CXCR4／SDF-1在肺癌中的表达研究

目的探讨肺癌患者外周血、胸水以及肿瘤组织中骨髓基质细胞衍化生长因子（SDF-1）及其趋化性细胞受体因子4（CXCR4）的表达及其临床意义。方法以酶联免疫吸附试验（ELISA）检测41例肺癌患者及12名正常人的外周血和／或胸水中的SDF-1表达，以免疫组化的方法检测肺癌组织中CXCR4的表达。结果41例肺癌患者外周血SDF-1表达高于正常对照组（P〈0．01），且晚期肺癌患者的表达高于早期患者，恶性度高的表达高于恶性度低的。但在胸水中SDF-1的表达没有差异。肺癌组织中CXCR4的表达强度与肿瘤的分化密切相关。结论肺癌外周血清SDF-1和肿瘤组织CXCR4的高表达与肺癌密切相关，且其高表达可能与肺癌的恶性程度和转移有关。     

109例直肠癌Miles术后造瘘口的优质护理研究

目的探讨直肠癌Miles术后造瘘口的优质护理方法。方法温馨及时的心理护理,正确的人工肛门袋使用方法,正确的造瘘口周围皮肤的护理方法,对造瘘口并发症的精心护理。结果本组患者平均住院13.2 d,所有患者都很快接受了现实,没有患者发生明显的心理障碍,更没有自杀和自残的患者,术后发生造瘘口狭窄5例,经过扩肛后,5例患者均解除了造瘘口狭窄,造瘘口周围皮炎6例,仅是皮肤发红,无皮肤破溃病例,经精心护理后治愈,切口感染10例,经换药治愈7例,二期缝合治愈3例,出血1例,经压迫止血后治愈,无造瘘口肠坏死病例。结论术后的优质护理能够解除Miles手术患者术后的心理障碍和减少造瘘口术后并发症的发生。     

探讨3种痰TB-DNA提取方法在肺结核诊断中的应用价值

目的优选肺结核诊断中理想的痰TB-DNA提取方法。方法选择我院肺科门诊肺结核患者185例,提取其痰液样本,应用煮沸裂解法、酚/氯仿法、以及进口离心柱法进行分析,对比实时荧光PCR结果。结果进口离心柱法下TB-DNA阳性检出率为81.08%(150/185),明显高于煮沸裂解法以及酚/氯仿法,P<0.05。结论在对疑似肺结核患者痰液标本进行检测中,可优先选择进口离心柱法作为TB-DNA的有效提取方法。     

医院门诊药房退药原因分析及对策

目的:分析门诊药房退药原因并提出对策,旨在减少门诊退药。方法:抽取2013年7月—2013年12月572例门诊患者退药审核表进行统计分析。结果:引起退药的主要原因有药品不良反应、患者拒绝使用、临床医师因素、患者病情变化、药品管理原因5个方面。结论:应提高医师、药师业务素质,加强医患沟通,完善医院相关管理制度,以减少退药现象发生。     

ERCP与EST并发出血的相关临床研究

目的 分析胆总管结石ERCP与EST并发出血的相关危险因素,并探讨有效防治措施。方法 回顾性分析皖南医学院弋矶山医院消化内镜中心2012年1月至2012年12月299例胆总管结石患者行ERCP与EST取石术的临床资料。结果 299例患者,术中少量出血52例,明显出血50例,其成功插入乳头时间经方差分析（F=3.713）差异有统计学意义（P=0.026,P〈0.05）;出血病例中,存在憩室21例,出血量与憩室的关系经卡方检验（x2=5.314）差异有统计学意义（P=0.021,P〈0.05）;术中出血患者分别采用内镜下电凝止血与钛夹止血处理,经Fisher精确概率检验法,提示内镜下钛夹止血治疗的止血有效率高于电凝止血治疗（P=0.464,P〈0.05）,并发术后出血8例,其中3例行内科保守治疗有效,1例无效,3例行内镜下止血治疗有效,1例行介入止血治疗并发重症急性胰腺炎。结论 胆总管结石ERCP与EST并发出血与成功插入乳头时间,有无憩室等因素相关,内镜下干预治疗是防治术中术后出血的有效措施。     

Interactions of the active components of Punica granatum (pomegranate) with the essential renal and hepatic human Solute Carrier transporters

Context: Solute carrier transporters (SLCs) are membrane proteins responsible for cellular influx of various substances including many pharmaceutical agents; therefore, they largely impact on drug disposition and elimination in body. Punica granatum Linnaeus (Lythraceae), pomegranate, is a fruit with antidiabetic potential. Oleanolic acid (OA), ursolic acid (UA), and gallic acid (GA) are the major bioactive components of pomegranate. Co-administration of these compounds with other drugs could result in altered drug pharmacokinetics, possibly due to competing for transporter proteins.

Objective: We investigated the interactions of these three compounds with the essential hepatic and renal SLC transporters.

Materials and methods: Uptake of radiolabeled transporter model substrates was assessed in HEK293 cells over-expressing SLC transporters including the organic anion transporters (OATs), organic anion transporting polypeptides (OATPs) and organic cation transporters (OCTs), in the presence or absence of 10.0?µM UA, OA, or GA. Their IC₅₀ values on specific SLC transporters were also evaluated using varying concentrations of the particular compound (ranging from 0.10?nM to 80.0?µM).

Results: Our results demonstrated UA could significantly inhibit OAT3 and OATP2B1 uptake (IC₅₀: 18.9?±?8.20?µM and 11.0?±?5.00?µM, respectively) and GA has a pronounced inhibitory effect on OATP1B3 uptake (IC₅₀: 1.60?±?0.60?μM).

Discussion and conclusion: Our study reports the interactions of OA, UA, and GA with the essential SLC transporters. This information may contribute to elucidating the drug–drug/herb interactions involved with these three compounds and form the basis of therapeutic optimization when drugs are co-administered.     

某二甲医院门诊及住院患者抗菌药物超说明书用药情况对比分析研究

目的了解某二甲医院门诊及住院患者抗菌药物超说明书用药现状,以期进一步规范抗菌药物临床应用行为,并为医疗管理者和卫生决策者提供基线数据。方法随机抽取该院2012年包含抗菌药物的门诊处方及住院医嘱,采集相关信息,依据药品说明书判断其是否属于超说明书用药,然后对比二者的区别。结果门诊患者抗菌药物超说明书用药发生率低于住院;门诊及住院各年龄段患者抗菌药物超说明书用药发生率均有统计学意义(P=0.000),发生率不全相同;门诊及住院不同性别患者抗菌药物超说明书用药发生率均无差异(P>0.05);门诊不同级别医师抗菌药物超说明书用药发生率无差异(P>0.05),而住院不同级别医师抗菌药物超说明书用药发生率有差异(P=0.000)。结论抗菌药物超说明书用药现象比较普遍,反映了药品说明书中规定内容与医师实际医疗行为存在较大差距,应进一步规范医师处方行为,加强抗菌药物管理。     

药品生产企业建立药品不良反应报告和监测管理制度的现状及思考

我国的《药品不良反应报告和监测管理办法》强制要求药品生产企业内部建立药品不良反应报告和监测管理制度。通过分析企业建立报告制度的现状,借鉴欧盟的相关政策要求,探讨改进我国企业落实该报告制度的方法及政府监管方式。     

Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing

Purpose

We assessed indications and outcomes of exchange nailing and augmentation plating for femoral shaft nonunion following femoral nail failure.

Methods

We retrospectively reviewed the records of 21 consecutive patients with femoral shaft nonunion treated with femoral nailing from August 2008 to June 2013. Nonunion cases with infection were excluded from this study. The study population consisted of nine men and 12 women, with an average age of 40 (range 21–61) years. All patients received internal fixation using exchange nailing and an augment plate coupled with decortication and bone graft.

Results

All patients in our study obtained osseous union with a mean time of six (range four to12) months. Mean operation time was three hours (range two to five hours), and mean blood loss was 800 ml (range 500–950 ml). There were no postoperative complications. At the last follow-up, all patients could flex their knees > 110°.

Conclusions

Exchange nailing and augment plating coupled with decortication and bone graft is an effective treatment option for femoral shaft nonunion and has more indications and higher union rate than the popular exchange nailing treatment.     

Meta-analysis of the Efficacies of Extended and Standard Pancreatoduodenectomy for Ductal Adenocarcinoma of the Head of the Pancreas

Background

The purpose of the present study was to evaluate the efficacy of extended pancreatoduodenectomy (EPD) and standard pancreatoduodenectomy (SPD) for ductal adenocarcinoma of the head of the pancreas via meta-analysis.

Methods

Relevant articles (published between 1995 and 2012) were compiled from online data sources. A total of nine studies satisfied the selection criteria, including a total of 973 patients (478 in the SPD group and 495 in the EPD group). Evaluation parameters included 1-, 3-, and 5-year survival, as well as mortality, morbidity, and specific morbidity outcomes.

Results

Meta-analysis revealed (1) differences in morbidity (Odds ratio [OR] = 1.740; 95 % confidence interval [CI], 0.840–3.600; P = 0.140), mortality (OR = 0.890; 95 % CI, 0.560–1.400; P = 0.620), 1-year overall survival (OS) rate (OR = 1.20; 95 % CI, 0.490–2.930; P = 0.69), 3-year OS rate (OR = 0.770; 95 % CI, 0.460–1.280; P = 0.190), and 5-year OS rate (OR = 1.12; 95 % CI, 0.690–1.810; P = 0.560) were not significant between EPD and SPD. (2) For bile leak (OR = 2.640; 95 % CI, 1.040–6.700; P = 0.040), pancreatic leak (OR = 1.740; 95 % CI, 1.040–2.91; P = 0.030), delayed gastric emptying (OR = 2.090; 95 % CI, 1.240–3.520; P = 0.006), and lymphatic fistula (OR = 6.120; 95 % CI, 1.06–35.320; P = 0.040) differences between EPD and SPD were significant, whereas other specific morbidities were not significantly different.

Conclusions

Extended pancreatoduodenectomy does not improve 1-, 3-, 5-year OS rates compared to SPD and there is a trend toward increased bile leak, pancreatic leak, delayed gastric emptying, and lymphatic fistula after EPD.