循证护理在乳癌术后放疗皮肤反应中的应用

目的应用循证护理探讨乳癌术后放疗患者皮肤反应的有效干预方法。方法根据76例患者产生皮肤反应的具体情况，提出护理问题，收集相关证据，结合实际制订切实可行的护理计划，采取相应的护理措施。结果76例患者干预后皮肤反应均得以缓解，减轻了患者的痛苦，患者能顺利完成放射治疗，达到有效的照射剂量。结论应用循证护理找出乳癌放疗患者皮肤损伤因素，采用循证护理寻求科学完整的护理方案，有助于提高护理质量。     

前置自适应统计迭代重建技术对体模肺纯磨玻璃结节图像质量及辐射剂量的影响

目的 分析高分辨率Revolution CT不同权重前置自适应统计迭代重建技术（Pre-ASiR-V）对仿真胸部体模中肺纯磨玻璃结节（pGGN）图像质量及辐射剂量的影响,以寻找最佳Pre-ASiR-V权重。方法 采用Revolution CT对含有4个pGGN的仿真胸部体模进行扫描,Pre-ASiR-V权重分别设置为0、20%、40%、60%、80%和100%,记录并比较不同Pre-ASiR-V权重图像的平均噪声、有效辐射剂量（ED）和pGGN图像质量的主观评分。结果 Pre-ASiR-V权重为0、20%、40%、60%、80%和100%的图像平均噪声分别为（17.93±2.20） HU、（17.30±3.68） HU、（18.20±3.44） HU、（18.80±0.20） HU、（19.87±2.56） HU和（15.90±4.56） HU,差异无统计学意义（F=0.568,P=0.723）;ED分别为7.40 mSv、5.16 mSv、3.36 mSv、1.97 mSv、0.97 mSv和0.33 mSv,与Pre-ASiR-V为0的图像比较,随着Pre-ASiR-V升高,ED分别降低30.27%、54.59%、73.38%、86.89%、95.54%。2名医师对pGGN图像的主观评分一致性较好（Kappa=0.778,P=0.003）,评分均 ≥ 3分。Pre-ASiR-V权重为80%及100%时,图像的主观评分略低。结论 Pre-ASiR-V权重对仿真胸部体模高分辨率图像的噪声影响较小,但可显著降低辐射剂量;Pre-ASiR-V权重60%为最佳选择。     

Improved electrical transport properties of an n-ZnO nanowire/p-diamond heterojunction

A heterojunction of n-ZnO nanowire (NW)/p-B-doped diamond (BDD) was fabricated. The rectifying behavior was observed with the turn on voltage of a low value (0.8 V). The forward current at 5 V is 12 times higher than that of a larger diameter n-ZnO nanorod (NR)/p-BDD heterojunction. The electrical transport behaviors for the comparison of n-ZnO NWs/p-BDD and n-ZnO NRs/p-BDD heterojunctions are investigated over various bias voltages. The carrier injection process mechanism for ZnO NWs/BDD is analyzed on the basis of the proposed equilibrium energy band diagrams. The ZnO NWs/BDD heterojunction displays improved I–V characteristics and relatively high performance for the electrical transport properties.

A heterojunction of n-ZnO nanowire/p-diamond was fabricated and exhibits improved electrical transport properties, which offer a promising design for developing optoelectronic nanodevices working at the nano-scale and with severe environments.     

Gastric adenocarcinoma of fundic gland (chief cell predominant type) coexisting with well differentiated intestinal adenocarcinoma: A case report

Rationale:Gastric adenocarcinoma of fundic gland (chief cell predominant type) (GA-FG-CCP) is a new, rare variant of gastric adenocarcinoma, which is characterized by mild nuclear atypia and specific immunohistochemical markers.Patient concerns:An 84-year-old Chinese man was referred to our hospital for endoscopic resection of a gastric lesion.Interventions:We performed endoscopic submucosal dissection, and successfully removed the lesion.Diagnosis:Esophago gastroduodenoscopy showed a slightly elevated lesion with a diameter of 22 mm in the posterior wall of cardia. Magnifying endoscopy with narrow band imaging revealed an abnormal microsurface and microvessels on the tumor surface. Endoscopic ultrasonography revealed a hypoechoic mass located in the first layer. The pathological diagnosis of the biopsy specimens indicated that the tumor was high grade intraepithelial neoplasia. The pathological diagnosis differed between the superficial and deeper part of the lesion. The superficial part was composed of a tubular structure with prominent atypia and was diagnosed as well differentiated intestinal adenocarcinoma. The deeper part was composed of a well-differentiated tubular adenocarcinoma mimicking the fundic gland cells, mainly the chief cells. The tumor cells showed mild nuclear atypia and was positive for pepsinogen-I (PG-I) and mucin-6 (MUC6). This deeper part was diagnosed as GA-FG-CCP.Outcomes:The tumor was successfully removed. This patient had no discomfort during the follow-up period (10 months).Lessons:We present a rare case of GA-FG-CCP coexisted with well-differentiated tubular adenocarcinoma. GA-FG-CCP exists in the deep mucosal layer and the muscularis mucosa, which could not be found under endoscopy, but could be discerned in pathology with mild nuclear atypia and special biomarkers.     

A rapid and simple UPLC-MS/MS method using collagen marker peptides for identification of porcine gelatin

Gelatin, which is mainly derived from bovine and porcine sources, has been used in many foods and pharmaceutical products. To ensure the compliance of food products with halal regulations, reliable analytical methods are very much required. In this study, one unique marker peptide for porcine gelatins was selected to develop an UPLC-MS/MS multiple reaction monitoring method. The capability of this method to identify porcine materials was demonstrated by analyzing in-house-made gelatins containing different amounts of porcine gelatins and commercial gelatin products. The adulteration of porcine gelatin could be sensitively detected at a low level of 0.04%. When combined with HPLC and mass spectrometry, this method is an accurate and sensitive quantitative method to identify porcine gelatins. Thus, the strategy can be used to verify halal authenticity of gelatin.

Gelatin, which is mainly derived from bovine and porcine sources, has been used in many foods and pharmaceutical products.     

Old boys’ network in general practitioners’ referral behavior?

We analyzed the impact of social networks on general practitioners’ (GPs) referral behavior based on administrative panel data from 2,684,273 referrals to specialists made between 1998 and 2007. For the definition of social networks, we used information on the doctors’ place and time of study and their hospital work history. We found that GPs referred more patients to specialists within their personal networks and that patients referred within a social network had fewer follow-up consultations and less inpatient days thereafter. The effects on patient outcomes (e.g. waiting periods, days in hospital) of referrals within personal networks and affinity-based networks differed. Specifically, whereas empirical evidence showed a concentration on high-quality specialists for referrals within the personal network, suggesting that referrals within personal networks overcome information asymmetry with respect to specialists’ abilities, the empirical evidence for affinity-based networks was different and less clear. Same-gender networks tended to refer patients to low-quality specialists.     

ANXA2敲除的A549细胞系的构建及其对H1N1和H9N2流感病毒复制的影响北大核心CSCD

目的旨在利用CRISPR/Cas9基因编辑技术构建ANXA2敲除的A549细胞,并探索ANXA2敲除对流感病毒复制的影响。方法本研究设计了3对靶向ANXA2基因外显子的特异性sgRNAs,分别将sgRNAs构建到LentiCRISPRv2载体上获得重组质粒,与辅助质粒共转染293T细胞包装成慢病毒后感染A549细胞,通过嘌呤霉素压力及有限稀释法筛选ANXA2基因敲除的单克隆细胞株,用靶基因测序及Western-blot验证ANXA2的敲除效果,并通过CCK-8试验比较ANXA2敲除细胞和野生型A549细胞的细胞活力。再分别用人流感病毒WSN(H1N1)和禽流感病毒SD98(H9N2)感染ANXA2敲除和野生型A549细胞,经TCID_(50)检测ANXA2敲除对流感病毒复制的影响。结果成功获得了ANXA2敲除的A549细胞系,且与野生型A549细胞相比,细胞活力无显著差异;ANXA2敲除后WSN(H1N1)和SD98(H9N2)流感病毒的病毒滴度均升高,其中ANXA2对SD98(H9N2)流感病毒的影响要大于WSN(H1N1)。结论本研究利用CRISPR/Cas9基因编辑技术构建了ANXA2敲除的A549细胞,并发现ANXA2敲除促进了流感病毒的复制,本研究为流感病毒复制和致病机制的研究奠定了基础。     

室间隔缺损并重度肺动脉高压外科疗效的多因素分析

目的:总结室间隔缺损(VSD)合并重度肺动脉高压(PH)的外科治疗疗效及其影响因素。方法:回顾性分析和随访62例VSD伴重度PH患者的诊治和预后情况,并对多种影响因素进行t检验及多元线性回归分析。结果:本组住院死亡6例,占9.6％;随访8个月～7年,1、3、5年生存率分别为96.4％、91.1％、80.4％;对多种相关因素进行t检验及多元线性回归分析,提示年龄,VSD的大小、位置,肺/体平均动脉压比值(Pp/Ps)>0.95与否,心功能,术后6个月肺动脉压/手术前肺动脉压>0.75与否,围术期综合性降肺动脉压处理,手术后定期应用前列腺素E1(PGE1)等与生存期有明显相关性。结论:明确VSD的位置,围术期综合性降肺动脉压处理不仅对选择手术时机有指导意义,而且可以降低手术死亡率,手术后定期应用PGE1可提高生存率。     

西吡氯铵含漱液治疗口腔念珠菌感染的临床疗效分析

目的分析西吡氯铵含漱液治疗口腔念珠菌感染的临床疗效。方法 128例口腔念珠菌感染病患,按照随机方法分为治疗组和对照组,每组64例。两组患者均给予基础的抗菌治疗。对照组选择复方氯己定含漱液施治,治疗组选择西吡氯铵施治。比较两组患者用药前后相关症状(疼痛、红斑、黏膜萎缩)评分及镜检阳性率、治疗效果、用药不良反应发生情况。结果用药后,两组患者的疼痛、红斑、黏膜萎缩评分均低于用药前,且治疗组疼痛、红斑、黏膜萎缩评分均高于对照组,差异具有统计学意义(P<0.05)。治疗组镜检阳性率为6.25%(4/64),对照组镜检阳性率为28.13%(18/64);治疗组镜检阳性率低于对照组,差异具有统计学意义(P<0.05)。治疗组患者的治疗总有效率95.31%高于对照组的78.13%,差异具有统计学意义(P<0.05)。治疗组患者的用药不良反应发生率7.81%(5/64)低于对照组的20.31%(13/64),差异具有统计学意义(χ2=4.137, P<0.05)。结论口腔念珠菌感染选用西吡氯铵含漱液能帮助患者及早控制症状,保障满意临床效果,且具备良好安全性。     

高分辨率CT鉴别诊断良、恶性实性孤立性肺结节

目的 观察实性孤立性肺结节（SPN）高分辨率CT（HRCT）表现。方法 回顾性分析235例HRCT检出的实性SPN患者,其中54例良性（良性组）,181例恶性（恶性组）。比较组间HRCT表现差异,包括分叶征、毛刺征、空洞征、空泡征、钙化、远端穿行血管、胸膜牵拉征、贴近胸膜及牵拉性肺气肿;评估差异有统计学意义的征象鉴别良、恶性SPN的效能,分析良、恶性SPN的影响因素。结果 组间毛刺征、胸膜牵拉征、钙化征象差异均无统计学意义（P均>0.05）,其余征象差异均有统计学意义（P均<0.05）。血管集束征鉴别良、恶性SPN的效能最高,敏感度达92.30%。回归分析显示血管集束征是恶性SPN的危险征象,牵拉性肺气肿为其保护因素（P均<0.05）。结论 良、恶性SPN的HRCT表现存在差异,对鉴别诊断具有一定价值。