早期乳腺癌保乳手术临床疗效观察

目的探讨早期乳腺癌保乳手术的临床疗效、美容效果和不良反应的发生情况。方法回顾性分析阜阳市人民医院自2009年5月至2011年5月,确诊为早期乳腺癌患者57例的临床资料,其中保乳手术组(27例)采用保乳手术,改良手术组(30例)采用改良根治术。全部患者均给予患侧全腋窝淋巴结清扫术。结果在近期手术并发症、无病生存分析中,两组比较差异无统计学意义(P>0.05)。但保乳手术组美容效果评价优的患者(22/27,81.5%)显著优于改良手术组,且评价手术近期疗效,两组比较差异有统计学意义(P<0.05)。结论保乳手术组的近期不良反应、无病生存时间与改良手术组相似,但美容评价显著优于改良手术组。     

中医药不同时机介入治疗脑梗死急性期

目的探讨中医药对脑梗死急性期患者不同时机介入治疗的疗效。方法在脑梗死急性期患者常规治疗的基础上,采用中医药介入疗法,时间点选择在治疗的第1、3、5、7天,利用美国国立卫生研究院卒中量表及日常生活活动量表(Brathel指数)等方法分析其临床疗效。结果Ⅲ组(第3天)介入中医药治疗总有效率为95.0%,优于其他各组。结论第3天介入中医药治疗效果最为明显,是相对平衡的介入时间点。     

癌症晚期患者丧亲者哀伤反应的质性研究

目的研究癌症晚期患者丧亲者的哀伤反应。方法 2014年6-8月,采用目的性抽样法选取在深圳市人民医院宁养院的15例晚期癌症患者的亲属为研究对象,对其进行深度访谈,采用Colaizzi的7步分析法进行分析、整理并提炼主题。结果癌症晚期患者丧亲个体的哀伤反应主要表现在身体、心理、社会和灵性方面。结论癌症晚期患者丧亲者经历艰难的心理历程,丧子、丧偶和丧亲的哀伤反应存在差异,护理人员应了解丧亲者的需求,帮助丧亲者建立积极的应对方式。     

早期慢性肾脏病患者肾组织甲状旁腺激素的表达及其作用

目的 探讨早期慢性肾脏病(CKD)患者肾组织甲状旁腺激素(PTH)表达和分布,以及其在CKD进展中的可能作用.方法 选取2009年至2012年间本科收治并经肾活检确诊的CKD 1期及2期的肾小球肾炎患者82例为研究对象.另取8例肾移植配型不符或肾肿瘤患者的正常肾组织作对照.受试者均检测Scr、BUN、血钙、磷、PTH及25(OH) VitD3等.以Cockcroft-Gault (CG)公式计算肌酐清除率(Ccr),双血浆99mTc-DTPA清除率法检测GFR.根据肾间质炎性细胞浸润程度,将患者分为轻、中、重组,用免疫组化方法观察肾组织PTH表达和分布；用Image-Pro Plus图像分析软件计算各例肾组织PTH阳性染色吸光度(A)值,并比较PTH表达强度差异.结果CKD1期及2期的肾小球肾炎患者的外周血钙、磷、25(OH) VitD3及PTH水平均处于正常范围,PTH与上述其他指标间无相关.不同病理类型肾小球肾炎患者肾组织均可见PTH表达,主要位于肾小管,而肾小球及肾间质也有少量分布,其表达强度均显著高于对照组(P＜0.01),且随肾间质炎性细胞浸润增多,PTH表达增强.各病理类型间肾组织PTH表达强度差异无统计学意义.结论 早期CKD(1期及2期)患者肾组织PTH表达增强,且早于外周血PTH的改变及矿物质和骨代谢紊乱,可能与局部炎性反应程度相关.     

Estimated Mortality of Breast Cancer Patients Based on Stage at Diagnosis and National Screening Guideline Categorization

PurposeTo compare overall and stage I to IV mortalities of patients diagnosed with breast cancer, calculated from stage at diagnosis using the Surveillance, Epidemiology, and End Results (SEER) database stage mortality estimates, which are based on national screening guideline categorization.MethodsFrom the stage at diagnosis of new breast cancer patients between 2010 and 2014, percentages of invasive cancers, stage 0 + I of total cancers, and stage I of invasive cancers, were calculated. Five-year estimated overall and invasive mortalities were calculated based on stage at diagnosis and SEER survival data. Program categories defined included an Annual Program, based on the ACR (annual screening age 40 and above), a Biennial Program, based on the US Preventative Services Taskforce (biennial screening ages 50 to 74 years), and a Hybrid Program, based on the American Cancer Society (annual screening ages 45 to 54 years, then biennially at ages 55 and above), including respective interval cancers.ResultsIn all, 445 breast cancers met the study inclusion criteria. Comparing program categories, the Annual Program had the lowest percentage of invasive cancers (75.3%), highest percentages of stage 0 + I of total cancers (75.3%) and stage I of invasive cancers (67.1%), and the lowest 5-year estimated overall (10.1%) and stage I to IV (12.0%) mortalities. Estimated overall and stage I to IV mortalities for the Annual Program was 37.3% and 30.6% less, respectively, than the Biennial Program, and 31.8% and 26.8% less, respectively, than the Hybrid Program.ConclusionsBased on stage at diagnosis, the greatest mortality reduction is achieved with mammography utilization starting at the age of 40.     

Video presentation of the second stage of a two-stage repair for proximal hypospadias: A safe and reproducible technique

ObjectiveThe aims of proximal hypospadias repair are good cosmetic outcomes with low rates of complication, with a low number of operative exposures, before the age of genital difference realisation. Neo-urethral fistula and stenosis are well recognised complications; with international rates of 3.8–16% and 1.3–15.6% respectively. We present the key steps of the second of a two staged repair in video format.MethodVideo recording of the procedure performed on an 18-month-old with mid-penile hypospadias is presented. The steps are described; the importance of tension free tubularisation, layered urethral closure, suture technique, vascularised prepucal graft technique, optimal glanuloplasty, and penile shaft skin repair are highlighted.ResultThe child was brought back to the day ward for catheter removal at 7 days; follow-up in clinic showed good postoperative appearance. This technique has been performed on 31 boys with a fistula rate and stenosis rate favourable to the literature.ConclusionWe demonstrate a two-stage technique by video format for proximal hypospadias which is reproducible and gives results comparable to the literature.