浙江新分离汉坦病毒ZT71株S基因片段的克隆及序列分析

目的为了获得浙江省汉坦病毒基因组更为详尽的资料,研究汉坦病毒的进化状况及变异程度,为疫苗病毒株的选择使用提供科学依据。方法本实验室利用RT-PCR方法扩增ZT71株S基因片段并克隆入质粒载体,进行核苷酸序列测定及分析。结果ZT71株S基因由1754个核苷酸组成,只有一个开放读码框架,共编码429个氨基酸。与HTN型病毒(76-118)的核苷酸和氨基酸同源性分别为72.0%和82.6%,与SEO型病毒(SR-11、R22、Guo3、8610)核苷酸和氨基酸同源性分别为88.4%—96.5%和98.1%—99.0%,与其它型汉坦病毒的同源都很低。结论表明此分离的病毒为SEO型汉坦病毒,为进一步研究其进化和变异提供了有利条件。     

N末端B型钠尿肽前体水平评价合并心脏病孕妇的心功能研究

目的探讨N末端B型钠尿肽前体(NT-pro BNP)水平与孕妇是否合并心脏病的相关性。方法选取妊娠合并心脏病孕妇74例和同期正常妊娠孕妇80人,两组分别检测晚妊期NT-pro BNP血浆浓度并作比较,其中正常妊娠孕妇组还检测早妊期NT-pro BNP血浆浓度,分别与该组晚妊期结果比较,同时对妊娠合并心脏病孕妇作心功能分级,并与晚妊期血浆NT-pro BNP水平作关联性分析。结果妊娠合并心脏病孕妇NT-pro BNP血浆浓度(中位数为352.50 pg/m L,浓度范围为84.00~3 806.00 pg/m L)明显高于正常妊娠孕妇晚妊期(中位数为58.00 pg/m L,浓度范围为26.00~164.00 pg/m L)(P0.01),其心功能分级越高,NT-pro BNP血浆浓度水平也越高(P0.01);正常妊娠孕妇的晚妊期NT-pro BNP血浆浓度高于早妊期(中位数为49.00 pg/m L,浓度范围为20.00~178.00 pg/m L)(P0.01)。结论 NT-pro BNP血浆浓度水平在评价合并心脏病孕妇心功能受损程度有重要的临床应用价值,妊娠对正常孕妇心功能有一定的影响。     

两种不同灌注方法对肩关节镜下手术出血与视野显露的影响

目的探讨改良加压灌注和常规重力灌注对肩关节镜下手术出血与视野显露的影响。方法选取我院2018-01/2019-07期间因肩袖撕裂收住我院骨科拟行肩关节镜手术治疗的患者60例,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为观察组(n=30)和对照组(n=30)。观察组应用改良气压止血仪加压灌注,对照组应用常规重力灌注,监测并记录关节腔压力(mmHg)、关节腔灌注引流液中红细胞计数(个)、灌注液总量(L)、手术时间(min)、术后肩关节肿胀度(cm)。结果观察组第1次更换灌注液时关节腔压力高于对照组,关节腔灌注引流液中的红细胞计数及手术时间少于对照组,差异有统计学意义(P<0.05);2组灌注液总量及术后肩关节肿胀度无统计学意义(P>0.05)。结论在肩关节镜手术中使用改良加压灌注法,具有操作简便、压力稳定、视野清晰、手术时间短等优点,值得临床推广使用。     

右旋美托咪定滴鼻用于小儿腭裂整复术麻醉中的临床研究

目的 观察右旋美托眯定(dexmedetomidine,Dex)滴鼻在小儿腭裂整复术中对血流动力学及麻醉并发症的影响.方法 60例腭裂患者随机分为Dex组和对照组,每组30例.静脉推注咪达唑仑0.1 mg/kg、丙泊酚2.0 mg/kg、芬太尼2.0μg/kg、琥珀胆碱1.5 mg/kg快速诱导后,经口腔气管插管.气管插管后Dex组按1.0 μg/kg的剂量经鼻滴入稀释至0.4 mL的Dex,对照组滴入0.4 mL生理盐水.麻醉维持全程使用七氟醚维持至术毕.术中维持脑电双频谱指数在45 ～ 55、呼末二氧化碳分压(PETCO2) 35 ～ 50 mmHg.记录诱导完(T0基础值)、滴鼻后5 min(T1)、分离腭瓣时(T2)、手术结束时(T3)、拔除气管导管时(T4)、拔除气管导管后15 min(T5)6个时点血流动力学数据;术后睁眼时间(术毕至睁眼时间)、麻醉苏醒时间(停药至离室时间)、拔管时间(术毕至拔管时间)及拔管后不良反应发生的情况.结果 与对照组比较,Dex组的平均动脉压在T2为(8.64±0.65) kPa、T3为(8.73±0.96)kPa、T4为(9.06±0.83) kPa,各时点均明显降低(P＜0.05);心率在T1、T2、L3、T4、T5点有不同程度的降低;躁动、呛咳与对照组比较均明显减少(P＜0.01).结论 小儿腭裂整复术中,诱导后应用1.0 μg/kg Dex滴鼻可使患儿术中及拔管期血流动力学更平稳,躁动、呛咳发生率低,且不影响麻醉苏醒时间及拔管时间.     

P-糖蛋白抑制剂对两性霉素B血脑屏障转运的作用

目的 探讨P-糖蛋白抑制剂对两性霉素B(AmB)血脑屏障转运的影响.方法 应用小鼠脑血管内皮细胞建立体外血脑屏障模型,选取维拉帕米作为P-糖蛋白抑制剂,AmB作为受试底物,经细胞毒性实验选定合适的温育时间及药物浓度,分别进行不同时间点的AmB细胞摄取实验及不同维拉帕米浓度的AmB细胞摄取实验.组间均数比较采用单因素方差分析,均数两两比较采用Bonferroni检验.结果 AmB的血脑屏障转运随时间延长不断积累,与同一时间点对照组相比,抑制剂组在90 min(t=6.753,P=0.001)、120 min(t=3.574,P=0.016)、150 min(t=4.759,P=0.005)处AmB细胞摄取水平明显升高,其余时间点两组间差异无统计学意义.与阴性对照组相比,AmB细胞摄取水平在不同浓度维拉帕米组(2、5、10、50、75和100μmol/L)均有显著提高(P=0.000、0.014、0.000、0.014、0.000、0.000),且随维拉帕米浓度升高增加幅度更明显.结论 P-糖蛋白抑制剂维拉帕米可提高脑毛细血管内皮细胞对AmB的摄取作用,提示P-糖蛋白参与血脑屏障AmB的转运.     

“双一流”背景下期刊论文规范“四要素”结构式摘要的实践优势

[目的] 分析摘要之内涵,并探讨“四要素”结构式摘要的优势,以及规范论文摘要的意义。[方法] 通过查阅相关文献,结合《浙江中医药大学学报》编辑部的工作经验,分别从摘要特点、分类等方面阐释摘要之内涵、“四要素”结构式摘要的优势,以及规范“四要素”结构式摘要在高校“双一流”建设背景下的实践意义。 [结果] 摘要乃论文内容之浓缩,具有完整性、自明性和独立性。根据撰写格式,可将摘要分为叙述式摘要和“四要素”结构式摘要。一篇完整充实的摘要是作者论文投稿后展现给编者的点睛之笔。“四要素”结构式摘要能够更完整地体现一篇论文调查研究所涉及的主题范围,是编者沟通作者至关重要的纽带,是信息化时代学术交流的主要桥梁,一篇完整精准的“四要素”结构式摘要更有利于国内外文化交流,提升期刊影响力,亦是编辑人员需要掌握的基本技能之一。[结论] “四要素”结构式摘要可以更好地发挥摘要在论文中的重要性,有助于读者快速明晰论文主旨内容,有助于促进编辑规范化的进程,有助于提高专家审稿速度,并有助于提升论文在相关专业的学术影响力和国际显示度,促进国际信息化发展,值得深入推广。     

室间孔区术后记忆功能障碍及其康复治疗探讨

目的探讨室间孔区术后患者记忆功能障碍的特征及其康复治疗。 方法利用龚耀先修订的韦氏记忆量表对25例室间孔区域手术患者手术前、手术后第3天及1个月进行记忆功能评定。应用日历本等工具辅助记忆，同时联合PQRST法（即浏览、提问、精读、表述和自我测验）对患者进行康复治疗。 结果记忆商低于85分者，术前占16%，术后第3天占48%，康复训练1个月后占28%。术前记忆商与术后第3天和1个月时比较（P<0.05），差异均有统计学意义。术后记忆障碍主要为短时记忆中的图片回忆、理解记忆、视觉再认、联想学习和记忆中的倒数，而在背数、顺数、积累、视觉再生、触摸检测等方面差异不明显。 结论室间孔区术后记忆障碍较为明显，主要为短时记忆障碍，同时累及长时记忆，瞬时记忆不受影响。室间孔区手术中应尽量避免损伤穹隆和丘脑前极，术后康复治疗有助于记忆的恢复。     

DESIGNING STUDIES FOR DOSE RESPONSE

‘Dose response’ refers to the regression of a response on a stimulus. We review a number of options for dose–response designs, and compare various designs which may be used in practice. We start with two group designs. Next, we introduce basic optimal approximate design theory for simple linear and quadratic regression illustrating different criteria of optimality and their effect on the allocation of the levels of the dose. Then we obtain the efficiencies of these optimal approximate designs and some simple designs which have intuitive appeal (symmetry, equal spacing of treatments, reduced numbers of observations at the highest and lowest doses).     

DOSE-RELATED EFFECTS OF RADIAL EXTRACORPOREAL SHOCK WAVE THERAPY FOR KNEE OSTEOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

ObjectiveTo assess the dose-related effects of radial extracorporeal shock wave therapy on pain alleviation in knee osteoarthritis.MethodsWith the use of a 2 × 2 factorial randomized controlled design, 89 patients diagnosed with knee osteoarthritis were assigned to 1 of 4 treatment groups, which varied in terms of shock intensity (0.12 mJ/mm², lower density, or 0.24 mJ/mm², higher density) and shock number (2,000 impulses or 4,000 impulses), or to a placebo control. Each group received 4 sessions of radial extracorporeal shock wave therapy, one week apart. The primary outcome was pain intensity measured on a visual analogue scale, and the secondary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Assessments were performed at baseline, after each session, and at 4-week follow-up.ResultsTwo-way repeated-measures analysis of variance revealed a significant effect on the Pain score for intensity (p < 0.001), with no effect for number (p = 0.467) or the intensity–number interaction (p = 0.536). Similar results were obtained for the WOMAC scores, except for an association between number and WOMAC score (p = 0.036). At the 4-week follow-up, all treatment groups showed greater reductions in the Pain and WOMAC scores than the control group. In addition, scores decreased more at higher densities of shock intensity than at lower densities, while there was no significant difference between the 2,000- and 4,000-shock conditions.ConclusionModerate-intensity radial extracorporeal shock wave therapy was effective, and a higher density might be more efficacious in alleviating pain in knee osteoarthritis.LAY ABSTRACTExtracorporeal shock wave therapy may be a viable treatment for knee osteoarthritis with local pain and dysfunction; however, there are no standards on how to choose the treatment parameters to obtain the best outcome. This study compared 5 different levels of amount of treatment in 89 patients with knee osteoarthritis, and found that a medium intensity of therapy was effective. In addition, a higher intensity of extracorporeal shock wave therapy, rather than higher shock numbers, might result in a higher level of alleviation of symptoms in these patients.Key words: dose-response relationship, radial extracorporeal shock wave therapy, knee osteoarthritis

Knee osteoarthritis (KOA) is the most common degenerative joint lesion; it has a high prevalence and a negative impact on the quality of life of affected individuals (1). It has been reported in a case–control study carried out in North Staffordshire that 9.6% of men and 18% of women have symptomatic KOA at the age of 60 years and over (2). In addition, approximately 25% of the population older than 55 years reports at least one episode of knee pain each year in the United Kingdom.(3). The management of early- medium stage KOA is crucial; the main aims during this stage of conservative therapy for KOA are to relieve pain and enhance joint mobility (4, 5). Treatments for KOA include oral medication, exercise therapy, intra-articular drug injection, and physiotherapy. Among these treatments, radial extracorporeal shock wave therapy (rESWT) has recently attracted increasing attention (6). rESWT is widely used for pain relief and the treatment of musculoskeletal disorders, and has proven beneficial at specific stages of KOA (7).An extracorporeal shock wave is a transient sequence of acoustic pulses with a high peak pressure of 100 MPa, followed by a negative pressure of approximately 5–10 MPa, with an energy density between 0.003 and 0.89 mJ/mm² (8). Radial shock wave devices generate the maximum energy at the probe tip and then distribute it radially into the tissue, providing effective treatment (9). rESWT may be a more acceptable treatment for some patients because of its non-invasiveness, low complication rate, lack of required hospitalization and low cost compared with other approaches. However, rESWT has not met established efficacy standards, and the optimal dose is unknown. A meta-analysis indicated that the effects of rESWT are superior to those of a placebo and physical therapy for pain relief in KOA (10). Nevertheless, an RCT that applied a relatively small dose of radial extracorporeal shock waves did not demonstrate any statistically significant difference from a placebo treatment in terms of pain control in patients with severe KOA (11). Another systematic review identified that the positive energy flux density (EFD) should be as high as possible; however, the dose was based on the subjective feeling of the individual patient (12).It is important to quantify the amount of rESWT needed to reduce symptoms of KOA and establish the efficacy of rESWT. Thus, the primary aim of this prospective randomized placebo-controlled study was to test whether there was a dose-response relationship between the treatment doses and reduction in pain and dysfunction. The secondary aim was to examine whether the mean change in pain and function scores was greater for the active rESWT conditions than for the placebo control 4 weeks after the final treatment.