阿片类药物对乳腺癌血管生成及休眠的影响

【摘要】〓在乳腺癌综合治疗中,外科手术治疗占有重要地位,由此导致围术期镇痛药物的使用不可缺少。在围术期镇痛以及包括癌性疼痛在内的多种疼痛的治疗中,阿片类药物起着无可替代的作用,故部分乳腺癌患者在治疗过程中需使用阿片类药物。然而阿片类药物可能影响乳腺癌血管生成以及肿瘤细胞休眠、复发、转移,进而有可能影响乳腺癌患者的预后。因此,阿片类药物对于乳腺癌复发转移方面的影响不容忽视。     

尿流式有形成分及干化学分析在尿路感染诊断中的应用评价

Objective To evaluate the clinical application of automated urine formed elements analyzer and/or urine dipstick analyzer for examination of urinary formed elements in screening urinary tract infection (UTI). Methods 148 fresh midstream clear-catch urine samples from the UTI patients and 284 fresh midstream clear-catch urine samples from non-UTI subjects were selected. Bacteria culture was performed for bacterial colony counting and identification. Bacteria counts ( BACT), yeast-like fungus and WBC were performed by UF-looOi automated urine formed elements analyzer. Leukocyte esterase test (LEU) and nitrite test (NIT) were performed by URISYS 2400 urine dipstick analyzer. We evaluated data obtained from urine dipstick analyzer, UF-1000i and combination of UF-1000i with urine dipstick analyzer and the results was compared with those obtained from quantitative bacterial culture. Then we evaluated the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Among the 148 patients with UTI, the positive rate of the quantitative bacterial culture was 73.6% (109/148), the positive rate of LEU and NIT detected by dipstick test 26. 4% (39/148).There was significantly statistical difference between bacterial culture and strip test(χ2 = 55.68 ,P < 0. 05 ). The positive rate of urine flow cytometry by UF-1000i with either positive of BACT and WBC was 91.2%(135/148), which was higher than the positive rate of the quantitative bacterial culture. There was significant difference between two methods (χ2 = 14. 70, P < 0. 05 ). The positive rate of anyone positive among BACT, WBC, LEU and NIT was 94. 6% (140/148) when detected with combination of dipstick test and UF-1000i, which was higher than the positive rate of the quantitative bacterial culture. And there was significant difference between two methods (χ2 = 20. 45, P < 0. 05 ). The sensitivity of dipstick test was low (26. 4% ,39/148 ), and specificity was high ( 99. 3%, 282/284 ) . The sensitivity, specificity, positive predictive value, negative predictive value of BACT detected by UF-1000i in diagnosing urinary tract infection were 92. 6% ( 137/148 ), 39. 8% ( 113/284 ). 44. 5% ( 137/308 ) and 91.1% ( 113/124 ), respectively. If the dipstick test was combined with UF-1000i, the sensitivity, negative predictive value, specificity, positive predictive value and accuracy were 98.0% ( 145/148 ), 97.1% ( 100/103 ). 35.2% (100/284) ,44. 1% (145/329) and 56. 7% (245/432), respectively. Conclusions The combination of urine dipstick test and automated urine formed elements analyzer UF-1000i plays an important role in early diagnosis of UTI. And it has significant value in diagnosis of UTI, especially for the patients with negative bacterial cultures of urine sample.     

有血流动力学意义的动脉导管未闭早产儿布洛芬治疗失败的危险因素分析

目的 研究有血流动力学意义的动脉导管未闭（hemodynamically significant patent ductus arteriosus, hsPDA）早产儿布洛芬治疗失败的高危因素。方法 回顾性收集华中科技大学同济医学院附属湖北妇幼保健院新生儿科2018年1月—2023年6月收治的胎龄<34周hsPDA早产儿的临床资料,根据治疗方式的不同分为布洛芬组（95例）和布洛芬+手术组（44例）,采用二元logistic回归分析探讨hsPDA早产儿布洛芬治疗失败的高危因素。结果 二元logistic回归分析显示,动脉导管直径增大、大脑中动脉阻力指数（resistance index, RI）值≥0.80、总有创机械通气时间延长是hsPDA早产儿布洛芬治疗失败的高危因素（P<0.05）。受试者操作特征曲线分析显示,动脉导管直径>2.85 mm,大脑中动脉RI值≥0.80,总有创机械通气时间>16 d对hsPDA早产儿布洛芬治疗失败具有预测价值（P<0.05）;三者联合预测价值最高,曲线下面积为0.843,灵敏度为86.5%,特异度75.0%(P<0....     

肺癌脊柱转移瘤患者术后生存分析及预测评分的验证

目的分析肺癌脊柱转移瘤开放手术患者术后的生存预后, 并评估现有生存期预测模型的准确度。方法回顾性收集2019年1月至2021年11月于广东省人民医院骨肿瘤科收治的76例肺癌脊柱转移行开放手术的患者资料, 男49例、女27例, 年龄(59.3±10.3)岁(范围26～80岁)。对骨转移数目、病理类型、内脏转移情况、表皮生长因子受体(epidermal growth factor receptor, EGFR)编码基因突变是否为敏感的靶向突变位点、血清碱性磷酸酶(alkaline phosphatase, ALP)水平、血红蛋白水平、Frankel分级等与术后生存期的关系进行Cox逻辑回归分析, 绘制Kaplan-Meier曲线, 确定潜在的预后因素。通过绘制受试者工作特征曲线(receiver operating characteristic curve, ROC), 验证Tomita评分、Tokuhashi修订评分(2005年)、Katagiri New评分、新英格兰脊柱转移评分系统(New England spinal metastasis score, NESMS)、骨骼肿瘤学研究...     

数字化X线片双侧股骨颈假阳性骨折1例报道

正老年人股骨颈骨折较多见,而依据普通X线片诊断股骨颈骨折漏诊率高达5%~10%[1-2],因此避免股骨颈骨折漏诊得到越来越多的重视。老年人摔伤后髋部痛普通X线片提示股骨颈骨折但实际为无骨折却罕见。本文现报道1例。1病例资料92岁男性患者,2016年10月23日夜间如厕时不慎摔倒,右髋部及臀部先后触地,当即感右髋痛,不能自行站起,由家人搀扶上床。次日晨家人搀起可行走,但右髋剧痛,变     

尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

乳腺癌术后化疗所致口腔黏膜炎的预防

口腔黏膜炎(oral mucositis,OM)是指口腔的炎症性和溃疡性反应,化疗患者OM发生率高,其持续疼痛不仅严重影响患者的营养摄入和生活质量,还可诱发腮腺炎、中耳炎或全身严重感染等并发症.是化疗所致的一种最常见的不良反应,发生率达40％ ～ 76％,严重时影响了化疗的进程和疾病的预后.另据报道,64％化疗患者的败血症是由OM所致[1].乳腺癌是女性高发肿瘤,也是普外科的常见肿瘤之一,术后辅助化疗是乳腺癌治疗的重要组成.口腔黏膜炎的评估:参照世界卫生组织(WHO)标准(关于口腔黏膜炎的分级标准):将OM分为0～Ⅳ级[2].0级:口腔黏膜无异常;Ⅰ级:口腔黏膜有1～2个＜1.0 cm的溃疡,出现红斑疼痛;Ⅱ级:口腔黏膜有1个＞1.0 cm的溃疡和数个小溃疡,但思者能进食;Ⅲ级:口腔黏膜有2个＞1.0 cm的溃疡和数个小溃疡,能进流质饮食;Ⅳ级:口腔黏膜有2个以上＞1.0 cm的溃疡或融合溃疡,不能进食[3].笔者应乳腺癌术后应用吡柔比星及紫杉醇进行新辅助化疗且曾出现OM的病因、发病机制、防治进展进行探讨,从而选择正确的防护措施,对减少患者OM的发生率和改善患者的生存质量十分重要.     

改良超滤对心脏瓣膜置换术后患者市功能的影响

目的探讨改良超滤对成人心脏瓣膜置换术后肺功能的影响。方法选取60例拟行成人心脏瓣膜置换术的患者,随机分为两组,M组为改良超滤组（n=30）,c组为无超滤对照组（n=30）。监测两组患者体外循环前、改良超滤前、改良超滤后的血细胞比容、氧合指数、肺泡-动脉氧分压差等各项指标。记录两组术后呼吸机辅助时间及术后重症监护室监护时间。结果M组超滤前的血细胞比容比体外循环前显著降低（P〈0．05）,超滤后血细胞比容比超滤前已有显著提高（P〈0．05）,但仍比体外循环前低（P〈0．05）。M组术后呼吸机辅助时间及术后重症监护室监护时间均明显短于c组（P〈0．05）,M组超滤后氧合指数值明显高于c组（P〈0．05）,M组超滤后肺泡一动脉氧分压差值明显低于c组（P〈0．05）。结论心脏瓣膜置换术患者体外循环过程中应用改良超滤,可以有效减轻术后组织水肿,降低炎症反应,促进术后早期肺功能的恢复。【     

结核杆菌原发耐药间隔五年对比分析

目的：探讨归口管理对原发耐药菌的影响。方法：回顾分析１９９４－１９９５年度与１９９８－１９９９年度结核杆菌原发耐药情况。结果：１９９８－１９９９年度原发耐药率较１９９４－１９９５年度明显下降。结论：我院通过五年归口管理，降低了原发耐药菌的比例，但仍需进一步加强归口管理力度，从而有效控制原发耐药菌的发生。