淋球菌LOS 2C7表位筛选及其与HBc融合蛋白的原核表达

目的:将淋球菌脂寡糖的2C7表位插入乙型肝炎病毒核心抗原(HBc)的MIR区,通过原核表达系统进行融合蛋白的表达,以期获得高免疫原性的淋球菌亚单位疫苗的候选靶位。方法:通过间接ELISA法,以CMCC29403菌株的LOS为包被抗原,对7个表位进行筛选;并通过杀菌试验检测肽段免疫动物产生血清的保护力。对已筛选好的肽段基因进行人工合成,通过重叠PCR将肽段基因嵌入HBc基因中,以增强表位的免疫原性,并进行原核表达。结果:初步研究表明了表位PEP1,PEP2,PEP7具有较强的脂寡糖(LOS)的免疫原性,能够模拟脂寡糖的抗原性。这3个肽段可能成为候选疫苗亚单位。通过重叠PCR方法:成功地将PEP1,PEP2,PEP7三个表位基因序列插入乙型肝炎病毒核心抗原(HBc)的刺突(MIR)部位,构建了HBc-PEP1,HBc-PEP2,HBc-PEP7融合基因,通过PET22b(+)载体进行原核表达,为下一步疫苗的研究奠定了基础。结论:2C7表位PEP1,PEP2,PEP7具有较强的脂寡糖(LOS)的免疫原性,能够模拟脂寡糖的抗原性。表位与HBc的融合蛋白可以通过原核表达系统进行可溶性表达,为下一步疫苗的研究奠定基础。     

Heparin sensitivity test for patients requiring cardiopulmonary bypass

Anticoagulation for the open heart surgery patient undergoing cardiopulmonary bypass (CPB) is achieved with the use of heparin. The industry standard of activated clotting time (ACT) was used to measure the effect of heparin. The commonly acceptable target time of anticoagulation adequacy is 480 seconds or greater. Some patients, however, exhibit resistance to standard dosing of heparin and do not reach target anticoagulation time (480 seconds). Antithrombin III deficiency has been previously cited as the cause of heparin resistance. Early detection of heparin resistance (HR) may avoid both the delayed start of CPB and inadequate anticoagulation, if emergency bypass is required. An anticoagulation sensitivity test (AST) was developed by adding 12 units of porcine mucosa heparin to the ACT tube (International Technidyne, celite type). Before anticoagulation, 4 mL of blood was drawn from the patient arterial line. Following the manufacturer's instructions, 2 mL of blood was added to each tube (ACT-baseline and ACT-AST). Three minutes after anticoagulation with 4 mg heparin/kg body weight, a second sample (ACT-CPB) was taken to determine anticoagulation adequacy. The ACT times of each sample were recorded for 300 procedures occurring during 2004 and were retrospectively reviewed. Heparin resistance occurred in approximately 20% of the patients (n = 61). In 54 patients, heparin resistance was predicted by the ACT-AST. This was determined by the presence of an ACT-AST time and an ACT-CPB that were both < 480 seconds. The positive predictive value was 90%, with a false positive rate of 3%. Heparin resistance occurs in patients undergoing CPB. We describe a simple and reliable test to avoid the delays of assessing anticoagulation for CPB (90% positive predictive value). Depending on program guidelines, patients can be given additional heparin or antithrombin III derivatives to aid in anticoagulation. An additional ACT must be performed and reach target times before CPB initiation. Testing of patient blood before the time of incision for sensitivity to heparin is a way to avoid a delay that can be critical in the care of the patient. Commercial tests are available, but efficacy data are limited, and they lead to added inventory expense. This method of titrating a diluted heparin additive, mixed with patient blood in a familiar ACT test, has proven to be an inexpensive and reliable test to predict patient's sensitivity to heparin.     

角色模拟培训对儿科低年资护士人文素养的影响

目的 探索角色模拟培训提升儿科低年资护士人文素养的效果。 方法 将儿科工作时间≤3年的低年资护士59人随机分为对照组（n=29）和观察组（n=30）。对照组按年度常规培训计划进行人文关怀及沟通培训,观察组在对照组基础上,进行为期2个月共8次的角色模拟培训。培训前后采用人文关怀能力量表、临床护士沟通能力量表测评培训效果。 结果 培训后观察组人文关怀能力、沟通能力总分显著高于对照组（均P＜0.05）。 结论 对儿科低年资护士进行角色模拟培训,可以有效提升护士的人文关怀能力及临床沟通能力。     

建立兔单纯腹壁爆炸伤合并内脏器官外露的动物模型

目的建立可进行长期观察的单纯腹壁爆炸伤合并内脏器官外露的动物模型,观察此类创伤的致伤和转归规律。方法 8～10周龄生长期白家兔12只,随机分为2组,每组6只。全身麻醉条件下,标记致伤部位。A组采用自制腹腔防护装置埋入腹腔,然后采用0.125 g TNT当量炸药球贴于致伤部位致伤;B组不经防护处理直接采用同样爆源致伤。伤后观察各组大体形态,对活体动物每日取伤部组织常规HE染色,切片观察;死亡动物记录生存时间并行尸检。结果两组动物致伤部位腹壁呈全层开放性爆炸伤。A组实验动物创面面积(3.9±0.56)cm2;B组创伤面积(3.83±0.49)cm2,两组间无显著差异(P0.05)。A组实验动物存活时间为(141±87.78)h。B组实验动物平均存活时间为(3.67±2.25)h,两组实验动物存活时间存在明显差异(P0.05)。尸检和病理观察发现,对照组动物早期死亡原因为内脏损伤和腹腔内出血,实验组发生内脏纤维粘连未见明显创伤。腹壁各层组织受爆炸的创伤有差异,呈现"外轻内重"的病理变化,并呈进行性发展,尤以肌肉组织的变化最为典型。结论本实验模拟了腹部爆炸伤致伤机制。经有效防护,建立了可用于长期观察的单纯腹壁爆炸伤动物模型。     

甘草酸二铵对肝病患者血糖的影响

 目的 研究甘草酸二铵(甘利欣)对肝病患者血糖的影响.方法 对甘利欣治疗的肝病患者进行前瞻性研究,治疗前先测定其空腹血糖及餐后2 h血糖,均正常者,开始甘利欣150 mg/d,静脉点滴,然后于治疗15 d、1个月、2个月时分别复查空腹血糖及餐后2 h血糖.急性肝病疗程1个月,慢性肝病及肝硬化疗程2个月,疗程不满1月者不于统计.此外,半数患者应用生理盐水做为稀释液,半数患者应用5% 葡萄糖作为稀释液,以观察不同稀释液对结果的影响.结果 对血糖正常的肝病患者,无论是急性肝病、慢性肝病及肝硬化患者的血糖,在疗程两个月之内,未发现有不利影响.其稀释液,无论是生理盐水还是5%葡萄糖也都没有影响.结论 甘草酸二铵(甘利欣) 150 mg/d, 静脉点滴,连续2个月,对血糖正常的肝病患者的血糖无不利影响.     

瑞芬太尼用于肝癌手术麻醉的临床观察

目的观察瑞芬太尼在肝癌手术中的应用效果。方法选择ASA（美国麻醉医师协会1分级Ⅰ～Ⅱ级择期在全身麻醉下行肝癌切除术患者30例,随机分为瑞芬太尼（R）组及异氟醚（I）组,R组采用瑞芬太尼和丙泊酚诱导及维持麻醉,Ⅰ组采用芬太尼和丙泊酚诱导,异氟醚维持麻醉。观察并比较两组患者麻醉诱导及维持期血流动力学的变化、术毕停药后患者自主呼吸恢复时间、清醒时间、拔管时间以及苏醒期不良反应等。结果Ⅰ组在手术牵拉过程中血压、心率升高明显,有统计学意义（P〈0．05）,而R组各时间点血流动力学变化稳定（P〉0．05）。且R组自主呼吸恢复时间、睁眼时间、拔管时间与1组相比恢复快,清醒程度高,有显著性差异（P〈0．05）。结论瑞芬太尼麻醉术中循环波动较小、苏醒快、术后并发症少,可安全有效地用于肝癌切除术。     

运用建构主义教育观增强中专德育实效性

运用建构主义理论对中专德育学习过程进行审视,将建构主义教学模式运用于中专德育课堂教学过程.     

Cardiopulmonary bypass in patients with pre-existing coagulopathy

Patients with pre-existing coagulopathies who undergo surgical interventions are at increased risk for bleeding complications. This risk is especially true in cardiac surgical procedures with cardiopulmonary bypass (CPB) because of the necessity for heparinization and the use of the extracorporeal circuits, which have destructive effects on most of the blood components. In this review, cases of cardiac surgeries in patients with certain pre-existing coagulopathies are summarized, which could shed a light on future managements of such patients undergoing cardiac procedures with CPB. Pre-existing coagulopathies include antithrombin III deficiency, heparin-induced thrombocytopenia, cancer, factor XII deficiency, hemophilia, idiopathic thrombocytopenic purpura, protein S deficiency, and drug-induced platelet inhibition. In summary, pre-existing coagulopathy in patients undergoing open-heart surgeries, if not recognized and appropriately managed, can cause serious complications. Management of patients undergoing cardiac procedures should include a routine coagulation work-up and a thorough past medical history examination. If any of the foregoing is abnormal, further evaluation is warranted. Proper diagnosis and management of the pre-existing coagulopathy disorders is of crucial importance to the surgical outcome and long-term morbidity.