儿童后腹膜肿块CT表现

目的：报告儿童后腹膜常见与不常见占位病变的CT表现。材料和方法：对34例（32例经病理证实，2例随访复查证实)儿童后腹膜肿块病例完整的临床及CT检查资料进行分析。结果：本组儿童后腹膜占位病变共有11种．以肾上腺瘤和后腹膜神经母细胞瘤最常见，畸胎瘤和肾胚胎瘤、新生儿肾上腺出血其次．肾上腺皮质癌较少见，罕见的有横纹肌肉瘤和血管外皮瘤。临床和CT特点各有其不同。结论：临床特点与CT表现相结合，极大部分儿童后腹膜肿块可作出明确诊断。     

无创高频振荡通气在极低出生体重早产儿呼吸窘迫综合征初始呼吸支持治疗中的应用

目的探讨经鼻无创高频振荡通气(NHFOV),在呼吸窘迫综合征(RDS)极低出生体重早产儿初始呼吸支持治疗的临床疗效。 方法选择2018年2月至2020年4月,于徐州市中心医院新生儿重症监护病房(NICU)治疗的92例RDS极低出生体重早产儿为研究对象。采用随机数字表法,将其分为NHFOV组(n＝48,采取NHFOV治疗)及经鼻持续气道正压通气(NCPAP)组(n＝44,采取NCPAP治疗)。对2组RDS极低出生体重早产儿一般临床资料,无创通气治疗前、后动脉血气分析指标,疗效,呼吸支持治疗相关并发症发生率及患儿死亡率,采用成组t检验、χ²检验及Mann-Whitney U检验进行统计学比较。本研究经徐州市中心医院医学伦理委员会审核批准(审批文号：XZXY-LJ-20170328-006),并且与患儿监护人均签署临床研究知情同意书。 结果①一般临床资料比较：2组RDS极低出生体重早产儿的性别、出生胎龄与体重及生后1、5 min Apgar评分,入院日龄及分娩前24 h母亲糖皮质激素使用率等一般临床资料比较,差异均无统计学意义(P>0.05)。② 2组RDS极低出生体重早产儿动脉血气分析指标组间比较：NHFOV组RDS极低出生体重早产儿无创通气治疗后1 h、24 h动脉血二氧化碳分压(PaCO₂)分别为(45.8±6.5) mmHg(1 mmHg＝0.133 kPa)及(40.8±4.7) mmHg,均显著低于NCPAP组的(49.3±5.7) mmHg及(44.2±5.2) mmHg;治疗后1 h、24 h动脉血氧分压(PaO₂)与吸入氧浓度分数(FiO₂)比值(P/F)分别为(198.8±30.5) mmHg及(215.1±32.1) mmHg,均显著高于NCPAP组的(176.4±28.1) mmHg及(190.0±29.7) mmHg,并且上述差异均有统计学意义(t＝2.809、3.301、3.663、3.881,P＝0.003、<0.001、<0.001、<0.001)。③2组动脉血气分析指标分别进行组内比较均为：无创通气治疗后24 h的pH值及治疗后1、24 h的PaCO₂水平,均较治疗前改善,而且治疗后24 h的P/F值高于治疗后1 h,并且差异均有统计学意义(P<0.05)。④无创通气疗效比较：NHFOV组RDS极低出生体重早产儿无创通气治疗后,肺表面活性剂(PS)使用率及有创机械通气率(22.9%、6.3%),均显著低于NCPAP组(45.5%、20.5%),并且差异均有统计学意义(χ²＝5.219、4.084,P＝0.022、0.043)。2组RDS极低出生体重早产儿无创通气时间、柠檬酸咖啡因使用率、频繁呼吸暂停发生率及总用氧时间比较,差异均无统计学意义(P>0.05)。⑤2组RDS极低出生体重早产儿鼻损伤、肺气漏、新生儿坏死性小肠结肠炎(NEC)、Ⅲ~Ⅳ级脑室内出血(IVH)、早产儿视网膜病(ROP)(≥Ⅱ期)及支气管肺发育不良(BPD)发生率,以及患儿死亡率比较,差异均无统计学意义(P>0.05)。 结论与NCPAP比较,NHFOV用于RDS极低出生体重早产儿初始呼吸支持治疗,能改善氧合、减少二氧化碳(CO₂)潴留、减少有创机械通气及PS使用,同时不增加呼吸支持治疗相关并发症发生。     

穴位敷贴联合哌拉西林钠他唑巴坦钠治疗小儿脓毒症临床研究

目的：观察穴位敷贴联合哌拉西林钠他唑巴坦钠治疗脓毒症的临床疗效。方法：回顾性选取脓毒症患儿566例,根据治疗方式不同分为对照组和观察组各283例。2组均给予对症治疗,对照组给哌拉西林钠他唑巴坦钠静脉滴注,观察组在对照组基础上给予穴位贴敷治疗。评价2组临床疗效,比较2组疾病严重程度、炎症水平和免疫功能。结果：观察组总有效率为95.76%,高于对照组80.57%,差异有统计学意义（P<0.05）。治疗后,2组急性生理学及慢性健康状况评分系统（APACHEⅡ）评分及多脏器功能障碍Marshall评分较治疗前降低（P<0.05）;且观察组APACHEⅡ评分、Marshall评分低于对照组（P<0.05）。治疗后,2组白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)、C-反应蛋白（CRP）水平较治疗前降低（P<0.05）,且观察组IL-6、TNF-α、CRP水平低于对照组（P<0.05）。治疗后,2组CD3+、CD4+、CD4+/CD8+较治疗前升高（P<0.05）,且观察组CD3+、CD4+、CD4+/CD8+高于对照组（P<0.05）。...     

Legumain expression in relation to clinicopathologic and biological variables in colorectal cancer.

PURPOSE: Legumain, a novel asparaginyl endopeptidase, has been observed to be highly expressed in several types of tumors including colorectal cancer. However, there is no study examining the relationship of legumain expression to clinocopathologic and biological variables in colorectal cancers. EXPERIMENTAL DESIGN: We investigated legumain expression in 164 primary colorectal cancers, 34 corresponding distant normal mucosa samples, 89 adjacent normal mucosa samples, and 33 lymph node metastases using immunohistochemistry. We also did Western blotting analysis on three additional colorectal cancers and three colonic cell lines. RESULTS: Legumain expression was increased in primary tumors compared with distant or adjacent normal mucosa (P < 0.05), but there was no significant change between primary tumors and metastases (P > 0.05). Legumain expression was positively related to poorer differentiation/mucinous carcinoma (P = 0.04), higher degree of necrosis (P = 0.03) and apoptosis (P < 0.0001), positive proliferating cell nuclear antigen (P < 0.0001) and p53 expression (P = 0.049), and had a positive tendency towards stromelysin 3 (P = 0.058) and PINCH positivity (P = 0.05). The patients with tumors that showed both weak and lower percentage of the legumain expression, either in tumor (P = 0.01) or in stroma (P = 0.04), had a better prognosis. CONCLUSIONS: The legumain expression may be involved in colorectal cancer development and have a prognostic value in the patients.     

终末期肾病患者对护理专业性社会支持体验及期望的叙事研究

目的了解终末期肾病患者住院期间对护理人员提供社会支持的体验及需求,为护士实施全面有效的社会支持提供依据。方法采用立意抽样法选取14例终末期肾病住院患者为研究对象,采用半结构式访谈提纲进行深入访谈并按三维度叙事分析法进行转录和分析。结果患者住院期间感受到的护理专业性社会支持主要有:护理帮助支持、情感支持、沟通和信息支持;患者期望获得及时的评价支持,更多的情感支持,针对性、多样化的沟通信息支持。结论护理人员为终末期肾病患者提供专业性社会支持时应关注患者的期望,提升护理服务效能。     

HPLC法同时测定磺啶新林胶囊中4个成分的含量

目的:建立同时测定磺啶新林胶囊中盐酸溴己新、盐酸氯丙那林、磺胺甲噁唑和甲氧苄啶含量的方法。方法:采用高效液相色谱法,Ecosil-C₁₈色谱柱（4.6 mm×250 mm,5μm）,以乙腈-0.001 5 mol·L^-1十二烷基硫酸钠的0.1%三乙胺溶液（用磷酸调pH值至3.0）（52:48）为流动相,流量1.0 mL·min^-1,检测波长为215 nm。结果:4个成分的峰面积与浓度的线性关系良好（r>0.999 9）;加样回收率为98.85%⁹9.58%。结论:该方法可用于磺啶新林胶囊中盐酸溴已新、盐酸氯丙那林、磺胺甲噁唑和甲氧苄啶4个成分的含量测定。     

近交系NJS小鼠红细胞变形能力及其与血清胆固醇水平的关系

本文观察近交系NJS小鼠红细胞变形能力及其与血清胆固醇的关系。以DXC—300型核孔膜红细胞变形能力测定仪测定小鼠的红细胞变形指数（EFI），同时以日立7150型血液自动生化分析仪测定血清胆固醇（CHO）含量，并以C57BL／6J正常小鼠作对照。结果表明：NJS／小鼠EFI（0．29±0．06）显著高于C57BL／6J小鼠（0．20±0．10，P＜0．01），小鼠EFI与CHO水平呈正相关（r＝0．785，P＜0．01）。提示：红细胞变形能力受损可能在高胆固醇血症小鼠动脉粥样硬化的发病过程中起重要作用。     

Analysis of differentially expressed advanced glycation end product-modified proteins in diabetic rat kidney

The objective of the study is to analyze and identify differentially expressed advanced glycation end product (AGE)-modified proteins in diabetic rat kidney tissues. A total of 60 healthy male Sprague-Dawley rats were randomly divided into the normal control group, 1-month diabetic group, and 3-month diabetic group. Two percent streptozotocin (55 kg/kg) was intraperitoneally injected to establish the diabetic rat model. AGE-modified protein concentrations in the renal tissues were measured by ELISA. The differentially expressed AGE-modified proteins in renal tissues were separated with one-dimensional electrophoresis (1-DE) Western blotting and analyzed and identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS). AGE-modified protein concentrations in the 1-month diabetic group (420.9?±?53.0 μg/mL) and 3-month diabetic group (618.8?±?86.1 μg/mL) were significantly higher than the control group (332.3?±?51.4 μg/mL) (p <?0.05 and p <?0.001, respectively). AGE-modified protein concentrations in the 3-month diabetic group were higher than in the 1-month diabetic group (p <?0.001). The blood glucose levels were positively correlated with AGE-modified protein concentrations in the diabetic groups (r =?0.4303, p =?0.4303). Four differentially expressed AGE-modified proteins were separated with 1-DE Western blotting, of which the expression levels of three proteins were twofold higher in the 3-month diabetic group as compared to the control group or 1-month diabetic group. The four upregulated proteins were identified by MALDI-TOF-MS as actin, transferrin, catalase, and albumin. Non-enzyme glycosylation of proteins may affect the structure of these proteins and probably the functions and cause kidney damage in diabetic rats.     

N末端脑钠肽前体联合在线血容量监测在维持性血液透析中的应用

目的观察血浆N末端脑钠肽前体(NT-proBNP)水平联合在线血容量监测(BVM)对维持性血液透析(MHD)患者容量负荷和并发症发生情况的评估效果。方法选取MHD患者140例作为研究对象,以透析期间体质量增长率(PIBWG)为标准评估容量负荷,检测患者透析前和透析2、4 h时的血浆NT-proBNP水平,应用BVM系统监测在线相对血容量(RBV)水平,采用Pearson相关性分析法分析血浆NT-proBNP、RBV水平与PIBWG、左室舒张末期容积(LVEDV)的相关性,并观察透析并发症(低血压和心律失常)发生情况。结果 140例患者平均PIBWG为(4.33±1.26)%,按照PIBWG的不同将患者分为低容量组(PIBWG 4.33%,50例)与高容量组(PIBWG≥4.33%,90例)。高容量组透析2、4 h时的血浆NT-proBNP、RBV水平高于低容量组,变化差值小于低容量组,差异有统计学意义(P 0.05)。Pearson相关分析显示,PIBWG、LVEDV分别与血浆NT-proBNP、RBV的变化差值呈正相关(P 0.05或P 0.01)。高容量组透析并发症发生率低于低容量组,差异有统计学意义(P 0.05)。结论血浆NT-proBNP水平联合BVM可用于MHD患者容量负荷和并发症发生情况的评估,与PIBWG、LVEDV水平有较好的一致性。分析血浆NT-proBNP或RBV水平透析2、4 h时与透析前的变化差值,可为准确评估透析效率和安全性提供更多信息。