术前白蛋白碱性磷酸酶比值对根治性膀胱切除术后总体生存期的影响

目的探讨术前白蛋白碱性磷酸酶比值(AAPR)与根治性膀胱切除术后患者总体生存期(OS)的关系。方法回顾性分析2007年1月至2015年12月青岛大学附属医院收治的166例膀胱癌患者的临床病理资料。男148例,女18例。年龄(65.1±9.4)岁。伴高血压病31例、糖尿病14例。体质指数(BMI)(24.00±3.32)kg/m^2。肿瘤单发92例,多发74例。肿瘤直径<3 cm者43例,≥3 cm者123例。合并肾积水33例,无肾积水133例。术前AAPR(0.62±0.23)。根据AAPR的三分位点将患者分为低AAPR组55例,AAPR(0.42±0.09);中AAPR组55例,AAPR(0.58±0.05);高AAPR组56例,AAPR(0.86±0.21)。美国麻醉医师协会(ASA)分级1级4例,2级65例,3级86例,4级11例。根治术前患者均行经尿道膀胱肿瘤切除术,病理诊断均为膀胱癌,高级别144例,低级别22例。166例均行根治性膀胱切除术,其中腹腔镜手术140例,开放手术26例。术中行输尿管皮肤造口55例,回肠代膀胱96例,回肠原位新膀胱15例。将AAPR连续性变量和AAPR分组作为原始模型,调整年龄、肿瘤大小、pT分期、pN分期、肾积水、ASA分级、辅助化疗的数据作为校准模型1,在校准模型1基础上增加BMI、肿瘤数目、病理等级的数据作为校准模型2。采用趋势性检验检测不同AAPR组间危险比(HR)变化趋势。分析不同因素分层的AAPR与OS的关系。采用Kaplan-Meier法绘制生存曲线。采用基于广义相加模型的曲线拟合表示AAPR与OS的关系。结果本组166例中位随访63个月,生存95例,死亡71例。3年生存率为61%,5年生存率为50%。术后病理分期:T1期27例,T2期82例,T3期48例,T4期9例;N0期145例,N1期14例,N2期6例,N3期1例。术后52例行辅助化疗。单因素Cox回归分析结果显示,AAPR(HR=0.09,95%CI 0.022~0.391,P=0.001)、高AAPR组(HR=0.40,95%CI 0.216~0.742,P=0.003)、年龄(HR=2.42,95%CI 1.294~4.531,P=0.006)、肿瘤大小(HR=2.11,95%CI 1.112~4.014,P=0.023)、肿瘤数目(HR=0.62,95%CI 0.378~1.022,P=0.061)、pT3期(HR=8.93,95%CI 3.173~25.114,P<0.001)、pT4期(HR=10.39,95%CI 3.110~34.707,P<0.001)、N1期(HR=2.80,95%CI 1.422~5.531,P=0.003)、N3期(HR=17.06,95%CI 2.192~132.863,P=0.007)、病理分级(HR=0.30,95%CI 0.113~0.817,P=0.019)、肾积水(HR=2.36,95%CI 1.406~3.939,P=0.001)、术后辅助化疗(HR=2.66,95%CI 1.674~4.247,P<0.001)均与术后OS相关。调整年龄、肿瘤大小、pT分期、pN分期、肾积水、ASA分级、辅助化疗、BMI、肿瘤数目、病理分级后,Cox回归分析结果显示,与低AAPR组相比,高AAPR组的死亡风险降低约59%(HR=0.406,95%CI 0.200~0.822,P=0.012),AAPR每升高1个单位,死亡风险下降约80%(HR=0.199,95%CI 0.051~0.779,P=0.020)。趋势性检验结果显示,原始模型和校准模型中,AAPR不同分组间OS的HR下降趋势均有统计学意义(P=0.016),提示两者呈线性关系。调整年龄、肿瘤大小、pT分期、pN分期、肾积水、ASA分级、辅助化疗、BMI、肿瘤数目、病理分级后,曲线拟合图显示,AAPR与OS呈线性相关,随AAPR升高,术后死亡风险下降,OS延长。结论AAPR与膀胱肿瘤患者根治性膀胱切除术后的OS成线性相关,随AAPR升高,患者术后死亡风险下降,OS延长。     

A diabetes risk index for small areas in England

UK and international studies point to significant area variation in diabetes risk, and summary indices of diabetic risk are potentially of value in effective targeting of health interventions and healthcare resources. This paper aims to develop a summary measure of the diabetic risk environment which can act as an index for targeting health care resources. The diabetes risk index is for 6791 English small areas (which provide entire coverage of England) and has advantages in incorporating evidence from both diabetes outcomes and area risk factors, and in including spatial correlation in its construction. The analysis underlying the risk index shows that area socio-economic status, social fragmentation and south Asian ethnic concentration are all positive risk factors for diabetes risk. However, urban-rural and regional differences in risk intersect with these socio-demographic influences.     

护士分团队管理的方法与体会

目的 探讨分团队管理模式的方法与效果.方法 根据护士特长及意向划分团队,实施分团队自主管理,确立目标,制订工作职责及奖惩机制.结果护理专业技能提高,协作能力增强.结论 实施分团队自主管理,激发了护士的工作热情,有利于护理质量的提高.     

Role of hypofractionated radiotherapy in breast locoregional radiation

Long-term results of randomised trials have confirmed the safety and efficacy of hypofractionated radiotherapy using approximately 2.6 Gy per fraction to lower total doses of 40–42.6 Gy delivered over 3 weeks, for postoperative treatment of early breast cancer. In these trials, hypofractionated radiotherapy was predominantly used for breast only treatment, while there are fewer trials that specifically examined hypofractionated radiotherapy to the breast plus regional nodes. Hypofractionated locoregional radiation is considered a standard of care in the United Kingdom and in some parts of Canada. We aim to review the radiobiology and normal tissue effects of hypofractionated locoregional radiation and to summarize available published clinical experiences using this treatment strategy as adjuvant therapy after breast conserving surgery or mastectomy for women with early breast cancer.     

关节镜下异体跟腱单双束重建后交叉韧带的随机对照*☆

背景：关节镜下重建后交叉韧带主要有单束重建和双束重建两种方式。 目的：随机对比应用异体跟腱单双束重建后交叉韧带损伤的临床疗效。 方法：选择青岛市市立医院骨科2006-01/2009-01的后交叉韧带损伤患者共70例，随机分为单束重建组和双束重建组，分别行异体跟腱单束重建及双束重建。 结果与结论：术后顺利完成康复计划并获得随访的病例共52例。双束重建组手术时间较单束重建组长，行关节腔穿刺的病例数较单束重建组多(P < 0.05)。手术后18个月随访结果显示，单束组重建及双束重建组的膝关节活动度、Lysholm评分、IKDC评分与术前比较有明显提高(P < 0.05)，两组膝关节屈曲30°和90°时用KNEELAX3测量胫骨端后移距离明显低于术前(P < 0.05)。两组术后Lysholm评分、 IKDC评分、两组膝关节屈曲30°和90°时用KNEELAX3测量胫骨端后移距离未见明显差别(P > 0.05)。说明与单束重建比较，双束重建后的早期临床疗效无明显提高，且双束重建的手术创伤大，手术时间长，术后关节肿胀重，故不推荐作为首选手术方式，其远期疗效优待进一步观察。     

左卡尼汀缓解顺铂造成急性肾损伤的血清代谢组学研究

目的 利用血清代谢组学探究顺铂诱导小鼠急性肾损伤的特异性变量,同时评价左卡尼汀的干预作用。 方法 将19只小鼠分为正常对照组、模型组和干预组,适应3 d后,对干预组给予左卡尼汀(400 mg/kg,ip)干预,2 d后给予模型组和干预组顺铂(20 mg/kg,ip)造模,每天称量各组小鼠的体质量,2 d后取小鼠血清进行LC-MS分析,结合模式识别分析各组间代谢组差异,并评价左卡尼汀的干预作用。 结果 代谢组学分析共鉴别28个差异代谢物,顺铂诱导的急性肾损伤主要涉及磷脂类、氨基酸类和脂肪酸类代谢途径的改变,而左卡尼汀有改善作用。 结论 左卡尼汀可改善顺铂诱导的急性肾损伤,其机制可能是通过调控色氨酸代谢、谷氨酸代谢和能量代谢,从而减缓急性肾损伤的疾病进程。     

Population Dynamics of Fish Species in a Marine Ecosystem: A Case Study in the Bohai Sea,China

There were rapid shifts of the dominant species in the Bohai Sea from the 1950s to the 1990s, with large-sized, high-valued species (e.g., Small Yellow Croaker Larimichthys polyactis and Largehead Hairtail Trichiurus lepturus) being replaced by small-sized, low-valued species (e.g., Japanese Anchovy Engraulis japonicus and Hairfin Anchovy Setipinna taty). From the 1990s to the present, the Small Yellow Croaker and some of the small-sized species (Hairfin Anchovy and Dotted Gizzard Shad Konosirus punctatus) have become the dominant species. The food web is now simple, with species from relatively low trophic levels controlling the energy flow within the fishery ecosystem. Along with the shift in community structure, the abundance of dominant species changed, the diversity of fish species and species number density decreased, and interannual and seasonal variations in species number density were found. Fish abundance had a decreasing trend and fish interannual and seasonal distribution greatly changed. Variation in the sizes of the ecological niches of the dominant species regulated the succession of the fish community, and the alteration of ecological niches caused changes in the fishery community.

Received August 11, 2014; accepted September 30, 2015