预见性护理模式对急性脑出血患者的影响观察

目的 探讨预见性护理模式对急性脑出血患者的影响.方法 选取北京海军总医院干部病房2010年4月～2012年11月收治的急性脑出血患者102例,随机分为研究组和对照组,每组各51例.对照组实施常规护理模式,研究组实施预见性护理模式.记录两组患者住院时间、并发症发生率及家属满意度情况.结果 ①研究组住院时间为(15.40±3.06)d,对照组为(20.15±5.13)d,差异有统计学意义(P＜0.05).②研究组肺部感染、脑部再出血、消化道出血、尿路感染及褥疮发生率均低于对照组,差异有统计学意义(P＜0.05).③研究组护理满意度为98.0％,对照组为82.4％,差异有统计学意义(P＜0.05).结论 预见性护理模式是一项科学、合理、有效的护理方案,不仅能降低脑出血患者并发症发生率,缩短住院时间,还能提高家属满意度,值得在临床上进一步推广.     

关节腔内给予地佐辛用于膝关节镜的临床观察

目的 评价关节腔内给予地佐辛对膝关节镜术后镇痛的影响。方法 选择择期行膝关节镜手术患者60例,随机分为A、B两组：A组关节腔内注射地佐辛5 mg（用生理盐水配制成10 mL）;B组关节腔内注射等量生理盐水10 mL。记录术后1、4、6、8、12和24 h患者在屈膝关节90°状态下的疼痛视觉模拟评分（VAS）,记录术毕至首次需要镇痛药时间以及术后不良反应的发生情况。结果 A组术后1,4,6,8,12 h的VAS评分分别为（2.3±0.6,2.6±0.5,3.0±0.5,2.8±0.6,2.9±0.7）明显低于B组（4.5±0.7,5.3±0.6,5.8±0.8,5.9±0.5,5.6±0.6）,差异有统计学意义（P〈0.05）,术后首次要求使用镇痛药物时间A组（265±40）min明显长于B组（62±11）min,差异有统计学意义（P〈0.01）。结论 关节腔内给予地佐辛用于膝关节镜能够提供良好的术后镇痛效果,延长术后镇痛时间。     

益气养阴治则在抗肿瘤转移中的应用

肿瘤的发生发展是由多因素、多环节的作用结果。中医学以其独特的辨证论治体系,在控制肿瘤转移方面的优势已为世人瞩目。其中,益气养阴法疗效显著,为常用治法之一,其抗肿瘤作用机制为全方位、多靶点的作用。     

异基因造血干细胞移植后急性移植物抗宿主病与肺损伤的关系

目的 分析研究异基因造血干细胞移植(allo-HSCT)后急性移植物抗宿主病(Agvhd)患者CT影像学特征和Agvhd诱导肺损伤的发病机制.方法 对47例Ⅱ～Ⅳ度Agvhd患者进行胸部CT检查及Agvhd发生时血清干扰素γ(IFN-γ)和肿瘤坏死因子α(TNF-α)测定,4例抗Agvhd治疗后肺损伤疗效不佳患者进行肺组织活检,生存期＞6个月的患者定期肺功能和CT检查.结果 47例患者在Agvhd后3 d内CT显示20例异常,其中17例疑诊为Agvhd诱导肺损伤(5例弥漫性间质渗出、7例弥漫性间质和肺泡渗出、5例弥漫性间质和部分小叶肺泡渗出);此外,9例患者有双侧胸腔和心包积液,4例伴心肌肥厚.血清IFN-γ和TNF-a水平在有肺损伤和无肺损伤患者分别为:(6.9±1.8)μg/L、(400±102)μg/L和(6.3±1.2)μg/L、(428±83)μg/,L,两者比较差异无统计学意义(均P＞0.05).肺组织病理显示组织结构破坏、上皮细胞损伤、间质纤维化和以T细胞或巨噬细胞为主的浸润.Agvhd治疗与肺损伤治疗有效率呈正相关(r=0.771,P=0.01).结论 肺是Agvhd作用的靶器官之一,T细胞、巨噬细胞和IFN-Γtnf-α与Agvhd造成肺损伤有关,Agvhd肺损伤可迁延为晚期非感染性肺损伤.     

Very Late Stent Thrombosis after Discontinuation of Antiplatelet Agents during Anticoagulation Therapy in a Patient with Peri-stent Contrast Staining after Implantation of a Second-generation Drug-eluting Stent

A 54-year-old man was admitted to our hospital due to intermittent chest pain. He had a history of acute myocardial infarction, and peri-stent contrast staining had been observed at the stent implantation site. The patient previously underwent anticoagulation therapy for left ventricular thrombus and antiplatelet therapy to prevent stent thrombosis. More than one year after implantation of a drug-eluting stent, antiplatelet drugs were discontinued, and anticoagulant alone was prescribed according to the guidelines, which resulted in very late stent thrombosis. The risks of both bleeding and thrombosis must be fully considered when deciding whether or not to discontinue antiplatelet therapy during anticoagulation therapy.     

Construction and evaluation of detachable bone-targeting MOF carriers for the delivery of proteasome inhibitors

Tumor bone metastasis is an important cause of tumor recurrence and death. Although bone-targeting nanoparticles decorated with targeting ligands have shown good affinity for bone tissues with the properties of adhesion to the bone matrix, it is not easy to detach from the surface of the bone matrix in the tumor-bone microenvironment, attributed to the robust coordination force between the targeting ligands, such as bisphosphates with bone-deposited calcium. This may hinder the transport of nanoparticles from bone tissue to bone metastatic tumors. In this research, we designed a bone-targeting nanocarrier with detachable bone-targeting character for the therapy of bone metastases. The nanoparticles were constructed by using ZIF-8 and bone-targeting and MMP enzyme sensitive polypeptide-modified hyaluronic acid as a carrier and proteasome inhibitor Bortezomib (BTZ) as cargo. The results show that the constructed D8-M3-HA-ZIF8@BTZ nanoparticles possessed several favorable properties such as good colloidal stability, acid-sensitive drug release, D8 peptide mediated bone targeting and MMP enzyme-responsive desorption. Besides, nanoparticle endocytosis and cytotoxicity were enhanced through HA-mediated targeting to CD44 over-expressing tumor cells. Altogether, this study provides a potential cascade targeting strategy for improving the delivery effects of bone targeted nanoparticles for the delivery of proteasome inhibitors.

Tumor bone metastasis is an important cause of tumor recurrence and death.     

间质微血管密度与乳腺癌临床病理因素的关系

目的:探讨乳腺癌微血管密度(MVD)与临床病理因素的关系.方法:应用免疫组织化学S-P法,对49例乳腺癌和10例癌旁正常组织MVD进行检测,并将其结果与影响预后的临床病理因素进行比较.结果:乳腺癌MVD明显高于癌旁正常组织(P＜0.01);乳腺癌MVD与组织学分级、淋巴结转移呈正相关(P＜0.05),与患者年龄、肿瘤大小、组织学分型、临床分期、雌孕激素受体水平无关.结论:乳腺癌MVD可作为判定肿瘤生物学行为、转移潜能、预后和指导临床治疗的参考指标.     

抗菌药物相关性癫发作临床特点回顾性分析

摘要目的回顾性分析抗菌药物相关性癫发作临床特点。方法检索维普、万方、中国知网数据库中报道的抗菌药物相关性癫发作病例,对其临床特点分析统计。结果共检索到238例患者,其中喹诺酮类130例,β 内酰胺类80例,大环内酯类和硝咪唑类各8例,氨基苷类7例,克林霉素类5例;静脉滴注给药者195例,口服给药者43例;大发作者197例,小发作者12例,肌阵挛者13例,部分性发作者16例;用药后2～4 d癫发作者157例;癫发作持续10～30 min者162例;经停药和抗癫治疗得以控制者210例。结论喹诺酮及β 内酰胺类抗菌药物最易诱发癫,有中枢神经系统疾病患者不应使用,有肾功能不全患者应减量使用。静脉滴注较口服给药更易诱发癫,应尽量口服给药。抗菌药物相关性癫以大发作为主要形式;癫发作高峰期为用药后2～4 d;多数癫能通过停药和抗癫治疗在10～30 min得到控制。