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全胸腔鏡下支氣管袖式成形肺癌切除術患者的護理體會

目的總結全胸腔鏡下支氣管袖式成形肺癌切除術患者的圍手術期護理經驗，提出護理體會。 方法回顧并總結2010年12月-2012年7月11例全胸腔鏡下支氣管袖式成形肺癌切除術患者的圍手術期護理措施，并觀察術后并發癥發生情況。 結果1例因支氣管胸膜瘺于術后49 d因呼吸道出血死亡，其余10例均順利出院，且隨訪3個月均未發現吻合口狹窄。 結論正確的護理干預、醫護一體化的圍手術期管理，可減少術后并發癥的發生，促進患者術后恢復。

知情同意教育對未成年女性尖銳濕疣患者的影響

目的評價知情同意教育和常規健康教育對未成年女性尖銳濕疣患者的影響。 方法選取2010年11月－2012年11月在門診接受治療的未成年女性尖銳濕疣患者62例，按就診先后排序，單數作為對照組（31例），進行常規健康教育，雙數作為觀察組（31例），進行知情同意教育。 結果觀察組患者6個月內均按時復診，對照組患者21 d內按時復診，21 d后至6個月內僅16例（51.6%）復診。觀察組和對照組患者治療的有效率（93.5%，90.3%）、近期復發率（6.5%，9.6%）差異無統計學意義（P＞0.05），治愈率（74.2%，48.4%）、遠期復發率（19.4%，41.9%）差異均有統計學意義（P＜0.05）。觀察組治愈率明顯增高，遠期復發率相對較低。 結論有目的、有計劃和系統的知情同意教育在提高未成年女性尖銳濕疣患者的治愈率和降低遠期復發率方面優于常規健康教育。

Reliability and Validity of SF-36 Scale for Evaluating Quality of Life of Thoracic Surgery Patients

ObjectiveTo investigate the reliability and validity of Short-Form 36 Health Survey Scale (SF-36) for evaluating quality of life (QOL) of thoracic surgery patients in a specific regional medical center,and improve care and nursing plan for these patients. MethodsNinety-five patients who were admitted in Department of Thoracic Surgery of West China Hospital from March to May 2012 were enrolled in this study. Ninety-four patients finished a valid questionnaire study including 68 male and 26 female patients with their average age of 62.0±13.0 years. Preoperative diagnosis was squamous cell lung cancer in 8 patients,lung adenocarcinoma in 6 patients,small cell lung cancer in 1 patient,esophageal cancer in 12 patients and undefined lung mass in 67 patients. Postoperative diagnosis was squamous cell lung cancer in 39 patients, lung adenocarcinoma in 28 patients,small cell lung cancer in 8 patients,esophageal cancer in 12 patients,pulmonary tuberculosis in 3 patients and inflammatory pseudo-tumor in 4 patients. Chinese edition of SF-36 was used to evaluate patients' QOL. Cronbach's coefficients (α) and split-half reliability were used to assess its reliability. Its validity was assessed through factor analysis. ResultsCronbach's coefficients (α) of SF-36 were as followed:Physical Functioning (PF) 0.721,Role-Physical (RP) 0.859,General Health (GH) 0.721,Vitality (VT) 0.899,Social Functioning (SF) 0.852,Role-Emotional (RE) 0.872,and Mental Health (MH) 0.598. Split-half reliability of each part was PF 0.725,RP 0.784,GH 0.758,VT 0.749,SF 0.745,RE 0.740,and MH 0.426. Nine principal components were extracted by factor analysis and generally reflected the 8 dimensions of SF-36,which was correspondent to the SF-36 structure. ConclusionSF-36 scale can be used to measure QOL of thoracic surgery patients with good reliability and validity.

Laparoscopic Cholecystectomy on Porcelain Gallbladder in 13 Cases

Objective　To investigate the possibility of laparoscopic cholecystectomy （LC） on porcelain gallbladder. Methods　Twenty-four cases of porcelain gallbladder， who were operated in China Medical University， including 13 LC cases， from 2006 to 2008 were retrospectively reviewed. Results　Of 24 porcelain gallbladder cases (0.48%) in 4964 cholecystectomy patients， calcification of gallbladder in 87.50%(21/24) patients was diagnosed by ultrasonography. Of 13 patients who were cured by LC, one suffered from postoperative leak bile, no metastasis were found by following up 12 or 14 months in two gallbladder carcinoma cases. Conclusion　There’s specificity of ultrasonographic image in porcelain gallbladder, in which LC is safe to be performed and routine frozen pathology during operation is necessary.

Computer-aided prediction and molecular mechanism investigation of active components in compound Kushen injection inhibiting p21-activated kinase 1

Targeting p21-activated kinase 1 (PAK1) is a novel strategy for pancreatic cancer treatment. Compound Kushen injection contains many anti-pancreatic cancer components, but the specific targets are unknown. In this study, 14α-hydroxymatrine, an active component of Kushen injection, was found to possess high binding free energy with the allosteric site of PAK1 by molecular docking based virtual screening. Molecular dynamics simulations suggested that 14α-hydroxymatrine caused the α1 and α2 helices of the allosteric site of PAK1 to extend outward to form a deep allosteric regulatory pocket. Meanwhile, 14α-hydroxymatrine induced the β-folding region at the adenosine triphosphate (ATP)-binding pocket of PAK1 to close inward, resulting in the ATP-binding pocket in a “semi-closed” state which caused the inactivation of PAK1. After removal of 14α-hydroxymatrine, PAK1 showed a tendency to change from the inactive conformation to the active conformation. We supposed that 14α-hydroxymatrine of compound Kushen injection might be a reversible allosteric inhibitor of PAK1. This study used modern technologies and methods to study the active components of traditional Chinese medicine, which laid a foundation for the development and utilization of natural products and the search for new treatments for pancreatic cancer.

Research progress of clinical therapy for concha-type microtia

ObjectiveTo summarize the current progress of clinical therapy for concha-type microtia.MethodsThe domestic and overseas literature about the treatment of concha-type microtia was reviewed and the contents of operative timing, operation selection, and complications were analyzed.ResultsThe unified therapeutic schedule of the concha-type microtia has not yet been determined due to its complicated various therapeutic methods and unknown etiology. The operation methods commonly used in clinic are partial ear reconstruction with autologous costal cartilage framework and free composite tissue transplantation. The timing of the partial ear reconstruction depends on the development of costal cartilage and children’s psychological healthy. The timing of free composite tissue transplantation depends on the severity. It is recommended to perform the operation at about 10 years old for mild patients. For moderate patients, ear cartilage stretching should be performed at 1-2 years old and free composite tissue transplantation would be performed at about 10 years old. The complications of partial ear reconstruction with autologous costal cartilage framework for concha-type microtia mainly include framework exposure, deformation, infection, cartilage absorption, and skin necrosis. The complications of free composite tissue transplantation have not been reported.ConclusionEtiology and elaborated classifications with individualized treatment are the future research directions.

姜黃素抗腫瘤機制研究進展

皮膚色素失禁癥合并雙眼視網膜病變一例

Predictive value of preoperative pulmonary function test indexes for postoperative pneumonia in patients undergoing upper gastrointestinal surgery

ObjectiveTo analyze the relationship between preoperative pulmonary function indexes and postoperative pneumonia (POP) in patients undergoing upper gastrointestinal surgery.MethodsThe clinical data of 303 patients who underwent lung function examination and upper gastrointestinal surgery in West China Hospital, Sichuan University from September 2020 to January 2021 were prospectively collected and analyzed. There were 217 males and 86 females, with an average age of 61.61±10.42 years. Pulmonary function was evaluated from four aspects including ventilatory function, pulmonary volume, diffusion function and airway resistance. Relevant pulmonary function indicators were displayed as the percentage of actual measured value to predicted value (%pred). The outcome index was pneumonia within 30 days after the surgery. Logistic regression was used to analyze the relationship between preoperative pulmonary function indicators and POP.ResultsA total of 196 patients with gastric cancer and 107 patients with esophageal cancer were included, and the incidence of POP in patients undergoing upper gastrointestinal surgery was 26.7% (81/303). Patients with preoperative low peak expiratory flow (PEF%pred) had a 3.094 times higher risk of developing POP than those with normal PEF%pred [OR=3.094, 95%CI (1.362, 7.032), P=0.007]. The incidence of POP had no correlation with the other preoperative indicators.ConclusionPreoperative PEF%pred may be an important indicator for predicting the occurrence of POP in patients undergoing upper gastrointestinal surgery.

胸外科危急值報告分析及護理對策的應用

目的分析胸外科常見危急值的種類及原因，探討其護理對策。 方法收集2013年1月－12月四川大學華西醫院胸外科報告的所有危急值，結合患者的臨床資料進行分析，針對形成原因探討相應的護理對策，并完善危急值的管理制度。 結果危急值報告共93例次涉及82例患者，其中7例患者多次出現危急值，出現2例次危急值4例，出現3例次危急值2例，出現4例次危急值1例。排除4例次假性危急值后，其余89例次危急值發生情況：血鉀異常（＞6.0或＜3.0 mmol/L）72例次（80.90%），血糖異常（＞18.0或＜2.8 mmol/L）11例次（12.36%），血培養陽性3例次（3.37），人類免疫缺陷病毒陽性2例次（2.25%），凝血功能異常1例次（1.12%）。 結論胸外科常見的危急值與術后應激狀態及電解質失衡有關，提供針對性的護理對策，落實危急值報告規范，對保證術后患者的安全和康復有重要意義。