乳腺癌超声弹性成像面积比与其组织学分级、临床分期关系的初步研究

目的探讨乳腺超声弹性成像面积比（AR）对乳腺癌患者病情发展及预后评估的参考价值。方法回顾性分析105例经病理结果证实的乳腺癌患者临床资料,术前行乳腺常规超声及超声弹性成像检查,分析乳腺癌患者不同组织学分级间、不同临床分期间AR参数的变化情况。结果术前以AR≥1.5为诊断恶性的标准,73例恶性,诊断符合率为69.52%。超声弹性成像AR在各组织学分级、临床分期组间差异有统计学意义（P〈0.05）：组织学分级Ⅰ～Ⅲ级的AR值分别为1.210±0.018、1.470±0.126、1.600±0.028,临床分期Ⅰ～Ⅳ期AR值分别为1.230±0.056、1.540±0.017、1.580±0.025及1.620±0.023,即AR在组织分级较高及临床分期较晚时增大。结论 AR可为乳腺癌病情发展及预后评估提供有价值的参考信息。     

Insulin-induced insulin receptor substrate-1 degradation is mediated by the proteasome degradation pathway.

Insulin receptor substrate (IRS) proteins are important intracellular molecules that mediate insulin receptor tyrosine kinase signaling. A decreased content of IRS proteins has been found in insulin-resistant states in animals, humans, and cultured cells under various conditions. However, the molecular mechanism that controls cellular levels of IRS proteins is unknown. We report that chronic insulin treatment induces the degradation of IRS-1, but not IRS-2, protein in cultured cells. The insulin-induced degradation of IRS-1 can be prevented by pretreatment with lactacystin, a specific inhibitor for proteasome degradation. These data demonstrate, for the first time, that insulin-induced degradation of IRS-1 is mediated by the proteasome degradation pathway. IRS-2 can escape from the insulin-induced proteasome degradation, suggesting the existence of specific structural requirements for this degradation process.     

乳腺癌124例X线病理分析

目的:探讨乳腺钼靶X线片对乳腺癌的诊断价值及病理类型与X线特征的联系。材料与方法:本组收集了124例乳腺癌患者,年龄28～76岁,以40～50岁发病率最高,均经手术病理证实。结果:乳腺癌多发生于外上象限,单侧多见,病理形态比较复杂,其X线特征为:(1)分叶状及毛刺状肿块;(2)晕轮征;(3)恶性钙化等。结论:本病根据X线片不难诊断,尤以细沙型钙化合并棍棒钙化时恶性率极高。对可疑病例应进行追踪观察。     

全直肠系膜切除术治疗直肠癌--附168例报告

目的　探讨全直肠系膜切除术在预防直肠癌术后局部复发中的作用 ,以及同该操作相关的一些并发症。方法　回顾性分析 16 8例直肠癌的临床资料。结果　全组无手术死亡 ,术后随访1～ 36月 ,局部复发 6例 (3.6 % ) ,术后吻合口漏 13例 (10 .7% ) ,多数保肛患者出现便频、便急等症状。结论　全直肠系膜切除术能有效降低直肠癌术后局部复发率 ,提高保肛率 ,但存在吻合口漏 ,控便功能等问题需进一步解决。     

Investigation on current roles of specialized nurses of gerontology

目的 了解广东省老年专科护士临床护理角色的现状,探讨存在的问题,促进其角色的发展.方法 采用自设问卷对54名经过专科培训的老年专科护士的角色现状进行调查.结果 52名(96.3％)老年专科护士在临床实践中开展专科护理工作,27.8％～86.3％承担着教育者、咨询者和科研者的角色.结论 老年专科护士在临床护理实践、研究、咨询、教育这四方面均发挥了一定的作用.应该在加强专科临床护理实践的基础上,积极开展老年护理研究,增加研究成果的利用,进一步探索老年专科护理模式,促进老年专科护理发展.     

Are cystatin C-based equations superior to creatinine-based equations for estimating GFR in Chinese elderly population?

Purpose

Cystatin C has been proposed as a surrogate marker of kidney function. The elderly population accounts for the largest proportion of chronic kidney disease (CKD) patients. The aim of this study was to assess the diagnostic value of serum cystatin C and compare the applicability of cystatin C-based equations with serum creatinine (Scr)-based equations for estimating glomerular filtration rate (GFR).

Methods

The estimated GFR (eGFR) values from six cystatin C-based equations (Tan, MacIsaac, Ma, Stevens1-3) and three Scr-based equations (CG, MDRD, CKD-EPI) were compared with the reference GFR (rGFR) values from ^99mTc-DTPA renal dynamic imaging method.

Results

A total of 110 elderly Chinese (60?C92?year, 71.05?±?7.62?year) were enrolled. Cystatin C had better diagnostic value than Scr (relationship coefficient with rGFR: cystatin C ?0.847 vs. Scr ?0.729, P?<?0.01; sensitivity: cystatin C 0.90 vs. Scr 0.55, P?<?0.01; AUC^ROC: cystatin C 0.857 vs. Scr 0.757, P?<?0.01). All the equations predicted GFR more accurately for rGFR????60?ml/min/1.73?m² than for rGFR?<?60?ml/min/1.73?m². Most equations had acceptable accuracy. The cystatin C-based equations deviated from rGFR by ?12.78?ml/min/1.73?m² to ?2.12?ml/min/1.73?m², with accuracy varying from 64.6 to 82.7?%. The Scr-based equations deviated from rGFR by ?5.37?ml/min/1.73?m² to ?0.68?ml/min/1.73?m², with accuracy varying from 77.3 to 79.1?%. The CKD-EPI, MacIsaac and Ma equations predicted no bias with rGFR (P?>?0.05), with higher accuracy and lower deviation in the total group. The MacIsaac, CKD-EPI and Stevens3 equations could be optimal for those with normal and mildly impaired kidney function, whereas the Ma equation for those with CKD.

Conclusion

Cystatin C is a promising kidney function marker. However, not all cystatin C-based equations could be superior to the Scr-equations.     

胆囊癌发生相关危险因素的探讨

目的 探索胆囊癌发生的相关危险因素,为防治胆囊癌提供理论依据.方法 回顾性分析2000年1月至2010年12月北京协和医院收治的153例胆囊癌患者(胆囊癌组)的临床病理资料,并抽取同期收治的300例胆囊结石患者(胆囊结石组)和300例非胆道疾病的成年患者(对照组)作为对照进行1:2病例对照研究.计数资料采用x2检验,对相关危险因素先进行单因素分析,采用x2检验,筛选出有统计学意义的可疑危险因素,再用多因素Logistic回归方程进行分析.结果 胆囊癌组与对照组患者比较,年龄、胆囊结石病史、绝经年龄、累积行经时间、生育与否及生育次数是胆囊癌的危险因素,差异有统计学意义(x2=58.22,180.14,9.59,24.30,18.66,15.17,P＜0.05);年龄、胆囊结石病史、累积行经时间及生育次数是胆囊癌的独立危险因素(x2=55.76,180.95,24.30,8.54,P＜0.05);进一步分析发现,有胆囊结石的患者罹患胆囊癌的危险性是无相关病史患者的34倍( OR =34.22).绝经年龄越晚(51～55岁)、累积行经时间越长(≥30年)、生育次数较多(3次)的女性患胆囊癌的可能性越大(OR=3.96,9.68,3.51).胆囊癌组胆囊结石患者与胆囊结石组患者比较,年龄、胆囊结石病程、累积行经时间及生育次数是胆囊癌的危险因素(x2=70.66,16.66,11.59,4.69,P＜0.05);年龄、胆囊结石病程及累积行经时间是患胆囊癌的独立危险因素(x2=64.29,8.82,5.58,P＜0.05);进一步分析发现,罹患胆囊癌危险性随着年龄升高而增大,胆囊癌发生的危险性随着结石病程延长而升高.对于女性患者,累积行经时间≥30年也会增加罹患胆囊癌的危险因素.结论 年龄、胆囊结石病史、胆囊结石病程、累积行经时间及生育次数可能是胆囊癌发病的危险因素.对于年龄≥60岁、胆囊结石病程≥3年的患者应切除胆囊,以降低胆囊癌的发病率;女性患者有以上表现者应高度重视,及时诊断和治疗.     

一级学科背景下的高等护理教育改革探析

根据我国国情和护理教育现状,查阅文献,访谈护理专家,提出我国高等护理教育改革措施主要包括护理教育由通才教育转向专科化教育、大力发展护理科研和高等护理教育、扩大招生规模、加强护生综合素质的培养、加强理论和实践的衔接等。     

Pyruvate Effects on Red Blood Cells During In Vitro Cardiopulmonary Bypass With Dogs’ Blood

To investigate the effects of pyruvate (Pyr) on adenosine triphosphate (ATP), endothelial nitric oxide synthase (eNOS), and nitric oxide (NO) in red blood cells (RBCs) during the cardiopulmonary bypass procedure (CPB), blood, 500 mL, was collected from each of 10 healthy dogs (weight 12–18 kg). The blood was divided into two parts (250 mL each) and randomly assigned into the control group (Group C, n = 10) or the Pyr group (Group P, n = 10). The blood was commingled with an equal volume of 0.9% NaCl and pyruvated isotonic solution (Pyr 50 mM) in the extracorporeal circuit in the two groups, respectively. The CPB procedure was fixed at 120 min, and the transferring flow was 4 L/min. Contents of ATP in RBCs, eNOS activities, and NO productions in plasma were measured before CPB and during CPB at 30, 60, 90, and 120 min in both groups. The ATP level, eNOS activity, and NO production were not different prior to CPB between the two groups. A decline of ATP levels was shown in both groups but remained significantly higher in Group P than in Group C at the same time points during in vitro CPB (P < 0.01). Values of eNOS and NO were significantly increased in Group C but markedly reduced in Group P during CPB, compared with pre‐CPB (P < 0.01). The CPB procedure significantly damaged dogs’ RBCs in the ATP level, eNOS activity, and NO production, in vitro, but Pyr effectively protected RBCs in these functions during CPB. Pyr would be clinically protective for RBCs during CPB.     

神经外科设置气道管理专职护士的实践

目的 探讨神经外科设置气道管理专职护士在提高人工气道患者气道管理质量的作用.方法 将120例颅脑损伤后气管切开患者随机分成对照组和观察组各60例,对照组采用小组制护理,即护理小组成员共同对气管切开患者实施气道护理.观察组由气道管理专职护士对气管切开患者实施气道管理.结果 观察组肺部感染发生率及其他气管切开相关并发症发生率显著低于对照组(P＜0.05,P＜0.01);观察组的气道管理质量、健康教育知晓率、服务满意率显著优于对照组(均P＜0.01).结论 在神经外科设置气道管理专职护士,可为患者提供规范化、个性化、连续性的气道管理,提高气道护理质量,促进护理专科发展.