封闭负压治疗对猪深Ⅱ度烧伤创面的影响

目的观察封闭负压治疗对猪深Ⅱ度烧伤创面的影响。方法采用控温控压电烫仪在3只普通家猪背部对称制造深Ⅱ度热力烧伤模型,每只猪背6个创面(共18个),左右对称创面视为一对,共9对创面随机分为持续负压组、间歇负压组、常规换药组。造模24 h后两负压组分别给予持续及间歇封闭负压治疗,压力值均为-125 mm Hg(1 mm Hg=0.133 k Pa),常规换药组给予常规换药治疗。于治疗后当天、第3、6、9、14天,分别测量创面面积并计算愈合率;取创面组织进行常规苏木精-伊红(HE)染色,光学显微镜下观察病理学变化,采用免疫组织化学染色法计算细胞增殖指数(PI)及血管内皮细胞计数;记录最终创面愈合时间。数据行单因素方差分析及LSD-t检验。结果 (1)治疗后第3天,持续负压组、间歇负压组创面愈合率分别为(18.51±4.38)%、(14.26±5.98)%,均高于常规换药组(3.86±2.35)%,差异有统计学意义(t=56.552、40.139,P﹤0.05、=0.001),治疗后第6天,两负压组分别达(24.74±3.25)%、(20.55±3.43)%,仍高于常规换药组(13.41±4.08)%,差异有统计学意义(t=5.473、3.432,P﹤0.05、=0.004),治疗后第9天,其愈合率分别达(49.81±3.88)%、(46.96±3.16)%,均高于常规换药组(34.29±6.69)%,差异有统计学意义(t=5.563、4.541,均P﹤0.05)。(2)持续负压组、间歇负压组愈合时间分别为(11.67±0.52)d、(11.50±1.05)d,均短于常规换药组(13.00±0.89)d,差异有统计学意义(t=2.715、3.055,P=0.016、0.008),两负压组间比较,差异无统计学意义(t=0.340,P=0.739)。(3)治疗后第3天,常规换药组创面炎症细胞浸润较两负压组重,其高峰持续到第9天,第14天逐渐消退。(4)治疗后第3天,持续负压组和间歇负压组细胞PI明显升高,高于常规换药组,差异有统计学意义(t=10.413、9.080,均P﹤0.05),治疗后第6天分别达高峰,仍高于常规换药组,差异有统计学意义(t=4.549、5.557,均P﹤0.05),治疗后第9、14天,3组细胞PI无明显差异。(5)治疗后第3、6天,持续负压组、间歇负压组血管内皮细胞计数均高于常规换药组,差异有统计学意义(均P﹤0.05)。治疗后第9、14天,3组血管内皮细胞计数差异无统计学意义(F=1.639、1.711,P=0.218、0.205)。结论与常规换药相比,封闭负压引流治疗能加快创面坏死组织清除,促进创面炎症反应消退,加速深Ⅱ度烧伤创面愈合。     

CD4+CD29+T cells are blamed for the persistent inflammatory response in ulcerative colitis

Ulcerative colitis (UC) is a chronic gastrointestinal disorder eliciting occurrence of colorectal cancer, the third most common human malignancy. The diagnosis of UC is based on clinical symptoms combined with typical findings on endoscopy, radiology, and ultimately pathology. We investigated the variation trend of CD4⁺CD29⁺T cells together with MPO, VCAM-1 in different periods of rat UC model and UC patients. We also evaluated the relationship between CD4⁺CD29⁺T cells and disease severity. UC model was induced by administering DNCB liquid and acetate solution. We found upregulated expression of CD4⁺CD29⁺T cells in both peripheral blood and colon from rats, and a similar trend for MPO and VCAM-1 in colon (P < 0.05); the expression was especially enhanced in UC rats at two weeks after the model was established (P < 0.01). Such upregulation was also indicated in active and remission UC patients as compared to the healthy and enteritis groups (P < 0.05), with the highest expression level detected in the active UC patients (P < 0.01). Pearson correlation analysis showed a positive correlation of CD4⁺CD29⁺T cells in rat and human peripheral blood with DAI score (r_rat = 0.712, r_human = 0.677, P < 0.01), and MPO in colon (r_rat = 0.514, r_human = 0.682, P < 0.05). These results suggest that CD4⁺CD29⁺T cells may act as major effector cell subsets in persistent inflammatory responses for UC and that infiltration into colon inflammation may be induced by the combination of VCAM-1 and CD29.     

High-grade ovarian cancer secreting effective exosomes in tumor angiogenesis

Ovarian cancer, the most lethal gynecological cancer, related closely to tumor stage. High-grade ovarian cancer always results in a late diagnose and high recurrence, which reduce survival within five years. Until recently, curable therapy is still under research and anti-angiogenesis proves a promising way. Tumor-derived exosomes are essential in tumor migration and metastases such as angiogenesis is enhanced by exosomes. In our study, we have made comparison between high-grade and unlikely high-grade serous ovarian cancer cells on exosomal function of endothelial cells proliferation, migration and tube formation. Exosomes derived from high-grade ovarian cancer have a profound impact on angiogenesis with comparison to unlikely high-grade ovarian cancer. Proteomic profiles revealed some potential proteins involved in exosomal function of angiogenesis such as ATF2, MTA1, ROCK1/2 and so on. Therefore, exosomes plays an influential role in angiogenesis in ovarian serous cancer and also function more effectively in high-grade ovarian cancer cells.     

卫生统计学“形成性评价”改革探索

探讨卫生统计学形成性评价体系的有效构建,以期推进卫生统计学课程的教学策略和教学行为的改革,提升教学效果、提高学习质量、促进学习收益。     

Pgp、GST-π、TOPO- Ⅱ 在胃 印戒细胞癌中的表达特点及临床意义

目的 探讨P-糖蛋白（Pgp）、谷胱甘肽转移酶π（GST-π）、拓扑异构酶Ⅱ（TOPO-Ⅱ）在胃印戒细胞癌中的表达特 点及其临床意义。方法 以免疫组化检测64例胃印戒细胞癌组织中Pgp、GST-π、TOPO-Ⅱ的表达,并分析其特点及与患者临床病理特征间的关系。结果 Pgp、GST-π、TOPO-Ⅱ在胃印戒细胞癌中的阳性表达率分别为25.0%（16/64）、35.9%（23/64）、40.6%（26/64）,在胃高-中分化腺癌中阳性表达率分别为10.9%（7/64）、37.5%（24/64）、60.9%（39/64）。Pgp在胃印戒细胞癌中阳性表达率高于高-中分化腺癌,TOPO-Ⅱ的阳性表达率则低于高-中分化腺癌,均有统计学差异（均P＜0.05）,而GST-π阳性表达率与胃高-中分化腺癌比较无统计学差异（P＞0.05）。胃印戒细胞癌的Pgp、GST-π、TOPO-Ⅱ阳性表达率在不同临床分期、淋巴结转移患者间比较均有统计学差异（均P＜0.05）,在不同年龄、性别患者间比较均无统计学差异（均P＞0.05）。结论 Pgp、GST-π、TOPO-Ⅱ的表达对治疗及预后判断具有一定的参考意义。     

在校护生基本情况对护理软技能水平影响的调查研究

目的:了解在校高职护生基本情况对护理软技能水平的影响,为提高在校护生护理软技能水平提供依据。方法:以护理软技能测评量表为工具,采取调查问卷的方法对在校2 408位高职护生施测,数据录入后用SPSS 17.0对资料进行t检验和方差分析。结果:我院高职护生护理软技能分值为(164.95±0.46)分;是否打工、学历高低、专业选择是否自己意愿等是影响护生护理软技能水平的显著因素(均P<0.05)。结论:在校护生护理软技能水平一般,在校护生的基本情况对护理软技能有明显影响。     

产前超声检查的临床价值分析

目的超声诊断胎儿先天结构畸形的临床应用价值。方法分析我院2013年7月至2014年1月就诊的710例孕妇进行产前超声检查,对发现胎儿结构畸形的资料进行保存、统计及系统分析,并进行超声检查结果与分娩、引产及尸解结果对照分析。结果产前超声检查共发现胎儿结构畸形阳性诊断40例,累计30项畸形,其中多发畸形16例,检出率5.63%,诊断符合率95.0%,误、漏诊率5.0%;其中神经系统畸形8例,心脏畸形7例,胸腔畸形1例,泌尿系统畸形2例,消化系统畸形3例,骨骼肌肉系统畸形3例,前腹壁异常2例,多胎异常2例,胎盘、脐带先天发育异常7例,颈部肿瘤4例,颜面部畸形1例。结论产前超声检查在恰当的孕周,应用标准化切面探查,可减少误、漏诊率,对提高胎儿结构畸形诊断具有不可忽视的临床价值。     

Surgical modality for stage IA non-small cell lung cancer among the elderly: analysis of the Surveillance,Epidemiology, and End Results database

BackgroundThe appropriate surgical modality for early-stage non-small cell lung cancer (NSCLC) among the elderly remains controversial; identifying appropriate modalities will be helpful in clinical practice.MethodsIt’s a cohort study and we explored the Surveillance, Epidemiology, and End Results (SEER) database for identifying patients aged ≥70 years with pathologic stage IA NSCLC. Three types of surgeries were compared (lobectomy, segmentectomy, and wedge resection) via survival and stratification analyses.ResultsOverall, 6,197 patients were enrolled. Among patients aged ≥76 years with tumor diameters ≤1 cm, significant differences in survival were noted for segmentectomy vs. lobectomy [hazard ratio (HR) =0.294, P=0.007] and wedge resection vs. lobectomy (HR =0.548, P=0.017) but not in those with tumors diameters >1 cm. Among patients aged 70–75 years with tumor diameters >1–2 cm, significant differences in survival were observed for segmentectomy vs. lobectomy (HR =0.671, P=0.037) and segmentectomy vs. wedge resection (HR =0.556, P=0.003) and for wedge resection vs. lobectomy (HR =1.283, P=0.003) among those with tumor diameters >2–3 cm but not in those with tumor diameters ≤1 cm.ConclusionsBoth age and tumor size should be considered when selecting the surgical modality. Lobectomy is not recommended for lesions ≤1 cm among patients aged ≥76 years. Segmentectomy was associated with superior prognosis for tumor diameters >1–2 cm and survival favored lobectomy rather than wedge resection for NSCLCs >2–3 cm among patients aged 70–75 years. Surgeons could rely on personal experience to determine the appropriate surgical modality for NSCLCs >1 cm among patients aged ≥76 years and NSCLCs ≤1 cm among patients aged 70–75 years.     

全身炎性反应综合征在乙型肝炎肝硬化合并腹水患者住院结局中的临床意义

目的探讨全身炎性反应综合征(SIRS)在乙型肝炎肝硬化合并腹水住院患者中的发生率及其对患者住院结局的影响。方法收集2013年1月至2018年1月东南大学医学院附属南京市第二医院住院的乙型肝炎肝硬化腹水患者的临床资料,分析SIRS的发生率及其与患者临床指标、住院期间出现死亡及门静脉高压并发症(包括食管胃底静脉曲张破裂出血、肝性脑病、肝肾综合征)的关系,分析乙型肝炎肝硬化合并腹水患者住院期间发生死亡和门静脉高压并发症的预测因素。结果乙型肝炎肝硬化合并腹水住院患者共461例,其中出现SIRS的有185例,发生率为40.1%;合并SIRS组患者与未合并SIRS组相比,存在较高的黄疸发生率、细菌感染率、血清胆红素(TBil)、国际标准化比值(INR)、Child-Pugh评分、MELD评分以及较长的住院时间,存在较低的血红蛋白浓度(Hb)、血小板(PLT)计数、钠离子浓度,差异均有统计学意义(P<0.05)。住院期间,共计22例患者死亡(5.8%),8例发生消化道出血(1.7%),4例发生1型肝肾综合征(0.9%),20例发生肝性脑病(4.3%)。SIRS的发生与患者的死亡(P<0.001)及门静脉高压并发症的出现(P<0.001)均有关。MELD评分可同时预测死亡和门静脉高压相关并发症的发生(P<0.001),而SIRS和血红蛋白可预测门静脉高压并发症的发生(P<0.05)。结论SIRS在乙型肝炎肝硬化合并腹水住院患者中较为常见,可加重患者肝损害,导致其住院期间的病死率和门静脉高压并发症的发生率增高,SIRS的存在可预测患者门静脉高压并发症的发生。