人文护理在肿瘤患者临终关怀中的应用进展

本文就临终关怀中护理的内涵、特点,临终关怀对护理的要求,以及人文护理模式在临终关怀这一特殊医疗领域中的具体应用进行综述,在于探讨人文方面的护理方式运用于肿瘤病人临终关怀的可行性和有效性。     

ⅠL-33、ⅠL-35在晚期胃癌术后加味五苓散联合超声药物透入治疗中的临床意义

目的：分析加味五苓散联合超声药物透入在晚期胃癌患者术后恢复胃肠道功能中的价值。方法将68例行晚期胃癌术后患者随机分为试验组和对照组,2组综合治疗相同,试验组加用加味五苓散联合超声药物透入治疗,观察2组患者血清ⅠL-33、血清ⅠL-35、腹围变化、肠鸣音恢复、肛门排气排便及住院时间。结果试验组血清ⅠL-33、ⅠL-35较对照组明显下降（ P＜0.05）;2组腹围差在治疗后48 h、72 h、96 h及120 h时比较差异均有统计学意义（ P均＜0.05）;2组肠鸣音恢复、排气、排便时间比较差异均有统计学意义（ P均＜0.05）。结论加味五苓散联合超声药物透入治疗可促进胃癌患者术后肠鸣音恢复、加快胃肠功能、减轻腹胀;血清ⅠL-33、ⅠL-35可评估治疗效果。     

Quercetin suppresses HeLa cells by blocking PI3K/Akt pathway

To explore the effect of quercetin on the proliferation and apoptosis of HeLa cells, HeLa cells were incubated with quercetin at different concentrations. Cell viability was evaluated by MTT assay, cell apoptosis was detected by Annexin- V/PI double labeled cytometry and DNA ladder assay. Cell cycle was flow cytometrically determined and the morphological changes of the cells were ob- served under a fluorescence microscope after Hoechst 33258 staining and the apoptosis-related pro- teins in the HeLa cells were assessed by Western blotting. The results showed that quercetin signifi- cantly inhibited the growth of HeLa cells and induced obvious apoptosis in vitro in a time- and dose-dependent manner. Moreover, quercetin induced apoptosis of HeLa cells in cell cycle-dependent manner because quercetin could induce arrest of HeLa cells at G0/G1 phase. Quercetin treatment down-regulated the expression of the PI3K and p-Akt. In addition, quercetin could down-regulate ex- pression of bcl-2, up-regulate Bax, but exerted no effect on the overall expression of Akt. We are led to conclude that quercetin induces apoptosis via PI3k/Akt pathways, and quercetin has potential to be used as an anti-tumor agent against human cervix oancer.     

miR-21 targets Fas ligand-mediated apoptosis in breast cancer cell line MCF-7

Over-expression of Fas ligand （FasL） on tumor cell surface can induce the apoptosis of spe- cific activated tumor infiltrating lymphocytes （TILs） via the Fas/FasL pathway, leading to the formation of a site of immune privilege surrounding the tumor mass for escaping immune surveillance and pro- moting tumor proliferation, invasion and metastasis. The blocking effect of miR-21 on FasL-mediated apoptosis in breast cancers was investigated in this study. The expression levels of miR-21 and FasL in human breast carcinoma cell lines were detected by using RT-PCR and Western blotting. FasL as a tar- get gene of miR-21 was identified by Luciferase assay. The apoptosis of Jurkat T lymphocytes induced by MCF-7 cells was determined by flow cytometry. It was found that in four human breast cancer cell lines, FasL expression level in MCF-7 cells was the highest, while miR-21 was down-regulated the most notably. After miR-21 expression in MCF-7 cells was up-regulated, FasL was identified as a target gene of miR-21. When the effector/target （E/T） ratio of MCF-7 cells and Jurkat cells was 10：1, 5：1 and 1：1, the inhibitory rate of apoptosis of Jurkat T lymphocytes induced by MCF-7 cells was 95.81%, 93.16% and 91.94%, respectively. It is suggested that in breast cancers miR-21 expression is negatively associ- ated with FasL expression, and FasL is a target gene of miR-21, miR-21 targeting and regulating FasL-mediated apoptosis will bring us the possibility of a new tumor immunotherapy via breaking tu- mor immune privilege.     

细菌生物膜在肿瘤生物学进程及治疗应用中的研究进展

细菌生物膜是细菌及其胞外聚合物形成的微生物群体,具有增强抗生素抵抗及抗宿主免疫等能力。肿瘤微环境中的细菌生物膜具有诱导炎症-癌症转化、促进癌细胞增殖转移和增强肿瘤耐药性等作用,影响着肿瘤的生物学进程。此外,细菌生物膜还被证实可协同抗癌药物抑制肿瘤细胞增殖、促进抗癌药物靶向定植及增强宿主免疫功能。本文就细菌生物膜在影响恶性肿瘤发生发展及抗肿瘤治疗中的研究进行综述。     

16例伪膜性肠炎临床分析

目的总结伪膜性肠炎的临床表现，分析讨论影响其治疗与预后的因素。方法回顾分析16例伪膜性肠炎患者的用药及临床资料。结果16例伪膜性肠炎患者中绝大部分患者有在使用广谱抗生素过程中出现腹泻、腹痛等表现，少部分在使用大量激素后出现腹泻、腹痛等表现，其发生与使用第三代头孢菌素和喹诺酮类关系最为密切。结论伪膜性肠炎多在应用抗生素或激素过程中发病，老年人、重症患者及外科大手术患者为易感人群。根据使用抗生素或激素的病史、临床表现及结肠镜下典型表现可做出临床诊断。     

血清泛素羧基末端水解酶1、脑红蛋白与心肺复苏后昏迷患者神经功能预后的关系研究

目的探讨血清泛素羧基末端水解酶1(ubiquitin C-terminal hydrolase-L1,UCH-L1)、脑红蛋白浓度与心肺复苏后昏迷患者神经功能预后的关系及预测价值。方法选取2018年2月至2020年6月四川省成都市第三人民医院收治的45例心肺复苏成功后昏迷患者为昏迷组,选取同期收治的62例心肺复苏成功后24 h内意识恢复患者为对照组进行前瞻性研究。入院24 h内均检测血清UCH-L1、脑红蛋白浓度,采用格拉斯哥昏迷(glasgow coma Scale,GCS)和格拉斯哥-匹兹堡脑功能表现分级(cerebral performance category,CPC)评分评估昏迷程度和神经功能预后。Spearman秩相关分析UCH-L1、脑红蛋白浓度与GCS评分、CPC评分相关性。Logistic回归分析影响心肺复苏后昏迷患者神经功能预后的因素,受试者工作特征曲线(receiver operator characteristics curve,ROC)分析UCH-L1、脑红蛋白预测心肺复苏术成功后昏迷患者神经功能预后的价值。结果昏迷组血清UCH-L1[(0.63±0.21) μg/L]、脑红蛋白浓度[(89.34±21.35) mg/L]高于对照组[(0.27±0.08) μg/L,(32.13±9.21) mg/L],差异有统计学意义(t值分别为12.338、18.846;P均<0.001)。UCH-L1、脑红蛋白在轻型、中型、重型昏迷组依次升高,组间比较,差异有统计学意义(F值分别为86.430、26.958;P均<0.001)。神经功能预后不良组血清UCH-L1[(0.72±0.06) μg/L]、脑红蛋白浓度[(100.35±5.79) mg/L]高于神经功能预后良好组[(0.52±0.08) μg/L、(75.58±6.91) mg/L],差异有统计学意义(t值分别为9.585、13.086;P均<0.001)。UCH-L1、脑红蛋白与GCS评分呈负相关(rs=-0.685、-0.669,P均<0.001),与CPC评分均呈正相关(rs=0.688、0.670;P均<0.001)。多因素Logistic回归分析结果显示低GCS评分(OR=0.552,95%CI:0.392~0.776,P<0.001)、高水平UCH-L1(OR=1.881,95%CI:1.276~2.773,P<0.001)和脑红蛋白(OR=1.677,95%CI:1.206~2.331,P=0.001)与心肺复苏后昏迷患者神经功能预后不良独立相关。联合UCH-L1、脑红蛋白预测心肺复苏后昏迷患者神经功能预后不良的AUC为0.954,大于单独UCH-L1、脑红蛋白的0.821、0.790(Z值分别为2.351、2.649,P均<0.05)。结论心肺复苏成功后昏迷患者血清UCH-L1、脑红蛋白浓度均增高,高浓度的UCH-L1、脑红蛋白与昏迷程度加重和神经功能不良有关,可作为神经功能预后评估的潜在生物学指标。     

产科急症:产前出血-子痫-HELLP综合征

孕晚期,产时及产后的急性出血都需紧急处理,并在短时间内作出鉴别诊断,还需麻醉科及新生儿科配合。本文介绍诊断及处理应遵循的原则。     

头静脉汇入颈外静脉的观测及其临床意义

对614侧成人尸体的头静脉末段进行了解剖观测，发现47侧（7.65%)与颈外静脉直接或间接相连。其中头静脉主干越过锁骨前面直接汇入颈外静脉41侧（6.68%)；与颈外静脉间接借越过锁骨前面的交通支相连6侧（0.98%)。头静脉主干汇入颈外静脉的部位距锁骨上方1.52±0.78cm；越过锁骨的位置，距锁骨内侧端的直线距离为8.54±1.10cm，距肩峰外侧端的直线距离为6.40±1.30cm；在锁骨前方的外径为3.40±1.10mm。本对头静脉的此种汇入变异的临床意义进行了讨论。