癌症晚期患者及家属对预前指示态度的一致性研究

目的 调查并分析癌症晚期患者及家属对预前指示及预前指示所含的生命维持治疗、死亡地点、诊断告知等态度的一致性。方法 便利抽取北京市某三甲医院肿瘤科268对癌症晚期患者及家属,采用预前指示态度及终末生命意愿量表调查患者及家属对预前指示及生命维持治疗、死亡地点、诊断告知的态度。结果 59.0%的患者愿意做预前指示,有88.4%的家属愿意遵守患者制定的预前指示意愿,患者及家属对预前指示态度的一致性系数Kappa值为0.010。患者及家属对生命维持治疗、死亡地点及诊断告知态度的Kappa值分别为0.158~0.235,0.227,0.056,一致性较差。结论 癌症晚期患者及家属对预前指示态度一致性较差,家属对生命维持治疗、死亡地点、诊断告知的态度不能代表患者本人的意愿。临床医护人员应加强与患者及家属的沟通,提高患者及家属对预前指示态度的一致性。     

TNFα-在小鼠叶酸诱导肾病中的致病作用及其机理研究

目的研究TNF-α在小鼠叶酸诱导肾病中的致病作用及其机制。方法建立小鼠叶酸诱导肾病模型，运用抗TNF-α多克隆抗体及对照抗体干预治疗，检测小鼠血清以及肾组织中TNF-α水平，肾小管上皮细胞凋亡情况以及凋亡相关蛋白的表达水平。结果在CD1小鼠叶酸诱导肾病模型中，尿素氮水平显著升高，肾小管上皮细胞坏死和凋亡增加，小鼠血清以及肾组织中TNF-α水平显著升高，肾皮质组织中Bcl-xL表达水平显著下降，运用抗TNF-α多克隆抗体干预治疗可保持Bcl—xL在肾组织中的表达水平，减少肾小管上皮细胞凋亡，有效减轻小鼠肾功能损害。结论TNF-α在小鼠叶酸诱导肾病发病机制中具有重要作用，阻断TNF-α是治疗急性肾衰的一种潜在有效手段。     

经皮肾镜取石术治疗肾结石的护理研究

微创经皮肾镜取石术是经皮肾造瘘,建立工作通道,结合气压弹道碎石治疗泌尿系统结石的一种微创手术,因其创伤小、疗效确切、术后恢复快等优点,在临床上广泛应用[1].虽然它是一种微创手术,但也有一定的并发症,加强病人围术期的护理是减少并发症的重要手段之一[2].为此,选择我科2005年12月-2007年12月的30例行微创经皮肾镜取石术病人,探讨其有效的护理措施,为临床诊治和护理提供一定的思路.现介绍如下.     

腺苷脱氨酶活性测定对胸腔积液鉴别诊断价值

目的：探讨胸腔积液中腺苷脱氨酸（ADA）的活性，为临床鉴别诊断提供依据。方法：对122例患者胸腔积液进行ADA检测，并进行比较分析。结果：结核性胸腔积液中ADA活性阳性率明显高于其他组。结论：测定胸腹水中ADA活性可用于结核性与非结核性胸腹水的鉴别诊断。     

妊娠糖尿病对婴儿影响的研究进展

妊娠糖尿病的发生率逐年上升,其对于婴儿有诸多短期及长期不良影响.因此,提高对相关不良影响的认识非常重要,积极采取各种措施保证妊娠期间血糖控制在最佳水平有助于改善母亲及后代的健康状况,降低围产期死亡率.该文综述妊娠糖尿病对婴儿的不良影响,包括巨大儿、呼吸系统疾病、代谢异常及先天畸形等.     

Inhibitory effects of phenolic compounds from Artocarpus styracifolius on respiratory burst of rat neutrophils

Context: Searching for polymorphonuclear neutrophils (PMNs) respiratory burst inhibitors is an important topic in the treatment of human diseases associated with inflammation.

Objective: To investigate the inhibitory effects of phenolics isolated from Artocarpus styracifolius Pierre (Moraceae) on respiratory burst induced by phorbol myristate acetate (PMA).

Materials and methods: The anti-respiratory burst activities of eight phenolics (20?µM) were assessed by determining luminol-dependent chemiluminiscence in rat PMNs. Cytotoxicity of active compounds (1–1000?µM) was assayed by Trypan blue dye exclusion method. Cell-free models were employed to evaluate scavenging capacity of active compounds (20?µM) against reactive oxygen species.

Results: The PMA-induced respiratory burst was significantly inhibited (p?1–6) at the concentration of 20?µM (below the toxic concentration) with the inhibition rate ranging from 25.0 to 99.6%. The inhibitory potency estimated by IC₅₀ was in the order of AS1 (3.1?µM) >AS6 (5.9?µM) >AS2 (9.1?µM) >AS3 (10.0?µM) >AS5 (29.7?µM) >AS4 (57.7?µM). AS1–4, four isoprenylated flavones, potently quenched superoxide anion, hydroxyl radical, and hydrogen peroxide at the concentration of 20?µM with their scavenging rates in the range of 30.1–78.1%, 35.4–69.7%, and 65.5–86.3%, respectively. In contrast, AS5–6, two isoprenylated 2-arylbenzofurans, showed less effect than that exhibited by AS1–4.

Conclusion and discussion: The isoprenylated phenolics from A. styracifolius can potently inhibit PMA-induced respiratory burst in rat neutrophils without showing cytotoxicity. The inhibitory effects of these isoprenylated phenolics on the respiratory burst might depend on their different types of structure.     

临床药师在COPD稳定期管理中的作用

我国慢性病患者数量庞大,反复住院治疗占用大量医疗资源。如何对慢病进行有效的管理,减少患者急性发作住院的次数成为临床药师需要探索的方向。本文就临床药师参与呼吸系统慢性阻塞性肺疾病（COPD）慢病管理的切入点进行分析探讨,为临床药师对COPD稳定期的管理提供工作思路。     

Should We Routinely Transfuse Platelet for Immune Thrombocytopenia Patients with Platelet Count Less Than 10 × 109/L Who Underwent Laparoscopic Splenectomy?

Background

Laparoscopic splenectomy (LS) is considered as the gold standard procedure for patients with immune thrombocytopenia (ITP). In many institutions, platelet counts less than 10 × 10⁹/L contraindicate LS.

Objective

This study aimed to investigate the safety and feasibility of LS for ITP patients with platelet counts less than 10 × 10⁹/L.

Methods

A total of 88 cases of LS were performed for ITP patients from June 2010 to December 2012. The patients were prospectively divided into three groups based on their immediate preoperative platelet count: < 10 × 10⁹/L (group 1); 10 × 10⁹/L to 30 × 10⁹/L (group 2); and > 30 × 10⁹/L (group 3). We collected the patients’ demographic characteristics, perioperative details, and platelet count response to surgery.

Results

The patients in the three groups had comparable demographic characteristics. Only one patient in group 1 required conversion (2.4 %). The patients in group 1 experienced more blood loss than those in group 3, but this was not statistically significant. There were no significant differences between group 2 and group 3 in terms of operating time and blood loss. No statistically significant differences were found between the three groups with regard to complications and postoperative hospital stay.

Conclusions

It is safe and feasible to perform LS in ITP patients with platelet count less than 10 × 10⁹/L, without platelet transfusion. The indication for platelet transfusion during LS for ITP patients should be the bleeding manifestations due to thrombocytopenia other than low platelet count itself.