硬膜外腔植入髓核对大鼠脊髓背根神经节SP和CGRP表达的影响

目的:观察硬膜外腔植入异体髓核对大鼠L6-S1脊髓背根神经节细胞SP和CGRP表达的影响,以期为椎间盘源性疼痛发病机制提供细胞生物学基础.方法:雄性SD大鼠(体重260～280g)随机分为四组:脂肪+生理盐水组(FS组)、脂肪+胶原酶组(FE组)、髓核+生理盐水组(NS组)、髓核+胶原酶组(NE组),每组n=6.观察指标:(1)痛阈测定:在手术前、术后第7天及术后第15天分别测定鼠尾对伤害性机械刺激的反应.(2)SP和CGRP表达:术后第15天取L6-S1背根神经节,采用免疫组织化学染色方法观察髓核对背根神经节细胞肽类神经递质SP和CGRP表达的影响.结果:(1)痛阈变化:NS组在术后第7天和第15天对机械刺激表现为痛觉过敏(P＜0.05),而其他组大鼠术后痛阈与术前相比没有显著差异(P＞0.05);术后第7天和第15天NS组与其他组组间比较痛阈显著性降低(P＜0.05).(2)SP和CGRP表达:术后15天FE组大鼠与FS组相比,背根神经节细胞SP和CGRP表达没有显著性差异(P＞ 0.05); NS组与FS组相比背根神经节细胞SP和CGRP表达显著增加(P＜ 0.05);NE组与NS组相比背根神经节细胞SP和CGRP表达显著降低(P＜0.05),接近于FS组水平(P＞0.05).结论:硬膜外腔植入异体髓核可引起背根神经节细胞SP和CGRP表达增加,这可能是导致大鼠出现痛觉超敏原因之一.     

脊髓背角ERK/MAPK通路在髓核致炎大鼠神经根炎性痛维持中的作用

目的:观察脊髓背角磷酸化ERK(pERK)在髓核致炎大鼠神经根炎性痛进程中的表达变化,及硬膜外腔注射ERK通路抑制剂U0126对大鼠机械性痛阈的影响。方法:成年雄性SD大鼠56只,随机分为3组:Blank组(13只)、Sham组(13只)、手术模型组(NP组,30只),检测所有大鼠术前1 d,术后1、4、7、14、21 d和28 d的50%机械痛缩足阈值(50%MWT)。Blank组和Sham组于术后7 d及NP组于术后1、4、7、14、21 d取大鼠腰段脊髓背角,应用Western blot方法检测各时点pERK蛋白含量。另一成年雄性SD大鼠80只,随机分为blank组(13只),sham组(13只),NP组(13只),DMSO组(13只)和U0126组(28只),DMSO组、U0126组分别于术后第6天单次硬膜外腔注射10%DMSO 50μl和10μg/50μl U0126。给药前和给药后多个时点均进行疼痛行为学测定。Blank、Sham和NP组于术后第6d取腰段脊髓背角,DMSO组于给药后6 h取材,U0126组于给药后2、4、6、24 h取材,通过免疫组化技术观察脊髓背角pERK阳性产物。结果:与Sham组相比,髓核致炎性神经根痛大鼠腰段脊髓背角pERK在术后1、4、7、14和21 d多个时点表达均增加(P<0.05)。术后第6 d单次硬膜外腔给予U0126后4 h髓核致痛大鼠的50%MWT明显提高(P<0.05),持续至给药后8 h,同时伴有脊髓背角pERK表达减少(P<0.05)。结论:腰段脊髓背角pERK在髓核致炎性神经根痛进程中表达增加,给予ERK通路抑制剂U0126可缓解痛觉过敏,脊髓背角ERK/MAPK通路在髓核致炎大鼠神经根炎性痛维持中起重要作用。     

鞘内单次注射吗啡对神经病理痛大鼠脊髓背角CGRP表达的影响

目的:观察鞘内单次注射吗啡对神经病理痛大鼠脊髓背角降钙素基因相关肽(Calcitonin gene-related peptide CGRP)表达的影响.方法:20只健康雄性SD大鼠,体重200～270 g,随机分为4组:对照组(C组,n=5),假手术组(S组,n=5),生理盐水组(N组,n=5),吗啡组(M组,n=5).C组不做任何处理,其它3组均根据改良Yaksh法进行鞘内置管;N组和M组制备神经病理痛模型(SNI模型),制模2 d后,N组和M组分别鞘内注射生理盐水和吗啡10μg,容量为20μl.每组均在SNI术前1d(基础值)到术后2d内每天测定机械痛阈和热缩足潜伏期,并全部在注药后2h处死大鼠,用免疫组织化学方法观察大鼠L5节段水平脊髓背角CGRP的表达.结果:与C组和S组比较,N组机械痛阈降低,CGRP表达上调(P<0.05),热缩足潜伏期差异无统计学意义(P0.05).与N组比较,M组机械痛阈升高,热缩足潜伏期延长,CGRP表达下调(P<0.05).结论:鞘内单次注射吗啡对神经病理痛大鼠在产生镇痛效应时引起脊髓背角CGRP表达下调.     

胶原酶对大鼠硬膜外腔植入髓核所致痛觉过敏的影响

目的:观察胶原酶对硬膜外腔异体髓核植入引起大鼠痛觉过敏的影响。方法:18只雄性SD大鼠(体重260～280g)随机分为脂肪 胶原酶(FE)组、髓核 生理盐水(NS)组和髓核 胶原酶(NE)组(n=6)。所有大鼠在水合氯醛腹腔注射麻醉下于L6～S1间隙手术暴露硬膜外腔,FE组植入异体脂肪(约3～4mg) 胶原酶(20μl,125万u/ml),NS组植入异体髓核(约3～4mg) 生理盐水(20μl),NE组植入异体髓核(约3～4mg) 胶原酶(20μl,125万u/ml)。异体脂肪和髓核由另外9只雄性SD大鼠获得。在手术前、术后第7天、术后第15天及术后第30天分别测定鼠尾对伤害性电刺激、温度刺激及机械刺激的反应。结果:FE组和NE组大鼠术后不同时间对各种伤害性刺激的反应与术前相比没有显著性差异(P>0.05),而NS组大鼠从术后7天至30天对各种伤害性刺激的反应与术前相比显著增强(P<0.05)。结论:胶原酶可以消除硬膜外腔植入髓核诱发的痛觉过敏。     

伏核内勿动蛋白A和降钙素基因相关肽1受体在炎性痛大鼠痛觉调制过程中的角色

目的:探讨大鼠伏核内勿动蛋白A(Nogo-A)和降钙素基因相关肽1(CGRP1)受体在痛觉调制过程中的作用。方法:健康雄性SD大鼠随机分为4组:空白对照组,伏核内注射生理盐水1μl;炎性痛模型对照组、吗啡组和纳洛酮组。福尔马林致炎成功后,分别向其伏核内注射生理盐水、吗啡、纳洛酮各1μl。采用Western blot法,观察各组大鼠伏核内Nogo-A和CGRP1受体蛋白表达的变化,分析炎性痛、吗啡、纳洛酮对大鼠伏核内Nogo-A和CGRP1受体蛋白表达的影响。结果:正常大鼠伏核内有Nogo-A和CGRP1受体蛋白表达;福尔马林致炎后Nogo-A的蛋白表达量降低(P<0.05),而CGRP1表达升高(P<0.05);与炎性痛模型对照组比较,吗啡组大鼠伏核内Nogo-A的蛋白表达量增高(P<0.05),CGRP1降低(P<0.05),而纳洛酮组Nogo-A降低(P<0.05),CGRP1增高(P<0.05)。结论:Nogo-A和CGRP参与了炎症致痛敏大鼠伏核内的痛觉调制过程,且二者之间存在反向调节关系,内源性阿片系统可能参与并影响了该过程。     

脊髓背角神经元凋亡在炎性痛大鼠吗啡耐受中作用研究

目的:探讨NMDAR及谷氨酸转运体(GT)在阿片耐受机制中的作用,以及脊髓神经元凋亡在慢性阿片耐受形成机制中的意义.方法:将60只健康雄性SD大鼠行鞘内置管后随机分为6组(n=10),空白对照组(A)于左后足踝关节腔注射生理盐水50μl,其他5组注射CFA 50μl.3d后分别经鞘内给予生理盐水10μl(A和B)、吗啡10μg(C组)、吗啡20μg(D组)、吗啡10μg+NMDA受体抑制剂MK-801 10nM(E组)、吗啡10μg+GT抑制剂PDC10μg(F组),1日2次,连续给药7 d.检测大鼠左后肢机械缩爪阈值评价其痛行为学,于给药后第7天取出左侧腰膨大处脊髓进行TUNEL染色和Western blotting检测.结果:C、D两组关节炎大鼠在鞘内给予吗啡第7天形成较稳定的吗啡耐受,MK-801和PDC分别对吗啡耐受的机械痛敏具有抑制和促进作用.B组大鼠脊髓背角凋亡细胞数及凋亡相关蛋白表达与A组比较,差异无统计学意义.与B组比较,C、D组大鼠脊髓背角的凋亡细胞数显著增加(P＜0.01),Bax和caspase-3蛋白表达上调(P＜0.01),Bcl-2表达下调(P＜0.01).与C组比较,E组大鼠脊髓背角凋亡细胞显著减少(P＜0.05),Bax和caspase-3蛋白表达下调(P＜0.01),Bcl-2表达上调(P＜0.05);F组凋亡细胞增多(P＜0.01),Bax和caspase-3蛋白表达上调(P＜0.01),Bcl-2表达下调(P＜0.01).结论:脊髓神经元凋亡可能是慢性阿片耐受的神经基础,NMDAR及GT在阿片耐受的神经细胞凋亡过程中发挥作用.     

大鼠PAG内Nogo-A在痛觉调制过程中角色的探索

目的:用脑内核团微量注射和免疫组化等方法,观察大鼠中脑导水管周围灰质( periaqueductal gray,PAG)内“勿动蛋白”-A(Nogo-A)、P物质(substanceP,SP)和降钙素基因相关肽(calcitoningene-related peptide,CGRP)表达的变化,研究探讨Nogo-A在痛觉调制过程中的角色,以及它在大鼠PAG内与CGRP、SP和内源性阿片系统在痛觉调制过程中的相互作用.方法:选用雄性SD大鼠32只,随机等分为4组:空白对照组8只,分别向PAG内注射0.9％生理盐水1μl;模型对照组、吗啡组和纳洛酮组各8只,首先单侧后爪掌心皮下注射1％的福尔马林0.1 ml复制炎症痛敏大鼠模型,3d后分别向PAG内注射等量0.9％生理盐水、吗啡或纳洛酮各1 μl,60 min后取大鼠大脑PAG区脑组织,采用免疫组化法观测各组大鼠PAG内Nogo-A、SP和CGRP免疫反应阳性神经元的表达差异.结果:与空白对照组比较,模型对照组大鼠PAG内Nogo-A的表达量显著降低(P＜0.01),CGRP及SP显著增高(P＜0.01);与模型对照组比较,吗啡组大鼠PAG内Nogo-A的表达量显著增高(P＜0.01),CGRP及SP显著降低(P＜0.05),而纳洛酮组PAG内Nogo-A的表达量显著降低(P＜0.05),CGRP及SP显著增高(P＜0.05).结论:(1)炎症痛敏大鼠PAG内Nogo-A的表达量比正常降低,而CGRP及SP显著增高;(2)阿片肽可增加PAG内Nogo-A的表达,并降低CGRP及SP的表达.     

硬膜外腔植入髓核对大鼠脊髓背根神经节TNF-α和IL-1表达的影响

目的：观察硬膜外腔植入异体髓核对大鼠L6-S1脊髓背根神经节细胞TNF-α和IL-1表达的影响,以期为椎间盘源性疼痛发病机制提供细胞生物学基础。方法：雄性SD大鼠（体重260—280g）随机分为4组：脂肪＋生理盐水组（FS组）、脂肪＋胶原酶组（FE）、髓核＋生理盐水组（NS）、髓核＋胶原酶组（NE组）,每组6只。术后第15天取L6-S1脊髓背根神经节,采用免疫组织化学染色方法观察髓核对背根神经节细胞炎性介质TNF-α和IL-1表达的影响。结果：术后15天FE组大鼠与FS组相比,背根神经节细胞TNF-α表达差异没有显著性意义（P〉0.05）;NS组与FE组相比背根神经节细胞TNF-α表达显著增加（P〈0.05）;NE组与NS组相比背根神经节细胞TNF-α表达显著降低（P〈0.05）,接近于FS组水平（P〉0.05）。IL-1在各组大鼠背根神经节中未染色。结论：硬膜外腔植入异体髓核可引起背根神经节细胞TNF-α表达增加。     

不同局部穴位电针对大鼠受损伤脊髓组织降钙素基因相关肽表达的影响

目的:观察不同局部穴位电针对大鼠受损伤脊髓组织降钙素基因相关肽CGRP表达和分布的影响。方法:将25只SD大鼠分为5组:正常对照组、脊髓损伤组、非穴位电针组、夹脊穴电针组和督脉穴电针组。在显微镜下予脊髓全横断术(正常对照组除外),自术后第7天分别采用局部选取电针非穴位、电针夹脊穴和电针督脉穴的方法治疗3d(脊髓损伤组不予任何治疗),取材并以免疫荧光组织化学染色的方法观察脊髓背角CGRP阳性染色区面积变化,用蛋白免疫印迹杂交法检测脊髓CGRP含量变化。结果:非穴位电针组和夹脊穴电针组的脊髓背角CGRP含量与脊髓损伤组比较,均有所升高(P0.05),但其CGRP阳性染色区面积没有明显差异(P0.05)。督脉穴电针组的脊髓背角CGRP含量和CGRP阳性染色区面积与非穴位电针组、夹脊穴电针组和脊髓损伤组比较,有明显增高、增大(P0.05)。结论:不同局部穴位电针对大鼠受损伤脊髓组织表达CGRP有不同的影响,其中督脉穴电针能够明显促进大鼠受损伤脊髓组织表达CGRP。     

异氟醚对甲醛致痛诱发大鼠脊髓背角P物质释放的影响

目的:研究异氟醚对甲醛疼痛模型大鼠脊髓背角P物质(SP)释放的影响。方法:SD大鼠16只,随机数字表法分为4组,每组4只。通过向右侧后肢跖部皮下注射40g/L甲醛150μL建立疼痛模型。A组、B组跖部皮下注射注射生理盐水,C组、D组注射甲醛,B组、D组在皮下注射前10min吸入15g/L异氟醚,并持续60min,A组、C组吸纯氧。麻醉大鼠,取脊髓L3～5节段。用SP免疫组化方法结合图像分析测定脊髓背角SP样免疫反应阳性(SPLI)纤维及终末的光密度(A)。结果:4组大鼠两侧脊髓背角SPLI的A值无显著差别(P>0.05,t=1.065);与A组脊髓背角SPLI的A值比较,B组无明显变化(P>0.05,t=1.987),C,D组显著小于A组(P<0.01,t=14.342,t=7.514),有明显的纤维和终末脱失趋势;D组SPLI的A值较C组显著增加(P<0.01,t=8.263)。结论:异氟醚不影响髓背角浅层SP含量,但能明显减轻甲醛引起的疼痛反应和脊髓背角SP的释放,部分阻断脊髓痛觉的传导。     

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.     

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。     

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.     

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。     

糖尿病视网膜病变筛查与防治中存在的问题及对策

目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者筛查和防治中存在的问题及对策。方法以76例糖尿病DR患者为对象,调查未能早期接受眼科诊治的原因。结果存在问题主要是患者对DR防治知识不了解、血糖控制不理想、内科医生未建议进行专科检查等。结论眼科医护人员应密切与糖尿病专科的联系,尽早对DM患者进行DR健康教育,并开展社区DR防治工作。