血卟啉单甲醚声动力疗法对兔耳增生性瘢痕的疗效

目的观察血卟啉单甲醚声动力疗法对兔耳增生性瘢痕（hyperplastic scar,HS）的疗效。方法成年大耳白兔60只,随机分成5组。在声动力治疗第2、4、6、8周分别切取两组瘢痕组织,进行指标检测。结果治疗组可降低成纤维细胞密度、瘢痕增生指数,与模型对照组比较差异有统计学意义（P〈O．05）,可降低胶原纤维的面密度,从上皮化后第4周开始与模型组比较差异有统计学意义（P〈O．01）。结论声动力效应能够显著降低兔耳HS,可望为HS治疗提供新的手段。     

肝癌微环境中影响转移相关通路的基因富集分析

目的 探讨肝癌微环境对肝癌发生门静脉转移起重要作用的基因簇或通路,为肝癌的治疗和研究提供理论依据.方法 利用基因组富集（GSEA）的方法,对美国国家生物技术信息中心（NCBI）的综合性的基因表达与杂交排序数据库（GEO数据库）中的11例肝癌无门静脉癌栓（PVTT）和9例肝癌合并PVTT的癌旁相对正常组织基因表达谱芯片进行分析,分析其在肿瘤相关通路中的富集特征与核心富集基因.结果 找到15条相关的信号通路,这些通路与癌旁微环境中的免疫功能状态有关,对于肝癌发生PVTT转移可能起重要作用.结论 肝癌发生门静脉转移除了与肿瘤细胞本身的恶性增殖和侵袭有关以外,还与周围微环境中的免疫状态和炎症反应有重要联系.     

预前护理计划之“让我说说”对养老院老人死亡及维持治疗态度的影响

目的探究预前护理计划之＂让我说说＂对养老院老人死亡及维持治疗态度的干预效果。方法便利抽取武汉市16所养老院259名老人,根据楼层将其分成干预组和对照组。干预组实施预前护理计划之＂让我说说＂,对照组不实施干预,比较干预后两组老人对待死亡及生命维持治疗态度的差异。结果干预前,两组老人对待死亡及维持生命治疗态度差异无统计学意义（均P〉0.05）。干预后,在对待死亡问题上,干预组（34.0%）比对照组（8.6%）更多地表现出恐惧,同时干预组（18.0%）比对照组（24.1%）较少表现出求死心态（P〈0.05）。在对待维持生命治疗上,干预组（49.0%）比对照组（29.3%）更愿意接受维持生命治疗（P〈0.05）。结论预前护理计划之＂让我说说＂可以给老人提供情感和行为支持,促使老人表达内心对死亡的真实想法,接受维持生命治疗。     

严重脓毒症患者外周血单个核细胞Toll样受体2、4和髓样分化因子88在胸腺肽α1治疗过程中的基因表达变化

目的 观察严重脓毒症患者外周血单个核细胞Toll样受体（TLR）2、4基因及其信号传导通路上的髓样分化因子88（MyD88）基因表达水平在胸腺肽α1治疗过程中的变化。方法 54例严重脓毒症患者被随机分为对照组（常规治疗,28例）和治疗组（胸腺肽α1治疗,26例）,采用实时荧光定量PCR监测两组患者入院时及治疗后第3、7天外周血单个核细胞TLR2、TLR4和MyD88基因表达水平变化,并观察两组的28 d病死率。结果 治疗组的28 d病死率虽低于对照组,但差异无统计学意义（23.1%vs 35.7%,P=0.310）。治疗组的患者单核细胞TLR2、TLR4和MyD88基因表达水平逐渐上升,而对照组未见该规律,与对照组相比,治疗后第3天时治疗组的TLR2（2.31±0.79 vs 1.83±0.51）、TLR4基因表达增高（7.31±0.79 vs 6.55±0.92）;第7天时治疗组TLR2（2.75±1.17 vs 1.63±0.36）、TLR4（7.75±1.03 vs 6.39±0.72）和MyD88（4.26±0.77 vs 3.77±0.68）水平明显增高,均P〈0.05。结论 胸腺肽α1在治疗严重脓毒症患者过程中可以上调患者单核细胞的TLR2、4和MyD88基因的表达水平。     

Medial sustainable nail versus proximal femoral nail antirotation in treating AO/OTA 31-A2.3 fractures: Finite element analysis and biomechanical evaluation

Objectives

Using finite element analysis and biomechanical tests, the biomechanical behaviors of Medial Sustainable Nail (MSN) and Proximal Femoral Nail Antirotation (PFNA) were compared for the fixation of fracture type of AO/OTA 31-A2.3.

社区护理人员灾害准备的研究进展

对国内外社区护理人员灾害准备模式、存在的问题、影响因素、培训现状及测量工具进行综述。提出应建立完善的社区护理人员灾害准备培训体系,建立适合我国国情的社区护理人员灾害应对准备模式并建立社区护理人员灾害准备测量工具的区域性常模,旨在为今后提高社区护理人员的灾害准备度提供参考依据。     

经肛肠减压后3D腹腔镜根治术治疗梗阻性结肠癌的临床观察

目的探讨经肛肠减压后3D腹腔镜根治术治疗梗阻性结肠癌的临床疗效。 方法回顾性分析2015年6月至2018年6月收治的54例梗阻性结肠癌患者的临床资料,所有患者术前均经肛肠减压,根据手术方式分为3D组(25例)和开腹组(29例),所有数据均应用SPSS22.0软件进行统计学分析,围术期相关指标等计量资料以( ±s)表示,采用独立样本t检验;术后并发症发生率组间比较采用χ²检验,P<0.05为差异有统计学意义。 结果两组患者术前减压管放置时间、手术时间和淋巴结清扫数目比较,差异均无统计学意义(P>0.05);3D组术中出血量、首次通气时间以及平均住院时间均明显少于开腹组,但平均住院费用高于开腹组;两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。 结论经肛肠减压后实施3D腹腔镜根治术治疗梗阻性结肠癌是安全、有效的,术中出血量少、术后恢复快,值得在临床广泛推广应用。     

Comparison of clinical effects of bare stent and covered metal stent graft in the treatment of complete occlusion of central venography in hemodialysis patients

Objective To evaluate the efficacy of bare mental stent (BMS) and covered stent (CS) in the treatment of complete central venous occlusive disease (CVOD) in hemodialysis patients. Methods A total of 66 cases of CVOD who have been treated by endovascular methods successfully in the First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Jan 2017 were enrolled in this study. According to the type of stent，the patients were divided into two groups, BMS group (n=46) and CS group (n=20). The demographic data, clinical signs and symptoms, and pre-procedure and post-procedure imaging data were followed up and recorded. The primary patency rates were calculated at 1, 3, 6, 9, and 12 months. Results The related symptoms were improved within 2 day post-procedure. The primary patency rates of BMS group in 1, 3, 6, 9 and 12 months were 97.83%, 95.65%, 69.56%, 41.3%, and 34.78% respectively. The rates of CS group were 100%, 100%, 95%, 65%, and 60% respectively. They did not reached statistical significance for primary patency rates between two groups in 1, 3, and 6 months (P＞0.05 respectively). However, from 9 months after procedure, it began to show the significant difference between two groups (P＜0.05). The median patency time of the CS group was (10.30±5.32) months, while BMS group was (8.52±0.49) months. The difference between the two groups was statistically significant (P=0.046). Conclusions Stent implantation for complete occlusion of central venous in hemodialysis patients can get credible effect. The use of CS for CVOD provides superior patency as well as patency time in long period after procedure as compared with BMS.     

Value of serum IgG combined with IgE in predicting steroid therapy response in children with primary nephrotic syndrome

Objective To observe the value of serum IgG combined with IgE in the diagnosis of steroid-sensitive nephrotic syndrome (SSNS) children. Methods Children with primary nephrotic syndrome diagnosed in Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to March 2019 were enrolled. According to the 4 weeks steroid therapy, the patients were divided into steroid sensitive group and steroid resistance group. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of serum IgG combined with IgE for SSNS. Results There were no significant differences in age, gender, course of the disease, hemoglobin, platelet, urea nitrogen, creatinine, albumin, globulin, 24 h urine protein, IgA level, IgM level and hematuria between steroid sensitive group and steroid resistance group (all P＞0.05). There were significant differences in C3, IgG and IgE levels (all P＜0.05). ROC curve analysis showed that the cut-off values of IgG and IgE in the diagnosis of SSNS were 2.57 g/L (AUC=0.717, 95%CI 0.623-0.812, P＜0.001) and 174.3 IU/ml (AUC=0.828, 95%CI 0.751-0.905, P＜0.001). The area under the ROC curve for IgG＜2.57 g/L in combination with IgE＞174.3 IU/ml in the diagnosis of SSNS was 0.904 (95%CI 0.834-0.953, P＜0.001). Logistic regression showed that children who met both IgG＜2.57 g/L and IgE＞174.3 IU/ml were 51.00 times more likely to have SSNS than those who did not (P＜0.001). Conclusion IgG combined with IgE can be used as a simple and practical clinical marker for predicting SSNS.     

经方中芍药配伍应用规律探析

考察《伤寒杂病论》经方中配伍应用芍药的61首经方（56首原方，5首加减方）及126条相关条文。通过对经方剂量、比例、配伍、病位主症的分析，认为：经方中芍药为白芍；白芍并非补血药，其益阴补血的功效是通过配伍实现；经方中"分"为计量单位；芍药在丸散汤中的常见用量；经方中芍药主治的症状包括四肢挛急、腹痛、烦满、下利、小便不利等。与不同药物配伍，作用部位与症状随之变化，常见配伍有桂枝、附子、甘草、柴胡、黄芩、枳实、当归、茯苓等。