生石膏治疗小儿发高烧36例

[目的]探讨生石膏对小儿发高烧的治疗效果。[方法]36例临床患者,均予以大剂量生石膏治疗,或适当加辅佐药配合治疗。[结果]36例患者用药后都达到了退烧的满意效果。其中24h内退烧者4例,占11.1%;24～48h退烧者25例,占69.4%;48h后退烧者7例,占19.5%。[结论]生石膏治疗小儿发高烧有较好疗效。     

心电图在急性肺栓塞诊断中的应用价值

目的探讨心电图在急性肺栓塞诊断中的应用价值。方法回顾性分析2008年1月～2010年1月在我院住院确诊的APE患者的心电图变化。结果溶栓加抗凝治疗65例,单纯抗凝治疗10例。治疗后病损肺段数减少（5．20±2．18）个。治疗前后行心电图检查,在溶栓后心电图变化的基础上,于出院前（约在溶栓3—4周）心电图又发生一些改变,如RⅡ增加,RⅢ减小,QⅢ减小;TⅢ变直立20例次,TV2直立12例次。结论肺栓塞的心电图变化为一过性、多变性改变,但仍有一些特征可循,所以要提高警觉、仔细分析、动态观察其心电图变化并结合临床特点和辅助检查作出正确的判断,提高心电图在急性肺栓塞诊断中的应用价值。     

肺癌组织中CD44s、CD44v6的表达及其临床意义

目的探讨标准型CD44（CD44s）和变异型CD44（CD44v6）在肺癌组织中的表达及其临床意义。方法应用免疫组织化学法检测96例原发性肺癌患者组织CD44s和CD44v6的表达情况。结果CD44s和CD44v6在小细胞肺癌患者中不表达,而表达于非小细胞肺癌（NSCLC）患者中,且CD44s和CD44v6在鳞癌中的表达强度高于腺癌;在NSCLC患者中CD44s强表达于高分化肺癌组织中,而CD44v6高表达于低分化肺癌组织中;在淋巴结转移的患者中CD44v6强表达,而CD44s表达水平则较低或不表达;早期肺癌患者多强表达CD44s,而进展期肺癌多强表达CD44v6。结论CD44s和CD44v6可作为一项评价肺癌的组织病理类型、淋巴结是否转移、临床分期及预后的重要指标。     

加味痛泻要方治疗腹泻型肠易激综合征的临床疗效

为观察加味痛泻要方治疗腹泻型肠易激综合征（IBS）的临床疗效,我们将100例符合罗马Ⅲ诊断标准的IBS患者随机分为治疗组和对照组,各50例。治疗组采用加味痛泻要方治疗;对照组则以得舒特治疗,同时口服培菲康调节肠道菌群。结果显示,治疗组痊愈10例,显效17例,有效18例,无效5例,总有效率为90％（45／50）;对照组痊愈7例,显效13例,有效15例,无效15例,总有效率为70％（35／50）。治疗组疗效明显优于对照组,P〈0．05。且治疗组在腹痛、泄泻症状改善,以及不良反应方面均明显优于对照组。结果表明,加味痛泻要方治疗IBS疗效优于单纯西药治疗。     

Effectiveness of a double-carbapenem combinations against carbapenem-resistant Gram-negative bacteria

The emergence of carbapenem-resistant organisms posed considerable threat to global health while only limited treatment options are available and led to efforts to discover a novel way to treat them. To evaluate in vitro synergistic activity of meropenem plus ertapenem, a total of 203 carbapenem-resistant strains, collected from 12 provinces and municipalities in China, were examined with a dual carbapenem combination therapy. The statistical software R was used for analysis. Two hundred and one (201) of carbapenem-resistant strains mainly produced four types of carbapenemase: KPC-2 (n = 142, 69.95%), OXA-232 (n = 7, 3.45%), NDM (n = 38, 18.72%; 36 NDM-1, 1 NDM-4, 1 NDM-5), and IMP (n = 15, 7.39%; 1 IMP-26, 10 IMP-30, 4 IMP-4). Fifty-one out of two hundred and three (51/203 or 25.12%) of the examined strains showed a synergistic effect for the meropenem plus ertapenem combination throughout the checkerboard method, while only three isolates showed potential clinically relevant synergy (3/203, 1.48%). An additive effect was observed in 55/203 (27.09%) of the examined strains. Ninety-seven of the examined isolates (47.78%) showed fractional inhibitory concentration (FIC) greater or equal to 2 (indicating antagonism). The synergistic activity of meropenem plus ertapenem combination suggests this combination can be a possible way to treat the infection caused by the carbapenem-resistant organisms, especially for IMP or NDM producer with a lesser minimum inhibitory concentration (MIC) and the infected individual who was not recommended to use colistin or tigecycline.     

PI3K/AKT pathway mediates the antidepressant- and anxiolytic-like roles of hydrogen sulfide in streptozotocin-induced diabetic rats via promoting hippocampal neurogenesis

We have previously demonstrated that hydrogen sulfide (H₂S), the third endogenous gasotransmitter, ameliorates the depression- and anxiety-like behaviors in diabetic rats, but the underlying mechanism remains unclear. The present was aimed to investigate whether the hippocampal phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway mediates H₂S-ameliorated depression- and anxiety-like behaviors in diabetic rats by improving the hippocampal neurogenesis. The depression-like behaviors were examined by Tail suspension test (TST), the anxiety-like behaviors were examined by Elevated plus maze test (EPM), and the locomotor activity was detected by Open Field Test (OFT). The expressions of doublecortin (DCX), neuron-specific nuclear protein (NeuN), glial fibrillary acidic protein (GFAP), p-AKT, and AKT in the hippocampus were determined by Western blot analysis. Results showed that NaHS, a donor of exogenous H₂S, not only activated the hippocampal PI3K/AKT pathway, as evidenced by the increase of phosphorylated AKT, but also favorably reversed streptozotocin (STZ)-disturbed hippocampal neurogenesis, as evidenced by the increases in the expressions of DCX and NeuN as well as the decrease in the expression of GFAP in the hippocampus of STZ-induced diabetic rats. Furthermore, inhibited PI3K/AKT pathway by LY294002 significantly abolished H₂S-exerted the improvement of hippocampal neurogenesis and the antidepressant- and anxiolytic-like effects in the STZ-induced diabetic rats. Taken together, these results uncover that the activation of hippocampal PI3K/AKT pathway plays an important role to restore hippocampal neurogenesis and subsequently to mediate the antidepressant- and anxiolytic-like roles of H₂S in STZ-induced diabetic rats and enhance our understanding of the robustness of H₂S as a therapeutic strategy for treatment of depression in diabetes mellitus.     

血液透析患者中心静脉置管的感染因素分析及对策

目的分析血液透析患者中心静脉置管的感染因素分析及对策。方法医院2009年7月-2011年6月共行中心静脉置管术112例,对其发生感染患者进行分析。结果 112例行中心静脉置管术患者中,22例发生医院感染,感染率为19.6%;股静脉感染率为21.9%,稍高于颈内静脉的17.1%及锁骨下静脉的15.4%,然而感染率差异无统计学意义;置管<10d患者的感染率为11.5%,低于置管10～20、>20d患者的17.4%及27.5%,差异有统计学意义(P<0.05);糖尿病肾病患者的感染率为31.6%,显著高于其他基础疾病(P<0.05);中心静脉置管血流通畅患者感染率为17.9%,血流不通畅感染率为22.2%,差异无统计学意义。结论为减少感染发生,首选颈内静脉或锁骨下静脉置管应作为中心静脉置管的部位,尽可能缩短导管留置时间;要严格无菌操作,提高护理质量能有效预防感染发生。     

Evaluation of immunogenicity and protection of the Mic1-3 knockout Toxoplasma gondii live attenuated strain in the feline host

Toxoplasmosis is a zoonotic disease caused by the parasite Toxoplasma gondii. Up to a third of the global human population is estimated to carry a T. gondii infection, which can result in severe complications in immunocompromised individuals and pregnant women. Humans and animals can become infected by ingesting either tissue cysts containing T. gondii bradyzoites, from raw or undercooked meat, or sporulated oocysts from environmental sources. T. gondii oocysts are released in the faeces of cats and other felids, which are the parasite's definitive hosts, leading to environmental contamination. Therefore, vaccination of the feline host against T. gondii is an interesting strategy to interrupt the parasitic life cycle and subsequently limit contamination of intermediate hosts. With this goal in mind, we tested in cats, an attenuated live strain of T. gondii deleted for the Mic1 and Mic3 genes (Mic1-3KO) that was previously shown to be an efficient vaccine candidate in mouse and sheep models. Subcutaneous or oral vaccination routes induced a high specific antibody titer in the cat sera, indicating that the Mic1-3KO strain is immunogenic for cats. To assess protection induced by the vaccine candidate strain, we followed oocysts shedding by vaccinated cats, after oral challenge with a T. gondii wild-type strain. Surprisingly, a high antibody titer did not prevent cats from shedding oocysts from the challenge strain, regardless of the vaccination route. Our results show that the Mic1-3KO vaccine candidate is immunogenic in the feline host, is well tolerated and safe, but does not confer protection against oocysts shedding after natural infection with wild type T. gondii. This result highlights the particular relationship between T. gondii and its unique definitive host, which indicates the need for further investigations to improve vaccination strategies to limit environmental and livestock contaminations.     

医院药师职业承诺的调查研究

目的了解医院药师的职业承诺现状,提升药房工作效率,提高患者对医院的满意度。方法对东阳市人民医院及周边医院53例医院药师的职业承诺现状进行调查分析,初步了解医院药师的职业承诺状况及影响因素。结果就职业承诺的三个维度来看,继续承诺水平最高,情感承诺较低。三大考察因素中,职称和年龄对医院药师的职业承诺影响较大(P<0.05或0.01),性别对医院药师的职业承诺影响较小,差异无统计学意义(P>0.05)。结论浙江省东阳市人民医院及周边医院药师的职业承诺水平处于一般状况,低职称及低年龄的药师相对缺乏稳定性,对所在岗位的满意度较低。     

罗格列酮对冠心病合并2型糖尿病患者MMP的影响

目的:研究罗格列酮治疗冠心病合并2型糖尿病患者时血清基质金属蛋白酶(MMP)-2、9的变化,以探讨罗格列酮减少动脉粥样硬化(AS)炎症反应、稳定斑块的作用机制。方法:选取冠状动脉造影证实的冠心病患者62例,其中单纯冠心病者34例,合并2型糖尿病者28例,两组均给予血管紧张素转化酶抑制剂、硝酸脂类、抗血小板等常规治疗,合并2型糖尿病者给予口服罗格列酮4mg,2次/d,共12周;比较两组间及治疗前、后MMP-2及9含量变化。结果:与单纯冠心病患者比,冠心病合并2型糖尿病患者血浆中MMP-2及MMP-9水平明显升高(P<0.01);经罗格列酮治疗12周后血清MMP-2、9水平较治疗前明显降低(P<0.01)。结论:罗格列酮可降低冠心病合并糖尿病患者血清MMP-2及9水平,从而可减少冠状动脉粥样斑块基质成分的降解和炎症反应,起到稳定动脉粥样硬化斑块的作用。