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ACEI与ARB临床联合应用防治糖尿病肾病

替吉奥治疗晚期胃癌的不良反应及其护理

目的　总结晚期胃癌患者口服替吉奥的不良反应，探讨其护理方法。 方法　对2010年2月－11月34例口服替吉奥的晚期胃癌患者，按个体体表面积计算：口服40～60 mg/次，每日早晚饭后各服1次，服药4周，休息2周，每6周为1周期。从给药后开始观察其不良反应，及时给予护理干预，做好心理护理，用药、饮食指导等。 结果　口服替吉奥不良反应小，多为Ⅰ～Ⅱ度不良反应，主要为骨髓抑制、消化道反应、色素沉着等。Ⅲ度以上发生较少。 结论　口服替吉奥治疗晚期胃癌患者的不良反应小、疗效好，患者易接受；使治疗能顺利完成。

同时性双侧原发性乳腺癌1例报道

保乳术后放射治疗的研究进展

Progress of stereotactic radiotherapy in the treatment of brain metastatic tumor

Patients with brain metastases are more prone to developing life-threatening neurological symptoms. Initial therapies include surgery, whole brain radiotherapy (WBRT), and stereotactic radiotherapy. With the progress of stereotactic radiotherapy, the indication of stereotactic radiosurgery (SRS) is gradually expanding, and the indications for surgery and WBRT gradually narrowed. The existing studies have shown that SRS can significantly benefit patients who are <50 years old with single brain metastasis, but the specific scope of the application with SRS is still controversial, and a large number of the phase Ⅲ randomized multicenter trials designed around the controversies are also developing. This review summarizes the results of clinical research and came to the conclusion. Firstly, postoperative adjuvant SRS in the treatment of brain metastases is superior to postoperative adjuvant WBRT. Secondly, using SRS in the elderly patients with multiple brain metastases are safe and effective. Thirdly, the use of targeted therapy in patients with brain metastases thereby delaying SRS may lead to poor prognosis. The focus of future research include selection of optimal timing for adjuvant targeted therapy after SRS and the appropriate patient population, as well as prevention of recurrence and metastasis after lacal treatment.

34例双镜联合胃间质瘤切除手术的护理体会

目的:总结腹腔镜联合胃镜切除胃间质瘤的手术配合要点,提高手术配合质量。方法：回顾分析本院34例腹腔镜联合内镜胃间质瘤切除术的临床资料,着重对术前准备、巡回护士和器械护士的术中配合进行总结。结果：34例手术顺利完成,无一例中转开腹,患者治疗效果良好。结论：术前充分的准备,术中手术室护士、外科医生、与胃镜医生的娴熟配合,是手术成功的保障。

Protective effect on rat retinal ganglion cells and the safety of intravitreal injected acteoside

Objective To observe the protective effect on retinal ganglion cells (RGC) and the safety of intravitreal injected acteoside in rats. Methods A total of 50 male Sprague Dawley rats with the weight of 190-210 g were used in this study. Fifteen rats were used for safety experiment of intravitreal injection of acteoside. The rats were divided into group A, B, C, control group and blank group, three rats in each group. The rats in group A, B and C were received intravitreal injection of 5 mu;l acteoside at the concentration of 1, 2, and 5 mg/ml, respectively. Phosphate buffer solution (PBS) was injected in rats of control group. No treatment was performed for blank group. The retinal structure was examined by hematoxylin-eosin (HE) staining of retinal frozen sections at one, two and three weeks after injection. The retinal ultrastructure was examined by ultrathin section under transmission electron microscope at one and three weeks after injection. Others 35 rats were used for experiment of protective effect of acteoside on RGC. The rats were divided into operation group A and B (n=8), sham operation group C and D (n=8), and blank group (n=3). The optic nerve of rats in operation group was clamped for 10 seconds after optic nerve exposure, while the optic nerve of rats in sham operation group was exposed only. The rats in operation group A and B were received intravitreal injection with 5 mu;l acteoside (1 mg/ml) and 5 mu;l PBS respectively. The rats in sham operation group C and D were received intravitreal injection with 1 mu;l acteoside (1 mg/ml) and 1 mu;l PBS respectively. No treatment was performed for blank group. The retinal structure was examined by HE staining of retinal frozen sections at one, two and four weeks after injection. Immunohistochemistry was used to measure the expression of growth associated protein 43 (GAP-43). RGC apoptosis was assessed by the terminal deoxynucleotidyl transferase mediated dUTPbiotin nickend labelling (TUNEL) method. Software of SPSS 13.0 was used for the data statistical analysis in this study. Results In the safety experiment of intravitreal injected acteoside, there was no abnormity of cornea, anterior chamber, lens, vitreous cavity and retina after injection. At one, two and three weeks after injection, the retina structure was normal without significant apoptosis, necrosis and inflammatory cell infiltration. The ganglion cell layer showed slightly edema; there was no obvious change of retinal ultrastructure after injection of acteoside with 5 mg/ml and 2 mg/ml, but slight change with the format of 1 mg/ml. Transmission electron microscopy showed that intravitreal injection of 5 mu;l acteoside at the concentration of 2 or 5 mg/ml can induce significant changes of micro-structures of retina, while injections at 1mg/ml can only induce minor changes.In the experiment of protective effect of acteoside on RGC, light microscope revealed that the cell showed typical changes of apoptosis in operation group, but not in sham operation group and blank group. At the first and second week after injection, compared with the sham operation group and blank group, the RGC number was decreased in operation group. The difference of RGC numbers between operation group A and B was statistically different (F=26.206,P＜0.05). The RGC numbers in operation group continues to decrease at the fourth week after injection, there was obvious difference compared with the first and second week after injection (F=17.364,P＜0.05), but there was no difference of RGC numbers among sham operation intragroup and between sham operation group and blank group at all the time points. Immunohistochemistry showed that at the first week after injection, the integrated absorbance (IA) value in operation group was higher than that in other groups (F=33.466,P＜0.05); there was no difference of IA value between operation group A and B. At the second week after injection,IA value in operation group A had slightly declined, but higher than that in operation group B (F=14.391,P＜0.05). At the fourth week after injection,IA value in operation group A declined further, but also higher than that in other groups (F=4.178,P＜0.05). TUNEL showed that on the first week after injection, RGC apoptosis rate in operation group was increased than that in other groups (F=15.365,P＜0.05). At the second week after injection, RGC apoptosis rate in operation group was decreased, and it in operation group A was lower than that in operation group B (F=15.365,P＜0.05). At the fourth week after injection, RGC apoptosis rate in operation group was decreased obviously, there was no difference compared with other groups (F=2.057,P＞0.05). There was no difference of RGC apoptosis rate between sham operation group and blank group at all the time points. Conclusion Intravitreal injection of 5 mu;l acteoside (1 mg/ml) is safe for rat retina, and can upregulate GAP-43 expression and inhibit RGC apoptosis in optic nerve crush rats.

Kallikrein-binding protein inhibits choroidal neovascularization

Objective To observe the inhibitory effect of kallikrein-binding protein (KBP) on choroidal neovascularization. Methods Forty Brown Norway rats were randomly divided into the KBP groups and the control group, 20 rats in each group, the right eye as the experimental eye. The rats were photocoagulated by 532 nm laser to induce CNV model. One week after laser photocoagulation, the rats were received FFA examination. At the second day after FFA examination, the rats of KBP group were received an intravitreal injection of KBP 5 mu;l (4 mg/ml KBP). The same volume of deionized water was injected into the rats in the control group. The rats of two groups received FFA examination at one, two and three weeks after injection. The expressions of vascular endothelial growth factor and pigment epithelium derived factor were observed using hematoxylin and eosin stain and immunohistochemistry stain. CNV leakage area and the cumulative absorbance of laser spot area were analyzed by Image-Pro plus 6.0 software. Results FFA examination showed that there were CNV and fluorescence leakage at one week after laser photocoagulation; one, two and three weeks after injection, the leakage decreased gradually in KBP group, but increased with time in control group. Compared with control group, the spot area and CNV in KBP group reduced gradually, but CNV was always there in control group. The differences of VEGF (F=1.29) and PEDF (F=6.29) expressions at one week after laser photocoagulation were not statistically significant (P＞0.05). The differences of VEGF and PEDF expressions at one, two and three weeks after injection were statistically significant（VEGF:F=14.16,66.89,24.34; PEDF：F=4.22,62.04,233.05;P＜0.001）.Conclusion Intravitreal injection with KBP can inhibit CNV.

硫糖铝涂剂联合益口含漱液治疗化学疗法后口腔黏膜炎的疗效观察

目的　观察硫糖铝涂剂联合益口含漱液治疗化学疗法（化疗）后口腔黏膜炎的疗效。 方法　将2011年1月－12月化疗后口腔黏膜炎患者63例， 随机分为治疗组32例和对照组31例。治疗组采用硫糖铝涂剂、益口含漱液治疗，对照组仅用益口含漱液常规治疗，观察两组疗效。 结果　治疗组的总有效率（93.8%）明显高于对照组（71.0%），两组经统计比较差异有统计学意义（P＜0.05）。 结论　硫糖铝涂剂联合益口含漱液治疗化疗后口腔黏膜炎，与单纯使用益口含漱液相比，有较好的疗效。

Research Progress in Preparation of Antimicrobial Peptides and Their Mechanisms of Action

Currently, all the conventional antibiotics have developed corresponding drug-resistant pathogenic strains, which have increasingly become a serious threat to people's health. Development of completely new types of antibiotics is one of effective ways to solve the drug resistance issue. Antimicrobial peptides with broad-spectrum antibacterial and antimicrobial activity and wild variety become the ideal alternative to traditional antibiotics. Antimicrobial peptides are derived from wide range of sources, such as plants, animals, and microorganisms. Mechanism of function of the antimicrobial peptides and the investigation approaches of different antimicrobial peptides also vary dramatically. In this paper, we give an overview of preparation, antibacterial mechanisms, and research methodology of antimicrobial peptides.