白血病患者造血干细胞移植前单次全身照射的预后分析

Objective To analyze the prognostic factors of patients with leukemia treated with single fraction total body irradiation (SFTBI) followed by hernatopoietic stem cell transplantation (HSCT).Methods From January 2001 to September 2008, 102 patients received HSCT. The differences of the survival rate, relapse rate and incidence of interstitial pneumonia (IP) between groups regarding different genders, ages, pathological types, transplantation methods and TBI parameters were compared and the factors related with the survival rate, relapse rate and incidence of IP were analyzed. Results The followup time ranged from 15 to 1482 days (median, 406 days). The follow-up rate was 95.1%. 86 and 55patients were followed up more than one year and three years. The 1-and 3-year survival rates were 59.0%and 44.0%. In univariate analysis, the 3-year survival rate was signifcantly different between the groups with and without relapse before transplantation (20% vs. 55%, χ2 = 6.33, P = 0. 012), allogeneictranplantation versus autologous tranplantation (39% vs. 68%, χ2 = 8.06, P = 0.005), grade 3 or more acute graft versus host disease (aGVHD) and grade 0 -2 aGVHD (0% vs. 54%, χ2 = 7.52, P = 0.006),with and without relapse after transplantation (19% vs. 58%, χ2 = 10.13, P =0.001), with and without IP (23% vs. 58%, χ2 =8.35, P=0.004). Multivariate analysis showed that grade 3 or more aGVHD was the only statistically significant prognostic factors (χ2 = 12. 74 ,P =0. 000). The l-and 3-year relapse rateswere 30. 0% and 50. 0%. The incidence of relapse was obviously higher in the group with relapse before transplantation than that without (47% vs. 16%, χ2 =7. 32, P=0. 007). Multivariate analysis showed thatrelapse before transplantation was a significant factor predicting relapse after transplantation (χ2 = 9. 39,P =0. 020). The cumulative incidence of IP was 35.0%. The incidence of IP was different between groups with dose homogeneity > 3% and ≤ 3% (27% vs. 4%, χ2 = 5. 21, P = 0. 023), with and without acute parotitis (34% vs. 3%, χ2 = 14. 15, P= 0.000), allogeneic transplantation group and autologous transplantation group (31% vs. 8%, χ2= 7.70, P= 0.006). Multivariate analysis showed that transplantation methods, acute parotitis and dose homogeneity were statistically significant factors in predictingIP (χ2 = 10. 08 , 10. 08 and 7.69 , P = 0. 002 , 0. 002 and 0. 010 , respectively) . Conclusions Patients who develop grade 3 or higher aGVHD have poor prognosis. Dose homogeneity influences the incidence of IP. Patients undergoing allogeneic transplantation are apt to have IP. Acute parotitis is related with IP and might be a predictor.     

罗布麻叶HPLC指纹图谱构建及在种属鉴别中的应用

目的 建立罗布麻叶的HPLC指纹图谱,用以控制罗布麻叶的内在质量,并对罗布麻叶药材与其混淆品进行鉴别.方法 采用HPLC梯度洗脱的方法建立指纹图谱,"计算机辅助相似度评价系统"软件进行数据处理,据此对不同种属的药材进行比较.结果 建立的罗布麻HPLC指纹图谱方法的精密度、稳定性和重现性较好.罗布麻叶(红麻叶)HPLC指纹图谱共标定12个共有指纹峰,与白麻属样品图谱之间呈显著差异,可以依此鉴别.结论 HPLC指纹图谱可以用作罗布麻叶药材的质量控制.     

小兒急性喉阻塞51例的观察

附屬二院耳鼻咽喉科自1958年10月至1959年2月共收住51例小兒喉阻塞患者,在全科医师、护士及在該科学习的60医3、9班同学細心医护下,仅对14例作了气管切开术(占27%)。今总結这項经验,供更进一步掌握对小兒喉阻塞患者的处理时作参考。     

皮肤外用药局部不良反应评价专家共识

皮肤外用药的局部不良反应并不少见,正确评价其不良反应对于合理使用皮肤外用药非常重要。本文报道了皮肤外用药局部不良反应评价专家共识,希望为临床合理用药提供帮助和指导。     

妇科腹腔镜术中神经损伤护理研究新进展

腹腔镜手术在妇科领域的应用越来越广泛,已成为治疗妇科疾病的一种安全有效的手术方法。由于术中手术野的显露不直观,常需要安置头低足高体位,随之也会产生一些与手术体位有关的并发症,神经损伤是主要合并症之一,美国医疗机构1980年调查显示,固定体位引起的神经损伤占手术室安全隐患的第4位,对于患者来说是一种心理和疾病的双重煎熬,     

乳腺癌ASAH1、Bcl-2蛋白表达及其临床意义的研究

目的探讨酸性神经酰胺酶(N-acylsphingosineamidohydrolase 1,ASAH1)蛋白在乳腺癌中的表达及临床。方法应用免疫组织化学法分别检测73例乳腺癌、25例正常对照组标本(来自乳腺癌患者乳房全切除后所切取的正常乳腺组织)ASAH1及Bcl-2蛋白的表达及与临床病理特征和预后的关系。结果 ASAH1在乳腺癌中表达阳性率为72.6%,Bcl-2在乳腺癌中阳性率为65.8%。与正常乳腺组织表达比较,差异有统计学意义(P<0.05)。二者具有相关性。结论 ASAH1、Bcl-2蛋白在乳腺癌组织中表达增强,ASAH1及Bcl-2蛋白蛋白表达增强预示生存率低。     

CBL结合BOPPPS教学模型对高职护生临床思维能力影响的研究

目的 探讨CBL结合BOPPPS教学模型对高职护生临床思维能力的影响。方法 选择2017级护理专业4个班的学生作为研究对象,实验组采用CBL结合BOPPPS教学模型的教学法,对照组采用传统教学法,比较两组的考核成绩及临床思维能力评估量表得分。结果 实验组考核成绩、临床思维能力评估量表得分均高于对照组（P<0.05）。结论 应用CBL结合BOPPPS教学模型有助于提高护生学习效果及其临床思维能力。     

血细胞分析仪自动计数外周血有核红细胞的临床应用

为探讨血细胞分析仪自动计数外周血有核红细胞(NRBC)的方法学特点,评价其临床应用价值,选择150例血液及非血液病患者,用Beckman LH750全自动血细胞分析仪及显微镜计数法计数其外周血中NRBC数量。结果,BeckmanLH750与显微镜计数法计数外周血中NRBC数量有极好的相关性(r>0.97),二者计数结果差异无显著意义(P=0.2016),高值、中值和低值NRBC标本绝对计数的批内CV平均<6.0%。在(0~15)×109/L范围内计数NRBC有极好的线性。Beckman LH750自动计数外周血中NRBC的灵敏度和阴性预测值均为100%。外周血中NRBC增高时,WBC显著高于去除NRBC的计数结果。表明LH750血细胞分析仪可灵敏、准确、精密地自动计数外周血中NRBC,并且可在NRBC增高的标本中准确计数白细胞数量。血细胞分析仪自动计数外周血中NRBC,有助于一些血液病及非血液病患者的筛查与诊断。     

我国卫生医疗资源供给水平的影响及路径提升分析

目的：构建我国医疗卫生资源供给评价体系,对各省份医疗供给水平进行测度和比较分析,探究地区间医疗资源水平的作用路径,以期为更好促进基本公共卫生服务均等化发展提供参考。方法：利用熵值法对我国区域层面医疗资源供给体系进行评价,运用模糊集定性比较分析方法分析影响我国卫生医疗资源配置的具体路径。结果：形成卫生医疗资源配置高水平组态有3种解,总体一致性为0.880,总体覆盖度为0.707;低水平组态有3种解,总体一致性为0.806,总体覆盖度为0.802。结论：影响我国卫生资源配置水平存在多种复杂因素,有多条路径可以提升我国卫生医疗资源供给水平,且地区间医疗资源供给水平实现路径存在较大差别。     

老年人血糖标准应放宽吗

上世纪90年代,通过几个大型对照研究证明,糖尿病患者严格控制血糖,可以减少慢性微血管并发症(如视网膜、肾脏病变等)的发生。自此之后,糖尿病患者的治疗策略有了突破,全世界都推行严格控制血糖的治疗目标。理想的血糖控制目标应该是正常的血糖值。通常,糖尿病患者至少应每月检查1次血糖,包括空腹和餐后血糖,有条件的还可以检查午餐和晚餐后血糖,糖化血红蛋白每3个月检查1次。