Immunocytochemical localization of caldesmon and calponin in chicken gizzard smooth muscle

Summary The distribution of caldesmon and calponin in chicken gizzard smooth muscle was investigated with immunofluorescence and immunogold electron microscopy. Immunofluorescence microscopy showed that in verapamil treated (relaxed) muscles the distributions of caldesmon and myosin appeared to be uniform throughout the cytoplasm, but clearly more textured than that of actin filaments as revealed by the distribution of tropomyosin. In shortened muscles both caldesmon and myosin became segregated, in contrast to the distribution of actin, which remained uniform. The distribution of calponin was even more textured, with no similarity to those of caldesmon or myosin. Instead, considerable overlap was observed between calponin and the cytoskeletal protein desmin and, to a lesser extent, -actin. By immunogold electron microscopy caldesmon appeared mostly near and around myosin filaments in both relaxed and shortened muscle. Calponin, on the other hand, was found primarily at the periphery of cytoskeletal structures in the same general region as desmin, and very often adjacent to -actin, which is mainly in the core. These observations indicated that caldesmon and calponin are associated with different subsets of actin filaments, caldesmon with contractile actin, while calponin with cytoskeletal actin. Thus the in situ localization of caldesmon is consistent with its proposed regulatory function. Calponin, on the other hand, is unlikely to directly regulate actomyosin interactions in these cells; instead, it may function as a bridging protein between the actin and the intermediate filament networks.     

A COMPARISON OF ATRACURIUM AND ALCURONIUM DURING HALOTHANE ANAESTHESIA BY MEASUREMENT OF THE TRAIN-OF-FOUR RESPONSE OF THE ADDUCTOR POLLICIS MUSCLE AND CLINICAL OBSERVATION

Atracurium and alcuronium have been compared during halothaneanaesthesia, by measurement of the mechanical response of theadductor pollicis muscles to train-of-four stimulation and byclinical observation. Atracurium appeared significantly shorter-actingthan alcuronium. However, results suggested that the actionof alcuronium may not be of "medium duration ". A comparisonof three indices of muscle twitch response to the train-of-fournerve stimulation, seemed to indicate that the D'/D ratio gavethe best overall index of neuromuscular blockade in this study.     

Cytologic diagnosis of hepatocellular carcinoma by fine-needle aspiration biopsy

From 1976 to June 1982, 237 patients with clinical suspicion of hepatic malignant disease underwent guided percutaneous fine-needle aspiration biopsy of the liver. Of these, 12 were diagnosed cytologically as "hepatocellular carcinoma" and this diagnosis was confirmed in the follow-up of all cases. On the basis of the cytomorphologic features observed in the aspirates, the tumor was subclassified into three types; well differentiated, pleomorphic large cell; and poorly differentiated. The various cytologic appearances of different types of hepatocellular carcinoma are presented and illustrated. Cytomorphologically, these three types of hepatocellular carcinoma were distinctly different and their cytomorphologic features were also sufficiently distinctive from those of secondary hepatic cancer to be diagnostic. Guided percutaneous fine-needle aspiration biopsy of the liver appears to be a definitive minimally invasive means of establishing the diagnosis of hepatocellular carcinoma, and promises to be a valuable diagnostic procedure for potentially resectable localized hepatocellular carcinoma.     

妊娠期高血压患者妊娠结局调查及相关影响因素分析

目的 调查温州市人民医院2018—2021年妊娠期高血压疾病(hypertensive disorders of pregnancy,HDP)患者妊娠结局,并分析其妊娠结局的相关影响因素,为临床采取对应干预措施、降低不良妊娠结局发生风险提供参考。 方法 选取2018年1月—2021年12月于温州市人民医院分娩的400例HDP患者(单胎妊娠)的临床资料,开展回顾性分析,根据其妊娠结局分为不良妊娠结局组(n=157)与正常妊娠结局组(n=243)。比较两组临床资料,分析HDP患者不良妊娠结局发生的影响因素,构建logistic回归模型方程,并分析logistic回归模型的预测价值。 结果 400例HDP患者中共157例(39.25%)发生不良妊娠结局;单因素分析显示患者年龄、孕前BMI、分娩方式、妊娠期糖尿病(gestational diabetes mellitus,GDM)、负性情绪与不良妊娠结局的发生有关(P＜0.05);logistic回归模型显示,年龄≥35岁(OR=23.815,95%CI:10.370～54.655)、孕前BMI≥24.0(OR=16.010,95%CI:6.832～34.620)、阴道分娩(OR=16.336,95%CI:7.325～36.403)、GDM(OR=26.337,95%CI:11.908～58.253)、负性情绪(OR=20.682,95%CI:2.791～54.876)均为HDP患者不良妊娠结局发生的独立危险因素(P＜0.05);5个独立危险因素构建logistic回归模型方程为logistic(P)=-4.125+年龄×3.170+孕前BMI×2.773+阴道分娩×2.793+GDM×3.271+负性情绪×3.029;当logistic(P)=4.11,预测HDP患者发生不良妊娠结局的曲线下面积为0.899(95%CI:0.865～0.926),预测敏感度为84.36%,特异度为82.17%;根据设定的评分标准与不良妊娠结局发生情况,可将HDP患者划分为低风险(0～4分)、中风险(5～8分)与高风险(9～12分)。 结论 HDP患者不良妊娠结局发生率较高,年龄、孕前BMI、阴道分娩、GDM、负性情绪均为不良妊娠结局发生的影响因素,构建logistic回归模型可预测不良妊娠结局发生风险,有助于临床制定相关干预措施。     

饮酒与慢性阻塞性肺疾病风险关系的meta分析

目的 探讨饮酒与慢性阻塞性肺疾病风险(chronic obstructive pulmonary disease, COPD)的关系。 方法 计算机检索PubMed、Web of Science、Embase、中国知网、万方数据库和维普数据库,搜集各数据库建库至2021年11月公开发表的有关饮酒与COPD风险的观察性研究。由2位研究者根据文献纳入及排除标准独立筛选文献并提取数据。采用Stata 12.0软件进行统计学分析。 结果 共纳入8篇文献(2篇队列研究文献和6篇横断面研究文献),共纳入209 489例研究对象。meta分析结果显示,与最低饮酒量组相比,最高饮酒量组发生COPD的风险无显著变化(RR=0.97, 95%CI:0.87~1.08);与不饮酒组相比,少量或中度饮酒组发生COPD的风险降低(RR=0.87, 95%CI:0.81~0.94);与少量或中度饮酒组相比,过量饮酒组发生COPD的风险无显著变化(RR=1.26, 95%CI:0.98~1.63)。 结论 meta分析结果提示少量或中度饮酒可降低COPD的风险。过量饮酒是否会增加COPD的风险尚需进一步研究。     

健康成年人接种两剂新型冠状病毒灭活疫苗后序贯加强免疫重组新型冠状病毒疫苗(CHO细胞)的免疫原性和安全性研究

目的 评价在接种两剂已上市新冠病毒灭活疫苗的人群中序贯加强免疫重组新型冠状病毒疫苗(CHO细胞)后的免疫原性和安全性,为制定新型冠状病毒疫苗的加强免疫策略提供科学依据。 方法 采用开放性试验设计,筛选入组360例已接种两剂新冠病毒灭活疫苗3～4个月、6～8个月、11～13个月的18周岁及以上研究对象并接种1剂重组新型冠状病毒疫苗(CHO细胞)。采集所有研究对象研究用疫苗接种前、接种后14 d血样,用于体液免疫检测,收集研究用疫苗接种后1个月内的所有不良事件。 结果 本研究入组360例研究对象,按研究对象加强免疫与基础免疫间隔时间分3组(A组91～120 d,B组181～240 d,C组331～390 d),各组120例,无研究对象脱落。三组年龄均值分别为38.13、40.22和45.73岁,各组间年龄差异有统计学意义(F=13.516,P＜0.001),A、B组差异无统计学意义(P=0.168),C组和A、B组间差异均有统计学意义(P＜0.001)。三组 IgG GMC(几何平均浓度)免疫前分别为4.81、4.23、2.12 AU/ml,差异有统计学意义(F=10.054,P＜0.001),C组和A、B组间差异均有统计学意义(P＜0.001),A、B组间差异无统计学意义(P=0.520);三组免疫后 IgG GMC 分别为106.69、124.05、80.04 AU/ml,差异无统计学意义(F=2.028,P=0.133)。三组 IgG 抗体阳转率分别为84.17%、87.50%、79.17%,差异无统计学意义(χ²=3.081,P=0.214)。免疫前血清针对Delta变异株和原型株不同组别的中和抗体滴度比较,三组原型株中和抗体GMT(几何平均滴度)为1∶2.18、1∶2.18、1∶2.19,差异无统计学意义(F=0.011,P=0.990);三组Delta变异株中和抗体GMT为1∶2.09、1∶2.17、1∶2.16,差异无统计学意义(F=0.378,P=0.686)。免疫后血清三组原型株中和抗体 GMT为1∶31.09、1∶34.90、1∶21.98,差异无统计学意义(F=2.262,P=0.106);三组Delta变异株中和抗体GMT为1∶61.46、1∶77.44、1∶43.71,差异无统计学意义(F=2.105,P=0.123)。序贯加强免疫后血清对新型冠状病毒Delta变异株和原型株的中和抗体阳转率分别达到82.78%、83.33%。三组 SARS-CoV-2原型株中和抗体阳转率分别为86.67%、87.50%、75.83%,差异有统计学意义(χ²=7.320,P=0.026),其中C组低于A组和B组;三组 SARS-CoV-2 Delta变异株中和抗体阳转率分别为87.50%、84.17%、76.67%,差异无统计学意义(χ²=5.183,P=0.075)。发生不良事件人数为124人,不良事件总体发生率为34.44%。各组发生率分别为35.83%、40.83%和26.67%,差异无统计学意义(χ²=5.487,P=0.064),所有研究对象出现的不良事件以接种部位不良事件为主,主要表现为疫苗接种部位疼痛(23.89%);全身不良事件主要表现为疲劳/乏力(6.94%),未发生与疫苗接种有关的SAEs。结论 接种两剂新型冠状病毒灭活疫苗后序贯加强免疫重组新型冠状病毒疫苗(CHO细胞)具有良好的免疫原性和安全性。较长间隔期的免疫前IgG和免疫后原型株中和抗体阳转率较低,不同间隔期的免疫后IgG 、Delta变异株和原型株中和抗体水平比较差异均无统计学意义,建议基础免疫后6~8个月为最佳的接种间隔。     

降低终末期肾病患者动静脉内瘘成熟不良率

目的降低终末期肾病患者动静脉内瘘成熟不良率。方法成立品管圈圈组,通过现状调查、原因解析明确问题真因,从制定动静脉内瘘院前指导规范,建立多学科协作模式;实施“VAP”评估模式,制定围手术期标准化管理流程;构建“互联网 +”智能宣教模式,优化院外延伸服务三方面进行改进。结果终末期肾病患者动静脉内瘘成熟不良率由10.6%降低至3.3%。结论开展品管圈活动降低了终末期肾病患者动静脉内瘘成熟不良率。     

老年髋部骨折患者围术期“2P-3R”营养管理模式构建

目的构建老年髋部骨折患者围术期营养管理模式,促进患者早手术、早下地、早康复。方法针对老年髋部骨折患者营养管理现状,采用课题研究型品管圈活动进行改进。经过科学循证、专家指导等,从术前、术后及家庭三个环节,骨科、营养科、家庭三个维度,人员、制度、材料设备、方法、信息五个方面,制定三大对策群组并予以实施,包括组建营养支持团队、构建营养管理策略、搭建多维信息交互平台等。结果老年髋部骨折患者首次下地时间缩短为26.7 h,平均住院日缩短为5.6 d,实现了早手术、早下地、早康复的目标。结论对老年髋部骨折患者实施个性化、全流程的序贯性营养干预具有重要意义。后续还需开展大样本多中心研究以进一步验证成效,数据自动采集与智能反馈也是今后研究重点。     

构建基于移动互联网的患者赋能型心衰健康管理平台

目的构建基于移动互联网的患者赋能型心衰健康管理平台,促进心衰患者进行自我管理,改善临床结局。方法开展课题研究型品管圈活动,搜集高质量临床证据,构建患者赋能型心衰健康管理平台,通过平台推广与应用,对心衰患者行为进行干预。结果平台应用后,医护人员心衰知识水平显著提升,心衰患者自我护理能力明显提升,患者再入院率、死亡率明显下降,应用效果良好。结论基于移动互联网的患者赋能型心衰健康管理平台是心衰慢性病管理的有效手段。     

支气管肺发育不良基因表达调控异常研究进展

支气管肺发育不良(BPD)是早产儿最常见的慢性肺部疾病。BPD由多种因素引起,其本质是在遗传易感性的基础上,各种环境因素引起的肺损伤和发育中的未成熟肺修复之间的不平衡。研究显示BPD致病分子机理多涉及炎症细胞因子、非编码RNA和各种信号通路因子的异常表达调控。这些相关基因的异常表达,不仅影响了胚胎或早期胎儿肺的正常发育,并阻碍了新生肺损伤后肺的修复,或导致肺功能不全。单独或协同影响了BPD的发生发展。同时研究发现环境风险因素如高氧暴露、炎症导致基因表达异常也是BPD发生的原因之一,环境和基因共同作用推动了BPD的发生发展。