2019冠状病毒病患者开展呼吸康复的几点思考

2019年底,一种新型冠状病毒SARS-CoV-2引起的2019冠状病毒病(COVID-19)迅速传播。目前对COVID-19仍无特效药,功能改善与康复可能是临床需要考虑的重要问题。本文就呼吸康复是否有助于COVID-19患者救治以及患者如何开展呼吸康复等方面提出意见和建议。     

伯氏疟原虫氯喹抗性株和敏感株基因组DNA比较研究

目的　比较伯氏疟原虫敏感株 (N株 )和抗性株 (RC株 )基因组DNA差异。　方法　应用基因组DNA随机多态性扩增 (RAPD)和锚定引物扩增DNA(APAD) ,分别对抽提的伯氏疟原虫N株和RC株基因组DNA进行PCR扩增 ,并对扩增的产物进行电泳 ,对结果进行统计分析。　结果　 3 7条随机引物RAPD方法扩增出 44 0条DNA条带 ,其中RC株和N株的共有条带是 196条 ,差异带 43条。 84条锚定多聚A引物APAD方法扩增出 95 2条DNA条带 ,其中RC株和N株的共有条带是 43 6条 ,差异带 5 3条。两种方法得到N株和RC株基因组DNA的同源性分别为 0 .89和0 .91;距离系数分别为 0 .197和 0 .15 5。　结论　伯氏疟原虫N株和RC株基因组DNA具有高度同源性。     

Coronary arterial remodeling in differing clinical presentations of unstable angina pectoris--an intravascular ultrasound study

BACKGROUND: Coronary arterial remodeling influences the clinical presentation of ischemic heart disease; however, there is little information on the relationship between coronary arterial remodeling and the type of angina pectoris that patients manifest. HYPOTHESIS: The study was undertaken to determine the difference of coronary arterial remodeling in patients with different types of angina pectoris. METHODS: We analyzed 100 patients with ischemic heart disease using intravascular ultrasound (IVUS). Intracoronary IVUS images of proximal reference (PR), distal reference (DR), and target lesion were recorded, and intraluminal area (LA) and external elastic membrane (EEM) were measured. We defined a remodeling index as 100 x (lesion EEM - [PR-EEM + DR-EEM]/2) / ([PR-EEM + DR-EEM]/2). Cases were classified into three groups according to the clinical history (Group 1a: de novo unstable angina pectoris, Group 1b: accelerating unstable angina pectoris, and Group 2; stable angina pectoris). RESULTS: The remodeling index in Group 1a was significantly larger than that in Groups 1b and 2 (18.6 +/- 28.5 vs. 5.3 +/- 27.1 and 18.6 +/- 28.5 vs. -2.7 +/- 17.6, p = 0.0347 and p = 0.0005, respectively), but there was no statistical difference in remodeling index between Groups 1b and 2. CONCLUSIONS: Our results indicate that positive coronary arterial remodeling is more prevalent in patients with new onset of angina pectoris. The specific type of coronary arterial remodeling may affect the clinical presentation of patients with coronary artery disease.     

调整肌松复合手法治疗非椎动脉型颈性眩晕60例临床研究

目的观察调整肌松复合手法治疗非椎动脉型颈性眩晕的临床疗效。方法120例患者随机分为2组。治疗组60例采用调整肌松复合手法治疗,对照组60例予西比灵口服、颈椎牵引治疗。2组均10日为1个疗程,2个疗程后统计疗效。结果治疗组治愈率为65.0%,对照组治愈率26.7%,2组比较有显著性差异(P<0.01);2组治疗后眩晕评分、X线表现的变化率均有统计学意义(P<0.01)。结论调整肌松复合手法治疗非椎动脉型颈性眩晕效果显著。     

Wasp venom from Vespa magnifica acts as a neuroprotective agent to alleviate neuronal damage after stroke in rats

ContextAcute ischaemic stroke (AIS) is a major cause of disability and death, which is a serious threat to human health and life. Wasp venom extracted from Vespa magnifica Smith (Vespidae) could treat major neurological disorders.ObjectiveThis study investigated the effects of wasp venom on AIS in rats.Material and methodsWe used a transient middle cerebral artery occlusion (MCAO) model in Sprague-Dawley rats (260–280 g, n = 8–15) with a sham operation group being treated as negative control. MCAO rats were treated with wasp venom (0.05, 0.2 and 0.6 mg/kg, i.p.) using intraperitoneal injection. After treatment 48 h, behavioural tests, cortical blood flow (CBF), TTC staining, H&E staining, Nissl staining, TUNEL assay, immunohistochemistry (IHC) and ELISA were employed to investigate neuroprotective effects of wasp venom.ResultsCompared with the MCAO group, wasp venom (0.6 mg/kg) improved neurological impairment, accelerated CBF recovery (205.6 ± 52.92 versus 216.7 ± 34.56), reduced infarct volume (337.1 ± 113.2 versus 140.7 ± 98.03) as well as BBB permeability as evidenced by changes in claudin-5 and AQP4. In addition, function recovery of stroke by wasp venom treatment was associated with a decrease in TNF-α, IL-1β, IL-6 and inhibition activated microglia as well as apoptosis. Simultaneously, the wasp venom regulated the angiogenesis factors VEGF and b-FGF in the brain.ConclusionsWasp venom exhibited a potential neuroprotective effect for AIS. In the future, we will focus on determining whether the observed actions were due to a single compound or the interaction of multiple components of the venom.     

灯盏花素注射液辅助治疗急性脑梗死的Meta分析

目的对灯盏花素注射液辅助治疗急性脑梗死进行Meta分析。方法检索CNKI、万方、维普、PubMed等数据库中关于灯盏花素注射液联合常规西药治疗急性脑梗死的临床随机对照试验,时限为建库至2019年4月,通过Cohrane协作网提供的Rev Man5. 3软件对提取的数据进行统计学分析,采用Jadad量表对纳入文献的临床试验方法进行质量评价。结果共纳入30篇文献、3 312例患者。与单用常规西药比较,联合灯盏花素注射液能改善患者各项指标,提高临床总有效率[RR=1. 24,95%CI (1. 20,1. 28),P<0. 000 01],降低血液流变学指标[MD血浆黏度=-0. 67,95%CI (-1. 28,-0. 07),P=0. 03;MD全血低切黏度=-1. 20,95%CI (-1. 65,-0. 75,P <0. 000 01;MD全血高切黏度=-0. 56,95%CI (-1. 07,-0. 05),P=0. 03]和神经功能缺损评分[MDNIHSS=-4. 15,95%CI (-5. 00,-3. 30),P <0. 000 01],并且未出现明显不良反应。结论灯盏花素注射液联合常规西药能有效改善急性脑梗死患者临床疗效,降低血液流变学指标,安全性较高。     

对《黄帝内经》中养生理论的认识

《黄帝内经》是我国现存最早的一部医学典籍(包括《灵枢》和《素问》,简称《内经》),是中国医学发展史上影响较大的鸿篇巨制,被后世尊为"医家之宗".     

大负荷运动后时钟基因Bmal1调控骨骼肌线粒体结构功能的作用机制

目的:探讨大负荷运动后大鼠骨骼肌时钟基因Bmal1节律振荡变化及其对线粒体结构功能的调控作用。方法:将156只成年SD大鼠随机分为对照组和运动组,运动组予以一次大负荷运动训练。每6 h取各组大鼠腓肠肌,使用RT-qPCR检测各时相时钟基因Bmal1的mRNA水平,并用余弦分析软件CircaCompare(R Packages)获取拟合余弦曲线参数,分析时钟基因Bmal1的mRNA表达节律性振荡情况,透射电镜下观察每周期始末(ZT0、ZT24、ZT48和ZT72)骨骼肌线粒体的形态学变化,Western blot检测Bmal1和过氧化物酶体增殖物激活受体γ辅激活因子1α(peroxisome proliferator activated receptorγcoactivator-1α,PGC-1α)的蛋白表达,ELISA测定ATP和ADP含量,以及线粒体氧化呼吸链酶细胞色素C氧化酶复合物亚单位Ⅱ(subunitsⅡof cytochrome C oxidase complex,COXⅡ)和COXⅣ的活性。结果:运动组Bmal1的mRNA表达在ZT0~ZT24时节律出现紊乱(P>0.05),ZT24~ZT48和ZT48~ZT72时节律恢复(P<0.05)。大负荷运动后运动组线粒体形态于ZT0出现肿胀、嵴结构损伤等异常,于ZT24和ZT48时有所恢复,ZT72时损伤基本消失。与对照组相比,运动组Bmal1、PGC-1α的蛋白表达于ZT0时显著升高(P<0.05),ATP和ADP含量分别于ZT0时显著下降和升高(P<0.05),COXⅡ和COXⅣ活性于ZT0时显著升高和下降(P<0.05),在ZT24时二者活性下降至最低(P<0.05)。结论:大负荷运动可诱发骨骼肌时钟基因Bmal1的节律紊乱,可能参与调控了线粒体的结构功能异常。     

Effects of lead exposure on hippocampal metabotropic glutamate receptor subtype 3 and 7 in developmental rats

Background  

A complete explanation of the mechanisms by which Pb²⁺ exerts toxic effects on developmental central nervous system remains unknown. Glutamate is critical to the developing brain through various subtypes of ionotropic or metabotropic glutamate receptors (mGluRs). Ionotropic N-methyl-D-aspartate receptors have been considered as a principal target in lead-induced neurotoxicity. The relationship between mGluR3/mGluR7 and synaptic plasticity had been verified by many recent studies. The present study aimed to examine the role of mGluR3/mGluR7 in lead-induced neurotoxicity.     

大脑中动脉血流变化对估计脐带绕颈胎儿预后的价值

目的探讨大脑中动脉血流变化对估计脐带绕颈胎儿预后的价值。方法选取2006年1月~2006年9月足月妊娠妇女51例。其中观察组39例,均为脐带绕颈一周并经阴道分娩。结合胎儿预后将观察组分为胎窘组(15例)和正常组(24例)。对照组12例,为随机选择的同期正常妊娠并顺产的妇女。应用彩色多普勒超声技术对全部孕妇于临产前和活跃早期检测胎儿大脑中动脉阻力指标-收缩期峰值流速/舒张末期流速(S/D)、阻力指数(RI)和搏动指数(PI)。结果(1)临产前,胎窘组胎儿大脑中动脉血流S/D、RI、PI值较对照组和正常组皆显著升高(P<0.05);而对照组和正常组比较,差异不显著(P>0.05)。(2)活跃早期胎窘组胎儿大脑中动脉血流S/D、RI、PI值较对照组和正常组皆显著降低(P<0.05);而对照组和正常组比较,差异不显著(P>0.05)。结论大脑中动脉血流阻力指标的变化与脐带绕颈胎儿不良预后密切相关;临产前监测脐绕颈胎儿MCA血流阻力指标的变化可以作为早期评估胎儿预后的理想方法。