skill performance (measured with a mini Objective Structured Clinical Examination), but not between the groups. Unexpectedly, the case‐study group had a higher level of self‐confidence (self‐reported). The results of this study indicate that further research is needed to support faculties' selection of learning strategies with the lowest cost and highest effectiveness in achieving the desired learning outcomes.     

妇科疾病患者发生症状性下肢深静脉血栓和症状性肺栓塞的临床对比分析

目的寻找妇科疾病患者从深静脉血栓进展为肺栓塞的高危因素,识别可能直接发生肺栓塞的高危患者并及时加以预防,在避免过度治疗的同时降低肺栓塞的发生。方法复习单纯深静脉血栓、单纯肺栓塞以及深静脉血栓合并肺栓塞的妇科患者的临床资料。结果从2000年1月1日至2012年10月31日,共有87 587名妇科疾病患者住院。其中0.43‰发生深静脉血栓(深静脉血栓组38例),0.18‰发生肺栓塞(肺栓塞组16例),0.21‰发生深静脉血栓合并肺栓塞(深静脉血栓合并肺栓塞组18例)。3组之间,血清纤维蛋白原水平具有显著性差异(P=0.007)。肺栓塞组和深静脉合并肺栓塞组中,67.7%的患者疾病原发于卵巢、输卵管或腹膜。在深静脉血栓组,65.8%的患者疾病原发于子宫、阴道和外阴(P=0.009)。双下肢深静脉血栓更易触发肺栓塞(P=0.015)。多元回归分析显示,疾病原发灶位于卵巢/输卵管/腹膜(P=0.004,OR=3.985),体重指数25.0kg/m2(P=0.018,OR=1.239),和双侧深静脉血栓(P=0.017,OR=6.81)的患者更容易发生肺栓塞。凝血酶时间值越低,越容易术前发生血栓(P=0.004,OR=2.416)。结论原发疾病位于卵巢/输卵管/腹膜、体重指数25.0kg/m2或者双侧深静脉血栓是深静脉血栓基础上发生肺栓塞,或者直接发生肺栓塞的危险因素。     

Modified total en bloc spondylectomy for thoracolumbar spinal tumors via a single posterior approach

Purpose

The objectives of this study were to describe our surgical management with a modified total en bloc spondylectomy (TES) and to evaluate the clinical effects in patients with thoracolumbar tumors.

Methods

Sixteen consecutive patients with thoracolumbar neoplasms underwent a modified TES via single posterior approach followed by dorsoventral reconstruction from December 2008 to July 2011. Details of the modified technique were described and the patients’ clinical information was retrospectively reviewed and analyzed.

Results

Significant improvements in neurological function were achieved in most of the patients. Local pain or radicular leg pain was relieved postoperatively. The mean operation time was 7.2 h, with an average blood loss of 2,300 ml. No major complications, instrumentation failure or local recurrence was found at the final follow-up. Five patients died of the disease during mean 14-month (3.0–23) follow-up.

Conclusions

The modified TES with a single posterior approach is feasible, safe and effective for thoracolumbar spine tumors.     

慢性丙型肝炎患者凝血功能与血清HCV-RNA含量的关系探讨

目的探讨慢性丙型肝炎患者凝血功能与血清HCV-RNA含量之间的关系及其意义。方法收集广州市第八人民医院慢性丙型肝炎患者182例,健康人群20例作为正常对照组,慢性丙型肝炎患者根据HCV-RNA含量分为A组(HCV-RNA含量:105IU/ml)、B组(HCV-RNA含量:105~IU/ml)、C组(HCV-RNA含量:106~IU/ml)、D组(HCV-RNA含量:107~IU/ml)。分别检测其血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、血浆纤维蛋白原(FIB)四项凝血功能指标及血清HCV-RNA含量。分析PT、APTT、TT、FIB指标在不同血清HCV-RNA含量组中的变化及其意义。结果除FIB值外,不同HCV-RNA含量组之间PT、APTT、TT比较差异均有统计学意义(χ2PT=32.91,χ2APTT=25.78,χ2TT=43.14,P均=0.000)。各组PT、APTT、TT值与正常对照组比较,差异均有统计学意义(P0.05),特别是病毒含量≥105IU/ml时,与正常对照组比较差异有显著统计学意义(P0.01)。对于FIB值,除了病毒含量≥107IU/ml≥106~107IU/ml组外,其余两组与正常对照组比较差异均有统计学意义(P0.05)。结论慢性丙型肝炎患者凝血功能随着病人体内HCV-RNA含量的增加有逐渐降低的趋势,特别是对于HCV-RNA含量≥106IU/ml的病人,应随时监测病人的凝血功能,以防出现严重的出血。     

早期宫颈腺癌的预后分析

目的探讨影响临床早期宫颈腺癌预后的相关因素,并分析不同辅助治疗方法对预后的影响。方法回顾性分析自1995年11月至2012年2月间于北京协和医院治疗的118例FIGOⅠa2期-Ⅱa2期宫颈腺癌患者的临床资料,记录人口统计学信息、诊断及治疗信息,并记录随访及生存资料,采用SPSS11.5软件Cox回归分析进行肿瘤复发相关因素分析。结果 118例患者的中位年龄为41岁(19～74岁),其中有102例(86.4%)初次治疗时采取了根治性子宫切除和/或双附件切除和/或盆腔腹主动脉旁淋巴结切除术。平均随诊29.8月(2～132月),19例患者在随访过程中肿瘤复发,7例患者死亡。与肿瘤复发相关的单因素分析显示,患者年龄大(P=0.008)、期别晚(P=0.008)、肿瘤≥4 cm(P=0.006)、淋巴结阳性(P=0.001)、宫颈有深肌层浸润(P=0.016)均是复发的高危因素,而淋巴血管间隙浸润及腺癌的病理类型与复发无明显相关性。多因素分析显示,仅淋巴结转移是肿瘤复发的独立高危因素(P=0.006)。淋巴结阴性和阳性患者的5年无瘤生存率分别为79.1%和12.7%,5年总生存率分别为94.0%和40.0%。淋巴结转移与肿瘤≥4 cm(P=0.018)、宫颈深肌层浸润(P=0.001)显著相关,而与年龄(P=0.746)、FIGO分期(P=0.155)、淋巴血管间隙浸润(P=0.802)不相关。对于高危患者,手术后辅助放化疗可延长患者无瘤生存期,但未达到统计学意义(P=0.201)。结论宫颈腺癌预后较差,早期患者的独立预后因素是盆腔淋巴结转移,对于高危患者于根治性子宫切除术后进行辅助放化疗可能延缓肿瘤复发。