浅议新医改框架下农村卫生人才队伍建设

2009年3月,中共中央国务院出台了《关于深化医药卫生体制改革的意见》,明确提出深化医药卫生体制改革的总体目标是：建立健全覆盖城乡居民的基本医疗卫生制度,为群众提供安全、有效、方便、价廉的医疗卫生服务。要实现这个目标,笔者认为,必须把农村卫生这个卫生事业发展的“短腿”摆在优先发展的地位,首先解决农民“看病贵、看病难”和“因病致贫、因病返贫”的问题.     

富于间质透明血管型Castleman病的病理形态、增生间质细胞组织起源和临床并发症关系探讨

目的 对透明血管型Castleman病滤泡间区内间质细胞的病理形态、免疫表型以及组织来源进行深入研究,在此基础上,对间质细胞在疾病形成以及副肿瘤天疱疮发生过程中的作用进行初步探讨.方法 选取透明血管型Castleman病23例,收集详细临床资料,分析组织病理形态,对全部病例进行免疫组织化学染色,抗体有CCL21、肌特异性肌动蛋白(MSA)、CD21、CD35、S-100蛋白和CD34.按照Danon等的标准进行分类,将滤泡间区占淋巴结面积大于50%的病例归入富于间质型,其余为普通型.结果 23例中,富于间质型14例,普通型9例.富于间质型病例伴副肿瘤天疱疮11例,普通型无一例伴副肿瘤天疱疮,两者差异有统计学意义(P<0.01).滤泡间区内间质细胞免疫组织化学染色结果:普通型9例,CCL21、MSA均为阳性,CD21、CD35、S-100蛋白、CD34均为阴性;富于间质型14例,CCL21阳性13例,MSA阳性13例,CD21、CD35、S-100蛋白、CD34均为阴性;组间差异无统计学意义(P>0.05).结论 透明血管型Castleman病在病理上存在普通型和富于间质型两种表现,两者在副肿瘤天疱疮的发生率上存在显著差异.纤维母细胞性网状细胞是透明血管型Castleman病滤泡间区内最主要的间质细胞,其特征性的免疫表型为CCL21~+/MSA~+/CD34~-/CD21~-/S-100~-.富于间质型患者易于伴发副肿瘤天疱疮,可能与纤维母细胞性网状细胞的过度增生有关,详细的机制有待进一步研究.     

综合医院急诊胸痛患者的心理状态及临床特征

目的:评估胸痛患者的心理状态,分析描述非心源性胸痛(non-cardiac chest pain,NCCP)的临床特征。方法:横断面研究。收集胸痛为主诉连续就诊的急诊患者711人,采用汉密顿焦虑量表(Hamilton Anxiety Rating Scale,HAMA)和汉密顿抑郁量表(Hamilton Depression Rating Scale-17,HAMD-17)评估患者心理状态,比较NCCP与心源性胸痛的临床特点。结果:共231例同意合作的胸痛患者入选,年龄19~79岁,男性106。其中182例为NCCP,49例为有器质性心脏病者(心源性胸痛组)。胸痛患者焦虑抑郁平均分均高于正常界值(HAMA得分≥14;HAMD-17得分≥8),以焦虑症状更明显,NCCP组有明显焦虑症状的患者比例高于心源性胸痛组(64.3%vs.57.1%,P0.01)。与心脏病患者相比,NCCP组年龄较小[(48.1±11.7)岁vs.(55.5±10.0)岁,P0.01],≤45岁者较多(37.9%vs.16.3%,P0.01),胸痛发作时更易出现死亡恐惧(59.3%vs.40.8%)、害怕(69.8%vs.34.7%)、失控感(31.9%vs.10.2%)、过度换气(37.4%vs.16.3%)和手脚麻木(37.4%vs.14.3%)等伴随症状(Ps0.05);伴随症状成组出现(≥4个)的比例更高(29.7%vs.10.2%,P0.01),发作时心电图正常、病程≥6月者更多(49.5%vs.30.6%,P0.05)。结论:急诊胸痛患者焦虑症状明显,其中大多数为非心源性胸痛,主要临床特征为年龄较轻、心电图正常、发作时常有特征性伴随症状,或特征性伴随症状成组出现。     

WNK3 bypasses the tonicity requirement for K-Cl cotransporter activation via a phosphatase-dependent pathway

SLC12A cation/Cl- cotransporters are mutated in human disease, are targets of diuretics, and are collectively involved in the regulation of cell volume, neuronal excitability, and blood pressure. This gene family has two major branches with different physiological functions and inverse regulation: K-Cl cotransporters (KCC1-KCC4) mediate cellular Cl- efflux, are inhibited by phosphorylation, and are activated by dephosphorylation; Na-(K)-Cl cotransporters (NCC and NKCC1/2) mediate cellular Cl- influx and are activated by phosphorylation. A single kinase/phosphatase pathway is thought to coordinate the activities of these cotransporters in a given cell; however, the mechanisms involved are as yet unknown. We previously demonstrated that WNK3, a paralog of serine-threonine kinases mutated in hereditary hypertension, is coexpressed with several cation/Cl- cotransporters and regulates their activity. Here, we show that WNK3 completely prevents the cell swelling-induced activation of KCC1-KCC4 in Xenopus oocytes. In contrast, catalytically inactive WNK3 abolishes the cell shrinkage-induced inhibition of KCC1-KCC4, resulting in a >100-fold stimulation of K-Cl cotransport during conditions in which transport is normally inactive. This activation is completely abolished by calyculin A and cyclosporine A, inhibitors of protein phosphatase 1 and 2B, respectively. Wild-type WNK3 activates Na-(K)-Cl cotransporters by increasing their phosphorylation, and catalytically inactive kinase inhibits Na-(K)-Cl cotransporters by decreasing their phosphorylation, such that our data suggest that WNK3 is a crucial component of the kinase/phosphatase signaling pathway that coordinately regulates the Cl- influx and efflux branches of the SLC12A cotransporter family.     

金丝李茎皮化学成分研究

目的对金丝李Garcinia paucinervis的茎皮化学成分进行分离鉴定,并进行抗肿瘤活性筛选。方法采用硅胶、反相RP-18,制备薄层色谱,Sephadex LH-20等柱色谱方法对乙醇提取物石油醚萃取部位化学成分进行分离和纯化,并根据其理化性质及波谱数据鉴定结构;采用MTT法进行抗肿瘤活性筛选。结果从金丝李乙醇提取物中分离得到10个化合物,分别鉴定为cambogin(1)、焦袂康酸(2)、β-谷甾醇(3)、胡萝卜苷(4)、7-prenyljacareubin(5)、parvifolixanthone A(6)、formoxanthone A(7)、termicalcicolanone A(8)、1,3,5,6-tetrahydroxy-4-prenylxanthone(9)、isogarcinol(10)。抗肿瘤活性筛选结果表明,化合物5和7对HL-60、SMMC-7721、A549、MCF-7和SW480细胞株有一定的抑制作用。结论化合物2～5和7～10均为首次从该植物中分离得到,同时首次报道了化合物5的13C-NMR数据。     

德都红花-7味散对CCl4诱导实验性肝纤维化治疗作用

目的:观察德都红花-7味散对四氯化碳(CCl4)所致大鼠肝纤维化的治疗作用。方法:将大鼠按体重随机分为空白对照组、模型组、秋水仙碱组、德都红花-7味散组。除空白对照组,其他组ip 30%CCl4橄榄油溶液诱导大鼠肝纤维化。造模同时德都红花-7味散组和秋水仙碱组分别ig德都红花-7味散和秋水仙碱每日0.62 g·kg-1和0.4 mg·kg-1,连续7周。观察肝脏系数、肝功能、纤维4项,用HE,Gomori,Masson 3种方法染色,观察肝组织病理学改变。结果:与空白对照组比较,模型组丙氨酸氨基转氨酶(ALT)、白蛋白(Alb)、总蛋白(TP)、总胆红素(TBIL)、碱性磷酸酶(ALP)等,肝脏指数、血清及肝组织匀浆纤维4项明显升高,Alb和体重降低,P<0.05。与模型组比较,德都红花-7味散组AST,ALT,ALP,肝脏指数,肝组织匀浆Hyp,血清和肝组织纤维4项明显降低,Alb升高,秋水仙碱组ALT,AST,ALP,BIL降低,肝组织HA升高,Ⅳ降低(P<0.05)。与秋水仙碱组比较德都红花-7味散组Alb含量升高,血清HA,LN含量降低,肝组织HA,LN,ⅣC,Hyp含量降低(P<0.05)。结论:德都红花-7味散有较好的降酶保肝、抗肝纤维化作用。     

蒙药哈日嘎布日-10味片对大鼠胃液分泌、胃蛋白酶活性及小鼠胃肠运动的影响

目的:评价哈日嘎布日-10味片对消化功能的影响.方法:采用滴定法、蛋白毛细玻管法测定哈日嘎布日-10味片高、中、低剂量组(1.52,0.76,0.38 g·kg-1)对大鼠胃液分泌、胃蛋白酶活性的影响;采用比色法、固体排空法测定哈H嘎布日-10味片高、中、低剂量组对小鼠胃排空、小肠推进的影响.结果:哈日嘎布日-10味片高、中剂量组对大鼠胃液量、胃总酸度和胃蛋白酶活性及小鼠胃排空率均有显著的促进作用(P＜0.05);哈日嘎布日-10味片高剂量组对小鼠小肠推进率有显著的促进作用(P＜0.05).结论:蒙药哈日嘎布日-10味片具有良好的消食、助消化作用.     

Evaluation of oxidative stress in D-serine induced nephrotoxicity

It has been suggested that oxidative stress is involved in d-serine-induced nephrotoxicity. The purpose of this study was to assess if oxidative stress is involved in this experimental model using several approaches including (a) the determination of several markers of oxidative stress and the activity of some antioxidant enzymes in kidney and (b) the use of compounds with antioxidant or prooxidant effects. Rats were sacrificed at several periods of time (from 3 to 24h) after a single i.p. injection of d-serine (400mg/kg). Control rats were injected with l-serine (400mg/kg) and sacrificed 24h after. The following markers were used to assess the temporal aspects of renal damage: (a) urea nitrogen (BUN) and creatinine in blood serum, (b) kidney injury molecule (KIM-1) mRNA levels, and (c) tubular necrotic damage. In addition, creatinine clearance, proteinuria, and urinary excretion of N-acetyl-beta-d-glucosaminidase (NAG) were measured 24h after d-serine injection. Protein carbonyl content, malondialdehyde (MDA), 4-hydroxy-2-nonenal (4-HNE), fluorescent products of lipid peroxidation, reactive oxygen species (ROS), glutathione (GSH) content, and heme oxygenase-1 (HO-1) expression were measured as markers of oxidative stress in the kidney. Additional experiments were performed using the following compounds with antioxidant or pro-oxidant effects before d-serine injection: (a) alpha-phenyl-tert-butyl-nitrone (PBN), a spin trapping agent; (b) 5,10,15,20-tetrakis (4-sulfonatophenyl) porphyrinato iron(III) (FeTPPS), a soluble complex able to metabolize peroxynitrite; (c) aminotriazole (ATZ), a catalase (CAT) inhibitor; (d) stannous chloride (SnCl(2)), an HO-1 inductor; (e) tin mesoporphyrin (SnMP), an HO inhibitor. In the time-course study, serum creatinine and BUN increased significantly on 15-24 and 20-24h, respectively, and KIM-1 mRNA levels increased significantly on 6-24h. Histological analyses revealed tubular necrosis at 12h. The activity of antioxidant enzymes catalase, superoxide dismutase, glutathione peroxidase, and glutathione reductase remained unchanged at all times studied. Protein carbonyl content, MDA, 4-HNE, and ROS remained unchanged at all time-points studied. GSH content decreased transiently on 9 and 12h. Interestingly, fluorescent products of lipid peroxidation decreased significantly on 3-24h. HO-1 expression was undetectable by Western blot and the immunohistochemistry studies revealed that the intensity of HO-1 staining was weak. The administration of PBN, FeTPPS, ATZ, SnCl(2), and SnMP did not prevent or enhance renal damage induced by d-serine. Our data taken as a whole suggest that oxidative stress is not involved in the early phase of the nephrotoxicity induced by d-serine.     

La frecuencia cardiaca en fetos con circular de cordón

ObjectiveTo determine heart rate and the frequency of type i and ii dips in fetuses with coiling of funis.Study designThere were 40 patients in the sample, divided in two groups: group 1: consisted of 20 pregnant women with a diagnosis of coiling of funis; group ii consisted of 20 patients with a normal pregnancy. Fetal heart rate (HR) and uterine contractility were recorded for 2 hours. For the statistical analysis, the SPSS^® package, Z-score and Student's t-test were used.ResultsFetal HR was 138 beats/min in group 1 and 135 beats/min in group ii. The difference between medians (Z-score) was 8.65, which was significant (P<.01).Amplitude and accelerations were calculated in both groups, with similar results (24 beats). The difference in means was not significant.The mean weight and height were compared in the two groups. Mean weight was 3,100 g in group 1 and 2,960 in group 1, while mean height was 50.72 cm in group i and 49.77 in group 2. The difference in means was not significant.Apgar tests were performed in both groups. In group 1, Apgar scores ranged from 7-9 at 1 minute and from 8-9 at 5 minutes. Values were similar in group 2.Type i dips gave a reading of 3, and type ii dips a reading of 2 (one with marked height and duration). No type iii dips were observed. No meconium was found in any of the deliveries.ConclusionsIn pregnancies with loosely coiled funises, there were no significant changes in fetal HR. In pregnancies with tightly coiled funises, type ii dips with wide amplitude and marked duration were found.