新运行实用量研究进展及对场所剂量监测的影响

在辐射防护领域,运行实用量用于估算防护量,是场所剂量监测中的重要量值。随着电离辐射粒子类型和能量范围的扩展,现行运行实用量在估算防护量的过程中出现局限。ICRU第95号报告提出了新的运行实用量体系,在定义方式和模体上与防护量相统一,在更广泛的粒子类型和能量范围中实现了对防护量的更好估算。本文重点关注新运行实用量体系在模体应用、转换系数更新、监测仪器的设计和校准等方面对场所剂量监测的影响。     

Vascular Effects of the Polyphenolic Nutraceutical Supplement Taurisolo®: Focus on the Protection of the Endothelial Function

Preservation of vascular endothelium integrity and functionality represents an unmet medical need. Indeed, endothelial dysfunction leads to decreased nitric oxide biosynthesis, which is prodromic of hypertension and hypercoagulability. In this panorama, the nutraceutical supplement Taurisolo^®, a polyphenolic extract from Aglianico cultivar grape, rich in catechin and procyanidins, was evaluated as a vasoprotective, vasorelaxing, anti-hypertensive and anti-coagulant agent in: cell lines, isolated vessels, in vivo models of chronic hypertension and hypercoagulability, and in clinical tests of endothelial reactivity. Taurisolo^® demonstrated to fully protect vascular cell viability from oxidative stimulus at 100 µg/mL and evoke vasorelaxing effects (Emax = 80.6% ± 1.9 and pEC50 = 1.19 ± 0.03) by activation of the Sirtuins-AMPK-pathway. Moreover, Taurisolo^®, chronically administered at 20 mg/Kg/die in in vivo experiments, inhibited the onset of cardiac hypertrophy (heart weight/rat weight = 3.96 ± 0.09 vs. 4.30 ± 0.03), hypercoagulability (decrease of fibrinogen vs. control: p < 0.01) and hypertension (mean of Psys: 200 ± 2 vs. control 234 ± 2 mmHg) and improved endothelial function (Emax = 88.9% ± 1.5 vs. control 59.6% ± 3.6; flow-mediated dilation in healthy volunteers after 400 mg twice daily for 8 weeks vs. baseline: p = 0.019). In conclusion, Taurisolo^® preserves the vascular function against ox-inflamm-ageing process and the consequent cardiovascular accidents.     

RBRVS-KPI模式下公立医院绩效考核体系构建及应用

目的探讨如何将以资源为基础的相对价值比率（RBRVS）与关键绩效指标法（KPI）相结合,运用于公立医院绩效考核体系实践中。方法分析样本医院绩效考核体系的应用效果,根据医院总体目标,经过点值测算、指标选择,建立了一套具有医院特色的改良型RBRVS-KPI模式绩效考核体系。结果经实践,医疗质量和运行效率大幅度提高,在一定程度上促进了医院管理的精细化。结论RBRVS-KPI模式下的绩效考核体系较唯财务导向的绩效模式更能体现医护人员劳动价值,值得探索与推广。     

心脏围手术期心肌肌钙蛋白T临床观察

目的评价心肌肌钙蛋白T(cTnT)作为判断心肌损伤指标的敏感性和特异性。方法对78例心脏手术患者(60例瓣膜替换术、18例动脉导管未闭和心包炎)进行分析。60例患者于术前和主动脉开放后2h测定血液中cTnT,进行阻断时间和cTnT的相关和回归分析;其中20例瓣膜手术患者与18例动脉导管结扎和心包剥脱术患者分别于术前,关胸后1,2,24和48h记录心电图,并抽血测定肌酸激酶(CK)、肌酸激酶-MB(CK-MB)和cTnT。结果60例瓣膜手术患者术前cTnT均在正常值范围内,主动脉开放后2h时,阻断时间和cTnT的相关系数为r=0.875(P＜0.01),回归方程为Y=0.019X-0.026;其中20例瓣膜手术患者心脏经过阻断后,心电图有缺血性改变,周围血液中的CK、CK-MB和cTnT均有明显升高,分别在关胸后2h达到高峰,数值分别为术前的12.6、9.2和257倍;18例行动脉导管结扎和心包剥脱术的患者术前和关胸后的心电图和血液中的cTnT均正常,CK和CK-MB除2例心包炎患者关胸后出现明显变化外,余均未见改变。结论cTnT作为判断心肌损伤的指标,其敏感性和特异性良好,且均优于CK和CK-MB。     

磷酸肌酸停搏液对缺血心肌的保护作用

目的 探讨外源性磷酸肌酸（creatine phosphate,CP）在心脏直视手术中作为添加剂加入心脏停搏液中对缺血心肌的保护作用。方法 66例接受心内直视手术的患者分为对照组（I组）及试验组（Ⅱ组）,各33例。I组使用冷晶体停搏液,Ⅱ组在I组停搏液中加入CP。于不同时段取血样检测5种心肌酶的含量。结果 两组心肌酶含量,术前差异无显著性;术后Ⅱ组心肌酶谱上升幅度低于I组,而下降速度则快于I组。结论 外源性CP加入心脏停搏液中对心肌具有良好的保护作用。     

Surgical management of a pulsatile chest wall mass secondary to an ascending aortic aneurysm in a patient with bovine arch

Ascending aortic pseudoaneurysms are rare, but life‐threatening conditions, that often require intervention. While endovascular techniques have advanced significantly, the majority of these clinical scenarios preclude endovascular options and the primary treatment modality remains open surgical repair. Repair of an aortic pseudoaneurysm eroding through the sternum resulting in a pulsatile chest wall mass is technically challenging. We report the successful repair of a large ascending aortic pseudoaneurysm in a 62‐year‐old male with bovine arch anatomy and prior Type A dissection repair, presenting with contained rupture and a pulsatile chest wall mass.     

Evaluation of N95 respirators,modified snorkel masks and low-cost powered air-purifying respirators: a prospective observational cohort study in healthcare workers

Disposable N95 respirator masks are the current standard for healthcare worker respiratory protection in the COVID-19 pandemic. In addition to shortages, qualitative fit testing can have low sensitivity for detecting poor fit, leading to inconsistent protection. Multiple groups have developed alternative solutions such as modified snorkel masks to overcome these limitations, but validation of these solutions has been lacking. We sought to determine if N95s and snorkel masks with attached high-efficiency filters provide consistent protection levels in healthcare workers and if the addition of positive pressure via an inexpensive powered-air purifying respirator to the snorkel mask would provide enhanced protection. Fifty-one healthcare workers who were qualitatively fitted with N95 masks underwent quantitative mask fit testing according to a simulated workplace exercise protocol. N95, snorkel masks with high-efficiency filters and snorkel masks with powered-air purifying respirators were tested. Respiratory filtration ratios were collected for each step and averaged to obtain an overall workplace protocol fit factor. Failure was defined as either an individual filtration ratio or an overall fit factor below 100. N95s and snorkel masks with high-efficiency filters failed one or more testing steps in 59% and 20% of participants, respectively, and 24% and 12% failed overall fit factors, respectively. The snorkel masks with powered-air purifying respirators had zero individual or overall failures. N95 and snorkel masks with high-efficiency filter respirators were found to provide inconsistent respiratory protection in healthcare workers.     

川陈皮素通过激活SIRT1/FOXO3a信号来减轻肾缺血再灌注损伤

目的：本研究旨在探究川陈皮素（NOB）保护小鼠肾缺血再灌注损伤（RIRI）的可能分子机制。方法：将Balb/c小鼠分为5组（n=6）：假手术组、模型组、NOB组（50 mg/kg）、组蛋白去乙酰化酶沉默信息调节因子1（SIRT1）抑制剂EX527组（5 mg/kg）、NOB+EX527组（50 mg/kg的NOB+5 mg/kg EX527）。在建模前24 h对小鼠进行药物处理。通过阻断小鼠左肾动静脉血流建立RIRI模型。建模24 h后检测肾组织中氧化应激标志物含量。通过苏木精-伊红（HE）染色和天狼星红染色评价肾组织病变和纤维化。通过TUNEL染色检测肾细胞凋亡。通过蛋白质免疫印迹法检测肾组织中SIRT1、叉头框蛋白O3a（FOXO3a）、细胞凋亡和自噬相关蛋白表达。通过实时荧光定量PCR检测肾组织中SIRT1和FOXO3a mRNA的水平。结果：与模型组比较,NOB组小鼠肾脏病变程度减轻,肾脏纤维化面积降低（均P<0.05）。与模型组比较,NOB组肾组织抗氧化作用升高（P<0.05）。与模型组比较,NOB组肾组织中细胞凋亡减少（P<0.05）。与模型组比较,NOB组肾组织中SIRT1和FOXO3a的mRNA和蛋白相对表达量升高,微管相关蛋白轻链(LC)3Ⅱ/LC3Ⅰ蛋白相对表达量升高,而p62降低（均P<0.05）。此外,EX527逆转了NOB对肾脏的保护作用（P<0.05）。结论：NOB通过激活SIRT-1/FOXO3a信号通路介导的自噬来减轻RIRI。     

红芪多糖药理作用及机制的研究进展

红芪是甘肃道地药材,现代药学研究表明红芪多糖是红芪的主要活性成分,是由五碳糖、六碳糖和其衍生物糖醇或糖酸构成的植物多糖,具有免疫调节、抗氧化、抗炎、抗肿瘤、机体保护、防治糖尿病及抗骨质疏松等药理作用。通过对红芪多糖的药理作用进行综述,阐明红芪多糖药理作用可能的机制,为红芪多糖的进一步研究及临床应用提供理论依据。     

多酚在植物中的分布及其生物活性研究进展

天然酚类化合物广泛存在于植物中,资源、种类丰富且具有多种药效如抗氧化、抗炎、抗病毒、抑菌、心脏保护、预防肥胖与糖尿病等多种药效作用。目前,植物多酚应用于食品、医药、化工、畜牧养殖等多个领域,利用纳米、微胶囊等技术可提高其生物利用度,从而产生较好的生物学效应。以植物多酚为研究对象,通过Phenol-Explorer等数据库挖掘,结合文献研究,综述其在植物中的分布、种类、生物活性及开发利用现状,为植物多酚的综合开发利用及植物多酚新资源的发现提供新思路。