ICU医护合作与护士职业获益感的相关性研究

目的调查ICU医护合作关系及ICU护士职业获益感,分析医护合作对护士职业获益感的影响。方法采用医护合作量表、护士职业获益感量表对230名ICU护士进行调查。结果医护合作量表总分为(90.60±14.48)分,条目均分为(3.62±0.58)分;护士职业获益感总分为(133.39±17.11)分,条目均分为(4.04±0.52)分。回归分析显示,护士和医生的关系、患者信息的交流能力及职称是护士职业获益感的主要影响因素(调整R2=0.428)。结论ICU医护合作和护士职业获益感较高,且医护合作是护士职业获益感的重要影响因素,管理者应重视医护合作关系的建设,提升护士的积极职业认知。     

Nasopharyngeal carcinoma--review of the molecular mechanisms of tumorigenesis

Nasopharyngeal carcinoma (NPC) is a head and neck cancer rare throughout most of the world but common in certain geographic areas, such as southern Asia. While environmental factors and genetic susceptibility play important roles in NPC pathogenesis, the Epstein-Barr virus in particular has been implicated in the molecular abnormalities leading to NPC. There is upregulation of cellular proliferation pathways such as the Akt pathway, mitogen-activated protein kinases, and the Wnt pathway. Cell adhesion is compromised due to abnormal E-cadherin and beta-catenin function. Aberrations in cell cycle are due to dysregulation of factors such as p16, cyclin D1, and cyclin E. Anti-apoptotic mechanisms are also upregulated. There are multiple abnormalities unique to NPC that are potential targets for novel treatments.     

Effect of preoperative concurrent chemoradiotherapy in locally advanced low rectal cancer after radical resection surgery

To evaluate the outcome of patients with locally advanced low rectal adenocarcinoma who required preoperative concurrent chemoradiotherapy (CCRT), a total of 22 patients underwent preoperative CCRT and radical resection for locally advanced low rectal adenocarcinoma. Patients received concurrent chemotherapy with high-dose 5-fluorouracil (5-FU) in continuous infusion and leucovorin and preoperative radiation with a mean dose of 50.4 Gy (range, 45-50.4 Gy). Radical resection surgery was performed 6 weeks after treatment. Fifty-five percent of patients achieved tumor downstaging, and 14% patients. showed pathological complete remission. No severe hematological and gastrointestinal toxicity of preoperative CCRT was noted. Sphincter-saving rate was 82%, and there were no deaths related to preoperative CCRT and surgery. Overall, 3-year survival rate was 69%, and a rate of locoregional recurrence was 13.6%. This study shows that many patients with locally advanced rectal cancer can be operated on with sphincter-saving radical resection surgery under good local control after preoperative concurrent chemoradiotherapy, which induces tumor downstaging.     

西地那非在干预男性肾移植受者移植前后勃起功能时的安全性及有效性研究

目的 评价西地那非在干预男性肾移植受者手术前后勃起功能时的有效性及安全性.方法 选取年龄23～58岁、移植肾存活1年以上、血肌酐在移植后1年内维持在150 μmol/L以下的成年男性肾移植受者41人,所有患者在血液透析期间及移植后均口服两地那非两月,对患者血液透析期间、移植后6月及1年的勃起功能进行调查(依据国际问卷表IIEF-5),记录其各个时段的环孢素浓度、血压及血肌酐.结果 肾移植前与移植后6月及1年患者的ED发生率相比,有显著性差异(P<0.05);不论血液透析期间还是移植后,西地那非治疗后的勃起功能与服药前勃起功能相比,有显著性差异(P<0.05);不论血液透析期间还是移植后,西地那非治疗后的环孢素浓度、血压及肌酐与服药前组相比,无显著性差异(P>0.05).结论 肾移植后,患者的勃起功能得到了改善:不论对于尿毒症血液透析患者,还是肾移植受者,西地那非都可以改善患者的勃起功能,而且两地那非的应用具有安全性.     

双极射频治疗山羊髌骨软骨退变的实验研究

目的探讨双极射频在治疗髌骨软骨退变中价值。方法采用髌骨外侧支持带紧缩和内侧支持带松解的方法制造16只山羊髌骨软骨退变的动物模型。3个月后对右髌骨退变的软骨进行双极射频成形手术,左膝为对照侧,两侧同时进行恢复髌股关节对合的手术。观察双极射频对退变软骨的即刻效应和后期效应。结果造模方法可以造成山羊髌股关节倾斜,3个月后发生以髌骨内侧面OuterbridgeⅠ级和Ⅱ级为主的病变。即刻观察发现射频处理后的软骨表面光整,小的裂隙被融合。浅层的少量软骨细胞死亡,深层细胞受到的影响比较小。3个月后发现治疗侧髌骨软骨表面仍光滑,改良Mankin’8软骨评分结果显示治疗侧（8．50±2．51）分,对照组（11．00±4．15）分（t=2．57,P〈0．05）,治疗侧软骨损伤比对照侧轻。流式细胞学检测发现治疗侧软骨细胞死亡率（18．69±7．26）％,和对照侧（25．66±13．04）％相比,差异无统计学意义（t：1．94,P〉0．05）。结论一个能级的双极射频不会对软骨细胞造成明显的损害,软骨成形术是治疗髌骨软骨退变的有效方法之一。     

Performance of Posttransplant Model for End-Stage Liver Disease (MELD) and Delta-MELD Scores on Short-Term Outcome After Living Donor Liver Transplantation

The performance of the Model for End-stage Liver Disease (MELD) and delta-MELD scores in predicting posttransplant survival has been variable and the results are conflicting, suggesting that posttransplantational factors are more important than pre- or peritransplantational factors in outcomes following liver transplantation (OLT). We assessed the value of posttransplant MELD and delta-MELD scores to predict short-term (90-day) posttransplant survival. We evaluated 279 consecutive patients undergoing living donor OLTs. The MELD scores were calculated serially from pretransplantation as well as 3, 7, and 14 days after transplantation. Twenty-seven (9.7%) among 279 patients died within 90 days after transplantation. Pretransplant MELD score was not associated with short-term posttransplant mortality. The area under the receiver operating characteristic (AUROC) curve in predicting 90-day mortality was 0.637 for posttransplant 3-day MELD, 0.746 for posttransplant 7-day MELD, and 0.859 for posttransplant 14-day MELD score (P = .047, <.001, and <.001, respectively); AUROC was 0.582, 0.646, and 0.784 for 3-day, 7-day, and 14-day delta-MELD scores (P = .235, .034, <.001, respectively). Upon multivariate analysis, posttransplant 14-day MELD (≥20 vs <20), and 14-day delta-MELD scores (≥−3 vs <−3) were independent short-term prognostic factors with risk ratios of 18.875 (95% confidential interval [CI]: 4.625-77.028, P < .001) and 13.577 (95% CI: 2.641-69.791, P = .002), respectively. In conclusion, determination of posttransplant 14-day MELD and 14-day delta-MELD scores may afford suitable short-term prognostic predictors for patients following living donor OLT.     

远外侧入路治疗颅颈交界腹侧病变的探讨

目的 探讨远外侧人路在处治中下斜坡、颈延交界区腹侧及颈静脉孔区病变的应用。方法对23例患者采用远外侧入路显微外科手术,其中枕髁后入路12例,经部分枕髁入路5例,经C1-2关节面侧方联合经部分枕髁入路3例,经颈静脉结节入路2例,经完整枕髁入路1例。结果20例肿瘤全部切除15例,近全部切除5例,3例椎一基底动脉瘤均顺利夹闭,3例行枕颈融合,无手术死亡率,结果满意。所有患者术后均未出现寰枕关节不稳定的症状,手术并发症主要是后组颅神经损伤、椎动脉损伤、脑脊液漏以及脑干、小脑或脊髓缺血。结论远外侧入路是脑干和上段颈髓腹侧、腹外侧病变的理想入路,但手术操作较复杂,具有一定的潜在风险,应根据病变性质、位置和延伸范围来选择入路,进而最低限度切除颅底骨质。     

谷氨酰胺颗粒对创伤患者免疫功能影响的多中心、随机、双盲对照研究

目的观察服用谷氨酰胺(GLN)颗粒对创伤、烧伤及大手术患者免疫功能的影响及可能发生的不良反应。方法采用随机、双盲、安慰剂平行对照法,将受试患者分为谷氨酰胺组(GLN组)和安慰剂对照组(P组),每组60例,两组患者采用等氮、等热量的营养支持。GLN组口服或管饲GLN 0.5 g.kg-1.d-1,对照组使用同等剂量的安慰剂(甘氨酸),疗程为7 d。比较两组患者血浆GLN浓度和各项免疫指标的变化,并观察患者肝肾功能的变化及不良反应发生情况。结果伤后患者血浆GLN浓度、多形核粒细胞(PMN)吞噬能力、淋巴细胞亚型比值(CD4/CD8)、白细胞介素2(IL-2)水平明显低于正常值,而免疫球蛋白和补体C3、C4含量变化不明显。与P组相比,GLN组患者用药7 d后血浆GLN浓度明显增高[(593±185)μmol/L和(407±190)μmol/L],增幅达45.7%(P<0.01),GLN组免疫球蛋白A(IgA)含量、IL-2水平、CD4/CD8及PMN吞噬率明显高于P组(P<0.05~0.01),而免疫球蛋白G、M(IgG、IgM)及补体C3、C4含量、血尿常规及肝、肾功能两组差异无统计学意义(P>0.05)。少数患者出现轻微不良反应,如恶心、腹泻和便秘等,两组间差异无统计学意义(P>0.05)。结论服用GLN颗粒能显著提高血浆GLN浓度,明显减轻伤后免疫抑制,提高机体免疫功能,临床应用无明显不良反应。     

小切口胆囊切除术中胆道损伤的预防

目的探讨预防小切口胆囊切除术（MC）中胆道损伤的方法。方法对本组15131例MC中发生的18例胆道损伤进行回顾分析。结果1994年12月前施行MC2321例，发生胆道损伤9例（0．39％），1995年以来实施MC12810例，发生胆道损伤9例（0．07％）。结论思想上高度重视、规范手术适应证、规范手术操作是预防MC中胆道损伤的关键。     

猪滑膜源性MSCs体外多向分化潜能的研究

目的 体外分离培养猪滑膜源性MSCs(synovium-derived MSCs,SMSCs),探讨其在体外多向分化潜能.方法 2月龄长枫杂交猪3头,雌雄不限,体重8～10kg.取猪膝关节滑膜组织分离SMSCs并行原代及传代培养,待第3代SMSCs长满培养皿后,吸去基础培养液,分别加入特定培养液进行成软骨、成骨、成脂诱导分化,作为实验组;以基础培养液培养作为对照组.成软骨诱导21 d后行甲苯胺蓝染色、免疫组织化学染色和实时荧光定量PCR检测;成骨诱导10 d后行ALP染色检测,21 d后行茜素红染色检测;成脂诱导21 d后行油红O染色检测.结果 SMSCs培养24 h后细胞形态细长或呈多角形;48 h后细胞数量增多;72 h后可见大量纺锤形细胞,其间散在分布少许小圆形细胞.实验组成软骨诱导21 d后甲苯胺蓝染色早阳性,细胞外有蛋白多糖(Aggrecan)形成;免疫组织化学染色示特异软骨基质ColⅡ表达;实时荧光定量PCR检测示Col Ⅱ A1、Aggrecan、SOX9 mRNA表达量与对照组比较,差异有统计学意义(P＜0.05).成骨诱导10 d后ALP染色阳性,21d后茜素红染色阳性,有钙结节形成.成脂诱导21 d后油红O染色示细胞内有脂滴形成.对照组除ALP染色观察呈弱阳性外,余染色均呈阴性.结论 猪膝关节滑膜组织可分离获取SMSCs,其在体外具有向成软骨、成骨、成脂多向分化潜能,有望成为组织工程种子细胞来源.