我国腹腔镜D2 淋巴结清扫术联合远端胃癌切除术治疗进展期远端胃癌安全性和疗效的系统评价

目的 系统评价我国腹腔镜D2淋巴结清扫术联合远端胃癌切除术治疗进展期远端胃癌的有效性和安全性。方法 计算机检索PubMed数据库、Cochrane图书馆、中国科学引文数据库（China science citation database,CSCD）、万方数据库（Wanfang）、中文科技期刊数据库（China science and technology journal database,CSTJ）、中国生物医学文献数据库（China biomedical literature database,CBM）和中国学术期刊网络出版总库（China academic journal network publishing database,CAJD）数据库,检索时限均从建库至2013年6月。采用Review Manager 5.2软件进行Meta分析。结果 最终纳入了7个临床随机对照试验,共548例进展期胃癌患者。Meta分析结果显示：与传统开放式远端胃癌切除术（CODG）相比,腹腔镜辅助远端胃癌切除术 （LADG）的术中出血量少（MD =-94.02,95% CI：-140.96～-47.07）、术后住院时间短（MD =-3.66,95% CI：-5.76～-1.57）、术后下床活动时间早（MD =-1.95,95% CI：-2.74～-1.17）、肛门排气时间早（MD =-1.67,95% CI：-2.05～-1.30）、总并发症发生率低（OR=0.26,95% CI：0.14～0.51）,差异均有统计学意义（P＜0.050）,但LADG组的手术时间长于CODG组（MD =35.01,95% CI：10.41～59.61,P=0.005）。2组间淋巴结清扫数量比较差异无统计学意义 （MD =-0.24,95% CI：-0.99～0.51,P=0.530）。结论 LADG的近期疗效及安全性均优于传统CODG,但其手术时间长,远期疗效尚需进一步探究。     

联合术式合并异体肌腱重建圆韧带治疗小儿发育性髋关节脱位

目的探讨联合术式合并异体肌腱重建圆韧带治疗小儿发育性髋关节脱位(DDH)的手术方法及疗效。方法对48例小儿DDH患者(56髋)行软组织松解、股骨上段截骨、Salter或Pemberton髂骨截骨及异体肌腱移植、重建圆韧带术治疗,测定并对比手术前后的AI、CE角等指标,采用Severin影像学及McKay临床疗效评价标准评价疗效。结果 AI由术前36.2°~58.1°降低至11.4°~21.3°,CE角由术前-10°~-50°提高至12°~45°,差异均有统计学意义(P0.05)。患儿均获随访,时间1~4年。根据Severin X线评定标准:优30髋(53.6%),良21髋(37.5%),可5髋(8.9%)。根据McKay临床疗效评定标准:优29髋(51.8%),良20髋(35.7%),可4髋(7.1%),差3髋(5.4%)。结论联合术式结合异体肌腱重建圆韧带治疗DDH有利于提高成功率、减少并发症,但须强调联合化及个体化原则。     

86例妊娠期肝内胆汁淤积症临床分析及护理

探讨妊娠期肝内胆汁淤积症对母儿的不良影响及护理。对我院86例患者的临床资料进行回顾性分析,并总结了护理经验。86例中剖宫产占60%,阴道产占40%,早产占52%,胎儿宫内窘迫占28%,新生儿窒息占7%,产后出血占3%。其中有3例死胎。在护理工作中,加强孕期保健,指导家庭的自我监护,做到早期诊断,早期治疗。做好产前监护及产时、产后的观察,加强皮肤护理、饮食指导与心理疏导。必要时,适时终止妊娠以降低围产儿死亡率和产科并发症。     

TNFα-Tumstatin45-132分子构建、生物学特征预测和活性验证

目的 构建人重组TNFα-Tumstatin45-132融合蛋白的表达载体，预测接头的合理性和可行性．并对融合蛋白活性进行验证。方法 采用基因融合序列重叠延伸（s0E）策略，构建新型TNFα-Tumstatin45-132表达载体；应用核酸和蛋白质序列软件Antheprot和PepTool对融合基因及接头部位翻译后在二级结构水平上的柔性、抗原性、亲水性等生物特性加以预测；用细胞毒试验和内皮细胞增殖试验测定表达的融合蛋白活性。结果 构建新型重组TNFα-Tumstatin45-132融合基因．经DNA测序证实与设计完全一致；TNFa-Tumstatinml32融合基因的氨基酸序列经软件分析，并与TNFα和Tumstatin45-132单独分析的结果比较，未出现新的抗原性，亲水性没有改变，接头部位具有很低的抗原性，接头部位呈中性；表达的融合蛋白经证实具有杀伤L929细胞和抑制ECV304细胞增殖的作用。结论 通过计算机软件对TNFα-Tumstatin45-132融合蛋白的预测，并与TNFα和Tumstatin45-132分别对比分析，有利于合理设计融合蛋白，最大程度地保留TNFα和Tumstatin45-132各自的生物活性和功能；生物活性分析证实设计具有一定的科学性和合理性。     

Characteristics of ''best'' and ''worst'' clinical teachers as perceived by university nursing faculty and students

This study identified and compared characteristics of 'best' and 'worst' clinical teachers as perceived by university nursing faculty and students. The Nursing Clinical Teacher Effectiveness Inventory (NCTEI) was distributed to 201 volunteer subjects. This survey instrument, developed by the authors, contains 48 clinical teacher characteristics grouped into five categories. Each participant was asked to rate, using the NCTEI, the 'best' and them the 'worst' clinical teacher from past observations. Results showed both groups perceived that being a good role model was the highest rated characteristic for 'best' teachers and the 'lowest' rated characteristic for 'worst' teachers. Faculty and students' perceptions were fairly similar as to highest rated characteristics of 'best' clinical teachers. Less agreement was noted about the characteristics of 'worst' clinical teachers. When categories of clinical teacher characteristics were compared, there were significant differences between the ratings of faculty and students for 'best' clinical teachers, but none for 'worst' clinical teachers.     

广谱抗生素对脓毒症大鼠肠道微生态环境的影响

目的 探讨广谱抗生素对脓毒症大鼠肠道微生态环境的影响.方法 56只健康SD大鼠被随机分为正常对照组、烫伤组和脓毒症组.于大鼠背部造成30%总体表面积Ⅲ度烫伤后24 h,间隔12 h分两次腹腔注射内毒素(20mg/kg)进行"二次打击"制备脓毒症模型.分别于烫伤及"二次打击"后24 h,间隔12 h分两次腹腔注射头孢曲松进行治疗,各组于治疗前及治疗3 d和9 d活杀8只大鼠,取胃窦、小肠、结肠内容物及结肠黏膜行细菌定量培养、菌种鉴定.结果 单纯烫伤对结肠内容物杆菌数量和种类无明显影响,"二次打击"后,杆菌数升高上千倍(P<0.01),应用头孢曲松治疗后大鼠结肠内容物杆菌数量明显减少(P均<0.01),小肠内容物肠杆菌亦有类似变化,而胃内容物肠杆菌数量变化不显著.经烫伤及"二次打击"后肠道杆菌数量显著增加,球/杆比值负值增大;应用头孢曲松后,肠球菌数量显著增多,球/杆比值严重倒置;厌氧菌数量亦有所减少,但差异不显著.结论 广谱抗生素使定植于肠道的厌氧菌和肠杆菌数量锐减,使肠球菌、耐药菌选择为优势菌群成为可能,造成肠道微生态环境破坏.     

Innervation zone locations in 43 superficial muscles: Toward a standardization of electrode positioning

Introduction: We describe the innervation zone (IZ) location in 43 muscles to provide information for appropriate positioning of bipolar electrodes for clinical and research applications. Methods: The IZ was studied in 40 subjects (20 men and 20 women) using multichannel surface electromyography (sEMG). Signal quality was checked visually to identify motor unit action potentials and estimate muscle fiber conduction velocity. Results: Results in 33 muscles were classified as excellent or good, because it was possible to identify an area which is favorable for appropriate positioning of an electrode pair without the need to previously determine the IZ location. Conclusions: Knowledge of IZ location will increase standardization and repeatability of sEMG measures. Muscle Nerve 49 :413–421, 2014     

Differences in Perioperative Care at Low- and High-Mortality Hospitals with Cancer Surgery

Objective

To evaluate adherence to perioperative processes of care associated with major cancer resections.

Background

Mortality rates associated with major cancer resections vary across hospitals. Because mechanisms underlying such variations are not well-established, we studied adherence to perioperative care processes.

Methods

There were 1,279 hospitals participating in the National Cancer DataBase (2005–2006) ranked on a composite measure of mortality for bladder, colon, esophagus, stomach, lung, and pancreas cancer operations. We sampled hospitals from among those with the lowest and highest mortality rates, with 19 low-mortality hospitals [(LMHs), risk-adjusted mortality rate of 2.84 %] and 30 high-mortality hospitals [(HMHs), risk-adjusted mortality rate of 7.37 %]. We then conducted onsite chart reviews. Using logistic regression, we examined differences in perioperative care, adjusting for patient and tumor characteristics.

Results

Compared to LMHs, HMHs were less likely to use prophylaxis against venous thromboembolism, either preoperative or postoperatively [adjusted relative risk (aRR) 0.74, 95 % CI 0.50–0.92 and aRR 0.80, 95 % CI 0.56–0.93, respectively]. The two hospital groups were indistinguishable with respect to processes aimed at preventing surgical site infections, such as the use of antibiotics prior to incision (aRR, 0.99, 95 % CI 0.90–1.04), and processes intended to prevent cardiac events, including the use of β-blockers (1.00, 95 % CI 0.81–1.14). HMHs were significantly less likely to use epidurals (aRR, 0.57, 95 % CI 0.32–0.93).

Conclusions

HMHs and LMHs differ in several aspects of perioperative care. These areas may represent opportunities for improving cancer surgery quality at hospitals with high mortality.