卒中临床路径实施概述

文章介绍和总结了国外目前卒中临床路径实施的概况，包括临床路径的简介、卒中临床路径的模式、实施效果（优点及存在的问题）以及卒中临床路径的制订。     

Pheophytin a, a low molecular weight compound found in the marine brown alga Sargassum fulvellum, promotes the differentiation of PC12 cells

We identified and characterized a neurodifferentiation compound from the marine brown alga Sargassum fulvellum collected from the Japanese coastline. Several instrumental analyses revealed the compound to be pheophytin a. Pheophytin a did not itself promote neurite outgrowth of PC12 cells. However, when PC12 cells were treated with a low concentration of pheophytin a (3.9 microg/ml) in the presence of a low level of nerve growth factor (10 ng/ml), the compound produced neurite outgrowth similar to that produced by a high level of nerve growth factor (50 ng/ml). Pheophytin a also enhanced signal transduction in the mitogen-activated protein kinase signaling pathway, which is also induced by nerve growth factor. The effect of pheophytin a on neurite outgrowth of PC12 cells was completely blocked by U0126, a representative mitogen-activated protein kinase kinase inhibitor. These results suggest that pheophytin a enhances the neurodifferentiation of PC12 cells in the presence of a low level of nerve growth factor and that this effect is mediated by activation of a mitogen-activated protein kinase signaling pathway.     

突触功能必需基因参与线虫衰老的调控(英文)

目的鉴定参与线虫衰老的神经内分泌调控的新基因。方法鉴于神经系统在衰老调控中的重要作用,通过寿命分析和脂褐质自发荧光的检测,从编码突触蛋白的遗传位点中筛选参与衰老调控的基因。我们还进一步检查了这些遗传位点相应的突变体的永久性幼虫形成情况,探讨它们是否可能受胰岛素样信号通路的调控。结果遗传位点 unc-10,syd-2,hlb-1,dlk-1,mkk-4,scd-2,snb-1,ric-4,nrx-1,unc-13,sbt-1,unc-64 可能参与线虫衰老的调控。而且在衰老的调控中,unc-10,syd-2,hlb-1,dlk-1,mkk-4,scd-2,snb-1,ric-4,nrx-1 的功能可能与unc-13,sbt-1,unc-64相反。肠道脂褐质自发荧光的检测进一步证明了筛选出的各基因对应突变体的长寿或短寿表型,是由减慢或缩短的组织衰老所致。在筛选出的基因中,syd-2,hlb-1,mkk-4,scd-2,snb-1,ric-4,unc-64 也参与了永久性幼虫形成的调控。另外,daf-2突变增强了syd-2和hlb-1的表达,降低了mkk-4,nrx-1,ric-4,sbt-1,rpm-1,unc-10,dlk-1,unc-13 的表达。daf-16突变提高了syd-2和 hlb-1 的表达,降低了mkk-4,nrx-1,sbt-1,rpm-1,unc-10,dlk-1,unc-13 的表达. 结论突触功能可能在个体寿命和永久性幼虫形成的调控机制中具有重要的作用。     

佩尔地平治疗妊娠高血压病人的护理管理路径

目的探讨护理管理路径在应用佩尔地平治疗的重度子痫前期病人的效果，以期达到最佳的治疗效果，并减少并发症的发生。方法将用佩尔地平针治疗的重度子痫前期的病人486例随机分为两组，一组按常规护理，另一组按制定的护理管理路径护理。结果患者依从性对照组为168例，占70％；观察组为228例，占92．68％，P〈0．05，其差异有统计学意义。胎死宫内发生率对照组为9．16％，观察组为0．81％，P〈0．05，其差异有统计学意义。血压的稳定性对照组为36．3％，观察组为97．6％，P〈0．05，其差异有统计学意义。结论护理管理路径可以提高重度妊娠高血压疾病的治疗效果，减少并发症的发生。     

The surfaces of the parasitic nematodes Trichinella spiralis and Toxocara canis differ in the binding of post-C3 components of human complement by the alternative pathway

The binding of human complement components C3, C5 and C9 to the surface of the infective larvae of the nematode parasites Toxocara canis and Trichinella spiralis, by the alternative pathway, was examined by direct and indirect immunofluorescence on the intact parasites. This showed that although C3 bound to both nematodes, they differed markedly in the binding of C5 and C9; C5 bound only minimally to T. spiralis, and C9 binding to this parasite was barely detectable. In contrast, both early and late components bound to T. canis to a high density, comparable to, or in excess of, the binding of these components to the infective larvae of the trematode Schistosoma mansoni. The lack of binding of the post-C3 components to T. spiralis did not correlate with enhanced binding of the control protein, Factor H.     

临床护理路径在臀肌挛缩症患者健康教育中的应用

目的 探讨应用临床护理路径对臀肌孪缩症患者健康教育的效果。方法 将60例臀肌挛缩症患者分为对照组（n=30）和实验组（n=30），对照组采用常规教育方法，实验组按制定好的健康教育路径进行教育，将两组患者的健康教育达标率、对护理工作的满意度进行比较。结果 两组患者在健康教育达标率、对护理工作的满意度方面比较，差异有统计学意义（P〈0．01）。结论 对臀肌挛缩症患者运用护理手段进行健康教育后提高了患者的健康教育达标率，提高了护理工作的满意度，效果优于常规教育方法。     

Demonstration of Right and Left Atrial Dissociation by Atrial Rapid Pacing or Extrastimulation During Fast-Slow (Uncommon) Form of Atrioventricular Nodal Reentrant Tachycardia

Some recent works suggest that extranodal atrial fibers may form part of the reenlry circuit in the atrioventricular (AV) nodal reentrant tachycardia (AVNRT). This hypothesis is based on the fact that the perinodal dissection successfully abolished AVNRT while preserving intact AV conduction. Apart from the surgical success, the electrophysiological evidence supporting this hypothesis has not been demonstrated, especially in the uncommon (fast-slow) form of AVNRT. We present some electrophysiological evidence suggesting atrial participation in eight patients with the fast-slow form of AVNRT. During the tachycardia, rapid pacing or extrastimulation was done from the orifice of the coronary sinus (CS) and the right atrium (RA), while recording the electrograms of the CS and the low septal RA. In seven patients, right and left atrial dissociation was demonstrated during pacing from the RA, while in the remaining one this was demonstrated from the CS. The interatrial dissociation will be unlikely if the intranodal reentry circuit connects with the atria via a single upper common pathway. This suggests that the upper turnaround of the reentry circuit involves atrial tissue and that the extranodal accessory pathway with long conduction times may form the ascending limb of the circuit (atrionodal reentry). Alternatively, the reentry circuit is entirely intranodal and two or more connecting pathways are present between the atria and the circuit.     

Chrome congestive heart failure: Radiofrequency ablation of accessory pathways: implications of accumulated experience and time dedicated to procedures

Previous reports on radiofrequency ablation of accessory pathwayshave shown that the experience of the operator is of crucialimportance in reducing fluoroscopy time and achieving highersuccess rates. However, a detailed analysis of this importantissue has not been previously attempted We analysed 71 consecutive ablation procedures undertaken atSt George's Hospital by the same electrophysiology group andalways with the same first operator. Of all procedures, 66 (916%)were successful, as judged by abolition of accessory pathwayconduction without recurrence within the next 24 h. Failuresincluded two out of 38 left-sided pathway procedures (5·3%),one out of 11 intermediate septal (9·1%) and four outof 22 right-sided pathway procedures (18·2%). These differencewere not statistically significant. Average procedure and screeningtimes for all procedures were 162·9±86·0min and 56·8±48·2 mm respectively, whereasthe median of the number of discharges was 12, ranging fromone to 51. There was no significant difference between pathwaygroups or between concealed and non-concealed pathways in respectto procedure and screening time or number of discharges. Therewas a significant tendency towards decreased procedure and screeningtimes with accwnulating experience and this was similar forall pathway groups. There was also a tendency towards improvedcwnulative success rates with time dedicated to procedures. We conclude that a certain amount of ablation experience isrequired, even by experienced electrophysiologists, before arelatively high success rate without long radiation exposurecan be achieved, regardless of the location or the mode of conductionof the pathway. Success rates increase with procedure time,suggesting that early abandonment of the procedure may resultin higher failure rates in diffcult cases.     

Total and free tissue factor pathway inhibitor in pregnancy hypertension.

OBJECTIVE: To clarify the role played by tissue factor pathway inhibitor (TFPI) in pregnancy hypertension. METHODS: Using enzyme-linked immunosorbent assays, hemostatic measurements were obtained for women with pre-eclampsia (n=51), nonproteinuric hypertension of pregnancy (n=62), postpartum pre-eclampsia 24 h after childbirth (n=31), and no hypertension (healthy pregnant controls, n=100). RESULTS: There was a significant increase in circulating free TFPI levels in women with pre-eclampsia (9.7+/-6.2 ng/mL) or nonproteinuric hypertension of pregnancy (8.3+/-5.3 ng/mL) compared with healthy controls (5.3+/-2.1 ng/mL). In women with pre-eclampsia the levels remained elevated after placental delivery (10.6+/-4.0 ng/mL). Free protein S levels were significantly higher in women with pre-eclampsia (40.0%+/-10.7%), nonproteinuric hypertension of pregnancy (37.1%+/-12.5%), or postpartum pre-eclampsia (39.3%+/-9.1%) than in healthy pregnant controls (32.2%+/-8.5%). CONCLUSION: Increased levels of the physiologically active free forms of TFPI and free protein S, 2 coagulation inhibitors, may protect women with pregnancy-induced hypertension from the risks of hemostatic activation.     

白细胞介素6、信号传导和转录活化因子3和血管内皮生长因子在人脑胶质瘤中的表达及相关性研究

目的研究人脑不同级别胶质瘤中白细胞介素（IL）-6，信号传导和转录活化因子3（STAT3）和血管内皮生长因子（VEGF）的表达，探讨IL-6、STAT3和VEGF与肿瘤病理级别和侵袭性的关系。方法采用免疫组织化学法，检测70例人脑胶质瘤，10例脑膜瘤和5例正常脑组织中IL-6、STAT3和VEGF的表达。结果胶质瘤中IL-6、STAT3和VEGF的表达水平在高级别组（Ⅲ、Ⅳ级）明显高于低级别组（Ⅰ、Ⅱ级），两组间差异有统计学意义（P〈0．01），STAT3的表达与IL-6和VEGF的表达均呈正相关（P〈0．01）。结论IL-6、STAT3和VEGF的表达与胶质瘤的恶性程度有密切关系；且三者协同在胶质瘤发生、发展过程中起重要作用。三者的相关性证实VEGF基因由STAT3蛋白调节，而STAT3又由IL-6刺激活化。