按揉合谷穴在阑尾切除手术中的应用

[目的]观察减轻阑尾切除手术过程中的牵拉反应有效方法。[方法]实验组30例采用按揉合谷穴配以言语引导;对照组30例只给予言语安慰。[结果]实验组优良率80%,对照组优良率43%。[结论]在阑尾切除手术中对患者的合谷穴进行正确及时的按揉,能很好的缓解和防治阑尾切除手术中因牵拉阑尾时所引起的不良反应。     

基于膜转运体在药物吸收、分布、代谢和排泄过程中功能的药物设计(英文)

膜转运体介导了多种药物的摄取和外排过程, 在药物吸收、分布、代谢和排泄 (ADME) 过程中起了重要作用。膜转运体的独特性质使其成为药物研发中的潜在靶标, 合理利用这一靶标可使药物具有理想的药动学特征包括靶向分布,临床疗效改进和不良反应的降低。本文综述了目前主要的摄取和外排转运体包括溶质转运蛋白 (SLC) 超家族和三磷酸腺苷结合盒超家族 (ABC) 的特异性组织分布, 转运功能和底物谱。例举了几个基于转运体的改良药物ADME特性的成功例子。在本文最后探讨了药物设计研发中常用于研究药物和转运体之间相互作用的体内体外的研究方法。     

Crk and CrkL present with different expression and significance in epithelial ovarian carcinoma

Adaptor protein Crk and CrkL were thought to be closely related because both consist of one SH2 and two SH3 domains and share 60% homology with the highest identity within their functional domains. Their functions were most presumed to be in part, if not all, redundant. And both were suggested to be implicated in carcinogenesis. In this study, both Crk and CrkL presented with much higher expression in ovarian cancer tissues than those in normal and benign ovarian tissues. However, in contrast with CrkL, high Crk expression displayed close association with advanced stages and high-grade diseases. Furthermore, the differential binding selectivity of Crk and CrkL to their downstream partners Dock 180 and C3G was demonstrated in ovarian cancer cell line SKOV3 through coimmunoprecipitation. Additionally, Crk-knockdown cells presented with changed morphology, reduced growth, and cell invasion but remained viable. In contrast, all CrkL-knockdown cells could not survive over time, gradually detaching from the bottom of plastic dish. In conclusion, these two highly homologous proteins hold features that allow for the differential association with each binding molecules, thereby activating different signaling pathways and being involved in diverse roles in ovarian cancer.     

Evaluation of unmeshed and 1:1 meshed AlloDerm bolsters for stapled rectal anastomoses in a porcine model

INTRODUCTION: The major morbidity of colorectal anastomoses is leaks. The concept of staple-line reinforcement is a growing area of interest. In this study, we evaluated the feasibility and effect of utilizing AlloDerm to bolster end-to-end stapled rectal anastomoses in a porcine model. METHODS: A total of 30 female 45-kg domestic pigs were studied, and each served as its own control by creating a bolstered and unbolstered anastomosis in each animal. All anastomoses were created with a 29-mm end-to-end stapling device. Bolstered anastomoses were randomized to proximal and distal positions along the rectum, and each rectorectal anastomosis was separated by an average of 10 cm. In 20 pigs, an unmeshed bolster of a 0.5-0.7-mm thickness was used. The remaining 10 pigs had a 1:1 meshed bolster that was 0.34-0.51 mm thick. The animals were survived for 14 days. Barium enemas were then performed and the two anastomotic sites harvested, and each anastomosis underwent burst testing. The internal diameter of each anastomosis was measured and a biochemical analysis was performed for matrix metalloproteinase (MMP), elastin and collagen content. RESULTS: The unmeshed bolstered anastomoses burst fewer times than the unbolstered anastomoses (P=0.004) and had higher burst pressures (P=0.023), though their anastomotic circumferences were smaller (P=0.007). Meshed bolsters offered no strength advantage to anastomoses and were significantly (P=0.009) smaller than unbolstered anastomoses in the same animal. No difference in elastin, collagen, or MMP content was observed between bolstered and unbolstered groups. No animals had clinical or radiographic leaks. CONCLUSIONS: The routine use of unmeshed and 1:1 meshed AlloDerm bolsters is safe and does not appear to inhibit healing in elective colorectal surgery on healthy subjects. AlloDerm may have a role as a tissue bolster in select patients who are more prone to develop anastomotic leaks.     

子宫内膜异位症在位内膜Bcl-2的表达及其意义

目的 检测子宫内膜异位症在位子宫内膜Ｂｃｌ－２的表达，探讨其在子宫内膜异位症发生机制中的作用。方法 采用免疫组织化学法（ＳＰ法）对４５例盆腔子宫内膜异位症和４４例壁间型子宫肌瘤患者在位子宫内膜进行Ｂｃｌ－２表达检测。结果 （１）对照组Ｂｃｌ－２主要表达于子宫内膜腺上皮细胞胞浆和／或胞膜。增生期Ｂｃｌ－２表达显著高于分泌期（Ｐ〈０．００１）。（２）子宫内膜异位症组Ｂｃｌ－２亦主要表达于子宫内膜腺上皮     

Evaluation of endocrine therapy combined with intensity modulated radiation therapy in patients with advanced prostate cancer

Objective The aim of this study was to study the effect of endocrine therapy combined with intensity-modulated radiation therapy in patients with advanced prostate cancer. Methods The clinical data of 231 patients with advanced prostate cancer treated with radiotherapy in our hospital from May 2010 to March 2018 were collected. A total of 135 patients were treated with endocrine therapy combined with intensity-modulated radiotherapy, and 96 patients were treated with intensity-modulated radiotherapy only because of drug allergy, serious adverse reactions, and economic reasons. Two months after the end of the treatment, the short-term curative effect was evaluated using imaging reexamination. The total prostate-specific antigen (TPSA) and free prostate-specific antigen (FPSA) were detected before and 2 months after the end of the treatment. All patients were followed up for at least 3 years, and the metastasis-free survival rate and cumulative survival rate of the two groups were calculated. Results The remission rates (RRs) of the observation and control groups were 64.45％ and 46.87％, respectively; the difference was not statistically significant (P > 0.05); however, the efficacy distribution of the endocrine therapy combined with intensity-modulated radiotherapy group was significantly better than that of the intensity-modulated radiotherapy group (P < 0.05). There was no significant difference in clinical efficacy between the two groups in different TNM stages and Gleason grades. After treatment, the levels of TPSA and FPSA were significantly decreased compared with those before treatment; however, the decrease in the endocrine therapy combined with the intensity-modulated radiation therapy (IMRT) group was significantly higher than that in the IMRT group (P < 0.05). Although there were no significant differences in the 1-year and 3-year cumulative survival rates between the two groups, the 1-year and 3-year metastasis-free survival rates of the endocrine therapy combined with the IMRT group were 60％ and 38.17％, respectively, which were significantly higher than those of the IMRT group (37.5％ and 20.83％, P < 0.05). Conclusion Endocrine therapy combined with IMRT significantly improved the clinical efficacy of advanced prostate cancer, reduced PSA (prostate specific antigen) levels, and improved the metastasis-free survival rates.     

黏膜黑色素瘤原发部位与转移部位相关性分析

目的:探讨黏膜黑色素瘤的原发部位与转移部位的相关性及基因组学特征。方法:对经病理确诊为黏膜黑色素瘤的92例患者进行流行病学调查,对肿瘤原发部位及转移部位的相关因素进行总结分析。结果:头颈部为黏膜黑色素瘤高发部位46人（50%）,其次为泌尿生殖系统25人（27.17%）,肛管直肠21人（22.83%）。最常见转移部位均为区域淋巴结,头颈部、肛管直肠、泌尿生殖系统分别为63.04%、57.14%、32.00%;其次为肺转移,头颈部、肛管直肠、泌尿生殖系统分别为23.91%、19.05%、32.00%;肛管直肠和泌尿生殖系统来源黑色素瘤还易出现肝转移,分别为28.57%和20.00%。进行基因检测的33人中,BRAF V600E突变2例（6.06%）,CKIT突变1例（3.03%）,NRAS突变4例（12.12%）。结论:淋巴结转移最常见于头颈部黑色素瘤,其次为肛管直肠黑色素瘤,泌尿生殖系统来源黑色素瘤淋巴结转移比例较低;局部复发伴淋巴结转移在头颈部黑色素瘤约占1/3。基因检测及靶向治疗为更多患者带来生存获益。     

二氧化氯对不同载体污染菌的杀灭效果

用载体定量杀菌试验法观察了非吸附型稳态固体二氧化氯对不同载体上污染菌的杀灭效果。结果表明,用含二氧化氯120 mg/L对玻片、不锈钢片、亚麻布片上大肠杆菌杀灭99.9％以上所需时间依次为5、10、20 min;用含二氧化氯150 mg/L对玻片和不锈钢片上枯草杆菌黑色变种芽孢杀灭100％所需时间分别为15 min和20 min,对亚麻布上作用20 min则只能杀灭99.89％。杀灭效果依三种载体种类不同而异,玻片上细菌较易杀灭,不锈钢片次之,亚麻布片上细菌较难杀灭。     

1例口服药物导致大疱性表皮松解坏死型药疹患者的护理

<正>药疹又称药物性皮炎,是药物通过口服、注射、吸入等途径进入人体后引起的皮肤黏膜炎症或非炎症性反应[1]。临床上常将重症多型红斑型、大疱性表皮松解坏死型、红皮病型或剥脱性皮炎型药疹称为重症药疹,其危害性大,死亡率高达25%~35%[2]。大疱性表皮松解坏死型药疹是药疹中最严重的一种类型,常由解热镇痛剂、抗生素、磺胺类、巴比妥类等药物引起。该病起病急,进展快,全身中毒症状严重,皮损