Hcy和BNP水平在急性心肌梗死患者中的表达及临床意义

目的：探究血浆同型半胱氨酸（Hcy）和B型钠尿肽（BNP）水平在急性心肌梗死（AMI）患者中的表达及临床意义。方法选取2011年4月至2013年2月在我院住院治疗确诊的AMI患者120例（治疗组）和健康体检者140例（对照组）。AMI患者采取药物溶栓治疗。分别比较治疗组与对照组、治疗组治疗前后患者的Hcy和BNP水平。结果治疗组治疗前Hcy、BNP水平均高于对照组,差异有统计学意义（P＜0．05）;120例AMI患者中,随访1年后有43例发生了心血管事件,77例未发生心血管事件;发生心血管事件者的Hcy、BNP水平均高于未发生者,差异有统计学意义（P＜0．05）。结论AMI患者体内Hcy和BNP表达升高,两者可作为AMI的临床诊断和预测指标。     

不同类型冠心病患者血浆B型钠尿肽水平的变化及其临床意义

目的 观察不同类型冠心病患者血浆B型钠尿肽（BNP）浓度的改变及其与左心室射血分数（LNEF）的相关性,并探讨其临床意义。方法 把经冠状动脉造影证实为冠心病的患者112例作为观察对象,按临床类型分为：急性心肌梗死（AMI）组（38例）,不稳定型心绞痛（UAP）组（50例）,稳定型心绞痛（SAP）组（24例）;对照组为非冠心病患者22例。采用双抗夹心免疫荧光法测定血浆B型钠尿肽（BNP）浓度,并行超声心动图检查评价心功能。比较不同组BNP浓度的差异以及各组BNP水平与LVEF的相关性,并观察AMI组心血管事件发生者与未发生者血浆BNP浓度的差异。结果 AMI组BNP水平明显高于UAP、SAP和对照组（P＜0．01）,UAP组BNP水平明显高于SAP组和对照组（P＜0．01）,SAP和对照组BNP水平无明显差异（P〉0．05）。AMI组和UAP组LVEF与血浆BNP水平均呈明显负相关,AMI组发生心血管事件的患者血浆BNP浓度明显高于未发生者（P〈O．05）。结论 不同类型冠心病患者血浆BNP浓度存在差异,血浆BNP浓度与LVEF有明显的负相关,血浆BNP浓度可预测AMI近期预后。     

急性脑梗死患者血浆BNP与Hcy检测的临床价值

目的探讨血浆B型脑钠肽（BNP）与同型半胱氨酸（Hcy）在急性脑梗死患者中的含量变化及其临床意义。方法采用化学发光法测定80例脑梗死急性期患者血浆BNP与Hcy浓度,并以30例健康自愿体检者作对照。结果急性脑梗死组血浆BNP、Hey水平[（153．24±69．76）ng／L,（30．34±9．46）μmol／L]显著高于与正常对照组[（85．16±28．15）ng／L,（11．54±3．29）μmol／L],差异具有统计学意义（P〈0．01）。大、中面积脑梗死组血浆BNP、Hcy水平均显著高于小面积脑梗死组,差异具有统计学意义（P〈0．01）。结论急性脑梗死患者血浆BNP和Hcy水平明显升高,它们与脑梗死的发生密切相关,可能在脑梗死的发病过程中起重要作用。     

辛伐他汀对急性心肌梗死患者左室收缩功能及血浆脑钠肽水平影响的研究

目的观察辛伐他汀对急性心肌梗死(AMI)患者左室收缩功能及血浆脑钠肽(BNP)的影响。方法经超声心动图检测80例AMI患者以及20例健康对照者的左室舒张末内径(LVEDd)、左室射血分数(LVEF)及左室短轴缩短率(LVFS),应用酶联免疫吸附法(ELISA)测定两组脑钠肽(BNP)的水平。将AMI患者随机分为常规治疗组(38例)和加用辛伐他汀组(42例),3周和3个月时再测定上述指标。结果AMI患者在治疗3周时LVEDd、LVEF及LVFS与治疗前比较差异均无统计学意义(P＞0．05);AMI患者在治疗3个月时的上述指标与治疗前比较差异有统计学意义(P＜0．01),两治疗组比较差异亦有统计学意义(P＜0．05),辛伐他汀组LVEF较常规治疗组两组比较升高明显。两组AMI患者在梗死后24h血浆BNP水平均高于正常对照组;AMI患者在治疗3周和3个月时与治疗前比较血浆BNP水平均明显下降,两组比较差异均有统计学意义(均P＜0．05),辛伐他汀组BNP水平下降明显。两组AMI患者血浆BNP水平与LVEF呈负相关(P＜0．01)。结论长期应用辛伐他汀可以改善AMI患者心功能,降低血浆BNP水平;AMI患者血浆BNP水平的改变早于心脏结构的变化,血浆BNP水平可作为治疗AMI的一个灵敏观察指标。     

B型钠尿肽在冠心病严重程度及预后评估中的应用

目的探讨B型钠尿肽（BNP）在冠心病严重程度及预后评估中的应用及作用。方法将胸痛并行冠状动脉造影的患者根据冠状动脉造影结果分为非冠心病组（95例）和冠心病组[256例,包括稳定性心绞痛（SA）组（111例）和急性冠状动脉综合征（ACS）组（145例）]。记录受试者的一般情况,记录患者病变支数和Gensini评分。用化学发光法检测基线BNP水平。冠心病患者随访1年,记录主要不良心血管事件。分析不同病例组、不同冠状动脉病变支数患者间及主要不良心血管事件发生患者与未发生患者间的差异。结果冠心病组BNP水平为（137．95±21．58）pg／mL,明显高于非冠心病组[（89．05±9．18）pg／mL]（P〈0．01）,且患者BNP水平[（177．83±22．16）pg／mL]亦高于SA患者[（121．17±19．98）pg／mL]（P〈0．01）。冠状动脉三支病变组BNP水平〉二支病变组〉一支病变组（P〈0．05）。按BNP水平把冠心病患者分为三分位[低、中、高分位BNP水平分别为112．05±9．52、147．56±17．12、（180．03±22．57）pg/mL],低分位患者Gensini积分为29．10±4．54,中分位患者为37．76±6．91,高分位患者为58．46±3．71,三者之间差异均有统计学意义（P〈0．05）。随访1年共发生不良心血管事件29例,其中非心源性死亡3例、急诊或择期冠状动脉造影12例、再次经皮冠状动脉介入治疗术（PGI）9例、心源性死亡5例）。不良心血管事件阳性患者BNP水平[（205．12±14．73）pg／mL]明显高于阴性患者[（108．27±11．96）pg／mL]（P〈0．01）。结论BNP可应用冠心病严重程度及冠心病患者预后评估。     

不同类型的心绞痛患者血浆脑钠肽浓度的变化及意义

目的：研究冠心病患者脑型利钠肽（BNP）浓度的变化,探讨BNP对急性冠脉综合征（ACS）危险分层的价值。方法：用酶联免疫吸附法（ELISA）检测了78例经冠脉造影证实的ACS患者[38例急性心肌梗死（AMI）,40例不稳定性心绞痛（UAP）]、42例稳定性心绞痛（SAP）及30例非冠心病健康对照组的BNP的水平。随访30d,观察终点为AMI新发或再发、出现或心衰恶化和心源性猝死。结果：血浆BNP在AMI组（197．57±72．12ng／L）和UAP组（120．10±51．11ng／L）明显高于SAP组（38．39±36．50ng／L）及对照组（28．09±21．34ng／L）（P〈0．05）。SAP组和对照组BNP浓度差异无统计学意义（P〉0．05）,AMI组和UAP组间有统计学意义（P〈0．05）。BNP≤80ng／L组较BNP〉80ng／L组有更高的AMI新发或再发率、心衰发生或恶化率。结论：BNP对ACS患者近期预后有重要的临床价值,可作为危险分层的指标。     

脑钠素对舒张性心力衰竭的诊断价值

目的评价血浆脑钠素（BNP）对舒张性心力衰竭（DHF）的诊断价值。方法选择2007年4月至2009年3月在本院门急诊就诊及住院的DHF患者49例和健康体检者22例,采用IRMA法测定患者血浆脑钠素（BNP）的浓度并应用多普勒超声心动图检测左室功能的多项指标。结果DHF组与对照组血清BNP水平分别为（635．97±388．94）pg／ml、（76．33±12．82）pg／ml,2组比较,差异有统计学意义（P〈0．05）。2组IVS、LVPW、E、A及E／A等左室舒张功能比较,差异有统计学意义（P〈0．05）。不同LVEF的各亚组心力衰竭患者血浆BNP水平间差异无统计学意义（P〉0．05）,但与LVEF呈负相关（r=-0．33,P〈0．05）。结论血浆BNP水平与心衰程度密切相关,测定患者血浆BNP水平是监测心衰程度的有效手段之一。     

血浆氨基末端B型利钠肽原水平监测对中重度心衰患者应用琥珀酸美托洛尔治疗的指导价值

【目的】探讨血浆氨基末端 B 型利钠肽原（NT‐pro BNP）水平监测对中重度心力衰竭（HF）患者应用琥珀酸美托洛尔治疗的指导意义。【方法】回顾性分析本院收治的106例中重度 HF 患者的临床资料,将其分为观察组和对照组,每组各53例。对照组根据患者的临床症状来指导琥珀酸美托洛尔的使用,观察组通过监测血浆 NT‐pro BNP 水平进行指导。比较两组患者琥珀酸美托洛尔用药时间,平均剂量,心脏左室射血分数（LVEF）水平和患者心力衰竭复发率及病死率等情况。【结果】观察组在 NT‐pro BNP 水平监测的情况下首次用琥珀酸美托洛尔的时间为住院治疗的（5．63±1．92） d 早于对照组的（7．52±2．51）d ,两组比较差异具有统计学意义（ t ＝2．341,P ＝0．032＜0．05）;观察组使用琥珀酸美托洛尔的平均剂量为（45．23±10．28）mg／d高于对照组的（33．56±12．56）mg／d ,两组比较差异具有统计学意义（ t ＝2．456,P ＝0．024＜0．05）。观察组HF 复发率及病死率均低于对照组,差异具有统计学意义（均 P ＜0．05）。两组患者治疗前 LVEF 水平无显著差异,治疗后 LVEF 水平均较治疗前升高,观察组提高水平高于对照组,差异均具有统计学意义（均 P ＜0．05）。【结论】通过监测中重度 HF 患者血浆 NT‐pro BNP 水平可及时、足量的指导琥珀酸美托洛尔的临床使用,有利于中重度 HF 患者的治疗。     

冠状动脉病变程度和血浆脑钠肽超敏C反应蛋白水平相关性的研究

目的 探讨冠心病患者冠状动脉病粥样硬化程度和血浆脑钠肽（BNP）、超敏C反应蛋白（hs-CRP）水平之间的相关性。方法163例经冠状动脉造影确诊为冠心病的患者分为稳定型心绞痛（SAP）组（79例）、不稳定型心绞痛（UAP）组（43例）和急性心肌梗死（AMI）组（41例），比较三组患者的冠状动脉病变支数、左主干病变、冠状动脉Gensini评分、血浆BNP和hs-CRP水平差异有无统计学意义。结果 三组患者的冠状动脉病变支数、左主干病变比较，差异有统计学意义（P〈0．01）；SAP组患者的Gensini评分、BNP、hs-CRP水平分别与UAP组和AMI组比较，差异有统计学意义（P〈0．01）；UAP组和AMI组患者的hs-CRP水平比较，差异有统计学意义（P〈0．05），两组患者的Gensini评分、BNP水平比较，差异无统计学意义（P〉0．05）。结论 冠心病患者的血浆BNP、hs-CRP水平和冠状动脉病变程度之间存在的相关性，可以反映心肌受损的程度，具有重要的临床意义。     

左西孟旦在慢性心衰急性发作中的临床疗效观察

【目的】探讨左西孟旦在慢性心衰急性发作中的临床疗效观察。【方法】选择2014年10月至2015年10月本院收治的108例慢性心衰急性发作患者作为研究对象,将其随机分为对照组与观察组,每组各54例。对照组采用常规治疗方案,观察组在常规治疗基础上给予左西孟旦治疗,对比分析两组患者治疗前后心功能指标及血清氨基末端 B 型利钠肽原（NT‐pro BNP）水平的影响,观察两组患者用药安全性。【结果】两组患者治疗前心功能指标均无显著性差异（ P ＞0．05）;治疗后两组患者心功能指标均比治疗前有显著变化（ P＜0．05）;观察组患者治疗后心功能指标均明显高于对照组,差异具有统计学意义（ P ＜0．05）;对照组患者治疗前 NT‐pro BNP 为（2788．0±688．4） pg／mL ,治疗后为（1980．5±440．3）pg／mL ;观察组患者治疗前 NT‐pro BNP 为（2801．1±655．3）pg／mL ,治疗后为（1644．2±420．7）pg／mL ;两组患者治疗前血清 NT‐pro BNP 水平均无显著性差异（ P ＞0．05）;治疗后两组患者血清 NT‐pro BNP 水平比治疗前有显著下降（ P ＜0．05）;观察组患者治疗后血清 NT‐pro BNP 水平均明显低于对照组,差异具有统计学意义（ P ＜0．05）;对照组低血压发生率明显高于观察组,差异具有统计学意义（ P ＜0．05）;两组患者心律失常、心肌缺血及心动过速等不良反应发生率差异无统计学意义（ P ＞0．05）。【结论】左西孟旦治疗慢性心衰急性发作,可有效改善患者心功能指标,降低血清 NT‐pro BNP 水平,不良反应少,具有较高的临床安全性。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。