bevacizumab治疗乳腺癌的基础和临床研究

分子靶向药物bevacizumab是针对血管内皮生长因子(VEGF)的重组人源化单克隆抗体,在多种恶性肿瘤的治疗中显示了临床效果。现就bevacizumab的作用机制及其在乳腺癌治疗中的临床研究进展作一综述。     

2型糖尿病患者血清von Willebrand因子变化与微血管并发症的关系

目的 :探讨 2型糖尿病患者的微血管内皮细胞功能损伤与微血管并发症之间的关系。方法 :从 3 3 4名 2型糖尿病患者中选择合并微血管并发症但未合并大血管并发症者 3 2人作为微血管并发症组 ,并选择年龄与之匹配的无大血管及微血管并发症 55人作为无并发症组 ,观察二组患者血清vonWillebrand因子 (vWF)水平 ,并与年龄相接近的正常对照组 ( 4 0例 )比较。结果 :血清vWF水平正常对照组 0 .92U± 0 .44U/ml;无并发症组 1.15U± 0 .42U /ml ;微血管并发症组 1.3 7U± 0 .44U/ml;三组之间均有显著性差异 (P <0 .0 5～ 0 .0 1)。多因素Logistic回归分析表明vWF、空腹血糖分别与糖尿病人是否合并微血管病变显著相关 (ExpB分别为 3 .0 2 3 ,1.3 3 7,P <0 .0 5～ 0 .0 1) ,以vWF为应变量的多元逐步回归分析表明年龄、糖尿病病程、甘油三酯分别与vWF呈显著独立正相关 (B =0 .53 ,0 .3 5,0 .2 9,P <0 .0 5～ 0 .0 1)。结论 :在糖尿病患者中存在不同程度的微血管内皮细胞的损伤 ,此变化随着微血管并发症的进展呈进行性加重。以vWF升高所反映的微血管内皮细胞损伤是一项值得临床推广的研究方法     

早期胃肠减压及胃肠内营养对极低出生体重儿存活质量的影响

目的探讨早期胃肠减压及胃肠内营养对极低出生体重儿存活质量的影响.方法将108例同期入院的极低出生体重儿随机分为两组,观察组54例,施行早期胃肠减压及母乳胃肠内营养;对照组54例,出生后先行静脉营养.结果观察组腹胀缓解时间、吸吮吞咽功能建立时间、足量喂养时间显著短于对照组(P均＜0.01).观察组体重增长、神经行为评分显著优于对照组(P均＜0.01),并发症显著少于对照组(P＜0.005),观察组存活率及存活质量显著优于对照组(P＜0.05).结论早期胃肠减压及母乳胃肠内营养,减少了常见并发症,提高了极低出生体重儿存活率及存活质量.     

Care related pain in hospitalized patients: A cross‐sectional study

Context: Care‐related pain includes pain occurring during transportation, movement, diagnostic imaging, physical examination, or treatment. Its prevalence has never been assessed in a large adult inpatient population. Objective: To identify the procedures likely to induce or increase pain in hospital patients, attempting to separate the most painful from those reported as most frequently inducing pain. Design: A single‐day cross‐sectional survey conducted in two large French teaching hospitals, including all hospitalized patients, free of communication problems. One third was randomly selected and interviewed about the painful episodes that had occurred or were associated with the procedures performed during the previous two weeks. Patients were interviewed using a structured questionnaire. Results: Six‐hundred‐eighty‐four patients were randomly selected. Six‐hundred‐seventy‐one painful events were reported in 55% of the patients, with an average of 1.8events/patient. Fifty‐two percent of the painful events were associated with procedures performed by non‐medical staff; 38% of the painful episodes occurred during procedures involving vascular puncture and 24% during patients’ mobilization. In 57% of painful procedures, pain was rated as severe or extremely severe. The most painful procedures were invasive procedures, other than vascular and non vascular punctures (74% of severe and extremely severe painful episodes). Maximum pain intensity was rated higher for procedures that were repeated than for those experienced only once (62% versus 53%, p=0.02). Conclusion: This survey gives new insight into our daily practice. Proper management of care‐related pain should be a major concern of all hospital staff to improve the quality of our health care.     

The use of head CT scan in adult trauma victims: an algorithm

INTRODUCTION: The purpose of this study was to identify, through recursive partitioning, clinically relevant criteria which predict the need for acute neurosurgical intervention in a group of patients with mild head injury. MATERIALS AND METHODS: A retrospective cohort of all adult patients, from April 2000 to March 2001, who sustained a blunt trauma and underwent head CT scan, was reviewed. The following inclusion criteria for mild head injury were used: initial Glasgow Coma Scale (GCS) ranging from 13 to 15; no loss of consciousness lasting more than one hour; no obvious skull fracture; a cranial CT scan performed. We collected demographic and trauma related data, interventions and outcome. Univariate and multivariate analyses were undertaken. In parallel, recursive partitioning was carried out using all variables to elaborate a decision algorithm. RESULTS: There were 405 patients in the sample. CT identified lesions in 12% of patients. Twelve patients (3%) required acute neurosurgical intervention. The recursive partitioning analysis identified three significant sequential nodes: deterioration of the GCS; an initial GCS of 13 vs 14 or 15; and the presence of associated injuries or comorbid conditions. CONCLUSIONS: A simple three step rule predicts the need for acute neurosurgical intervention based on clinical findings: a deteriorating GCS; an initial GCS of 13; and the presence of associated injuries or comorbid conditions.     

Evaluation of a continuous training program at Bichat hospital for in-hospital cardiac arrest resuscitation

Management of in-hospital cardiac arrest is now considered as a hospital quality indicator. Such management actually requires training health care workers (HCWs) for basic life support (BLS). OBJECTIVE: To assess the usefulness and efficacy of a short mandatory BLS training course amongst general ward HCWs in a 1,200 bed teaching hospital. STUDY DESIGN: The in-hospital medical emergency team (MET) established a 45-min BLS training course comprising 10 goals for basic CPR and preparing for the arrival of the MET. Assessment was based on satisfaction questionnaires, cross-sectional evaluation of knowledge and skills of HCWs before and 1 year after the start of the training course. Efficacy of BLS performed on ward was assessed by the MET on scene. RESULTS: One year after, 68 training sessions had been fulfilled and 522 HCWs had been trained (46.27% of total HCWs). HCWs were satisfied with the teaching course. Instant retention of objectives was over 90%. Cross-sectional surveys showed an improvement of BLS knowledge and skills. The knowledge of initial clinical assessment remained low. Knowledge and skills were significantly higher amongst HCWs who had been trained than amongst those who had not. Unfortunately, general ward BLS performance showed no improvement. CONCLUSION: Short mandatory training courses are stimulating and well appreciated amongst HCWs. Although basic knowledge and skills improve dramatically, no improvement of on-scene BLS performance occurs.     

青藏铁路现场管理人员血氧饱和度、睡眠质量及心理健康状况调查

目的:探讨青藏铁路现场管理人员的血氧饱和度(SaO2)、睡眠质量、心理健康状况及其影响因素.方法:采用随机整群抽样,应用Dash2000型生理多参数监护仪、匹兹堡睡眠质量指数(PSQI)问卷和症状自评量表(SCL-90),对青藏铁路现场管理人员117人进行现场测评,并与重庆地区铁路工程现场管理人员90人比较.结果:青藏铁路现场管理人员收缩压、舒张压较高,SaO2较低,PSQI总分及习惯性睡眠效率、使用睡眠药物两因子分及SCL-90总分及各因子得分较高,与非住藏铁路现场管理人员比较均有统计学差异.多因素分析结果显示白天功能紊乱、睡眠紊乱、睡眠持续性和年龄是影响受试心理健康水平的相关因素.结论:青藏铁路现场管理人员心理健康水平和睡眠状况明显差于非住藏铁路工程管理人员,睡眠是影响心理健康的重要因素.     

肝硬化肝癌大鼠TGF-β1和受体的表达及其意义

目的:探讨肝硬化、肝癌和肝切除与血清TGF-β1和细胞膜相关受体表达的关系及其意义。方法:将150只Wistar大鼠随机分成3组:A组30只,行70%肝切除;B组60只,制备肝硬化模型,获得模型鼠40只,行70%肝切除;C组60只,制备肝癌模型,获得模型鼠39只,行70%肝切除。采用ELISA法检测各组动物手术前后血清TGF-β1的表达水平,免疫组织化学方法检测各组动物手术前后肝组织中TGF-β受体的表达情况。结果:3组术后血清TGF-β1浓度均较术前显著提高;3组中,肝癌组术前、术后血清TGF-β1浓度最高,肝硬化组次之,组间比较均有显著差异(P均<0.01)。肝癌大鼠和肝硬化大鼠术后血清TGF-β1浓度升高幅度更为明显(与正常大鼠术后升高幅度相比,P<0.01)。正常组和肝硬化、肝癌组手术前后TGF-β受体表达无明显差异,但肝硬化组表达的TGF-β受体较正常高,而癌组织与癌周组织受体表达强度显著提高,其受体所在部位有明显不同。结论:TGF-β1与受体的相关表达与化学诱导的肝硬化和肝癌的发生有一定关系;肝切除术后残留肝硬化组织再生不完全可能与TGF-β1的高强度表达有关;对于肝癌大鼠、正常肝组织和肿瘤组织细胞膜表面受体表达的位置差异,可能是肿瘤细胞逃避TGF-β1对细胞增殖的抑制作用的重要原因。     

蜂毒素的抗肿瘤生物活性及其稳定性研究

目的：通过中压液相色谱提取、纯化蜂毒素，研究其抗肿瘤生物学活性，及其稳定性。方法：通过中压液相色谱提取蜂毒素，经HPLC检测纯度，采用MTT法，体外观察蜂毒素对4种肝癌细胞系增殖的抑制作用，同时与蜂毒素标准品进行抗肿瘤生物活性的比较，并比较不同批次提纯蜂毒素的抗肿瘤作用。结果：蜂毒素在16～128μg/ml对肝癌细胞增殖有抑制作用，并呈剂量依赖性，对人正常肝脏来源细胞株L-02细胞抑制作用不明显。在60μg/ml浓度，各批次提取的蜂毒素与蜂毒素标准品间抗肿瘤活性无显著性差异。结论：采用中压液相色谱提取、纯化的蜂毒素具有抗肿瘤生物活性，并且稳定性良好。