肺纤维化鼠Ⅰ型前胶原和Ⅲ型前胶原mRNA表达及芪丹颗粒剂的干预效应

目的:观察芪丹颗粒对博莱霉素致肺纤维化鼠的Ⅰ型前胶原和Ⅲ型前胶原mRNA表达的影响,探讨其作用机制。方法:实验于2004-10/2006-10在山东省医学科学院基础所病理实验室完成。实验材料:清洁级雄性SD大鼠160只,体质量180～210g。氢化可的松琥珀酸钠50mg/支;芪丹(颗粒剂)是由黄芪、丹参、川芎等中草药加工提纯后的粗提取物制成的颗粒剂,10g/包(1g干粉相当于原生药8g)。实验分组:160只SD大鼠按随机区组设计分为正常组20只、模型组40只、芪丹颗粒剂50只、氢化可的松50只。实验干预:正常组20只气管内灌注和灌胃均用生理盐水。其余大鼠经气管内一次性灌注博莱霉素A5按0.25mL左右(5mg/kg体质量)诱导大鼠肺间质纤维化。随机取40只为模型组。取芪丹颗粒剂组和氢化可地松组大鼠各30只,分别从造模后第2天灌注芪丹颗粒剂(3125mg/kg)和腹腔注射氢化可的松(25mg/kg),药物干预后第7,14,28天麻醉下处死动物。两组各余20只分别从造模14d后灌注芪丹颗粒剂和腹腔注射氢化可的松(用量同前),于第28、42天分别处死动物。实验评估:用苏木精-伊红评价肺组织病理学变化和原位杂交方法检测各组大鼠肺Ⅰ型和Ⅲ型前胶原mRNA表达。结果:160只大鼠全部进入结果分析。①大鼠肺脏大体标本观察:对照组肺组织各观察时间点无明显改变,模型组肺组织表面凸凹不平,部分肺叶体积缩小,表面见灰白色结节。氢化可的松组与模型组相似。芪丹颗粒剂组见部分肺叶表面不光滑及大小不等结节。②肺组织病理学观察:模型组7d肺泡腔内大量巨噬细胞淋巴细胞中性粒细胞浸润,肺间质成纤维细胞增殖,28d肺泡结构破坏肺泡内见大量胶原纤维和成纤维细胞。芪丹颗粒剂组肺泡炎及肺纤维化程度均明显轻于模型组和氢化可的松组(P<0.05)。③肺间质纤维化形成中Ⅰ型、Ⅲ型前胶原mRNA表达:原位杂交显示两种前胶原mRNA表达呈动态变化,早期肺泡炎以Ⅲ型前胶原mRNA大量增生为主,晚期纤维化期以Ⅰ型前胶原mRNA增生为主。芪丹颗粒剂组Ⅲ型前胶原mRNA的表达在第14天处于最高,至28d仍维持较高的水平,芪丹颗粒剂组Ⅲ型前胶原mRNA的表达高于模型组和氢化可的松组(P<0.05)。28d,Ⅰ型前胶原mRNA的表达在第二天给药芪丹颗粒剂组和氢化可地松组及第14天给药芪丹颗粒剂组和氢化可的松组组间差异均有显著性(P<0.05)。结论:大鼠肺纤维化的早期以Ⅲ型前胶原mRNA的表达为主,晚期纤维化期以Ⅰ型前胶原mRNA的大量表达为主。芪丹颗粒可减轻博莱霉素诱导的大鼠肺泡炎及肺纤维化的程度,其机制可能通过影响了Ⅰ型和Ⅲ型前胶原mRNA的代谢和表达,从而减慢肺间质纤维化的进程。芪丹颗粒对肺间质纤维化有治疗作用,且优于氢化可的松。     

大剂量免疫球蛋白预防肾移植术后肺部感染:随机对照

目的:肾移植术后半年内发生的并发症主要为感染,尤以肺部感染为重。静脉注射大剂量免疫球蛋白预防肾移植术后早期肺部感染的效果值得临床应用中予以总结提高。方法:①实验对象及分组:选择2002-01/2006-12于海南省人民医院肾内科就诊的肾移植术后半年内患者40例,对实验及治疗方案均知情同意,且得到医院伦理道德委员会批准。按随机数字表法分为2组,免疫球蛋白组、对照组各20例。②实验分组:免疫球蛋白组在应用免疫抑制剂基础上用0.4g/(kg·d)免疫球蛋白治疗;对照组应用免疫抑制剂。③实验评估:观察两组患者普通肺炎、重症肺炎发生率及血清IgG和T淋巴细胞亚群水平变化。结果:40例患者全部进入结果分析。①免疫球蛋白组患者的普通肺炎感染率及重症肺炎感染率均低于对照组(P<0.01)。②免疫球蛋白组患者血IgG、T淋巴细胞亚群CD3 ,CD4 ,CD8 水平均高于对照组(P<0.05),用免疫球蛋白治疗未见副作用。结论:随机对照结果显示,肾移植术后早期应用大剂量免疫球蛋白能明显减少肺部感染发生,减少并发症,提高肾移植患者生存率。     

Tourette's syndrome: a disorder of cingulate and orbitofrontal function?

We discuss the clinical characteristics of tics and Tourette's syndrome (TS) and also possible treatment options. Based upon an overview of published pathophysiological and PET data, and the results of a recent PET study of changes in opioid receptor binding in TS, we hypothesize that the disease arises due to dysfunction within the cingulate and orbitofrontal cortex. The beneficial effects of dopamine receptor antagonists and dopamine-depleting agents in TS are suggested to be mediated via basal ganglia-thalamo-frontal circuits, while opioid agents may act directly on the cingulate.      

荷兰异波帕明多中心研究(DIMT)

标题　ａ）Ｉｂｏｐａｍｉｎｅ和地高辛治疗轻到中度的心力衰竭ｂ）在６个月的随访中轻度而未治的心衰之发展及ｉｂｏｐａｍｉｎｅ和地高辛单疗之效果作者　ａ）ＶａｎＶｅｌｄｈｕｉｓｅｎＤＪ,ｅｔａｌ－ＪＡｍＣｏｌｌＣａｒｄｉｏｌ,１９９３,２２：１５６４（英文）ｂ）ＶａｎＶｅｌｄｈｕｉｓｅｎＤＪ,ｅｔａｌ－ＡｍＪＣａｒｄｉｏｌ,１９９５,７５：７９６（英文）　　研究疾病：轻到中度的心力衰竭。目的：评价ｉｂｏｐａｍｉｎｅ的疗效和安全性,并将其与地高辛和安慰剂相比较。　　设计：随机、双盲和安慰剂对照。病人资料…     

Time to solve persistent,pernicious and widespread nursing workforce shortages

Aim

This paper discusses four main strategies for addressing nursing shortages that have been persistent, widespread and growing. Fallout from the COVID-19 pandemic might offer valuable impetus to address this tenacious challenge.

Background

Nursing shortages are common, widespread and have been persistent for most of a century. Many of the reasons behind these shortages are well known and are themselves enduring, as are the types of strategies put forward for addressing them. These strategies can generally be classified into four main categories: enhancing retention, improving recruitment, encouraging return to practice and drawing on international human resources. The COVID-19 pandemic is the latest major threat to ensuring a sufficiently sized and skilled nursing workforce. Many nurses have succumbed to burnout as well the plethora of factors that predated the pandemic and have a negative impact on nurse wellbeing, turnover and intention to leave.

Sources of evidence

This discussion paper draws on international sources of evidence.

Discussion/conclusion

This paper highlights how many of the factors behind and strategies for addressing nursing shortages at the local, national and global levels are widely studied and known. A sustained combination of strategies that focus both within and beyond health and nursing, including on the broader social context, is necessary. While COVID-19 has been extremely damaging, it might present an opportunity to make sustainable, effective reforms to address nursing shortages.

Implications for policy

Knowledge users must recognise that a combination of approaches across the gamut of policies that influence nursing workforces is necessary to address nursing shortages. Attention must also focus on factors beyond nursing and healthcare if shortages are to be remedied.