白膜下睾丸实质剜除术与药物去势治疗Ⅳ期前列腺癌疗效回顾性研究

目的 回顾性分析白膜下睾丸实质剜除术与药物去势治疗Ⅳ期前列腺癌的疗效及副作用的差异.方法 2005年01月～2011年10月采用白膜下睾丸实质剜除术(n=70)和诺雷德联合康士得(n=62)治疗Ⅳ期前列腺癌并进行随访,分析其肿瘤缓解时间、总生存时间、手术并发症及对患者心理的影响.结果 随访时间1～59个月,手术组和药物组肿瘤缓解时间分别为18个月和17个月,两组差异无显著性(x2=0.166,P=0.682),总生存时间分别为33个月和31个月,两组差异无显著性(x2=0.080,P=0.778).手术组发生术后并发症的比率为10％,没有出现因睾丸切除导致的心理疾病.结论 白膜下睾丸实质剜除术作为Ⅳ期前列腺癌白膜下睾丸实质剜除方法,具有疗效确切、对心理影响少及成本低的特点,可作为Ⅳ期激素依赖型前列腺癌去势治疗的首选方法.     

Mechanism of regulation of CaCC by the Mas-related G protein-coupled receptor D

MrgD is expressed almost exclusively in dorsal root ganglion(DRG) neurons.And its activation inhibited KCNQ/M-currents that contributes to an increase in excitability of DRG neurons and thus may enhance the signaling of primary afferent nociceptive neurons.Ca2+-activated chloride channels(CaCCs) are found in DRG neurons and regulate neuronal cell excitability as well.But the interaction between CaCCS and MrgD is still unknown.We here found that β-alanine-induced activation of MrgD resulted in eliciting Ca2+-activated chloride currents.The currents were inhibited by flufenamic acid(FFA) and by inhibition of phospholipase C and Ca2+ chelating agent EGTA.However,calphostin C,a PKC inhibitor,had no effect on the currents.These present data show that the inward currents induced by activation of MrgD were mediated through Gq-phospholipase C-IP3-Ca2+ release pathway,but not via Gi pathway.     

Total Energy Expenditure of 16 Chinese Young Men Measured by the Doubly Labeled Water Method

Objective Doubly labeled water (DLW) method is the gold standard for measuring total energy expenditure (TEE). We used this method to measure TEE in Chinese young men. Methods Sixteen healthy young men age 23±1 years with body mass index 22.0±1.4 kg/m 2 were recruited. TEE was measured by the DLW method, and basal energy expenditure (BEE) was determined by indirect calorimetry. We also conducted 24-h activity, energy balance and factorial approach to estimate energy requirements of the subjects. Results TEE of subjects by DLW method was 9.45±0.57 MJ/day (2258±180 kcal/day). The 24-h activity was 10.80±0.33 MJ/day (2582±136 kcal/day). The energy requirement, derived from energy balance observations, was 9.93±1.32 MJ/day (2373±315 kcal/day). The BEE of 6.65±0.28 MJ/day (1589±67 kcal/day), calculated by the adjusted Schofield equation, was significantly higher (P<0.001) than that measured by indirect calorimetry, 5.99±0.66 MJ/day (1433±158 kcal/day). The TEE derived from the factorial approach was 10.31±0.43 MJ/day (2463±104 kcal/day). Conclusion The TEE of Chinese young men measured by the DLW method was about 10% lower than the current recommended nutrient intake (RNI), suggesting that the RNI for Chinese men maybe overestimated. Further studies are warranted to determine the value of the estimated energy requirement.     

广州地区肺炎克雷伯菌携带CTX-M-14质粒同源性分析

目的研究广州肺炎克雷伯菌(Klebsiella pneumonia,Kp)CTX-M-14型超广谱β-内酰胺酶(ESBLs)的质粒同源性特征。方法收集2007～2008年广州地区9家医院临床分离的产ESBLs肺炎克雷伯菌,PCR检测ESBLs分子表型;用肠杆菌科基因间重复序列PCR(Enterobacteriaceae repetive intergenic consensus-PCR,ERIC-PCR)分析产CTX-M-14型ESBLs菌株的分子同源性;取产CTX-M-14型ESBLs的Kp的所有非克隆株,通过结合试验、质粒图谱、PCR分析blaCTX-M-14基因环境。结果产ESBLsKp共181株,69.1%(125/181)的产ESBLs株为CTX-M表型;其中产CTX-M-14型ESBLs株的检出率为28.2%(51/181),经ERIC-PCR分析,共分为33个基因型;基因环境显示,75.7%(25/33)blaCTX-M-14位于90 kb的可接合质粒上,其他耐药基因blaSHV、blaDHA-1、blaOXA-1、qnr、aac(6’)-Ib-cr等均未检到;有28株菌的blaCTX-M-14位于ISEcp1-like插入序列下游,ISEcp1-like末端与blaCTX-M-14间距均为42 bp,有2株菌ISEcp1末端与blaCTX-M-14起始区间距也为42 bp;但在ISECP1中间有一个S10插入序列。结论广州地区ESBLs主要分子表型为CTX-M型,主要流行为CTX-M-14型,携blaCTX-M-14质粒的传播,可能是本地区CTX-M型ESBLs高发生率的主要原因。     

新生儿呼吸机相关性肺炎的临床分析

目的探讨新生儿呼吸机相关性肺炎(VAP)的发病率、高危因素、病原学特点、药敏情况及预防措施。 方法回顾性分析2009年1月至2013年1月本院新生儿重症监护室(NICU)中采用机械通气(MV)治疗的84例危重新生儿的临床病历资料。按照本组新生儿是否合并VAP,将其分为VAP组(n＝34)与非VAP组(n＝50) (本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书)。两组新生儿的分娩方式、接受MV治疗时日龄(10 min～25 d)等比较,差异无统计学意义(P>0.05)。 结果本组MV患儿的VAP发生率为40.5%(34/84)。VAP发生与早产、低出生体重、MV持续治疗时间、气管插管次数、原发性肺部疾患、是否早期使用静脉注射用人免疫球蛋白(IVIG)及是否早期使用肺表面活性物质等密切相关(r＝0.412,r＝0.331,r＝0.115,r＝0.561,r＝0.398,r＝0.412,r＝0.158;P<0.05);与患儿性别无相关性(r＝1.235,P>0.05)。本组导致VAP的病原菌以革兰阴性杆菌为主,占79.4%,其中以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌及鲍曼不动杆菌最多见,且多为耐药菌。 结论新生儿采用MV持续治疗导致的VAP发病率较高。VAP与MV持续治疗时间,患儿出生体重、胎龄、原发性肺部疾患、气管插管次数、是否早期使用IVIG及是否早期使用肺表面活性物质等多种因素有关。对VAP应采用综合预防措施。根据药敏试验结果合理选择抗菌药物,可提高治疗VAP的成功率。     

真空小梁成形术治疗原发性开角型青光眼患者的护理

总结真空小梁成形术(pneumatic trabeculoplasty,PNT)治疗原发性开角型青光眼患者的护理要点.治疗前充分的解释PNT治疗原理,减少青光眼患者的心理负担,注意避免在治疗环上施加过大的向下的压力,以眼表与治疗环接触无缝隙为度,告知患者治疗前20 s内会出现一过性黑矇,30 s后即可恢复,不必紧张,注重测量眼压来评价治疗效果,做好患者的出院回访工作及建立长期观察数据库,保证了治疗效果.治疗后第1、第7、第14、第30、第45、第60、第90、第120天患者眼压(13.0~25.0 mmHg,1 mmHg=0.133 kPa)与治疗前相比明显降低,术后90 d后部分患者眼压有升高趋势,其中3例4眼进行了第2次PNT治疗.本组患者PNT治疗前后的视力无变化,4个月后复查,视网膜神经纤维厚度和术前相比,无明显改变.     

医院感染相关知识培训的做法与体会

目的 提高医院工作人员的医院感染防控意识和知识水平,提升医院感染管理质量.方法 采用现场授课与课外网络系统自学相结合的方式,在全院范围开展医务人员医院感染相关知识培训.结果 5次系列培训共培训1 077人次,普及医院感染知识,提高医院感染意识,培养一批骨干力量.结论 医院感染是全员参与的工作,医务工作者的医院感染防控意识和认知需要不断提高和更新,多种形式的系统培训是切实提高医务工作和医院感染相关知识水平的有效手段.     

健康新生儿的失匹配负波研究

【目的】 研究健康新生儿失匹配负波的各指标及分布规律,为指导临床诊断治疗提供客观证据。 【方法】 使用听觉oddball范式对随机选择的56名产后2～3 d内健康新生儿进行声刺激,标准刺激和偏离刺激分别为1 000 Hz和2 000 Hz的纯音,二者概率比为4∶1。 【结果】 56 名足月新生儿有35名出现失匹配负波,主要分布在额区,潜伏期在F3、F4、Fz点分别为(234±50)、(248±51)、(239±45) ms。左右半球(150～450) ms时间窗平均振幅未见显著性差异。 【结论】 健康新生儿可诱发出失匹配负波。     

携带hIFN-γ的内皮祖细胞增强肿瘤化疗后维持治疗的效果

目的：观察携带hIFN-γ基因的内皮祖细胞（endothelial progenetor cells carrying hIFN-γ, EPC-hIFN-γ）在肿瘤化疗后维持治疗的效果。方法：LoVo大肠癌细胞加入喜树碱-11（camptothecin-11, CPT-11）,再分别加入 hIFN-γ或（和）西妥苷单抗（cetuximab, C225),MTT法观察其对LoVo细胞的抑制作用。荷Lovo大肠癌细胞移植瘤裸鼠在给药CPT-11后,再给予EPCs-hIFN-γ或（和）C225,观察对肿瘤的抑制作用和对裸鼠生存期的影响。结果：在体外,肿瘤细胞中加入CPT-11后再加入hIFN-γ或（和）C225可进一步抑制肿瘤细胞的生长。荷瘤裸鼠在给予CPT-11 50 mg/kg后,分别给予EPCs-hIFN-γ、C225或者EPCs-hIFN-γ + C225,均可以进一步抑制肿瘤的生长\[肿瘤平均体积(2 024.28±1 048.40) mm3 vs (764.94±720.14) mm3、(233.85±186.97) mm3、(186.95±133.43) mm3、(163.9±173.39) mm3,P＜005),均可进一步延长荷瘤裸鼠的生存期（中位生存期34.2 d vs 39.4 d、44.5 d、48.5 d、51.3 d,P<0.05或P＜001）;其中以CPT-11+EPCs-hIFN-γ+C225的治疗效果最好。结论：EPCs-hIFN-γ用于化疗后维持治疗可以抑制肿瘤细胞生长,延长荷瘤小鼠的生存。     

中国汉族正常成人视束的高分辨率MRI测量

Objective To explore the morphological characteristics of optic tracts in healthy Chinese Han adults on the high-resolution MRI and fill the database of Chinese standard brain with morphological data of optic tracts.Methods Cerebral MRI scans with T1 WI 3D MPRAGE sequence of 1000 healthy Chinese volunteers from 15 hospitals were divided into five stages, ranging in age from 18 to 70.With the technique of multi-baseline, structure and morphology of optic tracts were displayed optimally on the images with multiplanar reconstruction.Data were measured as following: transverse distance of the cisternal optic tract (TD1) and peri-crural optic tract (TD2), length from the cisternal optic tract to the peri-crural optic tract (L) ,angle between optic tract(AOT) and height of optic tract from its first segment to plane of anterior commissure (H) including H1, H2, H3, H4 and HS.The measurements of optic tracts between sexualities and among age groups were compared by anasis of covariance; those among five age groups were compared pairwisedly by least significant difference analysis (LSD); and the differences of measurements between left and right optic tracts were analyzed using paired t test.Results (1) Comparisons of optic tract structures between male and female: the mean optic tract length of male [(11.69±1.45),(11.56±1.44) mm] was significant longer than that of female [(10.58±1.29),(10.40±1.34) mm] (F=22.236, 29.703, P=0.000); the mean H1 of male [(2.56±0.28),(2.60±0.29) mm] and female [(2.57±0.31 ), (2.63±0.32) mm] were significantly different ( F =11.130,7.805, P = 0.000, 0.005).No significant differences of the other measurements were found between male and female ( P > 0.05 ).(2) Comparisons among age groups: among 5 age groups, TD1 of both sides [left TD1 :(4.64±0.51 ), (4.64±0.57), (4.55±0.58), (4.39±0.53), (4.36±0.58)mm;right TD1 :(4.84±0.53) ,(4.80±0.60), (4.77±0.65), (4.60±0.59), (4.57±0.59) mm] and the right TD2[(3.33±0.45),(3.34±0.41),(3.33±0.36),(3.23±0.38),(3.23±0.39) mm] had statistical differences ( F = 3.458, 2.735, 4.711, P = 0.008,0.028, 0.001 ).The LSD analysis found that the 50 years old group was the watershed with significant differences ( P < 0.05 ).The results also showed that the L of both sides had statistical differences among 5 age groups ( F = 14.510,14.532, P = 0.000).The LSD analysis found that the 60 years old group was the watershed with significant differences (P <0.05).Left TD2 and the H1-H5 of both sides had no significant differences among age groups ( P >0.05).(3) Comparisons of the measurements between left and right optic tracts: TD1 of bilateral optic tracts were (4.52±0.57)and(4.72±0.60) mm respectively; H1 of bilateral optic tracts were (2.56±0.30)and (2.61±0.30) mm respectively; H2 of bilateral optic tracts were (2.66±0.30)and (2.70±0.30) mm respectively; and L of bilateral optic tracts were ( 11.14±1.47 ) and ( 10.98±1.50 )mm respectively.There were significant differences in these measurements between left and right optic tracts( t =12.460, - 6.013,5.595,4.784, P = 0.000 ), while there were no significant differences in TD2, H3, H4 and H5( P > 0.05 ).Conclusions With high-resolution MR1 and 3D reconstruction, optic tract can be displayed clearly and measured accurately.There are definite differences in anterior segments of optic tracts between sexualities, sides and among ages in normal Chinese Han adults, while the posterior segments of optic tracts keep stable.Normal reference values of optic tracts in Chinese Han adults are provided to clinical practices and scientific researches, which are valuable for building of Chinese standard brain.