全身炎症反应综合征患者行连续性血液净化的护理

目的探讨连续性血液净化（CBP）治疗应用于全身炎症反应综合征患者的护理措施。方法对12例全身炎症反应综合征危重患者应用CBP治疗,重点对患者进行严格无菌操作,严密观察病情变化,做好针对性护理,及时发现并协助ICU医师处理各种并发症。结果经CBP治疗后,生化检查示多种炎症介质较治疗前滴度明显下降,全身炎症反应减轻,11例患者转普通病房继续治疗,1例患者因费用原因放弃治疗。结论CBP治疗对全身炎症反应综合征危重患者有显著疗效,治疗期间严密监控和精确护理是保证疗效的关键。     

Determinants of peripheral blood count value in long‐term survivors of allogeneic hemopoietic stem cell transplantation

Hemopoeitic stem cell transplant (HSCT) recipients are monitored by regular complete blood picture (CBP). The reference ranges for acceptable values are undefined. We analysed the CBP in 228 stable HSCT survivors (median follow‐up 103 months, range 60–212) without transplant‐related medications and complications. Compared with donors, recipients had lower absolute neutrophil count (ANC) and platelet levels (Plt) and higher mean corpuscular volume (MCV), but comparable hemoglobin (Hb) and absolute lymphocyte count (ALC). There was significant donor–recipient correlation in all CBP parameters (Hb, ALC, ANC, MCV, Plt). Significant correlation was also found between levels of Hb, white cell and Plt among recipients. All counts were higher in patients with longer follow‐up. Donor and recipient gender, age and underlying diagnosis can influence stable CBP values. We conclude that both host and marrow factors influence CBP values in stably engrafted recipients. ‘Abnormal’ CBP values deviating from that in normal populations may not have clinical significance. Copyright © 2009 John Wiley & Sons, Ltd.     

The prognostic significance of steroid receptor co-regulators in breast cancer: co-repressor NCOR2/SMRT is an independent indicator of poor outcome

BACKGROUND: Advances in understanding the molecular basis of breast cancer has necessitated a definition of improved indicators of prognosis that are central to the underlying cancer biology and that reflect the heterogeneous nature of the disease. This study investigates the pattern of expression of the steroid receptor co-regulators NCOA1/SRC1, NCOA3/RAC3, NCOR2/SMRT, and CBP/p300 in breast cancer. The aims were to identify whether their expression was related to patient outcome, their relationships to known prognostic factors and to provide a basis for further research into the mechanistic significance of such associations. METHODS: The protein levels of steroid receptor co-regulators were assessed by immunohistochemistry in a large well-characterised series of breast carcinomas prepared as tissue microarrays. Relationships between these targets, other clinicopathological variables and patients' outcome were examined. RESULTS: NCOR2/SMRT was an independent prognostic indicator of overall patient survival (OS) and disease free interval (DFI) and was significantly correlated with distant metastases and local recurrence whereas tumours expressing NCOA1/SRC1 had a significantly longer OS and DFI. There were also significant correlations between co-regulator expression of NCOA1/SRC1, CBP/p300 and NCOA3/RAC3, which were associated with lower tumour grade. NCOA1/SRC1 was also correlated with smaller tumour size. Furthermore, the co-activators had a significant association with steroid receptors, particularly ERalpha. CONCLUSIONS: NCOR2/SMRT is associated with poor patient outcome, independent of other prognostic factors. In contrast, steroid receptor co-activator expression is generally associated with a good prognosis. Further investigations are needed to establish the mechanisms of these links between the steroid receptor co-regulator system and patient outcome.     

危重病早期个体化连续性血液净化时机模式和终止的难点研究

目的研究危重症患者早期个体化连续血液净化适时治疗、透析模式选择和终止时间的最优方案。方法制定入选病例标准,将60例危重病患者以病情程度分为早、中、晚三期,用CBP治疗并观察各期的存活率和死亡率比较。各组间参数使用矿检验,进行统计学分析。结果治疗组（早期）22例,存活20例,死亡2例,死亡率9．09％,死亡率明显低于对照组（中期28．5％、晚期58．82％）,经统计学分析：卡方检验X^2=11．3259,P〈0．005结论危重病人宜早期使用CBP治疗,选择适当模式和治疗剂量,是提高危重病人抢救成功率和存活率的关键。     

吉西他滨+卡铂对比泰素(TB)治疗复发卵巢上皮癌的临床疗效观察

目的研究吉西他滨+卡铂治疗复发性上皮性卵巢癌的疗效和毒性。方法实验组:27例复发性上皮性卵巢癌应用吉西他滨1000mg/m2,第一、八天静脉滴注,曲线下面积=5,第一天静脉滴注。对照组:31例复发性上皮性卵巢癌应用紫杉醇175mg/m2,第一天静脉滴注,卡铂曲线下面积=5。第一天静脉滴注。每21天为一个疗程,坚持化疗3~12个疗程。分析两组之间的治疗效果以及毒副反应,探讨两组肿瘤患者的生活质量情况。结果实验组总有效率为77.8%,其中完全有效(26.0%),部分有效(51.9%),中位无进展生存4.2个月(2~10个月);对照组ORR为48.4%,其中完全有效(12.9%),部分有效(35.5%),位无进展生存为2.8个月(2~13个月),两组有显著差异。两组毒副反应均为骨髓抑制,对照组还以过敏反应为显著,导致4例终止疗程。对照组较实验组明显加剧其毒副反应,差异有显著意义。在肿瘤患者的生活质量评分中,实验组81.5%>50分,而对照组只有35.5%,差异有显著性。结论在治疗复发性复发性上皮性卵巢癌中,吉西他滨+卡铂较紫杉醇方案更为有效,安全性更高,毒副反应更轻,对患者的生活质量影响更少。     

人舌鳞癌Tca8113细胞荷瘤裸鼠体内诱导耐药性的实验研究

目的：探讨人舌鳞癌细胞荷瘤裸鼠体内化疗药物持续刺激状态下,肿瘤的生长及其耐药性的变化情况。方法：采用BALB／c-nu／nu裸鼠皮下接种Tca8113细胞悬液,待裸鼠成瘤后,采用卡铂（Carboplatin,CBP）进行小剂量长期暴露法诱导肿瘤耐药,以观察体内肿瘤耐药性的产生、肿瘤的生长变化及其各种耐药蛋白的表达。用免疫组化法检测部分耐药蛋白表达情况,RT-PCR检测相关耐药基因表达情况。结果：诱导后Tca8113／卡铂在免疫组化和RT-PCR检测中,MRP、GST-π等表达升高,TopoⅡ表达降低。结论：利用荷瘤裸鼠体内给药诱导肿瘤耐药性的产生可以更好地模拟临床舌鳞癌MDR的发生发展过程及其生物学特性,为多药耐药性及其逆转的进一步研究提供了一个有价值的研究平台。