终池闭式引流置换脑脊液治疗蛛网膜下腔出血患者的护理

对30例蛛网膜下腔出血患者采用深静脉导管终池置入进行闭式循环引流置换脑脊液。结果置管时间为4～8d，无1例发生继发性颅内感染及脑疝等并发症。治愈20例，好转6例，无效4例，其中1例因再出血病情加重死亡，总有效率86．7％。提出术前做好患者心理护理，术中准确传递所需用物，术后密切观察病情变化，严格控制脑脊液引流速度和置换速度，做好引流管护理，可促进颅内积血消散，改善患者预后。     

藏医药浴治疗类风湿性关节炎患者的辨证施护

目的 探讨藏医药浴治疗类风湿性关节炎的辨证施护的效果.方法 对60例类风湿性关节炎患者采用藏药浴及口服,同时辨证施护.结果 显效48例(80.0%),有效8例(13.3%),无效4例(6.7%).总有效率93.3%.结论 辨证施护能促进藏医药浴治疗类风湿性关节炎的疗效.     

认知行为疗法改善学龄前儿童牙科畏惧症

目的观察认知行为疗法在学龄前牙科畏惧症儿童口腔治疗中的临床效果。方法采用"儿童畏惧调查量表牙科分量表"对口腔科门诊初诊3~6岁龋病患儿开展问卷调查,筛选出牙科畏惧症患儿105例。随机分为对照组53例,予龋齿充填治疗;观察组52例,予龋齿充填治疗+认知行为疗法。比较两组治疗过程中行为分级及配合情况。结果观察组患儿治疗过程中Venham临床焦虑及合作行为级别显著低于对照组;观察组配合治疗患儿比例69.2%,高于对照组的35.8%,两组比较,差异有统计学意义(P0.01)。结论运用认知行为疗法进行心理干预,可缓解学龄前儿童口腔诊疗过程中的紧张情绪、增加对口腔诊疗的配合度。     

胰腺实性假乳头状瘤的诊断和治疗（附28例报告）

目的 总结分析胰腺实性假乳头状瘤（SPTP）的临床特点和治疗效果,提高对该病的认识.方法 回顾性总结2000年10月至2013年3月间经手术和病理证实的28例SPTP病人的临床资料,并对其进行随访.结果 28例中,体检中无意发现肿物者12例,外伤后腹痛检出肿物者6例（均为未成年病人）,腹痛为首发症状者7例,复查意外发现者2例,肠梗阻为首发症状者1例.手术方式：肿物核除术5例;胰十二指肠切除术4例;胰尾切除术5例;胰体尾切除术3例;胰尾切除加脾脏切除术3例;病理活检2例;转移瘤切除1例;胰体切除、胰肠吻合术3例.位于胰头：8例,胰体：4例,胰尾：15例;其他腹壁转移：1例.表现为囊实混合性者22例.所有病人术后均未辅助放化疗治疗.28例病人中2例失访,26例获随访,随访时间为3个月至10年,平均15个月.4例复发,其中1例复发后3个月因合并心肺功能衰竭死亡,另3例经再次手术后治愈.余22例预后良好.本组5年生存率为96.4％.结论 SPTP无特异性临床表现,起病隐匿,CT及彩超对SPTP有诊断意义,手术切除肿瘤为SPTP的主要治疗方式,不经术前术后放疗和化疗,预后良好.     

Prognostic Value of Diametrically Polarized Tumor-Associated Macrophages in Renal Cell Carcinoma

Background

As the most abundant tumor-infiltrating immune cells, tumor-associated macrophages (TAMs) are significant for fostering tumor progression. CD68⁺ TAMs display diversely polarized programs comprising CD11c⁺ proinflammatory macrophages (M1) and CD206⁺ immunosuppressive macrophages (M2). The aim of this study was to determine the survival impact of diametrically polarized TAMs in clear-cell renal cell carcinoma (ccRCC) and their application to stratification of patients according to their prognostic values.

Methods

The study included 185 consecutive patients with ccRCC who underwent nephrectomy between 1999 and 2001. CD68⁺ total and diametrically polarized (CD11c⁺ M1 and CD206⁺ M2) TAM densities were assessed by immunohistochemistry, and the relationships with clinicopathologic features and prognosis were evaluated.

Results

Low CD11c⁺ TAM density and high CD206⁺ TAM density were associated with reduced cancer-specific survival (P = 0.043 and P = 0.017, respectively), whereas CD68⁺ TAM density only had borderline prognostic significance (P = 0.062). Furthermore, combined analysis of CD11c⁺ and CD206⁺ TAMs (CD11c/CD206 signature) had a better power to predict patients’ outcome (P = 0.010). Together with TNM stage, tumor necrosis, and performance status, CD11c/CD206 signature was an independent prognostic factor (P = 0.010). When applied to the University of California Integrated Staging System intermediate-/high-risk group for localized ccRCC, CD11c/CD206 signature could further distinguish patients with dismal prognosis (P = 0.004).

Conclusions

Intratumoral balance of diametrically polarized TAMs is a novel independent predictor for survival in patients with ccRCC. Tipping the balance toward an antitumoral phenotype might be a promising target of postoperative adjuvant therapy.     

Hospital admissions and emergency department visits among kidney transplant recipients

Reducing acute care utilization is a means of improving long‐term patient outcomes. We sought to assess high inpatient (IP) admission and standalone emergency department (ED) utilization within a 9‐month period post‐kidney transplantation and to identify mutable factors to reduce utilization. In this ten‐year retrospective study, 1599 adult kidney transplant recipients were identified. A previous transplant, graft loss, or death within 3 months post‐transplantation excluded 319 patients. Comprehensive resource utilization data were obtained from a statewide database. Those with ≥2 IP admissions or standalone ED visits 4‐12 months post‐transplantation were classified as high utilizers. Multivariable logistic regression models were used for examining associations of predictors with high IP or ED utilization. Of 1280 kidney recipients, 209 and 183 were categorized as IP and ED high utilizers, respectively. Factors significantly associated with high IP utilization included valvular disease, body mass index ≥35, and IP or ED use <3 months post‐transplantation; while factors associated with high ED utilization included IP or ED use <3 months post‐transplantation, younger age, female, smoker, congestive heart failure, depression, and IP or ED use 1 year pre‐transplantation. Inpatient and standalone ED utilization within a 9‐month period after kidney transplantation is high and associated with sociodemographic factors, mutable comorbidities, and healthcare utilization.     

老年人认知衰弱现状及影响因素的研究进展

对认知衰弱的概念及内涵、流行现状及主要影响因素进行综述,老年人认知衰弱的总体发生率为0.72%～50.10%,主要影响因素包括人口和社会经济因素、躯体健康、心理社会因素、生活方式等。提出应全面系统地了解老年人认知衰弱情况并从多维角度对认知衰弱老年人进行照护;我国老年护理需开拓认知衰弱领域的研究视角、研制标准化测量工具及注重干预研究,以期引起国内医护人员对认知衰弱的重视,降低认知衰弱的发生率,提高老年人的健康状况和生活质量,最终促进健康老龄化的实现,同时为我国认知衰弱相关研究的开展提供参考依据。     

腹腔镜联合髂腹股沟淋巴结清扫术在黑色素瘤淋巴结转移中的应用

目的探讨腹腔镜联合髂腹股沟淋巴结清扫术在黑色素瘤淋巴结转移中的应用效果。 方法回顾性分析第四军医大学西京医院2015年5月至2017年2月收治的9例转移性黑色素瘤患者,均为下肢原发灶切除术后、IFN-β治疗期间经影像学检查发现髂血管旁和(或)腹股沟区淋巴结转移。手术方式为腹腔镜自髂血管分叉逆行清扫髂血管旁淋巴结,开放手术清扫腹股沟区淋巴结。 结果9例手术均顺利完成。平均手术时间(150.9±41.08)min、平均术中出血量(55±21.51)ml、平均术后下床活动时间(3.11±1.67)d、平均术后住院时间(8.57±2.19)d,术后病理均证实为髂血管旁淋巴结和(或)腹股沟区淋巴结转移。 结论腹腔镜联合髂腹股沟淋巴结清扫术是治疗下肢黑色素瘤转移的新术式探索,该术式手术创伤较小、恢复较快、清扫彻底,具备一定的临床应用价值。     

急性胰腺炎相关胃肠道衰竭的评价和早期诊断指标

目的探索急性胃肠道损伤分级在急性胰腺炎相关胃肠道衰竭中的应用及其早期诊断指标。方法回顾性分析2013年10月至2016年10月北京协和医院收治的中重度急性胰腺炎患者的临床资料,采用Logsitic回归分析和受试者工作特征曲线评价胃肠道衰竭的早期诊断指标。结果共202例患者纳入研究,其中胃肠道衰竭90例(44.6%)。生存分析结果显示,胃肠道衰竭组患者预后显著下降(P<0.05)。Logistic回归分析结果显示,年龄(OR=1.06,95%CI:1.03～1.09,P<0.001)、入院主诉排气排便停止(OR=7.02,95%CI:2.08～23.66,P=0.002)、血白细胞水平升高(OR=1.09,95%CI:1.02～1.17,P=0.015)、血白蛋白水平降低(OR=0.93,95%CI:0.86～1.00,P=0.048)、血肌酐水平升高(OR=1.02,95%CI:1.01～1.04,P=0.001)是胃肠道衰竭的独立危险因素。入院即刻急性生理与慢性健康评分Ⅱ和急性胰腺炎床旁严重程度指数评分诊断胃肠道衰竭的曲线下面积分别为0.999和0.782。结论胃肠道衰竭...     

宫内感染对新生大鼠早期生长及神经行为发育的影响

探讨宫内感染对新生大鼠出生后早期生长发育和神经行为发育的影响。 通过将大肠埃希菌注入孕15 d的SD大鼠的子宫颈内建立宫内感染大鼠模型,并观察宫内感染对孕鼠分娩的影响。HE染色法观察新生大鼠脑白质组织病理学变化;免疫组织化学染色和蛋白质印迹法检测新生大鼠脑白质组织胶质细胞原纤维酸性蛋白（GFAP）、2′,3′-环核苷酸磷酸二酯酶（CNPase）、神经丝（NF）表达。随机监测新生大鼠早期生长发育和神经行为功能。 孕鼠宫内感染后,子宫和胎盘组织白细胞计数升高,提示建模成功,但宫内感染对分娩无显著影响。新生大鼠7日龄时脑白质部位结构稀疏呈筛网状改变,GFAP表达增加（P＜0.01）,而CNPase和NF表达减少（P＜0.05或P＜0.01）。与对照组新生大鼠比较,感染组新生大鼠出生体质量轻、体质量增长缓慢（P＜0.05或P＜0.01）;耳廓分离、睁眼、平面翻正、负趋地性、听觉惊恐和游泳试验等完成日龄延长（P＜0.05或P＜0.01）。 宫内感染可导致新生大鼠脑白质损伤,并引起新生大鼠早期生长发育及神经行为发育延迟。