目的 观察5-氨基酮戊酸光动力疗法(ALA-PDT)治疗宫颈低级别鳞状上皮内病变(LSIL)合并高危人乳头瘤病毒(HR-HPV)感染的临床疗效和安全性.方法 选取132例宫颈组织学LSIL患者,其中实验组88例给予ALA-PDT治疗,对照组44例不进行任何治疗.分别于治疗后第6、12个月时随访,比较2组患者的疗效.结果 治疗后6个月,实验组治疗有效率为80.68％,对照组治疗有效率为20.45％,2组比较差异具有统计学意义(P＜0.05);治疗后12个月,实验组治疗有效率为84.10％,对照组治疗有效率为27.27％,2组比较差异具有统计学意义(P＜0.05);且实验组HR-HPV转阴率均高于对照组,差异具有统计学意义(P＜0.05).结论 ALA-PDT治疗宫颈LSIL疗效显著,且具有安全、无创、可重复治疗,为预防宫颈癌的发生和早期进行干预及保护女性的生育功能提供了重要手段.

目的 探讨乳腺外科开展日间医疗项目及预住院后运营效能的变化,为推广日间医疗项目及预住院提供相关参考及科学依据.方法 收集2015年1月1日-2016年5月31日乳腺外科推行日间手术、日间化疗及预住院前,及2018年1月1日-2019年5月31日推行后的乳腺外科科室绩效点数、床均结余点数、DRG效能数据、科室运行效能数据、手术结构数据,比较日间医疗项目及预住院推行后的指标变化,其中指标呈正态分布的计量资料采用t检验,分类资料采用卡方检验,运用典型相关分析医疗运行指标和日间医疗项目及预住院开展工作量的整体相关性.结果 乳腺外科推行日间医疗项目及预住院后平均每季度绩效点数从53 513提高至80 455,床均结余点数从7419提高至9258,DRG组数从22.8提高至31.8,总权重从648.6提高至1357.9,入院人数从1393.8人次提高至2632.7人次,手术人数从595.0人次提高至952.2人次,手术率从42.7％提高至59.0％,差异具有统计学意义,P＜0.05,时间消耗指数从1.13降低至0.60,术前平均住院日从2.27天降低至1.60天,床位使用率从131.3％降低至92.1％,差异具有统计学意义,P＜0.05,医疗运行效果指标和日间手术、日间化疗及预住院工作量存在典型相关关系,相关系数=0.990.结论 日间医疗项目及预住院的开展可以改善医疗指标,提高医护人员工作积极性和能动性,有效提高科室运行效能,产生良好社会效益,具有推广应用价值.

Objective To investigate the efficacy of doctor-nurse collaborative management model in the “Three Excellence and One Favor”management. Methods Doctor-nurse collaborative management model was adopted in 2964 patients from September 2013 which named experimental group, 2875 pa-tients without doctor-nurse collaborative management model before January 2012 was named control group. The average length of stay,the waiting days before surgery, nurse satisfaction and patient satisfac-tion between two groups were compared respectively. Results The average length of stay in control group and experimental group was respectively 8. 2 days and 7. 8 days. The waiting days before surgery in con-trol group and experimental group was respectively 4. 6 days and 3. 3 days(P<0. 01). The patient satis-faction in control group and experimental group was respectively 97 . 5% and 98 . 9%( P <0 . 01 ) . The nurse satisfaction in control group and experimental group was respectively 97 . 5% and 98 . 9%( P <0. 01). Conclusion The doctor-nurse collaborative management model can reduce the average length of stay and the waiting days before surgery,and improve the patient satisfaction and the nurse satisfaction.

临床护理风险是指在临床护理过程中对病人、探视人员、工作人员造成的损害或其他不安全事件，护理风险贯穿于护理操作、处置、抢救等环节，受患者、护理人员、医院管理、医疗水平等因素的影响。在临床护理工作中，应加强对护理人员的教育培训、加强临床护理制度建设，加强临床风险管理，以减少临床护理风险的发生。

Epidemiological and clinical studies have provided compelling evidence that suggests a link between the relative lack of infectious diseases and the increase in allergic disorders. Asthma usually starts early in life. The early occurrence of asthma suggests that prinatal influences are of importance.Prenatal or postnatal exposure to endotoxins and other bacterial products may protect against the development of asthma in the infant. We will briefly outline the current state of the relationship of the perinatal infection and asthma in the infant, and focus our review mainly on possible rneehanism of perinatal infection providing protection against asthma in the infant, such as Th1/Th2 immune system, transcription factors, protection by maternal antibodies, endotoxin tolerance, pulmonary inflammation and genetic influences.

OBJECTIVE:Inflammatory reaction and injury in immature lungs are associated with activation of nuclear factor-kappa B (NF-kappaB) to trigger proinflammatory cytokine release, but the mechanism thereof is not fully understood. The present study was conducted to understand possible relationship between expression of NF-kappaB and its inhibitor and severity and outcome of neonates with hyaline membrane disease (HMD). METHODS:Serial samples of bronchoalveolar lavage fluid (BALF) were obtained during mechanical ventilation from 31 preterm infants with HMD. These infants were divided into two groups: survivors group [n = 22, birth weight (1500 +/- 320) g and gestational age (31.2 +/- 1.8) weeks] and nonsurvivors group [birth weight (1340 +/- 280) g, gestational age (30.8 +/- 2.1) weeks]. Nineteen preterm infants [birth weight (1470 +/- 280) g, gestational age (30.6 +/- 1.9) weeks] without respiratory disorders were enrolled as control subjects. Alveolar macrophages (AM) were isolated by differential adherence. AM was cultured and treated with lipopolysaccharide (LPS) for 1 hr. Then, nuclear extracts of AM were analyzed by electrophoretic mobility shift assay (EMSA) for NF-kappaB expression. NF-kappaB inhibitor (IkappaB-alpha protein) in cytoplasmic extracts was detected by using Western blotting and IL-1beta and IL-8 in BALF by enzyme-linked immunosorbent assay (ELISA). RESULTS:NF-kappaB complexes were observed by EMSA, they were characterized by competition with cold oligonucleotide and p65-specific antibodies. The addition of an excess of cold oligonucleotide, corresponding to the NF-kappaB binding site, turned off the signal of the band, showing that the band was specific. An excess of an irrelevant oligonucleotide (corresponding to the SP-1) did not show any effect. The addition of an anti-p65 antibody caused the supershift of the two upper bands. After EMSA, the NF-kappaB complexes were quantified by using a ImageQuant software. NF-kappaB expression in AM at 24 hrs was higher in all the patients with HMD as compared with control subjects (survives/control, 34.1 vs 11.4 RDU, P < 0.01; nonsurvivors/control, 55.2 vs 11.4 RDU, P < 0.01). The NF-kappaB expression in AM at 72 hrs was higher than that in control subjects but not for nonsurvivors (survivors/control, 47.8 vs 25.6 RDU, P < 0.01; nonsurvivors/control, 21.8 vs 25.6, P > 0.05). The NF-kappaB expression in AM from nonsurvivors was depressed at 72 hrs as compared to 24 hrs (21.8 vs 55.2, P < 0.01), whereas the NF-kappaB expression in AM from survivors was still higher at 72 hrs than that at 24 hrs (47.8 vs 34.1, t = 4.43, P < 0.01). CONCLUSION:Altered NF-kappaB activation in AM of BALF of neonates with HMD was observed, and it may be mediated by decreased IkappaB synthesis, increased IkappaB degradation, or both. In HMD nonsurvivors NF-kappaB translocation was hampered upon LPS activation.

目的探讨肺泡巨噬细胞(AM)表面mCD14的表达在新生儿呼吸窘迫综合征(NRDS)发病和并肺炎中的作用.方法用流式细胞仪检测早产新生儿呼吸道清洗液中AM表面mCD14的阳性表达率,用酶联免疫吸附试验检测早产新生儿呼吸道清洗液中IL-1β、IL-8含量.结果1.病例组AM的mCD14阳性表达率[(54.772±17.341)%]高于对照组[(14.023±10.713)%],差异有显著性(t=-7.739 P＜0 001);病例组IL-1β含量[(263.220±69.015)ng/L]高于对照组[(73.979±40.850)ng/L],差异有显著性(t=-9.139 P＜0.001);病例组IL-8含量[(377.564±165.867)ng/L]高于对照组[(61.064±39.894)ng/L],差异有显著性(t=-7.185 P＜0.001).2.IL-1β和IL-8均与AM表面的mCD14阳性表达率呈显著正相关(r=0.872,0 847 P均＜0.01);IL-8与IL-1β含量呈显著正相关(r=0.861 P＜0.01).结论mCD14在AM表面的高表达以及细胞因子IL-1β和IL-8在NRDS发病及并肺部炎症的病理生理过程中起重要作用.

目的探讨新生儿医源性高血糖的相关因素.方法将96例住院新生儿以静脉输注葡萄糖的速度不同分为3组,分别对3组新生儿的血糖进行动态监测.结果 3组新生儿医源性高血糖的发生率,足月儿分别是81%、37%、0(P＜0.01),早产儿分别是95%、57%、22%(P＜0.005).结论静脉输注葡萄糖超速是引起新生儿医源性高血糖的主要原因.胎龄、日龄、体重和血糖值呈负直线相关.病情越重越易发生高血糖.

近年来人们对肺脏的认识逐渐增加,肺脏除具有气体交换、内分泌、代谢功能外,尚具有一套复杂的免疫防御系统.新生儿的早期防御主要依赖非特异性免疫,其特异性免疫是在新生儿成熟过程中逐渐获得的.机体非特异性免疫在新生儿期明显增强,从而补偿了特异性免疫的相对不成熟.由于对肺泡巨噬细胞和树突状细胞作用的进一步理解以及一些新免疫分子的发现,肺的非特异性免疫成为近年来研究热点,其在新生儿疾病的发生和发展中有重要作用,现综述如下.

目的探讨神经降压素(NT)在新生儿缺氧缺血性脑病中的作用.方法应用放射免疫法测定缺氧缺血性脑病新生儿中血浆NT的含量.结果缺氧缺血性脑病新生儿血浆NT明显高于单纯窒息新生儿和对照组,窒息新生儿血浆中NT高于对照组.窒息程度愈重,新生儿血浆中NT愈高.结论 NT在新生儿窒息和缺氧缺血性脑病的发病机制中起重要作用.

Objective Suspected subclinical intrauterine inflammation related to elevated proinflammatory cytokines in amniotic fluid constitutes a risk factor for postnatal development of chronic lung disease. Cellular immune response, mRNA-cytokine expression in fetal and neonatal pulmonary tissue in the presence or absence of chorioarnnionitis were investigated. Methods Serial tissue sections were obtained from 27 fetuses and 9 newborns. Immunhistochemical staining comprised lineage-specific markers (CD68, neutrophil elastase, CD3+). In-situ-hybridisation to assess the expression of interleukin-8 mRNA in the fetal and neonatal lung were undertaken. Results 7 out of 27 fetuses and 6 out of 9 newborns had been exposed to chrioamnionitis . Fetal and neonatal lung showed more increase in density of CD68 positive macrophages and neutrophils in the presence of chorioarnnionitis than that in the absence of chorioarnnionitis. Exposure to chorioarnnionitis resulted in Interleukin-8 (IL-8) mRNA expression higher compared to cell counts of the non-infectious group. Conclusion Chorioarnnionitis play an importent role in the pathophysiological mechanisms of fetal and neonatal pulmonary inflammation. This data strongly supports an association between chorioarnnionitis and inflammatory bronchopulmonary response in the development of neonatal respiratory distress syndrome (RDS) and chronic lung disease of prematurity (CLD).