快捷护理路径在重症颅脑损伤患者急救中的应用效果

目的 探讨快捷护理路径在重症颅脑损伤患者急救中的应用效果.方法 分别采用快捷护理路径和常规护理对观察组(71例)和对照组(69例)重症颅脑损伤患者进行护理,采用急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评估患者病情变化,对比两组APACHEⅡ、急救时间、住院时间、急救死亡率、住院死亡率和急救费用.结果 观察组与对照组入院时APACHEⅡ评分差异无统计学意义(P＞0.05),观察组治疗后病情稳定,APACHEⅡ评分显著低于对照组(P＜ 0.05),观察组急救时间和住院时间均显著少于对照组(P＜0.05).观察组和对照组急救死亡率差异无统计学意义(P＞0.05),观察组住院死亡率显著低于对照组(P＜0.05),急救费用显著少于对照组(P＜0.05).结论 快捷护理路径的应用能显著提高重症颅脑损伤患者的急救效率,改善患者预后,减轻经济负担,是一种高效经济的护理模式.     

抗IGF-ⅠR抗体联合顺铂对卵巢癌细胞及其移植瘤的抑制作用

目的：察抗胰岛素样生长因子Ⅰ型受体（insulin-like growth factor-Ⅰ receptor,IGF-ⅠR）单克隆抗体4F2联合顺铂对卵巢癌细胞及其移植瘤的生长抑制作用。方法：Western blotting检测4种卵巢癌细胞（CAOV3、ES2、SKOV3和Hey细胞）中IGF-ⅠR的表达;流式细胞术检测抗IGF-ⅠR单抗4F2与各卵巢癌细胞系的结合特异性;Western blotting检测4F2对SKOV3和 CAOV3细胞内IGF-ⅠR磷酸化水平的影响,CCK-8检测4F2、顺铂单用或联用对卵巢癌细胞的生长抑制作用;建立卵巢癌SKOV3、CAOV3细胞裸鼠移植瘤模型,观察4F2、顺铂单用或联合治疗对裸鼠移植瘤生长的抑制作用。结果：IGF-ⅠR在4种卵巢癌细胞中的表达水平由高到低为SKOV3、CAOV3、ES2,Hey细胞不表达, 4F2与SKOV3、CAOV3、ES2细胞均能特异性结合,并且4F2能够抑制IGF-ⅠR的酪氨酸磷酸化。联合组顺铂为0.2 μg/ml时细胞生长抑制率即显著高于4F2单抗组[SKOV3：（47.4±3.1）% vs (5.3±0.6）%;t=3.126,P=0.007。CAOV3：（51.6±2.3）% vs (8.2±1.8）%;t=3.516,P=0.009]及顺铂组[SKOV3：（47.4±3.1）% vs (30.5±4.1）%;t=2.933, P=0.027。CAOV3：（51.6±2.3）% vs (28.9±2.3）%;t=3.226,P=0.034];在体内,联合组对卵巢癌种植瘤小鼠肿瘤的抑制率亦显著高于4F2单抗组[SKOV3：（87.3±3.1）% vs (41.6±4.9）%;t=2.29, P=0.004 3。CAOV3：（86.6±3.5）% vs (42.1±7.7）%;t=3.02,P=0.009 1]及顺铂组[SKOV3：(87.3±3.1)% vs (28.9±5.5)%; t=2.56, P=0.008 7。CAOV3：（86.6±3.5）% vs (32.7±4.1）%;t=2.91,P=0.007 3]。结论：4F2单抗特异性结合IGF-ⅠR阳性卵巢癌细胞,联合顺铂能够协同抑制卵巢癌细胞及其移植瘤的生长。     

治疗慢性阻塞性肺病新药阿地溴铵

阿地溴铵是一种吸入、长效、选择性毒蕈碱性胆碱能受体拮抗剂(M受体拮抗剂),用于慢性阻塞性肺病(COPD)引起的支气管痉挛的维持治疗。研究显示阿地溴铵能明显改善患者的COPD症状,且安全、耐受性好,不良反应少。现对其药效学、药动学及临床研究等做一综述。     

不同亚型HPV感染情况及与CIN的关系研究

目的:探讨不同亚型HPV感染情况及与宫颈上皮内瘤变(CIN)的关系。方法:回顾性分析我院就诊的8640例行HPV检测的临床资料,统计不同亚型HPV感染情况及与不同级别CIN患者之间的关系,以及常见亚型HPV致病力的差异。结果:①HPV阳性1873例(21.7%),多重感染453例(5.24%),单一亚型感染1420例(16.44%),HPV检出频次2417次,检出频次最高的6种高危亚型分别为:HPV16(25.90%),HPV58(11.92%),HPV52(10.22%),HPV33(6.99%),HPV53(6.54%)和HPV18(5.63%)。372例CIN患者中有273例HPV阳性,其中检出频次最高的几个亚型:HPV16(57.51%),HPV18(16.48%),HPV58(13.92%),HPV52(9.16%),HPV33(8.79%)和HPV31(4.40%)。②检出频次较高的6种HPV亚型中,HPV52亚型发病年龄最低。③HPV16、HPV18亚型发生高级别CIN的风险较其他亚型更高(OR=24.056,OR=27.474);单一感染时,HPV16亚型感染导致CIN的发生率比HPV18亚型的高,且差异有高度统计学意义(P=0.003)。HPV58亚型感染导致CIN的发生率较HPV52亚型的高,且差异有高度统计学意义(P=0.003)。结论:CIN患者中感染HPV的常见亚型依次为:HPV16、18、58、52、33、31。HPV52亚型发病年龄低,致病力弱。在单一感染中HPV16亚型的致病力较HPV18亚型强,HPV58亚型的致病力较HPV52亚型强。     

HPV检测用于绝经后意义不明的非典型性鳞状细胞患者分流诊治的价值

目的:探讨人乳头状瘤病毒(HPV)检测对绝经后诊断为意义不明的不典型鳞状细胞(atypicalsquamous cells of undetermined significance,ASCUS)绝经后妇女宫颈上皮细胞内瘤样病变(CIN)诊断的临床价值。方法:回顾性分析应用超薄液基细胞技术(TCT)行宫颈脱落细胞学检查进行机会性宫颈癌筛、查诊断为ASCUS的339例绝经后患者的资料,并分析HPV分型检测和阴道镜下宫颈组织活检及病理检查对检出宫颈病变的效率。结果:339例绝经后ASCUS人群中,HPV感染率为23.89%(81/339)。不同年龄区间(47~59岁、60~69岁)HPV感染率分别为28.49%(49/172)和19.16%(32/167),差异有统计学意义(P=0.044)。以病理诊断为高级别CIN(≥CIN2)作为临界终点,分析显示HPV检查用于预测宫颈CIN的敏感度为90.91%(10/11),特异度为78.35%(257/328),阳性预测值和阴性预测值分别为12.34%(10/81)和99.6%(257/258)。结论:HPV检测可用于绝经后患者ASCUS的分流诊治,阴性预测价值高。对于60~69岁绝经后ASCUS患者,若无HPV感染,建议随访,无需立即行阴道镜检查。     

Combined inhibition of Dnmt and mTOR signaling inhibits formation and growth of colorectal cancer

Background and aims  Although the anticancer effects of rapamycin (RPM) and 5-aza-deoxycytidine (AZA) have been studied extensively, the combined effect of these two drugs on colorectal cancer (CRC) is still unknown. This study addresses the effect of AZA and RPM combination therapy on CRC and its influence on the mammalian target of rapamycin (mTOR) and its signal transduction pathway. Subjects and methods  Human CRC cell line HCT116 was treated with AZA alone, RPM alone, or concurrently with a combination of both drugs. Cell viability, apoptosis, and cell cycle distribution were analyzed. CRC was initiated in S-ICR mice, which were then treated with the drugs mentioned above, and tumor incidence and volume were measured. The activity of the mTOR signal transduction pathway was detected by Western blot analysis or immunohistochemistry. Results  Combination treatment with AZA and RPM inhibited the growth of HCT116 cells, induced apoptosis, arrested the cell cycle, and reduced the incidence and tumor volume of CRC in mice, as well as inhibited the phosphorylation of components of the mTOR signal transduction pathway. These effects were more significant than those of single-drug treatments. Conclusion  Combination treatment with AZA and RPM inhibits the formation and growth of CRC. These findings may provide a novel strategy for CRC treatment. Yan-Jie Zhang and Shu-Liang Zhao contributed equally to this work.     

慢性萎缩性胃炎胃窦病理与内镜表现对照研究

目的探讨慢性萎缩性胃炎（CAG）病理学指标与内镜表现的关系。方法对46例CAG患者胃窦黏膜病理结果与内镜下各种表现、幽门螺杆菌（Hp）感染情况进行对照比较分析。结果发现46例CAG患者萎缩均伴不同程度的慢性炎症,其中萎缩伴肠上皮化生32例（69．57％）,萎缩伴肠上皮化生和上皮内瘤变10例（21．74％）,与之对应镜下表现形式多种。胃镜下单红相为主（花斑样改变）表现与病理学诊断萎缩符合率60．87％（28／46）,且以轻中度萎缩为主。传统胃镜下萎缩表现与病理诊断萎缩的符合率为21．74％（10／46）,其中白相为主,血管透见或显露与病理学诊断萎缩符合率13．04％（6／46）,两种及以上胃镜下的表现共存时符合率则更低。结论用传统胃镜下萎缩的表现诊断CAG不可靠,应多作黏膜活检病理才能正确诊断。     

Functional Evidence for Oxygen-Sensitive Voltage-Gated Potassium Channels in Human Placental Vasculature

Hypoxic fetoplacental vasoconstriction (HFPV), involving voltage-gated potassium (K_V) channels, has been suggested in human placenta; the identity of these channels remains unclear.Using wire myography, chorionic plate blood vessels were exposed to isoform-specific K_V channel blockers. Dose-response curves (thromboxane mimetic U46619; 0.1–2000 nM) pre- and post-addition of K_V channel modulator were analysed.Arterial U46619-induced contraction increased with margatoxin and stromatoxin-1, whilst only correolide increased U46619-induced contraction in veins (P < 0.05 two-way ANOVA). Basal tone was unaffected in arteries or veins.These data implicate K_V1.2 and/or K_V2.1 and K_V1.5 in the control of agonist-induced contraction of human placental arteries and veins respectively.     

Utility and Safety of Tolvaptan in Cirrhotic Patients with Hyponatremia: a Prospective Cohort Study

Introduction and aimHyponatremia is common in patients with decompensated cirrhosis and is associated with increased mortality. Tolvaptan, a vasopressor V2 receptor antagonist, can increase free water excretion, but its efficacy and safety in cirrhotic patients remain unclear.Material and MethodsWe studied the usage and safety of tolvaptan in cirrhotic patients in a real-life, non-randomized, multi-center prospective cohort study. Forty-nine cirrhotic patients with hyponatremia were treated with tolvaptan 15 mg daily, and 48 patients not treated with tolvaptan in the same period served as controls. Improvement in serum sodium level was defined as an increase in serum sodium from < 125 to ≥ 125 mmol/L or from 125-134 to ≥ 135 mmol/L on day 7.ResultsTwenty-three (47%) patients in the tolvaptan group and 17 (35%) in the control group had normal serum sodium on day 7 (p = 0.25). Serum sodium improved in 30 (61%) patients in the tolvaptan group and 17 (35%) patients in the control group (p = 0.011). Adverse events occurred in 46-47% of patients in both groups, and tolvaptan was not associated with worsened liver function. No patient with normal serum sodium on day 7 died within 30 days of treatment, whereas 16% of those with persistent hyponatremia died (p = 0.0019).ConclusionIn conclusion, short-term tolvaptan treatment is safe and can improve serum sodium level in cirrhotic patients with hyponatremia. Normalization of serum sodium level is associated with better survival.     

哮喘患儿CD8+T淋巴细胞穿孔素与颗粒霉素B表达的研究

目的探讨CD8＋T细胞穿孔素与颗粒霉素B的表达在儿童哮喘发病机制中的临床意义。方法测定121例哮喘患儿的外周血血清穿孔素与颗粒霉素B,其中哮喘发作组58例,男30例、女28例,平均年龄（5.91&#177;2.84）岁;哮喘缓解组63例,男43例、女20例,平均年龄（7.16&#177;3.00）岁;另测定正常对照组29例,男23例、女6例,平均年龄（5.90&#177;1.01）岁。结果血清CD8＋T细胞穿孔素与颗粒霉素B平均荧光强度表达在哮喘发作组及哮喘缓解组均明显高于正常对照组（P〈0.001）哮喘发作组高于哮喘缓解组（P〈0.05）。结论儿童哮喘是多细胞因子参与的气道慢性炎症性疾病,检测血清CD8＋T细胞穿孔素及颗粒霉素B的表达有助于哮喘发病机制的深入研究,是否作为哮喘急性发病的检测指标有待进一步探讨。