慢性心力衰竭患者血红蛋白、血清肿瘤坏死因子和血管紧张素Ⅱ水平的变化及其关系的研究

目的:研究慢性心力衰竭(CHF)患者血红蛋白(Hb)、血清肿瘤坏死因子(TNF)-α和血管紧张素Ⅱ(AngⅡ)水平的变化及其之间的关系。方法:对入选的121例CHF患者(CHF组)和27例正常人(对照组)(均海拔2260m)测定了Hb、血清TNF-α和AngⅡ水平,超声心动图测量左室射血分数(LVEF),按Hb水平将CHF患者分为贫血组和非贫血组。结果:CHF患者Hb水平降低,而血清TNF-α和AngⅡ水平增高,与对照组比较均差异有统计学意义(均P<0.01);随着心功能恶化,Hb水平逐渐降低,而血清TNF-α和AngⅡ水平逐渐升高;贫血组患者血清TNF-α和AngⅡ水平明显增高,与非贫血组比较均差异有统计学意义(均P<0.01);随着Hb水平降低,CHF患者血清TNF-α和AngⅡ水平逐渐升高;CHF患者Hb水平与TNF-α和AngⅡ水平呈负相关(P<0.01)。结论:CHF患者Hb水平降低、TNF-α和AngⅡ水平的升高与CHF恶化有关,Hb水平与TNF-α和AngⅡ水平呈负相关。     

Correlation between dietary selenium intake and stroke in the National Health and Nutrition Examination Survey 2003–2018

BackgroundEpidemiologic evidence of the effect of dietary selenium intake on stroke risk remains controversial. This study aimed to examine the cross-sectional correlation between dietary selenium intake and the risk of stroke in adults.Materials and methodsWe retrospectively analysed 39,438 participants from the National Health and Nutrition Examination Survey 2003–2018, aged 20–85 years. Participants were divided into quartiles depending on daily dietary selenium intake: quartile 1 (0–77 μg), quartile 2 (77–108 μg), quartile 3 (108–148 μg), and quartile 4 (148–400 μg). The dose-response relationship was assessed using the restricted cubic spline function.ResultsThe adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of stroke were 0.70 (0.55, 0.88) for participants in quartile 2, 0.71 (0.53, 0.93) for quartile 3, and 0.61 (0.43, 0.85) for quartile 4 compared with that in quartile 1. p-Value for trend through quartiles was .007. A non-linear negative correlation between dietary selenium intake and stroke was observed in the threshold effect analysis and restricted cubic spline function (p-value for non-linearity < .001). An initial decrease in odds of stroke lower than 105 μg/day selenium intake (0.61 [0.44, 0.85], p = .004) was followed by a platform beyond 105 μg/day (0.97 [0.81, 1.16], p = .723). In the subgroup analysis, adjusted ORs (95% CIs) of stroke were 0.51 (0.36, 0.70) for female participants, 0.63 (0.40, 0.99) for participants with age <60 years, 0.63 (0.47, 0.85) for participants with poverty-income ratio < 2.14, 0.66 (0.50, 0.87) for participants with overweight and obesity, 0.66 (0.52, 0.84) for participants with hypertension, 0.72 (0.53, 0.97) for participants without diabetes, and 0.72 (0.56, 0.92) for non-anaemic participants.ConclusionsDietary selenium had a negative and non-linear correlation with the risk of stroke in adults. The correlation varied across different population subgroups.

KEY MESSAGES

• Dietary selenium had a negative and non-linear correlation with the risk of stroke in adults.
• Non-linear negative correlation trends were observed in subpopulations of females, age <60 years, poverty-income ratio <2.14, overweight and obesity, hypertension, non-diabetes, and non-anaemia.
• Dietary selenium intake of approximately 105 μg per day has an optimum effect on stroke.

     

不同性质球囊腹主动脉阻断术在凶险性前置胎盘应用中的对比研究

目的 对比不同球囊腹主动脉阻断术治疗凶险性前置胎盘的效果。方法 回顾性分析2018年2月至2021年5月遵义医科大学第二附属医院收治的102例凶险性前置胎盘患者临床资料。52例接受非顺应性球囊腹主动脉阻断术（研究组）,50例接受顺应性球囊腹主动脉阻断术（对照组）。观察两组腹主动脉球囊阻断术实施情况。记录两组患者腹主动脉阻断术前后血压、心率变化。统计两组球囊阻断时间、X射线辐射,剖宫产手术及术后并发症情况。结果 两组均成功置入球囊,腹主动脉阻断术成功,无死亡病例。两组腹主动脉球囊阻断术前后患者心率、收缩压差异无统计学意义（均P>0.05）。两组X线辐射剂量、胎儿射线暴露时间差异无统计学意义（均P>0.05）,研究组球囊阻断时间低于对照组（P<0.05）。研究组剖宫产术中出血量低于对照组（P<0.05）,两组输血率、红细胞输注量、子宫切除率差异无统计学意义（均P>0.05）。两组腹主动脉球囊阻断术相关并发症发生率差异无统计学意义（P>0.05）。结论 顺应性和非顺应性球囊腹主动脉球囊阻断术治疗凶险性前置胎盘均安全有效,但使用非顺应性球囊在减少剖宫产术中出...     

不同祖师麻提取物对后交联凝胶贴膏基质的性能影响

目的 以祖师麻Daphnes Giraldii Cortex不同体积分数乙醇渗漉流浸膏为药物模型,研究其对后交联凝胶基质黏弹性及释药性的影响。方法 结合黏附力测试、流变学指标、体外释放度试验及相关性分析,考察不同祖师麻提取物出膏率、软化点及pH值对后交联凝胶基质成型过程中关键流变学参数及贴膏释药性的影响。结果 当乙醇体积分数在75%～95%时,祖师麻提取物出膏率及pH值随乙醇体积分数的升高而显著降低,软化点则相反。出膏率主要通过影响基质的复合模量（G^*）及屈服应力（τ）值来影响贴膏内聚力及抗剪切能力,软化点和pH值主要通过影响基质G^*、τ、弹性模量（G′）、G值来影响贴膏的结构稳定性、抗剪切性、初黏力及剥离强度。体外释药结果显示,祖师麻甲素10 h内的累积释药率随提取物醇提体积分数的升高而增大,但提取物3个理化性质对释药率的影响并不显著。结论 不同祖师麻提取物对后交联基质的性能影响总体差异不大,通过检测基质相关的流变学指标可以有目的地对基质配方进行相应调整,从而进一步提高贴膏的成型质量和后交联基质的普遍适用性。     

军队基层医院内科医师继续教育的探索：基于能力教育的神经科培训

在部队基层医院代职过程中,结合医院特点、科室需求,对内科医师开展神经科继续教育培训。通过基于能力教育的培训思路,应用主题式教学及讨论方式渗透专业知识,采用形成性评价方式进行教学效果评估,强调科学思维培养促进终身学习的理念,在教学双方的共同沟通和努力下,培训取得了良好的临床效果和社会影响。     

自体精液冷冻保存患者细菌感染现状及对精子冷冻的影响

目的 探讨四川地区自体精液保存患者精液细菌感染现状和细菌感染与精液质量、冷冻效果的关系.方法 纳入2016年11月至2019年6月于四川大学华西第二医院精子库行自精保存的患者355例,分析其细菌感染情况.根据自精保存患者冷冻原因,将患者分为肿瘤患者及非肿瘤患者两类;再分别根据细菌感染情况,将患者分为细菌感染组及对照组,...     

miR-16-5p通过靶向YWHAQ调控乳腺癌耐药细胞的凋亡与迁移能力

目的 探究miR-16-5p对乳腺癌紫杉醇耐药细胞生物学活性的影响及分子机制。方法 以人乳腺癌亲本细胞（SKBR-3）与乳腺癌紫杉醇耐药细胞（SKBR-3/PR）为研究对象。实验设空白对照组、阴性对照组、miR-16-5p类似物组（miR-16-5p mimics）、miR-16-5p抑制剂组（miR-16-5p inhibitor）,YWHAQ干扰组（si-YWHAQ）,以及联合组（miR-16-5p mimics+si-YWHAQ）。利用qRT-PCR检测乳腺癌组织与癌旁组织、SKBR-3与SKBR-3/PR间miR-16-5p的表达水平。使用生信数据对miR-16-5p的靶基因做预测,双荧光素酶实验验证靶向结合。免疫印迹检测细胞YWHAQ、Bcl-2和Bax表达。CCK-8和Transwell检测细胞增殖迁移能力。流式细胞术检测耐药细胞周期凋亡改变。结果 qRT-PCR显示乳腺癌组织中miR-16-5p水平低于癌旁组织（-1.19±1.90 vs 1.59±1.76,P<0.01）。生物信息预测YWHAQ是miR-16-5p的靶基因,荧光素酶实验证实miR-16-5p能够靶...     

基于高分辨率MRI评估头颈动脉夹层与急性缺血性脑卒中的关系

目的 基于高分辨率磁共振成像(high-resolution magnetic resonance imaging,HR-MRI)探讨头颈动脉夹层(cervicocranial artery dissection,CCAD)致急性缺血性脑卒中的影响因素。材料与方法 回顾性分析经临床确诊的73例CCAD患者病例,根据其弥散加权成像(diffusion weighted imaging,DWI)明显高信号分为卒中组与非卒中组,收集临床和影像学资料,采用单因素和多因素Logistic回归方法分析CCAD与急性缺血性卒中的关系。结果 共73例CCAD患者、85条夹层血管纳入研究,其中卒中组45例,54条夹层血管;非卒中组28例,31条夹层血管。卒中组高血压患病率[34 (75.56%)]高于非卒中组[11 (39.29%)],差异具有统计学意义(P=0.002)。多因素Logistic回归分析显示,两组之间高血压、管腔轻度狭窄、管腔重度狭窄、管腔闭塞、内膜瓣、夹层动脉瘤差异均具有统计学意义(P均<0.05),高血压、管腔重度狭窄、管腔闭塞、内膜瓣与急性缺血性脑卒中显著相关(OR分别为4....     

焦点导向型心理干预在行内镜下逆行胰胆管造影治疗的胆总管结石患者围手术期的应用效果

目的 探讨焦点导向型心理干预在内镜下逆行胰胆管造影（ERCP）的胆总管结石患者围手术期的应用效果。方法 选取2020年6月至2021年8月景德镇市第二人民医院收治的80例胆总管结石患者作为研究对象,采用随机数字表法将其分为对照组（40例）与受试组（40例）,对照组采用常规护理,受试组采用焦点导向型心理干预。比较两组患者护理满意度,另比较两组患者护理干预前及干预1个月后的焦虑、抑郁情况及生活质量。结果受试组护理满意度高于对照组,差异有统计学意义（P<0.05）。受试组干预后综合性医院焦虑抑郁量表（HADS）评分低于对照组,差异有统计学意义（P<0.05）。受试组干预后的36条简明健康状况调查表（SF-36）评分高于对照组,差异有统计学意义（P<0.05）。结论 针对行ERCP治疗的胆总管结石患者,通过开展焦点导向型心理干预,改善负面情绪,提高生活质量及护理满意度,临床应用价值突出。     

Limbic and HPA axis function in an animal model of chronic neuropathic pain

Chronic pain can be considered a form of chronic stress, and chronic pain patients often have disturbances of the hypothalamic-pituitary-adrenal (HPA) axis, including abnormal cortisol levels. In addition, chronic pain patients have an increased incidence of depression and anxiety, stress-related disorders that are frequently accompanied by disturbances in the limbic system (e.g. hippocampus and amygdala) and the HPA axis. Despite the fact that the literature supports a strong link between chronic pain, stress disorders, and limbic dysfunction, the mechanisms underlying the effects of chronic pain on the HPA axis and limbic system are not understood. The current study employs a rodent neuropathic pain model (chronic constriction injury (CCI) of the sciatic nerve) to assess the long-term impact of chronic pain on the HPA axis and limbic system. Adult male rats received CCI or sham surgery; nociceptive behavioral testing confirmed CCI-induced neuropathic pain. Tests of HPA axis function at 13-23 days postsurgery demonstrated that CCI did not affect indices of basal or restraint stress-induced HPA axis activity. CCI increased the expression of corticotrophin releasing hormone mRNA in the central amygdala, and not the paraventricular nucleus of the hypothalamus or the bed nucleus of the stria terminalis. Moreover, glucocorticoid receptor mRNA expression in CCI rats was increased in the medial and central amygdala, unaffected in the paraventricular nucleus, and decreased in the hippocampus. These results suggest that increased nociceptive sensitivity during chronic pain is associated with alterations in the limbic system, but is dissociated from HPA axis activation.