急诊科护士遭受躯体暴力的预测线索探讨

目的探讨急诊科护士发生躯体暴力的预测线索。方法对四川省和重庆市5所医院的急诊科进行观察性研究,由专人观察和记录患方的行为线索,并根据行为变化是否转化为躯体暴力分为躯体暴力组和非躯体暴力组,统计分析两组行为变化的例数和躯体暴力的行为方式,采用Logistic回归分析确定护士发生躯体暴力的特定预测线索。结果共观察287例患者,非躯体暴力组219例,转化为躯体暴力组68例,躯体暴力发生率23.7%。Logistic回归分析显示当患方出现紧握双拳(OR=6.334)、挑衅(OR=5.672)、抵制护理措施(OR=5.164)、大声争吵(OR=4.651)、紧跟护理人员(OR=3.334)或鲁莽(OR=3.172)是发生躯体暴力的最强预测线索(P0.05,P0.01)。结论急诊科发生躯体暴力比较普遍,应快速、方便、有效地评估患方潜在的躯体暴力风险,采取相应的防范措施,以减少躯体暴力风险的发生,避免急诊科护士受到身体和心理伤害。     

某三甲医院73名护士离职原因及再就业情况调查分析

目的分析某三甲医院73名护士离职原因及再就业情况,探讨提高护士工作满意度,减少护士离职的对策。方法对73名护士采取电话访谈方式了解离职原因及再就业情况。结果护士离职的主要原因依次为护理工作紧张压力大(87.67%)、工作环境不满意(50.69%),科室人际关系紧张(41.10%)及考取外单位在编编制(38.36%)等6项原因。再就业包括继续从事护理专业(56.16%)、非护理专业(10.96%)、暂时休息(20.55%)等。结论应合理配置护士人力资源,缓解工作压力,实施更为人性化的管理,做好护士职业生涯规划等,以提高护士工作满意度,降低离职率。     

新疆多民族地区ICU临终患者家属放弃治疗真实体验的质性研究

目的了解新疆多民族地区ICU临终患者家属对放弃治疗的真实体验,为制定有效的干预措施、促进ICU放弃治疗的临终患者家属身心健康提供依据。方法采用质性研究中的现象学研究方法,对15名ICU放弃治疗的临终患者家属进行半结构式深入访谈,应用Colaizzi分析法进行资料分析。结果 ICU临终患者家属放弃治疗的真实体验提炼出5个主题:预后差,救治希望渺茫;文化背景及宗教信仰;经济负担过重;注重患者的生命质量;放弃治疗后表现出复杂的负性心理。结论新疆多民族地区ICU临终患者家属放弃治疗的原因多样,家属经历严重的负性情绪。需构建更完善的社会支持系统,逐步建立由患者、家属和医护人员共同组成的决策共享模式,以减轻家属因签署放弃治疗而导致的巨大心理压力。     

Association of serum sclerostin level with mineral disorder and bone density in patients on maintenance hemodialysis

Objective To explore the relationship between serum sclerostin level, and mineral metabolism, bone density, abdominal aortic calcification in maintenance hemodialysis (MHD) patients. Methods Serum sclerostin levels from 175 cases of MHD patients were measured by ELISA. Calcaneus bone mineral density (BMD) was measured by quantitative ultrasound (QUS). The abdominal aortic calcification was detected by abdomen lateral plain radiographs. Interrelations among above parameters were examined statistically. Results The median sclerostin concentration of 175 patients was 160.50(100.67, 256.39) pmol/L. Serum sclerostin levels were correlated positively with age, BMI, serum calcium and serum 25(OH)-vitamin D, while negatively with spKt/v and serum iPTH. In multiple regression analysis, serum sclerostin levels were associated significantly and independently with age, sex, BMI and serum iPTH. Compared to patients with normal BMD (T score≥-1s), the patients with low BMD (T score<-1s) had lower serum sclerostin level [142.97(99.52, 226.02) vs 201.13(107.40, 327.84) pmol/L, P=0.035]. Serum sclerostin levels were correlated significantly and positively with calcaneus BMD. Multivariate logistic regression analysis showed that serum sclerostin level was an independent protective factor for low BMD in MHD patients[OR=0.241, 95%CI (0.078, 0.749), P=0.014]. Conclusions Serum sclerostin levels are associated with mineral disorder and bone density. Sclerostin may become a promising marker of bone turnover in MHD patients.     

Heteromultimers of DEG/ENaC subunits form H+-gated channels in mouse sensory neurons

Acidic extracellular solution activates transient H(+)-gated currents in dorsal root ganglion (DRG) neurons. The biophysical properties of three degenerin/epithelial sodium (DEG/ENaC) channel subunits (BNC1, ASIC, and DRASIC), and their expression in DRG, suggest that they might underlie these H(+)-gated currents and function as sensory transducers. However, it is uncertain which of these DEG/ENaC subunits generate the currents, and whether they function as homomultimers or heteromultimers. We found that the biophysical properties of transient H(+)-gated currents from medium to large mouse DRG neurons differed from BNC1, ASIC, or DRASIC expressed individually, but were reproduced by coexpression of the subunits together. To test the contribution of each subunit, we studied DRG from three strains of mice, each bearing a targeted disruption of BNC1, ASIC, or DRASIC. Deletion of any one subunit did not abolish H(+)-gated currents, but altered currents in a manner consistent with heteromultimerization of the two remaining subunits. These data indicate that combinations of two or more DEG/ENaC subunits coassemble as heteromultimers to generate transient H(+)-gated currents in mouse DRG neurons.     

Effect of Danshao Huaxian capsule on expression of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 in fibrotic liver of rats

AIM: To investigate the effects of Danshao Huaxian (DSHX) capsules, a preparation of traditional Chinese medicine, on the expression of matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the fibrous livers of rats. METHODS: Eighty male Wistar rats were randomly divided into normal control group (group A), CCl4-induced hepatic fibrosis group (group B), non-DSHX-treated group (group C), low dose-treated group (group D), and high dose-treated group (group E). Fibrous liver models in rats were induced by subcutaneous injection of CCl4, oral administration of alcohol and high-lipid/low-protein diet for 8 wk. After the models were established, the rats in groups D and E were orally given a low dose (0.5 g/kg) and a high dose (1.0 g/kg) of DSHX daily for 8 wk, respectively. Then, the liver indexes, serum hyaluronic acid (HA) and alanine aminotransferase (ALT) were examined. The degree of hepatic fibrosis was evaluated by optical microscopy. Hydroxyproline (Hyp) in the urine was determined, and the expression of MMP-1 and TIMP-1 was detected by immunohistochemical techniques. RESULTS: In groups D and E, the liver indexes, levels of serum HA and ALT reduced and development of hepatic fibrosis weakened significantly. The urinary Hyp and expression of MMP-1 in the liver tissues elevated, but the expression of TIMP-1 decreased obviously, as compared to groups B and C. CONCLUSION: DSHX enhances the expression of MMP-1 but decreases that of TIMP-1 in liver tissues of CCl4-induced hepatic fibrotic rats, which may result in its elevated activity that contributes to fighting against hepatic fibrosis.     

Functional expression of the alpha 2 and alpha 3 isoforms of the Na,K-ATPase in baculovirus-infected insect cells.

Multiple isoforms of both the alpha and beta subunits of Na,K-ATPase have been identified. Elucidating their roles has been complicated by the fact that most tissues express multiple isoforms and purification techniques specific for each isoform have not been achieved. The baculovirus expression system, which uses the baculovirus Autographica californica to infect insect cells, is an ideal system for studying the Na,K-ATPase isoforms since high amounts of foreign proteins can be produced and some insect cell lines have low levels of endogenous Na,K-ATPase. Recombinant baculoviruses containing the cDNAs for the alpha 2, alpha 3, and beta 1 isoforms of the rat Na,K-ATPase were prepared and used to infect Sf-9 cells, an insect cell line derived from the ovary of the fall armyworm Spodoptera frugiperda. By using this system, Na,K-ATPase alpha 2 and alpha 3 subunits that were antigenically and electrophoretically indistinguishable from the native subunits were produced. When each subunit is expressed independently in the Sf-9 cells, it is primarily delivered to the plasma membrane. Although the isolated expression of each Na,K-ATPase subunit did not render active Na,K-ATPase molecules, the coexpression of alpha 2 or alpha 3 with beta 1 resulted in catalytically active molecules. This activity could be measured as a ouabain-sensitive ATPase activity or directly demonstrated using either [gamma-32P]ATP or 32Pi to identify the phosphorylated intermediates of the alpha 2 and alpha 3 isoforms. [3H]Ouabain binding studies showed that both isoforms are capable of binding the cardiotonic steroid with high affinity, alpha 3 being more sensitive to ouabain. These results demonstrate that the baculovirus system is suitable for the expression of the Na,K-ATPase isoforms and should provide a useful method for the characterization of the enzymatic properties of each isoform.     

Correlation among electrocardiogram, important risk factors of coronary artery diseases and coronary lesion in patients with chest pain]

Clinical and angiographic data from 103 patients with chest pain were evaluated to determine their correlation with ST-T abnormality in resting electrocardiogram. Univariate analysis suggested that male sex, hypertension, old myocardial infarction, severe coronary lesion, multiple vessel lesion and left ventricular wall motion abnormality significantly increase the likelihood of ST-T abnormality. Multivariate analysis suggested that male sex, hypertension and left ventricular wall motion abnormality were significant independent predictors of abnormal ST-T. It is essential to improve the electrocardiographic accuracy of diagnosing CAD so as to help clinical doctors in preventing and treating this disease.     

婴幼儿肺炎IL-2R和细胞体液免疫功能的检测

对 32例轻症和 44例重症婴幼儿肺炎检测外周血中可溶性白细胞介素 2受体 (s IL- 2 R)、白细胞介素 2膜受体 (m IL- 2 R)、T淋巴细胞亚群、血清 Ig、Ig A、Ig M和补体 C3的变化。结果 :重症婴幼儿肺炎 s IL- 2 R显著高于轻症婴幼儿肺炎 ,轻症高于对照组 (P<0 .0 5 ) ,而 m IL- 2 R则重症低于轻症、轻症低于对照组 (P<0 .0 5 ) ;婴幼儿肺炎 T细胞亚群 CD8显著低于对照组 (P<0 .0 5 ) ,CD4/ CD8高于对照组 (P<0 .0 5 ) ;Ig G、Ig A、Ig M和补体 C3重症低于轻症、轻症低于对照组 (P<0 .0 5 )。结果提示 s I1- 2 R和 m I1- 2 R表达异常和细胞免疫紊乱及体液免疫不足是婴幼儿肺炎的易患因素 ,且与病情严重程度有相关性。