静脉与硬膜外自控镇痛对老年髋关节置换术患者术后镇静、舒适度及并发症影响的比较

目的探讨疼痛VAS评分≤2分时静脉与硬膜外自控镇痛对老年髋关节置换术患者术后镇静、舒适度以及并发症的影响。方法择期行腰-硬联合麻醉下髋关节置换术患者60例,男27例,女33例,年龄≥60岁,BMI 18.5~25.0kg/m2,术后12h的疼痛VAS评分≤2分,静脉自控镇痛(PCIA组)与硬膜外自控镇痛(PCEA组)各30例,采用Ramsay镇静评分(RSS)、舒适度评分(BCS)量表评估术后12、24h患者的镇静及舒适度,并观察术后并发症发生情况。于术后12h检测患者血清TNF-α与IL-6的含量。结果术后12、24hPCEA组的BCS评分分别为(3.37±0.67)和(3.73±0.45)分,明显高于PCIA组的(2.73±1.14)和(3.03±0.85)分(P<0.05);RSS评分分别为(2.17±0.53)和(2.03±0.18)分,明显低于PCIA组的(2.70±1.02)和2.40±0.81)分(P<0.05)。PCIA组恶心呕吐发生率明显高于PCEA组(P<0.05)。术后12h,PCEA组血清TNF-α与IL-6含量明显低于PCIA组(P<0.05)。PCEA组术后低血压、导尿管停留时间延长、下肢乏力或麻木的发生率明显高于PCIA组(P<0.05)。结论在疼痛VAS评分≤2分时,PCEA可提供更好的舒适度及镇静效果,但增加术后低血压、导尿管停留时间延长等并发症发生率。     

江苏启东地区乙型肝炎疫苗接种人群HBV感染与ABO血型的关系

目的 分析江苏启东地区乙型肝炎(乙肝)疫苗接种人群HBV感染与ABO血型的关系。方法 2018—2020年随机抽取江苏启东市乙肝干预研究队列中的12 214例为研究对象。其中,新生儿期接种乙肝疫苗6 595例(疫苗组),未接种乙肝疫苗5 619例(对照组)。检测ABO血型、HBsAg、HBV表面抗体(抗-HBs)和HBV核心抗体(抗-HBc),分析不同血型与HBV感染之间的关系。结果 12 214例中,AB型1 122例,A型3 585例,B型3 466例,O型4 041例。疫苗组HBsAg和抗-HBc阳性率分布为1.79%和4.76%,低于对照组的7.54%和23.88%(P<0.01)。疫苗组中,AB型和A型血HBsAg阳性率分别为2.69%和2.30%,高于O型血的1.34%(P<0.05);与O型血比较,AB型血HBsAg阳性风险增加了1.01倍(P<0.05),A型血HBsAg阳性风险增加了72%(P<0.05)。结论 江苏启东地区乙肝疫苗接种人群发生HBV感染与ABO血型有关,AB型和A型血人群发生HBV感染的风险高于O型血。     

高危新生儿接种酶母重组乙肝疫苗12年效果

[目的]评价接种酶母重组乙肝疫苗（基因疫苗）的免疫效果与免疫持久性，为基因疫苗的推广应用及高危新生儿乙型肝炎的预防提供依据。[方法]1985年－1986年HBsAg( ）产妇93例及所生的新生儿94例，按0，1，6免疫程序接种美国Merck基因疫苗（5μg/剂），分别于免疫接种后6个月，12个月及12周岁后采血放射免疫法（RIA）作HBsAg及抗－HBs检测。[结果]新生儿接种基因疫苗12年后，母亲HGsAg阳性但HBeAg阴性者（单阳性）的HBsAg阳性率为4．17％，显著低于母亲HBsAg及HBeAg均阳性者（双阳性）的23．40％（P＜0．05）。两组对象12周岁时的免疫保护率分别为91．66％与74．00％，联合使用乙肝免疫球蛋白（HBIG）并未显示出能提高基因疫苗接种者的HBsAg阻断率及抗－HBs血清阳转率（P＞0．05）。[结论]Merck基因疫苗的短期和远期免疫效果可以肯定，其对于乙肝高危产妇所生儿童的有效保护率至少可以持续１２年，联合使用ＢＨＩＧ并不增加基因疫苗的长期免疫效果，基因疫苗可以取代乙肝血源疫苗，并将在乙肝免疫预防中发挥重要的作用。     

NMDA受体过度激活对严重创伤大鼠血清炎性细胞因子水平的影响

摘要：目的 观察N-甲基-D-天冬氨酸（N-methyl-D-aspartate， NMDA）受体的过度激活对大鼠严重创伤血清炎性细胞因子水平中的影响，为探索从中枢的某一环节着手，来抑制严重创伤后的炎性反应失调提供理论依据。方法 以30% TBSA Ⅲ度烧伤为严重创伤模型，利用ELISA方法检测激活NMDA受体对血清炎性细胞因子TNF-α、IL－1β、IL6水平的影响；通过膜片钳技术检测严重创伤能否导致大鼠神经元NMDA受体的过度开放；再观察阻断NMDA受体能否抑制严重烧伤后血清炎性细胞因子TNF-α、IL－1β、IL6水平的上升。结果 ①与对照组相比，使用NMDA 0.5mg/kg激活NMDA受体，血清TNF－α，IL－1β、IL6明显升高，加大剂量（2mg/kg ）可以使血清TNF－α，IL－1β、IL6进一步升高；②在35pS电导水平的开放中，烧伤使通道开放概率增加非常显著，在100pS电导水平的开放中，开放时间常数τ1、通道开放概率增加非常显著；③腹腔注射MK-801（3mg/kg）阻断NMDA受体可以抑制烧伤后血清TNF-α、IL－1β、IL6水平的上升，加大注射剂量（5mg/kg）可以进一步抑制烧伤后血清TNF-α、IL－1β、IL6水平的上升。结论 NMDA受体是严重创伤后（烧伤）大鼠血清炎性细胞因子过度升高的重要环节。     

高危新生儿接种酵母重组乙肝疫苗12年效果

[目的]评价接种酵母重组乙肝疫苗(基因疫苗)的免疫效果与免疫持久性，为基因疫苗的推广应用及高危新生儿乙 型肝炎的预防提供依据。[方法]1985年～1986年HBsAg(+)产妇93例及所生的新生儿94例，按0、1、6免疫程序接种美国 Merck基因疫苗(5μg/剂)；分别于免疫接种后6个月、12个月及12周岁后采血用放射免疫法(RIA)作HBsAg及抗-HBs检测。[结 果]新生儿接种基因疫苗12年后，母亲HBsAg阳性但HBeAg阴性者(单阳性)的HBsAg阳性率为4.17％，显著低于母亲HBsAg及 HBeAg均阳性者(双阳性)的23.40％(P<0.05)。两组对象12周岁时的免疫保护率分别为91.66％与74.00％。联合使用乙肝免 疫球蛋白(HBIG)并未显示出能提高基因疫苗接种者的HBsAg阻断率及抗-HBs血清阳转率(P>0.05)。[结论]Merck基因疫苗的 短期和远期免疫效果可以肯定，其对于乙肝高危产妇所生儿童的有效保护率至少可以持续12年。联合使用HBIG并不增加基因 疫苗的长期免疫效果。基因疫苗可以取代乙肝血源疫苗，并将在乙肝免疫预防中发挥重要的作用。     

心理咨询师的困惑与领悟

心理咨询师的职业总给人一种神秘感,本文是一位心理咨询师在工作中遭遇到的一些困惑和感言,来咨询的,不少涉及道德问题、爱情问题和金钱问题。咨询师要解答些问题,但这些问题有时也会给咨询师带来困惑。该如何解决?请看——当我第一次面对来求助的来访者的时候,脑袋里一直在想的是我如何才可以帮助到他?当他把自己的困惑     

乙肝疫苗母-婴阻断失败者病毒全基因变异分析

Objective To determine the factors responsible for failed postnatal immunoprophylaxis for hepatitis B virus(HBV) in Qidong, China. Methods Eleven children who developed into chronic HBV infection after receiving HBIG and HBV recombinant vaccines were recruited into the study. Eleven paired mothers with chronic hepatitis and other 6 mothers whose children successfully generated anti-HBs after im-munoprophylaxis were included as the control in the study. Full-length HBV DNA was amplified through ser-um sample by PCR method and underwent cloning and sequencing. HBV DNA level was quantified by real-time PCR. Results The mean levels of HBV DNA in mothers who had HBV DNA positive children and healthy children were ( 1.2 ×107± 3.1 × 106 ) copies/ml and ( 1.6× 107±8.8×106 ) copies/ml, respec-tively. There was no significant difference between the groups (P >0.05). Meanwhile, viral load in chil-dren was unrelated to that in their mothers (r2 =0.2429). In 11 HBV DNA positive children, 4(36.4% ) demonstrated amino acid substitutions in HBsAg "a" determinant region with 6 different types, I.e. T125A, I126T, Q129H, M133V, D144V and G145A. All of the mothers showed the wild-type sequence in "a" epitope, indicating surface escape mutants were not acquired from the initial infection, but developed under the immune pressure. The mutation rates after immunoprophylaxis for preS1, preS2, S, X, preC/C and P genes were 0.38%, 0. 22%, 0.27%, 0.17%, 0.11%, and 0.11%, respectively, nt2999-3157 in preS1, nt529-677 in S, nt1955-2016 in C, nt923-1001 and nt2489-2602 in P genes were among the hottest muta-tional spots throughout the HBV genome. Conclusion HBV mutation may occur in all the open readingframes after passive and active immunoprophylaxis. In addition to S gene, HBV preS and P genes could alsoassociate with the escape mutants.     

揭开学生力不从心之谜

笔者在心理咨询中常常与来访的学生和家长说,对于上进心很强,学习成绩忧秀的学生不急需我们的帮助．对于完全没有上进要求．学习又很差的学生不在我们的帮助范围：而对于有一定的上进愿望,但总是处于心有余而力不足的状态,学习成绩落后或明显退步的学生我们可以考虑从专业的心理领域给予一些有效的支持和处理。     

拿什么拯救你我的爱情

小敏坐在心理咨询中心的沙发上,无奈地把头埋在手里。只有在这里,她才能放松自己一直绷紧的神经,让自己宣泄出那焦虑、痛苦、怨恨交织在一起的复杂感受。小敏是一个理性而又坚强的女孩,在咨询中虽     

乙肝疫苗母-婴阻断失败者病毒全基因变异分析

Objective To determine the factors responsible for failed postnatal immunoprophylaxis for hepatitis B virus(HBV) in Qidong, China. Methods Eleven children who developed into chronic HBV infection after receiving HBIG and HBV recombinant vaccines were recruited into the study. Eleven paired mothers with chronic hepatitis and other 6 mothers whose children successfully generated anti-HBs after im-munoprophylaxis were included as the control in the study. Full-length HBV DNA was amplified through ser-um sample by PCR method and underwent cloning and sequencing. HBV DNA level was quantified by real-time PCR. Results The mean levels of HBV DNA in mothers who had HBV DNA positive children and healthy children were ( 1.2 ×107± 3.1 × 106 ) copies/ml and ( 1.6× 107±8.8×106 ) copies/ml, respec-tively. There was no significant difference between the groups (P >0.05). Meanwhile, viral load in chil-dren was unrelated to that in their mothers (r2 =0.2429). In 11 HBV DNA positive children, 4(36.4% ) demonstrated amino acid substitutions in HBsAg "a" determinant region with 6 different types, I.e. T125A, I126T, Q129H, M133V, D144V and G145A. All of the mothers showed the wild-type sequence in "a" epitope, indicating surface escape mutants were not acquired from the initial infection, but developed under the immune pressure. The mutation rates after immunoprophylaxis for preS1, preS2, S, X, preC/C and P genes were 0.38%, 0. 22%, 0.27%, 0.17%, 0.11%, and 0.11%, respectively, nt2999-3157 in preS1, nt529-677 in S, nt1955-2016 in C, nt923-1001 and nt2489-2602 in P genes were among the hottest muta-tional spots throughout the HBV genome. Conclusion HBV mutation may occur in all the open readingframes after passive and active immunoprophylaxis. In addition to S gene, HBV preS and P genes could alsoassociate with the escape mutants.