社区护理干预对提高糖尿病患者生活质量的影响

对８２例糖尿病患者实施社区护理干预，２个月后评估干预效果：血糖下降，生活质量提高；使疾病对社会活动的影响减少，抑郁和焦虑障碍减轻；本文还讨论了社区护理干预的方法和组织形式     

BMP signaling mediates astrocyte differentiation of oligodendrocyte progenitor cells

Oligodendrocyte precursor cells (OPCs) can differentiate into oligodendrocytes or astrocytes, depending on cellular microenvironments. OPCs, cultured in medium supplemented with 10% (v/v) fetal bovine serum (FBS), give rise to type II astrocytes that express glial fibrillary acidic protein and a cell surface ganglioside that is recognized by A2B5 monoclonal antibody. However, the factors in FBS that direct the astrocyte differentiation are not determined. Moreover, bone morphogenetic proteins (BMPs) have been reported to be involved in astrocyte differentiation of neural progenitor cells. We therefore examined whether BMPs are responsible for the serum-mediated astrocyte differentiation from OPCs. OPCs were isolated from the spinal cords of Wistar rat embryos (at day 14) using the A2B5 antibody. We measured the concentrations of BMP-2 and BMP-4 in FBS and rat and human sera and the expression of mRNAs for three types of BMP receptors (BMPRIa, Ib and II) in OPCs by RT-PCR. The serum samples of the three species contained BMP-2 and BMP-4, as judged by ELISA with each monoclonal antibody, and the BMP receptor mRNAs are expressed in OPCs. When OPCs were cultured in the medium containing 10% FBS, cells (more than 95%) differentiated into type II astrocytes. However, when OPCs were pretreated with noggin, a soluble antagonist of BMP action, the degree of astrocyte differentiation was markedly decreased from 95.39 to 38.36%. Taken together, these results suggest that BMP signaling may be responsible for the serum-mediated astrocyte differentiation of OPCs. Our findings provide new insights into the molecular basis of differentiation of OPCs.     

The early and mid-term results of mitral valve repair for mitral regurgitation in children

Purpose

To review the surgical techniques and mid-term results of mitral valve repair in children with moderate or severe mitral regurgitation (MR).

Methods

One hundred and seven children with moderate or severe MR, aged 19.6 ± 8.5 months, were enrolled in this study. The surgical techniques used for mitral valve repair varied according to the mitral valve morphology, and included annuloplasty, annuloplasty ring, cleft closure, reconstruction of the posterior leaflet, etc. The concomitant cardiac anomalies were treated simultaneously. The results of repair were evaluated by transesophageal echocardiography performed during the operation and by serial transthoracic echocardiography performed during the follow-up.

Results

One hundred and six cases had no more than mild regurgitation intraoperatively, whereas only one case had moderate regurgitation. This patient underwent redo repair immediately, and the subsequent regurgitation was trivial. The in-hospital mortality rate was 0.9 % (1/107). The average follow-up was 46.5 ± 8.2 months. One patient died of heart failure 10 months postoperatively. The freedom from moderate or severe regurgitation after mitral valve repair was 92.3 ± 3.3 %.

Conclusion

Pediatric patients with moderate or severe MR require early surgical treatment. The early and mid-term results of mitral valve repair in pediatric patients were satisfactory.     

Effect of mycophenolate mofetil on CD26 expression in the kidneys of diabetic rats

Objective To investigate the expression of CD26 (dipeptidyl peptidase 4) in the kidney tissues of diabetic rats and the effects of mycophenolate mofetil (MMF) on the renal CD26 expression. Methods Wistar rats were randomly divided into three groups: normal control group (NC group, n=7), diabetic model group (DM group, n=7) and MMF-treated group (MMF group, n=7). Wistar rats were fed with high-sucrose-high-fat diet and injected with streptozotocin into abdominal cavity to induce diabetes. Sixteen weeks later, blood glucose (BG), blood urea nitrogen (BUN), serum creatinine (Scr), renal hypertrophy index (kidney weight/body weight) and 24 hour urinary protein (24Upro) were measured. The number of CD3+/CD4+ T cells in renal tissues were measured through flow cytometry. The expression of CD26 in kidney was examined by using Western blotting and immunohistochemistry. Results Compared with NC group, BG, BUN, Scr, kidney weight/body weight, 24Upro were significantly increased in DM group (P﹤0.05). Except BG and kidney weight/body weight, the above-mentioned parameters were lower in MMF group compared with that in DM group (P﹤0.05). Intrarenal CD3+/CD4+ T cells were significantly up-regulated in DM group compared with that in NC group (P﹤0.01). CD26 in renal tissue was mainly expressed in T lymphocytes of renal interstitium. CD26 expression in DM group was significantly higher than that in NC group, and also higher than that in MMF group (P﹤0.05). In DM group, CD26+ T lymphocytes infiltration of renal interstitium was positively correlated with 24Upro (r2=0.770, P﹤0.05). Conclusions CD26 is related with diabetic nephropathy. MMF maybe inhibit T lymphocytes infiltration to reduce the expression of CD26 in renal interstitium, thus protecting the kidney function.     

乳腺癌患者术后认知闭合需要与坚韧性人格的关系研究

目的探讨乳腺癌患者认知闭合需要与坚韧性人格的关系,为护士对患者开展针对性健康教育提供参考。方法对319例乳腺癌患者运用中文版认知闭合需要量表和坚韧人格量表进行调查。结果乳腺癌患者认知闭合需要得分为206.94±28.91,坚韧性人格得分为46.61±8.25;认知闭合需要和坚韧性人格呈显著负相关,认知闭合需要的决断性及对结构的需求能预测坚韧性人格(均P0.01)。结论乳腺癌患者认知闭合需要程度较高,坚韧性程度较低,认知闭合需要能预测坚韧性人格。护士可针对乳腺癌患者的决断性与对结构的需求给予相应引导,以增强其坚韧性人格。     

胆碱能抗炎通路对失血性休克大鼠保护作用的研究

目的探讨胆碱能抗炎通路的抗休克作用及其可能的机制。方法采用改良Wiggers法复制失 血性休克动物模型。30只成年雄性SD大鼠随机分为假失血组(假Hem组)、失血性休克组(Hem组)、迷走神 经切断组(VGX组)、迷走神经电刺激组(STM组)、胆碱酯酶抑制组(THA组)和N受体拮抗组(α-BGT 组)。将左迷走神经远端连接刺激电极,于制模成功后即刻行电刺激(5 V、2 ins、1 Hz)12 min。颈总动脉置管连 续监测平均动脉压(MAP),模型稳定后45 min测定各组动物血浆肿瘤坏死因子-α(TNF-α)和肝组织核因 子-kB(NF-kB)含量。结果失血性休克动物的MAP持续处于低水平状态。与假Hem组比较。Hem组血浆 TNF-α含量明显升高(P<0.01).肝组织NF-kB表达明显增强。迷走神经电刺激组动物MAP迅速升高,血 浆TNF-α含量较Hem组显著降低(P均<0.01),肝组织NF-kB表达减弱。迷走神经离断后静脉注射胆碱 醣酶抑制剂四氢氨基丫啶(THA)可产生与电刺激迷走神经类似的作用。但电刺激前静脉注射N胆碱能受体 α7亚单位阻断剂(α-BGT),则可消除电刺激迷走神经的抗休克效应。结论 胆碱能抗炎通路具有潜在的抗失 血性休克作用,其机制可能是通过抑制休克病程中过度的全身性炎性反应而实现的。     

Involvement of Protease-Activated Receptor 2 in Nociceptive Behavior in a Rat Model of Bone Cancer

Treatment for bone cancer pain remains a clinical challenge due to a poor understanding of the underlying mechanisms. Protease-activated receptor 2 (PAR2), a receptor for inflammatory proteases, has been implicated in nociceptive signaling under both normal and pathologic pain states. However, little is known of the role of PAR2 in cancer-induced bone pain. Here we investigated the potential role of PAR2 in a rat model of bone cancer pain. The model of bone cancer pain was induced by inoculating Walker 256 into the tibia bone cavity of rats and verified by X-ray imaging, pathology, and behavior assessments. The rats with bone cancer exhibited marked mechanical allodynia, thermal hyperalgesia, and signs of spontaneous nocifensive behavior. Subcutaneous administration of the PAR2 antagonist FSLLRY-NH2 almost completely abolished mechanical allodynia and thermal hyperalgesia but had no effects on spontaneous pain behavior in the rats with bone cancer. Immunohistochemical study revealed that the expression of PAR2 was significantly increased in large- and medium-sized dorsal root ganglia (DRG) neurons but not in small-sized neurons after Walker 256 inoculation. These results suggest that the increased expression of PAR2 in the DRG may contribute to the development of mechanical allodynia and thermal hyperalgesia associated with bone cancer rats. PAR2 might become a novel target for the treatment of pain in patients with bone cancer.     

Gabapentin Enhances the Morphine Anti-Nociceptive Effect in Neuropathic Pain via the Interleukin-10-Heme Oxygenase-1 Signalling Pathway in Rats

In the present study, we investigated the anti-inflammatory mechanisms by which gabapentin enhances morphine anti-nociceptive effect in neuropathic pain in rats and the interaction between the anti-nociceptive effects of gabapentin on morphine and the interleukin (IL)-10-heme-oxygenase (HO)-1 signal pathway in a rat model of neuropathic pain. The neuropathic pain model was induced via a left L5/6 spinal nerve ligation (SNL) in rats. The anti-nociceptive effect of gabapentin and IL-10 on morphine was examined over a 7-day period, and the effects of the anti-IL-10 and HO-1 inhibitor zinc protoporphyrin (ZnPP) on gabapentin/morphine co-injection were assessed. Drug administration was given over 7 days, and on day 8, both anti-inflammatory cytokine IL-10, a stress-induced protein HO-1 and pro-inflammatory cytokines IL-1β, IL-6 and TNF-α were measured. Gabapentin attenuated morphine tolerance over 7 days of co-administration, and reduced the expression of pro-inflammatory cytokines but increased IL-10 and HO-1 expression. The effect of gabapentin on morphine was partially blocked using the anti-IL-10 antibody or the HO-1 inhibitor zinc protoporphyrin. Our findings indicated that the anti-nociceptive effects of gabapentin on morphine might be caused by activation of the IL-10-HO-1 signalling pathway, which resulted in the inhibition of the expression of pro-inflammatory cytokines in neuropathic pain in the rat spinal cord.     

Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer

Background

Accurate clinical staging of non-small cell lung cancer (NSCLC) is essential for developing an optimal treatment strategy. This study aimed to determine the predictive risk factors for lymph node metastasis, including both N1 and N2 metastases, in clinical T1aN0 NSCLC patients.

Methods

We retrospectively evaluated clinical T1aN0M0 NSCLC patients who showed no radiologic evidence of lymph node metastasis, and who had undergone surgical pulmonary resection with systematic mediastinal node dissection or sampling at the First Affiliated Hospital of Zhejiang University between January 2011 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for node metastasis.

Results

Pathologically positive lymph nodes were found in 16.2% (51/315) of the patients. Positive N1 nodes were found in 12.4% (39/315) of the patients, and positive N2 nodes were identified in 13.0% (41/315) of the patients. Some 9.2% (29/315) of the patients had both positive N1 and N2 nodes, and 3.8% (12/315) of the patients had nodal skip metastasis. Variables of preoperative radiographic tumor size, non-upper lobe located tumors, high carcinoembryonic antigen (CEA) levels and micropapillary predominant adenocarcinoma (AC) were identified as predictors for positive N1 or N2 node multivariate analysis.

Conclusions

Pathologically positive lymph nodes were common in small size NSCLC patients with clinical negative lymph nodes. Therefore, preoperative staging should be performed more thoroughly to increase accuracy, especially for patients who have the larger size, non-upper lobe located, high CEA level or micropapillary predominant ACs.     

磁共振弥散加权成像对胃癌淋巴结转移的诊断价值

目的探讨术前磁共振弥散加权成像（DWI）对胃癌淋巴结转移的诊断价值。方法对2011年12月至2012年12月间南京大学医学院附属鼓楼医院收治的52例胃癌患者进行磁共振DWI检查．对应术中标记的淋巴结,分别测量淋巴结的表观扩散系数（ADC）值及短径,并与术后病理结果相对照。采用受试者工作特征曲线（ROC）评价ADC值及短径对胃癌淋巴结转移的诊断价值。结果DWI检测到转移性淋巴结180枚,非转移性淋巴结57枚,均为高信号。DWI上转移性淋巴结ADC值明显低于非转移性淋巴结[（1．059±0．196）×10^-3mm2／s比（1．402±0．285）×10^-3mm2／s,P=0．000];以1．189×10^-3mm2／s作为ADC值评估转移性淋巴结的最佳阈值,其敏感度、特异度和曲线下面积（AUC）分别为78．9％、72．8％和0．840,其对术前N分期诊断的总体准确率为75．0％（39／52）。DWI上转移性淋巴结短径明显长于非转移性淋巴结[（8．08±3．99）mm比（6．75±2．70）mm,P=0．005];以5．05mm作为淋巴结短径评估转移性淋巴结的最佳阈值时,其敏感度、特异度和AUC分别为88．3％、29．8％和0．602,其对术前N分期诊断的总体准确率为67．3％（35／52）。结论磁共振DWI对胃癌淋巴结转移具有较高的诊断价值,以ADC值及淋巴结短径作为诊断标准可用于术前N分期的诊断。