马桑内酯致痫大鼠海马TNF-α和TNFR1免疫反应的变化

目的　研究TNF α与癫痫发病的关系 ,进一步探讨癫痫发病机理及为癫痫的临床治疗提供依据。方法　将SD大鼠随机分为空白对照组、生理盐水对照组和马桑内酯 (CL)致痫组 ,侧脑室给药后观察记录两组大鼠行为变化 ,存活 2h灌注取材切片 ,用SABC法进行免疫组织化学染色及图像分析观察大鼠海马内TNF α和TNFR1表达的变化。结果　CL致痫组均出现Ⅲ～Ⅴ级痫性发作 ,对照组无发作 ;CL致痫组TNF α与TNFR1在大鼠海马各区阳性细胞数较对照组增多 ,表达较对照组增强 ,其中TNF α在海马CA1、CA3区锥体细胞层 ,TNFR1在海马CA3区锥体细胞层表达显著增强 (均P <0 0 1)。结论　TNF α在癫痫发病中起促进作用 ,其作用可能是通过TNFR1介导的。     

Translating value‐based health care: an experiment into healthcare governance and dialogical accountability

This article analyses an experiment into healthcare governance in Denmark inspired by principles of value‐based health care and intended to re‐orient the focus of healthcare governance from ‘productivity’ to ‘value for the patient’. The region in charge of the experiment exempted nine hospital departments from activity‐based financing and accountability based on diagnosis‐related groups, which allegedly incentivised hospitals in ‘perverse’ and counterproductive ways. Instead, the departments were to develop new indicators from their local practices to support and account for quality and value for the patient. Drawing on the actor‐network theory concept of ‘translation’, this article analyses how the experiment was received and put into practice in the nine departments, and how it established new kinds of accountability relations. We argue that the experiment provides fruitful inspiration for future governance schemes in healthcare to embrace the local complexities of clinical practices. In particular, we argue that the locally developed indicators facilitated what we call ‘dialogical accountability’, and we discuss whether this represents a feasible way forward for value‐based health care.     

Operating (on) the self: transforming agency through obesity surgery and treatment

In this article, I describe the processes through which patients diagnosed with ‘morbid obesity’ become active subjects through undergoing obesity surgery and an empowerment lifestyle programme in a Dutch obesity clinic. Following work in actor‐network theory and material semiotics that complicates the distinction between active and passive subjects, I trace how agency is configured and re‐distributed throughout the treatment trajectory. In the clinic's elaborate care assemblage – consisting of dieticians, exercise coaches and psychologists – the person is not only actively involved in his/her own change, the subject of intervention is the self as ‘actor’: his/her material constitution, inclinations and feelings. The empirical examples reveal that a self becomes capable of self‐care only after a costly and laborious conditioning through which patients are completely transformed. In this work, the changed body, implying a new, potentially disruptive reality that patients must learn to cope with, is pivotal to what the patient can do and become. Rather than striving to be disembodied, self‐contained liberal subjects that make sensible decisions for their body, patients become empowered through submission and attachment and by arranging support.     

亚莫利对初诊2型糖尿病患者血糖、血脂、胰岛素抵抗和纤溶活性的影响

目的观察亚莫利治疗12周前后血糖、糖化血红蛋白、血脂、纤溶活性和胰岛素抵抗改善情况。方法初诊2型糖尿病患者33例,于入院后禁食8～12h行口服葡萄糖耐量试验,分别于试验前和口服葡萄糖后2h、用葡萄糖氧化酶法测空腹血糖和餐后2h血糖、以及糖化血红蛋白、酶法测血脂、放射免疫法测胰岛素水平、发色低物法测组织型纤溶酶原激活物和纤溶酶原激活物抑制剂1水平,胰岛素抵抗用Homa-IR表示。结果亚莫利治疗后患者血糖达到良好控制,糖化血红蛋白从治疗前8.6%±3.1%降至7.1%±1.6%(P<0.01),且未见明显低血糖。治疗后血清总胆固醇、低密度脂蛋白胆固醇、甘油三酯均较治疗前明显降低,高密度脂蛋白胆固醇有明显升高(P<0.01)。纤溶活性在治疗后获得显著改善,组织型纤溶酶原激活物从治疗前0.225±0.113kIU/L升高至0.457±0.177kIU/L(P<0.01)。纤溶酶原激活物抑制剂1从治疗前0.898±0.168kAU/L降至0.533±0.215kAU/L(P<0.01)。胰岛素抵抗指标Homa-IR也较治疗前明显降低,治疗前为4.11±0.85,治疗后为2.42±0.91(P<0.05)。结论对初诊2型糖尿病患者,亚莫利具有快速稳定控制血糖、改善脂质代谢和显著减轻胰岛素抵抗的作用,改善组织型纤溶酶原活性的作用。     

黄颜木素对HSC-T6细胞增殖和胶原合成的影响

目的：研究黄颜木素对激活的永生型大鼠肝储脂细胞--HSC-T6细胞增殖和胶原合成的影响。方法：细胞增殖采用结晶紫染色法检测,胶原合成采用3H-脯氨酸掺入法分析。结果：黄颜木素（6.25-50.00μmol/L）以剂量依赖方式显著抑制血小板源生长因子(PDGF)刺激的HSC-T6细胞增殖,并抑制转化生长因子β1(TGFβ1)诱导的细胞内胶原合成。结论：黄颜木素具有抑制激活的肝储脂细胞增殖和胶原合成的作用。     

中医八廓学说考辨

本文对清代以前中医八廓学说进行了全面、系统的分析,考辨了八廓的含义、八廓学说的理论渊源、演变轨迹及围绕八廓学说的争议.     

Self, agency and the surgical collective: detachment

In this article, I describe the socio-technical organisation of surgical rehabilitation. After having gone through surgical intervention, patients are implicated within various types of medical work aimed at adjusting their bodies to post-operative social and material environments. My argument is that the process of re-establishment of a 'self' is mediated through a re-disposition of agency in the socio-technical ensemble upon which the patient depends immediately after surgery. Drawing on one year of ethnographic fieldwork in a neurosurgical clinic, and theoretical resources from science and technology studies, this paper is an attempt to describe how, within surgical post-operative practices, the relational dynamics of social and material components endorsed within those practices may re-institute patients' sense of themselves, and re-organise their relationship with the world and other people. In surgery, the outcome of this dynamic process is the reorganisation of forms of agency for the patient. I will refer to this reorganisation as 'detachment'. It is my contention that this research may contribute to the literature on the experience of chronic illness by specifying the socio-technical conditions for the local achievement of self and agency.     

POST-NATAL DEVELOPMENT OF FACTOR IX

Abstract. Schettini F., De Mattia D., Altomare M. and Montagna O. (University of Bari, Institute of Child Health, Bari, Italy). Postnatal development of factor IX. Acta Paediatr Scand, 69: 53, 1980.—Post-natal development of clotting activity and of antigen level of Factor IX was evaluated in 111 healthy, breastfed, newborn infants, aged 1–30 days. Of these, 80 had received at birth 2 mg of vitamin K₁ orally. Factor IX clotting activity was determined by one-stage assay and antigen level by electroimmunoassay. On the 1st day both antigen level and clotting activity were low and the ratio was 1.01. There was a significant postnatal increase of the two activities of Factor IX during the first three days of life; thereafter both remained constant. No statistical difference in Factor IX activity was found with oral administration of vitamin K₁ after the birth. During the first month of life both clotting activity and antigen level of Factor IX were low as compared to adult values. There was no correlation with age. The Factor IX protein of newborns did not show molecular heterogeneity by crossed-immunoelectrophoresis     

褪黑素对糖尿病患者氧化应激抑制作用和糖脂代谢影响的观察

目的 探讨褪黑素对糖尿病患者氧化应激的抑制作用及糖脂代谢的影响。 方法 1998-12～2003-04东南大学附属中大医院采用随机、单盲、安慰剂平行对照的方法,观察褪黑素及安慰剂对91例糖尿病患者血清丙二醛(MDA)及超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)的影响,并分析上述影响与糖脂代谢变化之间的关系。 结果 治疗前糖尿病患者血清SOD、GSH-Px水平下降,MDA水平上升。褪黑素组8周处理后血清SOD和GSH-Px水平上升,而MDA水平明显下降,与处理前相比差异有显著;安慰剂组处理前后患者血清SOD、GSH-Px及MDA水平无明显变化。褪     

Patient profiles in heart failure with reduced ejection fraction: Prevalence,characteristics, treatments and outcomes in a real-world heart failure population

Aims

The Heart Failure Association of the European Society of Cardiology has recently proposed to optimize guideline-directed medical treatments according to patient's profiles. The aim of this analysis was to investigate prevalence/characteristics/treatments/outcomes for individual profiles.

Methods and results

Patients with heart failure (HF) with reduced ejection fraction (HFrEF) enrolled in the Swedish Heart Failure Registry (SwedeHF) between 2013 and 2021 were considered. Among 108 profiles generated by combining different strata of renal function (by estimated glomerular filtration rate [eGFR]), systolic blood pressure (sBP), heart rate, atrial fibrillation (AF) status and presence of hyperkalaemia, 93 were identified in our cohort. Event rates for a composite of cardiovascular (CV) mortality or first HF hospitalization were calculated for each profile. The nine most frequent profiles accounting for 70.5% of the population had eGFR 30–60 or ≥60 ml/min/1.73 m², sBP 90–140 mmHg and no hyperkalaemia. Heart rate and AF were evenly distributed. The highest risk of CV mortality/first HF hospitalization was observed in those with concomitant eGFR 30–60 ml/min/1.73 m² and AF. We also identified nine profiles with the highest event rates, representing only 5% of the study population, characterized by no hyperkalaemia, even distribution among the sBP strata, predominance of eGFR <30 ml/min/1.73 m² and AF. The three profiles with eGFR 30–60 ml/min/1.73 m² also showed sBP <90 mmHg.

Conclusions

In a real-world cohort, most patients fit in a few easily identifiable profiles; the nine profiles at highest risk of mortality/morbidity accounted for only 5% of the population. Our data might contribute to identifying profile-tailored approaches to guide drug implementation and follow-up.