75例直肠癌患者预后的影响因素分析

目的探讨直肠癌手术患者预后的影响因素。方法选取我院2006～2010年收治的75例直肠癌术后患者临床资料,最低随访3年,对年龄（≤65岁和〉65岁）、性别、部位（低位、中位和高位）、分化程度（高分化、中分化和低分化）、TNM分期方法（I期、Ⅱ期、Ⅲ期和Ⅳ期）、手术方式（根治切除术和姑息手术）、是否化疗和有无并发症等对预后影响进行统计学分析。结果总体平均生存期49．2个月,中位生存期63个月。单因素分析显示直肠癌I～Ⅳ分期（TNM分期方法）、术后有无并发症与生存期相关（P〈0．05）。Cox回归模型多因素分析提示临床分期是生存时间最大的影响因素（P〈0．05）。结论临床分期（TNM分期方法）是影响直肠癌预后的独立因素。     

The effects of ulinastatin on systemic inflammation,visceral vasopermeability and tissue water content in rats with scald injury

Background

The aim of this study was to examine whether administration of ulinastatin inhibits pro-inflammatory mediators and ameliorate visceral vasopermeability both in a rat model of major burn, and also in rat cultured endothelial cells stimulated with permeability-evoking mediators.

Methods

Plasma levels of tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), myeloperoxidase (MPO), microvascular permeability, and water content of organ tissues were evaluated in a rodent model of a 55% TBSA full-thickness scald injury. Microvascular permeability was also evaluated with a cultured pulmonary microvascular endothelial cells (PMECs) monolayer after stimulation with trypsin, bradykinin, histamine, prostaglandin E2 and burn serum.

Results

We found that the plasma levels of TNF-α, CRP, MPO, vascular permeability and water content of heart, lung, kidney, and small intestine tissues were significantly increased in animals after scald injury, and administration of ulinastatin lowered the levels TNF-α, CRP, MPO, vascular permeability and water content of those organ tissues. In vitro, ulinastatin lowered the levels of TNF-α, interleukin-6 (IL-6) and attenuated permeability in PMEC monolayers after being stimulated with burn serum or trypsin, but not by bradykinin, histamine or prostaglandin E2.

Conclusions

These results indicate that ulinastatin attenuates the systemic inflammatory response and visceral vasopermeability both in vivo and vitro, and may serve as a therapeutic agent for prevention of systemic inflammatory response and leakage of fluid into tissue after major burn.     

Role of glycogen synthase kinase 3β in protective effect of propofol against hepatic ischemia–reperfusion injury

Background

It was previously reported that propofol, an intravenously administered hypnotic and anesthetic agent, protects organs from ischemia–reperfusion (I/R) injury. However, the underlying mechanisms are largely unknown. Glycogen synthase kinase 3β (GSK-3β) is known to play an important role in the oxidative stress–induced apoptosis. In this study, we investigated the role of GSK-3β and mitochondrial permeability transition pore (MPTP) in the protective effects of propofol against hepatic I/R injury.

Materials and methods

The left and median hepatic artery and the portal vein branches were blocked by no-damage artery clips to create the model of partial ischemia (70%), and liver lobes were subjected to warm ischemia for 30, 60, 90 min, respectively. Reperfusion of 120 min was then initiated by the removal of clamp. The MPTP opening was assessed by measuring mitochondrial large amplitude swelling and mitochondrial membrane potential.

Results

Pretreatment with propofol in conditions of hepatic I/R inhibits the apoptosis of hepatocytes as evidenced by decreased terminal deoxynucleotidyl transferase dUTP nick end labeling–positive cells. Importantly, propofol suppressed the mitochondrial GSK-3β by promoting or preserving its phosphorylation at Ser9, thus restraining the opening of MPTP and preventing the mitochondrial swell and mitochondrial membrane potential collapse.

Conclusions

Propofol protects liver from I/R injury by sustaining the mitochondrial function, which is possibly involved with the modulation of MPTP and GSK-3β.     

Measurement of electrolyte concentrations in expressed prostatic secretion and urine from patients with chronic prostatitis and its implications

This study was aimed at measuring concentration of electrolytes, especially K+ in expressed prostatic secretion (EPS) and urine from patients with chronic prostatitis. The concentration of potassium, sodium, chloride, calcium in EPS and urine of 31 controls and 79 patients with prostatitis were measured and analyzed. There was no significant difference in the concentrations of potassium, sodium, chloride and calcium between the patients and the controls. Among the patients treated effectively, potassium concentration was 40.66 +/- 17.10 mmol/l before treatment and 33.42 +/- 17.27 mmol/l after treatment. While among the patients treated ineffectively, potassium concentration was measured as 37.57 +/- 16.93 mmol/l and 50.66 +/- 18.77 mmol/l before and after treatment respectively. The concentrations of electrolytes in prostatic fluid varied greatly between individuals. Potassium concentration in EPS decreased significantly after treatment among the patients with obvious treatment effectiveness, while increased among those who failed the treatment. EPS potassium concentration was also found to be lower in patients with pain than those without pain. No significant difference was found between the normal group and the no-pain patients.     

基于MEBT／MEBO的ERK1／2和p38信号通路与糖尿病足免疫表达关系的研究

目的：观察烧伤皮肤再生医疗技术[湿润暴露疗法（MEBT）／湿润烧伤膏（MEBO）]对糖尿病足部创面组织细胞外信号调节激酶（ERK）1／2和p38信号通路分子及免疫表达的调控作用及关系,探讨MEBT／MEBO对糖尿病足溃疡的修复机制。方法糖尿病足患者40例予MEBT／MEBO干预治疗,留取治疗前后创面组织行免疫组化检测ERK1／2和p38信号通路关键分子ERK1／2、p38、促分裂原活化蛋白激酶（MAPKK6）、原癌基因（c‐myc）、Akt、活化复制因子2抗体（ATF2）及免疫因子IgA、IgM、IgG、C3c、C4c表达情况,并观察二者间关系。结果经MEBT／MEBO治疗后,39例患者足部创面面积有不同程度缩小,仅1例患者无明显变化,显效14例（35．00％）,有效25例（62．50％）,无效1例（2．50％）。治疗前后信号通路分子全阳性表达、免疫阳性表达（任一指标）及免疫阳性表达（具体指标）比较差异均有统计学意义（P＜0．05）,在创面信号通路分子表达阳性率升高的同时,免疫因子阳性表达率亦升高。治疗前创面组织可见免疫因子极少量分布,治疗后创面组织免疫因子IgA、IgM、IgG、C3c、C4c呈广泛、弥漫分布。治疗前创面组织可见信号分子极少量分布,治疗后创面组织信号通路分子ERK1／2、p38、MAPKK6、c‐myc、Akt、ATF2呈广泛、弥漫分布。结论MEBT／MEBO可能促进了糖尿病足创面ERK1／2和p38信号通路分子及免疫表达,ERK1／2和p38信号通路及其交互作用可能通过增加创面组织免疫表达而促进了糖尿病足创面的愈合。     

MRI软骨下骨髓水肿与早期膝骨关节炎临床表现的相关性研究?

目的：探讨早期膝骨关节炎(KOA)MRI 软骨下骨髓水肿的程度,并探究骨髓水肿与 KOA 夜间休息痛、关节肿胀程度和骨关节炎功能(the western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分的相关性。方法本研究按纳排标准收集了早期 KOA 病例60例,其中伴骨髓水肿改变30例,设为观察组,不伴骨髓水肿改变30例,设为对照组。观察骨髓水肿程度评分、夜间休息痛视觉模拟(visular analogue scale, VAS)评分、关节肿胀程度及 WOMAC 功能评分情况。结果1)两组患者在夜间休息痛 VAS 评分、关节肿胀程度和 WOMAC 评分上比较,差异有统计学意义(P <0.05);2)观察组骨髓水肿程度越重,夜间休息痛 VAS 评分与WOMAC 评分越高;3)观察组骨髓水肿和夜间休息痛情况的相关系数 r =0.933(r >0)(P <0.05),二者呈正相关性;骨髓水肿与 WOMAC 评分的相关系数 r=0.555(r>0)(P <0.05),二者呈正相关性;骨髓水肿同关节肿胀程度相关系数 r=0.148(r>0)(P >0.05),二者间无明显相关性。结论MRI 软骨下骨髓水肿样改变与早期 KOA 夜间休息痛、WOMAC 评分具有正相关性;与关节肿胀情况无相关性。     

2016至2018年某医院真菌血流感染者流行病学特征及耐药性分析

目的分析真菌性血流感染的病原菌分布以及耐药特征,为真菌血流感染的早期合理用药提供理论依据。 方法回顾性分析武汉大学人民医院2016年1月至2018年12月收治的真菌性血流感染者的菌群、科室分布以及耐药性。 结果入组192例真菌血流感染者的血培养样本中共分离192株真菌,其中白色念珠菌检出率为31.77%（61/192）,其次热带念珠菌检出率为18.75%（36/192）;重症医学科检出率最高为33.85%（65/192）。所有菌株均对两性霉素B敏感,对其他抗菌药物耐药率分别为5-氟胞嘧啶4.49%（9/192）、伊曲康唑5.73%（11/192）、氟康唑10.94%（21/192）和伏立康唑11.46%（22/192）;除两性霉素B外,2016至2018年真菌对其他抗菌药物的耐药率均逐年上升,其中2018年所分离192株光滑念珠菌对伊曲康唑耐药菌率达46.7%。 结论真菌血流感染病原菌以念珠菌属为主,对目前抗真菌药物具有较高敏感性,但耐药率逐年上升,加强监测血培养病原菌变化及耐药趋势对指导临床用药至关重要。     

肺癌患者创伤后应激障碍及睡眠状况对心理健康的影响

目的调查首诊肺癌患者创伤后应激障碍、睡眠状况及其对患者心理健康状况的影响。方法采用事件冲击量表(IES)、睡眠状况自评量表(SRSS)及症状自评量表(SCL-90)对117例首诊肺癌患者进行调查。结果患者创伤后应激障碍总均分2.46±0.33,睡眠状态总均分2.41±0.68,心理健康状态总均分1.82±0.32;创伤后应激障碍、睡眠状况与心理健康状况呈正相关(均P0.01);创伤后应激障碍、睡眠状况、患者文化程度、家庭人均收入、医疗支付方式、肿瘤分期及是否转移是肺癌患者心理健康状况的主要影响因素(均P0.01)。结论肺癌患者创伤后应激障碍、睡眠状况影响其心理健康状况,需采取针对性干预降低患者创伤后应激障碍,提高睡眠质量,改善患者的心理健康状况。     

Aldrete评分在非胃肠道术后患儿早期进食中的应用

目的 探讨Aldrete评分指导早期进食在腹腔镜非胃肠道手术患儿中应用的可行性。 方法 将220例全麻下行腹腔镜非胃肠道手术患儿按时间顺序分为对照组和观察组各110例。对照组采用传统术后6 h进食方案;观察组采用Aldrete评分判断麻醉苏醒情况,指导术后个性化早期进食。 结果 观察组术后进食时间显著早于对照组,术后3 h口干、声音嘶哑及哭闹发生率显著低于对照组（均P＜0.01）;两组进饮后呕吐发生率比较,差异无统计学意义（P＞0.05）。 结论 对腹腔镜下非胃肠道手术后患儿采取Aldrete评分指导个体化早期进食,可降低术后禁食相关不良反应发生率,且安全。     

火针治疗结节性痒疹的临床研究进展

结节性痒疹属于结节性损害,四肢分布较多,尤以小腿伸侧分布较为常见,女性居多,为临床上较难治疗的慢性炎症性皮肤病之一。 结节性痒疹瘙痒无比且病程较长,又具有损容性,给病人的生活和身心都带来了巨大影响。如何较好治疗结节性痒疹,在医学界仍是一个较难解决的问题。近年来,随着医疗技术的不断研究和发展,火针疗法在治疗结节性痒疹中因其止痒迅速、简便价廉、疗效确切,在临床上大力推广,成为比较热门的治疗方法。文章通过近些年关于火针治疗结节性痒疹的文献查阅,介绍了结节性痒疹的发病机制及治疗方法,为临床医生对结节性痒疹的治疗提供多种治疗方法和思路,从而更好地将火针疗法推广到临床。