表浅膀胱肿瘤电切术后膀胱内药物灌注预防肿瘤复发的临床观察

目的 观察表浅膀胱肿瘤电切术后膀胱内灌注丝裂霉素和吡柔比星预防肿瘤复发的疗效和安全性.方法 回顾性分析我科2007年2月至2009年10月间收治的130例表浅膀胱肿瘤患者的临床资料,所有患者均行经尿道膀胱肿瘤电切和术后膀胱内灌注丝裂霉素或吡柔比星,其中术后膀胱内灌注丝裂霉素70例,吡柔比星60例.观察术后1年肿瘤复发和灌注药物的副作用.结果 ①术后膀胱内灌注丝裂霉素和吡柔比星的1年复发率分别为11.4%（8/70）和16.7%（10/60）（P＞0.05）.在丝裂霉素组,病理分级G1、G2、G3级肿瘤1年复发率分别为12.2%、8%和25%,它们之间无显著差异（P＞0.05）;在吡柔比星组,病理分级G1、G2、G3级肿瘤1年复发率分别为4%、12.5%和54.5%,其中G3级肿瘤复发率明显高于G1和G2级肿瘤（P＜0.05）.②130例患者中,进行即刻膀胱内药物灌注（24h内）和非即刻灌注的1年复发率分别为4%（1/25）和16.2%（17/105）,两者之间有显著性差异（P＜0.05）.③灌注丝裂霉素和吡柔比星后全身副作用发生率分别为18.5% 和 1.5%（P＜0.05）,局部副作用发生率分别为4.3% 和 33.3%（P＜0.05）.结论 术后膀胱内灌注丝裂霉素和吡柔比星预防肿瘤复发的效果无显著性差异,但G3级肿瘤的复发率高于G1和G2级肿瘤,对其灌注方案有待进一步研究;术后即刻膀胱内药物灌注可有效降低肿瘤1年复发率,值得推广;术后膀胱内灌注丝裂霉素和吡柔比星的副作用在全身和局部发生率不同,但均可耐受;由于观察时间短和例数有限,观察结果有待进一步研究.     

Hepatocyte growth factor and transforming growth factor β1 contribute to regeneration of small-for-size liver graft immediately after transplantation

Although the ability of the liver to regenerate to a predetermined size after resection made adult-to-adult living donor liver transplantation (LDLT) possible, there is little information regarding the growth regulatory mechanism for a small-for-size graft. Forty-one cases of LDLT were divided into two groups by graft volume to standard liver volume ratio (GV/SLV); small graft group (Group S, GV/SLV<40%, n=16) and non-small graft group (Group NS, GV/SLV>40%, n=25). The regeneration rate (GV at 1 week/harvested GV) and serum levels of hepatocyte growth factor (HGF), transforming growth factor- (TGF-) and transforming growth factor-1 (TGF-1) were compared between two groups. The regeneration rates in Group S were significantly higher than that of Group NS (217±12% and 178±10%, respectively, P<0.01). The serum HGF levels of Group S were significantly higher than those of Group NS on POD 1. The TGF-1 levels of Group S were significantly higher than those of Group NS on POD 3 and 5. The TGF- levels were not different at any time points studied. These results indicate that a small-for-size graft retains the capacity to regenerate faster by modulation of expression pattern of HGF and TGF-1 immediately after LDLT. After the acceleration of the regenerative response by HGF, subsequent elevation of TGF-1 synergistically controls graft size, regulating uncontrolled proliferation of hepatocytes.     

Inpatient and 90-day post-discharge outcomes in elective Medicare spine fusion surgery

Background Context

Elective spine surgery is a commonly performed operative procedure, that requires knowledge of risk-adjusted results to improve outcomes and reduce costs.

H∞ state‐feedback controller design for continuous‐time nonhomogeneous Markov jump systems

This paper studies the problem of H_∞ state‐feedback controller design for continuous‐time nonhomogeneous Markov jump systems. The time‐varying transition rate matrix in continuous‐time domain is considered to lie in a convex bounded domain of polytopic type. By constructing a parameter‐dependent Lyapunov function and fully considering the information about the rate of change of time‐varying parameters, a new sufficient condition on the existence of an H_∞ state‐feedback controller is provided in the form of a parameter‐dependent matrix inequality. Moreover, based on the structure characteristics of Lyapunov matrix and transition matrix, the parameter‐dependent matrix inequality is converted into a finite set of linear matrix inequalities, which can be readily solved. Two numerical examples are provided to demonstrate the effectiveness of the theoretical results. Copyright © 2016 John Wiley & Sons, Ltd.     

综合医院护士对住院患者自杀预防认知的调查研究

目的了解综合医院护士对住院患者自杀预防认知状况,为更好地预防患者自杀提供建议。方法采用自行设计的护士对住院患者自杀预防认知调查问卷,对412名临床护士进行调查。结果护士对住院患者自杀预防认知总均分9.56±2.20,正确率45.52%,其中自杀一般知识均分6.83±1.68,正确率52.54%,自杀预防知识均分2.73±1.41,正确率34.07%。不同年龄、工作年限、职称、学历护士对住院患者自杀预防认知水平比较,差异有统计学意义(P0.05,P0.01)。有护理自杀倾向/自杀未遂患者经历的护士自杀预防知识得分高于无经历者(P0.05)。结论综合医院护士预防住院患者自杀的认知水平尚不理想,护理管理者应结合影响因素开展培训。     

血管内皮生长因子受体启动子驱动双自杀基因联合survivin反义寡核苷酸对结直肠癌细胞及血管内皮细胞的特异性杀伤作用

目的探讨腺病毒介导血管内皮生长因子受体（KDR）启动子驱动的CDglyTK融合基因（AdKDR-CDsbrTK）体系联合survivin反义寡核苷酸（ASODN）对结直肠癌细胞（sw620）及血管内皮细胞（ECV304）的特异性杀伤作用。方法将质粒pAdEasy—KDR-CDglyTK在293细胞内包装、扩增产生重组腺病毒。体外感染表达KDR的SW620、ECV304细胞株,同时用survivin ASODN转染同一细胞株,观察腺病毒的感染效率和ASODN的转染情况。应用RT．PCR和Western印迹检测CDglyTK和survivin基因的表达．MTT法测定两者联合应用对细胞株的杀伤效应和旁观者效应。结果survivin ASODN可转染重组腺病毒感染的细胞,并且两者的转染及感染效率无明显变化。CDglyTK可在SW620、ECV304细胞株高效表达。survivin ASODN可明显降低survivin蛋白表达。各基因治疗组细胞存活率明显低于阴性对照组（P〈0．001）。survivinASODN与AdKDR—CDglyTK基因联用后。随着前药浓度的增加,细胞存活率迅速下降,两者联合作用与单一基因作用相比,差异具有统计学意义（P〈0．05）。但在GCV100μg／ml、5-FC 2000μg／ml时,联合基因治疗组细胞存活率略低于单用AdKDR-CDglyTK,两者间差异无统计学意义（P〉0．05）。Survivin ASODN和AdKDR—CDglyTK联合作用,在前药浓度较低时表现为协同效应,并具有更明显的旁观者效应。结论KDR启动子调控的AdKDR-cDglyTK体系和survivin ASODN基因联合,较单一基因具有更强的特异性杀伤结直肠癌细胞及血管内皮细胞的作用。     

Corticosteroid elimination in simultaneous liver–kidney transplantation recipients

Abstract: Background: Simultaneous liver–kidney transplantation (SLK) has more than doubled since 2002. While less common in kidney transplant alone recipients (KTA), corticosteroid discontinuation is performed routinely in liver transplantation, raising the question of optimal immunosuppression for SLK recipients. Methods: A retrospective case series of 16 SLK recipients under a steroid withdrawal protocol was performed to compare short‐term outcomes to a contemporaneous cohort of 32 KTA recipients. Results: In 69% of SLK recipients, corticosteroids were eliminated compared to 3% of KTA recipients, p < 0.0001. When comparing SLK and KTA recipients one yr post‐transplant, there were no significant differences in renal graft rejection (23.1% vs. 6.3%), death‐censored renal graft survival (100% vs. 97%), estimated glomerular filtration rate (74.4 vs. 62.6 mL/min), serum creatinine (1.10 vs. 1.39 mg/dL), or maintenance immunosuppression, respectively. Conclusions: Corticosteroids may be withdrawn safely in SLK recipients with one‐yr renal outcomes comparable to a KTA cohort.     

胃底贲门癌侵及胰体尾外科治疗的预后分析

目的 探讨影响胃底贲门癌侵及胰体尾外科治疗预后的因素.方法 对135例胃底贲门癌侵及胰体尾患者进行手术.其中剖腹探查术20例,联合脾及胰体尾切除术115例.对影响手术的预后进行单因素及多因素分析,并分析术后的并发症发生率和病死率.结果 剖腹探查术和联合脾及胰体尾切除术患者的中位生存期分别为4.7个月和30.5个月,差异有统计学意义(X2=403.8,P＜0.01).联合脾及胰体尾切除术患者的3、5年生存率分别为48.3%、26.6%;肿瘤的直径、大体分型、浸润深度、淋巴结转移、No.10或No.11淋巴结转移、根治程度和受侵脏器切除数目为影响预后的相关因素:其中浸润深度、淋巴结转移分期、手术根治程度及受侵脏器切除数目为影响预后的独立因素.术后并发症发牛率和病死率分别为20.0%和3.5%.结论 对于胃底贲门癌侵及胰体尾患者.施行联合脾及胰体尾切除术能够提高疗效.如果患者无淋巴结转移、或无不可根治因素存在、或无合并其他脏器受侵.施行联合脾及胰体尾切除术疗效最好.     

The increasing burden of pelvic fractures in older people, New South Wales, Australia

Despite their significant health burden, epidemiological information regarding pelvic fractures is scarce. In this study, we examine trends in admission for pelvic fractures to acute hospitals in New South Wales, Australia, between July 1988 and June 2000, using routinely collected hospital separations statistics. Over this period, the number of admissions for pelvic fractures among those aged 50 years and over increased by 58.4% in men and 110.8% in women. Age-specific rates of admissions per 100,000 population for pelvic fracture also rose significantly, particularly for those aged at least 75 years. The number and proportion of transport related pelvic fractures fell significantly for both men (chi(2)=23.82, d.f.=1, p<0.001) and women (chi(2)=49.26, d.f.=1, p<0.001) while those resulting from falls increased significantly over the 12-year-period. Falls are increasingly becoming the single most important cause of pelvic injuries in older people, suggesting that preventive measures aimed at reducing the risk of falls need to be pursued. Factors contributing to the rise of fall-related pelvic fractures need to be investigated to inform strategies aimed at reversing the observed increase in the number and age-specific rates of pelvic fractures in older people.     

彩色多普勒超声帧差伪像的成因与特征探讨

本文目的在于探讨超声帧差伪像的形成原因与声像图特征。通过分析医用超声诊断仪器所采用的设计模型与人体组织声学特性之间存在的矛盾、探头振元数与物理通道数之间的匹配关系、2D图像与彩色多普勒图像在显示屏上的“实时”复合方式,揭示出在图像复合显示过程中,因帧频不同而导致的人体解剖结构与血流信号在时间、空间上“错位”而导致的伪像,阐明它具有的必然性、复合性、隐蔽性、低关注度特点,为仪器设计开发和超声医生在工作中及时识别帧差伪像,减少误诊,提供思路。