cⅠ期周围型NSCLC纵隔淋巴结廓清范围的临床研究

目的:探讨cⅠ期周围型非小细胞肺癌(nonsmall cell lung cancer,NSCLC)纵隔淋巴结合理的廓清范围。方法:回顾性研究196例行系统性纵隔淋巴结廓清的cⅠ期周围型NSCLC患者的临床资料,分析临床病理特征与纵隔淋巴结转移的关系。结果:28例患者术后病理证实为N2,占14.3%(28/196),腺癌、鳞癌患者的纵隔淋巴结转移的发生率分别为18.8%(22/117)、7.6%(6/79),两者相比差异有统计学意义,P=0.023。ⅠA期、ⅠB期患者的发生率分别为7.5%(5/67)、17.8%(23/129),两者相比差异有统计学意义,P=0.049。上叶肿瘤纵隔淋巴结转移80.0%在上纵隔,下叶肿瘤纵隔淋巴结转移76.5%在下纵隔,上、下叶肿瘤均可发生隆突下淋巴结转移。结论:cⅠ期周围型NSCLC应行包括隆突下淋巴结在内的选择性区域纵隔淋巴结廓清。     

Role of lymphadenectomy and pelvic radiotherapy in patients with clinical FIGO stage I endometrial adenocarcinoma: an analysis of 208 patients

Two hundred and eight patients with a clinical stage I endometrial carcinoma were studied (164 fulfilled the inclusion criteria). High risk was defined as nonendometrioid, or endometrioid tumors grade 3 (G3), or G2 with any or G1 with deep (>1/2) myometrial infiltration. The low-risk group consisted of the remaining patients. Surgical staging in the high-risk group included pelvic lymphadenectomy with para-aortic lymphadenectomy in selected cases. Twelve percent of the high-risk patients had nodal metastasis. Patients with low-risk (group A, n = 85) and high-risk disease confined to the uterus (group B, n = 57) did not receive adjuvant radiotherapy. Patients with nodal metastases (group C, n = 10) received postoperative irradiation. The total recurrence rate of the entire population was 12.5%, and the actuarial overall survival, disease-specific survival, and disease-free survival were 90%, 94%, and 88%, respectively. All patients with only vaginal relapse (n = 9) were cured locally with salvage radiotherapy until the date of analysis. The pelvic relapse rate was low as only one patient of group B recurred in the pelvis. In conclusion, lymphadenectomy remains indicated to better select patients at high risk of pelvic recurrence that may benefit from postoperative radiotherapy.     

头孢米诺和其他14种抗菌药物对产与不产超广谱β-内酰胺酶菌株抗菌活性比较

目的测定头孢米诺和其他14种抗菌药物对产与不产超广谱β-内酰胺酶(ESBLs)菌株的体外抗菌活性.方法采用琼脂稀释法测定头孢米诺和其他14种抗菌药物的最小抑菌浓度(MIC),纸片确证法检测ESBLs.结果对110株产ESBL的大肠埃希菌和肺炎克雷伯菌,未发现亚胺培南耐药的菌株,除亚胺培南外,头孢米诺比其他的13种抗生素有较低的耐药性,其耐药率为7.3%,MIC50和MIC90值范围分别为0.5～1 mg/L和2～32 mg/L;对40株不产ESBLs的大肠埃希菌和肺炎克雷伯菌、头孢米诺、头孢美唑、头孢他啶、头孢噻肟、头孢曲松、头孢哌酮、头孢吡肟及亚胺培南,有相似的体外抗菌活性,其敏感率均为100%,MIC50和MIC90值范围分别为0.032～0.5 mg/L和0.064～4 mg/L.结论对产ESBL的大肠埃希菌和肺炎克雷伯菌,未发现亚胺培南耐药的菌株,头孢米诺比其他β-内酰胺类,庆大霉素和氟喹诺酮类有较高的体外抗菌活性;对不产ESBLs的菌株,头孢米诺、头孢美唑、头孢他啶、头孢噻肟、头孢曲松、头孢吡肟及亚胺培南有相同的抗菌活性,没有耐药的菌株发现.     

重症监护病房肺炎克雷伯菌临床特点及耐药分析

目的 分析重症监护病房（ICU）肺炎克雷伯菌感染的临床特点及耐药情况,为临床合理使用抗菌药物提供依据。方法 回顾性分析重庆医科大学附属第一医院2014年1月～2016年12月ICU肺炎克雷伯菌感染病例483例,药敏试验采用纸片扩散法,双纸片协同试验进行超广谱β内酰胺酶检测,WHONET5.6及SPSS 21.0软件统计分析数据。结果 ICU肺炎克雷伯菌感染常见于伴多种易患因素的老年患者,下呼吸道为主要感染部位;CREKp感染死亡率高,多合并感染性休克或多器官功能障碍。3年来ICU检出肺炎克雷伯菌对常用抗菌药物耐药率不同程度上升,特别是CREKp菌株分离逐渐增加且呈泛耐药特点,仅对替加环素、米诺环素敏感。结论 ICU肺炎克雷伯菌感染发病率高且病情重,CREKp感染死亡风险高,应充分认识其严重性。治疗上依据药敏试验结果指导临床选择适当抗菌药物尤为重要。     

Robotic-assisted radical cystectomy: current technique and outcomes

Robotic-assisted radical cystectomy continues to evolve as a surgical option in the management of muscle-invasive bladder cancer. Current oncologic outcomes appear comparable in the short-term with open radical cystectomy. Long-term follow-up, however, remains lacking for this emerging technique. Modern robotic technology allows a comparable extent of pelvic lymph node dissection as open surgery, a previous criticism of the procedure. Complications compare very favorably to open surgery in comparative series, and blood loss and transfusion rates are routinely lower. Length of stay has been shortened in some series, though not uniformly. Finally, robotic assistance can increase the cost of radical cystectomy.     

患者微信群结合奥马哈系统模式的延续护理对肺癌癌因性疲乏的影响

目的探讨患者微信群结合奥马哈系统模式的延续护理对肺癌患者癌因性疲乏的影响。方法选取我院2016年2月~2017年1月收治肺癌患者80例,随机将其分配至观察组与对照组,观察组实施为期3周的患者微信群结合奥马哈系统的延续性护理模式,对照组实施常规护理措施,比较两组患者癌因性疲乏评分与焦虑、抑郁量表评分。结果干预后,观察组患者癌因性疲乏评分与焦虑、抑郁量表评分较对照组明显缓解,差异有统计学差异(P0.05)。结论采用患者微信群结合奥马哈系统模式护理有助于改善肺癌患者癌因性疲乏,消除患者不良情绪,建立持续治疗信心,具有较好的应用前景。     

Innate immune factors modulate ethanol interaction with GABAergic transmission in mouse central amygdala

Excessive ethanol drinking in rodent models may involve activation of the innate immune system, especially toll-like receptor 4 (TLR4) signaling pathways. We used intracellular recording of evoked GABAergic inhibitory postsynaptic potentials (eIPSPs) in central amygdala (CeA) neurons to examine the role of TLR4 activation by lipopolysaccharide (LPS) and deletion of its adapter protein CD14 in acute ethanol effects on the GABAergic system. Ethanol (44, 66 or 100 mM) and LPS (25 and 50 μg/ml) both augmented eIPSPs in CeA of wild type (WT) mice. Ethanol (44 mM) decreased paired-pulse facilitation (PPF), suggesting a presynaptic mechanism of action. Acute LPS (25 μg/ml) had no effect on PPF and significantly increased the mean miniature IPSC amplitude, indicating a postsynaptic mechanism of action. Acute LPS pre-treatment potentiated ethanol (44 mM) effects on eIPSPs in WT mice and restored ethanol’s augmenting effects on the eIPSP amplitude in CD14 knockout (CD14 KO) mice. Both the LPS and ethanol (44–66 mM) augmentation of eIPSPs was diminished significantly in most CeA neurons of CD14 KO mice; however, ethanol at the highest concentration tested (100 mM) still increased eIPSP amplitudes. By contrast, ethanol pre-treatment occluded LPS augmentation of eIPSPs in WT mice and had no significant effect in CD14 KO mice. Furthermore, (+)-naloxone, a TLR4-MD-2 complex inhibitor, blocked LPS effects on eIPSPs in WT mice and delayed the ethanol-induced potentiation of GABAergic transmission. In CeA neurons of CD14 KO mice, (+)-naloxone alone diminished eIPSPs, and subsequent co-application of 100 mM ethanol restored the eIPSPs to baseline levels. In summary, our results indicate that TLR4 and CD14 signaling play an important role in the acute ethanol effects on GABAergic transmission in the CeA and support the idea that CD14 and TLR4 may be therapeutic targets for treatment of alcohol abuse.     

产ESBLs肺炎克雷伯菌ESBLs基因与可移动遗传元件相关性分析

目的 了解产超广谱β-内酰胺酶(extended spectrum beta-lactamases, ESBLs)肺炎克雷伯菌(Klebsiella pneumoniae, Kpn)ESBLs基因与可移动遗传元件(mobile genetic elements, MGEs)标记基因的携带情况及其相关性。方法 收集从住院患者标本中分离出的产与非产ESBLs Kpn非重复菌株各100株，采用PCR检测细菌中4种ESBLs基因与8种MGEs标记基因，并作指标聚类分析。结果 产ESBLs Kpn中，ESBLs基因阳性率高达100%；MGEs标记基因以IS26、ISEcp1、traA、trbC和intI1基因为主，阳性率高于非产ESBLs Kpn(P<0.05)；ESBLs基因与MGEs标记基因的同时检出率明显高于非产ESBLs Kpn (P<0.05)；基因blaSHV-12、blaOXA-1与MGEs基因tnpU、tnp513、merA、intI1相关联，基因blaTEM-1、blaCTX-M-125与MGEs基因ISEcp1、IS26、traA相关联。产与非产ESBLs Kpn均没有只检出MGEs标记基因的菌株。结论 产ESBLs Kpn ESBLs基因和MGEs标记基因携带率高，两者存在相关性，可能是产ESBLs Kpn出现多重耐药的重要原因；MGEs标记基因在Kpn中可能不是单独存在的。