高龄患者下肢手术行外周神经阻滞效果分析

目的：在老年患者下肢手术过程中分别采用硬膜外麻醉与外周神经阻滞两种方法,并观察这两种麻醉方法的麻醉效果和安全性。方法选取2013年1月~2014年1月因下肢外伤就诊于我院的老年患者24例。按随机分组的方法分为外周神经阻滞组和硬膜外麻醉组,每组12例。外周神经阻滞组：在神经刺激器引导下行后路腰丛及坐骨神经阻滞。硬膜外麻醉组常规硬膜外麻醉。结果两组手术麻醉效果无显著差异（P＞0.05）。血流动力学改变：外周神经阻滞组患者阻滞前后及术毕均无明显波动,麻醉后15,30min两组心率、收缩压、舒张压及平均动脉压均有显著差异（P＜0.05）。镇痛时间：外周神经阻滞组明显长于硬膜外阻滞组。外周神经阻滞组起效时间明显短于硬膜外阻滞组,差异有统计学意义（P＜0.05）。外周神经阻滞组维持时间长于硬膜外阻滞组,差异有统计学意义（P＜0.05）。运动神经阻滞：外周神经阻滞组起效时间、维持时间均短于硬膜外阻滞,差异有统计学意义（P＜0.05）。结论外周神经阻滞可安全有效地应用于80岁以上高龄老人下肢手术。     

流行性出血热等三种疾病发病季节性特征分析

应用园形分布法分析了泰安市１９９１～１９９５年流行性出血热、细菌性痢疾和甲型肝炎三种传染病不同性别患者的发病季节性特征。结果显示，除１９９５年甲肝和１９９２年出血热的女性患者外，各病男女性患者各年度发病均有显著的季节性特征（Ｐ＜０．０１）。性别之间发病季节性特征，除１９９４年出血热和１９９５年菌痢外，其余均无显著差异（Ｐ＞０．０５）。相关分析显示，菌痢的发病季节性强弱与流行强度呈正相关（Ｐ＜０．０１）。结果提示应根据各病的发病季节性特征而采取相应防治措施。     

焦虑症、抑郁症的关联性负变

目的 探讨焦虑症(AD)和抑郁症的关联性负变(CNV)变异.方法 应用Nicolet Bravo脑诱发电位仪,采用光和声成对刺激以及反应时间技术,记录了37例AD患者的CNV,并与36例健康成人(NC)和32例抑郁症患者的CNV进行比较.结果 AD和抑郁症组波形不规则,CNV-Ⅱ型尤甚.AD组、抑郁症组及NC组在潜伏期M2及波幅M1、M2差异有显著性(P＜0.05～0.01).与NC组相比,抑郁症组波幅降低和潜伏期延迟.AD组呈同样趋势.结论 CNV是评定AD患者和抑郁症患者大脑综合功能的有效工具,值得临床推广应用.     

Vasostatin-1 Stops Structural Remodeling and Improves Calcium Handling via the eNOS-NO-PKG Pathway in Rat Hearts Subjected to Chronic β-Adrenergic Receptor Activation

Purpose

Chronically elevated catecholamine levels activate cardiac β-adrenergic receptors, which play a vital role in the pathogenesis of heart failure. Evidence suggests that vasostatin-1 (VS-1) exerts anti-adrenergic effects on isolated and perfused hearts in vitro. Whether VS-1 ameliorates hypertrophy/remodeling by inducing the chronic activation of β-adrenergic receptors is unknown. The present study aims to test the efficacy of using VS-1 to treat the advanced hypertrophy/remodeling that result from chronic β-adrenergic receptor activation and to determine the cellular and molecular mechanisms that underlie this response.

Methods and Result

Rats were subjected to infusion with either isoprenaline (ISO, 5 mg/kg/d), ISO plus VS-1 (30 mg/kg/d) or placebo for 2 weeks. VS-1 suppressed chamber dilation, myocyte hypertrophy and fibrosis and improved in vivo heart function in the rats subjected to ISO infusion. VS-1 increased phosphorylated nitric oxide synthase levels and induced the activation of protein kinase G. VS-1 also deactivated multiple hypertrophy signaling pathways that were triggered by the chronic activation of β-adrenergic receptors, such as the phosphoinositide-3 kinase (PI3K)/Akt and Ca²⁺/calmodulin-dependent kinase (CaMK-II) pathways. Myocytes isolated from ISO + VS-1 hearts displayed higher Ca²⁺ transients, shorter Ca²⁺ decays, higher sarcoplasmic reticulum Ca²⁺ levels and higher L-type Ca²⁺ current densities than the ISO rat hearts. VS-1 treatment restored the protein expression of sarcoplasmic reticulum Ca²⁺ uptake ATPase, phospholamban and Cav1.2, indicating improved calcium handling.

Conclusions

Chronic VS-1 treatment inhibited the progression of hypertrophy, fibrosis, and chamber remodeling, and improved cardiac function in a rat model of ISO infusion. In addition, Ca²⁺ handling and its molecular modulation were also improved by VS-1. The beneficial effects of VS-1 on cardiac remodeling may be mediated by the enhanced activation of the eNOS-cGMP-PKG pathway.

     

论培养社区卫生工作需要的全科医生

分析社区卫生工作的特点及对全科医生的要求.并在此基础上,研究规范化培养全科医生需要注意的一些关键问题,主要表现在：全科医生培养的体系设置要结合社区卫生工作的实际需要;高度重视选拔和培养全科医生的师资;建设全科医生培养训练基地,狠抓社区在职医生转型教育工作;加强对农村贫困地区社区全科医生的“定向培养”,以此来培养符合社区卫生工作需要的全科医生.     

家兔C型利钠肽基因真核表达载体的构建及鉴定

目的为开展C型利钠肽(CNP)基因治疗构建家兔CNP基因真核表达载体。方法通过RT-PCR从家兔腹主动脉组织中克隆CNP基因全长编码区,将该DNA片段亚克隆至克隆载体pMD 18-T中,用PstⅠ单酶切筛选出负向插入片段,用HindⅢ和KpnⅠ双酶切将目的DNA片段定向克隆至真核表达质粒pEGFP-N1中,然后用双酶切、DNA序列测定鉴定方法对重组质粒进行鉴定。结果酶切及测序鉴定证实,家兔CNP基因全长编码区被准确插入到pEGFP-N1酶切位点HindⅢ和KpnⅠ中。结论含家兔CNP基因真核表达载体的成功构建和鉴定为CNP基因治疗的研究奠定了基础。     

服用小剂量阿司匹林对上消化道黏膜损伤的相关性研究

[目的]旨在研究服用不同小剂量阿司匹林对无消化道症状的病人上消化道黏膜损伤的影响。[方法]采用内镜观察,对正规使用阿司匹林超过3个月的心脏病门诊病人进行了胃镜检查。[结果]69例无消化道症状的心脏病病人中,每日阿司匹林用量为78.11mg±5.15mg,只有23.19%的病人使用了胃黏膜保护剂。胃镜显示异常33例(47.83%)的病例有溃疡或糜烂;尿素酶试验检测幽门螺杆菌(HP)阳性率为26.09%。提示阿司匹林是胃镜阳性唯一的相关因素,且随着阿司匹林剂量增加,内镜阳性率随之增加,经统计学处理有统计学意义(P<0.01)。[结论]重视服用小剂量阿司匹林对胃、十二指肠损伤的影响。     

Construction of Adeno-associated Virus System for Human Bone Morphogenetic Protein 7 Gene

To construct the recombinant adeno-associated virus （rAAV） vector with human bone morphogenetic protein 7 （BMP7） and observe the BMP7 mRNA expression in vitro, BMP7 CDS sequence was cloned into expression plasmid pAAV-MCS of AAV Helper Free System. The recombinant plasmid was identified with enzyme digestion and sequencing. The recombinant plasmid, pAAV-RC, pHelper were co-transfected into AAV-293 cells according to the calcium phosphate-based protocol. The viral stock was collected by 4 rounds of freeze/thaw. After purified and concentrated, the recombinant virus titer was determined by dot-blot assay. HEK293 cells were transfected with the recombinant virus at different MOI, and the expression of BMP7 mRNA was detected by RT-PCR. The results showed rAAV-BMP7 was constructed and packaged successfully. The physical particle titer was 2.5×10^11 vector genomes/mL. There was different expression level of BMP7 mRNA after transfecton. These data suggested that recombinant AAV mediated a stable expression of hBMP7 mRNA in 293 cells. The AAV production method may pave the way of an effective strategy for the jaw bone defection around dental implants.     

Smac蛋白表达与食管癌发生、发展的关系

目的探讨Smac的表达及与食管癌发生、发展的关系.方法采用免疫组织化学S-P法检测Smac在食管癌组织和癌旁正常食管组织中的表达情况.结果Smac在食管癌旁正常食管组织中的表达明显高于癌组织(P＜0.05).Smac表达与癌组织浸润深度和淋巴结转移呈负相关(P＜0.05).结论Smac在食管癌组织中异常表达,有望成为食管癌诊断和基因治疗的新靶点.