TMSG-1蛋白在结直肠癌中的表达及意义

目的探讨TMSG-1蛋白在结直肠癌组织中的表达及其与肿瘤病理特征的关系。方法采用免疫组织化学SP法检测98例结直肠癌组织中TMSG-1蛋白的表达,同时选取76例结直肠正常组织作对照。结果 TMSG-1蛋白在结直肠癌和正常结直肠组织中主要表达在细胞质,少量胞核可见着染。76例正常结直肠黏膜组织中TMST-1蛋白均表达阳性,其中11例呈弱阳性,65例强阳性表达。在98例结直肠癌中,32例TMST-1蛋白表达阴性,23例弱阳性表达,43例呈强阳性。两者表达差异有统计学意义(P<0.05)。在结直肠癌患者中TMSG-1蛋白表达与年龄、性别、肿瘤部位、肿瘤大小无明显相关(P>0.05),与肿瘤的浸润深度,分化程度、淋巴结转移及远处转移有明显负相关(P<0.05)。结论 TMSG-1蛋白低表达与结直肠癌恶性程度及肿瘤转移有密切相关,这为结直肠癌治疗提供新的治疗靶点且有可能成为判断结直肠癌细胞浸润及转移的重要预后指标。     

Microsatellite Instability Is Associated With a Better Prognosis for Gastric Cancer Patients After Curative Surgery

Background

Microsatellite instability (MSI) is one of the leading mechanisms for the carcinogenesis of gastric cancer. Its prognostic value is controversial.

Methods

Between May 1988 and Oct 2003, a total of 214 gastric cancer patients undergoing curative surgery were enrolled, and their MSI statuses were classified as MSI-H (high) or MSI-L/S (low/stable). The clinicopathologic characteristics of MSI-H and MSI-L/S gastric cancers were compared.

Results

The MSI-H tumors accounted for 11.7?% (n?=?25) of the 214 total gastric cancers. Although not statistically significant, the MSI-H gastric cancers were more frequently located in the lower third of the stomach (64?% vs. 49.2?%) and were more often the intestinal type (72?% vs. 61.4?%) compared to the MSI-L/S gastric cancers. The MSI-H gastric cancers had a significantly better 5-year overall survival (OS) rate (68?% vs. 47.6?%, p?=?0.030) and a trend of a better 3-year disease-free survival rate (71.8?% vs. 55.2?%, p?=?0.076) compared to the MSI-L/S gastric cancers. A multivariate analysis revealed that pathologic TNM stage and MSI status were the independent prognostic factors for OS after curative surgery.

Conclusions

Compared to MSI-L/S tumors, MSI-H tumors are associated with a better OS rate for gastric cancer patients after R0 resection.     

Are cystatin C-based equations superior to creatinine-based equations for estimating GFR in Chinese elderly population?

Purpose

Cystatin C has been proposed as a surrogate marker of kidney function. The elderly population accounts for the largest proportion of chronic kidney disease (CKD) patients. The aim of this study was to assess the diagnostic value of serum cystatin C and compare the applicability of cystatin C-based equations with serum creatinine (Scr)-based equations for estimating glomerular filtration rate (GFR).

Methods

The estimated GFR (eGFR) values from six cystatin C-based equations (Tan, MacIsaac, Ma, Stevens1-3) and three Scr-based equations (CG, MDRD, CKD-EPI) were compared with the reference GFR (rGFR) values from ^99mTc-DTPA renal dynamic imaging method.

Results

A total of 110 elderly Chinese (60?C92?year, 71.05?±?7.62?year) were enrolled. Cystatin C had better diagnostic value than Scr (relationship coefficient with rGFR: cystatin C ?0.847 vs. Scr ?0.729, P?<?0.01; sensitivity: cystatin C 0.90 vs. Scr 0.55, P?<?0.01; AUC^ROC: cystatin C 0.857 vs. Scr 0.757, P?<?0.01). All the equations predicted GFR more accurately for rGFR????60?ml/min/1.73?m² than for rGFR?<?60?ml/min/1.73?m². Most equations had acceptable accuracy. The cystatin C-based equations deviated from rGFR by ?12.78?ml/min/1.73?m² to ?2.12?ml/min/1.73?m², with accuracy varying from 64.6 to 82.7?%. The Scr-based equations deviated from rGFR by ?5.37?ml/min/1.73?m² to ?0.68?ml/min/1.73?m², with accuracy varying from 77.3 to 79.1?%. The CKD-EPI, MacIsaac and Ma equations predicted no bias with rGFR (P?>?0.05), with higher accuracy and lower deviation in the total group. The MacIsaac, CKD-EPI and Stevens3 equations could be optimal for those with normal and mildly impaired kidney function, whereas the Ma equation for those with CKD.

Conclusion

Cystatin C is a promising kidney function marker. However, not all cystatin C-based equations could be superior to the Scr-equations.     

情景式健康教育在初产妇母乳喂养培训中的应用

目的 探讨情景式健康教育在初产妇母乳喂养知识与技能培训中的有效性.方法 将120例初产妇按随机数字表法分为观察组与对照组各60例,对照组采用传统模式对初产妇进行母乳喂养健康教育,观察组进行情景式健康教育,比较两组健康教育的效果.结果 观察组初产妇母乳喂养知识、技能掌握及实践能力显著优于对照组(均P＜0.01);产妇对健康教育效果的满意度显著优于对照组(P＜0.01).结论 情景式健康教育可促进初产妇母乳喂养知识与技能的掌握,提高其实践能力;提高患者满意度,促进护患和谐.     

Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

Background:

Pelvic and acetabular fractures have been known as one of the high risk factors for developing deep vein thrombosis (DVT), but thromboprophylaxis for patients with such fractures remains underused despite its widely accepted benefits. Current guidelines have not been universally adopted in clinical practice. The purpose of this study is to introduce a Thrombotic Risk Assessment Questionary (assessment table) according to evidence-based guidelines and evaluate its impact on the use of thromboprophylaxis for patients with pelvic and acetabular fractures.

Materials and Methods:

We retrospectively reviewed 305 consecutive patients with pelvic and acetabular fractures from August 1, 2008 through September 30, 2010. The control group without using the assessment table included 153 patients admitted during the first 13 months, and the assessment group using the assessment table included 152 patients admitted during the following months. Data on clinical outcomes of DVT, the number of patients receiving prophylaxis, and the time of the first dose of anticoagulant were collected.

Results:

Compared with the control group, Patients using the assessment table were more likely to be given DVT prophylaxis (84.2% vs. 37.3%, P < 0.05) and the time of the first dose of anticoagulant was reduced (4.32 days ± 4.78 days vs. 6.6 days ± 5.96 days, P < 0.05). Patients in the assessment group had lower risk of developing DVT (8.6% vs. 20.3%, P < 0.05).

Conclusion:

The assessment table can significantly improve the use of thromboprophylaxis after pelvic and acetabular fractures, which will likely reduce the incidence of DVT. Developing individual hospital prophylaxis strategy is an effective way to determine whether hospitalized patients should receive pharmacologic and/or mechanical prophylaxis or not.     

经脐单一切口腹腔镜胆囊切除术：附35例报告

目的探讨经脐单一切口腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的可行性及安全性。方法2010年3月～2011年8月行经脐单一切口LC 35例。脐孔左缘做弧形3 cm开放切口,置入2.5 cm三通转换器,经三通转换器中孔置入5 mm腹腔镜,右孔置入10 mm弯曲操作钳作为主操作孔,左孔置入5 mm弯曲操作钳作辅助操作孔。解剖分离胆囊动脉、胆囊管,钛夹或可吸收夹处理胆囊管及胆囊动脉。将胆囊自肝床分离,切除胆囊,自3cm开放切口取出胆囊。结果2例因胆囊颈部结石嵌顿,胆囊三角解剖困难,中转开腹;33例顺利完成LC。手术时间45～125 min,平均65 min。术中出血量5～200 ml,平均20 ml。35例随访3～20个月,平均10个月,无术后大出血、胆漏等并发症发生。结论经脐单一切口LC操作可行、安全,美容效果明显。     

A型肉毒毒素治疗痉挛型脑性瘫痪患儿的护理

目的总结A型肉毒毒素治疗94例痉挛型脑瘫患儿的护理方法。方法在A型肉毒毒素治疗中实施相应的护理措施:注射前做好宣教、患儿的准备及药物的配制工作;注射中熟练配合医生,对患儿予以心理护理;注射后观察患儿反应,指导患儿在药效持续期继续康复训练。结果患儿均顺利完成A型肉毒毒素注射治疗,56例痉挛明显缓解,38例痉挛部分缓解,取得了预期治疗效果。结论积极有效的护理配合,保证肉毒毒素治疗顺利完成对促进脑瘫患儿的康复起着重要作用。     

冠心病患者的契约式健康教育

目的探讨提高冠心病患者健康教育效果的方法。方法将100例冠心病患者随机分为观察组与对照组各50例。对照组实施常规健康教育,主要采用口头宣教、健康教育处方、图文、示范教育等方法;观察组采用契约式健康教育,运用护患双方约定的契约方式进行健康教育。结果观察组健康教育效果显著优于对照组(P<0.01)。结论对冠心病患者采用契约式健康教育比常规方法更能提高健康教育效果。