冠心舒通胶囊对阿尔茨海默病患者血清超敏C反应蛋白和白介素-6及超氧化物歧化酶的影响研究

目的观察冠心舒通胶囊对阿尔茨海默病(alzheimer’s disease,AD)患者认知功能及血清超敏C反应蛋白(hs-CRP)、白介素(IL)-6及超氧化物歧化酶(SOD)水平的影响。方法将68例AD患者随机分为观察组36例,对照组32例,均予以常规指导,口服多奈哌齐片5 mg,1次/d治疗。观察组在此基础上加服冠心舒通胶囊2片,3次/d,总疗程为12周。监测两组患者治疗前后简易精神状态量表(MMSE)评分、血清hs-CRP、IL-6、SOD的变化,并予以对比分析。结果两组患者治疗后MMSE评分间差异无统计学意义(P>0.05),且均较治疗前明显升高,差异有统计学意义(P<0.05)。治疗后观察组血清hs-CRP、IL-6水平明显低于对照组,血清SOD水平明显高于对照组,差异有统计学意义(P<0.05)。结论冠心舒通胶囊可用于治疗AD,并可改善患者中枢神经系统的炎症反应和氧化应激状态。     

吉西他滨、氟尿嘧啶、亚叶酸钙联合治疗老年晚期食管癌临床疗效及其对血清胰岛素样生长因子-1和转化生长因子-β_1的影响

目的探讨由吉西他滨（GEM）、氟尿嘧啶（5-FU）、亚叶酸钙（LV）组成的GLF联合化疗方案治疗老年晚期食管癌的临床疗效及其对患者血清胰岛素样生长因子-1（IGF-1）及转化生长因子-β1（TGF-β1）的影响。方法选取老年食管癌患者68例为研究对象,行锁骨下静脉穿刺或经外周静脉穿刺中心静脉置管,予以GLF方案,检测患者血清IGF-1及TGF-β1水平,评价疗效,记录无进展生存期（PFS）与总生存期（OS）及治疗过程中的不良反应。结果患者治疗2～6个周期后,客观缓解率为54.41%,疾病控制率为76.47%,中位PFS为6.2个月,中位OS为10.5个月,不良反应发生率为14.71%。治疗后血清IGF-1及TGF-β1水平均明显降低,差异具有高度统计学意义（P〈0.01）。结论 GLF联合化疗方案治疗老年晚期食管癌具有较好临床效果,抑制了血清IGF-1及TGF-β1的活性,在提高患者生存质量、延长生存期方面具有较好的作用,且具有较高的安全性,比较适合于老年晚期食管癌的临床治疗。     

武汉市某医院频繁就诊多科室患者心理评估及护理干预研究

目的：探讨频繁就诊于门诊多科室患者的心理特征及护理干预措施。方法：选取60例频繁就诊于某医院门诊多科室患者（研究组）与60例在门诊单个科室就诊患者（对照组）进行抑郁自评量表（SDS）、焦虑自评量表（SAS）测评,并作相关分析。同时,对60例研究组又随机分为干预组和未干预组,每组30例,分析采取护理干预后的效果。结果：研究组SDS、SAS评分明显高于对照组（=18.15,〈0.001,=16.62,〈0.001）;其主诉多系统生理症状的出现频次也显著多于对照组;同时其躯体疾病确诊率、实验室检查阳性支持率、疗效均显著低于对照组。经过护理干预后,干预组SDS、SAS评分显著降低（=3.13,〈0.01,=4.68,〈0.01）,多系统生理症状的出现频次有明显减少。结论：频繁就诊于门诊多科室患者有明显的抑郁、焦虑情绪和多种躯体化症状,需给予积极的护理干预,提高患者对疾病的认知程度及应对能力,减轻患者的负性情绪,为积极配合诊疗创造条件。     

头孢尼西钠致迟发型过敏性休克1例

1例70岁患者因前列腺增生行前列腺汽化电切术后预防感染,给予注射用头孢尼丁钠,第4天患者自觉胸痛伴心悸、轻度呼吸困难,继而出现全身抽搐、周身出汗等休克症状。立即停止输液,给予吸氧、皮下注射肾上腺素、肌注异丙嗪、静脉推注地塞米松及静脉滴注多巴胺和间羟胺等治疗,约6h后生命体征趋于平稳。     

头颈部鳞癌及癌旁组织端粒酶活性检测

目的：研究原发头颈部鳞癌及相关癌旁组织中端粒酶活性表达，探讨春作为头颈部鳞癌分子生物学标志物的可能性。方法：采用ＴＲＡＰ－ＰＣＲ－ＥＬＩＳＡ，对３２例原发头颈部鳞癌及１５例癌旁组织进行端粒酶活性检测。结果：３２例原发头颈部鳞癌中，２７例端粒酶活化，阳性率为８４．４％；１５例癌旁组织中５例端粒酶活化，阳性率为３３．３％。有淋巴结累及者端粒酶阳性率（８６．７％）高于无淋巴结累及者（８２．４％），低分化     

血清胱抑素C在诊断糖尿病早期肾损伤中的价值

目的探讨胱抑素C(CysC)测定在糖尿病早期肾损伤诊断中的作用。方法采用免疫比浊法分别测定120例糖尿病患者和60例健康人员(健康对照组)的血清CysC水平。结果糖尿病组的CysC水平[(1.19±0.71)mg/L]明显高于健康对照组[(0.69±0.31)mg/L],差异有统计学意义(P<0.01)。结论血清CysC是反映早期肾小球损伤最灵敏的指标,对诊断糖尿病早期肾损伤有重要的临床参考及应用价值。     

Effects of Tongxinluo-facilitated cellular cardiomyoplasty with autologous bone marrow-mesenchymal stem cells on postinfarct swine hearts

Background  Treatment of ischemic heart disease remains an important challenge, though there have been enormous progresses in cardiovascular therapeutics. This study was conducted to evaluate whether Tongxinluo (TXL) treatment around the transplantation of mesenchymal stem cells (MSCs) can improve survival and subsequent activities of implanted cells in swine hearts with acute myocardial infarction (AMI) and reperfusion.
Methods  Twenty-eight Chinese mini-pigs were divided into four groups including a control group (n=7); group 2, administration of low-dose TXL alone from the 3rd day prior to AMI to the 4th day post transplantation (n=7); group 3, MSCs alone (n=7) and group 4, TXL + MSCs (n=7). AMI models were made by occlusion of the left anterior descending coronary artery for 90 minutes. Autologous bone marrow-MSCs (3×10⁷ cells/animal) were then injected into the post-infarct myocardium immediately after AMI and reperfusion. The survival and differentiation of implanted cells in vivo were detected by immunofluorescent analysis. The data of cardiac function were obtained at baseline (1 week after transplantation) and endpoint (6 weeks after transplantation) by single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Apoptosis was detected by TUNEL assay and the oxidative stress level was investigated in the post-infarct myocardium at endpoint.
Results  At endpoint, there was less fibrosis and inflammatory cell infiltration with more surviving myocardium in group 4 than in the control group. In group 4 the survival and differentiation of implanted MSCs were significantly improved more than that seen in group 3 alone (P<0.0001); the capillary density was also significantly greater than in the control group, group 2 or 3 both in the infarcted zone (P<0.0001) and the peri-infarct zone (P<0.0001). MRI showed that parameters at baseline were not significantly different between the 4 groups. At endpoint, regional wall thickening and the left ventricular ejection fraction were increased while the left ventricular mass index, dyskinetic segments and infarcted size were decreased only in group 4 compared with control group (P<0.0001). SPECT showed that the area of perfusion defect was significantly decreased at endpoint only in group 4 compared with control group (P<0.0001). TUNEL assay indicated that TXL administration significantly decreased cell apoptosis in peri-infarct myocardium in groups 2 and 4. Furthermore, superoxide dismutase (SOD) significantly increased and malondialdehyde (MDA) decreased in groups 2 and 4 by the administration of TXL.
Conclusions  Our study demonstrates the following: (1) immediate intramyocardial injection of MSCs after AMI and reperfusion resulted in limited survival and differentiation potential of implanted cells in vivo, thus being incapable of beneficially affecting post-hearts; (2) TXL-facilitation resulted in a significant survival and differentiation potential of implanted cells in vivo via inhibition of apoptosis and oxidative stress, accompanied by significant benefits in cardiac function.

     

儿童癫(癎)患者语言功能状况的临床评估

目的:观察儿童癫患者语言功能状况。方法:选择儿童癫患者56名为癫组,50名性别、年龄、文化程度与癫组匹配的健康儿童为健康组,均以标记测试(TheTokenTest)和WAB量表进行语言功能测试。结果:癫组与对照组比较,癫组WAB量表测试得分"听语理解"项和癫组标记测试得分明显低于对照组(P<0.05)。结论:儿童癫患者存在语言功能受损,主要表现在听语理解方面。在临床工作中,应重视儿童癫患者的语言功能状况,尽量避免可导致其语言功能受损的危险因素,提高患儿的生活质量。     

PBL教学模式在专本连读护生中的应用与改进策略

目的探讨PBL（problem-based learning,PBL）教学模式在专本连读护生《护理学基础》教学中的应用。方法实验组实施40学时PBL教学,对照组实施同学时量传统教学。结果97%以上的护生认为PBL教学可以提高自主学习所需要的选择信息的能力、合作学习能力、解决问题的能力,85%学生认为能提高学科知识的掌握程度,78%学生认为可提高学习主动性和兴趣。结论PBL教学是一种提高学生自主学习能力的教学法。要进一步提高PBL教学中学生的学习兴趣,必须将PBL教学与传统教学结合,优化PBL教学中问题、内容和时间的设置,强化教学和班级管理,提高教师科研水平。     

健康教育对临床护士营养现状和营养KAP影响的效果评价

目的了解基层临床护士营养知识、态度、行为(knowledge-attitude-practice,KAP)及营养现状,评价营养健康教育对临床护士的干预效果。方法将某基层医院360名护士随机分成干预组和对照组,每组180人,干预组进行为期12个月的营养健康干预后,再次进行问卷调查,将两组结果进行比较分析。结果干预组护士营养KAP调查评分明显较高,与对照组比较差异具有统计学意义(P<0.01);护士膳食能量、营养素日平均摄入量方面,将干预组和对照组与推荐摄入量(recommended nutrient intake,RNI)标准比较,干预组的能量、维生素A、维生素B、维生素D、钙、磷、钠、锌、硒、铜、碘、生物素等摄入量明显提高(P<0.01),更接近RNIs值。结论通过对临床护士进行营养健康教育,其营养摄入状况和营养KAP有很大提高。