A HEART Pathway pitfall in an admitted patient

This paper discusses a possible weakness of the HEART Pathway specific to patients identified as high risk, requiring admission for inpatient risk stratification. Emergency Department (ED) crowding is at an all-time high and the possibility that many of these patients will board in the ED for a period of time before they are transported to an inpatient ward is becoming more likely. Given troponins peak at 6?h after the initial cardiac injury, it is plausible an initial troponin could still remain negative upon arrival. Extending the HEART Pathway to include a 3-hour delta troponin for admitted patients boarded in the emergency department may help alert the patient's inpatient team of those requiring more aggressive evaluations or more timely interventions. The case discussed herein highlights the course of a patient who was admitted to a medicine floor for chest pain along the HEART Pathway. After remaining in the ED for 3?h following admission a second troponin was drawn that resulted in the diagnosis of a non-ST segment myocardial infarction. The patient then received further management in the ED and a change in admission to the Cardiac Care Unit instead of the medicine floor. The patient ultimately received a Coronary Artery Bypass Graft during admission. If the patient had not had the second troponin while in the ED this care would have been delayed.     

经脐单孔腹腔镜术在泌尿外科的应用(附52例报告)

目的:探讨经脐单孔腹腔镜技术在泌尿外科应用的疗效及安全性。方法:回顾性分析52例应用经脐单孔腹腔镜技术行肾上腺切除术、肾囊肿去顶减压术、无功能肾切除术、输尿管切开取石术、精索静脉高位结扎及前列腺根治性切除术,其中肾上腺切除7例,左侧4例,右侧3例;肾囊肿切除24例,左侧12例,右侧9例,双侧3例;无功能肾切除9例,左侧5例,右侧4例;输尿管切开取石7例,左侧3例,右侧4例;精索静脉曲张高位结扎3例,均为左侧;前列腺根治性切除2例。分别记录各种手术的手术时间、术中出血量、术后住院天数、术后下床活动时间、术后拔引流管时间、术后镇痛药使用情况、是否增加辅助孔及术后并发症等情况。结果:52例手术均获得成功,手术时间15~275min;估计术中出血量20~300ml,均无输血。术后24~48小时均下床活动。术后住院天数3~15d,术后拔引流管时间2~7d。4例术后24小时内应用镇痛药,5例术中增加1~2个5mm辅助孔,3例术后切口发生脂肪液化,5例术后低热,经治疗后均治愈出院。结论:经脐单孔腹腔镜术在泌尿外科中的应用安全有效,且术后脐部几乎无瘢痕,美容效果佳,术后患者恢复快。随着手术实践的增加,经脐单孔腹腔镜术必将在泌尿外科微创手术中得以进一步推广。     

医院新型放射防护管理实践与体会

目的 介绍福建医科大学附属协和医院新型放射防护管理的具体做法和成效，以期为同类医疗机构放射防护管理提供借鉴。方法 对比新型管理模式前后的做法及管理成效。结果 新型放射防护管理模式完善了事前、事中、事后监管，放射防护管理工作更加科学、有效。结论 医院领导的高度重视、职能部门的积极监管、放射工作人员对防护工作重要性的清醒认识与积极配合、行政监管部门主动监督检查是放射工作安全、可持续发展的重要保障。监管过程中部分流程的进一步优化，将使放射防护管理工作更加科学、更加有效。     

Genetic association of CHEK2, GSTP1, and ERCC1 with glioblastoma in the Han Chinese population

Glioblastoma (GBM), a deadly brain tumor, is the most malignant glioma. It mainly occurs in adults and occurs significantly more in males than in females. We genotyped 19 tag single nucleotide polymorphisms (tSNPs) from 13 genes in a case–control study of the Han Chinese population to identify genetic factors contributing to the risk of GBM. These tSNPs were genotyped by Sequenom MassARRAY RS1000. Statistical analysis was performed using χ ² test and SNPStats, a website software. Using χ ² test, we found that the distribution of two tSNPs (rs2267130 in checkpoint kinase 2 (CHEK2), p?=?0.040; rs1695 in GSTP1, p?=?0.023) allelic frequencies had significant difference between cases and controls. When we analyzed all of the tSNPs using the SNPStats software, we found that rs1695 in GSTP1 decreased the risk of GBM in log-additive model (OR?=?0.56, 95 % CI, 0.34–0.94, p?=?0.022). Besides, we found that there is an interaction between rs3212986 in excision repair cross-complementing group 1 (ERCC1) and gender under codominant and recessive models. The gene polymorphisms in CHEK2, GSTP1, and ERCC1 may be involved in GBM in the Han Chinese population. Since our sample size is small, further investigation needs to be performed.     

基质金属蛋白酶-9在后交通动脉瘤瘤周蛛网膜中的表达及临床意义

目的初步探讨基质金属蛋白-9(MMP-9)在后交通动脉瘤瘤周蛛网膜中的表达及意义。方法选取南方医科大学南方医院2010年11月~2011年11月手术切除的颅内动脉瘤标本12例作为颅内动脉瘤组,并选取同期行海绵状血管瘤手术或颞叶癫痫手术患者后交通动脉起始部附近蛛网膜组织6例作为对照组。标本行常规HE染色,并采用Envision法行免疫组化染色,比较组间MMP-9的阳性表达情况。结果 HE染色提示动脉瘤瘤周的蛛网膜存在一定的组织破坏,表现为蛛网膜结构松散,与血管壁之间的连接程度下降,局部存在脱离现象。动脉瘤组瘤周蛛网膜中MMP-9阳性表达均高于照组,具有统计学意义(P<0.05)。动脉瘤组内蛛网膜中MMP-9的阳性表达强度较血管壁弱,具有统计学意义(P<0.05);动脉瘤组内不同年龄、Hunt-Hess分级的MMP-9表达情况无显著性差异。结论动脉瘤瘤周蛛网膜中MMP-9表达明显增加预示着细胞外基质的溶解,破坏蛛网膜对血管壁的保护作用,可能与后交通动脉瘤的形成有重要关系。     

TAT-tCNTF 对CD 诱导HUVEC 细胞损伤的作用研究（摘要）

目的探讨TAT—tCNTF对细胞松弛素D（cD）诱导人脐静脉内皮细胞（HuvEc）损伤作用的影响。方法CCK-8法检测TAT—tCNTF对CD致HUVEC生长抑制的作用；荧光显微镜检测CD诱导HUVEC的F—actin的变化，以及在TAT—tCNTF作用下对细胞微丝的影响；荧光显微镜和流式细胞术检测CD和TAT—tCNTF作用后细胞内Ca^2＋浓度；Westernblot检测CD和TAT—tCNTF作用后F—actin的蛋白水平的变化。结果在1μg·ml^-1。的CD作用HUVEC后，细胞表现出明显的生长抑制，而在0．05～10μg·ml^-1。浓度范围内，TAT—tCNTF促进HUVEC的生长，并可改善CD对HUVEC的损伤，TAT—tCNTF组与CD＋TAT—tCNTF组细胞活动度具有明显差异；荧光显微镜下检测到经CD作用后细胞F-actin分布减少，而经TAT—tCNTF作用后细胞F-actin分布密集；采用Fluo4-AM荧光探针标记细胞内Ca^2＋浓度，荧光显微镜和流式细胞术检测到TAT—tCNTF能够降低经CD损伤HUVEC后的细胞内Ca^2＋浓度升高；FCM检测显示，CD组的MFI相对于对照组明显增加，而CD＋TAT—tCNTF组MFI较CD组明显降低。Westernblot显示各组之间的F—actin表达量没有明显改变。结论TAT—tCNTF对CD致内皮细胞的损伤有改善和逆转作用，其改善机制可能与增加细胞活性和维持细胞骨架有关。