持续健康教育在糖尿病并发视网膜病变患者中的应用

目的：探讨对糖尿病并发视网膜病变患者实施持续健康教育的效果。方法将280例糖尿病并发视网膜病变患者,按随机数字表法分为观察组和对照组,每组140例。两组患者均给予常规的基础治疗和护理方法进行治疗,观察组在常规治疗的基础上应用持续健康教育。依据自我护理能力测定表( ESCA)、自制自我管理能力调查表、视功能损害眼病患者生活质量量表对糖尿病并发视网膜病变患者的健康教育结果、自我管理能力和生活质量的水平进行评价。采用SPSS 18.0统计软件进行数据分析。结果实施健康教育前两组患者ESCA 4个维度评分及总分、生活质量评分差异均无统计学意义( P>0.05);实施健康教育后,观察组患者ESCA总分为(122.1±11.7)分,生活质量总分为(47.1±4．2)分,均高于对照组(106.0±10.3),(34.6±4.1)分,差异有统计学意义(t值分别为3.692,8.926;P<0.05), ESCA 4个维度评分两组比较差异均有统计学意义(P<0.05);观察组患者在对疾病的自我管理能力优于对照组,差异有统计学意义(P<0.01)。结论持续健康教育能够提升糖尿病并发视网膜病变患者健康教育的效果,提高患者自我管理能力,改善其生活质量。     

High-speed intravascular photoacoustic imaging at 1.7 μm with a KTP-based OPO

Lipid deposition inside the arterial wall is a hallmark of plaque vulnerability. Based on overtone absorption of C-H bonds, intravascular photoacoustic (IVPA) catheter is a promising technology for quantifying the amount of lipid and its spatial distribution inside the arterial wall. Thus far, the clinical translation of IVPA technology is limited by its slow imaging speed due to lack of a high-pulse-energy high-repetition-rate laser source for lipid-specific first overtone excitation at 1.7 μm. Here, we demonstrate a potassium titanyl phosphate (KTP)-based optical parametric oscillator with output pulse energy up to 2 mJ at a wavelength of 1724 nm and with a repetition rate of 500 Hz. Using this laser and a ring-shape transducer, IVPA imaging at speed of 1 frame per sec was demonstrated. Performance of the IVPA imaging system’s resolution, sensitivity, and specificity were characterized by carbon fiber and a lipid-mimicking phantom. The clinical utility of this technology was further evaluated ex vivo in an excised atherosclerotic human femoral artery with comparison to histology.OCIS codes: (140.3460) Lasers, (110.0110) Imaging systems, (110.5125) Photoacoustics, (170.5120) Photoacoustic imaging, (170.1610) Clinical applications     

Comparative structural analysis of human Nav1.1 and Nav1.5 reveals mutational hotspots for sodium channelopathies

Among the nine subtypes of human voltage-gated sodium (Na_v) channels, the brain and cardiac isoforms, Na_v1.1 and Na_v1.5, each carry more than 400 missense mutations respectively associated with epilepsy and cardiac disorders. High-resolution structures are required for structure–function relationship dissection of the disease variants. We report the cryo-EM structures of the full-length human Na_v1.1–β4 complex at 3.3 Å resolution here and the Na_v1.5-E1784K variant in the accompanying paper. Up to 341 and 261 disease-related missense mutations in Na_v1.1 and Na_v1.5, respectively, are resolved. Comparative structural analysis reveals several clusters of disease mutations that are common to both Na_v1.1 and Na_v1.5. Among these, the majority of mutations on the extracellular loops above the pore domain and the supporting segments for the selectivity filter may impair structural integrity, while those on the pore domain and the voltage-sensing domains mostly interfere with electromechanical coupling and fast inactivation. Our systematic structural delineation of these mutations provides important insight into their pathogenic mechanism, which will facilitate the development of precise therapeutic interventions against various sodium channelopathies.

The nine subtypes of human voltage-gated sodium (Na_v) channels are responsible for the initiation and transmission of electrical impulses in different tissues: Na_v1.1 to Na_v1.3 and Na_v1.6 mainly function in the central nervous system, Na_v1.7 to Na_v1.9 are mostly distributed in the peripheral nervous system, Na_v1.4 is specialized in skeletal muscle, and Na_v1.5 is the primary cardiac isoform (1–4). Abnormalities of these channels, hinging on their tissue specificity, are associated with a broad spectrum of channelopathies. To date, more than 1,000 disease mutations have been identified in the primary sequence of Na_v channels, among which Na_v1.1 and Na_v1.5 each host more than 400 missense mutations (5–8).Na_v1.1 is encoded by SCN1A, which may have the largest number of epilepsy-related mutations. Up to 900 SCN1A mutations, more than half of which result in truncations (9), have been identified in epilepsy syndromes with different severities. Nonsense and hundreds of missense mutations of SCN1A are found in 70 to 80% of patients with Dravet syndrome, which is also known as the severe myoclonic epilepsy of infancy (10–13) (SI Appendix, Table S1). Several dozen missense mutations are associated with generalized epilepsy with febrile seizures plus and intractable childhood epilepsy with generalized tonic-clonic seizures (10) (SI Appendix, Table S2). Although most of the Na_v1.1 disease mutations lead to loss of function to different degrees, some represent gain of function. In most cases, the pathogenic mechanism remains elusive.A brief summary of Na_v1.5 pathophysiology is presented in the companion paper (14). Mechanistic understanding of the sodium channelopathies entails high-resolution structures of human Na_v channels. In the past 4 y, we have reported the cryoelectron microscopy (cryo-EM) structures, at resolutions ranging between 2.6 and 4.0 Å, of Na_v channels from insect (Na_vPaS), electric eel (EeNa_v1.4), and finally human, including Na_v1.2, Na_v1.4, Na_v1.5, and Na_v1.7, in the presence of multiple modulators, such as β1 and β2 subunits, peptide toxins, and small-molecule toxins tetrodotoxin and saxitoxin (15–21). Structures of a truncated rat Na_v1.5 were recently reported (22). All structurally resolved eukaryotic Na_v channels except for Na_vPaS exhibit similar conformations of potentially inactivated state.Notwithstanding these advances, high-resolution structures of human Na_v1.1 and Na_v1.5 wild-type and representative disease variants are necessary to provide accurate templates to directly map the disease mutations and to facilitate drug discovery. Furthermore, as these two channels harbor 80% of all identified mutations related to sodium channelopathies, a comparative analysis of their structures may reveal potential mutational hotspots, offering invaluable insight into the function and disease mechanism of Na_v channels.Here we present the cryo-EM structure of human Na_v1.1 associated with a modulating auxiliary subunit β4. In the accompanying paper, we report the structure of human Na_v1.5 that carries a common disease variant E1784K. Comparative structural analyses have revealed several clusters of disease mutations that are common to both Na_v1.1 and Na_v1.5.     

The Differential Diagnostic Value of Serum NT‐proBNP in Hospitalized Patients of Heart Failure With Pneumonia

Serum N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is considered as an effective predictor for patients with heart failure (HF), while a strong body of evidence has found its utility in inflammatory diseases. It is difficult to differentiate HF and HF coexisting with other inflammations by measuring NT‐proBNP. The aim of this study was to estimate the differential diagnostic performance of serum NT‐proBNP in hospitalized HF patients with pneumonia. A prospective study was launched. Sixty nine HF patients, 51 HF patients complicated with pneumonia, and 38 patients with pneumonia were enrolled. Serum NT‐proBNP levels were measured on Roche Elecsys. X‐ray and the European Society of Cardiology (ESC) diagnostic principles were adopted to identify patients with pneumonia and HF, respectively. The diagnostic performance of NT‐proBNP was assessed by ROC. Serum NT‐proBNP [7,039(1,008–24,672) pg/ml] in patients of HF complicated with pneumonia was significantly higher than that in those of patients with single HF [3,147(616–24,062) pg/ml] or single pneumonia [911(98–3,812) pg/ml] (P < 0.0001). No correlation was found between the level of NT‐proBNP and hospital stay. The area under ROC curve (AUC) of NT‐proBNP for distinguishing patients of HF with pneumonia was 0.8082. At the level of 4,691 pg/ml, the optimal cutoff value, 74.5% sensitivity and 81.8% specificity of NT‐proBNP were predicted. Evaluation of serum NT‐proBNP is conducive for clinicians to identify patients of HF with pneumonia, but its poor efficacy in monitoring the curative therapy in this entire cohort is not recommended.     

179例血液病患者EBV和HCMV核酸检测阳性率与患者年龄的关系

目的了解再生障碍性贫血、急性淋巴细胞白血病及髓系白血病患者EB病毒(EBV)和人巨细胞病毒(HCMV)核酸检测阳性率与其年龄的关系。方法收集中国人民解放军海军总医院2012年1月至2013年12月骨髓穿刺后临床确诊为再生障碍性贫血、急性淋巴细胞白血病及髓系白血病患者为研究对象,采用达安基因核酸检测试剂盒对EBV和HCMV核酸进行检测,分析EBV和HCMV感染阳性率与患者年龄的关系。结果 EBV和HCMV在3种血液病中核酸检测阳性率不同,HCMV核酸检测阳性检出率(15.8%)低于EBV(43.7%)。再生障碍性贫血和髓系白血病患者中,不同年龄患者EBV核酸检测阳性率比较差异有统计学意义(P0.01)。结论对于儿童再生障碍性贫血病和髓系白血病患者应更加重视EBV和HCMV核酸的监测。     

鼠尾胶原联合血小板源性生长因子BB培养内皮细胞

背景:有研究证实,Ⅰ型鼠尾胶原可促进成肌纤维细胞的增加,对内皮细胞的迁移及成管有较为明显的作用,推断胶原可为细胞的生长提供一个较为合适的内环境。目的:探讨鼠尾胶原联合血小板源性生长因子BB抗人脐静脉内皮细胞凋亡的效果及安全性。方法:将第4代人脐静脉内皮细胞培养于铺有鼠尾胶原的培养皿上,用Alamar Blue法检测不同时间点的还原比率。将第4代人脐静脉内皮细胞分为4组培养于24孔板,其中生长因子组是在细胞接种前加入血小板源性生长因子BB蛋白于细胞悬浮液中;联合组需事先加入血小板源性生长因子BB蛋白于鼠尾胶中,铺于板底;最后各组均使用H2O2诱导凋亡,73 h后采用Western blot测定血小板源性生长因子BB、凋亡相关蛋白及抗凋亡蛋白的表达,同时Tunnel检测细胞凋亡阳性率。结果与结论:在铺有鼠尾胶原培养皿中培养人脐静脉内皮细胞的成管数量明显多于正常培养人脐静脉内皮细胞的成管数量(P<0.05)。鼠尾胶原培养的细胞与正常对照细胞生长状态相似,说明鼠尾胶原对细胞无明显毒性作用。联合组血小板源性生长因子BB、Bcl-2、p-Akt表达高于其余3组(P<0.05),Bax表达低于其余3组(P<0.05)。联合组细胞凋亡率低于生长因子组、H2O2组(P<0.05)。表明鼠尾胶原对人脐静脉内皮细胞无明显毒性作用,联合血小板源性生长因子BB生长因子后可显著增强抗细胞凋亡效果。     

构建中国人体器官捐献社会宣教系统的策略

背景:分析中国目前人体器官移植所面临的困境及导致器官移植供体短缺的社会影响因素,发现民众对器官移植及捐献流程相关知识普遍缺乏。目的:从器官捐献宣教系统构建的重大意义、现状总结、应遵循的伦理原则以及建议对策等4个方面进行了尝试性探索,为科学地进行器官捐献的宣传教育提供建议与参考。方法:在CNKI和Pub Med通过关键词"器官捐献、器官移植、伦理学原则、宣传教育"查阅相关文献,对来源于核心期刊的文章进行综合分析。以"器官捐献,器官移植,伦理原则,供体短缺,遗体捐献,宣传教育"为中文捡索词,以"organ donation,organ transplantation,shortage of donor,body donation,education system"为英文检索词,检索维普和中国知网(CNKI)期刊全文数据库万方、Pubmed,Medline,2005年1月至2014年11月有关器官捐献报告中主要涉及器官捐献宣传教育及协调员的相关报道。通过对文献归纳,总结分析目前中国器官捐献宣教的现况,提出构建器官捐献宣教系统的对策。结果与结论:详细阐述了器官捐献宣教系统的必要性,系统分析了国内目前器官捐献宣传教育存在的问题及应该遵循的伦理原则,探索了国内器官捐献宣教系统建设应采取的路径和方法。缓解器官移植供体紧张,扩大供体来源,必须要赢得公民的广泛支持与理解,才能保证器官捐献工作的可持续发展。因此构建人体器官捐献社会宣教体系具有重要意义。     

CT引导下骨水泥注入辅助人工虎骨粉修复骨质疏松性脊椎压缩性骨折:骨痂生长及骨愈合评价

背景:研究证实微创手术修复骨质疏松性脊椎压缩性骨折效果显著,能撑起椎体恢复高度和硬度,达到解除疼痛、早日活动的目的。但是患者术后长期卧床会导致较多的并发症,预后效果不理想。当前许多中药开始应用于骨质疏松性脊椎压缩性骨折的康复。目的:观察人工虎骨粉辅助CT引导下骨水泥注入微创修复骨质疏松性脊椎压缩性骨折患者的骨痂生长及骨折愈合情况。方法:选取85例骨质疏松性脊椎压缩性骨折患者为研究对象,随机将患者分为两组,观察组43例,对照组42例。观察组及对照组患者分别在CT引导下微创经皮椎体成形治疗的基础上配合服用人工虎骨粉及接骨七厘片,观察两组患者骨痂生长、骨折愈合情况以及疼痛缓解时间。结果与结论:观察组术后骨痂生长良好,多为Ⅲ级与Ⅳ级患者;显著优于对照组(P<0.05)。在疼痛缓解时间及骨折愈合时间上,观察组显著短于对照组,差异有显著性意义(P<0.05)。观察组患者的JOA评分优良率显著优于对照组(P<0.05)。提示微创经皮椎体成形联合辅助CT引导下骨水泥注入修复骨质疏松性椎体压缩性骨折效果显著,同时配合服用人工虎骨粉对骨折愈合有很好的促进作用。     

Reverse engineering the mechanical and molecular pathways in stem cell morphogenesis

The formation of relevant biological structures poses a challenge for regenerative medicine. During embryogenesis, embryonic cells differentiate into somatic tissues and undergo morphogenesis to produce three‐dimensional organs. Using stem cells, we can recapitulate this process and create biological constructs for therapeutic transplantation. However, imperfect imitation of nature sometimes results in in vitro artifacts that fail to recapitulate the function of native organs. It has been hypothesized that developing cells may self‐organize into tissue‐specific structures given a correct in vitro environment. This proposition is supported by the generation of neo‐organoids from stem cells. We suggest that morphogenesis may be reverse engineered to uncover its interacting mechanical pathway and molecular circuitry. By harnessing the latent architecture of stem cells, novel tissue‐engineering strategies may be conceptualized for generating self‐organizing transplants. Copyright © 2013 John Wiley & Sons, Ltd.     

Schistosomiasis in a migrating population in the lake region of China and its potential impact on control operation

Coverage of migrating people in schistosomiasis control program is a growing concern in China. Schistosomiasis caused by Schistosoma japonicum is still one of the major infectious diseases of public health importance in China though tremendous efforts have been made to control the transmission over the past decades. Along with the rapid social-economic development, migrant population has been remarkably increasing across the country. The infected migrants may introduce a new souse of infection to endemic areas or the areas where the transmission had been controlled or interrupted but the intermediate host Oncomelania snail is still present. Preliminary studies for surveillance on schistosomiasis prevalence in migrants were reported, but there is little basic information provided. We carried out an investigation on the prevalence in immigrants, emigrants and permanent residents in three villages of Hunan province located in the main endemic area of lake region, and analyzed the potential impact of migration on control practice. In the study villages, the migrant population accounts for 53.6% of the total. Schistosoma infection was detected by modified Kato-Katz method and miracidium hatching test. Questionnaire survey was conducted comprising knowledge of disease and its transmission, water contact, personal protective measures, and whether examined and treated after water contact. The survey indicated that the migrants and permanent residents had similar life style, and the majority of them experienced water contact in agricultural work or routine life activities. However, the infection rate in immigrants was significantly higher than that in permanent residents. It was also found that the migrants had significantly less knowledge about the disease than the permanent residents, and took no personal protective measures. This is due to that the control program could not cover the migrants when they were absent at the time the program being implemented. The present study suggested that the surveillance and intervention for migrants, immigrants in particular, should be included and strengthened in schistosomiasis control program and a feasible scheme be developed.