Cardiac Denervation for Arrhythmia Treatment with Transesophageal Ultrasonic Strategy in Canine Models

Stellate ganglion (SG) modification has been investigated for arrhythmia treatment. In this study, transesophageal SG imaging and intervention were explored using a homemade 30F integrated focused ultrasonic catheter in healthy mongrel canines in vivo. Anatomic details of SGs were ultrasonically imaged and evaluated. SG had a heterogeneous echoic structure and characteristic profiles sketched by hyper-echoic outlines in an ultrasonogram. Left SGs in the experimental group were successfully ablated through the esophagus under ultrasonic guidance provided by the catheter itself. Two weeks after the ablation, the QT and QTc of the experimental group decreased compared with those of the sham group and at baseline (both p values < 0.001). Histologic examination revealed that left SGs were destroyed. No major complications were observed. This approach may be further explored as a method for ganglia remodeling evaluation and as a strategy of ganglia modification for arrhythmia and for other diseases.     

Loss of GRB2 associated binding protein 1 in arteriosclerosis obliterans promotes host autophagy

Background:Arteriosclerosis obliterans (ASO) is a major cause of adult limb loss worldwide. Autophagy of vascular endothelial cell (VEC) contributes to the ASO progression. However, the molecular mechanism that controls VEC autophagy remains unclear. In this study, we aimed to explore the role of the GRB2 associated binding protein 1 (GAB1) in regulating VEC autophagy.Methods:In vivo and in vitro studies were applied to determine the loss of adapt protein GAB1 in association with ASO progression. Histological GAB1 expression was measured in sclerotic vascular intima and normal vascular intima. Gain- and loss-of-function of GAB1 were applied in VEC to determine the effect and potential downstream signaling of GAB1.Results:The autophagy repressor p62 was significantly downregulated in ASO intima as compared to that in healthy donor (0.80 vs. 0.20, t = 6.43, P < 0.05). The expression level of GAB1 mRNA (1.00 vs. 0.24, t = 7.41, P < 0.05) and protein (0.72 vs. 0.21, t = 5.97, P < 0.05) was significantly decreased in ASO group as compared with the control group. Loss of GAB1 led to a remarkable decrease in LC3II (1.19 vs. 0.68, t = 5.99, P < 0.05), whereas overexpression of GAB1 significantly led to a decrease in LC3II level (0.41 vs. 0.93, t = 7.12, P < 0.05). Phosphorylation levels of JNK and p38 were significantly associated with gain- and loss-of-function of GAB1 protein.Conclusion:Loss of GAB1 promotes VEC autophagy which is associated with ASO. GAB1 and its downstream signaling might be potential therapeutic targets for ASO treatment.     

贵州省"5+3"模式订单定向医学毕业生的离职意愿及影响因素研究

背景 我国基层全科医生的离职意愿较高，调查其离职意愿并分析影响因素，可以为减少基层卫生人才流失提供思路。目前，完成"5+3"模式（5年临床医学本科教育+3年住院医师规范化培训）培养的订单定向医学毕业生逐步履约进入基层工作，而针对该部分全科医生离职意向的研究相对较少。 目的 调查贵州省"5+3"模式订单定向医学毕业生回归基层工作后的离职意愿及影响因素，为完善吸引卫生人才留任、建设基层全科医生队伍相关政策提供依据。 方法 以贵州省截至2020年底已完成"5+3"模式培养并履约到基层医疗卫生机构工作的2015—2017级订单定向医学毕业生为研究对象。于2021-01-20至2021-02-10对其开展电子问卷调查，内容包括毕业生的一般情况、职业满意度、离职意愿、服务期满后职业方向。共回收问卷347份，其中有效问卷311份，问卷有效回收率为89.6%。采用单因素分析及多元逐步线性回归分析全科医生离职意愿的影响因素。 结果 贵州省"5+3"订单定向医学毕业生的整体离职意愿得分为（3.98±0.98）分，具有离职倾向者229例（73.6%）。不同性别、单位地理位置、每日工作量者的离职意愿得分比较，差异有统计学意义（P<0.05）。多元逐步线性回归分析显示，单位负责人对待下属的方式、在工作中获得的成就感、对当前收入满意程度、家人对工作的支持程度、当地激励政策执行程度是"5+3"订单定向医学毕业生离职意愿的影响因素（P<0.05）。服务期满后，计划留任原基层医疗卫生机构者12例（3.9%），计划去其他基层医疗卫生机构者21例（6.7%），计划离开基层去上级医院工作者196例（63.0%），计划攻读全日制硕士学位者60例（19.3%）。 结论 贵州省"5+3"模式订单定向医学毕业生的离职意愿较高，预计服务期满后基层全科人才流失较多，需从提高收入、重视全科医生心理需求、优化全科医生培养与使用、发展基层医疗卫生机构、加强全科宣传等方面着手改善。     

早期肠内营养支持对胃癌术后患者肠黏膜屏障功能保护的研究进展

胃癌患者在手术应激状况下，内脏血流减少，肠黏膜处于低灌注状态，易发生肠黏膜损伤。此外，手术刺激可导致肠黏膜充血、水肿、糜烂，加重肠黏膜损伤。近年来，肠内营养被作为保护肠黏膜屏障功能的有效手段。早期肠内营养在肠黏膜屏障功能保护中的作用机制已被证实，然而不同研究结果有一定差异。本研究综述了国内外有关胃癌术后患者行早期肠内营养支持的相关研究，整理、分析既往研究的结论和争议，为早期肠内营养支持的推广应用提供参考。     

全结构化电子护理记录单的开发与临床应用评价

目的开发全结构化电子护理记录单,评价其应用效果。方法设计全结构化电子护理记录单并在南院区投入使用,北院区仍采用自由文本输入的方式记录电子护理记录单。实施1年后从2个院区各抽取230份出院病历对比护理记录,通过查看录像资料对比护士的记录效率。结果南院区护理记录结构正确率、符合专科护理指南率、护理诊断/评价及护理措施记录量与合格率显著高于北院区(均P<0.01);2个院区相同科室(内分泌科、儿科除外)护理记录时间比较,差异有统计学意义(均P<0.01)。结论全结构化电子护理记录单能提高护理书写质量和数据质量,但用于部分专科会增加记录时间,仍需要进一步优化。     

VTA/SN-NAc通路及其参与痛信息和痒信息调控的机理

中脑腹侧被盖区(VTA)/黑质(SN)至伏核(NAc)通路是脑内多巴胺系统和与奖赏相关的重要通路,主要参与机体药物成瘾、动机等功能。痛刺激可激活VTA/SN-NAc通路,说明该通路可能直接参与痛信息的传递与调控。VTA/SN-NAc通路可能通过内侧前额叶皮质(mPFC)直接或间接提高脊髓背角处的多巴胺浓度,激活脊髓背角内的多巴胺2型受体(D2R),抑制脊髓背角的痛敏神经元的兴奋性从而起到镇痛作用。该通路不仅间接通过奖赏系统缓解瘙痒的症状,还能直接调控搔抓行为,参与对痒觉信息的调控。因此,VTA/SNNAc通路今后可能成为临床治疗急性和慢性痛和痒的新靶点。     

Gastrointestinal immunopathology of food protein–induced enterocolitis syndrome and other non-immunoglobulin E–mediated food allergic diseases

ObjectiveTo provide a concise summary of the current literature regarding gastrointestinal immunopathology of food protein–induced enterocolitis syndrome (FPIES) and other non-immunoglobulin E (IgE)–mediated food allergic diseases.Data SourcesData were extracted from PubMed, MEDLINE, and ScienceDirect databases.Study SelectionsOriginal articles, review articles, and guidelines published in the past 5 years in peer-reviewed journals were first summarized. The original articles cited were then reviewed and relevant results were extracted.ResultsPatients with FPIES and non-IgE–mediated food allergic diseases developed vomiting, diarrhea, and food aversion expelled food allergen from their bodies. Aside from T helper type 2 (T_H2) immunity, T_H1, T_H17, innate immunity, and epithelial mucosal barrier defect were also found to be important in the pathogenesis. Eosinophils, widely identified in the biopsy samples, were key players or were late-recruited cells for tissue repairs in those diseases. Intestinal dysbiosis and their metabolites stimulated enterochromaffin cells or enteroendocrine cells to produce serotonin, interfering with intestinal motility and subsequently affecting brain function. FPIES and non-IgE–mediated food allergic diseases were likely part of the atopic march. Allergic inflammation in intestinal mucosa might result in subsequent inflammation in the airway mucosa, suggesting the theory of “one mucosa, one disease.”ConclusionThe immune responses of FPIES and non-IgE–mediated food allergic diseases were not limited to the gastrointestinal tract, but also trigger wider inflammatory responses beyond it. Further research will be required to determine the systemic effect and intestinal microbiome of those diseases.     

雾化吸入布地奈德治疗AECOPD合并2型糖尿病患者疗效及对肺通气功能和糖代谢的影响

目的分析雾化吸入布地奈德治疗慢性阻塞性肺疾病急性加重(AECOPD)合并2型糖尿病(T2DM)患者疗效及对肺通气功能和糖代谢指标的影响。 方法选择四川大学华西医院2019年1月至2020年5月诊治的120例AECOPD合并T2DM患者作为对象，根据非随机临床同期对照研究及患者自愿原则分为对照组58例和观察组62例，其中对照组给予低剂量布地奈德治疗，观察组给予高剂量布地奈德治疗。比较两组患者治疗前后肺通气功能、糖代谢指标和炎性因子水平变化，并评估疗效和安全性。 结果两组患者治疗有效率比较无显著差异(P>0.05)；与治疗前比，两组患者治疗后肺通气功能指标均显著升高，但观察组较对照组升高更为显著(P<0.05)；两组患者之间及其治疗前后糖代谢指标均无显著差异(P>0.05)；与治疗前比，两组患者治疗后炎症因子水平均显著降低，但观察组较对照组降低更为显著(P<0.05)；两组不良反应发生率比较无统计学意义(P>0.05)。 结论布地奈德雾化吸入治疗AECOPD合并T2DM安全有效，对糖代谢指标无明显影响，但高剂量的布地奈德对于患者肺通气功能和炎症水平改善效果更好。