卵巢癌术后孤立性脾转移循证治疗一例

目的 借助循证医学的方法为一例临床罕见卵巢癌术后脾转移患者确定治疗目标和方案.方法 充分评估患者情况,提出临床问题,从Cochrane Library、CNKI、万方数据库、PubMed、Embase和ScienceDirect数据库检索相关证据,检索时间截至2009年10月.对所获证据进行评价,并结合医生经验及患者愿望制定治疗方案.结果 共检索出英文文献15篇,中文文献11篇.Cochrane数据库内尚无卵巢癌术后脾转移治疗方面的RCT,PubMed、Embase和ScienceDirect数据库含5篇综述类文章,CNKI和万方数据库含回顾性队列研究1篇,其余均为个例报道.综合分析检索结果,为患者制订相对合理方案,经20个月随访,该方案适合.结论 本例属罕见病例,虽然循证证据强度偏低,不能充分体现循证治疗的价值,但最终治疗结果 满意.本研究可为此类缺乏大型RCT的罕见病例运用循证思维诊治提供参考.     

管扎式结肠肛管吻合术治疗低位直肠癌(附256例报告)

目的:评价管扎式结肠肛管吻合术治疗低位直肠癌的安全性和临床效果.方法:回顾性分析1991年10月至2005年12月共256例低位直肠癌行管扎式结肠肛管吻合术的临床资料.结果:无手术死亡,术后发生吻合漏1例,吻合口狭窄16例,术后肛门功能优良率96.7%,术后5年肿瘤局部复发13.1%,5年存活率为71.9%.结论:该法具有操作简单易行安全可靠,减少了吻合口漏的发生,适用于各级医院开展.     

内毒素耐受和拟胆碱药物对巨噬细胞分泌肿瘤坏死因子-α的影响

目的:探讨内毒素耐受和拟胆碱药物卡巴胆碱对巨噬细胞肿瘤坏死因子-α(TNF-α)分泌的调节作用.方法:①分离小鼠腹腔巨噬细胞,将其与内毒素(LPS)作用不同时间(0、2、4、8 h);②小鼠腹腔巨噬细胞分为3组:空白对照组(RPMI1640常规培养),LPS耐受组(LPS预刺激20 h,再用LPS刺激4 h)和LPS不...     

大专护生逆境商与未来时间洞察力及成就动机的关系研究

目的了解在校大专护生逆境商、未来时间洞察力与成就动机现状,并探讨其相互关系。方法采用逆境商量表、大学生未来时间洞察力问卷及成就动机量表对285名在校大专护生进行调查。结果大专护生追求成功的动机(40.08±7.18)略高于避免失败的动机(38.69±8.00),成就动机总分为(1.39±13.19)分;逆境商总分及其4个因子(控制、归因、延伸、忍耐),未来时间洞察力总分及其4个因子与成就动机总分呈正相关(P<0.01,P<0.05);控制、忍耐、行为承诺、远目标定向及目的意识5个因子是成就动机的重要预测变量,能够联合解释56.4%的成就动机变异量。结论大专护生逆境商及未来时间洞察力可影响其成就动机,故应加强大专护生逆境商及未来时间洞察力的培养,以提高其成就动机。     

Comparison of the 6th and 7th Editions of the UICC TNM Staging System for Gastric Cancer: Results of a Chinese Single-Institution Study of 1,503 Patients

Aim

To evaluate the prognostic efficacy of the 7th edition tumor–node–metastasis (TNM) classification compared with the 6th edition in gastric cancer patients.

Methods

A total of 1,503 gastric cancer patients undergoing surgical resection were staged using the 6th and 7th edition staging systems. Homogeneity, discriminatory ability, and monotonicity of gradients of the two systems were compared using linear trend χ², likelihood ratio χ² statistics, and Akaike information criterion (AIC) calculations.

Results

Significant differences in 5-year survival rates were observed for the T, N, and M subgroups using the 7th edition system, except for stage N2 and N3 patients in the 6th edition system. There were no significant differences in survival between IB and IIA in the 7th edition system. Patients with stage IV disease due to T4/N3 in the 6th edition system who were downstaged to stage III in the 7th edition system had significantly better survival than those who remained at stage IV. The 7th edition system had higher linear trend and likelihood ratio χ² scores, and smaller AIC values compared with those for the 6th edition, which represented the optimum prognostic stratification.

Conclusions

Our study suggests that the 7th edition system performs better than the 6th edition in several aspects.     

Preparation of gentamicin-loaded electrospun coating on titanium implants and a study of their properties in vitro

Purpose

Implant-related infections are disastrous complications in the clinic, and there are no effective therapies. In this preliminary study, gentamicin-loaded coating on titanium implants was prepared using the electrospinning technique, and some properties of the coating titanium implants were studied.

Methods

We adopted the electrospinning technique to prepare gentamicin-coated titanium implants. The surface structure of the coating implants was observed using scanning electron microscope. An elution study was performed to determine the release behavior of the gentamicin from the coating. The antibacterial efficacy and quantitative analysis of the bacterial adhesion of Staphylococcus aureus were evaluated in vitro, and the cytotoxicity of the coated titanium implants on osteoblasts was investigated in vitro.

Results

The morphology of the gentamicin-coated titanium implants exhibited nanofibers, and the release of gentamicin showed an initial gentamicin burst followed by a slow release. The gentamicin-coated titanium implants had a persistent antibacterial efficacy for 1 week and significantly reduced the adhesion of the Staphylococcus aureus compared with bare titanium implants in vitro. There was no cytotoxicity observed in vitro for the gentamicin-coated implants.

Conclusion

The gentamicin-coated titanium implants, which were prepared using an electrospinning technique, present many advantages and may be considered to prevent and treat the implant-related infections.     

1例多器官功能衰竭体外膜肺联合连续性血液净化治疗的护理

对1例肺、肾功能衰竭患者行组合式体外膜肺联合连续性血液净化治疗,结果患者病情得到控制并最终康复出院.提出多器官功能衰竭患者病情发展迅速,预后极差,在临床上除行体外膜肺联合连续性血液净化治疗的护理外,还应注意预防感染、出血等严重并发症,以积极改善预后,提高患者生活质量.     

脑卒中患者跌倒恐惧心理的研究进展

阐述影响脑卒中患者跌倒恐惧的因素,包括人口学因素、跌倒史、平衡功能、功能锻炼情况及焦虑、抑郁情绪等。提出医护人员可通过评估工具对患者跌倒恐惧情况进行测量,根据患者的个体情况,制定相应的干预措施,帮助患者降低跌倒恐惧,提升其日常生活功能的独立性,增强其对自身跌倒预防的信心,从而有效预防脑卒中患者跌倒的发生。     

Thoracoscopy‐assisted mini‐open surgery for anterior column reconstruction in thoracic spinal tuberculosis

Objective: To evaluate the clinical effects of thoracoscopy‐assisted mini‐open surgery for anterior column reconstruction in thoracic spinal tuberculosis. Methods: Fifty‐eight patients, 35 men and 23 women, aged 39.2 (range, 19–60) years with thoracic spinal tuberculosis with an average kyphotic angle of 29.2° (range, 18°–42°) underwent thoracoscopy‐assisted mini‐open surgeries, including thorough debridement and anterior spinal reconstruction. According to the Frankel Grading system, preoperative neurological function was judged as Grade B in 3 cases, Grade C in 7, Grade D in 28, and Grade E in 20. All patients were followed up for an average of 4.6 years. Outcomes were evaluated retrospectively. Results: Surgery was accomplished successfully in all cases. The average operation time was 230 min (range, 180–320 min), the average intraoperative blood loss 570 ml (range, 350–1200 ml), and the mean drainage duration 3.6 days (3–5 days). Complications occurred in 19 patients (32.8%). Neurological improvement of one to three grades had occurred in 29 patients by final follow‐up. The average correction rate of the kyphotic angle was 36.4%, and no obvious correction loss was detected during follow‐up. No recurrent tuberculosis was found in the group. Conclusions: Thoracoscopy‐assisted mini‐open surgery provides a simple, safe, effective, and practical technology with minimal invasiveness for the treatment of thoracic spinal tuberculosis.     

小切口经前路腹膜后人工髓核置换术治疗退行性腰椎间盘疾患

目的：评价应用小切口技术进行人工髓核假体置换治疗退行性腰椎间盘疾患的临床初步疗效。方法：2003年6月～2004年9月共施行人工髓核（PDN）置换术12例，男4例，女8例，平均年龄28．5岁。其中腰椎间盘突出症10例，椎间盘源性腰痛2例。包容型腰椎间盘突出症和椎间盘源性腰痛采用前路PDN置换，脱出游离型椎间盘突出症采用后路椎间盘摘除、前路PDN置换；术后评价内容包括临床和影像学结果。结果：平均前路切口长度4．2cm，前路平均手术时间80min，平均术中出血量110ml。PDN置入部位均为L4／5，共置入PR925型假体12枚。所有患者术后腰痛症状得到改善。术后平均随访6．5个月，影像学检查未见假体移位和脱出。结论：应用前路腹膜后小切口进行PDN置换在减少手术创伤的同时，可以有效防止髓核脱入椎管。近期效果肯定，但长期疗效有待进一步观察。