肾上腺皮质髓质混合性病变的诊治研究

目的：提高对肾上腺皮质髓质混合性病变的诊治水平。方法：总结1987-2007年29例肾上腺皮质髓质混合性病变患者的临床资料。临床表现高血压29例,伴头痛16例、心悸10例和肌无力10例。10例血清钾2.4-3.2mmol／L,平均2.87mmol／L。血皮质醇9例增高,节律异常2例。24h尿香草基杏仁酸8例增高。2004年后8例24h尿甲氧基去甲肾上腺素中1例增高;24h尿甲氧基肾上腺素中2例增高。24例中血浆肾素：卧位中9例增高,2例降低。立位中7例增高,6例降低。血管紧张素：卧位中7例增高;2例降低。立位中6例增高,4例降低。醛固酮：卧位中5例增高,立位中3例增高。CT扫描检查：7例。肾上腺增生,14例肾上腺结节状增生,8例腺瘤,平扫CT值2.6-41.0Hu,平均21.0Hu;增强CT值26.0-74.3Hu,平均57.0Hu。结果：开放手术8例,后腹腔镜手术21例,手术时间：开放90-180min,平均110min;后腹腔镜25-70min,平均45min。术中血压变化6例〉50mmHg,23例〈50mmHg。术后7-10天出院。29例中26例随防时间1-5年手术部位未见增生、结节及肿瘤复发。18例患者血压正常,8例仍需服用降压药控制血压,但药物种类和剂量减少。病理诊断：13例肾上腺皮质髓质增生,3例肾上腺皮质髓质增生,皮质增生为主,4例肾上腺皮质髓质增生,髓质增生为主,1例。肾上腺皮质髓质增生伴嗜铬细胞瘤,1例肾上腺皮质结节状增生伴髓质增生,3例肾上腺皮质腺瘤伴皮质髓质增生,4例肾上腺皮质腺瘤伴髓质增生。结论：肾上腺皮质髓质混合性病变临床少见,确诊靠病理诊断。手术是治疗的主要方法,腹腔镜下手术值得推荐。     

Expressions of connexin and par-3 in the distal margin of rectal cancer after ultra-low anterior resection

This study examined the expression of connexin and protease-activated receptor 3 （par-3） in the distal resection margin of rectal cancer and the correlation of the expression of the two proteins with tumor relapse. A total of 40 patients with rectal cancer underwent ultra-low anterior resection with curved cutter stapler. The pathological specimens were divided into 3 groups in terms of sampling sites： tumor group, 2.0-cm group （in which the tissues were harvested 2.0 cm distal to the tumor tissues）, 3.0-cm group （in which the tissues were taken 3.0 cm away from the tumor tissues）. All the samples were pathologically observed and then measured for the expression of connexin and par-3 by employing immunohistochemistry and Western blotting. The operations in this series went uneventfully. No anastomotic stoma bleeding, stenosis and death occurred postoperatively. Histopathologically, in the tumor group, epithelial cells lost normal pattern of arrangement and polarity, and were loosely connected and even detached. In the 3.0-cm group, the epithelia had normal appearance, obvious cell polarity and essentially intact cell junction. Immunohistochemistry and Western blotting indicated that the 3.0-cm group had the strongest expression of connexin and par-3, and the expression in the 2.0-cm group and the tumor group was relatively weak. There existed significant difference in the expression of the two proteins among the three groups （P〈0.05 for all）. It was concluded that the down-regulated connexin and par-3 in the distal margin of rectal cancer tissues may indicate the progression of the disease and high likelihood of recurrence and metastasis. Although no tumor cells were found in the sections of the 2.0cm group, the decreased expression of connexin and par-3 may suggest the development of anaplasia and the increased odds of tumor relapse. Therefore, we are led to speculate that tumor resection only including 2.0 cm of unaffected rectum could not completely avoid the distant metastasis and local relapse.     

Sex- and age-dependent effects of early postnatal sibling deprivation on spatial learning and memory in adult rats

In this study, we investigated the effects of early postnatal sibling deprivation (EPSD) on spatial learning and memory in adult rats. Litters were culled to one pup with its mother on postnatal day (PN) 1 or 7 and their spatial learning and memory ability were examined with Morris water maze in adult. EPSD on PN1 improved, but on PN7 impaired performance of the spatial learning task in adult female rats. However, EPSD did not have any effect on the spatial learning ability in adult male rats.     

家兔全血细胞复阻抗谱的实验研究

目的 建立家兔全血细胞复阻抗谱的数据特征参数.方法 在0.01～100MHz频率范围,利用4294A阻抗分析仪测量了10只家兔30个血液样本的交流阻抗,通过Bode图、Nyquist图、Nichols图谱的数据分析,建立了家兔血液细胞电生理的频率特性.结果 (1)家兔血液细胞阻抗幅模最和相位角具有频率依从性.(2)家兔血液细胞阻抗谱具有两个特征频率:第1特征频率fC1=2.58MHz,第2特征频率fC2=5.21 MHz.结论 通过阻抗谱分析法可以确定血液细胞频率特性.     

肿瘤三维治疗计划系统的临床参数测量与验证

目的 对瓦里安Eclipse三维治疗计划系统(3D-TPS)进行临床应用前的系统参数测量与验证,并进行分析讨论.方法用三维水箱和剂量仪对3D-TPS所需的临床参数进行检测,并将监测结果输入到3D-TPS中,验证其符合程度,在射野内用电离室对水箱中感兴趣的四处点剂量进行测量,并对电子束"虚源"位置进行测量,最后再分别验证3D-TPS中计算剂量和电子束"虚源"位置(即有效源皮距)的实测值与计划值之间的符合性.结果 3D-TPS的计算曲线与瓦里安Clinac 23EX直线加速器上实测参数曲线符合度很好,并且实测剂量与3D-TPS中计算剂量相对误差在-0.55%～1.12%之间,平均误差为0.66%.电子束"虚源"中的有效源皮距实测值与瓦里安公司提供的有效源皮距参考值之间的相对误差在1.27%～1.86%之间,平均误差为1.62%.结论瓦里安Eclipse 3D-TPS能很好地满足三维适形及调强放射治疗的临床需要.     

Detection of parvovirus B19 nucleic acids and expression of viral VP1/VP2 antigen in human colon carcinoma

OBJECTIVES: The aim of this study was to evaluate whether parvovirus B19, a common infectious pathogen in humans, also was involved in human colon carcinoma. METHODS: A total of 119 paraffin-embedded specimens of colon polyps, adenocarcinomas, carcinoma-adjacent tissues, and normal controls were processed for nested polymerase chain reaction (PCR), in situ hybridization (ISH), immunohistochemistry (IHC), and laser capture micro dissection detection of B19 DNA and protein. The expression of cyclo-oxygenase-2 (COX-2) in the colon- cancer cells (Lovo) transfected by inducible vector for VP1u was determined by western-blot analysis. RESULTS: B19 DNA was detected in 94.6% (35/37) of colon adenocarcinomas, 67.6% (25/37) of adjacent noncancerous tissues, 85.6% (30/35) of polyps, and 60.0% (6/10) of normal controls by nested PCR, respectively. Analysis of the microdissected material confirmed the presence of viral DNA in colonic neoplastic epithelium. ISH detected B19 DNA in 81.1% (30/37) of colon adenocarcinomas, 43.2% (16/37) of adjacent noncancerous tissues, 74.3% (26/35) of polyps, and 50.0% (5/10) of normal controls, respectively. B19 protein VP1/VP2 was found in 78.4% (29/37), 32.4% (12/37), and 57.1% (20/35) of colon adenocarcinomas, tumor-adjacent tissues, and polyps, respectively, but not in normal colons (none of 10). There were significant differences in nested PCR, ISH, and IHC between adenocarcinoma and non-neoplastic adjacent tissues, and between adenocarcinoma and normal controls. Transfection of colon-cancer cells (Lovo) by inducible vector for VP1u resulted in marked upregulation of cyclo-oxygenase-2 proteins. CONCLUSIONS: Parvovirus B19 nucleic acids commonly exist in human colon tissues and VP1/VP2 antigen is preferentially located in colon polyps and adenocarcinomas lesions. B19 viral products VP1u may induce important oncogenic pathways in colon-cancer cells.     

Protective effect of glycyrrhizin, glycyrrhetic acid and matrine on acute cholestasis induced by alpha-naphthyl isothiocyanate in rats

Alpha-naphthyl isothiocyanate (ANIT) is a known hepatotoxicant that causes acute cholestatic hepatitis characterized by the infiltration of neutrophils around bile ducts and necrotic hepatocytes. The effects of glycyrrhizin (GL), 18beta-glycyrrhetinic acid (GA), matrine (MT), oxymatrine (OMT), salvianolic acid B (SAB), silymarin (SI) and dexamethasone (DEX) on ANIT-induced acute cholestasis in rats were investigated. Serological and histological data demonstrated that the administration of GL, GA or MT all protected against hepatocyte injury and cholestasis induced by ANIT. Furthermore, the bile flow and the accumulative bile excretion of ketoprofen glucuronide (KPG), that were significantly suppressed by ANIT, were preserved in rats administered GL, GA or MT. DEX protected against acute cholestasis but did not protect against hepatocyte necrosis and elevated serum alanine aminotransferase levels following ANIT administration. Rats administrated OMT, SAB or SI were not resistant to ANIT toxicity. In summary, the protective effect of DEX is directed toward cholangiocytes rather than hepatocytes whereas the natural products, GA, GL and MT, exhibit significantly better protective effects against ANIT-induced liver damage including the protection of hepatocytes as well as cholangiocytes.     

Sex difference in effects of typical and atypical antipsychotics on glucose-insulin homeostasis and lipid metabolism in first-episode schizophrenia

OBJECTIVE: The present study was to investigate the sex difference in effects of clozapine, olanzapine, risperidone, and sulpiride on glucose and lipid metabolism in first-episode schizophrenia. METHOD: One hundred twelve patients with schizophrenia were assigned randomly to receive clozapine, olanzapine, risperidone, or sulpiride for 8 weeks. Planned assessments included body mass index, waist-hip ratio, fasting glucose, insulin, C-peptide, insulin resistance index (IRI), cholesterol and triglyceride levels. All measures were collected at baseline and at the end of the 8-week treatment. RESULTS: After treatment, waist-hip ratio and triglyceride and IRI levels of men were increased higher than that of women in clozapine and olanzapine groups. In sulpiride group, body mass index and triglyceride, insulin, and IRI levels of women increased higher than those of men. There was no significant sex difference for all assessments in risperidone group. Insulin, C-peptide, and IRI, but not fasting glucose levels, were significantly increased in the 4 groups. Cholesterol and triglyceride levels were significantly increased in the clozapine and olanzapine groups. Patients treated with clozapine and olanzapine had higher fasting insulin, C-peptide, and IRI levels than those treated with risperidone and sulpiride. CONCLUSIONS: These results suggest that clozapine, olanzapine, and sulpiride had effects on glucose and lipid metabolism in first-episode schizophrenia with sex difference. Clozapine and olanzapine seem to have the greatest potential to induce glucose and lipid metabolism abnormalities, and risperidone has the least.     

广东省急诊护士灾害护理核心能力现状及其影响因素分析

目的　调查广东省急诊护士灾害护理核心能力现状并分析其影响因素。方法　采用便利抽样法,选取2021年11月10日至2021年11月20日期间在广东省各大医院临床工作的286名急诊科护士为研究对象,由性别分布统计得出：其中男护士45（15.7％）名,女护士241（84.3％）名。由年龄分布统计得出：20岁以下的护士7（2.4％）名,20～29岁的护士100（35.0％）名,30～39岁的护士139（48.6％）,40～49岁的护士36（12.6％）名。采用一般资料问卷、灾害护理核心能力问卷、护士创新行为量表对其进行调查,使用t检验、方差分析、秩和检验进行单因素分析,使用Pearson相关分析进行相关性分析,使用多元线性回归分析进行多因素分析等统计学方法,检验水准为双侧α=0.05,分析其灾害护理核心能力现状及其影响因素。结果　286 名急诊科护士灾害护理核心能力总均分为（3.210±0.735）分;单因素关联性分析显示不同特征的灾害护理核心能力得分比较结果为：性别（t=3.049、 P=0.003）、年龄（t=4.159、 P=0.003）、婚姻状况（t=6.285、 P<0.001）、工作年限（t=3.508、 P=0.008）、科室职务（t=5.091、 P=0.007）等差异均有统计学意义（均P<0.05）。影响灾害护士护理核心能力的多元线性回归分析结果为：年龄（t=2.766、 P=0.006）、创新能力（t=15.902、 P<0.001）是急诊护士灾害护理核心能力的主要影响因素（ P<0.05 ）,可解释总变异的 52％ 。结论　广东省急诊科护士灾害护理核心能力有待提高。急诊护理管理者应根据实际情况创建和优化灾害救援队伍,强化急诊护士灾害护理核心能力的培养,并重视培养灾害护士的创新能力,提高灾害救护质量。     

角膜病患者滴眼液使用规范现况的调查分析

目的　调查角膜病患者滴眼液规范使用现况,为正确使用滴眼液的健康教育提供指导。方法　将2021年8月至2022年2月在济南市第二人民医院眼科病房接收的角膜病患者346例作为调查对象,由经过培训后的1名眼科专科护士观测患者未开展滴眼液使用相关教育前的滴眼液使用过程,并评价其眼药水滴注行为的规范性;采用济南市第二人民医院眼科病房设计的《滴眼液规范使用认知调查表》调查角膜病患者滴眼液规范使用相关认知。结果　346例患者中,男156例（45.09%）,女190例（54.91%）;年龄30岁及以下36例（10.40%）,>30～40岁32例（9.25%）,>40～50岁47例（13.58%）,>50～60岁87例（25.14%）,>60～70岁94例（27.17%）,>70岁50例（14.45%）。专科护士对346例角膜病患者1次滴眼液使用行为观测发现,43.93%（152/346）的患者在滴注眼药水前未洗手;41.53%（49/118）的患者滴注混悬液型眼药水前未摇匀;41.62%（144/346）的患者滴注眼药水未选择正确的仰卧头后仰位;43.93%（152/346）的患者滴注眼药水时眼睛未向头顶方向看;43.06%（149/346）的患者眼药水孔直接与眼球接触;53.47%（185/346）的患者滴注时瓶口和睫毛接触;63.29%（219/346）的患者眼药水滴注时未按压鼻泪管;仅27.27%（42/154）的患者在眼药水外溢后正确选择了纸巾擦拭;36.13%（125/346）的患者滴注后立即揉按眼睛;69.08%（239/346）的患者滴注完毕后未执行牵拉眼睑并闭眼1 min以上的正确行为。问卷调查显示,346例患者中,34.97%（121/346）的患者认为滴注2种及以上眼药水时,间隔时间>10 min;53.18%（184/346）的患者认为滴眼液需兼顾温度、光线,参考说明书妥善保存;56.36%（195/346）的患者认为需根据医生或滴眼液说明书的建议滴眼;55.49%（192/346）的患者认为滴眼液开封后,需注意保质期;56.07%（194/346）的患者认为在2种及以上滴眼液滴注时需先滴刺激性弱的,后滴刺激性强的;58.96%（204/346）的患者认为每次眼药水滴注量为1～2滴;73.41%（254/346）的患者认为滴眼后出现异常症状需立即停药/就医;73.70%（255/346）的患者认为滴眼液药品颜色改变、浑浊时立即停用;47.40%（164/346）的患者认为滴眼液使用期间,无需限制饮食,52.60%（182/346）的患者认为滴眼液使用期间应根据说明书或医嘱限制某些食物摄入;仅56.36%（195/346）的患者在使用滴眼液前阅读了说明书。结论　角膜病患者滴眼液规范使用行为及认知并不理想,眼科护理人员需重视滴眼液使用的相关宣教,促进滴眼液的规范使用。