基于DEA方法的华法林抗凝分级管理模式的效率评价

目的:通过小范围的临床实践,使用数据包络分析(data envelopment analysis,DEA)方法对基于全程化抗栓药学服务模式的华法林抗凝管理工作效率进行评价。方法:选取2021年7-12月南京大学医学院附属鼓楼医院心胸外科瓣膜置换术后使用华法林抗凝的患者。将患者分为实验组和对照组,实验组由临床药师利用基于分级管理的全程化抗栓药学服务模式进行抗凝管理和药学监护,对照组由临床药师按照无差别监护模式进行抗凝管理和监护,记录2种模式下药师工作内容和工作成效,通过DEA方法分析比较2种抗凝管理模式的效率。结果:研究最终纳入服用华法林的患者233人(实验组116人,对照组117人),实验组的单位患者管理时间显著减少[(27.8±9.7)min vs.(34.8±11.4)min]。经模型计算后,实验组的总体效率值为1,说明其投入和产出最优,且效率高于对照组。结论:全程化抗栓药学服务模式下药师管理单位抗凝患者需要的时间更少,管理效率更高。     

健康儿童血清维生素E水平现状分析

目的 了解全国健康儿童血清维生素E水平状况,为合理膳食指导提供依据。 方法 利用反相高效液相色谱荧光检测法测定血清维生素E水平,对《维生素A、E水平与儿童反复呼吸道感染疾病发生、发展的相关性研究》课题组中保健门诊健康体检儿童的临床资料进行分析。 结果 符合入组标准儿童共41 964例,血清维生素E水平(9.12±2.96)mg/L,血清维生素E水平随年龄增加有减低趋势(P<0.001)。维生素E缺乏与不足占21.49%,其中,缺乏者仅为3.36%(1 409/41 964),不足儿童占18.13%(7 609/41 964)。不同年龄段儿童维生素E缺乏及不足比例不同,小于3岁组儿童维生素E缺乏、不足分别为4.1%、13.0%;3岁以上儿童维生素E缺乏、不足分别为2.5%、24.0%(P<0.001)。不同区域儿童血清维生素E水平存在差异,东部、中部儿童血清维生素E水平高于西部和东北部儿童(P<0.001)。 结论 我国婴幼儿维生素E营养状况良好,3岁及以上儿童维生素E缺乏及不足者占1/4,原因尚需进一步研究。     

Construction of a cDNA fragment library from SH-SY5Y cells using restriction display PCR

A complementary DNA (cDNA) fragment library from SH-SY5Y cells is constructed using a restriction display polymerase chain reaction (RD-PCR) technique. Messenger RNA (mRNA) is extracted from SH-SY5Y cells and single-strand cDNA synthesised using an anchored oligo primer (dT18). The second strand is produced by nick translation. The double strands are cleaved with the restriction enzyme Sau3AI and the fragments ligated with universal linker. The products are amplified with universal primers and selected primers, ligated into the pMDI8-T vector, and then sequenced. The library constructed contained 136 subgroups, each comprising seven to 12 cDNA fragments. RD-PCR proved a simple, effective way to construct a cDNA library, and this will contribute to the investigation of gene expression in the neuron in future microarray studies.     

Negative correlation between the conversion of thyrotropin receptor-bound blocking type thyrotropin receptor antibody to the stimulating type by anti-human IgG antibodies and the biological activity of blocking type thyrotropin receptor antibody.

It has been reported that receptor-bound blocking type TSH receptor antibody (TRAb) can be converted to the stimulating type by anti-human IgG antibodies. To evaluate the relationship between the conversion of receptor-bound blocking type TRAb to the stimulating type and the biological activity of blocking type TRAb, we compared converting activities of blocking type TRAb from 10 patients with primary nongoitrous hypothyroidism with both the doses of blocking type TRAb which show 50% inhibition of 125I-bTSH binding to the TSH receptor and those which show 50% inhibition of TSH-stimulated cAMP production in cultured rat thyroid cells (FRTL-5). The additions of anti-human IgG antibody to FRTL-5 cell-bound blocking IgGs resulted in the increase in cAMP production in a dose-dependent manner and the converting activities (percent increase of cAMP production) also depended on the doses of blocking IgGs. The converting activities were significantly correlated with the doses of blocking IgGs which showed 50% inhibition of 125I-bTSH binding to the TSH receptor (r = 0.71, p = 0.011). And these converting activities were also significantly correlated with the doses of blocking IgGs which showed 50% inhibition of TSH-stimulated cAMP increase (r = 0.81, p = 0.002), and were negatively correlated with thyroid stimulation blocking antibody activities (r = 0.58, p = 0.02). We have demonstrated that all cell-bound blocking type TRAb were converted to the stimulating type by anti-human IgG antibody and the degree of conversion was negatively correlated with the biological activity of blocking type TRAb.(ABSTRACT TRUNCATED AT 250 WORDS)     

基于目标管理理论的护理干预对脑卒中长期卧床肺部感染患者的效果研究

  目的  分析基于目标管理理论的护理干预对脑卒中长期卧床肺部感染患者的效果。  方法  选取2019年2月—2020年2月温州医科大学附属第二医院医学收治的脑卒中长期卧床肺部感染患者94例为研究对象,随机数字表法分为对照组47例,接受基础性护理,观察组47例在对照组基础上进行基于目标管理理论的呼吸康复护理,比较不同护理方式下患者护理依从度、生活质量评分。  结果  观察组患者护理依从度97.87%高于对照组85.11%,差异有统计学意义(χ2=4.918,P＜0.05);观察组患者干预后知识掌握评分(75.16±1.52)分、信念态度评分(76.95±1.74)分、行动评分(79.25±1.68)分评分高于对照组[(71.54±1.47)分、(69.56±2.42)分、(73.16±2.74)分, 均P＜0.05];观察组患者干预后知识掌握度(23.68±2.45)分、护理技能(25.19±1.47)分、营养状况(24.10±0.98)分、意识状态(22.42±1.41)分高于对照组[(18.16±1.84)分、(14.58±2.34)分、(16.82±1.76)分、(18.62±2.05)分,均P＜0.05];2组护理前呼吸功能差异无统计学意义(P＞0.05);干预后观察组患者呼吸功能指标明显优于对照组(P＜0.05);观察组患者生活质量评分高于对照组(P＜0.05)。  结论  为脑卒中长期卧床肺部感染患者进行目标管理理论下护理可有效提升患者护理依从度,也可提升患者生活质量评分,有临床应用价值。      

Survey: Chinese children get inadequate sleep

Background The identification of vulnerable plaques before rupture is an important clinical goal. The purpose of the present study was to assess the difference in plaque composition among patients with acute coronary syndrome （ACS） and stable coronary artery disease （SCAD） by intravascular ultrasound virtual histologic analysis. Methods One hundred and thirty-nine patients were divided into ACS group and SCAD group according to clinical presentation. A total of 229 de novo lesions with 〉50% stenosis in native coronary arteries with diameters 〉2.5 mm were studied with intravascular ultrasonography. Geometric and compositional data were obtained using intravascular ultrasound virtual histology software. Results There were no significant differences in overall lesions for fibrous （（52.0±11.9）% vs （54.3±8.5）%, P〉0.05）, fibrolipidic （（12.3±10.1）% vs （13.8±9.5）%,P〈0.05）, calcium （（14.0±9.1）% vs （19.3±13.1）%, P〉0.05）, or necrotic core （（22.0±11.1）% vs （19.7±5.4）%, P〉0.05） percentages in ACS and SCAD patients, respectively. There were also no significant differences in culprit lesions for fibrous （（46.4±12.0）% vs （53.6±8.8）%, P〉0.05）, fibrolipidic （（9.1±9.0）% vs （12.9±9.7）%, P〉0.05）, calcium （（16.6±9.7）% vs （21.8±26.3）%, P〉0.05）, or necrotic core （（28.0±12.6）% vs （20.6±5.2）%, P〉0.05） percentages in ACS and SCAD patients, respectively. High density lipoprotein-cholesterol levels 〉1.04 mmol/L were associated with more fibrolipidic （（14.5±10.4）% vs （7.1±6.5）%, P〈0.05） and less necrotic core （（20.6±9.7）% vs （27.9±12.6）%,P〈0.05） percentages in the cohort with ACS. Conclusions In this study, coronary plaque composition assessed by intravascular ultrasound virtual histologic analysis was not significantly different between ACS and SCAD patients. The anatomic relationship of the specific plaque components to the lumen of the vessel was more important than th     

Mitogenic effect of arginine vasopressin on adult rat cardiac fibroblast: involvement of PKC-erk1/2 pathway

Arginine vasopressin (AVP) has been implicated in the pathophysiology of cardiac hypertrophy. We previously demonstrated that AVP is a mitogen for neonatal rat cardiac fibroblasts (CFs). In the present study, we extend our investigation to adult rat CFs to explore whether AVP could induce adult rat CFs proliferation and, if so, to identify the underlying mechanisms. We found that AVP stimulated cell proliferation, an effect abolished by V1 receptor antagonist, d(CH2)5[Tyr2(Me), Arg8]-vasopressin, but not V2 receptor antagonist, desglycinamide-[d(CH2)5, D-Ile2, Ile4, Arg8]-vasopressin. AVP also activated extracellular signal-regulated kinase 1/2 (erk1/2), a response mimicked by protein kinase C (PKC) activator, phorbol 12-myristate 13-acetate (PMA), but abolished by depleting cellular PKC through chronic PMA incubation. Calphostin C, an inhibitor of PKC, attenuated and PMA mimicked the effect of AVP on cell proliferation, whereas Ca2+ chelating agent 1,2-bis(2-aminophenoxy)ethane N, N, N', N'-tetraacetic acid (BAPTA) had no effect. Further, AVP downregulated protein expression of p27Kip1, increased cyclins D1, A, and E expressions and induced cell cycle progression through G0/G1 into S stage. Antisense oligonucleotides against cyclins D1, A, and E decreased cell number in the presence of AVP. Whereas antisense treatment against p27Kip1 and overexpression of p27Kip1 exerted a stimulatory and inhibitory effect, respectively. Inhibiting erk1/2 activation by PD98059 abolished the effect of AVP on cell proliferation, cell cycle regulatory proteins, and cell cycle progression. These results suggest that AVP is a mitogen for adult rat CFs via the mediation of V1 receptor and PKC-erk1/2 pathway.     

西藏阿里地区碘营养状态调查

目的探究西藏阿里地区表观健康人群尿碘水平,以及尿碘与其他指标的相关性。方法横断面研究。2016年9至11月随机整群抽取的西藏阿里地区日土县、葛尔县509名表观健康志愿者,对其中的466名志愿者同时检测尿碘以及尿生化。结果男性和女性尿碘水平差异无统计学意义,且各年龄组不同性别的尿碘水平的差异均无统计学意义。各年龄组间尿碘水平差异无统计学意义。阿里地区碘营养缺乏占31.5%,碘营养充足占59.0%,碘营养过剩占9.5%。总人群尿碘的中位数为141.6(83.7,210.4)mg/L。尿碘水平与FT3、FT4、TSH的相关性均无统计学意义。结论西藏阿里地区碘营养状态存在一定程度缺乏。     

乳腺积乳囊肿35例临床分析

目的探讨乳腺积乳性囊肿的临床表现及治疗方法。方法对35例乳腺积乳囊肿病人,采用手术完整切除,手术中冰冻定性质。结果本组35例均采用手术治疗,全部治愈,术中和术后做病理均得到证实为乳腺积乳。结论乳腺积乳囊肿,手术治疗效果良好。