Klippel-Trenaunay综合征的微创治疗

目的总结血管内介入、激光光凝、硬化剂注射等微创技术治疗Klippel-Trenaunay综合征(Klippel-Trenaunay syndrome,K-TS)的临床经验. 方法 1989年2月～2004年11月我院收治32例K-TS,对深部异常的动静脉瘘和下肢异常的动脉侧枝进行栓塞治疗,对功能不全的深静脉瓣膜进行微创修复,对粗大的曲张静脉行激光光凝治疗,对肢体血管瘤和局限性迂曲成团的细小静脉丛注射硬化剂. 结果 32例随访1～7年,平均5年,未见复发.29例肢体曲张静脉包括网状静脉扩张完全消失,造影检查动静脉瘘当即消失,股骨异常血液供应消失.32例肢体增粗现象逐渐减轻.32例血管瘤于注射后2～3个月完全硬化、消失或明显减小但无按压缩小现象.7例瓣膜修复者多普勒检查股浅静脉无明显返流. 结论血管内介入、血管内激光光凝、硬化剂注射、小切口瓣膜修复等综合治疗K-TS可取得较好的疗效,值得推广应用.     

电针改善硬膜外吗啡用于术后镇痛所引起的免疫抑制

为观察硬膜外吗啡和电针对术后患者免疫功能的影响，检测自然杀伤细胞（ＮＫｃｅｌｌ）活性和ＰＨＡ诱导白细胞介素２（ＩＬ－２）水平在单纯胆囊切除术患者术前和术后第１、３、７天的动态变化情况。结果吗啡组ＮＫ活性在术后第１、３、７天抑制，手术组仅在术后第１、３天出现抑制，而抑制率低于同天的吗啡组，电针可拮抗吗啡引起的ＮＫ活性抑制加深状况。在术后第１天，手术组和吗啡组ＩＬ－２水平均下降，吗啡＋电针组无明显变化，术后第７天吗啡＋电针组ＩＬ－２升高接近正常人水平。表明电针能改善硬膜外吗啡引起的免疫抑制，促进术后机体的恢复。硬膜外吗啡结合电针是值得推荐的术后镇痛方法。     

CXC趋化因子与肿瘤血管新生

趋化因子在免疫调节、血管新生以及介导肿瘤的器官特异性转移中发挥重要作用。其中CXC趋化因子超家族由于N-端谷氨酸-亮氨酸-精氨酸基序(Glu-Leu-Arg,ELRmotif)的有无使其在血管新生过程中具有了促进或者抑制血管新生的不同作用:含有ELR(ELR )的CXC趋化因子经血管内皮组织上CXCR2介导血管新生促进作用;而不含有ELR(ELR-)的CXC趋化因子通过血管内皮组织上CXCR3介导血管新生抑制作用。     

类比思维结合创设乐学情境教学在眼科护理实习教学中的应用研究

目的 探讨类比思维结合创设乐学情境教学在眼科护理实习教学中的应用研究。方法 选取2020年10月至2022年1月在空军军医大学第一附属医院西京医院眼科实习的90名护生作为研究对象。按照不同的教学方法分为对照组和观察组,对照组45名护生采用常规教学,观察组45名护生采用类比思维结合创设乐学情境教学。评估两组护生的综合考核成绩、教学效果调查问卷及学生对带教教师的总满意度。采用SPSS 22.0进行t检验和卡方检验。结果 观察组护生的理论知识考核成绩[（85.39±1.57） vs. （84.41±1.34）]、护理技能考核成绩[（87.52±0.04） vs. （82.64±0.05）均高于对照组;观察组护生的眼科护理工作中的用药安全意识、专业兴趣与自主学习性提升、协作组织能力增强、独立思考和自主学习能力提升、达到多学科知识融会贯通的目的、信息量与知识面改善、临床思维沟通交流能力增强、理论知识灵活应用、动手操作能力提高、培养创新意识各个方面评分均优于对照组;带教教师对学生学习态度、语言表达、呼唤沟通能力、独立解决问题能力等方面的评价,观察组高于对照组（P <0.05）。结论 类比思维结合创设乐学情境教学能提高护生的平均考核成绩和护理技能考核成绩,能改善学生对带教教师的满意度。     

营养不良老年人非药物干预临床实践指南

老年人是营养不良的高发人群,营养不良与众多不良临床结局密切相关,严重影响老年人的身体健康和生活质量,给家庭和社会造成沉重负担。因此,采取有效措施改善老年人的营养不良至关重要,非药物干预是改善营养状况的重要措施。然而,国内尚无专门针对营养不良老年人的非药物干预临床实践指南,因此,中国老年护理联盟、国家老年医学中心和国家老年疾病临床医学研究中心的营养专家,通过对老年人营养不良最新的国内外文献的全面检索与分析,采用推荐意见评估、制订及评价(GRADE)分级体系制订了本指南,针对营养不良老年人非药物干预提出9条推荐意见,以期能够改善老年人营养不良状况,提高生活质量。本指南侧重于可经口进食的营养不良老年人,聚焦于肠内营养,肠外营养不在本指南讨论范围内。     

陡脉冲电场对荷瘤BALB/c小鼠癌细胞杀伤效应的实验研究

观测陡脉冲电场对荷瘤BALB/c小鼠癌细胞的杀伤效应。处理后的癌细胞在光镜下表现为细胞核固缩、核碎裂、核溶解;在电镜下表现为异染色质增加,边集,呈团块样改变,细胞质肿胀,脂滴数量增加,质膜破裂;核固缩,碎裂,线粒体肿胀。实验揭示了陡脉冲电场能有效地杀伤癌细胞,明显抑制了荷瘤小鼠恶性肿瘤的生长、增殖,有着良好的应用前景。     

Oligoclonal analysis of the atopic T cell response to the group 1 allergen of Cynodon dactylon (bermuda grass) pollen: pre- and post-allergen-specific immunotherapy

BACKGROUND: Bermuda grass pollen (BGP) is an increasingly important seasonal aeroallergen in Australia and other subtropical and temperate regions. BGP shares minimal allergenic cross-reactivity with pollens of rye grass or other Pooideae grasses often used for desensitization regimens in grass pollen allergy. Current allergen immunotherapy is seldom used in asthmatic patients due to IgE-mediated side effects. Since clinically effective immunotherapy is linked with altered allergen-specific T cell response, characterisation of human T cell reactivity to Cyn d 1, the major B cell allergen of BGP, should permit the design of effective and safe immunotherapy for BGP allergy. METHODS: Short-term BGP-specific CD4+ T cell lines were established from peripheral blood of 14 BGP-sensitive patients before and after conventional 50% BGP and 50% 7-grass mix subcutaneous specific allergen immunotherapy (SIT). T cell diversity of antigen specificity and function was assessed by proliferation and cytokine production to BGP, Cyn d 1 and Cyn d 1 peptides. RESULTS: Three highly immunogenic regions of Cyn d 1 were identified in 13/14 patients pre-SIT: Cyn d 1 (109-128), (181-209) and (217-241). The SIT regimen was clinically efficacious. Following SIT, decreased proliferation to BGP, Cyn d 1 and Cyn d 1 peptides was observed with a marked decrease in the IL-5:IFN-gamma ratio. CONCLUSIONS: Cyn d 1 is a major T cell allergen of BGP. Decreased Cyn d 1-specific IL-5 dominant T cell responses were observed in association with clinically effective treatment with the 50% BGP and 50% 7-grass mix. Identified dominant T cell regions of Cyn d 1 should facilitate safer vaccine development for BGP-induced asthma in addition to rhinitis.     

Diagnostic role of fine-needle aspiration of bone lesions in patients with a previous history of malignancy

At the present time fine-needle aspiration (FNA) is considered a routine diagnostic procedure in evaluating neoplastic vs. nonneoplastic lesions in many organs, with high sensitivity and specificity. The purpose of this study was to assess the utility of FNA in areas of diagnostic difficulty and its limitations in evaluating bone lesions in patients with a previous history of malignancy. From 1989 to 2000, 249 CT-guided FNAs of bone lesion were performed at our institutions; 187/249 (75.1%) patients had a previous history of malignancy. Aspirated material was air-dried for Diff-Quik stain or fixed in ethanol for Papanicolaou staining. Subsequent surgical tissue was available in 69/187 (36.9%) of the cases. There were 114 males and 73 females, ages 14-86 yr (mean, 64 yr). The primary tumor site was lung 49, genitourinary 46, breast 31, gastrointestinal 28, hematopoietic 26, soft tissue/skin 5, and thyroid 2. There were 125 FNAs of the vertebral spine, 19 from the pelvis, 11 from the ribs, 9 from the sternum, 5 from the femur, and 18 from miscellaneous bone sites. Out of 187, 166 (88.7%) were malignant aspirates confirming the patients' primary malignancies. The most common malignancy encountered was adenocarcinoma, 126/187 (67.4%). Surgical tissue was available for review in 69 patients and the results were in agreement with the FNAs diagnosis in all cases. Nine out of 187 (4.8%) cases were diagnosed as marrow elements on cytological material. These patients have been followed for 1-9 yr and have failed to reveal signs or symptoms of clinical recurrence. Three out of 187 (1.6%) cases showed osteomyelitis. Nine out of 187 (4.8%) were unsatisfactory specimens, with biopsy follow-up available in four cases, showing three metastatic tumors and one case of osteomyelitis. FNA of metastatic bone lesions is a major step in pretreatment diagnosis. On satisfactory specimens, the cytological diagnosis viewed in the clinical-radiological context proves to be similar to surgical diagnosis. FNA is an excellent technique with a high accuracy rate in assessing metastatic bone lesions.     

女性腹部脂肪抽吸手术前后焦虑抑郁状态调查

目的探讨女性腹部脂肪抽吸手术前后焦虑、抑郁情绪反应的发生率及变化情况。方法采用焦虑自评量表、抑郁自评量表对行腹部脂肪抽吸女性病人76例及随机抽取正常青年女性104人为调查对象。结果术前焦虑状态、抑郁状态发生率分别为28.96%、23.67%,术后焦虑状态、抑郁状态发生率分别为23.69%、18.40%,分别与对照组比较均存在显著性差异（P〈0.05）,手术前后焦虑自评量表、抑郁自评量表评分比较,术后焦虑量表评分明显低于术前（P〈0.05）,高于对照组（P〈0.05）,而术后抑郁自评量表与术前比较无显著性差异（P〉0.05）。结论女性腹部脂肪抽吸手术前普遍存在焦虑、抑郁情绪障碍,在病人术前和术后应加强心理干预。