结肠癌化疗引起预期性呕吐实施心理干预后的临床观察

[目的]探讨心理干预对结肠癌化疗病人引起预期性呕吐的影响。[方法]将65例病人分为观察组及对照组,对照组采取常规护理,观察组采取相应的心理调试和指导,两组均通过焦虑调查表(SAS)、症状自评量表(SCL-90)、莫洛恶性呕吐评估表(MorrowAssessment of Nausea and Emesis),显示在化疗期间恐惧化疗,处于焦虑、紧张、预期性恶心呕吐状态。[结果]观察组化疗后呕吐程度轻于对照组。[结论]预防性的心理行为干预能减病人化疗引起的呕吐,提高生活质量。     

HPV16-E7H2P融合钙网蛋白基因重组腺病毒载体疫苗的构建与免疫学鉴定

目的 构建表达钙网蛋白(CRT)与乳头瘤病毒16型E7基因H2P突变型(HPV16-E7H2P)融合蛋白重组腺病毒载体(Ad-CRT/HPV16-E7 H2P),为研发新型乳头瘤病毒治疗性疫苗奠定基础.方法 首先利用RT-PCR的方法扩增CRT基因,并进一步构建CRT与HPV16-E7H2P基因融合重组的pJW4303表达载体,将目的基因加上特定的CACC接头后克隆入载体pENTR/D-TOPO以获得入门克隆.经过入门克隆与表达载体(pAd-CMV/V5-DEST)间的重组反应获得表达克隆Ad-CRT/HPV16-E7 H2P.表达克隆线性化后转染HEK293A包装细胞,得到重组腺病毒.结果 构建的Ad-CRT/HPV16-E7H2P经PCR和测序鉴定构建正确;转染HEK293A细胞并扩增后获得的病毒滴度为1.95 × 1011 pfu/mL,该重组病毒载体能正确表达CRT/HPV16-E7H2P融合蛋白.结论 成功构建了Ad-CRT/HPV16-E7H2P,为HPV慢性感染以及宫颈癌的防治奠定了基础     

肠系膜上静脉血栓形成的诊治进展

急性肠系膜上静脉血栓(acute mesenteric venous thrombosis,MVT)形成于1935年由Warren等首先描述[1]。临床流行病学调查显示,MVT约占整个缺血性肠疾病的5%～15%[2]。MVT较难以及时确切诊断也容易误诊为其他外科急腹症,该病本身发展迅速,预后较差且病死率高,外科医师必需警惕。本文回顾国内外文献,对近年来的MVT诊治进展做一综述。     

三七总皂苷对兔胸膜粘连及纤维化的影响

目的研究不同浓度三七总皂苷（PNS）对兔胸膜粘连及纤维化的影响。方法白兔胸膜腔注射四环素盐酸盐溶液建立胸膜粘连及纤维化模型组,应用不同浓度三七总皂苷溶液作为试验组,留取不同时段胸腔积液作酶联免疫吸附试验（ELISA）检测转化生长因子（TGF-β）含量。14d时观察记录胸膜粘连积分情况。取胸膜组织做病理检查。结果36只白兔完成实验,TGF-β含量从开始观测的24h时段到最后的96h时段,8％三七总皂苷浓度组胸液中转化生长因子含量均低于其他3组,差异有统计学意义（P〈0．05）。胸膜粘连积分8％浓度组低于其余3组,差异有统计学意义（P〈0．01）。胸膜病理HE染色可见8％浓度组胸膜厚度比模型组、4％浓度组、2％浓度组的值低。炎细胞、成纤维细胞数减少。结论三七总皂苷可减少胸水中转化生长因子的产生,减少胸膜中炎细胞,成纤维细胞数量,减少胸膜粘连及肥厚,随着浓度增加其抑制胸膜粘连及纤维化效果增加。     

三七总皂苷与重楼皂苷对四环素刺激下兔胸膜腔TGF-β1、VEGF的影响及胸膜病理学观察

目的 观察三七总皂苷与重楼皂苷对四环素刺激下兔胸膜腔转化生长因子β1(transforming growth factor-β1,TGF-β1)、血管内皮生长因子(vascular endoheliai growth factor,VEGF)的影响及胸膜病理学改变.方法 兔胸膜腔注射四环素建立胸膜反应模型(模型组),分别注射尿激酶(尿激酶组)、三七总皂苷与重楼皂苷中药提取液(中药组)作为实验组.观察对比胸腔积液中TGF-β1、VEGF含量的变化,14d取胸膜组织做HE染色、Masson染色,观察胸膜厚度、胶原沉积情况.结果 共26只动物完成实验,TGF-β1含量,24、48h中药组明显低于尿激酶组与模型组(P<0.05),72、96h含量也明显偏低,差异有统计学意义(P<0.05).VEGF含量,在各同时刻点,中药组含量低于其他各组,差异有统计学意义(P<0.05),各组含量均在48h达最高值.胸膜病理,中药组和尿激酶组HE染色可见胸膜厚度比模型组降低,成纤维细胞数减少.Masson染色可见间皮下的结缔组织蓝绿色较前述2组颜色变浅,厚度变薄.结论 三七总皂苷、重楼皂苷可减少胸腔积液中TGF-β1,VEGF的产生,减少胸膜中成纤维细胞数量,抑制胶原产生,与尿激酶相比效果有明显优势,未见不良反应.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

走出医疗事故技术鉴定认识的三个误区

医疗事故技术鉴定结论,是指医疗技术鉴定委员会对医疗单位所致的损害事件进行技术鉴定所作的认定意见,它是处理医疗事故的基本依据。但在实际工作中,由于对医疗事故技术鉴定结论的意义认识不一,造成了处理医疗过失纠纷常见的三个误区。(医疗过失纠纷是因医务人员在诊疗过程中的过失而引起的医疗纠纷,主要区别于其他原因引起的患方与医疗单位产生的医疗纠纷)。1　误区之一:医疗事故技术鉴定是医疗过失纠纷处理的必经程序医疗过失纠纷的处理,主要有直接商议、行政调解、法律裁决等方式。一般纠纷可以接照直接商议、行政调解、法律裁决的程序来…     

胸腔排气、排液速度与复张性肺水肿关系的临床观察

临床在治疗大量气胸、胸腔积液过程中常能见到复张性肺水肿,对其发生机制有不同见解,为探讨肺萎陷后的复张速度对肺水肿发生的影响,笔者将不同时期所收治的大量气胸和胸腔积液患者按不同方法处理,并对复张性肺水肿的发生情况进行对比观察,总结如下。     

硫普罗宁(凯西莱)在腹部手术后对胃粘膜损伤保护作用的观察

目的　探讨腹部手术后硫普罗宁 (凯西莱 )对胃粘膜损伤的保护作用。方法　对普外科大手术后行胃肠减压管 ,观察在应用硫普罗宁 (凯西莱 )后减压管引流胃液量、隐血、胃液 p H值。结果　第 2天胃液稳血试验转阴 ,其余患者在术后第 3天转为正常胃液 ,胃液 p H值及胃液引流量均没有影响。结论　腹部大手术后许多患者较易出现胃出血 ,表现在胃肠减压管引流出咖啡样胃液。应用硫普罗宁 (凯西莱 )后可明显减少胃出血的时间。它具有保护胃粘膜的作用 ,可能与在腹部大手术后清除术后应激后产生氧自由基有关