成都市中学生吸烟和被动吸烟3年追踪调查

目的 分析成都市中学生吸烟行为,为针对性地制定控烟措施提供科学依据.方法 对730名来自21所中学的一年级学生开展为期3 a的追踪问卷调查,分析其尝试吸烟率、现在吸烟率、规律吸烟率和被动吸烟率的变化情况.结果 中学生尝试吸烟率、现在吸烟率、规律吸烟率均呈上升趋势.其中尝试吸烟率从一年级的24.52％上升到三年级的43.29％,上升了76.55％;现在吸烟率从一年级的9.32％上升到三年级的19.45％,上升了108.69％;规律吸烟率从一年级的3.01％上升到三年级的6.85％,上升了127.57％.不同学校学生被动吸烟率呈波动趋势.结论 成都市中学生吸烟人数呈现明显增长趋势,应加大青少年控烟干预的力度.     

药物干预缝隙连接蛋白43介导的氧化应激对交感性心房颤动犬的影响

目的研究膜转导蛋白阻滞剂和活性氧清除剂对缝隙连接蛋白43(Cx43)和氧化应激的影响及与心房颤动(房颤)诱发的关系。方法选择中华田园犬24只,随机分为4组,每组6只:对照组、交感性房颤1组、交感性房颤2组、交感性房颤3组,各组分别于交感神经刺激和药物干预前后测定心房有效不应期(AERP)及房颤诱发率,检测Cx43总蛋白及磷酸化水平。结果与干预前比较,交感性房颤各组干预后AERP明显缩短,房颤诱发率明显升高(P<0.05)。与交感性房颤1组和交感性房颤3组比较,交感性房颤2组AERP明显缩短,房颤诱发率明显升高(P<0.05)。与对照组比较,交感性房颤各组干预后Cx43总蛋白无明显改变(P>0.05),磷酸化Cx43水平明显下降(P<0.05);与交感性房颤1组和交感性房颤3组比较,交感性房颤2组磷酸化Cx43水平明显下降(P<0.05)。结论膜转导蛋白阻滞剂可阻断细胞膜Cx43向线粒体膜转运,磷酸化Cx43水平下降导致氧化应激失衡,增加了房颤的易感性。活性氧清除剂可减少过度氧化导致的细胞膜和线粒体Cx43损伤作用,减轻心房电重构,降低房颤诱发率。     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

贵州西江地区苗族β珠蛋白基因变异

目的对贵州西江地区苗族同胞进行β-地中海贫血基因分析,了解β-珠蛋白基因在苗族人群中的变异情况.方法用常规酚-氯仿抽提法提取β地中海贫血携带者DNA,经PCR-反向点杂交法对β珠蛋白进行突变基因分析,对未检出突变的标本,测定其β-珠蛋白基因序列确定基因变异情况.结果在受检的42例β-地中海贫血携带者中,经PCR-反向点杂交法检出CD41-42突变20例、 CD17 突变17例,未检出突变标本经β-珠蛋白基因序列测定发现了CD2(CAC → CAT)、IVS-2-16(C → G )、IVS-2-74(G → T)、IVS-2-81( C T重合)4种β-珠蛋白基因变异情况.结论贵州西江地区苗族人群中β-珠蛋白基因变异很有自己独特的特点.     

乡镇卫生院护理人员应急能力自评现状及培训需求调查分析

目的调查某市三区六县乡镇卫生院护理人员应急能力自评现状及培训需求,为制定和实施培训方案提供理论依据。方法采用分层随机整群抽样法对乡镇卫生院在职护理人员进行问卷调查,包括应急能力现状自评和应急能力培训需求。结果 17.35%的乡镇卫生院护理人员自评应急能力强,75.20%自评应急能力一般,7.46%自评应急能力差;87.68%乡镇卫生院护理人员认为有必要接受应急能力培训;期望的培训方式是:短期培训23.00%和上级医院进修21.94%;培训内容需求从高到低依次为:急救设备98.59%,急救技能96.13%,急救理论87.32%,协调组织与应急82.04%。结论乡镇卫生院护理人员应急能力偏低,对应急能力培训需求急迫,希望接受系统的应急能力培训,尤其对急救设备和急救技能。乡镇卫生院应重视护理人员的应急能力培训,提高护理人员的应急能力。     

白藜芦醇通过调控NLRP3/caspase-1信号通路抑制H2O2诱导的心肌纤维化

目的 探讨白藜芦醇(RES)通过抑制体外过氧化氢(H2 O2)诱导的心肌成纤维细胞(CFs)氧化应激而降低心肌纤维化及其与NOD样受体蛋白3(NLRP3)/半胱天冬酶-1(caspase-1)信号通路的关系.方法 从SD乳鼠取心脏进行原代CFs培养,分为对照组,H2 O2(10μmol/L)组、H2 O2(10μmol/L)+RES(5μmol/L)组.采用免疫荧光鉴定CFs,CCK-8法检测CFs存活率,聚合酶链反应检测CFs白细胞介素-1(IL-1)、caspase-1、Ⅰ型胶原(CollagenⅠ)、Ⅲ型胶原(CollagenⅢ)基因表达,Western blot法检测CFs NLRP3、caspase-1、CollagenⅠ、CollagenⅢ蛋白表达.结果 波形蛋白呈阳性表达,证明提取细胞为CFs;与对照组比较,H2 O2(10μmol/L)组CFs存活率明显降低,差异有统计学意义(P<0.05);H2 O2(10μmol/L)组IL-1、caspase-1、CollagenⅠ、CollagenⅢ基因表达均明显升高,差异均有统计学意义(P<0.05);NLRP3、caspase-1、CollagenⅠ、CollagenⅢ蛋白表达均明显升高,差异均有统计学意义(P<0.05).与H2 O2(10μmol/L)组比较,H2 O2(10μmol/L)+RES(5μmol/L)组CFs存活率升高;IL-1、caspase-1、CollagenⅠ、CollagenⅢ基因表达明显降低差异均有统计学意义(P<0.05);NLRP3、caspase-1、CollagenⅠ、CollagenⅢ蛋白表达明显降低,差异均有统计学意义(P<0.05).结论 RES可能通过抑制炎症从而有效缓解氧化应激损伤引起的心肌纤维化.     

优质急诊护理在创伤失血性休克患者救治中的应用效果

目的:观察优质急诊护理在创伤失血性休克患者救治中的应用效果。方法:选取72例创伤失血性休克患者为研究对象,按照随机数字表法分为对照组与观察组各36例。对照组应用常规急诊护理,观察组应用优质急诊护理。比较两组救治效果、救治时间和并发症发生率。结果:观察组救治总有效率为94.44%,高于对照组的77.78%,差异有统计学意义(P<0.05);观察组辅助检查时间、急诊抢救时间、急诊到手术室时间和多科会诊时间均短于对照组,并发症发生率明显低于对照组,差异均有统计学意义(P<0.05)。结论:优质急诊护理应用于创伤失血性休克患者救治中可提高救治总有效率,缩短辅助检查时间、急诊抢救时间、急诊到手术室时间和多科会诊时间,以及降低并发症发生率,效果优于常规急诊护理效果。     

6例以脓毒症样表现起病的感染后播散性脑脊髓炎的临床特征

目的:分析以脓毒症样表现起病的感染后播散性脑脊髓炎的临床特征,提高对此类疾病的认识?方法:总结6例以脓毒症样表现起病的感染后播散性脑脊髓炎的临床资料?实验室检查?影像学资料及随访结果?结果:6例患儿以头痛伴反复发热为主诉就诊,病程中有嗜睡或抽搐;应用过头孢菌素,甚至碳青霉烯类抗菌药物,由于脑脊液持续呈混合细胞反应,甚至曾应用抗结核药物;外周血白细胞(17.8~25.9)×109个/L,中性粒细胞78.3%~90.0%;脑脊液白细胞(100~>500)×106个/L,中性粒细胞40%~79%;血降钙素原(PCT)正常或0.25~0.50 ng/mL,病初头颅CT或MRI正常,入院后10~30 d复查头颅MRI提示皮层下白质和(或)深部白质脱髓鞘改变,部分累及基底节区;经单用糖皮质激素或联合丙种球蛋白治疗,均好转,临床症状消失,外周血象和脑脊液逐渐恢复正常,复查头颅MRI病灶消失或大部分吸收?结论:部分感染后脑脊髓炎,病初伴有脓毒症样表现,反复发热,外周血白细胞明显升高,中性粒细胞比例高,脑脊液呈混合细胞反应持续时间长,PCT基本正常,血及脑脊液培养阴性,抗菌药物治疗无效,早期头颅影像学正常,病程中需注意及时复查影像学,早期发现,早期治疗,提高治疗效果,减少抗菌药物应用?