慢性乙肝HBV-DNA载量对甘利欣降酶疗效的影响

甘利欣广泛用于各种急慢性肝炎的治疗,具有显著的降酶效果.然而,慢性乙型肝炎,尤其是"大三阳"者,有疗效差易反跳的现象.观察HBV-DNA载量的高低对其的影响,对提高"大三阳"慢性乙型肝炎的疗效有现实意义.     

A cross-sectional observational study to investigate daily symptom variability, effects of symptom on morning activities and therapeutic expectations of patients and physicians in COPD-SUNRISE study

Chronic obstructive pulmonary disease (COPD) is a lung disease characterized with limitation of airflow that is not completely reversible, progressive deterioration of airways and systemic inflammation. This study has been planned to determine daily symptom variability of patients, expectations of patient and physicians from treatment and patient profiles. A total of 514 patients with COPD from 25 centers were included in this national, multicenter, cross-sectional observational study. Data regarding demographic features, concomitant diseases, history and treatment of COPD and expectations of patients and physicians were all obtained in a single visit. Mean [standard deviation (SD)] age of the patients was 64.1 (9.5) years; age range was 41-92 years, 50% of the patients were younger than 65 years and 91% were males. Educational level of the patients was at least primary school in 80.2%; and 54.3% (30.4%) of the patients had at least one concomitant disease, particularly a cardiovascular disease. Mean (SD) duration of having COPD was 5.4 (4.6) years. The majority of patients were at moderate (43.2%) and severe (35.0%) COPD stages and one or more exacerbations per year was determined in 71%. Inhaled beta-2 agonists (84.2%), inhaled steroids (76.3%) and inhaled long-acting anti-cholinergics (70.0%) were the most commonly used medications. Dyspnea (99.0%), sputum production (92.8%) and wheezing (90.5%) were the most common symptoms, and symptom variability for dyspnea (41.1%), sputum production (61.0%) and cough (53.5%) were seen the most in the morning hours (p< 0.001). Most commonly affected morning activity was climbing up/down the stairs (point of effect: 6.7), followed by wearing socks/shoes (point of effect: 4.3) and showering/bathing (point of effect: 4.2) by COPD. Major treatment expectations of patients were greater symptomatic relief (82.3%) and greater mobility (70.0%), faster symptomatic relief (61.1%) and improvement in morning activities (59.3%); while major treatment expectations of physicians included increased quality of life (100.0%) and decreased morbidity (96.0%). Quitting smoking was the most commonly recommended (88.3%) and implemented (67.9%) non-drug protective approach aimed at decreasing the frequency of exacerbations. Consequently, our results demonstrate that COPD is not a disease of only the elderly, is an important healthcare issue that often disrupt daily living of the patients due to inadequate disease awareness leading to overlooking of the symptoms by patient and physicians, and that a patient-centered approach based on the living standards, life expectancies and preferences of patients was crucial in patient management.     

心理干预联合人文关怀在消化内镜诊疗患者的应用

目的探讨心理干预联合人文关怀在消化内镜诊疗患者的应用及对患者心理舒适度的影响。 方法选取2018年1月至2019年10月于徐州医科大学附属淮安医院行消化内镜诊疗患者80例，按照简单数字表法随机分成对照组(40例)和观察组(40例)。对照组患者予以实施常规护理，观察组患者则在予以常规护理的基础上予以心理干预以及人文关怀护理。分别比较两组患者的检查时的应激状态、舒适状况、心理状态以及治疗配合度。 结果观察组患者检查时期间的心率差值、收缩压差值均显著低于对照组患者(P<0.05)；观察组患者的舒适状况量表各维度评分显著高于对照组患者(P<0.05)；观察组的焦虑自评量表、汉密尔顿焦虑量表评分显著低于对照组(P<0.05)；观察组患者的治疗配合度(97.50%)明显优于对照组(82.50%)(P<0.05)。 结论在消化内镜诊疗中应用心理干预联合人文关怀对患者进行护理干预，能够有效缓解患者的诊疗应激状态，提高患者的治疗配合度及心理舒适度，取得良好的护理效果，值得广泛推广。     

Gli-1信号通路对TGF-β1诱导的人胃癌细胞上皮间质转化和侵袭的影响

目的:探讨核转录因子神经胶质瘤关联癌基因同源物1（glioma associated oncogene homolog 1,Gli-1）对转化生长因子-β1(transforming growth factor-β1,TGF-β1)诱导的人胃癌SGC-7901细胞发生上皮间质转化（epithelial-mesenchymal transition,EMT）的作用机制。方法:体外采用10 ng/ml TGF-β1对胃癌SGC-7901细胞进行处理,使用倒置显微镜观察细胞形态变化,RT-PCR和Western blot检测EMT上皮表型蛋白E-cadherin和间质表型蛋白Vimentin的表达水平;Transwell细胞侵袭实验检测细胞侵袭能力变化,检测TGF-β1 对SGC-7901细胞发生EMT 的影响;同时采用RT-PCR和Western blot检测Gli-1的mRNA和蛋白表达水平。随后进一步采用Gli-1基因特异性阻断剂GANT 61阻断Gli-1表达,并使用TGF-β1（10 ng/ml）对SGC-7901细胞进行处理,RT-PCR 和Western blot检测Gli-1、E-cadherin和Vimentin mRNA 及其蛋白表达水平的改变,并使用Transwell细胞侵袭实验检测阻断Gli-1对SGC-7901细胞侵袭能力的影响。结果:TGF-β1可以诱导人胃癌SGC-7901细胞发生上皮间质转化并促进细胞侵袭。TGF-β1可以在mRNA和蛋白水平下调上皮表型蛋白E-cadherin的表达、提高Gli-1和间质表型蛋白Vimentin的表达。TGF-β1可以明显提高SGC-7901细胞侵袭,而阻断Gli-1后可以抑制TGF-β1诱导的人胃癌SGC-7901细胞上皮间质转化和细胞侵袭。结论:胃癌SGC-7901细胞中Gli-1 可能参与TGF-β1 介导的EMT 的发生,Gli-1 可能作为胃癌基因治疗中的有效靶点发挥作用。     

书法治疗对抑郁症的作用

目的:研究书法治疗对抑郁症住院患者的治疗效果.方法:将61例人组患者随机分为治疗组和对照组,治疗组患者除药物治疗还进行书法治疗,对照组只使用药物治疗,两组在治疗前及治疗后第2、4、6周末使用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)进行评定和比较.结果:治疗组HAMD和HAMA减分率在第4周末与对照组比较有显著性差异,在第6周末有极显著性差异.结论:书法治疗是一种非常有效的辅助治疗方法,特别是对抑郁症患者的焦虑症状的控制和改善尤为明显,应在精神科治疗和康复中积极推广.     

以伤口专科护士为主导的创面修复病房的构建与运行

目的充分发挥伤口专科护士的作用,满足慢性伤口患者护理需求。方法自2018年5月起,建立以伤口专科护士为主导的创面修复病房,成立独立的创面修复护理小组,依托创伤中心医疗组和护理组开展工作。结果 2018年5月至2019年6月创面修复病房收治患者51例,通过创面床准备和负压伤口治疗技术,治愈21例,好转后转科、转院29例,无变化1例。2018年伤口专科护士护理会诊工作量、医疗会诊工作量、门诊工作量及患者对伤口专科护士满意度均高于2017年。结论创面修复病房的建立加强了医护各专科之间联系,充分展示了伤口专科护士的独立性,促进伤口专科护士的自我实现,能够满足慢性伤口患者护理需求。     

Mirizzi 综合征诊断与治疗

目的探讨Mirizzi 综合征的病理特点、临床表现、诊断及外科治疗.方法分析1993～2003年收集的16例Mirizzi综合征的临床资料.结果16例均采用手术治疗.手术方式采用单纯胆囊切除、胆囊切除加胆总管或肝总管探查、切开取石,T管引流术或胆肠内引流术.结论术前诊断困难,应及时手术,并根据不同类型采用相应手术方式.