血小板源生长因子受体结合域基因与乙型肝炎核心抗原基因融合克隆的构建

血小板源生长因子在动脉粥样硬化发生中起着重要的作用为了阻断血小板源生长因子致动脉粥样硬化的作用，我们利用基因工程技术试图制备血小板源生长因子受体结合域与乙型肝炎核心抗原的融合蛋白，并以此蛋白作为疫苗，探讨了基防治动粥样硬化发生发展是可能性，本文报道血小板源生长因子受体结合域基因的化学合成以及与乙型肝炎核心抗原基因的融合克隆的构建，经双酶切，序列分析证实，这两种基因融合成功。     

悬吊模式下的核心稳定性训练对脑卒中患者平衡功能的影响

目的 观察悬吊训练模式下的核心稳定性训练对脑卒中患者平衡功能的影响。 方法 选取符合标准的60例脑卒中患者按随机数字表法分成对照组和实验组,每组30例。2组患者均接受脑卒中后常规的康复训练;在此基础上,对照组进行传统核心稳定性训练,实验组则进行悬吊训练模式下核心稳定性训练,每日训练1次,每周5次,连续训练4周。分别于治疗前和治疗4周后（治疗后）,采用Prokin平衡仪对2组患者的站立位平衡能力进行评定,并记录患者睁眼、闭眼平衡测试时的运动轨迹长度及运动椭圆面积;同时利用表面肌电图（sEMG）记录平衡测试时双侧竖脊肌和多裂肌肌电信号的平均肌电（AEMG）值。 结果 ①平衡功能变化：治疗后,睁眼闭眼平衡测试,2组患者压力中心的运动轨迹长度、运动椭圆面积均少于组内治疗前（P<0.01）;实验组患者压力中心的运动轨迹长度［睁眼（226.40±88.59）mm、闭眼（312.07±118.45）mm］、运动椭圆面积［睁眼（198.83±84.99）mm2、闭眼（303.50±123.86）mm2］均少于对照组［运动轨迹长度：睁眼（291.23±117.71）mm、闭眼（405.27±181.05）mm;运动椭圆面积：睁眼（250.47±109.23）mm2、闭眼（379.03±144.91）mm2］,组间差异有统计学意义（P<0.05）。②表面肌电图变化：治疗后,睁眼和闭眼平衡测试时,2组患者双侧竖脊肌与多裂肌的AEMG值均大于组内治疗前（P<0.01）;闭眼平衡测试时,实验组患侧多裂肌的AEMG值［（58.48±10.40）μV］显著大于对照组［（52.39±10.63）μV］,且组间差异有统计学意义（P<0.05）。 结论 悬吊训练模式下的核心稳定性训练能显著改善脑卒中患者的平衡功能,其效果优于传统核心稳定性训练。     

穿刺活检在儿童及青少年颌面部肿瘤中的诊断价值

目的:探讨穿刺活检诊断儿童及青少年颌面部肿瘤的准确性和安全性。方法:收集2017年1月—2018年7月上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科门诊收治的18岁以下颌面部肿瘤病例共10例,其中男6例,女4例,平均年龄12岁（8~18岁）,所有患者均采用穿刺活检进行诊断。粗针穿刺：使用16G穿刺针取3~5条组织;细针穿刺：用10 mL针筒吸取细胞。对比穿刺病理及术后病理诊断,并记录穿刺后并发症情况。结果:粗针穿刺共4例,3例接受手术治疗。1例穿刺病理为纤维母细胞/肌纤维细胞性肿瘤。2例为横纹肌肉瘤,1例诊断为非肿瘤性病变。细针穿刺共6例,5例接受手术治疗。1例穿刺病理为朗格汉斯细胞组织细胞增生症或巨细胞肉芽肿待排;1例穿刺见大量血液;1例为小圆细胞肿瘤;1例为左下颌下淋巴结穿刺见大量炎症细胞;1例为上皮性恶性肿瘤;1例为横纹肌肉瘤。粗针及细针穿刺后进行手术的患者,大体标本病理诊断与穿刺病理诊断结果均一致。穿刺后均未发生大出血、伤口感染、肿瘤穿刺通道种植转移等并发症。结论:穿刺活检诊断儿童及青少年颌面部肿瘤安全、准确。     

药学学科研究生培养目标模型构建

利用Nvivo11软件对国内58所和美国30所药学院校的培养目标文本进行质性分析,探索了两国培养目标文本的结构和差异,根据学生发展核心素质理论、核心领域能力、领导技能等设计了适合我国药学院校培养目标构建的结构模型,有助于方便准确的构建出符合学校特色且完善的药学硕士研究生培养目标。本研究还提出国内药学院校在构建培养目标时,应更加尊重学校历史特色,同时注重研究生全球化、领导力意识、创新创业意识、人文素质、责任担当等方面的要求,才能保障研究生全面发展,增强研究生的职业竞争优势。     

护士核心胜任力研究现状

核心胜任力是护理人员必不可少的能力。从护士核心胜任力的产生和发展、国内外研究现状、影响因素等方面进行综述,分析了我国在护士核心胜任力领域研究的局限性及与国外的差异性,以期为未来临床护士核心胜任力的提升及研究提供借鉴。     

不稳定支撑面核心稳定性训练对胸腰段骨折伴不完全性脊髓损伤患者步行和静态平衡能力的影响

目的 观察不稳定支撑面核心稳定性训练对胸腰段脊柱骨折伴不完全性脊髓损伤患者步行和平衡功能的影响。 方法 将胸腰段脊柱骨折并不完全性脊髓损伤患者40例按随机数字表法分成实验组和对照组,每组患者20例。2组受试者均接受卧位以及坐位下的核心稳定性训练,每日30 min,每周5 d,连续8周。实验组在不稳定支撑面上进行训练,对照组在稳定支撑面上进行训练。于治疗前和治疗8周后（治疗后）采用三维步态分析仪对患者的步行能力进行评估,采用Active Balance EAB-100平衡检测仪对患者的立位静态平衡功能进行评估。 结果 治疗后,实验组步态参数中的跨步长为（0.54±0.18）m,舒适步速为（0.33±0.23）m/s,均显著优于对照组治疗后,差异均有统计学意义(P<0.05)。实验组立位静态平衡参数中的轨迹长-Romberg率、外周面积-Romberg率、矩形面积-Romberg率、有效值面积-Romberg率、X轴移动重心中心偏差-闭眼均优于对照组治疗后,差异均有统计学意义(P<0.05)。 结论 不稳定支撑面核心稳定性训练可显著改善胸腰段骨折并不完全性脊髓损伤患者的步行能力,疗效优于稳定支撑面训练,其机制可能是不稳定支撑面核心稳定性训练可提高患者不依赖视觉反馈的立位姿势控制能力。     

Isometric osteopathic manipulation influences on cervical ranges of motion and correlation with osteopathic palpatory diagnosis: A randomized trial

IntroductionIsometric manipulation is a current practice in osteopathy and treatment benefits have been reported in the literature. Such benefits could be assessed using experimental non-invasive cervical mobility measurements. The main objective was to quantitatively measure the effects of isometric manipulation on principal and compensatory cervical motions.Methods101 healthy volunteers were included in this study. 51 healthy volunteers selected randomly underwent the experimental protocol before and after isometric treatment and were compared to 50 healthy volunteers who underwent a placebo treatment. Osteopathic diagnosis was performed on each healthy volunteer before and after the treatment. The experimental protocol included measurements by a motion capture system focusing on principal range of motion and compensatory motions.ResultsIn both the isometric and the placebo sample, respectively including 51 (age: 29.2 ± 8.1, BMI: 22.2 ± 3.5) and 50 healthy volunteers (age: 27.4 ± 6.8, BMI: 22.9 ± 2.8), a pre-treatment diagnosis revealed a light cervical dysfunction in all subjects, mainly in levels C3 and C4. Altered ranges of motion thresholds (C3/C4 alterations) were identified: 113.2° for flexion, 130.0° for rotation and 90.2° for lateral flexion.After manipulations, the volunteers who underwent the isometric treatment presented a slight increase in amplitude for lateral flexion (p < 0.04), which was not found in the volunteers who underwent the placebo treatment. Compensatory motions showed differences pre and post isometric treatment without reaching significant values.ConclusionPrincipal ranges of motion were found significantly higher after osteopathic treatment when compared to the placebo treatment. Osteopathic palpatory diagnosis showed significant correlation with range of motions before treatment.     

护士对"互联网+护理服务"态度、核心能力自评现状及影响因素分析

目的:调查护士对“互联网+护理服务”态度、核心能力自评现状分析其影响因素。方法:2019年6月1日~7月1日,采用自行设计的一般资料调查问卷、护士对“互联网+护理服务”态度及核心能力自评调查问卷,对广州市5所“互联网+护理服务”试点三甲医院的1139名护士进行调查。结果:76.7%的护士对参与“互联网+护理服务”的意愿持积极态度;不同年龄、职称的护士对“互联网+护理服务”参与意愿比较差异有统计学意义(P<0.01,P<0.05);护士对“互联网+护理服务”核心能力的自评得分为(114.70±13.80)分,处于中等水平;不同婚姻状况、职称的护士核心能力自评比较差异有统计学意义(P<0.01,P<0.05)。结论:“互联网+护理服务”平台对护士具有较强的吸引力,但护士普遍对护患安全风险及医疗垃圾处理方面存在担忧;护士在核心能力方面亟待提高;因此,建立精细化的“互联网+护理服务”行业标准及培训机制势在必行。     

Osteopathic manipulative treatment combined with exercise improves pain and disability in individuals with non-specific chronic neck pain: A pragmatic randomized controlled trial

PurposeTo determine effectiveness of osteopathic manipulative treatment combined with stretching and strengthening exercises in the cervical region on pain and disability in individuals with non-specific chronic neck pain.Methods90 adults with non-specific chronic neck pain were randomized to either exercises group (EG, n = 45) or osteopathic manipulative treatment associated with exercises group (OMT/EG, n = 45). The primary outcomes were obtained by the use of Numeric Pain-Rating Scale (NPRS), Pressure Pain Threshold (PPT) and Neck Disability Index (NDI). Secondary outcomes included range of motion (ROM) for cervical spine rotation, Fear-Avoidance Beliefs Questionnaire Work/Physical Activity (FABQ-W/PA) and Pain-self efficacy at two different moments: baseline and 4 weeks after the first treatment. Techniques and dosages of OMT were selected pragmatically by a registered osteopath. Generalized Estimating Equations model (GEE), complemented by the Least Significant Difference (LSD) and the intention-to-treat analysis, was used to assess the clinical outcomes.ResultsAnalysis with GEE indicated that OMT/EG reduced pain and disability more than the EG alone after 4 weeks of treatment with statistically significant difference (p < 0,05), as well as cervical active rotation was significantly improved (p = 0.03). There were no between-group differences observed in Pressure Pain Threshold (PPT) measure, Fear-Avoidance Beliefs Questionnaire and Pain-self efficacy.ConclusionThe association between OMT and exercises reduces pain and improves functional disability more than only exercise for individuals with non-specific chronic neck pain.     

Treatment of panic disorder by trigeminal nerve manipulation: A case series

This is a report on two cases of patients with acute severe panic disorder relieved of their symptoms by manual manipulations of the trigeminal nerve's alveolar branches. The manipulations were performed via the oral cavity during one session, or two consecutive sessions less than a week apart. No other effective treatment was administered prior, concurrently or since the time of the treatment. The recovery from panic disorder was immediate and lasted for the entire period of observation of three years. The authors used the same procedure and achieved identical clinical results treating ten other clients over a period of three years. This was not a planned experiment or randomized study. Rather, this report presents clinical evidence and the authors' hypothesis based on clinical data and literature review.