结局指标在缺血性脑卒中病人康复护理路径中的应用研究

[目的]运用护理结局指标构建缺血性脑卒中病人康复护理路径,为护士在临床服务全过程中提供标准化的语言链接和可供度量的尺度,同时培养临床护士发现、思考、解决问题的能力,也为病人在临床就医体验提供规范化、连续性、科学化的护理服务模式。[方法]通过病例回顾性研究和文献研究,由2名研究者独立提取护理记录的相关概念、归类到缺血性脑卒中46项核心护理结局。[结果]最终10项护理结局中有33个结局指标差异具有统计学意义(P<0.01),包括上肢肌力、下肢肌力、爬楼梯的耐受性、以有效的步态行走、慢走、中速行走、走、平衡、协调、步态、表现正常的能力水平、显示完成日常任务的能力、表现出适当的修饰和卫生、括约肌伸缩性、排便时肌肉的伸缩性、排便无须辅助措施、如厕、沐浴、走路、吞咽测试的结果、对食物的容受、吞咽不适、音质变化、正确使用支持器械、采取正确推重物的技巧、表现出肌力良好、充足的液体摄入、排尿模式、意识的尿意、说道感到焦虑、血压升高、说道恐慌感、恐慌感。[结论]以护理结局指标为导向构建的缺血性脑卒中病人康复护理路径,可为病人在临床就医体验提供规范化、连续性、科学化的护理服务模式,提高医护工作的水平。     

基于网络药理学方法预测定喘汤治疗慢性阻塞性肺疾病的作用机制及验证研究

目的：分析定喘汤治疗慢性阻塞性肺疾病(COPD)的分子机制,并通过细胞实验验证定喘汤的药理学作用。方法：在中药系统药理学数据库与分析平台(TCMSP)数据库中,对定喘汤9味中药进行有效成分筛选,利用UniPort数据库得到中药活性成分相关靶点。随后在五大疾病数据库中以COPD作为关键词进行检索,收集疾病对应的靶点基因。对有效成分-交集靶点网络进行拓扑分析,根据中药有效成分与交集靶点之间连接情况筛选定喘汤治疗COPD关键成分。最后通过基因本体(GO)富集分析和京都基因和基因组百科全书(KEGG)富集分析确定定喘汤治疗机制并进行分子对接,从整体生物网络角度阐述定喘汤治疗COPD的免疫炎症机制,并通过细胞实验加以验证。结果：本实验筛选得到定喘汤274个活性成分,与疾病交集靶点262个。KEGG富集分析表明核心靶点作用于白细胞介素-17(IL-17)信号通路、NOD样受体信号通路及趋化因子信号通路等多种免疫和炎症反应相关的信号通路,分子对接显示核心化合物与靶点具有良好的对接活性。细胞实验表明,定喘汤能通过磷脂酰肌醇3激酶/蛋白激酶B(PI3K/AKT)信号通路,抑制人Ⅱ型肺泡上皮细胞炎症反应,...     

骨髓间充质干细胞和软骨细胞共培养复合同种异体脱钙骨基质修复关节软骨全层缺损

目的:探讨自体骨髓间充质干细胞(BMSCs)与软骨细胞共培养复合同种异体脱钙骨基质(DBM)修复关节软骨缺损的可行性,评价修复效果,为优化种子细胞源提供依据.方法:取浓度为5×109/L的第二代BMSCs和软骨细胞,按2:1比例混匀共培养作为种子细胞.DBM与共培养细胞复合植入修复为实验组(A组),单纯材料DBM组(B组)和不处理组(C组)作为实验对照组.移植8和16 wk后经大体观察、组织学评分和免疫组化染色评价缺损修复.结果:共培养的软骨细胞基质合成丰富,细胞增殖快,共培养5～7 d两种细胞比例达1:1以上.A组缺损修复组织呈软骨样,表面光滑平坦,与周围软骨整合的软骨细胞更为成熟.B组和C组的修复组织呈纤维组织.组织学评分表明A组优于B,C两组,差异具有统计学意义(P＜0.01),B组与C组差异无统计学意义(P＞0.05).免疫组化染色显示A组修复组织的细胞为透明软骨样细胞,柱状排列,Ⅱ型胶原染色阳性,与周围软骨及软骨下骨整合良好.结论:自体BMSCs与软骨细胞共培养,BMSCs能增强软骨细胞的增殖,促进软骨细胞基质合成,缩短软骨细胞培养时间和减少传代次数,可节省大量的软骨细胞,与DBM复合后能有效修复关节软骨缺损.     

反义波形蛋白逆转录病毒对损伤的星形胶质细胞的作用

目的探讨重组反义波形蛋白cDNA逆转录病毒重组质粒对体外培养损伤的星形胶质细胞(astrocyte,AST)波形蛋白(vimentin)表达的影响.方法采用体外培养AST划伤模型,设实验组及对照组,通过免疫荧光、RT-PCR、Western blot等方法,研究反义波形蛋白逆转录病毒感染对损伤AST波形蛋白表达的影响.结果反义波形蛋白逆转录病毒使损伤AST生长抑制,突起回缩,波形蛋白mRNA及蛋白水平表达降低.结论反义波形蛋白可有效抑制体外培养损伤AST的生长及其波形蛋白的表达.     

重组逆转录病毒双表达载体的构建及其对K562细胞增殖活性的影响

目的 构建针对慢性粒细胞白血病bcr-abl b3a2型mRNA的双表达逆转录病毒载体,初步探讨其对K562细胞表型的影响.方法 以逆转录病毒载体pMSCV-neo为骨架,构建eGFP及针对bcr-abl b3a2型mRNA的反义RNA双表达载体pMSCV/GFP-H1-BCR/ABL40AS,同时构建对照载体pMSCV/GFP-H1-BCR/ABL40S和pMSCV/GFP-H1-BCR/ABL80AS,酶切及测序鉴定各重组载体;以脂质体法转染各载体到PT67包装细胞后,G418筛选稳定的病毒产生细胞株,再以NIH3T3细胞测定病毒滴度并感染K562细胞,计数细胞数绘制细胞生长曲线,FCM检测细胞凋亡情况、并用Western blot检测PKR激活情况.结果 酶切及测序结果证实各重组载体构建完全正确;G418筛选到高滴度重组逆转录病毒生产细胞株:PT67-MSCV/GFP、PT67-40as、PT67-40s和PT67-80as,且PT67-40as上清感染组K562细胞生长受抑制,其24 h时早期细胞凋亡率为22.54±3.19%,与除PT67-80as组外的其余各组相比有显著差异(P＜0.05);PT67-40as和PT67-80as处理组细胞PKR磷酸化水平分别增高了59.20%和60.33%,2AP能抑制PT67-40as的作用.结论 成功构建重组逆转录病毒双表达载体,并发现其能抑制K562细胞生长并引起细胞凋亡,通过激活PKR抗肿瘤可望成为肿瘤新的靶向治疗策略.     

A REHABILITATION PROGRAMME FOCUSSING ON PELVIC FLOOR MUSCLE TRAINING FOR PERSISTENT LUMBOPELVIC PAIN AFTER CHILDBIRTH: A RANDOMIZED CONTROLLED TRIAL

ObjectiveTo evaluate the effects of a rehabilitation programme for lumbopelvic pain after childbirth.MethodsWomen with lumbopelvic pain 3 months postpartum were included in a randomized controlled trial. Patients in the intervention group (n = 48) received pelvic floor muscle training combined with neuromuscular electrical stimulation of the paraspinal muscles for 12 weeks, while patients in the control group (n = 48) received neuromuscular electrical stimulation for 12 weeks. Outcomes were measured with the Triple Numerical Pain Rating Scale (NPRS), Modified Oswestry Disability Questionnaire (MODQ) and Short-Form Health Survey-36 (SF-36).ResultsThe NPRS score was significantly better in the intervention group at 12 weeks compared with the control group (p = 0.000). The MODQ score was significantly better at 6 and 12 weeks compared with the control group (p = 0.009 and p = 0.015, respectively). The mean value of the Physical Components Summary of the SF-36, was significantly better in the intervention group at 6 weeks (p = 0.000) and 12 weeks (p = 0.000) compared with the control group, but there was no significant improvement in Mental Components Summary of the SF-36.ConclusionA postpartum programme for women with lumbopelvic pain is feasible and improves the physical domain of quality of life.LAY ABSTRACTPostpartum lumbopelvic pain is common, and there are a range of treatments available. The aim of this study was to establish a programme for use in clinical practice, comprising pelvic floor muscle training combined with other traditional treatments. The programme was shown to reduce pain and improve patients’ quality of life. No adverse events occurred.Key words: lumbopelvic pain, biofeedback, myoelectric stimulation, pelvic floor, postpartum women

Lumbopelvic pain refers to self-reported pain in the lower back, sacroiliac joints, or a combination of these locations, among pregnant and postnatal women (1). The pain may radiate into the posterior thigh and is also experienced in conjunction with, or separately from, symphysis pubis pain. Approximately 50% of pregnant women report lumbopelvic pain to some degree (1). Although the majority of women recover within 3 months of delivery, in a substantial number of women the pain persists, with prevalence ranging from 26.5% to 91.0% 2–3 years after delivery (2). Risk factors for such pain include maternal age, parity, body mass index, education, and uncomfortable working conditions (3). Recent studies indicate the importance of hip extensors, pelvic floor muscle (PFM) and transverse abdominal muscle (TrAM) in the development of lumbopelvic pain (4). Moreover, pelvic instability, asymmetry and insufficient compression of the sacroiliac joints contribute to continuous lumbopelvic pain after delivery (5). Studies have demonstrated the importance of choosing an optimal treatment strategy in clinical practice, and 5 subgroups of self-rated pain locations have been identified in the pelvic area (6). This study focused on pelvic girdle pain (PGP), or PGP in combination with lumbar pain, since these groups have been shown to have the highest impact on activity levels and health-related quality of life (6).Stabilization exercises that include dynamically controlling the lumbar segments and pelvic joints have been shown to result in functional improvement in patients with lumbopelvic pain (7). Different treatments have been used, including drugs, specific exercises, shortwave therapy, ultrasound, neuromuscular electrical stimulation, corsets, acupuncture and massage (2). The most frequently used interventions are strengthening exercises for the TrAM, PFM training, and a technique involving manipulation of the lumbar multifidus. Although several studies have shown that correct PFM contractions cause co-contractions of the abdominal muscles (8, 9), to date, studies of exercise programmes for treatment of lumbopelvic pain have shown mixed findings and there is insufficient evidence to guide clinical practice in this area. There was also variability across existing randomized controlled trials (RCTs) in the components of programmes, modes of delivery, follow-up times and outcome measures (3, 4, 7). It is therefore not known whether PFM training works well alone, or in combination with other therapies. There is a strong need for the development of a validated postpartum programme.A common concept in PFM training is the use of standardized exercises or electromyographic activity of the PFM (10). Physical therapists are frequently needed to give instructions on how to contract the PFM correctly at hospital or at home. A new validated myoelectric activation method, using biofeedback registration, was used in the current study (11). This technique can be regarded as an adjuvant electromyography, allowing both patients and physical therapists to observe PFM functioning and assess muscle integrity. This technique has been shown to improve self-reported subjective success and satisfaction in patients with pelvic floor dysfunction (11).The aim of the current study was to investigate whether a rehabilitation programme focusing on biofeedback-assisted PFM training is sufficient as treatment for women with PGP or combined pain postnatally.     

基于子午流注学说探究冠心病慢性心衰患者子午时辰NO、eNOS、ET-1及BNP水平变化

目的:对比健康人与冠心病慢性心衰患者子午时辰的一氧化氮(NO)、内皮型一氧化氮合成酶(eNOS)、内皮素1(ET-1)及B型脑钠尿肽(BNP)水平,探索冠心病慢性心衰患者内环境分子昼夜的节律变化及最佳用药时间点.方法:选取冠心病慢性心衰患者60例作为观察组,选取同时期健康人60例作为对照组;于子时(23:00至1:00...     

头颈部炎性肌纤维母细胞瘤

目的 炎性肌纤维母细胞瘤（inflammatory myofibroblastic tumor,IMT）是一种可发生于头颈部的罕见肿瘤,本文就其临床表现、病理组织学特征、治疗及预后进行探讨.方法 回顾性分析4例头颈部IMT患者的临床资料,并进行光镜检查及免疫组化染色.结果 IMT肿瘤组织学由具有平滑肌细胞和纤维母细胞特征的梭形肿瘤细胞、大量慢性炎性细胞及黏液血管样背景构成.免疫组化：平滑肌特异性肌动蛋白（smooth muscle actiVe,SMACTIN）、波形蛋白（Vimentin）呈强阳性表达.术后随访9～21月,2例声带IMT无复发,1例上颌窦IMT无复发,另1例上颌窦鼻腔IMT术后4个月再次复发.结论 IMT是兼有纤维母细胞及平滑肌细胞特征的肿瘤,具有局部复发倾向.治疗以根治性手术切除为主,术后放疗、化疗效果不确定.鼻窦I MT极易复发,具有局部浸润行为,手术切除须彻底.     

养阴利咽饮与玉液散吹喉对阴虚肺燥型慢性咽炎患者血清因子的影响

目的:探讨养阴利咽饮与玉液散吹喉对阴虚肺燥型慢性咽炎患者血清炎性因子的影响。方法:将2015年8月至2017年3月山东省淄博市第四人民医院收治的慢性咽炎患者118例作为研究对象,按治疗方法不同分为对照组和观察组,每组59例。对照组用常规西药治疗,观察组用养阴利咽饮与玉液散吹喉治疗,均连续治疗30 d。比较2组临床疗效,观察并比较治疗前后2组患者主要临床症状改善情况,唾液中分泌型免疫球蛋白A(SIgA)、血清炎性因子水平及生命质量变化。结果:治疗后观察组总有效率为91.53%,高于对照组的76.27%(P<0.05)。治疗后2组咽痛、干咳、咽黏膜充血水肿临床症状积分低于治疗前,且观察组低于对照组(P<0.01)。与治疗前比较,治疗后2组患者唾液中SIgA水平均明显升高,血清肿瘤坏死因子-α(TNF-α)及C-反应蛋白(CRP)水平均明显降低,且2组比较差异均有统计学意义(均P<0.01)。治疗后2组患者SF-36各项评分均明显高于治疗前,且观察组高于对照组(P<0.05或P<0.01)。结论:养阴利咽饮与玉液散吹喉联用可降低阴虚肺燥型慢性咽炎患者血清TNF-α、CRP水平,升高唾液中SIgA含量,改善患者临床症状,提高患者生命质量。     

冠心病患者血浆脂联素水平变化的探讨

目的 探讨冠心病患者血浆脂联索(Adiponectin)水平的变化及与动脉粥样硬化发生的关系.方法 选择冠心病(CAD)患者40例作为实验组,其中急性冠脉综合征(ACS)20例,包括急性心肌梗死(AMI)11例,不稳定性心绞痛(UA)9例,稳定性心绞痛(SAP)20例;选择排除心血管系统疾病的健康体检者20例作为对照组,分别采血测定血浆脂联素水平,比较冠心病组与对照组血浆脂联素水平有无差异.结果 ACS组血浆脂联素水平低于SAP组和对照组,有显著性差异(P＜0.05,P＜0.001),SAP组与对照组相比差异无统计学意义(P＞0.05).结论 脂联素与冠脉病变稳定性显著相关,脂联素水平可做为预测病情,诊断冠心病的一个指标.