基于乌斯坦因模式的心肺复苏研究报告

目的 心肺复苏Utstein评价模式已被许多国家广泛用于心肺复苏评价研究.本文以心肺复苏结果Utstein评价模式设计心肺复苏注册登记表,以评价中国海南海南省人民医院心搏骤停患者流行病学特征、心肺复苏效果与影响因素.方法 应用心肺复苏Utstein模式注册登记表,对海南省人民医院急诊科511例心肺复苏患者进行前瞻性观察研究,评价本组患者心搏骤停流行病学特征及心肺复苏结果.结果 注册登记的511例心肺复苏患者纳入研究.本研究患者以40 ～ 70岁等年龄段心搏骤停发生率较高.既往史中,心血管系统疾病(190例,37.2％)、脑血管疾病(48例,9.4％)及呼吸系统疾病(39例,7.6％)等慢性疾病较为常见.173例(33.9％)为心源性心搏骤停,其中109例(21.3％)为急性心肌梗死.80例(15.7％)患者首次监测心律为心室纤颤.院内心搏骤停患者自主循环恢复率及成活出院率分别为47.0％和13.5％,院外心搏骤停患者为16.7％和4.7％.结论 本研究表明心血管系统疾病、脑血管疾病及呼吸系统疾病为最常见慢性疾病.急性心肌梗死、中风及创伤为最常见心搏骤停病因.院内心搏骤停组自主循环恢复率及成活出院率均高于院外心搏骤停组,两组差异具有统计学意义.     

Sun‐exposure knowledge and protection behavior in a North Chinese population: a questionnaire‐based study

Background: Sun exposure can cause a range of skin disorders. Skin damage can be prevented by following certain sun‐protection measures. However, the majority of reported studies regarding sun‐exposure knowledge and behavior have involved Caucasian populations. Methods: A self‐administered multiple‐choice questionnaire was administered. The questionnaire consisted of 13 questions aimed at evaluating people's knowledge, awareness, and protection behavior regarding sun exposure, and their knowledge of sunscreens and sunscreen use. Results: A total of 623 volunteers were enrolled, including 238 men (38.2%) and 385 women (61.8%). The percentages of correct answers regarding sun‐exposure knowledge and awareness ranged from 50% to 80%. Overall, 58.8% used sunscreen as a sun‐protection measure in daily life, followed by use of protective clothes (49.3%), sun umbrella (45.4%), sunglasses (45.3%), and hat (42.2%). Fifty‐two percent thought that suntan was harmful or not attractive. The mean sun‐protection factor (SPF) of the sunscreens used was 27.7 ± 9.2 and the mean UVA protection grade (PA) was 2.3 ± 0.6. Conclusions: Knowledge and awareness concerning the harmful effects of sun exposure are widespread among the Chinese population. Sunscreens with high SPF and PA are the most commonly used among Chinese people. Clear sex differences were observed. There is a significant difference in the attitude toward suntan between Chinese and Caucasian populations.     

Reversible lesion involving the splenium of the corpus callosum caused by phenytoin sodium withdrawal

Neurological Sciences -     

Sex differences in the regulation of body weight

Obesity and its associated health disorders and costs are increasing. Males and females differ in terms of how and where body fat is stored, the hormones they secrete in proportion to their fat, and the way their brains respond to signals that regulate body fat. Fat accumulation in the intra-abdominal adipose depot is associated with the risk for developing cardiovascular problems, type-2 diabetes mellitus, certain cancers and other disorders. Men and postmenopausal women accumulate more fat in the intra-abdominal depot than do pre-menopausal women, and therefore have a greater risk of developing metabolic complications associated with obesity. The goal of this review is to explore what we know about sexual dimorphisms in adipose tissue accrual and deposition. Elucidating the mechanisms by which sex hormones may modulate the way in which fat is accumulated and stored is a critical area of research due to the prevalence of obesity and the metabolic syndrome, and the rapid increase in propensity for these diseases following menopause.     

邯郸市家庭护理人才状况的调查分析

随着现代医学模式的改变,社区护理已成为护理专业发展的方向.家庭护理是以家庭为单位的整体护理模式[1],是社区护理的重要组成部分,家庭护理人才状况是影响社区护理质量的重要因素.2007年7月-2007年11月,对邯郸市家庭护理人才状况、培养和需求等问题进行调查分析.现介绍如下.     

牵张成骨中植入物的临床应用特点

目的:阐述在领骨的牵张成骨过程中植入物的临床应用进展,并评价其生物相容性.方法:检索者为第一作者,分别以"颌骨,牵张成骨,治疗"和"Jaw,distraction osteogenesis,treatment"为检索词,在中国期刊全文数据库(CNKI:1989/2009)和Medline database数据库(1989/2009),采用电子检索的方式进行文献检索,共检索到56篇文章,按纳入和排除标准对文献进行筛选,共纳入20篇文章.从牵张成骨的治疗进展进行总结,对牵张成骨植入物的临床应用进展进行探讨.结果:牵张成骨植入物分为口内牵张器和口外牵张器,可进行转移盘的牵引.牵张器的选择应根据患者颅面骨具体情况而定,并符合患者的需要.牵张成骨己成为国内外口腔腔面外科及正畸处理诸多复杂牙颌面畸形、颌骨缺损等的重要手段.其与各种全身治疗、局部治疗和物理治疗等的联合应用可更有效的发挥成骨作用.目前牵张成骨植入物主要由金属材料构成.金属植入物在预防细菌滋生,保证植入物的牢固及牵引效应的发挥方面有很大优势,价格普遍昂贵.其中镍钛要忆合金丝成本较一般成品牵引器低的多.其固定装置及合金丝紧贴骨面,可完全植入组织内,且具有抗感染,可完全关闭内外伤口等优点.结论:牵张成骨是临床治疗牙颌面发育不足排齐牙齿及整复颌骨缺损畸形的行之有效的新方法. 金属材料植入物如植入小型的镍钦记忆合金丝的生物相容性较好.其他类型植入物的生物相容性有待提高.     

Prevalence and characteristics of psoriatic arthritis in Chinese patients with psoriasis

Background The prevalence and clinical characteristics of psoriatic arthritis (PsA) in patients with psoriasis vary widely in different countries and studies on Chinese population are rarely reported. Objective The aim of this study was to evaluate the prevalence and clinical characteristics of PsA in a Chinese population of patients with psoriasis. Methods A large cross‐sectional observational study was conducted in our outpatient dermatology department and consecutive psoriatic patients were evaluated for PsA according to Classification of Psoriatic arthritis (CASPAR) criteria. Demographic and medical parameters were recorded. Results Among 1928 patients with psoriasis, 112 patients (5.8%) had PsA, of which 92% was newly diagnosed. Oligoarthritis (48.2%) was the most common manifestation pattern, followed by spondylitis (26.8%), polyarthritis (19.6%) and classic distal interphalangeal (DIP) arthritis (5.4%). Enthesitis was present in 26.8% and dactylitis in 13.4% of the patients. Compared with patients without PsA, patients with PsA had more severe skin disease (mean PASI 9.7 vs. 6.0), higher frequency of nail changes (46.4% vs. 21.0%) and scalp involvement (90.2% vs. 76.4%). Conclusion The findings are consistent with a low prevalence of PsA among patients with psoriasis in Asia and confirm a high percentage of undiagnosed cases with active arthritis among PsA patients in dermatologist’s office. Dermatologists should screen for PsA in their patients, especially those with risk characteristics and early signs.     

后循环梗死的临床表现分析

目的 了解后循环梗死常见临床症状、体征及特征性表现.方法 回顾性分析2004-2006年在我院神经内科住院的急性后循环梗死且资料完整的216例资料.所有患者在入院时均接受头颅MRI检查,证实在后循环供血区存在责任病灶.总结患者的临床症状和体征,分析后循环临床表现的特征及与病灶部位的关系.结果 患者常见的症状为偏侧肢体无力(81.9%)、口齿含糊(46.3%)、头晕(33.8%)、偏侧麻木(31.0%);最常见的体征足偏侧运动障碍(81.9%)、中枢性面舌瘫(61.1%)、构音障碍(46.3%)、偏侧感觉障碍(31.0%)及共济失调(30.1%);交叉性瘫痪发生率低(2.8%),单独的眩晕极少(1.4%);延髓麻痹、意识障碍、视力障碍及记忆障碍等症状有助于定位;经典的脑干综合征具有定位意义.结论 后循环梗夕匕临床表现复杂多变,特征性临床表现和临床综合征有助于后循环梗死的诊断.     

Early-stage dynamics of chloride ion–pumping rhodopsin revealed by a femtosecond X-ray laser

Chloride ion–pumping rhodopsin (ClR) in some marine bacteria utilizes light energy to actively transport Cl⁻ into cells. How the ClR initiates the transport is elusive. Here, we show the dynamics of ion transport observed with time-resolved serial femtosecond (fs) crystallography using the Linac Coherent Light Source. X-ray pulses captured structural changes in ClR upon flash illumination with a 550 nm fs-pumping laser. High-resolution structures for five time points (dark to 100 ps after flashing) reveal complex and coordinated dynamics comprising retinal isomerization, water molecule rearrangement, and conformational changes of various residues. Combining data from time-resolved spectroscopy experiments and molecular dynamics simulations, this study reveals that the chloride ion close to the Schiff base undergoes a dissociation–diffusion process upon light-triggered retinal isomerization.

Chloride ion (Cl⁻) concentration in some bacterial cells is regulated by rhodopsin proteins, generally known as halorhodopsin, or hR. These proteins use light energy to pump Cl⁻ into cells (1, 2). Light is harvested by a molecule of retinal, covalently linked to an essential lysine residue in the seventh transmembrane helix of GPCR-like (G protein–coupled receptor) proteins. Light activation causes retinal to isomerize from the all-trans to the 13-cis configuration. This change triggers subsequent conformational changes throughout the rhodopsin molecule and releases chloride into the cytoplasm. Retinal thermally relaxes to the all-trans configuration within milliseconds and is then ready for the next photocycle. Cl⁻ ions are transported from the extracellular (EC) side to the cytoplasmic (CP) side during each photocycle (3, 4).Light-driven ion-pumping rhodopsin can be used to develop artificial solar energy harvesting and optogenetics (5–8), but the molecular mechanism must be understood in detail for such applications. Despite the importance of hR, our current experimental data concerning the structure and dynamics of the protein remain very limited. A related protein, proton (H⁺)-pumping bacteriorhodopsin (bR) discovered in the early 1970s, has been extensively studied by multiple methods, including time-resolved spectroscopy, crystallography, mutagenesis, and computer simulation (9–12). In particular, recent studies using time-resolved serial femtosecond crystallography (TR-SFX) methods performed at X-ray free-electron laser (XFEL) facilities allow three-dimensional (3D) visualization of retinal isomerization and associated local conformational changes. These changes are accompanied by movement of protons from a donor aspartate group to an acceptor aspartate (13–15). However, the central component of this process, the transported H⁺, is difficult to observe by X-ray crystallography and could not be directly traced in bR TR-SFX studies. Recently, a breakthrough was reported in a study on the sodium-pumping rhodopsin KR2 (K. eikastus rhodopsin 2), in which electron density signals of Na⁺ uptake were observed at Δt = 1 ms after laser illumination (16).Cl⁻, a strong X-ray scatterer, can be directly observed from electron density maps. These maps provide first-hand information on the movement of ions as being transported within short timescales after light activation. Furthermore, hR and bR presumably share a common molecular mechanism despite transporting ions in opposite directions. A close relationship is strongly implied by the interconversion of the function of two rhodopsins. Outward H⁺-pumping bR can be converted to an inward Cl⁻ pump by changing a single residue (D85T) (17), while hR from the cyanobacterium, Mastigocladopsis repens, is reported to pump protons after a single mutation (T74D) (18). The chloride pump can therefore serve as a system analogous to the proton transporter and provide valuable information that is difficult to obtain directly from bR.In this study, we focus on chloride ion–pumping rhodopsin (ClR) from the marine flavobacterium Nonlabens marinus S1-08T (19). The conserved DTD motif (Asp85-Thr89-Asp96) of the bR family, residues 85, 89, and 96, is replaced by an NTQ motif (Asn98- Thr102-Gln109) in ClR (Fig. 1). The sequence identity of ClR and canonical bR from Halobacterium salinarum is only 27%, but the two proteins, nevertheless, have highly similar structures, including the disposition of the retinal chromophore. ClR structures at cryogenic and room temperatures clearly reveal an architecture composed of seven transmembrane helices (TM A to G) (2, 20, 21). The retinal is covalently linked to the Nζ atom of the Lys235 located on TM-G. Anomalous diffraction signals of the Br⁻ identify a stable binding site near the protonated Schiff base (PSB) and a plausible exit site on the CP side (Fig. 1A). Buried water molecules and locations of cavities inside ClR suggest a pathway for Cl⁻ uptake on the EC side, but the molecular mechanism for light-triggered Cl⁻ pumping remains obscure. Upon light activation, the Cl⁻ tightly held near the PSB must break free from its hydrogen bonding network (Fig. 1B). It then passes through a hydrophobic region to reach the CP side (Fig. 1C). Crystal structures of ClR were previously determined with crystals under continuous illumination of visible laser light. Intriguingly, these steady-state models revealed unexpected movement of the retinal, without indication of photo-isomerization (22). Steady-state measurements, which show averages of mixed states, are thus of limited use in deciphering the molecular mechanism of light-driven Cl⁻ pumping.Open in a separate windowFig. 1.Structure of ClR and a plausible pathway of Cl⁻ transport. (A) Cross-sections of ClR with the backbone structure shown in cartoon representation. Transmembrane helices are marked using letters A through G, and the C-terminal helix H in the cytoplasm is also indicated. Surfaces are clipped to show the cross-section colored in yellow and the model being sliced and then opened about the axis near the helix E. Water molecules and Cl⁻ ions are shown as red- and green-colored spheres. Blue curves indicate the path of ion entering ClR and the principal pumping direction after passing retinal. (B) Key residues near the Cl⁻ ion and retinal, together with the NTQ motif shown in stick representation. (C) Residues that form a hydrophobic region between the retinal and the cytoplasm are highlighted in ball-and-stick representation. The red arrow points to a major barrier that Cl⁻ needs to overcome. ClR backbone is shown in cartoon representation, with residues colored based on hydrophobicity (the blue to red spectrum corresponds to the hydrophobicity scale from hydrophilic to hydrophobic).