绵毛马兜铃化学成分研究 Ⅴ.

从南京地区产的绵毛马兜铃(Aristolochia mollissima Hance)根茎中,分离出九个化合物(Ⅰ～Ⅸ),其中已报道的五个化合物是尿囊素、马兜铃内酯、绵毛马兜铃内酯、β-谷甾醇、马兜铃酸A,本文再报道另外两个新化合物Ⅴ和Ⅶ的结构测定。     

规律性运动干预慢性心力衰竭患者终点指标的Logistic回归分析

目的:多因素Logistic回归模型回顾性分析规律运动锻炼等影响因素与研究终点的关系,观察规律运动锻炼对慢性心力衰竭患者预后的影响。方法:选择2002-01/2004-03因冠心病、扩张性心肌病、高血压病引起慢性心力衰竭首次在北京大学第三医院心内科住院的患者73例。采用电话与通信方式随访其出院1年内的身体状况、用药情况、再住院以及日常锻炼情况等,其中规律运动锻炼指每日活动至少30min,每周至少5d,运动方式包括步行、慢跑、骑单车等。以1年内死亡或因心力衰竭再住院为研究终点,运用多因素Logistic回归模型回顾性分析规律运动锻炼等影响因素与研究终点的关系。结果:73例慢性心力衰竭患者中坚持规律运动锻炼者32例(43.8%),运动锻炼不规律或不锻炼者41例(56.2%)。①1年内因心力衰竭死亡17例,其中运动锻炼不规律或不锻炼者15例(36.6%),规律运动锻炼者2例(6.3%),差异有显著性意义(P<0.01);1年内因心力衰竭再住院40例(54.8%),其中运动锻炼不规律或不锻炼者28例(68.3%),规律运动锻炼者12例(37.5%),规律运动锻炼对再住院也是一个负性影响因素(P<0.01)。②多因素分析显示,排除性别、年龄、心功能分级、射血分数、有无合并症及治疗情况等干扰因素后,规律运动锻炼是预测慢性心力衰竭患者1年内死亡和再住院的独立因素。结论:以规律运动锻炼为主的康复治疗减少了慢性心力衰竭患者1年内的病死率和因心力衰竭再住院率。     

Influence of the HLA-DRB1 locus on susceptibility and severity in rheumatoid arthritis

We examined HLA-DR genotype risk in 288 patients with rheumatoid arthritis who were carefully categorized for disease severity. Five hundred ethnically-matched bone-marrow donors were controls. A hierarchy of positive allelic associations was noted with DRB1*0401 (p < 10(-38), *0404,8 (p < 10(-43), *0405 (p < 10(-8), *10 (p < 10(-3) and *0101,2 (p < 10(-2), while DRB1*0403 was negatively associated (p = 0.02). The DRB1 genotype relative risks (and 95% CIs) for RA were: *0404,5,8/*0404,5,8 = 36.2 (15-87), *0401/*0404,5,8 = 31.3 (18-55), *401/*0401 = 18.8 (11-35), *0101,2/*0404,5,8 = 6.0 (2-14), *0101,2/*0401 = 6.4 (3-12), *0101,2/*0101,2 = 1.3 (0.3-6), *10/*0404,5,8 = 27.8 (5-148), *10/*0401 = 20.8 (5-89), *10/*0101,2 = 22.3 (5-96), *0404,5,8/DRX = 5.0 (3-8), *0401/DRX = 4.7 (3-7), *0101,2/DRX = 2.3 (1.4-4), *10/DRX = 3.4 (0.8-14). No significant correlation of DRB1 genotypes was found with severity of RA as judged by nodules or articular erosions.      

HLA antibody enhancement by double addition of serum: use in platelet donor selection

The identification of HLA class I alloantibodies is important for organ transplantation and platelet transfusion in alloimmunized patients. Because microcytotoxicity testing against frozen trays of lymphocyte panels is rapid and efficient for determining specificities of unknown antibodies, a simple method was devised to increase test sensitivity to weak antibodies. Standard anti-human globulin (AHG)-facilitated microcytotoxicity was modified by the insertion of a double addition-of-serum (DAS) step, and reagent and patient's sera were evaluated by both methods. DAS modification increased antibody titers and, more significantly, made the identification of weak specificities easier because of the twofold to threefold increase in reactivity rates (29-42% for AHG vs. 75-82% for DAS) of panel cells that were expected to be positive, while low (approx. 1%) "extra" reaction rates were maintained for cells that were expected to be negative. DAS was relatively unaffected by variations in serum volumes or target cell preparation, and its use did not significantly increase test time or costs. In a program of platelet donor selection driven by donor antibody rather than donor-recipient antigen matching, DAS greatly facilitated platelet transfusion support for alloimmunized patients.     

精原干细胞在成骨培养条件下的生物学特征

目的:观察小鼠精原干细胞在成骨培养条件下的生物学特征,为探讨精原干细胞的多向分化能力提供实验依据。方法:实验于2006-03/2007-01在泸州医学院医学分子生物学实验室完成。①实验材料:生后6～8d左右昆明系小白鼠,雌雄均可,由泸州医学院动物科提供。②实验方法:取7～10d小白鼠双侧股骨和胫骨,制备骨髓基质饲养层。取6～8d雄性小鼠,脱颈椎处死后,无菌取出睾丸,进行精原干细胞分离、培养与鉴定。取培养3d的精原干细胞,分为两组:对照组用基本培养液(IMDM 100U/mL青霉素 100U/mL链霉素 10%胎牛血清)培养,实验组用条件培养液培养(基本培养液中添加50mmol/Lβ-甘油磷酸钠、10-6mol/L地塞米松、50mg/L维生素C、50nmol/L胰岛素、20nmol/L碱性成纤维细胞生长因子)培养。③实验评估:在倒置显微镜下观察细胞的形态学变化、紫外分光光度仪动态检测上清液中碱性磷酸酶活性变化、免疫荧光法检测细胞内Ⅰ型胶原的表达。结果:①细胞形态学特征变化:实验组精原干细胞在成骨条件培养液中较对照组细胞贴壁生长快,条件培养3～6d后见细胞生长迅速,呈集落样增长,细胞立体感增强,但未见明显细胞间桥;诱导培养15d见细胞增殖达高峰,增殖细胞的胞质间桥仍不明显。②Ⅰ型胶原免疫荧光检测结果:实验组细胞浆内出现绿色荧光,呈阳性反应,对照组细胞呈阴性反应。③培养上清液碱性磷酸酶活性变化:实验组与对照组培养上清液中的碱性磷酸酶活性开始很低,以后逐渐增强。实验组培养上清液的碱性磷酸酶活性每个时间段都明显高于对照组(P<0.05)。结论:小鼠精原干细胞在成骨诱导培养条件下能快速增殖,增殖过程中表现出成骨细胞的某些生物学特征,这为进一步研究精原干细胞的多向分化潜能提供实验参考。     

职业学校学生抑郁障碍与生活事件和应对方式的关系

目的:观察职业学校学生的抑郁状况并探索应激源、应对方式与抑郁的关系,进一步分析其可能的作用机制。方法:整群抽取山东省聊城市职业技术学院、工业学校、贸易学校、教育学院、东昌学院5所中等职业院校在校一～三年级学生500名为调查对象,对所有对象进行无记名问卷调查,全部采用封闭式问题,问卷内容包括性别、年级、对所学专业是否满意等,统一调查方法和指导语,以班级为单位填写,问卷当场收回。测试项目包括用抑郁自评量表(由20个项目组成,以总分<16分判为无抑郁症状,总分在16～19分判为可能有抑郁症状,总分≥20分判为肯定有抑郁症状,总分≥41分判为有明显抑郁症状)、青少年自评生活事件量表(共27个条目,每个条目分5个等级评定,按人际关系、学习压力、受惩罚、丧失、健康适应和其他共6个因子进行统计学分析)和特质应对方式问卷(分为积极应对和消极应对2个维度,各包括10个条目,以消极应对分数与积极应对分数之差作为被试的应对方式评定分数。分数越高表示应对方式越消极),采用多元相关分析探索生活事件应激强度、应对方式与抑郁的相关性;以抑郁为因变量、生活事件各因子为自变量的多元回归分析。结果:纳入受试学生500名,剔除无效问卷(缺项、漏项、连续选择同一选项)48份,共收回有效问卷452份,有效率为90.4%。女生287名(63.5%),男生165名(36.5%);年龄15～18岁。①抑郁症状的总检出率为40.93%,其中可能有抑郁症状的为13.05%,肯定有抑郁症状的为27.88%,有明显抑郁症状的为1.33%。女生的抑郁平均得分高于男生[(16.57±9.117),(13.39±7.558)分,P<0.01];对所学专业满意学生抑郁的平均得分显著低于对专业不满意的学生[(13.89±7.963),(20.56±9.174)分,P<0.01];二、三年级学生抑郁平均得分高于一年级[(16.51±9.112),(19.96±11.308),(14.47±8.077)分,P<0.05]。②对职业学校学生的抑郁具有预测作用的应激源为学习压力、受惩罚、健康适应、其他和人际关系;影响女生抑郁的应激源比男生要复杂得多;抑郁与生活事件各因子人际关系、学习压力、受惩罚、丧失、健康适应、其他均呈显著正相关(R=0.352,0.336,0.221,0.119,0.361,0.340,P<0.05～0.01)。应对方式与抑郁呈显著正相关(R=0.504,P<0.01);应对方式与生活事件各因子均呈显著正相关(R=0.330,0.283,0.196,0.103,0.299,P<0.05～0.01);应对方式对抑郁有预测作用。结论:职业学校学生的抑郁情况不容乐观;大部分应激源对职业学校学生的抑郁有预测作用;应对方式在应激源与抑郁之间起中介作用,但是中介程度不同。     

A narrative review of the effectiveness of aggression management training programs for psychiatric hospital staff

Workplace violence, including patient-perpetrated violence in healthcare settings, is increasingly being recognized as preventable. Staff training has been identified as a necessary component of any initiative aimed at preventing or reducing incidents of aggression and violence in the workplace. This narrative review of the literature evaluates the effectiveness of staff training programs designed to prevent and manage violence and aggression in psychiatric hospitals. An exhaustive review of the literature was performed on all articles published in English between January 1, 1990 and April 1, 2007 that evaluate an aggression management training program. Twenty-nine studies met the inclusion criteria for a full review and were summarized using a qualitative narrative approach. Aggression management training has been proven effective in some areas, such as reducing the use of restraints and other coercive control devices, but more methodologically rigorous research is needed to firmly establish whether it is effective in reducing aggression and staff injuries.
Implications: The findings of this study suggest that relying too heavily on aggression management staff training will have limited effect on addressing the range of issues related to patient-perpetrated violence in psychiatric hospitals. Mental healthcare organizations must look beyond staff training if they are to achieve meaningful reductions in aggressive incidents and staff injuries.