支气管哮喘( 简称哮喘) 是由多种细胞包括气道的炎性细胞和结构细胞( 如嗜酸粒细胞、肥大细胞、T 淋巴细胞、中性粒细胞、平滑肌细胞、气道上皮细胞等) 和细胞组分参与的气道慢性炎症性疾病。近年来其患病率在全球范围内呈逐年增长趋势, 虽然90% ～95% 的哮喘患者应用吸入β2 激动剂和糖皮质激素治疗能够控制症状, 但停药后症状可能再次出现, 部分患者对激素治疗抵抗。随着对哮喘发病机制的深入认识, 探索了多种新的靶向治疗, 但目前还处于研发和临床试验过程中。现简要概述免疫调节剂相关的哮喘靶向治疗的作用机制、效应及与之相关的不良事件。
Objective To evaluate the level of nursing professional competence of fulltime system graduated nurses in Sichuan province and determine its influencing factors, so as to provide references for nursing high-education reform and nursing human resource management. Methods With a self-designed questionnaire and stratified cluster sample method, both graduated nurses and their direct nursing managers were investigated and asked to evaluate nursing professional competence. Results The mean scores of nursing professional competence of the nurses’ self-evaluation and their managers’ evaluation were 69.90±10.27 and 68.96±11.33, respectively. Factors influencing nursing professional competence included individual interest in nursing, graduated institution, working position, and training provided by employer. Conclusion The professional competence of the nurses graduated with full-time bachelors of clinical nursing in Sichuan province is close to the intermediate level, and it still needs to be improved on the whole, especially in the aspects of nursing research and management. Besides, nursing institutions should further enhance the construction of inner teaching environment and the professional thoughts education of nurse students, while the employer should offer more professional development opportunities, so as to improve the professional self-identity and competence, and to finally lay the talent foundation for the development of nursing disciplines.
【摘要】 目的 了解结直肠癌患者术后发生抑郁、焦虑状况，分析其影响因素。 方法 2010年1-3月，采用Zung抑郁自评量表（SDS）、焦虑自评量表（SAS）和一般资料调查问卷，结合病历资料及心理评估，对64例结直肠癌术后患者进行测评，采用SPSS 13.0软件对数据进行统计分析。 结果 64例患者SDS（47.02±10.38）分，SAS评分（42.42±7.96）分，均高于国内常模（Plt;0.001）。抑郁和焦虑发生率分别为42.2%、20.3%。造口患者抑郁得分高于非造口患者（P=0.004），Miles术患者抑郁得分高于非造瘘根治术患者（P=0.039），姑息术患者抑郁得分高于非造瘘根治术患者（P=0.007）；家庭月收入≤1 000元者抑郁得分高于1 001~3 000元及gt;3 000元者（P=0.040，0.017）。不同情况患者焦虑得分差异无统计学意义（Pgt;0.05）。SDS与SAS呈正相关（Plt;0.001）。 结论 结直肠癌术后患者存在不同程度的抑郁和焦虑。护理人员尤其应关注造口术后、晚期患者及收入低下患者，并进行针对性健康教育和心理干预。【Abstract】 Objective To evaluate the postoperative anxiety and depression of patients with colorectal cancer and investigate its related factors. Methods From January to March 2010, 64 patients who were diagnosed to have colorectal cancer and received therapeutic operations were investigated with self-rating depressive scale (SDS), self-rating anxiety scale (SAS) and self-made related questionnaire respectively. Psychological assessment and medical records gathering were also carried out. The data collected were analyzed by SPSS 13.0. Results The total score of SDS (47.02±10.38) and SAS (42.42±7.96) of the 64 patients were both higher than those of the general population (Plt;0.001). The incidence rate of depression and anxiety was 42.2% and 20.3% respectively. Patients without stoma had lower SDS scores than those with stoma (P=0.004); patients undergoing Miles operation had higher SDS scores than those receiving non-fistula formation radical operations (P=0.039); patients receiving palliative treatment had higher SDS scores than those receiving non-fistula formation radical operations (P=0.007); patients with family monthly income less than 1 000 RMB had higher SDS scores than those with more than 3 000 RMB and between 1 001-3 000 RMB (P=0.017, 0.040). SAS scores among different patients were not significantly different (Pgt;0.05). SDS had positive correlation with SAS (Plt;0.001). Conclusions Patients with colorectal cancer have higher emotions of anxiety and depression after operation than those in the general population. It is suggested that more psychological consultation, treatment and nursing should be carried out to promote the overall physical and mental rehabilitation of the patients, especially for those having undergone stoma formation, late-stage patients and those with a low income.
Objective To investigate the relationship between blood CD4 + CD25 + regulatory T cells ( Treg cells) and cell immunity in patients with sepsis and its prognostic value.Methods 27 patients with sepsis admitted during August 2007 and August 2008 in ICU were enrolled, while 40 healthy volunteers served as control. According to the clinical outcome after 28 days’ treatment, the sepsis patients were assigned to a death group( n=8) and a survival group ( n =19) . Blood Treg% and CD4 /CD8 were detected by flow cytometry and total AgNOR area/nucleus area per cell ( IS%) was measured by silver nitrate staining and image processing. Results The Treg% in the patients with sepsis was significant higher than that in the normal control [ ( 5. 61 ±1. 60) % vs. ( 0. 78 ±0. 23) % , P lt; 0. 01 ] , while the level of CD4 /CD8 and IS% were significant lower[ CD4 /CD8: ( 1. 09 ±0. 30) vs. ( 1. 71 ±0. 36) , IS% : ( 5. 19 ±1. 07) % vs. ( 6. 76 ±0. 92) % , both P lt; 0. 01] . Significant correlations were found between Treg% and CD4 /CD8( r= - 0. 484, P lt;0. 01) , and between Treg% and IS% ( r = - 0. 588, P lt;0. 01) . Compared with the survival group, Treg% was significant higher [ ( 7. 09 ±1. 17) % vs. ( 5. 00 ±1. 33) % , P lt; 0. 01] , and CD4 /CD8 and IS% were significant lower[ CD4 /CD8: ( 0. 87 ±0. 22) vs. ( 1. 18 ±0. 29) , IS% : ( 3. 97 ±0. 42) % vs. ( 5. 71 ±0. 81) % , both P lt; 0. 01] in the death group. Conlusion Blood Treg% level can reflect the cell immune state of patients with sepsis and is of clinical value to assess the prognosis.
Objective To investigate the effects of ulinastatin on Treg/Th17 and immune status in patients with severe sepsis.Methods A total of 80 patients with severe sepsis, who were hospitalized in ICU during October 2011 to July 2012, were randomly divided into a routine group and a ulinastatin group. The patients in the ulinastatin group were intravenously administered 30mg ulinastatin three times per day for 5 days in addition to routine bundle treatment. The expression of Treg, Th17 and HLA-DR were detected on the first day in ICU and 5 days after treatment. 20 healthy individuals served as controls. Results Compared with the control group, the severe sepsis group had overexpression of Treg and Th17 ( P lt;0. 01) , higher ratio of Treg/Th17( P lt;0. 01) , and decreased HLA-DR expression of CD14 monocyte ( P lt; 0. 01) . In the severe sepsis patients, ulinastatin injection reduced the abnormal expression of Treg and Th17 ( P lt; 0. 01) , decreased the ratio of Treg/Th17( P lt; 0. 01) , and improved the expression of HLA-DR ( P lt; 0. 01) more effectively compared with the routine treatment. Ulinastatin also lowered 28-day mortality of the patients with sepsis, but the difference between the ulinastatin group and the routine group was not significant. Conclusions In severe sepsis patients, there were abnormal overexpression of Treg and Th17, imbalance of Treg/Th17, and underexpression of HLA-DR which imply an immune suppression. Ulinastatin can decrease the expression of Treg and Th17, inverses the ratio of Treg/Th17, and improve the expression of HLA-DR, so as to improve the prognosis of severe sepsis patients.
ObjectiveTo discover the indicators and develop a model for predicting protracted hypoparathyroidism (HPT) after thyroid cancer surgery in order to guide the early therapy for patients with HPT.MethodsThe clinical and postoperative pathological data of patients with thyroid cancer who received surgical treatment in the Xuanwu Hospital and Beijing Pinggu Hospital from January 2019 to December 2020 were retrospectively analyzed. The potential indicators of postoperative HPT and protracted HPT were analyzed by logistic and LASSO regression analysis. A nomogram for predicting protracted HPT was constructed in the training set, and the discrimination and consistency of the nomogram were verified in the training set and the validation set respectively.ResultsAccording to the inclusion and exclusion criteria, a total of 464 patients diagnosed with thyroid cancer were finally included in the study. Among the 100 patients with postoperative HPT (except 1 case of incomplete data), 62 patients showed short-term HPT and 37 patients developed protracted HPT. Multivariate logistic regression analysis showed that the preoperative intact parathyroid hormone (iPTH) level [OR=0.953, 95%CI (0.931, 0.976), P<0.001], lobectomy with contralateral partial lobectomy [OR=3.247, 95%CI (1.112, 9.485), P=0.031], and total thyroidectomy [OR=11.096, 95%CI (5.432, 22.664), P<0.001] were related to postoperative HPT. The multivariant logistic regression analysis revealed that postoperative iPTH level was a predictive factor for protracted HPT [OR=0.719, 95%CI (0.588, 0.879), P=0.001]. The area under receiver operating characteristic curve (AUC) value of postoperative iPTH level in predicting protracted HPT was 0.848 [95%CI (0.755, 0.942)]; The cut-off value was 9.405 ng/L, and its specificity and sensitivity were 0.659 and 0.944, respectively. Moreover, the AUC value of the nomogram model including postoperative iPTH level and other clinicopathologic features (extraglandular invasion, cumulative maximum tumor diameter, and central lymph node dissection) for predicting protracted HPT was 0.900 [95%CI (0.817, 0.982)]; The cut-off score was 118.891, and its specificity and sensitivity were 0.772 and 0.944, respectively; The Hosmer-Lemeshow goodness of fit test indicated good fit of nomogram (χ2=8.605, P=0.377). The AUC value of the nomogram was 0.640 [95%CI (0.455, 0.826)] in the validation set (Pinggu Hospital data). The Hosmer-Lemeshow goodness of fit test also indicated good fit of nomogram (χ2=12.266, P=0.140).ConclusionsThe postoperative iPTH level is an important influencing factor of protracted HPT. The nomogram prediction model based on postoperative iPTH level and other clinicopathologic features has a favorable predictive value for protracted HPT.