循证护理在急性心肌梗死后心律失常患者中的应用

目的探讨循证护理在急性心肌梗死后心律失常患者中的应用效果,以期促进患者尽快康复。方法选取2010年10月～2011年10月本院住院的符合WHO急性心肌梗死后心律失常标准的患者120例,将其随机分为循证护理组和常规护理组,各60例,常规护理组实施常规护理,循证护理组在常规护理的基础上实施循证护理措施,包括对急性心肌梗死后心律失常的时相分布特征、可控因素、心理干预措施、健康宣教等方面的偱证,用以指导临床护理。比较两组患者心律失常发生率、心功能分级、平均住院时间、平均卧床时间、平均医疗费用、患者健康知识达标率、患者满意度。结果常规护理组心率失常发生率为66.67%,明显高于循证护理组的13.33%,两组比较差异有高度统计学意义（P〈0.01）;常规护理组健康知识达标率为71.67%,循证护理组为96.67%,两组比较差异有统计学意义（χ^2=7.43,P〈0.05）。两组患者心功能分级比较差异有统计学意义（P〈0.05）。循证护理组患者平均住院时间为（11.02±1.01）d、平均住院费用为（5 174.95±612.30）元,均显著低于常规护理组,差异有高度统计学意义（t=13.98、16.12,P〈0.01）;循证护理组平均卧床时间为（2.96±0.73）d,与常规护理组比较差异有统计学意义（t=7.14,P〈0.05）。循证护理组患者满意度为96.67%,高于常规护理组的70.00%,两组比较差异有统计学意义（χ^2=7.06,P〈0.05）。结论循证护理可有效降低急性心肌梗死后心律失常的发生,提高患者满意度,促进患者尽快康复。     

Identification and analysis of potential virulence-associated genes in Haemophilus parasuis based on genomic subtraction

Haemophilus parasuis is a commensal bacterium in the swine upper respiratory tract, but virulent strains can invade host and cause Glässer’s disease under certain conditions. In order to explore the virulence difference in H. parasuis strains, a virulent isolate, SH0165 (serotype 5), and an avirulent isolate, 7140 (serotype 4), were selected to investigate genetic differences by genomic subtraction. A total of 560 clones were screened by dot-blot and PCR, and 33 fragments present in SH0165 but absent from 7140 were identified. They encode eight gene categories, the sclB family, restriction modification system, phage products, transport system, outer membrane proteins, metabolism, and DNA synthesis and insertion sequences. We investigated the distribution of 21 fragments in 15 reference strains. Six fragments were more prevalent in virulent strains than avirulent strains based on statistical analysis; three fragments were SH0165-specific, and the remaining 12 were diversely distributed. Having analyzed these significantly differential fragments, including the sclB family, ABC-type transporter, fhuA and nhaC, we presume that these genes are associated with virulence in H. parasuis.     

Combination of thiazolidinedione and hydralazine suppresses proliferation and induces apoptosis by PPARγ up-expression in MDA-MB-231 cells

No proven targeted therapy is currently available for the treatment of triple-negative breast cancer (TNBC). Ligand activation of peroxisome-activated receptor (PPAR)γ induces antitumor effects in cancer but not obviously in TNBC. In TNBC cells, combined treatment with thiazolidinedione and demethylation drugs Hydralazine up-regulated protein and mRNA levels of PPARγ. Besides, the combination of two drugs promote antiproliferative and apoptotic effects in TNBC cells and decrease the proliferation index in the tumor xenografts. Taken together, our results suggest that multidrug regimens including a combination of Thiazolidinedione and Hydralazine may provide a therapeutic advantage in TNBC.     

舒芬太尼在腹腔镜下胆囊切除术中的应用

目的:观察舒芬太尼用于腹腔镜胆囊切除术的血流动力学影响及麻醉恢复情况。方法:60例择期腹腔镜胆囊切除术患者,ASA分级I~II级,年龄36~72岁,均无高血压病史。随机分为舒芬太尼(SF)组和芬太尼(F)组。观察两组诱导前(T0)、气管插管即刻(T1)、气腹前(T2)、气腹后(T3)[压力达13mmHg(1mmHg=0.1333kPa)]5min的SBP、DBP、HR及术后麻醉恢复情况。结果:应用等效剂量SF和F,SF组SBP、DBP、HR均明显低于F组(P<0.05);两组自主呼吸恢复及时,F组初醒(呼之睁眼)时间早于SF组,而清醒及拔管时间晚于SF组(P<0.05)。结论:SF用于腹腔镜胆囊切除术能有效抑制术中应激反应,血流动力学稳定,麻醉恢复迅速平稳。     

加味四逆散抗肝纤维化大鼠机理研究

目的观察加味四逆散对肝纤维化大鼠的预防效果并探索其防治机理。方法采用四氯化碳（CCL4）植物油溶液和酒精复制大鼠肝纤维化模型,观察加味四逆散对肝纤维化大鼠肝窦内皮细胞（SEC）窗孔大小及层黏蛋白（LN）表达的影响。结果加味四逆散组大鼠SEC壁LN的表达明显减弱,SEC失窗孔减轻,窗孔变大,与模型组比较差异有高度统计意义（P〈0．01）。结论加味四逆散抗肝纤维化的机制之一是通过阻止SEC膜上筛状窗孔变小。降低LN表达．进而抑制肝窦毛细血管化来实现的。     

卵巢透明细胞癌脾脏转移并文献回顾

目的:探讨卵巢透明细胞癌脾脏转移的临床特点和治疗策略。方法:报告1例卵巢透明细胞癌脾脏转移的详细临床资料,并进行系统文献回顾。结果:卵巢癌出现脾脏转移以浆液性乳头状囊腺癌多见,卵巢透明细胞癌发生脾脏转移极为罕见。卵巢癌出现脾脏转移时间多在卵巢癌术后,少数出现于首次就诊时,多数表现为同时多发性的大网膜及盆腔转移,个别患者可表现为孤立性脾转移病灶。结论:卵巢癌脾脏转移诊断的确立需要结合肿瘤标志、影像学资料和组织病理;治疗方面需采取综合手段,应在准确评估病情的前提下,及时行减瘤术和脾切除术,以提高患者生存质量。     

卵巢透明细胞癌脾脏转移并文献回顾

目的：探讨卵巢透明细胞癌脾脏转移的临床特点和治疗策略。方法：报告1例卵巢透明细胞癌脾脏转移的详细临床资料,并进行系统文献回顾。结果：卵巢癌出现脾脏转移以浆液性乳头状囊腺癌多见,卵巢透明细胞癌发生脾脏转移极为罕见。卵巢癌出现脾脏转移时间多在卵巢癌术后,少数出现于首次就诊时,多数表现为同时多发性的大网膜及盆腔转移,个别患者可表现为孤立性脾转移病灶。结论：卵巢癌脾脏转移诊断的确立需要结合肿瘤标志、影像学资料和组织病理;治疗方面需采取综合手段,应在准确评估病情的前提下,及时行减瘤术和脾切除术,以提高患者生存质量。     

Marfan综合征合并视网膜脱离的护理

目的探讨Marfan综合征合并视网膜脱离患者的临床护理方法。方法对51例Marfan综合征合并视网膜脱离患者的护理进行回顾性分析,包括护理评估、心理护理、手术护理和健康教育。结果51例患者均平稳度过围手术期,配合良好。视网膜平伏51例。术后视力不同程度提高或不变,术后矫正视力>0.3者21眼,0.05~0.3者34眼,<0.05者5眼。结论对Marfan综合征合并视网膜脱离病人实施全面护理,对保证手术疗效和预防术后并发症发生起重要作用。     

铜川市环卫设施规划

分析铜川市环卫设施的现状及存在问题,结合《铜川市城市总体规划》,对城区环卫设施进行了规划。     

退变性腰椎不稳症手术治疗的疗效分析

目的:探讨退变性腰椎不稳症手术治疗的疗效。方法:随访我院60例腰椎不稳症患者运用椎板扩大开窗或全椎板切除减压,摘除髓核,椎体间植骨,后路钉棒系统加压内固定及腰椎间融合术。结果:术后随访半年到3.5年,平均12个月,复查X线示骨性融合,2例出现断钉及松动现象,患者症状完全消失48例,基本消失7例,无明显缓解5例(可3例,差2例)。根据日本骨科学会(JOA)评分法,优良率91.3%。结论:椎弓根螺钉内固定加椎管减压,椎体间植骨融合可使不稳节段即刻稳定,骨性融合率高,是治疗腰椎不稳症的较好方法。