Human Urine-derived Stem Cells Seeded Surface Modified Composite Scaffold Grafts for Bladder Reconstruction in a Rat Model

We conducted this study to investigate the synergistic effect of human urine-derived stem cells (USCs) and surface modified composite scaffold for bladder reconstruction in a rat model. The composite scaffold (Polycaprolactone/Pluronic F127/3 wt% bladder submucosa matrix) was fabricated using an immersion precipitation method, and heparin was immobilized on the surface via covalent conjugation. Basic fibroblast growth factor (bFGF) was loaded onto the heparin-immobilized scaffold by a simple dipping method. In maximal bladder capacity and compliance analysis at 8 weeks post operation, the USCs-scaffold^heparin-bFGF group showed significant functional improvement (2.34 ± 0.25 mL and 55.09 ± 11.81 µL/cm H₂O) compared to the other groups (2.60 ± 0.23 mL and 56.14 ± 9.00 µL/cm H₂O for the control group, 1.46 ± 0.18 mL and 34.27 ± 4.42 µL/cm H₂O for the partial cystectomy group, 1.76 ± 0.22 mL and 35.62 ± 6.69 µL/cm H₂O for the scaffold group, and 1.92 ± 0.29 mL and 40.74 ± 7.88 µL/cm H₂O for the scaffold^heparin-bFGF group, respectively). In histological and immunohistochemical analysis, the USC-scaffold^heparin-bFGF group showed pronounced, well-differentiated, and organized smooth muscle bundle formation, a multi-layered and pan-cytokeratin-positive urothelium, and high condensation of submucosal area. The USCs seeded scaffold^heparin-bFGF exhibits significantly increased bladder capacity, compliance, regeneration of smooth muscle tissue, multi-layered urothelium, and condensed submucosa layers at the in vivo study.     

Associations of visit-to-visit fasting glucose with risk of mortality: A retrospective cohort study of 48,077 people with type 2 diabetes

AimTo investigate the association between mean fasting glucose (FG) and variability in visit-to-visit FG and risk of mortality in people with type 2 diabetes (T2D).MethodsThis retrospective cohort study included 48,077 Chinese men and women with T2D. The yearly mean and coefficient of variation for fasting glucose (mean-FG and FG-CV, respectively) were based on at least two measurements taken each year over a mean duration of 4.5 years. Deaths and their causes were identified using the Shanghai Vital Statistics registry. Mean-FG and FG-CV served as time-dependent variables in Cox models to estimate their associations with risk of mortality; hazard ratios (HRs) were adjusted for baseline risk factors. Potential non-linear associations were examined by restricted cubic splines.ResultsDuring an average 4.5 years of follow-up, 2095 men and 1923 women died. Men with low mean-FG and women with low or high FG were at greater risk of death. Mean-FG was not associated with either cardiovascular disease (CVD) or cancer-specific mortality, whereas higher yearly FG-CV was associated with all-cause and CVD-/cancer-specific mortality in both genders. Compared with a yearly FG-CV of 1.76 (5th percentile), men and women with an FG-CV of 14.14 (75th percentile) had HRs (95% CI) of 1.41 (1.24–1.61) and 1.44 (1.26–1.65), respectively, for all-cause mortality.ConclusionVariability of visit-to-visit FG may be a more sensitive predictor of risk of death than mean-FG in people with T2D.     

医保总额控制下大型公立医院经营策略探讨

为解决医疗费用过快上涨、医保对供方行为约束不足、基金运行风险加剧等问题,人力资源和社会保障部等要求在统筹地区开展以总额控制为主的医保支付方式改革.总额控制对城市大型公立医院的经营管理产生了较大的影响.按照总额控制政策,提出3个层面的转型策略.在发展战略方面,转变增长方式,发挥医联体作用,增强辐射能力;在业务管理方面,确保医疗质量和安全,落实临床路径,优化服务流程;在行政管理方面,强化成本控制,加强信息化建设,转变管理职能.     

bFGF反义寡核苷酸对大鼠肺成纤维细胞增殖信号通路的影响

目的:观察碱性成纤维细胞生长因子(bFGF)反义寡核苷酸(AODN)对大鼠肺成纤维细胞增殖、转化信号通路的影响。方法:分离成年大鼠肺成纤维细胞,分为4组:对照组(未转染肺成纤维细胞);TGF-β1组(未转染肺成纤维细胞+5ng/ml TGF-β1刺激);TGF-β1+AODN组(转染AODN肺成纤维细胞+5ng/ml TGF-β1刺激);TGF-β1+RODN(正义寡核苷酸)组(转染RODN肺成纤维细胞+5ng/ml TGF-β1刺激)。每组设3复孔,并作细胞爬片,镜下计数肺成纤维细胞数量,绘制生长曲线。MTT比色法测定肺成纤维细胞增殖率。免疫细胞化学方法检测肌成纤维细胞特异性标志物α-平滑肌肌动蛋白(α-SMA)。通过ELISA法检测培养液中bFGF、CTGF及Ⅰ型胶原蛋白含量。用RT-PCR法分析肺成纤维细胞Smad3 mRNA、Smad7 mRNA、Ⅰ型胶原mRNA表达水平。结果:1细胞计数显示:TGF-β1+RODN组各时段成纤维细胞的数目均较对照组、TGF-β1组、TGF-β1+AODN组明显增多(P<0.05);TGF-β1+AODN组中成纤维细胞增殖数比TGF-β1组明显减低(P<0.05)。2MTT结果显示:TGF-β1+RODN组肺成纤维细胞光密度值明显高于对照组、TGF-β1组、TGF-β1+AODN组(P<0.05);TGF-β1+AODN组中肺成纤维细胞光密度值明显比TGF-β1组减低(P<0.05)。3免疫细胞化学染色结果显示:TGF-β1+RODN组肺成纤维细胞与对照组、TGF-β1组、TGF-β1+AODN组比较,α-SMA染色的平均光密度值(IOD)明显增加(P<0.05);TGF-β1+AODN组中肺成纤维细胞α-SMA染色的平均光密度值(IOD)比TGF-β1组明显减低(P<0.05)。4 ELISA法检测结果显示:在TGF-β1+RODN组肺成纤维细胞培养液中bFGF、CTGF及Ⅰ型胶原蛋白含量明显高于对照组、TGF-β1组、TGF-β1+AODN组(P<0.05);TGF-β1+AODN组肺成纤维细胞培养液中bFGF、CTGF及Ⅰ型胶原蛋白含量比TGF-β1组明显减低(P<0.05)。5RT-PCR法检测结果显示:在TGF-β1+RODN组肺成纤维细胞Smad3mRNA及Ⅰ型胶原蛋白mRNA表达明显高于对照组、TGF-β1组、TGF-β1+AODN组(P<0.05);TGF-β1+AODN组肺成纤维细胞Smad3mRNA及Ⅰ型胶原蛋白mRNA表达明显比TGF-β1组明显减低(P<0.05);TGF-β1+RODN组肺成纤维细胞Smad7mRNA表达明显低于对照组、TGF-β1组、TGF-β1+AODN组(P<0.05);TGF-β1+AODN组肺成纤维细胞Smad7 mRNA表达比TGF-β1组明显增加(P<0.05)。结论:bFGF反义寡核苷酸可抑制肺成纤维细胞的增殖、转化及胶原合成,bFGF反义寡核苷酸可能通过下调TGF-β1-Smad信号通路来发挥作用。     

实习护生对护理操作项目兴趣的调查分析

目的：了解实习护生对基础护理操作项目的兴趣程度并分析其原因,为学校和临床老师的带教提供帮助。方法：采用调查表对实习护生进行问卷调查,了解其对基础护理操作的兴趣程度,及对护士职业的社会地位和发展前景的看法。结果：护生们较感兴趣大多是静脉输液等专业性较强的操作,不感兴趣的大多是床上洗头、吸痰等生活和排泄方面的操作;本科生感兴趣人数的百分比要比专科生明显偏低。结论：护生对基础护理操作项目的兴趣大小与专业思想稳定与否、操作项目的技术含量大小、工作内容的重复单调以及学历的高低有关。     

浅析基层医院临床药师绩效考核指标体系的构建

目的：为提高对临床药师工作绩效考核的客观性和公正性提供参考。方法：采用客观方法,查阅相关文献报道,并结合临床药师的能力,制订考核的内容,构建临床药师绩效考核指标体系。结果与结论：我部以业绩和部分工作质量指标作为关键绩效指标,通过分值占总分的比重体现指标的权重,对临床药师的业绩和工作质量进行综合评价。并建议在实际应用中,根据情况变化对内容和权重做出调整。     

血流感染患者外周血淋巴细胞减少的影响因素研究

背景淋巴细胞减少提示机体免疫功能下降,目前临床关于血流感染患者外周血淋巴细胞减少影响因素的研究较少。目的探讨血流感染患者外周血淋巴细胞减少的影响因素,以期为临床诊疗提供参考。方法回顾性选取2019-2020年北京市石景山医院收治的血流感染患者102例,依据患者血培养当日外周血淋巴细胞计数分为淋巴细胞减少组(外周血淋巴细胞计数<1.0×10⁹/L)69例和对照组(外周血淋巴细胞计数≥1.0×10⁹/L)33例。比较两组患者的临床资料、病原菌检出率。采用多因素Logistic回归分析探讨血流感染患者外周血淋巴细胞减少的影响因素,分析血流感染患者感染源与病原菌情况。结果两组患者性别、年龄、感染源、感染性休克发生率、压疮发生率、超敏C反应蛋白(hs-CRP)、近3个月内有住院史者所占比例、近3个月内有抗生素治疗史者所占比例、长期卧床者所占比例、气管插管者所占比例、留置导尿管者所占比例、深静脉置管者所占比例,高血压、糖尿病、冠心病、肿瘤、脑梗死、脑出血、慢性阻塞性肺疾病(COPD)、慢性支气管炎、心律失常、心功能不全、肾功能不全、高脂血症、肝损伤发生率及有外科手术史者所占比例比较,差异无统计学意义(P>0.05);淋巴细胞减少组患者PCT高于对照组(P <0.05)。两组患者革兰阳性菌、革兰阴性菌检出率比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,年龄[OR=0.949,95%CI(0.903,0.998)]、PCT[OR=1.026,95%CI(1.002,1.050)]、合并冠心病[OR=6.749,95%CI(1.429,31.868)]、肺炎克雷伯菌[OR=9.400,95%CI(1.040,84.990)]是血流感染患者淋巴细胞减少的独立影响因素(P <0.05)。金黄色葡萄球菌血流感染最常表现为肺部感染(35.7%),其次为导管相关性感染(21.4%);粪/屎肠球菌血流感染最常见于肺部感染(62.5%),其次为泌尿系统感染(25.0%);大肠埃希菌血流感染最常表现为泌尿系统感染(35.4%),其次为肺部感染(33.3%)、腹腔感染(16.7%);肺炎克雷伯杆菌血流感染最常见于肺部感染(57.7%),其次为腹腔感染(15.4%)、泌尿系统感染(15.4%);鲍曼不动杆菌血流感染最常表现于肺部感染(75.0%);铜绿假单胞菌血流感染较少见。结论血流感染患者淋巴细胞减少发生率为67.6%,年龄、PCT、合并冠心病、肺炎克雷伯菌是血流感染患者淋巴细胞减少的影响因素,尤其是肺部感染者需警惕肺炎克雷伯菌血流感染的发生。     

抗肝纤维化药物治疗研究进展

肝纤维化（Liver fibrosis）是指各种损害因素导致的肝内结缔组织异常增生，汇管区和肝小叶内有大量纤维组织沉积，其中以Ⅰ、Ⅲ型胶原纤维为主，进一步发展可导致肝硬化。其病理机制主要在于肝星状细胞活化，细胞外基质代谢失衡。肝纤维化病理机制复杂，涉及因素较多，治疗上也就有广义与狭义的概念。     

原发性高血压患者缺血性脑血管病与颈动脉粥样硬化及碱性成纤维细胞生长因子的关系

目的探讨原发性高血压患者缺血性脑血管病与颈动脉粥样硬化及碱性成纤维细胞生长因子之间的关系及临床意义。方法采用惠普彩色多普勒仪测定颈动脉,观察颈总动脉、颈内动脉和颈动脉分叉部的图像。采用酶联免疫吸附试验方法测定外周血中碱性成纤维细胞生长因子。结果与高血压不伴缺血性脑血管病组比,高血压伴缺血性脑血管病组碱性成纤维细胞生长因子水平(364.5±91.0mg/L比283.4±91.2mg/L)、软斑检出率(92.3%比52.4%)和右侧颈内动脉收缩期峰值流速(57.65±7.34mm/s比52.41±7.97mm/s)均显著升高(P<0.05或0.01);软斑组碱性成纤维细胞生长因子水平比硬斑组明显升高(319.7±93.6mg/L比252.2±77.9mg/L,P<0.05)。结论碱性成纤维细胞生长因子和动脉粥样硬化斑块的形成在高血压缺血性脑血管病的发生发展过程中起重要作用,对判别高血压病变的程度、预防脑梗死提供了重要依据,有利于临床采取正确的干预治疗措施。     

基层医院开展细菌学检验的必要性和困难性调查分析

细菌学检验在疾病的诊断和治疗中起着至关重要的作用,然而在我国的基层医院中却未能很好地开展。其困难性是多方面的,主要包括临床医生、患者以及检验人员自身等方面的原因。