变频式桡动脉穿刺示教器在急诊护理教学中的应用

目的探讨提升急诊科进修护士桡动脉穿刺技术水平的有效方法。方法将64名进修护士按照入科时间分为对照组34名,实验组33名。在统一理论教学后,对照组采用互动方式互相触摸桡动脉并讲解穿刺方法。实验组采用变频式桡动脉穿刺示教器进行穿刺练习。结果实验组进修护士动脉穿刺成功率显著高于对照组,穿刺并发症发生率及患者疼痛程度显著低于对照组(P0.05,P0.01)。结论采用变频式桡动脉穿刺示教器进行教学,可使进修护士多次进行模拟穿刺练习,提高其桡动脉穿刺水平。     

我国肺癌患者医院感染高危因素Meta分析

目的系统分析肺癌患者医院感染高危因素及合并症特征,为制订医院感染管理策略提供依据。方法检索中国生物医学文献数据库（CBM）、中国知识基础设施工程(CNKI),万方、维普、PubMed以及Embase数据库中肺癌患者医院感染相关文献,提取数据进行Meta分析。结果共纳入19篇文献,包括肺癌住院患者 8 069例,其中医院感染1 280例。医疗因素发生医院感染的Meta分析合并值：抗肿瘤治疗(放射治疗和化学治疗)、化学治疗次数(≥2次)、预防性使用抗菌药物、使用免疫抑制剂及侵入性操作OR及95%CI分别为3.13(1.82,5.39)、9.20(3.04,27.87)、3.23(1.77,5.91)、2.00(1.56,2.57)、2.28(1.81,2.88);肺癌不同合并症发生医院感染的Meta分析合并值：肺部疾病、慢性阻塞性肺疾病(COPD)、糖尿病、肾功能不全、营养不良、低蛋白血症、中性粒细胞减少、白细胞减少症OR及95%CI分别为2.65(1.74,4.02)、2.40(1.76,3.27)、2.25(1.85,2.73)、2.56 (1.18,5.52)、5.51(1.70,17.89)、2.05(1.56,2.70)、3.38(1.40,8.18)、2.10 (1.22,3.62)。结论肺癌患者医院感染相关医疗及合并症因素复杂多样,抗肿瘤治疗、免疫抑制剂、预防性使用抗菌药物、侵入性操作、肺部疾病、COPD、糖尿病、肾功能不全、营养不良、低蛋白血症、中性粒细胞减少及白细胞减少等均为肺癌患者医院感染的高危因素。     

Interplay of metabolizing enzymes and transporter of xenobiotics

1.?Xenobiotics are metabolized and eliminated through the coordinated interplay of their metabolizing enzymes and transporters. However, these two activities in vitro are measured separately, with the addition of ATP as a pre-requisite.

2.?We propose a human renal cell-line model which integrates the sulfate and glutathione conjugation of xenobiotics with the efflux of their respective conjugates. Sulfation and glutathionylation represent two major Phase II detoxification of xenobiotics in man. The reactions are catalyzed, respectively, by phenolsulfotransferase and glutathione-S-transferase followed by extrusion of their respective conjugates.

3.?Using Ko-143, a specific inhibitor of breast cancer resistance protein (BCRP), an ATP-binding cassette (ABC) transporter, we identified this transporter to be responsible for the efflux of p-cresol sulfate, harmol sulfate and the glutathione conjugate of 1-chloro-2,4-dinitrobenzene.

4.?The conjugation-cum-efflux was inhibited by oligomycin and uncouplers, which highlights the role of cellular mitochondria in providing ATP for the biosynthesis of their conjugating agents, 3′-phosphoadenosine-5′-phosphosulfate (PAPS) and reduced glutathione as well as for the transport function of BCRP.

5.?The human 786-O renal cell-line provides a “3-in-1” system linking ATP biosynthesis to metabolism of xenobiotics and their ultimate transport and elimination by BCRP; this integrated system was not apparent in other human cell-lines examined.     

Two new bisamides from the leaves of Aglaia perviridis

Two new bisamides, aglaiamides A (1) and B (2), along with three known ones (3–5), were isolated from the leaves of Aglaia perviridis. Their structures were established on the basis of detailed spectroscopic analyses.     

Findings from the Adjuvant Colon Cancer End Points (ACCENT) Collaborative Group: the Power of Pooled Individual Patient Data from Multiple Clinical Trials

Randomized clinical trials (RCTs) are relied upon for determining the standard of care and changes to the standard of care in oncology. Through data sharing, the pooled individual patient data (IPD) from these trials can provide high-quality sources and enriched power for analyses beyond the original goals of each trial. To address important scientific questions in early-stage colon cancer, the Adjuvant Colon Cancer End Points (ACCENT) Collaborative Group has continuously integrated IPD from large adjuvant colon cancer RCTs conducted worldwide. Through June 2016, IPD from over 40,000 patients from 27 major trials (1977 to 2009) have been assembled. Over the past 20 years, a variety of clinical questions have been investigated and addressed by ACCENT collaborations. Many of the findings have provided additional understanding of treatment mechanisms, suggested changes or reinforced quality patient care, and informed and improved the design for the current and next generation of RCTs. We review these significant contributions from the ACCENT collaboration.     

内镜治疗与药物治疗黏附血凝块的消化性溃疡出血的疗效对比

目的:探讨内镜治疗与药物治疗黏附血凝块的消化性溃疡出血的疗效.方法:将黏附血凝块的消化性溃疡出血患者88例随机分为两组,对照组44例实施药物治疗,观察组44例实施内镜治疗,比较两组治疗效果.结果:治疗后,两组Blatchford评分、Rockall评分降低(P0.05),日常生活能力评分、生活质量评分增加(P0.05).观察组Blatchford评分、Rockall评分、治疗后再出血率、转外科手术率低于对照组(P0.05),日常生活能力评分、生活质量评分、治疗总有效率高于对照组(P0.05),止血时间早于对照组(P0.05),住院时间少于对照组(P0.05),住院费用多于对照组(P0.05).结论:与药物治疗相比,内镜治疗黏附血凝块的消化性溃疡出血的疗效更佳,值得临床推广使用.     

Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta‐analysis

Forceps biopsy (FB) is the most commonly used diagnostic tool for lung pathologies. FB is associated with a high diagnostic failure rate. Cryobiopsy (CB) is a novel technique providing a larger specimen size, few artefacts, more alveolar parts and superior diagnostic yield. CB, however, has drawbacks such as higher bleeding and pneumothorax rate. We conducted a meta‐analysis to investigate the specimen area, diagnostic rate and bleeding severity in CB versus FB in interstitial lung diseases (ILDs) and lung tumours. A systematic literature search of PUBMED, BIOSIS PREVIEW and OVID databases was conducted using specific search terms. Eligible studies including RCTs and non‐RCTs comparing cryobiopsy/cryotransbronchial biopsy (CB/CTBB) and forceps biopsy/forceps transbronchial biopsy (FB/FTBB) for specimen area, diagnostic rate and bleeding rate in ILDs and lung tumours were analysed. Two reviewers independently extracted data and evaluated the quality of the studies. Eight studies involving 916 patients were analysed. Specimen area (mm²) was significantly larger in CB/CTBB than FB/FTBB (standard mean difference = 1.21, 95% confidence interval (0.94, 1.48), P < 0.00001). The diagnostic rate was significantly higher in CB/CTBB than FB/FTBB (Risk ratio 1.36, 95% confidence interval (1.16, 1.59), P = 0.0002). Three studies compared the bleeding severity with only one showing significantly more bleeding in CB. Cryobiopsy/cryotransbronchial shows superiority to FB/FTBB for specimen area and diagnostic rate. CB/CTBB has better efficacy over FB/FTBB.     

不同频次肠道准备方法在肠镜检查中的多方面效果评估比较

目的探索不同的肠道准备频次在结肠镜检查中的清洁度评分、结肠息肉检出率和被检查者的主观感受的差异。方法收集2015年1月-2015年6月符合该研究的被检查者218例,随机分为3组;肠道准备的质量评估参照Boston肠道准备标准。等待检查期间行问卷调查了解被检查者的主观感觉,包括整体满意度和不适与进食情况、具体腹痛、腹胀等情况。结果肠道清洁度3组差异均有统计学意义,其中A组和C组之间差异有统计学意义。3组之间的息肉检出率差异无统计学意义,肠道准备的整体满意度、主观感受等方面3组之间差异无统计学意义。结论分次服用肠道准备用药在不影响被检查者主观体验的情况下可以提高肠道的清洁度,值得推荐。     

十二指肠乳头小切开+大气囊扩张治疗直径1.0～2.5 cm胆总管结石的临床分析

目的评价十二指肠乳头小切开+大气囊扩张(ESLBD)治疗直径1.0~2.5 cm胆总管结石的临床价值。方法收集2010年6月-2014年6月该院收治的直径1.0~2.5 cm胆总管结石病例,共426例,随机分为两组,一组进行ESLBD治疗(治疗组,218例),一组进行传统十二指肠乳头大切(常规EST对照组,208例),从治疗成功率、安全性和术后临床并发症的发生情况等方面评估ESLBD治疗方法的安全性及临床价值。结果治疗组所有结石一次性成功率为95.41%,略高于对照组,但差异无统计学意义。治疗组发生出血率为2.29%,机械碎石率为13.76%,明显低于对照组(7.69%,25.96%;P=0.025,0.002),尤其是在直径大于1.5 cm胆总管结石病例中;治疗组发生术后急性胰腺炎比例为9.17%,术后高淀粉酶血症比例为19.72%,与对照组(6.73%和18.27%)比较差异无统计学意义(P=0.452和P=0.796),两组穿孔率无差异,无死亡病例。结论 ESLBD方法治疗直径1.0~2.5 cm胆总管结石是安全可行的,相对于传统大切开治疗,能显著降低出血率和机械碎石率,不增加胰腺炎和高淀粉酶血症的比例,其并发症率低,值得临床推广。