床旁超声在股骨颈骨折患者围手术期下肢深静脉血栓筛查中的作用

目的探讨床旁超声在老年股骨颈骨折患者血栓筛查的应用价值。 方法回顾性收集2016年1月至2017年3月南京大学医学院附属鼓楼医院运动医学与成人重建外科收治的股骨颈骨折患者,术前常规用床旁超声行双下肢深静脉检查,观察血管内径、血栓部位、血栓回声以及血流情况。所有术前血栓患者于术后行常规随访观察。 结果共纳入135例患者,男性45例,女性90例;平均年龄（76±8）岁,平均身体质量指数为（22±3）kg/m²。术前共发现血栓45例,其中近端血栓7例,远端血栓38例。根据血栓累及部位,其中累及髂静脉1例,股静脉4例,腘静脉4例,腓静脉5例,胫后静脉3例,肌间静脉血栓40例。13例血栓患者暂停手术并接受治疗,治疗期间彩超隔日观察血栓溶解情况,其中经治疗好转10例,血栓无变化2例,加重1例,2例在术前置入下腔静脉滤器。术后彩超观察中,3例术前血栓患者在术后观察中发现进展至其他静脉,均及时接受抗凝治疗并通过床旁彩超随访,未见有血栓脱落以及肺栓塞形成。 结论床旁超声可用于股骨颈骨折患者血栓的诊断、监测及随访。     

口腔护理临床研究进展

从口腔护理溶液选择、口腔护理溶液使用方法、特殊病种口腔护理方面综述了口腔护理临床研究进展。     

第二代基因杂交捕获法与液基薄层细胞技术在宫颈癌早期筛查中的应用

目的探讨液基薄层细胞检测(thin-layer preparation cytologic test,TCT)、第二代基因杂交捕获法(hybrid capture 2,HC2)、阴道镜病理组织学检查对宫颈癌的预防与早期诊疗的意义。方法选取2013年8月—2016年8月在赣州市人民医院妇科门诊就诊的TCT阳性患者共15 200例,进一步采用HC2-HPV和病理组织学诊断方法检测,并以病理组织学诊断结果为金标准。结果单纯TCT检查与组织病理学的诊断符合率为77.51%(11 782/15 200),单纯HC2-HPV检测HPV阳性与组织病理学的诊断符合率为83.24%(12 652/15 200),而TCT联合HC2-HPV检查与组织病理学的诊断符合率为95.16%(11 212/11 782),差异有统计学意义(P0.01)。结论 TCT、HC2-HPV检测联合阴道镜组织病理学检查可以提高对宫颈癌及癌前病变诊断的准确率,值得临床上进一步推广。     

Lipid-mediated delivery of oligonucleotide to pulmonary endothelium

Pulmonary endothelium plays an important role in the maintenance of normal pulmonary physiology and its dysfunction is involved in a number of pulmonary diseases. Correction of endothelial dysfunction via antisense oligodeoxyonucleotides (ODN) is dependent on the development of a delivery vehicle that can efficiently deliver the ODN to pulmonary endothelium with minimal toxicity. To this end, we have developed a lipidic vector (LPD) that is composed of 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP) liposomes, protamine, and ODN. This formulation is highly efficient in delivering ODN to the lung via the vascular route. The efficiency of delivery is a function of lipid composition and of the charge ratio between lipid and ODN. Immunofluorescence staining of BrdU-labeled ODN suggested efficient accumulation of ODN in the alveolar capillary region. Transmission electron microscopy of immunogold localization of BrdU-labeled ODN confirmed that pulmonary endothelial cells were indeed targeted by the vector. Furthermore, this formulation is associated with minimal proinflammatory cytokine response and other hematologic toxicities when the ODN lack a potent unmethylated CpG motif. Pretreatment of mice with LPD containing an ODN against intercellular adhesion molecule-1 (ICAM-1) significantly decreased ICAM-1 expression in the lung following LPS challenge. These results provide a basis for lipid-mediated delivery of ODN for the treatment of pulmonary diseases.     

复方曲肽注射液用于防治肿瘤患者化疗后周围神经毒性的临床研究

目的 观察复方曲肽注射液用于防治肿瘤患者化疗后周围神经毒性的疗效.方法 收集2015年8月至2016年2月在解放军总医院接受化疗的肿瘤患者的临床资料,筛选出接受具有神经毒性化疗药的患者56例,采用数字表法随机分为2组,治疗组(28例)给予复方曲肽注射液10 ml,1/d,连用3d,对照组(28例)予空白对照.分别在治疗前及2个化疗周期后对2组患者的周围神经毒性按CTCAE评价标准分级评价后进行分析和对比.结果 56例患者均完成随访,治疗前2组间周围神经毒性分级情况无统计学差异(P＞0.05);治疗后2组间周围神经毒性分级情况有统计学差异(P＜0.05);其中治疗前存在周围神经毒性的15例患者,亚组分析显示治疗组总有效率为75.00％,对照组总有效率为0,差异有统计学意义(P＜0.05).结论 复方曲肽注射液预防和治疗化疗药物引起的周围神经毒性有一定的疗效,值得临床扩大样本量进一步研究.     

乳腺癌原发灶成纤维细胞活化蛋白α表达与患者预后相关

目的本研究旨在探讨乳腺癌原发灶成纤维细胞活化蛋白α(FAP-α)表达与临床病理特征以及预后的关系。方法回顾性收集2000-01-01/2002-12-31期间在解放军总医院手术的130例Ⅰ-Ⅲ期乳腺癌患者的临床资料及石蜡切片,免疫组织化学染色检测乳腺癌原发灶FAP-α表达,分析FAP-α表达与转化生长因子β1(TGF-β1)表达强度的关系,并分析FAP-α表达与乳腺癌预后的关联性以及与临床病理特征的相关性。结果 FAP-α表达在肿瘤细胞和间质成纤维细胞的细胞质,FAP-α阳性纤维细胞密度与TGF-β1阳性间质细胞密度正相关。FAP-α肿瘤细胞质强度与TGF-β1阳性肿瘤细胞质表达正相关。在雌激素受体和孕激素受体均阴性患者中,FAP-α阳性纤维细胞密度是无病生存(DFS)和总生存(OS)的独立不良预后因素;FAP-α阳性肿瘤细胞质强度是DFS和OS的独立不良预后因素。结论激素受体阴性乳腺癌患者中,原发灶FAP-α高表达与不良预后相关。乳腺癌原发灶TGF-β1的表达与FAP-α的表达正相关。     

Congenital muscular dystrophies in China

Congenital muscular dystrophies (CMDs) are clinically and genetically heterogeneous conditions. We launched a nationwide study to determine the frequency of CMD in the Chinese population and assess the status of diagnosis and disease management for CMD in China. Cases were chosen from databases in 34 tertiary academic hospitals from 29 first-level administrative divisions (provinces, municipalities, autonomous regions, and special administrative regions), and medical records were reviewed to confirm the diagnoses. The study included 409 patients, of those patients who consented to genetic testing (n = 340), mutations were identified in 286 of them. The most common forms identified were LAMA2-related CMD (36.4%), followed by COL6-related CMD (23.2%) and α-dystroglycanopathy (21.0%). The forms of CMD related to mutations in LMNA and SEPN1 were less frequent (12.5% and 2.4%, respectively). We also recorded a significant difference in the diagnostic capabilities and disease management of CMD, with this being relatively backward in research centers from less developed regions. We provide, for the first time, comprehensive epidemiologic information of CMD in a large cohort of Chinese people. To our knowledge, this is the largest sample size of its kind so far highlighting the prevalence of CMD in China.     

原发性肝癌患者癌症相关性乏力症状临床研究

目的探讨原发性肝癌患者癌症相关性乏力症状与临床病理特征的关系。方法回顾性分析421例Ⅱ-Ⅳ期原发性肝癌患者的临床资料,并依据Chalder乏力评价量表判断乏力程度,分析乏力程度与临床病理参数的相关性。结果 421例Ⅱ-Ⅳ期原发性肝癌患者中有340例发生不同程度乏力,发生率为80.76%。乏力发生情况与年龄、Child-Pugh分级、病程、白细胞计数、血红蛋白量有关(P<0.05),但与性别、肿瘤分期、近期治疗方式无关(P>0.05)。结论原发性肝癌患者癌症相关性乏力症状与年龄、肝功能、病程、白细胞计数、血红蛋白含量有关。