教学课程资源库 更多>>

关键词： 视网膜母细胞瘤   主要照顾者   照顾负担   影响因素  

摘要： 目的:探讨视网膜母细胞瘤(RB)患儿主要照顾者的照顾负担水平及其影响因素。方法:采用一般资料调查表、Zarit照顾者负担量表(ZBI)及社会支持评定量表(SSRS)对180例视网膜母细胞瘤患儿的主要照顾者进行调查。结果:视网膜母细胞瘤患儿主要照顾者的照顾负担总分为(44.37±14.27)分,社会支持总分为(36.62±7.69)分。回归分析结果显示,患儿年龄、疾病治疗时间、主要照顾者的照顾时长、工作状况、费用支付方式、社会支持是影响患儿主要照顾者照顾负担的主要因素,解释照顾负担变异的45.3%。结论:视网膜母细胞瘤患儿主要照顾者的照顾负担处于重度水平,建议护理人员采取积极的应对方式,帮助减轻照顾负担,从而提高照顾质量。

关键词： 乳腺良恶性肿瘤   高频彩超   超声特征   诊断价值  

摘要： 目的:探讨高频彩超诊断乳腺良恶性肿瘤的应用价值。方法:选取2018-01~2020-01于我院接受治疗的77例乳腺肿瘤患者,所有患者均行高频彩超检查,以穿刺活检结果作为“金标准”,比较高频彩超对乳腺良恶肿瘤诊断的超声特征、BI-RADS分级情况,分析高频超声对乳腺肿瘤良恶性诊断的一致性。结果:经穿刺活检结果得知,77例乳腺肿瘤患者中33例为恶性,占42.86%,44例为良性,占57.14%;乳腺恶性肿瘤高频超声特征中回声、后方衰竭、钙化、边缘、内部结构、边界方面均与良性肿瘤相比,差异有统计学意义(P<0.05);乳腺恶性肿瘤高频超声BI-RADS分级中2级、3级、4a级、4b级、4c级、5级与良性肿瘤相比,差异有统计学意义(P<0.05);高频超声检查的准确度、灵敏度、特异度、恶性预测价值、良性预测价值分别为87.01%(67/77)、87.88%(29/33)、86.36%(38/44)、82.86%(29/35)、90.48%(38/42);且与穿刺活检结果相比具有理想一致性(Kappa=0.737)。结论:乳腺良、恶性肿瘤在高频彩超检查中具有特异性表现,具有较高的诊断价值,为临床治疗方案的拟定提供依据。

关键词： 膝骨关节炎   疑难疾病   中西医临床   退行性骨关节病   新书介绍   广东科技出版社   科普性   科普知识  

摘要： 由广东科技出版社出版的《膝骨关节炎疼痛及治疗100问》为全国首部膝骨关节炎科普知识合集作品。为了响应国家大健康计划,查振刚教授团队对接诊的膝骨关节炎患者及其家属关于膝骨关节炎疼痛和治疗最关心及最常见的问题进行梳理,在国家中医药管理局办公室、国家卫生计生委办公厅、中央军委后勤保障部卫生局——重大疑难疾病中西医临床协作试点项目(退行性骨关节病)的支持下编纂此科普著作。本书兼顾科普性及学术性,旨在满足不同读者的需求。

关键词： 免疫炎症   前列腺增生   增殖   凋亡   雄激素受体信号通路   CD40/CD40L信号通路  

摘要： 目的:探讨由巨噬细胞(MAs)诱导的免疫炎症对前列腺增生(BPH)细胞增殖和凋亡的影响及可能的机制。方法:MAs经过丙二醇甲醚醋酸酯(PMA)刺激后,与BPH细胞(BPH-1)一起培养,然后进行雄激素受体(AR)抑制剂或抗CD40L抗体处理。检测处理前和处理后T淋巴细胞(CD4、CD8)、B淋巴细胞(CD20)、巨噬细胞(MAs)(CD68)、雄激素受体(AR)和炎症因子IL-1、IL-6、TNF-α的生物标志物。用MTT法、集落形成试验和流式细胞仪观察细胞增殖和凋亡情况。采用定量反转录聚合酶链反应(qRT-PCR)和Western blot检测凋亡相关蛋白和MAPK信号通路相关蛋白的表达。结果:与空白对照组(B-BPH-1组)相比,MAs处理组(M-BPH-1组)细胞增殖率明显升高,凋亡率显著下降,Bcl-2表达升高,Bax表达降低,免疫炎症因子IL-1、IL-6、TNF-α的表达明显升高,AR、CD40和CD40L的mRNA和蛋白表达明显升高(P<0.01)。与生理盐水组相比,CD40L单克隆抗体低剂量组(L-CD40L组)和CD40L单克隆抗体高剂量组(H-CD40L)组细胞增殖能力均受到抑制,细胞克隆数量均减少,细胞凋亡率明显上升,Bcl-2表达降低,Bax表达显著升高,免疫炎症因子IL-1、IL-6、TNF-α的表达均下降(P<0.01)。与生理盐水组相比,AR抑制剂低剂量组(L-AR抑制剂组)和AR抑制剂高剂量组(H-AR抑制剂组)细胞增殖率明显均降低,克隆细胞数量均减少;H-AR抑制剂组细胞凋亡率升高,Bcl-2表达降低,Bax表达升高,免疫炎症因子IL-1、IL-6、TNF-α的表达均下降(P<0.01)。与B-BPH-1组相比,M-BPH-1组的JNK、ERK和p38的磷酸化水平明显升高,而H-CD40L组和H-AR抑制剂组JNK、ERK和p38磷酸化水平明显被抑制,并呈浓度依赖性(P<0.01)。结论:由MAs诱导的免疫炎症可通过激活MAPK信号通路调节AR和CD40/CD40L表达,促进BPH-1细胞增殖并抑制凋亡。

关键词： 乳腺良性肿瘤   超声引导下麦默通微创术   消乳散结胶囊   预后  

摘要： 目的:探讨对乳腺良性肿瘤患者应用超声引导下麦默通微创术联合消乳散结胶囊治疗的临床疗效及对其预后的影响。方法:抽选于2019年12月—2021年3月期间我院共收治的乳腺良性肿瘤患者110例,随机均分为两组,即对照组、研究组,各55例。对照组接受超声引导下麦默通微创术治疗,研究组接受超声引导下麦默通微创术+消乳散结胶囊治疗。评价及对比两组的疗效、激素水平、血清炎症因子、不良反应发生率。结果:研究组的疗效总有效率高于对照组(P<0.05);治疗后,研究组的孕酮水平高于对照组,雌二醇水平低于对照组(P<0.05);研究组的各项血清炎症因子水平均低于对照组(P<0.05);两组的不良反应发生率比较无明显差异性(P>0.05)。结论:对乳腺良性肿瘤患者应用超声引导下麦默通微创术联合消乳散结胶囊治疗,可改善内分泌激素水平,减轻炎症,疗效确切,且不会明显增加不良反应,是一种安全、有效的治疗选择,值得临床开展。

关键词： 前列腺增生   伤寒论   蓄水证   蓄血症   张敏建  

摘要： 良性前列腺增生症是中老年男性常见病之一,是危害我国中老年男性健康的首要慢性病。张敏建教授强调东汉张仲景所著《伤寒杂病论》中诸多关于小便问题辨病和辨证的论述,其中对于诊治良性前列腺增生症而言,能否融会贯通正确理解小便不利与小便自利尤为重要。今从张敏建教授解析《伤寒论》第71和125条来介绍张师对良性前列腺增生症辨病辨证的临床经验。

关键词： 良性前列腺增生   钬激光   临床治疗   经尿道钬激光前列腺增生剜除术   经尿道前列腺电切术  

摘要： 良性前列腺增生(Benign prostatic hyperplasia,BPH)是中老年男性常见病、多发病,临床症状以排尿困难、膀胱刺激症状为主,病情进一步发展时,患者会出现尿潴留、肾积水等严重并发症,严重影响患者的生活质量,此时,患者需接受以手术为主的综合干预措施。伴随钬激光技术在泌尿外科领域的大力推广,经尿道钬激光剜除良性前列腺增生的手术方式越来越炙热化,自2016年起,就已被欧洲泌尿外科指南予以推荐。笔者就近年来钬激光技术应用于BPH的相关原理、发展史、现状及发展前景做一综述。

关键词： Primary bilateral macronodular adrenal hyperplasia (PBMAH)   Type 2 diabetes   Glucocorticoid-induced diabetes   Subclinical Cushing’   s syndrome   Unilateral adrenalectomy  

摘要： Primary bilateral macronodular adrenal hyperplasia (PBMAH) is characterized by bilateral multiple adrenal macro-nodules that often cause mild over-secretion of cortisol in the form of subclinical Cushing's syndrome. We herein describe a case, wherein unilateral adrenalectomy partially improved hyperglycemia in a patient with PBMAH and suggest the usefulness and limitations of this surgical strategy. A 64-year-old woman with type 2 diabetes had an incidental diagnosis of bilateral adrenal lesions. She had a family history of type 2 diabetes, and her HbA1c level was 8.9% under insulin therapy. She did not present with any symptoms associated with Cushing's syndrome. The basal cortisol level was in the normal range (12.0 mu g/dL);however, the adrenocorticotropic hormone (ACTH) level was suppressed (2.1 pg/mL) and the serum cortisol level was not suppressed in the dexamethasone test. Computed tomography and magnetic resonance imaging showed bilateral adrenal macro-nodules and I-131-adosterol accumulated in the bilateral adrenal lesions. Collectively, she was diagnosed with subclinical Cushing's syndrome due to PBMAH complicated with diabetes mellitus, hypertension, and dyslipidemia. Laparoscopic left adrenalectomy was performed, and the pathologic findings were consistent with PBMAH. After unilateral adrenalectomy, serum cortisol levels decreased, and hypertension improved. Both HbA1c levels and insulin requirement also decreased, but insulin therapy was continuously needed. It should be noted that hyperglycemia may not be cured after successful surgery in a patient with PBMAH. Additional operation or medical therapy should be considered if unilateral adrenalectomy is unable to correct hypercortisolism in PBMAH patients.

关键词： compensated advanced chronic liver disease   extreme gradient boosting   high-risk varices   machine learning model   SHapley Additive exPlanations   variceal bleeding  

摘要： Background and Aim Risk stratification beyond the endoscopic classification of esophageal varices (EVs) to predict first episode of variceal bleeding (VB) is currently limited in patients with compensated advanced chronic liver disease (cACLD). We aimed to assess if machine learning (ML) could be used for predicting future VB more accurately. Methods In this retrospective analysis, data from patients of cACLD with EVs, laboratory parameters and liver stiffness measurement (LSM) were used to generate an extreme-gradient boosting (XGBoost) algorithm to predict the risk of VB. The performance characteristics of ML and endoscopic classification were compared in internal and external validation cohorts. Bleeding rates were estimated in subgroups identified upon risk stratification with combination of model and endoscopic classification. Results Eight hundred twenty-eight patients of cACLD with EVs, predominantly related to non-alcoholic fatty liver disease (28.6%), alcohol (23.7%) and hepatitis B (23.1%) were included, with 455 (55%) having the high-risk varices. Over a median follow-up of 24 (12-43) months, 163 patients developed VB. The accuracy of machine learning (ML) based model to predict future VB was 98.7 (97.4-99.5)%, 93.7 (88.8-97.2)%, and 85.7 (82.1-90.5)% in derivation (n = 497), internal validation (n = 149), and external validation (n = 182) cohorts, respectively, which was better than endoscopic classification [58.9 (55.5-62.3)%] alone. Patients stratified high risk on both endoscopy and model had 1-year and 3-year bleeding rates of 31-43% and 64-85%, respectively, whereas those stratified as low risk on both had 1-year and 3-year bleeding rates of 0-1.6% and 0-3.4%, respectively. Endoscopic classification and LSM were the major determinants of model's performance. Conclusion Application of ML model improved the performance of endoscopic stratification to predict VB in patients with cACLD with EVs.