住院艾滋病患者主要照顾者负性心理的质性研究

目的了解住院艾滋病亲属照顾者在看护期间内的主要压力源及负性心理体验。方法采用个人深度访谈法,收集8名照顾者的资料,用主题分析法进行分析,归纳住院艾滋病患者主要照顾者的压力源种类及其负性心理体验。结果照顾者压力源主要来源包括与艾滋病相关的压力源、与经济相关的压力源及与社会文化相关的压力源;照顾者的负性心理体验主要有怀疑、否认,恐惧、害怕,痛苦、矛盾,愤怒,迷茫无助及社交减少。结论住院艾滋病患者照顾者的压力源来源于多个方面,其负性心理体验复杂,研究者应重视主要照顾者的压力,为其提供有效的干预措施,加强支持系统。     

Effects of WNK3 kinase on regulation of large-conductance calcium-activated potassium channels and its mechanisms

Objective To investigate the effects of WNK3 kinase on the regulation of large-conductance calcium-activated potassium channels (Maxi K channels) on African green monkey kidney fibroblast-like cells (Cos-7 cells) and its mechanisms. Methods (1) Cos-7 cells were transfected with 0, 0.6, 1.2, 1.8 μg WNK3 plasmid+0.5 μg Maxi K plasmid. The total protein expression of Maxi K channel and the phosphorylation of mitogen-activated protein kinase (MAPK) extracellular regulated kinase-1 and-2 (ERK1/2) were detected by Western blotting. (2) Cos-7 cells were divided into the control group (2.5 μg Maxi K plasmid) and the experimental group (2.5 μg WNK3 plasmid+2.5 μg Maxi K plasmid). Cell surface biotinylation was used to investigate the cell surface protein expression of Maxi K channel in Cos-7 cells. Immunoprecipitation and Western blotting were used to detect the ubiquitination of Maxi K channel protein. (3) WNK3 kinase was knocked down by WNK3 siRNA. The lysosomal degradation pathway was blocked by the proton pump inhibitor (Baf-A1). Cos-7 cells were divided into Maxi K+negative control siRNA group, Maxi K+WNK3 siRNA group and Maxi K+WNK3 siRNA+Baf-A1 group. The protein expression of Maxi K channel protein was detected by Western blotting. Results (1) Compared with those in 0 μg WNK3 plasmid groups, in 0.6, 1.2, 1.8 μg WNK3 plasmid groups the total protein expression of the Maxi K channel increased and the phosphorylation level of MAPK ERK1/2 reduced on a dose-dependent manner (all P＜0.01). (2) Compared with those in the control group, the total protein expression and cell surface membrane protein expression of the Maxi K channel increased in the experimental group (P＜0.01), while the ubiquitination of the Maxi K channel protein reduced (P＜0.01). (3) Compared with the Maxi K+negative control siRNA group, the expression of Maxi K protein reduced in the Maxi K+WNK3 siRNA group (P＜0.01), but did not change in the Maxi K+WNK3 siRNA+Baf-A1 group (P＞0.05). The expression of Maxi K protein in Maxi K+WNK3 siRNA+Baf-A1 group was higher than that in Maxi K+WNK3 siRNA group (P＜0.01). Conclusions WNK3 kinase inhibits the lysosomal degradation pathway of Maxi K channel protein by reducing the ubiquitination of Maxi K channel, and promotes the expression of Maxi K channel protein in cells and on cell membrane. These effects may be achieved by suppressing MAPK ERK1/2 signal transduction pathway.     

经肛肠减压后3D腹腔镜根治术治疗梗阻性结肠癌的临床观察

目的探讨经肛肠减压后3D腹腔镜根治术治疗梗阻性结肠癌的临床疗效。 方法回顾性分析2015年6月至2018年6月收治的54例梗阻性结肠癌患者的临床资料,所有患者术前均经肛肠减压,根据手术方式分为3D组(25例)和开腹组(29例),所有数据均应用SPSS22.0软件进行统计学分析,围术期相关指标等计量资料以( ±s)表示,采用独立样本t检验;术后并发症发生率组间比较采用χ²检验,P<0.05为差异有统计学意义。 结果两组患者术前减压管放置时间、手术时间和淋巴结清扫数目比较,差异均无统计学意义(P>0.05);3D组术中出血量、首次通气时间以及平均住院时间均明显少于开腹组,但平均住院费用高于开腹组;两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。 结论经肛肠减压后实施3D腹腔镜根治术治疗梗阻性结肠癌是安全、有效的,术中出血量少、术后恢复快,值得在临床广泛推广应用。     

试论岳甫嘉医案中不育的诊治思维

岳甫嘉诊病重视脉症合参,尤以诊脉见长;处方多用中和之剂,收固真阴,反对过用热药,耗散精血。诊治思维贯穿其著作《妙一斋医学正印种子编》上卷所载验案。此卷专门论述男性不育的诊治,虽仅载验案八则,但八者皆奇,诊治结合,涵盖多法,可归纳为“先清热毒,再施温补”“药用滑涩,当辨标本”“先治脾,后治肾”“脾肾同治”“先祛痰火,再滋肾阴”及“交通心肾”6类,诸法之中的诊治思维,蕴含奥妙,颇具特色,特作探析。     

再次或多次手术治疗复发性腹膜后 脂肪肉瘤的临床意义

目的 探讨再次手术或多次手术治疗复发性腹膜后脂肪肉瘤的治疗策略和临床意义。方法 回 顾性分析2013 年1 月—2017 年8 月北京大学第一医院普通外科收治的16 例腹膜后脂肪肉瘤术后复发患者（复 发组）行再次或多次手术的临床资料,随访时间12 ～ 62 个月,平均30 个月;观察其术后效果。结果 16 例 腹膜后肿瘤术后复发患者共行手术30 例次,手术时间60 ～ 840 min,平均360 min ;中位手术时间270 min, 术中出血50 ～ 33 100 ml,平均3 755 ml ;中位出血量800 ml。其中,28 例次手术为联合脏器切除。原发性腹 膜后脂肪肉瘤行手术治疗患者（原发组）与复发组在肿瘤最大径、是否多灶等指标比较,差异无统计学意义 （P >0.05）,而手术时间、出血量及是否联合脏器切除比较,差异有统计学意义（P <0.05）。随访期间无瘤存 活率为25%（4/16）,带瘤生存8 例,死亡4 例。结论 对于复发性腹膜后脂肪肉瘤患者,经多学科评估和完 善的术前准备,可行再次或多次手术治疗。     

纯音听阈正常糖尿病前期患者畸变产物耳声发射的变化特点

目的 观察纯音听阈正常的糖尿病前期（pre-diabetic）患者畸变产物耳声发射（distortion product otoacoustic emission,DPOAE）情况,探讨其变化特点。方法 根据口服葡萄糖耐量试验（oral glucose tolerance test,OGTT）和纯音测听结果连续入组年龄<60岁的纯音听阈正常的糖尿病前期患者30例,其中,男性13例,女性17例,平均年龄（49.80±8.23）岁,对照组为同期年龄、性别构成接近、血糖结果正常的健康体检人群30例,其中,男性9例,女性21例,平均年龄（46.55±5.09）岁。所有受试者进行内分泌相关检查（包括空腹血糖、2 h血糖、糖化血红蛋白、血脂、尿白蛋白/肌酐等）及畸变产物耳声发射检查,比较两组受试者各频率畸变产物耳声发射反应幅值及异常检出率。结果 糖尿病前期组左、右耳DPOAE反应幅值均低于对照组,其中左耳在0.7、1、1.5、2、3、4 kHz差异有统计学意义（P<0.05）,右耳在1.5、2、3、4、6 kHz差异有统计学意义（P<0.05）。在异常检出率方面,糖尿病前期组各频率均高于对照组,在3 kHz差异有统计学意义（P=0.037）。结论 糖尿病前期在纯音测听正常时就已出现耳蜗外毛细胞功能受损,以右耳受损更为显著,存在右耳优势减弱,畸变产物耳声发射较纯音测听敏感性更高。     

Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET

The purpose of this study was to determine the actual standardized uptake value (SUV) by using the lesion size from computer tomography (CT) scan to correct for resolution and partial volume effects in positron emission tomography (PET) imaging. This retrospective study included 47 patients with lung lesions seen on CT scan whose diagnoses were confirmed by biopsy or by follow up CT scan when the PET result was considered negative for malignancy. Each lesion's FDG uptake was quantified by the SUV using two methods: by measuring the maximum voxel SUV (maxSUV) and by using the lesion's size on CT to calculate the actual SUV (corSUV). Among small lesions (2.0 cm or smaller on CT scan), ten were benign and 17 were malignant. The average maxSUV was 1.43+/-0.77 and 3.02+/-1.74 for benign and malignant lesions respectively. When using an SUV of 2.0 as the cutoff to differentiate benignity and malignancy, the sensitivity, specificity, and accuracy were 65%, 70%, and 67% respectively. When an SUV of 2.5 was used for cutoff, the sensitivity, specificity, and accuracy were 47%, 80%, and 59% respectively. The average corSUV was 1.65+/-1.09 and 5.28+/-2.71 for benign and malignant lesions respectively. Whether an SUV of either 2.0 or 2.5 was used for cutoff, the sensitivity, specificity, and accuracy remained 94%, 70%, and 85% respectively. The only malignant lesion that was falsely considered benign with both methods was a bronchioalveolar carcinoma which did not reveal any elevated uptake of fluorine-18 fluorodeoxyglucose (FDG). Of the large lesions (more than 2.0 cm and less than 6.0 cm), one was benign and 19 were malignant and the corSUV technique did not significantly change the accuracy. It is concluded that measuring the SUV by using the CT size to correct for resolution and partial volume effects offers potential value in differentiating malignant from benign lesions in this population. This approach appears to improve the accuracy of FDG-PET for optimal characterization of small lung nodules.     

短期加用替罗非班在支架辅助弹簧圈栓塞梭形动脉瘤中的安全性与有效性研究

目的评估支架辅助弹簧圈栓塞梭形动脉瘤术中及术后24 h内,在标准双抗血小板治疗的基础上,短期应用小剂量替罗非班在降低缺血并发症方面的安全性及有效性。 方法回顾分析我中心2015年1月至2020年12月颅内未破裂梭形动脉瘤接受支架辅助弹簧圈栓塞治疗,并在手术过程中及术后24 h内静脉接受替罗非班（0.1 μg/kg/min）预防血小板聚集的患者资料。记录并分析围手术期并发症,动脉瘤栓塞程度及术后3个月随访时的mRS评分。 结果本研究共纳入38例患者,39枚动脉瘤,动脉瘤平均直径（6.4±2.1）mm。其中,26枚动脉瘤接受了单支架辅助弹簧圈栓塞治疗,13枚动脉瘤接受了双支架辅助弹簧圈栓塞治疗。术后即刻78.9%（30/38）的动脉瘤实现完全栓塞;在26例接受脑血管造影复查的患者中,92.3%（24/26）的患者动脉瘤实现完全闭塞。围手术期缺血并发症发生率为7.9%（3/38）;无出血并发症发生。3个月随访的良好预后率为97.4%（37/38） （mRS评分为0~1分）。 结论支架辅助弹簧圈栓塞梭形动脉瘤术中及术后24 h内,静脉加用小剂量替罗非班未增加出血并发症。但是,由于样本量偏少,缺少对比,在降低缺血并发症方面的有效性尚需进一步证实。     

家属培训对长期住院慢性精神分裂症患者康复的影响

目的探讨家属心理护理、生活技能培训在长期住院的慢性精神分裂症患者康复治疗中的作用。方法选取有家庭监护条件的长期住院的精神分裂症患者126例,将其随机分为干预组(66例)和对照组(60例)。干预组由心理咨询师对患者家属进行心理护理、生活技能培训,然后对患者实施假出院3个月。对照组患者仍住院治疗。实施前后采用护士用住院患者观察量表(NOS-IE)、自尊量表(SES)进行测试。结果干预后干预组NOSIE及SES评分显著优于对照组(P<0.01,P<0.05)。结论家属心理护理、生活技能培训用于长期住院的慢性精神分裂症患者,可使其社会能力、生活技能提高,激惹、抑郁等消极情绪减少;自尊水平提升。