临床药师在痛风管理中工作模式与效果评价的探讨

目的:探讨临床药师在基层医院痛风患者管理中的工作模式与效果.方法:选取某院110例痛风反复发作再次入院的患者作为研究对象,临床药师进行为期6个月的用药指导和健康管理,包括住院期间、出院时以及出院后6个月的药学监护、用药教育、健康宣教、生活方式指导和干预.监测患者干预前及干预后第3,6个月血尿酸水平及痛风复发情况,并通过...     

PAEs对原代培养的大鼠脂肪细胞PPAR-γ2表达的影响

目的:观察邻苯二甲酸酯类化合物(Phthalate acid esters,PAEs)对原代培养的大鼠脂肪细胞过氧化物酶体增殖剂激活受体-γ2(Peroxisome prolifcrator activated receptor gamma 2,PPAR-γ2)mRNA表达的影响。方法:对脂肪细胞进行PAEs染毒培养,观察脂肪细胞多方面的变化,评价PAEs对脂肪细胞的影响。主要实验:①显微镜每天观察脂肪细胞的形态变化;②油红O染色提取法和MTT比色法检查脂肪细胞的生长状况;③提取脂肪细胞的总RNA,通过逆转录PCR实验,分析PPAR-γ2 mR-NA的表达情况。结果:①PAEs处理过的脂肪细胞由最初的小圆形变化为梭形最后变成椭圆形,大鼠脂肪细胞内出现脂肪颗粒,并逐渐增加,最后部分脂肪颗粒融合为较大的脂肪颗粒,符合脂肪细胞的发育规律。②随着培养液中PAEs浓度的增加,大鼠脂肪细胞产生的脂肪颗粒数量增多。③PPAR-γ2的表达随着PAEs浓度的增加而增加。结论:可以认为PAEs通过增强PPAR-γ2表达来促进脂肪细胞的生长发育,研究结果将会为研究PAEs与肥胖的关系提供科学依据,为进一步研究PAEs对健康的影响提供了一个新的思路。     

Individual and joint effects of borderline ankle-brachial index and high plasma total homocysteine on all-cause death in hypertensive adults

BACKGROUNDThe cardiovascular hazards of total homocysteine (tHcy) are long known. In addition, despite the acknowledgment on the importance of low ankle-brachial index (ABI) (< 0.9), borderline ABI (0.91-0.99) was once commonly overlooked. This study aims to explore the independent and joint effect of tHcy level and borderline ABI on all-cause death in hypertensive population.METHODSThis study included 10,538 participants from China H-type Hypertension Registry Study. ABI was described into two groups: normal ABI (1.00-1.40) and borderline ABI. tHcy level was also divided into two groups: < 15.02 and ≥ 15.02 μmo/L. Four groups were analyzed, using COX proportional hazard regression model, separately and pairwise to observe the independent and joint effect on all-cause death.RESULTSA total of 126 (1.2%) deaths were observed in the 1.7 years follow-up time. Borderline ABI has a higher predicted risk of death than normal ABI (HR = 1.87, 95%CI: 1.17-3.00) after adjusting for potential covariates. Compare with tHcy level < 15.02 μmo/L (low tHcy), those with tHcy ≥ 15.02 μmo/L (high tHcy) had higher risk to event outcome (HR = 1.99, 95% CI: 1.30-3.05). According to the cumulative hazard curve, group with borderline ABI and high tHcy level has significantly higher altitude and larger increasing rate over follow-up period compare to other groups. Among those with borderline ABI, participants with high tHcy had higher death risk than those with low tHcy, nevertheless, no significant different between borderline and normal ABI among those with low tHcy levels.CONCLUSIONSBorderline ABI and tHcy level both have independent predictive value on all-cause death. The combined group of borderline ABI and high tHcy has highest risk factor of outcomes, which suggested the mutual additive value of borderline ABI and tHcy. More attention should be given to the importance of borderline ABI in hypertensive population, especially with elevated tHcy level.

Homocysteine (Hcy) is a sulfur-containing, non-proteinogenic amino acid synthesized through the transmethylation of amino acid methionine from one-carbon metabolism. Elevated plasma total homocysteine (tHcy) level is associated with endothelial dysfunction, increased blood coagulation, and metabolic disturbance, promoting cardiovascular diseases, stroke, and coronary artery disease.^[1,2] Notably, patients with high Hcy levels and concomitant hypertension were suggested to be at particularly higher risk.^[3] Moreover, increasing studies have explored a positive association between advanced Hcy level with all-cause mortality. According to a recent dose-response meta-analysis, for each 5-μmol/L increment of tHcy levels, the risk for all-cause mortality increased by 33.6%.^[4]The ankle-brachial index (ABI) is an effective, well-established measure that is commonly used in the diagnosis of peripheral artery disease (PAD),^[5] meanwhile was well studied as an important indicator of atherosclerosis and CVD events.^[6] Although ankle-brachial index (ABI) ≤ 0.90 has been recognized as the threshold value for abnormal/low ABI, which was proven to increase the risk of all-cause mortality,^[7] a study from the American Heart Association has suggested ABI between 0.91 and 1.00 should be considered as “borderline area” in terms of cardiovascular risks,^[8] considering of prior probability and sensitivity of ABI calculation. Emerging studies have aimed to explore the predictive value of borderline ABI,^[9-11] however, controversy remains because of limited and inconsistent data. The current study aimed to explore the individual and joint effect of borderline ABI and tHcy on all-cause mortality among hypertensive adults. Although ABI level ≤ 0.90 has been and is going to remain significant in clinical practice, we believe broader concern should be placed on borderline ABI, especially for its value in risk differentiation and identification. To the best of our knowledge, there are no similar previous studies.     

45例Pilon骨折的手术治疗效果与分析

目的探讨Pilon骨折手术治疗的方式、时机以及并发症的防治。方法回顾2003年10月～2006年8月收治的45例Pilon骨折患者的手术治疗,患者平均年龄39.5岁(17～62岁),其中Ⅰ型骨折3例,Ⅱ型28例,Ⅲ型14例;开放性骨折12例,闭合性骨折33例。本组患者中,21例行切开复位钢板内固定,12例行有限切开固定并辅以石膏托外固定,12例行急诊手术复位三叶草钢板内固定。结果按Mazur标准,优17例,良19例,可7例,差2例,优良率为80.00%。结论影响Pilon骨折预后的因素较多,针对不同的骨折类型,选择合适的手术方式及时机、提高胫骨关节面的复位质量和防治并发症,是Pilon骨折手术治疗成功的关键。     

首诊精神分裂症和首诊强迫症患者静息态脑功能低频振幅分数的对比研究

目的 探讨首诊精神分裂症(schizophrenia,SZ)和首诊强迫症(obsessive-compulsive disorder,OCD)患者静息态脑功能低频振幅分数(fractional amplitude of low-frequency fluctuations,fALFF)的变化特征.材料与方法 招募22例...     

东北农业大学在职教职工健康状况分析

目的了解高校在职教职工的健康状况,为有针对性地开展预防保健工作提供依据。方法对东北农业大学2067名在职教职工进行全面的体格检查并作统计分析。结果共检出患有各种疾病者1473例,检出率为71.3%。高血脂、脂肪肝、心电图异常、HBsAg阳性和高血压的检出率男性均高于女性。中年教职工心电图异常、高血脂、高血压,胆道疾患的检出率均高于青年教师。结论教职工健康状况不容乐观,学校必须引起足够重视,定期组织全面的体格检查,开展健康教育,加强教职工的保健,是高校医疗机构的重要任务。     

微透析技术在药动-药效学结合研究中的应用

微透析技术能直接、有效地对作用部位细胞外液中的内源性及外源性化合物进行持续检测,是药动-药效学结合研究的重要工具,具有不可替代的作用及广阔的应用前景。本文概述了微透析技术的基本原理及特点,并重点介绍了其在药动-药效学结合研究中的应用。     

ABO血型基因转录结构的研究及应用

目的 建立研究ABO血型系统基因转录结构的方法.方法 使用两套RNA逆转录-巢式PCR-序列测定的反应策略对中国人群6种常见ABO基因型的11个血液标本转录结构进行分析.应用所建立的方法对3例ABO血型正反定型不符的标本进行ABO基因转录结构的分析.结果 未能检测到O基因的转录结构;两套PCR策略均发现有2种转录结构,一种是完整的ABO基因编码区,另一种是缺失了整个第6外显子的ABO基因编码序列.一个变异的ABO等位基因在Bx表型个体被发现.结论 ABO基因转录结构的剪切方式是复杂的,不同剪切位点的ABO转录子被观察到.O等位基因的转录结构在RT-PCR分析未检测出来.O型基因转录结构这个特点的发现,可以应用于ABO基因单倍体序列测定中.     

乳腺癌手术治疗进展

手术是治疗乳腺癌的主要手段之一.随着医学基础研究的深入,新理论,新观念,新技术使乳腺癌的外科治疗向更科学、更合理的方向迈进.保乳手术广泛开展,前哨淋巴结活检技术亦开始在临床应用,同时新辅助化疗能够增加乳腺癌保乳治疗的机会.乳腺癌外科治疗的新进展使得我们必须重视乳腺癌的个体化手术治疗.     

青壮年股骨颈骨折患者行闭合复位内固定手术后发生股骨头无菌性缺血坏死影响因素分析

目的探讨青壮年股骨颈骨折患者经闭合复位内固定手术治疗后发生股骨头无菌性缺血坏死的影响因素。方法回顾性分析自2015年1月至2020年1月北部战区总医院骨科收治的经闭合复位内固定手术治疗的62例青壮年股骨颈骨折患者临床资料,包括年龄、性别、体质量指数、骨折侧、Garden分型、损伤至手术前时间、术前是否牵引、内固定是否取出、股骨头后倾角度、是否有股骨颈皮质粉碎、术后负重活动时间、复位质量等,并分析上述指标对术后发生股骨头无菌性缺血坏死的影响。结果青壮年患者发生术后股骨头无菌性缺血坏死与Garden分型、内固定是否取出、股骨头后倾角度、股骨颈皮质粉碎情况、复位质量相关(P<0.05)。多因素Logistic分析显示,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头无菌性缺血坏死关系密切(P<0.05)。结论青壮年股骨颈骨折闭合复位内固定术后发生股骨头坏死的影响因素较多,其中,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头坏死密切关系。