芦荟凝胶应用于烧伤豚鼠模型伤口局部上皮出现时间及皮肤组织中纤维连接蛋白含量测定

目的:据报道,芦荟中多糖醛酸酯具有促进肉芽组织生长作用,其中的一些生长因子对伤口愈合抑制物有综合作用。通过观察烧伤豚鼠伤口上皮出现时间、愈合时间及皮肤组织中纤维连接蛋白的含量,探讨芦荟对伤口愈合的作用机制。方法:实验于2006-10/11在咸宁学院医学院中心实验室完成。①实验材料:纤维连接蛋白;美国芦荟1株;健康豚鼠20只,体质量500～550g,雌雄随机。②实验分组:将豚鼠随机分为芦荟组及对照组,每组10只。③实验干预:芦荟组:将封包好的芦荟凝胶外涂伤口处用纱布包封,2次/d。对照组:用庆大霉素纱条外敷伤口处,2次/d。④实验评估:记录上皮出现时间,平均愈合时间及15～25d的愈合率;分别于治疗前,治疗后15d和25d取愈合后皮肤测定组织液中纤维连接蛋白的含量。结果:20只豚鼠全部进入结果分析。①用药后两组豚鼠伤口愈合时间:与对照组比较,芦荟组上皮出现时间早,伤口愈合时间明显缩短,15d和25d的愈合率高(15d愈合率P<0.005,其余均为P<0.001)。②涂药前后两组豚鼠皮肤组织中纤维连接蛋白的含量:用药前未测出皮肤中的纤维连接蛋白含量,用药后15和25d皮肤中纤维连接蛋白含量逐渐增多,与对照组比较,芦荟组纤维连接蛋白含量明显增加(P值均<0.001)。结论:芦荟凝胶中的多糖成分能使皮肤组织中纤维连接蛋白增加,是促进伤口愈合机制之一。     

透明质酸钠预防兔膝关节固定后关节软骨退行性改变的作用

目的:多项研究成果已证明透明质酸钠在软骨修复及重建过程中具有重要作用。观察关节内注射透明质酸钠对兔膝关节固定后关节软骨退行性改变中的预防作用,并评估其效率。方法:实验于2004-10/2005-05在泰山医学院基础研究所完成。①实验分组:雄性新西兰大白兔24只,体质量2.5～3.0kg,随机分为生理盐水对照组和透明质酸治疗组,每组12只。②实验方法:透明质酸治疗组给予左膝关节内注射0.3mL透明质酸,1次/周,共行5次;生理盐水对照组给予左膝关节注射同等剂量生理盐水,1次/周,共行5次。各组均于初次注射后将左下肢给予石膏管型固定,膝部预留窗口以备下次注射。于末次注射1周后麻醉处死动物,采集左膝关节股骨髁关节软骨制成石蜡切片。同时采集右膝同部位软骨作为正常对照。③实验评估:普通光学显微镜下观察苏木精-伊红染色切片的形态变化;对甲苯胺蓝染色切片利用Image-ProPlus6.0图像分析系统进行平均染色灰度质分析;激光共聚焦显微镜分析免疫荧光标记的Ⅱ型胶原荧光强度。结果:纳入兔24只,均进入结果分析。透明质酸治疗组苏木精-伊红染色显示软骨层无变薄现象,软骨细胞同源细胞簇排列整齐,细胞大小均匀,细胞核染色均匀,潮线较为完整,无血管翳增生;生理盐水对照组苏木精-伊红染色显示软骨层变薄,细胞排列紊乱无规律,细胞大小不等,核染色浓淡不一,潮线不完整,血管翳有侵入软骨基底部的迹象。透明质酸治疗组软骨甲苯胺蓝染色灰度值及Ⅱ型胶原荧光强度均明显高于生理盐水对照组软骨(P<0.01),与正常软骨亦有显著差异(P<0.01)。结论:透明质酸能够有效地预防兔膝关节固定后的软骨退行性改变,但这种预防作用所产生的效果与正常软骨尚有差距。     

SARS in Taiwan: an overview and lessons learned.

OBJECTIVES: This report aims to describe the epidemiology of severe acute respiratory syndrome (SARS) in Taiwan between March and July 2003, and to examine the public health response. METHODS: Surveillance for SARS was initiated on 14 March 2003. Response activities are described for the isolation of patients; contact tracing; quarantine of contact persons; fever screening for inbound and outbound passengers at the airport; and hospital infection control as assessed by mobile SARS containment teams. RESULTS: Between 14 March and 30 July 2003 a total of 668 probable cases of SARS were reported. Of the 668 cases, 181 (27%) were fatal. Compared to the survivors, fatal cases were more likely to be older (p < 0.001), male (p < 0.05), exposed through hospital contact (p < 0.001), and have a coexisting medical disorder (p<0.001). Between 28 March and 30 July a total of 151,270 persons were quarantined. Among them, 46 (3.0/10,000) were subsequently classified as being probable SARS cases. At the time of the mobile team assessments, 46 (53%) hospitals had implemented WHO infection control recommendations. CONCLUSIONS: In this outbreak, an emergency plan consisted of patient isolation and strict hospital infection control.     

Etiology and predictors of urinary incontinence and its effect on quality of life

Aim: Urinary incontinence associated with dementia can result in medical comorbidities. We aimed to determine the prevalence of urinary incontinence and to identify the etiology and factors associated with urinary incontinence in dementia patients. Methods: Patients with an Mini‐Mental State Examination (MMSE) score of more than 10, attending the memory clinic were recruited. Basic demographic data, types and duration of dementia, use of cholinesterase inhibitor and other drugs with anticholinergic effects, carer stress and presence of urinary incontinence in the previous 6 months were recorded. Urodynamic studies were carried out in those patients with urinary incontinence. Results: One hundred and forty‐four subjects with a mean age of 78 years (standard deviation 6.8) were included. Forty‐eight (33.3%) had urinary incontinence. There was no statistically significant difference between continent and incontinent groups regarding age, MMSE, duration of dementia, use of cholinesterase inhibitor and of drugs with anticholinergic effects. Presence of nocturia of more than twice per night (odds ratio [OR] 4, 95% confidence interval [CI] 1.7, 9.2), use of walking aids (OR 2.6, 95% CI 1.1, 5.9) and male sex (OR 1.36, 95% CI 1.1, 5.2) were independent predictors of urinary incontinence. Urodynamic studies showed that 21 subjects had detrusor overactivity, 13 had bladder outlet obstruction, two with low compliance bladder, two with small bladder capacity, four with detrusor hyperactivity and impaired contractility. Conclusion: Urinary incontinence commonly occurs in dementia subjects. Poor mobility and presence of nocturia increase the risk of urinary incontinence. Correction of the possible reversible factors may help to reduce the prevalence of urinary incontinence in patients with dementia and reduce carer stress.     

冠状动脉旁路移植术治疗无保护左主干病变疗效及安全性系统评价

目的 系统评价冠状动脉旁路移植术(CABG)与经皮冠状动脉支架置入术(PCI)治疗无保护左主干病变的疗效及安全性.方法 计算机检索The Cochrane Library(2012年第2期)、PubMed、EMbase、CBM、CNKI、WanFang Data、VIP等数据库,全面收集CABG与PCI比较治疗无保护左主干病变的随机对照试验(RCT),检索时限均为建库至2012年9月,并追溯纳入研究的参考文献.由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析.结果 纳入4个RCT,共1 611例患者(CABG组:802例,PCI组:809例).Meta分析结果显示:与PCI组相比,CABG组能显著降低术后靶血管血运重建率[OR=0.45,95％CI (0.31,0.66),P＜0.000 1],但在降低心肌梗死发生率[OR=1.28,95％C1(0.47,3.48),P=0.63]、病死率[OR=1.36,95％CI(0.80,2.34),P=0.26]及主要心脑血管事件发生率[OR=0.92,95％CI (0.66,1.28),P=0.61]方面,两组差异无统计学意义.结论 本系统评价结果提示,CABG在降低冠心病无保护左主干病变患者心梗发生率、病死率及主要心脑血管事件发生率方面与PCI差异无统计学意义,但在降低术后靶血管血运重建率方面,CABG疗效优于PCI.受纳入研究质量和数量所限,上述结论仍需开展更多高质量的RCT加以验证.     

血管内皮生长因子联合骨髓单个核细胞自体移植治疗大鼠肢体缺血

目的:将血管内皮生长因子应用于骨髓单个核细胞自体移植治疗肢体缺血,探索一种简单、安全有效治疗肢体缺血的方法,同时初步分析血管内皮生长因子促进血管新生的机制和疗效。方法:实验于2005-03/2006-07在上海交通大学附属第六人民医院动物实验中心完成。将48只雄性Wistar大鼠采用随机单位组设计分为4组:缺血对照组、血管内皮生长因子治疗组、骨髓单个核细胞治疗组、转染血管内皮生长因子基因的骨髓单个核细胞治疗组,每组12只。结扎所有动物左后肢股动脉及分支,制备后肢缺血模型。以微量加样器自结扎处以下2cm开始,间隔0.2cm为一注射点,共注射于内收肌和腓肠肌5点,每注射点各注射60μL,缺血对照组大鼠注射300μL培养液,血管内皮生长因子治疗组大鼠注射含5μg基因pcDNA3.1-hVEGF165的DNA-脂质体复合物,骨髓单个核细胞治疗组大鼠注射3×106个骨髓单个核细胞,转染血管内皮生长因子基因的骨髓单个核细胞治疗组大鼠注射含3×106个血管内皮生长因子的骨髓单个核细胞。于移植后4周行动脉造影,采用RT-PCR检测血管内皮生长因子基因的体内表达,采用免疫组化法检测缺血区新生血管密度,评价血管新生情况。结果:48只大鼠均造模成功,并进入结果分析。①移植后4周动脉造影显示,缺血对照组大鼠股动脉及其分支均未显影,血管内皮生长因子治疗组和骨髓单个核细胞治疗组可见中等量新生血管,两组效果相似,转染血管内皮生长因子基因的骨髓单个核细胞治疗组可见有大量新生血管新生,丰富的侧枝循环建立。②大鼠毛细血管密度测定结果显示,血管内皮生长因子治疗组和骨髓单个核细胞治疗组均较缺血对照组新生血管数量增加,转染血管内皮生长因子基因的骨髓单个核细胞治疗组可进一步增强疗效[(10.0±0.8),(21.7±1.9),(20.4±3.3),(42.1±3.5)个/HP,P<0.05],血管内皮生长因子治疗组和骨髓单个核细胞治疗组两组之间差异无明显统计学意义(P>0.05)。③RT-PCR检测大鼠血管内皮生长因子基因的体内表达,转染血管内皮生长因子基因的骨髓单个核细胞治疗组和血管内皮生长因子治疗组均有扩增,转染血管内皮生长因子基因的骨髓单个核细胞治疗组人血管内皮生长因子mRNA相对含量表达高于血管内皮生长因子治疗组(0.191±0.044,0.094±0.032,P<0.05)。结论:本组实验结果说明采用骨髓单个核细胞作为基因载体细胞治疗大鼠肢体缺血,能使血管内皮生长因子获得稳定有效的表达,其效果优于直接基因注射。     

At‐home disaster preparedness of elderly people in Hong Kong

Aim: The present study aims to explore the concerns relating to disasters among the elderly in Hong Kong, as well as the extent and predictive factors of their preparedness for disasters. The elderly are considered a vulnerable population, without the ability to protect themselves during disasters. Their accurate perception and preparedness for disasters can minimize damage to their health or threats to their lives when disasters strike. Methods: Elderly people who had installed an emergency call service in Hong Kong were contacted by telephone for an interview between the months of June to September 2010. Results: A total of 1137 questionnaires were analyzed for the present study. Elderly people considered major transport accidents (54.3%), fires (47.9%) and storms/flooding (41.5%) as the disasters most likely to occur in Hong Kong. In preparing for disasters, many of the elderly reported having a survival pack easily accessible (86.9%), knowing how to shut down the water, gas and electricity (79.2%), and knowing how to contact their family members (54%). A total of 255 (22.4%) elderly people were classified as being prepared for disaster. Those who were born in Hong Kong (OR = 1.471), living with other family members (OR = 1.742), had neighbors to provide support (OR = 2.92) and perceived themselves as having the ability to help themselves (OR = 1.34) were more prepared for disasters. Conclusion: The majority of elderly people are not prepared for disasters. Health professionals working with the elderly should recognize their characteristics and develop strategies to cater to their special needs in preparing for disasters. Geriatr Gerontol Int 2012; 12: 524–531.