癌性胸水胸腔热化疗对淋巴细胞亚群变化的临床意义

目的研究癌性胸水胸腔持续灌注热化疗对淋巴细胞亚群的变化。方法在全麻下对21例癌性胸水患者,内置二根胸管,出胸水管连接水封瓶,经过人工心肺机的灌注泵,接上铝制螺纹管(变温用),连接进胸水管入胸腔,向胸水中加入化疗药物顺铂200~250 mg/m2,保持胸水温度42~45℃,持续灌注60 m in左右,于术前、术后第3、7 d、2周分别作淋巴细胞亚群测定,以了解胸腔热化疗对免疫功能的影响。结果热化疗后CD19、CD25的表达率明显增高(P<0.05和<0.01)。结论胸腔持续灌注热化疗使癌性胸水缓解率明显提高,是一种安全、有效的治疗癌性胸水的好方法,而且能使B淋巴细胞免疫功能及T淋巴细胞活化率明显提高。     

与护理有关的医疗纠纷原因分析及其对策

对21所医疗机构与护理有关的医疗纠纷发生情况进行调查分析.结果 发现与护理有关的医疗纠纷案件增多,医疗事故争议诉讼案件显著增长,争议补(赔)偿数额明显增加.提出与护理有关的医疗纠纷发生原因包括医院管理方面、护理人员方面、患者方面及社会因素等;需要采取完善医院管理、提高护理人员自身防范意识、加强医护惠三方沟通及树立良好社会形象等措施加以防范.     

一氧化氮和前列腺素在门静脉高压性胃病大鼠胃粘膜灌注中的作用

目的 探讨一氧化氮（NO）和前列腺素在门静脉高压性胃病（PHG）大鼠胃粘膜灌注中的作用。方法 部分结扎大鼠门静脉主干2周后,采用中性红清除率法测定大鼠胃粘膜血流量（GMBF）,同时观察门静脉压力（PVP）的变化。结果 PHG组大鼠GMBF和PVP显著高于假手术组（t=3.431、3．312,P＜0．01）。低剂量的NO合成酶抑制剂L－硝基－精氨酸甲酯（L－NAME）呈剂量依赖性降低PHG大鼠GMBF,而对假手术组GMBF无明显影响;高剂量的L－NAME（12mg/kg)能非常显著降低PHG和假手术组大鼠GMBF。前列腺素环氧合酶抑制剂消炎痛能明显降低PHG组大鼠GMBF,而对假手术组GMBF无明显影响;预先给消炎痛处理后在假手术组大鼠中,静脉注射低剂量L－NAME（4mg/kg)前后GMBF无明显变化,高剂量L－NAME（12mg/kg)降低大鼠的GMBF与未用消炎痛处理组比无明显变化;预先给消炎痛处理后在PHG组大鼠中,L－NAME剂量（4mg/kg、12mg/kg)依赖性降低大鼠的GMBF与未用消炎痛处理组比无明显改变。结论 NO、前列腺素在调节PHG大鼠的GMBF起重要作用,但两者无协同作用。     

双源CT联合血清CRP水平检测对痛风性关节炎的诊断价值

目的 探讨双源CT联合血清C反应蛋白（CRP）水平检测对痛风性关节炎的诊断价值。方法 选择本院2018年1月—2022年3月收治的166例疑似痛风性关节炎患者,分为痛风性关节炎组与非痛风性关节炎组行双源CT及血清CRP水平检测,以美国风湿病协会（ACR）制定的痛风性关节炎诊断标准明确痛风性关节炎诊断,计算双源CT及血清CRP单独与联合诊断痛风性关节炎的效能并分析其临床价值。结果 共有126例患者（75.90%）明确痛风性关节炎诊断。痛风性关节炎组双源CT图像绿色结晶检出率高于非痛风性关节炎组,差异有统计学意义（P＜0.05）。痛风性关节炎组血清CRP水平高于非痛风性关节炎组（P＜0.05）,但两组血清CRP阳性率比较,差异无统计学意义（P＞0.05）。双源CT联合血清CRP诊断痛风性关节炎的特异性、准确率、阳性预测值、阴性预测值均高于单项诊断,差异有统计学意义（P＜0.05）。结论 双源CT联合血清CRP水平检测能够为痛风性关节炎的无创诊断提供可靠参考     

CD44v6、E-cadherin和nm23-H1在子宫颈癌中的表达及意义

目的:探讨CD 44V 6、E-cadherin和nm 23-H 1蛋白表达与子宫颈癌的发生、发展及转移的关系。方法:采用免疫组化SP法检测50例子宫颈癌组织和10例正常子宫颈组织中CD 44v6、E-cadherin和nm 23-H 1蛋白的表达情况。结果:CD 44v6蛋白在子宫颈癌组织中的阳性率为66%,CD 44v6高表达与宫颈癌的组织学分级、淋巴结转移呈正相关(P<0.05及P<0.01)。E-cadherin和nm 23-H 1蛋白在宫颈癌组织中阳性表达率分别为62%和48%,显著低于正常宫颈组织(100.0%),P<0.05及P<0.01,但E-cadherin和nm 23-H 1阳性表达与宫颈癌的临床分期、组织学分级、间质浸润和淋巴结转移无关(P>0.05)。宫颈癌中CD 44v6表达与E-cadherin和nm 23-H 1表达呈负相关(P<0.01及P<0.05)。结论:在子宫颈癌中CD 44v6蛋白高表达和E-cadherin、nm 23-H 1蛋白低表达是判断宫颈癌的生物学行为的良好指标。     

MGMT启动子与垂体腺瘤侵略性行为及ADC值的相关性研究

目的 探讨垂体腺瘤O-6-甲基鸟嘌呤DNA甲基转移酶(MGMT)启动子甲基化状态与肿瘤侵略性行为及ADC值的相关性.方法 采用前瞻性研究,选取我院2019年01月至2020年08月收治的垂体腺瘤的患者,所有患者术前接受MRI检查(平扫+增强+解剖弥散),术后对肿瘤组织标本进行苏木精-伊红(HE)染色、免疫组化检查,通过...     

Wound,pressure ulcer and burn guidelines – 4: Guidelines for the management of connective tissue disease/vasculitis-associated skin ulcers

The Japanese Dermatological Association prepared guidelines focused on the treatment of skin ulcers associated with connective tissue disease/vasculitis practical in clinical settings of dermatological care. Skin ulcers associated with connective tissue diseases or vasculitis occur on the background of a wide variety of diseases including, typically, systemic sclerosis but also systemic lupus erythematosus (SLE), dermatomyositis, rheumatoid arthritis (RA), various vasculitides and antiphospholipid antibody syndrome (APS). Therefore, in preparing the present guidelines, we considered diagnostic/therapeutic approaches appropriate for each of these disorders to be necessary and developed algorithms and clinical questions for systemic sclerosis, SLE, dermatomyositis, RA, vasculitis and APS.     

Tractostorm: The what,why, and how of tractography dissection reproducibility

Investigative studies of white matter (WM) brain structures using diffusion MRI (dMRI) tractography frequently require manual WM bundle segmentation, often called “virtual dissection.” Human errors and personal decisions make these manual segmentations hard to reproduce, which have not yet been quantified by the dMRI community. It is our opinion that if the field of dMRI tractography wants to be taken seriously as a widespread clinical tool, it is imperative to harmonize WM bundle segmentations and develop protocols aimed to be used in clinical settings. The EADC‐ADNI Harmonized Hippocampal Protocol achieved such standardization through a series of steps that must be reproduced for every WM bundle. This article is an observation of the problematic. A specific bundle segmentation protocol was used in order to provide a real‐life example, but the contribution of this article is to discuss the need for reproducibility and standardized protocol, as for any measurement tool. This study required the participation of 11 experts and 13 nonexperts in neuroanatomy and “virtual dissection” across various laboratories and hospitals. Intra‐rater agreement (Dice score) was approximately 0.77, while inter‐rater was approximately 0.65. The protocol provided to participants was not necessarily optimal, but its design mimics, in essence, what will be required in future protocols. Reporting tractometry results such as average fractional anisotropy, volume or streamline count of a particular bundle without a sufficient reproducibility score could make the analysis and interpretations more difficult. Coordinated efforts by the diffusion MRI tractography community are needed to quantify and account for reproducibility of WM bundle extraction protocols in this era of open and collaborative science.     

肝癌TACE中化疗和栓塞与肿瘤抑制和肝损伤关系的临床研究

目的 研究肝癌TACE中化疗与栓塞的并用与否对肿瘤抑制和肝损伤的影响.方法 回顾性分析152例HCC患者接受化疗灌注(A组30例)、栓塞(B组29例)或化疗栓塞(C组93例)后1天和4天,AFP下降及肝功能各指标变化.结果 (1)AFP下降人数,B组(56.5%,78.3%)和C组(67%,80.7%)显著大于A组(25%,25%)(P＜0.001).(2)肝功能异常人数增幅表现为:TBil,A、C组明显高于B组(P＜0.001).ALT及ALB,B、C组明显大于A组(P＜0.005).PA,C组明显高于A、B组(P＜0.005).结论 TACE对肿瘤的抑制主要归功于肿瘤供血血管的栓塞作用;加用肝动脉化疗灌注后,肝损伤的增加明显大于对肿瘤的抑制.     

心肌致密化不全研究进展

现介绍心肌致密化不全在发病机制、病理学、流行病学、临床特点、诊断及诊断标准、治疗及预后等方面的进展,并总结了国内心肌致密化不全患者的临床特点。