脑卒中后抑郁的影响因素及其心理干预研究

目的：研究脑卒中后抑郁症发生的可能影响因素,以及心理干预作用。方法：对2013年6月到2015年7月,就诊于本院的206例脑卒中患者,进行配对分组研究,并给与研究组患者心理干预,利用量表对患者评分,汇总并对结果进行统计分析。结果：神经功能损伤程度、生活事件总分、社会支持客观分、家庭负担、患者对治疗的依从性、病前吸烟状况和病变部位是影响脑卒中后抑郁发生的主要因素。心理干预在预防和治疗脑卒中抑郁症的发生中有明显效果,但在病后初期很难对抑郁症的发生有明显疗效,需要持续而耐心给予患者长期的心理干预。结论：脑卒中后抑郁症发生的影响因素众多,可以针对主要影响因素,给予患者病后疾病指导,同时,心理干预可以有效减少减轻脑卒中病人的抑郁症发生,这位临床治疗提供了新的思路。     

组织二尖瓣环位移评价冠状动脉慢血流患者左心房功能

目的 探讨组织二尖瓣环位移（TMAD）评价冠状动脉慢血流（CSF）患者左心房功能的应用价值。方法 44例CSF患者（CSF组）和42例无CSF患者（对照组）行常规超声心动图检查，采用Simpson法计算左心房射血分数（LAEF）、被动射血分数（LAPEF）和主动射血分数（LAAEF），采用TMAD检测二尖瓣环左心房充盈期位移、被动排空期位移及心房收缩期位移（TMAD_D、TMAD_P及TMAD_S）。结果 与对照组比较，CSF组LAEF和LAAEF降低，且TMAD_D和TAMD_S均降低（P均<0.01）。CSF组TMAD_D和TAMD_S均与冠状动脉平均血流帧数（TFC）呈负相关（r=-0.31，-0.36，P均<0.01）。结论 CSF患者左心房储器及泵功能降低，且冠状动脉血流速度越慢，功能降低越显著。TMAD可快速准确评价左心房功能，为临床治疗及预后评估提供重要依据。     

IgE reactivity to profilin in Platanus acerifolia pollen-sensitized subjects with plant-derived food allergy.

BACKGROUND: The presence of profilin-specific IgE antibodies is a cause of cross-reactivity between botanically-unrelated allergen sources. Recently, the association between Platanus acerifolia pollinosis and plant-derived food allergy has been described. The aim of this study was to ascertain whether the P. acerifolia profilin is involved in such cross-reactivity. METHODS: Twenty-three patients suffering from Platanus acerifolia pollinosis and plant-derived food allergy were evaluated in an allergy department. Specific IgE levels to P. acerifolia pollen, P. acerifolia profilin and food extracts were measured. Molecular masses of IgE-binding proteins were calculated by Western blotting and cross-reactivity studies among P. acerifolia profilin and different food extracts were evaluated by Enzyme AllergoSorbent Test (EAST)-inhibition assays. Also, EAST-inhibition assays with the two known P. acerifolia allergens, Pla a 1 and Pla a 2, were performed. RESULTS: Surprisingly, a high IgE-binding prevalence (90%) of P. acerifolia profilin was found. EAST-inhibition showed high inhibition values when Platanus acerifolia pollen extract was used as free phase and plant-derived food extracts as solid phase, whereas the other way round showed low inhibition values. IgE reactivity to profilin was studied using a pool of patient sera, by EAST-inhibition assays with hazelnut, apple peel, peanut, chickpea and peanut extracts as solid phase and no inhibition was obtained when P. acerifolia profilin was used as inhibitor phase. The same results were obtained when purified Pla a 1 and Pla a 2 were also used as inhibitor phase. CONCLUSIONS: The clinical association observed between Platanus acerifolia pollen and plant-derived food could be explained by the in vitro IgE cross-reactivity detected by EAST-inhibition. However, it appears that neither P. acerifolia profilin nor the two major allergens described (Pla a 1 and Pla a 2) can explain such a strong cross-reactivity.     

肺炎克雷伯菌与植生克雷伯菌喹诺酮类耐药基因研究

目的 分析宁波大学医学院附属医院克雷伯菌属的耐药性及其对喹喏酮类药物的耐药机制.方法 收集2009年10月-2011年3月分离出的20株克雷伯菌属菌株,经鉴定确认18株为肺炎克雷伯菌,2株为植生克雷伯菌.采用k-b纸片扩散法检测其对药物的敏感性.pcr法检测染色体介导的gyra、parc基因和质粒介导的aac(6’)-Ⅰ b-cr、qnra、qnrb、qnrs、qepa基因,pcr阳性产物采用pcr直接全自动荧光法测序.结果 20株克雷伯菌属菌对β-内酰胺类、氨基糖苷类、喹诺酮类抗菌药物均表现为多重耐药性(耐药率均在80％以上),其中植生克雷伯菌对亚胺培南和美罗培南敏感.18株(90％)菌株存在gyra、parc基因突变;aac(6’)-Ⅰ b-cr阳性12株(60％),qnrb和qnrs阳性均为4株(20％).结论 本组20株克雷伯菌属菌对喹诺酮类药物耐药主要与gyra和parc基因突变相关. abstract： objective to investigate the multi-drug resistance of klebsiella strains and its mechanism.methods twenty strains of klebsiella were isolated from the affiliated hospital of medical college,ningbo university from october 2009 to march 2011,in which 18 isolates were klebsiella pneumonia and 2 were klebsiella planticola. drug sensitivity was determined by k-b tests. drug resistant genes gyra,parc (chromosome mediated) and aac( 6′)-i b-cr,qnra,qnrb,qnrs,qepa (plasmid mediated) were amplified by pcr and verified by direct automated fluorogenic sequencing. results resistance to β-1actams,aminoglycosides and quinolones was observed in 20 strains,and resistant rates were all above 80％.klebsiella planticola strains were sensitive to imipenem and meropenem.mutations of gyra and parc genes existed in 18 strains (90％),and the positive rates of aac (6') -i b-c r,qnrb and qnrs were 60％ (12/20),20％ (4/20) and 20％ (4/20),respectively.conclusion the mutations ofgyra and parc genes may be the main cause of the resistance to quinolones in these strains.     

腹部提压法对窒息性心搏骤停猪复苏效果的实验研究

目的：比较胸外按压心肺复苏（CC-CPR）与腹部提压心肺复苏（ALc-CPR）对窒息性心搏骤停猪复苏时血流动力学指标和通气指标的影响。初步评价腹部提压法对窒息性心搏骤停猪的复苏效果。方法：健康家猪30只,建立窒息性心搏骤停模型。随机分为两组。每组15R,分别实施cc-cPR和ALc-cPR。窒息前10min开始连续记录心电圈（ECG）、经皮脉搏氧饱和度（Sp02）．呼气宋二氧化碳分压（PETC02）,主动脉收缩压（SBP）．舒张压（DBP）、中心静脉压（CVP）和潮气量（VT）直至试验结束;计算主动脉平均动脉压（MAP）、冠脉灌注压（CPP）和每分通气量（MV）;分别在窒息前10min（TI）,窒息后10min（T2）、复苏后5min（T3）、复苏后10mii3（T4）、复苏后20min（T5）抽取动脉血查血气。观察两组动物的自主循环恢复（ROSC）率,24h存活率和24h后神经功能缺损评分。结果：CC-CPR组MAP和CPP高于ALC-CPR组．两组间的差异有统计学意义;ALC-CPR组的VT和MV高于CC-CPR组,差异有统计学意义;CC-CPR组ROSC率为26．7％,ALC-CPR组为80％,差异有统计学意义;24h存活率CC-CPR组为13．3％,ALC-CPR组为60％。差异有统计学意义;24h神经功能评分ALC-CPR组优于CC-CPR组。结论：在窒息性心搏骤停猪的复苏早期,ALC-CPR较cc-CPR更具优势。     

Frequent intravenous pulses of growth hormone together with alanylglutamine supplementation in prolonged critical illness after multiple trauma: effects on glucose control, plasma IGF-I and glutamine.

OBJECTIVE: We aim to demonstrate that low dose growth hormone (GH) administered in i.v. pulses every 3h is able to normalize IGF-I levels in subjects with prolonged critical illness, after multiple trauma. We also ask whether it is possible to control glycaemia during such a treatment and how alanylglutamine (AG) supplementation influences plasma glutamine concentration. METHODS: We used a prospective double-blind (group 1 vs. 2), randomized trial with an open-label control arm (group 3). Thirty multiple trauma patients (median age: 36, 42, 46 years) were randomized on day 4 after trauma to receive (group 1, n=10) i.v. AG supplementation (0.3 g/kg day from day 4 till 17) and i.v. GH (0.05 mg/kg day divided into 8 boluses, maximum dose at 3 AM, administered on days 7-17) or AG and placebo (group 2, n=10). Group 3 (n=10) received isocaloric isonitrogenous (proteins 1.5 g/kg day) nutrition without AG. Glycaemia was controlled by i.v. insulin infusion according to a routine protocol. RESULTS: GH treatment caused an increase of IGF-I (from median 169 on day 4 to 493 ng/ml on day 17), IGFBP-3 (from 2.4 to 3.2 microg/ml) and a fall in IGFBP-1 (from 11.5 to 3.1 microg/ml), whilst in both groups 2 and 3 these indices remained unchanged. At the end of the study (day 17) IGF-I and IGFBP-1 differed significantly among groups (p=0.008 resp. p=0.010, Kruskal-Wallis). Plasma glutamine remained below the normal range through the study in all groups (median: 0.18-0.30 mM), but had a tendency to rise in group 2 in contrast with a fall in groups 1 and 3 (NS). Group 1 required more insulin (p<0.01) than did the control group but median glycaemia was only 0.4-0.5 mM higher in group 1 (6.5 mM) than in groups 2 and 3 (6.1 resp. 6.0 mM). CONCLUSIONS: GH (0.05 g/kg day) administered in i.v. pulses is able to normalize IGF-I levels in subjects with prolonged critical illness after trauma. During this treatment, the standard dose of AG prevents worsening of plasma glutamine deficiency and glucose control is possible using routine algorithms, but it requires higher insulin doses.     

Significance of arginase determination in body fluids of patients with hepatocellular carcinoma and liver cirrhosis before and after surgical treatment

Objective

To assess the utility of arginase activity and expression in diagnosis of liver diseases.

Design and methods

Arginase activity, sensitivity and specificity were determined in serum of 140 patients including 50 with HCC, 60 with LC, 30 with choledocholithiasis (CDL) and 90 healthy controls. In HCC and LC arginase activity in serum was studied before and after tumor resection or liver transplantation. Arginase sensitivity in HCC was compared to that of alpha-fetoprotein (AFP) and aminotransferases (AST, ALT). In LC the activity was determined also in bile before and after transplantation. The expression of arginase isoenzymes in serum was studied by Western blotting.

Results

In HCC and LC the preoperative arginase activity was significantly higher compared to controls, and it decreased after surgery. The sensitivity of arginase in HCC was much higher than that of AFP, AST and ALT (96, 40, 20 and 18%, respectively). In HCC it was higher than in LC (93%) and CDL (33%). The specificity of arginase was above 80%. In bile of cirrhotic patients the highest activity was immediately after liver transplantation. It decreased with time but increased dramatically at the time of the graft rejection. Arginase AII was present in serum of HCC and LC but not the control cases.

Conclusions

The increase of arginase activity in serum accompanied by the presence of isoenzyme AII can be useful in HCC and LC diagnosis. The determination of arginase activity in bile may be helpful in monitoring liver graft recipients.     

Drug abuse, AIDS, and the coming crisis in long-term care

As the 21st century approaches and the proportion of the US population over 65 years of age increases, it is expected that the demand for long-term care will expand dramatically. This expectation has been widely discussed. Less widely discussed is a potential for increase in the demand for long-term care resulting, not from the geriatric conditions with which the industry is already familiar, but from chronic and debilitating substance abuse-related diseases. In the United States, the incidence of severe cardiovascular and hepatological deterioration in younger patients has begun to increase, partly due to the increased scope of drug use and the increased variety of drugs used by individuals under the age of 35. HIV disease progression resembles these degenerative conditions in some important ways, and HIV infection is now often accompanied by substance abuse disorders. Thus, the care of HIV-infected patients can serve as a model for the impact on the long-term care industry that this new type of patient is likely to make. Using HIV as a particularly dramatic example, this paper discusses those changes in detail, and concludes with recommendations for successfully adapting to them.