综合提醒系统对脑卒中患者出院6个月知信行和临床结局的效果

目的 探讨健康信念综合提醒系统对脑卒中患者出院后6个月健康知识、信念、行为、卫生服务利用情况及临床结局的效果。方法 2015年2月至2016年3月,方便抽样广州市3家综合医院高血压并发缺血性脑卒中出院患者174例,分为对照组(n = 87)和干预组(n = 87)。对照组予常规健康教育;干预组在此基础上采用“基于健康信念模式的综合提醒系统”进行健康教育和延续护理。出院6个月后,采用脑卒中健康知识问卷(SKQ)、脑卒中患者健康信念简表(SF-HBMS-SP)和脑卒中健康行为量表(HBS-SP)进行调查,并记录临床结局(急诊就诊、再住院、复发和死亡)。结果 对照组75例、干预组76例完成调查。干预组SKQ (U = 903.000)、SF-HBMS-SP (t = -9.099)和HBS-SP (t = -7.786)总分均显著高于对照组(P < 0.001)。干预组门诊复诊率(97.37%)显著高于对照组(76.00%) ( P <0.001);两组急诊就诊数和再住院数无显著性差异(P > 0.05),死亡和复发率无显著性差异( P > 0.05)。 结论 健康信念综合提醒系统能提高脑卒中患者出院后健康知识、信念、行为和门诊复诊率,但尚未对临床结局产生明显效果。     

多种放射性肺损伤动物模型的建立和效应评价研究

放射性肺损伤是胸部肿瘤放疗后常见并发症,随着对放射性肺炎研究不断深入,如何为基础研究和药物干预寻求最佳的动物模型和效应评价已成为当前亟待解决的难题之一。通过检索近10年文献,对不同放射性肺损伤模型动物及放射部位的选择、照射剂量的确定、照射方法的比较和动物模型效应评价进行了对比研究,以期寻找建立放射性肺损伤动物模型的稳定方法和较为明确的效应机制,为防护和减缓放射性肺损伤的发生发展而进行的基础研究和药物研制提供可靠的方法。     

Depressive-like behaviors in mice with Imiquimod-induced psoriasis

Psoriasis is not only a chronic inflammatory skin disease but also a psychosomatic disorder. Depression is one of the most common associated diseases, which aggravates psoriatic skin lesions and affects the life quality of patients. Clinical experiments establish a correlation between psoriasis and depression; however, the mechanisms yet unclear because only a few related studies are available. Therefore, to investigate whether imiquimod-induced psoriasis-like mice showed depressive-like behavior, 5% imiquimod cream was smeared on the back of mice to induce psoriasis-like skin lesions for 8 days. Consequently, the psoriasis area and severity index (PASI) score, epidermal thickness, expression of Ki67 and CD3⁺ T lymphocyte, the content of IL-12p70, IL-17A, and IL-23 in skin lesions were increased. The psoriasis-like mice presented significant changes in body mass. The sugar water preference rate, the central area distance and area time, and the content of 3,4-dihydroxyphenylaceticacid (DOPAC) and noradrenaline (NE) in the prefrontal cortex, 5-hydroxytryptamine (5-HT), adrenaline (Ad), and DOPAC in the hippocampus, and Ad and γ-aminobutyric acid (GABA) in the hypothalamus of psoriasis-like mice were significantly decreased. The results showed that after the application of imiquimod, depressive-like behaviors appeared in psoriasis-like mice, and the secretion of related neurotransmitters was disordered. Thus, these mice could be used as animal models for studying psoriasis complicated with depression symptoms.     

‘I believe high blood pressure can kill me:’ using the PEN-3 Cultural Model to understand patients’ perceptions of an intervention to control hypertension in Ghana

Objectives: Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients’ perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana.

Design: Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data.

Results: Emergent themes included patients’ perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes.

Conclusions: This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management.     

Effect of different modeling time on intestinal bacteria in letrozole induced PCOS rats

Objective: The differences of ovarian morphology, reproductive hormones, glucose and lipid metabolism and intestinal bacteria in rats with polycystic ovary syndrome (PCOS) induced by triazole were compared. Method: Eighteen 21 SPF female SD rats were randomly divided into group A (3-week group), group B (5-week group) and group D (control group) by random number table.Group A received letrozole + CMC-Na mixture by gavage in the first 3 weeks and CMC-Na solution by gavage in the last 2 weeks, group B received letrozole + CMC-Na mixture by gavage for 5 weeks, and group D received CMC-Na solution by gavage for 5 weeks, and all three groups of rats were fed with normal diet.At the end of gavage, the body weight of rats in each group was observed, the histological changes of ovaries were observed by hematoxylin-eosin (HE) staining, the serum levels of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), total cholesterol (TC), triglyceride (TG), fasting blood glucose (Glu), fasting insulin (FINS) and lipopolysaccharide (LPS) were measured by enzyme-linked immunosorbent assay (ELISA), and the LH/FSH ratio and insulin resistance index (HOMA IR) were calculated; the intestinal bacteria of rats were detected by 16S rRNA technique. Result: 1. Comparison of ovary histomorphology: Under light microscope, multiple luteum and oocytes were observed in mature follicles in group D, and granulosa cells were orderly arranged and multilayered, without cystic dilated follicles. There were no mature follicles in the ovarian tissues of group A and GROUP B. The follicles were irregular in structure and more cystic dilated follicles were visible. The number of granular cells in some follicles decreased or even disappeared. 2. Comparison of sex hormone levels: compared with group D, T level in group B was significantly increased (P < 0.001), and T level in group A had an upward trend (P > 0.05); The LH/FSH levels in group A and B were significantly increased (P < 0.001; P < 0.001). Compared with group A, E2 in group B was significantly decreased (P < 0.05) and T was significantly increased (P < 0.01). 3. Comparison of glucose and lipid metabolism levels: Compared with group D, TC levels in groups A and B were significantly increased (P < 0.01; P < 0.01). Compared with group A, TG in group B was significantly increased (P < 0.05). There were no significant differences in Glu, FINS and HOMA-IR levels among all groups. 4. Comparison of LPS levels: Compared with group D, the serum LPS levels of rats in groups A and B were significantly increased (P < 0.001; P < 0.01). 5. Intestinal flora analysis and comparison: At the phylum level, compared with group D, the abundance of Firmicutes in group B increased (P < 0.01), Firmicutes in group A showed an upward trend (P > 0.05), and the abundance of Bacteroidetes in groups A and B decreased (P < 0.05). At the genus level, compared with group D, Lactobacillus in group B increased (P < 0.01). The results of LEfSe analysis showed that there were differences in the composition of various intestinal bacteria among the three groups (LDA > 3).Conclusion: The phenotype of PCOS rats was related to the length of modeling, and the phenotypic characteristics of PCOS in rats at 5 weeks of modeling were more typical than those in rats at 3 weeks of modeling; PCOS can cause changes in intestinal flora, and the changes in the structure of intestinal flora between groups are related to different modeling duration.     

轻度子宫内膜异位症诊断的研究进展

子宫内膜异位症（endometriosis,EMs）是一种常见的妇科疾病,可导致盆腔疼痛和不孕。轻度EMs（Ⅰ~Ⅱ期）约占EMs的80%,其病灶常为腹膜型/浅表型,常规的超声检查常无阳性发现。患者早期症状和体征隐匿,缺乏可应用于临床的特异性生物标志物,导致大部分轻度EMs患者诊断及治疗延迟,发展成中重度EMs,因此轻度EMs的早期诊断面临着巨大挑战。腹腔镜检查是诊断EMs的金标准,但腹腔镜费用高且为有创检查,不适用于筛查。近年来,越来越多的诊断方法相继被提出,如临床症状、体征、生物标志物、影像学的组合模型,为轻度EMs的诊断提供了新的思路。这些方法展现了对轻度EMs的诊断潜力,但仍需提高诊断效能和扩大样本量进一步验证。集合临床特征、妇科检查和生物标志物等组合可能成为准确诊断轻度EMs的解决方案。     

成年小鼠颈5脊髓钳夹损伤模型的制备与评价

目的 :制备小鼠C5脊髓背侧及背外侧束钳夹损伤模型,评价损伤后动物的行为学和组织学表现。方法:采用C57/BL成年小鼠为实验对象,将16只动物随机分为损伤组和对照组,每组8只。动物麻醉后,切开背侧颈部皮肤,显露并切除小鼠C5椎板,损伤组采用自制改良FST DUMONT 5号手术钳分别钳夹背侧皮质脊髓束(dCST)和脊髓背外侧束两次;对照组仅切除椎板不做脊髓钳夹损伤。分别在术前和术后3d、2周、4周、6周、8周时采用圆筒实验、水平楼梯实验和食物抓取实验评价动物的行为学表现;术后8周时采用BDA顺行示踪观察皮质脊髓束(CST)和红核脊髓束(RST)在损伤后的情况。结果:钳夹损伤后,小鼠后肢步行功能正常但肢体的精细活动能力受到明显影响。在圆筒实验中,损伤组小鼠伤侧前肢的使用频率下降,前肢梳洗动作幅度受限,伤后各时间点与对照组相比差异均有统计学意义(P0.05);在水平楼梯实验中,损伤组小鼠对横梁的抓握精确性降低,伤后各时间点与对照组相比差异有统计学意义(P0.05);在食物抓取实验中,损伤组小鼠的食物抓取能力也出现了明显受限,伤后各时间点与对照组相比差异有统计学意义(P0.05)。以上行为学结果在伤后3d达高峰,2周后逐渐恢复,但直至8周仍不达正常水平。术后8周顺行示踪结果显示对照组小鼠CST和RST均显露清晰,纤维束呈纵行排列;损伤组小鼠CST和RST在损伤处大量断裂、逆向崩解,且无再生迹象。结论:成年小鼠C5脊髓钳夹损伤模型能够方便观察动物随意运动的控制情况及评价轴突的再生状况,适合作为轴突再生的研究模型。