循证护理模式在心血管内科老年患者中的应用

目的:探讨循证护理模式在心血管内科老年患者中的应用效果。方法:将140例心血管内科老年患者随机分为对照组和观察组各70例,对照组采用常规护理模式,观察组采用循证护理模式,比较两组护理前及护理后1周的治疗依从性、积极性、满意度及SCL-90评分。结果:观察组护理后1周治疗依从性、积极性、满意率及SCL-90评分均优于对照组(P<0.05)。结论:循证护理模式可增强心血管内科老年患者的治疗信心,提高生存质量。     

大鼠角膜中央区SP样、CGRP样免疫阳性纤维的起源

向角膜中央区注射ＨＲＰ后，用抗ＳＰ和抗ＣＧＲＰ抗体对三叉神经节、颈上神经节和迷走神经节进行免疫组织化学处理。结果证明：双重阳性细胞出现于三叉神经节的内侧区且集中分布于背内侧部．ＣＧＲＰ样双重阳性细胞主要分布在节的背内侧部的周边区；ＳＰ样双重阳性细胞散在于节的背内侧部的深部。两者均为圆形或椭圆形。在颈上神经节和迷走神经节内未见双重阳性细胞。     

急性淋巴细胞白血病(上)

急性淋巴细胞白血病是淋巴前体细胞异常引起的恶性疾病,儿童与成人均可能发生。儿童发病高峰2～5岁。有效治疗的稳步进展使本病在儿童中的治愈率80％以上,同时为新的治疗方案提供了良机,新方案将保留我们在白血病无病生存病例中获得的治疗经验,同时减轻当前强化治疗方案中的毒副作用。     

Mechanisms of Andrographolide‐Induced Platelet Apoptosis in Human Platelets: Regulatory Roles of the Extrinsic Apoptotic Pathway

Andrographolide, a novel nuclear factor‐κB (NF‐κB) inhibitor, is isolated from the leaves of Andrographis paniculata. Platelet activation is relevant to a variety of coronary heart diseases. Our recent studies revealed that andrographolide possesses potent antiplatelet activity by inhibition of the p38 MAPK/^●HO‐NF‐κB‐ERK2 cascade. Although platelets are anucleated cells, apoptotic machinery apparatus recently has been found to regulate platelet activation and limit platelet lifespan. Therefore, we further investigated the regulatory effects of andrographolide on platelet apoptotic events. In this study, apoptotic signaling events for caspase‐3, ‐8, and Bid were time (10–60 min)‐ and dose (25–100 μΜ)‐dependently activated by andrographolide in human platelets. Andrographolide could also disrupt mitrochondrial membrane potential. In addition, caspase‐8 inhibitor (z‐IETD‐fmk, 50 μΜ) was found to reverse andrographolide‐induced caspase‐8 activation, whereas the antagonistic anti‐Fas receptor (ZB4, 500 ng/mL) and anti‐tumor necrosis factor‐R1 (H398, 10 µg/mL) monoclonal antibodies did not. In conclusion, this study for the first time demonstrated that andrographolide might limit platelet lifespan by initiating the caspase‐8‐dependent extrinsic apoptotic pathway, in spite of no direct evidence that death receptors are involved in this process proved. Overall, the various medicinal properties of andrographolide suggest its potential value in treating patients with thromboembolic disorders. Copyright © 2012 John Wiley & Sons, Ltd.     

Paired kidney analysis of tacrolimus and cyclosporine microemulsion-based therapy in Chinese cadaveric renal transplant recipients

Few studies used paired kidneys for comparison between tacrolimus and cyclosporine in renal transplantation. Most of the published data used whole blood trough levels for drug monitoring. However, the use of limited sampling strategy and abbreviated formula to estimate the 12-h area under concentration-time curve (AUC(0-12)) allowed better prediction of drug exposure. Sixty-six first cadaveric renal transplant recipients receiving paired kidneys were randomized to receive either tacrolimus-based (n = 33) or cyclosporine microemulsion (Neoral)-based therapies (n = 33). Abbreviated AUC(0-12) was used for drug monitoring and dose titration. Mean follow-up duration was 2.8 +/- 2 years. The patient and graft survival were comparable. Fewer incidence of acute rejection was observed in tacrolimus group (15% vs. 27.3%) though the difference was not significant (P = 0.23). The absolute value and the rate of decline of creatinine clearance were both significantly better in tacrolimus-treated patients. Prevalence of hypertension, post-transplant diabetes mellitus, infection, and malignancy were similar in both groups. Prevalence of hypercholesterolemia (11/33 vs. 4/33) and gum hypertrophy (6/33 vs. 1/33) was more common in cyclosporine-treated patients (P = 0.04 in both parameters). This was the first prospective, randomized study with paired kidney analysis showing the renal function was significantly better in tacrolimus-treated patients than in cyclosporine-treated patients.     

竹黄颗粒剂Ⅱ号对应激小鼠皮肤肥大细胞影响的实验研究

目的：阐明竹黄颗粒剂Ⅱ号治疗现的作用机制。方法：应用形态学方法观察竹黄Ⅱ号对应激小鼠皮肤肥大细胞的影响。结果：束缚应激诱导小鼠皮肤肥大细胞脱颗粒，竹黄Ⅱ号抑制了此效应。结论：提示竹黄颗粒剂Ⅱ号可抑制心理应激诱导的皮肤肥大细胞脱颗粒，可能是其治疗银屑病的疗效机制之一。     

Transduodenal local resection for low-risk group ampulla of vater carcinoma

BACKGROUND: Carcinoma of the ampulla of Vater has a more favorable prognosis, compared to other malignant tumors of the periampullary region, because it usually presents with symptoms in the early stage. However, treatment by local resection only of the ampullary carcinoma remains controversial. The aim of this study was to evaluate the treatment results of the ampulla of Vater carcinoma according to different types of operation in low-risk-group patients. METHODS: We retrospectively reviewed the medical records of 17 low-risk-group patients among a total of 102 patients with ampulla of Vater carcinoma who had underwent curative surgery from 1992 to 2002. All specimens were critically reviewed by a single expert pathologist, and the relationship between surgical outcomes and operation type was assessed. RESULTS: The low-risk group was comprised of 10 men and 7 women with a median age of 57.8 years. Thirteen of 17 patients underwent a pancreaticoduodenectomy (PD) or a pylorus preserving pancreaticoduodenectomy (PPPD), while 4 patients underwent a transduodenal local resection (TDLR). The operation time was significantly shorter in the TDLR group, compared to the PD or PPPD groups. Among the 17 patients, there was only 1 case of recurrence in the inguinal area 33 months after the pancreaticoduodenectomy. CONCLUSIONS: Transduodenal local resection is a comparable mode of operation for low-risk-group patients with Ampulla of Vater carcinoma. In particular, it is essential to evaluate the invasion depth in preoperative endoscopic ultrasonography, cell differentiation in preoperative biopsy, and positivity of resection margin accurately by using frozen section during the operation.     

Size fractions of ambient particulate matter induce granulocyte macrophage colony-stimulating factor in human bronchial epithelial cells by mitogen-activated protein kinase pathways

Environmental pollutants, including ambient particulate matter (PM), increase respiratory morbidity. Studies of model PM particles, including residual oil fly ash and freshly generated diesel exhaust particles, have demonstrated that PM affects inflammatory airway responses. Neither of these particles completely represents ambient PM, and therefore questions remain about ambient particulates. We hypothesized that ambient PM of different size fractions collected from an urban environment (New York City air), would activate primary culture human bronchial epithelial cells (HBECs). Because of the importance of granulocyte-macrophage colony-stimulating factor (GM-CSF) on inflammatory and immunomodulatory processes, we focused our studies on this cytokine. We demonstrated that the smallest size fraction (ultrafine/fine; < 0.18 micro m) of ambient PM (11 micro g/cm(2)), upregulated GM-CSF production (2-fold increase). The absence of effect of carbon particles of similar size, and the day-to-day variation in response, suggested that the chemical composition, but not the particle itself, was necessary for GM-CSF induction. Activation of the extracellular signal-regulated kinase and the p38 mitogen-activated protein kinase was associated with, and necessary for, GM-CSF release. These studies serve to corroborate and extend those on model particles. Moreover, they emphasize the role of the smallest size ambient particles in airway epithelial cell responses.     

Impaired design fluency is a marker of pathological cognitive aging; results from the Korean longitudinal study on health and aging

Objective

We investigated neuropsychological markers that can be used to discriminate pathological cognitive aging from normal cognitive aging.

Methods

We administered frontal lobe function tests including the Wisconsin Card Sorting Test (WCST), digit span test, lexical fluency test, fixed condition design fluency test, and Trail Making Test B (TMT-B) to 92 individuals with pathological cognitive aging (PCA) and 222 individuals with normal cognitive aging (NCA). We examined the main effects of participants'' diagnoses (PCA, NCA) and age (65-69 years old, 70-74 years old and 75 years old or over) on their test performance using multivariate analysis of variance.

Results

The main effects of both the diagnosis (F=2.860, p=0.002) and the age group (F=2.484, p<0.001) were significant. The PCA group showed lower performance on the backward digit span test (F=14.306, p<0.001), fixed condition design fluency test (F=8.347, p=0.004) and also exhibited perseverative errors in the WCST (F=4.19, p=0.042) compared with the NCA group. The main effect of the diagnosis on the backward digit span test and the fixed condition design fluency test remained significant after Bonferroni correction. The main effect of age remained significant in the TMT-B (F=8.737, p<0.001) after Bonferroni correction. Other test scores were not influenced by diagnosis or age.

Conclusion

The design fluency task may be a good neuropsychological marker to assess pathological cognitive aging.