Detection of HIV-1 viruses in tears of patients even under long-term HAART

To determine whether HIV-1 viruses exist in tears of patients under HAART, a cross-sectional study was designed. All participants who underwent long-term HAART with undetectable plasma viral load had detectable HIV-1 viral load in tears (n = 16) and had no difference from the controls (n = 5). Our data suggested that the lacrimal gland and/or other tear-associated tissues could be new reservoirs for HIV-1 and precautions should be taken when doing eye examinations.     

透析用水中游离氯与氯胺的测定

目的透析用水中游离氯和氯胺浓度超标会对人体造成巨大危害,而我国目前大多数透析中心只能检测游离氯,本研究通过检测自来水和透析用水中游离氯和氯胺含量,评估了单独检测游离氯的安全性,并评估了目前常用的TMB目视比色法的准确性.方法以DPD分光光度法为金标准,同时采用DPD分光光度法和TMB目视比色法对北京市9家透析中心的自来水和透析用水中游离氯和氯胺浓度进行检测,每家血液透析中心检测2d,每天检测10次,每次间隔1h;对透析用水中游离氯和氯胺浓度进行相关性分析,P＜0.05认为有统计学意义;对DPD分光光度法和TMB目视比色法的检测结果进行Kappa检验.结果在各个时点,各透析中心的透析用水中游离氯和氯胺浓度均在国家标准范围之内;透析用水中游离氯和氯胺浓度之间不存在线性相关关系(r=0.14,P=0.146):同DPD分光光度法相比,TMB目视比色法所测得游离氯结果的假阴性率为100%,kappa值为0,所测总氯结果的假阴性率10.67%,kappa值为0.88.结论单独检测游离氯是不安全的,必须同时检测总氯浓度;同DPD分光光度法相比,TMB目视比色法测得的游离氯和总氯结果存在一定的假阴性率,建议有条件的单位尽量采用DPD分光光度法.     

急诊护士工作家庭冲突现状及平衡策略

[目的]了解急诊护士工作-家庭冲突的现状,探讨工作和家庭平衡策略。[方法]采用工作-家庭冲突量表进行调查对130名急诊护士和130名普通科室护士进行工作家庭冲突情况调查。[结果]急诊护士工作-家庭冲突方向的得分及工作家庭冲突总分均高于普通科室护士（P〈0.05）;急诊护士工作-家庭冲突总分及各维度得分均高于家庭-工作冲突得分（P均〈0.05）;急诊护士工作-家庭冲突中时间维度得分最高,其次为压力维度得分。[结论]急诊护士感知的工作家庭冲突高于普通病房护士,且主要来自于工作-家庭冲突方向;急诊护士感知的工作-家庭冲突较家庭-工作冲突更显著;在急诊护士的工作-家庭冲突中,时间因素占首位,其次为压力和行为因素。护理管理者应重视急诊护士的工作家庭冲突,并采取切实有效的平衡策略以降低工作和家庭生活的冲突。     

Comparative study on the efficacy of tiotropium bromide inhalation and oral doxofylline treatment of moderate to severe stable chronic obstructive pulmonary disease

This study compared the efficacy and safety of tiotropium bromide inhalation powder (spiriva) and doxofylline oral tablet (doxofylline) in the treatment of chronic obstructive pulmonary disease (COPD). A multi-center, randomized, double-blind, double-dummy, parallel-controlled study involved 127 eligible stable moderate to severe COPD patients treated with inhaled tiotropium dry powder (18 μg/day) or oral doxofylline tablets (0.2 g/time, 2 times a day) for 12 and 24 weeks. Before and after treatment for 12 weeks and 24 weeks, respectively, pulmonary function, 6-min walking distance and dyspnea index were recorded. The results showed that in both tiotropium group and doxofylline groups, after 12-week treatment, FEV1, FEV1/FVC% and 6-min walk distance were sig-nificantly higher than those before the medication, while dyspnea index decreased as compared with that before treatment. After 24-week treatment, a slight improvement in the measures was observed as compared with that of 12-weeks treatment, but the difference was not statistically significant. With both 12-week and 24-week treatment, the effect of tiotropium was slightly better than that of doxofylline tablets, with the difference being statistically insignificant. The major adverse events in the tiotropium group and doxofylline group were observed in 9 cases (9.9%) and 12 cases (12.9%), respectively, and no statistically significant difference was found between them. We are led to conclude that both tiotropium at 18 μg a day and doxofylline tablets at 0.2 g/day (two times a day) are effective and safe for the treatment of COPD.     

老年结直肠癌患者术后早期化疗的安全性研究

目的探讨对老年结直肠癌患者进行术后早期化疗的安全性。方法将我科收治的老年结直肠癌患者随机分为两组,其中A组37例,于术后第4～7天开始使用FOLFOX4方案化疗;B组38例,使用同样方案于术后第28～31天开始化疗,比较两组的手术相关并发症及化疗不良反应。结果两组患者的手术相关并发症相比无统计学差异,化疗不良反应在肝脏毒性方面不同,A组患者的不良反应相对较重。恶心呕吐、腹泻、神经毒性、骨髓抑制等不良反应两组比较无统计学差异（P〉0.05）。结论对身体条件允许的老年结直肠癌患者,使用FOLFOX4方案进行早期化疗是安全可行的。     

机械通气高龄患者应用鼻肠管行肠内营养支持的临床意义

目的观察鼻肠管在使用机械通气的高龄病人行肠内营养支持中的应用效果。方法将52例使用机械通气的高龄病人随机分为观察组和对照组,每组26例,对照组采用鼻胃管进行肠内营养支持,观察组采用鼻肠管进行肠内营养支持。置管后1个月内分别观察并记录两组病人行肠内营养支持时不良反应的发生情况。结果观察组各种不良反应发生率均低于对照组（P〈0.05）。结论高龄机械通气病人应用鼻肠管行肠内营养支持可有效减少不良反应的发生,优于常规应用鼻胃管。     

真核表达载体pEGFP-N2/AT2R的构建及其在原代血管平滑肌细胞的表达

目的体外构建携带血管紧张素Ⅱ2型受体(ANGⅡType 2 Receptor,AT2R)基因的增强型绿色荧光蛋白真核表达载体,并观察其在大鼠血管平滑肌细胞(vascular smooth muscle cells,VSMCs)中的表达。方法以pUHD-10.3/AT2R质粒为模板,PCR扩增AT2R基因的全长cDNA序列,再将其克隆入载体pEGFP-N2,构建其真核表达载体pEGFP-N2/AT2R。以基因转染技术,将AT2R导入原代VSMCs。倒置荧光显微镜观测转染后VSMCs生长变化及AT2R在其中的表达等情况。图像分析技术检测AT2R在VSMCs中的转染效率。Western blot检测转染AT2R基因的VSMCs表达其编码蛋白。RT-PCR法对AT2R基因修饰的VSMCs进行鉴定。结果成功构建AT2R基因的真核表达载体pEGFP-N2/AT2R,该真核载体能携带AT2R基因转染并有效表达于VSMCs,其转染效率约40%,RT-PCR及Western blot均可检测到AT2RmRNA及蛋白在血管平滑肌细胞中高表达。结论成功地将克隆到的AT2R基因克隆入pEGFP-N2载体中,并实现了AT2R基因在原代VSMCs的表达。     

Lidocaine attenuates cognitive impairment after isoflurane anesthesia in old rats

Post-operative cognitive dysfunction (POCD) is a clinical phenomenon that has drawn significant attention from the public and scientific community. Age is a risk factor for POCD. However, the contribution of general anesthesia/anesthetics to POCD and the underlying neuropathology are not clear. Here, we showed that 18-month-old male Fisher 344 rats exposed to 1.2% isoflurane, a general anesthetic, for 2 h had significant learning and memory impairments assessed at 2-4 weeks after isoflurane exposure. These isoflurane effects were attenuated by intravenous lidocaine (1.5 mg/kg as a bolus and then 2 mg/kg/h during isoflurane exposure), a local anesthetic that has neuroprotective effect. Exposure to isoflurane or isoflurane plus lidocaine did not change the neuronal and synaptic density as well as the expression of NeuN (a neuronal protein), drebrin (a dendritic spine protein), synaptophysin (a synaptic protein), activated caspase 3 and caspase-activated DNase in the hippocampus at 29 days after isoflurane exposure when cognitive impairment was present. Isoflurane and lidocaine did not affect the amount of β-amyloid peptide, total tau and phospho-tau in the cerebral cortex as well as interleukin-1β and tumor necrosis factor-α in the hippocampus at 29 days after isoflurane exposure. Thus, isoflurane induces learning and memory impairment in old rats. Lidocaine attenuates these isoflurane effects. Isoflurane may not cause long-lasting neuropathological changes.     

A proposed scheme for the classification and surgical planning of falcine meningioma treatment

Falcine meningiomas (FM) represent a surgical challenge even in the microsurgical era. An individualised surgical approach to different FM is indispensable, but there have been few reports in this regard. Thus, based on our series of 20 patients with FM who underwent surgery between October 2001 and June 2010, we propose a classification scheme for FM removal and demonstrate its effectiveness. FM in our series were classified into four types, according to tumour growth patterns on coronal MRI: Type I, hemispheroid-shaped tumours invaginating deeply into one hemisphere without shifting the falx (10 patients); Type II, olive-shaped tumours shifting the falx substantially to the contralateral side (six patients); Type IIIA, globular- or dumbbell-shaped tumours extending into both hemispheres, but to different extents (one patient); and Type IIIB, globular- or dumbbell-shaped tumours extending into both hemispheres to approximately equal extent (three patients). An ipsilateral interhemispheric approach was performed for Type I tumours, and a contralateral transfalcine approach for Type II. Type IIIA tumour was approached from the side where the smaller tumour was located. Type IIIB tumours were approached from the non-dominant hemisphere. Simpson grade I resection was achieved in all 20 patients. The follow-up ranged from 12 months to 114 months. There was no postoperative mortality, serious neurological deficits, or tumour recurrence. The preliminary results suggest that the proposed scheme can facilitate surgical planning and accomplish complete tumour resection with minimal invasion.     

Use of aspirin in Chinese after recovery from primary intracranial haemorrhage

Intracranial haemorrhage (ICH) accounts for ~35% of all strokes in Chinese. Anti-platelet agent is often avoided after an index event due to the possibility of recurrent ICH. This single-centered observational study included 440 consecutive Chinese patients with a first spontaneous ICH surviving the first month performed during 1996-2010. The subjects were identified, and their clinical characteristics, anti-platelet therapy after ICH, and outcomes including recurrent ICH, ischaemic stroke, and acute coronary syndrome were checked from hospital records. Of these 440 patients, 56 patients (12.7%) were prescribed aspirin (312 patient-aspirin years). After a follow-up of 62.2 ± 1.8 months, 47 patients had recurrent ICH (10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have a higher risk of recurrent ICH compared with those not prescribed aspirin (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years (hazard ratio [HR]: 2.0, 95% confidence interval [CI]: 1.07-3.85, p=0.03) and hypertension (HR: 2.0, 95% CI: 1.06-3.75, p=0.03) as independent predictors for recurrent ICH. In a subgroup analysis including 127 patients with standard indications for aspirin of whom 56 were prescribed aspirin, the incidence of combined vascular events including recurrent ICH, ischaemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than those not prescribed aspirin (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). In conclusion, we observed in a cohort of Chinese post-ICH patients that aspirin use was not associated with an increased risk for a recurrent ICH.