维持性血液透析患者的舒适护理实践

目的探讨舒适护理在慢性肾衰竭患者维持性血液透析护理中的应用效果。方法便利抽取维持性血液透析患者70例,随机分为对照组和观察组各35例。对照组给予常规护理,观察组在对照组的基础上给予生理、心理、社会和环境的整体舒适护理干预。采用自制舒适度评分和护理满意度问卷于干预前和干预3个月后对患者进行评估。结果干预后观察组舒适度评分和护理满意度与对照组比较,差异有统计学意义(P<0.05,P<0.01)。结论舒适护理模式的应用可提高血液透析患者的舒适度,充分体现了以人为本的护理内涵。     

膀胱癌组织中血管内皮生长因子的表达及与血管生成的关系

目的 探讨血管内皮生长因子（ＶＥＧＦ）在原发性膀胱移行细胞癌中的表达及其与膀胱癌血管生成之间的关系。方法 免疫组织化学技术检测６８例原发性膀胱移行细胞癌和７例正常膀胱组织中血管内皮生长因子的表达,测定４０例浸润性膀胱癌的微血管密度,并分析ＶＥＧＦ和ＭＶＤ间以及它们与膀胱癌病理分级和临床分期间的关系。结果 ＶＥＧＦ在正常膀胱中不表达或低表达,而在膀胱表达较强;ＶＥＧＦ表达及ＭＶＤ值均与肿瘤的病理分级     

Circulating delta‐like Notch ligand 1 is correlated with cardiac allograft vasculopathy and suppressed in heart transplant recipients on everolimus‐based immunosuppression

Cardiac allograft vasculopathy (CAV) causes heart failure after heart transplantation (HTx), but its pathogenesis is incompletely understood. Notch signaling, possibly modulated by everolimus (EVR), is essential for processes involved in CAV. We hypothesized that circulating Notch ligands would be dysregulated after HTx. We studied circulating delta‐like Notch ligand 1 (DLL1) and periostin (POSTN) and CAV in de novo HTx recipients (n = 70) randomized to standard or EVR‐based, calcineurin inhibitor‐free immunosuppression and in maintenance HTx recipients (n = 41). Compared to healthy controls, plasma DLL1 and POSTN were elevated in de novo (P < .01; P < .001) and maintenance HTx recipients (P < .001; P < .01). Use of EVR was associated with a treatment effect for DLL1. For de novo HTx recipients, a change in DLL1 correlated with a change in CAV at 1 (P = .021) and 3 years (P = .005). In vitro, activation of T cells increased DLL1 secretion, attenuated by EVR. In vitro data suggest that also endothelial cells and vascular smooth muscle cells (VSMCs) could contribute to circulating DLL1. Immunostaining of myocardial specimens showed colocalization of DLL1 with T cells, endothelial cells, and VSMCs. Our findings suggest a role of DLL1 in CAV progression, and that the beneficial effect of EVR on CAV could reflect a suppressive effect on DLL1. Trial registration numbers— SCHEDULE trial: ClinicalTrials.gov NCT01266148; NOCTET trial: ClinicalTrials.gov NCT00377962.     

肌球蛋白轻链磷酸化与心肌损伤的实验研究

应用水平平板等电聚焦(电压2000V,时间2.5h、pH 4～6)、银染和凝胶光密度扫描相结合的一种新方法,研究去甲肾上腺素性心肌损伤兔心肌肌球蛋白轻链磷酸化(P-MLC/MLC×100%)的改变及α、β受体阻滞剂对该改变的影响。结果表明,去甲肾上腺素(NE,2mg/kg)显著降低心肌的P-MLC/MLC(P-MLC/MLC为35.40±5.37%;对照组为61.07±6.97%,P<0.01),酚妥拉明(10mg/只)可保护心肌P-MLC 66.43±8.43%,而普萘洛尔则无此作用(P-MLC/MLC为36.54±4.05%)。     

细胞外间质成分与肝病关系的研究

利用固相酶联免疫检测技术（ＥＬＩＳＡ），建立了层粘连蛋白（Ｌａｍｉｎｉｎ，ＬＮ）和透明质酸（Ｈｙａｌｕｒｏｎａｔｅ，ＨＡ）的检测方法，对１３８例肝病患者的血清含量进行了分析。结果发现，ＬＮ和ＨＡ随着肝病程度的加重而逐步升高，急性肝炎时ＨＡ含量轻度高于正常人（Ｐ＜０．０５），ＬＮ变化不显著。慢性肝病时ＬＮ与ＨＡ血清含量均明显升高（Ｐ＜０．０５～０．００１），于肝硬化时达到最高。以慢性活动性肝炎的上限值为界，ＬＮ和ＨＡ联合诊断肝硬化的敏感性、特异性和诊断符合率均为９０％，提示ＬＮ和ＨＡ是判断慢性肝病损伤程度和诊断肝纤维化的良好指标。     

Cross-host evolution of severe acute respiratory syndrome coronavirus in palm civet and human

The genomic sequences of severe acute respiratory syndrome coronaviruses from human and palm civet of the 2003/2004 outbreak in the city of Guangzhou, China, were nearly identical. Phylogenetic analysis suggested an independent viral invasion from animal to human in this new episode. Combining all existing data but excluding singletons, we identified 202 single-nucleotide variations. Among them, 17 are polymorphic in palm civets only. The ratio of nonsynonymous/synonymous nucleotide substitution in palm civets collected 1 yr apart from different geographic locations is very high, suggesting a rapid evolving process of viral proteins in civet as well, much like their adaptation in the human host in the early 2002–2003 epidemic. Major genetic variations in some critical genes, particularly the Spike gene, seemed essential for the transition from animal-to-human transmission to human-to-human transmission, which eventually caused the first severe acute respiratory syndrome outbreak of 2002/2003.     

Assessment of hepatocellular carcinoma vascularity before and after transcatheter arterial chemoembolization by using first pass perfusion weighted MR imaging

AIM: To assess the vascularity of hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE) with the quantitative parameters obtained by first pass perfusion weighted MR imaging (FP-MRI). METHODS: Seventeen consecutive patients with one to three lesions in liver underwent FP-MRI before treatment. FP-MRI was also performed one, three, six, nine months, and one year after TACE. The baseline signal intensity (S0) of pre-TACE and one month after TACE was analyzed, the vascularity of HCC assessed by steepest slope of the signal intensity versus time curves (SS) was blindly correlated with their DSA feature and clinical outcome. RESULT: No significant difference was found on baseline signal intensity (S0) between pre-TACE and one month after TACE (F=0.309, P=0.583), The SS (mean, 32% per second) of lesion one month after TACE was lower than that of pre-TACE (mean, 69% per second), but with no statistical significance (F=3.067, P=0.092). When local recurrence occurred, the time intensity curves became steeper. The vascularity of HCC before and after TACE graded by SS closely correlated with that by DSA (K=0.453, P<0.05). CONCLUSION: FP-MRI is a useful criterion for selecting effective interventional treatment for patients with HCC in their initial treatment and during follow up.     

三七皂甙诱导骨髓基质细胞分化为心肌样细胞的实验研究

目的探讨三七皂甙对体外定向诱导猪骨髓基质细胞(MSCs)分化为心肌样细胞的影响。方法用穿刺方法抽取猪骨髓,分离并培养骨髓基质细胞,中药三七皂甙定向诱导分化为心肌样细胞。倒置显微镜下观察细胞形态,免疫细胞化学法鉴定心肌细胞特异性抗原标志物肌钙蛋白T,用RT-PCR对心肌肌球蛋白重链(β-MHC)进行鉴定。取培养的猪心肌细胞作为阳性对照,未经三七皂甙诱导正常培养的骨髓基质细胞作为阴性对照。结果猪MSCs经三七皂甙诱导2h后,大部分MSCs可分化为心肌样细胞,免疫细胞化学检测细胞中的肌钙蛋白T呈阳性,RT-PCR显示能表达β-MHC。结论MSCs是骨髓来源的具有多向分化潜能的干细胞,在三七皂甙的定向诱导下,可以向心肌样细胞分化,有望成为心衰及心肌梗死等心肌损伤时干细胞移植治疗的理想细胞材料。     

乙状结肠镜检查对大肠肿瘤的漏诊研究

目的 探讨乙状结肠镜检查对大肠肿瘤的漏诊情况.方法 总结分析惠州市中心人民医院(2006年～2008年)和广州南方医院(2004年～2006年)行结肠镜检查发现大肠肿瘤者、年龄为50～79岁的连续性资料.结果 72.0%近端大肠肿瘤患者在其远端大肠未发现相应肿瘤性病变,其中男性该比例为66.5%,女性为82.3%;50～59岁、60～69岁、70～79岁年龄段的比例分别为74.7%、72.0%、67.9%.远近端大肠高级别癌灶比例分别为5.1%和15.8%(P<0.01).结论 近端大肠癌的恶性程度较远端大肠癌高;如果乙状结肠镜发现远端大肠肿瘤才进行全结肠镜检查,将导致72.0%近端大肠肿瘤漏诊.     

培哚普利联合醛固醇受体拮抗剂对心房纤颤犬心房结构重构的影响

目的:观察培哚普利和螺内酯及二者联用对长期心房快速起搏诱发心房纤颤(房颤,AF)犬心房结构和功能重构的影响。方法:实验犬24只,随机分为4组,即对照组、培哚普利组(P组)、螺内酯组(S组)和二者联用组(P+S组)。各组心房快速起搏8周,建立AF犬模型。分别于起搏前、起搏4周及8周测定血浆血管紧张素II(AngII)和醛固酮(Ald)水平;起搏前及起搏后8周,测定左心房结构和功能变化;起搏8周后停止起搏,观察各组犬AF维持的例数及AF自行持续时间;Masson染色检测各组犬心房肌胶原容积分数(CVF)改变。结果:与对照组相比,P组、S组和P+S组犬起搏4周和8周后血浆AngII及Ald水平明显降低,起搏8周后左心房左右径、上下径、收缩末期容积和舒张末期容积明显减小,左心房射血分数显著增大,停止起搏后AF维持率明显减少,AF平均持续时间明显缩短,CVF值明显降低。而3个用药组相比差异无统计学意义。结论:培哚普利和醛固酮受体拮抗剂(螺内酯)能够阻止长期心房快速起搏AF犬心房结构功能的改变及心房纤维化,减少AF发生率及持续时间,但二者联用效果并不优于单药。