肾移植术后他克莫司所致不良反应的危险因素研究

摘 要 目的：了解肾移植术后他克莫司所致不良反应的发生情况,分析与其发生相关的危险因素。方法: 以1997~2013年在广州军区武汉总医院进行肾移植术并在术后服用他克莫司的280例患者为研究对象,对他克莫司相关的不良反应及其危险因素进行统计分析。结果: 280位入选的肾移植患者中,不良反应发生率为39.65%,主要的不良反应事件为血液毒性、高血糖及高血脂。单因素统计结果发现年龄、体质量、体质指数（BMI）及用药疗程为他克莫司相关不良反应的可疑危险因素,多因素统计分析发现年龄、BMI及用药疗程是他克莫司发生不良反应的危险因素。结论:肾移植术后他克莫司所致不良反应发生率较高,当患者为高龄、营养状态差及长时间用药的情况可一定程度上增加不良反应的发生率。     

清热解毒汤治疗成人肺炎的疗效观察——108例中西药对比分析

本文总结了我院自1979～1983年收治的108例肺炎,经随机抽样分为自拟的清热解毒汤中药组(55例)和西药治疗组(53例)对照观察。结果表明在退热时间、临床症状消失、肺部炎症吸收速度等方面,中药组明显优于西药组。平均治愈天数,中药组为9.15±3.18天,西药组为16.37±8.5天,说明清热解毒汤治疗成人肺炎有较好的疗效。     

中国15省份中老年人营养素相关膳食模式与轻度认知功能障碍的关联性分析

目的探索中老年人营养素相关膳食模式与轻度认知功能障碍(MCI)的关系。方法选取2018年"中国健康与营养调查"中6 444名≥55岁中老年人为研究对象, 利用简明精神状态检查量表判定是否患有MCI, 采用连续3天24小时膳食调查和称重法获取各类食物摄入量, 结合食物成分表计算各类营养素和膳食总能量的摄入量。通过问卷调查和体格测量获得调查对象的社会人口学、生活方式和健康状况等信息。本研究选取维生素C、维生素E、锌、铁、铜和硒作为因变量, 采用降秩回归法提取营养素相关膳食模式, 并利用多因素logistic回归模型分析该膳食模式与MCI的关系。结果本研究提取了6种膳食模式, 选取解释度最高的膳食模式1纳入后续分析, 该膳食模式以较多的豆制品、蔬菜、水果、坚果、猪肉、水产类和植物油摄入为特征。多因素logistic回归分析结果显示, 在55～64岁组中, 相对于膳食评分Q1组, Q4组患MCI的风险降低(OR=0.69, 95%CI:0.49～0.98);在每日睡眠8 h组中, 相对于Q1组, 膳食评分Q2、Q3、Q4组患MCI的风险均降低, OR值分别为0.68(95%CI:0.51～0....     

CT引导徒手腔内联合插植自适应后装与传统A点后装治疗宫颈癌剂量比较

目的 探讨CT引导徒手腔内联合插植实现影像引导自适应后装(IGABT)相较于传统A点二维后装(CP)剂量学优势,明确其在宫颈癌治疗中的价值。方法 选取在中山大学肿瘤医院行全量放疗的宫颈癌患者 26例,每例患者行4次后装治疗。治疗时先徒手置入宫腔管及2根插植针,后增加插植针数量并调整方向、深度,分别行CT扫描获得2套图像。勾画高危临床靶区(HRCTV),A点和危及器官(直肠、膀胱及乙状结肠)。在2套图像上分别行CP和IGABT计划设计,并配对t检验、Wilcoxon检验两者剂量参数差异。结果 以CP计划的覆盖指数(CI)进行分组,A组(CI≥0.90)包含20个CP和对应IGABT计划,B组(CI<0.90)包含84个CP和对应IGABT计划。A组的HRCTV体积及肿瘤直径明显小于B组(46.7cm³∶62.1cm³,P<0.001及3.1cm∶4.4cm,P<0.0001)。IGABT显著提高所有及B组D90%及覆盖指数,降低膀胱剂量,减少A组乙状结肠剂量,并改善剂量适形度及均匀性。结论 IGABT能提高靶区覆盖、剂量适形度和均匀性,保护危及器官,且对肿瘤较大的患者仍有优势。     

转移肌皮瓣修复食管癌切除术后早期胸胃气管瘘患者的护理

目的探讨食管癌根治术后早期发生胸胃气管瘘患者的护理方法及要点。方法回顾性分析3例食管癌术后发生胸胃气管瘘后行转移肌皮瓣修复术患者的护理过程。护理要点包括术后密切观察病情变化,尽早发现临床症状,积极配合急诊手术;加强皮瓣观察,注意引流管道及胸腔逆行冲洗护理,做好呼吸道管理及肠内营养支持,预防感染促进肌皮瓣成活,促进瘘口愈合;做好基础护理及心理护理。结果 3例患者经积极治疗护理均康复出院,随访3个月患者进食、呼吸正常。结论胸胃气管瘘是食管癌术后严重的并发症之一,急诊下行转移肌皮瓣修复术,术后加强专科护理,做好基础护理及心理护理可以降低患者病死率。     

巴马神酒调节免疫及抗脂质过氧化药理作用研究

摘 要 目的： 观察巴马神酒对小鼠免疫功能、肝脏脂质过氧化损伤及游泳耐力的药理作用。方法: 采用碳粒廓清实验法及环磷酰胺致小鼠免疫低下模型评价巴马神酒对免疫功能的作用;建立四氯化碳致小鼠急性肝损伤模型,以血清中丙氨酸氨基转移酶（ALT）、天门冬氨酸转移酶（AST）、超氧化物歧化酶（SOD）以及丙二醛（MDA）的水平,评价巴马神酒抗肝脏脂质过氧化损伤作用;以小鼠负重游泳的持续时间,评价巴马神酒提高游泳耐力的功能。结果: 巴马神酒能提高小鼠吞噬指数K及吞噬系数α（与空白组比较,P<0.01或P<0.05）;对环磷酰胺诱发的胸腺、脾脏脏器指数的下降有一定的提高（与模型组比较,P<0.05）;能够降低四氯化碳致小鼠急性肝损伤血清中AST、ALT含量,降低血清MDA的含量,增强SOD的活性（与模型组比较,P<0.01或P<0.05）;可以延长小鼠负重游泳时间（与空白组比较,P<0.01或P<0.05）。结论: 巴马神酒具有提升小鼠巨噬细胞吞噬能力、保护免疫低下小鼠的胸腺和脾脏指数的作用,并具有抗肝脏脂质过氧化损伤和提高游泳耐力的作用。     

Clinicopathologic features and clinical outcomes of intravenous leiomyomatosis of the uterus: A case series

Rationale:Intravenous leiomyomatosis (IVL) is a rare and special type of smooth muscle tumor originating in the uterus. It is classified as a benign disease according to its histological features but shows the behavioral characteristics of a malignant tumor. It is easily misdiagnosed and recurrent. The purpose of this study was to retrospectively analyze clinicopathological data of 25 cases of IVL in order to enhance clinicians’ understanding of this rare disease.Patient concerns:We screened and identified 25 cases of IVL at our hospital from October 2013 to January 2020. Five patients had tumors.Diagnoses:The diagnosis in each case was pathologically confirmed after surgical treatment.Interventions:All patients were managed surgically. Although the surgical procedures were different, the surgical approach was geared towards achieving complete excision. Three patients received hormonal therapy with gonadotropinreleasing hormone agonists after surgery.Outcomes:We retrospectively reviewed all medical records and analyzed the clinicopathologic features and clinical outcomes of this disease as well as the correlations between the clinical features and risk of recurrence. Neither the symptoms nor the preoperative imaging results were suggestive of IVL in any of the cases. Except for two patients who were lost to follow-up, twenty-three patients who were followed up are still alive. Three patients experienced a recurrence.Lessons:The clinical manifestations and ultrasound images of IVL in the early stages are not typical; thus, IVL is easily misdiagnosed as uterine leiomyoma. Radiologists, pathologists, and surgeons should have a thorough understanding of IVL and a high index of vigilance for IVL in clinical practice. Surgery should always be aimed at achieving complete tumor excision. Patients with large lesions (≥7 cm) and lesions extending to the broad ligament may have an increased risk of recurrence. Early detection, diagnosis, and treatment are very important; once the diagnosis is confirmed, regular follow-ups are crucial.     

Variables predictive of successful medical therapy in patients with unstable angina: selection by multivariate analysis from clinical, electrocardiographic, and angiographic evaluations

Although unstable angina can be initially controlled with medical therapy in most patients, there is a high incidence of subsequent death, myocardial infarction, or need for coronary bypass surgery to control symptoms. Identification at the time of presentation of the patient likely to do poorly on continued medical therapy would be useful in advising consideration of surgical therapy. Since coronary arterial spasm may have a significant role in the pathophysiology of unstable angina in some patients, the recently developed calcium channel antagonists may therefore be of particular benefit in the medical therapy of unstable angina. One hundred thirty-eight patients were entered into a randomized double-blind study of the efficacy of adding nifedipine to conventional treatment of unstable angina (nitrates and beta-blockers) and were followed for 18 months. Of these patients, 104 underwent coronary arteriography. A multivariate Cox's hazard function analysis was applied to variables selected from the history, electrocardiographic (ECG) changes during chest pain, and from scintigraphic and coronary arteriographic data to determine those variables most predictive of response to medical therapy. The percentage of the left ventricular myocardium supplied by vessels with 70% or greater luminal stenosis was the most significant variable in influencing failure of medical therapy defined as sudden death, myocardial infarction, or need for bypass surgery. Whether or not the patient received nifedipine was the second most powerful variable, with the use of nifedipine reducing by half the relative risk of failing medical therapy. These were followed by cigarette smoking and presence of global ST segment changes during ischemia. After 18 months the nifedipine group had fewer patients failing medical therapy (p = .02), with fewer patients undergoing coronary bypass surgery (p less than .01). However, nifedipine did not appear to have a preventive effect against myocardial infarction or death. Kaplan-Meier actuarial curves confirmed that medical therapy was significantly less successful in the presence of increasing numbers of significantly stenotic vessels (p = .03). However, nifedipine provided a significant beneficial effect in patients with two or more stenotic vessels (p less than .01) and in whom 50% or more of the myocardium was supplied by vessels with 70% or greater stenosis (p = .01). Thus, although patients with advanced obstructive coronary disease have the greatest likelihood of unfavorable outcomes, the addition of nifedipine is of significant benefit.(ABSTRACT TRUNCATED AT 400 WORDS)     

CTA及动态血清S-100B蛋白检测对SAH患者脑损害程度及脑血管痉挛的评价作用

目的：分析讨论多层螺旋CT血管成像（CTA）对原发性蛛网膜下腔出血（SAH）患者的诊断价值及动态血清S‐100B蛋白检测SAH患者脑损害程度及脑血管痉挛的评价作用。方法对166例SAH患者行CTA检查,抽取患者入院后1、2、3、7d时的肘静脉血检测血清S‐100B蛋白水平。结果166例SAH患者中,CTA共检出119处动脉瘤。Hunt‐HessⅠ～Ⅱ级患者入院后1dS‐100B蛋白水平为（0．71±0．11）μg／L,7d为（0．62±0．09）μg／L,Hunt‐HessⅣ级的患者入院后1dS‐100B蛋白水平为（2．12±0．23）μg／L,7d为（1．97±0．06）μg／L,S‐100B蛋白水平与Hunt‐Hess分级呈正比。格拉斯哥昏迷（GCS）评分3～8分的患者入院后1dS‐100B蛋白水平为（1．87±0．23）μg／L,7d为（1．87±0．23）μg／L。GCS评分13～15分的患者入院后1dS‐100B蛋白水平为（0．63±0．17）μg／L,7d为（0．44±0．15）μg／L,GCS评分越低,S‐100B蛋白水平越高。结论CTA可显示血管的空间立体结构及周边关系,有助于治疗方法的选择和难度的评估。检测血清中S‐100B蛋白浓度能评估继发性脑损害的严重情况和脑血管痉挛的可能性。