我院收治产后确诊为肝癌患者1例,住院期间表现出一系列的负性情绪,采取阶段性心理护理结合专业指导,未见负性情绪爆发及其他并发症的发生,现报道如下: 1 病历摘要 患者女,36岁,初中文化.2021年7月8日因产后42天需行产后常规检查.实验室检查:甲胎蛋白6855 ng/mL.进一步行腹部增强MRI:肝S2占位灶,考虑肝癌.拟"肝癌"收住我院肝胆外科.入院时神志意识清,眉头紧锁,情绪焦躁,坐立不安,时而哭泣,时而发呆.采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估患者情绪状况,分别为62、67分,为中度焦虑、抑郁;采用心理痛苦温度计(DT)评估患者的心理痛苦度,评分7分,为重度心理痛苦.体温36.8℃,脉搏93次/min,呼吸18次/min,血压112/67 mm Hg.查体:腹软,无压痛及反跳痛.患者7月15日行肝脏穿刺活检术,病理示左肝肝细胞肝癌.患者完善全部检查后,7月21日在全麻下行复杂肝癌切除术、膈肌修补术、肠粘连松解术.期间我们根据患者的心理问题,采取阶段性的个性化心理护理,消除其内心的孤独感、无助感、焦虑、抑郁等负性情绪,树立积极战胜疾病的信心,实现自我价值感,于7月29日康复出院.

Background NADH: ubiquinone oxidoreductase subunit C1(NDUFC1) encodes a subunit of the Complex I, which may support the structural stability of Complex I and assist in its biogenesis. The expression and functional roles of NDUFC1 in hepatocellular carcinoma (HCC) remain unknown. Result We knocked down the expression of NDUFC1 in HCC cell lines to explore the effects of NDUFC1 downregulation on HCC in vitro. MTT assay determined that downregulation of NDUFC1 significantly inhibited cell proliferation. Flow cytometry with (propidium iodide) PI staining indicated silencing of NDUFC1 arrested cell cycle of BEL-7404 cells at G2 phase and SK-HEP-1 cells at S/G2 phase. Annexin V-PI double staining and flow cytometric analysis showed that the downregulation of NDUFC1 significantly increased the population of apoptotic cells. Wound-healing assay and transwell assay indicated that the downregulation of NDUFC1 suppressed the migration and invasion of HCC cells. According to the detection of complex1 activity, we found that the activity of NDUFC1 silenced group decreased, whereas the content of ROS increased. Furthermore, combined with bioinformatics analysis of senescence-related genes, we found that the silence of NDUFC1 in HCC could induce senescence and inhibit autophagy. In addition, NDUFC1 could correlate positively with cancer-related pathways, among which the p53 pathways and the PI3K/Akt/mTOR pathways. Finally, NDUFC1 is high expression in HCC specimens. High NDUFC1 expression was associated with poor prognosis and was an independent risk factor for reduced overall survival (OS). Conclusions Our study indicated, for the first time, that NDUFC1 is an independent risk factor for the poor prognosis of HCC patients. NDUFC1 may promote tumor progression by inhibiting mitochondrial Complex I and up-regulating ROS through multiple cancer-related and senescence-related pathways of HCC, including p53 pathways and PI3K/Akt/mTOR pathways. We suppose that NDUFC1 might be a potential target for the mitochondrial metabolism therapy of HCC.

Objective:To explore the correlation between cancer fear and coping style in patients after laparoscopic radical resection for liver cancer.Methods:From February 2017 to October 2020, convenience sampling was used to select 1 320 patients undergoing laparoscopic radical resection for liver cancer in the Department of Abdominal Surgery of Zhejiang Cancer Hospital as the research object. The general information questionnaire, Chinese version of the Short Form of the Fear of Progression Questionnaire (FoP-Q-SF) and the Medical Coping Modes Questionnaire (MCMQ) were used for the survey. Pearson correlation was used to analyze the correlation between patients' cancer fear and coping style. A total of 1 320 questionnaires were distributed and 1 308 valid questionnaires were returned with the valid response rate of 99.09%.Results:Among 1 308 patients, the total score of the Chinese version of FoP-Q-SF was (36.51±6.23), and 56.65% (741/1 308) patients scored more than 34 points. There were statistically significant differences in the Chinese version of the FoP-Q-SF scores of patients with different gender, age, marital status, economic pressure caused by the disease, number of hospitalizations for liver cancer, and cancer family history after laparoscopic radical resection of liver cancer ( P<0.01). The confrontation dimension scores of patients in MCMQ were lower than the domestic norm, and the avoidance and resignation dimension scores were higher than the domestic norm, and the differences were statistically significant ( P<0.01). The total score and dimension scores of the Chinese version of FoP-Q-SF were negatively correlated with the confrontation dimension score of the MCMQ ( P<0.01), and positively correlated with the resignation and avoidance dimension scores ( P<0.01) . Conclusions:More than half of the cancer fear of patients after laparoscopic radical resection of liver cancer exceeds the normal level, and those who adopt avoidance and resignation methods to face the disease have a high level of fear. Nursing staff should provide targeted nursing interventions according to the emotional level of different patients, and help patients establish positive coping styles.

目的 探讨疏肝利胆汤对预防胃癌根治术后胆囊结石形成的疗效.方法 选取2016年1-12月期间浙江省肿瘤医院腹部外科行胃癌根治术的120例患者,且术前行超声检查排除胆道系统疾病(包括胆囊炎症、胆囊或胆管结石等),除外糖尿病等可能影响胆囊排空功能的疾病.将120例患者按随机数字表法分为观察组和对照组,各60例.2组术后均给予常规治疗,观察组于术后第10天开始每天1贴,分2次给予疏肝利胆汤200 mL口服,连续服用20 d.观察2组患者胃肠道反应情况.2组患者术前3d和术后30 d测空腹胆囊收缩素浓度,超声测量空腹及脂肪餐后胆囊容积,计算胆囊排空率.随访观察2组患者胆囊结石发生情况.结果 2组患者胃肠道反应发生率相近,差异无统计学意义.术后观察组和对照组血清CCK含量均有升高,观察组CCK含量明显高于对照组,差异有统计学意义(P＜0.05).术后观察组和对照组胆囊排空率均较术前下降,但观察组胆囊排空率高于对照组,差异有统计学意义(P＜0.05).25例(20.8％)患者发生胆囊结石,其中观察组8例(13.3％),对照组17例(28.3％),差异有统计学意义(x2=4.093,P=0.043).结论 疏肝利胆汤可以改善胃癌根治术后胆囊排空功能,降低胆囊结石的发生率.

目的 探讨肿瘤医院外科片区夜班护士的心理灵活性与焦虑、抑郁情绪的相关性.方法 随机抽取外科片区夜班护士40名,运用焦虑自评量表(SAS)和抑郁自评量表(SDS)评定其焦虑、抑郁情绪或状态程度,采用接纳与行动问卷第二版(AAQ-Ⅱ)、认知融合问卷(CFQ)测量其心理灵活性.结果 夜班护士伴有焦虑情绪或焦虑状态占50.0％,伴有抑郁情绪或抑郁状态占55.0％.Person相关性分析结果显示,心理灵活性的两因子与SAS,SDS评分相关性较高(P<0.01),AAQ-II和CFQ之间高水平相关(r=0.691,P<0.001).结论 心理灵活性越高的护士其焦虑、抑郁情绪发生的概率越低,经验性回避、认知融合得分越高的护士,越易并发焦虑、抑郁情绪或焦虑、抑郁状态.

通过文献归纳法总结了肺癌患者癌因性疲乏发生的相关因素、评估工具和系统管理策略,以丰富临床对肺癌患者癌因性疲乏的评定和应对策略,最大限度地改善患者疲乏程度,减少负性情绪,提高治疗依从性及效果,改善患者的生存质量,建立并完善癌因性疲乏综合评估、应对系统.

总结1例结节性硬化症伴双肾错构瘤一侧破裂出血患者的护理.护理要点是在肾动脉栓塞治疗前后做好出血的观察与护理,加强高热护理及靶向药物的用药及副反应管理,予以良好的心理支持和出院康复指导.经过治疗及护理,患者病情控制良好,住院19 d出院.

1 病历摘要 患者男,52岁,文盲,先天性聋哑.2018年1月8日以尿痛就诊,无尿急、尿频感,无排尿淋漓不尽感,无肉眼血尿等表现.实验室检查:前列腺抗原7.7ng/ml,伴升高两周;前列腺增强MRI:前列腺周围叶左后方结节,拟"前列腺癌"收住浙江省肿瘤医院泌尿外科.入院时意识清,情绪焦躁,紧张不安伴有双手冒汗,无头晕、心悸.当时在家属翻译下,我们采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估患者情绪,SAS、SDS得分分别为68.0分、61.0分,为中度焦虑和抑郁.

总结了5例游离股前外侧皮瓣修复皮肤恶性黑色素瘤术后大面积缺损血管危象的观察及护理，包括重点观察移植皮瓣的颜色、毛细血管充盈的反应，针刺出血实验结果，并及时判断动、静脉危象，并给予对症处理：包括改善病房环境，加强体位护理及切口护理，预防皮瓣血栓形成等。认为通过适当地护理与观察可预防皮瓣血栓形成，明显提高皮瓣的存活率。

目的 探讨保和汤联合穴位贴敷对胃癌术后肠蠕动恢复的作用.方法 选择2014年8月～2015年2月在我院腹部外科行全胃切除术的62例胃癌患者,对照组31例采用常规护理方法;观察组31例则在常规护理方法的基础上,加用鼻饲保和汤、联合生大黄穴位贴敷的护理方法.观察两组患者术后胃管拔除的时间、首次肛门排气和排便时间以及腹痛腹胀发生率等.结果 观察组胃管拔除时间明显早于对照组[(2.74±0.69)d vs (3.61±1.07)d,t=-2.131,P=0.037)];观察组肛门首次排气时间[(74.87±23.9)hvs(94.87±20.92)h,t=-3.502,P=0.001)]和首次排便时间[(5.68±1.48)dvs(6.45±1.22)d,t=-2.241,P=0.029)]明显早于对照组;观察组腹痛腹胀发生率明显低于对照组(16.12％ vs 41.93％,x2=5.010,P=0.025).结论 保和汤联合穴位贴敷可有效促进胃癌术后肠蠕动恢复.