培门冬酶在儿童急性淋巴细胞白血病诱导化疗中的应用研究

目的 :探讨儿童急性淋巴细胞白血病诱导化疗中培门冬酶与左旋门冬酰胺酶的毒副作用以及治疗效果。方法 :从本院2009年2月~2014年2月收治的儿童急性淋巴细胞白血病患者中随机选择95例进行研究,随机分为对照组(47例)和观察组(48例),分别给予左旋门冬酰胺酶和培门冬酶治疗。观察两组的毒副反应发生情况以及治疗效果,并进行比较。结果 :两组在治疗总缓解率和毒副反应发生率方面经比较差异无统计学意义;但观察组的住院时间显著短于对照组,用药次数显著少于对照组,经比较差异均有统计学意义。结论 :儿童急性淋巴细胞白血病诱导化疗过程中,利用培门冬酶和左旋门冬酰胺酶进行治疗均能获得一定的治疗效果,并导致一定毒副作用的出现,但培门冬酶治疗在用药次数和住院时间方面存在明显的优势。     

米口袋化学成分的研究

从米口袋（Gueldenstae dtia multiflora Bge.）中分离得到11个化合物,应用光谱学和化学方法鉴定了其中7个化合物的结构,分别为黑麦草内酯、烈香杜鹃素Ⅰ、木栓醇、木栓酮、4-烯-3-酮豆甾烷、A’-Neogammacer-22（29）-en-3β-ol,acetate和β-谷甾醇。7个化合物均从该植物中首次分离得到,其中化合物Ⅰ是该植物中的水溶性成分。     

Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection

Objective: In acute DeBakey type I aortic dissection, it is still controversial whether to perform extended aortic replacement to improve long-term outcome or to use a conservative strategy with ascending aortic and hemiarch replacement to palliate a life-threatening condition. Methods: Between 1999 and 2009, 188 consecutive patients (93 women; mean age, 57.4 ± 11.7 years) with acute DeBakey type I aortic dissection underwent hemiarch (Hemiarch group; n = 144) or total arch replacement (Total arch group; n = 44) in conjunction with ascending aorta replacement. Clinical outcomes were compared after adjustment for baseline characteristics using inverse-probability-of-treatment weighting. Results: Median follow-up was 47.5 months (range 0–130.4 months) and was 92.0% (n = 173) complete. Five-year unadjusted survival and permanent-neurologic-injury-free survival rates were 65.8 ± 8.3% and 43.1 ± 9.7% in the Total arch group, and 83.2 ± 3.3% and 75.2 ± 4.0% in the Hemiarch group, respectively (P = 0.013 and <0.001). After adjustment, the Total arch group patients were at greater risks of death (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.21–4.67; P = 0.012), and permanent neurologic injury (HR 3.25, 95% CI 1.31–8.04; P = 0.011) compared to the Hemiarch group patients. The risks of the re-operation for aortic pathology or distal aortic dilatation (>55 mm) were similar for both groups (HR 0.33, 95% CI 0.08–1.43; P = 0.14). Conclusions: Total arch repair was associated with greater morbidity and mortality compared with hemiarch repair in acute DeBakey type I aortic dissection. Rates of aortic re-operation or aortic dilatation were not significantly different between the two surgical strategies. These findings support a conservative surgical approach to circumvent this life-threatening situation.     

Identification of novel biomarkers differentially expressed between African-American and Caucasian-American prostate cancer patients

Prostate cancer (PCa) incidence and mortality rate vary among racial and ethnic groups with the highest occurrence in African American (AA) men who have mortality rates twice that of Caucasians (CA). In this study, we focused on differential expression of proteins in AA prostate cancer compared to CA using Protein Pathway Array Analysis (PPAA), in order to identify protein biomarkers associated with PCa racial disparity. Fresh frozen prostate samples (n=90) obtained from radical prostatectomy specimens with PCa, including 25 AA tumor, 21 AA benign, 23 CA tumor, 21 CA benign samples were analyzed. A total of 286 proteins and phosphoproteins were assessed using PPAA. By PPAA analysis, 33 proteins were found to be significantly differentially expressed in tumor tissue (n=48, including both CA and AA) in comparison to benign tissue (n=42). We further compared protein expression levels between AA and CA tumor groups and found that 3 proteins were differentially expressed (P<0.05 and q<5%). Aurora was found to be significantly increased in AA tumors, while Cyclin D1 and HNF-3a proteins were downregulated in AA tumors. Predicted risk score was significantly different between AA and CA ethnic groups using logistic regression analysis. In conclusion, we identified Aurora, Cyclin D1 and HNF-3a proteins as being differentially expressed between AA and CA in PCa tissue. Our study suggests that these proteins might be involved in different pathways that lead to aggressive PCa behavior in AA patients, potentially serving as biomarkers for the PCa racial disparity.     

PTEN重组腺病毒载体的构建及其在气道平滑肌细胞的表达

目的 应用pAdxsi载体系统构建携带PTEN基因的腺病毒载体.方法 将PTEN cDNA自载体pcDNA3-PTEN中切出,克隆至穿梭质粒pShuttle-GFP-CMV中,然后与腺病毒质粒pAdxsi在化学感受态细胞DH5α菌株内同源重组,经Pac-Ⅰ线性化后,重组子通过脂质体2000介导转染HEK293细胞,产生有感染能力的腺病毒,并测定其滴度,通过荧光显微镜能观察HEK293细胞内绿色荧光的表达;PCR检测腺病毒载体PTEN mRNA的表达,Western blotting检测PTEN蛋白在气道平滑肌细胞的表达.结果 感染腺病毒载体的HEK293细胞表达GFP随着时间逐渐增强,并且出现明显的细胞病变效应,经过3轮扩增后病毒达到合适的滴度,构建的Ad-PTEN腺病毒滴度为2×1010pfu/ml,PCR扩增后经琼脂糖凝胶电泳证实其表达,Western blotting检测纠腺病毒感染的气道平滑肌细胞内PTEN蛋白表达明显增高.结论 成功构建了携带野生型PTEN腺病毒载体,为进一步研究PTEN基因应用于哮喘治疗提供了实验基础.     

青霉素、硫酸庆大霉素对红剑鱼、孔雀鱼和食蚊鱼的急性毒性实验

目的 :观察青霉素、硫酸庆大霉素对红剑鱼、孔雀鱼和食蚊鱼的急性毒性影响 ,以探讨红剑鱼、孔雀鱼和食蚊鱼作为水生实验动物的可行性及对药物急性毒性的检测效果。方法 :用水毒理学方法测定它们对三种鱼类的 2 4hLC50 。结果 :青霉素对红剑鱼、孔雀鱼和食蚊鱼的急性毒性观察结果 ,2 4hLC50 值分别为 2 83.0 6mg/L、2 79.92mg/L、2 89.4 4mg/L ;硫酸庆大霉素对红剑鱼、孔雀鱼和食蚊鱼的急性毒性观察结果 ,2 4hLC50 值分别为 2 95 .97ug/L、2 73.74ug/L、30 9.0 3ug/L。结论 :红剑鱼、孔雀鱼和食蚊鱼可作为急性毒性的试验材料。     

供心冷缺血保存时间较长的体外循环管理

目的总结3例较长时间供心缺血[367~542(465)m in]的原位心脏移植体外循环管理经验。方法1例二次手术者采用股动脉、股静脉及上腔静脉插管,另2例采用升主动脉及上、下腔静脉插管;采用中度低温(鼻咽温28.1℃~29℃),轻-中度血液稀释(血红蛋白82~119 g/L),50~83 m l/(kg.m in)的流量进行体外循环灌注;供心保护方法:经主动脉根部灌注冷心脏停搏液,快速取下心脏,再灌注冷UW液,并放置于UW液中低温保存。结果3例均顺利脱离体外循环机,术后康复出院。结论合理的灌注技术及良好的心肌保护,可使供心冷保存时间较长的原位心脏移植获得成功。     

药物性肝损伤临床特点分析

【目的】分析药物性肝损伤（drug—inducedliverinjmy,DILI）患者的临床特点,以期提高对该病的临床认识。【方法】回顾性分析临床诊断为药物性肝损伤的患者资料,对其用药情况、性别、年龄分布、临床表现及分型、相关生物化学指标和病理学特点加以分析。两组比较非参数统计采用秩和检验,两样本率的比较采用x。检验。【结果】对159例患者资料进行分析,其中男57例,女102例;年龄18～82岁,平均50．8岁;用药种类以中草药为主（66．0％）,其次为抗生素（8．8％）、化疗药物（4．4％）。临床分型：肝细胞型104例（65．4％）,胆汁淤积型21例（13．2％）,混合型34例（21．4％）。【结论】药物性肝损伤以女性、中老年人多见。引起成人药物性肝损伤的主要药物依次为中草药、抗菌药、化疗药。肝细胞型为主要临床类型。大多数成人患者预后良好,肝衰竭者预后较差。     

出院病案医嘱的常见问题及对策

目的 规范电子医嘱,减少医嘱缺陷及差错的发生,减少或降低医疗事故风险,确保医疗质量.方法 随机抽取2013年5月份归档病案500份,按医嘱单书写规范标准对其医嘱部分进行检查,将检查结果录入Excel表中进行统计分析.结果 500份医嘱中366份合格,合格率为73.2％,不合格医嘱中常见的问题依次是医师或护士缺手工签名,占12％;用药医嘱不规范,占11.2％;自定义医嘱,占8.6％;有医嘱无对应的报告单,占8.4％;护理常规、饮食、护理级别不规范,占7.6％.结论 通过采取规范医嘱流程、规范医嘱术语及行为、加强院科两级质量管理、增强医务人员的责任心和法律意识等措施,医嘱质量得到提高,医疗安全得到保障.     

慢性硬膜下血肿钻孔引流术后并发症及防治

目的　探讨老年慢性硬膜下血肿 (CSDH)钻孔引流术后并发症的发生原因和防治措施。方法　分析 80例临床资料。结果　 80例CSDH患者钻孔引流治愈 77例 (占 96 .3% ) ,死亡 3例 (占 3.7% ) ;术后发生并发症 2 8例 (占 35 .0 % ) ,其中并发颅内血肿 5例 (占 6 .3% ) ,血肿复发 4例 (占 5 .0 % ) ,大量颅内积气并张力性气颅 10例 (占 13.8% ) ,脑脊液漏 4例 (占 5 .0 % ) ,癫痫或精神障碍 5例 (占 6 .3% )。结论　充分认识CSDH钻孔引流术后的多种并发症 ,密切观察病情变化 ,早期发现并及时处理 ,可提高该病的治愈率