亚低温疗法对复苏后家兔心肌的保护作用

目的 明确亚低温疗法对复苏后家兔心功能的影响,同时探讨其可能作用机制.方法 通过体外致颤法建立家兔心肺复苏模型,20只健康家兔在麻醉置管前随机(随机数字法)分为常温复苏组(A组,n=10)与亚低温复苏组(B组,n=10).常温复苏组在常温状态下行标准心肺复苏,整个实验过程中家兔体温维持在正常体温38.3 ～ 39.2℃;亚低温复苏组在常温下行标准心肺复苏至自主循环恢复(ROSC)后快速诱导亚低温.亚低温诱导采用从家兔耳缘静脉以1.0md/(kg· min)速度泵入4℃生理盐水,同时配合体表降温方法,要求10～ 15 min后降至目标温度(32～34℃).动态观察左室舒张末压(LVEDP)、左室内压上升和下降最大速率(±dp/dtmax)、血清心型脂肪酸结合蛋白(H-FABP)、8-异前列腺素F2a(8-iso-PGF2a)以及环氧合酶-2(COX-2)质量浓度变化.结果 ①与致颤前相比,两组LVEDP值在复苏后各时间点均有不同程度升高,±dp/dtmax值均有不同程度降低(P＜0.01),但B组LVEDP升高幅度及±dp/ dtmax下降幅度均小于A组(P＜0.05);②与致颤前比较,两组血清H-FABP,8-iso-PGF2a及COX-2值在复苏后各时间点明显上升(P＜0.01),但B组H-FABP、8-iso-PGF2a及COX-2值升高幅度明显小于A组(P＜0.05).结论 亚低温治疗能够改善家兔复苏后心功能不全,其心肌保护机制可能与抑制COX-2减少自由基生成,以及减少自由基脂质过氧化物8-iso-PGF2a生成有关.     

不同时程亚低温治疗在重型颅脑损伤患者中的疗效比较

目的:探讨不同时程亚低温治疗在重型颅脑损伤(severe traumatic brain injury,sTBI)患者中的临床疗效差异。方法:采用前瞻性研究方法选取安徽医科大学第三附属医院本部及滨湖院区ICU在2016年8月至2017年12月收治的90例sTBI患者为研究对象,按照患者入院顺序随机分为常规组(A组,n=30)、长时间亚低温组(B组,n=30)、短时间亚低温组(简称C组,n=30)。A组仅给予基础治疗;B组在A组基础上入院后立即行亚低温治疗,体温控制在33～35℃,持续5 d;C组在A组基础上入院后立即行亚低温治疗,体温控制在33～35℃,持续2 d,比较3组患者治疗6 d后的临床疗效差异。结果:3组患者治疗前的颅内压(intracranial pressure,ICP)差异无统计学意义(P0.05);治疗第6天,差异有统计学意义(P0.05),且C组高于B组(P0.05)。3组患者第6天的APACHE II评分差异有统计学意义(P0.05),且C组高于B组(P0.05)。在并发症发生率方面,A组高于其他2组(P0.05),C组高于B组(P0.05)。在28d病死率方面,A组高于其他2组(P0.05),C组高于B组(P0.05)。结论:亚低温治疗在sTBI患者治疗中的效果显著,与短时间亚低温治疗相比,长时间亚低温治疗虽不能显著降低患者短时间内病死率,但能显著降低ICP、远期死亡风险,对并发症发生率增加没有显著影响。     

血清蛋白因子水平对精神分裂症及抑郁症的诊断价值

目的：探讨血清蛋白因子检测对精神分裂症与抑郁症的临床诊断价值。方法将120例精神分裂症患者设为A组、120例抑郁症患者设为B组、120名健康体检者设为C组,对3组被试血清脑源性神经营养因子、血清神经生长因子、髓鞘碱性蛋白、钙结合蛋白、白细胞介素6、肿瘤坏死因子α、干扰素‐γ、神经角质纤维酸性蛋白水平进行检测分析。结果 A组、B组血清髓鞘碱性蛋白及脑源性神经营养因子水平显著低于C组（P＜0．01）,A组显著低于B组（P＜0．05或0．01）;A组血清神经生长因子水平显著低于B组、C组（ P＜0．01）,B组与C组比较差异无显著性（P＞0．05）;A组血清白细胞介素6水平显著高于B组、C组（P＜0．01）,B组与C组比较差异无显著性（P＞0．05）;A组、B组血清钙结合蛋白水平显著高于C组（P＜0．01）,A组显著低于B组（P＜0．01）。结论血清蛋白因子水平变化与精神分裂症及抑郁症的病理生理、临床表现密切相关,检测血清蛋白因子水平对于精神分裂症及抑郁症的诊断具有重要意义。     

心肺复苏后大鼠脑红蛋白变化及氯化血红素的作用

目的 观察心肺复苏(CPR)后大鼠脑皮质脑红蛋白(NGB)表达、神经功能评分(NDS)、大脑皮质病理的变化及氯化血红素(Hemin)干预的影响.方法 成年雄性SD大鼠120只,随机(随机数字法)分为3组(n=40):对照组(A)、复苏组(B)、药物组(C),建立窒息致大鼠心搏骤停CPR模型,观测大鼠自主循环恢复(ROSC)后各时间点(0.5 h,3 h,6 h,12 h,24 h)NGB表达、NDS及大脑皮质病理改变.实验数据作单因素方差分析,组间比较用Tukey检验.结果 与A组同时间点比较,B组ROSC后12 h,24 h NGB表达显著升高(P＜0.05或P＜0.01),ROSC后各时间点NDS显著降低(P＜0.01)、脑组织形态学明显异常;C组ROSC后6 h,12 h,24 h NGB表达显著升高(P＜0.05或P＜0.01),ROSC后3 h,6 h,12 h NDS显著降低(P＜0.01).与B组同时间点比较,C组ROSC后12 h,24 hNGB表达和NDS均显著升高(P＜0.01),ROSC后脑组织形态学异常明显减轻.结论 大鼠CPR后大脑皮质区NGB表达增加、NDS降低、脑组织形态学明显异常,Hemin能增加大脑皮层NGB表达、提高NDS、减轻皮层病理损伤,具有一定的脑保护作用.     

亚低温治疗及选择时机对窒息大鼠心肺复苏后的脑保护作用

【目的】探讨亚低温治疗及选择时机对窒息大鼠心肺复苏后的脑保护作用。【方法】36只成年 SD 大鼠随机分为假手术组(6只,A 组)、常温组(6只,B 组)和亚低温治疗组(24只,C 组),C 组随机分为 C1、C2、C3和 C4组四个亚组,每组6只。A 组仅进行麻醉、气管切开及血管穿刺操作,不进行心肺复苏;B 组不行低温治疗;C1~4组分别于心脏骤停后2、4、6、8 min 立即实施心肺复苏。统计各组复苏成功率;免疫组化法检测皮质及海马组织 Nrf2及 HO-1蛋白表达;按 Elliott 法计算脑组织百分水含量。【结果】C 组皮质、海马组织 Nrf2及 HO-1蛋白表达水平均显著高于 A 组和 B 组(P <0.05);C1、C2、C3和 C4四个亚组比较差异无统计学意义(P >0.05)。B 组和 C 组脑组织含水量均显著高于 A 组(P <0.05),但 B 组和 C 组比较差异无统计学意义(P >0.05),C1、C2、C3和 C4四个亚组比较差异也无统计学意义(P >0.05)。【结论】亚低温干预对心肺复苏大鼠的脑保护作用可能是通过激活 Nrf2-ARE 信号通路,上调 Nrf2及其下游基因 HO-1表达实现的,对窒息性心脏骤停心肺复苏后应早期进行亚低温治疗以减轻脑损伤,提高心肺复苏的成功率。     

亚低温治疗及诱导时机对兔复苏后心功能影响的实验研究

目的 明确亚低温治疗及诱导时机对复苏后家兔心功能的影响,同时探讨其可能的作用机制.方法 通过体外致颤法建立家兔心肺复苏模型.18只健康家兔随机分为三组:常温复苏组(A组)、自主循环恢复后亚低温复苏组(B组)、心脏骤停后亚低温复苏组(C组).A组家兔体温维持在38.3~39.6℃之间,B、C两组从家兔耳缘静脉以1.0 m...     

亚低温对犬心脏骤停后脑水肿及血脑屏障的影响

目的观察亚低温干预对犬心脏骤停后脑水肿及血脑屏障的影响。方法共选取16只成年健康杂种犬，将其随机分为亚低温组（n=8）和对照组（n=8），采用诱发室颤的方法导致上述2组动物心跳、呼吸骤停，随后施行脑复苏程序；亚低温组动物在心跳骤停期间给予亚低温干预。采用双抗夹心酶联免疫吸附技术测定各组动物血清S100B蛋白含量，同时观察其脑组织含水量及病理学改变。结果亚低温组动物经亚低温干预后，发现其血清S100B蛋白含量显著低于对照组（P〈0．05），脑组织含水量也显著低于对照组（P〈0．05）；2组实验动物脑标本经病理学检测后发现，亚低温组动物脑组织缺氧损伤程度明显轻于对照组。结论亚低温干预能减轻心跳骤停实验犬的脑水肿程度，改善其血脑屏障功能，从而发挥脑保护效应。     

白细胞介素-1受体拮抗剂对大鼠心肺复苏后脑水肿及MMP-9 mRNA表达的影响

目的 观察重组人白细胞介素-1受体拮抗剂(recombinant human interleukin-1 receptor antagonist,rhIL-1ra)对大鼠心肺复苏后脑水肿及腩组织MMP-9 mRNA表达的影响,探讨心肺复苏后rhIL-1ra的脑保护作用及其机制.方法 健康雄性SD大鼠72只,随机分为假手术组(A组)、生理盐水对照组(B组)和药物干预组(C组),每组各24只.各组均行左侧股动静脉置管及气管捕管,B组和C组用窒息法建立心搏骤停模型并进行心肺复苏,C组复苏即刻及ROSC后4、8、12及18 h给予rhIL-1ra干预,B组以等量生理盐水对照,A组于术后3、6、12及24 h处死留取标本,B组和C组于ROSC后3、6、12及24 h处死.利用干-湿质量法测定脑组织含水量,免疫组织化学染色法检测脑海马区白细胞介素1β(IL-1β)表达水平,逆转录聚合酶链反应(RT-PCR)检测脑组织基质金属蛋白酶9(MMP-9)mRNA的表达.结果 B组大鼠于ROSC后各观察时间点均出现脑组织IL-1β显著表达,以海马区明显,与A组相比差异具有统计学意义(P＜0.01),且于ROSC后12 h达高峰;各观察时间点脑组织含水量呈上升趋势,于24 h达高峰;MMP-9 mRNA表达较A组显著升高(ROSC 3 h,P＜0.05;ROSC 6、12、24 h,P＜0.01),24 h达高峰,相关性分析显示MMP-9 mRNA表达与IL-1β表达及脑组织含水量变化呈显著正相关(r=0.867,P＜0.01;r=0.800,P＜0.01).与B组相比,C组经药物干预后于ROSC 6、12、24 h各时间点脑组织含水量均较B组显著降低(P＜0.01),MMP-9 mRNA表达水平下降,(ROSC 6 h,P＜0.05;ROSC 12、24 h,P＜0.01).结论 rhIL-1ra能降低心肺复苏后早期脑水肿程度及脑组织MMP-9 mRNA的表达.     

亚低温治疗对心肺复苏成功患者免疫功能 肺功能的影响

目的 探讨亚低温治疗对心肺复苏成功患者免疫功能、肺功能的影响.方法 选择心肺复苏成功患者62例.随机分为常温组和亚低温组,每组各31例.分别于治疗第1、3、7天检测所有患者的体液免疫功能指标：IgA、IgG、IgM及补体C3,及细胞免疫指标：T淋巴细胞转化率（T-LTR）、CD3、CD4、CD8、CD4/CD8比值.于治疗前及治疗后24h内,监测患者的肺顺应性指标：气道峰压、平台压、肺静态顺应性及肺动态顺应性,并比较两组差异.结果 治疗后第1、3、7天,两组患者血清IgG、IgA、IgM水平及补体C3水平比较,差异均无统计学意义（P〉0.05）;两组IgG和补体C3水平均随治疗时间的延长而显著降低（亚低温组：FIgG=6.836,F补体C3=6.526,P〈0.05;常温组：FIgG=5.559,F补体C3=5.231,P〈0.05）;两组患者血清T-LTR及CD3、CD4、CD8和CD4/CD8比较差异均无统计学意义（P〉0.05）.治疗后,常温组气道峰压、平台压、肺静态顺应性及肺动态顺应性与治疗前比较差异无统计学意义（P〉0.05）;亚低温组气道峰压较治疗前显著降低（P〈0.05）,肺动脉顺应性显著升高（P〈0.01）;亚低温组气道峰压显著低于常温组（P〈0.05）,肺动脉顺应性显著高于常温组（P〈0.05）.结论 相比常温治疗,亚低温治疗可以更显著得改善患者肺功能,对肺起到保护作用.     

心肺复苏与心肺脑恢复

目的观察在不同时间内心肺复苏后与心肺脑恢复的关系。方法选择意外事件所致心跳呼吸骤停患者97例，按在不同时间内心肺复苏分为3组：A组1～5min；B组6—30min；C组31～60min。比较A、B、C组心肺复苏后的心肺脑恢复率。结果A组：心肺脑完全恢复为71．4％，心跳和呼吸均恢复为85．7％，心肺脑始终无恢复者为14．3％；B组：心肺脑完全恢复为0％，心跳和呼吸均恢复为2．9％，心跳恢复为22．8％；C组：心肺脑完全恢复0％，心跳和呼吸均恢复为0％，心跳恢复为5．0％。A组心肺脑恢复率显著优于B组及C组（P〈0．05）。结论对意外事件所致心跳呼吸骤停患者在1—5min内进行有效的心肺复苏，是提高心肺复苏抢救成功率的关键。     

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。     

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。     

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。     

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。