运动负荷试验预测高血压的意义及运动触发高血压生化因子的变化

对４０例２２～３５岁血压正常的原发性高血压病患者子女以及２０例无高血压病者子女进行运动负荷试验。结果：前者１４例出现运动触发性高血压（≥３０．０／１２．７ｋＰａ），运动触发高血压者肾素活性、血管紧张素Ａ_２、血浆５－羟色胺浓度运动后均较正常血压者升高（Ｐ＜０．０５）；内源性洋地黄因子静息状态显著升高（Ｐ＜０．００１），而运动后降低；血小板５－羟色胺静息时无显著变化，运动后降低。高血压患者子女运动后心钠素较无高血压者子女升高（Ｐ＜０．０５），其中运动触发高血压者升高的较显著。前列环素、血栓素Ａ_２运动后较运动前升高，但差异无显著意义。     

肾盏憩室误诊为肾囊肿导致术后漏尿的防治探讨（附8例报道）

目的探讨肾盏憩室去顶术后漏尿的治疗方法及预防措施。方法选择2003年至2013年我院收治的8例术后漏尿的患者,术前均误诊为肾囊肿,术后证实为肾盏憩室。在逆行插入D-J管的基础上,1例漏尿自然愈合;7例行手术治疗,其中1例采取微创顺行切开扩大憩室颈的方法,4例行开放手术,2例行腹腔镜手术,术中缝合憩室颈开口,灼烧憩室腔黏膜。结果所有患者漏尿均愈合,患者无发热,无腰痛,B超显示患肾周围无积液,其中6例憩室完全消失,2例可见憩室较术前明显减小。结论肾盏憩室行去顶减压后出现的漏尿不易自行愈合,应采用手术治疗,预后较好。而术前正确诊断肾盏憩室是减少术后漏尿的关键。     

二例外籍艾滋病感染者监护案例的分析

通过对二例外籍艾滋病病毒感染者的发现及采取的措施,结合相关法规进行分析,显示在监测、感染者控制等方面存在相应的操作误区和不足。这些因素是可导致上报疫情延误,感染者失控,影响部门间协作机制的主要原因。提示外籍人员艾滋病监测控制政策存在漏洞,同时警示口岸一线人员熟悉掌握相关艾滋病卫生法规是做好外籍人员艾滋病监测和后续管理工作的基础。     

Microstructures and Soft Magnetic Properties of Fe73.5−xCu1Nb3Si13.5B9Gdx (x = 0–1.5) Alloys

In this experiment, the rare earth Gd element was added to Finemet alloy to observe the microstructure and soft magnetic properties. The experimental results showed that the samples with the addition of 0.5% Gd and 1.0% Gd can be quenched and cast normally, and the M_S of Fe₇₃Cu₁Nb₃Si_13.5B₉Gd_0.5 alloy was 10.41% higher than that of Finemet. After annealing, crystal grains of about 10 nm were formed. The μ_i and μ_m values of Fe₇₃Cu₁Nb₃Si_13.5B₉Gd_0.5 alloy were 25.51% and 22.23% higher, respectively, and the coercivity H_C was reduced by 12.19% compared to Finemet. At 1 kHz, the μ_e value of Fe₇₃Cu₁Nb₃Si_13.5B₉Gd_0.5 alloy at room temperature was 14.57% higher than that of Finemet, while the μ_e reached 162.34 k and 142.42 k at 90 °C and 150 °C (24% and 29.51% higher, respectively). The Fe_72.5Cu₁Nb₃Si_13.5B₉Gd_1.0 alloy had the best performance at 100 kHz, with higher μ_e values than Finemet across the ambient temperature range of 30 °C to 150 °C. After tension annealing, the μ_e values of Fe_72.5Cu₁Nb₃Si_13.5B₉Gd_1.0 alloy were 20–30% higher than those of Finemet.     

Identification of a novel ene reductase from Pichia angusta with potential application in (R)-levodione production

Asymmetric reduction of electronically activated alkenes by ene reductases (ERs) is an attractive approach for the production of enantiopure chiral products. Herein, a novel FMN-binding ene reductase (PaER) from Pichia angusta was heterologously expressed in Escherichia coli BL21(DE3), and the recombinant enzyme was characterized for its biocatalytic properties. PaER displayed optimal activity at 40 °C and pH 7.5, respectively. The purified enzyme was quite stable below 30 °C over a broad pH range of 5.0–10.0. PaER was identified to have a good ability to reduce the C C bond of various α,β-unsaturated compounds in the presence of NADPH. In addition, PaER exhibited a high reduction rate (k_cat = 3.57 s⁻¹) and an excellent stereoselectivity (>99%) for ketoisophorone. Engineered E. coli cells harboring PaER and glucose dehydrogenase (for cofactor regeneration) were employed as biocatalysts for the asymmetric reduction of ketoisophorone. As a result, up to 1000 mM ketoisophorone was completely and enantioselectively converted to (R)-levodione with a >99% ee value in a space–time yield of 460.7 g L⁻¹ d⁻¹. This study provides a great potential biocatalyst for practical synthesis of (R)-levodione.

Asymmetric reduction of electronically activated alkenes by ene reductases (ERs) is an attractive approach for the production of enantiopure chiral products.     

单盲法观察气管拔管时脉搏氧饱和度的变化

0　前言　脉搏氧饱和度仪监测 ,在防止全麻术后拔管时发生低氧血症可能性具有重要意义 .但是在国内许多基层医院尤其是边远地区 ,由于限于条件 ,未把血氧的监测作为常规指标 ,而依然把血压、脉搏、通气量、意识、呛咳及咽反射等传统拔管指征作为依据 .其间低氧血症发生的危险性究竟如何 ,我们采用单盲法进行了调查 .1　对象和方法1.1　对象　选择上腹部手术患者 30 (男 2 2 ,女 8)例 ,年龄 33～ 6 1(平均 47)岁 ,体质量 (5 2± 10 ) kg,无心肺功能不全 ,ASA分级 - 级 .麻醉前用药安定 10 mg,阿托品 0 .5 mg im ;麻醉诱导用药为 :咪唑安…     

物联网在临床护理中的应用

探讨物联网技术给临床护理带来的机遇与挑战;重点介绍物联网在临床护理中如移动查房、患者安全管理、医疗物资管理、精准化护理、健康监测等方面的实际应用;分析了该技术在临床护理中的应用前景。     

狼疮性肾炎环磷酰胺冲击治疗的间期与剂量研究

探讨不同活动程度的狼疮性肾炎(LN)使用环磷酰胺冲击治疗的最佳间期与合理剂量。方法 将96例重症LN患者随机分成三组。A组:环磷酰胺冲击治疗(Ⅳ-CTX),每2周1次,每次8～12mg/kg,连用2天。B组:Ⅳ-CTX每月1次,每次0.5～1.0/m~2。C组:Ⅳ-CTX每三个月1次,每次0.5～1.0/m~2。三组均同时口服强的松。结果 A组起效时间显著比B组与C组快;病情缓解率A组也显著高于B组及C组(P<0.01);病情活动性积分下降至50％时,三组CTX累积量无显著性差异(P>0.05)。B、C两组共15例(23.8％)治疗过程中因病情加重,改为2周1次后得到控制,而A组则有3例(9％)因白细胞下降需将冲击间期延后1周。三组副反应及其发生率无显著统计学差异(P>0.05)。结论 Ⅳ-CTX应根据狼疮活动程度进行选择。在急、重症LN治疗的初期,Ⅳ-CTX以每2周1次,每次8～12mg/kg,连用2天,有利于及时缓解病情,提高疗效;治疗后病情减轻时改为每月1次,每次0.51.0/m~2,狼疮活动基本控制后应以每三个月1次,每次0.5～1.0/m~2,以巩固疗效。     

TGF-β Induces Foxp3 + T-Regulatory Cells from CD4 + CD25 − Precursors

CD4 + CD25 + regulatory T cells (Tregs) are potent suppressors, playing important roles in autoimmunity and transplantation tolerance. Understanding the signals necessary for the generation and expansion of Tregs is important for clinical cellular therapy, but only limited progress has been made. Recent reports suggest a role for TGF-beta in the generation of Tregs from CD4 + CD25 - precursors, but the mechanism remains unknown. Here, we demonstrate that TGF-beta2 triggers Foxp3 expression in CD4 + CD25 - precursors, and these Foxp3 + cells act like conventional Tregs. The generation of Foxp3 + Tregs requires stimulation of the T-cell receptor, the IL-2R and the TGF-beta receptor. More importantly, strong costimulation through CD28 prevents Foxp3 expression and suppressive function in an IL-4-dependent manner. Furthermore, TGF-beta-driven Tregs inhibit innate inflammatory responses to syngeneic transplanted pancreatic islets and enhance islet transplant survival. Thus, TGF-beta is a key regulator of the signaling pathways that initiate and maintain Foxp3 expression and suppressive function in CD4 + CD25 - precursors. TGF-beta and signaling through TGF-beta receptor, CD28 costimulation and IL-4 may be key components for the manipulation of Treg. The de novo generation of Foxp3 + cells from CD4 + cells has the potential to be used for treatment of autoimmune diseases and induction of transplant tolerance.     

MRI在腰椎间盘突出症诊断中的应用价值

从1990年12月至1991年12月我科手术治疗腰椎间盘突出症59例,术前作MRI检查24例,经手术证实其诊断准确率高。作者认为MRI扫描是诊断腰椎盘突出症的有效检查方法有助于发现椎间盘变性情况椎间盘突出的部位、大小、神经根及硬膜囊压迫的程度、为指导治疗、拟定手术方案提供客观依据