高龄患者气管切开术后更换气囊套管的配合及护理

1临床资料2003-12/2004-12高龄患者60例,年龄80～95(平均86)岁,带管时间不等.     

急性CO中毒患者激素干预对血清TNF-α,IL-8水平的影响

1 临床资料选择2002-11/2003-04急性CO中毒患者60(男37,女23)例,年龄15～78(平均40)岁. 常规治疗组给予常压高流量鼻导管吸氧,每日高压氧治疗1次(2ATA下经活瓣式面罩吸入纯氧1 h),脱水减轻脑水肿、改善脑代谢、促进脑细胞功能恢复等治疗;干预治疗组在常规治疗的基础上,地塞米松10 mg iv, 2次/d,分别于病例确诊后即刻(中毒后2 h以内)、12,24和48 h抽取肘静脉血3 mL,采用放免法(试剂盒由北京东亚免疫技术研究所提供),严格按说明书操作检测血清检测TNF-α,IL-8.     

Living donor liver transplantation with body-weight more or less than 10 kilograms

AIM: To compare the outcomes of pediatric patients weighing less than or more than 10 kg who underwent liver transplantation.METHODS: Data for 196 pediatric patients who underwent living donor liver transplantation between June 1994 and February 2011 were reviewed retrospectively.The information for each patient was anonymized and de-identified before analysis. The data included information regarding the pre-transplant conditions, intraoperative fluid replacement and outcomes for each patient. The 196 patients were divided into two groups: those with body weights of less than 10 kg were included in group 1(G1; n =101), while those with body weights of more than 10 kg were included in group 2(G2; n = 95). For each group, the patients' ages, body weights, heights,pediatric end stage liver disease scores, anesthesia times, and warm and cold ischemic times were analyzed. In addition, between-group comparisons were also made. Mann-Whitney U tests were used to compare all the variables except for complications and survival rates, which were analyzed using χ 2 tests and Kaplan-Meier tests, respectively.RESULTS: The general medical conditions of the G1patients were worse than those of the G2 patients, as shown by the higher pediatric end stage liver disease scores and poorer Z-scores. In addition, the preoperative Hb and serum albumin levels were all lower for the G1 patients than for the G2 patients. The G1 patients also had significantly more intraoperative blood loss than the G2 patients. In addition, the intraoperative fluid requirements for the G1 patients,including leukocyte poor red blood cell transfusions,5% albumin infusions and crystalloid infusions, were significantly higher than those for the G2 patients. The risk of intraoperative portal vein thrombosis was higher for the patients in G1 than for those in G2. However,the one-year survival rates(95.9% and 96.8% for G1 and G2, respectively) and three-year survival rates(94.9% and 94.6% for G1 and G2, respectively) for both groups were similar.CONCLUSION: Patients weighing less than 10 kg typically have poorer conditions, but their survival rates are comparable to those of children weighing more than 10 kg.     

Discrimination and adjustment among Chinese American adolescents: family conflict and family cohesion as vulnerability and protective factors

Objectives. We examined racial/ethnic discrimination experiences of Chinese American adolescents to determine how discrimination is linked to poor adjustment (i.e., loneliness, anxiety, and somatization) and how the context of the family can buffer or exacerbate these links.Methods. We collected survey data from 181 Chinese American adolescents and their parents in Northern California. We conducted hierarchical regression analyses to examine main effects and 2-way interactions of perceived discrimination with family conflict and family cohesion.Results. Discrimination was related to poorer adjustment in terms of loneliness, anxiety, and somatization, but family conflict and cohesion modified these relations. Greater family conflict exacerbated the negative effects of discrimination, and greater family cohesion buffered the negative effects of discrimination.Conclusions. Our findings highlight the importance of identifying family-level moderators to help adolescents and their families handle experiences of discrimination.Discrimination is one of the most significant stressors facing adolescents in immigrant families, especially those who are ethnic minorities.^1–4 Discrimination is robustly linked to a host of negative outcomes for immigrants of Asian background, at least among college students and adults. These negative outcomes include lower levels of social competence, social connectedness, and self-esteem, and higher levels of substance abuse, depressive symptoms, psychological distress, and chronic illness (i.e., heart disease, pain, and respiratory illnesses).^5–9 However, there are few studies of younger populations that include Asian American adolescents.Although discrimination at any age is harmful, there are several reasons to focus on discrimination during adolescence. Adolescents who experience discrimination adjust more poorly in terms of having lower self-esteem and more depressive symptoms.^10–12 Further, adolescents have fewer and less sophisticated coping strategies to deal with stressors (such as discrimination) than do adults.¹³ Finally, adolescence is a time when issues of identity, self-concept, and self-esteem come to the fore.^14,15 Thus, assaults on a person''s sense of self may be particularly harmful during this developmental period, when the adolescent''s sense of self is still emerging. To address the lack of literature on discrimination among Asian American adolescents, we examined the racial/ethnic discrimination experiences of Chinese American adolescents to determine how discrimination is linked to poorer adjustment (i.e., loneliness, anxiety, and somatization) and how the context of the family can buffer or exacerbate these links.     

Efficacy of medium-chain triglycerides compared with long-chain triglycerides in total parenteral nutrition in patients with digestive tract cancer undergoing surgery

The objectives of this prospective, randomized study were to evaluate the efficacy and tolerability of the short-term use of medium-chain triglyceride/long-chain triglyceride (MCT/LCT) fat emulsions, and to compare the hematologic and biochemical effects of MCT/LCT fat emulsions with LCT fat emulsions in gastrointestinal (GI) tract cancer patients following surgery. Thirty patients with GI tract cancer requiring total parenteral nutrition (TPN) were equally randomized to receive MCT/LCT or LCT emulsions for 7 days. After 7 days, no sign of complications directly related to administration of fat emulsions was observed and there were no marked differences in anthropometry, length of hospital stay, and surgical complication rates between the two groups. However, MCT/LCT significantly improved plasma prealbumin concentration (p = 0.005). Changes in complements C3 and C4, total lymphocyte count, and immunoglobulins after TPN were not significantly different between the groups. Serum triglyceride and cholesterol levels remained constant. The serum insulin level in the MCT/LCT group was higher than in the LCT group (p = 0.048). Our data revealed that MCT/LCT fat emulsions significantly enhanced nutritional status in patients with GI tract cancer, indicated by higher prealbumin levels, which might be partially due to the higher circulating insulin levels in the MCT/LCT group.     

Rising prevalence of migraine in Taiwanese adolescents aged 13-15 years

Whether the prevalence of migraine is increasing is controversial. We conducted annual surveys in 1999-2001 to investigate migraine prevalence among a nationwide sample of 13 426 adolescents aged 13-15 years. Participants from five junior high schools around different regions of Taiwan completed self-administered questionnaires. The diagnosis of migraine was based on the classification criteria proposed by the International Headache Society, 1988. Data for 23 433 person-years were collected and analysed for trends in prevalence and incidence. The 1-year prevalence of migraine increased 42% during 1999-2001 (from 5.2 to 7.4%, P < 0.001). This increasing trend was demonstrated in both sexes, all ages, and all but one studied regions of Taiwan. Of note was the biggest increment of prevalence (79%) among 7th graders (students aged 13 years) through these 3 years. Annual incidence rates did not differ between 1999 and 2000 and 2000 and 2001 (6.1% vs. 5.7%; P = 0.4). One-year persistence rates of migraine diagnosis, surrogates of migraine duration, did not differ between 1999 and 2000 and 2000 and 2001 (34.2% vs. 41.2%; P = 0.1). Our study found that the prevalence of migraine was increasing in our sampled adolescents, which results from an increment starting at age 13 or younger. The prevalence of migraine in Asians might be increasing, although previous studies showed lower prevalence in this region. Children or adolescents may be more vulnerable to the environmental or societal change.     

Effects of heme oxygenase-1 transgenic islets on transplantation

Heme oxygenase-1 (HO-1) has been described as a protein capable of cytoprotection via radical scavenging and apoptosis prevention. The aim of this study was to analyze whether HO-1 overexpression in freshly isolated murine transgenic islets resulted in cell protection and improved in vivo functional performance after transplantation. We produced transgenic mice in which the human HO-1 transgene driven by chicken beta-actin promoter was expressed in the heart, liver, spleen, lung, kidney, muscle, intestine, and pancreas in Balb/c mice. One hundred fifty islets isolated from HO-1 transgenic and control Balb/c mice were syngeneically transplanted under the left kidney capsule of the streptozotocin-diabetic Balb/c mice. The recipients who underwent transplantation with HO-1 transgenic islets showed higher blood glucose than those with control islets at 4 weeks (320 +/- 25 vs 189 +/- 43 mg/dL; P < .05). Body weight was not significantly different between the 2 groups. Our data indicate transgenic islets with high HO-1 expression did not improve transplantation outcome.     

Cell growth effects of triiodothyronine and expression of thyroid hormone receptor in prostate carcinoma cells

Thiiodothyronine (T3) plays an important role in the regulation of cell growth and differentiation. In this study, we show the different effects of T3 on cell growth response and expression of the thyroid hormone receptor in human prostate cell lines from normal to hormonal refractory metastatic cancer cells. Although the thyroid hormone receptor (TRbeta1) ubiquitously express in human prostatic epithelium cell lines (PZ-HPV-7, CA-HPV-10, LNCaP, DU145, PC-3), T3 did not show any effect on the cell proliferation of prostatic cell lines except LNCaP cells in vitro. Immunoblot assay revealed that PZ-HPV-7 and CA-HPV-10 cells express 5-10-fold of TRbeta1 more than LNCaP cells; however, the immunocytochemical staining and immunoblot assay of cellular fractions suggested the TRbeta1 is located on the cell nuclear membrane of PZ-HPV-7 and CA-HPV-10 cells. Our results suggested that T3 upregulates cellular proliferation on LNCaP cells but not other prostatic carcinoma cells and PZ-HPV-7 and CA-HPV-10 cells express the novel TRbeta1, which locates at cell nuclear membrane.