黑寡妇蜘蛛螫伤患者的急救护理

对140例被黑寡妇毒蜘蛛蛰伤的患者实施环形封闭,使用肌松药物、抗生素、破伤风抗毒素等对症治疗,并积极防治并发症。结果 140例中,11例死亡,129例痊愈且未留后遗症。住院3～35d,平均14.6d。提出准确及时给药并观察治疗效果及不良反应,有效减轻患者的疼痛;做好患者不同时期的心理护理;密切观察患者生命体征变化及意识状态,观察尿量、尿色、性质的变化以及皮肤黏膜淤点、淤斑和局部伤口等情况,使用特异性抗毒素中和毒素,积极预防严重并发症的发生,可有效挽救患者生命。     

金属带膜自膨式支架在放疗后食管气管瘘中的临床应用

目的：探索放置金属带膜自膨式支架治疗放疗后食管气管瘘的功效厦生存时间。方法：在遥控X光机监视导引下，18例放疗后食管气管瘘的患者放置了自膨式金属带膜支架。结果：18根支架被成功释放，气管食管瘘口完全封堵，饮水呛咳立即改善。并发症胸骨后疼痛13例，气管受压2例，上消化道少量出血8例。结论：置入金属带膜支架是治疗放疗后食管气管瘘安全有效的方法，达到了解除症状，提高生活质量，延长生命的目的。     

产后早期吮吸及健康教育对初产妇泌乳情况及身体康复的影响

目的：探讨产后早期吮吸及健康教育在产妇产后护理中的应用效果。方法将2013年12月至2014年4月在我院进行分娩的80例初产妇随机分为观察组和对照组各40例,对照组采用常规护理,观察组在对照组的基础上进行产后早期吮吸,并加强健康教育,采用综合指标评定两组的护理效果。结果观察组的母婴保健知识的知晓率、护理能力高于对照组,泌乳始动时间少于对照组,泌乳量多于对照组,差异有统计学意义（ P＜0．05）。观察组产后子宫纳入骨盆的时间、恶露时间、并发症、住院时间少于对照组,焦虑、抑郁评分低于对照组,各方面的生活质量评分高于对照组,差异有统计学意义（ P＜0．05）。结论产后早期吮吸及健康教育有利于促进产妇的泌乳能力,改善自护能力,促进身体康复。     

肌钙蛋白Ⅰ及肌红蛋白对非ST段抬高急性冠状动脉综合征的预后评价

目的探讨肌钙蛋白(troponinI,TnI)、肌红蛋白(myoglobin,Mb)对非ST段抬高急性冠状动脉综合征病人预后的预测价值。方法因急性胸痛拟诊非ST段抬高急性冠状动脉综合征病人而连续收入院的120例病人,入院后仔细询问病史、检查体格,并在10min内完成常规12导联心电图检查,同时测定静脉血TnI、Mb。以血TnI1.0μg/L将病人分成TnI阳性组和TnI阴性组;Mb70μg/L分为Mb阳性组和阴性组。随访各组6个月主要心血管事件发生率。结果TnI阳性组及Mb阳性组的随访期因反复心绞痛住院及复合心管事件显著增多。多因素Logistic回归分析显示,TnI阳性较Mb阳性及ST段压低因素对病人随访期复合心血管事件有独立预测价值。结论TnI及Mb水平对非ST段抬高ACS病人的危险分层及心血管事件预测有重要价值。     

心房颤动电重构心房肌Ca2+调控蛋白异常与解剖学改变关系的研究

目的探讨心房肌Ca2+调控蛋白(calcium handling proteins)在心房颤动(atrial fibrilation,AF)电重构中的作用及与解剖学结构改变的关系.方法测定10例慢性AF患者和6例对照组心房肌Ca2+含量和细胞膜L型Ca2+通道(L-type calcium channel)、肌浆网钙泵(sarcoplasmic reticulum calciumadenodinetriphosphatase,SR Ca2+-ATPase)、磷酸受纳蛋白(phospholamban)、兰尼碱受体(ryanodine receptor)和肌集钙蛋白(calsequestrin)的信使核糖核酸(messenger ribonucleic acid,mRNA)表达;测量AF患者左、右心房内径、二尖瓣口面积和肺动脉收缩压.结果与对照组比较,AF患者心肌细胞内Ca2+含量增加[(1 330±770)μg/ml vs(302±31)μg/ml,P<0.01];细胞膜L型Ca2+通道、SR Ca2+-ATP ase和兰尼碱受体mRNA下调[(0.65±0.30)v(0.97±0.19),P<0.01;(0.73±0.13)vs(1.10±0.11),P<0.001;(0.71±0.25)vs(0.90±0.13),P<0.05].SRCa2+-ATPasemRNA表达与左心房内径中度负相关(r=-0.56,P<0.05);与二尖瓣口面积正相关(r=0.70,P<0.05);细胞膜L型Ca2+通道mR-NA表达与二尖瓣口面积显著正相关(r=0.84,P<0.01).结论频率相关的细胞内Ca2+超负荷可能是AF电重构的始动因素,心房肌Ca2+调控蛋白异常是Ca2+超负荷的分子生物学机制,Ca+调控蛋白mRNA表达异常与左心房解剖学改变之间存在内在联系.     

Involvement of calcineurin in angiotensin II-induced cardiomyocyte hypertrophy and cardiac fibroblast hyperplasia of rats

A rapidly emerging body of literature implicates a pivotal role for the Ca2+-calmodulin-dependent phosphatase, calcineurin, as a cellular target for a variety of Ca2+-dependent signaling pathways culminating in cardiac hypertrophy. The aim of the present study was to test whether calcineurin is involved in the signal transduction of angiotensin II (AngII)-induced cardiac myocyte hypertrophy and fibroblast hyperplasia. Firstly, we observed that calcineurin activity was significantly increased in AngII-stimulated cardiac myocytes as well as fibroblasts, but was markedly inhibited by Losartan (50 micromol/l), H7 (50 micromol/l), and Fura-2/AM (5 micromol/l). It is indicated that AngII-induced activation of calcineurin is through an ATI receptor, may be dependent on the sustained increases of [Ca2+]i, and be regulated by protein kinase C. In a second experiment, we found that cyclosporin (0.1-10micromol/l), a specific inhibitor of calcineurin, decreased the protein synthesis rate in AngII-stimulated cardiomyocytes and the DNA synthesis rate in AngII-treated fibroblasts in a dose-dependent manner. In the latter experiment, calcineurin inhibition reduced the mRNA level of the atrial natriuretic factor gene. These results indicate that calcineurin is involved in the signal transduction of AngII-induced cardiomyocyte hypertrophy and fibroblast hyperplasia.     

Immune checkpoint inhibitors combined with chemotherapy/bevacizumab therapy for patients with advanced lung cancer and heavily treated with EGFR mutation: a retrospective analysis

BackgroundEGFR-mutated lung cancer poorly responded to anti-programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) monotherapy. Whether patients with EGFR-mutated lung cancer can benefit from anti-PD-1/PD-L1 therapy combined with other drugs remains controversial. We retrospectively evaluated the safety and efficacy of the PD-1 inhibitor combined with other drugs (chemotherapy and/or bevacizumab) in patients with EGFR-mutated lung cancer, who have progressed on EGFR–TKI treatment to determine the activity of the anti-PD-1/PD-L1 therapy combined with chemotherapy or/and bevacizumab therapy in heavily treated patients with EGFR-mutated lung cancer.MethodsWe identified 56 patients with EGFR-mutated lung cancer treated with PD-1/PD-L1 inhibitors alone or combined with the chemotherapy/bevacizumab therapy. The objective response rates were assessed using RECIST v1.1. Adverse events (AEs) were graded in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events v4.0. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Academic Ethics Committee of Jiangsu Cancer Hospital. (NO. 2019 160), and individual consent for this retrospective analysis was waived.ResultsObjective responses were observed in 6 of 56 (10.7%) patients, and the disease control rate was 53.6% (30/56). The median progression-free survival (PFS) was 3.33 months with 95% CI of 1.58–5.08 months. No patient achieved a complete response. All six patients that achieved PR were treated with the PD-1 inhibitor combined with chemotherapy or bevacizumab therapy. Three of the six patients who achieved PR were treated with radiotherapy combined with PD-1 inhibitor-based therapy. Patients treated with the PD-1 inhibitor-based therapy as second-line therapy showed relatively longer PFS and higher objective response rates than those treated with PD-1 inhibitor-based therapy as third- or late-line therapy (PFS: 5.50 vs. 3.27 months, P=0.301; objective response rates: 25.0% vs. 6.82%, P=0.071). No additional AE profile was observed.ConclusionsThe PD-1 inhibitor combined with the chemotherapy/bevacizumab therapy showed acceptable toxicity profile and moderate efficacy on heavily treated advanced EGFR-mutated lung cancer after the exhaustion of target therapy.     

CARCINOEMBRYONIC ANTIGEN EXPRESSION IN GASTRIC CANCER AS RELATED TO BIOLOGICAL BEHAVIOUR AND PROGNOSIS

Objective: To determine the relationship betweencarcincembryonic antigen(CEA)expression in gastriccancer and biological behaviour or prognosis.Material and Methods: Surgically resected speci-mens of gastric cancer from 104 patients were obtained.The content and distribution of CEA in gastric cancerwere studied by immunohistochemical staining andimmunoelectron microscopic technique. The relationshipbetween CEA in gastric cancer and biological behaviouror prognosis were evaluated.Results: The positivity of CEA Was significantlyhigher in the patients with advanced stage, vascularinvasion and lymph node metastasis than that in thepatients without. The S-year survival rate of thc CEA (-)group was significantly higher than that of the CEA ( )group. Among the patients with advanced stage orlymph node metastasis, the survival rate was higher in theCEA(-) group tban in the CEA( )group.Conclusions: Immunostaining for CEA in gastriccancer tissue may be helpful in differentiating amongtumors that appear similar by c     

RP-HPLC法测定降糖清胶囊中马钱素的含量

建立了测定降糖清胶囊中马钱素含量的 ＲＰ－ＨＰＬＣ法，固定相为Ｓｐｅｒｉｓｏｒｂ－Ｃ_(１８)［ ４．６ｍｍ（ｉｄ）×２５０ｍｍ］色谱柱，流动相为甲醇－水（３０：７０），检测波长为２３６ｎｍ；马钱素的平均加样回收率为９６．５２％。本法快速、专一、重现性好，为降糖溶胶囊质控提供了可靠的检测手段。