三级医院心力衰竭门诊管理方案对患者预后的影响

目的 探索结合心力衰竭(心衰)门诊、心衰教育和电话随访的心衰疾病管理方案的可行性,观察该方案对患者预后的影响.方法 入选住院的心衰患者145例,男91例,女54例,平均年龄(69.6±11.3)岁,纽约心功能分级(NYHA分级)Ⅱ-Ⅳ级,左室射血分数(LVEF)≤45%或LVEF>45%时N末端B型利钠肽原>1500 ns/L.根据个人意愿分为非疾病管理组和疾病管理组,疾病管理组进行一系列的干预措施,包括开展心衰教育、电话随访、定期心衰门诊就诊.于分组后10～12个月比较两组患者的结果.结果 基线时两组患者临床特征、LVEF及药物使用率、达标率差异无统计学意义.随访时,疾病管理组NYHA分级为(1.4±0.5)级,LVEF为40%±8%;非疾病管理组NYHA分级为(3.2±0.5)级,LVEF为31%±6%.疾病管理组自行监测体重、血压和脉搏的比例均显著高于非疾病管理组(P<0.05).在收缩性心衰患者中,疾病管理组40%患者的β受体阻滞剂达标剂量显著高于非疾病管理组的11%(P<0.05);疾病管理组66%患者的血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂达标剂量高于非疾病管理组的37%,但差异无统计学意义(P=0.09).非疾病管理组心血管病事件率为91.5%,疾病管理组心血管事件率为27.0%,两者差异有统计学意义(P<0.05).结论 结合心衰门诊、心衰教育和电话随访的心衰疾病管理方案可显著改善心衰患者的治疗依从性,增加有效药物的治疗剂量,改善患者的心功能并降低心血管病事件率.     

南水北调东线工程源头地区钉螺监测

目的了解南水北调东线工程源头地区钉螺分布及其对调水安全的影响。方法每年春季采取系统抽样结合环境抽查法对东线工程源头地区进行钉螺分布调查,同时选择江都水利枢纽泵站消力池滩地定点监测钉螺扩散。结果2006-2009年东线工程源头地区查出钉螺面积分别为256.11、184.55、164.92hm2和121.16hm^2;感染性钉螺面积分别为8.3、1.0、1.0hm^2和0hm^2;活螺密度也呈逐年下降趋势。GoogleEarth地图显示东线工程源头地区钉螺主要分布在夹江和芒稻河。对江都泵站消力池滩地定点监测发现局限性低密度扩散钉螺,分析原因为引河疏浚工程建筑垃圾携带所致。结论南水北调东线源头地区存在钉螺扩散的风险,因此有必要长期开展监测和控制。     

喹诺酮类药物对老年患者神经系统影响的观察与护理对策

目的：由于老年患者使用喹诺酮类药物后神经系统反应率高且严重,为了提高老年患者喹诺酮类药物用药后的生活安全展开研究。方法：通过3年时间对135例使用喹诺酮类药的70岁以上老年患者,观察药物对其神经系统产生的影响,对不同神经系统症状出现的比例进行分析。结果：发现70岁以上老年患者神经系统反应的发生率高达13.51%,而且存在多种反应同时出现的问题,对患者的生活安全造成非常大的影响,有跌倒、坠床、意外伤害等风险暴露。结论：护理人员通过细致全面的护理观察、护理人员培训、强化安全宣教、提供个性化的安全护理措施,最大程度的及早发现安全隐患,不但保障了老年患者住院期间的安全而且对患者出院后的安全也起到了一定的警示作用。     

Carcinoma obstruction of the proximal colon cancer and long-term prognosis—obstruction is a predictor of worse outcome in TNM stage II tumor

Purpose  

Colon obstruction is suggested to be a predictor of poor outcome in colon cancer. However, the effect of obstruction on outcome in patients with different tumor–nodes–metastases (TNM) stage cancer has not been fully addressed. The aim of this study is to determine whether colon obstruction predicts surgical and long-term oncologic outcomes in patients with proximal colon cancer.     

Molecular cloning of the carboxylesterase gene and biochemical characterization of the encoded protein from Pseudomonas citronellolis ATCC 13674

A genomic library of Pseudomonas citronellolis ATCC 13674 was constructed and screened for esterase activity in Escherichia coli using tributyrin-containing medium. One positive transformant was isolated, and subsequent analyses of the plasmid by restriction mapping revealed a 4.1-kb DNA fragment potentially carrying an esterase gene. The deduced nucleotide sequence of the DNA was found to contain an open reading frame encoding carboxylesterase and designated estA. Amino acid sequence analysis of estA showed the serine conservative motif, GDSAG, located between residues 208 and 212. Together with Ser, residues 310 and 334 corresponding to aspartic acid and histidine, respectively, comprised the catalytic triad. With the aid of immobilized metal ion affinity chromatography, the carboxylesterase fused with poly His at its C-terminus was purified and shown to be strongly inhibited by the tryptophan modifier and mercuric ion, indicating the important role of conservative Trp (189) and cysteine (152 and/or 183) residues in maintaining the structural integrity of the protein. Further analyses showed that the carboxylesterase functioned optimally at 37-40 degrees C with pH ranging between 8 and 9 and displayed a broad substrate spectrum. The protein exhibited greater preference toward short-chain (C2-C4) than medium- and long-chain fatty acids. Higher substrate specificity on para-nitrophenol butyrate was observed in comparison with para-nitrophenol acetate as indicated by the higher kcat/Km value of the former.     

Epitope mapping and characterization of a novel CD4-induced human monoclonal antibody capable of neutralizing primary HIV-1 strains

Human immunodeficiency virus (HIV-1) enters target cells by binding its gp120 exterior envelope glycoprotein to CD4 and one of the chemokine receptors, CCR5 or CXCR4. CD4-induced (CD4i) antibodies bind gp120 more efficiently after CD4 binding and block the interaction with the chemokine receptor. Examples of CD4i antibodies are limited, and the prototypes of the CD4i antibodies exhibit only weak neutralizing activity against primary, clinical HIV-1 isolates. Here we report the identification of a novel antibody, E51, that exhibits CD4-induced binding to gp120 and neutralizes primary HIV-1 more efficiently than the prototypic CD4i antibodies. The E51 antibody blocks the interaction of gp120-CD4 complexes with CCR5 and binds to a highly conserved, basic gp120 element composed of the beta 19-strand and surrounding structures. Thus, on primary HIV-1 isolates, this gp120 region, which has been previously implicated in chemokine receptor binding, is accessible to a subset of CD4i antibodies.     

信息追溯系统在消毒供应中心的应用

总结了信息追溯系统在消毒供应中心的开发与应用,包括系统配置、工作流程、质量追溯、系统应用效果分析,认为质量追溯系统的应用可全面控制重复使用物品在回收、清洗、消毒、灭菌各环节的处理流程,有效实现无菌物品管理信息化,提高工作效率,减少和杜绝差错事故发生。     

CD4+CD25+ regulatory T cell therapy for the induction of donor-specific clinical transplantation tolerance

Naturally occurring CD4+CD25+ regulatory T cells (Tregs) have been shown to play a key role in the control of autoimmunity. Interestingly, they are also capable of mediating transplantation tolerance and they can have indirect allospecificity for donor antigens. An increasing body of evidence in experimental studies has indicated that adoptive transfer of in vitro expanded CD4+CD25+ Tregs with indirect antidonor allospecificity can induce long-term donor-specific transplantation tolerance. Thus, adoptive cell therapy using patient-specific CD4+CD25+ Tregs as individualised medicine to promote clinical transplantation tolerance is promising.     

眉部运动的显微外科解剖学研究及其临床意义

目的：为解决除皱术中眉毛上提效果欠佳,不够持久的问题。方法：对10例新鲜尸体进行了大体及显微解剖。结果：证实了额肌深面“滑动层”和“滑动间隙”的存在,观察了眉内侧2／3自皮肤向深面发出固定到眉嵴处的眉毛支持韧带,外侧上方的颞融合线和下方的眉限制韧带静态固定结构,上述结构决定了眉毛的形态;阐述了额肌、皱眉肌和降眉肌的眉毛动力机制,探讨了老年性外侧眉毛下垂主要由于外侧的滑动脂肪垫向下“疝出”所致。结论：通过破坏“滑动间隙”,切断颞融合线和眉限制韧带,切除外侧滑动脂肪垫,达到眉部上提的良好、持久效果。     

北京地区汉族人群DNA修复基因XPD单核苷酸多态性与肺癌及食管癌风险的研究

目的：研究核苷酸切除修复基因XPD单核苷酸多态性与北京地区汉族人群肺癌及食管癌风险的关系。方法：采用以医院患者为基础的病例－对照研究方法，包括正常对照383人，肺癌患者351例，食管癌患者325例。以聚合酶链反应－限制性片段长度多态性方法分析了XPD基因Asp312 Asn和Lys751Gln多态性，比较不同基因型与肺癌及食管癌风险的关系，并探讨吸烟与基因多态交互作用对患癌风险的影响。结果：与携带312 Asp/Asp基因型者比较，携带至少1个312Asn等位基因者（即Asp/Asn和Asn/Asn基因型）罹患肺鳞癌的风险增加1．8倍（95％CI1．10－2．93），而与肺腺癌无关（校正的比值比为1．07，95％CI0．55－2．08）。分层分析显示，风险型等位基因312Asn和751Gln与吸烟有明显的交互作用。吸烟剂量≥29包／年且携带312Asn或751Gln者罹患肺鳞癌的风险最高，校正的比值比分别为12．44（95％CI4．97－31．17）和10．74（95％CI4．51－25．57）。XPD基因Asp312Asn和Lys751Gln多态与食管鳞癌风险无关。结论：XPD基因Asp312Asn和Lys751Gln多态是地区汉族人群肺鳞癌遗传易感因素，而与肺腺癌以及食管鳞癌风险无关，可能反映了不同组织学类型肺癌以及肺癌和食管癌之间的病因学差异。