配偶夫妻疾病沟通与肠造口患者感知社会约束的交叉滞后模型

目的 探讨SHEL事故分析法在院前急救护理安全管理中的应用效果.方法 应用SHEL事故分析法对2010年1月至2011年12月院前急救护理工作中出现的25例次护理缺陷进行分析,制定护理安全管理措施并进行针对性的管理.结果 加强护理安全管理后,2012年1～12月发生护理缺陷4例次,较管理前(25例次)显著减少(P＜0.05).结论 应用SHEL事故分析法对院前急救护理缺陷进行原因分析,针对性的制定护理安全管理措施,能明显降低护理缺陷的发生,保证护理安全.     

关节镜下经髌腱入路空心拉力螺钉复位固定治疗胫骨髁间嵴撕脱骨折*

目的探讨在关节镜下经髌腱入路,利用空心拉力螺钉复位固定胫骨髁间嵴撕脱骨折(TEFx)的安全性和有效性。方法选取2014年1月-2015年12月23例TEFx的患者,均在关节镜下经髌腱入路,用空心拉力螺钉复位固定。术前Meyers-McKeever分型:Ⅱ型8例,Ⅲ型10例,Ⅳ型5例;男17例,女6例;年龄16～53岁,平均27.8岁。术前前抽屉试验、Lachman试验均阳性。比较术前术后的视觉模拟评分(VAS)、Lysholm、Tegner和国际膝关节文献委员会(IKDC)评分评价患侧膝关节功能。结果 23例患者均得到随访,随访时间30～40个月,平均36个月。术后即刻X线片示TEFx均复位良好,术后3个月骨折均愈合。无1例感染、关节僵硬、伸直受限、复位丢失及神经血管损伤等并发症。最终随访患侧膝关节活动度均恢复正常,前抽屉试验、Lachman试验均阴性。VAS评分术前(4.8±1.2)分,最终随访为(1.2±0.8)分,术前术后比较,差异有统计学意义(t=18.72,P=0.003);Lysholm评分术前为(50.8±6.2)分,最终随访为(90.8±5.4)分,术前术后比较,差异有统计学意义(t=-42.64,P=0.000);Tegner评分术前为(4.0±1.0)分,最终随访为(5.1±1.2)分,术前术后比较,差异有统计学意义(t=-16.82,P=0.005);IKDC主观评分术前为(52.5±7.4)分,最终随访为(91.5±5.7)分,术前术后比较,差异有统计学意义(t=-40.58,P=0.000)。结论膝关节镜下经髌腱入路空心拉力螺钉内固定治疗TEFx具有微创、操作简捷、固定可靠和恢复快的优点。     

毛囊角化病ATP2A2基因突变二例及家系调查

【摘要】 例1男，16岁，面部、颈部及双腋下见密集褐色毛囊角化性丘疹，部分融合成斑块，局部可见疣状增生；母亲与其有相似的病史及临床表现。例2男，21岁，头面部、颈部、躯干、双腋下及臀部见弥漫性毛囊角化性丘疹，部分融合成片，局部可见疣状增生；家族成员均无类似症状。例2颈部皮损组织病理：表皮角化过度伴灶状角化不全，棘层部分区域棘刺松解并有腔隙形成，可见绒毛、圆体和谷粒细胞，真皮浅层炎症细胞浸润。2例患者及其父母基因检测：例1及母亲ATP2A2基因存在第15外显子c.2300A>G错义突变；例2第15外显子与第15内含子交界处存在c.2097+5G>A 剪切区域突变。2例患者其他家族成员未见上述突变。     

二元应对干预对乳腺癌术后患者及配偶的影响

目的探讨二元应对干预对乳腺癌术后患者心理资本及其与配偶间疾病沟通问题的影响。方法选取乳腺癌改良根治术后患者及其配偶为研究对象,按住院时间段分为对照组和干预组各48例,对照组给予常规护理,干预组在此基础上实施二元应对护理干预。干预前及干预16周后采用积极心理资本问卷、夫妻癌症相关沟通问题量表、二元应对量表评价干预效果。结果干预后,干预组患者心理资本得分,夫妻双方二元应对得分显著高于对照组,患者自评夫妻间疾病沟通问题得分显著低于对照组(均P<0.01)。结论二元应对干预能够提高乳腺癌患者心理资本、二元应对水平,降低其与配偶间疾病沟通问题。     

Insulin-like growth factor binding protein-1 inhibits cancer cell invasion and is associated with poor prognosis in hepatocellular carcinoma

Insulin-like growth factor binding protein-1 (IGFBP-1) plays an important role in the development and progression of cancer. However, the expression of IGFBP-1 remains equivocal, and little is known about its clinicopathological significance and prognostic value in hepatocellular carcinoma (HCC). In this study, we evaluated the expression of IGFBP-1 in 90 paired HCC tissues and adjacent non-cancerous liver tissues and analyzed its clinical and prognostic significance. The results showed that IGFBP-1 was detected in cytoplasm as well as cell nucleus, and down-regulated in HCC tissues compared to the adjacent non-cancerous liver tissues. The decreased expression of IGFBP-1 was correlated with tumor differentiation, liver cirrhosis, microvascular invasion or metastasis, TNM stage and poor survival. Moreover, low levels of IGFBP-1 may be an independent prognostic indicator for the survival of patients with HCC. We also evaluated its function by adding recombinant IGFBP-1 to the cultured HCC cell lines HepG2 and MHCC97-H. The result of the invasion chamber assay showed that IGFBP-1 could inhibit the invasion of HepG2 and MHCC97-H. MMP-9 secretion by these cells was significantly decreased when the cells were treated with IGFBP-1. Our results suggest that IGFBP-1 inhibits the invasion and metastasis of HCC cells and that IGFBP-1 may be useful as a valuable marker for the prognosis of patients with HCC.     

KISS-1和VEGF—C在乳头状甲状腺癌组织中的表达及临床意义

目的研究KISS—1、VEGF—C在乳头状甲状腺癌组织中的表达情况，分析两者表达与乳头状甲状腺癌临床病理特征的关系以及两者的相关性。方法收集乳头状甲状腺癌组织病理标本48例及其正常甲状腺组织20例，采用免疫组织化学SP法检测KISS—1、VEGF—C在乳头状甲状腺癌组织中的表达情况，分析KISS—1、VEGF—C在乳头状甲状腺癌组织中阳性表达率与临床病理学特征之间的关系以及两者表达之间的相关性。结果KISS-1、VEGF—C在乳头状甲状腺癌组织和正常甲状腺组织中的阳性表达率之间具有显著性差异（P〈0．01）。KISS-1、VEGF—C在乳头状甲状腺癌组织中的阳性表达率与肿瘤大小、颈部淋巴结转移、临床分期相关且均有显著性差异（P〈0．05）。KISS-1和VEGF—C的表达与患者的性别、年龄均无关（P〉0．05）；KISS-1与VEGF—C在乳头状甲状腺癌组织表达存在负相关关系（P〈0．05）。结论KISS—1、VEGF—C的表达水平与乳头状甲状腺癌有关，且与肿瘤大小、颈部淋巴结转移状况、临床分期相关，与患者性别、年龄无关。KISS-1在乳头状甲状腺癌组织的表达与VEGF—C呈负相关关系。KISS-1、VEGF—C联合检测可作为乳头状甲状腺癌恶性潜能的判断指标。     

Mangiferin Stimulates Carbohydrate Oxidation and Protects Against Metabolic Disorders Induced by High-Fat Diets

Excessive dietary fat intake causes systemic metabolic toxicity, manifested in weight gain, hyperglycemia, and insulin resistance. In addition, carbohydrate utilization as a fuel is substantially inhibited. Correction or reversal of these effects during high-fat diet (HFD) intake is of exceptional interest in light of widespread occurrence of diet-associated metabolic disorders in global human populations. Here we report that mangiferin (MGF), a natural compound (the predominant constituent of Mangifera indica extract from the plant that produces mango), protected against HFD-induced weight gain, increased aerobic mitochondrial capacity and thermogenesis, and improved glucose and insulin profiles. To obtain mechanistic insight into the basis for these effects, we determined that mice exposed to an HFD combined with MGF exhibited a substantial shift in respiratory quotient from fatty acid toward carbohydrate utilization. MGF treatment significantly increased glucose oxidation in muscle of HFD-fed mice without changing fatty acid oxidation. These results indicate that MGF redirects fuel utilization toward carbohydrates. In cultured C2C12 myotubes, MGF increased glucose and pyruvate oxidation and ATP production without affecting fatty acid oxidation, confirming in vivo and ex vivo effects. Furthermore, MGF inhibited anaerobic metabolism of pyruvate to lactate but enhanced pyruvate oxidation. A key target of MGF appears to be pyruvate dehydrogenase, determined to be activated by MGF in a variety of assays. These findings underscore the therapeutic potential of activation of carbohydrate utilization in correction of metabolic syndrome and highlight the potential of MGF to serve as a model compound that can elicit fuel-switching effects.