MRI成像对子宫内膜癌侵犯肌层的评估

目的探讨MRI对子宫内膜癌肌层浸润深度的评估价值。方法回顾性分析67例经分段刮宫并施行手术治疗的子宫内膜癌患者MRI表现,并与术后病理结果进行对照。结果 MRI判断子宫内膜癌局限于内膜、浸润浅肌层、浸润深肌层及浸透浆膜层的准确性分别为92.5%、80.5%、88.0%、80.5%。结论磁共振可多方位、多序列、多角度成像,对软组织有较高分辨率,对准确判断子宫内膜癌肌层有无浸润具有明显优势。     

Efficacy of radical cystectomy plus adjuvant intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced bladder cancer

Background Bladder cancer is the ninth most common cancer in the world; fewer than 15％ of transitional-cell carcinoma patients survive 2 years if left untreated.Although radical cystectomy is the standard treatment of choice,much of them relapse and the necessity of adjuvant chemotherapy is still under debate.The aim of the study was to evaluate the efficacy of adjuvant intraarterial chemotherapy （IAC） with gemcitabine and cisplatin （GC） on locally advanced bladder cancer.Methods This is a retrospective study on 60 patients with locally advanced bladder carcinoma who underwent radical cystectomy between May 2000 and June 2011.Patients were studied in two groups based on IAC and followed up for up to 5 years.Results Among 60 patients,there were 25 patients who underwent IAC （GC） after radical cystectomy （the IAC group） and 35 patients who underwent radical cystectomy alone （the control group）.Although not significant,the relapse rates were slightly reduced in the IAC group than in the control group.Patients with IAC had a reduction in mortality compared with patients without IAC over 5 years.Specifically,IAC significantly reduced about 82％ of mortality within the first year （hazard ratio=0.18,95％ Cl 0.03-0.97,P=-0.04）.Additionally,IAC was well tolerated and safe.The most common adverse effect was transient myelosuppression （10/25,40％）,which was resolved by various medical treatments.Conclusions Compared with radical cystectomy alone,radical cystectomy in combination with adjuvant IAC moderately but significantly reduces 1-year mortality.Our preliminary data showed only marginal benefit for the early survival.However,a randomized clinical study is needed to determine the long-term survival benefit.     

‘Struggling to be an insider’: a phenomenological design of new nurses’ transition

Aims and objectives. To obtain a comprehensive understanding of the transition process of new nurses in Taiwan. Background. The transition period for new nurses can be a daunting and traumatic experience. The large number of newly graduated Taiwanese nurses who resign from their jobs within three months indicates that this process can be complicated. However, the problems associated with the experiences of new nurses have not yet been recognised. Design. We adopted a phenomenological design using focus group interviews. Methods. Sixteen new nurses (less than one year working experience) participated in eight weekly group interviews lasting two hours each to grasp their experience of ‘being new’. Interview data were analysed according to Sloan’s (2002) three moments, and the whole process of analysis followed the suggestions of Agar (1986) , which was performed in a close collaboration between researchers until the consensus about the findings could be reached. Results. The overarching pattern of the transition process of new nurses becoming experienced members of the clinical nursing team was revealed as a journey of ‘struggling to be an insider’. This phenomenon was characterised by four themes, including (1) ‘being new as being weak’, (2) ‘masking myself’, (3) ‘internalising the unreasonable’ and (4) ‘transforming myself to get a position’. Conclusions. While Western culture view abusive indoctrination of new nurses as toxic behaviour, under the Chinese traditions of yield, tolerance and self‐oppression, following the power hierarchy and seeking harmony, the transition of new nurses is interpreted differently. Relevance to clinical practice. Recognition of the journey of ‘struggling to be an insider’ helps nurse administrators to (1) gain a better understanding of what new nurses encounter in their transition process, (2) help new nurses without harm, (3) improve in‐service training programmes and (4) retain future nurses.     

Prophylactic juxtapapillary laser photocoagulation in pediatric morning glory syndrome

AIM: To determine the anatomic and visual outcomes of prophylactic juxtapapillary laser photocoagulation treatment alone in the prevention of retinal detachment (RD) in a cohort of pediatric patients diagnosed with morning glory syndrome (MGS). METHODS: A total of 24 eyes of 22 consecutive patients aged 0-15y diagnosed with MGS treated with prophylactic juxtapapillary laser photocoagulation alone were reviewed. Data including demographics, ocular examination, anatomic and visual outcomes, following treatment and complications were collected. RESULTS: Two patients had bilateral laser treatment and 20 had monocular laser treatment. The age at treatment of 13 (59.1%) patients was less than 12mo. The presenting symptoms included strabismus (6/22, 27.3%), decreased vision (2/22, 9.1%), and routine fundus screening (14/22, 63.6%). Fifteen (68.2%) patients underwent cranial magnetic resonance imaging (MRI) examinations, and 3 of those 15 (20.0%) had abnormal findings in the nervous system. Based on preoperative wide-field fundus photography and B-scan echography, all (100.0%) eyes had no obvious RD. On postoperative 1mo and 6mo and the following follow-ups, the anatomic outcomes of all eyes remained stable. The mean follow-up duration was 27.7±17.5mo. No severe complications were found. Preoperative visual acuity acquired from 2 (9.1%) patients ranged from light perception to 20/200. Postoperative acuity acquired from 11 (50.0%) patients ranged from light perception to 20/125. CONCLUSION: The preliminary anatomic and visual outcomes of prophylactic juxtapapillary laser treatment alone in pediatric MGS patients are relatively stable in a short-term follow-up. Further long-term clinical observation will be needed to confirm its efficacy and safety.     

双相障碍的功能损害及相关因素

本文目的是探讨双相障碍社会功能和认知功能的特点及其影响因素,为临床识别与干预提供参考。研究显示,双相障碍功能损害显著,即使在稳定期,双相障碍患者仍存在不同程度的认知功能和社会功能损害,双相障碍的功能损害可能存在病理心理机制和相关影响因素。本文从双相障碍社会功能损害、认知功能损害和二者的关系等方面进行阐述,并总结当前研究的不足之处。     

微创经皮伤椎置钉治疗胸腰椎骨折:6个月随访脊柱生物力学变化

背景:脊柱微创外科的迅速发展,对于脊柱骨折尤其是胸腰椎骨折的治疗在器械和理念上近年来都不断迅速更新,减少了手术创伤、缩短康复时间、提高了治疗满意度.目的:对比微创经皮与开放伤椎置钉在无神经损伤胸腰椎骨折治疗中的应用效果.方法:回顾性分析解放军东部战区海军医院2015年1月至2018年12月收治的52例无神经损伤胸腰椎骨...     

船舶噪声对豚鼠耳蜗微音电位响应曲线的影响

在排除电场干扰伪迹后，耳蜗微音电位响应曲线可以作为反映近全耳蜗电生理功能的一项测试指标。能方便而迅速地完成测试，结果可靠。船舶噪声暴露后，显示耳蜗损伤频带主要在３．１５～８ｋＨｚ范围。这与人噪声性听力损失的特征非常类似。