亚抑菌浓度茅苍术挥发油对金黄色葡萄球菌毒力因子表达的抑制作用初步研究

目的探索亚抑菌浓度茅苍术挥发油对金黄色葡萄球菌(Staphylococcus aureus)毒力因子如α溶血素等表达的抑制作用及其机制。方法采用微量肉汤稀释法测定茅苍术挥发油对4株金黄色葡萄球菌的最小抑菌浓度(minimum inhibitory concentration,MIC);吸光度测量等方法体外检测亚抑菌浓度茅苍术挥发油作用下金黄色葡萄球菌毒力因子产量的变化;采用Real-Time PCR法检测亚抑菌浓度挥发油对AgrA和Hla mRNA表达的影响。结果茅苍术挥发油可抑制金黄色葡萄球菌生长并呈现浓度依赖性,标准菌株ATCC25923的MIC为0.0625%(v/v),临床菌株的MIC为0.03125%(v/v)。亚抑菌浓度茅苍术挥发油作用后4株菌株凝固酶的分泌受到抑制,标准菌株ATCC25923的凝固酶效价只有对照组的1/4,差异有统计学意义(P<0.05),临床菌株的凝固酶效价都只有对照组的1/8,差异有统计学意义(P<0.05)。亚抑菌浓度茅苍术挥发油减弱了四株菌株的粘附能力,ATCC25923、SA1.5、SA2.3和SA4.12的粘附能力分别只有对照组的(53.71±6.56)%(P<0.01)、(53.10±9.39)%(P<0.01)、(74.70±9.00)%(P<0.01)和(45.62±21.22)%(P<0.01)。标准菌株ATCC25923和SA2.3的溶血活力受到亚抑菌浓度挥发油的显著抑制,溶血活力分别只有对照组的(18.48±23.88)%(P<0.01)和(1.63±4.18)%(P<0.01)。α-溶血素毒力基因Hla及其调控基因AgrA的表达受到了亚抑菌浓度挥发油的抑制,其表达水平分别只有对照组的(6.17±2.23)%(P<0.01)和(24.79±9.19)%(P<0.01)。结论茅苍术挥发油能抑制金黄色葡萄球菌的生长,并且对多种毒力因子的表达有抑制作用。     

围手术期康复功能锻炼对半髋关节置换术后隐性失血量的影响

目的 探讨围术期主动和被动康复功能锻炼对半髋关节置换术后隐性失血的影响。方法 回顾性分析2010年1月—2015年6月在南京中医药大学附属八一医院行半髋关节置换术的208例老年股骨颈骨折患者的临床资料。其中,男78例,女130例;年龄70～90岁,平均81.75岁。根据围术期患者完成康复功能锻炼的强度和方式分为A组(无或少量主动康复功能锻炼)、B组(少量主动+被动康复功能锻炼)、C组(正常主动康复功能锻炼)和D组(正常主动+被动康复功能锻炼)。根据身高、体质量、术中出血量、术后第1~5天引流和渗出量、手术前(入院当天)后(术后第5天)红细胞压积(Hct),计算患者的总失血量及其占原血容量比例、隐性失血量及其占总失血量比例,观察不同功能锻炼方式患者围术期血液观察指标的变化情况。按照平均隐性失血量占总失血量的比例将患者分为低隐性失血量组和高隐性失血量组,观察不同功能锻炼方式患者高隐性失血发生率的变化情况。结果 208例患者不同康复功能锻炼组围术期血液观察指标比较,术前Hct、术中失血量差异均无统计学意义(P值均> 0.05),而总失血量、总失血量/原血容量、隐性失血量、隐性失血量/总失血量均随着主动功能锻炼强度的增加和被动功能锻炼的加入依次降低,差异均有统计学意义(F=7.980、34.934、50.430、25.850,P值均＜0.01)。所有患者总失血量平均为976.92 mL,隐性失血量平均为452.94 mL,平均隐性失血量占总失血量的比例46.36%,＜46.36%者116例纳入低隐性失血量组,≥46.36%者92例纳入高隐性失血量组。高隐性失血发生率随着主动功能锻炼强度的增加和被动功能锻炼的加入而逐渐降低(χ²=22.430, P<0.05)。结论 半髋关节置换围手术期高隐性失血与康复功能锻炼的强度和方式紧密相关,主动功能锻炼基础上加强被动锻炼能够有效地减少关节置换围术期总失血量,降低高隐性失血的发生率。     

老年人营养状况与关节置换术后切口愈合的关系研究

目的分析老年股骨颈骨折患者入院时营养状况与手术切口延迟愈合之间的关系,为老年患者临床营养护理提供理论依据。方法根据简易营养评价精法(MNA-SF)评分和糖尿病筛查,将226例股骨颈骨折患者分为营养良好组、营养良好+糖尿病组、营养不良组、营养不良+糖尿病组。研究各组MNA-SF评分与传统营养指标、血清营养学指标的相关性,并分析切口延迟愈合发生率与各指标间的关系。结果术前MNA-SF评分与血清营养学指标所反映的营养评价结果均有良好的相关性。共64例患者发生切口延迟愈合,发生率为28.32%,其中营养良好组切口延迟愈合发生率(3.57%)明显低于营养不良组(33.33%);切口延迟愈合组MNA-SF评分及其评估的营养不良发生率明显低于正常愈合组。结论 MNA-SF营养风险评估是老年人营养状况评价的可靠方法,老年患者营养不良和糖尿病与股骨颈骨折术后切口延迟愈合紧密相关,MNA-SF营养风险评估和血清营养学指标可作为判断患者预后的重要指标。     

HPLC测定盐酸替罗非班的含量和有关物质

目的 采用HPLC法测定盐酸替罗非班的含量及有关物质.方法 采用Venusil XBD C18色谱柱(250 mm×4.6 mm,5μm),流动相为0.01 mol·L-1磷酸二氢钾缓冲液(磷酸调pH2.3)-乙腈(72:28),流速1.0 mL· min-1,柱温35℃,检测波长227 nm.结果 主成分与各杂质峰的分离度良好,盐酸替罗非班10.0～ 100.0 μg· mL-1与峰面积有良好的线性关系(r=0.9999),平均回收率为99.4％,RSD=1.3％ (n =9),检测限和定量限分别为0.3、1.0 ng.结论 所用方法专属性强、灵敏度高,适用于盐酸替罗非班的含量和有关物质的测定.     

老年股骨转子间骨折修复术前隐性失血与营养状况的关系

BACKGROUND:The emergence of a large number of hidden blood loss during perioperative period of intertrochanteric fracture in the elderly not only increases the risk of perioperative period and complications, but also affects the postoperative recovery of joint function. At present, there is no relevant report about nutritional status and the hidden blood loss before surgery in and outside China.  OBJECTIVE: To identify the effect of nutritional status on preoperative hidden blood loss in elderly patients with intertrochanteric fracture.  METHODS: 183 elderly patients with fresh and initial femoral intertrochanteric fracture were included. Laboratory serological examinations on admission and preoperation were completed. By mini nutritional assessment, patients were randomly divided into normal-nourishment group, malnourishment at risk group, and malnourishment group. The original blood volume and preoperative hidden blood loss were calculated depending on height, weight, hematocrit on admission and preoperation. According to the proportion of mean preoperative hidden blood loss on the original blood volume, patients were divided into low and high hidden blood loss groups. We compared preoperative hidden blood loss, and their proportion on the original blood volume and the preoperative incidence of high hidden blood loss, and analyzed the correlations between preoperative high hidden blood loss and preoperative nutritional status. RESULTS AND CONCLUSION: (1) The nutritional status of elderly intertrochanteric fracture patients measured by mini nutritional assessment score was that the number of patients was 48 cases (26%) in normal-nourishment group, 64 cases (35%) in the malnourishment at risk group, and 71 cases (39%) in the malnourishment group. There were no obvious differences in the preoperative complications between any two groups (P > 0.05). (2) Thirty-eight cases affected high hidden blood loss. The mean preoperative hidden blood loss was 260.43 mL. The proportion of preoperative hidden blood loss to the original blood volume was 6%. (3) The preoperative hidden blood loss, their proportion on the original blood volume and the incidence of high hidden blood loss were significantly higher in the malnourishment at risk group and malnourishment group than in the normal-nourishment group. Paired comparison showed significant differences (P < 0.05). (4) Results confirmed that preoperative hidden blood loss, their proportion on the original blood volume and the incidence of high hidden blood loss gradually increased with deterioration of nutritional status. The nutritional status is an important factor influencing the occurrence of preoperative hidden blood loss, and can be used as an important index for judging the high hidden blood loss and prognosis in elderly patients with intertrochanteric fracture. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

核苷酸结合寡聚结构域样受体蛋白3基因多态性与哈萨克族高血压颈动脉粥样硬化的关系

目的探讨核苷酸结合寡聚结构域样受体蛋白3(NLRP3)基因多态性与新疆哈萨克族高血压颈动脉粥样硬化的相关性。方法选择哈萨克族原发性高血压患者350例,其中伴颈动脉粥样硬化150例(阳性组),无颈动脉粥样硬化200例(阴性组),另选择同期哈萨克族健康体检者200例为对照组。采用TapMan探针法检测所有受试者的NLRP3rs10754558基因型和等位基因,采用ELISA法检测血浆白细胞介素1β(IL-1β)水平。结果与对照组比较,阳性组rs10754558 GG基因型和G等位基因频率明显升高(20.0%vs 9.0%,43.0%vs 34.8%,P0.05)。阳性组与阴性组NLRP3rs10754558基因型和G等位基因比较,差异无统计学意义(P0.05)。与对照组比较,阳性组和阴性组血浆IL-1β水平显著升高[(2.79±0.83)ng/L和(2.82±0.92)ng/L vs(2.21±0.91)ng/L,P0.05],且阳性和阴性组携带GG基因型患者血浆IL-1β水平显著高于对照组[(3.40±0.37)ng/L和(3.35±0.43)ng/L vs(2.21±0.90)ng/L,P0.05]。结论 NLRP3rs10754558基因多态性可能与哈萨克族高血压颈动脉粥样硬化的遗传易感性有关。     

全髋关节置换后隐性失血与老年患者营养状况的关系

BACKGROUND: Perioperative high hidden blood loss affects the recovery of joint function after total hip replacement.