加速康复外科理念指导腹腔镜全子宫切除术对绝经后妇女术后镇痛及胃肠功能恢复的影响

目的:探讨加速康复外科理念指导腹腔镜全子宫切除术对绝经后妇女术后镇痛及胃肠功能恢复的影响。方法:选择2016年1月1日至2020年12月31日南京医科大学附属淮安第一医院收治94例行腹腔镜全子宫切除术的绝经后妇女为研究对象,根据围术期干预方法不同分为对照组（46例）和试验组（48例）。对照组年龄（52.34±7.46）...     

Oral contraceptive containing natural estradiol for premenopausal women

An open multicenter trial was performed in six centers in Finland to study the efficacy, safety and acceptability of a new biphasic oral contraceptive pill containing natural estradiol and cyproterone acetate. The participants were 288 women with a mean age of 39.3 ± 3.4 years (range 30–49) who were willing to use the new pill as their only contraceptive method. In total, 23% of the women were smokers. The cumulative experience was 2800 treatment cycles during the first year. The net 12-month continuation rate was 63%. One pregnancy occurred in a woman who lost 5 tablets in the second treatment cycle, which gives a 12-month cumulative pregnancy rate of 0.4%. Serum progesterone values, determined twice during the third treatment cycle, showed ovulation inhibition in 95% of women. There were no serious side effects. Intermenstrual bleeding was recorded by 35.5% and 24.5% of women at 3 and 12 months, respectively. The bleedings became scantier in most women and dysmenorrhoea disappeared. No changes were observed in total and high density lipoprotein cholesterol concentrations after 1 year. With the exception of intermenstrual spotting, the efficacy, safety and acceptability of the new pill was almost as good as that of the modern low dose oral contraceptives. This is the first pill containing natural estradiol that has gained clinical acceptance and which can also be prescribed for smokers over 35 years old until the climacteric.     

公立医院纪检机构监察对象范围及职能定位探讨

深化监察体制改革是党中央全面加强党的领导、推进全面从严治党向纵深发展的重大决策部署.公立医院的人员构成复杂,《监察法》对医疗卫生单位的监察对象边界规定较为模糊,实践中也存在医院纪检机构职能定位不明确等问题.文章对新形势下公立医院人员构成、监察对象范围、内设纪检机构职能定位进行分析,通过厘清内设纪检机构与派驻纪检监察组的...     

连续股神经阻滞与静脉自控对全膝关节置换的镇痛效果比较

背景：近年来连续股神经阻滞在人工全膝关节置换过程中广为使用,但是临床上对于该镇痛模式的效果尚存在较大的争议。 目的：对比连续股神经阻滞和常规静脉自控镇痛方法在人工全膝关节围置换期的镇痛的效果。 方法：纳入南京医科大学附属淮安第一医院骨科2014年1月至2015年1月收治的单侧人工全膝关节置换患者50例,原发病均为膝关节骨关节炎。按随机数字表法分为两组,对照组采用静脉自控镇痛,试验组采用连续股神经阻滞镇痛。对比观察两组患者置换后的疼痛目测类比评分、不良反应及镇痛满意度评分等。 结果与结论：试验组患者置换后4,12,24,48,72 h目测类比评分均显著低于对照组(P < 0.05)。试验组置换后48-72 h内镇痛辅助药物应用率为4%,显著低于对照组24%(P < 0.05)。试验组并发症发生率为12%,显著低于对照组48%(P < 0.05);试验组置换后镇痛满意率为88%,显著高于对照组60%(P < 0.05)。试验组置换后2,3,4 d及出院时的患肢膝关节活动度均显著大于对照组(P < 0.05);试验组置换后住院时间显著短于对照组(P < 0.05)。提示连续股神经阻滞多模式镇痛在人工全膝关节围置换期镇痛效果理想,不良反应发生率低,患者满意度高,是人工全膝关节置换后理想的镇痛方案。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

干扰素诱导跨膜蛋白１对结肠癌ＳＷ４８０细胞株侵袭和转移能力的影响

目的　研究干扰素诱导跨膜蛋白１（ＩＦＩＴＭ１）对结肠癌ＳＷ４８０细胞株侵袭和转移的影响。方法　构建ＩＦＩＴＭ１／ｐＥＧＦＰ-Ｃ３重组质粒并且转染大肠癌细胞株ＳＷ４８０,免疫荧光显微镜和激光共聚焦显微镜（ＬＣＳＭ）、ＲＴ ＰＣＲ和Ｗｅｓｔｅｒｎｂｌｏｔｔｉｎｇ鉴定ＩＦＩＴＭ１／ｐＥＧＦＰ-Ｃ３重组质粒。Ｇ４１８筛选稳定过表达ＩＦＩＴＭ１的ＳＷ４８０细胞株（ＩＦＩＴＭ１／ＳＷ４８０）,细胞侵袭性实验、明胶酶法测定ＭＭＰ-２和ＭＭＰ-９活性,Ｗｅｓｔｅｒｎｂｌｏｔｔｉｎｇ检测ＭＭＰ-９蛋白表达及ＩＦＩＴＭ１／ＳＷ４８０侵袭和转移能力。结果　成功构建ＩＦＩＴＭ１／ｐＥＧＦＰ-Ｃ３重组表达质粒,获得ＩＦＩＴＭ１／ＳＷ４８０细胞株;细胞侵袭实验显示ＳＷ４８０细胞、ＩＦＩＴＭ１／ＳＷ４８０细胞的细胞穿透数分别为（４４８.６４±３８.０９）个和（５４０.４５±４４.６１）个,差异有统计学意义（Ｐ＜０.０１）;明胶酶法测定显示ＩＦＩＴＭ１／ＳＷ４８０细胞ＭＭＰ-２、ＭＭＰ-９活性较ＳＷ４８０和ｐＥＧＰＦ／ＳＷ４８０细胞明显增强。Ｗｅｓｔｅｒｎｂｌｏｔｔｉｎ显示ＩＦＩＴＭ１／ＳＷ４８０细胞ＭＭＰ-９表达水平明显高于ＳＷ４８０和ｐＥＧＦＰ／ＳＷ４８０细胞株。结论　ＩＦＩＴＭ１可增加大肠癌ＳＷ４８０细胞株侵袭和转移的能力。     

2005-2007年淮安第一医院抗抑郁药临床应用分析

目的了解淮安第一医院抗抑郁药的应用情况和发展趋势。方法分别统计2005—2007年各类抗抑郁药的用药总金额，并依据每种药物的限定日剂量（DDD），计算出每种药物的用药频度（DDDs）和药品日消耗费用（DDE），并由此进行分析和讨论。结果用药金额逐年提高，呈增长趋势，2007年的用药金额比2005和2006年分别增长53．47％和43．74％。结论传统抗抑郁药正逐步被新型抗抑郁药所替代。     

胃异位胰腺患者应用内镜黏膜下剥离术和内镜黏膜下隧道剥离术的诊治分析

目的 探讨内镜黏膜下剥离术（ESD）和内镜黏膜下隧道剥离术（STER）在胃异位胰腺诊治中的价值.方法 86例疑诊为胃异位胰腺患者住院接受ESD或STER,随访观察治疗效果和安全性.结果 术后病理确诊胃异位胰腺54例,位于胃窦43例,胃底体交界7例,胃体4例;其中45例行ESD,9例行STER,完整切除率88.9％ （48/54）,余6例剥离后有少许组织残留.术后迟发性出血1例（1.9％,1/54）,无术中及术后穿孔.术后随访1～ 32个月未见复发.结论 ESD能完整大块地切除病变组织,能提供标本获得准确的病理学诊断,是胃异位胰腺有效且安全的诊治手段,STER可能为胃异位胰腺的诊治提供一种新的方法.     

重度颅脑损伤患者术后应用重组人促红细胞生成素对血清VEGF、NSE水平及脑血管痉挛的影响

目的 探讨重度颅脑损伤患者术后应用重组人促红细胞生成素(r-HuEPO)对血清血管内皮因子(VEGF)、神经元特异性烯醇化酶(NSE)水平及脑血管痉挛的影响。方法将86例重度颅脑损伤患者分为对照组与观察组各43例,两组均接受手术治疗,术后对照组予常规治疗,观察组应用r-HuEPO治疗。比较两组患者治疗前后外周血VEGF、NSE、S100B蛋白(S-100B)水平及格拉斯哥昏迷指数评分(GCS)及格拉斯哥预后评分(GOS)的变化,并采用经颅多普勒超声(TCD)监测患者脑血流,统计脑血管痉挛发生率。结果治疗2周,两组NSE、VEGF、S-100B水平及大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)、基底动脉(BA)、椎动脉(VA)血流速率均降低,观察组降低幅度高于对照组(P<0.05)。治疗2周,两组GCS、GOS评分均上升,观察组上升幅度高于对照组(P<0.05)。观察组术后脑血管痉挛发生率低于对照组(P<0.05)。结论重度颅脑损伤患者术后采用r-HuEPO干预,可下调NSE、VEGF、S-100β蛋白表达,减轻脑血管损伤程度,降低脑血管痉挛发生率。     

Crosstalk between TGF-β signaling and miRNAs in breast cancer metastasis

Transforming growth factor-β (TGF-β) signaling pathway is a key regulator of various cancer biologies, including cancer cell migration, invasion, angiogenesis, proliferation, as well as apoptosis, and it is one of indispensable signaling pathways during cancer metastasis. TGF-β signaling pathway can regulate and be regulated by a series of molecular and signaling pathways where microRNAs (miRNAs) seem to play important roles. miRNAs are small non-coding RNAs that can regulate expressions of their target genes. Emerging evidence suggest that miRNAs participate in various biological and pathologic processes such as cancer cells apoptosis, proliferation, invasion, migration, and metastasis by influencing multiple signaling pathways. In this article, we focus on the interaction between miRNAs and TGF-β in breast cancer (BC) metastasis through modulating invasion-metastasis-related factors, including epithelial-to-mesenchymal transition (EMT), cancer stem cells (CSCs), matrix metalloproteinase (MMP), tissue inhibitors of MMPs (TIMPs), cell adhesion molecules (CAMs), and tumor microenvironment (TME). Through a clear understanding of the complicated links between TGF-β pathway and miRNAs, it may provide a novel and safer therapeutic target to prevent BC metastasis.     

32例老年性痴呆患者护理体会

目的:总结老年性痴呆患者的临床护理措施。方法:对2008—2010年我科收治的32例老年性痴呆患者,进行心理、生活、安全、康复、预防并发症的护理。结果:患者在日常生活自理能力、认知能力、适应能力都有不同程度的提高。结论:通过对老年性痴呆患者的针对性预防和护理措施,延缓病情发展,提高了患者的生活质量。