成年人被动吸烟情况调查研究

调查成年人被动吸烟情况,了解人们对被动吸烟的知识、态度和行为,为制定控烟政策提供依据。方法采用拦截调查的方法,在山东省济南市、聊城市、平阴县三地共调查543人,其中不吸烟者397人。采用χ2检验、Logistic回归分析方法统计分析有关因素与被动吸烟的关系。结果不吸烟者中426％的人被动吸烟,其中524％的男性被动吸烟,478％的女性被动吸烟,男性被动吸烟率高于女性。597％的不吸烟者主动反对吸烟者在自己面前吸烟。男性、从事室内工作、不主动拒绝被动吸烟和吸烟者吸烟前不征求他人意见是不吸烟者被动吸烟的危险因素。结论人群中被动吸烟率仍然较高,人们对被动吸烟危害的认识尚不足,拒绝被动吸烟的意识淡漠,对不同公共场所全部禁烟的态度不尽一致,多数人支持在学校、医院、公交工具中全部禁烟。需要进一步加强对公众的控烟宣传,加大公共场所禁烟的力度,减少全人群的烟草暴露特别是加强对不吸烟者的保护力度。     

肩关节镜下应用骨锚治疗肩袖全层撕裂的临床观察

目的 探讨肩关节镜下应用骨锚进行肩袖全层撕裂修复术的临床治疗效果.方法 自2004年10月-2007年1月选择13例肩袖全层撕裂患者,应用骨锚行肩关节镜下肩袖撕裂修复术,术后随访1年.使用美国肩肘外科医师评分(American shoulder and elbow surgeons score,ASES)、Constant-Murley评分(Constant-Murley score,CMS)及简明肩关节功能测试(simple shoulder test,SST)评分进行评价.结果 术后1年随访时,肩关节疼痛明显减轻,肩关节功能明显改善.ASES评分、CMS评分和SST评分均较术前有显著性提高(P<0.01).结论 应用骨锚进行肩关节镜下肩袖修复术是治疗肩袖撕裂的有效方法,手术创伤小、恢复快.     

胰腺损伤的CT诊断

目的探讨胰腺损伤的CT表现,提高诊断的准确率。方法收集10例经临床手术证实的胰腺损伤病历资料,分析CT平扫及增强时的表现。结果胰腺内血肿2例,胰腺局限或弥漫性肿胀7例,网膜囊积液8例,胰周积液及左侧肾前筋膜增厚10例,平扫5例可见胰腺实质内低密度撕裂口,增强扫描所有病例胰腺实质内均可见低密度撕裂伤口,其中胰头3例,胰颈5例,胰腺体尾部2例。主胰管损伤CT诊断符合率80%,合并其它脏器损伤8例。结论胰腺撕裂伤有较特征性的CT表现,CT薄层增强扫描可准确诊断胰腺损伤。但CT对主胰管损伤有一定的限度。     

以病例为基础的教学法联合传统教学法在5年制临床医学实习医师脑血管病带教中的应用

目的探讨分析以病例为基础的教学(case based learning,CBL)联合传统教学模式在脑血管病5年制临床医学实习医师带教中的效果。方法以2015年9月-2016年9月于首都医科大学附属北京潞河医院神经内科脑血管病教学组5年制临床医学实习医师60例作为教学对象,按照1∶1比例随机分入传统教学模式组、CBL联合传统教学模式组。教学结束后以基础理论知识考核、实践考核(包括查体及病例分析)以及问卷调查等方式进行评价。结果两组的基础理论知识考核成绩无显著性差异;CBL联合传统教学组神经系统体格检查及病例分析成绩显著高于对照组[(89.10±2.99)分vs(86.60±3.41)分,P=0.015];CBL联合传统教学组学生在自我评价是否增加了学习兴趣、学习主动能力、文献查阅能力、综合分析问题的能力、知识拓展能力、团队合作能力、教学满意度及系统诊断能力等方面均显著优于对照组。结论 CBL联合传统教学模式可以有效提高实习医师掌握脑血管病临床诊疗能力。     

超声微泡介导H-FABP基因改善慢性心衰大鼠的心功能

目的 研究超声靶向破坏微泡(ultrasound targeted microbubble destruction,UTMD)技术转染H-FABP基因对心肌梗死后心功能的影响.方法 通过结扎成年雄性Wistar大鼠46只,体质量(220±20)g,冠状动脉前降支建立心肌梗死模型.于心肌梗死8周后,将存活的31只心衰大鼠随机分为4组:①H-FABP+超声+微泡组(H-FABP+ US/MB组,n=8),用超声破坏携H-FABP基因微泡转染大鼠心肌;②超声+微泡组(US/MB组,n=8),用超声破坏不含基因的微泡;③H-FABP+生理盐水组(H-FABP+NS组,n=8),由颈静脉输入含基因的生理盐水;④单纯手术组(SA组,n=7),仅由颈静脉输入生理盐水;⑤假手术组(SS组,n=6).基因转染14d后测定各组大鼠心功能,Western blot检测左心室非梗死区H-FABP表达,ELISA法检测静脉血及非梗死区心肌游离脂肪酸(FFA)含量,硫代巴比妥酸反应物(TBARS)法检测非梗死区心肌组织脂质过氧化水平,免疫组织化学法检测非梗死区心肌诱导型一氧化氮合酶(iNOS)表达.结果 心肌梗死大鼠各组与假手术组比较心功能明显下降(P＜0.05),H-FABP表达明显下降(P＜0.05),静脉血及心肌FFA含量明显升高(P＜0.05),丙二醛(MDA)水平明显升高(P＜0.05),iNOS表达明显升高(P＜0.05).H-FABP+超声+微泡组与心肌梗死大鼠中的另外3组比较心功能明显改善(P＜0.05),H-FABP表达升高(P＜0.05),心肌FFA含量降低(P＜0.05),MDA水平降低(P＜0.05),iNOS表达受抑制(P＜0.05).结论 超声微泡介导的H-FABP转染可改善大鼠慢性心衰时心功能.可能与通过提高H-FABP表达、降低心肌FFA含量、改善心肌氧化应激水平、进而抑制iNOS的表达有关.     

Comparative performance of warfarin pharmacogenetic algorithms in Chinese patients

Introduction

Multiple warfarin pharmacogenetic algorithms have been confirmed to predict warfarin dose more accurately than clinical algorithm or the fixed-dose approach. However, their performance has never been objectively evaluated in patients under low intensity warfarin anticoagulation, which is optimal for prevention of thromboembolism in Asian patients.

Material and methods

We sought to compare the performances of 8 eligible pharmacogenetic algorithms in a cohort of Chinese patients (n = 282) under low intensity warfarin anticoagulation with target international normalized ratio (INR) ranged from 1.6 to 2.5. The performance of each algorithm was evaluated by calculating the percentage of patients whose predicted dose fell within 20% of their actual therapeutic dose (percentage within 20%), and the mean absolute error (MAE) between each predicted dose and actual stable dose.

Results

In the entire cohort, the pharmacogenetic algorithms could predict warfarin dose with the average MAE of 0.87 ± 0.17 mg/day (0.73-1.17 mg/day), and the average percentage within 20% of 43.8% ± 8.1% (29.1% - 52.1%). By pairwise comparison, warfarin dose prediction was significantly more accurate with the algorithms derived from Asian patients (48.6% - 50.0%) than those from Caucasian patients (29.1% - 39.7%; odds ratio [OR]: 1.61-3.36, p ≤ 0.02). Algorithms with additional covariates of INR values or CYP4F2*3 performed better than those without the covariates (adding INR: OR: 1.71 (1.08-2.72), p = 0.029; adding CYP4F2*3: OR: 2.67(1.41-5.05), p = 0.004). When the patients were stratified according to the dose range, the algorithms from Caucasian and racially mixed populations tended to perform better in higher dose group (≥ 4.5 mg/day), and algorithms from Asian populations performed better in intermediate dose group (1.5-4.5 mg/day). None of the algorithms performed well in lower dose group (≤ 1.5 mg/day).

Conclusions

No eligible pharmacogenetic algorithm could perform the best for all dosing range in the Chinese patients under low intensity warfarin anticoagulation. Construction of a refinement pharmacogenetic algorithm integrating 3 genotypes (CYP2C9, VKORC1 and CYP4F2) and INR data should be warranted to improve the warfarin dose prediction in such patients.     

Abnormal nuclear envelope in the cerebellar Purkinje cells and impaired motor learning in DYT11 myoclonus-dystonia mouse models

Myoclonus-dystonia (M-D) is a movement disorder characterized by myoclonic jerks with dystonia. DYT11 M-D is caused by mutations in SGCE which codes for ?-sarcoglycan. SGCE is maternally imprinted and paternally expressed. Abnormal nuclear envelope has been reported in mouse models of DYT1 generalized torsion dystonia. However, it is not known whether similar alterations occur in DYT11 M-D. We developed a mouse model of DYT11 M-D using paternally inherited Sgce heterozygous knockout (Sgce KO) mice and reported that they had myoclonus and motor coordination and learning deficits in the beam-walking test. However, the specific brain regions that contribute to these phenotypes have not been identified. Since ?-sarcoglycan is highly expressed in the cerebellar Purkinje cells, here we examined the nuclear envelope in these cells using a transmission electron microscope and found that they are abnormal in Sgce KO mice. Our results put DYT11 M-D in a growing family of nuclear envelopathies. To analyze the effect of loss of ?-sarcoglycan function in the cerebellar Purkinje cells, we produced paternally inherited cerebellar Purkinje cell-specific Sgce conditional knockout (Sgce pKO) mice. Sgce pKO mice showed motor learning deficits, while they did not show abnormal nuclear envelope in the cerebellar Purkinje cells, robust motor deficits, or myoclonus. The results suggest that ?-sarcoglycan in the cerebellar Purkinje cells contributes to the motor learning, while loss of ?-sarcoglycan in other brain regions may contribute to nuclear envelope abnormality, myoclonus and motor coordination deficits.     

1例颈内动脉闭塞患者动脉溶栓联合机械取栓术报告

1病例介绍患者,男,40岁,主因"突发左侧肢体无力2 h"于2011年3月30日入院。患者2 h前安静状态下无明显诱因出现左侧肢体无力,伴言语不清、不能行走、意识模糊。无视物旋转、视物成双、耳鸣、恶心、呕吐,无饮水呛咳及吞咽困难,无流涎,无肢体抽搐,无大小便失禁。当日就诊于首都医科大学附属北京朝阳医院急诊,行头颅磁共振成像（magneticresonance imaging,MRI）示:右侧额叶、顶叶、颞叶、枕叶、岛叶及右侧基底节区等大脑中动脉供血区可见大片浅淡状略长T₁、长T₂信号,弥散加权     

Dopamine D4 and D5 receptor gene variant effects on clozapine response in schizophrenia: Replication and exploration

Objectives

This study aimed to: 1) replicate previously reported associations between dopamine D4 receptor gene (DRD4) polymorphisms and antipsychotic (AP) response in a clozapine (CLZ) response sample; and 2) explore possible associations of polymorphisms across dopamine D5 receptor gene (DRD5) as well as other DRD4 regions.

Methods

DRD4 exon III 48-bp, intron I (G)_n, and 120-bp repeat polymorphisms, and three DRD4 single nucleotide polymorphisms (SNPs); and DRD5 (CA/CT/GT)_n microsatellite and four DRD5 SNPs were assessed using standard genotyping and statistical procedures.

Results

We report evidence, which does not survive correction for multiple testing, supporting previous DRD4 findings. Findings of interest include the 120-bp 1-copy allele, intron I (G)_n 142-bp/140-bp genotype, and exon III 4R allele with CLZ response. All DRD5 tests were negative.

Conclusions

Overall, these results suggest a possible minor contribution of DRD4 variants, but not DRD5 variants, towards the AP/CLZ response phenotype.