医务人员控烟行为与态度调查

目的对成都市武侯区2家公立医院医务人员的控烟行为和态度等情况进行调查,为更好地贯彻落实医疗卫生系统全面禁烟工作奠定基础。方法采用整群抽样方法抽取武侯区2家医院的医务人员,对其进行问卷调查。结果男性医务人员的吸烟率为34.84%;女性医务人员无吸烟者;多因素分析结果表明影响吸烟医务人员对医院控烟态度的因素有:烟龄、日吸烟量、收入、对被动吸烟危害性认识;女性、不吸烟、接受过控烟培训,了解控烟方法以及希望通过培训使自己有能力开展控烟服务的医务人员更积极开展控烟宣传教育工作。结论成都市2家公立医院医务人员吸烟率相对较低,应进一步加强责任教育、帮助吸烟者戒烟,开展控烟知识与控烟技巧培训,是进一步推进医院控烟工作的重点。     

职业危害因素接触者体检参与情况及影响因素

目的探讨职业危害因素接触者积极参加体检的基本情况及其影响其积极参加体检的影响因素,为有关部门制定改善职业病危害现状的政策及措施提供科学根据。方法选取成都市某职业病医院组织的体检参与个体366人,依照其是否积极参加体检分组,进行基本的统计分析描述,并利用多变量非条件logistic回归模型探索影响其积极体检的相关因素。结果其中体检积极参与者比例为87.70%;城市积极体检参与者比例(90.88%)高于农村(78.26%);不同文化水平下,以本科及以上学历积极参加体检比例最高,为96.47%,初中及以下最低,为80.00%。影响因素分析发现:医保类型、单位性质及单位是否有专人管理均会影响职业危害因素接触者积极参加体检。结论职业危害因素接触者积极参加体检与城乡环境,参与者自身文化程度与单位环境、医保等因素有关,提高职业危害因素接触者积极参加体验,需要国家、单位、相关部门以及个人的共同努力。     

磁共振定量分析在类风湿关节炎手腕部骨侵蚀中的应用

目的　对磁共振定量分析在类风湿关节炎手腕部骨侵蚀中的应用进行分析与评价,为今后的临床应用提供参考.方法 随机抽取在2007年1月～2011年10月这段时间里采用MRI对手腕部进行扫描的临床患者病例108例,在1周之后均进行了实验室检查,将确诊为类风湿关节炎(RA)的患者作为本次研究的研究对象.将所有研究对象按照性别、年龄、病程、类风湿因子、抗环瓜氨酸肽、C反应蛋白、血沉等观察指标进行分组,采用Mann-Whimey方法对各组间骨侵蚀的差异进行分析.结果 在本次研究中所接受检查的108名患者中有73例符合RA标准,约占67.59％;对于CRp阳/阴性组、早期/中晚期RA组以及ESR阳/阴性组间的骨侵蚀评分之间存在的差异有统计学意义(P＜0.05);对于CCP阳/阴性组之间的骨侵蚀评分存在的差异具有明显的统计学意义(P＜0.05).结论 磁共振定量分析能够对为类风湿关节炎手腕部骨侵蚀的诊断以及预后评估提供有效的依据,能够在今后的临床诊疗工作中对其予以广泛应用.     

虹膜识别联合波前像差引导的LASIK手术临床疗效

目的 观察虹膜识别联合波前像差引导的准分子激光原位角膜磨镶术(LASIK)对近视和近视性散光的治疗效果.方法 前瞻性病例对照研究.选择术前高阶像差均方根(RMS HO)≥0.30 μm的近视或近视性散光患者30例(30眼),随机分为A组和B组.A组患者接受虹膜识别联合波前像差引导的LASIK手术,B组患者接受传统的LASIK手术.术前及术后1个月、3个月分别行波前像差检查和对比敏感度测试.采用两独立样本t检验.结果 随访至术后3个月,A组和B组的logMAR视力分别为-0.12±0.06和-0.09±0.07,两组间差异无统计学意义.术后1个月,A组患者的RMS HO值明显小于B组,差异有统计学意义(t=-2.097,P＜0.05).术后3个月,A组患者在明视无眩光环境1.5 c/d空间频率和3.0 c/d空间频率及暗视无眩光环境18 c/d空间频率下的对比敏感度均较B组患者高,差异均有统计学意义(t=2.517、2.175、2.263,P＜0.05).结论 虹膜识别联合波前像差引导的LASIK手术治疗近视和近视性散光安全、有效,在减少术后高阶像差、提高视觉质量方面具有明显的优势.     

多种验光模式在LASIK术前检查中的应用

目的 比较准分子激光原位角膜磨镶术(LASIK)前多种验光模式的差异性和相关性.方法 前瞻性临床研究.拟接受LASIK手术122例(241眼),近视球镜度为-0.75～-13.25 D,平均(-5.57±2.40)D;柱镜度为-0.25～-5.50 D,平均(-0.96±0.66)D.术前分别进行检影验光、电脑验光、主觉验光以及OrbscanⅡ检查;术后1年进行主觉验光,对获得数据进行分析.检影验光、电脑验光与主觉验光结果的差异性采用单因素方差分析,Orbscan Ⅱ结果与主觉验光结果的差异性采用配对t检验.不同验光结果的相关性采用Pearson相关分析.结果 通过检影验光、电脑验光和主觉验光获得的球镜度分别为(-5.20±2.61)D、(-5.64±2.71)D和(-5.57±2.40)D,差异具有统计学意义(F=38.586,P＜0.01);检影验光、电脑验光和主觉验光获得的柱镜度分别为(-0.99±0.66)D、(-1.03±0.73)D和(-0.96±0.66)D,差异具有统计学意义(F=15.147,P＜0.01),OrbscanⅡ获得的柱镜度为(-1.16±1.84)D,与主觉验光的差异具有统计学意义(t=3.190,P＜0.01);检影验光、电脑验光和OrbscanⅡ提示的散光轴向与主觉验光结果差异均无统计学意义.不同验光模式所得的验光结果均具有密切的线性相关(r均＞0.9,P＜0.01).结论 应采取多种验光手段对预进行LASIK手术患者的屈光状态进行综合评估,以确保手术效果.     

A low-affinity human granulocyte-macrophage colony-stimulating factor/murine erythropoietin hybrid receptor functions in murine cell lines

To identify domains in hematopoietic growth factor receptors that are important for signal transduction, a hybrid receptor (GMER) was constructed by splicing the DNA of the entire extracellular and transmembrane domains of the human granulocyte-macrophage colony- stimulating factor (GM-CSF) receptor alpha 2 subunit (GMR) to the cytoplasmic domain of the murine erythropoietin receptor (mEpoR). The hybrid receptor was introduced into the interleukin-3 factor-dependent murine hematopoietic cell line Ba/F3. Cells that expressed high receptor numbers were selected by cell sorting using phycoerythrin- labeled human GM-CSF. Immunoprecipitation of GMER from Ba/F3 cells showed a band with an Mr of 105,000 daltons. Human GM-CSF binding to Ba/F3 cells that expressed GMER showed a kd of 3.0 nmol/L and 475 binding sites/cell, while the same cells that expressed GMR had 300 sites/cell and a kd of 3.5 nmol/L. The proliferative response to GM-CSF of Ba/F3 cells that expressed GMER showed 1/2 maximal cell growth (as measured by 3H-thymidine incorporation) at a GM-CSF concentration of 2.5 x 10(-8) mol/L. When cultured in human GM-CSF, Ba/F3-GMER cells expressed cell surface glycophorin. Similar results were obtained with Ba/F3 cells transfected with the mEpoR and cultured in erythropoietin. Expression of GMR plus the human GM-CSF receptor beta chain in the same cell line also resulted in human GM-CSF stimulated proliferation; however, cell surface glycophorin was not detected. These data show that a low-affinity GM-CSF/Epo hybrid receptor can promote GM-CSF- dependent proliferation and can induce the expression of glycophorin, an erythroid-specific protein.     

Wnt/β-catenin信号通路调控哮喘气道重塑的机制研究

目的:探讨Wnt/β-catenin信号通路调控哮喘气道平滑肌细胞(ASMC)的功能和参与哮喘气道重塑的机制。方法:建立大鼠哮喘模型,提取大鼠ASMC。Western blot法检测哮喘组和正常组大鼠ASMC中β-连环蛋白(β-catenin)、糖原合成酶激酶-3β(GSK-3β)、原癌基因c-Myc和细胞周期蛋白D1(cyclin D1)的蛋白表达。抑制哮喘组和对照组ASMC中β-catenin和转录辅助因子p300/CBP间的相互作用后,采用CCK-8法和流式细胞术检测ASMC的细胞活力和周期变化。抑制P38丝裂原活化蛋白激酶(MAPK)活性后,采用Western blot法检测c-Myc和cyclin D1的蛋白表达变化。结果:Western blot法显示哮喘组ASMC中β-catenin、c-Myc和cyclin D1的蛋白表达水平均明显高于对照组(P0.05),同时GSK-3β的蛋白表达水平则低于对照组(P0.05)。抑制β-catenin和p300/CBP间相互作用后,哮喘组ASMC的细胞活力下降幅度和细胞周期改变程度均较对照组更为明显(P0.05)。抑制P38 MAPK活性后,哮喘模型大鼠及对照大鼠ASMC中Wnt/β-catenin信号通路的靶蛋白c-Myc和cyclin D1的表达均下调,差异有统计学意义(P0.05)。结论:Wnt/β-catenin信号通路可能通过上调c-Myc和cyclin D1的表达、与P38 MAPK信号通路相互作用以及调控ASMC的生长和分化等途径,影响ASMC的功能,参与哮喘气道重塑。     

Heparin cofactor II activity in patients with disseminated intravascular coagulation and hepatic failure

Heparin cofactor II (HCII) is a glycoprotein in human plasma which inactivates thrombin rapidly in the presence of heparin or dermatan sulfate. We have developed a functional assay for HCII in which inhibition of thrombin by plasma is determined in the presence of dermatan sulfate. The assay is specific for HCII by the following criteria: (a) under the conditions of the assay, 125I-thrombin forms complexes in plasma which comigrate with the thrombin-HCII complex during sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS- PAGE); (b) activity detected by the assay is decreased in plasma absorbed with monospecific antibodies against HCII; and (c) purified antithrombin III (ATIII) is unreactive in the assay system. Addition of Polybrene to the assay permits determination of HCII activity in samples containing less than or equal to 12 U/mL of heparin. The range of HCII concentrations in normal individuals is 1.2 +/- 0.4 mumol/L (mean +/- 2 SD, n = 34). HCII activity was determined in 54 consecutive patients undergoing evaluation for the possibility of disseminated intravascular coagulation (DIC). Ten of the 11 patients with documented DIC had decreased HCII activity as compared with only 7 of the 43 patients without DIC (chi 2 = 19.3, P less than .0001). The concentrations of HCII and ATIII varied in parallel in most of the patients tested. A significant correlation between decreased HCII activity and decreased serum albumin concentration was also observed in these patients and in eight additional patients with hepatic failure in the absence of DIC. We conclude that HCII activity is decreased in many patients with DIC and hepatic failure.     

Alloimmunization prevents the migration of transfused indium-111- labeled granulocytes to sites of infection

111In-labeled granulocytes were used to study the effects of histocompatibility factors on the migration of transfused granulocytes to infected sites. Fourteen alloimmunized and 20 nonalloimmunized patients received approximately 10(8) 111In-labeled granulocytes from ABO-compatible, non-HLA-matched donors, and scans were performed over known infected sites. All 14 alloimmunized patients had lymphocytotoxic antibody (LCTAb) and required HLA-matched platelet transfusions. Of the nonalloimmunized patients, 20/20 had positive scans at sites of infection. None of the 20 had LCTAb, 0/17 had a positive lymphocytotoxic crossmatch (LCTXM) with the donor, and 3/18 had a positive leukoagglutinin crossmatch (LAXM). Thus, histocompatibility testing was not found to be important in nonalloimmunized patients. In contrast, only 3/14 alloimmunized patients had positive scans at sites of infection (p = 0.00001 compared to nonalloimmunized patients). One of 3 had a positive LCTXM and 2/3 had a positive LAXM. Of the alloimmunized patients, 10/11 with negative scans had a positive LCTXM and 8/11 had a positive LAXM. Labeled granulocytes failed to reach sites of infection in 11/14 (78%) alloimmunized patients, demonstrating that histocompatibility factors can be of major importance in affecting the outcome of granulocyte transfusions. Granulocytes from random donors are unlikely to be effective in alloimmunized patients. The lack of an adequate crossmatching technique is a major problem limiting the ability to provide granulocyte transfusions for alloimmunized patients.     

不同药物对青春前期大鼠睾丸扭转复位健侧睾丸的远期影响

目的:观察牛磺酸、丹血通(丹参联合血栓通)和灯盏花素对青春前期大鼠睾丸扭转复位后健侧睾丸的远期影响及其保护作用,比较3种药物对抗睾丸缺血再灌注损伤的保护作用。方法:64只4周龄健康雄性SD大鼠,随机分为假手术组、模型组、牛磺酸单次和连续给药组、丹血通单次和连续给药组以及灯盏花素单次和连续给药组,每组8只,建立左侧睾丸扭转复位动物模型(720°,2 h)。于术后6周处死大鼠,取右侧睾丸及附睾,检测睾丸组织总抗氧化能力(T-AOC)、超氧化物歧化酶(SOD)活性、一氧化氮合酶(NOS)活性和丙二醛(MDA)含量,测定精子畸形率和精子活动率和精子浓度,行睾丸组织病理学观察。结果:与模型组相比,3个连续组的SOD活性、TAOC、精子活动率和精子浓度均增加,MDA含量和精子畸形率均降低(P0.05)。3个单次组的SOD活性和精子活动率(除灯盏花素单次组)均增加,MDA含量和精子畸形率均降低,牛磺酸单次组T-AOC和精子浓度增加(P0.05)。模型组可见生精小管退变,间质水肿,其它给药组睾丸扭转复位诱发的组织学改变明显改善。结论:青春前期大鼠单侧睾丸扭转复位后可致健侧睾丸缺血再灌注损伤,牛磺酸、丹血通和灯盏花素均对青春前期大鼠睾丸扭转复位后健侧睾丸远期功能恢复起到一定的保护作用,其作用效果牛磺酸明显优于丹血通和灯盏花素,丹血通明显优于灯盏花素,且连续给药明显优于单次给药。