卡贝缩宫素和缩宫素治疗剖宫产高危产妇的效果比较

目的:比较卡贝缩宫素和缩宫素治疗剖宫产高危产妇的效果。方法:选取122例剖宫产高危产妇为研究对象,按照随机数字表法分为观察组与对照组各61例。两组均行剖宫产手术,胎儿娩出后,对照组给予缩宫素治疗,观察组给予卡贝缩宫素治疗,比较两组术中、产后2、24 h出血量,产后加用前列素氨丁三醇率,凝血功能指标[纤维蛋白原(FIB)、D-二聚体(D-D)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)]水平,心率,血压,血红蛋白水平和不良反应发生率。结果:观察组术中、产后2、24 h出血量均低于对照组,差异有统计学意义(P<0.05);观察组加用卡前列素氨丁三醇率为4.92%(3/61),明显低于对照组的16.39%(10/61),差异有统计学意义(P<0.05);术后,两组FIB、D-D水平均高于术前,且观察组高于对照组,两组PT、APTT均短于术前,且观察组短于对照组,差异有统计学意义(P<0.05);术后,两组血红蛋白水平均低于术前,但观察组高于对照组,差异有统计学意义(P<0.05);手术前后,两组心率、血压和不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:卡贝缩宫素治疗剖宫产高危产妇可减少出血量和加用卡前列素氨丁三醇率,提高其术后血红蛋白水平,以及改善凝血功能指标,效果优于缩宫素。     

Surgical resection after neoadjuvant durvalumab and radiation is feasible and safe in non–small cell lung cancer: Results from a randomized trial

ObjectiveSeveral trials have recently reported the safety of pulmonary resection after neoadjuvant immunotherapy with encouraging major pathological response rates. We report the detailed adverse events profile from a recently conducted randomized phase II trial in patients with resectable non–small cell lung cancer treated with neoadjuvant durvalumab alone or with sub-ablative radiation.MethodsWe conducted a randomized phase II trial in patients with non–small cell lung cancer clinical stages I to IIIA who were randomly assigned to receive neoadjuvant durvalumab alone or with sub-ablative radiation (8Gyx3). Secondary end points included the safety of 2 cycles of preoperative durvalumab with and without radiation followed by pulmonary resection. Postoperative adverse events within 30 days were recorded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0).ResultsSixty patients were enrolled and randomly assigned, with planned resection performed in 26 patients in each arm. Baseline demographics and clinical variables were balanced between groups. The median operative time was similar between arms: 128 minutes (97-201) versus 146 minutes (109-214) (P = .314). There was no 30- or 90-day mortality. Grade 3/4 adverse events occurred in 10 of 26 patients (38%) after monotherapy and in 10 of 26 patients (38%) after dual therapy. Anemia requiring transfusion and hypotension were the 2 most common adverse events. The median length of stay was similar between arms (5 days vs 4 days, P = .172).ConclusionsIn this randomized trial, the addition of sub-ablative focal radiation to durvalumab in the neoadjuvant setting was not associated with increased mortality or morbidity compared with neoadjuvant durvalumab alone.     

己糖激酶-Ⅱ在胃癌组织中的表达及其临床意义

目的探讨己糖激酶-Ⅱ(HK-Ⅱ)在人体胃癌组织中的表达情况及其临床意义,分析HK-Ⅱ与临床病理特征之间的关系。方法选取2013年3—9月在东南大学医学院附属江阴医院确诊的胃癌病患100例,切除标本,运用免疫组化及RTPCR方法检测胃癌组织及正常胃黏膜组织中HK-Ⅱ的表达情况,并分析其与性别、年龄、浸润深度、TNM分期、分化程度、淋巴结转移、脉管侵犯、肿瘤大小等的关系。结果 HK-Ⅱ在胃癌组织中的阳性表达率为68.00%,显著高于正常胃黏膜组织(P0.05)。HK-Ⅱ表达与性别、年龄、浸润深度无关(P0.05);与TNM分期、分化程度、淋巴结转移、脉管侵犯、肿瘤大小有关(P0.05)。胃癌组织HK-ⅡmRNA阳性率显著高于正常胃黏膜组织(P0.01)。结论 HK-Ⅱ在胃癌组织中高表达,可作为胃癌的恶性预后指标和临床治疗靶点。     

自制可冲洗大便收集装置在ICU的应用

目的探讨自制可冲洗大便收集器在ICU大便失禁患者中的临床应用。方法随机将66例大便失禁的ICU危重患者分为对照组(33例)和观察组(33例)。对照组采用常规方法用温水擦拭后涂鞣酸软膏,观察组采用自制可冲洗大便收集器(造口袋加三通接头接负压引流瓶)收集大便法进行肛周皮肤护理。比较两组患者肛周皮肤炎性反应发生情况。结果观察组发生皮肤反应2例,均为I度反应;对照组发生皮肤反应19例,其中,Ⅰ度反应14例,Ⅱ度与Ⅲ度分别为4例和1例。两组患者肛周皮肤反应发生率比较,观察组明显低于对照组,χ2=27.93,P=0.01,差异有统计学意义。结论应用自制可冲洗大便收集器引流收集大便,不但能有效预防大便失禁患者肛周皮肤炎性反应的发生,而且能提高病人的舒适度,值得临床推广应用。     

黄芪建中汤加减联合针刺治疗消化性溃疡

目的探究黄芪建中汤加减方联合针刺治疗消化性溃疡(脾胃虚寒型)的疗效。方法选取2016年6月-2019年6月本院门诊收治的消化性溃疡(脾胃虚寒型)患者96例作为研究对象,年龄在26~68周岁。根据门诊单双号分为治疗治疗组和对照组,每组48例。对照给予常规口服埃索美拉唑镁肠溶片、阿莫西林胶囊、克拉霉素缓释片、胶体果胶铋胶囊等,治疗组则给予黄芪建中汤加减联合针刺治疗,疗程6周。观察两组患者治疗有效率及不良反应,并采用专业量表调查患者治疗前后中医症候积分、简式McGill疼痛问卷结果。结果两组疗效对比显示,治疗组总有效率明显高于对照组,差异对比有统计学意义(P <0.05);两组患者在中医症候积分、简式McGill疼痛问卷各项积分方面均有显著降低,提示两组均有明显治疗效果。治疗组简式McGill疼痛问卷表中VAS、PPI及PRI(感觉项总分、情感项总分)、差异有统计学意义(P <0.05)。两组不良反应发生情况差异无统计学意义(P> 0.05)。结论黄芪建中汤联合针刺治疗可有效缓解消化性溃疡(脾胃虚寒型)患者中医症候及降低简式McGill疼痛问卷各项积分,疗效可靠,值得临床应用。     

Membrane-associated mucins of the ocular surface: New genes,new protein functions and new biological roles in human and mouse

The mucosal glycocalyx of the ocular surface constitutes the point of interaction between the tear film and the apical epithelial cells. Membrane-associated mucins (MAMs) are the defining molecules of the glycocalyx in all mucosal epithelia. Long recognized for their biophysical properties of hydration, lubrication, anti-adhesion and repulsion, MAMs maintain the wet ocular surface, lubricate the blink, stabilize the tear film and create a physical barrier to the outside world. However, it is increasingly appreciated that MAMs also function as cell surface receptors that transduce information from the outside to the inside of the cell. A number of excellent review articles have provided perspective on the field as it has progressed since 1987, when molecular cloning of the first MAM was reported. The current article provides an update for the ocular surface, placing it into the broad context of findings made in other organ systems, and including new genes, new protein functions and new biological roles. We discuss the epithelial tissue-equivalent with mucosal differentiation, the key model system making these advances possible. In addition, we make the first systematic comparison of MAMs in human and mouse, establishing the basis for using knockout mice for investigations with the complexity of an in vivo system. Lastly, we discuss findings from human genetics/genomics, which are providing clues to new MAM roles previously unimagined. Taken together, this information allows us to generate hypotheses for the next stage of investigation to expand our knowledge of MAM function in intracellular signaling and roles unique to the ocular surface.     

Protective Effects of a Hydrogen-Rich Preservation Solution in a Canine Lung Transplantation Model

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Vancomycin-related convulsion in a pediatric patient with neuroblastoma: A case report and review of the literature

BACKGROUNDVancomycin is often used as an anti-infective drug in patients receiving anti-tumor chemotherapy. There are concerns about its adverse drug reactions during treatment, such as nephrotoxicity, ototoxicity, hypersensitivity reactions, etc. However, potential convulsion related to high plasma concentrations of vancomycin in children receiving chemotherapy has not been reported.CASE SUMMARYA 3.9-year-old pediatric patient with neuroblastoma receiving vancomycin to treat post-chemotherapy infection developed an unexpected convulsion. No other potential disease conditions could explain the occurrence of the convulsion. The subsequently measured overly high plasma concentrations of vancomycin could possibly provide a clue to the occurrence of this convulsion. The peak and trough plasma concentrations of vancomycin were 59.5 mg/L and 38.6 mg/L, respectively, which were much higher than the safe range. Simulation with the Bayesian approach using MwPharm software showed that the area under the concentration-time curve over 24 h was 1086.6 mg· h/L. Therefore, vancomycin was immediately stopped and teicoplanin was administered instead combined with meropenem and fluconazole as the anti-infective treatment strategy.CONCLUSIONUnexpected convulsion occurring in a patient after chemotherapy is probably due to toxicity caused by abnormal pharmacokinetics of vancomycin. Overall evaluation and close therapeutic drug monitoring should be conducted to determine the underlying etiology and to take the necessary action as soon as possible.