目的 探讨成人急性髓系白血病(AML)患者CD68、C反应蛋白(CRP)、血小板计数(PLT)与疗效的相关性.方法 根据疗效是否为完全缓解(CR)将96例AML患者分为CR组(n=53)和非CR组(n=43).分析疗效的影响因素及CD68、CRP、PLT与疗效的相关性.结果 CR组患者CD68和CRP均明显低于非CR组,PLT明显高于非CR组,差异均有统计学意义(P﹤0.01).多因素分析显示,CD68、CRP及PLT均是AML患者疗效的独立影响因素(P﹤0.05).Kendall分析显示,AML患者疗效与CD68、CRP均呈负相关,与PLT呈正相关(P﹤0.01).结论 CD68、CRP及PLT均是AML患者接受治疗后疗效的独立影响因素,并且CD68、CRP与疗效呈负相关,PLT与疗效呈正相关,因此在AML患者的治疗过程中,动态监测相关影响因素的变化情况可以为临床医师诊断病情提供依据.

目的:观察动机行为转化护理在老年股骨转子间骨折患者中的应用效果.方法:选取2018年6月至2019年12月该院收治的90例接受手术治疗的老年股骨转子间骨折患者进行前瞻性研究,采用随机数字表法将其分为对照组与观察组各45例.对照组采用围术期常规护理,观察组在对照组基础上联合动机行为转化护理,比较两组术前、术后7 d负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]评分、疼痛程度[视觉模拟评分法(VAS)]评分、Harris髋关节功能评分和并发症发生率.结果:术后7 d,观察组SAS、SDS评分均低于对照组,差异有统计学意义(P<0.05);术后3个月,观察组VAS评分低于对照组,差异有统计学意义(P<0.05);术后1、3个月,观察组Harris评分均高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05).结论:在围术期常规护理基础上采用动机行为转化护理可提高老年股骨转子间骨折手术患者Harris髋关节功能评分,降低负性情绪评分、VAS评分和术后并发症发生率,其效果优于单纯围术期常规护理.

Objective:To explore and analyze the application of progressive functional training on the affected side to prevent limb function and edema after breast cancer chemotherapy.Methods:A total of 110 breast cancer chemotherapy patients admitted to our hospital from June 2018 to March 2021 were selected and divided into a control group and an observation group by a random number table, with 55 cases in each group. The control group was given conventional limb activity on the affected side, and the observation group was given progressive functional training on the affected side. The enumeration data were expressed as %, and the χ2 test was used. The measurement data were expressed as the mean±standard deviation ( ± s), and the t test was used to compare the compliance of the two groups of patients with limb activities, degree of edema, grip strength and shoulder range of motion. Results:The compliance rate in the control group and observation group was 76.36% and 96.36% respectively ( χ2=9.340, P<0.05). In the control group, mild edema, moderate edema, and severe edema accounted for 38.18%, 41.82%, and 20.00%, respectively. In the observation group, mild edema, moderate edema, and severe edema accounted for 69.09%, 27.27%, and 3.64%, respectively. Compared with the control group after exercise, the degree of edema on the affected side was reduced, and the difference was statistically significant ( χ2=12.813, P<0.05). The grip strength, abduction range of motion, flexion range of motion, and extension range of motion in the control group after exercise were (212.65±45.23) N, (134.98±6.22)°, (140.98±19.10)°, and (50.60±4.33)°, respectively, and those in the observation group after exercise were (230.99±41.60) N, (139.70±8.54)°, (149.33±15.24)°, (53.10±4.17)°, respectively. The grip strength, shoulder joint abduction, flexion, and extension range of motion in the two groups after chemotherapy were significantly lower than those before chemotherapy, and those in the observation group after chemotherapy were significantly higher than those in the control group ( t=0.303, 2.213, 0.808, 3.313, 0.572, 2.534, 0.666, 3.084, P<0.05). Conclusion:The application of progressive functional training on the affected side to breast cancer chemotherapy can significantly improve the patient’s compliance with the affected side limbs, reduce the degree of edema, and promote the improvement of grip strength and shoulder mobility.

Objective To study effects of phosphoinositide 3 kinase (PI3K) and Notch signaling pathway on the proliferation and activation of CD4+ T cells in peripheral blood of patients with psoriasis vulgaris. Methods Peripheral venous blood was collected from 28 patients with psoriasis vulgaris and 28 healthy controls. CD4+ T cells in peripheral blood were sorted by immunomagnetic bead method. CD4+T cells from peripheral blood of patients with psoriasis vulgaris were divided into four groups: the blank control group, and 10 μmol/L PI3K blocker group (LY294002 group), 25 μmol/L Notch blocker group (DAPT group), 10 μmol/L LY294002+25 μmol/L DAPT group (LY294002+DAPT group). CD4+T cells were stimulated with phytohemagglutinin (PHA) 10 μg/ml and interleukin (IL) -2 1000 U/ml for 6 hours. The protein levels of Cyclina, Cyclin D1 and P27kipl in CD4+T cells were detected by FCM, and the mRNA levels of Cyclin A, Cyclin D1 and P27kipl were detected by reverse transcription polymerase chain reaction (RT-PCR). Results The purity of CD4+ T cells were (90.00±3.90)%, and the survival rate of CD4+ T cells was (92.50±4.60)%. The protein levels of Cyclin A and Cyclin D1 in peripheral blood CD4+ T cells of patients with psoriasis vulgaris were (27.60±3.80)%, (14.70±3.20)%, and the mRNA levels were (0.56±0.14) and (1.37±0.39)%, respectively. Compared with the healthy control group (13.50±3.70)%, (7.80±2.00)% and (0.31±0.12), (0.93±0.35), the difference was statistically significant (P=0.002, 0.037, 0.008 and 0.043). The level of P27kipl Protein and mRNA of CD4+ T cells in peripheral blood of patients with psoriasis vulgaris were (23.50±3.60)% and (0.17±0.02)% respectively, which were significantly lower than those in healthy control group (36.80±5.60)% and (0.33±0.05) (P=0.007, P=0.001). The expression of Cyclin D1 protein and mRNA in CD4+ T cells of the blank control group were (12.30±3.50)% and (1.74±0.39), respectively, while the level in LY294002 group, DAPT group and LY294002+DAPT group decreased significantly, with (7.20±3.10)%, (8.20±2.50)%, (4.30±1.50)% and (1.11±0.29), (1.26±0.28), (0.63±0.20), respectively (all P<0.05). Compared with the blank control group, the level of P27kipl Protein of CD4+ T cells in LY294002 group, DAPT group and LY294002+DAPT group increased significantly with (30.90±5.10)%, (27.60±5.20)%, (43.90±3.00%) respectively (P=0.005, 0.006 and 0.001). Compared with the level of the blank control group (0.15±0.08), the level of CD4+T cell P27kipl mRNA of LY294002 group, DAPT group and LY294002+DAPT group increased significantly with (0.37±0.07), (0.62±0.09), (0.99±0.21), respectively (P=0.018, 0.002, 0.003). There was no significant difference in the expression of Cyclin A protein and mRNA in CD4+ T cells in blank control group, LY294002 group, DAPT group and LY294002+DAPT group (all P>0.05). Conclusions PI3K and Notch signaling pathway can synergistically enhance the increase of positive regulatory protein Cyclin D1 and the decrease of negative regulatory protein P27kipl in CD4+ T cells, suggesting that PI3K and Notch signaling pathway play a synergistic regulatory role in the proliferation and activation of peripheral blood CD4+ T cells in patients with psoriasis vulgaris.

目的 分析血清肿瘤标志物糖类抗原153(CA153)、糖类抗原153(CA125)、人表皮生长因子受体-2(HER-2)检测在乳腺癌诊断中的价值.方法 选取2018年1月至2020年1月郑州大学第三附属医院收治的30例乳腺癌患者为观察组,选取同期的30例健康体检者为对照组,检测并比较分析2组血清肿瘤标志物CA153、CA125、HER-2水平.结果 观察组乳腺癌患者血清CA153、CA125和HER-2水平均高于对照组,差异均有统计学意义(t=7.482,P＜0.001;t=7.054,P＜0.001;t=7.853,P＜0.001).2.CA153 检出 8 例(26.67％),CA125 检出10 例(33.33％),HER-2 检出 9 例(30.00％),CA153、CA125 和 HER-2 联合检测检出 20 例(66.67％),联合检测的阳性检出率高于各单项检测阳性检出率,且其敏感性和特异性均升高.结论 乳腺癌患者血清CA153、CA125、HER-2水平较高,三者联合检测对乳腺癌患者的诊断具有辅助价值.

目的:探讨网络健康管理联合家庭跟进服务模式对初诊冠心病(CHD)患者的影响.方法:将2018年6月1日～2019年5月31日初次确诊并收治的CHD患者64例作为研究对象,按照随机数字表法分为对照组和干预组各32例,对照组进行常规健康管理及延续性护理,干预组在对照组基础上采用网络健康管理联合家庭跟进服务模式;比较两组干预前后心功能指标[包括左心室射血分数(LVEF)、左心室收缩末期直径(LVESD)、左心室舒张末期直径(LVEDD)]、自我感受负担[采用自我感受负担量表(SPBS)]、负性情绪[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)]、自我效能感[采用一般自我效能感量表(GSES)]及生活质量[采用西雅图心绞痛量表(SAQ)].结果:干预后,干预组LVEF高于干预前和对照组(P<0.05),LVESD、LVEDD均低于干预前和对照组(P<0.05);干预后,两组SPBS中身体因素、情感因素、经济因素评分低于干预前(P<0.05),且干预组低于对照组(P<0.01);干预后,两组SAS、SDS评分低于干预前(P<0.05),且干预组低于对照组(P<0.01);干预后,两组GSES评分、SAQ各维度评分高于干预前(P<0.05),且干预组高于对照组(P<0.05).结论:网络健康管理联合家庭跟进服务模式能有效改善初诊CHD患者负性情绪,提高其自我效能感和生活质量.

在临床中支气管哮喘是常见且多发疾病,疾病特点为发病机制复杂、以反复发作等,疾病特征为气流受限、气道重塑,对患者正常生活与工作造成了极大影响.支气管哮喘除了在医院进行正规治疗外,通过有效护理可提高患者对疾病认知程度,从而加强自我管理,提高治疗依从性,控制病情发展.在此次研究中主要分析护理干预在支气管哮喘缓解期中的应用效果,报告如下.

背景 急性白血病(acute leukemia,AL)是一类危及生命的血液系统恶性肿瘤,病情进展快、自然病程短、治疗费用高,已经成为全球关注的重大公共卫生问题之一.时至今日,AL的病因尚未完全阐明,流行病学病因研究的结果仍存争议;我国尚缺乏近年来与现实生活接轨的最新数据.目的 探讨成人AL发病相关的生活及环境危险因素.方法 采用1:1病例对照研究的流行病学方法,以我国北方地区(北京、天津、沈阳、郑州、菏泽)五家三级甲等医院为研究现场,通过面对面问卷调查的方式收集2020年1-12月在上述五家医院住院诊治的AL患者和非肿瘤患者的相关信息.以新确诊的成人AL患者为病例组,非肿瘤患者为对照组,按照年龄、性别、民族、居住地、来源医院进行1:1配比,患者入院时间相近,纳入12个危险因素,通过单因素分析和多因素logistic回归模型,筛选成人AL发病相关危险因素.结果 病例组和对照组各纳入175例患者,中位年龄分别为46(33～58)岁、46(31～60)岁(P=0.915),男女比例均约为1.5:1.单因素分析显示,两组的房屋装修3个月内入住史(χ2=10.002,P=0.002)、居住地附近300 m范围内电磁辐射暴露史(χ2=4.010,P=0.045)差异有统计学意义.多因素logistic回归分析发现,房屋装修后3个月内入住史(OR=2.801,95％CI:1.400～5.607,P=0.004)、居住地附近300 m范围内电磁辐射暴露史(OR=2.330,95％CI:1.099～4.938,P=0.027)可增加成人AL的患病风险.结论 房屋装修3个月内入住史、居住地附近300 m范围内电磁辐射暴露史为成人AL的可疑危险因素.

Clinical efficacy and safety of flumatinib combined with multidrug chemotherapy in the treatment of 12 cases with Ph acute lymphoblastic leukemia Mi Ruihua, Chen Lin, Yang Haiping, Wei Xiuli , Liu Jia, Yin Qingsong, Zhang Lina, Wei Xudong 1 The Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou 450008, China; 2 The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China; 3 The First People's Hospital of Xinxiang City, Xinxiang 453000, China Corresponding author: Wei Xudong, Email: weixudon63@126.com

目的 探讨HUTT在儿童POTS诊断中的应用以及治疗效果评价.方法 随机选取2017-01—2019-05在郑州大学第三附属医院小儿心脏中心门诊或住院的POTS患儿40例为POTS组,对照组选取健康体检儿童,比较2组儿童行HUTT中血流动力学变化;POTS组经综合治疗后复查HUTT结果与治疗前进行比较,评价治疗效果.结果 (1)POTS组倾斜位时心率显著高于对照组(P<0.05),收缩压及舒张压显著低于对照组(P<0.05);(2)39例POTS患儿复诊时27例转为阴性,转阴率69.2％;(3)治疗后POTS组行HUTT时心率达到最快的时间明显延长(P<0.05),最快心率显著低于治疗前(P<0.05),心率最快时的收缩压与舒张压显著高于治疗前(P<0.05).结论 HUTT对儿童POTS有较好的诊断价值,并且可以很好地评价其治疗效果.

Objective:To investigate the effect of decitabine maintenance treatment after transplantation of myelodysplastic syndrome(MDS).Methods:Seven patients with MDS after allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of Zhengzhou University from April 2016 to October 2019 and received low-dose decitabine maintenance transplantation were included, 5 males and 2 females, aged 15 to 43 years. Seven patients were treated with decitabine or a combination of low-dose cytarabine, aclamycin, and granulocyte colony-stimulating factor regimens before transplantation, and they all achieved complete remission before transplantation, and decicabine was maintained for 56 (31~78) days after tranplantation. The treatment results were analyzed retrospectively.Results:None of the patients recurred after transplantation, 1 case died of acute intestinal graft-versus-host disease, six cases were followed-up to date, and 2 case of chronic mild liver graft-versus-host disease, with a median follow-up of 12 months (3~30 months) after transplantation.Conclusions:Low dose of decitabine could improve post-transplant survival in high-risk MDS patients, but further research is needed to confirm.

目的 探讨早期颈部静力性运动对改善颈椎融合术后患者轴性症状的效果.方法 将2017年4～8月入院的120例患者作为对照组接受常规护理,2017年9月至2018年1月入院的120例为观察组,在常规护理的基础上增加早期颈部静力性运动.对两组术后第1、3、5天及术后3个月随访时颈部不适度、颈部活动度、Barthel指数评分以及轴性症状发生率进行统计分析.结果 观察组术后第1、3、5天颈部不适评分显著低于对照组(均P＜0.05);术后第1、3、5天,观察组颈部前屈、后伸、左右侧侧屈的活动度显著大于对照组(P＜0.05,P＜0.01);观察组术后第3、5天Barthel指数评分显著高于对照组,差异有统计学意义(均P＜0.01);随访3个月,观察组轴性症状发生率显著低于对照组(P＜0.05).结论 早期颈部静力性运动可改善颈椎融合术后患者的颈部不适,增加颈部活动度,促进其生活自理能力的恢复,减少轴性症状的发生.

目的 探讨利用CHA2DS2-VASc评分对接受急诊介入治疗的ST段抬高性心肌梗死患者危险分层的价值.方法 取2017年10月-2019年10月就诊于郑州大学人民医院并接受急诊经皮冠状动脉介入治疗的ST段抬高性心肌梗死患者(425例)作为研究对象,利用CHA2DS2-VASc评分进行分组(组1:1-2分、组2:3-4分、组3:＞4分),探讨其急诊介入手术情况及随评分不同院内主要不良心血管事件发生情况,利用ROC曲线验证有效性.结果 三组患者急诊介入情况对比:多支病变患者占比对比:组1(29.37％)低于组2(45.95％),差异有统计学意义(P＜0.05);组2(45.95％)低于组3(62.22％),差异无统计学意义(P＞0.05);组1(29.37％)低于组3(62.22％),差异有统计学意义(P＜0.05;门囊时间对比:组1[90(84,107)]低于组2[105(90,118)],差异有统计学意义(P＜0.05);组2[105(90,118)]低于组3[108(102,119)],差异有统计学意义(P＜0.05);不同CHA2DS2-VASc评分患者院内主要不良心血管事件比例不同,差异有统计学意义(P＜0.001);ROC曲线示曲线下面积为:0.73,95％置信区间为:(0.68,0.78),最佳截断值为3.5.结论 临床工作中,可以利用CHA2DS2-VASc评分对接受急诊介入治疗的ST段抬高性心肌梗死患者进行快速危险分层;随着评分的增加,院内主要不良心血管事件呈上升趋势.

目的 将急性心肌梗死(AMI)患者分为单支病变组和多支病变组,对比分析两组差异,探索AMI患者多支冠脉病变的危险因素.方法 选取2017年10月至2018年5月就诊于郑州大学人民医院并接受CT冠脉造影(CAG)检查的122例AMI患者,分为单支病变组(25例)和多支病变组(97例).对比两组资料,利用回归分析探索多支冠脉病变的危险因素.结果 多支病变组患者年龄[(59.64±11.99)岁]高于单支病变组[(53.36±11.18)岁],血清载脂蛋白B100(ApoB100)水平[(0.90±0.21)g·L-1]高于单支病变组[(0.80±0.20)g·L-1],差异有统计学意义(均P<0.05).Logistic回归分析示高龄和血清ApoB100水平增高为AMI患者多支冠脉病变的危险因素.结论 高龄和血清ApoB100水平升高是AMI患者多支冠脉病变的危险因素.

目的 探讨多穴位贴敷中药膏对乳腺癌患者靶向治疗后消化道反应的影响.方法 将80例乳腺癌靶向治疗后消化道不良反应患者按入院时间分为贴敷组及常规组,每组40例.两组均予以靶向治疗及常规护理干预,贴敷组在此基础上予以多穴位贴敷中药膏治疗,观察7d.统计两组临床疗效、患者满意度、并发症发生状况,于干预前后评定消化道反应程度及卡氏评分.结果 贴敷组总有效率及满意率显著高于常规组(P<0.05).治疗后两组消化道反应程度均显著减轻(P<0.01),卡氏评分均较治疗前显著提高(P<0.01),贴敷组显著优于常规组(P<0.01).两组均未出现血常规、肝肾功能、心电图异常等,安全性评价为1级,贴敷组穴位贴敷未见不耐受或过敏情况.结论 多穴位贴敷中药膏能有效缓解乳腺癌患者靶向治疗后消化道反应情况,效果显著,安全性高,且对改善患者生活质量,提升干预认可度具有积极作用.

Clinical analysis of 10 patients of acute promyelocytic leukemia with a variant RARα translocation Mi Ruihua, Chen lin, Liu Jia, Liu Tao, Wang Kai, Dong Lihua, Li Xu, He Yuzhuo, Liu Zhengbiao, Guo Xuejun, Guo Shuli, Zhao Hongmian, Tang Jiahong, Ma Xiaomiao, Li Yufu, Wei Xudong Henan Cancer Hospital/the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China; Zhoukou Central Hospital, Zhoukou 466000,China; Henan University First Affiliated Hospital, Kaifeng 475004, China;Puyang City Oilfield General Hospital, Puyang 457001, China;Luoyang Central Hospital, Luoyang 471099, China; Henan University Huaihe Hospital, Kaifeng 475399, China; People’s Liberation Army in the 988 Hospital (Kaifeng District), Kaifeng 475002, China; Pingdingshan First People's Hospital,Pingdingshan 467021, China Corresponding author: Wei Xudong, Email: weixudong63@126.com

Objective To observe the efficacy of maintenance treatment with decitabine and dasatinib after allogenic hematopoietic stem cell transplantation for myeloid sarcoma.Methods A 29-year-old male patient was diagnosed with abdominal myeloid sarcoma and acute myeloid leukemia with c-kit mutation and t(8;21).Allogeneic hematopoietic stem cell transplantation was performed after inducted remission.The conditioning regimen was decitabine + FLAG + modified Bu/Cy.Prophylaxis of GVHD was performed with cyclosporine mycophenolate mofetil and short-term methotrexate.The patient received 11.73 × 108 mononucleated cells/kg and 17.59 × 106CD34+ cells/kg from donor.At Day 13 post-transplantation,neutrophils reached 0.5 × 109/L and platelet count was 20 × 109/L.Decitabine was prescribed since Day 50 post-transplantation monthly for 5 courses.And dasatinib was offered orally since Day 100 for 4 months.Results It was followed up to 16 months post-transplantation.There were no obvious abnormalities of bone marrow cytology,AML/ETO fusion gene quantification,cerebrospinal fluid or abdominal enhanced computed tomography (CT).Conclusions Hematopoietic stem cell transplantation is an effective treatment for myeloid sarcoma.Decitabine has some efficacy for myeloid sarcoma and it may be used for maintenance treatment after transplantation.Tyrosine kinase inhibitors reduce recurrence in myeloid sarcoma with c-kit mutation.The treatment of decitabine and dasatinib after allogeneic hematopoietic stem cell transplantation yield excellent outcomes.This is the first report in domestic and foreign literatures.

目的 探讨直立倾斜试验在儿童不明原因晕厥诊断中的应用,为临床提供指导.方法 回顾性统计2017-01—2019-05在郑州大学第三附属医院门诊或住院部行直立倾斜试验的184例儿童患者资料,分析不同性别、不同年龄、有无晕厥史患儿试验结果的差异.结果 (1)75例患者直立倾斜试验呈阳性,阳性率40.76％;其中体位性心动过速综合征40例(53.33％),血管迷走性晕厥25例(33.33％),直立性低血压5例(6.67％),直立性高血压5例(6.67％);(2)不同性别患儿之间阳性率差异无统计学意义(P>0.05),学龄期儿童阳性率高于学龄前期(P<0.05),有晕厥史儿童阳性率显著高于无晕厥史者(P<0.05).结论 直立倾斜试验对儿童不明原因晕厥有较好的诊断价值,学龄期儿童特别是过往有明确晕厥史者其阳性率显著增高.

目的 探究情志干预联合家属参与式护理干预对非小细胞肺癌靶向治疗患者自我效能及生存质量的影响.方法 选取我院2018年6月～2018年10月非小细胞肺癌靶向治疗患者54例,随机数字表法分为对照组与观察组各27例.对照组给予常规护理干预,观察组给予情志干预联合家属参与式护理干预.对比两组护理满意度,及干预前后自我效能感量表(GSES)评分、生存质量评分(KPS评分)、应对方式问卷(TCSQ)评分.结果 干预后两组GSES、KPS评分高于干预前,且观察组高于对照组(P<0.05);干预后观察组PC评分高于对照组,NC评分低于对照组(P<0.05);两组护理满意度对比,观察组96.30较对照组70.37％高(P<0.05).结论 情志干预联合家属参与式护理干预应用于非小细胞肺癌靶向治疗患者,可改善应对方式、自我效能,提高生存质量及护理满意度.

Objective To explore the effects of application of self-made assessment card for spinal nerve motor function in clinical nursing.Methods An assessment card for spinal nerve motor function was designed and produced according to "spinal cord injury grading standards" by American Spinal Injury Association(ASIA).A total of 40 nurses working in orthopedic ward of our hospital were selected as study subjects,and divided into the experimental group and the control group with 20 nurses in each group.Theoretical and practical training regarding spinal nerve motor function was provided to nurses in both groups.Then totally 398 patieuts with spine or spinal cord diseases hospitalized in our orthopedic ward were recruited from June to September 2016 as subjects for assessment.The experimental group used self-made assessment card for spinal nerve motor function as guidance;the control group performed routine assessment for spinal nerve motor function.Results There were no significant differences between the experimental group and the control group in scores of theoretical and practical examinations (P＞0.05);compared with the control group,the error of assessment in the experimental group was reduced by 9.5％,missed assessment rate decreased by 16.2％;and the time for assessnent in the experimental group was significantly shorter than that in the control group(P＜0.05).Conclusion The assessment card for spinal nerve motor function can reduce the error of assessment,save the time for assessment,enhance the capacity of specialist nurses and improve work efficiency.