个体化护理对肾结石经皮肾镜超声碎石术后肾造瘘管的影响

目的探讨个体化护理对肾结石经皮肾镜超声碎石术（PNUL）后患者肾造瘘管的影响。方法选择2010年3月—2013年3月收治的肾结石患者184例,按照随机数字表法分为研究组与对照组,每组各92例。两组患者均采取PNUL治疗,对照组患者术后采取常规护理,研究组患者在此基础上采取个体化护理干预,比较两组患者住院时间、拔出造瘘管时间及术后并发症发生情况。结果研究组患者住院时间、拔出造瘘管时间分别为（7．98±1．68）,（5．12±1．66）d,均少于对照组的（10．23±2．54）,（7．54±1．12）d,差异有统计学意义（t值分别为2．824,2．537;P〈0．05）。研究组无瘘管堵塞和感染患者;瘘管脱落发生率研究组为1．09％,对照组为11．96％,两组比较差异有统计学意义（x2=8．915,P〈0．01）;研究组护理的总满意度为98．91％,对照组为78．26％,两组比较差异有统计学意义（x2=114．649,P〈0．01）。结论针对肾结石PNUL术后患者。肾造瘘管采取个体化护理,能够有效降低术后并发症,保障治疗效果及手术的成功率。     

临床护士积极心理品质与专业自我概念的相关性研究

目的：了解临床护士积极心理品质与专业自我概念状况及两者相关性,为护理管理提供依据。方法采用自制一般情况调查表、积极心理品质量表和护理专业自我概念量表（ PSCNI ）对1139名临床护士进行问卷调查。结果临床护士积极心理品质量表总分为（174．95±16．68）分,节制维度条目平均得分最高,为（3．76±0．59）分,超越维度平均得分最低,为（2．13±0．41）分;护理专业自我概念量表总分为（91．32±12．76）分,技能维度条目平均得分最高,为（3．65±0．28）分,满意度条目平均得分最低,为（2．46±0．36）分。专业自我概念得分值与积极心理品质得分值呈正相关（ r值分别为0．218～0．526,P＜0．05）;多元回归分析显示,认知维度、情感维度、人际维度、公正维度及超越维度是专业自我概念的主要影响因素。结论临床护士专业自我概念状况不佳,提高护士积极心理品质,有助于增强专业自我概念水平。     

养血清脑颗粒对偏头痛病人头痛发作的影响研究

目的 :观察养血清脑颗粒对偏头痛病人的治疗效果。方法 :将 70例确诊为偏头痛的病人随机分为养血清脑颗粒组(治疗组 ) 3 5例和对照组 3 5例 ,治疗组服用养血清脑颗粒 ,对照组给予西比灵胶囊治疗 ,连续观察 3 0d。结果 :两组均可减少偏头痛发作持续时间和发作次数 ,但养血清脑颗粒组优于西比灵组 (P <0 .0 5 ) ;两组总有效率比较无统计学意义 ,但在缓解率上 ,治疗组优于对照组 (P <0 .0 1) ,在伴随症状的改善上 ,治疗组亦优于对照组。结论 :养血清脑颗粒对偏头痛病人头痛发作有良好的治疗作用。     

E-cadherin gene C-160A promoter polymorphism and risk of non-cardia gastric cancer in a Chinese population

AIM: To test the hypothesis that E-cadherin gene (CDH1) C-160A promoter variant genotype is associated with an increased risk for developing gastric cancer. METHODS: In this population-based case-control study of gastric cancer in Jiangsu Province, China, we performed polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to genotype the C-160A polymorphism of CDH1 promoter in 206 non-cardia gastric cancer patients and 261 age- and sex-matched but unrelated cancer-free controls. RESULTS: The frequencies of genotypes CC, CA and AA were 57.8%, 36.4% and 5.8% in gasfric cancer cases, respectively, and 58.2%, 34.9% and 6.9% in controls respectively. The distributions of CDH1 genotypes were not significantly different between gastric cancer cases and controls (P=0.87 for genotype frequency and P=0.92 for allele frequency). Compared with the CC genotype, the CA and AA genotypes were not associated with an increased risk for non-cardia gastric cancer (adjusted odds ratios (OR)=1.15, and 95% confidence interval (95% CI)=0.78-1.72 for CA genotype, and OR = 0.90 and 95% CI = 0.42-2.01 for AA genotype). CONCLUSION: E-cadherin gene C-160A promoter polymorphism may not play a major role in the etiology of non-cardia gastric cancer in Chinese population.     

Work disability and its economic effect on 55–64‐year‐old adults with rheumatoid arthritis

Objective

To examine the extent and financial impact of work disability among older workers with rheumatoid arthritis (RA).

Methods

Year 2002 data from 5,419 subjects with RA <65 years of age in the National Data Bank for Rheumatic Diseases were used, along with US population data. Measures of work disability were employment status, part‐time work, sick day use, and limitation in work demands; the latter was assessed by the Work Limitations Questionnaire (WLQ). Measures of financial status were median household income and poverty level income. Statistical procedures included logistic and linear regression, Wilcoxon's rank sum test, and chi‐square test.

Results

Despite being better educated, subjects with RA ages 55–64 years had lower employment rates than individuals of the same age in the US (women 40% versus 53% and men 54% versus 66%). These older subjects with RA had stopped working more often than younger subjects with RA, and more worked part time (40% versus 34%; P < 0.01). However, the older subjects used sick time less often than younger subjects (35% versus 41%; P < 0.01) and were similarly limited in job demands, e.g., physical demands (mean WLQ subscale score 27.0 versus 26.6; P = 0.65). Median household income of older employed subjects was $20,000 greater than that of retired subjects; 56% of retired subjects had incomes lower than US median income versus 32% of employed subjects, and 11% had income below the poverty level.

Conclusion

Premature work cessation in persons with RA ages 55–64 years is a serious problem that needs to be addressed.

     

肝癌的冷冻治疗

冷冻疗法已成为治疗不能手术切除肝癌的重要手段.冷冻方法可选择手术中冷冻,切除或不切除肿瘤、腹腔镜下冷冻,或在超声、cT或MRI监测下,经皮冷冻.作为一局部治疗,冷冻具有超越其他治疗方法的若干优点:仅消融肝内肿瘤组织,而少伤及正常组织;由于大血管流动血流的温热作用,冷冻可安全地治疗临近大血管的肝肿瘤:冷冻比之手术更适宜治疗肝多发性肿瘤.冷冻联合肝动脉化学栓塞(TACE)、酒精注射或125碘粒子植入,有相辅相成的作用.对于冷冻在肝癌治疗中应用,可归结如下:(1)小于5 cm,尤其小于3 cm的肝癌,数目不超过3个,可以手术中冷冻或经皮冷冻.(2)大于5 cm的肝癌,先作TACE,再给予经皮冷冻.(3)大于5 cm,边缘不整,预计冷冻不完全的肝癌,可予手术中或经皮冷冻,同时在冷冻区周边部注射酒精或植入125碘粒子.     

Intervertebral focal surgery for the treatment of non-contiguous multifocal spinal tuberculosis

Purpose

The purpose of this study was to assess the clinical efficacy of intervertebral focal surgery by complete debridement, deformity correction, graft fusion, and internal fixation for patients with non-contiguous multifocal spinal tuberculosis.

Methods

A total of 29 cases with non-contiguous multifocal spinal tuberculosis admitted to the hospital from January 2000 to January 2007 were treated by intervertebral focal surgery. There were 63 foci in 29 cases, averaging 2.2 foci per case, and 146 affected vertebral bodies, averaging 2.3 vertebral bodies per focus. Three cases had one normal intervertebral disc between two foci, and the other 26 cases had two or more normal intervertebral discs between two foci.

Results

All cases were followed-up for an average of five years. The kyphosis showed a mean correction rate of 67.7% after surgery. A mean loss rate of correction of 8.2% was observed at the final follow-up. The levels of erythrocyte sedimentation rate and C-reactive protein returned to normal in 27 cases on average at 5.8 months and bone union could be observed at five months after surgery. Eleven cases with nerve damage recovered to E grade at the final follow-up.

Conclusions

Intervertebral focal surgery by complete debridement, deformity correction, graft fusion, and internal fixation for patients with non-contiguous multifocal spinal tuberculosis was feasible and effective.     

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia

Objective

Laparoscopic simple prostatectomy for large volume benign prostatic hyperplasia (BPH) has been reported in the literature and may be a viable alternative to open surgery for large prostate glands. While previous publications have shown comparable outcomes between laparoscopic and open simple prostatectomy, there have been few publications describing improved laparoscopic operative technique to further improve these outcomes. The authors describe a novel technique of prostatic urethra preservation during laparoscopic simple prostatectomy.

Materials and methods

From January 2006 to September 2009, laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 51 patients with symptomatic BPH. This technique included extraperitoneal insufflation of the retropubic space by balloon dilation, placement of five trocars in an inverted U shape, transverse prostatic capsular incision, development of a subcapsular plane, and removal of prostatic adenoma with preservation of the prostatic urethra followed by suturing of the prostatic capsule. Demographic, perioperative and outcome data were recorded.

Results

The mean operative time was 126±51.98 min and the estimated blood loss was 232.55±199.54 mL. Significant improvements were noted in the International Prostate Symptom Score (IPSS), quality of life (QOL) questionnaires and maximum flow rate (Q_max) of patients three months after surgery. No incontinence was reported in any patient. Moreover, there was no significant difference in the 5-Item International Index of Erectile Function (IIEF-5) score pre- and post- operatively in patients who had erectile function before surgery and no patient complained of retrograde ejaculation during the postoperative follow-up period.

Conclusions

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia is feasible and reproducible. With this technique, postoperative morbidity can be reduced and antegrade ejaculation preserved.KEY WORDS : Benign prostatic hyperplasia, laparoscopy, prostate, prostatectomy