脉络宁注射液对肢体缺血-再灌注损伤一氧化氮及一氧化氮合酶的影响

目的:探讨脉络宁注射液对肢体缺血-再灌注损伤一氧化氮(NO)和一氧化氮合酶(NOS)的影响.方法:健康成年家兔20只,随机分为对照组和实验组,建立后肢缺血-再灌注损伤动物模型.在即将恢复血流灌注时,实验组家兔自耳缘静脉注射脉络宁注射液,对照组注射等量生理盐水.在缺血前、缺血后2 h、再灌注后1 h和4 h各自从术侧股静脉采血,分离血清,测定血清NO和NOS的含量;取胫前肌行电镜观察.结果:两组血清NO含量在缺血后2 h比缺血前均明显增高(P均<0.05),再灌注后均明显降低(P均<0.05).两组NOS活性在缺血后2 h比缺血前明显降低(P均<0.01),再灌注后比缺血后2 h均明显增高(P<0.05或P<0.01),且实验组明显高于对照组(P<0.01和P<0.05).电镜观察可见再灌注后对照组组织损伤严重,而实验组较轻.结论:脉络宁注射液能抑制肢体缺血-再灌注损伤NO的过量产生,提高NOS活性,对肢体缺血-再灌注损伤具有保护作用.     

皮肤压疮缺血再灌注损伤及其作用机制研究

[目的]探讨压疮缺血再灌注时氧化物歧化酶(SOD)、乳酸脱氢酶(LDH)活性和氧化亚氮(NO)、丙二醛(MDA)、内皮素-1(ET-1)含量的变化及其意义。[方法]将48只雄性SD大鼠随机分为6组:对照组、缺血组、再灌注1h组、再灌注2h组、再灌注4h组、再灌注6h组,建立大鼠压疮缺血以及缺血-再灌注模型,进行对照研究,分别测定6组大鼠血浆中SOD、LDH的活性以及NO、MDA、ET-1的含量。[结果]再灌注组各组较对照组和缺血组SOD活性和NO含量明显下降(P<0.05或P<0.01),MDA、ET-1含量和LDH活性明显增加(P<0.05或P<0.01);缺血组较对照组LDH活性和ET-1含量明显增加(P<0.05)。[结论]皮肤压疮缺血再灌注时存在损伤,该损伤与氧自由基和血管内皮细胞损伤有关。     

芒果苷在大鼠脊髓缺血再灌注性损伤中的保护作用及机制研究

目的探索芒果苷(MAN)对大鼠脊髓缺血再灌注损伤的保护作用及相关分子机制。方法腹主动脉夹闭法制备大鼠脊髓缺血再灌注损伤模型,采用前瞻性分析,实验分3组:对照组、模型组和实验组。实验组利用50 mg/kg芒果苷干预治疗,对照组和模型组给予等量生理盐水腹腔注射。于造模后第7天和14天检测各组大鼠下肢运动功能;14 d利用ELISA法检测肝脏组织中丙二醛(MDA)含量、过氧化氢酶(CAT)、超氧化物歧化酶(SOD)以及谷胱甘肽过氧化氢酶(GSH-px)活性;化学定量法及Western blotting法分别检测肝脏组织中一氧化氮(NO)和内皮型一氧化氮合酶(eNOS)、Bax、Bcl-2蛋白表达;14 d后取脊髓组织进行快蓝/HE(LFB/HE)染色和eNOS、Bax免疫组织化学染色。结果BBB评分显示,第7天,与对照组比较,模型组下肢运动功能评分明显下降,而实验组较模型组有升高(P0.05);第14天,实验组BBB评分显著高于模型组(P0.05);ELISA法显示,模型组大鼠脊髓组织MDA含量显著高于对照组,CAT、SOD和GSH-px显著高于对照组,而实验组MDA含量显著低于模型组,CAT、SOD和GSH-px显著高于模型组(P0.05);化学定量法和Western blotting显示,模型组肝脏组织中NO和eNOS、Bax表达量显著高于对照组,而Bcl-2显著低于对照组(P0.05),而实验组肝脏组织中NO和eNOS、Bax表达量显著低于模型组,而Bcl-2显著高于模型组(P0.05)。免疫组织化学染色显示eNOS、Bax平均光密度实验组显著低于模型组(P0.05)。结论芒果苷可通过抗氧化应激和细胞凋亡保护大鼠脊髓缺血再灌注性损伤。     

皮肤压疮缺血再灌注损伤及其作用机制研究

[目的] 探讨压疮缺血再灌注时氧化物歧化酶（SDD）、乳酸脱氢酶（U）H）活性和氧化亚氮（NO）、丙二醛（MDA）、内皮素-1（ET-1）含量的变化及其意义。[方法] 将48只雄性SD大鼠随机分为6组：对照组、缺血组、再灌注1h组、再灌注2h组、再灌注4h组、再灌注6h组，建立大鼠压疮缺血以及缺血-再灌注模型，进行对照研究，分别测定6组大鼠血浆中90D、LDH的活性以及NO、MDA、ET-1的含量。[结果] 再灌注组各组较对照组和缺血组SOD活性和NO含量明显下降（P〈0．05或P〈0．01），MDA、ET-1含量和LDH活性明显增加（P〈0．05或P〈0．01）；缺血组较对照组LDH活性和ET-1含量明显增加（P〈0．05）。[结论] 皮肤压疮缺血再灌注时存在损伤，该损伤与氧自由基和血管内皮细胞损伤有关。     

抑肽酶预处理对兔脊髓缺血再灌注损伤后NO及NOS的影响

目的 观察抑肽酶预处理对家兔脊髓缺血再灌注损伤后脊髓中一氧化氮(NO)及一氧化氮合酶(NOS)的影响.方法 45只新西兰大白兔随机分为抑肽酶预处理组、生理盐水组及假手术空白组,每组15只.以体外松解法建立家兔脊髓缺血模型,缺血60 min后恢复血流再灌注24 h.抑肽酶预处理组于缺血前10 min静脉注射抑肽酶3×107 IU/kg,继而用微量泵持续静脉注入抑肽酶1×107 IU/kg/h至实验结束;生理盐水组缺血再灌注时间同实验组,并用等量生理盐水代替抑肽酶;假手术空白组只暴露腹主动脉,不夹闭、不给药.分别于缺血前、缺血再灌注后8 h、24 h处死动物,取腰段脊髓做NO及NOS测定.结果 抑肽酶预处理组与生理盐水组再灌注8 h和24 h的NO、总NOS(TNOS)、诱导型NOS(iNOS)较缺血前升高( P＜0.05);再灌注8 h时,抑肽酶预处理组与生理盐水组之间的TNOS、iNOS有显著性差异( P＜0.05),NO有非常显著性差异( P＜0.01);再灌注24 h时,抑肽酶预处理组与生理盐水组之间的NO、TNOS、iNOS均有非常显著性差异( P＜0.01);抑肽酶预处理组与生理盐水组在再灌注8 h、24 h时,NO、TNOS、iNOS较假手术空白组明显升高( P＜0.01).结论 缺血再灌注时,脊髓中产生过量NO是引起脊髓损伤的重要因素,抑肽酶预处理可以降低脊髓缺血再灌注时脊髓中NO的含量,减轻再灌注损伤,对脊髓缺血再灌注损伤具有保护作用.     

腺苷对兔缺血再灌注心肌和ET-1作用的研究

目的评价腺苷对缺血再灌注心肌的作用和对ET-1的影响,探讨腺苷预处理对缺血再灌注心肌保护作用的可能机制。方法家兔24只,随机分成对照组、腺苷预处理组、腺苷治疗组,每组8只。冠状动脉结扎40min,再灌注3h制备缺血再灌注模型。测定缺血前和再灌注3h后血CK的变化和心肌梗死区重量的大小,比较各组再灌注3h后SOD和MDA的变化。采用放免法测定结扎冠脉前,再灌注时,再灌注后30、60、120min血浆ET-1的变化。结果与对照组和腺苷治疗组相比,腺苷预处理组在再灌注3h后血清中CK、SOD、MDA的水平降低(P<0.01),心肌梗死面积明显减少(P<0.01);与对照组和腺苷治疗组相比,腺苷预处理组除结扎冠脉前,其余时间点ET-1的水平明显降低(P<0.01)。结论腺苷预处理可减轻再灌注损伤,对缺血再灌注心肌具有明显的保护作用,腺苷可能通过保护内皮细胞减少血浆ET-1的水平,减轻缺血再灌注损伤。     

缺血预处理对缺血骨骼肌收缩功能的影响

背景缺血预处理能有效提高骨骼肌缺血耐受性,减轻骨骼肌缺血再灌注期间的坏死范围,但缺血预处理对骨骼肌收缩功能的影响文献报道不多.目的探讨缺血预处理对骨骼肌缺血再灌注期间收缩功能的影响.设计以实验动物为研究对象的随机对照研究.单位华中科技大学同济医学院及解放军第二五二医院.材料实验地点为解放军第二五二医院中心实验室.选用健康雄性SD大鼠14只.方法采用大鼠后肢缺血再灌注模型,将14只大鼠随机分为对照组和实验组.对照组持续缺血4 h,再灌注1 h;实验组缺血5 min,再灌注5 min,重复3次后,持续缺血4 h再灌注1 h.测定缺血再灌注期间腓肠肌收缩功能变化及再灌注1 h后,血清磷酸激酶(CK),丙二醛和腓肠肌99锝m亚甲基二磷酸钠(99TcmMDP)吸收量变化.主要观察指标缺血预处理对腓肠肌收缩力及对血清CK,丙二醛及99TcmMDP吸收量的影响.结果实验组腓肠肌收缩力在缺血4h时为(14.32±5.05)g,再灌注1 h时为(25.71±7.58)g,对照组分别为(0,4 73±2.05)g,两者相比差异有显著性意义(P＜0.05),实验组血清CK为(104.85±9.84)nkat/L,丙二醛为(3988.60±455.92)nmol/L,99TcmMDP吸收量为(56.0±8.1)mBq/g·mir,对照组CK为(136.36±14.50)nkat/L,丙二醛为(6 542.90±536.72)nmol/L,99TcmMDP吸收量为(97.3±5.8)mBq/g·min,两者相比差异有显著性意义(P＜0.05,P＜0.01).结论缺血预处理能有效改善缺血再灌注期间骨骼肌的收缩力,减轻骨骼肌坏死程度.因此,缺血预处理对缺血骨骼肌的收缩功能具有保护作用.     

早期电针对局灶性脑缺血大鼠双侧皮质脑源性神经营养因子表达的影响

目的:观察早期电针治疗对局灶性脑缺血大鼠双侧皮质脑源性神经营养因子(BDNF-m RNA)的时序性变化,探讨电针治疗偏瘫的交叉迁移效果的分子生物学机制。方法:用线栓法建立局灶性脑缺血模型,将建模成功的54只SD大鼠随机分为健肢治疗组(UALTG)、患肢治疗组(ALTG)、对照组(CG),各组再随机分为1周、2周、3周组,造模成功24h后对治疗组浅麻醉行电针穴位治疗,每组各时间段结束24h内分离缺血皮质及对侧同部位皮质,采用RT-PCR法测定BDNF-m RNA表达量。结果:1对缺血皮质BDNF-m RNA表达的影响:ALTG组BDNF-m RNA在第7天、第14天、第21天时表达量均有增加,与CG组相比有显著性增高(P0.01),而UALTG组在第7天和第21天时表达量均有增加,与CG组相比有显著性增高(P0.01);在第7天和第21天时UALTG组较ALTG组表达量更高(P0.01)。2对缺血对侧皮质BDNF-m RNA表达的影响:ALTG组在第7天和第21天时BDNF-m RNA表达量高于CG组(P0.01);UALTG组在第14天时表达量高于CG组(P0.01),且ALTG组表达量同时也高于UALTG组(P0.01);而UALTG组和ALTG组在第21天时的表达量均下降,低于CG组(P0.01)。结论:早期电针治疗MCAO局灶性脑缺血大鼠健侧肢体和患侧肢体都能有效促使双侧皮质BDNF-m RNA的表达上调,具有明显的交叉迁移效果,且健侧较患侧更大幅度提高缺血皮质BDNF-m RNA的表达,这种变化可能是大鼠功能恢复较好和病死率较低的分子机制之一。     

MMP-9抑制剂对大鼠肝脏缺血再灌注模型的影响分析

目的探讨基质金属蛋白酶-9(MMP-9)抑制剂对大鼠肝脏缺血再灌注模型的影响。方法选择36只健康雄性Wistar大鼠,将其随机分成3组,对照组(大鼠未进行任何处理不建立肝脏缺血再灌注模型)12只,模型组(肝脏缺血再灌注模型组建立前采用生理盐水处理)12只大鼠,实验组(肝脏缺血再灌注模型建立前采用盐酸多西环素处理)12只。检测各组大鼠肝脏缺血再灌注1 h、6 h、24 h血清天冬氨酸氨基转移酶(AST)与丙氨酸氨基转移酶(ALT)含量;观察评价肝脏组织损伤情况,肝脏组织的淤血、空泡样变、坏死程度以及MMP-9水平。结果模型组与实验组再灌注1 h、6 h、24 h的血清ALT与AST水平、肝组织病理评分均显著高于对照组(P <0.05)实验组低于模型组(P <0.05),模型组和实验组在肝脏缺血再灌注6 h时血清ALT与AST水平最高(P <0.05)。模型组与实验组再灌注1 h、6h、24 h的肝组织MMP-9相对表达水平均显著低于对照组(P <0.05),实验组高于模型组(P <0.05)。结论 MMP-9抑制剂能抑制大鼠肝脏缺血再灌注损伤,促进恢复大鼠的肝功能,缓解肝组织病变状况。     

补阳还五汤预处理减轻脑缺血再灌注损伤的实验研究

【目的】探讨补阳还五汤预处理减轻SD大鼠脑缺血再灌注损伤的机制。【方法】采用钳夹双侧颈总动脉建立SD大鼠脑缺血模型,将130只SD大鼠随机分为假手术组,脑缺血再灌注损伤组(IR组)、脑缺血预处理组(IPC组)、补阳还五汤预处理组(NPC组),根据再灌注不同时间(24 h、48 h、72 h和7 d)。将IR组、IPC组、NPC组各分4个亚组(n=10)。观察各时相大鼠血清腺苷含量和血清NO含量的变化。【结果】①IPC组、NPC组与IR组同期比较,血清腺苷含量以及第24 h、48 h血清NO含量明显升高(P<0.05 或P<0.01);②各组不同时相比较:随着再灌注时间延长,血清腺苷含量呈上升趋势,且三组腺苷含量均于再灌注后第7 d达最高,血清NO含量逐渐下降,至第7 d达到最低;③药物预处理组与缺血预处理组比较:血清腺苷含量以及第24 h、48 h血清NO含量差异有显著性意义(P<0.05)。【结论】补阳还五汤预处理保护作用与内源性腺苷以及NO增加有一定相关性。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

骨脂肪瘤及血管脂肪瘤的CT及MRI表现:9例报告并文献复习

目的探讨骨脂肪瘤及血管脂肪瘤的CT及MRI表现。方法收集手术病理证实的9例骨脂肪瘤及血管脂肪瘤的临床及影像学资料,9例术前8例接受CT扫描,3例接受MRI检查。结果9例中骨脂肪瘤6例,骨血管脂肪瘤3例。6例骨脂肪瘤发生于骨内4例,骨旁2例。骨内脂肪瘤跟骨1例,距骨1例,眶骨1例,肱骨1例。骨旁脂肪瘤颅骨1例,股骨1例。骨血管脂肪瘤发生于肋骨1例,颅骨1例,椎骨1例。骨内脂肪瘤CT显示病变骨质呈轻度膨胀性改变,边缘见轻度硬化环,病灶内见脂肪密度及条弧形、结节状钙化,MRI显示病灶T1WI呈高信号,PDWI及T2WI抑脂序列呈低信号。骨旁脂肪瘤CT呈不均匀高密度团块,MRI显示病灶T1WI呈高信号,T1WI及T2WI抑脂序列呈低信号。3例骨血管脂肪瘤CT显示病变骨质呈显著膨胀性改变,骨破坏边缘及内部见多发骨嵴及粗大骨小梁,高密度骨针呈放射状、簇状或不规则排列。结论骨内脂肪瘤及血管脂肪瘤CT及MRI表现均以脂肪成分为主要特征,骨旁脂肪瘤CT以骨化性团块为特征,骨血管脂肪瘤骨质膨胀性改变较骨内脂肪瘤显著,病灶边缘及中心以多发骨嵴及粗大骨小梁为特征。